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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-365988

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1. Prison Health Services, Inc. Political Action Committee

    105 Westpark Drive Suite 200
    Brentwood, TN 37027
    Email: info@pacout.com

2. Date: 10/03/2008

3. FEC Committee ID #: C00345496 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Prison Health Services, Inc.
105 Westpark Drive
Suite 200
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

PAC Outsourcing LLC
6192 Oxon Hill Rd
Suite 601
Oxon Hill, MD 20745
Title: Custodian of Records
Phone # (301) 839-6510

Treasurer:

James Sprouse
105 Westpark Drive
Suite 200
Brentwood, Tennessee 37027
Title: PAC Treasurer
Phone # (615) 376-0693

Designated Agent(s):

Banks or Depositories

Bank of America
One Bank of America Plaza
Nashville, Tennessee 372391697

Signed: James Sprouse
Date Signed: 10/03/2008

(End FEC FORM 1)

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