FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1783631
1. Blue Cross and Blue Shield of Kansas, Inc. Employee PAC
1133 SW Topeka Blvd.CC:855 - B3
Topeka, KS 66629
Email: jason.droge@bcbsks.com
2. Date: 07/10/2013
3. FEC Committee ID #: C00197202 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital StockIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Blue Cross and Blue Shield of Kansas, Inc.1133 SW Topeka Blvd.
Topeka, Kansas 66629
Affiliated Relationship Code: Connected Organization
Committee ID# C00194746
BLUEPAC - BLUE CROSS BLUE SHIELD ASSOC
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# C00084061
BLUE CROSS BLUE SHIELD OF MICHIGAN PAC
232 S. CAPITOL AVE.
MC L10A
LANSING, Michigan 48933
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# 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:
Jason Droge1133 SW Topeka Blvd
Topeka, KS 66629
Title: Treasurer
Phone # (785) 291-8171
Treasurer:
Jason Droge1133 SW Topeka Blvd
Topeka, Kansas 66629
Title: PAC Treasurer
Phone # (785) 291-8171
Designated Agent(s):
Sunee Mickle1133 SW Topeka Blvd
Topeka, Kansas 66629
Title: VP Govt Relations
Phone # (785) 291-7194
Banks or Depositories
Intrust Bank105 N. Main
Wichita, Kansas 67202