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FEC Form 1 for AHS Medical Holdings LLC Good Government FundForm 1 for AHS Medical Holdings LLC Good Government Fund

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-871054


1. AHS Medical Holdings LLC Good Government Fund

    One Burton Hills Boulevard
    Suite 250
    Nashville, TN 37215
    Email: Ashley.Crabtree@ardenthealth.com

2. Date: 05/15/2013

3. FEC Committee ID #: C00390963 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

AHS Medical Holdings LLC
One Burton Hills Boulevard
Suite 250
Nashville, Tennessee 37215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Ashley M. Crabtree
4200 Belmont Boulevard
Nashville,, TN 37215
Title: Treasurer
Phone # (615) 296-3202

Treasurer:

Mrs. Ashley M. Crabtree
4200 Belmont Boulevard
Nashville,, Tennessee 37215
Title: Treasurer
Phone # (615) 296-3202

Designated Agent(s):

Mr. Stephen C. Petrovich
9013 Brentmeade Boulevard
Brentwood,, Tennessee 37027
Title: Assistant Treasurer
Phone # (615) 296-3384

Banks or Depositories

Bank of America N.A.
600 Peachtree Street NE
14th Floor
Atlanta,, Georgia 30308

Fifth Third Bank
Nashville Financial Center
424 Church Street, Suite 600
Nashville,, Tennessee 37219

Signed: Mrs. Ashley M. Crabtree
Date Signed: 05/15/2013

(End FEC FORM 1)


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