XGR Sullivan SFI

8/14/2019 XGR Sullivan SFI

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, - ~~l1n,-&./ .I ) ()NEBRASKA POSTMARK ~ACCOUNT ABILITY AND DATEDISCLOSURE COMMISSION STATEMENT MICROFILM 79 '7 0 f . I . . ~ I{NUMBER . -;. v.A.\V11th Floor, State Capitol OF OfijKl~ R F r ;P } Y S : 0 ..O. Box 95086Lincoln, NE 68509 FINANCIAL . - "vr...I~IH.Uf\H0(402) 471-2522 INTERESTS 2 0 U 9 A P R - / A ~ l l O :

BEFORE COMPLETING ~ W A C C O I l f l , ! T h B f ! ! " "READ FILING REQUIREMENTS .; '.~. t ;"i-l ,".". It..~I;)h(,1 (!SU R f.' C ! H " M 'S


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< ()ITEM 6 I SOURCES OF INCOME OF OVER $1,000Income includes money or any other form of recompense constitutino income under the Internal Revenue Code. (See definitions)Name and address of any source" (including an individual, business, List the nature of the source's business and the nature of the services youbody of government, pol it ical subdivision or body corporate) from rendered or the circumstances under which income was received. NOTE: Dwhom income of over $1 ,000 was received. list the amount of the income.1.) Cedar Rapids State Bank ta.) Banking

P.O. Box 158 Employee & DirectorCedar Rapids, NE 68627 Salary & Director Fees

2.) Cedar Rapids State Insurance 2a.) Crop InsuranceP.O. Box 158 CommissionsCedar Rapids, NE 68627

3.) Kokes Corporation 3a.) Family Farm CorporationP.O. Box 130 Director FeesCedar Rapids, NE 68627

4.) Bluestem Beef 4a.) Meat SalesP.O. Box 130 Subchapter S Profit/LossCedar Rapids, NE 68627 - - ..

"NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNECORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME, BUT NOT THE PATRONS, CUSTOMERS, PATIENTCLIENTS THEREOF.ITEM 7 I BUSINESSES WITH WHICH YOU ARE ASSOCIATED (See definitions)Name and address of all businesses, organizations, or associations (profit and non-profit) with which you held a position of officer, director, limitedcompany member, partner, or stockholder and any entity in which you held a position of trustee. Such reporting is required based on the position hon whether income was received. You need not report business associations which are otherwise listed under Item 6.

Name and Address of Business or Organization Nature of Association1.) Nebraska Children and Families Foundation 1a.) Board of Directors

215 Centennial MallLincoln, NE 68508

2.) Cedar Rapids Senior Center 2a.) Board of Directors306 West MainCedar Rapids, NE 68627

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3.) 3a.)

4.) 4a.)

5.) 5a.)

6.) 6a.)

7.) 7a).


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g ]'\.ITEM 8 r REAL PROPERTY OF THE FILER IN NEBRASKA (Real property valued at less than $1,000 and yourpersonal residence need not be reported.)List all real property in your name or in which you have a direct ownership interest. The description required must be sufficient to idthe location of the property. Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your peresidence of real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent landfor house-hold purposes, such as lawns and aardens.

Location of Property Nature of Property(Description or Address (such as: agricultural, commercial, industrial, residential-rental)Greeley County RanchlandBoone County Recreational RealEstateAlbion, NE Residential RealEstate

- -' .-..ITEM 9 I OTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENT

WHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERI(a) List the names and addresses of the institutions in which you had checking and savings accounts and certif icates of deposit.Financial Institution Address

Cedar Rapids State Bank P.O. Box 158, Cedar Rapids, NE 68627First National Bank 1411 M. Street,Ord, NE 68862TierOne Bank 1504 L. Street, Ord, NE 68862

(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.Verizon & Berkshire Hathaway

(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b). Includeleaseholds and other interests in real estate, promissory notes and other obligations owed to you, beneficial interests in trusts anestates, cash value life insurance, IRAs, deferred income and retirement plans. Exception: Do not includeaccounts receivable,inventory, fixtures and equipment owned or used by a business listed in Items 6 & 7 or household goods, personal automobiles aother tangible personal property unless such property was held primarily for sale or exchange.


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~~ ~(~~1 ~('~~)IRA - Cedar Rapids State Bank


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o oITEM 10 I CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER O

YOUR IMMEDIATE FAMILY.Exception: Loans from a relative and land contracts which have been recorded with the County Clerk or Register of Deeds need noreported. Accounts payable, debts arising out of retail instal lment transactions or loans made by a financial institution in the ordinarycourse of business need not be reported.

Name Address

ITEM 11 I SOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVE(See definitions) .

Name and address of Donor Occupation or nature of business of Value of Gift Description of Gift andDonor (See Key Below) Circumstances or OccasionGiftChoose Value:Choose Value:Choose Value:Choose Value:Choose Value:Choose Value:Choose Value:Choose Value:

The monetary value of each gift shall be categorized based on the good faith estimate of the filer. For each reported gift insert in theValue column the letter which corresponds to the value category of the gift. The value categories are:A) $100.Q1 to $200; B) $200.01 to $500; C) $500.01 to $1,000; D) $1,000.01 or more.ITEM 12 I SIGNATURE OF FILER AND DATE.I hereby state that I have used all reasonable diligence in the preparat ion of this Statement and that to the best of my knowledge it isand complete.

~ ~&fu~ 1- l- tY I(Si9nyture of Filer) (Date)

XGR Sullivan SFI

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