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HFA Statement of Organization

RF.Cf.IVEO EC MAIL CENTER n r STATEMENT OF 20I5IPRI3 AN 9: 03 FEC ORGANIZATION FORM 1 1. NAME OF (Check If name Example: If typing, type 12FE4M5°°" COMMITTEE (in full) Is changed) over the lines. iHillary for America I I I I ­^1 I I I I I I I Ill I I I I I I I I I I I I I I I I I I I I I I I I I I I ADDRESS (number and street) P.O. Box 5256 I I I I I I I I I I I I I I I I I I I I I I I I I (Check If address I I } I I I I I I I I I I I I I I I I I I I I I ID Is changed) .New York I |NY, |10185 I ,5256 , I I I I I I I J I I I I I I I I i­i I I I I 4 CITY STATE ZIP CODE I COMMITTEE'S E­MAIL ADDRESS (Please provide only one e­mall address) 1 (Check If address ifeq@iTHi^rvciiintptn.pom Is changed) i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I J COMMITTEE'S WEB PAGE ADDRESS (URL) ih,iiip(y,ci)nt9nqom I I I I I I I I I I (Check If address Is changed) III I 2. DATE 3. FEC IDENTIFICATION NUMBER 4. IS THIS STATEMENT X NEW (N) OR AMENDED (A) I certify that I have examined this Statement and to the best at my imowtedge and belief it is true, correct and complete. Type or Print Name of Treasurer Jose H. Villarreal / Sfja «"~Y Signature of Treasurer Date NOTE: Submission of false, erroneous, or Incomplete Information may subject the person signing this Statement to the penalties of 2 U.S.C. §437g. ANY CHANGE IN INFORMATION SHOULD BE REPORTED WITHIN 10 DAYS. Office For furttier ln(ormatlon contact: FEC FORM 1 Use Federal Election Commission L Only Toli Free 800­424­9530 (Revised 02/2009) J Locai 202­694­1100

r n FEC Form 1 (Revised 02/2009) Page 2 5, TYPE OF COMMITTEE Candidate Committee: (a) X This committee is a principal campaign committee. (Complete the candidate information below.) (b) This committee is an authorized committee, and is NOT a principal campaign committee. (Compiete the candidate information below.) Candidate |H)ll3ry,Rpdhapi,qiiintpri III Candidate Office State cz Party Affiliation Sought; House Senate a President District 5 (C) This committee supports/opposes only one candidate, and is NOT an authorized committee. 0 Name of I I I I I I i I I I I I I i I I I I I i I I I I I I I I I I I I I I I I I Candidate I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Party Committee: I (National, State (Democratic, (d) This committee is a or subordinate) committee of the nn Republican, etc.) Party. ! Political Action Committee (PAC): (e) ^ This committee is a separate segregated fund, (identify connected organization on line 6.) Its connected organization is a: Corporation I Corporation w/o Capital Stock Latjor Organization Membership Organization |_| Trade Association Cooperative In addition, this committee is a Lobbyist/Registrant PAC. (f) This committee supports/opposes more than one Federal candidate, and is NOT a separate segregated fund or party — committee, (i.e., nonconnected committee) In addition, this committee is a Lobbyist/Registrant PAC. In addition, this committee is a Leadership PAC. (identify sponsor on line 6.) Joint Fundraising Representative: (g) This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political — committees/organizations, at least one of which is an authorized committee of a federal candidate. (h) This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political committees/organizations, none of which is an authorized committee of a federal candidate. Committees Participating in Joint Fundraiser 1. M FEC ID numberlQ 2. J FEC ID number|Qi 3. J FEC ID number^ 4. J FEC ID numberlQ L J

r n FEC Form 1 (Revised 02/2009) Page 3 Write or Type Committee Name Hillary for America 6. Name of Any Connected Organization, Affiiiated Committee, Joint Fundraising Representative, or Leadership PAC Sponsor i"Nqnp 1 1 1 1 1 1 1 1 1 II II 1 1 1 II 1 1 1 1 II 1 1 1 Ml 1 1 Mill Mailina Address 1 1 1 1 1 II 1 1 ! 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 1 1 1 1 1 i 0 Mill Ml 1 Ml M , , , ­M , , 1 5 CITY STATE ZIP CODE Relationship: Connected Organization Affiliated Committee [joint Fundraising Representative Leadership PAC Sponsor 1 7. Custodian of Records: Identify by name, address (phone number ­­ optional) and position of the person in possession of committee S books and records. lEIizabeth Jones Full Name Lj I l_L_i I l_l L J l—i 1_1 I—I i I I i l_l I I—I i 1—1 I—I i I I i_J i i I ft/laiiing Address I I I I I I I I I I I I I I I I I I I I I I ! I I I I I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i m Title or Position CITY STATE ZIP CODE iCOO I I I I I I I I I I I Telephone number I i i I ­ L I I ! I i 8. Treasurer: List the name and address (phone number ­­ optional) of the treasurer of the committee; and the name and address of any designated agent (e.g., assistant treasurer). Full Name Jose H. Villarreal of Treasurer _J i I I I I l_l I L_L I I I I I I I ­I I Mailing Address ^1^^^ I I I I I I I I I I I I I I I I Xprk CITY STATE ZIP CODE Title or Position L I I I I I I I I i i Telephone number I i i i I I I I J

r n FEC Form 1 (Revised 02/2009) Page 4 Full Name of Agent"^'^'' |S|l^lly jVlp^ky)/^ I I I I I I I I I I I I I I I I I I I I I I Mailing Address iPi­q­ 1111111 i i i i i 111 i 1111111111 11 11111111111 I I N|evy Yoifk I I I I I L_j 1 1*^^ I I I I CITY STATE ZIP CODE Title or Position 1 I |A^S,iS^a9t7r^afiHrQr | Telephone number I I I I ­1 I 1 I ­1 1 1 1 I 2 9. Banks or Other Depositories: List all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds. J Name of Bank, Depository, etc. I |A/n|alg^rT)a^e | (Dgj |2pop4, ,1­1,,, CITY STATE ZIP CODE L J

5 Hand Delivered B 1 B 3 2

Federal Election Commission ENVELOPE REPLACEMENT PAGE FOR INCOMING DOCUMENTS The FEC added this page to the end of this filing to indicate how it was received. / 1 Date of Receipt Hand Delivered ^//?>/|^ i/ Postmarked Date of Receipt USPS First Class Mail Postmarked (R/C) USPS Registered/Certified Postmarked USPS Priority Mail Postmarked USPS Priority Mail Express Postmark Illegible No Postmark Shipping Date Overnight Delivery Service (Specify): Next Business Day Delivery Date of Receipt Received from House Records & Registration Office Date of Receipt Received from Senate Public Records Office Date of Receipt Received from Electronic Filing Office Date of Receipt or Postmarked Other (Specify): 4^ PREPARER DATE PREPARED (3/2015)