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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1155851

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1. SCA-MC VBP, INC. POLITICAL ACTION COMMITTEE (SCA PAC)

    NOTE:Commmittee Name is different than previously reported

    569 BROOKWOOD VILLAGE
    SUITE 901
    BIRMINGHAM, AL 35209
    Email: Rich.Sharff@scasurgery.com

2. Date: 03/24/2017

3. FEC Committee ID #: C00440743 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

SCA-MC VBP, Inc.
569 Brookwood Village
Suite 901
Birmingham, Alabama 35209
Affiliated Relationship Code: Connected Organization

UnitedHealth Group Incorporated PAC (U
701 Pennsylvania Ave, NW
Suite 200
Washington, DC 20004
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Richard L. Sharff, Jr.
569 Brookwood Village
Suite 901
Birmingham, AL 35209
Title: Treasurer/Custodian
Phone # (205) 545-2572

Treasurer:

Richard L. Sharff, Jr.
569 Brookwood Village
Suite 901
Birmingham, Alabama 35209
Title: Treasurer/Custodian
Phone # (205) 545-2572

Designated Agent(s):

Kelli Collins
3820 North Elm Street
Greensboro, North Carolina 27455
Title: Assistant Treasurer
Phone # (336) 854-1663

Banks or Depositories

Wells Fargo Bank
2527 John Hawkins Pky.
Hoover, Alabama 35244

Signed: Richard L. Sharff, Jr.
Date Signed: 04/10/2017

FORM TEXT-1

(End FEC FORM 1)

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