FEC Form 1 for The Doctors' Company Federal PAC (DOCPAC)Form 1 for The Doctors' Company Federal PAC (DOCPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-133107

1. The Doctors' Company Federal PAC (DOCPAC)

185 Greenwood Road
Napa, CA 94558
Fax: 7072260153
Email: lsiadek@thedoctors.com

2. Date: 08/30/2004

3. FEC Committee ID #: C00300376 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

The Doctors Company
185 Greenwood Road
P.O. Box 2900
Napa, California 945580900
Relationship: Connected Org.
Organization Type: Membership Organization

Custodian of Records:

Leona Egeland Siadek
185 Greenwood Road
Napa, CA 94558
Title: Treasurer
Phone # (707) 226-0373

Treasurer:

Leona Egeland Siadek
185 Greenwood Road
Napa, California 94558
Title: Treasurer
Phone # (707) 226-0373

Designated Agent(s):

Mr. Sal Bianco
185 Greenwood Road
P.O. Box 2900
Napa, California 945580900
Title: Assistant Treasurer
Phone # (707) 226-0160

Banks or Depositories

Wells Fargo Bank
200 B Street
Suite 300
Santa Rosa, California 95401

Signed: Leona Egeland Siadek
Date Signed: 08/30/2004
Official Committee FAX: 7072260153

(End FEC FORM 1)

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