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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-976006

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1. Anthem, Inc. Political Action Committee (Anthem PAC)

    NOTE:Commmittee Name is different than previously reported

    120 Monument Circle
    Indianapolis, IN 46204
    Email: Tracy.Winn@anthem.com;john.willey@anthem.com

    NOTE: Email address is different than previously reported

2. Date: 12/03/2014

3. FEC Committee ID #: C00197228 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

Anthem, Inc.
120 Monument Circle
Indianapolis, Indiana 46204
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Tracy Winn
1001 Pennsylvania Ave., NW
Washington, DC 20004
Title: Assistant Treasurer
Phone # (202) 628-7838

Treasurer:

Mr. John Willey
120 Monument Circle
Indianapolis, Indiana 46204
Title: Treasurer
Phone # (317) 488-6044

Designated Agent(s):

Tracy Winn
1001 Pennsylvania Ave., NW
Suite 710
Washington, DC 20004
Title: Assistant Treasurer
Phone # (202) 628-7838

Banks or Depositories

JP Morgan Chase
111 Monument Circle
Indianapolis, Indiana 46204

Signed: Mr. John Willey
Date Signed: 12/03/2014

(End FEC FORM 1)

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