FEC Form 1 for Fiserv Health Inc. PACForm 1 for Fiserv Health Inc. PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-325920

1. Fiserv Health Inc. PAC

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

2. Date: 03/06/2008

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

Affiliated Committees/Organizations

United for Health Incorporated PAC
9900 Bren Road
Minnetonka, Minnesota 55343
Relationship: Affiliated Committee
Organization Type: Corporation

Sierra Health Services PAC
PO Box 15645
Las Vegas, Nevada 89114
Relationship: Affiliated Committee
Organization Type: Corporation

Custodian of Records:

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

Treasurer:

Paul Buchberger
11 Scott Street Suit
Wausau, Wisconsin 54401
Title: Tresurer
Phone # (715) 841-6107

Designated Agent(s):

Banks or Depositories

Northern Trust Bank
PO Box 92918
Chicago, Illinois 60675

Signed: Paul Buchberger
Date Signed: 03/06/2008
Official Committee URL: N/A
Official Committee FAX: 715-841-6195

FORM TEXT-1

(End FEC FORM 1)

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