FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-214494
1. Health Net Incorporated Political Action Committee
455 Capitol Mall Suite 801Sacramento, CA 95814
Fax: 9164427759
2. Date: 04/24/2006
3. FEC Committee ID #: C00230789 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Health Net Inc.21650 Oxnard Street 25th Floor
Woodland Hills, California 91367
Relationship: Connected Organization
Custodian of Records:
Thomas W. Hiltachk455 Capitol Mall Suite 801
Sacramento, CA 95814
Title: Custodian of Records
Phone # (916) 442-7757
Treasurer:
Thomas W. Hiltachk455 Capitol Mall Suite 801
Sacramento, California 95814
Title: Treasurer
Phone # (916) 442-7757
Designated Agent(s):
Ashlee N. Titus455 Capitol Mall Suite 801
Sacramento, California 95814
Title: Assistant Treasurer
Phone # (916) 442-7757
Banks or Depositories
Commercial Capital Bank1565 Exposition Blvd.
Sacramento, California 95815