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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1103891

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1. CC SERVICES INC COUNTRY POLITICAL ACTION COMMITTEE

    1701 N TOWANDA AVENUE
    PO BOX 2020
    BLOOMINGTON, IL 617022020
    Email: josh.johnson@countryfinancial.com;brenda.mcqueen@countryfinancial.com

2. Date: 10/11/2016

3. FEC Committee ID #: C00390971 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00390971
CC SERVICES INC COUNTRY POLITICAL ACTION COMMITTEE
1701 N TOWANDA AVENUE
PO BOX 2020
BLOOMINGTON, Illinois 617022020
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Joshua Johnson
1711 G.E. Road
P.O. Box 2020
Bloomington, IL 617022020
Title: Dir. Corp. Complianc
Phone # (309) 821-2101

Treasurer:

Miles Kilcoin
1711 G.E. Road
P.O. Box 2020
Bloomington, Illinois 617022020
Title: CFO
Phone # (309) 821-2669

Designated Agent(s):

Joshua Johnson
1711 G.E. Road
P.O. Box 2020
Bloomington, Illinois 617022020
Title: Dir. Corp. Complianc
Phone # (309) 821-2101

Brenda McQueen
1711 G.E. Road
P.O. Box 2020
Bloomington, Illinois 617022020
Title: Reg. Affairs Coordin
Phone # (309) 821-2410

Banks or Depositories

Commerce Bank
1339 East Empire St
Bloomington, Illinois 61701

Signed: Miles Kilcoin
Date Signed: 10/11/2016

(End FEC FORM 1)

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