UGE Form 2736 (March 2014)

US. Of?ce of Government Ethics; 5 C.F.R. part 2634 Form Approved: OMB No. (3209-0001)

 

 

 

 

 

 

Report Type: Candidate
Year (Annual Report only):
Date of Appointment/ Termination: 514/201 5

 

 

worse arms-s OFHCE oi?
QQVERNMENT 


 

 

?re-venting. traumas of'ln?tmmt
in the incentive Branch

Executive Branch Personnel Public Financial Disclosure Report (OGEiiFiorhi i278e) f: H. '1 

 

 

 

iler's Information [j  1f 
Last Name First Name MI Position 1 I - Agency
Carson, Sr. Benjamin Candidate for President

 

 

 

 

 

Other Federal Government Positions Held During the Preceding 12 Months:

 

None

 

Name of Congressional Committee Consideration Nomination (Nominees only):

 

 

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

 

Signature:

 

Date:

N)th

at{

at a

 

 

 

Agency EtthS Of?cial?s Opinion On the basrs of informath Contalned in tins report, I conclude that the flier is in compliance with laws and regulations

(subject to any comments below)
.

 

 

 

Signature: Date: 
JM 221:?
Other Review Conducted 
Signature: Date:

3W 

 

U.S. Of?ce of Government Ethics Certi?cation (if required):

 

Signatur 



 

 

 




 

Comments of Reviewing Of?cials:

 

Reviewed for
With the Federal

Apparent Compliance
Electwn Campaign Act.

A ll Pam Placeoi by '91ier?. 81'ch us?

 

 

OGE Form 278:: (March 2014)

instructions for Part 1

Note: This is a public form. 00 not include account numbers, street addresses, or family member names. See instructions for required information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filer's Name Page Number
Benjamin S. Carson, Sr. 1 of1
Part 1: Filer?s Positions Held Outside United States Government
Organization Name City/State Organization Type Position Held From To
1_ Johns Hopkins University Baltimore, MD Hospital University Physician, Professor 7/1984 6/2013
2, Carson Scholars Fund, Inc. Towson, MD Non?Profit Charity Co-Founder, President (no 5/1994 5/2015
compensation earned)
3, Kellogg Company Battle Creek, MI Publicly Traded Corporation Member, Board of Directors 8/1997 5/2015
4, Costco Wholesale Corporation Issaquah. WA Publicly Traded Corporation Member, Board of Directors 5/1999 5/2015
5, Academy of Achievement Washington, DC Non-Profit Organization Member, Board of Directors (no 2003 Present
compensation earned)
6, BenCan, LLC Pittsburgh, PA Self-Employed LLC entity owning rental Manager Member 1/2007 Present
real estate property
7, American Business Collaborative, LLC W. Palm Beach, FL Self?Employed LLC entity - Manager Member 6/2013 Present
entity for public speaking, and book
royalties
8_ Berg, LLC Framingham, MA Private Corporation Member, Advisory Board (no 2013 5/2015
compensation earned)
9, Vaccinogen, Inc. Baltimore, MD Publicly Traded Corporation Chairman, Board of Directors (no 8/2014 5/2015
compensation earned)
10, HomeCentris Healthcare, LLC Baltimore, MD Private Corporation Member, Advisory Board (no 3/2015 5/2015
compensation earned)
11.
12.
13.
14.
15.
16.
17.
18.

 

 

OGE Form 2786 (March 20M)

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
Benjamin S. Carson, Sr. 1 of 13
Part 2: Filer's Employment Assets and Income
Description EIF Value Income Type Income Amount
1, American Business Collaborative, LLC - self-employed $1,000,001 $5,000,000 self-employed 1,500,000
entity for public speaking, and book royalties. income
Income shown represents distributions taken from the LLC
(duplicative of income figures below).
2, Kellogg Company board of director 124,995
compensation
3, Costco Wholesale Corp. board of director 45,500
compensation
4_ Kellogg Company $1,000,001 - $5,000,000 dividends $5,001 $15,000
5, Costco Wholesale Corp. NKA $1,000,001 - $5,000,000 dividends $50,001 - $100,000
6, Kellogg Company exercise of vested stock 35 94,903
options
Costco Wholesale Corp. exercise of vested stock 88,263
options
8_ Kellogg Company vesting of restricted 2,726,597
stock
9, Costco Wholesale Corp. vesting of restricted 1,154,758
stock
10, Kellogg Company (outstanding vested stock options) WA $100,001 - $250,000 None (or less than $201)
11, Review Herald Publishing Assn - paid through American value is not readily author! book royalties $15,001 $50,000
Business Collaborative, LLC ascertainable
TITLE: Gifted Hands: The Ben Carson Story
12_ HarperCollins Christian Publishing paid through American value is not readily author! book royalties $15,001 $50,000
Business Collaborative, LLC ascertainable
TITLE: Think Big: Unleashing Your Potential for Excellence
13, HarperCollins Christian Publishing - paid through American NIA value is not readily author I book royalties $2,501 $5,000
Business Collaborative, LLC ascertainable
TITLE: The Big Picture
14, HarperCollins Christian Publishing - paid through American value is not readily author! book royalties $5,001 - $15,000
Business Collaborative, LLC ascertainable
TITLE: Take the Risk: Learning to Identify, Choose, and Live
with Acceptable Risk
15, HarperCollins Christian Publishing - paid through American value is not readily author! book royalties $100,001 - $1,000,000

 

 

Business Collaborative, LLC
TITLE: America The Beautiful: Rediscovering What Made
This National Great

 

ascertainable

 

 

 

 

 

Note: This is a public form. 00 not include account numbers, street addresses, or family member names. See instructions for required information.

 

Filer?s Name

Page Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Benjamin S. Carson, Sr. 2 of 13

Part 2: Filer's Employment Assets and Income

it Description EIF Value Income Type Income Amount

1, HarperCollins Christian Publishing - paid through American value is not readily author! book royalties $5,001 - $15,000
Business Collaborative, LLC ascertainable
TITLE: You Have a Brain: A Teen's Guide to T.H.I.N.K.
BIG.

2_ Penguin Group USA - paid through American Business value is not readily author! book royalties $100,001 - $1,000,000
Collaborative, LLC ascertainable
TITLE: One Nation: What We Can All Do to Save America's
Future

3, Penguin Group USA - paid through American Business value is not readily author book royalties $100,001 - $1,000,000
Collaborative, LLC ascertainable
TITLE: A More Perfect Union: What We the People Can Do
to Reclaim Our Constitutional Liberties

4, Tyndale House Publishers, Inc. - paid through American value is not readily author! book royalties $15,001 - $50,000
Business Collaborative, LLC ascertainable
TITLE: One Vote: Make Your Voice Heard

5, The Washington Times, LLC - paid through American non-employee 137,148
Business Collaborative, LLC compensation

6, Fox News Network paid through American Business non?employee 492,115
Collaborative, LLC compensation

7, Creators Syndicate - paid through American Business non-employee 9,079
Collaborative, LLC compensation

3_ Coffman for Congress - paid through American Business speaking fee honoraria 15,000
Collaborative, LLC (7/17/14)

9, Colorado Christian University - paid through American speaking fee honoraria 20,000
Business Collaborative, LLC (7/18/14)

10, Tuckahoe Woman's Club - paid by Washington Speakers speaking fee honoraria 19,800
Bureau through American Business Collaborative, LLC (1/8/14)

11_ The Hanover Theatre paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (1/9/14)

12, Associated Equipment Distributors, Inc. (AED) - paid by speaking fee honoraria 24,500
Washington Speakers Bureau through American Business (1/17/14)
Collaborative, LLC

13, Crown College - paid by Washington Speakers Bureau speaking fee honoraria 16,500
through American Business Collaborative, LLC (1/18/14)

14, MorseLife Foundation, Inc. paid by Washington Speakers speaking fee honoraria 23,000

 

 

Bureau through American Business Collaborative, LLC

 

 

 

(1/20/14)

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

iler's Name Page Number

Benjamin S. Carson, Sr. 3 of 13

Part 2: iler's Employment Assets and Income

Description EIF Value Income Type Income Amount

1_ Palm Beach Atlantic University - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (1/28/14)
LLC

2, Thunderbird Adventist Academy - paid by Washington speaking fee honoraria 40,500
Speakers Bureau through American Business Collaborative, (1/28/14)
LLC

3_ Sacred Heart of Jesus High School - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (2/4/14)
LLC

4, Pacific Union College paid by Washington Speakers speaking fee honoraria 28,500
Bureau through American Business Collaborative, LLC (2/8/14)

5, Sangamon County Republican Central Committee - paid by speaking fee honoraria 24,000
Washington Speakers Bureau through American Business (2/11/14)
Collaborative, LLC

6, Virginia Beach Forum, Inc - paid by Washington Speakers speaking fee honoraria 18,500
Bureau through American Business Collaborative, LLC (2/12/14)

7, Feed My Lambs - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (2/13/14)

8, Hillsdale College - paid by Washington Speakers Bureau speaking fee honoraria 28,500
through American Business Collaborative, LLC (2/18/14)

9, Scott County Missouri Republican Committee - paid by speaking fee honoraria 20,500
Washington Speakers Bureau through American Business (2/22/14)
Collaborative, LLC

10, Eastman Chemical Company - paid by Washington Speakers speaking fee honoraria 16,500
Bureau through American Business Collaborative, LLC (2/25/14)

HopeWorks, Inc. - paid by Washington Speakers Bureau speaking fee honoraria 24,500
through American Business Collaborative, LLC (3/1/14)

12, Boys Giris Clubs of Martin County - paid by Washington speaking fee honoraria 24.500
Speakers Bureau through American Business Collaborative, (3/3/14)
LLC

13, Oklahoma Baptist University - paid by Washington Speakers speaking fee honoraria 32,500

 

Bureau through American Business Collaborative, LLC

 

 

 

(3/4/14)

 

 

 

 

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

Benjamin S. Carson, Sr. 4 of 13

Part2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, The Women's Center of NW lndiana - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (3/6/14)
LLC

2, Southeastern University paid by Washington Speakers speaking fee honoraria 30,500
Bureau through American Business Collaborative, LLC (3/7/14)

3, Family Research Council - paid by Washington Speakers speaking fee honoraria 32,000
Bureau through American Business Collaborative, LLC (3/11/14)

4, Stillwater Christian School paid by Washington Speakers speaking fee honoraria 42,100
Bureau through American Business Collaborative, LLC (3/13/14)

5, New Community Horizons - paid by Washington Speakers speaking fee honoraria 24,500
Bureau through American Business Collaborative, LLC (3/15/14)

6, Harding University - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (3/18/14)

7, Dayspring Christian Academy - paid by Washington speaking fee honoraria 16,500
Speakers Bureau through American Business Collaborative, (3/21/14)
LLC

8, Great Home School Conventions, inc. - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (3/22/14)
LLC

9, Desert Forum, Inc paid by Washington Speakers Bureau speaking fee honoraria 24.500
through American Business Collaborative, LLC (3/24/14)

10, Hinman Dental Society - paid by Washington Speakers speaking fee honoraria 16,500
Bureau through American Business Collaborative, LLC ((3/27/14)

11, Operation H.O.P.E. - paid by Washington Speakers Bureau speaking fee honoraria 24,500
through American Business Collaborative, LLC (3/29/14)

12, Plumstead Christian School - paid by Washington Speakers speaking fee honoraria 24.500
Bureau through American Business Collaborative, LLC (3/31/14)

13, University of the Cumberlands - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (4/1/14)
LLC

14, American Medical Group Foundation - paid by Washington speaking fee honoraria 24,500
Speakers Bureau through American Business Collaborative, (4/5/14)
LLC

15, Foothills Community Christian School - paid by Washington speaking fee honoraria 32,500

Speakers Bureau through American Business Collaborative,
LLC

 

 

 

 

 

{4/7/14)

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Speakers Bureau through American Business Collaborative,
LLC

 

 

 

(5/13/14)

 

iler's Name Page Number

Benjamin S. Carson, Sr. 5 of 13

Part 2: Filer?s Employment Assets and Income

Description EIF Value Income Type Income Amount

1, Weinberg Center for the Arts, Inc. - paid by Washington speaking fee honoraria 16,000
Speakers Bureau through American Business Collaborative, (4/9/14)
LLC

2, Rochester College - paid by Washington Speakers Bureau speaking fee honoraria 16,500
through American Business Collaborative, LLC (4/12/14)

3, Vitae Foundation - paid by Washington Speakers Bureau speaking fee honoraria 28,500
through American Business Collaborative, LLC (4/15/14)

4, Ohio Christian University - paid by Washington Speakers speaking fee honoraria 20,500
Bureau through American Business Collaborative, LLC (4/21/14)

5, Mississippi College - paid by Washington Speakers Bureau speaking fee honoraria 44,000
through American Business Collaborative, LLC (4/22/14)

6, Manufacturers' Association of South Central PA - paid by speaking fee honoraria 24,500
Washington Speakers Bureau through American Business (4/23/14)
Coilaborative, LLC

7, Great Home School Conventions, Inc. - paid by Washington speaking fee honoraria 16,500
Speakers Bureau through American Business Collaborative, (4/26/14)
LLC

8, Wisonsin Right to Life - paid by Washington Speakers speaking fee honoraria 20,500
Bureau through American Business Collaborative, LLC (5/1/14)

9, Vitae Foundation - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (5/2/14)

10, Regent University paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (5/3/14)

1 1, Lifehouse Center - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (5/5/14)

12_ Minnesota Family Council - paid by Washington Speakers speaking fee honoraria 20,500
Bureau through American Business Collaborative, LLC (5/5/14)

13, Memorial Health Foundation - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (5/7/14)

14, Millis Price Properties, LLC - paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (5/9/14)

15_ Salvation Army Western Division - paid by Washington speaking fee honoraria 28,500

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

iler?s Name Page Number

Benjamin S. Carson, Sr. 6 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, New Jersey Right to Life paid by Washington Speakers speaking fee honoraria 20,500
Bureau through American Business Collaborative, LLC (5/16/14)

2, Associated Builders 8 Contractors, Inc - paid by Washington speaking fee honoraria 28,000
Speakers Bureau through American Business Collaborative, (6/10/14)
LLC

3, National Health Systems, Inc. and Affiliates - paid by speaking fee honoraria 32,500
Washington Speakers Bureau through American Business (6/1 3114)
Collaborative, LLC

4, National Organization for Marriage paid by Washington speaking fee honoraria 20,000
Speakers Bureau through American Business Collaborative, (62?192?14)
LLC

5, Squire Creek Country Club LLC paid by Washington speaking fee honoraria 40,500
Speakers Bureau through American Business Collaborative, 
LLC

6_ Calvary Chapel of Philadelphia - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (6/26114)
LLC

7, Health Forum - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (772214)

8, Carolinas AGC, Inc. - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (8K2li 4)

9, Ashland University paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (8/21/14)

10_ The Steamboat Institute - paid by Washington Speakers speaking fee honoraria 28,000
Bureau through American Business Collaborative, LLC (812211 4)

11, Hope Pregnancy Center College Station - paid by speaking fee honoraria 40,500
Washington Speakers Bureau through American Business 
Collaborative, LLC

12_ Aiabama Republican Party - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (8228/14)

13, Wake Up America - paid by Washington Speakers Bureau speaking fee honoraria 40,500
through American Business Collaborative, LLC (95114)

14, Christians Aligned for Actions and Principles, Inc. with Truth speaking fee honoraria 20,500
for the Next Generation - paid by Washington Speakers (sis/14)
Bureau through American Business Collaborative, LLC

15, The Salvation Army - Winnebago County - paid by speaking fee honoraria 32,500

Washington Speakers Bureau through American Business
Collaborative, LLC

 

 

 

 

 

(9/911 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

Benjamin S. Carson, Sr. 7 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, Valdosta State University - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (9/11/14)

2, St. Joseph Public Schools Foundation - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (9/24/14)
LLC

3, Vitae Foundation paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (9/25/14)

4, Life Services of Spokane paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (9/28/14)

5, Solutions for Change - paid by Washington Speakers Bureau speaking fee honoraria 40,500
through American Business Collaborative, LLC (9/27/14)

6, Faulkner University - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (10/2/14)

7_ The Family Foundation of Virginia - paid by Washington speaking fee honoraria 32,000
Speakers Bureau through American Business Collaborative, (10/4/14)
LLC

8, Grand Rapids Right to Life - paid by Washington Speakers speaking fee honoraria 16,500
Bureau through American Business Collaborative, LLC (10/8/14)

9, Pregnancy Care Center paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (10/7/14)

10_ Vitae Foundation - paid by Washington Speakers Bureau speaking fee honoraria 28,000
through American Business Collaborative, LLC (10/10/14)

11_ Texas Surgical Society - paid by Washington Speakers speaking fee honoraria 20,400
Bureau through American Business Collaborative, LLC (10/11/14)

12, The Women's Clinic of Kansas City - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (10/14/14)
LLC

13, Family Legacy Missions International - paid by Washington speaking fee honoraria 44,500
Speakers Bureau through American Business Collaborative. (10/18/14)
LLC

14, Pacific Justice Institute - paid by Washington Speakers speaking fee honoraria 28,500
Bureau through American Business Collaborative, LLC (10/18/14)

15_ San Joaquin Community Hospital - paid by Washington speaking fee honoraria 20,000

 

 

Speakers Bureau through American Business Collaborative,
LLC

 

 

 

(10/19/14)

 

 

 

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

Benjamin S. Carson, Sr. 8 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, Oklahoma City Town Hail - paid by Washington Speakers speaking fee honoraria 31,000
Bureau through American Business Collaborative, LLC (10/21/14)

2_ LGE Community Credit Union - paid by Washington speaking fee honoraria 35 24,500
Speakers Bureau through American Business Collaborative, (10/22/14)
LLC

3, Georgia Independent School Association - paid by speaking fee honoraria 24,500
Washington Speakers Bureau through American Business (11/3/14)
Collaborative, LLC

4, Omaha Christian Academy - paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (11/6/14)

5, Alliance Defending Freedom - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (11/8/14)

6_ First Presbyterian Church of Bonita Springs a paid by speaking fee honoraria 24,500
Washington Speakers Bureau through American Business (11/10/14)
Collaborative, LLC

7, Kalamazoo Christian Schools Association - paid by speaking fee honoraria 32,500
Washington Speakers Bureau through American Business (11/13/14)
Collaborative, LLC

8, Caring to Love Ministries - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (11/14/14)

9, Vitae Foundation paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (11/16/14)

10, Stifel, Nicolaus Company, incorporated - paid by speaking fee honoraria 35,700
Washington Speakers Bureau through American Business (11/18/14)
Collaborative, LLC

1 1, Somerset Christian School Foundation - paid by Washington speaking fee honoraria 24,500
Speakers Bureau through American Business Collaborative, (12/2/14)
LLC

12_ Lehighton 9/12 Project, inc. - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (12/3/14)

13_ Freed-Herdsman University - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (12/5/14)

14, Foundation for Government Accountability - paid by speaking fee honoraria 32,500
Washington Speakers Bureau through American Business (12/9/14)
Collaborative, LLC

15, Man in the Mirror - paid by Washington Speakers Bureau speaking fee honoraria 32,500

 

 

through American Business Collaborative, LLC

 

 

 

(12/10/14)

 

 

 

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

Benjamin S. Carson, Sr. 9 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, Spencer Stuart - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (1/13/15)

2, Spencer Stuart paid by Washington Speakers Bureau speaking fee honoraria 32,000
through American Business Collaborative, LLC (1/14/15)

3, Texas Hospital Association paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (1/22/15)

4, Louisiana Association of Business and Industry (LABI) - paid speaking fee honoraria 32,500
by Washington Speakers Bureau through American Business (1/27/15)
Collaborative, LLC

5_ Palmer Home for Children - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (1/31/15)

6, Oklahoma Christian Home Educators' Consociation - paid by speaking fee honoraria 40,500
Washington Speakers Bureau through American Business (2/10/15)
Collaborative, LLC

7, Boyle County of Kentucky Republican Party - paid by speaking fee honoraria 32500
Washington Speakers Bureau through American Business (2/12/15)
Collaborative, LLC

3_ Great Home School Conventions, Inc. - paid by Washington speaking fee honoraria 20,500
Speakers Bureau through American Business Collaborative, (2/14/15)
LLC

9_ Parkgate Pregnancy Clinic paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (2/17/15)

10, Gwinnett Medical Center Foundation paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (2/21/15)
LLC

11, Hoover Institution - paid by Washington Speakers Bureau speaking fee honoraria 30,800
through American Business Collaborative, LLC (2/22/15)

12, University of the Southwest - paid by Washington Speakers speaking fee honoraria 44,500
Bureau through American Business Collaborative, LLC (2/23/15)

13_ Leading Authorities, Inc. - paid by Washington Speakers speaking fee honoraria 28,000
Bureau through American Business Collaborative, LLC (2/25/15)

14, International Cooperating Ministries - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (2/25/15)
LLC

15, National Association for Developmental Education (NADE) - speaking fee honoraria 24,500

 

 

paid by Washington Speakers Bureau through American
Business Collaborative, LLC

 

 

 

(2/27/15)\

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

iler?s Name Page Number

Benjamin S. Carson, Sr. 10 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, National Association of (NAR) - paid by speaking fee honoraria 40,500
Washington Speakers Bureau through American Business (2f28/15)
Collaborative, LLC

2, BridgeBuilders - paid by Washington Speakers Bureau speaking fee honoraria 40,500
through American Business Collaborative, LLC (3/1/15)

3, Embry-Riddie Aeronautical University - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (3/2/15)
LLC

4_ World LEADERS Group, Inc. paid by Washington Speakers speaking fee honoraria 28,000
Bureau through American Business Collaborative, LLC (3/4/15)

5, Maison Money paid by Washington Speakers Bureau speaking fee honoraria 40,500
through American Business Collaborative, LLC (3/5/15)

6, Luther F. Carson Four Rivers Center - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, 
LLC

7_ Lifehouse Center - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (3/7115)

8, New Hope Academy - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (3/10l15)

9, Community Pregnancy Clinics, lnc. paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (3i12li5)
LLC

10, Covenant Health System - paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (3113/15)

11, Conestoga Christian School paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (3/20/15)

12, CSP Business Media, LLC paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (3/23/15)

13, American Academy of Orthopaedic Surgeons - paid by speaking fee honoraria 40,500
Washington Speakers Bureau through American Business (3/26/15)
Collaborative, LLC

14_ John W. Pope Civitas Institute - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (3127/15)
LLC

15, Operation H.O.P.E. - paid by Washington Speakers Bureau speaking fee honoraria 24,500

 

 

through American Business Collaborative, LLC

 

 

 

(3/28/15)

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Collaborative, LLC

 

 

 

(11/12/14)

 

Filer's Name Page Number

Benjamin S. Carson, Sr. 11 of 13

Part 2: Filer's Employment Assets and Income

Description EIF Value Income Type Income Amount

1, American Bakers Association - paid by Washington speaking fee honoraria 32,500
Speakers Bureau through American Business Collaborative, (3/30/15)
LLC 

2_ Alma College - paid by Washington Speakers Bureau speaking fee honoraria 20,500
through American Business Collaborative, LLC (4/1/15)

3, Scholarship Foundation of Indian River County - paid by speaking fee honoraria 30,800
Washington Speakers Bureau through American Business (4/2/15)
Collaborative, LLC

4_ Sunbird Conservatives a paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (4/3/15)

5_ Right to Life of Southwest indiana paid by Washington speaking fee honoraria 35,700
Speakers Bureau through American Business Collaborative, (4/7/15)
LLC

6, Texas Energy Museum - paid by Washington Speakers speaking fee honoraria 40,500
Bureau through American Business Collaborative, LLC (4/9/15)

7_ Michael W. Haley Foundation - paid by Washington speaking fee honoraria 48,500
Speakers Bureau through American Business Coliaborative, (4/14/15)
LLC

8, Taylors Free Medical Center - paid by Washington Speakers speaking fee honoraria 35,700
Bureau through American Business Collaborative, LLC (4/16/15)

9, Hays County Republican Party paid by Washington speaking fee honoraria 40,500
Speakers Bureau through American Business Collaborative, (4/17/15)
LLC

10, Cornell University - paid by Washington Speakers Bureau speaking fee honoraria 32,500
through American Business Collaborative, LLC (4/21/15)

1 1, Summit Educational Association - paid by Washington speaking fee honoraria 35,700
Speakers Bureau through American Business Collaborative, (4/22/15)
LLC

12, Fort Worth Christian School - paid by Washington Speakers speaking fee honoraria 44,500
Bureau through American Business Collaborative, LLC (4/26/15)

13, Mason Classical Academy - paid by Washington Speakers speaking fee honoraria 32,500
Bureau through American Business Collaborative, LLC (4/28/15)

14, University of Mobile - paid by Washington Speakers Bureau speaking fee honoraria 35,700
through American Business Collaborative, LLC (4/30/15)

15, Second Baptist Church - paid through American Business speaking fee honoraria 30,000
Collaborative, LLC (1/23/15)

16, Aging Resource Center Foundation - paid through American speaking fee honoraria 19,097

 

 

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

 

Benjamin S. Carson, Sr.

 

12 of13

 

Part 2: Filer's Employment Assets and Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description EIF Value Income Type Income Amount

1, INVESCO CONV SECURITIES FD CL A (held in 401 Plan) $100,001 $250,000 dividends $1,001 - $2,500

2, STONE RIDGE US SM CAP VARIANCE RISK PREM $50,001 $100,000 dividends $201 $1 ,000
(held in 401k Plan)

3, DEUTSCHE BANK 0%18 DUE 05/28/18 (held in De?ned WA $100,001 - $250,000 None (or less than $201)
Bene?t Plan)

4_ JPMORGAN CHASE BANK 0%20 CD FDIC DUE 04/30/20 WA $100,001 - $250,000 None (or less than $201)
(held in Defined Benefit Plan)

5_ WELLS FARGO CO 0%17 DUE 09/01/17 (held in Defined $250,001 $500,000 None (or less than $201)
Benefit Plan)

6, INVESCO BALANCED RISK ALLOC FD CL A (held in $50,001 - $100,000 dividends $1,001 $2,500
Defined Bene?t Plan)

7, AMERICAN CENTURY MID CAP VALUE FD INV CL (held in $100,001 - $250,000 dividends $201 - $1,000
Defined Benefit Plan)

8, STONE RIDGE ALL ASSET VARIANCE RISK PREM COM $250,001 $500,000 None (or less than $201)
CL (held in Defined Benefit Plan)

9_ HARBOR INTERNATIONAL FUND INST CL (held in Defined $100,001 - $250,000 dividends $2,501 - $5,000
Benefit Plan)

10, METROPOLITAN WEST HIGH YIELD BOND (held in $100,001 - $250,000 dividends $5.001 - $15,000
Defined Benefit Plan)

11, OPPENHEIMER DEVELOPING MKTS FD CL A (held in $15,001 - $50,000 dividends None (or less than $201)
Defined Benefit Plan)

12, PIMCO ALL ASSET ALL AUTHORITY CL (held in Defined $50,001 - $100,000 dividends $2,501 $5,000
Benefit Plan)

13, PIMCO COMMODITY REAL RETURN STRAT (held in $50,001 - $100,000 dividends None (or less than $201)
Defined Bene?t Plan)

14, ALLIANZ GI NFJ SMALL CAP VALUE FD CL (held in $50,001 - $100,000 dividends $1,001 - $2,500
Defined Benefit Plan)

15, DEUTSCHE GLOBAL REAL ESTATE SECS 8 (held in $15,001 - $50,000 dividends $201 - $1,000
De?ned Benefit Plan)

16, FIRST EAGLE OVERSEAS FUND CL A (held in Defined $100,001 $250,000 dividends $201 - $1,000
Benefit Plan)

17, STONE RIDGE HIGH YIELD REINSURANCE RISK PREM $50,001 - $100,000 dividends $5.001 - $15,000
(held in De?ned Bene?t Plan)

18, STONE RIDGE REINSURANCE RISK PREM (held in $100,001 - $250,000 dividends $15,001 $50,000
Defined Benefit Plan)

19, USAA SHORT TERM BD (held in De?ned Benefit Plan) $100,001 - $250,000 dividends None (or less than $201)

20, WESTPORT FUND CLASS (held in Defined Benefit Plan) $100,001 - $250,000 None (or less than $201)

21, PIMCO TOTAL RETURN CL (held in De?ned Bene?t Plan) None (or less than $1,001) dividends $201 - $1,000

22, STONE RIDGE US MASTER VARIANCE RISK PREM COM None (or less than $1,001) dividends $5,001 - $15,000

 

 

CL (held in Defined Benefit Plan)

 

 

 

 

 

 

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

 

Benjamin S. Carson, Sr.

 

130113

 

Part 2: Filer?s Employment Assets and Income

 



Description



Value

Income Type

Income Amount

 

1.

Save Our Youth - will be paid by Washington Speakers
Bureau through American Business Collaborative, LLC

$50,001 - $100,000

receivable speaking
fee honoraria (5/11/15)

 

Meals on Wheels Plus, Inc. - will be paid by Washington
Speakers Bureau through American Business Collaborative,
LLC

$50,001 - $100,000

receivable speaking
fee honoraria (5/28/15)

 

Phil Waldrep Ministries will be paid by Washington
Speakers Bureau through American Business Collaborative,
LLC

$15,001 - $50,000

receivable speaking
fee honoraria (6120/1 5)

 

Dayton Right to Life - will be paid by Washington Speakers
Bureau through American Business Collaborative, LLC

$15,001 $50,000

receivable - speaking
fee honoraria (9/22/15)

 

YMCA of the Suncoast - will be paid by Washington
Speakers Bureau through American Business Collaborative,
LLC

$15,001 - $50,000

receivable - speaking
fee honoraria (11/3/15)

 

CSP Business Media, LLC - will be paid by Washington
Speakers Bureau through American Business Collaborative,
LLC

$50,001 $100,000

receivable - speaking
fee honoraria
(11/14/15)

 

 

 

YPO Cincinnati - will be paid by Washington Speakers
Bureau through American Business Collaborative, LLC

 

 

$15,001 - $50,000

 

receivable - speaking
fee honoraria
(11/18/15)

 

 

 

OGF. Form 2?8e (March 20] 4)

Instructions for Part 3

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

 

Filer's Name

Page Number

 

Benjamin S. Carson, Sr.

 

?loft

 

Part 3: iler's Employment Agreements and Arrangements

 

 

 

 

 

 

 

 

 

 

 

 

Employer or Party City/State Status and Terms Date
1, Kellogg Company Battle Creek, MI Hold vested stock options awarded during tenure on Board of Directors (options expire 10 years after initial grant). 8/1997
Asset value listed on Part 2, Page 1, Line 10.

2_ Washington Speakers Washington, DC Agent for booking speeches (will receive compensation for previously arranged speeches listed on Part 2. Page 212000
Bureau 13)

3, Carson Scholars Fund, Towson, MD Currently on leave of absense from charitable organization 512015
Inc.

4_ American Business West Palm Beach, Maintain retirement plan through current self~emp oyment entity. Two sub?plans exist - a 401 Profit Sharing Plan 72013
Collaborative, LLC FL and Defined Benefit Plan. Specific asset holdings for each plan listed on Part 2, Page 12.

5.

6.

7.

8.

9.

10.

11.

 

12.

 

 

 

 

 

 

 

OGE Form 2786 [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

 

Benjamin S. Carson, Sr.

 

10H

 

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

 

Source Name City/State Brief Description of Duties

 

18.

 

19.

 

20.

 

 

 

 

 

 

OGF. Form 278s (March 2014)

Instructions for Part5
Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

iler's Name Page Number
Benjamin S. Carson, Sr. 1 of1
Part 5: Spouse's Employment Assets and Income
Description EIF Value Income Type Income Amount
1, American Business Collaborative, LLC (spouse) - selfw self-employed
employed entity for book royalties. Income income
shown represents distributions taken from the LLC
(duplicative of income figures below).
2_ HarperCoIIins Christian Publishing (spouse) - paid through value not readily ascertainable author;I book royalties $100,001 - $1 ,000,000
American Business Collaborative, LLC
TITLE: America The Beautiful
3, INVESCO CONV SECURITIES FD CL A (spouse) $15,001 - $50,000 dividends None (or less than $201)
4, STONE RIDGE INTL MASTER VARIANCE RISK PREM $50,001 - $100,000 dividends $1,001 - $2,500
(spouse)
5.
6.
7.
8.
9.
IO.
11.
12.
13.
14.
15.
16.
17.
18.
19.

 

 

 

 

 

 

 

 

OGE Form 2786(MarcI12014)

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
Benjamin S. Carson, Sr. 1 of 2
Part 6: Other Assets and Income
Description EIF Value Income Type Income Amount
1_ BenCan, LLC (Self-Employed LLC entity - owning $1,000,001 - $5,000,000 rental income $100,001 - $1 ,000,000
commercial rental real estate property in Pittsburgh, PA)
2, INBS, LLC (spouse) (Self-Employed LLC entity - owning Over $1 ,000,000 rentai income $100,001 $1,000,000
commerical rental real estate property in Pittsburgh, PA)
3, Pruco Life Insurance Co (Cash Value - Variable Annuity) $500,001 - $1,000,000 None (or less than $201)
AST Advanced Strategies Portfolio
4, Bank of America (Cash) WA $50,001 - $100,000 interest None (or less than $201)
5, Bank (Cash) NIA $50,001 - $100,000 interest None (or less than $201)
6_ First Mariner Bank (Cash) NIA $15,001 $50,000 interest None (or less than $201)
7, Bank (Cash) $1 ,001 - $15,000 interest None (or less than $201)
8, Colombo Bank (Cash) $1,001 - $15,000 interest None (or less than $201)
9_ Vanguard VII-A LP. (2 underlying holdings listed below) $15,001 - $50,000 partnership distributions 4,103
10, Dfine, Inc. (non-publicly traded holding within the Vanguard $1,001 - $15,000 None (or less than $201)
L.P. fund) Medical device company located in San
Jose, CA.
11, Vormetric (non-publicly traded holding within the Vanguard NIA $15,001 a $50,000 None (or less than $201)
VII-A L.P. fund) Data security company located in San Jose,
CA.
12, BLACKSTONE GROUP LP. (stock in the ?rm itself, not any NIA $1,001 - $15,000 dividends $201 - $1,000
of the funds managed by Blackstone)
13, HANSEN MEDICAL INC $1,001 - $15,000 None (or less than $201)
14, VOCERA COMMUNICATION WA $15,001 - $50,000 None (or less than $201)
15_ STONE RIDGE US MASTER VARIANCE RISK PREM $100,001 $250,000 dividends $5,001 - $15,000
16_ JPMORGAN CHASE BANK FDIC DUE 0781119 NIA $100,001 - $250,000 None (or less than $201)
17, Schwab Money Market Fund $1,000,001 $5,000,000 dividends $5,001 - $15,000
13, DEUTSCHE BANK DUE 06/28/18 WA $100,001 - $250,000 None (or less than $201)
19, BARON GROWTH FUND $50,001 - $100,000 None (or less than $201)
20, INVESCO CONV SECURITIES FD CL A $100,001 $250,000 dividends $2,501 - $5,000

 

 

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

 

Benjamin S. Carson, Sr.

20f2

 

 

Part 6: Other Assets and Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description EIF Value Income Type Income Amount

HARBOR INTERNATIONAL FUND INST CL $100,001 - $250,000 dividends $1,001 - $2,500

2, JPMORGAN STRATEGIC INCM OPPTY A $100,001 - $250,000 dividends $2,501 - $5,000

3, OPPENHEIMER DEVELOPING MKTS FD CL A $100,001 - $250,000 dividends $201 - $1,000

4, COMMODITY REAL RETURN STRAT $15,001 - $50,000 dividends None (or less than $201)

5, PIMCO INCM CL $100,001 $250,000 dividends $5,001 - $15,000

6, FIRST EAGLE OVERSEAS FUND CL A $100,001 - $250,000 dividends $1,001 - $2,500

7, STONE RIDGE REINSURANCE RISK PREM $100,001 - $250,000 dividends $201 - $1,000

8_ USAA SHORT TERM BD $50,001 - $100,000 dividends $201 - $1,000

9, STONE RIDGE INTL MASTER VARIANCE RISK PREM $100,001 $250,000 dividends $2,501 $5,000

10, CPC Grand Prix South Lot (investment real estate in West MA $1,000,001 $5,000,000 None (or less than $201)
Palm Beach, FL)

11_ GOLDMAN SACHS GROUP 0%15 DUE 08/10/15 WA $250,001 - $500,000 None (or less than $201)

12, JPMORGAN CHASE BANK FDIC DUE 07/31/19 WA $50,001 $100,000 None (or less than $201)

13, THORNBURG LTD TERM MUNI FD CL A $100,001 - $250,000 dividends $1,001 - $2,500

14, American Funds New Perspective 529 F-1 $1,001 - $15,000 dividends None (or less than $201)
CollegeAmerica 529 Plan (State of VA)

15_ PIMCO LOW DURATEON CL None (or less than $1,001) dividends $1,001 - $2,500

16, SCHWAB US LARGE CAP ETF None (or less than $1,001) dividends $201 - $1,000

17. Quiet Valley Farm (rental income received from granting use WA $100,001 - $250,000 rental income $2,501 - $5,000
of a section of farmland on residential property)

18.

19.

 

 

20.

 

 

 

 

 

 

 

OGE Form 2786 (March 2014)

Instructions for Part 7
Note: This is a public form. Do not inciude account numbers, street addresses, or family member names. See instructions for required information.

 

Filer's Name Page Number

 

Benjamin S. Carson, Sr. 1 of 1

 

Part 7: Transactions

 

Description Type Date Amount

 

1, 

 

2.

 

 

 

 

 

 

 

 

10.

 

 

12.

 

13.

 

14.

 

15.

 

16.

 

17.

 

18.

 

19.

 

20.

 

 

 

 

 

 

 

OGE Form 27"8e (March 2014)

Instructions for Part 8
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

 

Benjamin S. Carson, Sr. 1 of1

 

Part 8: Liabilities

 

Creditor Name Type Amount Year Incurred Rate Term

 

1. PNC Bank mortgage on commercial rental real $1,000,001 - $5,000,000 2007 5.907% 10 year loan, due
estate property co?owned by 2017
BenCan, LLC and INBS, LLC

 

 

 

 

 

 

 

 

 

10.

 

11.

 

12.

 

13.

 

 

15.

 

16.

 

17.

 

18.

 

19.

 

 

 

 

 

 

 

 

 

OGF, Form 2786 (March 2014)

Instructions for Part 9
Note: This is a public form. Do not include account numbers, street addresses, or family member names. See instructions for required information.

 

iler's Name Page Number

 

Benjamin S. Carson, Sr. 1 of?i

 

 

Part 9: Gifts and Travel Reimbursements

 

Source Name City/State Brief Description Value

 

1, WA

 

2.

 

 

 

 

 

 

 

 

10.

 

11.

 

12.

 

l3.

 

14.

 

15.

 

16.

 

17.

 

18.

 

l9.

 

20.

 

 

 

 

 

 

 

OGE Form ZTSC (March 2014)
Summarv of Contents

1. Filer?s Positions Held Outside United States Government

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

the ?ler 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 ?ler's of?cial 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 ?ler totaling more than $200 during the reporting period salary, fees, partnership share, honoraria, scholarships,

and prizes)

- Assets related to the ?ler'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 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 ?ler's business, employment, or other
income-generating activities 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
quali?es as an excepted investment fund (EIF).

3. Filer's Employment Agreements and Arrangements

Part 3 discloses agreements or arrangements that the ?ler had during the reporting period with an employer or form er 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 bene?t plan, such as pensions or a deferred compensation plan

- Retention or disposition of employer-awarded equity, sharing in pro?ts or carried interests vested and unvested stock options, restricted stock, future share of a company's
pro?ts, 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 ?ler?s services during any year of the reporting period. The ?ler

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

OGE Form 2786: (March 2014)
5. Spouse's Employment Assets and Income

Part 5 discloses the following:

- Sources of earned income (excluding honoraria) for the ?ler's spouse totaling more than $1,000 during the reporting period salary, consulting fees, and partnership share)

- Sources of honoraria for the ?ler's spouse greater than $200 during the reporting period

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

(2) produced more than $200 in income during the reporting period 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 ?ler's spouse's business,
employment, or other income-generating activities 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 quali?es 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 ?ler aggregates the ?ler's interests with those of the ?ler?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 bene?ts associated

with United States Government employment Thrift Savings Plan); and (3) cash accounts checking, savings, money market accounts) at a single ?nancial 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 quali?es 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 ?ler, 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 checking, savings, CDs, money market
accounts) and money market mutual ?inds; (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 ?ler, the ?ler'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 ?lers); (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 ?ler, the ?ler's spouse, and dependent children received from any one source during the reporting period.
- Travel reimbursements totaling more than $375 that the ?ler, the ?ler's spouse, and dependent children received from any one source during the reporting period.

For purposes of this section, the ?ler need not aggregate any gift or travel reimbursement with a value of $1 50 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 ?ler's agency in connection with the ?ler?s official travel; (5) gifts of hospitality (food,
lodging, entertainment) at the donor?s residence or personal premises; and (6) anything received by the ?ler's spouse or dependent children totally independent of their relationship to the
?ler. Additional exceptions apply.

OGE Form 2?8e (March 20 I4)
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 CPR. 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(botherwise 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: (l)to any requesting person, subject to the limitation contained in section 208(d)( l) of title 18, any
determination granting an exemption pursuant to sections 208(b)(l) 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 ajudge-issued subpoena; (4) to a source when necessary to obtain information relevant to a conflict of interest investigation or determination; (S) to

the National Archives and Records Administration or the General Services Administration in records management inspections; (6) to the Of?ce 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 of?ce, 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-Govemment employees working on a contract, service or assigrunent for
the Federal Government when necessary to accomplish a function related to an OGE Government?wide system of records; and (l l) 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 con?rmation. See also the 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,
US. Of?ce 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 ?rst page of this OGE Form 278e).