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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-911669

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1. CAPELLA HEALTHCARE, INC. GOVERNMENT AFFAIRS COMMITTEE

    501 CORPORATE CENTRE DRIVE STE 200
    FRANKLIN, TN 37067
    Email: jim.wiseman@capellahealth.com

    NOTE: Email address is different than previously reported

2. Date: 07/25/2011

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

Affiliated Committees/Organizations

Capella Healthcare, Inc.
501 Corporate Centre Drive
Suite 200
Franklin, Tennessee 37067
Affiliated Relationship Code: Connected Organization

Custodian of Records:

James R. Wiseman
501 Corporate Centre Drive
Suite 200
Franklin, TN 37067
Title: Treasurer
Phone # (615) 764-3007

Treasurer:

James R. Wiseman
501 Corporate Centre Drive
Suite 200
Franklin, Tennessee 37067
Title: Treasurer
Phone # (615) 764-3042

Designated Agent(s):

Neil Kunkel
501 Corporate Centre Drive
Suite 200
Franklin, Tennessee 37067
Title: SVP/Chief Counsel
Phone # (615) 764-3000

Banks or Depositories

Suntrust Bank
731 Cool Springs Blvd
Franklin, Tennessee 37067

Signed: James R. Wiseman
Date Signed: 03/12/2014

(End FEC FORM 1)

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