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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1025759

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1. AHS Legacy Operations LLC Federal PAC

    NOTE:Commmittee Name is different than previously reported

    One Burton Hills Boulevard
    Suite 250
    Nashville, TN 37215
    Email: Ashley.Crabtree@ardenthealth.com

2. Date: 09/19/2015

3. FEC Committee ID #: C00550392 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

AHS Legacy Operations LLC
One Burton Hills Boulevard
Suite 250
Nashville, Tennessee 37215
Affiliated Relationship Code: Connected Organization

AHS Legacy Operations LLC Good Governm
One Burton Hills Boulevard
Sutie 250
Nashville,, Tennessee 37215
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mrs. Ashley M. Crabtree
One Burton Hills Boulevard
Suite 250
Nashville,, TN 37215
Title: Treasurer
Phone # (615) 296-3202

Treasurer:

Mrs. Ashley M. Crabtree
One Burton Hills Boulevard
Suite 250
Nashville,, Tennessee 37215
Title: Treasurer
Phone # (615) 296-3202

Designated Agent(s):

Mr. Stephen C. Petrovich
One Burton Hills Boulevard
Suite 250
Nashville, Tennessee 37215
Title: Assistant Treasurer
Phone # (615) 296-3384

Banks or Depositories

Bank of America, N.A.
600 Peachtree Street NE
Atlanta,, Georgia 30308

Signed: Mrs. Ashley M. Crabtree
Date Signed: 09/19/2015

(End FEC FORM 1)

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