ooEFonn278(Rev.o9/2oJo)5 C.F.R. Part 2634                                                     Executive Branch Personnel P...
OGE Fonn 278 (Rev. 09/2010)5 C.F.R. Part 2634U.S. Office of Govenunent Ethics  Reporting Individuals Name                 ...
OGE Form 278 (Rev. 09/20 I 0)5 C.F.R. Part 2634U.S. Office of Government Ethics     Reporting Individuals Name            ...
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  1. 1. ooEFonn278(Rev.o9/2oJo)5 C.F.R. Part 2634 Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT Form Approved: OMB No. 3209- 0001U.S. Office of Government Ethics Calendar Year Termination Termination Date ( /{Appli- Reporting Incumbent Covered by Report New Entrant, Nominee, or )(I Filer 0 cable) (Month, Day, lear) Fee for Late Filing 05/03/2011 (Check Appropriate Boxes) D I I Candidate I I 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 Last Name First Name and Middle Initial filed, or, if an extension is granted, more Reporting than 30 days after the last day of the Individuals N arne Cain Herman filing extension period, shall be subject to a $200 fee. Title of Position Department or Agency (If Applicable) Position for Which Filing Candidate for President Reporting Periods Incumbents: The reporting period is Address (Number Street City )tate and ZIP Code) T 1 h N (I d A C d ) the preceding calendar year except Part Location of · · e ep one 0 · nc1u c rca 0 c II of Schedule C and Part I of ScheduleD Present Office 223 Montrose Drive. McDonough, GA, 30253 (678) 565-5335 where you must also include the filing (or forwarding address) year up to the date you file. Part II of1I Title of Position(s) and Date(s) Held ScheduleD is not applicable. losilion(s) Held with the Federal Government During the !receding Termination Filers: The reporting 12 Months (I[ Not Same as Above) period begins at the end of the period covered by your previous filing and endst---------------------------+-:-:---:----------------------.----------------------1 at the date of termination. Part II of Presidential Nominees Subject Name of Congressional Committee Considering Nomination Do You Intend to Create a Qualified Diversified Trust? I Schedule D is not applicable. to Senate Confirmation Not Applicable DYes I8J No Nominees, New Entrants and Candidates for President and __ o_f_R_e_p_o-rt-in_g ln_d_•_·v-id_u_a_I____________________________________ __ Vice President: I CERTIFY that the statements I have Schedule A--The reporting period made on this form and all attached for income (BLOCK C) is the preceding schedules arc true, complete and correct -;J_.t..(-;)..0(( to the best or my knowledge. calendar year and the current calendar year up to the date of filing. Value assets Signature of Other Reviewer Date (Month, Day, Year) as of any date you choose that is within Other Review 31 days of the date of filing. (If desired by agency) Schedule B--Not applicable. Schedule C, Part I (Liabilities)--The AgencyEthicsOfflcialsOpinion Signature of Designated Agency Ethics O!Iiciai/Reviewing Official Date (Month, Day, Year) reporting period is the preceding calendar . . . . . . year and the current calendar year up to On the ba"s of mformat10n contmncd m thiS any date you choose that is within 31 days report. I conclude thal the filer IS an compliance f 1 with applicable laws and regulations (subjeel to of the date 0 f1 mg. anv comments in the box below). Office of Government Ethics I Signature I Date (MonLh Day Year) ISchedule C, Part II (Agreements or Arrangements)--Show any agreements or Use Only arrangements as of the date of filing. ScheduleD--The reporting period is Comments of Reviewing Officials (If additional space is required, usc the reverse side of U1is sheet) the preceding two calendar years and the current calendar year up to the date of filing. ·::- .1"I u·· ,.·J t _l ..,.. • ·.1 (C/Jeck box if filing exrension granted & indicatc number of days----) D 1.f :1 ... •I I ; ·-· • n ·...J , ...,! l...,l :;J 1:1 10 _j... ..] Agency Use Only :8 Hd 9Z IIGl OGE Use Only (C/Jeck box Jf comments are continued on UJC reverse side) D Supersedes SF u !j J;<{J [) j ..:;.1 ::u
  2. 2. OGE Fonn 278 (Rev. 09/2010)5 C.F.R. Part 2634U.S. Office of Govenunent Ethics Reporting Individuals Name Page NumberCain, Herman SCHEDULE A 2 of 13 Assets and Income Valuation of Assets ·Income: type and amount. If "None (or less than $201)" is at close of reporting period checked, no other entry is needed in Block C for that item. BLOCK A BLOCKB BLOCKCFor you, your spouse, and dependent children, Type Amountreport each asset held for investment or theproduction of income which had a fair market ..... 0value exceeding $1,000 at the close of theing period, or which generated more than 200 0 q 0 0 0 0 0 0 ] .... 0in income during the reporting period, together .... 0 0 0 Q, q 0 0 0 o. J:l.<· 0 N 0 0 0 q Other Datewith such income. 0 0· 0 0 - .Q 0 0 Income (Mo., Day, ; 0 0 8· 0 0 -1< 0 q ci 0 g" b 0For yourself, also report the source and actual 0 0 0 0 0 0 0 0 0 0 lJ"l 0 q 0 lJ"l N £ q 0 0 N· lJ"l ...... 0 0 -0 q lJ"l lJ"l 0 0 § " Q) :0 t:: cO ..c: 0 0 R 0 0 0 0 q q 0 (Specify Type& Yr.) 0 0 q 0 0 0 lJ"lamount of earned income exceeding $200 (other "I - ...... 0 " " - Cil: - 0 0 0 0 .... 0 0 0 Actual Only if .s q 0 " ...... lJ"l ...... Ef7than from the U.S. Government). For your spouse, 0 ...... ...... 0 0 2 -" ...... lJ"l .... lJ"l I .... I .s 0 0 lJ"l lJ"l I " " 0 N 0 Amount) Honorariareport the source but not the amount of earnedincome of more than $1,000 (except report the I-< I ...... .... I .... ,...., ...... q o-: 0 0 0 "d E-< 1." I "1. 0 ,...., 0 0 0 "d. cO Cl Q) ... ....... lJ"l ...... ,...., ...... q I I 0 0 0 o_ 6 0 g lJ"l 2l ] ..._,_ .... o. 0 0· 0 0 o· I 0 ·;. ,...., 0actual amount of any honoraria over $200 of 0 0 0 ] 0 ..._, .... 0 .... ...... g. 0 0 0 lJ"l 0 0 0 ... 0: q .n. ... 0 .... ... ... !your spouse). Q) 0 0. 0 0 0 0 0 0 q .n· :a q "!. q vi" 0 0 Q) §. ...... ...... 0 ....... N o: o: lJ"l 0 d & t:: 0 0 .... 0 Q)NoneD z lJ"l l/"l. lJ"l N· Jj § 0 •Q) ..s u cO z 0 N- ...... N· lJ"l lJ"l ,_.;- > 0 Central Airlines Common · . ·- .:_ ·- 1- - - 1 - - r- X X X 1 - - - - - - - - - - - - - ·- 1- I- f.,- I- 1-- 1- 1-.- ·- ·- I- 1-- 1- 1- ---·-Examples DoeJones&Smith. Hometown, Stale 1 - - -Equity Fund- - - - - - - ·-- 1- --- ·- ·.- ·- - _I __ - - -- ·- ··- - - 1- - ··- - - - ·- law Partnership Income $130,000 1---- Kempslone -:-1-r: I- 1--. I- 1 - - - -500 Index Fund- - - - - -- - ·---. ..__ i-. - 1-- - ,. X _I_L -- -.- - :.:.1_ 1.,- f- -- 1---- IRA: llearlland ---- X 1--: :- ·- - X - ·- ·- X - --- --- 1---- 1 Cox Radio, Inc, Atlanta, GA Salary $165,1832 (S) The New Voice, Inc., Stockbridge, GA Salary ·.3 Hallmark Cards, Inc., Kansas City, MO ., Directors Fees $120,0004 Agco Corporation, Duluth, GA Directors Fees $202.5005 Whirlpool Corporation, Bento("! Harbor, Ml Dir. Fees/Stk Option Exercise $359.0086 Whirlpool Corporation Common .· ·. X I X X * This category applies only if the asset/income is solely that of the filers spouse or dependent children. If the asset/income is either that of the filer or jointly held by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate.
  3. 3. OGE Form 278 (Rev. 09/20 I 0)5 C.F.R. Part 2634U.S. Office of Government Ethics Reporting Individuals Name Page NumberCain, Herman SCHEDULE A continued (Use only if needed) 3 of 13 Assets and Income Valuation of Assets Income: type and amount. If "None (or less than $201)" is at close of reporting period checked, no other entry is needed in Block C for that item. BLOCK A BLOCKB BLOCKC Type Amount 0 ;::::;- 0 o_ 0 0 0 0 0 0 0 0 § ...... 0 0 ...... 0 0 0 0 0 0 J.!.< 0 N 0 0 0 Other Date I 0 0 0 0 0 0 0 0 0 0 0 Income (Mo., Day, 0 q 0 0 0 0 0 0 0 0 0 0 q 0 0 i< 0 Lrl 0 0 0 0 i< 8 (Specify Yr.) .s 0 0 0 0 ...... 0 0 Lrl. N 0 Lrl .-I 0 0 0 v) Lrl N I 0 0 0 " ;g (/) ..... ;:1 Cil .s 0 0 0 0 0 0 0 o_ 0 0 0 0 0 0 0 q .-I 0 0 q v) 0 0 0 Type& Actual Only if a v) >, Lrl .s 0 (/) (/) (/) (/) Lrl 0 I I .-I 0 (/) 0 v) ...... Lrl Lrl ...... 0 I 0 Amount) Honoraria .-I .I I I 0 .-I ...... 0 0 q N I 0 .-I 0 I I ...... ...... o_ 0 0 0 0 (/) ell ...... I I ...... q 0 q E ] "d .-I 1-< ...... .c..? 1-< .S· ...... I 0 .-I 0 0 0 0 0 0 0 0 ...... 0 0 0 0 Lrl 0 "d t:: Q) ] " .-; (/) ..... 0 I I ...... .-I I I ...... .-I 0 ...... 0 0 0 .-I o. 0 Lrl ! 0 0 0 0 o" g" 0 0 0. 0 q J 0 "d 0 0 0 0 0 q 0 1-< q Vi 1-< ·:;: q 1-< q ·!i 0 Ill q Q) 0 aa 0 Lrl Q) Vl 0 .-t" 0 ...... ...... .-I Lrl .-1 N Vl Lrl N JS .5 u z N .-I .N Lrl .-I Lrl (,1> 0 .(,I> 1 The Coca-Cola Company Common X X X2 (S) The Coca-Cola Company Common X X X "C3 Sale of 2,000 shares SonicWalllnc Common X I X X4 I Federated GA Municipal Cash Trust .. X . I X X X 5 Supervalu Inc Common X X X ...6 .. Whirlpool Corporation Common X X X ·• 7 Agco Corporation Common X 8 Delaware National Hi-Yield Municipal Bond A X X X Common C) Sale of 2,000 shares Whirlpool Corporation I X X X Common " * This category applies only if the asset/income is solely that of the filers spouse or dependent children. If the asset/income is either that of the filer or jointly held by the filer with the spouse or dependent children, mark the other higher categories of value, as appropriate. ---
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