FEC Form 1 for American College of Nurse Practitioners Political Action CommitteeForm 1 for American College of Nurse Practitioners Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-758306

1. American College of Nurse Practitioners Political Action Committee

225 Reinekers Lane
Suite 525
Alexandria, VA 22314

NOTE: Address is different than previously reported

Email: acnp@electioncompliance.com

2. Date: 01/19/2012

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
225 Reinekers Lane
Suite 525
Alexandria, Virginia 22314
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):

David Hebert
225 Reinekers Lane
Suite 525
Alexandria, Virginia 22314
Title: Assistant Treasurer
Phone # (703) 740-2529

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-758306

1. American College of Nurse Practitioners Political Action Committee

NOTE: Address is different than previously reported

2. Date: 01/19/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Wade S, Williams
Date Signed: 01/19/2012

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-758306

1. American College of Nurse Practitioners Political Action Committee

NOTE: Address is different than previously reported

2. Date: 01/19/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Wade S, Williams Date Signed: 01/19/2012

(End FEC FORM 1)

Signed: Wade S, Williams
Date Signed: 01/19/2012