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-1505856

1. ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

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

2. Date: 03/22/2021

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
5845 Richmond Highway
Suite 820
Alexandria, VA 22303
Title: Custodian of Records
Phone # (703) 347-6551

Treasurer:

Hormaz Dubash
Eli Lilly and Company
Lilly Corporate Center
Indianapolis, Indiana 46285
Title: Treasurer
Phone # (317) 276-5764

Designated Agent(s):

Jennifer Fulk
Eli Lilly and Company
Lilly Corporate Center
Indianapolis, Indiana 46285
Title: Assistant Treasurer
Phone # (317) 433-4769

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1505856

1. ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

2. Date: 03/22/2021

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Hormaz Dubash
Date Signed: 03/22/2021

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1505856

1. ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

2. Date: 03/22/2021

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Hormaz Dubash Date Signed: 03/22/2021

(End FEC FORM 1)

Signed: Hormaz Dubash
Date Signed: 03/22/2021