FEC Form 1 for American Dental Association Political Action CommitteeForm 1 for American Dental Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1547082

1. American Dental Association Political Action Committee

1111 14th Street, NW
Suite 1100
Washington, DC 200055627
Email: krejcis@ada.org;federalcompliance@nossaman.com

2. Date: 10/16/2021

3. FEC Committee ID #: C00000729 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

Committee ID# C00082636
Indiana Dental PAC
PO Box 2467
Indianapolis, Indiana 462062467
Affiliated Relationship Code: Affiliated Committee

American Dental Association
1111 14th St NW
Ste 1100
Washington, DC 200055627
Affiliated Relationship Code: Connected Organization

Committee ID# C00012211
North Carolina Dental PAC
1600 Evans Road
Cary, North Carolina 275132790
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00011544
Ohio Dental PAC
1370 Dublin Road
Columbus, Ohio 432151049
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00326918
New Jersey Dental PAC
One Dental Plaza
PO Box 6020
North Brunswick, New Jersey 089024313
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Ms. Sarah Krejci
1111 14th St NW
Ste 1100
Washington, DC 200055627
Title: Custodian of Records
Phone # (202) 898-2403

Treasurer:

Dr. Julian H Fair, III
PO Box 800
Wagener, South Carolina 291640800
Title: Treasurer
Phone # (803) 564-3463

Designated Agent(s):

Ms. Sarah Krejci
1111 14th St NW
Ste 1100
Washington, DC 200055627
Title: Designated Agent
Phone # (202) 898-2403

Banks or Depositories

Citibank
1101 Pennsylvania Avenue, NW
11th Floor
Washington, DC 20004

Signed: Dr. Julian H Fair, III
Date Signed: 11/03/2021
Official Committee URL: www.ada.org

FORM TEXT-1

(End FEC FORM 1)

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