FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-290378
1. PREMERA BLUE CROSS POLITICAL ACTION COMMITTEE/PREMERA PAC
7001 220TH STREET SW MS355MOUNTLAKE TERRACE, WA 98043
Fax: 2483717272
Email: Holly_J_Morris@comerica.com
2. Date: 06/06/2007
3. FEC Committee ID #: C00409227 This committee is a Separate Segregated FundAffiliated Committees/Organizations
PREMERA BLUE CROSS7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432124
Relationship: CONNECTED
Organization Type: Corporation W/O Capital Stock
BLUEPAC-BCBS ASSN PAC
1310 G STREET NW
WASHINGTON, DC 20005
Relationship: AFFILIATED PAC
Custodian of Records:
JAMES HOEBERLINGCOMERICA BANK PAC SERVICES
P.O. BOX 75000
DETROIT, MI 482752250
Title: RECORDKEEPER
Phone # (248) 371-5562
Treasurer:
JACK McRAE7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432124
Title: TREASURER
Phone # (425) 918-5757
Designated Agent(s):
JUDSON GREIF7001 220TH STREET SW
MS 355
MOUNTLAKE TERRACE, Washington 980432124
Title: ASST. TREASURER
Phone # (425) 918-6129
Banks or Depositories
COMERICA BANKPAC SERVICES
P.O. BOX 75000
DETROIT, Michigan 482752250