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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1165436

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1. Premera Blue Cross Political Action Committee/Premera PAC

    7001 220th Street SW
    MS 355
    Mountlake Terrace, WA 98043
    Email: mrgriffin@comerica.com

    NOTE: Email address is different than previously reported

2. Date: 06/12/2017

3. FEC Committee ID #: C00409227 This committee is a Principal Campaign Committee. Candidate:
Party:
Office Sought:
State is in District:

Affiliated Committees/Organizations

Premera Blue Cross
7001 220th Street SW
MS 355
Mountainlake Terrace, Washington 98043

Custodian of Records:

Comerica Bank
PAC Services, MC #2250
PO Box 75000
Detroit, MI 482752250
Title: Book Keeper
Phone # (248) 371-7271

Treasurer:

Leonard H. Sorrin
7001 220th St SW, MS 355
Mountlake Terrace, Washington 98043
Title: Treasurer
Phone # (425) 918-5786

Designated Agent(s):

Heather Soto
7001 220th Street SW
MS355
Mountainlake Terrace, Washington 98043

Banks or Depositories

Comerica Bank
PAC Service, MC 2250
P O Box 75000
Detroit, Michigan 48275

Signed: Leonard H. Sorrin
Date Signed: 06/12/2017

FORM TEXT-1

(End FEC FORM 1)

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