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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1589149

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1. Bluepac - Blue Cross Blue Shield Association Pac

    1310 G Street NW
    Washington, DC 20005
    Email: christina.fisher@bcbsa.com;jennifer.towey@bcbsa.com

    NOTE: Email address is different than previously reported

2. Date: 04/13/2022

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# C00503003
Bluecross Blueshield of Tennessee Inc
1 Cameron Hill Circle
Chattanooga, Tennessee 37402
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00651265
LOUISIANA HEALTH SERVICE & INDEMNITY C
5525 REITZ AVENUE
BATON ROUGE, Louisiana 70809
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00639245
HORIZON HEALTHCARE SERVICES, INC.-HORI
3 PennPlz E
PP-11G
Newark, New Jersey 07105
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# C00161141
Guidewell Mutual Holding Corporation P
4800 Deerwood Campus Parkway
DC3-4
Jacksonville, Florida 32236
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# C00270967
CAPITAL BLUEPAC, THE POLITICAL ACTION
PO Box 60710
C/O Linda Melusky
Harrisburg, Pennsylvania 17106
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# C00286922
Carefirst Bluecross Blueshield Associa
10455 Mill Run Circle
Owings Mill, Maryland 21117
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# C00312223
Blue Cross and Blue Shield of North Ca
PO Box 2291
Durham, North Carolina 27702
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# C00342022
Wellmark, Inc. Pac (WELLPAC)
1331 Grand Avenue
Sta. 5W570
Des Moines, Iowa 50309
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# C00409227
Premera Blue Cross Politicial Action C
7001 220th Street SW
MS 355
Mountlake Terrace, Washington 98043
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# C00457242
Blue Cross Blue Shield of Alabama Pac
2 North Jackson Street
Suite 202
Montgomery, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Christina Fisher
225 N. Michigan Avenue
Chicago, IL 60601
Title: Custodian of Records
Phone # (312) 297-5760

Treasurer:

Christina Fisher
225 N. Michigan Avenue
Chicago, Illinois 60601
Title: Treasurer
Phone # (312) 297-5760

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: Christina Fisher
Date Signed: 04/13/2022

FORM TEXT-1

(End FEC FORM 1)

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