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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1160239

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1. Henry Ford Health System Government Affairs Services PAC

    c/o Comerica Bank, PAC Services
    3551 Hamlin Road, MC2250
    Auburn Hills, MI 48326
    Email: kaduncan@comerica.com

    NOTE: Email address is different than previously reported

2. Date: 04/20/2017

3. FEC Committee ID #: C00552141 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock

Affiliated Committees/Organizations

Henry Ford Health System Government Affairs Services
One Ford Place
Detroit, Michigan 48202
Affiliated Relationship Code: Connected Organization

Health Alliance Plan PAC
2850 West Grand Boulevard
Detroit, Michigan 48202
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Comerica Bank PAC Services
P.O. Box 75000
MC2250
Detroit, MI 48275
Title: Recordkeeper
Phone # (248) 371-7045

Treasurer:

Edward Chadwick
c/o Comerica Bank, PAC Services
3551 Hamlin Road, MC2250
Auburn Hills, Michigan 48326
Title: PAC Treasurer
Phone # (248) 371-7268

Designated Agent(s):

Banks or Depositories

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

Signed: Edward Chadwick
Date Signed: 04/20/2017

FORM TEXT-1

(End FEC FORM 1)

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