Nominee Report US. 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 Domenech, Douglas William Assistant Secretary of the Interior Insular Areas, Department of the Interior Other Federal Government Positions Held During the Preceding 12 Months: Senior White House Advisor, Dept. of the Interior (1 /201 7 - Present) Names of Congressional Committees Considering Nomination: Committee on Energy and Natural Resources Electronic Signature - I certify that the statements I have made in this form are true, complete and correct to the best of my knowledge. ls/ Domenech, Douglas William [electronically signed on 05/11/2017 by Domenech, Douglas William in Integrity.gov] Agency Ethics Of?cial'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). McDonnell, Edward F, Certifying Official [electronically signed on 06/30/2017 by McDonnell, Edward in Integrity.gov] Other review conducted by McDonnell, Edward F, Ethics Of?cial [electronically signed on 06/30/2017 by McDonnell, Edward in Integrity.gov] Domenech, Douglas William - Page 1 US. Of?ce of Government Ethics Certi?cation ls/ Apol, David, Certifying Of?cial [electronically signed on 07/10/2017 by Apol, David in Integritygov] Domenech, Douglas William - Page 2 1. Filer's Positions Held Outside United States Government ORGANIZATION NAME CITY, STATE ORGANIZATION POSITION HELD FROM TO TYPE 1 Texas Public Policy Foundation Austin, Texas Non-Pro?t Director, Fueling 3/2015 1/2017 Freedom Project 2 Domenech Strategies Alexandria, LLC Principal 3/2014 3/2015 Virginia 3 Presidential Transition Team Washington, Transition Team Interior 8/2016 1/2017 District of for Donald J. Transition Columbia Trump Member/Lead 2. Filer's Employment Assets Income and Retirement Accounts DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 1 Texas Public Policy Foundation Salary/Bonus $142,872 2 Capital Research Center Paid $1,500 honorarium of $1,500 for writing a paper in Green Watch March 2016. 3. Filer's Employment Agreements and Arrangements None Domenech, Douglas William - Page 3 4. Filer's Sources of Compensation Exceeding $5,000 in a Year SOURCE NAME CITY, STATE BRIEF DESCRIPTION OF DUTIES 1 Texas Public Policy Foundation Austin, Texas Directed a research project called the Fueling Freedom Project. 5. Spouse's Employment Assets Income and Retirement Accounts DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 1 Romania Reborn (Non-pro?t philanthropic $1,001 - $15,000 consulting fees 501(c)3) 2 Homer International Law (International $1,001 - $15,000 consulting fees Nonpro?t and Religious Organization's Legal Servnces) 3 Morning Bird Designs (Floral design WA $15,001 - sole proprietor (weddings, events, workshops, etc.) $50,000 6. Other Assets and Income DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 1 EPIPHANY FFV FUND CLASS Yes $100,001 - $1,001 - $2,500 - $250,000 2 MFS GLOBAL GROWTH FUND CL A Yes $50,001 - $1,001 - $2,500 $100,000 3 MICROSOFT CORP COM $15,001 - Dividends $1,001 - $2,500 $50,000 4 ABBVIE INC COM $15,001 - Dividends $201 - $1,000 $50,000 Domenech, Douglas William - Page 4 DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT DREYFUS GENERAL MNY MKT FUND CL Yes $15,001 - None (or less $50,000 than $201) 6 ENBRIDGE INC COM $15,001 - Dividends $201 - $1.000 . $50,000 Capital Gains 7 DTE ENERGY CO COM WA $15,001 - Dividends $201 - $1,000 $50,000 8 CHEVRON CORP NEW COM WA $15,001 - Dividends $201 - $1 ,000 $50,000 9 AXIS CAPITAL LTD PFD SER WA $15,001 - Dividends $1 ,001 - $2,500 $50,000 10 CULLEN FROST BANKERS WA $15,001 - Dividends $201 - $1,000 $50,000 11 ANWORTH MTG CORP PFD SER WA $15,001 - Dividends $1,001 - $2,500 $50,000 12 WELLTOWER INC COM WA $15,001 - Dividends $201 - $1,000 $50,000 13 CHESAPEAKE UTILS CORP COM WA $15,001 - Dividends $201 - $1,000 $50,000 14 UNITED TECHNOLOGIES CORP COM $1 ,001 - $15,000 None (or less than $201) 15 NEW YORK BANCORP INC $1.001 - $15,000 Dividends $201 - $1 .000 16 QUALCOMM INC $1,001 - $15,000 Dividends $201 - $1,000 17 VERIZON COMMUNICATIONS INC $1,001 - $15,000 Dividends $201 - $1,000 18 PRICE ROWE GROUP INC COM $1,001 - $15,000 None (or less than $201) 19 INC COM $1,001 - $15,000 Dividends $201 - $1 .000 20 CORP COM $1,001 - $15,000 None (or less than $201) Domenech, Douglas William - Page 5 DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 21 EMERSON ELEC CO COM $1,001 - $15,000 Dividends $201 - $1,000 22 VALERO ENERGY CORP NEW COM $1,001 - $15,000 Dividends $201 - $1,000 23 CAREY INC COM $1,001 - $15,000 Dividends $201 - $1,000 24 MERCURY GEN CORP NEW COM $1,001 - $15,000 Dividends $201 - $1 ,000 25 FORD MOTOR CO DEL COM PAR None (or less Dividends $201 - $1,000 than $1 ,001) 26 MFS GLOBAL GROWTH FUND CL A Yes $50,001 - $1 ,001 - $2,500 $100,000 27 EPIPHANY FFV FUND FUND CLASS Yes $15,001 - $201 - $1,000 $50,000 28 AMAZON COM INC WA $15,001 - None (or less $50,000 than $201) 29 CISCO SYSTEMS INC None (or less Dividends $201 - $1,000 than $1 ,001) 30 TEVA PHARMACEUTICAL LTD $1,001 - $15,000 None (or less than $201) 31 SPDR INDEX EURO STOXX 50 ETF Yes $1,001 - $15,000 None (or less than $201) 32 KOHLS CORP COM $1 ,001 - $15,000 Dividends $201 - $1,000 33 EMERSON ELEC CO COM $1,001 - $15,000 Dividends $201 - $1.000 34 CVS HEALTH CORP COM $1,001 - $15,000 None (or less than $201) 35 ENERGY TRANSFER PARTNERS $1,001 - $15,000 Dividends $201 - $1,000 36 HUNTINGTON BANCSHARES SER $1,001 - $15,000 Dividends $201 - $1,000 37 ANWORTH MTG CORP PFD SER $1,001 - $15,000 Dividends $1,001 - $2,500 38 QUALCOMM INC $1,001 - $15,000 Dividends $201 - $1,000 Domenech, Douglas William - Page 6 DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 39 SPECTRA ENERGY PARTNERS LP $1 ,001 - $15,000 Dividends $201 - $1 ,000 40 WAL MART STORES INC COM $1,001 - $15,000 Dividends $201 - $1 ,000 41 CAREY INC COM $1,001 - $15,000 Dividends $201 - $1,000 42 GLAXOSMITHKLINE PLC SPONS ADR $1,001 - $15,000 Dividends $201 - $1.000 43 ANWORTH MTG CORP PFD SER A $1,001 - $15,000 Dividends $201 - $1 ,000 44 BECTON DICKINSON CO $1,001 - $15,000 None (or less than $201) 45 INTEL CORP COM $1,001 - $15,000 Dividends $201 - $1,000 46 MONSANTO CO NEW COM $1.001 - $15,000 None (or less than $201) 47 HCP INC COM $1,001 - $15,000 Dividends $201 - $1,000 48 FORD MOTOR CO DEL COM PAR None (or less Dividends $201 - $1,000 than $1,001) 49 MALLINCKRODT PUB LTD MA I $1,001 - $15,000 None (or less than $201) 50 POTASH CORP INC COM $1,001 - $15,000 Dividends $201 - $1,000 51 PERSHING GOVT ACCOUNT Yes $1,001 - $15,000 None (or less than $201) 52 FREEPORT-MCMORAN INC CL $1.001 - $15,000 None (or less than $201) 53 FERRELLGAS PARTNERS $1,001 - $15,000 Dividends $201 - $1 ,000 54 JOHNSON CTLS INTL PLC $1.001 - $15,000 None (or less than $201) 55 CST BRANDS INC COM $1,001 - $15,000 None (or less than $201) Domenech, Douglas William - Page 7 DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 56 BROOKFIELD PPTY PARTNERS None (or less Dividends $201 - $1,000 than $1 ,001) Capital Gains 57 UNILEVER PLC SPON ADR None (or less Dividends $2,501 - $5,000 than $1,001) Capital Gains 58 KOHLS CORP COM None (or less Dividends $201 - $1,000 than $1,001) Capital Gains 59 PEOPLES UNITED FINANCIAL None (or less Dividends $1,001 - $2,500 than $1,001) Capital Gains 60 SALLIE MAE PREF SER A None (or less Dividends $201 - $1,000 than $1,001) Capital Gains 61 GENERAL ELECTRIC CO COM None (or less Dividends $5,001 - $15,000 than $1,001) Capital Gains 62 RLTY TR INC COM None (or less Dividends $5,001 - $15,000 than $1,001) Capital Gains 63 CYPRESS SEMICONDUCTOR CORP COM None (or less Dividends $1,001 - $2,500 than $1,001) Capital Gains 64 CHESAPEAKE UTILS CORP COM None (or less Dividends $5.001 - $15,000 than $1,001) Capital Gains 65 AMERICAN TOWER REIT COM None (or less Dividends $5,001 - $15,000 than $1,001) Capital Gains 66 PEOPLES UNITED FINANCIAL None (or less Dividends $1,001 - $2,500 than $1,001) Capital Gains 67 HCP INC COM None (or less Dividends $201 - $1.000 than $1,001) Capital Gains 68 DIGITAL RLTY TR INC COM None (or less Dividends $2,501 - $5,000 than $1,001) Capital Gains 69 us. bank account #1 (cash) $1.001 - $15,000 None (or less than $201) Domenech, Douglas William - Page 8 DESCRIPTION EIF VALUE INCOME TYPE INCOME AMOUNT 70 US. bank account #2 (cash) $1,001 - $15,000 Interest None (or less than $201) 71 EPIPHANY FFV FUND CLASS Yes $15,001 - $1,001 - $2,500 $50,000 72 United Parcel Service Inc $1,001 - $15,000 None (or less than $201) 73 T. Rowe Price Group, Inc. - Common Stock $1,001 - $15,000 None (or less than $201) 74 Ladenburg Thalmann Financial Services Inc $1,001 - $15,000 None (or less Preferred Series A than $201) 75 Macquarie Infrastructure (MIC) $1,001 - $15,000 None (or less than $201) 7. Transactions - Not required for this type of report 8. Liabilities CREDITOR NAME TYPE AMOUNT YEAR RATE TERM INCURRED 1 Arvest Central Mortgage Company Mortgage on $500,001 - 2015 3.5 percent 30 year fixed Personal $1,000,000 Residence 9. Gifts and Travel Reimbursements Domenech, Douglas William - Page 9 - Not required for this type of report Endnotes Domenech, Douglas William - Page 10 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 ?ler did not receive compensation. This section does not include the following: (1) positions with religious, social, fraternal, or political organizations; (2) positions solely of an honorary nature; (3) positions held as part of the ?ler?s of?cial duties with the United States Government: (4) mere membership in an organization; and (5) passive investment interests as a limited partner or non-managing member of a limited liability company. 2. Filer's Employment Assets Income and Retirement Accounts Part 2 discloses the following: 0 Sources of earned and other non-investment income of the ?ler totaling more than $200 during the reporting period salary, fees, partnership share, honoraria, scholarships, and prizes) 0 Assets related to the ?ler's business, employment, or other income-generating activities that (1) ended the reporting period with a value greater than $1,000 or (2) produced more than $200 in income during the reporting period equity in business or partnership, stock options, retirement plans/accounts and their underlying holdings as appropriate, deferred compensation, and intellectual property, such as book deals and patents) This section does not include assets or income from United States Government employment or assets that were acquired separately from the ?ler's business, employment, or other income-generating activities assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0 - $200 or if the asset quali?es as an excepted investment fund (EIF). 3. Filer's Employment Agreements and Arrangements Part 3 discloses agreements or arrangements that the ?ler had during the reporting period with an employer or 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 bene?t plan, such as pensions or a deferred compensation plan Retention or disposition of employer-awarded equity, sharing in pro?ts or carried interests vested and unvested stock options, restricted stock, future share of a company's pro?ts, etc.) Domenech, Douglas William - Page 11 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 penod. The ?ler discloses payments both from employers and from any clients to whom the ?ler personally provided services. The ?ler discloses a source even if the source made its payment to the ?ler's employer and not to the ?ier. The ?ler 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: 0 Sources of earned income (excluding honoraria) for the ?ler's spouse totaling more than $1,000 during the reporting period salary, consulting fees, and partnership share) 0 Sources of honoraria for the ?ler's spouse greater than $200 during the reporting period 0 Assets related to the ?ler'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 equity in business or partnership, stock options, retirement plans/accounts and their underlying holdings as appropriate, deferred compensation, and intellectual property, such as book deals and patents) This section does not include assets or income from United States Government employment or assets that were acquired separately from the ?ler?s spouse's business, employment, or other income-generating activities assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0 - $200 or if the asset quali?es as an excepted investment fund (EIF). Amounts of income are not required for a spouse?s earned income (excluding honoraria). 6. Other Assets and Income Part 6 discloses each asset, not already reported, that (1) ended the reporting period with a value greater than $1,000 or (2) produced more than $200 in investment income during the reporting period. For purposes of the value and income thresholds, the ?ler aggregates the ?ler's interests with those of the ?ler's spouse and dependent children. This section does not includethe following types of assets: (1) a personal residence (unless it was rented out during the reporting period); (2) income or retirement bene?ts associated with United States Government employment Thrift Savings Plan); and (3) cash accounts checking, savings, money market accounts) at a single ?nancial institution with a value of $5,000 or less (unless more than $200 of income was produced). Additional exceptions apply. Note: The type of income is not required if the amount of income is $0 - $200 or if the asset quali?es as an excepted investment fund (EIF). 7. Transactions Domenech, Douglas William - Page 12 Part 7 discloses purchases, sales, or exchanges of real property or securities in excess of $1,000 made on behalf of the filer, the ?ler's spouse or dependent child during reporting period. This section does not include transactions that concern the following: (1) a personal residence, unless rented out; (2) cash accounts checking, savings, CDs, money market accounts) and money market mutual 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 ?ler, the ?ler's spouse or dependent child owed at any time during the reporting period. This section does not include the following types of liabilities: (1) mortgages on a personal residence, unless rented out (limitations apply for PAS ?lers); (2) loans secured by a personal motor vehicle, household furniture, or appliances, unless the loan exceeds the item's purchase price; and (3) revolving charge accounts, such as credit card balances, if the outstanding liability did not exceed $10,000 at the end of the reporting period. Additional exceptions apply. 9. Gifts and Travel Reimbursements This section discloses: 0 Gifts totaling more than $375 that the ?ler, the ?ler?s spouse, and dependent children received from any one source during the reporting period. 0 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 ?ler 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 ?ler'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 ?ler's spouse or dependent children totally independent of their relationship to the ?ler. Additional exceptions apply. Domenech, Douglas William - Page 13 Privacy Act Statement Title 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. Of?ce of Government Ethics regulations require the reporting of this information. The primary use of the information on this report is for review by Government of?cials 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 othen/vise 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 con?ict 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 ofJustice 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 of?cials in a new of?ce, department or agency when an employee transfers or is detailed from one covered position to another; (9) to a Member of Congress or a congressional of?ce 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 ?led with OGE by an individual nominated by the President to a position requiring Senate con?rmation. See also the executive branch-wide Privacy Act system of records. Public Burden Information This collection of information is estimated to take an average of three hoUrs per response, including time for reviewing the instructions, gathering the data needed, and completing the form. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Program Counsel, US Of?ce of Government Ethics (OGE), Suite 500, 1201 New York Avenue, NW., Washington, DC 20005-3917. Pursuant to the PapenNork Reduction Act, as amended, an agency may not conduct or sponsor, and no person is required to respond to, a collection of information unless it displays a currently valid OMB control number (that number, 3209-0001, is displayed here and at the top of the ?rst page of this OGE Form 278e). Domenech, Douglas William - Page 14