FEC Form 1 for KENTUCKY HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEEForm 1 for KENTUCKY HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1605603

1. KENTUCKY HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEE

2501 NELSON MILLER PARKWAY
LOUISVILLE, KY 40253
Email: info@khacoffp.org;bwarman@kyha.com

2. Date: 06/27/2022

3. FEC Committee ID #: C00806117 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Committee ID# C00106146
AMERICAN HOSPITAL ASSOCIATION PAC
800 TENTH STREET, NW
TWO CITYCENTER, SUITE 400
WASHINGTON, DC 20001
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Brent Wates
2501 Nelson Miller Parkway
Louisville, KY 40253
Title: Custodian of Records
Phone # (502) 992-4343

Treasurer:

Harold C Warman, Jr.
2501 NELSON MILLER PARKWAY
Louisville, Kentucky 40253
Title: Treasurer
Phone # (502) 992-4348

Designated Agent(s):

James Musser
2501 Nelson Miller Parkway
Louisville, Kentucky 40253
Title: Assistant Treasurer
Phone # (502) 593-2339

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1605603

1. KENTUCKY HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEE

2. Date: 06/27/2022

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Harold C Warman, Jr.
Date Signed: 06/27/2022

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1605603

1. KENTUCKY HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEE

2. Date: 06/27/2022

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Harold C Warman, Jr. Date Signed: 06/27/2022

(End FEC FORM 1)

Signed: Harold C Warman, Jr.
Date Signed: 06/27/2022