FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-749811
1. American Dental Association Political Action Committee
1111 14th Street, NWSuite 1100
Washington, DC 20005
Email: taylorc@ada.org
2. Date: 10/19/2011
3. FEC Committee ID #: C00000729 This committee is a separate segregated fund. Its connected organization is a Membership OrganizationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
AMERICAN DENTAL ASSOCIATION1111 14TH STREET, NW
SUITE 1100
WASHINGTON, DC 20005
Affiliated Relationship Code: Connected Organization
California Dental PAC
PO Box 13749
Sacramento, California 95853
Affiliated Relationship Code: Affiliated Committee
Indiana Dental PAC
PO Box 2467
Indianapolis, Indiana 462062467
Affiliated Relationship Code: Affiliated Committee
New Jersey Dental PAC
One Dental Plaza
North Brunswick, New Jersey 089026020
Affiliated Relationship Code: Affiliated Committee
North Carolina Dental PAC
1600 Evans Road
Cary, North Carolina 27513
Affiliated Relationship Code: Affiliated Committee
Ohio Dental Association PAC
1370 Dublin Road
Columbus, Ohio 43215
Affiliated Relationship Code: Affiliated Committee
Custodian of Records:
Mrs. Cynthia Taylor1111 14th Street, NW
Suite 1100
Washington, DC 20005
Title: Mgr, Mbrshp & Compli
Treasurer:
Dr Richard Huot1111 14th Street NW
Suite 1100
Washington, DC 20005
Title: Dentist
Phone # (202) 898-2424
Designated Agent(s):
Banks or Depositories
CITIBANK1101 PENNSYLVANIA AVENUE, NW
11TH FLOOR
WASHINGTON, DC 20004