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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-716811

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1. ULLICO INC. POLITICAL ACTION COMMITTEE (ULLIPAC)

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

2. Date: 03/13/2011

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:

DAVID BARRA
8403 COLESVILLE RD
SILVER SPRING, Maryland 20910
Title: TREASURER
Phone # (202) 962-8409

Designated Agent(s):

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

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

DAVID BARRA
8403 COLESVILLE RD
SILVER SPRING, Maryland 20910
Title: TREASURER
Phone # (202) 962-8409

Banks or Depositories

UNITED BANK
1001 G ST NW
WASHINGTON, DC 20001

Signed: DAVID BARRA
Date Signed: 03/13/2011

(End FEC FORM 1)

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