FEC Form 1 for Symbion Good Government FundForm 1 for Symbion Good Government Fund

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-981708

1. Symbion Good Government Fund

40 Burton Hills Boulevard
Suite 500
Nashville, TN 37215
Email: dbell@symbion.com;swhitmore@symbion.com

NOTE: Email address is different than previously reported

2. Date: 12/26/2014

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

Novamed Inc. Political Action Committe
333 W. Wacker Drive
Suite 1010
Chicago, Illinois 60606
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mr. Derek Edward Bell
40 Burton Hills Blvd.
Suite 400
Nashville, TN 37215
Title: Treasurer
Phone # (615) 234-5911

Treasurer:

Mr. Derek Edward Bell
40 Burton Hills Blvd.
Suite 400
Nashville, Tennessee 37215
Title: Treasurer
Phone # (615) 234-5911

Designated Agent(s):

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

Banks or Depositories

Bank of America
4011 Hillsboro Road
Nashville, Tennessee 37215

Signed: Mr. Derek Edward Bell
Date Signed: 12/29/2014
Official Committee URL: www.symbion.com

(End FEC FORM 1)

Generated Sun Jun 30 08:17:36 2024