Her father, Josiah K. Lilly Jr., joined the family firm in 1914 and served as its president (1948–53) and chairman of the board (1953–66).

Her brother, J. K. (Joe) III, joined the family business in 1939, but resigned from the firm in 1948 and did not succeed his father as president.

[7] In 1941 Lilly married Guernsey van Riper Jr., an author and the son of an Indianapolis advertising executive.

[1] News sources, including the Indianapolis Star, reported that Lilly suffered from depression for much of her life.

[9][10] It was also reported that when Lilly was in her early seventies her health improved after she began taking Prozac, an antidepressant her family's pharmaceutical firm brought to market in 1988.

"[12] The donations included an unexpected pledge valued at $100 million, mostly in Eli Lilly and Company stock, to Chicago-based Poetry magazine in November 2002.

At the time of Lilly's headline-making donation, the monthly publication had a circulation of approximately 12,000 and its non-profit publisher, the Modern Poetry Association, had a four-person staff and an annual budget of less than $700,000.

[2][4][8] The same year that Lilly made the major donation to Poetry magazine, she also pledged two other large gifts.

[1] In her final years, Lilly's health began to decline and physical limitations confined her to a wheelchair.

In 2006 the court established a niece and nephew as her legal guardians with responsibility for making decisions concerning her estate, which was estimated at more than $1 billion at that time.

Lilly's parents purchased the Ayres's Colonial Revival-style home on Kessler Boulevard in 1955 and renovated it in a European style.

Although Lilly's parents never made Twin Oaks their home, it served as Ruth's residence until her death in 2009 and as a gathering place for the family.

[18] A service in celebration of her life was held on January 11, 2010, at Indianapolis's Christ Church Cathedral, where she had been a member.

The other trust, valued at $200 million in 2008, benefits the Indianapolis Museum of Art,[11] which is located on the grounds of Oldfields, her family's former estate.

Indiana University received additional gifts from Lilly's estate and her related philanthropic foundations.

[23] Many arts-related organizations have been recipients of her support, especially the Americans for the Arts, to whom she pledged a gift valued at $120 million in 2002.

Lilly was also contributor to the Heritage Museums and Gardens in Sandwich, Massachusetts, which her brother established as a tribute to their father.

[1] Twin Oaks, Lilly's Indianapolis home, is privately owned and under lease to the Indiana Historical Society, who manages the site and uses it as a hospitality center.