FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-429250
1. Acacia Life Insurance Company PAC
7315 Wisconsin AveBethesda, MD 20814
Email: jim.harvey@acaciagroup.com
2. Date: 08/11/2009
3. FEC Committee ID #: C00169789 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital StockAffiliated Committees/Organizations
Acacia Life Insurance Company7315 Wisconsin Ave
Bethesda, Maryland 20814
Affiliated Relationship Code: Connected Organization
Committee ID# C00187138
AMERITAS FINANCIAL SERVICES PAC
5900 O Street
Lincoln, Nebraska 68510
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00179010
UNION CENTRAL LIFE INSURANCE COMPANY P
P O BOX 40888
1876 WAYCROSS ROAD
CINCINNATI, Ohio 45240
Affiliated Relationship Code: Affiliated Committee
Custodian of Records:
Treasurer:
James Harvey7315 Wisconsin Ave
Bethesda, Maryland 20814
Designated Agent(s):
Banks or Depositories
Acacia Federal Savings Bank7600 Leesburg Pike
Falls Church, Virginia 22043