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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-898588

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1. ELI LILLY AND COMPANY POLITICAL ACTION COMMITTEE

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

2. Date: 12/23/2013

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:

Jonathan Haug
Eli Lilly and Company
Lilly Corporate Center, DC 1072
Indianapolis, Indiana 46285
Title: Treasurer
Phone # (317) 655-1852

Designated Agent(s):

Kevin Hern
Eli Lilly and Company
Lilly Corporate Center, DC 1878
Indianapolis, Indiana 46285
Title: Assistant Treasurer
Phone # (317) 655-1838

Banks or Depositories

JP Morgan Chase
1 Chase Manhattan Plaza, 7th Floor
New York, New York 10005

Signed: Jonathan Haug
Date Signed: 12/23/2013

(End FEC FORM 1)

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