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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-290441

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1. Gambro BCT Inc. PAC

    10811 W. Collins Ave.
    Lakewood, CO 80215

    NOTE: Address is different than previously reported

    Fax: 3032314934
    Email: taras.skibicky@gambrobct.com

2. Date: 06/08/2007

3. FEC Committee ID #: C00388652 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Deb Phillips
10810 W. Collins Avenue
Lakewood, CO 80215
Phone # (303) 231-4822

Treasurer:

, ____

Designated Agent(s):

Banks or Depositories

Signed: Taras Skibicky
Date Signed: 06/08/2007
Official Committee FAX: 3032314934

(End FEC FORM 1)

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