FEC Form 1 for Blue Cross and Blue Shield of Kansas PACForm 1 for Blue Cross and Blue Shield of Kansas PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-359149

1. Blue Cross and Blue Shield of Kansas PAC

1133 SW Topeka Blvd.
CC:808 - B2
Topeka, KS 66629
Fax: 7852917098
Email: ann.shelton@bcbsks.com

2. Date: 08/21/2008

3. FEC Committee ID #: C00197202 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock

Affiliated Committees/Organizations

Committee ID# C00197202
Blue Cross and Blue Shield of Kansas PAC
1133 SW Topeka Blvd.
CC:808 - B2
Topeka, Kansas 66629
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Ann M. Shelton
1133 SW Topeka Blvd
Topeka, Kansas 66629
Title: Treasurer
Phone # (785) 291-8262

Designated Agent(s):

Banks or Depositories

Intrust Bank
105 N. Main
Wichita, Kansas 67202

Signed: Ann M. Shelton
Date Signed: 08/21/2008
Official Committee FAX: 7852917098

(End FEC FORM 1)

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