FEC Form 1 for Great-West Life & Annuity Insurance Company Political Action CommitteeForm 1 for Great-West Life & Annuity Insurance Company Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-312017

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

8515 E. Orchard Road
7T2
Greenwood Village, CO 80111
Fax: 303-737-3827
Email: robert.onstad@gwl.com

2. Date: 11/29/2007

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

Affiliated Committees/Organizations

Great-West Life & Annuity Insurance Company
8515 E. Orchard Road
7T2
Greenwood Village, Colorado 80111
Relationship: Connected
Organization Type: Corporation

Putnam Investments Inc. Public Affairs
One Post Office Square
Boston, Massachusetts 02109
Relationship: Affiliated

Custodian of Records:

Mr. David Smith
8525 East Orchard Rd.
2T3
Greenwood Village, CO 80111
Phone # (303) 737-2984

Treasurer:

Mr Robert Onstad
8515 E. Orchard Road
7T2
Greenwood Village, Colorado 80111
Title: Asst. Vice-President
Phone # (303) 737-2016

Designated Agent(s):

David Smith
8525 East Orchard Road 2T3
Greenwood Village, Colorado 80111
Title: Assistant Treasurer
Phone # (303) 737-2984

Banks or Depositories

US Bank
P.O. Box 1800
Saint Paul, Minnesota 551010800

Signed: Mr Robert Onstad
Date Signed: 11/29/2007
Official Committee FAX: 303-737-3827

FORM TEXT

(End FEC FORM 1)

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