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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-190203

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1. COOPERATIVE OF AMERICAN PHYSICIANS - MUTUAL PROTECTION TRUST (CAP-MPT) FEDERAL PAC

    NOTE:Commmittee Name is different than previously reported

    333 South Hope Street
    8th Floor
    Los Angeles, CA 90071

2. Date: 10/19/2005

3. FEC Committee ID #: C00161604 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Cooperative of American Physicians-Mutual Protection Trust
333 South Hope
8th Floor
Los Angeles, California 90071
Relationship: Connected Organization
Organization Type: Membership Organization

Custodian of Records:

Cindy Lesonsky
333 South Hope Street
8th Floor
Los Angeles, CA 90071
Title: Assistant Treasurer

Treasurer:

Kirk Alan Pessner
20 Park Road
Suite E
Burlingame, California 94010
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: Kirk Alan Pessner
Date Signed: 10/19/2005

(End FEC FORM 1)

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