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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-969746

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1. CVS Health PAC

    NOTE:Commmittee Name is different than previously reported

    1275 Pennsylvania Avenue, NW
    Suite 700
    Washington, DC 20004

    NOTE: Address is different than previously reported

    Email: heather.cutler@cvshealth.com

    NOTE: Email address is different than previously reported

2. Date: 10/28/2014

3. FEC Committee ID #: C00384818 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

Committee ID# C00327916
CVS Health
One CVS Drive
Woonsocket, Rhode Island 02895
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Heather A Cutler
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer
Phone # (202) 772-3523

Treasurer:

Heather A Cutler
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer
Phone # (202) 772-3523

Designated Agent(s):

Heather A Cutler
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer
Phone # (202) 772-3523

Tracy Smith
1 CVS Drive
Woonsocket, Rhode Island 02895
Title: Assistant Treasurer
Phone # (401) 770-5097

Banks or Depositories

Wells Fargo Bank
420 Montgomery Street
San Francisco, California 94104

Signed: Heather A Cutler
Date Signed: 10/28/2014

(End FEC FORM 1)

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