FEC Form 1 for Delta Dental Plans Association PACForm 1 for Delta Dental Plans Association PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1605322

1. Delta Dental Plans Association PAC

1515 W 22nd Street Suite 450
Oak Brook, IL 60523
Email: jdaughn@deltadental.com;fecinfo@pass1.com

2. Date: 06/24/2022

3. FEC Committee ID #: C00213819 This committee is a separate segregated fund. Its connected organization is a Trade Association
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00213819
Delta Dental Plans Association
1515 W 22nd Street Suite 450
Oak Brook, Illinois 60523
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Samantha Quinn
1515 W 22nd Street Suite 450
Oak Brook, IL 60523
Title: Custodian of Records
Phone # (630) 574-6851

Treasurer:

Samantha Quinn
1515 W 22nd Street Suite 450
Oak Brook, Illinois 60523
Title: Treasurer
Phone # (630) 574-6851

Designated Agent(s):

Grant Brenneman
1515 W 22nd Street, Suite 450
Oak Hill, Illinois 60523
Title: Assistant Treasurer

Banks or Depositories

The Northern Trust Company
50 S. LaSalle Street
Chicago, Illinois 60675

Signed: Samantha Quinn
Date Signed: 06/24/2022
Official Committee URL: None

FORM TEXT-1

(End FEC FORM 1)

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