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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1361973

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1. Empower - A Great-West Life & Annuity Insurance Company Political Action Committee ('Empower PAC')

    8515 E. Orchard Road
    Number 7T2
    Greenwood Village, CO 80111
    Email: Empower_PAC@greatwest.com;jeshaw@skadden.com

2. Date: 11/07/2019

3. FEC Committee ID #: C00571125 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Great - West Life & Annuity Insurance Company
8515 E. Orchard Road
Number 7T2
Greenwood Village, Colorado 80111
Affiliated Relationship Code: Connected Organization

Committee ID# C00289595
Putnam Investments, LLC Political Acti
100 Federal Street
Boston, Massachusetts 02110
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Robert Onstad
8515 E. Orchard Road
Number 7T2
Greenwood Village, CO 80111
Title: Treasurer
Phone # (303) 737-2106

Treasurer:

Robert Onstad
8515 E. Orchard Road
Number 7T2
Greenwood Village, Colorado 80111
Title: Treasurer
Phone # (303) 737-2106

Designated Agent(s):

Robert Onstad
8515 E. Orchard Road
Number 7T2
Greenwood Village, Colorado 80111
Title: Treasurer
Phone # (303) 737-2106

Banks or Depositories

U.S. Bank
8505 E. Orchard Road
1T1
Greenwood Village, Colorado 80111

Signed: Robert Onstad
Date Signed: 11/07/2019

(End FEC FORM 1)

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