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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1102263

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1. eyePAC Political Action Committee for American Society of Cataract and Refractive Surgery

    4000 Legato Road, Suite 700
    Fairfax, VA 22033
    Email: nmccann@ascrs.org;tobrien@ascrs.org

    NOTE: Email address is different than previously reported

2. Date: 10/04/2016

3. FEC Committee ID #: C00171504 This committee is a separate segregated fund. Its connected organization is a Membership Organization
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Society of Cataract & Refractive Surgery
4000 Legato Road
Suite 700
Fairfax, Virginia 220334055
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Nancey McCann
4000 Legato Rd., Suite 700
Fairfax, VA 220334055
Title: Custodian of Records
Phone # (703) 591-2220

Treasurer:

Nancey McCann
4000 Legato Rd., Suite 700
Fairfax, Virginia 220334055
Title: Treasurer
Phone # (703) 591-2220

Designated Agent(s):

Tami OBrien
4000 Legato Rd.
Ste 700
Fairfax, Virginia 220334055
Title: Designated Agent
Phone # (703) 788-5798

Banks or Depositories

United Bank
14426 Albemarle Point Place
Suite 100
Chantilly, Virginia 20151

Signed: Nancey McCann
Date Signed: 10/04/2016

(End FEC FORM 1)

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