FEC Form 1 for SmithKline Beecham Corporation Political Action Committee (GlaxoSmithKline PAC)Form 1 for SmithKline Beecham Corporation Political Action Committee (GlaxoSmithKline PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-158382

1. SmithKline Beecham Corporation Political Action Committee (GlaxoSmithKline PAC)

Five Moore Drive
P.O. Box 13358
Res. Triangle Park, NC 27709
Email: cfs@pass1.com

2. Date: 01/10/2004

3. FEC Committee ID #: C00199703 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

SmithKline Beecham Corporation (DBA GlaxoSmithKline)
Five Moore Drive
Res. Triangle Park, North Carolina 27709
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Megan L. Brier
1500 K Street N.W.
Suite 650
Washington, DC 20005
Title: PAC Manager

Treasurer:

Gary J. Salamido
Five Moore Drive
Res. Triangle Park, North Carolina 27709
Title: Treasurer

Designated Agent(s):

Dick J. Domann
Five Moore Drive
Res. Triangle Park, North Carolina 27709
Title: Assistant Treasurer

Sarah J. Walsh
1500 K Street N.W.
Suite 650
Washington, DC 20005
Title: Assistant Treasurer

Banks or Depositories

Mechanics and Farmers Bank
P.O. Box 1932
Durham, North Carolina 27702

Signed: Gary J. Salamido
Date Signed: 01/10/2004
Official Committee URL: N/A

(End FEC FORM 1)

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