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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1590084

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1. UNITED HEALTH SERVICES PAC, INC.

    1626 JEURGENS COURT
    NORCROSS, GA 30093
    Email: SRalston@pruitthealth.com;taxinfo@pruitthealth.com

2. Date: 04/22/2022

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 Court
Norcross, Georgia 30093
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sarah Ralston Stephens
1626 Jeurgens Court
Norcross, GA 30093
Title: VP Government Affair
Phone # (706) 279-6200

Treasurer:

Sarah Ralston Stephens
1626 Jeurgens Court
Norcross, Georgia 30093
Title: VP of Government Aff
Phone # (706) 279-6200

Designated Agent(s):

Amy Clements
1626 Jeurgens Court
Norcross, Georgia 30093
Title: Snr. Fin. Analyst
Phone # (770) 279-6200

Banks or Depositories

Synovus
PO Box 2646-R
Columbia, Georgia 31902

Wells Fargo
1625 Indian Trail Lilburn Rd
Norcross, Georgia 30093

Signed: Sarah Ralston Stephens
Date Signed: 04/22/2022

(End FEC FORM 1)

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