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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-812339

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1. American Osteopathic Information Association - Osteopathic Political Action Committee

    1090 Vermont Ave., NW
    Suite 500
    Washington, DC 20005

    NOTE: Address is different than previously reported

    Email: opac@osteotech.org

2. Date: 09/25/2012

3. FEC Committee ID #: C00113803 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Osteopathic Information Association
142 East Ontario Street
Chicago, Illinois 606114864
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ronnie Martin, D.O.
175 Fanklin Park
Christiansburg, VA 24073
Title: Treasurer
Phone # (720) 891-9708

Treasurer:

Ronnie Martin, D.O.
175 Fanklin Park
Christiansburg, Virginia 24073
Title: Treasurer
Phone # (720) 891-9708

Designated Agent(s):

Leann Fox
1090 Vermont Ave., NW
Suite 500
Washington, DC 20005
Title: Assistant Treasurer
Phone # (202) 414-0144

Banks or Depositories

Citibank F.S.B.
1001 Pennsylvania AVe., NW
Washington, DC 20004

Signed: Ronnie Martin, D.O.
Date Signed: 09/25/2012

(End FEC FORM 1)

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