FEC Form 1 for Aetna Inc. Political Action CommitteeForm 1 for Aetna Inc. Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-756506

1. Aetna Inc. Political Action Committee

20 F Street, N.W.
Suite 350
Washington, DC 20001
Email: AbelK@aetna.com

2. Date: 01/06/2012

3. FEC Committee ID #: C00181826 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Aetna Inc.
151 Farmington Avenue
Hartford, Connecticut 06156
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Kate Abel
20 F Street, NW
Suite 350
Washington, DC 20001
Title: Asst. Treasurer
Phone # (202) 419-7041

Treasurer:

Peter L. Rubin
20 F Street, NW
Suite 350
Washington, DC 20001
Title: Treasurer
Phone # (202) 419-7053

Designated Agent(s):

Kate Abel
20 F Street, NW
Suite 350
Washington, DC 20001
Title: Asst. Treasurer
Phone # (202) 419-7041

Banks or Depositories

Bank of America
2775 Main Street
Hartford, Connecticut 06120

Signed: Mr. Peter L. Rubin
Date Signed: 01/06/2012

(End FEC FORM 1)

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