FEC Form 1 for Anthem, Inc. Political Action Committee (Anthem PAC)Form 1 for Anthem, Inc. Political Action Committee (Anthem PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1038126

1. Anthem, Inc. Political Action Committee (Anthem PAC)

120 Monument Circle
Indianapolis, IN 46204
Email: Tracy.Winn@anthem.com;kevin.riordan@anthem.com

NOTE: Email address is different than previously reported

2. Date: 01/04/2016

3. FEC Committee ID #: C00197228 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

Anthem, Inc.
120 Monument Circle
Indianapolis, Indiana 46204
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Tracy Winn
120 Monument Circle
Indianapolis, IN 46204
Title: Assistant Treasurer
Phone # (317) 488-6773

Treasurer:

Mr. Kevin Riordan
4433 Corporation Lane
Virginia Beach, Virginia 23462
Title: Treasurer
Phone # (757) 321-3581

Designated Agent(s):

Tracy Winn
120 Monument Circle
Indianapolis, Indiana 46204
Title: Assistant Treasurer
Phone # (317) 488-6773

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1038126

1. Anthem, Inc. Political Action Committee (Anthem PAC)

NOTE: Email address is different than previously reported

2. Date: 01/04/2016

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Kevin Riordan
Date Signed: 01/04/2016

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1038126

1. Anthem, Inc. Political Action Committee (Anthem PAC)

NOTE: Email address is different than previously reported

2. Date: 01/04/2016

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Kevin Riordan Date Signed: 01/04/2016

(End FEC FORM 1)

Signed: Mr. Kevin Riordan
Date Signed: 01/04/2016