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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-338826

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1. Fidelis Political Action

    PO BOX 2709
    Chicago, IL 60690

    NOTE: Address is different than previously reported

    Fax: 3129245905
    Email: brianburch@fidelis.org

2. Date: 05/15/2008

3. FEC Committee ID #: C00411181 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Fidelis
PO BOX 2709
Chicago, Illinois 60690
Relationship: Connected Org.
Organization Type: Membership Organization

Custodian of Records:

Joshua O. Mercer
PO BOX 2709
Chicago, IL 60690
Title: Assistant Treasurer
Phone # (312) 276-5119

Treasurer:

Brian F. Burch
65 E. Wacker Place
Suite 300
Chicago, Illinois 60601
Title: Treasurer
Phone # (312) 201-6559

Designated Agent(s):

Joshua O. Mercer
PO BOX 2709
Chicago, Illinois 60690
Title: Assistant Treasurer
Phone # (312) 276-5119

Banks or Depositories

Private Bank
70 W Madison St.
Ste 200
Chicago, Illinois 60602

Signed: Brian F. Burch
Date Signed: 05/15/2008
Official Committee URL: www.fidelis.org
Official Committee FAX: 3129245905

(End FEC FORM 1)

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