FEC Form 1 for CareSource Management Services, Co. Political Action Cmte (CSMS PAC)Form 1 for CareSource Management Services, Co. Political Action Cmte (CSMS PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-395045

1. CareSource Management Services, Co. Political Action Cmte (CSMS PAC)

NOTE:Commmittee Name is different than previously reported

One Dayton Centre, One South Main
Dayton, OH 45402
Email: mkdempsey@comerica.com

2. Date: 01/13/2009

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.
One Dayton Centre
One South Main Street
Dayton, Ohio 45402
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Comerica Bank
P.O. Box 75000
MC 2250
Detroit, MI 482752250
Title: Recordkeeper
Phone # (248) 371-7268

Treasurer:

James Hoeberling
P.O. Box 75000
MC 2250
Detroit, Michigan 482752250
Title: Treasurer
Phone # (248) 371-5562

Designated Agent(s):

Ronald Siemiontkowski
P.O. Box 75000
MC 2250
Detroit, Michigan 482752250
Title: Assistant Treasurer
Phone # (248) 371-7270

Banks or Depositories

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

Signed: James Hoeberling
Date Signed: 01/13/2009

(End FEC FORM 1)

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