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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1707194

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1. BLUE CROSS AND BLUE SHIELD OF NEBRASKA PAC

    1919 AKSARBEN DRIVE PO BOX 3248
    OMAHA, NE 681800001
    Email: David.Sederburg@nebraskablue.com

    NOTE: Email address is different than previously reported

2. Date: 06/13/2023

3. FEC Committee ID #: C00276311 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

David Sederburg
10220 N 168TH STREET
BENNINGTON, NE 68007
Title: VP Finance
Phone # (402) 889-7046

Treasurer:

David Sederburg
10220 N 168TH STREET
BENNINGTON, Nebraska 68007
Phone # (402) 889-7046

Designated Agent(s):

Banks or Depositories

First National Bank of Omaha
1620 Dodge Street
Omaha, Nebraska 68197

Signed: David Sederburg
Date Signed: 06/13/2023

(End FEC FORM 1)

Generated Sat Aug 17 19:39:06 2024