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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1096507

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1. Northwest Med-Tech Osteoarthritis Relief PAC

    11419 Patriot Lane
    Potomac, MD 20854
    Email: jrushmdmba@yahoo.com

2. Date: 08/22/2016

3. FEC Committee ID #: C00624445 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Northwest Med-Tech
11419 Patriot Lane
Potomac, Maryland 20854
Affiliated Relationship Code: Connected Organization

Custodian of Records:

John J. Rush
11419 Patriot Lane
Potomac, MD 20854
Title: Treasurer
Phone # (301) 928-1697

Treasurer:

John J. Rush
11419 Patriot Lane
Potomac, Maryland 20854
Title: Treasurer
Phone # (301) 928-1697

Designated Agent(s):

John J. Rush
11419 Patriot Lane
Potomac, Maryland 20854
Title: Treasurer
Phone # (301) 928-1697

Banks or Depositories

The Vanguard Group
2000 Kubach Road
Philadelphia, Pennsylvania 19116

Signed: John J. Rush
Date Signed: 08/22/2016

(End FEC FORM 1)

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