FEC Form 1 for Great-West Life & Annuity Insurance Company Political Action Committee ('A Great-West Financial Political Action CommittForm 1 for Great-West Life & Annuity Insurance Company Political Action Committee ('A Great-West Financial Political Action Committ

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-981661

1. Great-West Life & Annuity Insurance Company Political Action Committee ('A Great-West Financial Political Action Committ

8515 E. Orchard Road
7T2
Greenwood Village, CO 80111
Email: GreatWest_Financial@greatwest.com

NOTE: Email address is different than previously reported

2. Date: 12/26/2014

3. FEC Committee ID #: C00263723 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Great-West Life & Annuity Insurance Company
8515 E. Orchard Road
7T2
Greenwood Village, Colorado 80111
Affiliated Relationship Code: Affiliated Committee

Putnam Investments Inc. Public Affairs
One Post Office Square
Boston, Massachusetts 02109
Affiliated Relationship Code: Affiliated Committee

Empower - a Great-West Political Acti
8515 E. Orchard Rd.
Number 7T2
Greenwood Village, Colorado 80111
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mr. Robert Onstad
8515 East Orchard Rd.
7T2
Greenwood Village, CO 80111
Title: Treasurer
Phone # (303) 737-2016

Treasurer:

Mr Robert Onstad
8515 E. Orchard Road
7T2
Greenwood Village, Colorado 80111
Title: Treasurer
Phone # (303) 737-2016

Designated Agent(s):

Robert Onstad
8515 East Orchard Road
Number 7T2
Greenwood Village, Colorado 80111
Title: Treasurer
Phone # (303) 737-2016

Banks or Depositories

US Bank
P.O. Box 1800
Saint Paul, Minnesota 551010800

Signed: Mr Robert Onstad
Date Signed: 12/26/2014

FORM TEXT

(End FEC FORM 1)

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