Académique Documents
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1212011)
5 C.F.R, Part 2634
Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT Form Approved:
OMB No. 3209 - 0001
U.s·. Office ofGovernment Ethics
f I
'Oateof1\ppointri1ent,Candidacy,,l'10.><tlori, Reporting
~Y.......... D Incumbent Calendar Year New Entrant,
DQ/JJ Termination TerminatlonDate Ofr'.\ppl/-.
le)IMoritiijDay.J~1
1
..o...r_.N.. 1a..tl0
'o,,..in...11... ...-n...
f;,v....ro.·n..,,.11.,.1..-...
o.. Yt._!.tr..,'.i .__--1 Status covered by Report Nominee, or 15(1 Filer Fee or Late Fi ing
(Check Appropriate
Boxes)
I I Candidate ~ Any individual who is required to file
this report and does so more than 30 days
1-------------..,....L-a-st-N-am_e_ _ _..__ _ _ _.....,_ _ _ _ __._.....___,,__-----_._------'------_.___,... after the date the report is required to be
Rep Orting ~----------------------+F::..;l::.:rs::..;tc..:N.;.;a;;;:m::.e;:...;;;an"'d::...:.M.:.:lc:dc:dl::.:e;..;I;:;n:.:.it:.:'ia::.:1;..;__ _..,.,__..,...-----! filed, or, If an extension Is granted, more
Individual's Name Slavitt Andrew than30daysafterthelastdayofthe
filing extension period, shall be subje(."t
t----------------+------'---------'---------+---------~----------..-...----1 toa$200fee.
Title of Position Department or Agency (If Applicable)
Position for Which
Filing Administrator HHS, CMS Reporting Periods
Incumbents: The reporting period is
t-------------+A-d_d_r-es_s_(_N_u_m_b_e_r_,-St-r-ee-1-,-C-it-y-,-St-a-te-,-an_d_Z-lP_C_o_d_e...;.)_ ___,..___ _ _ _ _--rT-e-le_p_h_o_n_e_N_o___(_In_c_J_u_de_Ar
_ e_a_ C_
o _de_)-l the preceding calendar year except Part
Loe a ti on of ------------------------------+---''------'---'---'--'-:.:...:.~"'-j II of Schedule C and Part I of Schedule D
Present Office 200 Independence Ave., SW Washington, DC 20201 202-690-6726 where you must also include the filing
(or forwarding address) year up to the date you file. Pan Il of
t--------------+T-it_l_e_o_f_P_os-i-ti-o-n(_s_)_a_n_d_D_a-te_(_s_)_ H _ e _ l d - - - - - - - - - - - - - - - - ' - - - - - - - - - - - - - - - l Schedule Dis not applicable.
Posltion(s) Held with the Federal
Government During the Preceding Acting Administrator, CMS, HHS: 03/03/15-Present Termination Filers: The reporting
12 Months (If Not Same as Above) Principal Deputy Administrator, CMS, HHS: 07/08114- 03/02/15 period begins at the end of the period
covered by your previous filing and ends
1 - - - - - - - - - - - - - - - , t . ._________..........._______________......._ _ _ _ _ __ ______ _ _ _ _ atthedateoftennination.PartITof ~------1
Presidential Nominees Subject Name of Congressional Committee Considering Nomination Do You Intend to Create a Qµalified Diversified Trust7 Schedule D Is not applicable.
to Senate Confirmation 0Yes
Committee on Finance 'X1
.,_____________. . ____________..___________._-c..:=""---------==:........-------------i Nominees, New
Candidates for President bell
Entrants and
and
No
. t_u_re_ _--:,
F::::------:..,.·-'""'.::--,..........,..'--------:::;~----....,..+Da-l..,.e_(,_r.i_on_th.;.,_D_ay,"",-Y._ear_.;.)_ _ _ _-i
1
Office of Government Ethics t-S_i_gn_a... ~!~~~!~t~~-::o~ ~;~fr!=:~~~~
Use Only u4-=: ~d ~ ·'J/~//..S-- arrangements as of the date of filing.
Schedule D--The reporting period is
Comments of Reviewing Offlc!als (lf additional space is required, ~ e re~de of this sheet) the preceding two calendar years and
1---------------------------'-------------------------------------.,....----------l thecurrentcalendaryearuptothedate
of filing.
(Check box if filing extension granted & indicate number of days---)
D
Agency Use Only
Ass e ts and Income Valuation of Ass ets Income : type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
0 io
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0
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at close of reporting period checked, no other entry .is needed in Block C for that item.
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* This category applies only if the asset/income is solely that of the filer's spouse or dependent children.
If the asset/income is either that of the filer or jointly held
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-
OOE Fonn 278 (Rev. 1212011)
5 C F.R. Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt, Andrew SCHEDULE A continued
(Use only if needed) 4 of 34
Assets and Income ValuationofAssets Income: type and amount. lf "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
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• This category applies only if the asset/income is solely that of the flier's spouse or dependent children. If the asset/income is either that of the filer or j ointly held
by the filer with the spou se or dependent children, mark the other higher categories of value, as appropriate.
OGEForm278(Rev.12/20ll)
5 C.F.R Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt, Andrew SCHEDULE A continued
(Use only if needed} 5 of 34
Assets and Income Valuation of Assets Income: type and amount. If "None (or less than $201)" is
at dose of reporting period checked, no other entry is needed in Block C for that item.
~ % "'
0 0 ~
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* This category applies only if the asset/income is solely that of the filer's spouse or dependent children.
If the asset/income js either that of the filer or jointly held
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
•---·•w---• •---•-•w•---W-WOW_ •_W_ _ _ ,_ - - -·---~ -~••wwo- ••·-
Assets and Income Valuationof As s ets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
.
BLOCK A BLOCK B BLOCK C
Type Amount
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* This category applies only if the asset/income is solely that of the fil er's spouse or dependent children.
If the asset/income Is either that of the filer or jointly held
by the filer with the sp ouse or dependent children, mark the other higher categories of value, as appropr iate.
OGE Fonn 278 (Rev..121201 1)
5 C.F .R. Part 2634
U .S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt, Andrew SCHEDULE A continued
(Use only if needed) 7 of 34
Assets and Inc ome Valuati on o f As sets Incom e : type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for th at item.
£ ..... .....
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Assets and Income Valuation of Assets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
& ;e;; 0
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l -- Fundamental Credit Opportunities II Fund ·- -- -
J (Hedge Fund) x - x x
2 - PH_LX..HQuSing ·Sector (HGX) $tepup Notes
J Issuer Bank of America (Notes) · .. x x
- ..
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J x x ' x
4 - Wal-Mart:Stores (WMJ) (Stock)
J x X - x x
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#1 (Annuity Var.)
Assets and Income ValuationofAssets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
I
(I)
0 0 0 o_ 0 0 (I)
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.
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... x x x x
·' .. [
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5 - Arkansas State Federal Hfghway and Grant
J Anticipation (Bond) x x x
6 -- Artisan Global Opportunities Investment I•
J Fund (ARTRX) (Mutual Fund) x x •' x
-- '
7 -- AsflmoreEmergfng Markets T otal Return '
'
J Fund Institutional Class (EMKIX) (Mutual Fund) x x x
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8 --Avago Technologies (AVGO) (Stock)
J x I x x '
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qJ
x x ;x
* This category applies only if the asset/lncome is solely that of the filer's spouse or dependent children. If the asset/income is either that of the filer or jointly held
by the filer With the spouse or dependent children, mark the other higher categories of value, as appropriate.
- -- ---------------------·--··--·-----
Assets and Income ValuationofAssets Income: type and amount. lf"None (or less than $201)" is
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'
J Institutional Fund (6S11X) (Mutual Fund} x x ; x I
Assets and Income Valuation of Assets Income: type and ainot}llt. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
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J x x x x
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J x x x
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qJ
x :
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If the asset/income is either that of the filer or jointly held
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
..
---- ------
Assets and Income Valuation of Assets Income : type and amount. If "None (or less than $201)" is
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!
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J x x x
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.\f\/lr 6,,,v fl:ln~..i,
x x x
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J Fund (EIFAX) (Mutual Fund) x x x
~
Assets and Income Valuation of Assets Income: type and amount. If "None (or less than $201)" is
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J x x x x
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J (Mutual Fund) x x x
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J {Mutual Fund) x x ~
x -
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x
This cat egory .applfo$ only if the asset/income is solely that of the flier's spouse or dependent children. If the asset/income is either that of the filer or jointly held
x x
fx1
by the 111.er with the spo_use or dependent children, mark the other higher categories of value, as appropriate.
OGE Fonn 278 (Rev. 12/201 1)
5 C.F.R. Part 2634
U .S. Office of Government Ethics
Assets and Income Valuation of Assets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
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* This category applies only if the asset/income is solely
that of the filer's spouse or dependent children. If the asset/income is either that of the filer or jointly held
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
- --
OGE Form 278 (Rev. 12/2011 )
5 C.F.R. Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt, Andrew SCHEDULE A continued
(Use only if needed) 19 of 34
Assets and Income ValuationofAssets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
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J Strategies Fund Class I (JHAIX) (Mutual Fund) 1X X' x
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J x x x x
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J (Bond) x x x .
- . .. ;
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J x x x
..
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J Y (NEZYX) (Mutual Fund) x I x x .i
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J (LISFX) (Mutual Fund) x x x
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. --
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J (LDLFX) (Mutual Fund) x x x
- Lyondell Basell lndustrie (LYB) (Stock)
qJ
x x x x
" This category applies only if the asset/income is solely that of the filer's spouse or dependent children. If the asset/In come is either that of the filer or jointly h eld
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
OGE Fonn 278 (Re v. 1212011)
5 C.F.R. Part 2634
U.S. Office of Government Etnics
Reporting Indivldual's Name Page Number
Slavitt, Andrew SCHEDULE A continued
('(,Is~ only if needed) 20 of 34
Assets and Income ValuationofAssets Income: type and amount. If "None (or less than $201)"is
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J x x x ><
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J x x x x : .•
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l -- S&P 500 Capped Leveraged Index Return
J Notes Issuer Deutsche Bank (MLHJP) (Notes) x x 0
. - ·-
2 - S&P 500 Capped Leveraged Index Return
Notes Linked Issuer HSBC (Notes) x .-
x x
·-·
3 -- S&P 500 Lookback Accelerated Return -·
Notes Issuer Bank of America (MLGVL) (Notes) x x x
'.
4 -- S&P 500 Lookback Accelerated Return "
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(NnlP!>\
5 - · S&P· Oil & Gas Exploration and Pr!l'duction
JSelect Industry Index Stepup Notes Issuer Bank x x
, nf Aml'>rii'..::i IMI 7HN\ INnf P.¢\
6 - Salt River Project Arizona - Agricultural
J Serles B Bond (Bond) x x x
7 -- Sarasota County Florida Infrastructure Sales
J Surtax Revenue Refunding Bonds (Bond) x x x
'·
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J x x x x
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qJ
Company Fund (FNDF) (Mutual Fund) x x ' x
* This category applies only if the asset/income i s solely that of the filer's sp ouse or dependent children. If the asset/income Is either that of the filer or jointly held
b y the filer with the spouse or dependent children, mark t he other higher cat egories of val ue, as appr opriate.
-··
OGE Form 278 (Rev. 1212011 )
5 C F .R Part 2634
U.S. Office of Government Ethics
Reponing Individual's Name Page Number
.Slavitt, Andrew SCHEDULE A continued
;
(Use only if needed) 25 of 34
Assets and Income ValuationofAssets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
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.J x x x
3 -- SPDR S&P 500 ETF Trust (SPY) (Mutual
J Fund) x t
x t
x
4 -- Templeton Global Bond Fund (TGBAX) It
J (Mutual Fund) x x x
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..
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.J (Mutual Fund)
... ,...
x x x
7 --Third Avenue Focused Credit Fund
Institutional Class (TFCIX) (Mutual Fund) x x x
8 -- United Parcel Svc CL B (Stock)
J x x x x
-- United Rentals (URI) (Stock)
"J x x x
* This category applies only if the asset/income is sol ely that of the filer's spouse or dependent
children. If the asset/income is either that of the filer or join tly held
by the flier with the spouse or dependent children, mark the other higher categories of value, as appropriate.
OGE form 278 (Rev. 121201 I)
5 C.F.R. Pan 2634
U.S. Office ofGovemment Ethics --
Assets and Income ValuationofAssets Income: type and am:ottht. If "None (or less than $201)" is
at close of reporting period checked, no other entry fs· needed in Block C for that item.
0 0 "CJ
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.,
1 -- UnitedHealth Group Inc (Stock) '
J x x x
-
2 - Utah State Recapitalization Revenue Bonds
J Series 201 OB (Water Resources) (Bond) · x x x
-
3 -- Vanguard Emerging Markets Stock Index
J Fund tyWO) (Mutual Fund) x •·, .x 1:
1:
x i
i Assets and Income Valuation ofAssets Income: type and am.ount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
~
~
0 : 0 0 0 ...... 0
q 0 :l
...... 0 0
0
0
0
6
0
0 8 ..
0
N
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v; 0
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s"' ....
0 0 II)
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0
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1 -- William Blair Macro Allocation Fund ; . .
(WMCIX) (Mutual Fund) x x x '
··-
2 - Zimmer Holdings Inc Com (ZMH) (Stock) .
J x : x x x . __.
..
.. , -· : .. ·- ·, ··- ··-
3 Merrili"Lynch CMAM Pledged Acct (Brokerage
Acct.) --
' ..
.·. I'
••
--- ,,
4 - Merrill Lynch Winton Futures Access LLC .
J (Hedge Fund) x x ,: x
..
'
5 PowerShares QQQ Trust Units ETF (QQQ)
J (Mutual Fund) x x :, x
6 Promissory Notes - EnerAIHes (Convertible ..
Notes) x x ..
·- ,,
7 Reta il Properties of America REIT (REID
J x x , X
8 Stlfel Investments (Brokerage Acct.) ·' · .
. ·.. .. . ·- 1:
-- Enterprise Products Partners Limited :·
·'
qJ
(Partnership) x x x .-
* This category applies only if the asset/income ls solely that of the filer's spouse or dependent chlldren.
If the asset/income ls either that of the filer or jointly held
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
OGE Fonn 278 (Rev. 1212011)
S C.F.R. Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt. Andrew SCHEDULE A continued
(Use only if needed) 28 of 34
=
Assets and Income Valua tion of Assets Income: type and amount. If "None (or less than $201)" is
at close of reporting period checked, no other entry is needed in Block C for that item.
....
~
0
0
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0
q
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•00 ..,.
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Yr.)
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0 8 0
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l - Goldman Sachs Depositary Shares Floai '. '. ..
J Rate Non-cumulative Preferred Stock Series D x ' x x x
m~·m l~tnr.k\ --
.
-- Marf<West Energy Partners (MWE) ·'
2
J (Partnership) x x ' x
3 -- Morgan Stanley Dep Shares Preferred
J Series A (MS'A) (Stock) x 'x x
-
J x x x
5 -- Vascular Solutions Inc (Stock)
J x x .X
6 -- Williams Cos Inc. Del (WMS) (Stock)
J x x x x
- - -
Strategic Storage Trust, Inc. (REIT) - · -- ' -·
7 !
J x x -: X
8 The Oakmark Select Fund (OAKLX) (Mutual
J Fund) x x x
'
United Techs Corp Com (UTX) (Stock)
qJ
x x x x !
* Thls category applies only if the asset/income ls solely that of the filer's spouse or dependent children . If the asset/Income ls either that of the flier or jointly held
by the filer with the spouse or dependent children, mark the other higher ·categories of value, as appropriate.
OGE Fonn 278 (Rev. 12/201 l)
5 C.F .R, Part 2634
U.S. Office of Government Ethics
Reporting lndivl duai's Name Page Number
Slavitt, Andrew SCHEDULE A continued :
·- ·
Assets and Income Valuation of Assets Income: type a~d amo9nt. If "None (or less than $201)" is
at close of reporting period checked, no othe1~ entry fa needed in Block C for that item.
~...
0 0 0 o - ~
...... . 0
: q o: 0
0
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Other Date
...... o· 0
~
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0 0 0 0 q 0 .0 .,, . al 0 0
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·~ ...
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Oldlnal)I
l UnitedHealth Group (Exercised & Sold) ' ' Income
(Restricted Stock. Units) x ' : $2,193,609
'
z UnitedHealth Group (Exercised and Sold) ' - O!ll1n•l)I
(Stock Option) x : ·. .'
I: _,
lncom~
$1 ,490,046
--
3 UnitedHealth Group (Exercised and Sofd) . Ordinary
Income
(Stock Appreciation Rights) x : I• $3,122,004
-.
4 UnitedHealth Group (UNH) (Stock) ;
II
J x ..
:
x x
. ....
:
I
..
D
Accounts) x x ..
I•
7 Wells Fargo Account (UTMA) (DC1) (Cash .
D
Accounts) x x '
J x !:
x x
·;
" -····
$252,613
* This category applies only if the asset/income is sol ely that of the filer's spouse or dependent children.
If the asset/income is either that of the filer or jointly held
by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
OGE Fonn 278 (Rev. 1212011)
5 C.F.R. Part 2634
U.S. Office of Government Ethics
Repor ting Individual's Name Page Number
S lavitt, Andrew SCHEDULE A continued
(Use only if needed) 30 of 34
Assets a nd Income Valuation ofAssets Income: type and amount. If "None (or less than $201)" is
at dose of reporting period checked, no other entry is needed in Block C for that item.
. I I
' I
~ ..,
I 0 0 0
Q) 0 0 0 c5 r::5 c5 ... 0o~ 0 0 ... Q) Cl. Cl. ~ .... Q) ..... 0 0ti) 0 q 0 c5
i::: q .,; c5 0 U'l
...... ..... ti) .... N
~ &') (I'} ..., {;'t &')
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..., b {;'t.... ...,
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0
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Sa1ary PIUS
1 UnitedHealth Group borMJs
$2,303,158
'
4 .
s
- -·- -·
6
•
' '
-
8
q I
. .. -
* This category applies only if the asset/ income is solely that of the filer's spouse or depend ent children. lf the asset/ income is either that of the flier or join tly held
by the filer with the spouse or dependent children, mark the other hlgher categories of value, as appropria te •
.. . . . .
OGE Form 278 (Rev. 12/201 1)
5 C.F.R. Part 2634 Do not complete Schedule B if you are a new entrant, nominee, or V ice Presidential or Presidential Candidate
U.S. Office of Government Ethics
Part I: Transactions
Report any purchase, sale, or exchange Do not report a transaction involving None O
by you, your spouse, or dependent property used solely as your personal
children during the reporting period of any residence, or a transaction solely between Transaction
real property, stocks, bonds, commodity you, your spouse, or dependent child. Type (x)
.
Amounl of Transaction (x)
.
~§: 0i'80 - 80 Ci
futures, and other securities when the
amount of the transaction exceeded $1,000.
Check the "Certificate of divestiture" block
to indicate sales made pursuant to a ...,.. .. Date
(Mo.,
'8
'
.-.Q
'0
~o
-(0
'
... 8 8~
.o
... o 8 oo
0
""0
qo_
g§ 88 t§ -.a ' 0-
.,:!!
· o ~';l
~~ ~~ og ...C).c5oo §8
a
Include transactions that resulted in a loss. certificate of divestiture from OGE.
~
<=
ta
Day, Yr .)
§o 0 ,0
.vi ~~ a8
......
g.~
qV{ qq, ~~;>.
~. ..
~ OVI V>O 0 • VlO
~vi
o~
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~;j
"' ~ """' ~~ ;;;iCJ. $~ u:a
N II>
ldent:lflC:ntion of Alise ts a.
"'""" V>I'>
""""", YIY> '~·~, "'"'
V>;il
·-··
4
.
5
--,--
*This category applies only if the underlying asset is solely that of the filer's spouse or dependent children. If the underlying asset Is either held
by the flier or jointly held by the filer with the spouse or dependent children, use the other higher categories of value, as appropriate.
Examples rnnkJones,
- -- San- - - CA
and Address)
5 '
OGE Form 278 (Rev. 12/2011)
5 C.F.R. Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Slavitt, Andraw
SCHEDULE c 32 of 34
-- ...
. ·x .
Examples 1-fclrstDlstrictBank, Washington, DC
ohn Jones. Washington. DC
_M~a~o.!J..!e:J!E9.2!:.0~~Delaw~
Promissory note
___
1999
8%
r------
10%
-... --~!f.-
on demand
- : ~---'
-- .- "
'--
x . .
--~ '-- --
1 G(ia~nt¢ed Rate, iric, ChlC<1"90 JL Mortgage on Personal Residence
2015 3.62%
30 yts,
x
2 Blackstone Capital Holdings Trust Capital Call
2014 000%
On
demand
'
:x .
5
·Merri(( Lyncn Home Loans, Jacl<sonville FL Mortgage on family residence
2012 4.25%
30y(1!,
. .
x
I· . -
*This category applies only if the liability is solely that of the filer's spouse or dependent children. If the liability is that of the filer or a joint liability of the filer
with the spouse or dependent children, mark the other higher categories, as appropriate.
Example
1
I Pursuant to partnership agreement, will receive lump sum payment of capital account & partnership share
calculated on service performed through 1/00.
Doe Jones & Smith, Hometown, State 7/85
·· ··-···- ..
2
3
'
6
.. -
OOE Fonn 278 (Rev. 12/2011 )
5 C ,F,R . Part 2634
U.S. Office of Government Ethics
Reporting Individual's Name Page Number
Part II: Compensation in Excess of $5,000 Paid by One Source Do not complete this part if you are an
Incumbent, Termination Filer, or Vice
Report sources of more than $5,000 compensation received by you or your non-profit organization when Presidential or Presidential Candidate.
bushi~.ss· a.fflliatio,i'I Jor ,s~~ces 11r~videdd!l'e~tlfby you during My one year of vou directly provided the
the rep.orung.penqc\. lhis mclpi:les.the na!11es o .cHencs ~!"Id customers ofany services generating a' fe,e or payment of more than $5,000. You
corporatibn, flri:n, panliership, or other busl.ness·enterpi'ise, or any other need ht)t rep0l'Mhe,.U.S. Government as a source. None D
Source (Name and Address) Brlef Description of Duties
~~Jones & Smith, Hometown, State U!g,11 $.t!t"Vitti
Examples - Vn
tro - lverslty
- - (d lent
- of - Doe
- JonL>s
- -& Smith),
- - M-one)<town,
- - State
- - - - - - ~~-----------~----~~--~--------
Legal seJVlces ln connection ll'lt,li university construction
l 1;;ape11a touca.lion company Minneapolis Mrt Boaro of Directors
6
OGE Fonn 278 (Rev. 1212011)
5 G.F.R. Part 2634
U.S. Office of Government E1hics
Reporung Individual's Name Page Number
Slavltt, Andrew
SCHEDULE D 34 of 34
2 Opium (subsidiary of UnitedHealth Group) Minneapolis MN Healthcare services Group Executive Vice President
09/2003 07/2014
3 UnitedHealth Foundation Minneapolis MN- Nonprofit Foundation Member. Board of Directors
06/2013 07/201 4
... .. -
4 UnTvers1ty <if Pennsylvania Philaaelphia PA - Nonprofit education institute Member, Major Gifts committee
06/2012 07/2014
Part II: Compensation in Excess of$ 5 ,000 Paid by One Source Do not complete this part if you are an
Incumbent, Termination Filer, or Vice
Report sow;ces of more than $5,000 compensation r:eceived by you or your non-p;~fit 9rgani~ation when Presidential or Presidential Candidate.
busln~ss a:fflllation forservices provided directly by you· during any one year of you dtrectly provided the
the :reporting li>eriod. This il1cludes the names-of clleilts and t:ustomers of any services generali.ng a fee or payment of more than $5,000. You
<;OJ'.pQ~~tlo.u, non, parmeli$hip, ot other b.usiness ~pterprise, or any other ri<-:ed not report t11e l).S. Government as a source. None D
Source (Name and Address) Brief Description of Duties
~e Jones & Smith, Hometown, State ~SCr\i(~
Examples tro t,Jnlvi:rSltY ll:ll~n~ of Doe Jones & Sruith); ~!orie}~<il~•i. st;;" - - - - - -~g~~~~~~with~~fy com~~ ----------------
1