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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1241475

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1. CVS Health PAC

    1275 Pennsylvania Avenue, NW
    Suite 700
    Washington, DC 20004
    Email: Shannon.Penberthy@CVSHealth.com

2. Date: 07/03/2018

3. FEC Committee ID #: C00384818 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

CVS Health
1 CVS Drive
Woonsocket, Rhode Island 02895
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Shannon Penberthy
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer

Treasurer:

Shannon Penberthy
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer

Designated Agent(s):

Tracy Smith
1 CVS Drive
Woonsocket, Rhode Island 02892
Title: Assistant Treasurer

Shannon Penberthy
1275 Pennsylvania Avenue, NW
Suite 700
Washington, DC 20004
Title: Treasurer

Tracy Smith
1 CVS Drive
Woonsocket, Rhode Island 02892
Title: Assistant Treasurer

Banks or Depositories

Wells Fargo Bank
420 Montgomery Street
San Francisco, California 94104

Signed: Shannon Penberthy
Date Signed: 07/03/2018

(End FEC FORM 1)

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