FEC Form 1 for Mutual of Omaha Companies PAC (IMPAC)Form 1 for Mutual of Omaha Companies PAC (IMPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-867011

1. Mutual of Omaha Companies PAC (IMPAC)

Mutual of Omaha Plaza
Omaha, NE 68175
Email: sue.miner@mutualofomaha.com

2. Date: 04/16/2013

3. FEC Committee ID #: C00094581 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

Mutual of Omaha Companies
Mutual of Omaha Plaza
Omaha, Nebraska 68175
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Galen F. Ullstrom
Mutual of Omaha Plaza
Omaha, Nebraska 68175
Title: Treasurer
Phone # (402) 351-5235

Designated Agent(s):

Banks or Depositories

Mutual of Omaha Bank
33rd & Farnam
Omaha, Nebraska 68175

Signed: Galen F. Ullstrom
Date Signed: 04/16/2013

(End FEC FORM 1)

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