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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-303544

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1. Covidien Political Action Committee (Covidien PAC)

    NOTE:Commmittee Name is different than previously reported

    900 7th Street N.W.
    Suite 975
    Washington, DC 20001
    Fax: 202-310-5137
    Email: jonathan.collard@covidien.com

2. Date: 09/11/2007

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

Affiliated Committees/Organizations

Covidien
15 Hampshire Street
Mansfield, Massachusetts 02048
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Jonathan Collard
900 7th Street N.W.
Suite 975
Washington, DC 20001
Title: Dir Govt Affairs
Phone # (202) 310-5120

Treasurer:

Kevin DaSilva
15 Hampshire Street
Mansfield, Massachusetts 02048
Title: Treasurer
Phone # (508) 261-8000

Designated Agent(s):

Scott Grossman
15 Hampshire Street
Mansfield, Massachusetts 02048
Title: Assistant Treasurer
Phone # (508) 261-8000

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Kevin DaSilva
Date Signed: 09/17/2007
Official Committee FAX: 202-310-5137

FORM TEXT

(End FEC FORM 1)

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