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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1116651

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1. TELADOC, INC. POLITICAL ACTION COMMITTEE

    2350 KERNER BLVD., SUITE 250
    SAN RAFAEL, CA 94901
    Email: fecform1@nmgovlaw.com

2. Date: 10/26/2016

3. FEC Committee ID #: C00579359 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

TELADOC, INC.
2 MANHATTANVILLE RD., SUITE 203
PURCHASE, New York 10577
Affiliated Relationship Code: Connected Organization

Custodian of Records:

DARRIN LIM
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, CA 94901
Title: Custodian of Records
Phone # (415) 389-6800

Treasurer:

Darrin Lim
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Treasurer
Phone # (415) 389-6800

Designated Agent(s):

STEVEN S. LUCAS
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Assistant Treasurer
Phone # (415) 389-6800

Banks or Depositories

BANK OF MARIN
504 TAMALPAIS DRIVE
CORTE MADERA, California 94925

Signed: STEVEN S. LUCAS
Date Signed: 10/26/2016

(End FEC FORM 1)

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