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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1018760

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1. eviCore healthcare PAC

    NOTE:Commmittee Name is different than previously reported

    400 Buckwalter Place Blvd
    Bluffton, SC 29910

    NOTE: Address is different than previously reported

    Email: matthew.ness@medsolutions.com;philip.clark@medsolutions.com

2. Date: 04/15/2015

3. FEC Committee ID #: C00547018 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

eviCore healthcare
400 Buckwalter Place Blvd
Bluffton, South Carolina 29910
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Matthew Alan Ness
209 Lauderdale Road
Nashville, TN 37205
Title: Gov't Affairs
Phone # (615) 517-0501

Treasurer:

Philip S. Clark
173 Kenner Ave
Nashville, Tennessee 37205
Title: General Counsel
Phone # (615) 468-4362

Designated Agent(s):

Matthew Alan Ness
209 Lauderdale Road
Nashville, Tennessee 37205
Title: Sr. Govt Affairs Rep

Banks or Depositories

Sun Trust Bank
201 4th Ave North
Nashville, Tennessee 37219

Signed: Matthew Alan Ness
Date Signed: 07/29/2015
Official Committee URL: www.carecorenational.com

NOTE: URL is different than previously reported

(End FEC FORM 1)

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