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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-408050

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1. AMERICAN SOCIETY OF ANESTHESIOLOGISTS POLITICAL ACTION COMMITTEE

    520 N. NORTHWEST HIGHWAY
    PARK RIDGE, IL 60068
    Email: t.conway@asahq.org

2. Date: 03/18/2009

3. FEC Committee ID #: C00255752 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00255752
AMERICAN SOCIETY OF ANESTHESIOLOGISTS POLITICAL ACTION COMMITTEE
520 N. NORTHWEST HIGHWAY
PARK RIDGE, Illinois 60068
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

THOMAS CONWAY
520 N NORTHWEST HWY
PARK RIDGE, Illinois 60068
Title: TREASURER
Phone # (847) 825-5586

Designated Agent(s):

THOMAS CONWAY
520 N NORTHWEST HWY
PARK RIDGE, Illinois 60068
Title: TREASURER
Phone # (847) 825-5586

Banks or Depositories

NORTHERN TRUST CO
50 S LASALLE
CHICAGO, Illinois 60675

Signed: THOMAS CONWAY
Date Signed: 03/18/2009

(End FEC FORM 1)

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