FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1041185
1. AmSurg Corp. Good Government Fund
1A Burton HillsNashville, TN 37215
Email: goodgovernmentfund@amsurg.com;matt@mdlangley.com
2. Date: 01/20/2016
3. FEC Committee ID #: C00484410 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
AmSurg Corp.1A Burton Hills Blvd.
Nashville, Tennessee 37215
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Thomas M. Sloan, Jr.1A Burton Hills Blvd
Nashville, TN 37215
Title: Treasurer
Phone # (615) 665-3608
Treasurer:
Thomas M. Sloan, Jr.1A Burton Hills Blvd
Nashville, Tennessee 37215
Title: Treasurer
Phone # (615) 665-3608
Designated Agent(s):
Banks or Depositories
Bank of America414 Church Street
Nashville, Tennessee 37219