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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-157531

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1. Highmark Health PAC of Highmark Inc.

    NOTE:Commmittee Name is different than previously reported

    1800 Center Street
    Camp Hill, PA 17089
    Fax: 7173023969
    Email: jane.rodkey@highmark.com

2. Date: 01/03/2005

3. FEC Committee ID #: C00302844 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Highmark Inc.
1800 Center Street
Camp Hill, Pennsylvania 17089
Relationship: Connected
Organization Type: Corporation W/O Capital Stock

Custodian of Records:

Jane Rodkey
1800 Center Street
Camp Hill, PA 17011
Title: Govt Affairs Coord
Phone # (717) 302-3977

Treasurer:

Gayeta C. Porter
100 Senate Avenue SP 4CC
Camp Hill, Pennsylvania 17011
Title: PAC Treasurer
Phone # (717) 302-2537

Designated Agent(s):

Banks or Depositories

Citizens Bank of Pennsylvania
10 South Market Square
PO Box 1010
Harrisburg, Pennsylvania 17108

Signed: Gayeta C. Porter
Date Signed: 01/04/2005
Official Committee FAX: 7173023969

(End FEC FORM 1)

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