FEC Form 1 for North Carolina Dental Society PACForm 1 for North Carolina Dental Society PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-745818

1. North Carolina Dental Society PAC

NOTE:Commmittee Name is different than previously reported

1600 Evans Road
Cary, NC 27513
Email: LWard@ncdental.org

2. Date: 09/20/2011

3. FEC Committee ID #: C00012211 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

North Carolina Dental Society
1600 Evans Road
Cary, North Carolina 27513
Affiliated Relationship Code: Connected Organization

Committee ID# C00000729
AMERICAN DENTAL ASSOCIATION POLITICAL
1111 14TH STREET, NW
SUITE 1100
WASHINGTON, DC 20005
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Lisa Ward
1600 Evans Road
Cary, NC 27513
Title: Custodian of Records
Phone # (919) 677-1396

Treasurer:

Dr. George Sutton
218 Professional Circle
Morehead City, North Carolina 28557
Title: Treasurer
Phone # (252) 726-2360

Designated Agent(s):

Dr. M. Alec Parker, DMD
1600 Evans Road
Cary, North Carolina 27513
Title: Assistant Treasurer
Phone # (919) 677-1396

Banks or Depositories

RBC Bank
7033 Lewis Stephens Dr
Morrisville, North Carolina 27560

Signed: Dr. M. Alec Parker, DMD
Date Signed: 09/20/2011
Official Committee URL: www.ncdental.org

(End FEC FORM 1)

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