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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-357946

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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: 08/14/2008

3. FEC Committee ID #: C00263723 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Great-West Life & Annuity Insurance Company
8520 E. Orchard Road, 7T2
Greenwood Village, Colorado 80111
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Richard Schultz
8525 East Orchard Rd.
2T3
Greenwood Village, CO 80111
Title: V.P. & Counsel
Phone # (303) 737-3000

Treasurer:

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

Designated Agent(s):

Richard Schultz
8525 E. Orchard Road, 2T3
Greenwood Village, Colorado 80111
Title: V.P. & Counsel
Phone # (303) 737-3000

Banks or Depositories

U.S. Bank
P.O. Box 1800
Saint Paul, Minnesota 551010800

Signed: Mr Robert Onstad
Date Signed: 08/14/2008
Official Committee FAX: 303-737-3827

FORM TEXT

(End FEC FORM 1)

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