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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-768182

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1. Boehringer Ingelheim USA Corporation Political Action Committee

    900 Ridgebury Road
    Ridgefield, CT 06877
    Email: outsourcing@aritstotle.com

    NOTE: Email address is different than previously reported

2. Date: 02/23/2012

3. FEC Committee ID #: C00420398 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

Boehringer Ingelheim USA Corporation
900 Ridgebury Road
Ridgfield, Connecticut 06877
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Jonathan McPherson
1120 G Street, NW
Suite 1050
Washington, DC 200053829
Title: Custodian of Records

Treasurer:

Frank A. Pomer
900 Ridgebury Road
Ridgefield, Connecticut 068771058
Title: Treasurer
Phone # (203) 837-4895

Designated Agent(s):

Mr. Jonathan McPherson
1120 G Street, NW
Suite 1050
Washington, DC 200053829
Title: Custodian of Records

Banks or Depositories

Deutsche Bank Trust Company Americas
60 Wall Street
New York, New York 10005

Signed: Frank A. Pomer
Date Signed: 02/28/2012

(End FEC FORM 1)

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