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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1290878

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1. Genoa Healthcare PAC

    NOTE:Commmittee Name is different than previously reported

    3140 Neil Armstrong Blvd Ste 110
    Eagan, MN 55121

    NOTE: Address is different than previously reported

    Email: VBreed@genoahealthcare.com

    NOTE: Email address is different than previously reported

2. Date: 11/07/2018

3. FEC Committee ID #: C00603373 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00603373
Genoa Healthcare
3140 Neil Armstrong Blvd Ste 100
Eagan, Minnesota 55121
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Dale Masten
8150 Corporate Park Drive Ste 350
Cincinnati, OH 45242
Title: Custodian of Records
Phone # (513) 804-8618

Treasurer:

Victor Breed
707 S. Grady Way Ste 700
Renton, Washington 98057
Title: Treasurer
Phone # (425) 679-5696

Designated Agent(s):

Dale Masten
8150 Corporate Park Drive Ste 350
Cincinnati, Ohio 45242
Title: Assistant Treasurer
Phone # (513) 804-8618

Banks or Depositories

Access National Bank
1800 Robert Fulton Drive
Reston, Virginia 20191

Signed: Victor Breed
Date Signed: 11/07/2018

FORM TEXT-1

(End FEC FORM 1)

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