FEC Form 1 for Covidien (U.S.) Political Action Committee (Covidien PAC)Form 1 for Covidien (U.S.) Political Action Committee (Covidien PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-296771

1. Covidien (U.S.) Political Action Committee (Covidien PAC)

NOTE:Commmittee Name is different than previously reported

900 7th Street N.W.
Suite 975
Washington, DC 20001

NOTE: Address is different than previously reported

Fax: 703-684-7121
Email: jonathan.collard@covidien.com

2. Date: 07/20/2007

3. FEC Committee ID #: C00433490 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Covidien (U.S.)
900 7th Street N.W.
Suite 975
Washington, DC 20001
Relationship: Connected
Organization Type: Corporation

Tyco International Management Company
9 Roszel Road
Princeton, New Jersey 08540
Relationship: Affiliated Committee

Tyco International Management Company-
P.O. Box 529
Washington, DC 20044
Relationship: Affiliated Committee

Custodian of Records:

Jonathan Collard
900 7th Street N.W.
Suite 975
Washington, DC 20001
Title: Dir Govt Affairs
Phone # (703) 684-2915

Treasurer:

Kevin DaSilva
900 7th Street N.W.
Suite 975
Washington, DC 20001
Title: Treasurer
Phone # (703) 684-2915

Designated Agent(s):

Scott Grossman
900 7th Street N.W.
Suite 975
Washington, DC 20001
Title: Assistant Treasurer
Phone # (703) 684-2915

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Kevin DaSilva
Date Signed: 07/20/2007
Official Committee FAX: 703-684-7121

(End FEC FORM 1)

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