FEC Form 1 for KINETIC CONCEPTS INC POLITICAL ACTION COMMITTEE (KCIPAC)Form 1 for KINETIC CONCEPTS INC POLITICAL ACTION COMMITTEE (KCIPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-765107

1. KINETIC CONCEPTS INC POLITICAL ACTION COMMITTEE (KCIPAC)

PO BOX 659508
SAN ANTONIO, TX 782659508
Email: lulu.olson@kci1.com

2. Date: 02/08/2012

3. FEC Committee ID #: C00235176 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

KCI USA, Inc.
P.O. Box 659508
San Antonio, Texas 78265
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms Lulu P., Olson
P.O. Box 659508
San Antonio, TX 782659508
Title: Treasurer
Phone # (210) 255-6000

Treasurer:

Ms. Lulu P. Olson
P.O. Box 659508
San Antonio, Texas 782659508
Title: Treasurer
Phone # (210) 255-6000

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank
4351 Medical Drive
San Antonio, Texas 78229

Signed: Ms. Lulu P. Olson
Date Signed: 02/09/2012

(End FEC FORM 1)

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