Susan H Black Financial Disclosure Report for 2010

8/3/2019 Susan H Black Financial Disclosure Report for 2010

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FINANCIAL DISCLOSURE REPORTFOR CALENDAR YEAR 201 0

Report Required by the Ethicsin Government Act of 1978(5 U.S.C. app. 101-111)

1 . P e r s o n R e p o r t i n g ( l a s t n a m e , f ir s t , m i d d l e i n i t ia l )Black , Susan H.

4. Title (Article 111 judges indicate active or senior status;magistrate judges iudioate full- or part-time)

2. Court or O rganizat ionU . S . Cour t o f Appeals

5a. Repor t Type (check app ropr ia te type)] Nomina t ion , D a t eCirc u i t J udge -Ac t ive

7. Cha m be rs o r Off i c e Addre ss300 N Hogan S tree tSui te 14 -150Jacksonvi l le , FL 32202-4258

[] Initial [] Annual [] FinalI 5b. [] Amended Report8. On the basis of the information contained in this Report and any

modifications pertaining thereto, it is, in my opinion, in compliancewith applicable laws and regulations.

R evi ew i ng O f f i ce r Date

3. Date of Report05/06/2011

6. Repor t ing Per iod01/01/2010

to12/31/2010

I M P O R T A N T N O T E S : The instructions accompanying this form must be followed. Complete all parts,checking the NON E box for each part w here you have no reportable informatlon. ~ign on last page.

I . P 0 S I T I O N S . ~ R c p o n i n g i n d i v i d u a l only; see p p . 9 - 1 3 of filing instructions.)~ N O N E (No reportablepositions.)

P O S I T I O N1 . Tru s t e e

2.

NAME OF ORGANIZATION/ENTITYLife Ins. Trust (Part VIII )

I I , A G R E E M E N T S . ( R ~ , o n i n g individual only; see pp. 14-16 of filing instructions.)[~ N O N E (No reportable agreements.)

DATE PARTIES AND TERMS


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N a m e o f P e r s o n R e p o r t in gB la ck , Su san H .

D a t e o f R e p o r t05/06/2011

I II . N O N - I N V E S T M E N T I N C O M E . (Repo.ing individual andspouse; seepp. 17-24 of filing instructions.)A. Filers Non-lnvestment IncomeD (No reportable income.)ONE non-investment

DATE SOURCE AND TYPE I N C O M E(yours , not s p ous e s )1. 2010 D u ke U n iv er sity S c ho o l o f L a w -ap p ella te p rac tice c o ur se $4 ,5 00.002.3.4.

B . S p o u s e s N o n - I n v e st m e n t I n c o m e - if you were ma rried during any portion of the reporting year, com plete this section.(Dollar am ount not required except for honoraria.)

N O N E ( N o reportable non-investment income.)

1 . 2 0 1 02 .2 0 1 03 . 2 0 1 04.

D A T E SOURCE AND TYPESe lf -emp loyed pre s ident o f t r ave l agencySe l f -emp loyed rea l e s ta te b roke rS e l f - em p l o y e d o w n e r o f l i m o s e r v ic e

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 o filling instructions.)D NO N E ( N o reportable reimbursements.)

SOURCE1 . Duke U niver s i ty2. U niver s i ty o f F lo r ida3.4.5.

D A T E SN ov 14 -16 , 2010Feb 3 , 2010

LOCATIOND u r h a m , N CGainesvi l le , FL

PURPOSETeachRound tab le

ITEMS PAID OR PROVIDEDAir far e , ho te lM eals


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N a m e o f Pe r s o n R e p o r t i n gBlack, Susan H.

D a t e o f R e p o r t05/06/2011

V . G I F T S . a n c l u d e s t h o s e t o s p o u s e u n d d e p e n d e n t children; see p p . 2 8 - 3 1 of filing instructions.)N O N E ( N o reportable g ifts.)

SOURCEI.2.3.4.5.

DESCRIPTION V A L U E

V I . L I A B I L I T I E S . a n d u d e s those of spouse and dependent children; seepp. 32-33 of filing instructions.)D N O N E ( N o reportable liabilities.)

C R ED IT O R D ES C R IP T IO N VALUE CODE1 . B a n k o f A m e r i ca Mor tgage -Pa rce l 33 (Pa r t VII , l ine 13) P12. SunTr us t Bank Mortgage -Pa rce l 39 (Pa r t VII , l ine 29) M3. M ercan tile B an k M o rtg ag e -P a rce l 38 (P art V II, lin e 1 8) N

4.5.


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N a m e o f P e r s o n R e p o r t in gB l a c k , Su san H .

D a t e o f R e p o r t05/06/2011

V I I . I N V E S T M E N T S a n d T R U S T S - i ncome, value, transactions (lndudes those of spouse and dependent children; see pp. 34-60 of filing instructions.)N O N E (No reportable income, assets, or transactions.)

A. B. C. D.Desc rip t ion o f Asse ts Income during Gross value at end Transactions during rep0iting period(includ ing trust assets) reporting period of report ing pe riod

(2) : (3) (4) "Date . . . .. . V a l ue Gain I d e n t i , ty of

exempt f rom prio r d isc losure C o d e t d i v . ,~ :e n t ; Code2 : Method buy, se l l , m n ~ d d / y y C 0 d e 2 C o d e . l : : ~ . : . . . . . . . . :buyedse l l e~(A :H) : orint2) (J-P) C ode 3 redemption) (J~P) (A-H) ( i t ~ P r iv a t e

( Q - W ) transaction)

1 . Rea l Es ta te Pa rce l 2 Am el ia Is land , FL2. Rea l Es ta te Pa rce l 5 Jackson vi l le , FL

A R e n t J WN o n e O W

3. Real Es ta te Par ce l 10 Jacksonv i l l e , FL C R e n t J W4. W e l ls F a r g o I R A A Int . /Div. C l o s e d 01 /27/10 K5. - C a l a m o s C o n v O p p o r t u n i ti e s & I n c o m e F d Sold 01 /21 /10 J6. -DW S Inves tmen t T r us t Cap i ta l Gr ow th Fd S o l d 01 /21 /10 JC I B7. - W e l ls F a r g o B a n k D e p o s i t C lo sed 01 /27 /1 0 K8. -Ever g r een Eq u i ty T r Asse t Al loca t ion Fd C1 Sold 01 /21 /10 KC9. W e l ls F a r g o I R A N o n e J T1 0 . -Cen tu r y Pr oper t i es Fund X V LP1 1 . Real Es t a t e Parce l~ Mars Hi l l , NC D R e n t N W1 2 . Real Es t a t e Parce l~ Jacksonv i l l e , FL D R e n t L W1 3 . R e a l E s t a t e P a r c e l ~ Or a n g e P a r k , F L G R e n t PI W1 4 . L o a n - P l u m l e e A Interes t J U1 5 . Real Es t a t e Parce l~ Jacksonv i l l e , FL N o n e L W

1 6 . L oa n -S m ith N o n e Closed 12/31/10 J1 7 . SunTr us t accoun t A Interes t K T

1. Incom e Gain C od es: A =$1,000 or less(See C o lu mn s B t an d D4 ) F =$50,001 - $100,000

2. Value C o des J = $1 5,000 or less( Se e C olu m ns C I a nd D 3) N -$ 25 0,00 1 - $5 00 ,00 0

P3 -$25,000,001 - $50,000,0003. Value Method Codes Q =A p p r a i sa l(See C o lu mn C 2 ) U = Bo o k Va lu e

B =$1,00t r $2,500G=$100,001 - $1,000,000K ~$15;001-$50;000O =$500;001 = $1,000,000R = C o s t (Rea l Es ta te On ly )V --Other

C =$2,501 - $5,000 D =$5,001 - $15 ,000 E = $1 5,001 - $50,000H = $1 0 0 0 0 0 1 -$5,0 0 0 0 0 0 H2 =M 0r~ t ha~ $ ~ 000 ,000L ~ $ 5 o , o 0 i - $ 1 0 0 ;0 0 o M : $ 1 0 0 ,0 0 i : $ ~ 5 o , 0 o 0PI =$1,000,001 - $5,000~000 P2 =$5 ,000;001, $25,000,000S = Asse ssmen t T =Cash Market w = Es t ima ted


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N a m e o f P e r s o n R e p o r t i n gB la ck , Su san H .

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V I I . I N V E S T M E N T S a n d T R U S T S - i.come, v a~ue, transactions (Includes those of spo .... nd dependent children; seepp. 34-60 of f!ling instructions.)D NONE incom e, assets, or transactions.)eportable

18 . Real Estate Parcel~ Jacksonville, FL E Rent O W

19 . Loan-S.K. H o n g Ine D Interest L U Redeemed 07/16/10 L( p a r t )20 . Loan -Sm ith 2 None Closed 12/31/10 J

21. Loan -B ragg Non e Closed 12/31/10 J

2 2. Lo an -H ew et t 2 None Closed 12/31/10 J

23. Loan -Norm an Non e Closed 12/31/10 J

: 2 4 . Loan-Norman 2 None Closed 12/31/10 J

2 5. Lo an -La b In v es tm e nt s None Closed 12/31/10 J

26. Loan-Forte D I n t e r e s t L U

27 . Compass Bank accounts A I n t e r e s t J T28 . Mercant i l e Bank account A I n t e r e s t J T29 . Real Esta te Parcel~Jacksonv i l l e , FL None M W30. M id Atl an t ic Res i d en t i a l In v e sto rs LP None J W31 . Real Esta te Parcel~Jacksonv i l l e , FL D Rent M W

32 . Real Esta te Parcel~Jacksonv i l l e , FL D Rent L W33. Loan -G rum ling None Closed 12/31/10 J

34. Loa n-G ib son C I n t e r e s t K U

( ~ ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .

1. I n c o m e G a i n C o d e s : A = $1.000 or le ss B = $1 .001 - $2,500(See Columns BI and D4) F =$50.001 - $100,000 G =$100_001 - $1.000.000

2. V a l u e C o d e s J ~$15.000 or less K =$15.001 - $50.000(See Columns C I a n d D 3 ) N =$250.001 - $ 500.000 O =$5 00,001 - $1 ,000 .000

P3 =$25.000.001 - $50.000.0003. Value Method Codes Q =A p p r a i sa l R =Cos t (Real Estate Only)(See Colum n C2 ) U = Bo o k Va lu e V = O t h e r

C =$ 2,501 - $5 ,000 D = $5 ,001 - $ 15 .000HI =$1.000.001 - $ 5.000.000 H2 =More than $5,000,000L =$50.001 - $100.000 M =$100.001 - $250.000P 1 = $1,000,001 - $5,000,000 P2 =$5,000,001 - $25,000,000P4 =More than $50,000,000S = Asse ssmen t T = C a s h M a r k e~W =Estimated

E = $ 1 5 . 0 0 1 - $ 5 0 , 0 0 0


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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 m e , v a lu e , transactions (Includes those of spouse and dependent children; see pp. 34-60 of f!ling instructions.)D N O N E ( N o reportable incom e, assets, or transactions.)

35. Loan-Gibson 2 A I n t e r e s t K U36. Bank of Am eric a a ccou n t Non e J T37 . Real Estate Parcel~ Jacksonvil le, FL None L W38 . Loan -B l a c k 1 D I n t e r e s t O U39. Lo an -B la ck 2 D I n t e r e s t O U

4 0. Rea l Es ta t e Pa r c e l~ Ja c k sonv i ll e , F L41 .

None K W B u y 02/16/10 K Rory Pire

i ln~0me Gain Codes: A =$1;000 or less : B =$ 1 ,001 - $ 2 ,500 : :=$2;501, $5,000 D =$5,001- $15,000(See C o lu mn s BI and D4) F =$50100i - $100,000 G :$]001001 ; $i i0~01000 ~i ~ , i 3 0 0 ;0 0 i ; s S ~ 0 0 O ~ 0 ~ ~ ~ b ~ m a a s 5 ~ 0 0 0 ;0 0 0

2. Val ueCodes J =$15,000 or lesS : K =$15 00! :~ $50 000 L~$5600 :$100000 M ~ $ I 0 0 0 0 ] - S 2 5 0 0 0 0(See C o l u ~ s C I a n d D 3 ) N =$ 250 001 - $ 500 000 O =$500;001 : $1~0~ 000 P 1 = $ 1 ; 0 0 0 ; 0 0 1 ~ $ 5 ~ 0 0 0 ; 0 0 0 ~ ~$5i000,001 - $25;000,000

P3 =$25,000,001 - $50;000,000 ~ ~ More t han $ 50 ,000 ,0003 . V a l u e M e t h o d C ~ Q = A p p ~ i ~l : R = C o s t (Real EState Only) S =Assessment T:~Cash M arket(See Column C2) U = Bo o k Va lu e V = O t h e r W =Est ima t~

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 gBlack , Susan H .

D a t e o f R e p o r t05/06/2011

V III. ADDITIONAL INFORMATION OR EX PLANATIONS. (lndicate part of report.)Part I ~ L i f e I n s u ran ce T ru s t - n o t l i s ted i n P a r t VI I , a s i t i s an u n f u n d e d t r u s t .


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IX. CERTIFICATION.

Iame of Person Rep ort ingB l a c k , S u s a n H . Date o f Report05/06/2011I c e r t if y t h a t a l l i n fo r m a t i o n g i v e n a b o v e ( i n c lu d i n g i n fo r m a t i o n p e r t a i n i n g t o m y s p o u s e a n d m i n o r o r d e p e n d e n t c h i l d re n , i f a n y ) i s

a c c u r a t e , tr u e , a n d c o m p l e t e t o t h e b e s t o f m y k n o w l e d g e a n d b e l i e f , a n d t h a t a n y i n f o r m a t i o n n o t r e p o r t e d w a s w i t h h e l d b e c a u s e i t m e t a p p l i c a b l e st a t u t o r yp r o v i s i o n s p e r m i t t in g n o n - d i s c l o s u r e .I f u r t h e r c e rt if y t h a t e a r n e d i n c o m e f r o m o u t s i d e e m p l o y m e n t a n d h o n o r a r i a a n d t h e a c c e p t a n c e o f g i f t s w h i c h h a v e b e e n r e p o r t e d a r e i nc o m p l i a n c e w i t h t h e p r o v i s i o n s o f 5 U . S . C . a p p . 5 0 1 e t . s e q . , 5 U . S . C . 7 3 5 3 , a n d Ju d i c i a l C o n f e r e n c e r e g u l a t io n s .

Signa ture: S/Susan H . Blac k

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 L Y A N D W I L FU L L Y F A L SI FI E S O R F A I L S T O F IL E T H I S R E PO R T M A Y B E S U B JE C T T O C I V ILA N D C R I M I N A L S A N C T I O N S ( 5 U .S . C . a p p . 1 0 4 )

C o m m i t te e o n F i n a n c ia l D i s c l o s u r eA d m i n is t ra t iv e O f f i c e o f t h e U n i t e d S t a t e s C o u r t sSu i te 2-301O n e C o l u m b u s C i rc le , N . E .W a s h in g t o n , D . C . 2 0 5 4 4

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Susan H Black Financial Disclosure Report for 2010