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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409765

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

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

2. Date: 03/26/2009

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
15 Hampshire Street
Mansfield, Massachusetts 02048
Affiliated Relationship Code: Connected Organization

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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409765

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

2. Date: 03/26/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Kevin DaSilva
Date Signed: 03/26/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409765

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

2. Date: 03/26/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Kevin DaSilva Date Signed: 03/26/2009

(End FEC FORM 1)

Signed: Kevin DaSilva
Date Signed: 03/26/2009