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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-943374

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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: 07/29/2014

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

Affiliated Committees/Organizations

Surgical Care Affiliates, Inc.
3000 Riverchase Galleria
Suite 500
Birmingham, Alabama 35244
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) 545-2572

Treasurer:

Richard L. Sharff, Jr.
3000 Riverchase Galleria
Suite 500
Birmingham, Alabama 35244
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: 07/29/2014

(End FEC FORM 1)

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