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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1211792

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1. Lundbeck LLC Employee Political Action Committee

    Six Parkway North
    Suite 400
    Deerfield, IL 60015
    Email: NGOL@Lundbeck.com

    NOTE: Email address is different than previously reported

2. Date: 02/28/2018

3. FEC Committee ID #: C00491118 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

Lundbeck LLC
Six Parkway North
Suite 400
Deerfield, Illinois 60015
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Nicholas G Olivares
Six Parkway North
Suite 400
Deerfield, IL 60015
Title: Custodian of Records
Phone # (224) 507-8406

Treasurer:

Nicholas G Olivares
Six Parkway North
Suite 400
Deerfield, Illinois 60015
Title: Treasurer
Phone # (224) 507-8406

Designated Agent(s):

Heather Strawn
601 13th Street, N.W.
Suite 610 N
Washington, DC 20005
Title: Assistant Treasurer
Phone # (202) 412-1563

Banks or Depositories

Bank of America
135 S. LaSalle Street
Chicago, Illinois 60603

Signed: Nicholas G Olivares
Date Signed: 02/28/2018

FORM TEXT-1

(End FEC FORM 1)

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