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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-858566

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1. SYMBION INC GOOD GOVERNMENT FUND

    40 BURTON HILLS BLVD SUITE 500
    NASHVILLE, TN 37215
    Email: swhitmore@symbion.com;swhitmore@symbion.com

    NOTE: Email address is different than previously reported

2. Date: 02/26/2013

3. FEC Committee ID #: C00520833 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Symbion Inc
40 Burton Hills Blvd
Suite 500
Nashville, Tennessee 37215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Whitmore Steve
40 Burton Hills Blvd
Suite
Nashville, TN 37215
Title: VP Corporate Svcs
Phone # (615) 234-7916

Treasurer:

Whitmore Steve
40 Burton Hills Blvd
Suite 500
Nashville, Tennessee 37215
Title: Treasurer
Phone # (615) 234-7916

Designated Agent(s):

Martin Sarah
40 Burton Hills Blvd
Suite 500
Nashville, Tennessee 37215

Banks or Depositories

Bank of America
4011 Hillsboro Rd
Nashville, Tennessee 37215

Signed: Whitmore Steve
Date Signed: 02/26/2013

(End FEC FORM 1)

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