FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-103698
1. PacifiCare Health Systems Inc. Employees' Political Action Committee
NOTE:Commmittee Name is different than previously reported
M/S CY20-5365995 Plaza Drive
Cypress, CA 90630
Fax: 714-226-3653
Email: leigh.volkland@phs.com
2. Date: 01/15/2004
3. FEC Committee ID #: C00240903 This committee is a Separate Segregated FundAffiliated Committees/Organizations
PacifiCare Health Systems Inc.5995 Plaza Drive CY20-536
Cypress, California 90630
Relationship: Connected organization
Organization Type: Corporation
Custodian of Records:
Phone # 0
Treasurer:
Nick FranklinM/S CY20-536
5995 Plaza Drive
Cypress, California 90630
Title: SVP Public Affairs
Phone # (714) 226-3360
Designated Agent(s):
Leigh Volkland5995 Plaza Drive CY20-536
Cypress, California 90630
Title: Director
Phone # (714) 226-3211
Banks or Depositories
Wells Fargo707 Wilshire Boulevard
Los Angeles, California 90017
Signed: Nick Franklin
Date Signed: 01/15/2004
Official Committee FAX: 714-226-3653
FORM TEXT