FEC Form 1 for Independence Blue Cross LLC PACForm 1 for Independence Blue Cross LLC PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1569180

1. Independence Blue Cross LLC PAC

1901 Market Street
Philadelphia, PA 19103
Email: jmannion@skadden.com

2. Date: 06/07/2021

3. FEC Committee ID #: C00450056 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

AmeriHealth, Inc.
1901 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Connected Organization

Bluepac - Blue Cross Blue Shield Assoc
1310 G Street NW
Washington, DC 20005
Affiliated Relationship Code: Affiliated Committee

Bluecross Blueshield of Tennessee Inc
1 Cameron Hill Circle
Chattanooga, Tennessee 37402
Affiliated Relationship Code: Affiliated Committee

LOUISIANA HEALTH SERVICE & INDEMNITY C
5525 REITZ AVENUE
BATON ROUGE, Louisiana 70809
Affiliated Relationship Code: Affiliated Committee

HORIZON HEALTHCARE SERVICES, INC.-HORI
3 PennPlz E
PP-11G
Newark, New Jersey 07105
Affiliated Relationship Code: Affiliated Committee

Blue Cross Blue Shield of Michigan Pac
232 S. Capitol
MC L10A
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

Guidewell Mutual Holding Corporation P
4800 Deerwood Campus Parkway
DC3-4
Jacksonville, Florida 32236
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of Kansas,
1133 SW Topeka Blvd
Topeka, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

Healthy Government Committee-the Polit
Post Office Box 13466
Phoenix, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Bluepac of Pennsylvania (THE BLUE CROS
PO Box 60710
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of Nebraska
7261 Mercy Road
Omaha, Nebraska 68180
Affiliated Relationship Code: Affiliated Committee

Carefirst Bluecross Blueshield Associa
10455 Mill Run Circle
Owings Mill, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of Kansas C
One Pershing Square
2301 Main Street
Kansas City, Missouri 64108
Affiliated Relationship Code: Affiliated Committee

Highmark Health Pac of Highmark Inc.
1800 Center Stree
Camp Hill, Pennsylvania 17089
Affiliated Relationship Code: Affiliated Committee

Blue Cross and Blue Shield of North Ca
PO Box 2291
Durham, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Blue Shield of California Political Ac
50 Beale Street
San Francisco, California 94105
Affiliated Relationship Code: Affiliated Committee

Wellmark, Inc. Pac (WELLPAC)
1331 Grand Avenu
Sta. 5W570
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee

Blue Cross Blue Shield of South Caroli
Interstate 20 at Alpine Road
Columbia, South Carolina 29219
Affiliated Relationship Code: Affiliated Committee

Premera Blue Cross Politicial Action C
7001 220th Street SW
MS 355
Mountlake Terrace, Washington 98043
Affiliated Relationship Code: Affiliated Committee

Blue Cross Blue Shield of Alabama Pac
2 North Jackson Street
Suite 202
Montgomery, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00804096
AMHP HOLDINGS CORP. POLITICAL ACTION C
200 STEVENS DRIVE
PHILADELPHIA, Pennsylvania 19113
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Juan Lopez
1901 Market Street
Philadelphia, PA 19103
Title: Custodian of Records
Phone # (215) 241-2851

Treasurer:

Juan Lopez
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Treasurer
Phone # (215) 241-2851

Designated Agent(s):

Jennifer Bowers
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Assistant Treasurer
Phone # (215) 241-3442

Banks or Depositories

Citizens Commercial Banking
602 West Office Drive Suite 100
Fort Washington, Pennsylvania 19034

Signed: Juan Lopez
Date Signed: 02/16/2022

(End FEC FORM 1)

Generated Tue Nov 19 06:30:46 2024