FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-794352
1. SURGICAL CARE AFFILIATES POLITICAL ACTION COMMITTEE
3000 RIVERCHASE GALLERIASUITE 500
BIRMINGHAM, AL 35244
Email: Rich.Sharff@scasurgery.com
2. Date: 06/14/2012
3. FEC Committee ID #: C00440743 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
ASC Acquisition, LLC301 Commerce Street
Suite 3300
Fort Worth, Texas 76102
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Richard L. Sharff, Jr.3000 Riverchase Galleria
Suite 500
Birmingham, AL 35244
Title: Treasurer/Custodian
Phone # (205) 545-2764
Treasurer:
Richard L. Sharff, Jr.3000 Riverchase Galleria
Suite 500
Birmingham, Alabama 35244
Title: Treasurer/Custodian
Phone # (205) 545-2764
Designated Agent(s):
Banks or Depositories
Regions Bank1900 5th Avenue N
Birmingham, Alabama 35203
Wells Fargo Bank
7000 Central Pkwy, Suite 600
Atlanta, Georgia 30328