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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1786186

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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;Jennifer.Davenport@nebraskablue.com

2. Date: 05/28/2024

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

Affiliated Committees/Organizations

Committee ID# C00503003
BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)
1 CAMERON HILL CIRCLE
CHATTANOOGA, Tennessee 37402
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

Committee ID# C00409227
PREMERA BLUE CROSS POLITICAL ACTION CO
7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432160
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00457242
BLUE CROSS BLUE SHIELD OF ALABAMA PAC
2 NORTH JACKSON STREET
SUITE 202
MONTGOMERY, Alabama 361043821
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00194746
BLUEPAC - BLUE CROSS BLUE SHIELD ASSOC
750 9TH STREET, NW
WASHINGTON, DC 20001
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00651265
LOUISIANA HEALTH SERVICE & INDEMNITY C
5525 REITZ AVENUE
BATON ROUGE, Louisiana 70809
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00276311
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
1919 AKSARBEN DRIVE PO BOX 3248
OMAHA, Nebraska 681800001
Affiliated Relationship Code: Connected Organization

Committee ID# C00639245
HORIZON HEALTHCARE SERVICES, INC.-HORI
THREE PENN PLAZA EAST
PP-11G
NEWARK, New Jersey 07105
Affiliated Relationship Code: Affiliated Committee

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
GUIDEWELL MUTUAL HOLDING CORPORATION P
4800 DEERWOOD CAMPUS PARKWAY
DC1-7
JACKSONVILLE, Florida 32246
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# C00215202
HEALTHY GOVERNMENT COMMITTEE-THE POLIT
P.O. BOX 13466
PHOENIX, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
CAPITAL BLUEPAC, THE POLITICAL ACTION
P.O. BOX 60710
HARRISBURG, Pennsylvania 171060710
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00286922
CAREFIRST BLUECROSS BLUESHIELD ASSOCIA
10455 MILL RUN CIRCLE
OWINGS MILLS, 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 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
P.O. BOX 2291
DURHAM, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00340364
BLUE SHIELD OF CALIFORNIA PAC (SHIELD
601 12TH STREET
OAKLAND, California 94607
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

Custodian of Records:

Jennifer Davenport
1919 Aksarben Drive
Omaha, NE 68180
Title: PAC Accountant
Phone # (402) 321-2155

Treasurer:

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

Designated Agent(s):

Denna Hodges
1919 Aksarben Drive
Omaha, Nebraska 68180
Title: Accountant
Phone # (402) 999-3990

Erin Russell
1919 Aksarben Drive
Omaha, Nebraska 68180
Title: Manager
Phone # (208) 661-8286

Jennifer Davenport
1919 Aksarben Drive
Omaha, Nebraska 68180
Title: Accountant
Phone # (402) 321-2155

Banks or Depositories

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

Signed: David Sederburg
Date Signed: 05/28/2024

(End FEC FORM 1)

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