FEC Form 1 for PacifiCare Health Systems Inc. Employees' Political Action CommitteeForm 1 for PacifiCare Health Systems Inc. Employees' Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-191480

1. PacifiCare Health Systems Inc. Employees' Political Action Committee

5995 Plaza Drive M/S CY20-536
Cypress, CA 90630
Fax: 714-226-3653
Email: leigh.volkland@phs.com

2. Date: 11/10/2005

3. FEC Committee ID #: C00240903

Affiliated Committees/Organizations

NONE
n/a
n/a, nA n/a
Relationship: n/a

Custodian of Records:

Janet Newport
CY20-536
5995 Plaza Drive
Cypress, CA 90630
Title: Treasurer
Phone # (714) 226-3707

Treasurer:

Janet Newport
M/S CY20-536
5995 Plaza Drive
Cypress, California 90630
Title: Treasurer
Phone # (714) 226-3707

Designated Agent(s):

Banks or Depositories

Signed: Janet Newport
Date Signed: 11/10/2005
Official Committee FAX: 714-226-3653

FORM TEXT

(End FEC FORM 1)

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