FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-811857
1. HCR MANOR CARE PAC
333 NORTH SUMMIT STREET16TH FLOOR
TOLEDO, OH 43604
Email: bbury@hcr-manorcare.com;kejackson@hcr-manorcare.com
NOTE: Email address is different than previously reported
2. Date: 09/27/2012
3. FEC Committee ID #: C00260141 This committee is a separate segregated fund. Its connected organization is a CorporationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Committee ID# C00260141HCR MANOR CARE PAC
333 NORTH SUMMIT STREET
16TH FLOOR
TOLEDO, Ohio 43604
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Mr. Kevin Jackson333 North Summit Street
16th Floor
Toledo, OH 436042617
Title: AP Manager
Phone # (419) 254-5434
Treasurer:
Brad Bury5627 Maple Creek Blvd
Sylvania, Ohio 43560
Title: Sr. Accounting Mgr
Phone # (419) 252-5805
Designated Agent(s):
Banks or Depositories
The Huntington National BankP.O. Box 5065
Cleveland, Ohio 441010065