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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-271362

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1. Delta Dental Plans Association PAC

    1515 W 22nd Street Suite 450
    Oak Brook, IL 60523

2. Date: 01/25/2007

3. FEC Committee ID #: C00213819 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Title: Custodian

Treasurer:

Ben Yomtoob
1515 22ND ST
SUITE 450
Oak Brook, Illinois 60523
Title: Treasurer

Designated Agent(s):

Robert Reese
1515 22nd St W
Suite 450
Oak Brook, Illinois 60523
Title: Assistant Treasurer

Banks or Depositories

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

Delaware Place Bank
190 E. Deleware Place
Chicago, Illinois 60611

Signed: Ben Yomtoob
Date Signed: 01/25/2007
Official Committee URL: http://www.ddpa.org

(End FEC FORM 1)

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