New Entrant Report   U.S. Office of Government Ethics; 5 C.F.R. part 2634   Form Approved: OMB No. (3209-0001) (March 2014)

Executive Branch Personnel
Public Financial Disclosure Report (OGE Form 278e)
Filer's Information
Powell, Dina
Assistant to the President and Senior Counselor for Economic Initiatives, White House
Date of Appointment: 02/03/2017
Other Federal Government Positions Held During the Preceding 12 Months:
None

Electronic Signature - I certify that the statements I have made in this form are true, complete and correct to the best of my knowledge.
/s/ Powell, Dina [electronically signed on 01/21/2017 by Powell, Dina in Integrity.gov]

Agency Ethics Official's Opinion - On the basis of information contained in this report, I conclude that the filer is in compliance with applicable laws and regulations
(subject to any comments below).
/s/ Passantino, Stefan, Certifying Official [electronically signed on 02/14/2017 by Passantino, Stefan in Integrity.gov]

Other review conducted by

U.S. Office of Government Ethics Certification

Data Revised 03/30/2017

 Data Revised 02/09/2017

Data Revised 02/08/2017

Data Revised 01/27/2017

1. Filer's Positions Held Outside United States Government
#

ORGANIZATION NAME

CITY, STATE

ORGANIZATION
TYPE

POSITION HELD

FROM

TO

1

Harvard Business School Social Enterprise
Initiative

Boston,
Massachusetts

University/Colle
ge

Advisory Board
Member

1/2014

Present

2

American University in Cairo

New York, New
York

University/Colle
ge

Trustee

7/2007

Present

3

Center for Global Development

Washington,
District of
Columbia

Non-Profit

Board Member

7/2012

Present

4

Nightingale Bamford School

New York, New
York

Non-Profit

Trustee

7/2013

Present

5

Tory Burch Foundation

New York, New
York

Non-Profit

Advisory Board
Member

6/2014

Present

6

Goldman Sachs Bank USA

New York, New
York

Corporation

Participating
Managing
Director (PMD)

1/2011

Present

7

The Goldman Sachs Foundation

New York, New
York

Non-Profit

President

1/2010

Present

VALUE

INCOME TYPE

INCOME
AMOUNT

See Endnote

2. Filer's Employment Assets & Income and Retirement Accounts
#

DESCRIPTION

EIF

1

Goldman Sachs Bank USA

N/A

Salary and
Benefits

$1,082,602

2

Goldman Sachs Bank USA

N/A

Cash Bonus

$3,075,000

3

Goldman Sachs Bank USA - Restricted Stock
Units

N/A

RSU (Equity)
Delivery

$1,971,348

4

Goldman Sachs Bank USA - Unvested
Restricted Stock Units

N/A

Dividend
Equivalent Cash Payment

$30,449

 #

DESCRIPTION

EIF

VALUE

5

Goldman Sachs 401 (k) Treasury Money
Market - GSAM

Yes

$50,001 $100,000

None (or less
than $201)

6

Goldman Sachs 401 (k) International Equity
Index (US Dollar Hedged) - SsgA

Yes

$50,001 $100,000

$2,501 - $5,000

7

Goldman Sachs 401 (k) Opportunistic Fixed
Income - GSAM

Yes

$15,001 $50,000

$1,001 - $2,500

8

Goldman Sachs 401 (k) Mid Cap Eq Index SSgA

Yes

$50,001 $100,000

$2,501 - $5,000

9

Goldman Sachs 401 (k) Small Cap Eq Index SSgA

Yes

$50,001 $100,000

$2,501 - $5,000

10

Goldman Sachs 401 (k) Multi-Strategy Hedge
Fund - Och Ziff

Yes

$1,001 - $15,000

None (or less
than $201)

11

Goldman Sachs 401 (k) Multi-Market Hedge
Fund - Omega

Yes

None (or less
than $1,001)

$2,501 - $5,000

12

The Goldman Sachs Group, Inc. (GS) - 2011
Restricted Shares

See Endnote

N/A

$50,001 $100,000

Dividends

$201 - $1,000

13

The Goldman Sachs Group, Inc. (GS) - 2012
Restricted Shares

See Endnote

N/A

$500,001 $1,000,000

Dividends

$5,001 - $15,000

14

The Goldman Sachs Group, Inc. (GS) - 2013
Restricted Shares

See Endnote

N/A

$250,001 $500,000

Dividends

$2,501 - $5,000

15

The Goldman Sachs Group, Inc. (GS) - 2014
Restricted Shares

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

16

The Goldman Sachs Group, Inc. (GS)

N/A

None (or less
than $1,001)

Capital Gains

$15,001 $50,000

17

The Goldman Sachs Group, Inc. (GS)

N/A

None (or less
than $1,001)

Dividends

$201 - $1,000

18

The Goldman Sachs Group, Inc.,
Outstanding 2013 Restricted Stock Units

N/A

$250,001 $500,000

Dividends

$2,501 - $5,000

19

The Goldman Sachs Group, Inc.,
Outstanding 2014 Restricted Stock Units

N/A

$500,001 $1,000,000

Dividends

$5,001 - $15,000

20

The Goldman Sachs Group, Inc.,
Outstanding 2015 Restricted Stock Units

N/A

$1,000,001 $5,000,000

Dividends

$15,001 $50,000

See Endnote

INCOME TYPE

INCOME
AMOUNT

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

21

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$1,001 - $15,000

Interest

None (or less
than $201)

22

GS HIGH YIELD FLOATING RATE FUND
INSTITUTIONAL SHARES

Yes

$100,001 $250,000

$5,001 - $15,000

23

The Goldman Sachs Group, Inc.,
Outstanding 2016 Restricted Stock Units

N/A

$1,000,001 $5,000,000

None (or less
than $201)

3. Filer's Employment Agreements and Arrangements
#

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

1

The Goldman Sachs Group, Inc.

New York, New
York

Restricted Stock Units (RSUs) and Restricted Shares- I
currently hold RSUs that were granted to me as part
of my compensation for fiscal years 2014, 2015, and
2016. Under the terms of the awards, stock
underlying these awards is scheduled to be delivered
in 2018-2020. A portion will be delivered in Restricted
Shares. I also hold Restricted Shares associated with
RSU awards that were granted to me as part of my
compensation for fiscal years 2011, 2012, 2013, 2014
and 2015. The restrictions on the Restricted Shares
generally remain in place for five years after the RSU
grant. The award agreements applicable to these
awards provide for accelerated settlement of the
RSUs and lifting of the transfer restrictions on the
Restricted Shares if I enter into certain types of
“conflicted employment.” I expect that the position of
Assistant to the President will be viewed by Goldman
Sachs as “conflicted employment.”

1/2012

2

The Goldman Sachs Group, Inc.

New York, New
York

Participating Managing Director Employment
Agreement - I am subject to a participating managing
director agreement that provides, among other
things, for confidentiality, non-competition, and nonsolicitation obligations that survive the termination of
my employment.

1/2011

 #

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

3

The Goldman Sachs Group, Inc.

New York, New
York

Shareholders Agreement - As a participating
managing director of Goldman Sachs I am subject to
a shareholders’ agreement which requires that I
retain a certain percentage of my Goldman Sachs
shares for so long as I remained a participating
managing director. The agreement also requires that
I participate in a voting arrangement with respect to
certain of my Goldman Sachs shares whereby such
shares are voted in accordance with the majority of
the shares voted by all the parties to the agreement.
All substantive obligations under the Shareholders’
Agreement will terminate when my employment as a
Goldman Sachs participating managing director
terminates.

1/2011

4

The Goldman Sachs Group, Inc.

New York, New
York

Goldman Sachs Investment Fund Interests – I am
invested in certain private investment funds
established by Goldman Sachs to permit its
employees to participate in the firm's private equity,
hedge fund and other similar activities by investing in
or alongside funds and investments that the firm
manages or sponsors for independent investors
and/or for the firm. Certain of the funds provide
employee investors with an interest in the override
the firm receives for managing the funds, and/or are
offered to employee investors on a fee-free or
reduced fee basis. All such funds are disclosed in
Part 6 of this form.

3/2011

5

The Goldman Sachs Group, Inc.

New York, New
York

401(k) Plan – I contributed a portion of my annual
compensation to a 401(k) plan. Pursuant to the terms
of the plan, I will cease to be eligible to participate in
the plan when my employment with Goldman Sachs
terminates. At that time, I will be permitted to retain
the account and direct the investment of the account
at my discretion. In addition, based on my 2016
employee contributions to the plan, I am entitled to a
2016 firm matching contribution in the amount of
$10,600, which will be allocated to my account during
the first quarter of 2017, and based on my 2017
contributions to the plan, I am entitled to a 2017 firm
matching contribution in an amount to be
determined, which will be allocated to my account
during the first quarter of 2018.

6/2007

 #

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

6

The Goldman Sachs Group, Inc.

New York, New
York

Executive Retiree Health Care Plan – On the
termination of employment, I will be eligible to
participate in the Executive Retiree Health Care Plan.
I will be responsible for paying the full cost of such
coverage.

2/2017

4. Filer's Sources of Compensation Exceeding $5,000 in a Year
#

SOURCE NAME

CITY, STATE

BRIEF DESCRIPTION OF DUTIES

1

Goldman Sachs Bank USA

New York, New
York

Participating Managing Director leading Goldman Sachs' Impact
Investing Business and the Environmental Markets Group. President of
the Goldman Sachs Foundation.

5. Spouse's Employment Assets & Income and Retirement Accounts
None

6. Other Assets and Income
#

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1

BROKERAGE ACCOUNT #1

1.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$250,001 $500,000

Interest

$1,001 - $2,500

1.2

GS ETF TRUST - GS ACTIVEBETA U.S. LARGE
CAP EQUITY ETF

Yes

$100,001 $250,000

$2,501 - $5,000

1.3

GS MLP ENERGY INFRASTRUCTURE I

Yes

$100,001 $250,000

$5,001 - $15,000

1.4

GS FOCUSED INTERNATIONAL EQUITY FUND
INSTITUTIONAL SHARES

Yes

$100,001 $250,000

$5,001 - $15,000

1.5

BROAD STREET SENIOR CREDIT PARTNERS
EMPLOYEE FUND, L.P. (CLASS A)

No

$15,001 $50,000

See Endnote

Interest

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1.5.1

Broad Street Senior Credit Partners, L.P. Aggregator with External Fund

Yes

1.6

GLOBAL LONG SHORT PARTNERS QP LP GLOBAL LONG SHORT PARTNERS QP LP

No

$50,001 $100,000

Interest
Capital Gains
Dividends

$5,001 - $15,000

1.7

BRIDGE ST 2015 L.P.

No

$100,001 $250,000

Dividends
Capital Gains
Interest

$2,501 - $5,000

1.7.1

110 University Place - Americas - Property
Development

N/A

1.7.2

Advanced Recovery Systems, LLC - Americas
- Healthcare Industry

N/A

1.7.3

Alexan Glenwood - Americas - Property
Development

N/A

1.7.4

Aruba Caribbean Hotel Holding VBA Americas- Hotel Industry

N/A

1.7.5

Ascletis BioScience Co. Ltd. - Asia Healthcare Industry

N/A

1.7.6

Axioma, Inc. - Americas - Portfolio
Management

N/A

1.7.7

Broadstone Sandy Spring - Americas Property Development

N/A

1.7.8

Credible Behavioral Health, Inc. - Americas Healthcare Industry

N/A

1.7.9

El Camino Real - Americas - Property
Development

N/A

1.7.10

Evariant, Inc. - Americas - Software

N/A

1.7.11

GCA Services Group, Inc. - Americas Maintenance

N/A

1.7.12

Golden State Medical Supply Co., Ltd. Americas - Pharmaceutical Industry

N/A

1.7.13

Gridsum Holding Inc. - Asia - Business
Solutions

N/A

See Endnote

 #

DESCRIPTION

EIF

1.7.14

GS Mezzanine Partners VI - Various Investments

1.7.15

Guahao.com Limited - Asia - Mobile Health
Care

N/A

1.7.16

Hamlet Protein AS - Europe - Animal Health

N/A

1.7.17

Laboratoire HRA Pharma SAS - Europe Pharmaceutical

N/A

1.7.18

Llamasoft, Inc. - Americas - Software
Industry

N/A

1.7.19

Luvo, Inc. - Americas - Food Industry

N/A

1.7.20

M-Tec Holding Dnmark ApS - Europe Software Industry

N/A

1.7.21

nanoPay Holdings Inc. - Americas Merchant Services

N/A

1.7.22

Oncoclinicas Do Brasil Servicos Medicos SA Americas - Healthcare Industry

N/A

1.7.23

Option Care - Americas - Medical Industry

N/A

1.7.24

Park Avenue Buckhead - Americas - Property
Development

N/A

1.7.25

Pepperfry.com - India - Retail Industry

N/A

1.7.26

Persado Holdings Ltd. - Americas Technology

N/A

1.7.27

PRL Developers Private Limited - India - Real
Estate Industry

N/A

1.7.28

ProQuest Holdings LLC - Americas Research

N/A

1.7.29

Qubit Digital Ltd - Europe- E-commerce

N/A

1.7.30

ScienceLogic, Inc. - Americas - Information
Management

N/A

1.7.31

Sterling Talent Solutions - Americas Preemployment Screening

N/A

See Endnote

N/A

VALUE

INCOME TYPE

INCOME
AMOUNT

 #

DESCRIPTION

EIF

1.7.32

Suja Life, LLC - Americas - Food Industry

N/A

1.7.33

Talentsoft SA - Europe - Software Industry

N/A

1.7.34

Tastemade, Inc. - Americas - Media Industry

N/A

1.7.35

Tutorgroup Holding - Asia - Learning
Services

N/A

1.7.36

Venus Medtech (Hangzhou) Inc. - Asia Production

N/A

1.7.37

Vero Group - Europe - Real Estate Industry

N/A

1.7.38

WeWork Companies, Inc. - Americas Workspace Rental

N/A

1.7.39

Xiaomi Technology Company Limited - Asia Technology Company

N/A

1.7.40

Zigbang Co., Ltd. - Asia - Real Estate Industry

N/A

1.7.41

Cash, Other Assets

1.7.42

Alta on the Park - Americas - Property
Development

N/A

1.7.43

Ciro's Plaza - Asia - Real Estate Industry

N/A

1.8

BRIDGE ST 2016 L.P.

1.8.1

Alexan Central Park - Americas - Property
Development

N/A

1.8.2

Austin Proper Hotel and Residences Americas - Property Development

N/A

1.8.3

Broadstone South Gulch - Americas Property Development

N/A

1.8.4

Broadstone Westside - Americas Management

N/A

1.8.5

Cell Site Solutions - Americas Communications Industry

N/A

1.8.6

Continental Bakeries - Europe - Distributors

N/A

See Endnote

See Endnote

VALUE

INCOME TYPE

INCOME
AMOUNT

$100,001 $250,000

Interest
Dividends

None (or less
than $201)

N/A

No

 #

DESCRIPTION

EIF

1.8.7

Cova Beijing Zpark Investment Ltd. - Asia Real Estate Industry

N/A

1.8.8

DEN Networks Limited - India Communications

N/A

1.8.9

Digital Management, Inc. - Americas - Digital
Industry

N/A

1.8.10

Godfrey Hollywood - Americas - Hotel
Development

N/A

1.8.11

Happy Call Co., Ltd. - Asia - Manfacturer

N/A

1.8.12

Jiangsu Carzone Auto Parts Co., Ltd. - Asia Distributor

N/A

1.8.13

MavenLink, Inc. - Americas - Software
Industry

N/A

1.8.14

North Shore Lofts - Americas - Property
Development

N/A

1.8.15

Santa Monica Proper - Americas- Hotel
Development

N/A

1.8.16

Sprout Social, Inc. - Americas - Social Media
Products

N/A

1.8.17

Tienda Inglesa U.S. Holdings LLC - Americas
- Food Industry

N/A

1.8.18

TraceLink, Inc. - Americas - Software
Industry

N/A

1.8.19

Transbay Development Project - Americas Property Development

N/A

1.8.20

Cash, Other Assets

2

BROKERAGE ACCOUNT #2

2.1

N Y N Y FOR PREVIOUS ISSUES GO 5.3750%
04/01/36 AO PREREFUNDED-SUBSER I-1
PRERE 04/01/19 UT BEO OID

See Endnote

VALUE

INCOME TYPE

INCOME
AMOUNT

$50,001 $100,000

Interest

None (or less
than $201)

N/A

N/A

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

2.2

DORM ATH OF THE ST OF NEW YORK REV
5.0000% 06/15/19 JD STATE PERSONAL
INCOME TAX REVENUE BONDS BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.3

RYE CITY N Y GO 4% 09/15/19 MS RFDG-PUB
IMPT UT BNK QUAL BEO SR LIEN

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.4

NY CITY TRANSITIONAL FIN AUTH REV
5.0000% 11/01/17 MN RFDG-FUTURE TAX
SECD-SUBSER BEO

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.5

N Y ST DORM AUTH ST PERS REV 5.0000%
02/15/18 FA NON-DEFEASED BALANCE
2014-GEN PURP-SER E BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.6

NEW YORK ST TWY AUTH ST PERS REV
2.5000% 03/15/20 MS INCOME TAX REV
TRANSN-SER A BEO

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.7

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$50,001 $100,000

Interest

None (or less
than $201)

2.8

NY CITY TRANSITIONAL FIN AUTH REV
4.5000% 11/01/19 MN FUTURE TAX
SECURED SUBORDINATE BONDS BEO SUB
LIEN

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.9

ROBBINSDALE MINN INDPT SCH GO
4.0000% 02/01/17 FA DIST # 281 RFDG-SCH
BLDG- SER B BEO

N/A

$50,001 $100,000

Interest

None (or less
than $201)

2.10

NEW YORK CITY REV 5.5000% 06/15/26-CA
JD MUNICIPAL WATER FINANCE AUTH BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.11

NEWBURGH N Y CITY SCH DIST GO 2.2500%
09/01/18 MS RFDG BEO

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.12

N Y CITY MUNI WTR FIN AUTH REV 5.0000%
06/15/17 JD WATER AND SEWER SYSTEM
SECOND GENERAL RESOLUTION

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.13

NY ST ENV FACS CLEAN WTR& REV 5.0000%
09/15/24 MS DRINKG WTR CORPORATION
PRERE 09/15/17 BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.14

COLD SPRING HBR N Y GO 5.0000%
02/01/18 FA CENT SCH DIST RFDG UT BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

2.15

NY N Y CITY HEALTH & HOSP CORP REV
5.0000% 02/15/19 FA HEALTH AND
HOSPITALS CORPORATION BEO

N/A

$50,001 $100,000

Interest

$201 - $1,000

2.16

NEW YORK CITY REV 5.1250% 06/15/19-CA
JD MUNICIPAL WATER FINANCE AUTH BEO
OID

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.17

PORT AUTH N Y & N J REV 5% 08/15/29 FA
RFDG-CONS-ONE HUNDRED FORTY EIGHTH
PRERE 08/15/17 INS BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.18

HUNTINGTON N Y GO 2% 12/01/17 JD PUB
IMPT LT BEO

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.19

SCOTIA GLENVILLE N Y CENT SCH GO
2.5000% 06/15/20 JD DIST BEO

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.20

NY STATE URBAN DEV CORP REV 5.0000%
03/15/20 MS URBAN DEVELOPMENT CORP
BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.21

SALAMANCA N Y CITY CENT SCH GO 4%
06/15/20 JD DIST RFDG LT BNK QUAL BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.22

N Y CITY HLTH AND HOSP CORP REV
5.5000% 02/15/19-CA FA HEALTH AND
HOSPITALS CORP BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.23

SCHALMONT CENT SCH DIST N Y GO
5.0000% 06/15/19 JD RFDG BEO

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.24

NEW YORK STATE URBAN REV 5.0000%
01/01/20 JJ DEVELOPMENT CORPORATION
BEO

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.25

NEW YORK ST ENVIRONMENTAL FACS REV
5% 05/15/20 MN CORP REV ST REVOLVING
FDS-SER C BEO

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.26

PULASKI N Y CENT SCH DIST GO 3%
06/15/21 JD RFDG LT BEO

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.27

MET TRANSN AUTH N Y REV 5.0000%
11/15/21 MN TRANSN-SER C BEO

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

2.28

SEWANHAKA CENT HIGH SCH DIST N GO 2%
07/15/21 JJ Y ELMONT ETC UT BEO

N/A

$50,001 $100,000

Interest

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

2.29

P R COMWLTH HGWY & TRANS AUTH REV
5.5000% 07/01/36 JJ HIGHWAY REV SER YFSA CR PRERE 07/01/16 FSA

N/A

None (or less
than $1,001)

Interest

$2,501 - $5,000

2.30

NY CITY TRANSITIONAL FIN AUTH REV
5.0000% 11/01/16 MN NON DEFEASED
BALANCE-FUTURE TAX-SUBSER I-2 BEO SUB
LIEN

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

2.31

POWER AUTH OF THE ST OF N Y REV
5.0000% 11/15/16 MN REVENUE BONDS
MBIA BEO

N/A

None (or less
than $1,001)

Interest

$2,501 - $5,000

2.32

NEW YORK STATE MUNICIPAL BOND REV
5.0000% 12/15/16-CA JD BANK AGENCY
SUB-SER A1 MK WHLE @ TREASURY RATE
+25BP

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

3

BROKERAGE ACCOUNT #3

3.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$15,001 $50,000

Interest

$201 - $1,000

3.2

BRIDGE STREET 2011, L.P.

N/A

$50,001 $100,000

Interest
Dividends
Capital Gains

$5,001 - $15,000

3.2.1

Associated Asphalt Partners, LLC - Americas
- Industrial

N/A

3.2.2

EdgeMarc Energy Holdings, LLC - Americas Energy Industry

N/A

3.2.3

Endurance International Group Holdings,
Inc. - Americas - Software Industry

N/A

3.2.4

Husky International Ltd. - Americas Manufacturer

N/A

3.2.5

Rosslyn Portfolio - Americas - Property
Management/Development

N/A

3.2.6

U.S. Security Associates, Inc. - Americas Security Services

N/A

3.2.7

Gan & Lee Pharmaceutical, Ltd. - Asia Pharmaceutical Industry

N/A

See Endnote

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

3.2.8

Novast Pharmaceutical Limited - Asia Pharmaceutical Industry

N/A

3.2.9

Qingdao Liqun Department Store Company
- Asia - Retail Industry

N/A

3.2.10

ReNew Power Ventures Private Limited India - Renewable Energy Industry

N/A

3.2.11

Cash, Taxes Receivable, Other Assets

3.3

CIP 2011 Partners

N/A

$100,001 $250,000

Dividends

$5,001 - $15,000

3.3.1

Taikang Insurance Group Inc. - AsiaFinancial Services

N/A

3.3.2

Cash, Taxes Receivable

4

BROKERAGE ACCOUNT #4

4.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$1,001 - $15,000

Interest

$1,001 - $2,500

4.2

DEUTSCHE X-TRACKERS MSCI EAFE EQUITY
ETF

Yes

$250,001 $500,000

5

BROKERAGE ACCOUNT #5 (D)

5.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$1,001 - $15,000

5.2

GS TAX-ADVANTAGED GLOBAL EQUITY
PORTFOLIO INSTITUTIONAL CLASS SHARES

Yes

$15,001 $50,000

6

BROKERAGE ACCOUNT #6 (D)

6.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$1,001 - $15,000

6.2

GS TAX-ADVANTAGED GLOBAL EQUITY
PORTFOLIO INSTITUTIONAL CLASS SHARES

Yes

$15,001 $50,000

7

BROKERAGE ACCOUNT #7 (J)

7.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

N/A

$15,001 $50,000

See Endnote

See Endnote

N/A

N/A

$5,001 - $15,000

Interest

None (or less
than $201)
$201 - $1,000

Interest

None (or less
than $201)
$201 - $1,000

Interest

$201 - $1,000

 #

DESCRIPTION

8

BROKERAGE ACCOUNT #8

8.1

GOLDMAN SACHS BANK DEPOSIT (BDA)
(Cash)

9

529 Account #1 (D)

9.1

Virginia 529 -2024 Portfolio (Alleghany)

10

529 Account #2 (D)

10.1

Virginia 529 - 2021 Portfolio (Chesapeake)

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

N/A

None (or less
than $1,001)

Interest

$201 - $1,000

Yes

$50,001 $100,000

None (or less
than $201)

Yes

$100,001 $250,000

None (or less
than $201)

7. Transactions
(N/A) - Not required for this type of report

8. Liabilities
#

CREDITOR NAME

TYPE

AMOUNT

YEAR
INCURRED

RATE

TERM

1

Bridge St. 2016 L.P.

Capital Call

$100,001 $250,000

2016

N/A

On Demand

2

Broad Street Senior Credit Partners
Employee Fund, L.P.

Capital Call

$50,001 $100,000

2015

N/A

On Demand

3

Bridge St. 2011 L.P.

Capital Call

$10,001 $15,000

2011

N/A

On Demand

4

CIP 2011 Partners L.P.

Capital Call

$10,001 $15,000

2011

N/A

On Demand

9. Gifts and Travel Reimbursements

 (N/A) - Not required for this type of report

Endnotes
PART

#

ENDNOTE

1.

1

January 2014 is an estimated start date

2.

12

Pursuant to a pre-existing legal agreement, 33% of the value of this asset is notionally allocated to a
third party. The full value of the asset is attributed to the filer for tax purposes.

2.

13

Pursuant to a pre-existing legal agreement, 25% of the value of this asset is notionally allocated to a
third party. The full value of the asset is attributed to the filer for tax purposes

2.

14

Pursuant to a pre-existing legal agreement, 20% of the value of this asset is notionally allocated to a
third party. The full value of the asset is attributed to the filer for tax purposes.

2.

18

Pursuant to a pre-existing legal agreement, 3.8% of the value of this asset is notionally allocated to a
third party. The full value of the asset is attributed to the filer for tax purposes.

6.

1.5

Broad Street Senior Credit Partners, L.P. - Aggregator with External Fund
CY Tax Estimate - Other Income - $2,980

6.

1.6

Global Long Short Partners QP LP (formerly Goldman Sachs Investment Partners QP Fund, L.P.) is a
Delaware limited partnership. As of December 31, 2015, the Partnership had invested all or
substantially all of its assets in Global Long Short Partners Aggregating LP (formerly Goldman Sachs
Investment Partners Aggregating Fund, L.P.) (the “Aggregating Vehicle”), a Delaware limited
partnership. The Aggregating Vehicle in turn had invested a significant portion of its assets in Global
Long Short Partners Masters LP (formerly Global Strategic Investment Partners Master Fund, L.P.) and
a wholly owned subsidiary, Global Long Short Partners Aggregating Holding LP (formerly Goldman
Sachs Investment Partners Aggregating Fund Holdings, L.P.).
The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.
PY Other Income - $5,695

6.

1.7.14

The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.

6.

1.7.41

The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.

6.

1.8

CY Tax Estimate - Other Income - $361

 PART

#

ENDNOTE

6.

1.8.20

The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.

6.

3.2

CY Tax Estimate - Other Income - $7,995
Pursuant to a pre-existing legal agreement, 50% of the value of this asset is notionally allocated to a
third party. The full value of the asset is attributed to the filer for tax purposes.

6.

3.2.11

The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.

6.

3.3.2

The remainder of the underlying assets are not ascertainable. This asset will be divested within 120
days of appointment.

 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 & Income and Retirement Accounts
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 (e.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.
5. Spouse's Employment Assets & Income and Retirement Accounts
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.

 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, U.S. 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).