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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1012364

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1. Bluepac - Blue Cross Blue Shield Association Pac

    1310 G Street NW
    Washington, DC 20005
    Email: berry.trimble@bcbsa.com

2. Date: 07/02/2015

3. FEC Committee ID #: C00194746 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

Blue Cross Blue Shield Association
1310 G Street NW
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Committee ID# C00409227
Premera Blue Cross Politicial Action C
7001 220th Street SW
MS 355
Mountlake Terrace, Washington 98043
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00379537
Blue Cross Voice
19 North Main Street
Wilkes Barre, Pennsylvania 18711
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00450056
Independence Blue Cross Pac (IBC PAC)
1901 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00406850
Blue Cross Blue Shield of South Caroli
Interstate 20 at Alpine Road
Columbia, South Carolina 29219
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00342022
Wellmark, Inc. Pac (WELLPAC)
1331 Grand Avenue
Sta. 5W570
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00340364
Blue Shield of California Political Ac
50 Beale Street
17-C356
San Francisco, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00321992
Hawaii Medical Service Association Emp
818 Keeaumoku Street
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00312223
Blue Cross and Blue Shield of North Ca
PO Box 2291
Durham, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00301358
Blue Cross and Blue Shield of Kansas C
One Pershing Square
2301 Main Street
Kansas City, Missouri 64108
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00302844
Highmark Health Pac of Highmark Inc.
1800 Center Street
Camp Hill, Pennsylvania 17089
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00286922
Carefirst Bluecross Blueshield Associa
10455 Mill Run Circle
Owings Mill, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00276311
Blue Cross and Blue Shield of Nebraska
7261 Mercy Road
PO Box 3248
Omaha, Nebraska 68180
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
Bluepac of Pennsylvania (THE BLUE CROS
PO Box 60710
C/O Linda Melusky
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
Florida Health Political Action Commit
PO Box 6936
4800 Deerwood Campus Parkwy, Dc3-4
Jacksonville, Florida 32236
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00084061
Blue Cross Blue Shield of Michigan Pac
232 S. Capitol
MC L10A
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00197202
Blue Cross and Blue Shield of Kansas,
1133 SW Topeka Blvd.
Cc:855 - B3
Topeka, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00215202
Healthy Government Committee-the Polit
Post Office Box 13466
Phoenix, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00457242
Blue Cross Blue Shield of Alabama Pac
2 North Jackson Street
Suite 202
Montgomery, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

Bluecross Blueshield of Tennessee Inc
1 Cameron Hill Circle
Chattanooga, Tennessee 37402
Affiliated Relationship Code: Affiliated Committee

Massachusetts Blue PAC of Blue Cross B
401 Park Drivelandmark Center
Boston, Massachusetts 02215
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Berry Trimble
1310 G Street NW
Washington, DC 20005
Title: Custodian of Records

Treasurer:

Kathy Didawick
1310 G Street NW
Washington, DC 20005
Title: Treasurer
Phone # (202) 626-4804

Designated Agent(s):

Bill Breskin
1310 G Street NW
Washington, DC 20005
Title: Assistant Treasurer
Phone # (202) 626-4795

Banks or Depositories

Bank of America
135 S LaSalle Street
Chicago, Illinois 60603

Signed: Kathy Didawick
Date Signed: 07/02/2015

(End FEC FORM 1)

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