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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1525697

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

    12587 Fair Lakes Circle
    #348
    Fairfax, VA 22033

    NOTE: Address is different than previously reported

    Email: mmoseley@ascrs.org;sshaffer@ascrs.org

    NOTE: Email address is different than previously reported

2. Date: 07/14/2021

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:

Matthew E Moseley, ASCRS
12587 Fair Lakes Circle
#348
Fairfax, VA 22033
Title: Treasurer
Phone # (703) 591-2220

Treasurer:

Matthew E Moseley, ASCRS
12587 Fair Lakes Circle
#348
Fairfax, Virginia 22033
Title: Treasurer
Phone # (703) 591-2220

Designated Agent(s):

Scott Shaffer
12587 Fair Lakes Circle
#348
Fairfax, Virginia 22033
Title: Designated Agent
Phone # (703) 615-2764

Banks or Depositories

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

Signed: Matthew E Moseley, ASCRS
Date Signed: 07/14/2021

(End FEC FORM 1)

Generated Tue Jul 16 06:13:36 2024