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FEC Form 1 for CUNA Mutual Holding Company Political Action Committee (CUNA Mutual PAC)Form 1 for CUNA Mutual Holding Company Political Action Committee (CUNA Mutual PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-761267


1. CUNA Mutual Holding Company Political Action Committee (CUNA Mutual PAC)

    NOTE:Commmittee Name is different than previously reported

    5910 Mineral Point Rd, PO Box 747
    Mail Stop 5910 4 A2
    Madison, WI 537010747
    Email: christopher.roe@cunamutual.com

2. Date: 02/01/2012

3. FEC Committee ID #: C00402107 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

CUNA Mutual Holding Company
5910 Mineral Point Road
Madison, Wisconsin 53705
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Christopher P. Roe
2 Hawk Feather Cir
Madison, WI 53717
Title: SVP

Treasurer:

Christopher P. Roe
2 Hawk Feather Cir
Madison, Wisconsin 53717
Title: SVP

Designated Agent(s):

Banks or Depositories

Summit Credit Union
401 South Yellowstone Drive
Madison, Wisconsin 53719

Signed: Christopher P. Roe
Date Signed: 01/30/2012
Official Committee URL: http://www.cunamutual.com/cmg/home/

(End FEC FORM 1)


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