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-122542

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

1155 21st Street NW
Suite 202
WASHINGTON, DC 20036

NOTE: Address is different than previously reported

Fax: 2023319334
Email: tketch@ahqa.org

2. Date: 06/14/2004

3. FEC Committee ID #: C00370213 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00370213
AMERICAN HEALTH QUALITY ASSOCIATION POLITICAL ACTION COMMITTEE (AHQA-PAC)
1155 21st Street NW
Suite 202
WASHINGTON, DC 20036
Relationship: connected
Organization Type: Trade Association

Custodian of Records:

Todd Ketch
1140 Connecticut Ave. NW
Ste. 1050
Washington, DC 20036
Title: VP Govt. Affairs
Phone # (202) 261-7570

Treasurer:

Todd Ketch
1140 Connecticut Ave. NW
Ste. 1050
Washington, DC 20036
Title: VP Govt. Affairs
Phone # (202) 261-7570

Designated Agent(s):

Banks or Depositories

United Bank
1667 K Street NW
Washington, DC 20006

Signed: Todd Ketch
Date Signed: 06/14/2004
Official Committee FAX: 2023319334

(End FEC FORM 1)

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