FEC Form 1 for BLUEPAC - BLUE CROSS BLUE SHIELD ASSOCIATION POLITICAL ACTION COMMITTEEForm 1 for BLUEPAC - BLUE CROSS BLUE SHIELD ASSOCIATION POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-130700

1. BLUEPAC - BLUE CROSS BLUE SHIELD ASSOCIATION POLITICAL ACTION COMMITTEE

1310 G STREET NW
WASHINGTON, DC 20005
Email: James_W_Hoeberling@Comerica.com

2. Date: 08/10/2004

3. FEC Committee ID #: C00194746 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

BLUE CROSS BLUE SHIELD ASSOCIATION
1310 G STREET NW
WASHINGTON, DC 20005
Relationship: CONNECTED
Organization Type: Membership Organization

HEALTHY GOVERNMENT COMMITTEE - THE PAC
P.O. BOX 13466
PHOENIX, Arizona 85002
Relationship: AFFILIATED PAC

BLUE SHIELD OF CALIFORNIA
50 BEALE STREET
SAN FRANCISCO, California 94105
Relationship: AFFILIATED PAC

FLORIDA HEALTH POLITICAL ACTION COMMIT
532 RIVERSIDE AVENUE
JACKSONVILLE, Florida 92202
Relationship: AFFILIATED PAC

HAWAII MEDICAL SERVICE ASSOCIATION EMP
818 KEEAUMOKU
HONOLULU, Hawaii 96814
Relationship: AFFILIATED PAC

REGENCE BLUEPAC
2890 EAST COTTONWOOD PARKWAY
DEPT. #8
SALT LAKE CITY, Utah 84121
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF ILLINOIS
233 NORTH MICHIGAN AVENUE
CHICAGO, Illinois 60690
Relationship: AFFILIATED PAC

ANTHEM INSURANCE COMPANIES INC. GOOD G
120 MONUMENT CIRCLE
INDIANAPOLIS, Indiana 462044903
Relationship: AFFILIATED PAC

WELLMARK INCORPORATED PAC WELLPAC
636 GRAND AVENUE
STATION 13
DES MOINES, Iowa 50309
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF KANSAS E
1133 TOPEKA BLVD.
TOPEKA, Kansas 666290001
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF MARYLAND
10455 MILL RUN CIRCLE
OWINGS MILLS, Maryland 21117
Relationship: AFFILIATED PAC

FEDERAL CAREPAC - THE BCBS OF MASSACHU
100 SUMMER STREET
BOSTON, Massachusetts 02110
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF MICHIGAN
600 LAFAYETTE EAST
DETROIT, Michigan 482262298
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF KANSAS C
2301 MAIN
KANSAS CITY, Missouri 641082488
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF NEBRASKA
7261 MERCY ROAD
OMAHA, Nebraska 681800001
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF NORTH CA
5901 CHAPEL HILL ROAD
BOX 2291
DURHAM, North Carolina 27702
Relationship: AFFILIATED PAC

BLUEPAC CAPITAL INDEPENDENCE NORTHEAST
2500 ELMERTON AVENUE
HARRISBURG, Pennsylvania 17177
Relationship: AFFILIATED PAC

HIGHMARK HEALTH PAC OF HIGHMARK BLUE C
1800 CENTER STREET
CAMP HILL, Pennsylvania 17011
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD OF TEXAS IN
901 SOUTH CENTRAL EXPRESSWAY
RICHARDSON, Texas 75080
Relationship: AFFILIATED PAC

TRIGON BLUE CROSS BLUE SHIELD FEDERAL
2015 STAPLES MILLS ROAD
RICHMOND, Virginia 23230
Relationship: AFFILIATED PAC

BLUE CROSS AND BLUE SHIELD UNITED OF W
401 WEST MICHIGAN STREET
MILWAUKEE, Wisconsin 53203
Relationship: AFFILIATED PAC

AMERICAN MEDICAL SECURITY INC. PAC
3100 AMS BLVD.
P.O. BOX 19032
GREEN BAY, Wisconsin 54307
Relationship: AFFILIATED PAC

EMPIRE HEALTHCHOICE POLITICAL ACTION C
11 W. 42ND STREET
NEW YORK, New York 10036
Relationship: AFFILIATED

Custodian of Records:

COMERICA BANK JAMES HOEBERLING
PAC SERVICES
P.O. BOX 75000
DETROIT, MI 482752250
Title: RECORDKEEPER
Phone # (248) 371-5562

Treasurer:

KATHY DIDAWICK
1310 G STREET NW
WASHINGTON, DC 20005
Title: TREASURER
Phone # (202) 626-4804

Designated Agent(s):

BILL BRESKIN
1310 G STREET NW
WASHINGTON, DC 20005
Title: ASST. TREASURER
Phone # (202) 626-4795

Banks or Depositories

COMERICA BANK
P.O. BOX 75000
DETROIT, Michigan 482752250

Signed: KATHY DIDAWICK
Date Signed: 08/10/2004

(End FEC FORM 1)

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