FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1228813
1. AHOLD DELHAIZE USA, INC POLITICAL ACTION COMMITTEE
NOTE:Commmittee Name is different than previously reported
PO BOX 13302110 EXECUTIVE DRIVE
SALISBURY, NC 28145
Email: Jennifer.Gardner@RetailBusinessServices.com,Teross.Young@RetailBusinessServices.com
NOTE: Email address is different than previously reported
2. Date: 05/03/2018
3. FEC Committee ID #: C00214304 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Ahold Delhaize USA, Inc.P.O. Box 1330
Salisbury, North Carolina 281451330
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Teross Willievick YoungPO Box 1330
Salisbury, NC 28145
Title: Custodian of Records
Phone # (704) 633-8250
Treasurer:
TEROSS WILLIEVICK YOUNGPO Box 1330
2110 Executive Drive
Salsibury, North Carolina 28145
Title: Treasurer
Phone # (704) 633-8250
Designated Agent(s):
Jennifer GardnerP.O. Box 1330
Salisbury, North Carolina 281451330
Title: Government Affairs M
Phone # (703) 633-8250
Banks or Depositories
Wells Fargo Bank, N.A.P.O. Box 63020
San Francisco, California 94163