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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-935041

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1. AVIVA USA Corporation POLITICAL ACTION COMMITTEE

    7700 Mills Civic Parkway
    West Des Moines, IA 50266

    NOTE: Address is different than previously reported

    Email: lolson@athene.com

    NOTE: Email address is different than previously reported

2. Date: 07/07/2014

3. FEC Committee ID #: C00180901 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Aviva USA Corporation
7700 Mills Civic Parkway
West Des Moines, Iowa 50266
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Erik Askelsen
7700 Mills Civic Parkway
West Des Moines, IA 50266
Title: Treasurer
Phone # (800) 800-9882

Treasurer:

Erik Askelsen
7700 Mills Civic Parkway
West Des Moines, Iowa 50266
Title: Treasurer
Phone # (800) 800-9882

Designated Agent(s):

Banks or Depositories

Bankers Trust Company
665 Locust Street
Des Moines, Iowa 50309

Signed: Erik Askelsen
Date Signed: 07/07/2014

(End FEC FORM 1)

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