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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-481374

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1. ULLICO INC. POLITICAL ACTION COMMITTEE (ULLIPAC)

    1625 EYE ST NW
    WASHINGTON, DC 20006
    Email: ullipac@ullico.com

2. Date: 07/15/2010

3. FEC Committee ID #: C00236760 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

ULLICO INC
1625 EYE ST NW
WASHINGTON, DC 20006
Affiliated Relationship Code: Connected Organization

Custodian of Records:

JOHN F HOFFEN, JR
8403 COLESVILLE RD
SILVER SPRING, MD 20910
Title: ASSISTANT TREASURER
Phone # (202) 962-8412

Treasurer:

EDWARD SMITH
614 KINGS CLOISTER CIRCLE
ALEXANDRIA, Virginia 22302
Title: TREASURER
Phone # (202) 682-6602

Designated Agent(s):

EDWARD MCELROY
1625 EYE ST NW
WASHINGTON, DC 20006
Title: CHAIRMAN
Phone # (202) 682-6624

EDWARD SMITH
1625 EYE ST NW
WASHINGTON, DC 20006
Title: TREASURER
Phone # (202) 682-6602

JOHN F HOFFEN, JR
8403 COLESVILLE RD
SILVER SPRING, Maryland 20910
Title: Assistant Treasurer
Phone # (202) 962-8412

DAMON GASQUE
8403 COLESVILLE RD
SILVER SPRING, Maryland 20910
Title: Designated Agent
Phone # (202) 682-4693

Banks or Depositories

UNITED BANK
1001 G ST NW
WASHINGTON, DC 20001

Signed: EDWARD SMITH
Date Signed: 07/15/2010

(End FEC FORM 1)

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