OGE Form 278e (March 2014)
Instructions for Part 7
Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

Filer's Name iPage Number

Part 7: Transactions

# |Description Type Date Amount

ie

19.

20.



OGE Form 278e (March 2014)

Instructions for Part 1

Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

\Filer's Name

Page Number

Part 1: Filer's Positions Held Outside United States Government

i# |Organization Name City/State

Organization Type

Position Held

From



OGE Form 278e (March 2014)
5. Spouse's Employment Assets and Income

Part 5 discloses the following:

+ Sources of earned income (excluding honoraria) for the filer's spouse totaling more than $1,000 during the reporting period (e.g., salary, consulting fees, and partnership share)

+ Sources of honoraria for the filer's spouse greater than $200 during the reporting period

+ Assets related to the filer's spouse's employment, business activities, other income-generating activities that (1) ended the reporting period with a value greater than $1,000 or

(2) produced more than $200 in income during the reporting period (e.g., equity in business or partnership, stock options, retirement plans/accounts and their underlying holdings as
appropriate, deferred compensation, and intellectual property, such as book deals and patents)

This section does not include assets or income from United States Government employment or assets that were acquired separately from the filer's spouse's business,
employment, or other income-generating activities (e.g., assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0 - $200
or if the asset qualifies as an excepted investment fund (EIF). Amounts of income are not required for a spouse's earned income (excluding honoraria).

6. Other Assets and Income

Part 6 discloses each asset, not already reported, that (1) ended the reporting period with a value greater than $1,000 or (2) produced more than $200 in investment income during
the reporting period. For purposes of the value and income thresholds, the filer aggregates the filer's interests with those of the filer's spouse and dependent children. This section
does not include the following types of assets: (1) a personal residence (unless it was rented out during the reporting period); (2) income or retirement benefits associated

with United States Government employment (e.g., Thrift Savings Plan); and (3) cash accounts (e.g., checking, savings, money market accounts) at a single financial institution
with a value of $5,000 or less (unless more than $200 of income was produced). Additional exceptions apply. Note: The type of income is not required if the amount of income is
$0 - $200 or if the asset qualifies as an excepted investment fund (EIF).

7. Transactions

Part 7 discloses purchases, sales, or exchanges of real property or securities in excess of $1,000 made on behalf of the filer, the filer's spouse or dependent child during reporting
period. This section does not include transactions that concern the following: (1) a personal residence, unless rented out; (2) cash accounts (e.g., checking, savings, CDs, money market
accounts) and money market mutual funds; (3) Treasury bills, bonds, and notes; and (4) holdings within a federal Thrift Savings Plan account. Additional exceptions apply.

8. Liabilities

Part 8 discloses liabilities over $10,000 that the filer, the filer's spouse or dependent child owed at any time during the reporting period. This section does not include the following types
of liabilities: (1) mortgages on a personal residence, unless rented out (limitations apply for PAS filers); (2) loans secured by a personal motor vehicle, household furniture, or appliances,
unless the loan exceeds the item's purchase price; and (3) revolving charge accounts, such as credit card balances, if the outstanding liability did not exceed $10,000 at the end of the
reporting period. Additional exceptions apply.

9. Gifts and Travel Reimbursements
This section discloses:

* Gifts totaling more than $375 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.
+ Travel reimbursements totaling more than $375 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.

For purposes of this section, the filer need not aggregate any gift or travel reimbursement with a value of $150 or less. Regardless of the value, this section does not include the
following items: (1) anything received from relatives; (2) anything received from the United States Government or from the District of Columbia, state, or local governments;

(3) bequests and other forms of inheritance; (4) gifts and travel reimbursements given to the filer's agency in connection with the filer's official travel; (5) gifts of hospitality (food,
lodging, entertainment) at the donor's residence or personal premises; and (6) anything received by the filer's spouse or dependent children totally independent of their relationship to the
filer. Additional exceptions apply.


Applicability: All filers must complete Part 3.
Reporting Period:
Candidate, Nominee, or New Entrant: As of the date of filing

Candidate, Nominee, or New Entrant:

Annual: Preceding calendar year and current year to filing date

Termination: End of period covered by last report to termination date

Reporting Requirement:

Report any agreements or arrangements that you had during the
reporting period for the following: (1) continuing participation in an
employee welfare or benefit plan maintained by a former employer;
(2) leave of absence; (3) future employment; or (4) continuation of
payments by a former employer (e.g., severance payments).

Exceptions:

Do not report the following: (1) agreements and arrangements with the
United States Government, such as your participation in the Federal
Employees Retirement System or the Civil Service Retirement System;
(2) agreements and arrangements of your spouse or your dependent
children; (3) if you are a Presidential nominee, any agreement or
arrangement that will end before you file your Nominee report; and

(4) if you are filing a New Entrant report, any agreement or arrangement
that ended prior to the beginning of your appointment to your current

Instructions for Completing Part 3 of the OGE Form 278e: Filer's Employment Agreements and Arrangements

Completing the Fields:

Employer or Party: Provide the parties to the agreement or arrangement,
other than yourself. In most cases, the other party will be your employer.

City/State: Provide the city and state of the other parties.
Status and Terms: Briefly describe the type of agreement or arrangement,

its terms (in particular, the ing and form of any payments), and its
current status.

Date: Provide the month and year in which the agreement or
arrangement began. In many cases, this will be when you joined the
employer or otherwise became eligible for coverage under the
agreement or arrangement.

Nothing to Report: If you do not have anything to report, write “None.”



OGE Form 278e (March 2014)

Instructions for Part 8

Note: This is a public form. Do not include account numbers, street addresses, OF famil

member names. See instructions

for required information.

Filer's Name Page Number
Part 8: Liabilities
# |Creditor Name Type Amount Year Incurred [Rate Term

1.



OGE Form 278¢ (March 2014)
Summary of Contents

1. Filer's Positions Held Outside United States Government

Part 1 discloses positions that the filer held at any time during the reporting period (excluding positions with the United States Government). Positions are reportable even if

the filer did not receive compensation. This section does not include the following: (1) positions with religious, social, fraternal, or political organizations; (2) positions solely of an
honorary nature; (3) positions held as part of the filer’s official duties with the United States Government; (4) mere membership in an organization; and (5) passive investment interests
as a limited partner or non-managing member of a limited liability company.

2. Filer's Employment Assets and Income
Part 2 discloses the following:

+ Sources of earned and other non-investment income of the filer totaling more than $200 during the reporting period (e.g., salary, fees, partnership share, honoraria, scholarships,

and prizes)

+ Assets related to the filer's business, employment, or other income-generating activities that (1) ended the reporting period with a value greater than $1,000 or (2) produced more than
$200 in income during the reporting period (e.g., equity in business or partnership, stock options, retirement plans/accounts and their underlying holdings as appropriate, deferred
compensation, and intellectual property, such as book deals and patents)

This section does not include assets or income from United States Government employment or assets that were acquired separately from the filer’s business, employment, or other
income-generating activities (e.g., assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0 - $200 or if the asset
qualifies as an excepted investment fund (EIF).

3. Filer's Employment Agreements and Arrangements

Part 3 discloses agreements or arrangements that the filer had during the reporting period with an employer or former employer (except the United States Government), such as
the following:

+ Future employment

+ Leave of absence

+ Continuing payments from an employer, including severance and payments not yet received for previous work (excluding ordinary salary from a current employer)

+ Continuing participation in an employee welfare, retirement, or other benefit plan, such as pensions or a deferred compensation plan

+ Retention or disposition of employer-awarded equity, sharing in profits or carried interests (¢.g., vested and unvested stock options, restricted stock, future share of a company's
profits, etc.)

4. Filer's Sources of Compensation Exceeding $5,000 in a Year
Part 4 discloses sources (except the United States Government) that paid more than $5,000 in a calendar year for the filer's services during any year of the reporting period. The filer

discloses payments both from employers and from any clients to whom the filer personally provided services. The filer discloses a source even if the source made its payment to the
filer’s employer and not to the filer. The filer does not disclose a client's payment to the filer's employer if the filer did not provide the services for which the client is paying.


OGE Form 278e (March 2014)

Instructions for Part 5

Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information

Filer's Name

Page Number

Part 5: Spouse's Employment Assets and Income

# |Description

ELF

Value

Income Type

Income Amount

de



instructions for Completing Part 8 of the OGE Form 278e: Liabilities

(Applicability: All filers complete Part 8.
Reporting Period:

Candidate, Nominee, or New Entrant: Preceding calendar year and
current year to filing date

Annual: Preceding calendar year

Termination: End of period covered by last report to termination date

Reporting Requirement:

Report liabilities over $10,000 that you, your spouse, or your
dependent child owed at any time during the reporting period.

Reporting Exceptions:

Do not report the following: (1) loans secured by a personal motor
vehicle, household furniture, or appliances, provided that the loan does
not exceed the item’s purchase price; (2) revolving charge accounts,
such as credit card balances, where the outstanding liability did not
exceed $10,000 at the end of the reporting period; (3) personal
liabilities owed to a spouse, parent, sibling, or child of yours, your
spouse, or your dependent child; (4) liabilities of a spouse living
separate and apart with the intention of terminating the marriage or
providing for a permanent separation; (5) liabilities of a former spouse
or a spouse from whom you are permanently separated; and

(6) obligations arising from divorce or permanent separation.

Additional Exception for Certain Mortgages:

¢ If you are not a nominee or appointee to a Presidentially-appointed,
Senate-confirmed (PAS) position, you do not need to report a mortgage
or home equity loan secured by your personal residence, unless you
rented out the personal residence during the reporting period.
However, you must report mortgages or home equity loans on
properties that do not qualify as personal residences.

¢ If you are a nominee or appointee to one of the three types of PAS
positions listed below, you do not need to report a mortgage or home
equity loan secured by your personal residence, unless you rented out
the personal residence during the reporting period. However, you
must report mortgages or home equity loans on properties that do not
qualify as personal residences. The three types of PAS positions are:
(1) a position in which you will serve as a special Government
employee (SGE); (2) a position as a Foreign Service Officer below

the rank of ambassador; or (3) a position in the uniformed services for
which the pay grade prescribed by section 201 of title 37, United
States Code is O-6 or below.

¢ If you are a nominee or appointee to any other type of PAS posi
you must report a mortgage or home equity loan secured by your
personal residence as you would a mortgage on any other property.

ion,

(Instructions continue on the following page.)



Instructions for Completing Part 5 of the OGE Form 278e: Spouse's Employment Assets and Income

Applicability: All filers complete Part 5.
Reporting Period:

Candidate, Nominee, or New Entrant: Preceding calendar year and
current year to filing date

Annual: Preceding calendar year

Termination: End of period covered by last report to termination date

Reporting Requirement:

Report each source of earned income, excluding honoraria, for your
spouse over $1,000 during the reporting period.

Report each source of honoraria for your spouse over $200 during the
reporting period.

* Report each asset related to your spouse’s employment, business
activities, other income-generating activities that (1) ended the
reporting period with a value greater than $1,000 or (2) produced more
than $200 in income during the reporting period (e.g., equity in business
or partnership, stock options, retirement plans/accounts and their
underlying holdings as appropriate, deferred compensation, and
intellectual property, such as book deals and patents).

Exceptions:

Do not include assets or income from United States Government
employment. In addition, do not include assets that were acquired
separately from your spouse’s business, employment, or other income-
generating activities (e.g., assets purchased through a brokerage account)
because you will report these assets in Part 6.

Completing the Fields:

Complete these fields using the instructions from Part 2 with two
exceptions. First, you do not need to provide the exact amount of your
spouse’s earned income, other than honoraria. Instead, simply describe
the type of income in the Income Type field and leave the Income
Amount field blank. Second, the value and income amount fields
include a category labeled “Over $1,000,000.” You may use this
category or you may use the higher value and amount categories.

Nothing to Report: If you do not have anything to report, write “None.”



Instructions for Completing Part 4 of the OGE Form 278e: Filer's Sources of Compensation Exceeding $5,000 in a Year

Applicability: Complete Part 4 if you are filing a Nominee or
New Entrant report. Otherwise, leave this Part blank.

Reporting Period:

Nominee or New Entrant: Preceding two calendar years and current
year to filing date

Other Reports: N/A
Reporting Requirement:

Report any source (except the United States Government) that paid
more than $5,000 for your services during any year of the reporting
period. Report employers and any clients to whom you personally
provided services. You must report a source even if the source made
its payment to your employer and not to you. Do not report a client
who paid your employer if you did not provide the services for which
ithe client made the payment.

Exception:

In certain rare cases, you need not provide the identity of confiden
clients. In those cases, indicate the number of confidential clients that
have not been disclosed (e.g., “2 confidential clients not disclosed”).

Completing the Fields:

Source Name: Provide the name of the source.

City/State: Provide the city and state in which this source is located.

Brief Description of Duties: Provide a brief description of your duties
or the type of services rendered.

* Confidential Clients: You do not need to report the identity of a
client if the client’s identity is protected by a court order or is under
seal. In limited circumstances, the exception may also apply if the c
is considered confidential because:

1. the client is the subject of a pending grand jury proceeding or other
non-public investigation in which there are no public filings, statements,
appearances, or reports that identify him or her;

2. disclosure is prohibited by a rule of professional conduct that can be
enforced by a professional licensing body; or

3. a privileged relationship was established by a written confidentiality
agreement, entered into at the time that your services were retained,
that expressly prohibits disclosure of the client's identity.

A client will not be deemed confidential merely based on the filer’s
belief that the client would prefer not to be disclosed or based on the
fame or social standing of the client.

Nothing to Report: If you do not have anything to report and you are
filing a Nominee or New Entrant report, write “None.”



OGE Form 278e (March 2014)

Instructions for Part 6

Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information

Filer's Name

Page Number

Part 6: Other Assets and Income

'# |Description

EIF

Value

Income Type

Income Amount

10.

ll.

12.



Instructions for Completing Part 7 of the OGE Form 278e: Transactions

‘Applicability: Complete Part 7 if you are filing an Annual
or Termination report. Otherwise, leave this Part blank.

Reporting Period:
Candidate, Nominee, or New Entrant: N/A

Candidate, Nominee, or New entrant

Annual: Preceding calendar year

Termination: End of period covered by last report to termination date

Reporting Requirement:

Report any purchase, sale, or exchange of real property or securities in
lexcess of $1,000 that was made by you, your spouse, or your dependent
child during the reporting period.

Do not report the following: (1) a personal residence, unless the
personal residence was rented out at any point during the reporting
period; (2) cash accounts (e.g., checking, savings, CDs, money market
accounts) and money market mutual funds; (3) Treasury bills, notes,
land bonds; (4) Thrift Saving Plan accounts; (5) an underlying asset of
an excepted investment fund, an excepted trust, or a qualified trust;
(6) transactions that you already reported in your periodic transaction
report (OGE Form 278-1), unless your agency requires duplicate
reporting; (7) transactions that occurred when you were not an
lemployee of the United States Government; (8) transactions that
occurred solely by and between you, your spouse, and your dependent
children; (9) interests of a spouse living separate and apart with

the intention of terminating the marriage or providing for a permanent
separation; and (10) interests of a former spouse or a spouse from
lwhom you are permanently separated.

Description: Provide the name of the asset.
Type: Specify the type of transaction as a purchase, sale, or exchange
Date: Provide the month, day, and year of the transaction.

Amount: Report the amount of transaction by selecting the appropriate
category. You may use the “Over $1,000,000” category only for
transactions involving your spouse’s or dependent child’s assets.

Do not use this category for your assets or assets held jointly with your
spouse or dependent child.

Nothing to Report: If you do not have anything to report, write “None.”



OGE Form 278e (March 2014)
Privacy Act Statement

Title I of the Ethics in Government Act of 1978, as amended (the Act), 5 U.S.C. app. § 101 et seq., as amended by the Stop Trading on Congressional Knowledge Act of 2012

(Pub. L. 112-105) (STOCK Act), and 5 C.F.R. Part 2634 of the U. S. Office of Government Ethics regulations require the reporting of this information. The primary use of the
information on this report is for review by Government officials to determine compliance with applicable Federal laws and regulations. This report may also be disclosed upon request
to any requesting person in accordance with sections 105 and 402(b)(1) of the Act or as otherwise authorized by law. You may inspect applications for public access of your own form
upon request. Additional disclosures of the information on this report may be made: (1) to any requesting person, subject to the limitation contained in section 208(d)(1) of title 18, any
determination granting an exemption pursuant to sections 208(b)(1) and 208(b)(3) of title 18; (2) to a Federal, State, or local law enforcement agency if the disclosing agency becomes
aware of violations or potential violations of law or regulation; (3) to another Federal agency, court or party in a court or Federal administrative proceeding when the Government is a
party or in order to comply with a judge-issued subpoena; (4) to a source when necessary to obtain information relevant to a conflict of interest investigation or determination; (5) to

the National Archives and Records Administration or the General Services Administration in records management inspections; (6) to the Office of Management and Budget during
legislative coordination on private relief legislation; (7) to the Department of Justice or in certain legal proceedings when the disclosing agency, an employee of the disclosing agency, or
the United States is a party to litigation or has an interest in the litigation and the use of such records is deemed relevant and necessary to the litigation; (8) to reviewing officials in a
new office, department or agency when an employee transfers or is detailed from one covered position to another; (9) to a Member of Congress or a congressional office in response

to an inquiry made on behalf of an individual who is the subject of the record; (10) to contractors and other non-Government employees working on a contract, service or assignment for
the Federal Government when necessary to accomplish a function related to an OGE Government-wide system of records; and (11) on the OGE Website and to any person, department
or agency, any written ethics agreement filed with OGE by an individual nominated by the President to a position requiring Senate confirmation. See also the OGE/GOVT-1 executive
branch-wide Privacy Act system of records.

Public Burden Information
This collection of information is estimated to take an average of three hours per response, including time for reviewing the instructions, gathering the data needed, and completing the
form. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Program Counsel,

USS. Office of Government Ethics (OGE), Suite 500, 1201 New York Avenue, NW., Washington, DC 20005-3917.

Pursuant to the Paperwork Reduction Act, as amended, an agency may not conduct or sponsor, and no person is required to respond to, a collection of information unless it displays a
currently valid OMB control number (that number, 3209-0001, is displayed here and at the top of the first page of this OGE Form 278e).


General Instructions for Completing the OGE Form 278e

Should | Use This Form?

Candidate: Yes, you should file your report using this form.

Other Category of Filer: In most cases, individuals will file their
public financial disclosure reports through an electronic financial
disclosure system. Do not use this form if you plan to file using
an electronic financial disclosure system.

When Must | File?

Candidate: Within 30 days of becoming a candidate for nomination or
election to the office of President or Vice President, or by May 15 of
that calendar year, whichever is later, but at least 30 days before the
election, and on or before May 15 of each succeeding year you
continue to be a candidate

Nominee: No later than 5 days after nomination by the President

New Entrant: Within 30 days of assuming a covered position

Annual: No later than May 15 annually

Termina’

ion: Within 30 days of leaving a covered position

Extensions

The employing agency may grant you an extension of up to 45 days for
good cause shown with the possibility of one additional extension of
up to 45 days. Extensions for Candidates are granted by the Federal
Election Commission.

Late Filing

You will be subject to a $200 late filing fee if you file your report
more than 30 days after the due date (including any extensions). A
report is considered to be filed when it is received by the agency.
Agencies may waive this fee if the delay was caused by extraordinary
circumstances. Unless waived, the agency will collect the fee for
deposit with the United States Treasury.

Warnings

Knowing and willful falsification of information, or failure to file or report
information required to be reported by section 102 of the Ethics in
Government Act of 1978, as amended (the Act), may subject you toa

civil monetary penalty and to disciplinary action by your employing
agency or other appropriate authority under section 104 of the Act.
Knowing and willful falsification of information required to be filed

by section 102 of the Act may also subject you to criminal prosecution.



Applicability: Complete Part 9 if you are filing an Annual or
Termination report. Otherwise, leave this Part blank.

Reporting Period:
Candidate, Nominee, or New Entrant: N/A
Annual: Preceding calendar year

Termination: End of period covered by last report to termination date

Reporting Requirement:

¢ Gifts totaling more than $375 that you, your spouse, and your
dependent children received from any one source during the reporting
period.

Travel reimbursements totaling more than $375 that you, your
spouse, and your dependent children received from any one source
during the reporting period.

If more than one gift or travel reimbursement was received from a
single source: (1) Determine the value of each item received from

that source; (2) exclude each item valued at $150 or less; and (3) add
the value of those items valued at more than $150. If the total is more
than $375, then you must report each item valued at more than $150.

Except

Do not report the following: (1) anything received from a relative;

(2) bequests and other forms of inheritance; (3) suitable mementos of
a function honoring you (e.g., retirement party); (4) food, lodging,
transportation, and entertainment or reimbursements provided by a
foreign government within a foreign country or by the United States
Government, the District of Columbia, or a State or local government;
(5) food and beverages not consumed in connection with a gift of
overnight lodging; (6) anything given to your spouse or dependent child

Instructions for Completing Part 9 of the OGE Form 278e: Gifts and Travel Reimbursements

totally independent of their relationship to you; (7) gifts in the nature
of communications to your office, such as subscriptions to newspapers
and periodicals; (8) gifts of hospitality (food, lodging, entert ment)
on the donor's personal or family premises, as defined in 5 C.F.R.

Part 2634; (9) any gifts and travel reimbursements received when you
were not an employee of the United States Government; and (10) any
reimbursements you received for political trips that were required to
be reported under section 304 of the Federal Election Campaign Act
of 1971 (2 U.S.C. § 434).

Completing the Fields:

Source Name: Provide the identity of the source.

City/State: Provide the source’s city and state of business or
residence.

Brief Description: Describe the nature of the item or reimbursement
received. For travel-related gifts and reimbursements, include a travel
erary, the dates of travel, and the nature of the expenses. Although
not required, it is helpful to specify your relationship to the source or
note the basis on which you accepted the gift or reimbursement.

Value: Provide the fair market value of the gift(s) or travel
reimbursement(s).

Nothing to Report: If you do not have anything to report, write “None.”



Completing the Fields:

Creditor Name: Provide the name of the creditor/lending institution.

Type: Identify the type of liability.

Amount: Select the appropriate category of amount or value. For
revolving charge accounts, use the value of the liability at the end of the
reporting period. For all other liabilities, select the category that
corresponds to the highest amount owed during the reporting period.
You may use the “Over $1,000,000” category only for your spouse’s

or dependent child’s liabilities. Do not use this category for your
liabilities or a joint liability for you and your spouse or dependent child.

Year Incurred: Provide the year that the liability was incurred.

Rate: Provide the interest rate. Describing the rate in reference toa
prime rate, such as “prime + 1,” is also sufficient.

Term: Specify, in years or months, the time that the loan allows for
repayment. If applicable, you may write “on demand” or “revolving.”

Nothing to Report: If you do not have anything to report, write “None.”



Instructions for Completing Part 6 of the OGE Form 278e: Other Assets and Income

Applicability: All filers complete Part 6.
Reporting Period:

Candidate, Nominee, or New Entrant: Preceding calendar year and
current year to filing date

Annual: Preceding calendar year

Termination: End of period covered by last report to termination date

Reporting Requirement:

Each asset held for investment or the production of income, not already
reported in Part 2 or Part 5, that ended the reporting period with a value
greater than $1,000 or that produced more than $200 in income during
the reporting period. For purposes of the value and income thresholds,
aggregate your interests with those of your spouse and your dependent
children.

Exceptions:

Do not report any of the following: (1) a personal residence that you
did not rent out during the reporting period; (2) retirement benefits
from the United States Government, including the Thrift Savings Plan;
(3) income from social security, veterans’ benefits, and other similar
United States Government benefits; (4) deposits in a single financial
institution aggregating $5,000 or less in money market accounts,
certificates of deposit, savings accounts, checking accounts or other
cash deposits; (5) shares in a single money market mutual fund
aggregating $5,000 or less; (6) loans made by you or your spouse to
each other or to a parent, sibling, child, or grandchild; (7) interests of a
spouse living separate and apart with the intention of terminating the
marriage or providing for a permanent separation; (8) interests of a
former spouse or a spouse from whom you are permanently separated;
land (9) payments from a spouse or former spouse associated with a
divorce or permanent separation.

Completing the Field:

Complete these fields using the instructions from Part 2 with one
exception. The value and income amount fields include a category
labeled “Over $1,000,000.”

You may use this category only for your spouse’s or dependent child’s
assets. Do not use this category for your assets or assets held jointly

with your spouse or dependent child.

Nothing to Report: If you do not have anything to report, write “None.”



OGE Form 278e (March 2014)
Instructions for Part 9
Note: This is a public form. Do not include account numbers, street addresses, or famil member names. See instructions for required information.

Filer's Name Page Number

Part 9: Gifts and Travel Reimbursements

1# |Source Name City/State Brief Description Value

1,

17,

18.

19,

20.



Income Type:

(1) Income Less than $201: Leave this field blank.
(2) Asset Qualifies as an EIF: Leave this field blank.

(3) Dividends, Interest, Capital Gains, or Rent or Royalties: Enter these
types of income into the field.

(4) Other Income: Provide an appropriate description (e.g., “salary”).

Income Amount:

(1) Income Less than $201: Select “None (or less than $201).”

(2) Asset Qualifies as an EIF: Select the category that corresponds to
the total amount of income produced during the reporting period.

(3) Dividends, Interest, Capital Gains or Rent or Royalties: Select the
category that corresponds to the total amount of income produced
during the reporting period.

(4) Other Cases: Provide the exact amount of income produced during
the reporting period in the space provided.

Nothing to Report: If you do not have anything to report, write “None.”



OGE Form 278e (March 2014)

Instructions for Part 2

Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

Filer's Name

Page Number

Part 2: Filer's Employment Assets and Income

# |Description

EIF

Value

Income Type

Income Amount



OGE Form 278e (March 2014)
Instructions for Part 4
Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

Filer’s Name Page Number

Part 4: Filer's Sources of Compensation Exceeding $5,000 in a Year

# |Source Name |City/State Brief Description of Duties

ti



Applicability: All filers complete Part 2.

Reporting Period:

Candidate, Nominee, or New Entrant: Preceding calendar year and

Candidate, Nominee, or New Entrant:

current year to filing date

Annual: Preceding calendar year

Termination: End of period covered by last report to termination date
Reporting Requirement:
Report each source of your earned and other non-investment income

lover $200 during the reporting period (e.g., salary, fees, partnership
share and other business income, honoraria, scholarships, and prizes).

Report each asset related to your business, employment, or other
income-generating activities if the value of the asset at the end of the
reporting period exceeded $1,000 or if the asset produced more than
$200 in income during the reporting period (e.g., equity in business or
partnership, stock options, retirement plans/accounts and their
underlying holdings as appropriate, anticipated payments such as
severance payments, deferred compensation, and intellectual property
such as book deals and patents).

Exceptions:

Do not include assets or income from United States Government
employment. In addition, do not include assets that were acquired
separately from your business, employment, or other income-generating
activities (e.g., assets purchased through a brokerage account) because
you will report these assets in Part 6.

Instructions for Completing Part 2 of the OGE Form 278e: Filer's Employment Assets and Income

Completing the Fields:

Description: Provide a desc! in sufficient to identify the asset or

source being reported.

EIF: If you are reporting an investment vehicle that invests in assets

of its own, you need to report each underlying asset that was individually
worth more than $1,000 at the end of the reporting period or that
individually produced more than $200 in income during the reporting
period. As an exception to this requirement, however, you do not need
to report the underlying assets of an investment vehicle that qualifies as
an excepted investment fund (EIF). Indicate whether your entry qualifies
an excepted investment fund. If your entry is not an investment veh le
at all, select "N/A."

Definition of “Excepted Investment Fund”: An excepted investment

fund is an investment fund that is (1) widely held; (2) either “publicly
traded or available” or “widely diversified”; and (3) independently
managed, meaning you neither exercise control nor have the ability to
exercise control over the financial interests held by the fund. A fund is
widely diversified if it holds no more than 5% of the value of its

portfolio in the securities of any one issuer (other than the United States
Government) and no more than 20% in any particular economic or
geographic sector.

Value: Report the value of an asset by selecting the appropriate
category.

(instructions continue on the following page.)



Instructions for Completing Part 1 of the OGE Form 278e: Filer's Positions Held Outside United States Government

Applicability: All filers complete Part 1.

Candidate, Nominee or New Entrant: Preceding two calendar years
and current year to filing date

Annual: Preceding calendar year and current year to filing date

Termination: End of period covered by last report to termination date

Reporting Requirement:

Report any positions that you held at any time during the reporting
period (excluding positions with the United States Government).
Reportable positions include those of an officer, director, trustee,
general partner, proprietor, representative, employee, or consultant
lof any for-profit or non-profit organization (whether compensated
lor uncompensated).

Exceptions:

Do not report the following: (1) positions held as part of your official
duties with the United States Government; (2) positions with religious,
social, fraternal, or political entities; (3) positions solely of an honorary
nature; (4) mere membership in an organization; and (5) passive
investment interests as a limited partner or non-managing member of a
limited liability company.

In addition, you do not need to report service as a member of an
advisory board or committee if the following criteria are met:

(1) the advisory board or committee is that of a non-profit organization;
(2) your service is unpaid; and (3) you have no fiduciary duties of the
sort exercised by officers, directors, or trustees.

Completing the Field:

Organization Name: Provide the name of the organization.
City/State: Provide the city and state in which the organization is located.
Organization Type: Describe the type of organization.

Position Held: Provide the title or a brief functional description of the
position you hold or held.

From: Provide the month and year in which you began in the position.

To: Provide the month and year in which the position ended. If you still
hold the position, write “present.”

Nothing to Report: If you do not have anything to report, write “None.”



OGE Form 278e (March 2014)

U.S. Office of Government Ethics; 5 C.F.R. part 2634 | Form Approved: OMB No. (3209-0001) UNITED STATES OFFICE OF

Report Type:

Year (Annual Report only):

‘Date of Appointment/Termination:

GOVERNMENT ETHICS

*

Preventing Conflicts of Interest
in the Executive Branch

Executive Branch Personnel Public Financial Disclosure Report (OGE Form 278e)

Filer's Information

[Last Name First Name MI

Position Agency

Other Federal Government Positions Held During the Preceding 12 Months:

Name of Congressional Committee Considering Nomination (Nominees only):

Filer's Certification - I certify that the statements I have made in this report are true, complete and correct to the best of my knowledge:

Signature:

Date:

[Agency Ethics Officials Opinion — On the basis of information contained in this report,
(subject to any comments below)

T conclude that the filer is in compliance with applicable laws and regulations

Signature: Date:
Other Review Conducted By:

Signature: Date:
U.S. Office of Government Ethics Certification (if required):

Signature: Date:

|Comments of Reviewing Officials:



OGE Form 278e (March 2014)

Note: This is a public form. Do not include account numbers,

Instructions for Part 3

street addresses, or family member names. See instructions for required information.

Filer's Name

|Page Number

Part 3: Filer's Employment Agreements and Arrangements

# |Employer or Party

City/State

Status and Terms

Date

1,

10.

12: