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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-896449

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1. Hilex Poly Co. LLC Responsible Government Fund

    P.O. Box 1720
    Hartsville, SC 29551

    NOTE: Address is different than previously reported

    Email: Administrator@hilexpac.org

2. Date: 11/26/2013

3. FEC Committee ID #: C00508127 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Hilex Poly Co. LLC
101 E Carolina Ave
Hartsville, South Carolina 29550
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Paul M. Palmisano
101 E. Carolina Avenue
Hartsville, South Carolina 29550
Title: CFO
Phone # (843) 857-4975

Designated Agent(s):

KIM NORTHCUTT
101 E Carolina Ave
Hartsville, South Carolina 29550
Title: Asst Treasurer
Phone # (843) 857-4832

Banks or Depositories

First Citizens Bank and Trust
130 S Fifth Street
Hartsville, South Carolina 295504210

Signed: Paul M. Palmisano
Date Signed: 11/26/2013
Official Committee URL: www.HilexPAC.org

FORM TEXT

(End FEC FORM 1)

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