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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-786916

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1. Terumo BCT, Inc.

    NOTE:Commmittee Name is different than previously reported

    10811 W. Collins Ave.
    Lakewood, CO 80215
    Email: scott.larson@terumobct.com

    NOTE: Email address is different than previously reported

2. Date: 05/22/2012

3. FEC Committee ID #: C00388652 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Scott T Larson
13271 West 83rd Place
Arvada, CO 80005
Title: Secretary/GC
Phone # (303) 205-2814

Treasurer:

Mark Ingebritson
10606 Ridgecrest Circle
Highlands Ranch, Colorado 80129
Title: Controller/Treasurer
Phone # (303) 231-4067

Designated Agent(s):

Banks or Depositories

US Bank
P.O. Box 6343
Fargo, North Dakota 58125

Signed: Mark Ingebritson
Date Signed: 05/22/2012
Official Committee URL: www.Terumobct.com

NOTE: URL is different than previously reported

(End FEC FORM 1)

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