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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744224

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1. National Health Corporation Political Action Committee

    P.O. Box 1398
    Murfreesboro, TN 37130
    Email: jbkinney@nhcanderson.com

    NOTE: Email address is different than previously reported

2. Date: 09/09/2011

3. FEC Committee ID #: C00153445 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

, ____

Designated Agent(s):

Banks or Depositories

Signed: J. B. KINNEY, Jr.
Date Signed: 09/09/2011

(End FEC FORM 1)

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