OGE Form 278e: Part 2
Your Employment Assets and Income (including retirement accounts)
Introduction
Report your assets and income related to employment in Part 2. For purposes of this Part, “employment-related” is interpreted broadly to cover all of your non-investment activities as well as your retirement accounts. Learn how to report a particular asset by selecting that asset or source of income from the table below.
Other Assets and Income Related to Your Employment
If you have a type of asset or income related to employment that is not listed above, click here for general guidance.
No Assets or Income Related to Your Employment
If you do not have any assets or sources of income to report related to employment, you need to state this fact. Within Integrity, you would make this statement by marking the “I do not have...” checkbox. For hard copy reports, write “None.”
Award or Prize
Report the source and amount of your award or prize in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Alliance for Excellence in Achievement: Auditor of the Year
|
N/A
|
|
award
|
$700
|
2
|
Dover City Marathon: Race
|
N/A
|
|
prize
|
$5,000
|
For You
Part 2
Report an award or prize if you received more than $200 from a single source during the reporting period.
Description: Provide the name of the source and describe the type of award or prize.
EIF: Select “N/A.”
Income Type: Describe the type of income as “award” or “prize.”
Income Amount: Provide the exact amount of the award or prize that you received during the reporting period.
Bonus (cash)
Report a cash bonus that you received or will receive in Part 2. In addition, report an arrangement to receive a bonus in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Xylophone Technologies Corporation
|
N/A
|
|
bonus
|
$11,750
|
2
|
Quasar Engineering (ventilation systems), anticipated bonus
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting a Bonus You Have Already Received
Report the source and amount of your bonus (or bonuses) if you received more than $200 from that source during the reporting period.
Description: Provide the name of the source. In addition, if the source is a privately held business, provide the source’s line of business.
EIF: Select “N/A.”
Income Type: Describe the type of income as “bonus.”
Income Amount: Provide the exact amount of the bonus (or bonuses) received during the reporting period.
Reporting a Bonus You Have Not Received
Report an anticipated bonus payment if the value of the anticipated bonus was more than $1,000 at the end of the reporting period.
Description: Provide the name of the source and write “anticipated bonus.” In addition, if the source is a privately held business, provide the source’s line of business.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the anticipated bonus.
Income Amount: Select the “None (or less than $201)” category.
Carried Interest
Report your carried interests in Part 2. In addition, report carried interest as an arrangement in Part 3 (see Part 3 of this guide for details).
The term “carried interest” may have different meanings. Consult our definition of “carried interest” to see how we use this term for purposes of executive branch financial disclosure. For interests that do not meet this specific definition, your agency’s ethics official will need to consult OGE for guidance on the reporting requirements.
Carried Interest in Entity that Does Not Qualify as an EIF
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Crocus Partners II, LP (venture capital)
|
No
|
|
|
|
1.1
|
Nutrodesign, LLC (agricultural products)
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
1.2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
1.3
|
WQX Optics (medical devices)
|
N/A
|
$1,001 - $15,000
|
capital gains
|
$5,001 - $15,000
|
2
|
Crocus Partners II, LP, carried interest (value not readily ascertainable): 20% of profits over 6% hurdle rate, See Endnote
|
N/A
|
|
|
None (or less than $201)
|
Endnote to #2: See lines 1.1 through 1.3 for the holdings of this fund on which the carried interest is based.
Carried Interest in Entity that Qualifies as an EIF (rare)
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Crocus Partners II, LP (venture capital)
|
Yes
|
$50,001 - $100,000
|
|
$5,001 - $15,000
|
2
|
Crocus Partners II, LP, carried interest (value not readily ascertainable): 20% of profits over 6% hurdle rate
|
N/A
|
|
|
None (or less than $201)
|
For You
Part 2
As a matter of policy, OGE deems a carried interest to have a value that exceeds $1,000. Therefore, carried interests must be reported. Also, if you received more than $200 in income related to a carried interest during the reporting period, you need to report the income.
Description: Indicate that the asset is a carried interest, provide the name of the entity on which the carried interest is based, and, except in the rare case that the entity qualifies as an excepted investment fund, list the underlying assets of that entity.
In the typical case, filers with a carried interest based on an entity also have a direct equity interest in that entity and the entity usually will not qualify as an excepted investment fund. In such cases, the underlying assets of the entity will have been reported already, so, they do not have to be reported again.
EIF: Select “N/A.”
Value: Report the value of the carried interest by marking the appropriate category. If you cannot ascertain the value, leave this field blank but write “value not readily ascertainable” in the “Description” field. In addition, provide basic information as to how the carried interest is calculated (e.g., hurdle rate and percentage).
Income Type: Specify the type of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category that corresponds to the total amount of income during the reporting period.
Cash Balance Pension Plan
Report your cash balance pension plan in Part 2. In addition, report your participation in a cash balance pension plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Regional Electric, cash balance pension plan
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
2
|
Widgets Unlimited, cash balance pension plan
|
N/A
|
$100,001 - $250,000
|
retirement payments (monthly)
|
$1,500
|
3
|
Tyler Informatics, cash balance pension plan
|
N/A
|
None (or less than $1,001)
|
lump sum
|
$51,502
|
For You
Part 2
Report a cash balance pension plan if the value of the plan was more than $1,000 at the end of the reporting period or if you received more than $200 in retirement payments during the reporting period.
Description: Report the name of the employer providing the plan and write “cash balance pension plan.”
EIF: Select “N/A.”
Value: Report the value of the plan by marking the appropriate category. The value is the dollar value indicated in the statement that your plan’s administrator has provided to you.
Income Type: Specify the type of income if the total amount of income during the reporting period exceeded $200. Describe regular payments as “retirement payments” and indicate whether you are providing the monthly or annual amount. Describe a lump-sum distribution as “lump sum.”
Income Amount: The level of detail required for income depends on the amount and type(s) of income.
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Regular payments: Provide either the monthly or annual amount that you receive.
(3) Lump-sum distribution: Provide the exact amount.
Contingency Fee
Report your interest in contingency fee cases in Part 2. In addition, report your contingency fee interests in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Faraday, Maxwell & Franklin, contingency fee cases (value not readily ascertainable)
|
N/A
|
|
|
None (or less than $201)
|
For You
Part 2
Report an interest in contingency fee cases if the value of the interest was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the law firm through which you acquired your interest in the cases and write “contingency fee case” or “contingency fee cases.”
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the interest. If you cannot ascertain the value, which will usually be the case if you have not set a cap on your fee, leave this field blank and write “value not readily ascertainable” in the “Description” field.
Income Type: Write “contingency fees” if the total amount of income during the reporting period exceeded $200.
Income Amount: Provide the exact amount of income over $200 received during the reporting period. Otherwise, select the “None (or less than $201)” category.
Deferred Compensation
Report your deferred compensation in Part 2. In addition, report your participation in a deferred compensation plan in Part 3 (see Part 3 of this guide for details).
Deferred compensation can take many forms, and the reporting requirements will vary based on the timing of the compensation and its form. The examples below are intended to be merely illustrative of the various forms that deferred compensation may take. Regardless of the form of your deferred compensation, you should work with an ethics official at your agency to ensure complete and accurate disclosure.
The guidance on deferred compensation is broken into the following sections:
Example 1: Cash Payments from a Deferred Compensation Plan
Example 2: Future Cash Payment That is Fixed
Example 3: Payments in the Form of Assets – Received or Anticipated
Example 4: Deferred Compensation Plan with Underlying Assets
Example 5: Deferred Compensation Plan Linked to an Index or Other Benchmark
Example 1: Cash Payments from a Deferred Compensation Plan
If you have received cash payments from deferred compensation, report as follows.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Gupta Engineering, deferred compensation
|
N/A
|
|
cash payment
|
$97,850
|
Part 2
Report a cash payment (or payments) that you received from a source if the total amount exceeded $200 during the reporting period.
Description: Report the name of the employer providing the payment and write “deferred compensation.” In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Income Type: Describe the type of income as “cash payment” or “cash payments.”
Income Amount: Provide the exact amount of your payment(s) received during the reporting period.
Example 2: Future Cash Payment That is Fixed
You may not have received your deferred compensation, but your employer may owe you deferred compensation in the future in the form of a cash payment. That payment may be a fixed, as opposed to variable, amount that has already been determined. In that case, this example provides guidance on reporting the fixed-amount cash payment that your employer owes you.
Instead of being fixed, the amount of your future payment may depend on the performance of investments. Alternatively, it may depend on the performance of something tracked, such as an index, a mutual fund, or some other benchmark. In either of those cases, this example would not apply to your situation. You should refer to either Example 4 or 5 below for guidance on a “Deferred Compensation Plan with Underlying Assets” or a “Deferred Compensation Plan Linked to an Index or Other Benchmark.”
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Gupta Engineering, deferred compensation: cash receivable
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
Part 2
Report an anticipated, fixed cash payment if the fixed amount that you are owed was more than $1,000 at the end of the reporting period.
Description: Report the name of the employer providing the payment and write “deferred compensation: cash receivable.” In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the fixed payment that you are owed.
Income Amount: Select the category for “None (or less than $201).” OGE does not treat tax-deferred compensation owed to you or tax-deferred income accruing within a deferred compensation plan as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans. You, however, would report distributions as having been received. See Example 1 above.
Example 3: Payments in the Form of Assets – Received or Anticipated
You may have an arrangement for deferred compensation in the form of assets, rather than cash. If you have not yet received the deferred compensation, provide the name of the employer and write “deferred compensation receivable” in the “Description” field. Then, report the assets using the guidance appropriate for that type of asset (e.g., stock, stock options, restricted stock, stock appreciation right, phantom stock, and restricted stock units).
Note that OGE does not treat tax-deferred compensation owed to you or tax-deferred income accruing within a deferred compensation plan as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans. You, however, would report distributions as having been received. See Example 1 above.
Example 4: Deferred Compensation Plan with Underlying Assets
This example addresses the situation of a deferred compensation plan that holds underlying assets.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Gupta Engineering, deferred compensation:
|
No
|
|
|
|
1.1
|
Gupta Engineering
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
Part 2
Report the deferred compensation plan and each underlying asset of the plan that individually was worth more than $1,000 at the end of the reporting period.
Description: Provide the name of the employer and write “deferred compensation.” In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
Next, report each underlying asset that individually was worth more than $1,000 at the end of the reporting period.
EIF: Select “No” for the plan. In addition, for each underlying asset, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment vehicle that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).
Value: You do not need to provide the overall value for the plan. Instead, provide the individual value of each underlying asset by selecting the appropriate category.
Income Amount: Select “None (or less than $201)” for the underlying assets. OGE does not treat tax-deferred compensation owed to you or tax-deferred income accruing within a deferred compensation plan as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans. You, however, would report distributions as having been received. See Example 1 above.
Example 5: Deferred Compensation Plan Linked to an Index or Other Benchmark
You may have an interest in a deferred compensation plan under which your employer owes you a future payment that depends on the performance of something tracked, such as an index, a mutual fund, or some other benchmark. However, you do not, through the deferred compensation plan, own the thing being tracked. For instance, the plan may track the performance of the S&P 500 or the performance of a mutual fund that mirrors the S&P 500, but you do not hold, through the deferred compensation plan, shares of the companies listed on the S&P 500 or shares of the mutual fund. Instead, your employer owes you a cash payment, and your employer may pay more money if the S&P 500 performs well or may pay less money if the S&P 500 performs poorly.
This example provides guidance on reporting the variable payment of deferred compensation that your employer owes you.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Gupta Engineering, deferred compensation: tracks S&P 500
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
2
|
Positron Ventures, deferred compensation: tracks basket of stocks, See Endnote
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
Endnote to #2: The stocks tracked by this deferred compensation plan are as follows: Nutrodesign, LLC (agricultural products); BMSL Propulsion, Inc. (rocket fuel research); WQX Optics (medical devices)
Part 2
Report your interest in the plan if the value of your interest was more than $1,000 at the end of the reporting period.
Description: Provide the name of the employer, write “deferred compensation,” and specify the index or other benchmark that your future payment tracks. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of your interest.
Income Amount: Select the category for “None (or less than $201).” OGE does not treat tax-deferred compensation owed to you or tax-deferred income accruing within a deferred compensation plan as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans. You, however, would report distributions as having been received. See Example 1 above.
Defined Benefit Plan
Report your defined benefit plan in Part 2. In addition, report your participation in a defined benefit plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Regional Electric, defined benefit plan (value not readily ascertainable): eligible for $3,000/mo. at age 65
|
N/A
|
|
|
None (or less than $201)
|
2
|
Widgets Unlimited, defined benefit plan (value not readily ascertainable)
|
N/A
|
|
retirement payments (annual)
|
$20,000
|
For You
Part 2
Report a defined benefit plan if the value of the plan was more than $1,000 at the end of the reporting period or if you received more than $200 in retirement payments during the reporting period. Do not report a plan that you obtained through United States Government employment.
Description: Report the name of the employer providing the plan and write “defined benefit plan.”
EIF: Select “N/A.”
Value:
(1) If the value of the plan is readily ascertainable: Report the value of the plan by marking the appropriate category.
(2) If the value of the plan is not readily ascertainable but you received more than $200 in income during the reporting period: Leave the “Value” field blank and write “value not readily ascertainable” in the “Description” field.
(3) If the value of the plan is not readily ascertainable and you did not receive more than $200 in income during the reporting period: Leave the “Value” field blank. In the “Description” field, write “value not readily ascertainable” and indicate the monthly or annual amount that you will be eligible to receive at a certain age (e.g., “eligible for $3,000/mo. at age 65”).
Income Type: If the total amount of income during the reporting period exceeded $200, write “retirement payments” and indicate whether you are reporting a monthly or annual amount. Otherwise, leave the field blank.
Income Amount: If the total amount of income during the reporting period exceeded $200, provide either the monthly or annual amount that you receive. Otherwise, select the “None (or less than $201)” category.
Defined Contribution Plan (e.g., 401k, 403b, 457)
Report your defined contribution plan in Part 2. In addition, report your participation in a defined contribution plan in Part 3 (see Part 3 of this guide for details).
Assets within a Defined Contribution Plan – No distributions yet
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Tyler Informatics, 401(k) plan:
|
No
|
|
|
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Assets within and Distributions from a Defined Contribution Plan
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Tyler Informatics, 401(k) plan:
|
No
|
|
cash distributions
|
$17,850
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Final Distribution from a Defined Contribution Plan – No remaining assets
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Tyler Informatics, 401(k) plan, no remaining assets
|
N/A
|
|
cash distribution
|
$17,850
|
For You
Part 2
Reporting Assets within a Defined Contribution Plan
Report each underlying asset of the defined contribution plan that individually was worth more than $1,000 at the end of the reporting period. Although this information is not required, it is helpful if you specify that the assets are held within a defined contribution plan.
Description and EIF: This guide contains specific instructions for common types of assets held within a defined contribution plan (e.g., mutual funds, exchange-traded funds, stocks, and corporate bonds).
Value: Report the value of the underlying asset by selecting the appropriate category.
Income Type: Leave this field blank.
Income Amount: Select the category for “None (or less than $201).” Note that OGE does not treat tax-deferred income accruing within a retirement plan as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans. You, however, would report distributions as having been received. See below.
Reporting Distributions from a Defined Contribution Plan
Report a cash distribution (or distributions) that you received from a defined contribution plan if the total amount of distributed income exceeded $200 during the reporting period. If the plan continues to have reportable assets and you specified that the assets are held within the plan, you may report these distributions as part of the entry for the overall plan. Otherwise, report the distributions as a separate line entry using the guidance below.
Description: Report the name of the plan sponsor and describe the type of plan. In addition, unless otherwise clear, explain whether (1) the assets of the plan are reported elsewhere or (2) the plan has no remaining assets.
EIF: Select “N/A.”
Income Type: Describe the type of income as “cash distributions” or “cash payments.”
Income Amount: Provide the exact amount of your distributed income during the reporting period.
Director Fee
Report the source and amount of your director fees in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Xylophone Technologies Corporation
|
N/A
|
|
director fees
|
$17,850
|
2
|
DSLK Financial Techniques, Inc. (financial services)
|
N/A
|
|
director fees
|
$5,375
|
For You
Part 2
Report the source and amount of your director fees if you received more than $200 from that source during the reporting period.
Description: Provide the name of the source. In addition, if the source is a privately held business, provide the source’s line of business.
EIF: Select “N/A.”
Income Type: Describe the type of income as “director fees.”
Income Amount: Provide the exact amount of your director fees during the reporting period.
Employee Stock Ownership Plan
Report your employee stock ownership plan (ESOP) in Part 2. In addition, report your participation in an employee stock ownership plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, ESOP account
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Report an employee stock ownership plan account if the value of the account was more than $1,000 at the end of the reporting period or if you received more than $200 in income from the account during the reporting period.
Description: Provide the name of the employer and write “ESOP account” or “employee stock ownership plan account.” In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the account by selecting the appropriate category.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category corresponding to the total amount of income received during the reporting period. Most filers select “None (or less than $201).”
Employee Stock Purchase Plan
Report your employee stock purchase plan (ESPP) in Part 2. In addition, report your participation in an employee stock purchase plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, ESPP account
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting an Employee Stock Purchase Plan Account
Report an employee stock purchase plan account if the cash balance of the account was more than $1,000 at the end of the reporting period or if you received more than $200 in income from the account during the reporting period.
Description: Provide the name of the employer and write “ESPP account” or “employee stock purchase plan account.” In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the account by selecting the appropriate category.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category corresponding to the total amount of income received during the reporting period. Most filers select “None (or less than $201).”
Reporting Stock Acquired through an Employee Stock Purchase Plan
Report any stock that you acquired as a separate line entry, using the standard instructions for stock.
Executor or Administrator Fee
Report fees for your service as an executor or administrator in Part 2. In addition, report the following interests in Part 6: (1) assets distributed from an estate and (2) a beneficial interest in an estate that has not yet been distributed. Do not report an interest in the will of a living person.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Estate of Ms. Eliot
|
N/A
|
|
executor fees
|
$4,300
|
2
|
Estate of a family member
|
N/A
|
|
administrator fees
|
$1,900
|
For You
Part 2
Report the source and amount of your fees if you received more than $200 from that source during the reporting period.
Description: Identify the estate. If the estate is that of a family member, you may write “estate of a family member.” In other cases, identify the estate by the last name of the party (e.g., “Estate of Ms. Eliot”).
EIF: Select “N/A.”
Income Type: Write “executor fees” or “administrator fees.”
Income Amount: Provide the exact amount of your fees during the reporting period.
Farm (operated as a business)
Report a farm that you operate as a business in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Highlands Farm, Papillion, NE, general partner (crops)
|
N/A
|
$500,001 - $1,000,000
|
partnership income
|
$130,005
|
2
|
Bailey Horse Farm, Ashburn, VA, sole proprietor (livestock)
|
N/A
|
$250,001 - $500,000
|
farming income
|
$76,513
|
For You
Part 2
Report a farm that you operate as a business if its value was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Do not report passive investment interests in a farm in Part 2. Report these interests in Part 6 instead.
Description: Provide the name of the farm; the location of the farm (either the city and state or the county and state); and the business of the farm, such as crops or livestock. In addition, it is helpful if you specify the type of interest that you have in the farm, such as “sole proprietor” or “general partner.”
EIF: Select “N/A.”
Value: Select the appropriate category to report the value of the farm, including such assets as the land, the crops (standing or in storage), the livestock, the farm equipment, the buildings, etc.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: The level of detail required for income depends on the amount and type(s) of income.
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Dividends, capital gains, interest, rent, or royalties: Select the category that corresponds to the total amount of income received during the reporting period.
(3) Other income: Provide the exact amount of income received during the reporting period.
Gambling Winnings
Report the source and amount of your gambling winnings in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Royal Pond Casino
|
N/A
|
|
gambling winnings
|
$7,489
|
For You
Part 2
Report gambling winnings if you received more than $200 from a single source during the reporting period. This threshold is based on gross winnings, not net winnings.
Description: Provide the name of the source.
EIF: Select “N/A.”
Income Type: Describe the type of income as “gambling winnings.”
Income Amount: Provide the exact amount of your winnings during the reporting period.
Government Benefit or Payment
For You
Part 2
Report the following:
- Honoraria you received from the United States Government.
- Consulting fees you received as an independent contractor with the United States Government.
- Salary you received from state, local, or foreign government employment.
- Honoraria or consulting fees you received from state, local, or foreign government sources.
- Your retirement benefits from a state, local, or foreign government, such as participation in a defined benefit plan or a defined contribution plan.
- Your income from state, local, or foreign government benefits programs.
Do not report the following:
- Income you received as an employee of the United States Government, including military Reserve pay.
- Retirement benefits you received from the United States Government, including the Thrift Savings Plan and any other United States Government retirement system.
- Your income from the United States Government’s Social Security, veterans’ benefits, and other similar United States Government benefits programs
Note: For purposes of financial disclosure, your unemployment benefits would be considered reportable income from a state benefit program.
Health Savings Account (HSA)
A Health Savings Account does not need to be reported unless you receive over $200 of income from it in the reporting period or if it has a balance of over $1,000 at the end of the reporting period. If an employer sponsored health savings account has a value of over $1,000, report the underlying assets of a health savings account in Part 2. If you received over $200 in income from the account, report the income. If you do not know how much of a distribution is income, as opposed to a return of your contributions, you can report the total distributions in lieu of income.
Health Savings Account - Cash only with income less than $201
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ABC Co. HSA: U.S. bank #1 (cash)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Health Savings Account - Cash only reporting distributions instead of income
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ABC Co. HSA: U.S. bank #1 (cash)
|
N/A
|
$1,001 - $15,000
|
cash distribution
|
$850
|
Health Savings Account - Assets with income less than $201
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ABC Co. HSA:
|
No
|
|
|
|
1.1
|
Arrow Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Health Savings Account - Assets reporting distributions instead of income
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ABC Co. HSA:
|
No
|
|
cash distributions
|
$850
|
1.1
|
Arrow Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting Assets within a Health Savings Account
Report each underlying asset of your health savings account that individually was worth more than $1,000 at the end of the reporting period. Indicating that the assets are held within a health savings account will help explain the income figures provided; however, this indication is not required.
This guide contains specific instructions for common types of assets held within a health savings account (e.g., cash, mutual funds, exchange-traded funds, stocks, and corporate bonds).
Note that OGE does not treat tax-deferred income accruing within a health savings account as having been received because of the limitations on withdrawal and other regulatory requirements governing such accounts. You, however, would report distributions as having been received. See below.
Reporting Distributed Income from a Health Savings Account
If you had more than $200 in income in your health savings account, report the total amount of distributed income. If the account continues to have reportable assets and you specified that the assets are held within the account, you may report these distributions as part of the entry for the overall account. Otherwise, report the distributions using the guidance below.
Description: Health savings account. In addition, if the account has no remaining assets, add “no remaining assets” to the description.
EIF: Select “N/A.”
Income Type: Describe the type of income as “cash distributions” or “cash payments.”
Income Amount: Provide the amount of income received or distributed during the reporting period.
Honorarium
Report an honorarium that you received or will receive in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Loomis County University – 8/14/2022
|
N/A
|
|
honorarium
|
$220
|
2
|
Loomis County University – 10/19/2022
|
N/A
|
|
honorarium
|
$220
|
3
|
East State College, anticipated honorarium
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting an Honorarium You Have Already Received
If you received honoraria from a single source aggregating more than $200 during the reporting period, report each honorarium received from that source.
Description: Provide the name of the source that paid the honorarium and enter the date of the services.
EIF: Select “N/A.”
Income Type: Describe the type of income as “honorarium.”
Income Amount: Provide the exact amount of your honorarium.
Reporting an Honorarium You Have Not Received
Report an honorarium that you anticipate receiving if (1) you have provided the service for which the honorarium will be paid or have a contractual right to an honorarium after providing the service in the future and (2) the value of the anticipated honorarium is more than $1,000.
Description: Provide the name of the source and write “anticipated honorarium.” If you have already provided the services, enter the date in the space provided.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the anticipated honorarium.
Income Amount: Select the “None (or less than $201)” category.
Click Here for Frequently Asked Questions
Intellectual Property
Report your intellectual property and income from intellectual property in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
“History of Clocks,” Stateburg University Press (value not readily ascertainable)
|
N/A
|
|
rent or royalties
|
$201 - $1,000
|
2
|
“Financial Disclosure,” 4th ed., Zorn & Co. (value not readily ascertainable)
|
N/A
|
|
advance
|
$22,000
|
3
|
“Circular frame and hub system for a conveyance,” Patent # 202,482,924 (value not readily ascertainable)
|
N/A
|
|
|
None (or less than $201)
|
For You
Part 2
Report intellectual property if the value of the intellectual property was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Note that being difficult to value is not the same thing as having little or no value. Often, filers are unable to determine the applicable value range of intellectual property, and the instructions below provide some guidance on how to handle this situation. However, in such a case, you would still report the intellectual property, unless you are asserting that the value (which includes the present discounted value of all future income) was, in fact, no more than $1,000 at the end of the reporting period.
Description: Describe the intellectual property. For a book, provide the name of the book and identify the publisher. For a patent, provide the patent number and a very brief description of the patent. For other types of intellectual property, provide a similarly specific description that is sufficient for the reader to understand the nature of your property.
EIF: Select “N/A.”
Value: Report the value of the intellectual property by selecting the appropriate category. If you cannot ascertain the value, leave this field blank but write “value not readily ascertainable” in the “Description” field.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200 (e.g., select “rent or royalties” or write “advance”).
Income Amount: The level of detail required for income depends on the amount and the type(s) of income.
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Dividends, capital gains, interest, rent, or royalties: Select the category that corresponds to the total amount of income received during the reporting period.
(3) Other income: Provide the exact amount of income received during the reporting period.
Investment Fund (general)
If you have an equity interest in an investment fund related to or acquired through employment, report the fund in Part 2, and report any arrangements related to the fund in Part 3 (see Part 3 of this guide for details). In addition, report any investment fund held through a retirement plan or individual retirement account in Part 2, and report any continued participation in the retirement plan in Part 3.
Note that other entries in this guide specifically address mutual funds, exchange-traded funds, and money market funds. See those entries for more targeted guidance if applicable.
Investment Fund Qualifies as an EIF
#
|
Description
|
EIF
|
Value
|
|
Income Type
|
Income Amount
|
1
|
Positron Investments XI, LP
|
Yes
|
$100,001 - $250,000
|
|
|
$5,001 - $15,000
|
Investment Fund Does Not Qualify as an EIF – If you know the value of and income from the underlying assets
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
1201 Capital Ventures, LLC
|
No
|
|
|
|
1.1
|
Nutrodesign, LLC (agricultural products)
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
1.2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
1.3
|
WQX Optics (medical devices)
|
N/A
|
$1,001 - $15,000
|
capital gains
|
$5,001 - $15,000
|
Investment Fund Does Not Qualify as an EIF – If you know the value of the underlying assets but the income from those assets is not readily ascertainable
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
1201 Capital Ventures, LLC
|
No
|
|
capital gains
|
$5,001 - $15,000
|
1.1
|
Nutrodesign, LLC (agricultural products)
|
N/A
|
$15,001 - $50,000
|
|
|
1.2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
$15,001 - $50,000
|
|
|
1.3
|
WQX Optics (medical devices)
|
N/A
|
$1,001 - $15,000
|
|
|
Investment Fund Does Not Qualify as an EIF – If the value and income of the underlying assets are not readily ascertainable
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
1201 Capital Ventures, LLC
|
No
|
$50,001 - $100,000
|
capital gains
|
$5,001 - $15,000
|
1.1
|
Nutrodesign, LLC (agricultural products)
|
N/A
|
|
|
|
1.2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
|
|
|
1.3
|
WQX Optics (medical devices)
|
N/A
|
|
|
|
For You
Part 2
Report an equity interest in an investment fund if the value was more than $1,000 at the end of the reporting period or if you received more than $200 in total income during the reporting period. See “Other Interests” below if you manage the investment fund.
The reporting requirements will depend on whether the investment fund qualifies as an excepted investment fund (EIF).
Investment Fund Qualifies as an EIF
Description: Provide the name of the investment fund and, unless it is clear from the name that you are reporting a fund, describe the type of asset.
EIF: Select “Yes.”
Value: Report the value of the fund by selecting the appropriate category.
Income Type: Leave this field blank.
Income Amount: Select the category that corresponds to the total amount of income received during the reporting period.
Investment Fund Does Not Qualify as an EIF
Description: Provide the name of the investment fund and, unless it is clear that you are reporting a fund, describe the type of asset.
EIF: Select “No” for the fund.
Additional Disclosure of Underlying Assets: Because the investment fund does not qualify as an EIF, you need to report each underlying asset of the fund that was worth more than $1,000 at the end of the reporting period or from which you received more than $200 in income during the reporting period. Report each underlying asset using the guidance applicable to that type of asset.
For purposes of valuing an underlying asset in a fund, you may use the value of the proportionate interest that you have in the underlying asset. For purposes of measuring income from an underlying asset, you may use the amount of income received from that underlying asset that is attributable to you.
In certain cases, investment funds do not provide information regarding an investor’s interest in the value and/or income of the fund’s underlying assets. If you are unable to ascertain the value of the underlying assets, you may instead provide value information for the total interest that you have in the fund. Similarly, if you are unable to ascertain the income from the underlying assets, you may instead provide income information for the total interest that you have in the fund.
Other Interests
Additional requirements may apply if you have ever worked for the company that manages the investment fund. Click here for guidance on these additional requirements.
IRA, Roth IRA, SEP IRA, or Keogh Plan
Report the underlying assets of your Individual Retirement Account (IRA), Roth IRA, Simplified Employee Pension Individual Retirement Account (SEP IRA), or Keogh plan in Part 2.
Assets within an IRA, Roth IRA, SEP IRA, or Keogh Plan – No distributions yet
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
IRA #1:
|
No
|
|
|
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
or
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Assets within and Distributions from an IRA, Roth IRA, SEP IRA, or Keogh Plan
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
IRA #1:
|
No
|
|
cash distributions
|
$17,850
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Final Distribution from an IRA, Roth IRA, SEP IRA, or Keogh Plan – No remaining assets
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
IRA #1, no remaining assets
|
N/A
|
|
cash distribution
|
$17,850
|
For You
Part 2
Reporting Assets within an IRA, Roth IRA, SEP IRA, or Keogh Plan
Report each underlying asset of your IRA, Roth IRA, SEP IRA, Keogh plan, or other individual account that individually was worth more than $1,000 at the end of the reporting period. Indicating that the assets are held within a retirement account will help explain the income figures provided; however, this indication is not required.
Description and EIF: This guide contains specific instructions for common types of assets held within a retirement account (e.g., mutual funds, exchange-traded funds, stocks, and corporate bonds).
Value: Report the value of the underlying asset by selecting the appropriate category.
Income Type: Leave this field blank.
Income Amount: Select the category for “None (or less than $201).” Note that OGE does not treat tax-deferred income accruing within a retirement account as having been received because of the limitations on withdrawal and other regulatory requirements governing such accounts. You, however, would report distributions as having been received. See below.
Reporting Distributions from an IRA, Roth IRA, SEP IRA, or Keogh Plan
Report a cash distribution (or distributions) that you received from an IRA, Roth IRA, SEP IRA, Keogh plan, or other individual account if the total amount of distributed income exceeded $200 during the reporting period. If the account continues to have reportable assets and you specified that the assets are held within the account, you may report these distributions as part of the entry for the overall account. Otherwise, report the distributions using the guidance below.
Description: Describe the type of account. In addition, unless otherwise clear, explain whether (1) the assets of the account are reported elsewhere or (2) the account has no remaining assets.
EIF: Select “N/A.”
Income Type: Describe the type of income as “cash distributions” or “cash payments.”
Income Amount: Provide the exact amount of your distributed income during the reporting period.
Click Here for Frequently Asked Questions
Law Firm (partnership)
Report your law firm partnership in Part 2. In addition, report what will happen to your interest in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Faraday, Maxwell & Franklin (law firm)
|
N/A
|
|
partnership share
|
$287,539
|
2
|
Faraday, Maxwell & Franklin, anticipated partnership share
|
N/A
|
$100,001 - $250,000
|
|
None (or less than $201)
|
3
|
Faraday, Maxwell & Franklin, capital account
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
For You
Part 2
Report a law firm partnership interest if its value was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
If You Received a Partnership Share
Description: Provide the name of the law firm. You should also indicate that the entity is a law firm, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Income Type: Describe the type of income as “partnership share.”
Income Amount: Provide the exact amount of your partnership share, including draw and any distributions, received during the reporting period.
If You Anticipate Payment of an Outstanding Partnership Share
Description: Provide the name of the law firm and write “anticipated partnership share” or “partnership share receivable.” You should also indicate that the entity is a law firm, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the anticipated payment, including draw, distributions, and any other related components of your compensation.
Income Amount: Select the “None (or less than $201)” category for income.
Capital Account
Description: Provide the name of the law firm and write “capital account.” You should also indicate that the entity is a law firm, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the capital account.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200. The type of income is usually “interest” for capital accounts.
Income Amount: Select the category that corresponds to the total amount of income received during the reporting period.
Other Interests
Business Assets and Liabilities: You need not itemize the assets of the law firm in Part 2. Disclosing the law firm itself is normally sufficient. As an exception to this rule, you would report any assets that are unrelated to the operations of the law firm. Report any liabilities for which you are personally liable in Part 8.
Compensation and Other Benefits: In addition to partnership income, report any additional compensation and other benefits. Report these as separate line entries using the instructions for that type of asset or income. For example, various sections of this guide address severance payments, bonuses, deferred compensation, defined benefit plans, defined contribution plans, and other items.
Contingency Fee Interests: If you have any interests in contingency fee cases, report these interests in Part 2 and Part 3 using the instructions provided in this guide.
Legal practice (solo practice)
Report your solo legal practice in Part 2. In addition, report what will happen to your solo legal practice in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Law Office of John Lopez (solo legal practice)
|
N/A
|
$100,001 - $250,000
|
legal fees
|
$157,106
|
For You
Part 2
Report a solo legal practice if the value of the practice was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Indicate that you practice law as a solo practitioner. You may also include the name under which you do business; however, it is not required.
EIF: Select “N/A.”
Value: Report the value of the practice by selecting the appropriate category. The value of the practice would include all assets held by the practice, unless itemized separately.
Income Type: Describe the type of income as “legal fees.”
Income Amount: Provide the exact amount of income received during the reporting period.
Business Assets and Liabilities
You need not itemize the assets of your legal practice in Part 2. Disclosing the value of and income from the legal practice is normally sufficient. As an exception to this rule, you would itemize any assets that are unrelated to the operations of the practice. Report any liabilities for which you are personally liable in Part 8.
Other Interests
Referral Fees: If you have an arrangement to receive referral fees from another attorney after you enter government service, report the arrangement in Part 3.
Contingency Fee Interests: If you have any interests in contingency fee cases, report these interests in Part 2 and Part 3 using the instructions provided in this guide.
Life Insurance (split-dollar)
Report your coverage by a split-dollar life insurance policy in Part 2. In addition, report the arrangement for this coverage in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Mutual of Spokane, split-dollar variable life through SendNow Co.:
|
No
|
|
|
|
1.1
|
Liberty Income Securities Fund
|
Yes
|
$15,001 - $50,000
|
|
None (or less than $201)
|
1.2
|
American U.S. Large Cap Value
|
Yes
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Report a split-dollar life insurance policy if the value of the policy was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the insurance company issuing the policy; write “split-dollar” to describe the payment method; note the type of policy (e.g., whole, universal, or variable); and provide the name of the employer through which you hold the policy. In addition, for a variable split-dollar policy, provide the name of each underlying asset within the policy that individually was worth more than $1,000 at the end of the reporting period.
EIF: For whole or universal split-dollar policies, select “N/A.” For variable split-dollar policies, select “No” for the first line entry because the overall policy is an investment vehicle that does not qualify as an excepted investment fund. For each underlying asset of a variable split-dollar policy, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment vehicle that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).
Value: For whole or universal split-dollar policies, report the value of the policy by selecting the appropriate category. For variable split-dollar policies, report the value of each underlying asset.
Income Type: If applicable, report the type of income received from the policy during the reporting period.
Income Amount:
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Dividends, capital gains, interest, rent, royalties, or income from EIFs: Select the category that corresponds to the total amount of income received during the reporting period.
(3) Other income: Provide the exact amount of income received during the reporting period.
Money Purchase Pension Plan
Report your money purchase pension plan in Part 2 using the guidance for defined contribution plans. In addition, report your participation in a money purchase pension plan in Part 3 (see Part 3 of this guide for details).
Option (incentive stock option plan) or Warrant
Report your stock options or warrants acquired through business or employment activities in Part 2 as well as any stock acquired through the exercise of those options or warrants. In addition, report your participation in an employee stock option or warrant plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, vested stock options
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
2
|
Widgets Unlimited, stock options (value not readily ascertainable):740 unvested shares, strike $19, vest 2/2022, exp. 1/2025
|
N/A
|
|
|
None (or less than $201)
|
3
|
BMSL Propulsion, Inc. (rocket fuel research), warrants (value not readily ascertainable): 200 vested shares, strike $10, exp. 10/2028
|
N/A
|
|
|
None (or less than $201)
|
For You
Part 2
Reporting Stock Options or Warrants
Report a stock option or warrant if the value of the option/warrant was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the exact name of the stock for which the option/warrant was issued, write “stock option” or “warrant,” and indicate whether the option/warrant is vested. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: If you are able to determine the value of your option/warrant, report the value by marking the appropriate category. Keep in mind that the value of an option/warrant is not the same as the value of the stock for which it was issued. In addition, an option/warrant may have reportable value even if the option is currently “underwater” (i.e., the strike price is above the market price), depending on how much time remains to exercise the option/warrant. The human resources office of the company that issued the options/warrants may be able to provide a valuation. If the company has not provided you with this information, OGE will accept either of the following methods of valuation:
(A) If the option/warrant is “underwater” or if the value of the option is otherwise difficult to determine, write “value not readily ascertainable” in the “Description” field and provide the following additional information: (1) the number of shares of the stock for which the option/warrant was issued; (2) the strike price; (3) the expiration date; and (4) the date on which the option/warrant will vest, if the option/warrant is unvested.
(B) Alternatively, you may use any commonly accepted formula to calculate the value of your options/warrants (e.g., the Black-Scholes pricing model).
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category corresponding to the total amount of income received during the reporting period. Options/warrants obtained through business activities or employment normally do not produce income until they are exercised or until the resulting stock is sold, which means that most filers select “None (or less than $201).”
Reporting Stock Acquired by Exercising Stock Options or Warrants
Report any stock that you acquired as a separate line entry, using the standard instructions for stock.
Phantom Stock
Report your phantom stock and income from phantom stock in Part 2. In addition, report your participation in a phantom stock plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, vested phantom stock
|
N/A
|
$15,001 - $50,000
|
cash payment
|
$14,025
|
2
|
Xylophone Technologies Corporation, unvested phantom stock
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting Phantom Stock
Report phantom stock if the value of the phantom stock was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the employer, write “phantom stock,” and indicate whether the phantom stock is vested. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the phantom stock by selecting the appropriate category.
Income Type: Write “cash payment” for cash income over $200.
Income Amount: Provide the exact amount of cash income over $200 during the reporting period. Otherwise, select the “None (or less than $201)” category.
Reporting Stock Acquired through a Phantom Stock Plan
Report any stock that you acquired as a separate line entry, using the standard instructions for stock.
Restricted Stock
Report your restricted stock and income from restricted stock in Part 2. In addition, report your participation in a restricted stock plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, unvested restricted stock
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting Restricted Stock
Report restricted stock if the value of the stock was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the exact name of the stock, write “restricted stock,” and indicate whether the restricted stock is vested. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the restricted stock by selecting the appropriate category.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category corresponding to the total amount of income received during the reporting period.
Reporting Restricted Stock That Has Vested and Has No Remaining Restrictions
Report the stock as you would any other stock.
Restricted Stock Unit (RSU)
Report your restricted stock units and income from restricted stock units in Part 2. In addition, report your participation in a restricted stock unit plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, vested restricted stock units
|
N/A
|
$15,001 - $50,000
|
cash payment
|
$14,025
|
2
|
Xylophone Technologies Corporation, unvested restricted stock units
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting Restricted Stock Units
Report a restricted stock unit if its value was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the employer, write “restricted stock unit,” and indicate whether the restricted stock unit is vested. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the restricted stock unit by selecting the appropriate category.
Income Type: Write “cash payment” for cash income over $200.
Income Amount: Provide the exact amount of cash income over $200 during the reporting period. Otherwise, select the “None (or less than $201)” category.
Reporting Stock Acquired through a Restricted Stock Unit Plan
Report any stock that you acquired as a separate line entry, using the standard instructions for stock.
Salary
Report the source and amount of your salary in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Xylophone Technologies Corporation
|
N/A
|
|
salary
|
$187,489
|
2
|
DSLK Financial Techniques, Inc. (financial services)
|
N/A
|
|
salary
|
$195,375
|
For You
Part 2
Report the source and amount of your salary if you received more than $200 from that source during the reporting period. Do not report salary from United States Government employment.
Description: Provide the name of your employer. In addition, if your employer is a privately held business, provide your employer’s line of business.
EIF: Select “N/A.”
Income Type: Describe the type of income as “salary.”
Income Amount: Provide the exact amount of your salary income during the reporting period.
Self-Funded Defined Benefit Plan
Report your self-funded defined benefit plan and its underlying assets in Part 2.
Assets within a Self-Funded Defined Benefit Plan
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Betsy Cohen, self-funded defined benefit plan (DSLK Financial Techniques, Inc.):
|
No
|
|
|
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
Assets within and Distributions from a Self-Funded Defined Benefit Plan
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Betsy Cohen, self-funded defined benefit plan (DSLK Financial Techniques, Inc.):
|
No
|
|
cash distributions
|
$17,850
|
1.1
|
ABC Diversified Bond Fund
|
Yes
|
$50,001 - $100,000
|
|
None (or less than $201)
|
1.2
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
Report a self-funded defined benefit plan if the value of the plan was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period. In addition, provide the names of each underlying asset within the plan that individually was worth more than $1,000 at the end of the reporting period. Income is ordinarily reported when distributions are received.
Reporting the Plan
Description: Write your name and describe the type of plan. Provide the name of the financial institution through which the plan is held.
EIF: Select “No” because a self-funded defined benefit plan is an investment vehicle that does not qualify as an excepted investment fund.
Income Type: If applicable, describe the type of income received as “cash distributions” or “cash payments.”
Income Amount: Provide the exact amount of your income during the reporting period. If you do not have such income to report, leave this field blank.
Reporting the Underlying Assets
Description: Provide the name of the underlying asset.
EIF: For each underlying asset, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment vehicle that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).
Value: Report the value of the underlying asset by selecting the appropriate category.
Income Type: Leave this field blank.
Income Amount: Select the category for “None (or less than $201).”
Severance Payment (cash)
Report a cash severance payment that you received or will receive in Part 2. In addition, report an arrangement to receive severance in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Xylophone Technologies Corporation
|
N/A
|
|
severance
|
$11,508
|
2
|
Quasar Engineering (ventilation systems), anticipated severance
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting a Severance Payment You Have Already Received
Report the source and amount of your severance payment(s) if you received more than $200 from that source during the reporting period.
Description: Provide the name of the source. In addition, if the source is a privately held business, provide the source’s line of business.
EIF: Select “N/A.”
Income Type: Describe the type of income as “severance.”
Income Amount: Provide the exact amount of the severance payment(s) received during the reporting period.
Reporting a Severance Payment You Have Not Received
Report an anticipated severance payment if its value was more than $1,000 at the end of the reporting period.
Description: Provide the name of the source and write “anticipated severance.” In addition, if the source is a privately held business, provide the source’s line of business.
EIF: Select “N/A.”
Value: Select the category that corresponds to the value of the anticipated severance payment.
Income Amount: Select the “None (or less than $201)” category.
Small Business (general)
Report a small business that you operate in Part 2.
Note that other entries in this guide specifically address farms, law firms, and corporate stock. See those entries for more targeted guidance if applicable.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Advanced Systems, LLC (software)
|
N/A
|
$500,001 - $1,000,000
|
business income
|
$130,005
|
2
|
ABC Holdings, Inc., S-Corp, d/b/a Good Management Solutions (business process consulting)
|
N/A
|
$15,001 - $50,000
|
business income
|
$88,130
|
3
|
Accountant, sole proprietor
|
N/A
|
$1,001 - $15,000
|
accounting fees
|
$93,153
|
4
|
Piano teacher, sole proprietor
|
N/A
|
$1,001 - $15,000
|
lesson fees
|
$35,650
|
For You
Part 2
Report your small business if its value was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of your business and the type of business being conducted. In the absence of a specific business name, describe the trade practiced. If the legal name of the business differs from the name under which the business operates, it is helpful if you provide both names for clarity. In addition, unless otherwise specified, reported business interests are generally assumed to be structured as C-corporations. Consequently, if your business is otherwise structured, it is helpful to describe the type of business interest, such as “LLC” or “sole proprietorship.”
EIF: Select “N/A.”
Value: Select the appropriate category to report the value of the business.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: The level of detail required for income depends on the amount and type(s) of income.
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Dividends, capital gains, interest, rent, or royalties: Select the category that corresponds to the total amount of income received during the reporting period.
(3) Other income: Provide the exact amount of income received during the reporting period.
Note that some businesses may produce (1) income categorized as dividends, capital gains, interest, rent, or royalties and (2) other income that does not fall into one of these categories. In such cases, you may select a category for the dividends, capital gains, interest, rent, and royalties and then provide the exact amount of the other income as a separate line entry. Alternatively, you may provide an exact amount of the total income received from the business as a single line entry.
Business Assets and Liabilities:
You need not itemize the assets of the business in Part 2. Disclosing the value of and income from the small business is normally sufficient. As an exception to this rule, you would report any assets that are unrelated to the operations of that business. Report any liabilities for which you are personally liable in Part 8.
Additional Requirements
Compensation and Other Benefits: In addition to business income, you may receive other compensation and benefits. Report these as separate line entries using the instructions in this guide for that type of asset or income. For example, various entries in this guide address severance payments, bonuses, deferred compensation, defined benefit plans, defined contribution plans, and other items.
Honoraria: In general, you need to report the source of an honorarium (income for an appearance, speech, or article) separately even if you received the income through a single-member LLC or a speakers’ bureau. See the honorarium entry in this guide for additional information.
Copyright on a Book: In general, you need to report the copyright on a book even if you received the income through a single-member LLC. Report your LLC on one line in Part 2 and then report each book on a separate line.
Interests Arising from the Sale of a Business: Report a note from an installment sale or third-party escrow agreement using the instructions in this guide for such interests.
Small Business (installment sale)
Report in Part 2 your interest in an installment sale note and income related to the installment sale of your business. In addition, report the terms of your agreement in Part 3 if you are selling your interest to the business itself or the other owners (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, note (due to installment sale of WQX Systems, LLC)
|
N/A
|
$500,001 - $1,000,000
|
interest capital gains
|
$100,001 - $1,000,000
|
For You
Part 2
Report an installment sale if the value of the note was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the company or person who owes the note (e.g., “Widgets Unlimited” or “Ms. Nilsson”), indicate that the note is for an installment sale, and identify the sold business. If the party is a family member, you may identify the party as a “family member.”
EIF: Select “N/A.”
Value: Select the appropriate category to report the value of the note.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount: Select the category that corresponds to the total amount of income received during the reporting period. Generally, with an installment sale, capital gains are apportioned over the life of the note for federal income tax purposes and that same method may be used for financial disclosure purposes. If you choose to recognize all income in the year of sale for federal income tax purposes, then that same method would be used for financial disclosure purposes.
Additional Requirements
Escrow agreement: Report a third-party escrow agreement using the instructions in this guide for such agreements.
Small Business (third-party escrow agreement)
Report in Part 2 your interest in an escrow agreement from the sale of your business. In addition, report the terms of your agreement in Part 3 if you are selling your interest to the business itself or the other owners (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Third-party escrow account with Tristate Bank (due to sale of ABC Widgets , LLC, to Widgets Unlimited)
|
N/A
|
$1,000,001 - $5,000,000
|
|
None (or less than $201)
|
For You
Part 2
Report your interest in an escrow agreement if the value of the escrow property was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the account, including the name of the third-party escrow holder with whom the escrow property is held in trust, and write a short description of the nature of the transaction (e.g., “due to sale of ABC Widgets, LLC, to Widgets Unlimited”).
EIF: Select “N/A.”
Value: Report the value of the escrow property by selecting the appropriate category.
Income Type: Specify the type(s) of income if the total amount of income during the reporting period exceeded $200.
Income Amount:
(1) Income less than $201: Select the category for “None (or less than $201).”
(2) Dividends, capital gains, interest, rent, or royalties: Select the category that corresponds to the total amount of income received during the reporting period.
(3) Other income: Provide the exact amount of income received during the reporting period.
Stable Value Fund
Report a stable value fund held in your retirement account or plan in Part 2. In addition, report your participation in the retirement account or plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
ING Stable Value Fund
|
Yes
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Report a stable value fund if the value of the stable value fund was more than $1,000 at the end of the reporting period.
Description: Provide the name of the stable value fund and the institution that manages the fund (e.g., Fidelity, Vanguard, T. Rowe Price, etc.), unless the institution is part of the fund name. In addition, although not required, it is helpful if you indicate the type of account or plan in which the fund is held (e.g., defined contribution plan, 401(k), 403(b), 457, etc.).
EIF: Stable value funds often qualify as excepted investment funds. In such cases, select “Yes” for this field.
Value: Report the value of the stable value fund by selecting the appropriate category.
Income Type: Do not complete this field for EIFs.
Income Amount: Select the “None (or less than $201)” category for funds held within a retirement plan or account. OGE does not treat tax-deferred income accruing within a retirement plan or account as having been received because of the limitations on withdrawal and other regulatory requirements governing such plans and accounts. You, however, would report distributions as having been received. See the entries for defined contribution plans and individual retirement accounts.
Stock
Report stock obtained through your business, employment, or other income-generating activities in Part 2.
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Xylophone Technologies Corporation (XYZ)
|
N/A
|
$15,001 - $50,000
|
dividends
|
$201 - $1,000
|
2
|
BMSL Propulsion, Inc. (rocket fuel research)
|
N/A
|
None (or less than $1,001)
|
capital gains
|
$1,001 - $2,500
|
For You
Part 2
Report a stock if the value of the stock was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the exact name of the stock (e.g., “Xylophone Technologies Corporation”). In addition, for stock of a privately held company, provide a description of the issuer’s trade or business (e.g., grain distributor, supermarket, financial advisory, etc.). For publicly traded stocks, it is helpful to provide the ticker symbol in addition to the name of the stock.
EIF: Select “N/A.”
Value: Report the value of the stock by selecting the appropriate category.
Income Type: Specify the type(s) of income if the total amount of income received during the reporting period exceeded $200. Stocks normally produce dividend income but may also produce capital gains if sold.
Income Amount: Select the category corresponding to the total amount of income received during the reporting period.
Equity Compensation Plans and Other Interests
Stock obtained through employment-related activities often originates from equity compensation plans and other interests, such as deferred compensation, employee stock ownership plans, employee stock purchase plans, options (incentive stock options plan), phantom stock, restricted stock, restricted stock units, stock appreciation rights and warrants. Report these interests in Part 2 and any related arrangements in Part 3 if applicable.
Stock Appreciation Right
Report your stock appreciation rights and income from stock appreciation rights in Part 2. In addition, report your participation in a stock appreciation right plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Widgets Unlimited, unvested stock appreciation rights
|
N/A
|
$15,001 - $50,000
|
cash payment
|
$14,025
|
2
|
Xylophone Technologies Corporation, vested stock appreciation rights
|
N/A
|
$15,001 - $50,000
|
|
None (or less than $201)
|
For You
Part 2
Reporting Stock Appreciation Rights
Report a stock appreciation right if the value of the stock appreciation right was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.
Description: Provide the name of the employer, write “stock appreciation right,” and indicate whether the stock appreciation right is vested. In addition, for a privately held business, describe the line of business, unless you have already provided this information in another entry.
EIF: Select “N/A.”
Value: Report the value of the stock appreciation right by selecting the appropriate category. If the stock appreciation right is “underwater” or if its value is otherwise difficult to determine, write “value not readily ascertainable” in the “Description” field and provide the following additional information: (1) grant price; (2) number of shares; (3) expiration date; and (4) for an unvested stock appreciation right, the vesting date.
Income Type: Write “cash payment” for cash income over $200.
Income Amount: Provide the exact amount of cash income over $200 during the reporting period. Otherwise, select the “None (or less than $201)” category.
Reporting Stock Acquired through a Stock Appreciation Right Plan
Report any stock that you acquired as a separate line entry, using the standard instructions for stock.
TIAA
Report a TIAA product obtained through your business, employment, or other income-generating activities in Part 2. In addition, if you hold this product through a retirement plan, report your participation in the plan in Part 3 (see Part 3 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
East State College, 403(b) plan
|
No
|
|
|
|
1.1
|
TIAA Tradtional
|
N/A
|
$50,001 - $100,000
|
|
None (or less than $201)
|
2
|
IRA #1
|
No
|
|
|
|
2.1
|
TIAA Real Estate
|
Yes
|
$1,001 - $15,000
|
|
None (or less than $201)
|
For You
Part 2
The specific reporting requirements will depend on the type of TIAA product that you hold.
For specific instructions on reporting the TIAA Traditional Annuity, click here.
For specific instructions on reporting CREF accounts and TIAA Real Estate, click here.
Trustee Fee
Report the source and amount of your trustee fees in Part 2.
Note that you may have to report the underlying holdings of the trust in Part 6 if you, your spouse, or dependent child have an interest in or have received income from the trust (see the trust entries in Part 6 of this guide for details).
#
|
Description
|
EIF
|
Value
|
Income Type
|
Income Amount
|
1
|
Family Trust #1
|
N/A
|
|
trustee fees
|
$2,300
|
For You
Part 2
Report the source and amount of your trustee fees if you received more than $200 from that source during the reporting period.
Description: Identify the trust. If the trust is for the benefit of you or family members, you may use initials in lieu of a person’s name (e.g., “2003 J.S. Trust”) or simply refer to the entity as a family trust (e.g., “Family Trust #1”). In other cases, identify the trust by the last name (e.g., “Sanchez Family Trust”).
EIF: Select “N/A.”
Income Type: Describe the type of income as “trustee fees.”
Income Amount: Provide the exact amount of your fees during the reporting period.