FEC Form 1 for Association for Quality Imaging Political Action CommitteeForm 1 for Association for Quality Imaging Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409919

1. Association for Quality Imaging Political Action Committee

P.O. Box 50230
Washington, DC 20091
Email: AQIPAC@AQImaging.net

2. Date: 03/27/2009

3. FEC Committee ID #: C00458075 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

Association for Quality Imaging
P.O. Box 50230
Washington, DC 20091
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Allison L. Fox
400 Massachusetts Ave NW
#603
Washington, DC 20001
Title: Assistant Treasurer
Phone # (202) 289-8114

Treasurer:

Mr. Robert V. Baumgartner
P.O. Box 50230
Washington, DC 20091
Title: Treasurer
Phone # (202) 289-8114

Designated Agent(s):

Ms. Allison L. Fox
400 Massachusetts Ave NW
#603
Washington, DC 20001
Title: Assistant Treasurer
Phone # (202) 289-8114

Banks or Depositories

Wachovia
Capitol Hill Financial Center
215 Pennsylvania Ave SE DC2201
Washington, DC 20003

Signed: Mr. Robert V. Baumgartner
Date Signed: 03/27/2009
Official Committee URL: www.AQImaging.org

(End FEC FORM 1)

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