FEC Form 1 for SENTRY INSURANCE A MUTUAL COMPANY FEDERAL POLITICAL ACTION COMMITTEEForm 1 for SENTRY INSURANCE A MUTUAL COMPANY FEDERAL POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1158813

1. SENTRY INSURANCE A MUTUAL COMPANY FEDERAL POLITICAL ACTION COMMITTEE

10 East Doty Street
Suite 701
MADISON, WI 53703
Email: kip.kobussen@sentry.com;kati.lorge@sentry.com

NOTE: Email address is different than previously reported

2. Date: 04/18/2017

3. FEC Committee ID #: C00545194 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

SENTRY INSURANCE A MUTUAL COMPANY
1800 NORTHPOINT DRIVE
STEVENS POINT, Wisconsin 54481
Affiliated Relationship Code: Connected Organization

Custodian of Records:

KATI LORGE
10 EAST DOTY STREET
SUITE 701
MADISON, WI 53703
Title: POL ENGAGEMENT DIR
Phone # (608) 826-3273

Treasurer:

PAUL GWIDT
1800 NORTHPOINT DRIVE
G3106B
STEVENS POINT, Wisconsin 54481
Title: DIR-FIN REPORTING
Phone # (715) 346-6174

Designated Agent(s):

KIP KOBUSSEN
10 EAST DOTY STREET
SUITE 701
MADISON, Wisconsin 53703
Title: CCO AVP-GOV® AFFS
Phone # (608) 826-3272

Banks or Depositories

BMO HARRIS BANK NA
P.O. BOX 755
CHICAGO, Illinois 60690

Signed: PAUL GWIDT
Date Signed: 04/18/2017
Official Committee URL: www.sentry.com

(End FEC FORM 1)

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