FEC Form 1 for CHS/Community Health Systems, Inc. Political Action Cmte (CHS PAC)Form 1 for CHS/Community Health Systems, Inc. Political Action Cmte (CHS PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1154487

1. CHS/Community Health Systems, Inc. Political Action Cmte (CHS PAC)

4000 Meridian Blvd
Franklin, TN 37067
Email: mkdempsey@comerica.com

2. Date: 04/01/2017

3. FEC Committee ID #: C00485896 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

CHS/Community Health Systems, Inc.
4000 Meridian Blvd
Franklin, Tennessee 37067
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:

Benjamin C. Fordham
4000 Meridian Blvd
Franklin, Tennessee 37067
Title: Treasurer
Phone # (615) 465-7371

Designated Agent(s):

Jesse C. Neil
4000 Meridian Blvd
Franklin, Tennessee 37067
Title: Asst. Treasurer
Phone # (615) 465-7115

Banks or Depositories

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

Signed: Benjamin C. Fordham
Date Signed: 04/01/2017

FORM TEXT-1

(End FEC FORM 1)

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