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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1187704

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1. American Society of Plastic Surgeons Plastypac

    444 E Algonquin Road
    Arlington Heights, IL 60005
    Email: jfrasco@plasticsurgery.org

2. Date: 10/09/2017

3. FEC Committee ID #: C00249342 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

American Society of Plastic Surgeons
444 E Algonquin Rd
Arlington Heights, Illinois 600054654
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

J. Peter Rubin, MD
304 Hallsborough Dr
# 1
Pittsburgh, Pennsylvania 152381604
Title: Treasurer
Phone # (412) 478-7821

Designated Agent(s):

J. Peter Rubin, MD
304 Hallsborough Dr
# 1
Pittsburgh, Pennsylvania 152381604
Title: Treasurer
Phone # (412) 478-7821

Banks or Depositories

JP Morgan Chase
1201 South Milwaukee Ave
Libertyville, Illinois 60048

Signed: J. Peter Rubin, MD
Date Signed: 10/16/2017
Official Committee URL: www.plastypac.net

(End FEC FORM 1)

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