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-198234

1. PACIFICARE HEALTH SYSTEMS INC. EMPLOYEES' POLITICAL ACTION COMMITTEE

5995 Plaza Drive M/S CY20-536
5995 Plaza Drive
Cypress, CA 90630
Fax: 7142263658
Email: leigh.volkland@phs.com

2. Date: 01/25/2006

3. FEC Committee ID #: C00240903 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Pacificare Health Systems Inc.
5995 Plaza Drive M/S CY20-536
Cypress, California 90630
Relationship: Connected
Organization Type: Corporation

GOLDEN RULE FINANCIAL CORPORATION - PO
7440 WOODLAND DRIVE
INDIANAPOLIS, Indiana 46278
Relationship: Affiliated Committee

UNITEDHEALTH GROUP INCORPORATED POLITI
9900 BREN ROAD EAST
9900 BREN ROAD EAST
MINNETONKA, Minnesota 55343
Relationship: Affiliated Committee

Custodian of Records:

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

Treasurer:

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

Designated Agent(s):

Leigh Volkland
5995 Plaza Drive M/S CY20-536
Cypress, California 90630
Title: Asst. Treasurer
Phone # (714) 226-3211

Banks or Depositories

Wells Fargo
707 Wilshire Blvd
Los Angeles, California 90017

Signed: Janet Newport
Date Signed: 01/27/2006
Official Committee FAX: 7142263658

(End FEC FORM 1)

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