Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Rick Berg's 2011 Personal Financial Disclosure Form

Rick Berg's 2011 Personal Financial Disclosure Form

Ratings: (0)|Views: 125|Likes:
Published by NorthDakotaWay
Rick Berg's 2011 Personal Financial Disclosure Form.
Rick Berg's 2011 Personal Financial Disclosure Form.

More info:

Categories:Types, Legal forms
Published by: NorthDakotaWay on Aug 09, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

08/09/2012

pdf

text

original

 
HAND
DELIVERED
2DI2
JW!
I 4
M:
I
:
00
UNITED
STATES
HOUSE
OF
REPRESENTATIVES
I
FORM
A
P•ge
1
or
11
CALENDAR
YEAR
2011
FINANCIAL
DISCLOSURE STATEMENT
For use
by
Members,
oflloel'll,
and
em~loyHII
~u
ichard
A (Rick)
Berg
202-225-9575
(Full
Name)
<DI)IIrne
TelePhone)
__
_
(Office
Uae
Only)
Flllr
;
~
Memberofttle
u.s.
State:
NO
:I
0OfficerOr
Employing
Oflloe:
A
UOO
penalty
ahaD
Status
I
House
of
Re~reaenlalives
Clstrlct:
1
Emptoyeii
be'"'""
egllnet
-.
1nyone
who
fltn
Report
~.Annual
(May
15)
l
c:
lc
Termln11lion
Date
:
morethan
30
d.ya
TypeAmendment
Tennlnatlon
lm.
PRELIMINARY
JNFORMATION-
ANSWER EACH OFTHESEQUESTIONS
t
Dltl
1ouor
fiiUt
opo""o.......
•a.....,.
Into-
(o.c.,
111
111•
or
ftN)
ol
UIIG
Gilt
YQV,
y-
epo~~
uo,...llont
ohlld
.....,..,
Ani'
ropool&l>lo
gill
m
,__,.
lro"'8ft1-rcellllht
~
ptllod'/
Yta
li(
No
r::::J
VI,
flit
NPOIUIO
piiiGd
IIIIDrttllilng
-'""
no
ua
1101
0111o1wtoo
Y
"_.J
No~
~7
II
y
,
co"'fflettland attach
SeM<IUio
1.
It
r-.
campi.Wand
llttach
Sdledu'*
VI.
II.
Did
..,.lndtvlduol
or
_..,
.,Uon
""""a.,_.,.
o
C/111111
In
II
of
JIIIYIIIQ
-
Did
JOU,
y-..,....
or
tponde4.ieNid
....rn..,
~.
·
trO;
.,,.,
yourora-ll,tppo
........
ellklttnthoNportl•tl"'rtod?
v
.
n
No~
VII.
-..-tortr
...
lolbonportl•gpll1ocl~-~~~iti•HO
Yea
LJ
No
li!l
"""'011010<11"")'
lfy•
,
~end
-ch
Schedule
H.
If
Y•·
compr.w
..
r
lllaeh Sct.tdur.
VII
.I
ll
.
Dl-
yov,
your
epouu,.,
a
~opeo~donl
GIIU
IICII.,..
•vn..,otd"l
........
ol
Old
rou
11011111111
"pol!lllll"
.0.1110011""
or-..
IMI-
Dtftlflll
In
11>1
--
szoo
Is
tbo
...,......ng
fii'IDd
0111Cid...,.
,.
....
,.
-·•-
""!ill
No
0
VUI.
.......acolorldu,..-7
Y
J!ll
No
O
"'""'then
ft,OOO
at
tbo
tnd
Of
tilt
plllod7
II
r .
omplelle
lllld
-Oh
Schedule
Ill
.
If
y•.
con~
pi*
aftd
-~~
Selutcllde
VIII
.
IV
.
~~~-fOlio
'OOI'IpGUH,
ot
dopo'ldt~l
dlllcf
,.....I\
..
,
10
11
, ....
-hal!gO
I
Ill
IX.
Did
you...V.
iny
11'Q1111H
"'-or""""~~",_
,..h
llll
oullldo
-'""
oo..t
ln
o1r-.ollon
OliCIOdliiQ
rt,
GOG
dUIIng
tho
,..,.,.
Y
..
lil)
No
[]
ril(l
v
.
n
No
'i']
-
~';':,'
oom,.._
and
Mtach
Schedule
rv.
-
w,-.
conpl.te
1111<1
IIIIIch
SclltcluleiX
.
..
·-
---
·-
Dlclro<~
,
your.,;;ii.i
o,
oriidopoodonl
chN"""•anrroporUbt.
..
lllly
v.
,_
......
f10.t00)4urlntlhl
._.,.,,....d?
v
.
~
Non
Each
qu1etlon
In
tflls
p;~rt
must
be
an.wered
and the
1pprop~
lr
Y
.
_,lllett
11'<1
attt.m
SCMdu'*
v.
schlltdule 1t11ched
for
each
"Y•"
reepon
...
EXCLUSION
OF
SPOUSE, OEPENDENT,
OR
TRUST
INFORMATION-
ANSWER EACH
OF
THESE QUESTIONS
Trueta-
DIUie Npodlng
"Quollllld
a/nd
,.,.._.
•Pf1"11*1
b1
the
Cornmllhl
on
Elhl
..
id
~In
olher
·•-pte~~
trua•
need
noUe
dii,ICIMd.
Haw
JOII
tnlud.cl
fnlrn
thll
raport
dllalll
of
llllah I
111.111
benefiting you, )'Oir lfiOUII,
or
depend.nt
dlild?
Exemptlone~;
.
.k;..;
rnu
acludldlnm
ttu
,.part
any
other
••
.-.
u.-mld"
In~
tr111111~,
or lllbllllltl
ola
apouu
01
dep•'*nt
chid
-.u
.
Mv
meltlllllwN
....
I'Cir
eumpllon?
Do
not
--
"Y•"
unlen
you
,_,..lht
c<>r~oult..s
with
the
CommiiiM
on
Ethln.
v
..
[l
No~
·
------
-
--
--
---
...
-
--
·-
.
...
·--·
..
 
SCHEDULEI·EARNEDJNCOME
j
Name
R!cnard
A. (Rick) Berg
1
l'lol2ol 1t
U.t
he
~urce,
t)lpt
,
1111d
amount
o1
eM'Md
Income
from
any
~
(ottMr than
the
flier'•
ourrent MnPfl)1ment
b)'
1tlt
U.S. G<MIT\IIlant)
tote•ne
$200
or
more
during
the
pneudng
cetendar
r-.
Fo~
epou••·
11at
the
aource
andamount
of
any
honoraria
;
llet
ontv 1tla eouroe
for
o1tler
epoue•
earned Income exceeding
tt,OOB
.
Sourc•
Type
Amount
U.S.
House of Representatives
House
of
Rep.
Salary
$156,662
·--··-
..
..
-
Real
~tate
Sales -Sole Proprietor Commission-For services
rendered
prior
$15,151
to
becoming
a
Member
of
the
House
·
--
..
lndep-mdent Family
Doctors,
Ltd.
Spouse
Salary
N/A
-
-
-
--
-
--
-
--
-
..
Cattle Ranch-Oliver
County.
ND
i
pouse
Cattle
Ranch
NIA
-----···
·
-
---
·--···---·
..
..
 
SCHEDULE Ill ·ASSETS AND "UNEARNED"
INCOME
I
amctRichard A-
(Rid()
Berg
SLOCKA
"-••t
and/or
Income Source
ldNIIify
(a)
.-oh
-~~
held
for
lnwllmenl
ar
produc:clon
of
In-..,..,
a hllr
111tr11et
v.lue
~In
I ,1,0DO Ill
Ill•
end
of
the
reporting
period,
and
(b)
1111J
oltlerrepott.ble
_...or
-
ot
lncDme
which
geN
...
d
m.,..
than
UOO
In
"11nNIMd''
IIICOIM
dlltlng
they-.
PI'OIIIde aompletlo
Nl-
of
atock8
aiiCI
mutu&l
f...a
(do
not
ueetJcaor
ll"flllbOia.)
ForalfiRAa
.nd
Dtl!et'
.........,_,,pia.,.
(euch M
'111(k)
JIIM•)
lh&Ure
11lf.<IIN-
(l.e.,plenaln
wllich
you
have
the.,_.,-~~
If nat
t!CefGlMCI,
to
MiliCI the a.,.clf".c
IIIVMimttnta),
provide !he value
for
each
a...t
hllld
In
tlw
acaount
thalexaelda
tilt
reporting lhJUhalda. For
retlrwnMitac;couraWhlctoare
nollalf-dlreeud,
prowlc141
anlr1h•
.....,.
of
lllllns11tutton
holding lhe
IeCoUnt
and
llallllluellttMendofthe
repoftlng
IWf'!Ool.
Far ftln\al or
other
rell
proper1¥
held for
IIIYMimenl,
provide
a complete
add-.
For
an
-n•rWIIp
lrtt-ln
prlvii!Myonlld bullln
...
hltla
not
JM*IIcaiJy
....._abita
IN
nun.
ofltla
lila"-,
he
natww
af
Ita
actiwlllN,
and
..
gqnephlc
loc.tlon
In
Block
A.
Ellclude: Your
I!'Nonll
reeld-,
Including HCOnd
ho..-
.,d
wc:atlon
hom•
(IIIIJMa
~ -
renlallnc:oma during
lhe
repo<tlng
-·•-.t'•
.......
.,a_.,._,..._ •
.......,,_,..
H
ftJ\ft
oOIPIIIIIr-r-1.,. A
--"""..1
..t,..-.&.l
.
_-
ILOCKB
Year·End
Value
of
Asset
11
··-of
eporting
y-.
rtrouUiea
Vllultl
on
111elll0d
othtrlhan
fair
mllbl
......,.,
pltMa
apaGify
lhe
.....
hod
...
.
If
Dll
Mlat-IOidllftll.
IIICkldad
only
becauH
llla~lll-,
the
V.IIM
1howlcl
be
11
None
...
I
Weekare Bldg. (30%):
$100,001-
BLOCKC
Type
of
Income
Ch•ck•ll col...,.,.
lhM
apptf.
Nlra
-ntalhat
do
not
..
_youtochoOM
ll)lelftc
lnvulrMnlilor
lt\lll
Cll,.,..
u-dalornedI
ncar.•
(•lllh
u 401(k)
~~~-or
IRAI).
VOU
1MY
cheak
the
"Mont•
column.
Clvldencle,
l
..
wt,
and
~llal
gains,
....
n
llrei11Y81ttd,
muet
be
dleet011ea A
lncomt
.Check "NDM.If1h•
1aNt
Cll-dnGinCOIM
during
the
reporting
peTIOcL
RENT
:2302
30
112
Ave.
So.
Fargo,
ND
i
$250,000Farmland-Benson county,-ND
---
r-
soo-.oo
1--
--1-
R
ENT
$1,000,000
I
BLOCKD
Amount
of
Income
For
redrement
...
counta
1111t
dD
not
lllD'W
you
to
chao•
apeclllc
~~-
Drthllgen•rata
tax~
lnooma
(IUd\
U 401(k) pia
...
or
IRAa),
YOU
111a11Mck
the
.,..,,...
column.
For
Ill
other
....,
lndlcm
the
cuuuary
of
lnc0111t
bv
check~
u.
appr<>prtale
......
....,
,
Olvldellda,
lntaN..,
.w1
.,...,,.1
galna,
even
If
rei.,_...,
muatb•
dlactoaecl
lnoom•.
Clleck
"NoN"
If
no
lncom~
-d
t
genam.d.
$15,001 • $50,000
$5,001
$15,000
Paga3of
111
ILOCKE.
Tran•actlon
IndiCt"
lr..
hlld
pllfDIIIHI
~.-(l).or
ewtanga(E)
--ding
11,DOO
In
reportlngyMr,
1---
·
--1-
-
·-
--
--
---1--
-
--
--
--
-
·
-
SP
Farmland-Oliver County,
NO
$500,001
-
$1,000,000
-
--
-+--·--
------
-
-
--
----+
.
.
..
Residential
Land-
Washbum,
NO
$15,001.
$50,000
RENT
None
·
----+--
--
-·-
·
-·
---l
r--
--
--
INREIT
Real
Estate Investment
$100,001
-
DIVIDENDS
Trust-Minot,
NO
$250,000$15,001 -$50,000
-·-·
--
---
NONE
$5,001 -$15,000
-
---
-· -·
·-
-
·--
--+--------+
--
..
-
·-
-·
--+--
----
--
SP
Independent Family Doctors, $15,001-S
Corp $15,001
-$50,000
Ltd-
Physician-Fargo,
ND
$50,000
Income
S(part)
-
·-
-

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->