FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-484688
1. LUMBERMENS INSURANCE CAMPAIGN FUND
NOTE:Commmittee Name is different than previously reported
Lumbermens Mutual Group1 Corporate Drive, Suite 200
Lake Zurich, IL 60047
NOTE: Address is different than previously reported
2. Date: 07/21/2010
3. FEC Committee ID #: C00009035 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Lumbermens Mutual Casualty Company1 Corporate Drive, Suite 200
Lake Zurich, Illinois 60047
Affiliated Relationship Code: Connected Organization
Custodian of Records:
John K ConwayLumbermens Mutual Group
1 Corporate Drive, Suite 200
Lake Zurich, IL 60047
Title: Secretary/Treasurer
Phone # (847) 320-3262
Treasurer:
John K ConwayLumbermens Mutual Group
1 Corporate Drive, Suite 200
Lake Zurich, Illinois 60047
Title: Secretary/Treasurer
Phone # (847) 320-3262
Designated Agent(s):
Raymond J JilekLumbermens Mutual Group
1 Corporate Drive, Suite 200
Lake Zurich, Illinois 60047
Title: Assistant Treasurer
Phone # (847) 320-3595
Banks or Depositories
American Chartered Bank459 So. Rand Road
Lake Zurich, Illinois 60047