FEC Form 1 for Medtronic Inc. Medical Technology FundForm 1 for Medtronic Inc. Medical Technology Fund

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-751780

1. Medtronic Inc. Medical Technology Fund

950 F Street NW Suite 500
Washington, DC 20004
Email: fecinfo@PASS1.com

NOTE: Email address is different than previously reported

2. Date: 11/04/2011

3. FEC Committee ID #: C00311878 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

Medtronic Inc.
710 Medtronic Parkway NE
Minneapolis, Minnesota 55482
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Peter B Slone
950 F Street NW
Suite 500
Washington, DC 20004
Title: Custodian
Phone # (202) 393-0444

Treasurer:

Gary Ellis
710 Medtronic Parkway NE
Minneapolis, Minnesota 55482
Title: Treasurer
Phone # (763) 505-2770

Designated Agent(s):

Banks or Depositories

Bank of America N.A.
P.O. Box 27128
Concord, California 94520

Signed: Gary Ellis
Date Signed: 11/04/2011

FORM TEXT

(End FEC FORM 1)

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