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-147872

1. COOPERATIVE OF AMERICAN PHYSICIANS FEDERAL ACTION COMMITTEE

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

2. Date: 10/26/2004

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

Affiliated Committees/Organizations

Cooperative of American Physicians
333 South Hope
8th Floor
Los Angeles, California 90071
Relationship: Sponsoring Organization
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):

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

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: 10/26/2004

(End FEC FORM 1)

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