FEC Form 1 for Grifols, Inc. Political Action Committee (GRIFOLSPAC)Form 1 for Grifols, Inc. Political Action Committee (GRIFOLSPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744013

1. Grifols, Inc. Political Action Committee (GRIFOLSPAC)

NOTE:Commmittee Name is different than previously reported

4101 Research Commons
79 TW Alexander Drive
Research Triangle, NC 27709
Email: grifolspac@grifols.com

NOTE: Email address is different than previously reported

2. Date: 09/06/2011

3. FEC Committee ID #: C00464958 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

Grifols, Inc.
4101 Research Commons
79 TW Alexander Drive
Research Triangle, North Carolina 27709
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Brian Scheuer
4101 Research Commons
79 TW Alexander Drive
Research Triangle, NC 27709
Title: Assistant Treasurer
Phone # (919) 316-6687

Treasurer:

Max Debrouwer
2410 Lillyvale Avenue
Los Angeles, California 900323514
Title: Treasurer
Phone # (323) 356-3135

Designated Agent(s):

Brian Scheuer
4101 Research Commons
79 TW Alexander Drive
Research Triangle, North Carolina 27709
Title: Assistant Treasurer
Phone # (919) 316-6687

Banks or Depositories

Wachovia National Bank, NA
Research Triangle Park Financial C
Four Park Drive
Research Triangle, North Carolina 27709

Signed: Mr. Max Debrouwer
Date Signed: 09/06/2011

(End FEC FORM 1)

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