FEC Form 1 for American Academy of Ophthalmology Inc Political Committee (OPHTHPAC)Form 1 for American Academy of Ophthalmology Inc Political Committee (OPHTHPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-184617

1. American Academy of Ophthalmology Inc Political Committee (OPHTHPAC)

655 Beach Street
San Francisco, CA 94109
Fax: 4155618545
Email: bbank@aao.org

2. Date: 08/18/2005

3. FEC Committee ID #: C00196246 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Benjamin Bank
c/o AAO 655 Beach Street
San Francisco, California 94109
Title: Treasurer
Phone # (415) 561-8500

Designated Agent(s):

Steve Rausch
c/o AAO 655 Beach Street
San Francisco, California 94109
Title: Assistant Treasurer
Phone # (415) 561-8500

Banks or Depositories

Union Bank
400 California Street
San Francisco, California 94104

Signed: Benjamin Bank
Date Signed: 08/18/2005
Official Committee FAX: 4155618545

(End FEC FORM 1)

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