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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-740818

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1. PRIVATE CARE ASSOCIATION POLITICAL ACTION COMMITTEE, THE

    C/O JOSEPH BENSMIHEN
    4700 NW 2ND AVENUE 4TH FLOOR
    BOCA RATON, FL 33431
    Email: Hava@bocahomecare.com

    NOTE: Email address is different than previously reported

2. Date: 08/04/2011

3. FEC Committee ID #: C00498154 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Private Care Association
4700 NW 2nd Avenue
Fourth Floor
Boca Raton, Florida 33431
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Joseph Bensmihen
4700 NW 2nd Avenue
Fourth Floor
Boca Raton, FL 33431
Title: Custodian

Treasurer:

Amy Natt
676 NW Broad Street
Southern Pines, North Carolina 28387
Title: Treasurer
Phone # (910) 690-2558

Designated Agent(s):

Banks or Depositories

Wells Fargo
980 North Federal Highway
Boca Raton, Florida 33432

Signed: Amy Natt
Date Signed: 08/04/2011

FORM TEXT

(End FEC FORM 1)

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