FEC Form 1 for Amerigroup Corporation Political Action Committee (Amerigroup PAC)Form 1 for Amerigroup Corporation Political Action Committee (Amerigroup PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-835700

1. Amerigroup Corporation Political Action Committee (Amerigroup PAC)

4425 Corporation Lane
Virginia Beach, VA 234623103
Email: john.littel@amerigroup.com

NOTE: Email address is different than previously reported

2. Date: 11/27/2012

3. FEC Committee ID #: C00428102 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

Amerigroup Corporation
4425 Corporation Lane
Virginia Beach, Virginia 23462
Affiliated Relationship Code: Connected Organization

Custodian of Records:

John E. Littel
4425 Corporation Lane
Virginia Beach, VA 234623103
Title: Treasurer
Phone # (757) 518-3649

Treasurer:

John E. Littel
4425 Corporation Lane
Virginia Beach, Virginia 234623103
Title: Treasurer
Phone # (757) 518-3649

Designated Agent(s):

Harry Kaplan
Two Hanover Square
Ste 2140
Raleigh, North Carolina 27601
Phone # (916) 836-4001

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-835700

1. Amerigroup Corporation Political Action Committee (Amerigroup PAC)

NOTE: Email address is different than previously reported

2. Date: 11/27/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: John E. Littel
Date Signed: 11/27/2012

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-835700

1. Amerigroup Corporation Political Action Committee (Amerigroup PAC)

NOTE: Email address is different than previously reported

2. Date: 11/27/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: John E. Littel Date Signed: 11/27/2012

(End FEC FORM 1)

Signed: John E. Littel
Date Signed: 11/27/2012