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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1081416

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1. Global Atlantic Financial Group Limited Political Action Committee

    132 Turnpike Road
    Suite 110
    Southborough, MA 01772
    Email: globalatlanticpac@gafg.com

2. Date: 07/06/2016

3. FEC Committee ID #: C00572479 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00572479
Global Atlantic Financial Group Limited Political Action Committee
132 Turnpike Road
Suite 110
Southborough, Massachusetts 01772
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Donna Lasick
132 Turnpike Road
Suite 110
Southborough, MA 01772
Title: Treasurer
Phone # (508) 460-2433

Treasurer:

Donna Lasick
132 Turnpike Road
Suite 110
Southborough, Massachusetts 01772
Title: Treasurer
Phone # (508) 460-2433

Designated Agent(s):

Sean Markes
132 Turnpike Road
Suite 110
Southborough, Massachusetts 01772
Title: Assistant Treasurer
Phone # (508) 460-2426

Banks or Depositories

US Bancorp Center
800 Nicollet Mall
Minneapolis, Minnesota 55402

Signed: Donna Lasick
Date Signed: 07/06/2016

(End FEC FORM 1)

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