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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-164385

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1. First Health Group Corp-Coventry Health Care Inc. PAC

    NOTE:Commmittee Name is different than previously reported

    1133 21st Street NW
    Suite 450
    Washington, DC 20036

    NOTE: Address is different than previously reported

    Email: TomMastri@firsthealth.com; MelissaSchooley@firsthealth.com

2. Date: 02/04/2005

3. FEC Committee ID #: C00217216 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

First Health Group Corp
1133 21st Street NW
Suite 450
Washington, DC 20036
Relationship: Connected Organization
Organization Type: Corporation

Coventry Health Care Inc.
6706 Rockledge Dr.
Suite 900
Bethesda, Maryland 20817
Relationship: Connected Organization
Organization Type: Corporation

Custodian of Records:

Melissa Schooley
1133 21st Street NW
Suite 450
Washington, DC 20036
Title: Custodian of Records
Phone # (202) 872-0556

Treasurer:

Tom Mastri
3200 Highland Ave.
Downers Grove, Illinois 60515
Title: Treasurer
Phone # (630) 737-5735

Designated Agent(s):

John Stelben
6705 Rockledge Drive
Suite 900
Bethesda, Maryland 20817
Title: Asst. Treasurer
Phone # (301) 581-5729

Banks or Depositories

The LaSalle Bank
135 LaSalle St.
Chicago, Illinois 60603

Signed: Tom Mastri
Date Signed: 02/08/2005

(End FEC FORM 1)

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