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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-136066

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1. COOPERATIVE OF AMERICAN PHYSICIANS FEDERAL ACTION COMMITTEE

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

2. Date: 09/24/2004

3. FEC Committee ID #: C00161604

This 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
333 South Hope
8th Floor
Los Angeles, California 90071
Relationship: Sponsoring Org
Organization Type: Membership Organization

Custodian of Records:

Brett LaRock
333 South Hope Street
8th Floor
Los Angeles, CA 90071
Title: Assistant Treasurer
Phone # (213) 473-8600

Treasurer:

Vincent Gualtieri, MD
333 South Hope Street
8th Floor
Los Angeles, California 90071
Title: Treasurer
Phone # (213) 473-8600

Designated Agent(s):

Cindy Lesonsky
333 South Hope Street
8th Floor
Los Angeles, California 90071
Title: Assistant Treasurer
Phone # (213) 473-8600

Brett LaRock
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: 09/24/2004

(End FEC FORM 1)

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