FEC Form 1 for FIRST COLONIES ANESTHESIA ASSOCIATES LLC POLITICAL ACTION COMMITTEEForm 1 for FIRST COLONIES ANESTHESIA ASSOCIATES LLC POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1328861

1. FIRST COLONIES ANESTHESIA ASSOCIATES LLC POLITICAL ACTION COMMITTEE

7490 NEW TECHNOLOGY WAY
FREDERICK, MD 21703
Email: info@campaignfinancial.com

2. Date: 04/26/2019

3. FEC Committee ID #: C00416305 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

First Colonies Anesthesia Associates, LLC
3626 Ruffin Road
San Diego, California 92123
Affiliated Relationship Code: Connected Organization

Committee ID# C00574103
U.S. Anesthesia Partners, Inc. PAC D/B
12222 Merit Drive
Suite 700
Dallas, Texas 75251
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Financial Services Campaign
PO Box 30844
Bethesdas, MD 20824
Title: Custodian of Records
Phone # (301) 654-3220

Treasurer:

Jeremy Roth, MD
3626 Ruffin Road
San Diego, California 92123
Title: Treasurer
Phone # (301) 654-3220

Designated Agent(s):

Banks or Depositories

SunTrust Bank
1445 New York Ave NW
Washington, DC 20005

Signed: Jeremy Roth, MD
Date Signed: 04/26/2019

(End FEC FORM 1)

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