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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1755591

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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: 01/01/2024

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:

Alex Luke
5820 Westown Parkway
West Des Moines, Iowa 50266
Title: Financial Reporting
Phone # (515) 695-3422

Designated Agent(s):

Matt Reeve
5820 Westown Parkway
West Des Moines, Iowa 50266
Title: Accounting
Phone # (515) 267-2811

Banks or Depositories

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

Signed: Alex Luke
Date Signed: 01/01/2024

FORM TEXT-1

(End FEC FORM 1)

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