FEC Form 1 for American Dental Hygienists' Association Political Action Committee (HYPAC)Form 1 for American Dental Hygienists' Association Political Action Committee (HYPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1040921

1. American Dental Hygienists' Association Political Action Committee (HYPAC)

444 N. Michigan
Suite 3400
Chicago, IL 606113980
Email: hypac@adha.net

2. Date: 01/20/2016

3. FEC Committee ID #: C00345868 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Peter American Dental Hygienists' Association
58 Lyndale Avenue
Methuen, Massachusetts 01844
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Peter Gangi
58 Lyndale Avenue
Methuen, Massachusetts 01844
Title: Treasurer
Phone # (508) 641-4499

Designated Agent(s):

Jose Rodriguez
444 N Michigan Ave
Suite 3400
Chicago, Illinois 60611
Title: Assistant Treasurer
Phone # (312) 440-8914

Banks or Depositories

US Bank
444 N Michigan Ave Suite 3400
Chicago, Illinois 606113980

Signed: Peter Gangi
Date Signed: 01/20/2016

FORM TEXT-1

(End FEC FORM 1)

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