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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-731177

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1. Wellmark, Inc. PAC (WellPac)

    1331 Grand Avenue
    Sta. 5W570
    Des Moines, IA 50309
    Email: lickteigmm@wellmark.com

    NOTE: Email address is different than previously reported

2. Date: 06/14/2011

3. FEC Committee ID #: C00342022 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

Wellmark, Inc.
1331 Grand Avenue
Sta. 5W570
Des Moines, Iowa 50309
Affiliated Relationship Code: Connected Organization

Committee ID# C00340364
BLUE SHIELD OF CALIFORNIA POLITICAL AC
50 BEALE STREET
17-C356
SAN FRANCISCO, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00379537
BLUE CROSS VOICE THE POLITICAL ACTION
19 NORTH MAIN STREET
WILKES BARRE, Pennsylvania 18711
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00406850
BLUE CROSS BLUE SHIELD OF SOUTH CAROLI
INTERSTATE 20 AT ALPINE ROAD
COLUMBIA, South Carolina 29219
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00409227
PREMERA BLUE CROSS POLITICIAL ACTION C
7001 220TH STREET SW
MOUNTLAKE TERRACE, Washington 98043
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00457242
BLUE CROSS BLUE SHIELD OF ALABAMA PAC
2 NORTH JACKSON STREET
SUITE 202
MONTGOMERY, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00450056
INDEPENDENCE BLUE CROSS PAC (IBC PAC)
1901 MARKET STREET
PHILADELPHIA, Pennsylvania 19103
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00084061
BLUE CROSS BLUE SHIELD OF MICHIGAN PAC
602 W. IONIA
LANSING, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
FLORIDA HEALTH POLITICAL ACTION COMMIT
P.O. BOX 6936
4800 DEERWOOD CAMPUS PARKWY, DC3-4
JACKSONVILLE, Florida 32236
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00368480
BLUE PAC
PO BOX 34676
WASHINGTON, DC 20043
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00197202
BLUE CROSS AND BLUE SHIELD OF KANSAS,
1133 SW TOPEKA BLVD.
CC:855 - B3
TOPEKA, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199166
FED CAREPAC, THE BLUE CROSS AND BLUE S
401 PARK DRIVE
LANDMARK CENTER
BOSTON, Massachusetts 02215
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199711
HEALTH CARE SERVICE CORPORATION EMPLOY
300 E. RANDOLPH
LEGAL DEPT.
CHICAGO, Illinois 60601
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00215202
HEALTHY GOVERNMENT COMMITTEE-THE POLIT
POST OFFICE BOX 13466
PHOENIX, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00252684
THE REGENCE GROUP BLUEPAC
330 9TH ST. SE
WASHINGTON, DC 20003
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
BLUEPAC OF PENNSYLVANIA (THE BLUE CROS
PO BOX 60710
HARRISBURG, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00276311
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
7261 MERCY ROAD
PO BOX 3248
OMAHA, Nebraska 68180
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00286922
CAREFIRST BLUECROSS BLUESHIELD ASSOCIA
10455 MILL RUN CIRCLE
OWINGS MILL, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00301358
BLUE CROSS AND BLUE SHIELD OF KANSAS C
ONE PERSHING SQUARE
2301 MAIN STREET
KANSAS CITY, Missouri 64108
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00302844
HIGHMARK HEALTH PAC OF HIGHMARK INC.
1800 CENTER STREET
CAMP HILL, Pennsylvania 17089
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00312223
BLUE CROSS AND BLUE SHIELD OF NORTH CA
P.O. BOX 2291
DURHAM, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001347
HAWAII MEDICAL POLITICAL ACTION COMMIT
1360 S. BERETANIA ST.
#200
HONOLULU, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

M. Michelle Lickteig
1331 Grand Ave
Sta. 5W570
Des Moines, IA 50309
Title: Treasurer
Phone # (515) 376-4981

Treasurer:

M. Michelle Lickteig
1331 Grand Ave
Sta. 5W570
Des Moines, Iowa 50309
Title: Treasurer
Phone # (515) 376-4981

Designated Agent(s):

M. Michelle Lickteig
1331 Grand Ave
Sta. 5W570
Des Moines, Iowa 50309
Title: Treasurer
Phone # (515) 376-4981

Banks or Depositories

Bankers Trust
453 7th Street
Des Moines, Iowa 50309

Signed: M. Michelle Lickteig
Date Signed: 06/14/2011

(End FEC FORM 1)

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