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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-803479

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1. SURGICAL CARE AFFILIATES POLITICAL ACTION COMMITTEE

    3000 RIVERCHASE GALLERIA
    SUITE 500
    BIRMINGHAM, AL 35244
    Email: Rich.Sharff@scasurgery.com

2. Date: 08/06/2012

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

Affiliated Committees/Organizations

ASC Acquisition, LLC
301 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

Wells Fargo Bank
7000 Central Pkwy, Suite 600
Atlanta, Georgia 30328

Signed: Richard L. Sharff, Jr.
Date Signed: 08/08/2012

FORM TEXT

(End FEC FORM 1)

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