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-843238

1. Amerigroup Corporation Political Action Committee (Amerigroup PAC)

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

2. Date: 12/28/2012

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

WellPoint, Inc. WELLPAC
120 Monument Circle
Indianapolis, Indiana 46204
Affiliated Relationship Code: Affiliated Committee

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):

Banks or Depositories

Wells Fargo Bank, N.A.
400 World Trade Center
VA 95566
Norfolk, Virginia 23510

Signed: John E. Littel
Date Signed: 12/28/2012

(End FEC FORM 1)

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