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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1017255

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1. FC Compassus, LLC PAC (Compassus PAC)

    12 Cadillac Drive, Ste 360
    Brentwood, NC 37027
    Email: Craig.Jeffries@hospicecom.com

2. Date: 07/20/2015

3. FEC Committee ID #: C00581728 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

FC Compassus, LLC
12 Cadillac Drive, Ste 360
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Kerry Massey
12 Cadillac Drive, Ste 360
Brentwood, TN 37027

Treasurer:

craig jeffries
12 Cadillac Drive, Ste 360
Brentwood, Tennessee 37027
Title: V.P. Public Policy
Phone # (828) 772-2843

Designated Agent(s):

Kerry Massey
12 Cadillac Drive,Ste 360
Brentwood, Tennessee 37027
Phone # (615) 425-5421

Banks or Depositories

Fifth Third Bank
5000 Maryland Way
Brentwood, Tennessee 37027

Signed: craig jeffries
Date Signed: 07/21/2015

(End FEC FORM 1)

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