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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1244445

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1. Quorum Health Corporation Political Action Committee

    1573 Mallory Lane
    Suite 100
    Brentwood, TN 37027
    Email: Hal_McCard@QuorumHealth.com;mkdempsey@comerica.com

    NOTE: Email address is different than previously reported

2. Date: 07/12/2018

3. FEC Committee ID #: C00622654 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Quorum Health Corporation
1573 Mallory Lane
Suite 100
Brentwood, Tennessee 37027
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Comerica Bank PAC Services
PO Box 75000
MC2250
Detroit, MI 48275
Title: Recordkeeper
Phone # (248) 371-7270

Treasurer:

Hal McCard
1573 Mallory Lane
Suite 100
Brentwood, Tennessee 37027
Title: Treasurer
Phone # (615) 221-3507

Designated Agent(s):

Banks or Depositories

Comerica Bank
P.O. Box 75000
Detroit, Michigan 48275

Signed: Hal McCard
Date Signed: 07/12/2018

FORM TEXT-1

(End FEC FORM 1)

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