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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-172238

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1. GuideOne Insurance Federal PAC

    1111 Ashworth Rd
    West Des Moines, IA 50265
    Fax: 5152675546

2. Date: 04/19/2005

3. FEC Committee ID #: C00348011 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Thomas Carey Farr
1111 Ashworth Road
West Des Moines, IA 502653538
Title: Custodian
Phone # (515) 267-5572

Treasurer:

Mark Lynn Joos
1111 Ashworth Road
West Des Moines, Iowa 502653538
Title: Treasurer
Phone # (515) 267-2008

Designated Agent(s):

Diane Duffy
1111 Ashworth
West Des Moines, Iowa 50265
Title: Asst Treasurer
Phone # (515) 267-5748

Banks or Depositories

Signed: Mark Lynn Joos
Date Signed: 04/20/2005
Official Committee FAX: 5152675546

(End FEC FORM 1)

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