Statement of economic interest for a public official

Official: Forrest Clark, Ann

Statement last updated: 6/25/2020

Occupation:	Occupational Therapist
Employer:	St. Luke's


	Duluth, MN 55805

Positions held

Agency	Position held	Appointment date	Appointment ends	Appointment authority
Occupational Therapy Practice, Board of	Occupational Therapist Member	1/1/2018	6/16/2020	Governor

Sources of income

Name of source	Relationship to source
Name of source	Director	Officer	Owner	Member	Partner	Employer	Employee	Honorarium
Cloquet Community Memorial Hospital
College of St. Scholastica 1200 Kenwood Ave Duluth, MN 55811
Northland Driving School
St. Luke's

Business or professional activity categories

Business or professional activity category	Employee and owns 25% or more of business	Independent contractor
Health care - ambulatory health care services

Securities

Name of security
Fidelity Puritan Fund
The Travelers Companies, Inc
Transamerica
Washington Mutual Investment Funds

Real property

County	Address or section information	Owner	Mortgagee	Contract for deed	Option to buy $2500 rule	Option to buy $50000 rule
Itasca	Sec: 18 TWP 58.0 RG: 23

Pari-mutuel horse racing interests

None reported