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 StockAffiliated Committees/Organizations
Committee ID# C00197202Blue 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. Shelton1133 SW Topeka Blvd
Topeka, Kansas 66629
Title: Treasurer
Phone # (785) 291-8262
Designated Agent(s):
Banks or Depositories
Intrust Bank105 N. Main
Wichita, Kansas 67202