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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1536346

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1. Humana Inc. Political Action Committee

    975 F Street, NW
    Suite 520
    Washington, DC 20004
    Email: humanapac@humana.com

2. Date: 08/17/2021

3. FEC Committee ID #: C00271007 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Humana Inc.
975 F Street, NW
Suite 520
Washington, DC 20004
Affiliated Relationship Code: Connected Organization

Gentiva Health Services Inc PAC Gentiv
3350 Riverwood Parkway, Suite 1400
Atlanta, Georgia 30339
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Alyssa Greenhut
215 South Monroe Street
Suite 510
Tallahassee, FL 32301
Title: Assistant Treasurer
Phone # (850) 300-6566

Treasurer:

Anmol Jay Khosla
975 F Street, NW
Suite 520
Washington, DC 20004
Title: Treasurer
Phone # (202) 603-1868

Designated Agent(s):

Alyssa Greenhut
215 South Monroe Street
Suite 510
Tallahassee, Florida 32301
Title: Assistant Treasurer
Phone # (850) 300-6566

Banks or Depositories

Bank of America
600 Peachtree St.
Atlanta, Georgia 30308

Signed: Anmol Jay Khosla
Date Signed: 08/26/2021

(End FEC FORM 1)

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