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FEC Disclosure Form 1M for United Surgical Partners International Inc. Political Action CommitteeForm 1M for United Surgical Partners International Inc. Political Action Committee

FEC FORM 1M

NOTIFICATION OF MULTICANDIDATE STATUS

FILING FEC-169737


1. United Surgical Partners International Inc. Political Action Committee

15305 Dallas Parkway Suite 1600
Addison, TX 75001

2. FEC Committee ID #: C00402073

3. This is NOT a state party committee

4. STATUS BY AFFILIATION:

The committee submitted its Statement of Organization (FEC FORM 1)
on ________________________ and simultaneously qualified as a multicandidate committee through its
affiliation with:

Committee Name: ________________________
FEC Identification Number: _______________________

5. STATUS BY QUALIFICATION:

(a) Candidates: The committee has made contributions to the five federal candidates listed below:


NameOffice SoughtState/DistrictDate
(i) Arlen Specter
Senate
Pennsylvania/
08/03/2004
(ii) Blanche Lincoln
Senate
Arkansas/
09/15/2004
(iii) Roy Blunt
House of Representatives
Missouri/07
08/03/2004
(iv) Tom Price
House of Representatives
Georgia/06
10/04/2004
(v) Randy Neugebauer
House of Representatives
Texas/19
09/29/2004

(b) Contributors: The committee received a contribution from its 51st contributor on: 09/29/2004

(c) Registration: The committee has been registered for at least 6 months. FEC FORM 1 was submitted on: 06/10/2004

(d) Qualification: The committee met the above requirements on: 12/10/2004

Treasurer: John Wellik
Date Signed: 04/08/2005

(End FEC FORM 1M)


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