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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-994180

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1. SHELTER MUTUAL INSURANCE COMPANY FEDERAL PAC

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

    NOTE: Email address is different than previously reported

2. Date: 02/19/2015

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:

Brian Waller
1817 West Broadway
Columbia, MO 65218
Title: Director, Govt Relat
Phone # (573) 214-4872

Treasurer:

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

Designated Agent(s):

Brian Waller
1817 West Broadway
Columbia, Missouri 65218
Title: Director, Govt Relat
Phone # (573) 214-4872

Banks or Depositories

Shelter Insurance Federal Credit Union
1817 West Broadway
Columbia, Missouri 65218

Signed: S. Daniel Clapp
Date Signed: 02/19/2015

(End FEC FORM 1)

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