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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-922807

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1. Highmark PAC of Highmark Inc.

    NOTE:Commmittee Name is different than previously reported

    1800 Center Street
    Camp Hill, PA 17089
    Email: Stephen.Wojnaroski@highmark.com

    NOTE: Email address is different than previously reported

2. Date: 04/30/2014

3. FEC Committee ID #: C00302844 This committee is a separate segregated fund. Its connected organization is a Corporation
     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

BLUEPAC - BLUE CROSS BLUE SHIELD ASSOC
1310 G Street,NW
Washington, DC 20005
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Stephen J. Wojnaroski
1800 Center Street 1B L4
Camp Hill, PA 17011
Title: PAC Administrator
Phone # (717) 302-4516

Treasurer:

Kenneth B Gebhard
1800 Center Street
Camp Hill, Pennsylvania 17089
Title: VP, Cost Mgmt & Anal
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: 04/30/2014

(End FEC FORM 1)

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