FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-765302
1. AMBULATORY SURGERY CENTER ASSOCIATION PAC (ASCAPAC)
NOTE:Commmittee Name is different than previously reported
1012 Cameron StAlexandria, VA 22314
Email: bdavis@ascassociation.org
2. Date: 02/10/2012
3. FEC Committee ID #: C00424788 This committee is a separate segregated fund. Its connected organization is a Trade AssociationAffiliated Committees/Organizations
Ambulatory Surgery Center Association (ASCA)1012 Cameron St
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Treasurer:
Brendan Davis1012 Camerson St
Alexandria, Virginia 22314
Title: PAC Director
Phone # (703) .34-5.02
Designated Agent(s):
Banks or Depositories
Wachovia330 N WASHINGTON ST
Alexandria, Virginia 22314