FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-172904
1. COOPERATIVE OF AMERICAN PHYSICIANS-MUTUAL PROTECTION TRUST(CAP-MPT)FEDERAL PAC
NOTE:Commmittee Name is different than previously reported
333 South Hope Street8th Floor
Los Angeles, CA 90071
2. Date: 04/27/2005
3. FEC Committee ID #: C00161604This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
Affiliated Committees/Organizations
Cooperative of American Physicians-Mutual Protection Trust
333 South Hope
8th Floor
Los Angeles, California 90071
Relationship: Sponsor
Organization Type: Membership Organization
Custodian of Records:
Cindy Lesonsky
333 South Hope Street
8th Floor
Los Angeles, CA 90071
Title: Assistant Treasurer
Treasurer:
Vincent Gualtieri, MD
333 South Hope Street
8th Floor
Los Angeles, California 90071
Title: Treasurer
Designated Agent(s):
Cindy Lesonsky
333 South Hope Street
8th Floor
Los Angeles, California 90071
Title: Assistant Treasurer
Banks or Depositories
Wells Fargo Bank
3550 Wilshire Blvd.
Los Angeles, California 90010
Signed: Vincent Gualtieri, MD
Date Signed: 04/27/2005
(End FEC FORM 1)
Date Signed: 04/27/2005