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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-426792

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1. Blue Cross Blue Shield of Alabama PAC

    2 North Jackson Street
    Suite 202
    Montgomery, AL 36104
    Email: alcox@comerica.com

2. Date: 07/24/2009

3. FEC Committee ID #: C00457242 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

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

Custodian of Records:

COMERICA BANK
PAC SERVICES MC#2250
P.O. BOX 75000
DETROIT, MI 482752250
Title: RECORD KEEPER
Phone # (248) 371-7271

Treasurer:

Ronald S. Siemiontkowski
Comerica Bank PAC Services MC#2250
PO Box 75000
Detroit, Michigan 482752250
Title: TREASURER
Phone # (248) 371-7271

Designated Agent(s):

J. Robin Stone
2 North Jackson Street
Suite 202
Montgomery, Alabama 36104
Title: Asst. Treas.
Phone # (334) 262-4657

Banks or Depositories

Comerica Bank
P.O. Box 75000
PAC Services MC 2250
Detroit, Michigan 482752250

Signed: Ronald S. Siemiontkowski
Date Signed: 07/24/2009

FORM TEXT

(End FEC FORM 1)

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