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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1531472

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1. Health Care Service Corporation Employees' Political Action Committee

    300 E. Randolph
    Legal Department
    Chicago, IL 606015014
    Email: Amy_Cline@bcbsil.com;outsourcing@aristotle.com

    NOTE: Email address is different than previously reported

2. Date: 07/28/2021

3. FEC Committee ID #: C00199711 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

Health Care Service Corporation
300 E Randolph St
Chicago, Illinois 606015014
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Theodore Kenneth Spohnholtz
300 E Randolph St
Chicago, IL 606015014
Title: Custodian of Records
Phone # (312) 653-4338

Treasurer:

Theodore Kenneth Spohnholtz
300 E Randolph St
Chicago, Illinois 606015014
Title: Treasurer
Phone # (312) 653-4338

Designated Agent(s):

Christian R Swanson
300 E Randolph St
Chicago, Illinois 606015014
Title: Assistant Treasurer
Phone # (312) 653-4815

Banks or Depositories

Northern Trust
50 S. LaSalle St.
Chicago, Illinois 60603

Signed: Theodore Kenneth Spohnholtz
Date Signed: 07/28/2021

FORM TEXT-1

(End FEC FORM 1)

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