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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1005820

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1. Covidien Holdings Inc. Political Action Committee

    NOTE:Commmittee Name is different than previously reported

    950 F Street NW Suite 500
    Washington, DC 20004

    NOTE: Address is different than previously reported

    Email: fecinfo@PASS1.com

    NOTE: Email address is different than previously reported

2. Date: 04/24/2015

3. FEC Committee ID #: C00433490 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

Covidien Holdings Inc.
15 Hampshire Street
Mansfield, Massachusetts 02048
Affiliated Relationship Code: Connected Organization

Medtronic Inc. PAC
950 F Street NW Suite 500
Washington, DC 20004
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Peter Slone
950 F Street NW Suite 500
Washington, DC 20004
Title: Custodian of Records
Phone # (202) 393-0444

Treasurer:

Gary Ellis
710 Medtronic Parkway NE
Minneapolis, Minnesota 55482
Title: Treasurer
Phone # (763) 505-2770

Designated Agent(s):

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Gary Ellis
Date Signed: 04/24/2015

FORM TEXT-1

(End FEC FORM 1)

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