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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1373288

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1. Delek US Holdings LLC PAC (aka DK PAC)

    7102 Commerce Way
    Brentwood, TN 37027
    Email: DKPAC@DelekUS.com

2. Date: 01/27/2020

3. FEC Committee ID #: C00736421 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Delek US Holdings LLC
7102 Commerce Way
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Michael Ralsky
7102 Comemrce Way
Brentwood, TN 37027
Phone # (615) 435-1407

Treasurer:

Mary Ryan
7102 Commerce Way
Brentwood, Tennessee 37027
Phone # (615) 435-1410

Designated Agent(s):

Amy Harrison
7102 Commerce Way
Brentwood, Tennessee 37027

Banks or Depositories

Regons Bank
6200 Poplar Avenue
Memphis, Tennessee 38119

Signed: Mary Ryan
Date Signed: 01/27/2020

(End FEC FORM 1)

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