FEC Form 1 for TriWest Healthcare Alliance Corp. PAC (TriWest Alliance PAC)Form 1 for TriWest Healthcare Alliance Corp. PAC (TriWest Alliance PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1033227

1. TriWest Healthcare Alliance Corp. PAC (TriWest Alliance PAC)

15810 N. 28th Ave.
Phoenix, AZ 85053
Email: jrhill@comerica.com

NOTE: Email address is different than previously reported

2. Date: 11/18/2015

3. FEC Committee ID #: C00459743 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

TriWest Healthcare Alliance
15810 N. 28th Ave.
Phoenix, Arizona 85053
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Comerica Bank PAC Services
PO Box 75000
MC 2250
Detroit, MI 482752250
Title: Bookeeper
Phone # (248) 371-7269

Treasurer:

Beth Dodd
15810 N. 28th Ave
Phoenix, Arizona 85053
Title: Treasurer
Phone # (602) 564-2120

Designated Agent(s):

Banks or Depositories

Comerica Bank
P.O. Box 75000
Detroit, Michigan 48275

Signed: Beth Dodd
Date Signed: 11/18/2015

FORM TEXT-1

(End FEC FORM 1)

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