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Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app..~ 101-111)
4. Title (Article III judges indicate active or senior status; magistrate judges indicate full- or part-time)
7. Chambers or Office Addrt~s 307 U. S. Courthouse 1716 SpielBusch Avenue Toledo, OH 43604
8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable la~vs and regulations. Re~,iev,ing Officer Date
IMPORTANT NOTES: The instructions accompanying this form must be followetL Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.
NAME OF ORGANIZATION/ENTITY
David S. Stone Foundation National Council of Ohio State University College of Law Mercy Health System - Northern Region
II. AGREEMENTS. (Reporting individual only; see pp. 14-16 of filing instructions.)
~] NONE (No reportable agreements.) DATE PARTIES AND TERMS
Katz, David A.
III. NON-INVESTMENT INCOME. (Repotting individual and spouse; see pp. 17-24 of filing instructions.)
A. Filers Non-Investment Income
~] NONE (No reportable non-investment income.) DATE SOURCE AND TYPE
2. 3. 4.
B. Spouses Non-Investment Income - If you were married during any portion of the reporting year, complete this section.
(Dollar amount not required except for honoraria.)
~
1. 2.
SOURCE
U.S. Russia Foundation American Conference Institute Geroge Mason University Foundation American Conrference Institute
DATES
7/I 1/10 - 717/10 9/29/10 - 9/30/10
LOCATION
Russia New York, NY
PURPOSE
Panel Member Panel Member
3.
10/7/10 - 10/10/10
Arlington, VA
4.
12/8/10 - 12/9/10
New York, NY
Panel Member
5.
V. GIFTS. ancludes those to spouse and dependent children; see pp. 28-31 of filing instructions.)
NONE (No reportable gifts.)
SOURCE
I. 2. 3. 4.
DESCRIPTION
VALUE
5.
VI. LIABILITIES. ancludes those of spouse and dependent children; see pp. 32-33 of filing instructionsO
NONE (No reportable liabilities.) CREDITOR
I. 2. 3. 4. 5.
DESCRIPTION
VALUECODE
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; seepp. 34-60 of filing instruction~.)
NONE (No reportable income, assets, or transactions.)
A. Description of Assets (including trust assets) Place "(X)" after each asset exempt from prior disclosure B. Income during reporting period (I) Amount Code I (A-H) (2) Type (e.g., div., rent, or int.) C. Gross value at end of reporting period (D Value Code 2 (J-P) (2) Value Method Code 3 (Q-W) W Sold 08/18/10 J O) Type (e.g., buy, sell, redemption) D. Transactions during reporting period (2) (3) Date Value mm]dd/yy Code 2 (J-P)
Lepercq Corp Inc fomerly Pacific Place Ltd Citigroup Inc. Fifth Third Banksafe (4) Express Scripts Inc. UMB Scout Worldwide Fund Vanguard Total Skt Mkt-Vipers IRA, composed of security investment fund Fifth Third Vanguard Long-Term Bond Earthlink, Inc. Quantum CP Web.Com Group American Growth Fund Federated Strategic Value Team Touchstone Mid Cap Growth Vanguard Short-Term lnv Oppenheimer Div. MKT
B A A
K Sold J Sold O Redeemed 03/31/10 K J Sold J L M K T T T T Redeemed 06/29/I 0 L J A 08118/10 J 08/18110 J 10/05110 J
A A E B
D D C
Dividend
I. Income Gain Codes: (See Columns BI and 134) 2. Value Codes ISec Columns CI and D3} 3. Value Method Codes ~Scc Column C21
A =$1,000 or less F =$50,001 - $10O,00~ J =$15,0~0 or less N =$250,0~1 - $50~,000 P3 $ 25,000,001 - $ 50.000.000 Q =Appraisal U =Book Value
B =$1,001 - $2,500 G =SI00,0~l - $1,000.0~0 K $15,001 - $50.000 O =$500.001 - $1,00O.000 R =Cost (Real Estate Only) V Other
C =$2,501 - $5,000 HI =SI,0~9.001 - $5,00~,0~0 L =$50,0~1 PI =$1.0~0.001 - $5,000,0,00 P4 =More than $50,000.0~0 S =Assessment W =Estimatod
D =$5,001 - $15,000 H2 =More than $5,000,0~O M =$100,0~1 - $250,000 P2 ~$5,090,001 - $25,000,000 T =Cash Market
E =$15,001 - $50.000
IX. CERTIFICATION.
I certify that all information given above (including information pertaining to my spouse and minor or dependent children, if any) is accurate, true, and complete to the best of my knowledge and belief, and that any information not reported was withheld because it met applicable statutory provisions permitting non-disclosure.
1 further certify that earned income from outside emplo)anent and honoraria and the acceptance of gifts ~vhich have been reported are in compliance with the provisions of 5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations.
Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544