OGEForrn278 (Rev. [2/2011) 5 C.F.R. Part 2634 US.

Office of Government Ethics

Executive

Branch
Incumbent

Personnel

PUBLIC FINANCIAL DISCLOSURE REPORT

Form Approved: OMB No. 3.209 - 0001

Date ofAppointment, Candidacy, Election, Reporting or Nomination (Month. Day, Yea~) Status (Check Appropriate 01/20/2009 Boxes) Reporting Indi vid Last Name

~

J 2011

Calendar Year Covered by Report

I

New Entrant, Nominee, or Candidate

D

Termination Filer

0

Termination Date (IfApplicable)(Month,DaY,Year)

I

I
H.

First Name and Middle Initial Barack Department or Agency (IfAppIkable)

ual r s
for

Name

Obarna Title of Position

Fee for Late Filing Any individual who is required to file this report and does so more than 30 days after the date the report is required to be filed, or, if an extension is granted, more than 30 days after the last day of the filing extension period, shall be subject to a $200 fee. Reporting Periods Incumbents: The reporting period is the preceding calendar year except Part II of Schedule C and Part I of Schedule D where you must also include the filing year up to the date you file. Part II of Schedule D is not applicable. Termlnation Filers: The reporting period begins at the end of the period covered by your previous filing and ends at the date of termination. Part II of Schedule D is not applicable. Nominees, New Entrants Candidates for President Vice President: and and

PoSition Filing

Which

President Address
(Number, Street, City, State, and lIP Code)

Location of Present Office (or forwarding address) Position(s) Held with the Federal Government During the Preceding 12 Months (If Not Same as Above)

Telephone

No. (Include

Area Code)

White House,

1600 Pennsylvania

Ave,

NW, Washington,

D.C. 20500

202-456·1414

Title of Position(s)

and Date(s) Held

Presidential Nominees to Senate Confirmation Certification

Subject

Name of Congressional Not Applicable Signatu~Reportin!il

Committee

Considering

Nomination

Do You Intend to Create a Qualified Diversified Trust?

DYes
Individual

~NO
Date (Month, Day, Year)

T CERTIFY that the statements I have made on this form and all attached schedules are: true, complete andcorrect to the best of my knowledge.

Other Review (If desired by agency)

Signature

C~

S-) y-i

1

"Z-

of Other Reviewer

Date (Month, Day, Year)

Schedule A--The reporting period for income (BLOCK C) is the preceding calendar year and the current calendar year up to the date of filing. Value assets as of any date you choose that is within 31 days of the date of filing. Schedule B--Not applicable.

(~d,
Signature of Designated

(~
Agency Ethics Official/Reviewing Official

6-cF-/.2..
Date (Month, Day, Year)

Agency Ethics Official's Opinion
On the baSIS of information contained in this report, 1 conclude that the filer is in compliance with applicable laws and regulations (subject to any comments in the box below).

~r-M.~a_
Signature

Office

of Government Use Only

Ethics

Comments

of Reviewing Officials

(If additional

space Is required,

e:-:
»:

/L

.4"
side of this sheet)

s-J 'i)'L_
Date (Month, pay, Yey)

Schedule C, Part I (Liabilities)--The reporting period is the preceding calendar year and the current calendar year up to any date you choose that is within 31 days of the date of filing. Schedule C, Part II (Agreements Arrangernents)--Show any agreements arrangements as of the date of filing. or or

I /"

5!ril!/.2_
)

use the revers;

(Check box if filing

extension granted & indicate number of days ___

0

S c h e d u leD +The reporting period is the preceding two calendar years and the current calendar year up to the date of filing.

Agency

Use Only

(Check box if COmments are continued on the reverse side)

D

OGE Use Only
I

Supersedes

Prior Editions.

aGE Form 278 (Rev. 12/2011) 5 C.F.R Part 2634 US. Office of Government Ethics

Reporting lndrvidual's Name Obarna, Barack H.

SCHEDULE
Val uation 0 f Assets at close of reporting period
BLOCKB

A

Page Number 2 of 8

Assets and Income
BLOCK A

Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in BlockC for that item.
BLOCK C

For you, your spouse, and dependent children, report each asset held for investment or the productionof income which had a fair market value exceeding $1,000 at the close of the re$orting period, or which generated more than 200 in income during the reporting period, together with such income. For yourself, also report the source and actual amount of earned income exceeding $ 200 (other than from the U.S, Government), For your spouse, report the source but not the amount of earned income of more than $1,000 (except report the actual amount of any honoraria over $200 of your spouse). NoneD

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* TIns 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 mer or jointly held by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.

aGE Form 278 (Rev. 12/2011) 5 C.F.R Part 2634 U.S. Office of Government Ethics Reporting Individual's Obama, Baraek H. Name

SCHEDULE A continued
(Use only if needed) Valuationo f Assets at close of reporting period
BLOCKB
,I

Page Number 3 of 8

Assets and Income

Income: type and amount. If "None (or less than $201)" is
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BLOCKC

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OGEFonn278(Rev 12/2011) 5 C.F.R. Part 2634 U. S Office of Government Ethics Reporting Individual's. Name Obama, Barack H.

SCHEDULE
Valuation of Assets at close of reporting period
BLOCKB

(Use only if needed)

A continued

Page Number
4 of

8

Assets and Income

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OGEFolll1278(Rev 12/2011) 5 C.F.R Part 2634 U.S. Office of Government Ethics

Reporting Individual's Name Obama, Barack H.

SCHEDULE A continued
(Use only if needed)
Valuation of Assets at dose of reporting period
BLOCK B

Page. umber N 5 of

8

Assets and Income

Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in BlockC for that item.
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,

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7

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* This category applies only

jf the asset/income is solely that of the filer's spouse or dependent children. If the asset/income by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.

is either that of the filer or jointly

held

OGEFonn 278 (Rev. 12/2011) 5 C.F.R. Part 2634 U.S. Office of Government Ethics

Do not complete Schedule 8 if you are a new entrant, nominee, or Vice Presidential or Presidential Candidate

Reporting Individual'sName Obama, Barack H.

i

SCHEDULE B
Do not report a transaction involving property used solely as your persona] residence, or a transaction solely between you, your spouse, or dependent child. Check the "Certificate of divestiture" block to indicate sales made pursuant to a certificate of divestiture from OGE. None

PageNumber 6 of

8

Part I: Transactions
Report any purchase, sale, or exchange by you, your spouse, or dependent children during the reporting period of any real property, stocks, bonds, commodity futures, and other securities when the amount of the transaction exceeded $1,000. Include transactions that resulted in a loss. ExampleCentral.Airllnes Common I
1 2 3

181
Amountof Transaction (x)
(Mo., Day. Yr.)

Transaction Type (x)
<h

s:
0..

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Date

Identificationof Assets

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2/1/99

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=Tlnscategory 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 filer or jointly held by the filer with the spouse or dependent children, use the other higher categories of value, as appropriate.

Part II: Gifts, Reimbursements,

and Travel Expenses
the U.S. Government; given to your agency In connection with official travel; received from relatives; received by your spouse or dependent child totally independent of their relationship to you; or provided as personal hospitality at the donor's residence. Also, for purposes of aggregating gifts to determine the total value from one source, exclude items worth $140 or less. See instructions for other exclusions. None BriefDescription

For you, your spouse and dependent children, report the source, a brief description, and the value of: (1) gifts (such as tangible items, transportation, lodging, food, or entertainment) received from one source totaling more than $350 and (2) travel-related cash reimbursements received from one source totaling more than $350. For conflicts analysis, it is helpful to indicate a basis for receipt, such as personal friend, agency approval under 5 U.S.C. § 4111 or other statutory authority, etc. For travel-related gifts and reimbursements, include travel itinerary, dates, and the nature of expenses provided. Exclude anything given to you by Source (Name
and Address)

181
Value $500
$~B5

S~rat'lAssn. f Rock o Collectors, NY NY, Examples ____________ ank jones, SailFrancisco. CA
1 2

Airlineticket,hotelroom & meals incidentto nationalconference 6/15/99 (personalactivityunrelatedto duty) ----------------------------------Leather briefcasepersonal ( friend)

----

3
4 5

aGE Form 278 (Rev. 12/201 1) 5 c.p .R. Part 2634 U .. Office of Government Ethics S

Reporting Individual's Name
Obama, Baraek H.

SCHEDULE C
a mortgage on your personal residence unless it is rented out; loans secured by automobiles, household furniture or appliances; and liabilities owed to certain relatives listed in instructions. See instructions for revolving charge accounts.
,

Page Number 7 of 8

Part I: Liabilities
Report liabilities over $10,000 owed to anyone creditor at any time during the reporting period by you, your spouse, or dependent children. Check the highest amount owed during the reporting period. Exclude Creditors
(Name and Address)

NoneD Category of Amount or Value {x) , , , , 06
,0 0 0 ...... 0 0 0 00 ·0 0 0.0 ... o . ",0

~

Type of Liability
Promissory note .

Date Incurred
I- 1999
1991

Interest Rate
8% --10%

Term if applicable
1---25 yrs, on demand
-3D yrs.

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"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.

Part II: Agreements

or Arrangements
of absence; and (4) future employment. See mstructions regarding Ing of negotiations for any of these arrangements or benefits. Parties
&

Report your agreements or arrangements for: (1) continuing participation in an employee benefit plan (e.g, pension, 401k, deferred compensation); (2) continuation of payment by a former employer (including severance payments); (3) leaves Status and Terms of any Agreement or Arrangement
Example I 2 3 4

the reportNoneD Date
7/85 01197

GeneralAssemblyDefinedBenefitPension Plan (nofurthercontributions formeremployer) by

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278 (Rev 12/2011)

5 C.F.R. Part 2634

U.S. Office of Government Ethics Reporting Individual's Name Obama, Barack H. Page Number

SCHEDULE D Held Outside U.S. Government

8 of 8

Report any positions held during the applicable reporting period, whether compensated or not. Positions include but are not limited to those of an officer, director, trustee, general partner, proprietor, representative, employee, or consultant of any corporation, firm, partnership, or other business enterprise or any non-profit
Organization (Name and Address) Examples
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Part I: Positions

organization or educational institution. Exc1 ude positions with religious, social, fraternal, or political entities and those solely of an honorary nature. None
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Part II: Compensation

in Excess of $5,000

Paid byOne

Source

Report sources of more than $5,000 compensation received by you or your business affiliation for services provided directly by you during anyone year of the reporting period. This includes the names of clients and customers of any corporation, firm, partnership, or other business enterprise, or any other
Source (Name and Address) ~~ Examples
1

non-profit organization when you directly provided the services generating a fee or payment of more than $5,000, You need not report the U.S. Government as a source,
Brief Description of Dunes

Do not complete this part if you are an Incumbent, Termination Filer, or Vice Presidential or Presidential Candidate. None

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ATTACHMENT A TO SCHEDULE A - ASSETS AND INCOME On January 9, 2009, Barack Obama executed an amendment to his previously disclosed, December 2004 agreement with Crown Publishing Group, a division of Random House, Inc. Under this agreement, a non-fiction work, the subject to be determined, would not be delivered during his term in office and the schedule for any future book publications would be accordingly revised. On January 15,2009, Barack Obama approved a $500,000 advance against royalties under an agreement between Crown Publishing Group, a division of Random House, Inc., and Random House Children's Books, for an abridged version of Dreams From My Father suitable for middle grade or young adult readers, as proposed by the publisher in 2008. The President received the last advance payment for the abridged version of Dreams From My Father in 2010. Royalties for the book are: 15% of the U.S. sales price for hardcover book sales, 7.5% to 10% of the U.S. price for trade paperback book sales, 10% for the U.S. price for the mass-market paperback book sales, and other standard royalties. The abridged, young adult version of Dreams From My Father will be prepared and released by the publisher subject to the President's approval. Prior to taking office in January 2009, Barack Obama wrote and delivered the manuscript of Of Thee 1 Sing, a children's book. This book is part of his previously disclosed December 2004 agreements with Crown Publishing Group, a division of Random House, Inc. Of Thee 1 Sing was published in November 2010 and all after-tax, author proceeds from this book have been and will continue to be donated to the Fisher House Foundation for a scholarship fund for children of fallen and disabled soldiers.