FEC Form 1 for Gentiva Health Services Inc PAC GentivaPACForm 1 for Gentiva Health Services Inc PAC GentivaPAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1548299

1. Gentiva Health Services Inc PAC GentivaPAC

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

2. Date: 11/09/2021

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:

Jeremy Ballard
3350 Riverwood Parkway
Suite 1400
Atlanta, GA 30339
Title: PAC Treasurer
Phone # (770) 951-6030

Treasurer:

Jeremy Ballard
3350 Riverwood Parkway
Suite 1400
Atlanta, Georgia 30339
Title: PAC Treasurer
Phone # (770) 951-6030

Designated Agent(s):

Banks or Depositories

Bank of America
PO Box 31900
Tampa, Florida 336313900

Signed: Jeremy Ballard
Date Signed: 11/15/2021

(End FEC FORM 1)

Generated Sat Jul 13 16:27:51 2024