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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-933373

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1. American Society of Anesthesiologists Political Action Committee

    1061 American Lane
    Schaumburg, IL 60173

    NOTE: Address is different than previously reported

    Email: m.mathy@asahq.org

    NOTE: Email address is different than previously reported

2. Date: 06/20/2014

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

American Society of Anesthesiologists Political Action Committee
1061 American Lane
Schaumburg, Illinois 60173
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Treasurer:

Mr. Thomas Conway
1061 American Lane
Schaumburg, Illinois 60173
Title: Treasurer
Phone # (847) 825-5586

Designated Agent(s):

Mr. Thomas Conway
1061 American Lane
Schaumburg, Illinois 60173
Phone # (847) 825-5586

Banks or Depositories

JP Morgan Chase Bank
PO Box 659754
San Antonio, Texas 78265

Signed: Mr. Thomas Conway
Date Signed: 06/25/2014

(End FEC FORM 1)

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