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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-894698

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1. Amerigroup Corporation Political Action Committee (Amerigroup PAC)

    4425 Corporation Lane
    Virginia Beach, VA 234623103
    Email: Kristina.gill@amerigroup.com

    NOTE: Email address is different than previously reported

2. Date: 11/08/2013

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

Committee ID# C00197228
WellPoint, Inc. WELLPAC
120 Monument Circle
Indianapolis, Indiana 46204
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Kristina V. Gill
4425 Corporation Lane
Virginia Beach, VA 234623103
Title: Treasurer
Phone # (757) 473-2733

Treasurer:

Kristina V. Gill
4425 Corporation Lane
Virginia Beach, Virginia 234623103
Title: Treasurer
Phone # (757) 473-2733

Designated Agent(s):

Banks or Depositories

JPMorgan Chase
270 Park Avenue
New York, New York 10017

Signed: Kristina V. Gill
Date Signed: 11/13/2013

(End FEC FORM 1)

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