FEC Form 1 for PREMERA BLUE CROSS POLITICAL ACTION COMMITTEE / PREMERA PACForm 1 for PREMERA BLUE CROSS POLITICAL ACTION COMMITTEE / PREMERA PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-195672

1. PREMERA BLUE CROSS POLITICAL ACTION COMMITTEE / PREMERA PAC

7001 220TH STREET SW
MS 355, WA 98043
Fax: 2483717272
Email: Holly_J_Morris@comerica.com

2. Date: 01/10/2006

3. FEC Committee ID #: C00409227 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

PREMERA BLUE CROSS
7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432124
Relationship: CONNECTED
Organization Type: Corporation

BLUEPAC- BCBS ASSN PAC
1310 G STREET NW
WASHINGTON, DC 20005
Relationship: AFFILIATED PAC

Custodian of Records:

JAMES HOEBERLING
COMERICA BANK PAC SERVICES
P.O. BOX 75000
DETROIT, MI 482752250
Title: RECORDKEEPER
Phone # (248) 371-5562

Treasurer:

JACK McRAE
7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432124
Title: TREASURER
Phone # (425) 918-5757

Designated Agent(s):

JAMES HOEBERLING
COMERICA BANK PAC SERVICES
3551 HAMLIN ROAD
AUBURN HILLS, Michigan 483262250
Title: ASST. TREASURER
Phone # (248) 371-5562

Banks or Depositories

COMERICA BANK
PAC SERVICES
P.O. BOX 75000
DETROIT, Michigan 482752250

Signed: JACK McRAE
Date Signed: 01/10/2006
Official Committee FAX: 2483717272

(End FEC FORM 1)

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