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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-755233

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1. Novo Nordisk Inc. PAC (Novo Nordisk PAC)

    NOTE:Commmittee Name is different than previously reported

    1155 F Street NW
    Suite 1150
    Washington, DC 20004
    Email: shno@novonordisk.com

2. Date: 12/17/2011

3. FEC Committee ID #: C00424838 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

Novo Nordisk Inc.
100 College Road West
Princeton, New Jersey 08540
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Lauren Semeniuk
1155 F Street NW
Ste 1150
Washington, DC 20004
Title: Custodian of Records
Phone # (202) 626-4531

Treasurer:

Michael Mawby
1155 F Street NW
Ste 1150
Washington, DC 20004
Title: Treasurer
Phone # (202) 626-4521

Designated Agent(s):

Kevin Ryan
1155 F Street NW
Ste 1150
Washington, DC 20004
Title: Asst. Treasurer
Phone # (202) 626-4524

Banks or Depositories

Wells Fargo
444 N Capitol Street NW
Washington, DC 20001

Signed: Michael Mawby
Date Signed: 12/17/2011

(End FEC FORM 1)

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