FEC Form 1 for UBS Americas Inc. Political Action Committee (UBS PAC)Form 1 for UBS Americas Inc. Political Action Committee (UBS PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030760

1. UBS Americas Inc. Political Action Committee (UBS PAC)

677 Washington Boulevard
c/o Per Dyrvik
STAMFORD, CT 06901
Email: SH-PAC_Administrator@ubs.com;pacservices@ddcpublicaffairs.com

2. Date: 10/19/2015

3. FEC Committee ID #: C00012245 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

UBS Americas Inc.
677 Washington Boulevard
STAMFORD, Connecticut 06901
Affiliated Relationship Code: Connected Organization

Custodian of Records:

DDC Advocacy
805 15th Street NW
Suite 300
Washington, DC 20005
Title: Custodian of Records
Phone # (202) 830-2038

Treasurer:

Per Dyrvik
677 Washington Boulevard
Stamford, Connecticut 06901
Title: Treasurer
Phone # (203) 719-4381

Designated Agent(s):

Bryan Hormann
315 Deaderick Street
Nashville, Tennessee 37238
Title: Assistant Treasurer
Phone # (615) 393-7266

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030760

1. UBS Americas Inc. Political Action Committee (UBS PAC)

2. Date: 10/19/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Per Dyrvik
Date Signed: 10/21/2015

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030760

1. UBS Americas Inc. Political Action Committee (UBS PAC)

2. Date: 10/19/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Per Dyrvik Date Signed: 10/21/2015

(End FEC FORM 1)

Signed: Per Dyrvik
Date Signed: 10/21/2015