FEC Form 1 for Anthem Insurance Companies Inc. Good Government Program PACForm 1 for Anthem Insurance Companies Inc. Good Government Program PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-15635

1. Anthem Insurance Companies Inc. Good Government Program PAC

120 Monument Circle
Indianapolis, IN 46204
Email: john.willey@anthem.com

2. Date: 01/01/1993

3. FEC Committee ID #: C00198069 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

BluePac BlueCross BlueShield Association PAC
1310 G Street N.W.
Washington, DC 20005
Relationship: Affiliated Committees

Anthem Inc
120 Monument Circle
Indianapolis, Indiana 46204
Relationship: Connected Organizations
Organization Type: Corporation

Custodian of Records:

Tracy Winn
120 Monument Circle
Indianapolis, IN 46204
Title: Mgr. Govt. Relations
Phone # (317) 488-6134

Treasurer:

John Willey
120 Monument Circle
Indianapolis, Indiana 46204
Title: Dir. Govt. Relations
Phone # (317) 488-6044

Designated Agent(s):

Tracy Winn
120 Monument Circle
Indianapolis, Indiana 46204
Title: Mgr. Govt. Relations
Phone # (317) 488-6134

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-15635

1. Anthem Insurance Companies Inc. Good Government Program PAC

2. Date: 01/01/1993

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. John Willey
Date Signed: 06/28/2001

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-15635

1. Anthem Insurance Companies Inc. Good Government Program PAC

2. Date: 01/01/1993

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. John Willey Date Signed: 06/28/2001

(End FEC FORM 1)

Signed: Mr. John Willey
Date Signed: 06/28/2001