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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-805067

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1. Blue Cross Blue Shield of South Carolina Federal Government Programs

    Interstate 20 at Alpine Road
    Columbia, SC 29214
    Email: outsourcing@aristotle.com

    NOTE: Email address is different than previously reported

2. Date: 08/08/2012

3. FEC Committee ID #: C00406850 This committee is a Principal Campaign Committee. Candidate:
Party:
Office Sought:
State is in District:

Affiliated Committees/Organizations

Blue Cross Blue Shield of South Carolina
Interstate 20 at Alpine Road
Columbia, North Carolina 29219
Affiliated Relationship Code: Connected Organization

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

Committee ID# C00321992
Hawaii Medical Service Assn Empl Cmte
818 Keeaumoku
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
BLUEPAC, Capital Blue Cross
PO Box 60710 Elmerton Avenue
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00302844
Highmark Health PAC of Highmark Inc.
1800 Center Street
Camp Hill, Pennsylvania 17011
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
Florida Health Political Action Commit
PO Box 6936
Jacksonville, Florida 32202
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00409227
Premera Blue Cross PAC
7001 220th Street SW
Mountlake Terrace, Washington 98043
Affiliated Relationship Code: Affiliated Committee

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

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

Committee ID# C00084061
Blue Cross and Blue Shield of MI PAC
602 West Ionia
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

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

Committee ID# C00286922
Carefirst Associates Federal PAC
10455 Mill Run Circle
Owens Mills, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

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

Committee ID# C00340364
Blue Shield of California PAC
50 Beale Street
San Fransisco, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00312223
Blue Cross and Blue Shield of NC Emplo
5901 Chapel Hill Road
Box 2291
Durham, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00215202
Healthy Government Cmte, The Policital
PO Box 13466
Phoenix, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199711
Health Care Service Corporation Employ
330 East Randolph Street
Chicago, Illinois 60601
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00194746
BLUEPAC - Blue Cross Blue Shield Assn
1310 G Street NW
Washington, DC 20005
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00197202
Blue Cross and Blue Shield of Kansas,
1133 Topeka Blvd
Topeka, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00342022
Wellmark, Incorporated PAC, WELL PAC
636 Grand Avenue
v
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00252684
Regence BLUEPAC
330 9th Street SE
Washington, DC 20003
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199166
Federal CAREPAC-The Blue Cross Blue Sh
401 Park Drive
Boston, Massachusetts 02115
Affiliated Relationship Code: Affiliated Committee

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

Custodian of Records:

Mr. Dave Mason
205 Pennsylvania Avenue, SE
Washington, DC 200031164
Title: Custodian of Records

Treasurer:

Mr. Dave Mason
205 Pennsylvania Avenue, SE
Washington, DC 200031164
Title: Treasurer

Designated Agent(s):

JAMES A DALESSIO
209 FETTERBUSH ROAD
Elgin, South Carolina 290459185
Title: Designated Agent

Banks or Depositories

BB&T
BB&T
1901 Assembly Street
Columbia, South Carolina 29201

Signed: Mr. Dave Mason
Date Signed: 08/08/2012

(End FEC FORM 1)

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