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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1738333

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1. Envision Healthcare Corporation Political Action Committee

    20 Burton Hills Blvd
    Suite 500
    Nashville, TN 37215

    NOTE: Address is different than previously reported

    Email: patrick.velliky@envisionhealth.com;robin.sexton@fiscalnote.com

    NOTE: Email address is different than previously reported

2. Date: 12/12/2023

3. FEC Committee ID #: C00398271 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

Envision Healthcare Corporation
20 Burton Hills Blvd, Suite 500
Nashville, Tennessee 37215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Patrick Velliky
20 Burton Hills Blvd, Suite 500
Nashville, TN 37215
Title: Custodian of Records
Phone # (202) 412-3407

Treasurer:

Patrick Velliky
20 Burton Hills Blvd, Suite 500
Nashville, Tennessee 37215
Title: Treasurer
Phone # (202) 412-3407

Designated Agent(s):

Banks or Depositories

Bank of America
PO Box 15284
Wilmington, Delaware 19850

Signed: Patrick Velliky
Date Signed: 12/12/2023

(End FEC FORM 1)

Generated Sat Jul 13 15:37:55 2024