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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1045299

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1. GlaxoSmithKline LLC PAC (GSK PAC)

    Five Moore Drive
    PO Box 13358
    Res. Triangle Park, NC 27709
    Email: GSKPAC@720Strategies.com

2. Date: 01/20/2016

3. FEC Committee ID #: C00199703 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

GlaxoSmithKline LLC
Five Moore Drive
Res. Triangle Park, North Carolina 27709
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sherry C Smith
1050 K Street, NW
Suite 800
Washington, DC 200014450
Title: Custodian of Records
Phone # (202) 715-1019

Treasurer:

Michael Andy Devine
Five Moore Drive
Res. Triangle Park, North Carolina 277090143
Title: Treasurer
Phone # (864) 680-1656

Designated Agent(s):

William J Schuyler
5 Crescent Drive
Philadelphia, Pennsylvania 19112
Title: Assistant Treasurer
Phone # (202) 715-1020

Banks or Depositories

Machanics and Farmers
PO Box 1932
Durham, North Carolina 27702

Signed: Michael Andy Devine
Date Signed: 01/29/2016

(End FEC FORM 1)

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