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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-65761

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1. Mariner Health Care Inc. Federal Political Action Committee

    One Ravinia Drive
    Suite 1500
    Atlanta, GA 30346

2. Date: 11/27/2002

3. FEC Committee ID #: C00294371 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Mariner Health Care Inc.
1 Ravinia Drive
Suite 1500
Atlanta, Georgia 30346
Relationship: Connected Organizations
Organization Type: Corporation

Custodian of Records:

William Straub
1 Ravinia Drive
Suite 1500
Atlanta, GA 30346
Title: Treasurer

Treasurer:

William Straub
1 Ravinia Drive
Suite 1500
Atlanta, Georgia 30346
Title: Treasurer

Designated Agent(s):

Cynthia Rifkin
1 Ravinia Drive
Suite 1500
Atlanta, Georgia 30346
Title: Assistant Treasurer

Banks or Depositories

Bank of America
500 N. Akard
Dallas, Texas 75283

Signed: Mr. William Straub
Date Signed: 11/27/2002

(End FEC FORM 1)

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