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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1291112

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1. Allergy Associates PA Political Action Committee

    6701 Baum Drive
    Ste. 140
    Knoxville, TN 37919
    Email: allergyassocpac@allergyasc.com

2. Date: 11/10/2018

3. FEC Committee ID #: C00691378 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Allergy Associates P.A.
6701 Baum Drive
Ste. 140
Knoxville, Tennessee 37919
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ned DeLozier
6701 Baum Drive
Ste. 140
Knoxville, TN 37919
Title: Treasurer
Phone # (865) 584-5727

Treasurer:

Ned DeLozier
6701 Baum Drive
Ste. 140
Knoxville, Tennessee 37919
Title: Treasurer
Phone # (865) 584-5727

Designated Agent(s):

Dave Zaczyk
6701 Baum Drive
Ste. 140
Knoxville, Tennessee 37919
Title: Assistant Treasurer
Phone # (865) 584-5727

Banks or Depositories

Pinnacle Financial Partners
1111 Northshore Drive
Ste S800
Knoxville, Tennessee 37919

Signed: Ned DeLozier
Date Signed: 11/10/2018
Official Committee URL: allergyassocpac.com

(End FEC FORM 1)

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