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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-454269

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

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

    NOTE: Email address is different than previously reported

2. Date: 02/25/2010

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:

Whitney Hale
900 7th Street N.W.
Suite 975
Washington, DC 20001
Title: Dir Govt Affairs
Phone # (202) 310-5121

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: 02/25/2010

FORM TEXT

(End FEC FORM 1)

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