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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1371018

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1. OHIO AMBULATORY SURGERY CENTERS PAC

    500 W. Wilson Bridge Rd., Suite 12
    Worthington, OH 43085

    NOTE: Address is different than previously reported

    Email: sam@oaasc.net;kam@oames.org

    NOTE: Email address is different than previously reported

2. Date: 01/17/2020

3. FEC Committee ID #: C00389866 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Ohio Association of Ambulatory Surgery Centers
P.O. Box 340225
Columbus, Ohio 43234
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Heidi Moss
500 W. Wilson Bridge Rd., Suite 12
Worthington, OH 43085
Phone # (614) 358-0177

Treasurer:

Heidi Moss
500 W. Wilson Bridge Rd., Suite 12
Worthington, Ohio 43085
Phone # (614) 358-0177

Designated Agent(s):

Barbara Drayes
19250 Bagley Road
Middleburg Heights, Ohio 44130

Banks or Depositories

Huntington National Bank
PO Box 1558 EA1W37
Columbus, Ohio 43216

Signed: Heidi Moss
Date Signed: 01/17/2020

(End FEC FORM 1)

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