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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1115771

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1. CAPELLA HEALTHCARE, INC. GOVERNMENT AFFAIRS COMMITTEE

    103 CONTINENTAL PLACE
    SUITE 200
    BRENTWOOD, TN 37027

    NOTE: Address is different than previously reported

    Email: chris.minar@rcchhealth.com

    NOTE: Email address is different than previously reported

2. Date: 10/26/2016

3. FEC Committee ID #: C00421420 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Capella Healthcare, Inc.
103 Continental Place
Suite 200
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Chris Minar
103 Continental Place
Brentwood, TN 37027
Title: Treasurer
Phone # (615) 844-9815

Treasurer:

Chris Minar
103 Continental Place
Brentwood, Tennessee 37027
Title: Treasurer
Phone # (615) 844-9815

Designated Agent(s):

Howard Wall
103 Continental Place
Suite 200
Brentwood, Tennessee 37027
Title: EVP/General Counsel
Phone # (615) 844-9871

Banks or Depositories

Suntrust Bank
731 Cool Springs Blvd
Franklin, Tennessee 37067

Signed: Chris Minar
Date Signed: 10/26/2016

(End FEC FORM 1)

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