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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1184723

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1. Cumberland Health and Wellness PAC

    2525 West End Avenune
    Suite 950
    Nashville, TN 37203
    Email: CumberlandPAC@CumberlandPharma.com;wpendleton@cumberlandpharma.com

2. Date: 10/09/2017

3. FEC Committee ID #: C00657536 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Cumberland Pharmaceuticals Inc.
2525 West End Ave.
Suite 950
Nashville, Tennessee 37203
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Abbi Maher
2525 West End Ave.
Suite 950
Nashville, TN 37203
Title: Custodian of Records

Treasurer:

Mr. Michael Bonner
2525 West End Ave.
Suite 950
Nashville, Tennessee 37203
Title: Treasurer
Phone # (615) 255-0068

Designated Agent(s):

Mr. A.J. Kazimi
2525 West End Ave.
Suite 950
Nashville, Tennessee 37203
Title: Chairman

Banks or Depositories

Pinnacle Financial Partners
150 Third Avenue South
Suite 900
Nashville, Tennessee 37201

Signed: Mr. Michael Bonner
Date Signed: 10/09/2017

(End FEC FORM 1)

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