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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1093201

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1. INTUITIVE SURGICAL INC PAC

    1020 Kifer Road
    SUNNYVALE, CA 940865304

    NOTE: Address is different than previously reported

    Email: ISRGPAC@INTUSURG.COM;Brian.King@intusurg.com

    NOTE: Email address is different than previously reported

2. Date: 06/30/2016

3. FEC Committee ID #: C00462622 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Brian King
1020 Kifer Road
Sunnyvale, CA 94086
Title: Assistant Treasurer
Phone # (408) 523-2064

Treasurer:

Marshall Mohr
1020 Kifer Road
Sunnyvale, California 94086
Title: Treasurer
Phone # (408) 523-2160

Designated Agent(s):

Brian King
1020 Kifer Road
Sunnyvale, California 94086
Title: Assistant Treasurer
Phone # (408) 523-2064

Banks or Depositories

Wells Fargo Bank
400 Hamilton Ave
Palo Alto, California 94301

Signed: Marshall Mohr
Date Signed: 08/09/2016

(End FEC FORM 1)

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