FEC Form 1 for AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)Form 1 for AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1023934

1. AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)

7918 Jones Branch Drive
Suite 300
McLean, VA 22102
Email: ceubanks@ahqa.org;ceubanks@ahqa.org

NOTE: Email address is different than previously reported

2. Date: 09/02/2015

3. FEC Committee ID #: C00370213 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 Health Quality Association
7918 Jones Branch Drive
Suite 300
McLean, Virginia 22102
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Colleen Eubanks
7918 Jones Branch Drive
Suite 300
McLean, VA 22102
Title: Executive Director
Phone # (202) 331-5790

Treasurer:

Colleen Eubanks
7918 Jones Branch Drive
Suite 300
McLean, Virginia 22102
Title: Treasurer
Phone # (202) 331-5790

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1023934

1. AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)

NOTE: Email address is different than previously reported

2. Date: 09/02/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Colleen Eubanks
Date Signed: 09/02/2015

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1023934

1. AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)

NOTE: Email address is different than previously reported

2. Date: 09/02/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Colleen Eubanks Date Signed: 09/02/2015

(End FEC FORM 1)

Signed: Colleen Eubanks
Date Signed: 09/02/2015