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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-156525

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1. WellPoint Inc. WELLPAC

    120 Monument Circle
    Indianapolis, IN 46204

2. Date: 12/14/2004

3. FEC Committee ID #: C00197228 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

WellPoint Inc.
120 Monument Circle
Indianapolis, Indiana 46204
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Tracy Winn
120 Monument Circle
Indianapolis, IN 46204
Title: Assistant Treasurer
Phone # (317) 488-6134

Treasurer:

John Willey
120 Monument Circle
Indianapolis, Indiana 46204
Title: Treasurer
Phone # (317) 488-6044

Designated Agent(s):

Tracy Winn
120 Monument Circle
Indianapolis, Indiana 46204
Title: Assistant Treasurer
Phone # (317) 488-6134

Banks or Depositories

Bank of America
P.O. Box 27128
Concord, California 94520

JPMorgan Chase Bank N.A.
111 Monument Circle
Indianapolis, Indiana 46204

Signed: John Willey
Date Signed: 12/14/2004

(End FEC FORM 1)

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