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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409303

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1. FLORIDA HEALTH POLITICAL ACTION COMMITTEE (The PAC of Blue Cross & Blue Shield of FL, Inc)

    P.O. Box 6936
    4800 Deerwood Campus Parkwy, DC3-4
    Jacksonville, FL 32236
    Email: deborah.easterling-charles@bcbsfl.com

2. Date: 12/16/2008

3. FEC Committee ID #: C00161141 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 of FL, Inc.
4800 Deerwood Campus Pkwy, DC3-4
Jacksonville, Florida 32246
Affiliated Relationship Code: Connected Organization

Committee ID# C00457242
Blue Cross and Blue Shield of Alabama
2 North Jackson Street, Suite 202
Montgomery, Alabama 36104
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# C00340364
BLUE SHIELD OF CALIFORNIA POLITICAL AC
50 Beale Street
18-105
SAN FRANCISCO, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00321992
HAWAII MEDICAL SERVICE ASSOCIATION EMP
818 Keeaumoku Street
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00252684
REGENCE GROUP BLUEPAC, THE
317 Massachusetts Avenue NE
Suite 300E
Washington, DC 20002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199711
BLUE CROSS AND BLUE SHIELD OF ILLINOIS
300 E RANDOLPH STE 1500 15TH
.
CHICAGO, Illinois 60601
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00342022
WELLMARK, INC. PAC (WELLPAC)
636 Grand Avenue
Sta. 13
Des Moines, Iowa 50309
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# 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 POLITICAL ACTION CO
7001 220TH STREET SW MS355
MOUNTLAKE TERRACE, Washington 98043
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# C00199166
FED CAREPAC, THE BLUE CROSS AND BLUE S
401 PARK DRIVE
LANDMARK CENTER
BOSTON, Massachusetts 02215
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00084061
BLUE CROSS BLUE SHIELD OF MICHIGAN PAC
602 W. Ionia
Lansing, Michigan 48933
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# C00312223
BLUE CROSS AND BLUE SHIELD OF NORTH CA
P.O. Box 2291
Durham, North Carolina 27702
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# C00379537
BLUE CROSS VOICE
19 NORTH MAIN STREET
WILKES BARRE, Pennsylvania 18711
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# C00197202
BLUE CROSS AND BLUE SHIELD OF KANSAS E
1133 SW TOPEKA BLVD
CC: 803C2
TOPEKA, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
BLUEPAC OF PENNSYLVANIA (INDEPENDENCE
P.O. Box 60710
c/o Linda Melusky
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00194746
BluePAC - BCBSA
1310 G STREET NW
WASHINGTON, DC 20005
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Suzanne Horne
12876 Plummer Grant Rd.
Jacksonville, FL 32258
Title: President
Phone # (904) 905-8720

Treasurer:

Mr. Gary M. Healy
285 Odoms Mill Blvd
Ponte Vedra Beach, Florida 32082
Title: Treasurer
Phone # (904) 905-4420

Designated Agent(s):

Banks or Depositories

Bank of America
9000 Southside Boulevard
Jacksonville, Florida 32256

Signed: Mr. Gary M. Healy
Date Signed: 03/24/2009

(End FEC FORM 1)

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