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FEC Form 1 for DELEK US HOLDINGS, INC (AKA DK PAC)Form 1 for DELEK US HOLDINGS, INC (AKA DK PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1493517


1. DELEK US HOLDINGS, INC (AKA DK PAC)

    NOTE:Commmittee Name is different than previously reported

    7102 COMMERCE WAY
    BRENTWOOD, TN 37027
    Email: DKPAC@delekus.com

2. Date: 01/29/2021

3. FEC Committee ID #: C00736421 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

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

Custodian of Records:

Michael Ralsky
6060 Westview Ave
Nashville, TN 37208
Title: Custodian of Records

Treasurer:

Fernando Contreras
7102 Commerce Way
Brentwood, Tennessee 37027
Title: Treasurer
Phone # (615) 721-3719

Designated Agent(s):

Amy Harrison
7102 Commerce Way
Brentwood, Tennessee 37027
Title: Assistant Treasurer

Banks or Depositories

Regions Bank
6200 Poplar Avenue
Memphis, Tennessee 38119

Signed: Fernando Contreras
Date Signed: 01/29/2021

(End FEC FORM 1)


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