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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1091312

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1. Cambia Health Solutions Inc. PAC

    200 SW Market ST
    PO Box 1271/MS E12C
    Portland, OR 972071271
    Email: sean.robbins@cambiahealth.com

    NOTE: Email address is different than previously reported

2. Date: 07/27/2016

3. FEC Committee ID #: C00252684 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Cambia Health Solutions, Inc.
200 SW Market St
PO Box 1271/MS E12C
Portland, Oregon 97201
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sean M Robbins
100 SW Market St
M/S E15B
Portland, OR 97201
Title: Custodian of Records
Phone # (503) 721-7050

Treasurer:

Sean M Robbins
100 SW Market St
M/S E15B
Portland, Oregon 97201
Title: Treasurer
Phone # (503) 721-7050

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank NA
PO Box 63020
San Francisco, California 94163

Signed: Sean M. Robbins
Date Signed: 07/27/2016

FORM TEXT-1

(End FEC FORM 1)

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