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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1292295

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1. Health Industry Distributors Association Political Action Committee

    310 Montgomery Street
    Alexandria, VA 22314
    Email: babb@hida.org,fecinfo@pass1.com

    NOTE: Email address is different than previously reported

2. Date: 11/27/2018

3. FEC Committee ID #: C00486498 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

Health Industry Distributors Association
310 Montgomery Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Vincent Tallman
1950 Roland Clarke Pl., Suite 300
Reston, VA 20191
Title: Custodian
Phone # (703) 476-3070

Treasurer:

Vincent Tallman
1950 Roland Clarke Pl., Suite 300
Reston, Virginia 20191
Title: Treasurer
Phone # (703) 476-3070

Designated Agent(s):

Lisa Queeney
310 Montgomery Street
Alexandria, Virginia 22314
Title: Assistant Treasurer
Phone # (703) 838-6124

Banks or Depositories

Burke & Herbert
100 South Fairfax Street
Alexandria, Virginia 22314

Signed: Vincent Tallman
Date Signed: 11/27/2018

FORM TEXT-1

(End FEC FORM 1)

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