FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-194633
1. Great-West Life & Annuity Insurance Company Political Action Committee
8525 E. Orchard Road2T3
Greenwood Village, CO 80111
Fax: 303-737-3827
Email: louise.lella@gwl.com
2. Date: 12/21/2005
3. FEC Committee ID #: C00263723 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Custodian of Records:
Louise A Lella, Asst8525 E. Orchard Road
2T3
Greenewood Village, CO 80111
Title: Legal Assistant II
Phone # (303) 737-0305
Treasurer:
, ____
Designated Agent(s):
Louise A Lella, Asst8525 E. Orchard Road
2T3
Greenewood Village, Colorado 80111
Title: Legal Assistant II
Phone # (303) 737-0305