FEC Form 1 for KAH Hospice Company, Inc. PACForm 1 for KAH Hospice Company, Inc. PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1622810

1. KAH Hospice Company, Inc. PAC

NOTE:Commmittee Name is different than previously reported

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

2. Date: 08/10/2022

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

Affiliated Committees/Organizations

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

KAH Hospice Company, Inc.
3350 Riverwood Parkway, Suite 1400
Atlanta, Georgia 30339
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ronald Lazas, Jr.
3350 Riverwood Pkwy, Suite 1400
Atlanta, GA 30339
Title: PAC Treasurer
Phone # (770) 951-6426

Treasurer:

Ronald Lazas, Jr.
3350 Riverwood Pkwy, Suite 1400
Atlanta, Georgia 30339
Title: PAC Treasurer
Phone # (770) 951-6426

Designated Agent(s):

Banks or Depositories

Bank of America
PO Box 31900
Tampa, Florida 336313900

Signed: Ronald Lazas, Jr.
Date Signed: 08/10/2022

(End FEC FORM 1)

Generated Sat Jul 13 10:35:56 2024