FEC Form 1 for First Health Group Corp-Coventry Health Care Inc. PACForm 1 for First Health Group Corp-Coventry Health Care Inc. PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-191585

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

1133 21st Street NW
Suite 450
Washington, DC 20036
Email: TomMastri@firsthealth.com; MelissaSchooley@firsthealth.com

2. Date: 11/14/2005

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

J.P. Morgan Chase Bank N.A.
300 South Riverside Plaza
Mailcode IL1-0196 Flr 18
Chicago, Illinois 60670

Signed: Tom Mastri
Date Signed: 11/14/2005

(End FEC FORM 1)

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