FEC Form 1 for BLUEPAC OF PENNSYLVANIA (Independence Blue Cross; BluePAC-The BlueCross & BlueShield Ass.)Form 1 for BLUEPAC OF PENNSYLVANIA (Independence Blue Cross; BluePAC-The BlueCross & BlueShield Ass.)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-157304

1. BLUEPAC OF PENNSYLVANIA (Independence Blue Cross; BluePAC-The BlueCross & BlueShield Ass.)

NOTE:Commmittee Name is different than previously reported

P.O. Box 60710
c/o Linda Melusky
Harrisburg, PA 17106
Email: linda.melusky@capbluecross.com

2. Date: 12/30/2004

3. FEC Committee ID #: C00270967 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Independence Blue Cross
1901 Market Street
Philadelphia, Pennsylvania 19103
Relationship: Affiliated Corporation
Organization Type: Corporation

Committee ID# C00194746
BluePAC
1310 G Street NW
Washington, DC 20005
Relationship: Affiliated Committee
Organization Type: Membership Organization

Custodian of Records:

Traci Lumadue
2500 Elmerton Avenue
Harrisburg, PA 171773238
Title: Jr. Accountant
Phone # (717) 541-7257

Treasurer:

Aji Abraham Esq.
2500 Elmerton Avenue
Harrisburg, Pennsylvania 171772531
Title: Director
Phone # (717) 541-6134

Designated Agent(s):

Linda Melusky
2500 Elmerton Avenue
Harrisburg, Pennsylvania 171772531
Title: Gov. Affairs Rep.
Phone # (717) 541-6135

Banks or Depositories

M&T Bank
213 Market Street
Harrisburg, Pennsylvania 17101

Signed: Aji Abraham Esq.
Date Signed: 12/30/2004
Official Committee URL: www.capbluecross.com

(End FEC FORM 1)

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