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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1127983

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1. UNITED HEALTH SERVICES PAC, INC.

    1626 JEURGENS COURT
    NORCROSS, GA 30093
    Email: cdowning@pruitthealth.com;rgseney@pruitthealth.com

    NOTE: Email address is different than previously reported

2. Date: 12/02/2016

3. FEC Committee ID #: C00400135 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

UNITED HEALTH SERVICES, INC
1626 JEURGENS CT
NORCROSS, Georgia 30093
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Chris Downing
1626 Jeurgens Court
Norcross, GA 30093
Title: VP Government Affair
Phone # (770) 279-6200

Treasurer:

Chris Downing
1626 Jeurgens Court
Norcross, Georgia 30093
Title: VP Government Affair
Phone # (770) 279-6200

Designated Agent(s):

Banks or Depositories

Wells Fargo
1625 Indian Trail Lilburn Rd
Norcross, Georgia 30093

Signed: Chris Downing
Date Signed: 12/02/2016

(End FEC FORM 1)

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