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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1079602

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1. CareFirst BlueCross BlueShield Associates' Federal PAC

    10455 Mill Run Circle
    Owings Mill, MD 21117
    Email: Jeanne.Kennedy@carefirst.com,Debbie.Credito@carefirst.com

2. Date: 06/21/2016

3. FEC Committee ID #: C00286922 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

CareFirst Blue Cross BlueShield
10455 Mill Run Circle
01-960
Owings Mills, Maryland 21117
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Debbie Credito
10455 Mill Run Circle
Owings Mills, MD 21117
Phone # (410) 528-7061

Treasurer:

Jeanne Kennedy
10455 Mill Run Circle
Owings Mill, Maryland 21117
Title: Vice President, Corp
Phone # (410) 998-6767

Designated Agent(s):

Banks or Depositories

BB &T
Operations Center
P.O. Box 819
Wilson, North Carolina 278940819

Signed: Jeanne Kennedy
Date Signed: 06/21/2016

FORM TEXT-1

(End FEC FORM 1)

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