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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-426717

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1. CareSource Management Services, Co. PAC

    230 N. Main Street
    Dayton, OH 45402

    NOTE: Address is different than previously reported

    Email: mkdempsey@comerica.com

2. Date: 07/24/2009

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.
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:

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

Designated Agent(s):

Stephanie Ming
P.O. Box 75000
MC 2250
Detroit, Michigan 482752250
Title: Assistant Treasurer
Phone # (248) 371-7268

Banks or Depositories

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

Signed: Ronald S. Siemiontkowski
Date Signed: 07/24/2009

(End FEC FORM 1)

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