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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-185546

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1. Great-West Life & Annuity Insurance Company Political Action Committee

    8525 E. Orchard Road
    2T3
    Greenwood Village, CO 80111
    Fax: 303-737-3827
    Email: brian.mcclure@gwl.com

2. Date: 08/31/2005

3. FEC Committee ID #: C00263723 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Brian McClure, Asst
8525 E. Orchard Road
2T3
Greenewood Village, CO 80111
Title: Legal Assistant II
Phone # (303) 737-2953

Treasurer:

, ____

Designated Agent(s):

Brian McClure, Asst
8525 E. Orchard Road
2T3
Greenewood Village, Colorado 80111
Title: Legal Assistant II
Phone # (303) 737-2953

Banks or Depositories

US Bank
P.O. Box 1800
St. Paul, Minnesota 55101

Signed: Mark J. Pavlik, Trea
Date Signed: 08/31/2005
Official Committee FAX: 303-737-3827

(End FEC FORM 1)

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