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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-437935

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1. OHIO DENTAL ASSOCIATION POLITICAL ACTION COMMITTEE

    1370 DUBLIN ROAD
    COLUMBUS, OH 43215
    Email: peg@oda.org

2. Date: 11/16/2006

3. FEC Committee ID #: C00011544 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

Ohio Dental Association
1370 Dublin RD
Columbus, Ohio 43215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Dr. Bruce Grbach
9203 Mentor Avenue
Mentor, Ohio 44060
Title: Treasurer
Phone # (614) 486-2700

Designated Agent(s):

Banks or Depositories

Chase
100 Board Street
Columbus, Ohio 43215

Signed: Dr. Bruce Grbach
Date Signed: 10/21/2009

(End FEC FORM 1)

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