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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-457621

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1. CLINICAL LABORATORY MANAGEMENT ASSOCIATION POLITICAL ACTION COMMITTEE

    401 North Michigan Avenue
    Chicago, IL 60611
    Email: info@clma.org

2. Date: 03/29/2010

3. FEC Committee ID #: C00381152 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Clinical Laboratory Management Assoc, Inc
401 North Michigan Avenue
Chicago, Illinois 60611
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Treasurer:

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Designated Agent(s):

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Banks or Depositories

M & T Bank
38 West Avenue
Wayne, Pennsylvania 19087

Signed: Diane Evans
Date Signed: 03/29/2010
Official Committee URL: http://www.clma.org

(End FEC FORM 1)

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