FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1573740
1. FROGMAN PAC
11972 GREY OAKS PARK RD.GLEN ALLEN, VA 23059
Email: margee@sageadvisorygroup.co;staci@sageadvisorygroup.co
2. Date: 03/14/2022
3. FEC Committee ID #: C00809012This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
In addition, this committee is a Leadership PAC.
Affiliated Committees/Organizations
Candidate ID# H0WI03175
Mr. DERRICK F. VAN ORDEN
PO BOX 565
PRAIRIE DU CHIEN, Wisconsin 53821
Affiliated Relationship Code: Leadership PAC Sponsor
Custodian of Records:
MARY CLANCY
11972 GREY OAKS PARK RD.
GLEN ALLEN, VA 23059
Title: TREASURER
Phone # (703) 989-6167
Treasurer:
MARY CLANCY
11972 GREY OAKS PARK RD.
GLEN ALLEN, Virginia 23059
Title: TREASURER
Phone # (703) 989-6167
Designated Agent(s):
STACI GOEDE
7816 ROSE GARDEN LN.
SPRINGFIELD, Virginia 22153
Title: ASSISTANT TREASURER
Phone # (703) 371-5852
Banks or Depositories
Chain Bridge Bank, NA
1445A Laughlin Ave.
McLean, Virginia 22101
Signed: MARY CLANCY
Date Signed: 03/14/2022
(End FEC FORM 1)
Date Signed: 03/14/2022