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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-226956

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1. BLUE SHIELD OF CALIFORNIA POLITICAL ACTION COMMITTEE

    50 Beale Street
    18-105
    SAN FRANCISCO, CA 94105

2. Date: 05/26/2006

3. FEC Committee ID #: C00340364 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00194746
BLUEPAC - BCBSA PAC
1310 G STREET NW
WASHINGTON, DC 20005
Relationship: Affiliated
Organization Type: Corporation

Custodian of Records:

Tin Nguyen
50 Beale St.
San Francisco, CA 94105
Title: Assistant Treasurer
Phone # (415) 229-5891

Treasurer:

Karman Chan
50 Beale St.
San Francisco, California 94105
Title: Treasurer
Phone # (415) 229-5102

Designated Agent(s):

Tin Nguyen
50 Beale St.
San Francisco, California 94105
Title: Assistant Treasurer
Phone # (415) 229-5891

Banks or Depositories

Bank of America
345 Montgomery St.
San Francisco, California 94101

Signed: Karman Chan
Date Signed: 07/07/2004

(End FEC FORM 1)

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