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 Sullivan, James J. Commissioner, Occupational Safety and Health Review Commission Other Federal Government Positions Held During the Preceding 12 Months: None Names of Congressional Committees Considering Nomination: ● Committee on Health, Education, Labor, and Pensions 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/ Sullivan, James J. [electronically signed on 04/03/2017 by Sullivan, James J. 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/ Moran, Eugene P, Certifying Official [electronically signed on 06/15/2017 by Moran, Eugene P in Integrity.gov] Other review conducted by /s/ Moran, Eugene P, Ethics Official [electronically signed on 06/15/2017 by Moran, Eugene P in Integrity.gov] U.S. Office of Government Ethics Certification /s/ Apol, David, Certifying Official [electronically signed on 06/21/2017 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 Buchanan, Ingersoll & Rooney Pittsburgh, Pennsylvania Law Firm Shareholder 7/2006 Present 2 Brandywine Red Clay Alliance West Chester, Pennsylvania Non-Profit Board Member 1/2014 Present INCOME TYPE INCOME AMOUNT 2. Filer's Employment Assets & Income and Retirement Accounts # DESCRIPTION EIF VALUE 1 IRA No.1 - Vanguard Growth Index Fund Yes $15,001 $50,000 2 Buchanan Ingersoll & Rooney PC Restated 2013 Cash Balance Pension Plan N/A $50,001 $100,000 3 Buchanan, Ingersoll & Rooney capital account N/A $100,001 $250,000 4 Buchanan Ingersoll & Rooney 5 IRA No.2 No 5.1 First Trust Dorsey Wright Focus 5 ETF Yes $1,001 - $15,000 None (or less than $201) 5.2 iShares MSCI World Yes $1,001 - $15,000 $201 - $1,000 5.3 U. S. Sweep Program (cash) N/A $1,001 - $15,000 None (or less than $201) 6 Buchanan Ingersoll & Rooney PC 401(k) plan No 6.1 American Century Investments 2025 One Choice Portfolio Institutional Class Yes $1,000,001 $5,000,000 None (or less than $201) 7 Buchanan Ingersoll & Rooney, anticipated shareholder distribution N/A $1,001 - $15,000 None (or less than $201) None (or less than $201) Interest $1,001 - $2,500 None (or less than $201) shareholder distribution $298,543 # DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 8 Buchanan Ingersoll & Rooney PC, 2006 Cash Balance Pension Plan N/A None (or less than $1,001) lump sum $124,313 3. Filer's Employment Agreements and Arrangements # EMPLOYER OR PARTY CITY, STATE STATUS AND TERMS DATE 1 Buchanan Ingersoll & Rooney, anticipated shareholder distribution Pittsburgh, Pennsylvania Pursuant to the Shareholder Agreement, I will receive my final shareholder distribution from the firm based on the value of the my shareholder interests for services performed in 2017 through the date of my withdrawal. 1/2017 2 Buchanan Ingersoll & Rooney PC Restated 2013 Cash Balance Pension Plan Pittsburgh, Pennsylvania I will continue to participate in the cash balance pension plan. The plan sponsor will not make further contributions after my separation. This account will be rolled over into the Buchanan Ingersoll and Rooney 401(k) plan. 7/2006 3 Buchanan, Ingersoll & Rooney capital account Pittsburgh, Pennsylvania Pursuant to the shareholder agreement, following my withdrawal from the firm, I will receive a refund of my capital account. The amount will be calculated as of the date of my withdrawal. The refund will be paid in three annual installments over a three-year period starting in 2017 7/2006 4 Buchanan Ingersoll & Rooney 401(k) Pittsburgh, Pennsylvania I will continue to participate in this 401(k) plan. The firm will not make further contributions. 7/2006 5 Buchanan Ingersoll & Rooney PC, 2006 Cash Balance Pension Plan Pittsburgh, Pennsylvania I received a lump sum payout of my 2006 cash balance pension plan which was terminated in 2016. 7/2006 4. Filer's Sources of Compensation Exceeding $5,000 in a Year # SOURCE NAME CITY, STATE BRIEF DESCRIPTION OF DUTIES 1 Buchanan ingersoll & Rooney Pittsburgh, Pennsylvania Shareholder 2 Main Line Health System Bryn Mawr, Pennsylvania Legal Services # SOURCE NAME CITY, STATE BRIEF DESCRIPTION OF DUTIES 3 Saber Healthcare Group Bedford Heights, Ohio Legal Services 4 PQ Corp. Valley Forge, Pennsylvania Legal Services 5 Central Bucks School District Doylestown, Pennsylvania Legal Services 6 Thomas Jefferson University Hospital Philadelpia, Pennsylvania Legal Services 7 Philaelphia Marine Trade Association Philadelphia, Pennsylvania Legal Services 8 Advoserv Bear, Delaware Legal Services 9 AmerisourceBergen Corp. Conshohocken, Pennsylvania Legal Services 10 Philadelphia Energy Solutions Refining and Marketing LLC Philadelphia, Pennsylvania Legal Services 11 Community Education Centers, Inc. West Caldwell, New Jersey Legal Services 12 Back to Basics Learning Dynamics, Inc. Wilmington, Delaware Legal Services 13 Gateway Lab School Wilmington, Delaware Legal Services 14 J & J Snack Foods Corp. Pennsauken, New Jersey Legal Services 15 High Company LLC Lancaster, Pennsylvania Legal Services 16 Matthews International Corp. Pittsburgh, Pennsylvania Legal Services 17 Eco Services Operations LLC Houston, Texas Legal Services 18 N.K.S. Distributors, Inc. New Castle, Delaware Legal Services 19 The Pennsylvania Convention Center Authority Philadelphia, Pennsylvania Legal Services # SOURCE NAME CITY, STATE BRIEF DESCRIPTION OF DUTIES 20 Ellis Coffee Company Philadelphia, Pennsylvania Legal Services 21 Origlio Beverage Philadelphia, Pennsylvania Legal Services 22 United States Roofing Corp. Norrristown, Pennsylvania Legal Services 23 Allegheny Technologies Inc. Pitttsburgh, Pennsylvania Legal Services 24 Agora Cyber Charter School King of Prussia, Pennsylvania Legal Services 25 Lentz Milling Co. Reading, Pennsylvania Legal Services 5. Spouse's Employment Assets & Income and Retirement Accounts # DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 1 IRA No. 1 No 1.1 RBC US Govt Money Market Fund Yes $1,001 - $15,000 None (or less than $201) 1.2 ALPS Sector Dividend DOGS ETF Yes $15,001 $50,000 $201 - $1,000 1.3 TEKLA World Healthcare Fund Yes $1,001 - $15,000 $1,001 - $2,500 1.4 Wisdomtree Trust small cap dividend fund ETF Yes $15,001 $50,000 $1,001 - $2,500 1.5 Vanguard FTSE Emerging Markets ETF Yes $1,001 - $15,000 None (or less than $201) 1.6 Wisdomtree TR Europe Hedged Equity Fund Yes $1,001 - $15,000 $201 - $1,000 2 American Airlines/USAIR, defined benefit plan (value not readily ascertainable) N/A 3 IRA No.2 None (or less than $201) # DESCRIPTION EIF VALUE 3.1 VRTS Strategic Growth Fund A Yes $1,001 - $15,000 INCOME TYPE INCOME AMOUNT None (or less than $201) 6. Other Assets and Income # DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 1 Visa Inc. Class A Common Stock N/A $1,001 - $15,000 Dividends None (or less than $201) 2 U S bank Acct. No. 1 (Cash) N/A $1,001 - $15,000 None (or less than $201) 3 US bank Acct. No.2 (Cash) N/A $1,001 - $15,000 None (or less than $201) 4 Irrevocable Family Trust No 4.1 Security Life of Denver, variable universal life insurance policy, guaranteed interest account No $1,001 - $15,000 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 PNC Bank Mortgage on Personal Residence $500,001 $1,000,000 2012 3.49 30 year 2 PNC Bank Exercised Line of Credit $15,001 $50,000 2012 variable 9. Gifts and Travel Reimbursements - Not required for this type of report Endnotes 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). June 28, 2017 Patrick Moran Designated Agency Ethics Official Occupational Safety and Health Review Commission 1120 20th Street NW, 9th Floor Washington, DC 20036 Re: Addendum to Financial Disclosure Report of James J. Sullivan Dear Mr. Moran: The purpose of this letter is to supplement my public financial disclosure report signed on April 3, 2017. The following information was inadvertently omitted from Part 5 of my report: Parts Description EIF Value Goldman Sachs Group Inc., bond due 3/31/2020 NI A $15,001 - $50,000 Income Type Income Amount None (or less than $201) I understand that this supplement will be attached to my financial disclosure report and released upon request with that report.