FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1093724
1. American Renal Associates Holdings, Inc. Political Action Committee (a.k.a. American Renal PAC)
500 Cummings CenterSuite 6550
Beverly, MA 01915
Email: mcosta@americanrenal.com
2. Date: 08/12/2016
3. FEC Committee ID #: C00623819 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
American Renal Associates Holdings, Inc.500 Cummings Center
Suite 6550
Beverly, Massachusetts 01915
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Treasurer:
Jonathan Wilcox500 Cummings Center
Suite 6550
Beverly, Massachusetts 01915
Title: Chief Financial Off.
Phone # (978) 922-3080
Designated Agent(s):
Jason Boucher500 Cummings Center
Suite 6550
Beverly, Massachusetts 01915
Title: VP of Finance
Phone # (978) 922-3080
Banks or Depositories
Eastern Bank195 Market Street
Lynn, Massachusetts 01901