Dyes II!~ '-I/(fO/O? · SF27S (Rev. 03/2000) S C.F.R Part 2634 U.S. Office ofOovemment Ethics Date...

SF27S (Rev. 03/2000)

S C.F.R Part 2634

U.S. Office ofOovemment Ethics

Date of Appointment. Candidacy, Election or Nomination (Month. D,lV. Year)

Reporting Individual's Name

Position for Which Filing

Location of Present Office (or forwarding address)

Position(s) Held with the Federal Government During the Preceding 12 Months (lfNot Same as Above)

Presidential Nominees Subiect to Senate Confirmation

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

Otber Review (If desired by

a2cncy)

A2encY Ethics Official's Opinion On the basis of information contained in this report, I conclude that the filet is in compliance with applicable laws and. regulations (subject to any comments in the box below).

Office of Government Ethics Use Onlv

Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT

Reporting Status Calendar Year Termination Date (if Appli-(Ch.ck Incumbent Covered by Report New Entrant. Nominee. Termination cable) (Month. uay. Year)

upproprilJle boxes) 0 I mor Candidate o Filer I Last Name First Name and Middle Initla

Rogers Thomasina V

Title of Position Deoartment or Al!encv I Aoolicable)

Chairman Occupational Safety & Health Review Commission

Address (Number. Street Citv. State. and ZIP Code TeleDhone No. Include Area Code

1120 20th Street, N.W. (Ninth Floor) Washington, DC 20036-3457 202-606-5370

Title of Position s and Date( s Held

Acting ChairmanlOSHRC 02/17/2009 - present; Commissioner/OSHRC 07/31/2003 - 02/16/2009

Name ofConl!tessional Committee onsldering Nominatio[ Do You Intend to Create a ualified Diversified Trust?

Committee on Health, Education, Labor and Pensions Dyes E]NO Sil!nature of Reoortmll ndivldual J..)ate (MOnm. uay. rear)

~ II!~ '-I/(fO/O? 1~lgnature 0 : L tner KeVlewer Date (Month. Dav. Year)

SilUlature of Desil!nated Agency Ethics OfficiallReviewing Official Date Month. DOll. Year

~e 4:('-0 (O~ fM--.I

Sianature \,L.. // // \. ./ /7 ate Month DOlI. Year

Lv'i4 LAA- ' c.t';Z//Ci Comments of Reviewing l)fficials (11 additional Sf)ace ;s reauired. lise the reverse side of this sheet)

(Check box if filing extension granted & indicate number of days )CI

(Check box if comments are continued on the reverse side) CI Supersedes Prior Editions, Which Cannot Be Used.

. . 278-112 Form Designed in Microsoft Excel 2000

FOIDl Approved:

OMB No. 3209·0001

F ...... for I.llt ... 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 su~iect to a $200 fee.

Reportine 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.

Termination 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 and Candidates for President and Vice President:

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.

Schedule C. Part I {Liabililies}-The reporting period is the preceding calendar year a'nd the current calendar year up to any date you choose that i~ within 31 days of the date of filing.

Schedule C. Part II (Al!reements or Arrangements}- Show any agreements or arrangements as of the dale of filing.

Schedule D-The reportinp; period is the preceding two calendar years and the currenl calendar year up to the date offili"" .

A2encv Use Only

OGEUseOnlv

NSN 7540·01-070-8444

SFtl3 (Rev. 0312000) S C.F.RPart2634 u.s. Office of Governmeut Ethics .t\.cponmg ,sName

lihnm""in:> V. Rogers

Assets and Income Valuation of Assets at close of

reporting period

SCHEDULE A

Income: type and amoUnt. If "None (or less than $200" is checked, no lother entry is needed in Block C fot that item. .

BLOCK" A BLOCK B BLOCK C

__ moil i ' .... .

eanled mCome exceedmg $200 (othel·,OS g ?§!. ~ :,~, i ;g. c> ~\lI)' ~:~! 8 il'rl t: !j... ';i,. ;"'i;;- -= ;;\d{ ... ;is § ! § , ~ !,~.c g :;'!ii' g

Other Income (Speci!y Type & Actual

Amount)

Date (Mo .• D(1I'.

l'r.)

Only if Honoraria

~7;~~~~E~Ps~~~ I : I i I! I f I ! III i I ! I J I i I ; I! II ; Ii I·~ . I<:.e!!!!:a~ ~l~n~ ~o~m.?~ ~ - - - - ~;:~;:~~ _1~~':+I·· X~:t~:::;: '~l'~~;;t' -I'1:%!" -1;'11;::~ ~ ~~~t· -1~~f~1 XI~I~;:;!i '-1:1;1~ --':t:,l: x ~I::i; -j~):~I:E; - i'l~{~ -~I!J:~~I' -1--------~ ---Examples Doe Jones & SmIth. Hometown, State 'i\(". .~·,x:;: ,'f!,:,;, :-i":'.~ ':'!'~i ';:';;'i'. /}/~H;!: i'c":;' ,:""i, \:'.i;; :>.:!i: ::~ .. '.< 1H<' ,;\,.:" l.o"·,, .... <t>I,P'MO ... SlJo.""'t

tPN:l~!U~~;I~nL F~d = = = ~ffl;; = ,~;it : ;'~i.~ = ~:~:;. = ;::,;:t = ;~tii: ~~ .. : ;~j = ;j~~~: ~~' : ~~ g~; ~ ;~~; : ~~!i -: i:.~~~ = = = = : = : =~ = : = : = I····· ······1]···-11 Ii}.:! Ptd l ii~ 1 I<kl I :f';I· (""f': ,,& f"'cl 1";"1 I:nl 1;:'::1 I;::J'I I:?:' .~ i ~ ~ l~i ~ I ~1 ~ ~ I I i HEW Federal Credit Uinion

2

~:I;I I(~)I I;~!I If'81 ~I I'~I_I*;I .. 1~i{1 X 1~1~1 . llifjl I~ ':t~.; ;~ 1:/ I }~!C:: F US Savings Bond , .. ;.

:,:

3

IVenable (Spouse's Salary) Ilt, .. ~ IDi fll~il 10111 I*!lllifl If!;1 r!~ I;·:": ;:\ '.~'. :.

Salary

4

IB~ I . !l~r I"~ I 1~1~11*;11 ~'!!II~~cl I;' >:.

,:: Cassidy & Associates (Spouse 2008) Salary

6

Iwells Fargo Advantage C&B Large-Cap Value Fund

IweliS Fargo Advantage C&8 Large-Cap Value Fund

I ' [his category applies orily Iffue "hiltl ... n , mark the other higher I

Prior Editions CarulOt be Used.

:,:(r

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1 !i:1 I'!' 1 1Nl01 I )/1 I;'! \1 I"UI 1<1)1 F?" lv I ;;;'1 I "~I I::FI 1>:"\ 1"''-:: :i:}, ·.~·(\I I:-!::);/f ):i;. 'Z:L im g " rw ':a-::H\',,':'; t,. ; solely that of the filets-spouse or dependent children. If the assetliricome IS eltherthat of the filer or jointly held by the flier with the spouse or __ C"

: of value, as -

SF278 (Rev. 03f2(00)

5 C.F.R Part 2634 U.S. Office of Govommen! Ethics

IReportmg IndIvIdual's Name

Thomasina V. Rogers

Assets and Income

BLOCK A

NoneD

Bank of America Checking Account

2 Congressional Federal Credit Union

3 ICassidy & AssocialeslSpouse 401k5: - JP Morgan Stable Value Fund - Barclavs Global Investors US Debt

4 I -.PIMCOHigh Yield Fund - Dodge & Cox Stock Fund - JP MorQan SmartRetirement 2020

5 I - Royce Premier Fund - Artio International Equity Fund

6 I International-City/County Management Assocation (Spouse 401k):

7

8

9

- VantageTrust PLUS Fund

College Investment Plan (MD 529) - Portfolio 2015

Valuation of Assets at close of

. reporting period BLOCKB

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PageNumoer 3 of 11

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Date (Mo .. Dal'.

Yr.)

Onlvif Honoraria

* This category applies onfy if the asset/income is solely that of the filer's spouse or dependent children, If the asset/income is either that o{theftler or jointly held by the filer with the spouse or dependent childrel mark the other higher categories of value, as appropriate ..

Prior Editions Cannot be Used.

SF278 (Rev. 03/2000) S C.F.R Part 2634 U.s. Office of Goverruncnt Ethics R'eportmg InifiViQiiiil's Name

Thomasina V. Rogers

Assets and Income

BLOCK A

NoneD

Amazon.Com Inc.

z Amgen Inc.

3

Anadarko Pete Corp

4

Bed Bath & Beyond

5

Bidgen Idee Inc.

st-CablevisionSYS Corp NY

+-Cisco Systems Inc.

Coca Cola Co.

gl Comeas! Corp .

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reporting period BLOCKB

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SCHEDULE A continued (Use only if needed)

1 Page Number

4of11

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

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Date (Mo .. Dav.

Yr.)

Only if Honoraria

• This category applies only if the asset/income is solely that of the filer's spouse ordependent chiidren.-IftheassetJincomeis either that of the filer or jointly held by the filer with the spouse oidependent cbildi'eJ mark the other higher categories of value, as appropriate. .


SF278 (Rev. 0312000) 5 C.F.R PBrt2634 U.S. Office of Govemment Billies

jReportmg IndJvldual's Name

Thomasina V. Rogers

Assets and Income

BLOCK A

NoneD

Covidien Limited Com

2 Disney Walt Co.

3

Electronic Arts

4

Forest Labo~atories Inc.

5

6

General Electric ·Co.

7

Genzyme 'Corp Com

8

Home Depot

9

Intel Corp

',:',;'.<

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SCHEDULE A continued (U se only if needed)

IPage Number

5 of 11


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Date (Mo .. Da· ...

}'r.)

Only if Honoraria

• This category applies only if the asset/income is solely that of the filer's spouse or dependent cli1ldren . . If\he asseilincome is either that of the filer or jointly held by the filer with the spouse or dependent childrel mark the other higher categories of value, as appropriate.

Prior Editions Carmot be Used.

SF278 (Rev. 03/2000) 5 C.F.R Part 2634 U.S. Office ofGovemmeut Ethies

Reporting IridlvlduaJ's Name

Thomasina V . Rogers

Assets and Income

BLOCK A

NoneD

Intel Corp

2 Johnson & Johnson

'3 I-L-3 Communications Holdings Inc.

<I Liberty Media Corp New Entertainment

s Microsoft Corp

6 NASDAQ OMX Group Inc.

7 Pall Corp

8

PepsiCo Inc

'9 I---Pfizer Inc



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SCHEDULE A continued (Use onJy if needed)

IPage Number

6 of"11

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

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Only if Honoraria

* . This category apPlies only If!be asset/income is solely that oftfiefiIer's spouse or dependellfchildren. If!be asset/income is either !bat of the flier or jofutIyhefdbytlie filer wi!b the spouse or dependent childrel mark the o!ber highert:lltegories of value, as appropriate.


SF278 (Rev. 0312000) 5 C.F.R Part 2634 U.S. Office of Government Ethico rRepoffirii InaiVi~uiiVs Name

Thomasina V. Rogers

2

3

4

5

6

7

8

9

Assets and Income

BLOCK A

NoneD

Proctor & Gamble

Texas Instruments

Tyco Electronics

United Health Group

Weatherford International

Charles Schwab

Sears Holding

Columbia Cash Reserves Daily 7 Day Averaae Net Yield

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• This category applIes-only if the assetJm.collieiSsolelythafiiI'thefilei's spouse or depelldent children. lfllieassevm.come is either that oftheftier or jointly held hy the filer wftJithe spouse or dependenfchildicl mark the other higher categ


SF278 (Rev. 0312000) 5 C.F.R Part 2634 U.S. Office of Government E1hic.

' IReportmg Individual's Name

Thomasina V. Rogers

Assets and Income

BLOCK A

NoneD

Columbia Cash Reserves 7 Day Averaoe NET Yield .

2 Exportfinans Bond

3 CVS

4 Google

5

6

' 7

8

9



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Amount)

Date (Mo .. Dav.

Yr.)

Only if Honoraria

* This category applies only if the asset/income is solely that of the filer's spouse or dependent children. lfthe asset/income is either tliafofthe fileI'or jointly held by the iller with the spouse or dependent childrci mark the other higher categ .


SF Z78 (Rev. 0312000)

5 C.F.R Part 2634 Do not Complete Schedule B if you are a new entrant, nominee, Vice Presidential or Presidential Candidate U.S. Office of Government Ethics Reporung IndiVidual's Name I Page Number

Thomasina V. Rogers SCHEDULEB 9 of 11

Part I: Transactions None D Report any purchase, sale. or exchange by you, your spouse. report a transaction involving property used solely as your Transaction Amount of Transaction (x) or dependent children during the reporting period of any rea personal residence, or a transaction solely between you TYDe (x) property, stocks, bonds, commodity futures, and other your spouse, or dependent child. Check the "Certificate of Date (Mo. ,

§. ~8 -0

securities when the amount of the transaction exceeded divestiture" block to indicate sales made pursuant to a ~ Day. Yr.) , , ,0 8 8 8.8. ., , i 8 g 8

_ 0

- 8 8 0.

$l,OOO .. lnclude transactions that resulted in a loss. Do not certificate of divestiture from OGE. ta '" ~ g g 8 88 go· 06 08 8.8. .<.: '" a

'. ~ ., ..c:: 8 "'- ~g gg ~§ g 8. ~ 8 8 8 8°· u an o· :!l:il O! >< ..: ~. ~;; _ . .ri

~a Identification of Assets en IJ.I

_ \0 It) _ _ N 10 _ .. ... .. .. .... .. .. ... .. ...... .. ... .....

Example: ICentral Airlines Common x 211 /99 x 1

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3

4

5

* This category applies only if the underlying asset is solely that of the fuer's spouse or dependent children. If the underlying asset is either held by the filer or iointlv held bv the filer with the soouse or dependent children. use the other higl1er catel1:ories of value. as appropriate.

Part ll: Gifts, Reimbursements, and Travel Expenses For you, your spouse arid dependent children, report the source, a brief descrip- the U.S. Government; ~iven to your a~ency in connection with official travel: tion. and the value of: (l) I?;ifts (such as tangible items, transportation. lodging, received from relatives; received by your spouse or dependeQt child totally food. or entertainment) received from one source totalinl?; more than $260; and independent of their relationship to you; or provided as personal hospitality al (2) travel-related cash reimbursements received from one source totaling more the donor's residence. Also, for purposes of a~gregating gifts to determine the than $260. For conflicts analysis, it is helpful to indicate a basis for receipt, such total value from one source, exclude items worth $104 or less. See instructions

o ... o 0 o ..

~ ~ ~ ~ a t: III ..

.. u

as personal friend, agency approval under 5 U.S.C. § 4111 or other statutory for other exclusions. None c::J authority, etc. For travel-related ~ifts and reimbursements, include travel itinerary.

dates. and the nature of expenses provided. Exclude anything given to you by

Source (Name Clnd Ad/i,." .. s) Brief Description Value ExampleS:I~!!:! f.~n;. of~o~ <;oIl~t~,,~._N"y' ______ e-!!:!!'!.c ~~c.!:..h~'!!.r2~ §t '!!!e.!I1s il!.c~~t~ ~a.!:!2l!.a~0!l~e!l~ 61lli9J iJ:c,!SonaJ !£t~!!x. ~'!E:!~t~ t~ dutxL ____________________ $500

Frank Jones. San Francisco, CA Leather briefcase (personal friend) . . . --$300--1

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Prior Editions Cannot Be Used.

SF 278 (Rev. 03/2000) 5C.F.R Pan 2634 U.S. Office ofGovemment Ethi - .. _- ~

IReporting Individual's Name - Pago N\unber

IThomaSina V. Rogers SCHEDULEC 10 of 11

PartI: Liabilities Report liabilities over,$IO,OOO owed to anyone creditor at personal residence unless it is rented out; loans secured NonelJD Category of Amount or Value (xl any time during the reporting period by you, your spouse, by automobiles, household furn'iture or appliances; and or dependent children. Check the highest amount owed . liabilities owed to certain relatives listed in instructions. . . . , 0 T" 0

during the reporting period. Exclude a mortgage on your See instructions for revolving charge accounts, Date Interest Term if . . ,0 o T" 0 ... 0 gg , , :- g 1; 8 1; 8 t; & 000 o 0 ... 0 ... 0 o~ q, 0. qci 0"0· Incurred Rate appli o ' && 8 .. 8. 8 .. ~ 00 o 0 ~g 0 88 g g 00

cable c:i 0-

!fj~ ~ 0 0 0 q ~ cu 0 00 o -

~ ~ ~ . ~ :5~ Oll)

o _ u)~ Creditors (Name and Address) Type of Liability ... N '" ... o~ ~u) ~~c ... ... ...... ... ... .... ... .... ... ... .. ... ....

Exam les' W~~S!,!?!,s~t ~n!<.2Y!~nJ!on,.DC - -;.. - - - - -- ~2~.B~'!. ~~l..E!,!p!..~ . .Qela~a~e ___________ 1991 8% _~}!'L_ r-- x -- ------ -- -- 1--- -- -1999- .... io%- --p , John Jones 123 J St.. Washington DC Promissory note on demand x 1

2 -

3

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5

* This category applies only if the liability is solely that of the fLIer'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 Report your agreements or an·angements for: continuing participation in an 'Of absence; and (4) future employment See instructions regarding the reporting employee benefit plan (e.g. 401k, deferred compensation; (2) coritinuation of negotiations for any of these arrangements Dr benefits payment by a former employer (including severance payments); (3) leaves

None DO Status and Terms of any Agreement or Arrangement Parties Date

Example: I Pursuant to partnership agreement. will receive lump sum payment of capital account & partnerShip share Doe Jones &. Smith. Hometown. State 7/85 calculated on service oerformed through 1100,

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SF 278 (Rev. 03/2000) 5 C.F.R Part 2634 U.S. Office of Government Ethics

Reporting Individual's Name

Thomasina V. Rogers

Part I: Positions Held Outside U.S. Government Report any positions held durmg 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

Organization (Name and Address)

Examples: m:rl..,~,s.!n.;.2(Ro.CIi £2!1!~~,.!::!'y .. 1::!Y ________________ Doe Jones & SmIth, Hometown. State

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Children's National Medical Center-Committee on Advocacy 2 (Cont'd) and Public Policy

3

Community· Support Systems Advocacy Council 4

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age l''1umoer .

SCHEDULED 11 of 11

consultant of any corporation, firm, partnership, or other business enterprise or any non-profit organiiation or educational institution. Exclude positions with religious. social. fraternal. or political entities and those solely of an honorarY nature.

D None

Type of Organization Position Held From (Mo., Yr.) To (Mo., Yr.) _ ~'!!!:P!<ill! ~~,!!i2!!. ______ • __ _l'~i~~ ___________

I--~~-.-- _l'~eE~._ Law finn . Partner 7/85 1/00

Non-Profit Health Priorities Committee Member 11/2/2008 Present

Non-Profit Social Service Advisory Council Member 0612007 Present

Part II: Compensation In Excess Of $5~OOO Paid by One Source Do not complete this part Report sources of more than $5,000 compensation received by you or your corporation, firm, partnership, or other business enterprise, or any other non-profit if you are an Incumbent, business affiliation for services provided directly by ·you during anyone year of organization when you directly provided the services generating a fee or payment Termination Filer, or the reporting period. This includes the names of clients and customers of any of more than $5,000. You need not report the U.S. Government as a source. Vice Presidential

. or Presidential Candidate

None CJ Source (Name and Address) Brief Description of Duties

. ~~e Jones & Smith, Hometown State . . ...l-~a\s~~c:.s _________________ . _ _____ • .:-.. ___________ • _____ Examples: M;tr-;-U~~r~ity-(cl~tofD~eJo~eT&-smith). Moneio~ ·State- - - - -- LCl!;a\ services in connection with university construction

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Dyes II!~ '-I/(fO/O? · SF27S (Rev. 03/2000) S C.F.R Part 2634 U.S. Office ofOovemment Ethics Date...

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Transcript of Dyes II!~ '-I/(fO/O? · SF27S (Rev. 03/2000) S C.F.R Part 2634 U.S. Office ofOovemment Ethics Date...