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-789101

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

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

2. Date: 06/08/2012

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

Treasurer:

Gregory Andrulonis
15 Hampshire Street
Mansfield, Massachusetts 02048
Title: Treasurer
Phone # (508) 452-4492

Designated Agent(s):

Jessie Hsiao
15 Hampshire Street
Mansfield, Massachusetts 02048
Title: Assistant Treasurer
Phone # (508) 452-4485

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Gregory Andrulonis
Date Signed: 06/08/2012

FORM TEXT

(End FEC FORM 1)

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