8/3/2019 David J Folsom Financial Disclosure Report for 2010

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N a m e o f P e r s o n R e p o r t i n g

Folsom, David J .

D a t e o f R e p o r t

07/I 1/2011

I II . N O N - IN V E S T M E N T I N C O M E .(Reporting individual and spouse; see pp. 17-24 offiling instructions.)

A. Filer s Non-Investment Incom e

~ (No reportable income.)ONE non-investment

DATE SOURCE AND TYPE

2.

3.

4.

INCOME(yours, not spouses)

B. Spouses Non-Inves tmentI n c o m e -t f ~ .ouwere m arriedduring any portion of the reporting year, complete this section.(Dollar amount not required except for honoraria.)

D (No reportable non-investment income.)ON E

1.2010

2.2010

3.

4.

DATE SOURCE AND TYPE

Emp ire Electric Company--Retired June 2010

Century 21 Real Estate--Began July 2010

I V . R E I M B U R S E M E N T S- transportation, lodging, food, entertainment.(Includes those to spouse and dependent children," see pp. 2 5-27 of filing instructions.)

D (No reportable reimbursements.)ONE

3.

4.

5.

SOURCE DATES LOCATION PURPOSE

Federal C ircu it Bar 06/21/10 to 06/27/10 C olorado Sp rin gs, C O Activity ofp rofessional orAssociation civic organ ization

ITEMS PAID OR PROVIDED

Airfare, meals, hotel

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FINANCIAL DISCLOSURE REPORT

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Name of Person Reporting

Folsom, David J .

Date of Report

07/I 1/2011

V. G I F T S .~lnctudes those to spouse and depe ndent children; see pp. 28 -31 of filing instructions.)

N O N E(No rep ortable gifts.)

SOURCE

1.

2.

3.

4.

5.

DESCRIPTION VALUE

V I .L I A B I L lT I E S .a n c l u d e s t h o s o o S s p o . s e .n d d e p e n d e n t c h i ld r e n : s e ep~ , . s~ . s~of filing instructions.)

~ ] N O N E(No reportable l iabilities.)CRED1TOR DESCRIPTION

I.

2.

3.

4.

5.

VALUECODE

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N a m e o f P e r so n R e p o r t i n g

Folsom, David J.

Date of Report

07111/201 I

V I I. I N V E S T M E N T S a n d T R U S T S- income , value, transactions (Includes those of spouse and depend ent children; ste pp. 34-60 of filing instructions.)

3.

4.

5.

:6.

7.

8.

9.

1 0 .

II.

12 .

13 .

14 .

15 .

16 .

N O N E(No reportable income, assets, or transactions.)

A. B. C. D.

Descr ip t ion of Asse ts I n c o m e d u r i n g Gross va lu e at e n d Tran sac tion s du rin g re p or tin g p er iod

( includingt rus t asse ts ) repor t ing per iod of repor t ing per iod

O) (2) O) (2) O) (2) (3) i (4) (5 )Place "(X)" after each asset A m o u n t Type (e.g., V a lu e V a lu e Type (e.g., Date Value i Gain Identity of

exempt from prior disclosure Code I div., rent, C o d e 2 M e t h o d buy, sell , mm/dd/yy Code 2 [ Code I buyer/seller

(A-H) or int.) (J-P) Code 3 redempt ion) (J-P) (A-H) ( i f pr iva te

(Q-W) i transaction)

We lls Fargo-checking

Wells Fargo--checking

Wells Fargo--certificate of deposit

Commer cial National Ban k CD 880

EDWARD JONES (Securities account) #8

Money mar ket funds

Automatic Data Processing

Broa dridge Financial Solutions

Eli Lilly & Co

Illinois Tools Wor ks

Scana Corp

Franklin Equity Income Fd

Franklin Flex Cap Gr owth Fd

Franklin Small Cap V alue Fd

Mural Global Discovery Fund

A I n t e r e s t K

A I n t e r e s t K

A I n t e r e s t Matured 06/30/I 0 K

B I n t e r e s t L

A I n t e r e s t

A Dividend

A Dividend

A Dividend

A Dividend

A Dividend

A Dividend

A Dividend

A Dividend

A Dividend

J

J

J

J

J

J

J

J

J

J

T

T

T

T

T

T

T

T

T

T

1 7 .

I. Income Gain Codes: A =$1,000 or less B =$1,001 - $2,500 C =$2.501 - $5,0~0 D =$5,1)01 - $15,000

(See Columns BI and D4) F =$50,001 - SI00.00~ G =$100,001 - $1,000,000 HI =$1,000,001 - $5,0~.000 H2 =More than $5.0~0,00

2. Value Codes J =$15,0~0 or less K =$1 5.001 - $50,000 L =$50,001 - $100,000 M =$ 100,001 - $250,000

(See Columns CI and D3) N =$250.001 - $500,0~0 O $500,001 - $1,0~),00~ p I = $ 1,000,001 . $5,000,000 P2 =$5,000,001 - $25,00~.000

P3 =$25,000,0 1 - $50.000,000 P4 =More than $50,000,000

3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T -Cash Market

(See Column C2) U =Book Value V Other W =Estimated

E =$15,001 - $50,000

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N a m e o f P e r so n R e p o r t i n g

Folsom, David J.

D a t e o f R e p o r t

07/I 1/2011

V I I . I N V E S T M E N T S a n d T R U S T S- income , value, transactions (Includes those of spouse and depend ent children; see pp. 34-60 of filing instructio.~.)

NONE (Noreportable income, assets, or transactions.)

Descr ip t ion of Asse ts I n c o m e d u r i n g

(in c lu d in g tru st asse ts) rep orlin g p er iod

(l) (2)Place "(X)" after each asset A m o u n t Type (e.g.,

exempt from p rior disclosure Code I div., rent,(A-H) or int.)

Gross va lue a t endof repor t ing per iod

(1) (2)V a lu e V alu e

Code 2 Method

(J-p) Code 3

( Q - W )

Typ~ (e.g.,buy, sell ,

redempt ion)

Transac t ions dur ing repor t ing per iod

(2) (3) (4) (5 )Date Value i Gain Identity of

mm/dd/yy Code 2 i Code l buyer/seller

(JP) i (A-H) (ifprivate! t ransac t ion)

1 8 . We lls Fargo #10(Securities account)

19. Cash Account A Dividend J

20 . Goldman Sachs Group

21 .

A Dividend

22 .

23 .

24 .

O NEquity Sales Co (Securities Account)#11:

Federated Capital Reserves MM A Interest

OSI Pharmaceuticals Inc Co None Sold 07/12/10 J Loss on sale

25 . W h ole Fo od s M a rk et None J

26 . The Bond Fu nd of America Class C B I n t e r e s t K

27 . Capital Income B uilder Fund Class C B I n t e r e s t K

28. The Income Fund of Am erica Class C C I n t e r e s t K

T

T

29 . Putnam V oyager Fund Class A

30 .

A Dividend

31 . Genworth Financial(Annuity)

32 .

Int./Div.

33. The Ohio N ational Life Insurance C oAnnuity # 12

34 .

lnt./Div. M

I. Income Gain Codes: A ~$1,000 or less B =$1,001 - $2,500 C =$2,501 - $ 5,000

tS~ Columns B I and D4) F =$50.0~1 o $100,000 G =$10O,001 - $1,0(~t,000 HI =$1.000.001 - $5.0~0.0002. Value Codes J =$15,000 or le ss K =$1 5,001 - $50,000 L =$50.001 - $ 100,000

( .Sc Columns C I and D3) N 45250,001 - $500,000 O = $500,001 - $1,000,000 PI =$1.000,001 -$5,000,000

P3 -$25,000,001 - $50.000.000 P4 =More Ihan $50,000,000

3. Value Method Codes Q ~Appraisal R =Cost (Real Estate Only) S =Ass,cssmcnl(See Column C2) U =Book Value V -Other W =Estimated

D =$5.0~1 - $15.000H2 =~.torc than

M =$ 100.001 - $250.00~P2 =$5,090,0~ I - $25,0~0.000

=Cash Market

E =$15,001- $50.000

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N a m e o f P e r s o n R e p o r t in g

Folsom, David J .

D a l e o f R e p o r t

0 7 / I 1 / 2 0 1 1

V I I . I N V E S T M E N T S a n d T R U S T S -i n c o . ,o , , ,a l ~ . , ,r a n s a c t io . s a n c l a d e s , h o s e o y s p o a ~ o a n d d o p e . d e .,children; see pp. 34-60 of filing instructions.)

NONE (Noreportable income, assets, or transactions.)

Descr ip t ion of Asse ts I n c o m e d u r i n g

( inc lud ing t rus t asse t s ) repor t ing per iod

( 1 ) ( 2 )

Place "(X)" after each asset A m o u n t Typ~ (e.g.,

exempt from p rior disclosure Code I di~., rent,(A-H) or int .)

Gross va lue a t end

of repor t ing per iod

O ) ( 2 )V al ue Va lue

C o d e 2 M e t h o d

(J-P) Code 3

(O-w)

Type (e.g.,

buy, sell ,redempt ion)

Transac t ions dur ing repor t ing per iod

(2) (3) (4)

D a t e Value Gainmm/dd/yy Code 2 Code I

( J - P ) ( A - H )

(5 )I d e a t i ty o fbuyer/seller( i f .pr iva te

transaction)

35 .

36 .

37 .

38 .

M ERRILL LYNCH (SEP/IRA): No. 3 :

ML Retirement Money Fund A

Invesco Constellat ion Fund--Former ly AIM A

Dividend

Dividend

J T

T Name chg f r AIM to

Invesco

39 . MERRILL LYN CH (SEP/IRA) No. 4 :

40. ML Cash account A Dividend

41 . PMC S ierra lnc None J

42 . FederaINatl Mtg Assn A Interest Redeemed 10/22/I 0 J

43.

4 4. F LO Y D C AP ITAL M G M T- -S ch w a b ( S EP /IRA): #7:

45 . Schwab U S Treasury Money Fund B I n t e r e s t M

4 6. I sh a r e s R us se ll 20 00 A Dividend K

47 . Powershar es Trust Series 1 A Dividend K

48 . S P D R S& P 50 0 A Dividend K

T

T

T

Bu y 12/02/10 K

Bu y 12/07/10 K

Buy 12/01110 K

1. Income Gain Codes: A =$ 1,000 or less B =$1,001 - $2,500 C =$2,501 - $5,000

(See Columns B I and IM) F =$50,001 - $ 100,0~0 G = $ 100,001 - $1,000,000 H 1 =$1,000.001 - $5.000,000

2. Value Codes J =$15.000 or less K =$15.001 - $50.000 L =$50.0~ I - $ 100.000

(See Columns CI and D3) N ~$250.001 - $500,00~ O =$ 500 ,00 1 - $1 .04) 0.00 0 P I -$ 1.1~ .{ KII - $5 .0 4) 0.0 04)P3 =$25,000.001 - $50.00~.000 P4 =More than $50.000.000

3. Value Method Codes Q =Appraisal R =Cosl (Real Eslale Only) S =Assessment(see Column C2) U =Book Value V O t h e r W =Estimated

D =$5,001 - $15,000

H2 -More than $5.000.000M $100.04)1-$250,000P2 =$5,000.001 - $25.00~.000

T =Cash Market

E =$15,001 - $50,000

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Name of Person Reporting

Folsom, David J .

Date of Report

07/11/2011

VIII. ADDITIONAL INFORM ATION OR EXPLANATIONS.(lndicate part of report.)

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N a m e o f P e r s o n R e p o r t in g

Folsom, David J.

Dale of Report

07/I 1/2011

IX. CER TIFICATION.

I ce r t i fy tha t a l l in format ion g iven abov e ( inc lud ing in format ion per ta in ing to my spou se and m inor o r depen dent ch i ld ren , i f any) i s

accura te , t rue , and comple te to the bes t o f my know ledge and be l ie f , and tha t any in format ion no t repor ted was wi thhe ld because i t met app l icabprov is ions permi t t ing non-d isc losure .

I fu r ther ce r t ify tha t earned income f rom ou ts ide em plo~anent and hon orar ia and the accep tance of g i f t s which have been repor ted a re incomp l iance w i th the p rov i s ions o f 5 U.S .C . app . 501 e t . seq . , 5 U.S .C . 7353 , and Jud ic ial Confe renc e regu la tions .

Signature: S/David F o l s o m

N O T E : A N Y I N D I V I D U A L W H O K N O W I N G LY A N D W I L F U L LY FA L S IF I E S O R FA L L S TO F I L E T H I S R E P O RT M AY B E S U B J E C T TOAND C RIMIN AL SANCT ION S (5 U.S .C. app . 104)

Com mittee on Financ ial DisclosureAdministrative Office of the United States CourtsSuite 2-301One C olumbus Circle , N .E.Washington, D.C. 20544