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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-725793

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1. HIGHMARK HEALTH PAC OF HIGHMARK INC.

    1800 Center Street
    Camp Hill, PA 17089
    Email: toni.theis@highmark.com

2. Date: 04/20/2011

3. FEC Committee ID #: C00302844 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Highmark Inc.
1800 Center Street
Camp Hill, Pennsylvania 17089
Affiliated Relationship Code: Connected Organization

Blue Cross Blue Shield Association
1310 G Street, NW
Washington, DC 20005
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Toni L Theis
1800 Center Street
Camp Hill, PA 17089
Title: Govt Affairs Coord.
Phone # (717) 302-3977

Treasurer:

Kenneth B Gebhard
1800 Center Street
Camp Hill, Pennsylvania 17089
Title: VP Cost Mgmt&Ana
Phone # (717) 302-2544

Designated Agent(s):

Kelly S Lieblein
1800 Center Street
Camp Hill, Pennsylvania 17011
Title: VP Sales&Client Mgmt
Phone # (717) 302-2013

Banks or Depositories

Citizens Bank
4101 Carlisle Pike
Camp Hill, Pennsylvania 17011

Signed: Kenneth B Gebhard
Date Signed: 04/20/2011

(End FEC FORM 1)

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