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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-120412

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1. Gambro Healthcare Inc. PAC

    10810 West Collins Avenue
    Lakewood, CO 80215
    Fax: 3032314955
    Email: theresa.moran@us.gambro.com

2. Date: 05/19/2004

3. FEC Committee ID #: C00373704 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Theresa Moran
10810 West Collins Avenue
Lakewood, CO 80215
Phone # (303) 231-4525

Treasurer:

Geoff Simpson
10810 W. Collins Avenue
Lakewood, Colorado 80215
Phone # (303) 239-2167

Designated Agent(s):

Lynn Shanks
10810 W. Collins Avenue
Lakewood, Connecticut 80215
Title: Assistant Treasurer
Phone # (303) 239-2149

Banks or Depositories

U. S. Bank
918 17th Street
Denver, Colorado 80202

Signed: Geoff Simpson
Date Signed: 05/19/2004
Official Committee FAX: 3032314955

(End FEC FORM 1)

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