New Entrant Report   U.S. Office of Government Ethics; 5 C.F.R. part 2634   Form Approved: OMB No. (3209-0001) (January 2018)

Executive Branch Personnel
Public Financial Disclosure Report (OGE Form 278e)
Filer's Information
Muzinich, Justin
Counselor to the Secretary, Department of the Treasury
Date of Appointment: 02/27/2017
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/ Muzinich, Justin [electronically signed on 03/28/2017 by Muzinich, Justin 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/ Horton, Elizabeth A, Certifying Official [electronically signed on 05/05/2017 by Horton, Elizabeth A in Integrity.gov]

Other review conducted by
/s/ Paisley, Daniel, Ethics Official [electronically signed on 04/26/2017 by Paisley, Daniel in Integrity.gov]

U.S. Office of Government Ethics Certification

Muzinich, Justin - Page 1

 Data Revised 04/26/2017

Data Revised 04/12/2017

Muzinich,Justin - Page 2

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

ORGANIZATION NAME

CITY, STATE

ORGANIZATION
TYPE

POSITION HELD

FROM

TO

1

New York Presbyterian Hospital

New York, New
York

Hospital

Trustee

11/2016

Present

2

Friend Trust #1 (HRB)

New York, New
York

Trust

Trustee

6/2016

2/2017

3

Family Trust #1

See Endnote

New York, New
York

Trust

Trustee

1/2008

2/2017

4

Family Trust #2

See Endnote

New York, New
York

Trust

Trustee

1/2011

Present

5

Family Trust #3

See Endnote

New York, New
York

Trust

Trustee

1/2012

Present

6

Muzinich & Co.

See Endnote

New York, New
York

Corporation

President

3/2012

2/2017

7

Muzinich & Co.

New York, New
York

Corporation

Director

1/2004

2/2017

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

N/A

$5,000,001 $25,000,000

Company
Income

$9,853,077

N/A

$5,000,001 $25,000,000

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

DESCRIPTION

1

Muzinich & Co. Stock

2

Muzinich & Co. Stock Options

3

Fidelity Simple IRA

See Endnote

None (or less
than $201)

Muzinich, Justin - Page 3

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

3.1

Fidelity Adv Growth & Income-CL T

Yes

$1,001 - $15,000

None (or less
than $201)

3.2

Fidelity Adv Stock Selector Mid Cap - CL T

Yes

$1,001 - $15,000

None (or less
than $201)

4

Lincoln Financial 401k

4.1

Franklin Income Adv

Yes

$100,001 $250,000

$2,501 - $5,000

5

TD Ameritrade - IRA

5.1

Cash

$1,001 - $15,000

None (or less
than $201)

5.2

Equinix, Inc. (EQIX)

N/A

$100,001 $250,000

5.3

Mastercard (MA)

N/A

$1,001 - $15,000

5.4

PowerShares QQQ Trust, Series 1 (QQQ)

N/A

$15,001 $50,000

5.5

SPDR S&P 500 ETF Trust (SPY)

Yes

$15,001 $50,000

6

Columbia University

7

Receivable from Muzinich & Co.

Dividends

$5,000,001 $25,000,000

$1,001 - $2,500
None (or less
than $201)

Dividends

$201 - $1,000
$201 - $1,000

Earned Income
N/A

INCOME
AMOUNT

$40,000
None (or less
than $201)

3. Filer's Employment Agreements and Arrangements
#

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

1

Muzinich & Co.

New York, New
York

I will continue to participate in Muzinich & Co.'s 401(k)
plan. No contributions will be made by my former
employer after my resignation.

1/2004

Muzinich, Justin - Page 4

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

SOURCE NAME

CITY, STATE

BRIEF DESCRIPTION OF DUTIES

1

Muzinich & Company

New York, New
York

President of Muzinich & Company.

2

Columbia University

New York, New
York

Adjunct Professor

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

DESCRIPTION

1

NY and Presbyterian Hospital

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

Wages

6. Other Assets and Income
#

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1

US Bank Account (Institution #1) (Money
Market Savings)

N/A

$250,001 $500,000

Interest

$201 - $1,000

2

US Bank Account (Institution #1) (Checking)

N/A

$50,001 $100,000

3

US Bank Account (Institution #2) (Savings)

N/A

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

Interest

$1,001 - $2,500

4

US Bank Account (Institution #2) (Checking)

N/A

$500,001 $1,000,000

Interest

$201 - $1,000

5

TD Ameritrade

None (or less
than $201)

Muzinich, Justin - Page 5

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

5.1

Cash

N/A

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

5.2

Mastercard (MA)

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

5.3

Visa (V)

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

5.4

Alphabet Inc Class C (GOOG)

N/A

$100,001 $250,000

None (or less
than $201)

5.5

Alphabet Inc. Class A (GOOGL)

N/A

$100,001 $250,000

None (or less
than $201)

5.6

PowerShares QQQ Trust, Series 1 (QQQ)

Yes

$15,001 $50,000

$201 - $1,000

5.7

SPDR S&P 500 ETF Trust (SPY)

Yes

$15,001 $50,000

$201 - $1,000

5.8

Wells Fargo & Co (WFC)

N/A

$100,001 $250,000

$2,501 - $5,000

5.9

Amazon.com, Inc. (AMZN)

N/A

None (or less
than $1,001)

$100,001 $1,000,000

5.10

Monsanto Company (MON)

N/A

None (or less
than $1,001)

Dividends
Capital Gains

$15,001 $50,000

5.11

American Tower Corporation (AMT)

N/A

None (or less
than $1,001)

Dividends
Capital Gains

$15,001 $50,000

6

Fidelity Brokerage (Cash)

7

Family Trust #3 - Muzinich & Co.

8

2012 Trust

8.1

Austin Family Partners

None (or less
than $201)

$15,001 $50,000
N/A

Over
$50,000,000

INCOME
AMOUNT

None (or less
than $201)
Share of
company's
earnings

$5,720,000

See Endnote

Muzinich, Justin - Page 6

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.1.1

Charles Schwab US Treasury Fund

N/A

Over $1,000,000

$201 - $1,000

8.1.2

Alden Global Opportunities Fund, LPReceivable

N/A

$1,001 - $15,000

None (or less
than $201)

8.1.3

Alden Global Value Recovery Fund, LPReceivable

N/A

$100,001 $250,000

None (or less
than $201)

8.1.4

Tiger Accelerator Partners, L.P.-Receivable

N/A

$1,001 - $15,000

None (or less
than $201)

8.1.5

Tiger Ratan Capital Fund, LP-Receivable

N/A

$1,001 - $15,000

None (or less
than $201)

8.1.6

Altria Group Inc

N/A

$15,001 $50,000

Dividends

$1,001 - $2,500

8.1.7

Anheuser-Busch InBev NV

N/A

$50,001 $100,000

Dividends

$1,001 - $2,500

8.1.8

Berkshire Halthaway Inc Del CL B

N/A

$250,001 $500,000

Dividends

None (or less
than $201)

8.1.9

British American Tobacco PLC

N/A

$15,001 $50,000

Dividends

$1,001 - $2,500

8.1.10

Brown Forman Corp Cl A

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.11

Brown Forman Corp Cl B

N/A

$1,001 - $15,000

Dividends

None (or less
than $201)

8.1.12

Cie Financiere Richemont A

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

8.1.13

Comcast Corp New Cl A

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.14

Diageo PLC

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.15

Heineken Holding NV

N/A

$50,001 $100,000

Dividends

$1,001 - $2,500

Muzinich, Justin - Page 7

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.1.16

JCDecaux SA

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.17

Martin Marietta Matls Com

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.18

MasterCard Inc Cl A

N/A

$250,001 $500,000

Dividends

$1,001 - $2,500

8.1.19

Nestle SA Sponsored ADR

N/A

$100,001 $250,000

Dividends

$2,501 - $5,000

8.1.20

Pernod Ricard SA

N/A

$50,001 $100,000

Dividends

$1,001 - $2,500

8.1.21

Philip Morris Intl Inc

N/A

$500,001 $1,000,000

Dividends

$15,001 $50,000

8.1.22

Scripps Networks Interactive Cl A

N/A

$1,001 - $15,000

Dividends

None (or less
than $201)

8.1.23

Swatch Group AG

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.24

Unilever NV NY Shs New

N/A

$50,001 $100,000

Dividends

$1,001 - $2,500

8.1.25

Wells Fargo & Co New

N/A

$100,001 $250,000

Dividends

$2,501 - $5,000

8.1.26

Tiger Accelerator Partners, L.P.

Yes

$50,001 $100,000

$15,001 $50,000

8.1.27

Anchor Bolt Fund, LP

Yes

$250,001 $500,000

None (or less
than $201)

8.1.28

Senator Global Opportunity Fund, LP

Yes

$250,001 $500,000

$50,001 $100,000

8.1.29

Teton Capital Fund, LP

Yes

$500,001 $1,000,000

$50,001 $100,000

Muzinich, Justin - Page 8

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.1.30

Tiger Eye Partners, LP

Yes

$50,001 $100,000

None (or less
than $201)

8.1.31

Yost Partners, LP

Yes

$100,001 $250,000

None (or less
than $201)

8.1.32

Alphabet Inc Cl A

N/A

$100,001 $250,000

Dividends

None (or less
than $201)

8.1.33

Alphabet Inc Cl C

N/A

$100,001 $250,000

Dividends

None (or less
than $201)

8.1.34

Apple Inc

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

8.1.35

Bristol Myers Squibb Com

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.36

Coca Cola Co

N/A

$15,001 $50,000

Dividends

$1,001 - $2,500

8.1.37

Intel Corp

N/A

$50,001 $100,000

Dividends

$1,001 - $2,500

8.1.38

Johnson & Johnson

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

8.1.39

Kinder Morgan Inc

N/A

$250,001 $500,000

Dividends

$5,001 - $15,000

8.1.40

LegacyTexas Financial Group Inc

N/A

$50,001 $100,000

Dividends

$201 - $1,000

8.1.41

Merck & Co., Inc.

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

8.1.42

Microsoft Corp

N/A

$50,001 $100,000

Dividends

$201 - $1,000

8.1.43

Pepsico Inc

N/A

$100,001 $250,000

Dividends

$1,001 - $2,500

Muzinich, Justin - Page 9

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.1.44

RSP Permian Inc

N/A

$50,001 $100,000

Dividends

None (or less
than $201)

8.1.45

Shake Shack Inc - Class A

N/A

$15,001 $50,000

Dividends

None (or less
than $201)

8.1.46

Visa Inc Com Cl A

N/A

$15,001 $50,000

Dividends

$201 - $1,000

8.1.47

Alpenglow Management Group, LLC (Finch &
Sons)

No

$1,001 - $15,000

8.1.48

Azaya Therapeutics

N/A

$15,001 $50,000

8.1.49

Bienville Argentina Opp Master Fund, LP

Yes

$100,001 $250,000

8.1.50

BiO2 Medical, Inc

N/A

$50,001 $100,000

8.1.51

Halifax Investors II L.P.

Yes

$1,001 - $15,000

8.1.52

Healthpoint Capital Partners II, LP

No

$250,001 $500,000

8.1.52.
1

Alphatec Spine, Inc.

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.52.
2

BioHorizons

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.52.
3

Prosomnus Sleep Technologies

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.53

IP Bennett, LP

See Endnote

N/A

$15,001 $50,000

8.1.54

IP Highland Park LP

See Endnote

N/A

$100,001 $250,000

See Endnote

None (or less
than $201)
Dividends

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

Dividends

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

Portfolio
Income

Real Estate
Operations

$1,298
None (or less
than $201)

Muzinich, Justin - Page 10

 #

DESCRIPTION

EIF

VALUE

8.1.55

IP Tenison, LP

8.1.56

INCOME TYPE

See Endnote

N/A

$100,001 $250,000

None (or less
than $201)

IP San Antonio Station, LLC

See Endnote

N/A

$15,001 $50,000

None (or less
than $201)

8.1.57

Jonah Energy LLC - Oil & Gas mineral
Interest in Wyoming and Colorado

See Endnote

N/A

$250,001 $500,000

None (or less
than $201)

8.1.58

RLH Investors II, LP

See Endnote

No

$100,001 $250,000

8.1.58.
1

Total Woman Holdings Inc

See Endnote

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.58.
2

Avella Specialty Pharmacy

See Endnote

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.58.
3

RLH Bluewolf Holding, LLC

See Endnote

N/A

None (or less
than $1,001)

None (or less
than $201)

8.1.59

RLH Investors III, LP

See Endnote

No

$250,001 $500,000

Portfolio
Income

$13,492

8.1.59.
1

Bluewolf Group

See Endnote

N/A

8.1.59.
2

DCRX Infusion

See Endnote

N/A

8.1.59.
3

RMG Group

See Endnote

N/A

8.1.59.
4

Sitworx

See Endnote

N/A

8.1.59.
5

The Chartis Group

See Endnote

N/A

8.1.60

The Garden of the Gods LLC - Residential
Real Estate Development

See Endnote

N/A

$100,001 $250,000

Real Estate
Operations

$5,062

Portfolio
Income

INCOME
AMOUNT

$23,169

Muzinich, Justin - Page 11

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

8.1.61

Las Vivoritas, Ltd - South Texas Ranch - Jim
Hogg County

N/A

Over $1,000,000

Ranch
Operations

$20,000

9

Fidelity - UTMA #1

9.1

Cash

N/A

$15,001 $50,000

None (or less
than $201)

10

SPDR S&P 500 (SPY)

Yes

$15,001 $50,000

None (or less
than $201)

11

Fidelity - UTMA #2

12

Cash

$1,001 - $15,000

None (or less
than $201)

See Endnote

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

8. Liabilities
#

CREDITOR NAME

TYPE

AMOUNT

YEAR
INCURRED

RATE

TERM

1

Muzinich & Co.

Note Payable

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

2013

1%

9 years

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

Muzinich, Justin - Page 12

 Endnotes
PART

#

ENDNOTE

1.

3

Start date is approximate.

1.

4

Start date is approximate.

1.

5

Start date is approximate.

1.

6

Start date is approximate.

2.

1

This includes wages, bonuses and filer's share of company's earnings.

6.

8.1

This entity is owned both by the 2012 Trust and filer's spouse individually

6.

8.1.47

Breckenridge, CO - Medical marijuana dispensary.

6.

8.1.53

This entity holds residential property in Dallas, TX.
Data per 2015 K-1.

6.

8.1.54

This entity holds residential property in Dallas, TX.
Data per 2015 K-1.

6.

8.1.55

This entity holds residential property in Dallas, TX.
Data per 2015 K-1.

6.

8.1.56

The entity holds residential property in San Antonio, TX.
Data per 2015 K-1.

6.

8.1.57

Data per 2015 K-1.

6.

8.1.58

Data per 2015 K-1.

6.

8.1.58.1

Los Angeles, Calif. women's gym and spa facilities

6.

8.1.58.2

Phoenix, Ariz. specialty pharmacy company

Muzinich, Justin - Page 13

 PART

#

ENDNOTE

6.

8.1.58.3

holds an interest in Bluewolf Group, a New York software and IT consulting business

6.

8.1.59

Data per 2015 K-1.

6.

8.1.59.1

New York, N.Y. software and IT consulting business

6.

8.1.59.2

Sunrise, Fla. intravenous nutrition company

6.

8.1.59.3

New York, N.Y. digital advertising company

6.

8.1.59.4

Reston, Va. digital marketing software company

6.

8.1.59.5

Chicago, Ill. provider of services to hospitals

6.

8.1.60

Data per 2015 K-1.

6.

8.1.61

Estimated 2016 income

Muzinich, Justin - Page 14

 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.)

Muzinich, Justin - Page 15

 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

Muzinich, Justin - Page 16

 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 $390 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.
Travel reimbursements totaling more than $390 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 $156 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.

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 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).

Muzinich, Justin - Page 18