Nominee 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
Azar, Alex M.
Secretary, Department of Health & Human Services
Other Federal Government Positions Held During the Preceding 12 Months:
None
Names of Congressional Committees Considering Nomination:
• Committee on Finance

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/ Azar, Alex M. [electronically signed on 10/23/2017 by Azar, Alex M. 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/ Fischmann, Elizabeth, Certifying Official [electronically signed on 11/15/2017 by Fischmann, Elizabeth in Integrity.gov]

Other review conducted by
/s/ Hall, Randall, Ethics Official [electronically signed on 11/15/2017 by Hall, Randall in Integrity.gov]

U.S. Office of Government Ethics Certification
/s/ Apol, David, Certifying Official [electronically signed on 11/17/2017 by Apol, David in Integrity.gov]

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

ORGANIZATION NAME

CITY, STATE

ORGANIZATION
TYPE

POSITION HELD

FROM

TO

1

Lilly USA, LLC

Indianapolis,
Indiana

LLC

President

1/2012

1/2017

2

HMS Holdings, Inc.

Irving, Texas

Corporation

Member, Board
of Directors

10/2016

Present

3

American Council on Germany

New York, New
York

Non-Profit

Member, Board
of Directors

12/2010

Present

4

Biotechnology Innovation Organization

Washington,
District of
Columbia

Non-Profit

Member, Board
of Directors;
Member,
Executive
Committee; Co­
Chair of Board
Standing
Committee on
Reimbursement

4/2013

1/2017

5

Healthcare Leadership Council

Washington,
District of
Columbia

Non-Profit

Member, Board
of Trustees and
Executive
Committee,
Treasurer

1/2008

1/2017

6

Indianapolis Symphony Society

Indianapolis,
Indiana

Non-Profit

Member, Board
of Directors

11/2008

Present

7

Seraphim Strategies, LLC

Indianapolis,
Indiana

LLC

Chairman and
Founder

1/2017

Present

8

Alex M. Azar II Trust

Indianapolis,
Indiana

Trust

Trustee

1/2009

Present

VALUE

INCOME TYPE

INCOME
AMOUNT

See Endnote

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

DESCRIPTION

EIF

1

IRA Roth

No

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1.1

IShares Core S&P 500 ETF (IVV)

Yes

$1,001 - $15,000

None (or less
than $201)

1.2

IShares Core S&P Mid-Cap ETF (IJH)

Yes

$1,001 - $15,000

None (or less
than $201)

1.3

American Funds Growth Fund of Amer F-1
(GFAFX)

Yes

$50,001 $100,000

$2,501 - $5,000

1.4

Columbia Contrarian Core (SMGSZ)

Yes

$100,001 $250,000

$1,001 - $2,500

1.5

Columbia Acorn Z (ACRNX)

Yes

$15,001 $50,000

$5,001 - $15,000

1.6

Keeley Small Cap Value A (KSCVX)

Yes

$15,001 $50,000

$1,001 - $2,500

1.7

Dodge & Cox International Stock (DODFX)

Yes

$50,001 $100,000

$2,501 - $5,000

1.8

Goldman Sachs Strategic Income Instl
(GSZIX)

Yes

$100,001 $250,000

$5,001 - $15,000

1.9

Columbia Value and Restructuring (UMBIX)

Yes

None (or less
than $1,001)

$5,001 - $15,000

2

IRA Rollover

No

2.1

iShares Core S&P Mid-Cap ETF (IJH)

Yes

$100,001 $250,000

$2,501 - $5,000

2.2

iShares Core S&P Small-Cap ETF (IJR)

Yes

$250,001 $500,000

$2,501 - $5,000

2.3

iShares S&P 500 Value (IVE)

Yes

$15,001 $50,000

$201 - $1,000

2.4

Schwab Government money market SWGXX

Yes

$1,001 - $15,000

None (or less
than $201)

3

Eli Lilly & Co. 401(k)

No

3.1

Stable Value Fund

Yes

None (or less
than $1,001)

$5,001 - $15,000

3.2

US All Cap Equity - Active

Yes

None (or less
than $1,001)

$2,501 - $5,000

 #

DESCRIPTION

EIF

VALUE

3.3

US All Cap Equity - Index

Yes

None (or less
than $1,001)

$201 - $1,000

3.4

International Equity - Active

Yes

None (or less
than $1,001)

$1,001 - $2,500

4

Lilly Excess Savings Plan

No

4.1

Stable Income - Active

Yes

None (or less
than $1,001)

$5,001 - $15,000

4.2

US All Cap Equity - Active

Yes

None (or less
than $1,001)

$5,001 - $15,000

4.3

US All Cap Equity - Index

Yes

None (or less
than $1,001)

$1,001 - $2,500

4.4

International Equity - Active

Yes

None (or less
than $1,001)

$5,001 - $15,000

5

Seraphim Strategies, LLC

N/A

$15,001 $50,000

None (or less
than $201)

5.1

Med Impact (booked through World Wide
Speaker's Group) - 03/10/2017

N/A

Speaker
honorarium

$12,000

5.2

Veeva Systems (booked through World Wide
Speaker's Group) - 5/8/17

N/A

Speaking
honorarium

$12,000

5.3

National Association of Specialty Pharmacy
(booked through World Wide Speaker's
Group) - 9/9/17

N/A

Speaking
honorarium

$20,000

5.4

Center for Corporate Innovation, Inc. 3/2/17

N/A

Speaking
honorarium

$2,500

6

Lilly USA, LLC

N/A

Severance

$1,600,000

7

Lilly USA, LLC

N/A

Salary/Bonus

$1,996,817

8

Lilly USA, LLC

N/A

Value of various
travel reported
as income and
associated tax
gross-up
payments.

$16,199

See Endnote

INCOME TYPE

INCOME
AMOUNT

 #

DESCRIPTION

EIF

9

Lilly USA, LLC

10

INCOME TYPE

INCOME
AMOUNT

N/A

Payment of
accrued
vacation upon
departure.

$5,479

Lilly USA, LLC

N/A

Employer match
to excess
savings plan.

$28,352

11

Lilly USA, LLC

N/A

Distribution of
excess savings
plan after
departure.

$705,073

12

Eli Lilly & Co (LLY)

Dividends
Capital Gains

$100,001 $1,000,000

13

Lilly USA, LLC

N/A

Contributions to
health savings
account.

$1,600

14

Eli Lilly and Company Defined Benefit Plan
(Nonqualified)

N/A

15

Eli Lilly and Company Defined Benefit Plan
(Qualified) (value not readily ascertainable):
eligible for benefits at ages 55 and 65;
estimated benefit for age 55 with 75%
annuity for spouse is $64,577/year

16

HMS Holdings Inc. Deferred Compensation
Plan

16.1

HMS Holdings, Inc., stock options (vested)
(7057 options)

See Endnote

N/A

16.2

HMS Holdings, Inc. stock options (unvested
until 5/23/2018) (6743 options) (value not
ascertainable)

See Endnote

N/A

16.3

HMS Holdings, Inc. restricted stock units
(vested) (10,291 units)

See Endnote

N/A

$100,001 $250,000

None (or less
than $201)

16.4

HMS Holdings, Inc. restricted stock units
(unvested until 5/23/2018) (6,743 units)

See Endnote

N/A

$100,001 $250,000

None (or less
than $201)

See Endnote

See Endnote

N/A

VALUE

None (or less
than $1,001)

$500,001 $1,000,000

N/A

None (or less
than $201)
None (or less
than $201)

No
$15,001 $50,000

None (or less
than $201)
None (or less
than $201)

 3. Filer's Employment Agreements and Arrangements
#

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

1

HMS Holdings, Inc.

Irving, Texas

Pursuant to the company's compensation plan, I will
continue to receive restricted stock units on a
quarterly basis until my resignation from the board. I
will forfeit any stock options and restricted stock units
that are unvested at the time of my resignation.
Within 90 days of my confirmation, I will divest all of
my vested stock options in HMS Holdings, Inc. If I
divest the stock options by exercising them, I will
divest any resulting stock within 90 days of my
confirmation. I will receive stock for all my vested
restricted stock units. I will divest all of the resulting
stock within 90 days of my confirmation.

10/2016

2

Eli Lilly and Company

Indianapolis,
Indiana

I will continue to participate in the Eli Lilly and
Company defined benefit plan, which has both
qualified and unqualified components. The
organization does not make any further contributions
to my account. The distributions are set and defined.
I am eligible to start receiving such payments at ages
55 and 65.

6/2007

3

Seraphim Strategies, LLC

Indianapolis,
Indiana

This LLC will be inactive during the period of my
appointment. Any outstanding fees will be received
prior to my entering Government service.

1/2017

4

Eli Lilly and Company

Indianapolis,
Indiana

I receive, as a former employee of Lilly, Departing
Executive Outplacement services which will expire in
February 2018. If confirmed I will no longer accept
this service.

1/2017

5

Indianapolis Airport Authority

Indianapolis,
Indiana

As a former member of the Board of Directors of the
Indianapolis Airport Authority, I have two parking
passes for the Indianapolis Airport.

12/2012

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

SOURCE NAME

CITY, STATE

BRIEF DESCRIPTION OF DUTIES

1

Lilly USA, LLC

Indianapolis,
Indiana

President of U.S. affiliate of biopharmaceutical company Eli Lilly and
Company

 #

SOURCE NAME

CITY, STATE

BRIEF DESCRIPTION OF DUTIES

2

National Pharmaceutical Council

Washington,
District of
Columbia

Retained Seraphim Strategies, LLC, for my consulting activities.

3

Veeva Systems

Pleasanton,
California

Through World Wide Speakers Group, retained Seraphim Strategies,
LLC, for me to deliver a speech.

4

MedImpact

San Diego,
California

Through World Wide Speakers Group, retained Seraphim Strategies,
LLC, for me to moderate a debate.

5

UCB, Inc.

Smyrna,
Georgia

Retained Seraphim Strategies, LLC, for my consulting activities.

6

National Association of Specialty Pharmacy

Alexandria,
Virginia

Through World Wide Speakers Group, retained Seraphim Strategies,
LLC, for me to deliver a speech.

7

HMS Holdings, Inc.

Irving, Texas

Member, Board of Directors

8

Seraphim Strategies, LLC

Indianapolis,
Indiana

Chairman and Founder

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

DESCRIPTION

EIF

i

IRA ROTH

No

1.1

iShares Core S&P 500 ETF (IVV)

Yes

$1,001 - $15,000

None (or less
than $201)

1.2

iShares Core S&P Mid-Cap ETF (IJH)

Yes

$1,001 - $15,000

None (or less
than $201)

1.3

American Funds Growth Fund of Amer F-1
(GFAFX)

Yes

$100,001 $250,000

$5,001 - $15,000

6. Other Assets and Income

VALUE

INCOME TYPE

INCOME
AMOUNT

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1

Brokerage Account #1

No

1.1

Schwab Municipal Money Fund (SWXXX)

Yes

$50,001 $100,000

$201 - $1,000

1.2

iShares Core S&P 500 ETF (IVV)

Yes

$500,001 $1,000,000

$15,001 $50,000

1.3

iShares Core S&P Mid-Cap ETF (IJH)

Yes

$100,001 $250,000

$15,001 $50,000

1.4

iShares Core S&P Small-Cap ETF (IJR)

Yes

$250,001 $500,000

$5,001 - $15,000

1.5

iShares S&P 500 Value (IVE)

Yes

$500,001 $1,000,000

$15,001 $50,000

1.6

iShares Core MSCI EAFE (IEFA)

Yes

$500,001 $1,000,000

$15,001 $50,000

1.7

iShares Core MSCI Pacific (IPAC)

Yes

$100,001 $250,000

$5,001 - $15,000

1.8

iShares Currency Hedged MSCI EAFE (HEFA)

Yes

$50,001 $100,000

$1,001 - $2,500

1.9

Vanguard FTSE Emerging Markets ETF (VWO)

Yes

$250,001 $500,000

$15,001 $50,000

1.10

Loomis Sayles Bond Retail (LSBRX)

Yes

$1,001 - $15,000

None (or less
than $201)

1.11

iShares S&P 500 Growth (IVW)

Yes

$500,001 $1,000,000

$5,001 - $15,000

2

CHET 529 Plan (FBO Minor Child #1)

No

2.1

Moderate Managed Allocation 17 Years

Yes

$250,001 $500,000

None (or less
than $201)

3

CHET 529 Plan (FBO Minor Child #2)

No

3.1

High Equity Balanced Option

Yes

$100,001 $250,000

None (or less
than $201)

4

IN College Choice 529 Plan (FBO Minor Child
#1)

No

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

4.1

US Equity Index Portfolio

Yes

$15,001 $50,000

None (or less
than $201)

5

IN College Choice 529 Plan (FBO Minor Child
#2)

No

5.1

US Equity Index Portfolio

Yes

$250,001 $500,000

None (or less
than $201)

6

Brokerage Account #2

No

6.1

American Mun Pwr Ohio Inc Rev (CUSIP:
02765UHH0)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.2

American Mun Pwr Ohio Inc Rev Energy Re
(CUSIP: 02765UBB9)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.3

Bloomington Ind Redev Dist Tax (CUSIP:
094717BH7)

N/A

$15,001 $50,000

Interest

$5,001 - $15,000

6.4

Chicago Ill Brd Ed (CUSIP: 1675016D2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.5

Concord Ind Cmnty Schs Bldg Co (CUSIP:
206256PV5)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.6

Delaware Mun Elec Corp Elec Re (CUSIP:
246154BU1)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.7

Dover Del Elec Rev (CUSIP: 260039JC7)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.8

Evansville Ind Loc Pub Impt Bd (CUSIP:
299348BV3)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.9

Greater Clark Cnty Sch Bldg Co (CUSIP:
391673EG1)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.10

Gulf Shores Ala Pub Edl Bldg A (CUSIP:
40252NAW0)

N/A

$100,001 $250,000

None (or less
than $201)

6.11

Harris Cnty Tex Cultural Ed Fa (CUSIP:
414008BJ0)

N/A

$50,001 $100,000

None (or less
than $201)

6.12

Humble Tex Indpt Sch Dist Sch Bldg (CUSIP:
4450425Q3)

N/A

$50,001 $100,000

Interest

INCOME
AMOUNT

$5,001 - $15,000

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

6.13

Illinois St Toll Hwy Auth Toll (CUSIP:
452252JV2)

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

6.14

Illinois St Toll Hwy Auth Toll (CUSIP:
452252KS7)

N/A

$50,001 $100,000

Interest

$2,501 - $5,000

6.15

Indiana Fin Auth Hosp Rev (CUSIP:
45471AKA9)

N/A

$100,001 $250,000

Interest

$1,001 - $2,500

6.16

Indiana Fin Auth Hosp Rev (CUSIP:
45471ANW8)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.17

Indiana Health Fac Fing Auth R (CUSIP:
454798TA7)

N/A

$50,001 $100,000

Interest

$2,501 - $5,000

6.18

Indiana St Fin Auth Rev (CUSIP: 45506DUL7)

N/A

$100,001 $250,000

Interest

$5,001 - $15,000

6.19

Indiana St Fin Auth Rev (CUSIP: 455057F87)

N/A

$15,001 $50,000

6.20

Indiana St Fin Auth Wastewater (CUSIP:
45505MAT3)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.21

Indiana St Fin Auth Wastewater (CUSIP:
45505MBJ4)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.22

Indiana St Fin Auth Wastewater (CUSIP:
45505MFD3)

N/A

$50,001 $100,000

Interest

$2,501 - $5,000

6.23

Indianapolis Ind Loc Pub Impt (CUSIP:
45528UAT8)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.24

Indianapolis Ind Loc Pub Impt (CUSIP:
45528UAV3)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.25

Indianapolis Ind Loc Pub Impt (CUSIP:
45528UFU0)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.26

Jackson Cnty Miss Util Auth Wt (CUSIP:
467319AV1)

N/A

$100,001 $250,000

Interest

$2,501 - $5,000

6.27

King Cnty Was Sch Dist No 401 Go Bds
(CUSIP: 495033AL6)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.28

Lake Central Ind Multi-Dist Sc (CUSIP:
507686PP2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

6.29

Laredo Tex Wtrwks Swr Sys Rev Rev Bds
(CUSIP: 517039FZ1)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.30

Las Vegas Valley Nev Wtr Dist (CUSIP:
5178405T7)

N/A

$100,001 $250,000

6.31

Lee Cnty Fla Tourist Dev Tax R (CUSIP:
523520CK8)

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

6.32

Lower Colo Riv Auth Tex Rev (CUSIP:
54811GLU2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.33

Lower Colo Riv Auth Tex Transm (CUSIP:
54811BPX3)

N/A

$100,001 $250,000

Interest

$1,001 - $2,500

6.34

Maine Mun Bd Bk (CUSIP: 560459M97)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.35

Metropolitan Govt Nashville & (CUSIP:
592090FH2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.36

Miami-Dade Cnty Fla Wtr & Swr (CUSIP:
59334DGU2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.37

Mt Vernon Ind Sch Bldg Corp (CUSIP:
623495BP2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.38

N Tx Twy Auth (CUSIP: 66285WTE6)

N/A

$1,001 - $15,000

Interest

$201 - $1,000

6.39

N Tx Twy Auth (CUSIP: 66285WPS9)

N/A

$15,001 $50,000

Interest

$2,501 - $5,000

6.40

N Tx Twy Auth (CUSIP: 66285WSW7)

N/A

$15,001 $50,000

Interest

$5,001 - $15,000

6.41

Noblesville Ind Redev Auth Eco (CUSIP:
65516QFW7)

N/A

$50,001 $100,000

Interest

$15,001 $50,000

6.42

Olmsted Falls Ohio City Sch Di (CUSIP:
681233DU3)

N/A

$100,001 $250,000

6.43

Orlando & Orange Cnty Expwy Au (CUSIP:
686543UB3)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.44

Pennsylvania St Tpk Commn Tpk (CUSIP:
709223ZQ7)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

None (or less
than $201)

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

6.45

Pennsylvania St Tpk Commn Tpk (CUSIP:
709224HN2)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.46

Port Tacoma Wash (CUSIP: 735422LD7)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.47

Regional Transn Dist Colo Ctfs (CUSIP:
75913THV9)

N/A

$100,001 $250,000

Interest

$15,001 $50,000

6.48

Riverside Ohio Loc Sch Dist (CUSIP:
769229BJ3)

N/A

$100,001 $250,000

Interest

$5,001 - $15,000

6.49

Rock Hill S C Util Sys Rev (CUSIP:
772249QC5)

N/A

$100,001 $250,000

Interest

$2,501 - $5,000

6.50

Sandusky Ohio City Sch Dist (CUSIP:
800205EP7)

N/A

$100,001 $250,000

6.51

South Carolina St Pub Svcs Aut (CUSIP:
837151HW2)

N/A

$100,001 $250,000

6.52

South Montgomery In (CUSIP: 84455RCC6)

N/A

$50,001 $100,000

6.53

Utah Tran Auth Sales Tax Rev (CUSIP:
917565MK6)

N/A

$100,001 $250,000

Interest

$15,001 $50,000

6.54

Warsaw Ind Multi-Sch Bldg Corp (CUSIP:
93638RCK9)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.55

Washington St Higher Ed Facs A (CUSIP:
939781Q60)

N/A

$50,001 $100,000

Interest

$5,001 - $15,000

6.56

Winton Woods City Sch Dist Ohi (CUSIP:
97650ECE6)

N/A

$100,001 $250,000

6.57

Wppi Energy Wis Pwr Supply Sys (CUSIP:
92937NAQ7)

N/A

$50,001 $100,000

6.58

Wells Fargo Advantage Ult S/T Mun Inc A
(SMAVX)

Yes

$250,001 $500,000

6.59

DALLAS TEX AREA RAPID TRAN (CUSIP:
235241RF5)

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

6.60

Dallas Tex Area Rapid Tran Sales Tax Rev
Prerefund (CUSIP: 235241QS8)

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

None (or less
than $201)
Interest

$15,001 $50,000
None (or less
than $201)

None (or less
than $201)
Interest

$5,001 - $15,000
$2,501 - $5,000

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

6.61

Massachusetts St Sch Bldg Auth (CUSIP:
576000SL8)

N/A

None (or less
than $1,001)

Interest

$5,001 - $15,000

6.62

N Tx Twy Auth (CUSIP: 66285WQC3)

N/A

None (or less
than $1,001)

Interest

$201 - $1,000

6.63

Washington St Higher Ed Facs A (CUSIP:
939781Q60)

N/A

None (or less
than $1,001)

Interest

$2,501 - $5,000

6.64

Aldine Tex Indpt Sch Dist (CUSIP:
014393MS8)

N/A

None (or less
than $1,001)

Interest

$5,001 - $15,000

6.65

Arizona St Transn Brd Hwy Rev (CUSIP:
040654PV1)

N/A

None (or less
than $1,001)

Interest

$5,001 - $15,000

6.66

Chicago Ill Brd Ed (CUSIP: 167505FA9)

N/A

None (or less
than $1,001)

Interest

$201 - $1,000

6.67

Cincinnati Ohio Wtr Sys Rev Rmkt Wtr
(CUSIP: 172311FT4)

N/A

None (or less
than $1,001)

Interest

$5,001 - $15,000

6.68

Clark Cnty Nev For Issues Dtd Bond Bk B
(CUSIP: 180848AL7)

N/A

None (or less
than $1,001)

Interest

$2,501 - $5,000

6.69

North Carolina Eastn Mun Pwr A Pwr Sys R
(CUSIP: 658196P46)

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

6.70

Pierce Cnty Wash Sch Dist No 4 Ult Go Bd
(CUSIP: 720560QJ3)

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

6.71

Seminole Cnty Fla Wtr & Swr Re Wtr And S
(CUSIP: 816705GQ4)

N/A

None (or less
than $1,001)

Interest

$5,001 - $15,000

6.72

Washington St Go Bds (CUSIP: 93974BSD5)

N/A

None (or less
than $1,001)

Interest

$1,001 - $2,500

6.73

U.S. brokerage account (Cash)

N/A

$50,001 $100,000

7

NBC Investors, LLC

No

7.1

NBC Industrial, LLC

No

7.1.1

Commercial Real Estate #1, Indianapolis
Indiana

See Endnote

N/A

$250,001 $500,000

None (or less
than $201)

Rent or
Royalties

$15,001 $50,000

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

7.1.2

Commercial Real Estate, Indianapolis, IN

N/A

None (or less
than $1,001)

Rent or
Royalties
Capital Gains

$100,001 $1,000,000

8

SQN Venture Income Fund, LP

No

8.1

Mainframe, loan receivable (cloud-based
platforms)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

8.2

Soraa, loan receivable (lighting
development and manufacturing)

N/A

$50,001 $100,000

Interest

$1,001 - $2,500

8.3

Calysta, loan receivable (development of
biological)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

8.4

Tigo Energy, loan receivable (solar power
installations)

N/A

$50,001 $100,000

Interest

$2,501 - $5,000

8.5

Boardwalk Tech, loan receivable (business
process automation)

N/A

$15,001 $50,000

Interest

$5,001 - $15,000

8.6

Kaazing Inc, loan receivable (enterprise
infrastructure products)

N/A

$15,001 $50,000

Interest

$2,501 - $5,000

8.7

Vantage Robotics, loan receivable (flying
camera technology)

N/A

$1,001 - $15,000

Interest

$201 - $1,000

8.8

Crop One Holdings, Inc, loan receivable
(farming technology)

N/A

$1,001 - $15,000

Interest

$201 - $1,000

8.9

Knowledge Factor, loan receivable
(education software)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

8.10

Shapeways, loan receivable (3D printing and
related services)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

8.11

FR8Hub, loan receivable (freight industry
technology)

N/A

$1,001 - $15,000

8.12

Luminar, loan receivable (sensor
technologies for automatic vehicles)

N/A

$15,001 $50,000

Interest

$201 - $1,000

8.13

Gluware, loan receivable (multi-vendor IT
automation)

N/A

$15,001 $50,000

Interest

$201 - $1,000

8.14

Volta Charging, loan receivable (electronic
vehicle charging)

N/A

$1,001 - $15,000

See Endnote

None (or less
than $201)

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.15

Volta Charging warrants (electronic vehicle
charging)

N/A

$1,001 - $15,000

None (or less
than $201)

8.16

Soraa warrants (lighting development and
manufacturing)

N/A

$1,001 - $15,000

None (or less
than $201)

8.17

Mainframe warrants (cloud based
platforms)

N/A

$1,001 - $15,000

None (or less
than $201)

8.18

Tigo Energy warrants (solar power
installations)

N/A

$1,001 - $15,000

None (or less
than $201)

8.19

Boardwalk Tech warrants (business process
automation)

N/A

$1,001 - $15,000

None (or less
than $201)

8.20

Knowledge Factors warrants (education
software)

N/A

$1,001 - $15,000

None (or less
than $201)

8.21

Kaazing Corp. warrants (enterprise
infrastructure products)

N/A

$15,001 $50,000

None (or less
than $201)

8.22

Shapeways warrants (3D printing and
related services)

N/A

$1,001 - $15,000

None (or less
than $201)

8.23

Gluware warrants (multi-vendor IT
automation)

N/A

$1,001 - $15,000

None (or less
than $201)

8.24

Incredible Foods warrants (frozen food
production and marketing)

N/A

$1,001 - $15,000

None (or less
than $201)

8.25

Suniva, loan receivable (solar power
technology)

N/A

$50,001 $100,000

None (or less
than $201)

8.26

U.S. bank account (Cash Account)

N/A

$100,001 $250,000

None (or less
than $201)

9

U.S. Credit Union #1 (Cash Account)

N/A

$1,001 - $15,000

None (or less
than $201)

10

U.S. Credit Union #2 (Cash Account)

N/A

$1,001 - $15,000

None (or less
than $201)

11

Health Savings Account

No

11.1

U.S. bank account (Cash Account)

N/A

$1,001 - $15,000

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

11.2

PIMCO Investment Grade Corporate Bond
Instl Fund (PIGIX)

Yes

$15,001 $50,000

None (or less
than $201)

11.3

Vanguard Total Stock Market Index Fund
(VITSX)

Yes

$50,001 $100,000

None (or less
than $201)

11.4

MFS Agressive Growth Allocation Fund Class
A (MAAGX)

Yes

None (or less
than $1,001)

$1,001 - $2,500

11.5

PIMCO StocksPLUS Small A Fund (PCKAX)

Yes

None (or less
than $1,001)

$1,001 - $2,500

12

Irrevocable Life Insurance Trust

12.1

Northwestern Mutual Estate Complife Policy
#1 (whole life and term hybrid product)

N/A

$50,001 $100,000

Dividends

$2,501 - $5,000

12.2

Northwestern Mutual Estate Complife #2
(whole life and term hybrid product)

N/A

$100,001 $250,000

Dividends

$5,001 - $15,000

12.3

Northwestern Mutual Life Insurance
Adjustable Complife (whole life and term
hybrid product)

N/A

$250,001 $500,000

Dividends

$15,001 $50,000

13

SD College Choice Savings

No

13.1

Age-Based 9 (Ages 17 and Over) Class A

Yes

$15,001 $50,000

See Endnote

INCOME TYPE

INCOME
AMOUNT

No

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

Elements Financial

Mortgage on
Personal
Residence

$500,001 $1,000,000

2009

prime + 1

300 months

 #

CREDITOR NAME

2

Morgan Stanley

3

Morgan Stanley

TYPE

AMOUNT

YEAR
INCURRED

RATE

TERM

See Endnote

Exercised Line
of Credit

$15,001 $50,000

2016

3.27%

revolving

See Endnote

Exercised Line
of Credit

$15,001 $50,000

2016

3.10%

revolving

9. Gifts and Travel Reimbursements
(N/A) - Not required for this type of report

Endnotes
PART

#

ENDNOTE

1.

8

This trust has not been funded and holds no assets.

2.

5

The LLC functions as a vehicle to perform consulting work and receive payment for speaking
engagements.

2.

12

As part of my compensation for my position at Lilly USA, LLC between 1/1/2016 and 1/31/2017, I
received Eli Lilly & Co stock units at a total share value of $3,434,219.08. I no longer hold any Eli Lilly &
Co stock.

2.

15

Yearly disbursement is a good faith estimate based on assumption of retirement at age 55 with
annuity after death for my spouse.

2.

16.1

Directors fees for board service on HMS Holdings, Inc. Options issued at $16.54 strike price; current
market value of $19.36. Value per option calculated as difference between market value and strike
price. Options expire 11-11-2026.

2.

16.2

Directors fees for board service on HMS Holdings, Inc. Options issued at $17.45 strike price; current
market value of $19.36. Options expire 8-21-2027.

2.

16.3

Directors fees for board service on HMS Holdings, Inc. Market value of $19.36.

2.

16.4

Directors fees for board service on HMS Holdings, Inc.

6.

7.1.1

Consists of six properties on a single deed.

6.

7.1.2

Property no longer held.

 PART

#

ENDNOTE

6.

12

This is a life insurance trust established by the filer's father. The filer is a co-beneficiary with his sister;
reported values and income represent his 50% interest.

8.

2

Paid in full on 10/17/16.

8.

3

Paid in full on 12/01/16.

 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.
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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).