SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0104 |
Expires: |
December 31, 2014 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/01/2003
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3. Issuer Name and Ticker or Trading Symbol
LILLY ELI & CO
[ LLY ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
EVP, Science and Technology |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock |
20,504 |
D |
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Common Stock |
2,105 |
I |
401(k) |
Common Stock |
579 |
I
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by daughter |
Common Stock |
38,877 |
I
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by wife |
Common Stock |
589 |
I
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by wife as custodian for son |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Employee stock option (right to buy) |
10/17/1997 |
10/15/2004 |
Common Stock |
18,700 |
14.66 |
D |
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Employee stock option (right to buy) |
10/16/1998 |
10/14/2005 |
Common Stock |
24,000 |
23.41 |
D |
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Employee stock option (right to buy) |
10/21/1999 |
10/20/2006 |
Common Stock |
16,000 |
34.6 |
D |
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Employee stock option (right to buy) |
07/21/2000 |
07/18/2007 |
Common Stock |
100,000 |
54.8 |
D |
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Employee stock option (right to buy) |
10/20/2000 |
10/19/2007 |
Common Stock |
20,000 |
64.06 |
D |
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Employee stock option (right to buy) |
10/19/2001 |
10/17/2008 |
Common Stock |
25,000 |
74.28 |
D |
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Employee Stock Option (right to buy) |
10/18/2002 |
10/16/2009 |
Common Stock |
46,000 |
66.38 |
D |
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Employee stock option (right to buy) |
02/20/2004 |
02/18/2011 |
Common Stock |
75,900 |
73.98 |
D |
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Employee stock option (right to buy) |
10/04/2002
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10/04/2011 |
Common Stock |
23,000 |
79.28 |
D |
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Employee stock option (right to buy) |
02/19/2005 |
02/17/2012 |
Common Stock |
46,000 |
75.92 |
D |
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Employee stock option (right to buy) |
02/17/2006 |
02/15/2013 |
Common Stock |
50,000 |
57.85 |
D |
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Employee stock option (right to buy) |
12/19/2005
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12/17/2010 |
Common Stock |
100,000 |
88.41 |
D |
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Explanation of Responses: |
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Steven M. Paul |
07/10/2003 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
Steven M. Paul
Lilly Corporate Center
Indianapolis, Indiana 46285
Securities and Exchange Commission
Washington, D.C. 20549
Authorization Regarding Reporting Forms
I hereby authorize and designate the following persons to sign and file
with the Commission on my behalf Forms 4 and 5 covering my transactions and
holdings in the common stock and other equity securities of Eli Lilly and
Company as required by Section 16 of the Securities Exchange Act of 1934
and the rules thereunder:
Alecia A. DeCoudreaux, Lilly Corporate Center, Indianapolis, Indiana
James B. Lootens, Lilly Corporate Center, Indianapolis, Indiana
Bronwen L. Mantlo, Lilly Corporate Center, Indianapolis, Indiana
This authorization and designation shall remain in effect until a written
revocation is signed by me and provided to the Commission.
Steven M. Paul
June 24, 2003