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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-723074

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1. Nationwide Mutual Insurance Company Iowa Political Action Committee

    1100 Locust
    DM-01-0301
    Des Moines, IA 503910301
    Email: pac@nationwide.com

    NOTE: Email address is different than previously reported

2. Date: 04/14/2011

3. FEC Committee ID #: C00123976 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 Po
One Nationwide Plaza
1-27-10
Columbus, Ohio 43215
Affiliated Relationship Code: Affiliated Committee

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

Custodian of Records:

Shannon Wilks
One Nationwide Plaza
2-5-18
Columbus, OH 43215
Title: Custodian of Records
Phone # (614) 249-5470

Treasurer:

Kay Godfredsen
1100 Locust Street
Dept. 1199
Des Moines, Iowa 50391
Title: Treasurer
Phone # (515) 508-4305

Designated Agent(s):

Banks or Depositories

Nationwide Bank
One Nationwide Plaza
Columbus, Ohio 43215

Wells Fargo
666 Walnut Street
Des Moines, Iowa 50309

Signed: Kay Godfredsen
Date Signed: 04/14/2011

(End FEC FORM 1)

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