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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-458628

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1. HCR Manor Care PAC

    333 North Summit Street
    16th Floor
    Toledo, OH 436042617
    Email: aswartz@hcr-manorcare.com

    NOTE: Email address is different than previously reported

2. Date: 02/01/2010

3. FEC Committee ID #: C00260141 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

Committee ID# C00260141
HCR Manor Care PAC
333 North Summit Street
16th Floor
Toledo, Ohio 436042617
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Adam Swartz
333 North Summit St.
Toledo, OH 43699
Title: Senior Accountant
Phone # (419) 252-5663

Treasurer:

Mr. Adam Swartz
333 North Summit St.
Toledo, Ohio 43699
Title: Senior Accountant
Phone # (419) 252-5663

Designated Agent(s):

Banks or Depositories

The Huntington National Bank
P.O. Box 5065
Cleveland, Ohio 441010065

Signed: Mr. Adam Swartz
Date Signed: 04/06/2010

(End FEC FORM 1)

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