FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-12809
1. American Medical Security Inc. PAC
3100 AMS BoulevardP.O. Box 19032
Green Bay, WI 543079032
Email: amsinfo@amschoices.com
2. Date: 03/19/2001
3. FEC Committee ID #: C00283457 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Blue Cross & Blue Shield United of Wisconsin401 West Michigan Street
Milwaukee, Wisconsin 53203
Relationship: Connected Organizati
Organization Type: Corporation
American Medical Security Inc.
3100 AMS Boulevard
P.O. Box 19032
Green Bay, Wisconsin 543079032
Relationship: Connected Organizati
Organization Type: Corporation
Custodian of Records:
Treasurer:
Gary Guengerich297 Desplaines Road
De Pere, Wisconsin 54115
Designated Agent(s):
Banks or Depositories
Bank One - Green BayP.O. Box 19029
Green Bay, Wisconsin 54307