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FORM 3
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Washington, D.C. 20549 |
OMB APPROVAL
OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response... 0.5 |
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| 1. Name and Address of Reporting Person * Canute Scott A |
2. Date of Event Requiring Statement (MM/DD/YYYY)
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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)
_____ Director
_____ 10% Owner
__ X __ Officer (give title below) _____ Other (specify below) President, Mfg. Operations / |
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
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1.Title of Security
(Instr. 4) |
2. Amount of Securities Beneficially Owned
(Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) |
4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common Stock | 3000.00 | D | |
| Common Stock | 5179.00 | I | 401(k) |
| Common Stock | 11857.00 | I (1) | Amy D. Canute Rev. Trust |
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Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) |
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1. Title of Derivate Security
(Instr. 4) |
2. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) |
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) | 10/16/1998 | 10/15/2005 | Common Stock | 8000.00 | $23.4075 | D | |
| Employee stock option (right to buy) | 10/21/1999 | 10/20/2006 | Common Stock | 4000.00 | $34.595 | D | |
| Employee stock option (right to buy) | 10/20/2000 | 10/19/2007 | Common Stock | 5700.00 | $64.06 | D | |
| Employee stock option (right to buy) | 10/19/2001 | 10/17/2008 | Common Stock | 5700.00 | $74.2813 | D | |
| Employee Stock Option (right to buy) | 10/18/2002 | 10/16/2009 | Common Stock | 14000.00 | $66.375 | D | |
| Employee stock option (right to buy) | 2/20/2004 | 2/18/2011 | Common Stock | 50600.00 | $73.98 | D | |
| Employee stock option (right to buy) | 10/3/2003 | 10/4/2011 | Common Stock | 23000.00 | $79.28 | D | |
| Employee stock option (right to buy) | 2/18/2005 | 2/17/2012 | Common Stock | 46000.00 | $75.92 | D | |
| Employee stock option (right to buy) | 2/17/2006 | 2/15/2013 | Common Stock | 50000.00 | $57.85 | D | |
| Employee stock option (right to buy) | 2/19/2007 | 2/14/2014 | Common Stock | 46000.00 | $73.11 | D | |
| Explanation of Responses: | |
| ( 1) | Revocable Trust of which reporting person and his wife are trustees. |
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| 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 control number. | |
Scott A. Canute
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:
Robert A. Armitage, Lilly Corporate Center, Indianapolis, Indiana 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.
August 22, 2004