FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-405924
1. Health Care Service Corporation Employees' Political Action Committee
300 E. RandolphLegal Dept.
Chicago, IL 60601
Email: stutzm@bcbsil.com
2. Date: 01/09/2009
3. FEC Committee ID #: C00199711 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Health Care Service Corporation300 E. Randolph
Chicago, Illinois 60601
Affiliated Relationship Code: Connected Organization
Committee ID# C00301358
BLUE CROSS AND BLUE SHIELD OF KANSAS C
ONE PERSHING SQUARE
2301 MAIN STREET
KANSAS CITY, Missouri 64108
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00084061
BLUE CROSS BLUE SHIELD OF MICHIGAN PAC
602 W. Ionia
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00340364
BLUE SHIELD OF CALIFORNIA POLITICAL AC
50 Beale Street
18-105
SAN FRANCISCO, California 94105
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00286922
CAREFIRST BLUECROSS BLUESHIELD ASSOCIA
10455 Mill Run Circle
Owings Mill, Maryland 21117
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00199166
FED CAREPAC, THE BLUE CROSS AND BLUE S
401 PARK DRIVE
LANDMARK CENTER
BOSTON, Massachusetts 02215
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00161141
FLORIDA HEALTH POLITICAL ACTION COMMIT
P.O. Box 6936
Jacksonville, Florida 32236
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00321992
HAWAII MEDICAL SERVICE ASSOCIATION EMP
818 Keeaumoku Street
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00215202
HEALTHY GOVERNMENT COMMITTEE-THE POLIT
POST OFFICE BOX 13466
PHOENIX, Arizona 85002
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00252684
REGENCE GROUP BLUEPAC, THE
330 9th St. SE
Washington, DC 20003
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00342022
WELLMARK, INC. PAC (WELLPAC)
636 Grand Avenue
Sta. 13
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00276311
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
7261 MERCY ROAD
PO BOX 3248
OMAHA, Nebraska 68180
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00312223
BLUE CROSS AND BLUE SHIELD OF NORTH CA
P.O. Box 2291
Durham, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00302844
HIGHMARK HEALTH PAC OF HIGHMARK INC.
1800 Center Street
Camp Hill, Pennsylvania 17089
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00379537
BLUE CROSS VOICE
19 NORTH MAIN STREET
WILKES BARRE, Pennsylvania 18711
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00406850
Blue Cross and Blue Shield of South Ca
Interstate 20 at Alpine Road
Columbia, South Carolina 29219
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00197202
BLUE CROSS AND BLUE SHIELD OF KANSAS P
1133 SW Topeka Blvd.
CC:808 - B2
Topeka, Kansas 66629
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00270967
BLUEPAC OF PENNSYLVANIA (THE BLUE CROS
PO Box 60710
c/o Linda Melusky
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee
Committee ID# C00194746
BLUEPAC - BLUE CROSS BLUE SHIELD ASSOC
1310 G STREET NW
WASHINGTON, DC 20005
Affiliated Relationship Code: Affiliated Committee
Custodian of Records:
Mary Lou Stutz300 E. Randolph
Legal Department
Chicago, IL 60601
Title: Asst. Treasurer
Phone # (312) 653-6363
Treasurer:
Gerard T. Mallen300 E. Randolph
Treasury Operations
Chicago, Illinois 60601
Title: Treasurer
Phone # (312) 653-6649
Designated Agent(s):
Mary Lou Stutz300 E. Randolph
Legal Department
Chicago, Illinois 60601
Title: Asst. Treasurer
Phone # (312) 653-6363
John E. Kosky
300 E. Randolph
Legal Dept.
Chicago, Illinois 60601
Title: Asst. Treasurer
Phone # (312) 653-8445
Banks or Depositories
Northern Trust50 S. LaSalle St.
Chicago, Illinois 60603