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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1566536

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1. 1199 32BJ/144 Service Employees International Union Home Care Political Action Fund

    498 Seventh Avenue, 24 Fl.
    New York, NY 10018

    NOTE: Address is different than previously reported

    Email: helen.schaub@1199.org,outsourcing@pacservices.com

    NOTE: Email address is different than previously reported

2. Date: 01/28/2022

3. FEC Committee ID #: C00344531 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

Service Employees International Union
1313 L Street NW
Washington, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Helen Schaub
498 Seventh Avenue, 24th Flr
New York, NY 10018
Title: Treasurer
Phone # (202) 603-3782

Treasurer:

Helen Schaub
498 Seventh Ave, 24th Flr
New York, New York 10018
Title: Treasurer
Phone # (212) 603-3782

Designated Agent(s):

Alexander Rabb
80 - 8th Avenue 8th Floor
New York, New York 10011
Title: Assistant Treasurer
Phone # (212) 627-8100

Banks or Depositories

TD Bank
1710 Route 70 East
Cherry Hill, New Jersey 08034

Signed: Helen Schaub
Date Signed: 01/28/2022

(End FEC FORM 1)

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