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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-266620

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1. Fiserv Health Inc PAC

    5500 Wayzata Blvd
    Suite 500
    Minneapolis, MN 55416
    Fax: 715-841-6195
    Email: paul.buchberger@wausaubenefits.com

2. Date: 12/20/2006

3. FEC Committee ID #: C00399949 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Fiserv Health Inc
5500 Wayzata Blvd
Suite 500
Minneapolis, Minnesota 55416
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Paul Buchberger
11 Scott Street
Suite 100
Wausau, WI 54401
Title: Treasurer
Phone # (715) 841-6107

Treasurer:

Paul Buchberger
11 Scott Street
Suite 100
Wausau, Wisconsin 54401
Title: Treasurer
Phone # (715) 841-6107

Designated Agent(s):

Banks or Depositories

Northern Trust Bank
P.O. Box 92918
Chicago, Illinois 60675

Signed: Paul Buchberger
Date Signed: 12/28/2006
Official Committee URL: n/a
Official Committee FAX: 715-841-6195

FORM TEXT

(End FEC FORM 1)

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