FEC Form 1 for Blue Cross and Blue Shield of North Carolina Employee Political Action CommitteeForm 1 for Blue Cross and Blue Shield of North Carolina Employee Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-46841

1. Blue Cross and Blue Shield of North Carolina Employee Political Action Committee

P.O. Box 2291
Durham, NC 27702

2. Date: 11/18/2001

3. FEC Committee ID #: C00312223 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

BCBSA BluePac
1310 G. Street N.W.
12th Floor
Washington, DC 20005
Relationship: Affiliated
Organization Type: Corporation W/O Capital Stock

Blue Cross and Blue Shield of North Ca
P.O. Box 2291
Durham, North Carolina 27707
Relationship: Connected
Organization Type: Corporation W/O Capital Stock

Custodian of Records:

Treasurer:

Bradley Adcock
106 Lindenthal Court
Cary, North Carolina 27513
Title: Treasurer
Phone # (919) 765-7404

Designated Agent(s):

Kenneth Wright
618 S. Wingate
Wake Forest, North Carolina 27587
Title: Assistant Treasurer
Phone # (919) 765-7582

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-46841

1. Blue Cross and Blue Shield of North Carolina Employee Political Action Committee

2. Date: 11/18/2001

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Bradley Adcock
Date Signed: 08/15/2002

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-46841

1. Blue Cross and Blue Shield of North Carolina Employee Political Action Committee

2. Date: 11/18/2001

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Bradley Adcock Date Signed: 08/15/2002

(End FEC FORM 1)

Signed: Bradley Adcock
Date Signed: 08/15/2002