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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-457139

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1. MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND

    471 E BROAD ST
    COLUMBUS, OH 43215
    Email: susan.haack@motoristsgroup.com

    NOTE: Email address is different than previously reported

2. Date: 03/22/2010

3. FEC Committee ID #: C00336834 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00336834
MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND
471 E BROAD ST
COLUMBUS, Ohio 43215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Susan E. Haack
7494 Heffley Court
Canal Winchester, OH 43110
Title: Sr. VP/Secretary
Phone # (614) 225-8691

Treasurer:

Michael L. Wiseman
90 Timberknoll Loop
Powell, Ohio 43065
Title: Sr. VP/Treasurer
Phone # (614) 225-8494

Designated Agent(s):

Michael L. Wiseman
90 Timberknoll Loop
Powell, Ohio 43065
Title: Sr. VP/Treasurer
Phone # (614) 225-8494

Banks or Depositories

Motorists Insurance Emp Credit Union
471 East Broad Street
Columbus, Ohio 43215

Motorists Insurance Emp Credit Union
471 East Broad Street
Columbus, Ohio 43215

Signed: Michael L. Wiseman
Date Signed: 03/22/2010
Official Committee URL: www.motoristsgroup.com

(End FEC FORM 1)

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