FEC Form 1 for Baxalta US Inc. Political Action CommitteeForm 1 for Baxalta US Inc. Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1012158

1. Baxalta US Inc. Political Action Committee

NOTE:Commmittee Name is different than previously reported

901 15th Street, NW
Suite 500
Washington, DC 20005
Email: Danita.Humphries@Baxalta.com;Kendra.Crowley@Skadden.com

NOTE: Email address is different than previously reported

2. Date: 07/01/2015

3. FEC Committee ID #: C00578336 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

Baxalta US Inc.
1 Baxter Parkway
Deerfield, Illinois 60015
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Jed Perry
901 15th Street, NW
Suite 500
Washington, DC 20005
Title: Treasurer

Designated Agent(s):

Banks or Depositories

JPMorgan Chase Bank, N.A.
10 South Dearborn
Floor 9
Chicago, Illinois 60603

Signed: Jed Perry
Date Signed: 07/02/2015

(End FEC FORM 1)

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