FEC Form 1 for Renaissance Health Service Corporation Political Action CommitteeForm 1 for Renaissance Health Service Corporation Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-926619

1. Renaissance Health Service Corporation Political Action Committee

P.O. Box 293
Okemos, MI 48864
Email: rlantz@deltadentalmi.com

NOTE: Email address is different than previously reported

2. Date: 05/20/2014

3. FEC Committee ID #: C00450288 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Renaissance Health Service Corporation
P.O. Box 30381
Lansing, Michigan 489097881
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Richard Lantz
P.O. Box 293
Okemos, MI 48864
Title: Manager, Gov't Rel.
Phone # (517) 347-5436

Treasurer:

Richard Lantz
P.O. Box 293
Okemos, Michigan 48864
Title: Manager, Gov't Rel.
Phone # (517) 347-5436

Designated Agent(s):

Banks or Depositories

Bank of America
201 Townsend St.
Ste. 600
Lansing, Michigan 48933

Signed: Richard Lantz
Date Signed: 05/20/2014

FORM TEXT

(End FEC FORM 1)

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