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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1556251

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1. Headwaters Incorporated PAC

    10701 S. River Front Parkway
    Suite 300
    South Jordan, UT 84095
    Email: mindy@wardo.com;mindy.ward@boral.com

    NOTE: Email address is different than previously reported

2. Date: 01/01/2022

3. FEC Committee ID #: C00388751 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Headwaters Inc.
10653 S River Front Parkway
Suite 300
South Jordan, Utah 84095
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. John Ward
4732 W Bayview Drive
South Jordan, UT 84009
Title: Treasurer
Phone # (801) 560-9801

Treasurer:

Mr. John Ward
4732 W Bayview Drive
South Jordan, Utah 84009
Title: Treasurer
Phone # (801) 560-9801

Designated Agent(s):

Banks or Depositories

Mountain America Credit Union
753 W South Jordan Parkway
South Jordan, Utah 84095

Signed: Mr. John Ward
Date Signed: 01/14/2022

(End FEC FORM 1)

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