FEC Form 1 for AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEEForm 1 for AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1201846

1. AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

9700 WEST BRYN MAWR AVE.
ROSEMONT, IL 60018
Email: tmacino@aaoms.org

2. Date: 01/30/2018

3. FEC Committee ID #: C00005660 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr
Rosemont, Illinois 60018
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Jeffrey Wallen
1200 48th Ave N
Suite 101
Myrtle Beach, South Carolina 29577
Title: Treasurer
Phone # (847) 678-6200

Designated Agent(s):

Jeanne Tuerk
9700 W Bryn Mawr Ave
Rosemont, Illinois 60018
Title: Assistant Treasurer
Phone # (847) 678-6200

Jeffrey Wallen
1200 48th Ave N
Suite 101
Myrtle Beach, South Carolina 29577
Title: Treasurer
Phone # (847) 678-6200

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1201846

1. AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

2. Date: 01/30/2018

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Jeffrey Wallen
Date Signed: 01/30/2018

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1201846

1. AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

2. Date: 01/30/2018

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Jeffrey Wallen Date Signed: 01/30/2018

(End FEC FORM 1)

Signed: Jeffrey Wallen
Date Signed: 01/30/2018