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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1422070

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1. Urgent Care Association Political Action Committee

    28600 Bella Vista Parkway
    Suite 2010
    Warrenville, IL 60555
    Email: jkulin@urgentcarenownj.com;kyoungblood@ucaoa.org

    NOTE: Email address is different than previously reported

2. Date: 10/12/2018

3. FEC Committee ID #: C00689844 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Urgent Care Association
28600 Bella Vista Parkway
Warrenville, Illinois 60555
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Kim Youngblood
28600 Bella Vista Pkwy.
2010
Warrenville, IL 60555
Phone # (630) 544-6534

Treasurer:

Ms. Kim Youngblood
28600 Bella Vista Pkwy.
2010
Warrenville, Illinois 60555
Phone # (630) 544-6534

Designated Agent(s):

Kim Youngblood
28600 Bella Vista Parkway
Suite 2010
Warrenville, Illinois 60555
Title: Assistant Treasurer
Phone # (630) 544-6534

Banks or Depositories

Hinsdale Bank & Trust
25 East First Street
Hinsdale, Illinois 60521

Signed: Ms. Kim Youngblood
Date Signed: 07/15/2020
Official Committee URL: www.ucaoa.org/About-UCA/Strategic-Affiliates/UCAPAC/UCAPAC-Membership

NOTE: URL is different than previously reported

(End FEC FORM 1)

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