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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1135998

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1. MidCountry Financial Corp. PAC (MidCountry PAC)

    201 Second Street
    Suite 950
    Macon, GA 31201
    Email: alison@midcountryfinancial.com

2. Date: 12/22/2016

3. FEC Committee ID #: C00480673 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

MidCountry Financial Corp.
201 Second Street
Suite 950
Macon, Georgia 31201
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Autumn Goldin
500 Northridge Road
Suite 200
Atlanta, GA 30350
Title: Custodian of Records
Phone # (678) 585-8704

Treasurer:

Alison N. LaBruyere
30 Patewood Drive
Suite 160
Greenville, South Carolina 29615
Title: Treasurer
Phone # (864) 286-5352

Designated Agent(s):

Roy Jones
30 Patewood Drive
Suite 160
Greenville, South Carolina 29615
Title: Assistant Treasurer
Phone # (864) 286-5355

Banks or Depositories

MidCountry Bank
14617 Highway 7
Minnetonka, Minnesota 553453798

Signed: Alison N. LaBruyere
Date Signed: 12/22/2016

(End FEC FORM 1)

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