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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-764456

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1. Alliance for Quality Nursing Home Care Inc. Political Action Committee (AQNHC PAC)

    1350 Connecticut Avenue NW
    Suite 900
    Washington, DC 20036
    Email: AlliancePAC@myfecnotices.com

    NOTE: Email address is different than previously reported

2. Date: 02/01/2012

3. FEC Committee ID #: C00432336 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

Alliance for Quality Nursing Home Care Inc.
1350 Connecticut Avenue NW
Suite 900
Washington, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Alan Rosenbloom
1350 Connecticut Avenue NW
Suite 900
Washington, DC 20036
Title: Treasurer
Phone # (202) 459-6310

Treasurer:

Alan Rosenbloom
1350 Connecticut Avenue NW
Suite 900
Washington, DC 20036
Title: Treasurer
Phone # (202) 459-6310

Designated Agent(s):

Banks or Depositories

SunTrust Bank
25 Park Place
Atlanta, Georgia 30303

Signed: Alan Rosenbloom
Date Signed: 02/01/2012

(End FEC FORM 1)

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