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-803878

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

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

2. Date: 08/10/2012

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 Park, North Carolina 27709
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Maxime De Brouwer
2410 Lillyvale Avenue
Los Angeles, California 900323514
Title: Treasurer
Phone # (323) 356-3135

Designated Agent(s):

Javier Chagoyen-Lazaro
2410 Lillyvale Avenue
Los Angeles, California 90032
Title: Assistant Treasurer
Phone # (323) 227-7236

Banks or Depositories

Wells Fargo
Research Triangle Park Financial C
Four Park Drive
Research Triangle Park, North Carolina 27709

Signed: Mr. Maxime De Brouwer
Date Signed: 08/10/2012

(End FEC FORM 1)

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