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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1781916

1. Independence Blue Cross LLC PAC

1901 Market Street
Philadelphia, PA 19103
Email: IBCPAC@ibx.com

2. Date: 05/01/2024

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

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: Treasurer
Phone # (215) 241-4614

Treasurer:

Juan Lopez
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Treasurer
Phone # (215) 241-4614

Designated Agent(s):

Regina Jolly
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Assistant Treasurer
Phone # (215) 241-2336

Banks or Depositories

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

Signed: Juan Lopez
Date Signed: 05/09/2024

(End FEC FORM 1)

Generated Wed Nov 13 01:30:44 2024