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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1782645

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1. Blue Cross Blue Shield of Michigan PAC

    232 S. Capitol Ave.
    MC L10A
    Lansing, MI 48933

    NOTE: Address is different than previously reported

    Email: rspencer@bcbsm.com;mcook@bcbsm.com

    NOTE: Email address is different than previously reported

2. Date: 05/14/2024

3. FEC Committee ID #: C00084061 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Committee ID# C00194746
BLUEPAC - BLUE CROSS BLUE SHIELD ASSOCIATION PAC
750 9TH STREET, NW
WASHINGTON, DC 20001
Affiliated Relationship Code: Affiliated Committee

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
THREE PENN PLAZA EAST
PP-11G
NEWARK, New Jersey 07105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
GUIDEWELL MUTUAL HOLDING CORPORATION P
4800 DEERWOOD CAMPUS PARKWAY
DC1-7
JACKSONVILLE, Florida 32246
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
P.O. BOX 13466
PHOENIX, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
CAPITAL BLUEPAC, THE POLITICAL ACTION
P.O. BOX 60710
HARRISBURG, Pennsylvania 171060710
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00276311
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
1919 AKSARBEN DRIVE PO BOX 3248
OMAHA, Nebraska 681800001
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00286922
CAREFIRST BLUECROSS BLUESHIELD ASSOCIA
10455 MILL RUN CIRCLE
OWINGS MILLS, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00301358
BLUE CROSS AND BLUE SHIELD OF KANSAS C
2301 MAIN STREET
KANSAS CITY, Missouri 64108
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00302844
HIGHMARK 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
P.O. BOX 2291
DURHAM, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00340364
BLUE SHIELD OF CALIFORNIA PAC (SHIELD
601 12TH STREET
OAKLAND, California 94607
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 29214
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00409227
PREMERA BLUE CROSS POLITICAL ACTION CO
7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432160
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00457242
BLUE CROSS BLUE SHIELD OF ALABAMA PAC
2 NORTH JACKSON STREET
SUITE 202
MONTGOMERY, Alabama 361043821
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Rebecca Spencer
232 S. Capitol Ave.
MC L10A
Lansing, MI 48933
Title: Senior Analyst
Phone # (517) 325-4606

Treasurer:

Mr. Mark Cook
232 S. Capitol Ave
MC L10A
Lansing, Michigan 48933
Title: Vice President Gover
Phone # (517) 371-7910

Designated Agent(s):

Banks or Depositories

Capitol National Bank
200 Washington Sq.
Lansing, Michigan 48909

Signed: Mr. Mark Cook
Date Signed: 05/14/2024

(End FEC FORM 1)

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