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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-924432

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1. LIFEPOINT HOSPITALS INC GOOD GOVERNMENT FUND

    330 Seven Springs Way
    BRENTWOOD, TN 37027

    NOTE: Address is different than previously reported

    Email: Penny.Brake@lifepointhospitals.com

2. Date: 01/23/2002

3. FEC Committee ID #: C00347955 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

LifePoint Hospitals, Inc.
330 Seven Springs Way
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Josh Hopson
330 Seven Springs Way
Brentwood, TN 37027
Phone # (615) 920-7612

Treasurer:

Penny Brake
1809 Mt. Zion Rd
Ashland City, Tennessee 37015
Title: Treasurer
Phone # (615) 920-7612

Designated Agent(s):

Banks or Depositories

Regions (formerly AmSouth)
915 Deaderick Street
Nashville, Tennessee 37237

Signed: Penny Brake
Date Signed: 05/12/2014

(End FEC FORM 1)

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