FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1183774
1. EMBLEMHEALTH SERVICES COMPANY LLC FEDERAL PAC (AKA EMBLEMHEALTH PAC)
55 WATER STREETNEW YORK, NY 10041
Email: CGoff@emblemhealth.com;IHendrickson@emblemhealth.com
NOTE: Email address is different than previously reported
2. Date: 10/02/2017
3. FEC Committee ID #: C00412247 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital StockIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
EmblemHealth Services Company LLC55 Water Street
New York, New York 10041
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Ms. Cindy Goff55 water Street
New York, NY 100418190
Title: VP of Public Policy
Phone # (646) 447-7399
Treasurer:
Ms. Cindy Goff55 water Street
New York, New York 100418190
Title: VP of Public Policy
Phone # (646) 447-7399
Designated Agent(s):
Ms. Cindy Goff55 water Street
New York, New York 100418190
Title: VP Public Policy
Phone # (646) 447-7399
Banks or Depositories
TD Bank2 Wall Street
New York, New York 10005