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FEC Form 1 for U.S. Anesthesia Partners, Inc. PAC d/b/a/ USAP PACForm 1 for U.S. Anesthesia Partners, Inc. PAC d/b/a/ USAP PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1106217

1. U.S. Anesthesia Partners, Inc. PAC d/b/a/ USAP PAC

    NOTE:Commmittee Name is different than previously reported

    12222 Merit Drive
    Suite 700
    Dallas, TX 75251

    NOTE: Address is different than previously reported

    Email: brian.mccullough@usap.com

    NOTE: Email address is different than previously reported

2. Date: 10/14/2016

3. FEC Committee ID #: C00574103 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

U.S. Anesthesia Partners, Inc.
12222 Merit Drive
Suite 700
Dallas, Texas 75251
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Brian McCullough
12222 Merit Drive
Suite 700
Dallas, TX 75251
Title: Treasurer
Phone # (972) 852-6933

Treasurer:

Brian McCullough
12222 Merit Drive
Suite 700
Dallas, Texas 75251
Title: Treasurer
Phone # (972) 852-6933

Designated Agent(s):

Banks or Depositories

Bank of Texas
PO Box 29775
Dallas, Texas 75229

Signed: Brian McCullough
Date Signed: 10/14/2016

(End FEC FORM 1)


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