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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-877110

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1. Capital BluePAC

    NOTE:Commmittee Name is different than previously reported

    PO Box 60710
    Harrisburg, PA 17106
    Email: linda.melusky@capbluecross.com

2. Date: 04/04/2012

3. FEC Committee ID #: C00270967 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

BluePAC, The BlueCorss and BlueShield Association Political Action Committee
c/o Mr. Berry Tremble BCBSA
1310 G Street, NW
Washington, DC 200053000
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Traci L Lumadue
2500 Elmerton Ave
Harrisburg, PA 171779764
Title: Custodian of Records

Treasurer:

Robert Baker
2500 Elmerton Ave
Harrisburg, Pennsylvania 171779764
Title: Treasurer

Designated Agent(s):

Banks or Depositories

M&T Bank
1002 North 7th Street
Harrisburg, Pennsylvania 17102

M&T Bank

, ____ 0.00

M&T Bank
, ____ 0.00

Signed: Robert Baker
Date Signed: 07/12/2013

FORM TEXT

(End FEC FORM 1)

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