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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1705340

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1. TIVITY HEALTH FEDERAL PAC

    4031 Aspen Grove Drive, Suite 250
    FRANKLIN, TN 37067

    NOTE: Address is different than previously reported

    Email: Vicki.shepard@tivityhealth.com

2. Date: 12/04/2022

3. FEC Committee ID #: C00411918 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Tivity Health
4031 Aspen Grove Drive, Suite 250
Franklin, Tennessee 37067
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Wendy Gomez
4031 Aspen Grove Drive, Suite 250
Franklin, TN 37067
Title: Procurement Coord.
Phone # (800) 869-5311

Treasurer:

Ryan Wagers
4031 Aspen Grove Drive, Suite 250
Franklin, Tennessee 37067
Title: Chief Accounting Off
Phone # (800) 869-5311

Designated Agent(s):

Vicki Shepard
14 Compton Trace
Nashville, Tennessee 37215
Title: VP-Govt/External Rel
Phone # (615) 614-4249

Banks or Depositories

Truist
PO Box 200
Wilson, North Carolina 27894

Signed: Ryan Wagers
Date Signed: 05/19/2023
Official Committee URL: www.tivityhealth.com

(End FEC FORM 1)

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