FEC Form 1 for BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)Form 1 for BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1264961

1. BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)

1 CAMERON HILL CIRCLE
CHATTANOOGA, TN 37402
Email: trey_white@bcbst.com;Tavarski_Hughes@bcbst.com

NOTE: Email address is different than previously reported

2. Date: 10/03/2018

3. FEC Committee ID #: C00503003 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock

Affiliated Committees/Organizations

Committee ID# C00457242
Blue Cross Blue Shield of Alabama PAC
2 North Jackson Street
Suite 202
Montgomery, Alabama 36104
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00215202
Healthy Government Committee - the Pol
PO Box 13466
Phoeniz, Arizona 85002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00379537
Blue Cross Voice
19 North Main Street
Wilkes Barrre, Pennsylvania 18711
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00450056
Independence Blue Cross Pac (IBC PAC)
1901 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00406850
Blue Cross Blue Shield of South Caroli
Interstate 20 at Alpine Road
Columbia, South Carolina 29219
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00342022
Wellmark, Inc. Pac (WELLPAC)
1331 Grand Avenue
Sta. 5W570
Des Moines, Iowa 50309
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00340364
Blue Shield of California Political Ac
50 Beale Street
17-C356
San Francisco, California 94105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00321992
Hawaii Medical Service Association Emp
818 Keeaumoku Street
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00312223
Blue Cross and Blue Shield of North Ca
PO Box 2291
Durham, North Carolina 27702
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00301358
Blue Cross and Blue Shield of Kansas C
One Pershing Square
2301 Main Street
Kansas City, Missouri 64108
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00302844
Highmark Health PAC of Highmark Inc.
1800 Center Street
Camp Hill, Pennsylvania 17089
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00286922
Carefirst BlueCross Blueshield Associa
10455 Mill Run Circle
Owings Mill, Maryland 21117
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00276311
Blue Cross and Blue Shield of Nebraska
7261 Mercy Road
PO Box 3248
Omaha, Nebraska 68180
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00270967
Bluepac of Pennsylvania
PO Box 60710
Harrisburg, Pennsylvania 17106
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00161141
Florida Health Political Action Commit
4800 Deerwood Campus Parkwy, Dc3-4
PO Box 6936
Jacksonville, Florida 32236
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00084061
Blue Cross Blue Shield of Michigan PAC
232 S. Capitol
MC L10A
Lansing, Michigan 48933
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00199711
Health Care Service Corporation Employ
300 E. Randolph
Chicago, Illinois 60601
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00197202
Blue Cross and Blue Shield of Kansas
1133 SW Topeka Blvd
Cc:855 - B3
Topeka, Kansas 66629
Affiliated Relationship Code: Affiliated Committee

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

Committee ID# C00252684
Cambia Health Solutions Inc. PAC
200 SW Market St.
PO Box 1271 MS E12C
Portland, Oregon 97207
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00409227
Premera Blue Cross Political Action
7001 220th Street SW
Mountlake Terrace, Washington 98043
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00503003
BLUECROSS BLUESHIELD OF TENNESSEE INC
1 CAMERON HILL CIRCLE
CHATTANOOGA, Tennessee 37402
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Mr. Trey White
1 Cameron Hill Circle
Chattanooga, Tennessee 37402
Title: VP Contr & Chief Acc
Phone # (423) 535-7036

Designated Agent(s):

Mr. Tavarski Hughes
572 Vinton Square
Memphis, Tennessee 38104
Title: Public Policy Liaiso
Phone # (901) 544-2249

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1264961

1. BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)

NOTE: Email address is different than previously reported

2. Date: 10/03/2018

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Trey White
Date Signed: 10/03/2018

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1264961

1. BLUECROSS BLUESHIELD OF TENNESSEE INC POLITICAL ACTION COMMITTEE (BCBSTN PAC)

NOTE: Email address is different than previously reported

2. Date: 10/03/2018

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Trey White Date Signed: 10/03/2018

(End FEC FORM 1)

Signed: Mr. Trey White
Date Signed: 10/03/2018