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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-767433

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1. SHELTER MUTUAL INSURANCE COMPANY FEDERAL PAC

    1817 WEST BROADWAY
    COLUMBIA, MO 65218
    Email: swoodbury@shelterinsurance.com

2. Date: 02/23/2012

3. FEC Committee ID #: C00140384 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Shelter Mutual Insurance Company
1817 West Broadway
Columbia, Missouri 652180001
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Tina M Workman
1817 West Broadway
Columbia, MO 65218
Title: Assistant Treasurer
Phone # (573) 214-4574

Treasurer:

S. Daniel Clapp
1817 West Broadway
Columbia, Missouri 65218
Title: Treasurer
Phone # (573) 214-4790

Designated Agent(s):

Tina M Workman
1817 West Broadway
Columbia, Missouri 65218
Title: Assistant Treasurer
Phone # (573) 214-4574

Banks or Depositories

Shelter Financial Bank
1817 West Broadway
Columbia, Missouri 65218

Signed: S. Daniel Clapp
Date Signed: 02/23/2012

(End FEC FORM 1)

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