FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-751786
1. Skilled Healthcare Group Inc. Political Action Committee
27442 Portola Parkway Suite 200Foothill Ranch, CA 92610
Email: fecinfo@pass1.com
NOTE: Email address is different than previously reported
2. Date: 11/04/2011
3. FEC Committee ID #: C00442426 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Skilled Healthcare Group, Inc.27442 Portola Parkway #200
Foothill Ranch, California 92610
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Chris Felfec/o PASS
1950 Roland Clarke Place
Reston, VA 20191
Title: Custodian
Phone # (703) 476-3070
Treasurer:
Jon Sadayasu27442 Portola Parkway Suite 200
Foothill Ranch, California 92610
Title: Treasurer
Phone # (949) 282-5885
Designated Agent(s):
Chris Felfe27442 Portola Parkway
Suite 200
Foothill Ranch, California 92610
Title: Assistant Treasurer
Phone # (949) 282-5954
Banks or Depositories
Burke & Herbert Bank & Trust Co.100 South Fairfax Street
Alexandria, Virginia 22314