Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT. Candidate. RickJ.

Transcription

1 F {Rev. /) C.F.R. Part.s. Office of Government Ethics Reporting ---Status (Check Appropriate Boxes) Reporting ndividual's Name Position for Which Filing Executive Branch Personnel PUBLC FNANCAL DSCLOSURE REPORT Form Approved: OMB No. 9 - ncumbent Calendar Year New Entrant, Termination Termination Date (f Appli Covered by Report Nominee, or ( Filer cable)(month,day, Year) Fee for Late Filing D Candidate Any individual who is reuired to file this report and does so more than days after the date the report is reuired to be Last Name First Name and Middle nitial filed, or, if an extension is granted, more Santorum RickJ. than days after the last day of the filing extension period, shall be subject Title of Position. Department or Agency (f Appllcable) to a $ fee. President Reporting Periods ncumbents: The reporting period is Address (Number, Street, City, State' and ZP Code) Telephone No. (nclude Area Code) thefpreceding calendar year except Part L oca ti on o f o Schedule C and Part of ScheduleD Present Office PO Box, Verona PA -- where you must also include the filing {or forwarding address) year up to the date you file. Part of Title of Posltion(s) and Date(s) Held Schedule Dis not applicable. Posltlon{s) Held with the Federal Government During the Preceding Not Applicable Months (f Not Same as Above) Termination Filers: The reporting period begins at the end of the period covered by your previous filing and ends at the date of termination. Part of Name of Congressional Committee Considering Nomination Do You ntend to Create a Qualified Diversified Trust? Schedule D is not applicable Pres! d entia N om nees Su b ject to Senate Confirmation Not Applicable Yes ' No Nominees, New Entrants and _ L == Candidates for President and Certification Vice President: CERTFYthatthestatementslhave Schedule A--The reporting period made on this form and all attached.. schedulesaretrue,completeandcorrect for income (BLOCK C) S the precedmg.t.o:t:h:ebe:s: tofm::y:k:no:w:l:e:dg:e: L::::-'-=:::::::::: :LL calendaryearandthecurrentcalendar year up to the date of filing. Value assets Date (Month, Day, Year) as of any date you choose that is within Other Review t ".,=::::=o,...::; l ;_; -- days of the date of filing. (f desired by agency) Schedule B-Not applicable.,.... Schedule C, Part (Liabilities)-The AgencyEthlcsOfflclal soplrilon Stgnature of Deslgi;Jated Agency Ethics Offtctallwl Date (Month, Day, Year) reporting period is the preceding calendar on the basis of information contained in this / - --_, year and the current calendar year up to repon, conclude that the filer is in comptia ce any date you choose that is within days with applicable_ laws and regulations {subj to ) ol z / of the date of filing. anycommentsmtheboxbelow). A'A R./A:L-r? / ---:r:tis'gnatur :--- '. / c -=c /- m ----Date(Month,Day,Year) Schedule c, Part (Agreementsor Office of Government cs. Arrangements)-Show an)' agreements or Use Only arrangements as of..tae doffiling. ScheduleD-T!{;jepng period is the preceding two_lenfiit yeaj.nd Comments of Reviewing Officials (f additional space is reuired, use the reverse side of this sheet).,., the crrent calenda[!.yearup to jtbtj date i, ' ' <:'" c of fihng. )::> N,.--.. '.' \/ :- ' -- ' ',_' ''.. ::.-:J (Check box if filing extension granted & indicate number of days f.::,;l_) r,'::.r;:: t _,. Q! --.,./.: f..:j..j,_,_ --- Agelll:\Y Use.nly: - -! L,-:-. 'r: c., ng c_:,:) lu& Reviewed for Apparent Compliance with the Federal Election Campaign Act.- \;,'... L :J OL_: ;. - i.,.,,-, r -: ; - ;J-. :...] :...t..j_j '-' - ' -Sl.ipers'edes Prior Editions, Which Cannot Be Used. (Check box f comments are continued on the reverse side) & -- i OG"E'-i!sely NSN Q-Ol-Q- OGE/Adobe Acrobat version.. {//)

2 U.S. Office - of Government Ethics SCHEDULE A of checked, no other entry is ne.eded in Block C for that item. For you, your spouse, and dependent children, report each asset held for investment or the production of income which had a fair market value exceeding. $, at the close of the reorting period, or which generated more than in income during the reporting period, together with such income. For yourself, also report the source and actual amount of earned income exceeding $ (other than from the U.S. Government). For your spouse, report the source but not the amount of earned income of more than $, (except report the actual amount of any honoraria over $ of your spouse). NoneD Central Airlines Common ' Examples Doejones&Smith, Hometown, State Kempstone Euity Fund RA: Heartland ndex Fund Rental Property: Beaver Plaza State College, PA. _. f.') f....s. z BLOCK B d s:: ::s. o. r.t.. Other Date... N f.') s:: ncome (Mo., Day, _ o -!< o. s:: -!< V) V) (Specify cd Yr.) V) o. V) N f.') c;l f V) _ o. & f.') f.') _ f.') N V). ]. Actual Only if & V) V). f.') f.') V). s:: _. V) V) f.') f.') f.') ;a ) Honoraria _ N V) f.') (A (A.. o. (A (A (A _ d d d ]. (.!).... V) (A. (]) (]). v).s. (A (A... <;:::: c;l. (A (A _ P.... o. [; _... (]). v) 'i:j - _ ll _ V).... _... V) V) v) u (]). V) N V). N &l & a Q : N N V). V) [[ -- (A (A (A (A (A (A (A (A (A u f.') (A (A (A (A (A (A (A - J ,-- t ,-- -,-- - t t---- Law Partnership ncome $, - _l_l_: - - r ==L t xl=[ : , r---- Rental Property: Beaver Plaza State College, PA Rental Property: Beaver Terrace State College, PA Rental Property: Beaver Terrace State College, PA Rental Property: Beaver Terrace State College, PA Checking Account: PNC Bank * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the tler or jointly held OGE/Adobe Acrobat ver.;ion!.. ( //)

3 (Use only if needed) of Valuationo f Assets BLOCKB Checking Account: BB&T.-< ro -B -o z '.-< N (/) ojc tr) ojc f) - ro o_ f) o_ N.. f) -B f).. N C\ f).-< tr) >, f).-< (/).-< u:. (/) f) f).-<.-<.-<.-< (/) c::.:: "Cil N ll"l.-<.-< '.-<.-< ' ' '.-<.-< ' ' ' '.-< f). ' '.-<.-<.-< f).-< o_ :: o, N. f) i o_ ll"l- f).-< ll"l N f).-< f) N M a Other Date ncome (Mo., Day, (Specify Yr.) &.-< Actual Only if ) Honoraria ]. '.-<.-< -o C\. ' -o -o :;: "@: o_ u:. ll"l i N.-< N ll"l i ll"l ".E " " u z " " " " " " " Checking Account: Citibank Universal Health Services, nc. Stock King of Prussia, PA RA: Stifel Financial (Civic Science, nc. Stock) $9.- Director Fees/ Stock Options RA: Stifel Financial (ishares ibo Corp. Bond Fund) RA: Stifel Financial (Apple Computer Stock) RA: Stifel Financial (American Funds - Washington Mutual nvestors Fund) RA: Stifel Financial (American Funds -Ticker: ABND) RA: Stifel Financial (Opnext, nc. Stock) * This category applies only if the asset/income is solely that of the filer's spouse or dependent children_ f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (//

4 (Use only if needed) of BLOCKB RA: Stifel Financial (SPDR Gold Trust- ETF),.,. & lil -B -< -S. lli s:: z ' s::,. rf N Other Date & ncome (Mo., Day, ) Cl) s:: i< o. v) lli i< o. (Specify J Yr.) CS :.:: J J N &...,...,..., (;l -B J & o. N & J,. & Cl) &,. J J,. & Actual Only if & & &,. J s:: J J,. &,. & &,. N' o",. ) Honoraria "til J,. & &,. &,. o. Cl),. & & & o.,.,.,.,.,.,. J lli...,,.,.,. J. & & ' ' ' ] ' &.s.g;j (;l,.,.,....., lli & & lli,. v) -< -< o. lli -< s:: o. -< J J lli ::: lli J.,. o. v) -< J,.,. N J J")" N N,. N" J,. J,.,. b a i. & & & & & & & & & u & & & & & & & & o" RA: Stifel Financial (Oncogenex Pharmaceuticals, nc. Stock) RA: Stifel Financial (Market Vectors Gold Miners Fund) RA: Stifel Financial (Expedia, nc. Stock) RA: Stifel Financial (Range Resources Corporation Stock) RA: Stifel Financial (JDS Uniphae Corporation) RA: Stifel Financial (Market Vectors ETF Jr. Gold Minders Fund) RA: Stifel Financial (Frontier Communications Corporation Stock) RA: Stifel Financial (Keryx Biopharmaceuticals, nc. Stock) * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (

5 (Use only if needed) of RA: Stifel Financial (Annaly Capital Management, nc. Stock) RA: Stifel Financial (nvestment Co. of America Mutual Fund) RA: Stifel Financial (Universal Health RET) RA: Stifel Financial (Bank of America Stock) RA: Stifel Financial (General Mills Stock) RA: Stifel Financial (Exfo nc. Stock) RA: Stifel Financial (Rex Energy Corporation Stock) RA: Stifel Financial (lshares Silver Trust ETF) - Q o:s -s C) -< -< J BLOCKB ] ;:::;- Other Date N Q -!< c:. <) vl -!< c:. (Specify Yr.) o.n o:s o_ - o.n c:. o.n N -s c:. o.n & c:. N <;l il o.n o.n. o.n >. Actual Only if o.n il c:.. s vl o.n il...-< il ) Honoraria o_ N o.n...-< il c:. o:s...-< o_ o_...-<...-< ' ' ' ' ' " o.n <) Q l l,...,...-< o.n C) - <;l o_ c:... C) ' <) c:. -< c:. -< <) c:. C) o.n o.n : t:l - Q o_ o.n o.n <) c:. o.n c:. N N" g; o.n o.n. o.n N o.n o.n N a il il il Cl. u z il il ncome (Mo., Day, RA: Stifel Financial (Finisar Corporation Stock) * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. ( /

6 (Use only if needed) of BLOCK B RA: Stifel Financial (Fabrinet nc. Stock) RA: Stifel Financial (Dreyfus Money Market Account) 9 Plan (Sarah Maria): Stifel Financial (American Funds -Ticker: CCA) 9 Plan (Sarah Maria): Stifel Financial (American Funds -Ticker: CLBA) 9 Plan (Sarah Maria): Stifel Financial (American Funds- Ticker: CT A) 9 Plan (Sarah Maria): Stifel Financial (American Funds -Ticker: CFAA) 9 Plan (Sarah Maria): Stifel Financial (American Funds- Ticker: CGFA) 9 Plan (Daniel): Stifel Financial (American Funds -Ticker: CCA) 9 Plan (Daniel): Stifel Financial (American Funds -Ticker: CLBA) ' s:: CS Vl Vl t; ' s:: &! N Other Date :: ' ncome (Mo., Day, Vl s s:: (Specify b v) V) CS -< Yr.) V) o. N '.., p o. V) V) & '.., Vl N ' t; Cil Lr) Vl ' Actual Only if & V) V) ' E Vl V) ' ' Vl V) V). '. ' ' N v-.. ) Honoraria ;;; ' ' ' ' ' ' ' ' ' (.!)... '. Lr) s::.., K.s V). ' '. Cil ' ' o..... '..,.., o_ : s:: V) V) V) V) d V) V) N Lr) V) N N N V) & Lr) ' ' ' ' ' ' ' ' ' Q z ' ' ' ' ' ' ' ' * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (//

7 (Use only if needed) of 9 Plan (Daniel): Stifel Financial (American Funds- Ticker: CT A) 9 Plan (Daniel): Stifel Financial (American Funds- Ticker: CFAA) 9 Plan (Daniel): Stifel Financial (American Funds- Ticker: CGFA) 9 Plan (Patrick): Stifel Financial (American Funds- Ticker: CNWA) 9 Plan (Patrick): Stifel Financial (American Funds -Ticker: CLBA) 9 Plan (Patrick): Stifel Financial (American Funds- Ticker: CT A) 9 Plan (Patrick): Stifel Financial (American Funds- Ticker: CFAA) 9 Plan (Patrick): Stifel Financial (American Funds - Ticker: CWA) 9 Plan (Patrick): Stifel Financial (American Funsd- Ticker: CGFA) -< z BLOCKB ] Other Date c ncome (Mo., Day, c N c c Cl) c d c (Specify b o_ vi' Yr.)..., -p «S b V) c lf) & <..., <a N lf) c c :>, Cl) Actual Only if V) V) d Y Cl) lf) V) c ) Honoraria p:: c;; N V) Y c c "d "d "d "d -< o_ lf)..., V) c c..., c -< c -< <a : d - "l vi' c lf) V) : N N V) lf) d «S,..., c c V) lf) c N c Cl) vi' Y.a " Y Y d Y Y <a Y Y c c c o_ vi' c ' V) N lf) rl..., vi' N a Y Y Y Y.s Cl u Y Y <T.> Y Y " * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (//

8 (Use only if needed) of BLOCKB 9 Plan (Patrick): Stifel Financial (American Funds -Ticker: CCA) 9 Plan (Peter): Stifel Financial (American Funds -Ticker: CCA) 9 Plan (Peter): Stifel Financial (American Funds -Ticker: CLBA) 9 Plan (Peter): Stifel Financial (American Funds- Ticker: CT A) 9 Plan (Peter): Stifel Financial (American Funds- Ticker: CFAA) 9 Plan (Peter): Stifel Financial (American Funds -Ticker: CGFA) 9 Plan (John): Stifel Financial (American Funds -Ticker CWA) 9 Plan (John): Stifel Financial (American Funds- Ticker: CT A) 9 Plan (John): Stifel Financial (American Funds- Ticker: CFAA). _....., = z " = ;:::;- Other N Date (Mo., Day, ncome Q (Specify b _ <l) o.rl Vl e<$ -< Yr.) p Vl Vl N..,.. & c;l _ Vl.., N Vl. o.rl. Actual Only if Vl.--< Vl _. = o.rl N Vl...-l...-l...-l...-l ) Honoraria Vl...-l. "(i$...-l...-l...-l...-l " _ -g c;....-l...-l " " "...-l Vl..,....-l...-l Vl.--<....,. Vl Vl Vl...-l...-l Vl. N Vl...-l N c;l...-l...-l...-l :.., ". = o,! ": Vl _ o.rl N...-l N Vl...-l Vl...-l. a.e u z * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held -- OGE/Adobe Acrobat version.. (/

9 SF (Rev. /} (Use only if needed) 9 of BLOCKB RA (Spouse): American Funds- Ticker: ANCF RA (Spouse): American Funds- Ticker: AMEC RA (Spouse): American Funds- Ticker: ABAL E*Trade Account: Opnext, nc. Stock E*Trade Account: Keryx Biopharmaceuticals, nc. Stock E*Trade Account: Rex Energy Corporation Stock E*Trade Account: JDS Uniphase Corporation Stock E*Trade Account: Frontier Communications Corporation Stock E*Trade Account: Finisar Corporation Stock,, ' Q,,- Other Date N iiol Q iiol Q Cl) Q (Specify b.($ vi ic tr) ($ n _ Yr.) -B _ tr) tr) _ N iiol -B _ V) _ & iiol Cl) Cil N tr),, iiol Cl) ' _,, iiol :>. Cl) Cl) tr) Actual Only if Cl) V) V) iiol iiol iiol ' ' o_ Q Cl) iiol iiol,, N".,, Cl). a _ V),, iiol iiol,, iiol,, _ iiol iiol iiol o_ ' ' ' -g ' (.!),, tr)..., _ iiol,, vi iiol iiol Cl) Cil,, iiol iiol :g o_.. '..., :g vi _ - o_ tr) V) Q V) : o_ vi,, V),, N" a tr),,,, N tr) N N tr) V),, ncome (Mo., Day, V) V) iiol o" ' ) Honoraria _ iiol iiol iiol iiol iiol iiol iiol iiol iiol Q.s u z iiol iiol iiol iiol iiol iiol iiol iiol * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (

10 (Use only if needed) of E*Trade Account: Exfo nc. Stock E*Trade Account: Oclaro, nc. Stock E*Trade Account: Fabrinet, nc. Stock,_,,_," d «S Cll -< -S d BLOCKB ],_, c c c N c c c Cll d c b c vi i< c U) p «S o, U) ] <a c N U),_, c >. Cll Cll v:. o_,_, U) U),_,..,., c,_, d Cll a U) U),_,,,,, a N U),,,_, Cll,, c,,,_, c " " " -g " -<,, U) c -S,_,,_,,, U) c,, <a,_, c c c c.. ",_, o, vi c -< -< c -< U) U) Other Date ncome (Mo., Day, (Specify Yr.) c o, U) N c o, U) & -<,, ;;: U),_,,_, N U) vi N b i. u c Actual Only if c c ) Honoraria - d o_ U) o_ -< U) c N,, N" U),, U),_,,_, E*Trade Account: Oncogenex Pharmaceuticals, inc. Stock Ethics and Public Policy Center, Washington, DC News Corp., New York, NY Philadelphia nuirer, Philadelphia, PA Salem Radio, Camarillo, CA Consol Energy nc., Canonsburg, PA * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held $,. Senior Fellow Compensation $9,. Contributor Compensation $,. Columnist Compensation $,999 Talk Show Host Compensation $, Consultant Compensation ---- OGE/Adobe Acrobat version.. ( /

11 (Use only if needed) of BLOCKB Clapham Group, Washington, DC American Continental Group, Washington, DC &' = (!$ - ) ). -< = z 'Cl = & Other Date N 'i:i &' ncome (Mo., Day, ) = (Specify ) ) (!$ Yr.) p ) vi cs ll) o_ N &'._. l C\l o_ -s o_ & N &' ) &' ) ' o. &' >. o_ ) ) ) Actual Only if ) ) &' &' &' ' ' a = &' &' ' ' ' ) ) ) &' ' ca N ) Honoraria ) &' &' &'. ' ' ) &' &' &' ' ' ' 'Cl 'Cl 'Cl -g 'Cl -< )._. &' ' ' -S ' ) &' &'. C\l o. cs &'.._. &'._. -< " -< -< cs : -< ) a = ll) -< ) ll) vi - ) N ) ) N ro N N a ) ) >,;- &' &' &' &' &' &' &' &' &' Q p::..s u z &' &' &' &' &' &' &' &' $,- Consultant Compensation $,- Consultant Compensation * This category applies only if the asset/income is solely that of the filer's spouse or dependent children. f the asset/income is either that of the filer or jointly held OGE/Adobe Acrobat version.. (/

12 Do not complete Schedule B if you are a new entrant, nominee, or Vice Presidential or Presidential Candidate SCHEDULE B of Part : Transactions Report any purchase, sale, or exchange Do not report a transaction involving NoneO by you, your spouse, or dependent property used solely as your personal children during the reporting period of any residence, or a transaction solely between Transaction (x) of Transaction (x) real property, stocks, bonds, commodity you, your spouse, or dependent child. ' Check the "Certificate of divestiture" block.. ' 'O o futures, and other securities when the Date oo o,, 'ti amount of the transaction exceeded $,. (Mo., ' 'O o o,,o a ao a to indicate sales made pursuant to a a a o,..,a a a ao. a a a.a U> Cl Day, Yr.) a a a a <ll c,..,a a a a a ao nclude transactions that resulted in a loss. certificate of divestiture from OGE. a a a.c; <ll oa a a g a a a._.a oa ao oa... o.!::.c a..no.. oa a :p V>a. QJO..no <lja ::! (ij,,,,,,,,,,n NV>,, >.;'v) ON NV> >V> -- U"O dentification of Assets a. Cll w o o... Example J Central Airlines Common //99 Not Applicable *This category applies only if the underlying asset is solely that of the filer's spouse or dependent children. f the underlying asset is either held by the filer or jointly held by the filer with the spouse or dependent children, use the other higher categories of value, as appropriate. Part : Gifts, Reimbursements, and Travel Expenses For you, your spouse and dependent children, report the source, a brief descrip- the U.S. Government; given to your agency in connection with official travel; tion, and the value of: () gifts (such as tangible items, transportation, lodging, received from relatives; received by your spouse or dependent child totally food, or entertainment) received from one source totaling more than $, and independent of their relationship to you; or provided as personal hospitality at () travel-related cash reimbursements received from one source totaling more the donor's residence. Also, for purposes of aggregating gifts to determine the than $. For conflicts analysis, it is helpful to indicate a basis for receipt, such total value from one source, exclude items worth $ or less. See instructions as personal friend, agency approval under U.S.C. or other statutory for other exclusions. authority, etc. For travel-related gifts and reimbursements, include travel itinerary, dates, and the nature of expenses provided. Exclude anything given to you by None!! Source (Name and Address) Brief Description Value j-;,.at'l Assn. of Rock Collectors, NY, NY Airline ticket, hotel room & meals incident to national conference //99 (personal activity unrelated to duty) $ Examples ankjones, San Francisco, CA Leather briefcase (personal friend) $ Not Applicable OGE/Adobe Acrobat version.. ( ----

13 Do not complete Schedule B if you are a new entrant, nominee, or Vice Presidential or Presidential Candidate SCHEDULE B continued Part : Transactions (Use only if needed) of Not Applicable Transaction (x) of Transaction (x).. ' o '.-< Date 'c; ' oo.-<.- '.,., (Mo., ' 'O.-<.-<,..;., Cl) 'O.-<.-< o > Day, Yr.).o. U) <:::.-<.s:: og,_,o., ".s:: vi'o!: u Otn tno.,o..., J:: P vi' c) O "iii..-<.-<.-<tn tn.-<.-<n Ntn tn..-< >,;-...;-v) ' VlN dentification of Assets a. (/) w..,..,..,..,..,..,.. o. " o... Ntn >tn!d 9 *This category applies only if the underlying asset is solely that of the filer's spouse or dependent children. f the underlying asset is either held by the filer or jointly held by the filer with the spouse or dependent children, use the other higher categories of value, as appropriate. - OGE/Adobe Acrobat version.. (//

14 Part : Liabilities Report liabilities over $, owed to any one creditor at any time during the reporting period by you, your spouse, or dependent children. Check the highest amount owed during the reporting period. Exclude Examples Creditors (Name and Address) Garst District Bank, Washington, DC ohnjones,jst., Washington, DC M&T Bank, Buffalo, NY M&T Bank, Buffalo, NY Ford Credit, Sterling, VA SCHEDULE C a mortgage on your personal residence None unless it is rented out; loans secured by automobiles, household furniture or appliances; and liabilities owed to certain relatives listed in instructions. See instructions for revolving charge '.-< accounts. Date nterest Term if V)... of Liability ncurred Rate applicable o!lpo.!!.eel.!:.:!:!:, 99!%_ yrs. i---- Promissory note - 999" % on demand - Mortgage on rental properties, State College, PA 9. Mortgage on rental properties, State College, PA 9. Automobile Loan.9 yrs. yrs. yrs. Category of or Value (x) of.. ' ' 'O.-tO.o.-<.-tO ' 'O.-< '.-to,o o.-to.-<.o cc c c cc o_ c cc cc o Oo._. V) V) V) - & - - vi'o <L>O.-<V) V).-<.-<N NV) V).-< >.-t..-v) V)N NV) > ''" o.. o r f *This category applies only if the liability is solely that of the filer's spouse or dependent children. f the liability is that of the filer or a joint liability of the filer with the spouse or dependent children, mark the other higher categories, as appropriate. Part : Agreements or Arrangements of absence; and () future employment. See instructions regarding the report- ing of negotiations for any of these arrangements or benefits. None Report your agreements or arrangements for: () continuing participation in an employee benefit plan (e.g. pension, lk, deferred compensation); () continuation of payment by a former employer (including severance payments); () leaves Status and Terms of any Agreement or Arrangement Parties Date Example Pursuant to partnership agreement, will receive lump sum payment of capital account & partnership share Doe jones & Smith, Hometown, State / calculated on service performed through /. None OGE/Adobe Acrobat version.. (//)

15 SCHEDULED of Part : Positions Held Outside U.S. Government Report any positions held during the applicable reporting period, whether compensated or not. Positions include but are not limited to those of an officer, director, trustee, general partner, proprietor, representative, employee, or consultant of any corporation, firm, partnership, or other business enterprise or any non-profit organization or educational institution. Exclude positions with religious, social, fraternal, or political entities and those solely of an honorary nature. None D Organization (Name and Address) of Organization Position Held From (Mo. Yr.) To (Mo.,Yr.) Hat'l Assn. of Rock Collectors, NY, NY Non-profit education i ::..- Present Law firm Partner / / Examples.;Jo &sxilih:fioo-;;;."&at;-" f r---- Universal Health Services, King of Prussia, PA Hospital Management Board of Directors Member / / Christendom College, Front Royal. VA Non-profit Education Advisory Board Member Ethics and Public Policy Center, Washington, DC Christian Policy Center Senior Fellow News Corp., New York, NY Media Conglomerate News Contributor / / / / / / Philadelphia nuirer, Philadelphia, PA Newspaper Newspaper Columnist / / Salem Radio, Camarilla, CA Radio Station Talk Show Host Part : Compensation in Excess of $, Paid by One Source /9 / Do not complete this part if you are an ncumbent, Termination Filer, or Vice Report sources of more than $, compensation received by you or your non-profit organization when Presidential or Presidential Candidate. business affiliation for services provided directly by you during any one year of you directly provided the the reporting period. This includes the names of clients and customers of any services generating a fee or payment of more than $,. You corporation, firm, partnership, or other business enterprise, or any other need not report the U.S. Government as a source. None D Source (Name and Address) Brief Description of Duties, Jones & Smith, Hometown, State Legal services Examples tro University (client of Doe jones & Smith), Moneytown, State Legal services in connection With university construction Universal Health Services, King of Prussia, PA Advise company as Member of Board of Directors Ethics and Public Policy Center, Washington, DC Policy analysis News Corp., New York, NY News Contributor Philadelphia nuirer, Philadelphia, PA Newspaper Columnist Salem Radio, Camarilla. CA Talk Show Host CONSOL Energy nc., Canonsburg, PA Energy policy consulting services OGE/Adobe Acrobat version.. (/)

16 SCHEDULED of Part : Positions Held Outside U.S. Government Report any positions held during the applicable reporting period, whether compensated or not. Positions include but are not limited to those of an officer, director, trustee, general partner, proprietor, representative, employee, or consultant of any corporation, firm, partnership, or other business enterprise or any non-profit organization or educational institution. Exclude positions with religious, social, fraternal, or political entities and those solely of an honorary nature. None D Organization (Name and Address) of Organization Position Held From (Mo., Yr.) To (Mo.,Yr.) Examples.:_A. Rk CollectoNN.!. Non-profit education ident!_- Present Doe Jones & Smith, Hometown, State Law firm Partner / / CONSOL Energy nc., Canonsburg, PA Diversified Energy Company Consultant / / Clapham Group, Washingon, DC Consulting Firm Consultant American Continentia! Group, Washington, DC Government Affairs and Consulting Firm Consultant / Present /9 Present Part : Compensation in Excess of $, Paid by One Source Do not complete this part if you are an ncumbent, Termination Filer, or Vice Report sources of more than $, compensation received by you or your non-profit organization when Presidential or Presidential Candidate. business affiliation for services provided directly by you during any one year of you directly provided the the reporting period. This includes the names of clients and customers of any services generating a fee or payment of more than $,. You corporation, firm, partnership, or other business enterprise, or any other need not report the U.S. Government as a source. None D Source (Name and Address) Brief Description of Duties Jones & Smith, Hometown, State Legal services Examples tro University (client of Doe jones & Smith), Moneytown, State - Lega!e"rviCesin cnwio-;:;-" with u'itivetyrom"rucri'on Clapham Group, Washington, DC Consulting services. American Continental Group, Washington, DC Fortegra Financial (client of American Continental Group), Jacksonville, FL Legislative policy consulting services Consulting in connection with insurance processing policy OGE/Adobe Acrobat version.. (/)