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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-909955

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1. Health Care Service Corporation Employees' Political Action Committee

    300 E. Randolph
    Legal Department
    Chicago, IL 60601
    Email: stutzm@bcbsil.com;Ariana_Voigt@bcbsil.com

2. Date: 02/27/2014

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
Chicago, Illinois 60601
Affiliated Relationship Code: Connected Organization

Committee ID# C00084061
Blue Cross Blue Shield of Michigan PAC
232 S. Capitol
Mc L10A
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
Florida Health Political Action Commit
PO Box 6936
4800 Deerwood Campus Parkwy, Dc3-4
Jacksonville, Florida 32236
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

Committee ID# C00197202
Blue Cross and Blue Shield of Kansas,
1133 SW Topeka Blvd.
Cc:855 - B3
Topeka, Kansas 66629
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# C00215202
Healthy Government Committee-the Polit
Post Office Box 13466
Phoenix, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00252684
Cambia Health Solutions Inc PAC
200 SW Market St
PO Box 1271/MS E12C
Portland, Oregon 972071271
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
Capital Bluepac, the Political Action
PO Box 60710
Harrisburg, Pennsylvania 171772531
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# C00286922
Carefirst Bluecross Blueshield Associa
10455 Mill Run Circle
Owings Mill, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00301358
Blue Cross and Blue Shield of Kansas C
2301 Main Street
Kansas City, Missouri 64108
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# C00312223
Blue Cross and Blue Shield of North Ca
PO Box 2291
Durham, North Carolina 27702
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# C00340364
Blue Shield of California
50 Beale Street
17-C356
San Francisco, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00342022
Wellmark, Inc. PAC (WELLPAC)
1331 Grand Avenue
Sta. 5W570
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00379537
Blue Cross Voice the Political Action
19 North Main Street
Wilkes Barre, Pennsylvania 18711
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00406850
Blue Cross Blue Shield of South Caroli
Interstate 20 at Alpine Road
Columbia, South Carolina 29214
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of Alabama
2 North Jackson Street, Suite 202
Montgomery, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

IBC Pac, Independence Blue Cross Pac
1901 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of Tennesse
1 Cameron Hill Circle
Chattanooga, Tennessee 37402
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mary Lou Stutz
300 E. Randolph
Legal Department
Chicago, IL 60601
Title: Asst. Treasurer
Phone # (312) 653-6363

Treasurer:

Gerard T. Mallen
300 E. Randolph
Legal Department
Chicago, Illinois 60601
Title: Treasurer
Phone # (312) 653-6649

Designated Agent(s):

Mary Lou Stutz
300 E. Randolph
Legal Department
Chicago, Illinois 60601
Title: Asst. Treasurer
Phone # (312) 653-6363

Ariana G Voigt
300 E. Randolph St
Chicago, Illinois 60601
Title: Assistant Treasurer
Phone # (312) 653-2814

Banks or Depositories

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

Signed: Gerard T. Mallen
Date Signed: 02/27/2014

(End FEC FORM 1)

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