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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-742561

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1. Nationwide Mutual Insurance Company Political Action Committee

    One Nationwide Plaza
    1-32-301
    Columbus, OH 43215

    NOTE: Address is different than previously reported

    Email: pac@nationwide.com

2. Date: 08/19/2011

3. FEC Committee ID #: C00076174 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Nationwide
One Nationwide Plaza
Columbus, Ohio 43215
Affiliated Relationship Code: Connected Organization

Nationwide Mutual Insurance Company Fi
One Nationwide Plaza, 1-32-301
Columbus, Ohio 43215
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Shannon Wilks
One Nationwide Plaza
1-32-301
Columbus, OH 43215
Title: Custodian of Records
Phone # (614) 249-5470

Treasurer:

Carol Dove
One Nationwide Plaza
1-3-802
Columbus, Ohio 43215
Title: Treasurer
Phone # (614) 249-6963

Designated Agent(s):

James Benney
One Nationwide Plaza
Mail Code 1-26-05
Columbus, Ohio 43215
Title: AssistantTreasurer
Phone # (614) 249-7811

Banks or Depositories

Huntington National Bank
41 South High Street
HC0810
Columbus, Ohio 43215

Signed: Ms. Carol Dove
Date Signed: 08/19/2011

(End FEC FORM 1)

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