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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1723769

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1. Hy-Vee Inc Employees' Political Action Committee

    5820 Westown Parkway
    West Des Moines, IA 50266
    Email: ARoth@hy-vee.com

2. Date: 08/01/2023

3. FEC Committee ID #: C00243659 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00243659
Hy-Vee PAC
5820 Westown Parkway
West Des Moines, Iowa 50266
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Anne Roth
5820 Westown Parkway
West Des Moines, IA 50266
Title: Government Director
Phone # (515) 314-2705

Treasurer:

Abbey Haack
5820 Westown Parkway
West Des Moines, Iowa 50266
Title: Financial Reporting
Phone # (515) 267-2800

Designated Agent(s):

Michael Bellinghausen
5820 Westown Parkway
West Des Moines, Iowa 50266
Title: Accounting
Phone # (515) 267-2800

Banks or Depositories

Midwest Heritage Bank
3580 EP True Parkway
West Des Moines, Iowa 50265

Signed: Abbey Haack
Date Signed: 08/01/2023

FORM TEXT-1

(End FEC FORM 1)

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