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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1547471

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1. TRIWEST HEALTHCARE ALLIANCE CORP. PAC (TRIWEST ALLIANCE PAC)

    NOTE:Commmittee Name is different than previously reported

    15810 N. 28TH AVE.
    PHOENIX, AZ 85053
    Email: zpacs@cox.net;pmackmer@triwest.com

    NOTE: Email address is different than previously reported

2. Date: 11/09/2021

3. FEC Committee ID #: C00459743 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

TRIWEST HEALTHCARE ALLIANCE CORP.
15810 N. 28TH AVENUE
PHOENIX, Arizona 85053
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Paul Mackmer
15810 N. 28th Avenue
Phoenix, AZ 85053
Title: Custodian of Records
Phone # (602) 564-2010

Treasurer:

Robert Wolpert
15810 N. 28th Avenue
Phoenix, Arizona 85053
Title: Treasurer
Phone # (602) 564-2443

Designated Agent(s):

Elizabeth Kinsley
15810 N. 28th Avenue
Phoenix, Arizona 85053
Title: Assistant Treasurer
Phone # (602) 564-2120

Banks or Depositories

CAPITAL BANK
2275 RESEARCH BLVD
SUITE 600
ROCKVILLE, Maryland 20850

Signed: Robert Wolpert
Date Signed: 11/08/2021

(End FEC FORM 1)

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