FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1032173
1. EmblemHealth Services Company LLC Federal PAC (aka EmblemHealth PAC)
55 WATER STREETNEW YORK, NY 10041
Email: emblemfedpac@emblemhealth.com
2. Date: 10/18/2010
3. FEC Committee ID #: C00412247 This committee is a separate segregated fund. Its connected organization is aIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Health Insurance Plan of Greater New York55 Water St.
New York, New York 10041
Affiliated Relationship Code: Connected Organization
Custodian of Records:
David Abernethy55 Water St.
5th Floor
New York, NY 10041
Title: Senior VP
Phone # (646) 447-6001
Treasurer:
Ms. Robin Chappelle Golston55 Water Street
New York, New York 10041
Title: VP
Phone # (646) 447-4516
Designated Agent(s):
Jay A. Schoenfeld55 Water St.
New York, New York 10041
Title: Assistant Treasurer
Phone # (646) 447-5950
Banks or Depositories
TD Bank2 Wall St.
New York, New York 10005