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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1039197

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1. CareSource Management Services Co. PAC

    230 N. Main Street
    Dayton, OH 45402
    Email: mkdempsey@comerica.com

2. Date: 01/12/2016

3. FEC Committee ID #: C00424879 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

CareSource Management Services Co.
230 N. Main Street
Dayton, Ohio 45402
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Comerica Bank PAC Services
P.O. Box 75000
MC 2250
Detroit, MI 482752250
Title: Recordkeeper
Phone # (248) 371-7270

Treasurer:

L. Tarlton Thomas III
230 N. Main Street
Dayton, Ohio 45402
Title: Treasurer
Phone # (248) 371-7270

Designated Agent(s):

Banks or Depositories

Comerica Bank
P.O. Box 75000
MC 2250
Detroit, Michigan 482752250

Signed: L. Tarlton Thomas III
Date Signed: 01/12/2016

FORM TEXT-1

(End FEC FORM 1)

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