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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-789861

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1. Aqua America, Inc. H2O Political Action Committee

    762 West Lancaster Avenue
    Bryn Mawr, PA 19010
    Email: H2O_PAC@myfecnotices.com

2. Date: 06/08/2012

3. FEC Committee ID #: C00340455 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Aqua America, Inc.
762 West Lancaster Avenue
Bryn Mawr, Pennsylvania 19010
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Political Action Committee Services, LLC
5710 Kirby Road
Clinton, MD 20735
Title: Custodian of Records
Phone # (301) 868-1888

Treasurer:

Heidi Hawkins
762 West Lancaster Avenue
Bryn Mawr, Pennsylvania 19010
Title: Treasurer
Phone # (610) 645-1178

Designated Agent(s):

Karen Carlson
762 West Lancaster Avenue
Bryn Mawr, Pennsylvania 19010
Title: Assistant Treasurer
Phone # (610) 645-1019

Banks or Depositories

PNC Bank
18 South Bryn Mawr Avenue
Bryn Mawr, Pennsylvania 19010

Signed: Heidi Hawkins
Date Signed: 06/08/2012

(End FEC FORM 1)

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