FEC Form 1 for Independence Blue Cross PAC (IBC PAC)Form 1 for Independence Blue Cross PAC (IBC PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-408848

1. Independence Blue Cross PAC (IBC PAC)

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

2. Date: 03/20/2009

3. FEC Committee ID #: C00450056 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00450056
Independence Blue Cross
1901 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Royal E. Brown
1901 Market Street
Philadelphia, PA 19103
Title: Treasurer
Phone # (215) 241-2590

Treasurer:

Royal E. Brown
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Treasurer
Phone # (215) 241-2590

Designated Agent(s):

Stephen P. Fera
1901 Market Street
Philadelphia, Pennsylvania 19103
Title: Assistant Treasurer
Phone # (215) 241-3027

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-408848

1. Independence Blue Cross PAC (IBC PAC)

2. Date: 03/20/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Royal E. Brown
Date Signed: 03/20/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-408848

1. Independence Blue Cross PAC (IBC PAC)

2. Date: 03/20/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Royal E. Brown Date Signed: 03/20/2009

(End FEC FORM 1)

Signed: Royal E. Brown
Date Signed: 03/20/2009