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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1536373

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1. Gentiva Health Services Inc PAC GentivaPAC

    3350 Riverwood Parkway, Suite 1400
    Atlanta, GA 30339
    Email: GentivaPAC@myfecnotices.com

2. Date: 08/17/2021

3. FEC Committee ID #: C00407080 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Gentiva Health Services Inc
3350 Riverwood Parkway, Suite 1400
Atlanta, Georgia 30339
Affiliated Relationship Code: Connected Organization

Committee ID# C00271007
HUMANA INC. POLITICAL ACTION COMMITTEE
975 F STREET, NW
SUITE 520
WASHINGTON, DC 20004
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Chris Downing
3350 Riverwood Parkway
Suite 1400
Atlanta, GA 30339
Title: PAC Treasurer
Phone # (770) 951-6134

Treasurer:

Chris Downing
3350 Riverwood Parkway
Suite 1400
Atlanta, Georgia 30339
Title: PAC Treasurer
Phone # (770) 951-6134

Designated Agent(s):

Banks or Depositories

Bank of America
PO Box 31900
Tampa, Florida 336313900

Signed: Chris Downing
Date Signed: 08/26/2021

(End FEC FORM 1)

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