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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-898693

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1. Skilled Healthcare Group Inc. Political Action Committee

    27442 Portola Parkway Suite 200
    Foothill Ranch, CA 92610
    Email: fecinfo@pass1.com

2. Date: 12/31/2013

3. FEC Committee ID #: C00442426 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Skilled Healthcare Group, Inc.
27442 Portola Parkway #200
Foothill Ranch, California 92610
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Chris Felfe
c/o PASS
1950 Roland Clarke Pl Ste 300
Reston, VA 20191
Title: Custodian
Phone # (703) 476-3070

Treasurer:

Pat Ikerd
27442 Portola Parkway Suite 200
Foothill Ranch, California 92610
Title: Treasurer
Phone # (949) 380-2027

Designated Agent(s):

Chris Felfe
27442 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

Signed: Pat Ikerd
Date Signed: 12/30/2013

FORM TEXT

(End FEC FORM 1)

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