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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1122050

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1. TELADOC, INC. POLITICAL ACTION COMMITTEE

    28 LIBERTY SHIP WAY, SUITE 2815
    SAUSALITO, CA 94965

    NOTE: Address is different than previously reported

    Email: reporting@politicomlaw.com

    NOTE: Email address is different than previously reported

2. Date: 11/01/2016

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
28 LIBERTY SHIP WAY, SUITE 2815
SAUSALITO, CA 94965
Title: Custodian of Records
Phone # (415) 903-2800

Treasurer:

DARRIN LIM
28 LIBERTY SHIP WAY, SUITE 2815
SAUSALITO, California 94965
Title: Treasurer
Phone # (415) 903-2800

Designated Agent(s):

ERIN LAMA
28 LIBERTY SHIP WAY, SUITE 2815
SAUSALITO, California 94965
Title: Assistant Treasurer
Phone # (415) 903-2800

Banks or Depositories

BANK OF MARIN
2656 BRIDGEWAY, SUITE D
SAUSALITO, California 94965

Signed: DARRIN LIM
Date Signed: 11/01/2016

(End FEC FORM 1)

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