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FINANCIAL DISCLOSURE REPORTPage 2 of 8
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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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