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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-417641

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1. Unity Mutual Life Insurance Company PAC

    P.O. Box 5000
    Syracuse, NY 132505000
    Email: nmcmanus@unity-life.com

    NOTE: Email address is different than previously reported

2. Date: 05/18/2009

3. FEC Committee ID #: C00331348 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock

Affiliated Committees/Organizations

Unity Mutual Life Insurance Company
P.O. Box 5000
Syracuse, New York 132505000
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Nicole McManus
P.O. Box 5000
Syracuse, NY 132505000
Title: Treasurer
Phone # (315) 448-7038

Treasurer:

Nicole McManus
P.O. Box 5000
Syracuse, New York 132505000
Title: Treasurer
Phone # (315) 448-7038

Designated Agent(s):

Banks or Depositories

Chase Manhattan Bank
One Lincoln Center
Syracuse, New York 13202

Signed: Ellen M. Faigle
Date Signed: 05/19/2009
Official Committee URL: www.unity-life.com

(End FEC FORM 1)

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