FEC Form 1 for Outpatient Ophthalmic Surgery Society Political Action CommitteeForm 1 for Outpatient Ophthalmic Surgery Society Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-751362

1. Outpatient Ophthalmic Surgery Society Political Action Committee

701 8th Street, NW
Suite 500
Washington, DC 20001
Email: mklesher@wms-jen.com

NOTE: Email address is different than previously reported

2. Date: 10/06/2011

3. FEC Committee ID #: C00217323 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Outpatient Opthalmic Surgery Society
6564 Umber Circle
Arvada, Colorado 80007
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Meredith Lesher
701 8th Street, NW
Suite 500
Washington, DC 20001
Title: Treasurer
Phone # (202) 659-8201

Treasurer:

Meredith Lesher
701 8th Street, NW
Suite 500
Washington, DC 20001
Title: Treasurer
Phone # (202) 659-8201

Designated Agent(s):

Banks or Depositories

United Bank
1875 Eye Street, N.W.
Washington, DC 20006

Signed: Meredith Lesher
Date Signed: 10/06/2011

(End FEC FORM 1)

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