FEC Form 1 for UBS Americas Inc. Political Action Committee (UBS PAC)Form 1 for UBS Americas Inc. Political Action Committee (UBS PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-807238

1. UBS Americas Inc. Political Action Committee (UBS PAC)

400 ATLANTIC STREET
c/o Per Dyrvik
STAMFORD, CT 06901
Email: SH-PAC_Administrator@ubs.com,pacservices@ddcadvocacy.com

2. Date: 08/23/2012

3. FEC Committee ID #: C00012245 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

UBS Americas, Inc.
400 ATLANTIC STREET
STAMFORD, Connecticut 06901
Affiliated Relationship Code: Connected Organization

Custodian of Records:

DDC Advocacy
174 Waterfront Street
Suite 500
National Harbor, MD 20745
Title: Custodian of Records
Phone # (877) 332-6556

Treasurer:

Per Dyrvik
400 Atlantic St
Stamford, Connecticut 069013512
Title: Treasurer
Phone # (203) 719-4381

Designated Agent(s):

Banks or Depositories

JPMorgan Chase Bank
1251 Avenue of the Americas
New York, New York 10020

Signed: Per Dyrvik
Date Signed: 08/23/2012

(End FEC FORM 1)

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