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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-214496

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1. Health Net Incorporated Political Action Committee

    455 Capitol Mall Suite 801
    Sacramento, CA 95814

    NOTE: Address is different than previously reported

    Fax: 9164427759

2. Date: 04/24/2006

3. FEC Committee ID #: C00230789 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Health Net Inc.
21650 Oxnard Street 25th Floor
Woodland Hills, California 91367
Relationship: Connected Organization

Custodian of Records:

Thomas W. Hiltachk
455 Capitol Mall Suite 801
Sacramento, CA 95814
Title: Custodian of Records
Phone # (916) 442-7757

Treasurer:

Thomas W. Hiltachk
455 Capitol Mall Suite 801
Sacramento, California 95814
Title: Treasurer
Phone # (916) 442-7757

Designated Agent(s):

Ashlee N. Titus
455 Capitol Mall Suite 801
Sacramento, California 95814
Title: Assistant Treasurer
Phone # (916) 442-7757

Banks or Depositories

Commercial Capital Bank
1565 Exposition Blvd.
Sacramento, California 95815

Signed: Thomas W. Hiltachk
Date Signed: 04/24/2006
Official Committee FAX: 9164427759

(End FEC FORM 1)

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