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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-751098

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1. American College of Nurse Practitioners Political Action Committee

    1501 Wilson Blvd.
    Suite 509
    Arlington, VA 22209
    Email: acnp@electioncompliance.com

2. Date: 10/25/2011

3. FEC Committee ID #: C00382440 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

American College of Nurse Practitioners
1501 Wilson Blvd.
Suite 509
Arlington, Virginia 22209
Affiliated Relationship Code: Connected Organization

Custodian of Records:

PAC Outsourcing LLC
6192 Oxon Hill Rd
Suite 601
Oxon Hill, MD 207453140
Title: Custodian of Records
Phone # (301) 839-6510

Treasurer:

Wade S, Williams
6192 Oxon Hill Rd
Suite 601
Oxon Hill, Maryland 20745
Title: Treasurer
Phone # (301) 839-6510

Designated Agent(s):

Carolyn Hutcherson
1501 Wilson Blvd.
Suite 509
Arlington, Virginia 22209
Title: Assistant Treasurer
Phone # (703) 740-2533

Banks or Depositories

Bank of America
6011 Oxon Hill Rd
Oxon Hill, Maryland 20745

Signed: Wade S, Williams
Date Signed: 10/25/2011

(End FEC FORM 1)

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