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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-726006

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1. National Union of Healthcare Workers Federal Committee on Political Education

    5940 College Avenue
    Oakland, CA 94618

    NOTE: Address is different than previously reported

    Email: stacy@hanklevycpa.com

    NOTE: Email address is different than previously reported

2. Date: 04/19/2011

3. FEC Committee ID #: C00461418 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

National Union of Healthcare Workers
5801 Christie Avenue, Suite 525
Emeryville, California 94608
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sal Rosselli
5801 Christie Ave., Suite 525
Emeryville, CA 94608
Title: Custodian of Records
Phone # (510) 834-2009

Treasurer:

Sal Rosselli
5801 Christie Ave., Suite 525
Emeryville, California 94608
Title: Treasurer
Phone # (510) 834-2009

Designated Agent(s):

Stacy Owens
5940 College Avenue
Oakland, California 94618
Title: Assistant Treasurer
Phone # (510) 652-1000

Banks or Depositories

Wells Fargo Bank
2144 Shattuck Ave
Berkeley, California 94704

Signed: Stacy Owens
Date Signed: 04/19/2011

(End FEC FORM 1)

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