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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-66922

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1. Anthem Insurance Companies Inc. Good Government Program PAC

    120 Monument Circle
    Indianapolis, IN 46204

2. Date: 12/04/2002

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

Affiliated Committees/Organizations

Anthem Insurance Companies Inc.
120 Monument Circle
Indianapolis, Indiana 46204
Relationship: Connected
Organization Type: Corporation

Bluepac - Blue Cross Blue Shield Assoc
1310 G Street NW
Washington, DC 20005
Relationship: Affiliated Committee

The Trigon Blue Cross Blue Shield Fede
2015 Staples Mill Road
Richmond, Virginia 23230
Relationship: Affiliated Committee

Healthy Government Committee Blue Cros
P.O. Box 13466
Phoenix, Arizona 85002
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Michigan
Blue Cross and Blue Shield of MI
600 Lafayette East
Detroit, Michigan 48226
Relationship: Affiliated Committee

Blue Cross and Blue Shield United of W
401 West Michigan Street
Milwaukee, Wisconsin 53203
Relationship: Affiliated Committee

Florida Health Political Action Commit
Blue Cross Blue Shield Florida
532 Riverside Ave.
Jacksonville, Florida 92202
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Kansas E
1133 Topeka Boulevard
Topeka, Kansas 66629
Relationship: Affiliated Committee

Federal CarePAC Blue Cross and Blue Sh
Blue Cross Blue Shield of MA
100 Summer Street
Boston, Massachusetts 02110
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Illinois
233 North Michigan Ave.
Chicago, Illinois 60690
Relationship: Affiliated Committee

Regence BluePAC
The Regence Group
2890 E Cottonwood Pkwy Dept. #8
Salt Lake City, Utah 84121
Relationship: Affiliated Committee

BluePAC Capital Independence and North
2500 Elmerton Avenue
Harrisburg, Pennsylvania 17177
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Nebraska
7261 Mercy Road
Omaha, Nebraska 68180
Relationship: Affiliated Committee

American Medical Security Incorporated
3100 Ams Blvd.
PO Box 19032
Green Bay, Wisconsin 54307
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Maryland
CareFirst Blue Cross & Blue Shield
10455 Mill Run Circle
Owings Mills, Maryland 21117
Relationship: Affiliated Committee

Blue Cross and Blue Shield of Kansas C
2301 Main
Kansas City, Missouri 64108
Relationship: Affiliated Committee

Highmark Health PAC of Highmark Blue C
1800 Center Street
Camp Hill, Pennsylvania 17011
Relationship: Affiliated Committee

Blue Cross and Blue Shield of North Ca
5901 Chapel Hill Road
P.O. Box 2291
Durham, North Carolina 27702
Relationship: Affiliated Committee

Hawaii Medical Service Association Emp
Hawaii Medical Service
818 Keeaumoku Street
Honolulu, Hawaii 96814
Relationship: Affiliated Committee

Blue Shield of California
50 Beale Street
San Francisco, California 94105
Relationship: Affiliated Committee

Wellmark Incorporated PAC
636 Grand Ave. Station 13
Des Moines, Iowa 50309
Relationship: Affiliated Committee

Empire HealthChoice Political Action C
11 West 42nd Street
New York, New York 10036
Relationship: Affiliated Committee

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 One Indiana NA
111 Monument Circle
Indianapolis, Indiana 46226

Signed: John Willey
Date Signed: 12/04/2002

(End FEC FORM 1)

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