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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1418136

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1. Blue Shield of California Political Action Committee

    601 12th Street
    Oakland, CA 94607

    NOTE: Address is different than previously reported

    Email: bsca@politicomlaw.com

    NOTE: Email address is different than previously reported

2. Date: 07/07/2020

3. FEC Committee ID #: C00340364 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

Committee ID# C00194746
BLUEPAC - Blue Cross Blue Shield Association PAC
1310 G Street NW
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Darrin Lim
28 Liberty Ship Way, Suite 2815
Sausalito, CA 94965
Title: Custodian of Records
Phone # (415) 903-2800

Treasurer:

Emily Glidden
601 12th Street
Oakland, California 94607
Title: Treasurer
Phone # (415) 903-2800

Designated Agent(s):

Darrin Lim
28 Liberty Ship Way, Suite 2815
Sausalito, California 94965
Title: Assistant Treasurer
Phone # (415) 903-2800

Banks or Depositories

Bank of America
345 Montgomery Street
San Francisco, California 94101

Signed: Darrin Lim
Date Signed: 07/07/2020

(End FEC FORM 1)

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