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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1233873

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1. Moda PAC

    601 SW Second Avenue
    Portland, OR 97204
    Email: Terry.Connolly@modahealth.com

2. Date: 05/23/2018

3. FEC Committee ID #: C00679373 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Moda, Inc.
601 SW Second Avenue
Portland, Oregon 97204
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. James Francesconi
601 SW Second Avenue
Portland, OR 97204
Title: VP Public Policy
Phone # (503) 228-6554

Treasurer:

Mr. James Francesconi
601 SW Second Avenue
Portland, Oregon 97204
Title: VP Public Policy
Phone # (503) 228-6554

Designated Agent(s):

Mr. Terry Connolly
601 SW Second Avenue
Portland, Oregon 97204
Title: Public Policy
Phone # (503) 228-6554

Banks or Depositories

US Bank
421 SW Sixth Avenue
Portland, Oregon 97204

Signed: Mr. James Francesconi
Date Signed: 05/23/2018

(End FEC FORM 1)

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