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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1180375

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1. EMCARE HOLDINGS INC POLITICAL ACTION COMMITTEE

    6363 S Fiddlers Green Circle
    14th Floor
    Greenwood Village, CO 80111
    Email: john.ranieri@evhc.net

    NOTE: Email address is different than previously reported

2. Date: 08/22/2017

3. FEC Committee ID #: C00398271 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00389585
AMERICAN MEDICAL RESPONSE INC POLITICAL ACTION COMMITTEE
6363 S FIDDLERS GREEN CIRCLE
14TH FLOOR
GREENWOOD VILLAGE, Colorado 80111
Affiliated Relationship Code: Affiliated Committee

EMCARE HOLDINGS INC
13737 Noel Road
Suite 1600
Dallas, Texas 75240
Affiliated Relationship Code: Connected Organization

Committee ID# C00484410
AMSURG CORP. GOOD GOVERNMENT FUND
1A BURTON HILLS BLVD
NASHVILLE, Tennessee 37215
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Terri Olmsted
6363 S Fiddlers Green Circle
14th Floor
Greenwood Village, CO 80111
Title: Supervisor Bank Rec
Phone # (303) 495-1418

Treasurer:

John Ranieri
1000 River Road
Suite 100
Conshohocken, Pennsylvania 19428
Title: Dir Govt Relations
Phone # (610) 834-2828

Designated Agent(s):

John Ranieri
1000 River Road, Suite 100
Conshohocken, Pennsylvania 19428
Title: Dir Govt Relations
Phone # (610) 834-2828

Banks or Depositories

Wells Fargo Bank
600 Cuthbert Blvd
Haddon Township, New Jersey 08108

Signed: John Ranieri
Date Signed: 08/22/2017

(End FEC FORM 1)

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