FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-150045
1. BLUEPAC OF PENNSYLVANIA
NOTE:Commmittee Name is different than previously reported
P. O. Box 60710Harrisburg, PA 171060710
Fax: 7175263207
Email: linda.melusky@capbluecross.com
2. Date: 10/27/2004
3. FEC Committee ID #: C00270967 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Independence Blue Cross1901 Market Street
Philadelphia, Pennsylvania 19103
Relationship: Affiliated Corp.
Organization Type: Corporation
BlueCross and BlueShield Association
1310 G Street NW
Washington, DC 20005
Relationship: Affiliated Committee
Organization Type: Membership Organization
Custodian of Records:
Ms Traci Lumadue2500 Elmerton Avenue
Harrisburg, PA 171773238
Title: Jr. Accountant
Phone # (717) 541-7257
Treasurer:
Mr. Aji Abraham2500 Elmerton Avenue
Harrisburg, Pennsylvania 171772531
Title: Director/Treasurer
Phone # (717) 541-6134
Designated Agent(s):
Ms Linda Melusky2500 Elmerton Avenue
Harrisburg, Pennsylvania 171772531
Title: Asst. Treasurer
Phone # (717) 541-6135
Ms Traci Lumadue
2500 Elmerton Avenue
Harrisburg, Pennsylvania 171773238
Banks or Depositories
M&T Bank213 Market Street
Harrisburg, Pennsylvania 17101