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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1091565

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1. Wellcare Health Plans, Inc. PAC (WellCare PAC)

    8735 Henderson Road
    Tampa, FL 33634
    Email: Jacob.Horner@wellcare.com;nwatkins@robertwatkins.com

    NOTE: Email address is different than previously reported

2. Date: 07/29/2016

3. FEC Committee ID #: C00390575 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

WellCare Health Plans, Inc.
8735 Henderson Road
Tampa, Florida 33634
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Nancy H. Watkins
610 S. Boulevard
Tampa, FL 33606
Title: Custodian
Phone # (813) 254-3369

Treasurer:

Goran Jankovic
8735 Henderson Road
Tampa, Florida 33634
Title: Treasurer
Phone # (813) 290-6200

Designated Agent(s):

Goran Jankovic
8735 Henderson Road
Tampa, Florida 33634
Title: Assistant Treasurer
Phone # (813) 290-6200

Banks or Depositories

Wells Fargo Bank
P. O. Box 563966
Charlotte, North Carolina 28262

Signed: Goran Jankovic
Date Signed: 07/29/2016

(End FEC FORM 1)

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