FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-118759
1. WellPoint Health Networks WELLPAC
1 WellPoint Way T2-1A6Thousand Oaks, CA 91362
Fax: 0-
Email: Susan.Nagy@wellpoint.com
2. Date: 05/03/2004
3. FEC Committee ID #: C00197228 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Custodian of Records:
Nancy Thompson1 WellPoint Way T2-1A6
Thousand Oaks, CA 91362
Title: Executive Assistant
Phone # (805) 557-6787
Treasurer:
Callen M. Lockett1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: VP Public Affairs
Phone # (805) 557-6888
Designated Agent(s):
Susan Nagy1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: Manager
Phone # (805) 557-6788
Banks or Depositories
Bank of AmericaP.O. Box 27128
Concord, California 94520