FEC Form 1 for ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEEForm 1 for ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-729460

1. ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

LILLY CORPORATE CENTER
INDIANAPOLIS, IN 46285
Email: LillyPAC@electioncompliance.com

2. Date: 05/20/2011

3. FEC Committee ID #: C00082792 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

Eli Lilly and Company
Lilly Corporate Center
Indianapolis, Indiana 46285
Affiliated Relationship Code: Connected Organization

Custodian of Records:

PAC Outsourcing LLC
6192 Oxon Hill Rd
Suite 601
Oxon Hill, MD 20745
Title: Custodian of Records
Phone # (301) 839-6510

Treasurer:

John Huesing
Lilly Corporate Center
Indianapolis, Indiana 46285
Title: Treasurer
Phone # (317) 276-6178

Designated Agent(s):

Kevin Hern
Lilly Corporate Center
Indianapolis, Indiana 46285
Title: Assistant Treasurer
Phone # (317) 276-6178

Banks or Depositories

JP Morgan Chase
300 Riverside Plaza
Mail Suite IL 0239 10th Floor
Indianapolis, Indiana 462850001

Signed: John Huesing
Date Signed: 05/20/2011

FORM TEXT

(End FEC FORM 1)

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