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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1439473

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1. Health Policy Forum

    1420 Spring Hill Road Suite 600
    Tysons, VA 22102
    Email: wewalters@selectmedical.com;fecinfo@pass1.com

    NOTE: Email address is different than previously reported

2. Date: 09/18/2020

3. FEC Committee ID #: C00653154

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Committee ID# C00653154
NONE
, ____

Custodian of Records:

William Walters
1420 Spring Hill Road Suite 600
Tysons, VA 22102
Title: Custodian of Records
Phone # (202) 281-9897

Treasurer:

William Walters
1420 Spring Hill Road Suite 600
Tysons, Virginia 22102
Title: Treasurer
Phone # (202) 281-9897

Designated Agent(s):

Banks or Depositories

Atlantic Union Bank
43325 Junction Plaza
Ashburn, Virginia 20147

Signed: William Walters
Date Signed: 09/18/2020

FORM TEXT-1

(End FEC FORM 1)

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