FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1504745
1. ModivCare Inc. Political Action Committee
1275 Peachtree St NE 6th FlAtlanta, GA 303097515
Email: fecinfo@pass1.com;heath.sampson@modivcare.com
NOTE: Email address is different than previously reported
2. Date: 03/18/2021
3. FEC Committee ID #: C00754077 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Committee ID# C00754077ModivCare Inc.
1275 Peachtree St NE 6th Fl
Atlanta, Georgia 303097515
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Kenneth Shepard1275 Peachtree St NE 6th Fl
Atlanta, GA 303097515
Title: Custodian of Records
Phone # (404) 888-5800
Treasurer:
Heath Sampson1275 Peachtree St NE 6th Fl
Atlanta, Georgia 303097515
Title: Treasurer
Phone # (404) 888-5800
Designated Agent(s):
Kenneth Shepard1275 Peachtree St NE 6th Fl
Atlanta, Georgia 303097515
Title: Assistant Treasurer
Phone # (404) 888-5800
Banks or Depositories
Bank of America100 N Tryon St
Charlotte, North Carolina 28255