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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-803778

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1. 1199 32BJ/144 SERVICE EMPLOYEES INTERNATIONAL UNION HOME CARE POLITICAL ACTION FUND

    330 WEST 42ND STREET, 7TH FLOOR
    NEW YORK, NY 10036
    Email: arabb@levyratner.com

    NOTE: Email address is different than previously reported

2. Date: 08/10/2012

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

Affiliated Committees/Organizations

SERVICE EMPLOYEES INT'L UNION
1313 L STREET, N.W.
WASHINGTON, DC 20036
Affiliated Relationship Code: Connected Organization

SERVICE EMPLOYEES INT'L UNION COMM. ON
1313 L STREET, N.W.
WASHINGTON, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

KEVIN FINNEGAN
330 WEST 42ND STREET, 7TH FLOOR
NEW YORK, NY 10036
Title: TREASURER
Phone # (212) 603-1743

Treasurer:

KEVIN FINNEGAN
330 WEST 42ND STREET, 7TH FLOOR
NEW YORK, New York 10036
Title: TREASURER
Phone # (212) 603-1743

Designated Agent(s):

Banks or Depositories

TD BANK
1710 ROUTE 70 EAST
CHERRY HILL, New Jersey 08034

Signed: KEVIN FINNEGAN
Date Signed: 08/10/2012

(End FEC FORM 1)

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