~3/25/2009 15:32 SUPREME CARERS PAGE 01/04

NEBRASKA POSTMARK
DATI: -r---
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="01(
ACCOUNTABILITY AND
DISCLOSURE COMMISSION
11th Floor. State Capitol
STATEMENT MICROFILM
NUMflf;S. ~,940{63
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P.o. Box 95086 OF !.
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Lincoln, NE 68509
(402) 471-2522
FINANCIAL
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INTERESTS vV

BEFORE COMPLETING ti... ArTnl!f'-l

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READ FILING REQUIREMENTS [. I')
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NADC FORM C-1
• Candidates for designated offices and holders of desIgnated offices and positions must file this statement, See Sections 1A and
1 B of the instructions.
•• Candidates (including incumbents) subject to this filing requirement must tile with the Commission and with the appropriate
election official (See Instructions).
• Designated offioeholders and holders of designat~d positions must file this statement with the Commission annually.
• Dollar values need not be report for any item, except Item 11.
• Persons who fails to file as recuired is subiect to a civil oenahv of UD to $2 000.
- ..
JTEM 1 1YOUR NAME, ADDRESS AND PHONE NUMBER

Name GIESE ROBERT J Telephone No. 402-494-4962

LAST FIRST MIDDLE
Address 500 BROADMOOR DRIVE SSIOUXCITY NE S8776
STREET ADDRESS OR ~URAL ROUTE CITY STATE ZIP CODE

ITEM 2 I OCCASION FOR FIL.ING (Check Appropriate Box)

o A candidate for elective office o Left office or position

D Annual officeholder's or state employee's report ~ Newly appointed to office or position

ITEM 3 I OFFICE HELD & TERM OF OFFICE (Incumbent electedfapPointl!d officials and state employees.
IB of instructions)
See

List th~ office or position you currently hOldwhich requires this filing. If you have left office, list the office you held.
Office or Position: STATE LEGISLATURE Term: 2009
BEGINS ENDS
Name of City, County, District, or State Agency: DISTRICT 17

I1l:M4 I OFFICE SOUGHT (Candidates only. See 1A of instructions)

List the office sought which requires this filing.
Office:

Name of City, County, District. or State Office:

ITEMS IPERIOD COVERED BY THIS STATE;MI:NT

Thls statement must coVElr aU financial interests for the entire "preceding calendar year" and not just as of year-end. If you have
left office, this statement must cover an financial interests from the end of the calendar year for which you previously filed I.lP to and
including the date you left office.

~ This statement covers the preceding calendar year January1 through December 31, 2008

0 Left office, this statement COvers the period January 1, to

(DATE YOU LEFT OFF1C~ OR POSITION)

f' ,
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ITEM 6 I SOURCES OF INCOMe OF OVER $1.000

body of government, political subdillision or body corporate) from

I
Income includes monev or anY otMr form of recompense eonstilutinll income under the Intemal Revenue Code, (See definitions}
Name and address of any source* (IncltAdingan individual, business, List the nature of tile source's business and the nature of tile 9~l'Viees you
rendere(l or tile circumstances under whiCh incom@was received. NOTE: 00 not
whom income of over $1 000 was received, list the amount of the incoma.
1.) HYNE~, INC. ta) EMPLOYER
5820 WESTOWN PKWY
W~ST DES MOINES, IA 50266

2,) CITI' OJ: SOUTH SIOUX CITY 2a.) EMPLOYER

16151$1 AVE
SOUTH SIOUX CITY, NE 68776

3.) 3a.)

4.) 4a.)

, "'-"~'

"NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PRoPRIETORSHIP, PARTNERSHIP,
CORPORATION OR OTHER PERSON. LIST THE SAME AS THE SOURCE OF INCOMJ;:. BUT NOT THE PATRONS, CUSTOMERS, PATIENTS, OR
CLIENTS THEREOF.
ITEM 7 I BUSINESSES WITH WHICH YOU ARE ASSOCIATED (See definitions)
Name and address of all businesses, organizations, or associations (profit and nOI'1-profit) with which you held a posRlon of officer. director, limited liability
company member. partner, or stOCkholderand eny entity in which you neld a position of trustee. Such reporting is required basad 01\ the pOSitionheld, not
on whether income WIISre~ived. You need not report business G99oci"ticns which are otherwise listed under Item 6.
Name and Addl'1!t$sof BU$iness or Organiz:ation I Nature of Association
1.) 13.)

2.) 2a.)

3.) 3a.)

4.) 48.)

5.) 53.)

S.) ea.)

7,) 7a).
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ITEM 8 I REAL PROPERTY OF THE FILER IN NEBRASKA (Real property valued at legs than $1,000 and your
personal 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 sufftOient to identify
the location of the property. Exception$; You need not report real estate owned by a business listed in Item 6 or 7, your personal
residence of real property valued at less than $1,000, Personal residence refers to your principal dwelling-house and adjacent land used
fot house-hold Durooses, such as lawos and nardens,
Location of Property Nature of Property
(Description OrAddress (such as: agricultural, commercial, industria', residential-rental)

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 PERIOD
(a) List the names and addresses of t~ institutions in which you had checking and savings accounts and certificates of deposit.
Financi.ellnstitution Address

SIOUXLANDFEDERAL.CREDIT UNION SOUTHSIOUXCITY, NE 68776

VANTUSaANK SOUTH SIOUXCITY, NE 68776

MIDWESTHERITAGESANK CHARITON, IA 50049

PRINCIPAL. FINANCIAL.GROUP DES MOINES, IA

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

(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b). Include
leaseholds and other interests in real estate, promissory notes and other Obligations owed to you, beneficial interests in trusts and
estates, cash value life insurance. IRAs, deferred Income and retirement plans. Exception: Do not: include accounts receivable,
inventory, fixtures and equipment owned or used by a business listed in Items 6 & 7 or household goods, personal automobiles and
ether tanQible oersonat orooertv unless such prooe-rtv was held ~rimarilY for sale or exchange.

HV-V~~ TRUST ~UNO

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I1"EM 10 I CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED

YOUR IMMEDIATE FAMILY.
BY YOU OR A MEMBER OF

Exception; Loans from a relative OIndland contracts which have been recorded with the County Clerk or Regi~ter of Deeds MEld not be
reported, Accounts payable. debts arising out of retail installment transactions or loans made by a financial institution in the ordinary
course of business need not be reported.
Name Address

ITEM 11 I SOURCES OF GIFTS OF A VAL.UE OF MORE THAN $100 RECEIVED

(See definitioO$)
EXCEPT GIFTS FROM REL.ATIVES.

:.:-":: Name and address of Donor Occupation or nature of business of Value of Gift ·Description of Gift and
Donor (See Key Below) Circumstances or Occasion for
Gift
BERT s
LEONARD GILL BUSINESS OWNER B DINNER MEETING
JACKSON, NE
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 the
Value column the letter which corresponds to the value category of the gift. The value categories are:

A) $100.01 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 preparation of this Statement and that to the best of my knowledge It is true
ana complete.

~~ ;;J~Z6'~07
(Sign<lture of Filer) (bate)