FEC Form 1 for Cooperative of American Physicians Federal Action CommitteeForm 1 for Cooperative of American Physicians Federal Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-29303

1. Cooperative of American Physicians Federal Action Committee

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

2. Date: 03/08/2002

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

Affiliated Committees/Organizations

Cooperative of American Physicians
333 South Hope Street
8th Floor
Los Angeles, California 90071
Relationship: Sponsoring Organizat
Organization Type: Membership Organization

Custodian of Records:

Brett LaRock
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):

Brett LaRock
333 South Hope Street
8th Floor
Los Angeles, California 90071

Banks or Depositories

Wells Fargo Bank
3550 Wilshire Blvd
Los Angeles, California 90010

Signed: Vincent Gualtieri, MD
Date Signed: 03/08/2002

(End FEC FORM 1)

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