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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1080564

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1. ATN International, Inc. Political Action Committee (ATN PAC)

    NOTE:Commmittee Name is different than previously reported

    C/O ATN International, Inc.
    500 Cummings Center
    Beverly, MA 01915

    NOTE: Address is different than previously reported

    Email: ATNPAC@atni.com

2. Date: 07/01/2016

3. FEC Committee ID #: C00494526 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

ATN International, Inc.
500 Cummings Center
Beverly, Massachusetts 01915
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mary Mabey
c/o Atlantic Tele-Network, Inc.
500 Cummings Center
Beverly, MA 01915
Title: Assistant Treasurer
Phone # (978) 619-1300

Treasurer:

Domenic Micale
c/o Atlantic Tele-Network, Inc.
500 Cummings Center
Beverly, Massachusetts 01915
Title: Treasurer
Phone # (978) 619-1300

Designated Agent(s):

Mary Mabey
c/o Atlantic Tele-Network, Inc.
500 Cummings Center
Beverly, Massachusetts 01915
Title: Assistant Treasurer
Phone # (978) 619-1300

Banks or Depositories

TD Bank, N.A.
15 Broad Street
Boston, Massachusetts 02109

Signed: Domenic Micale
Date Signed: 07/01/2016

(End FEC FORM 1)

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