Aaron N. McKethan

COMPLETE THIS FORM AND MAIL SIGNED, ORIGINAL TO STATE ETHICS COMMISSION, 1324 MAIL SERVICE CENTER, RALEIGH, NC 27699-1324 NORTH CAROLINA STATE BOARD OF ELECTIONS AND ETHICS ENFORCEMENT 2018 STATEMENT OF ECONOMIC INTEREST 919-814-3600 www.ncsbe.gov/Ethics/SEI FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Dr. Aaron Nance McKethan CURRENT EMPLOYER JOB TITLE Duke University Senior Fellow NATURE OR TYPE OF BUSINESS Academia REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify Agency) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) Health Plan Board, State; JUDICIAL OFFICER (Specify Office) LEGISLATOR (Specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 A. Do other immediate family members reside in your household? Yes No When used throughout this form, the term Immediate family includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. List the full name of all adults and emancipated minors in your household. A minor is a child under 18 years old. Minors are emancipated by marriage, enlistment in the US military, or court order for emancipation. FULL NAME OF ADULTS & EMANCIPATED MINORS RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS Sarah McKethan Wife n/a n/a n/a B. List ONLY the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. INITIALS FOR UNEMANCIPATED CHILDREN RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS AM child n/a n/a n/a NM child n/a n/a n/a JM child n/a n/a n/a WM child n/a n/a n/a PROPERTY INTERESTS 1. As of December 31, 2017, did you, your spouse, or members of your immediate family: A. Have an ownership interest in North Carolina real estate (including your residence) with a market value of $10,000 or more? Yes No Owner of Real Estate % Ownership Interest Location by City Location by County Aaron and Sarah McKethan 100 Durham Durham Aaron and Sarah McKethan 100 Holden Beach Brunswick B. Lease or rent real estate or personal property to or from the State of North Carolina with a market value of $10,000 or more? Yes No Name of Lessor Name of Lessee (Renter) If Real Estate, Location by City & County If Personal Property, Describe The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 2. At any time during 2016 or 2017 , did you, your spouse, or members of your immediate family sell to or buy from the State of North Carolina personal property with a market value of $10,000 or more? Yes No Name of Purchaser Name of Seller Type of Property FINANCIAL INTERESTS 3. As of December 31, 2017, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY A. Stock in a publicly owned company? Yes No Do not list ownership interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: (i) the fund is publicly traded or its assets are widely diversified; and (ii) neither you nor an immediate family member are able to control the assets held in the mutual fund, investment company, or pension or deferred compensation plan. Owner of Interest Full Name of Company (Do not use a ticker symbol) Aaron and Sarah McKethan Apple Aaron and Sarah McKethan Alphabet Aaron and Sarah McKethan Amazon Aaron and Sarah McKethan JP Morgan Chase Aaron and Sarah McKethan Microsoft B. Stock Options in a company or business? Yes No Owner of Stock Option Full Name of Company (Do not use a ticker symbol) The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 C. Interests in a non-publicly owned company or business entity (including interests in sole proprietorships, partnerships, limited partnerships, joint ventures, limited liability companies, limited liability partnerships, and closely held corporations)? Yes No If "No", proceed to question 4. Owner of Interest Name of Company or Business Entity C (1). For each non-publicly owned company or business entity (the “primary company”) identified in question 3.C above, please list the names of any other companies or business entities in which the primary company owns securities or equity interests valued at over $10,000, if known. Non-Publicly Owned Company or Business Entity (the Primary Company) Other Companies in which the Primary Company Owns Security or Equity Interests None or Not Known C (2). If you know that any company or business entity listed in 3.C or 3.C(1) above has any material business dealings or business contracts with the State of North Carolina, or is regulated by the State, provide a brief description of that business activity. Name of Company or Business Entity Description of Business Activity with the State None or Not Known 4. As of December 31, 2017, were you, your spouse, or members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that was created, established, or controlled by you? Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” Yes No Name and Address of Trustee Description of the Trust Your Relationship to the Trust 5. As of December 31, 2017, did you, your spouse, or members of your immediate family have liabilities of $10,000 or more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student loans, personal loans and intra-family debt. Yes No Name of Debtor (You, Spouse, Immediate Family Member) Type of Creditor (Commercial Bank, Credit Union, Individual, etc.) The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family during 2017. Include salary, wages, state/local government retirement, professional fees, honoraria, interest, dividends, rental income, business income, and other types of income required to be reported on your State and federal tax returns. Do not include income received from the following sources: Capital gains Federal government retirement Military retirement Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income I had no reportable income over $5,000 in 2017. Aaron McKethan Duke University Academia salary Aaron McKethan Department of Health and Human Services government consulting fees Aaron McKethan RxAnte, Inc. technology timed payment associated with previous (2013) company acquisition PROFESSIONAL AND CIVIC RELATIONSHIPS 7(a). During 2017, were you, your spouse or members of your immediate family a director, officer, governing board member, employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in the State of North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? Yes No If "No", proceed to question 8. Do not list State boards or entities, or entities created by a political subdivision of the State. Do not list organizations of which you are a mere member. Name of Person His/Her Position Name of Nonprofit Corporation or Organization Nature of Business or Purpose of Organization Aaron McKethan board HOPE International charity 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, please provide a brief description of the nature of that business, if known or with which due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 Please answer the following question as it pertains to the following board/agency: Health Plan Board, State 8. During 2017, were you, your spouse, or members of your immediate family a director, officer, or governing board member of any society, organization, or advocacy group with an interest in matters over which your agency or board may have jurisdiction? Yes No Legislator/Judicial Officer - You are not required to complete this question if you are filing because you are a legislator or a judicial officer or you are filing as an appointee to those offices. Do not list organizations of which you are only a member (not serving in a leadership role). Name of Person Name of Society, Organization or Advocacy Group Leadership Position (Director, Officer, Board Member) 9(a). List the name of each company or business with which you were associated where you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2017. Name of Person Relationship to Filer Name of Company Role of Person No Business Associations Aaron McKethan self Duke University employee/faculty Aaron McKethan self Department of Health and Human Services consultant 9(b). If you know that any company or business entity listed in 9(a) above had any material business dealings or business contracts with the State of North Carolina or was regulated by the State as of December 31, 2017, provide a brief description of that business activity. Name of Company or Business Entity Description of Business Activity with the State Not applicable (No entities listed on #9a) No relationship / Not known 10. Are you a practicing attorney? Yes No Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2017. Administrative Admiralty Corporate Criminal Decedent’s Estates Environmental Insurance Labor Local Government Real Property Securities Tax Tort litigation (including negligence) Utilities Regulation Other category not listed. The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 11. During 2017, were you a licensed professional (other than an attorney) or did you provide consulting services individually or as a member of a professional association for which you charged or were paid over $10,000? Yes No Type of Business Nature of Services Rendered government consulting Please answer the following question as it pertains to the following board/agency: Health Plan Board, State 12. Are you or your employer, your spouse or members of your immediate family, or their employer currently: • Licensed by the State board or employing entity with which you are or will be associated or • Regulated by the State board or employing entity with which you are or will be associated or • Have a business relationship with the State board or employing entity with which you are or will be associated? Yes No Legislator/Judicial Officer - You are not required to complete this question if you are filing because you are a legislator or a judicial officer (“judicial officer” is defined in the SEI Helpful Tips) or you are filing as an appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Are you, your spouse, or a member of your immediate family currently registered as a lobbyist or lobbyist principal or were you registered as such within the 12 months preceding your filing of this form? Yes No Name of Lobbyist Lobbyist’s Principal Date of Registration Registration Expiration OTHER DISCLOSURES The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 14. During any calendar quarter in 2017 (but only the time period after you were appointed, employed or filed or were nominated as a candidate), did you • receive any gift(s) exceeding $200 per quarter from a person or group of persons acting together, and • when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and • the gift(s) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? Yes No Do not report gifts given by members of your extended family. Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the "Expense Report for Exempted Persons." Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market Value Please answer the following question as it pertains to the following board/agency: Health Plan Board, State 15. During 2017 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) did you • accepted a “scholarship” exceeding $200 from a person or group of persons acting together and • those person(s) were outside North Carolina and • the scholarship was related to your public position? A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. Yes No Judicial Officer - You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly is a member or participant or an affiliate of that organization. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 Please answer the following question as it pertains to the following board/agency: Health Plan Board, State 16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or another Council of State member? Council of State members are: • Governor • Lt. Governor • Secretary of State • State Auditor • State Treasurer • Superintendent of Public Instruction • Attorney General • Commissioner of Agriculture • Commissioner of Labor • Commissioner of Insurance Yes No If “Yes”, list all contributions you (NOT immediate family members) made during 2017 with a cumulative total of more than $1,000 to the Governor or other Council of State member who appointed you. Contributions are defined in N.C.G.S. 163-278.6(6) and include, but are not limited to, “any advance, conveyance, deposit, distribution, transfer of funds, loan, payment, gift, pledge or subscription of money or anything of value whatsoever.” Date Amount Contributed to No contribution(s) with a cumulative total of more than $1,000 The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 11 Please answer the following question as it pertains to the following board/agency: Health Plan Board, State 17. Are you an appointee or prospective appointee to: a. the head of a principal state department (e.g. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or c. a member of any of the following boards: • ABC Commission • Coastal Resources Commission • State Board of Education • State Board of Elections • Division of Employment Security • Environmental Management Commission • Industrial Commission • Human Resources Commission • Rules Review Commission • Board of Transportation • UNC Board of Governors • Utilities Commission • Wildlife Resources Commission Yes No If "No", proceed to question 18. d. If so, were you appointed or are you being considered for appointment to that public position by a Council of State member? Council of State members are listed in question 16. Yes No If "No", proceed to question 18. e. If so, you must indicate whether during 2017 you (not immediate family members) engaged in any of the following activities with respect to or on behalf of the candidate or campaign committee of the Council of State member who appointed you to your public position: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? Contributions are defined in question 16. Yes No ii. Hosted a fundraiser at your residence or place of business? Yes No iii. Volunteered for campaign-related activities, which include, but are not limited to, phone banks, event assistance, mailings, canvassing, surveying, or any other activity that advances the campaign of a candidate? Yes No 18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon of innocence; or (ii) an order of expungement regarding that conviction? Yes No Offense Date of Conviction County of Conviction State of Conviction The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 19. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? Yes No If yes, please provide such information below. For clarity, I am an employee of Duke University. Starting in October 2017, I have also been a consultant to the NC Department of Health and Human Services (NC DHHS) (an approved activity of Duke University), and NC DHHS is aware and supportive of my role at Duke, vice versa. As a consultant to DHHS, I serve as Chief Data Officer. Please confirm if this is not clear throughout my answers and let me know if there is anything I need to revise about my responses accordingly. AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 5/18/2018 Signature Date Aaron Nance McKethan Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11

, NORTH CAROLINA STATE ETHICS COMMISSION roe hy Cote Receives 2 2017 STATEMENT OF ECONOMIC INTEREST RECEIVED MAY 1 2 20 NO CHANGE FORM Pi Checked for completion /” "_ THIS ENTIRE FORM MUST BE COMPLETED TO | <cuvece 7) (” onel//2// 7 FULFILL YOUR ETHICS FILING OBLIGATION 5] Entered in 08 fi L-by {17 FILER'S NAME (FIRST, MIDDLE, LAST) [Prenx | FirstName Widdle Name Last Name suffix | REASON FOR FILING (COMPLETE ALL THAT APPLY STATE GOVERNMENT JOB (Specify Agency and Position) | BOARD/ COMMISSION (Lit the complete name of all Site | boards on whien you are serving or are being consicered | Stete Heed fn flan JUDICIAL OFFICER (specty Office) | LEGISLATOR (Specty House or Senate) F— ee affirm that th information provided in ths Statement of Economic Interest and any attachments hereto are true, complete, and accurate o the st of my Knowieage and ener also certify that have not transfered, and wil rot transer, any asset, interest or property fo the purpose of concealing. | irom dsciosure while retaining an equitable meres. | understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of he Confidential Form regarding Unemandipated Chicren) are pubic record Lacknowladge tha 1 have read and understand N.C... 138A-26 regarding concealing or allng to disclose material information and N.C.G.5. 138A-27 regarding providng false Information § 1384.25. Concealing or failing to discose material formation, i A fling person who knowingly conceals or knowinaly ais to disclose information that is required to be disclosed on 2 statement of cconamic Interest under ins Arce Shall be Uy 01 5 Clots 1 misdemeanar ond Snal be supjoct Giscipinary action under G.5. 130A.45. I fing person who provides fais information on a statement of economic Interest as required under this Article Knowing tht th information s fase 1s Quit of & Class. felony nd shall be Subiec 10 scolar acon onder GS. 1305. I hereby affirm that 1 have reviewed my most recently filed 2016 Statement of Economic Interest and that as of December 31, 2016, my responses continue to be true, correct, and complete 0 the best of my knowledge and belief. E11 Agree (Jor—ro Ye) | Signature E— Fmted Name | Submit SIGNED, ORIGINAL documents only. Do not fax or e-mail this form. _ This entire document is a public record.

NORTH CAROLINA STATE ETHICS COMMISSION 2016 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Dr. Aaron Nance McKethan REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Please specify the agency for which you work or are being considered) BOARD/COMMISSION (Please list complete name of all State boards on which you are serving or are being considered) Teachers' & State Employees' Retirement System; Health Plan Board, State; JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2015 Statement of Economic Interest and that as of December 31, 2015, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 4/18/2016 Signature Date Aaron Nance McKethan Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

4 #// 2015 STATEMENT OF ECONOMIC INTEREST IFOR BRAGS COMMISSION USE Oly 919-715-2071 www. ethicscommission.nc.gov WS OT 20 PH I: 21 FILER'S NAVE (FIRST, MIDDLE, LAST) Frstame | wiaaienome | Gotan smc Roo Nevce Meat ann - ‘CURRENT EMPLOYER Jos TIE Anke, LU ben, NATURE OR TYPE OF BUSINESS _ “nay BG Ar weve REASON FOR FILING (SELECT ALL THAT APPLY) [J STATE GOVERNMENT JOB (Please specify the agency for XgoarD/comMISSION (Please list complete name of all ‘which you work or are being considered) State boards on which you are serving or are being considered Shade Gury Lt 4 okies Heel lew (J JUDICIAL OFFICER (Please specify the office you hold) | [J LEGISLATOR (Please specify House or Senate) Do other immediate family members reside in your household? - BYes [Ne ‘When used throughout this form, the term Immediate family includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse's children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. ‘ONLY LIST THE INITIALS OF UNEMANCIPATED CHILDREN. However, you MUST submit the children’s ull ames on the Confidential Form available at the end of this document. Minors are emancipated by marriage, enlistment in the US miltary, or court acion for emancipation. FULL NAME OF ADULTS & [ revamzonswre | EMPLOYER 08 TITLE NATURE OF EMANCIPATED MINORS BUSINESS Sarat MAA wan| Spore | WA | NE | Vx | fe — an) — The SEI and any attachments, excluding the Confidential Form, are public records. Page 10f 10 UNEMANCIPATED ‘BUSINESS CHILDREN TT kM | Ny ——] YN > SV RN = ee ; 1 EE i ——— PROPERTY INTERESTS 1. As of December 31, 2014, did you, your spouse, or members of your immediate family: A. Have an ownership interest In North Carolina real estate (Induding your residence) with a marke value of $10,000 or more? Res Ono “owner of neat Estate| 9 ownership terest | Location oy city | vocation oy County [bron WlCettean] toe [lh \ou Goad M Brorvick ©. Lease or rent real estate or personal property 0.a from the State of North Carolina with a market value of $10,000 Oves go Name of Lessee | If Real Estate, Location | If Personal Property, (Renter) by City & County Describe 2. At any time during 2013 or 2014, did You, your spouse, or members of your Immediate family sel to or buy from the ‘State of North Carolina personal property with a market value of $10,000 or more? Ove We Samer mere pr The SEI and any attachments, excluding the Confidential Form, are public records. Page 20110 FINANCIAL INTERESTS 5 3s of December 31232014, dd you you spouse, o members of your mada ari own any of he Following Femme interests valued at fiogoo or more? A. Stock in a publiefy owned company? Pres Ono »00 not lst owners interests in a widely held investment fund (ncuding mutual fund, regulted investment companies, or person o deere compensation lane) (1) tn ond pave wa 5 Je aored, Investment versed? and (1) nether you nor 2n mediate Tomy arbor oe abe to mits to me ls el Full Name of Company (Do not use » ticker symbol) Revo Melero YP gle, Inc B. Stock Options in a company or business? Oves Do Owner of Stock Option Full Name of Company (09 ot use ticker symbat) C. Interests in a non-publicly owned company or business entity (including interests in sole proprietorships, arnersips, Imes Danesh, ont erro, nied Jay compen et ap mer a closely held corporations)? Woes CIN - 17007, proceed to question a. [prr— Name of Company or Business Entity fan Mmellettion hela Bates BBE The SEE and any attachments, excluding the Confidential Form, are public records. Pages or 10 "above, please list the names of any other companies or business entities in which the primary company owns Securities or equity interests valued at over $10,000, 7 known: Non-publicly Owned Company or Business Entity | _ Other Companies in which the Primary Company (the primary Company) ‘Owns Security or Equity Interests € (2). If you know that any company or business entity listed in 3.C or 3.C(1) above has any material business Genlings o business contract with th State of North Carolina or 5 regulated y the Sate, provide a biel Gescrption of hat business ectiy: Name of Company or Business Entity Description of Business Activity with the State [Riione or ot Known 4. As of December 31, 2014, were you, your spouse, or members of your immediate family the beneficiaries of a vested rust with 3 va of $10,000 0 ore that was created, established, of conrohed bf yous D0 not list assets held in blind trusts. See 2015 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” Oves “vo Description of the Trust 5. As of December 31, 2014, did you, your spouse, or members of your immediate family have liabilities of $10,000 or more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, er amos Sersone oars a re arty Gee ave fre Name of Debtor (You, Spouse, Immediate Family “Type of Creditor (Commercial Bank, Credit Union, Member) Individual, etc.) The SEE and any attachments, excluding the Confidential Form, are publi records. Page dof 10 your immediate family during 2014. Include salary, wages, state/local government retirement, professional fees, honoraria, interest, dividends, rental income, business income, and other types of income required reg ur State and federal tax returns. pes rea ob aspurted of ye ort ete eee ri Recipient of Income Name of Source Type of Type of Income fr— TT 7 oN LS SN Vi 7 ow ow py = — 7(a). During 2014, were you, your spouse or members of your immediate family a director, officer, governing board Oves No - If “No”, proceed to question 8. MICE or En | Sn Sos mm a | Se Se a 2 St tmnt xin ort Form rept J meme of any society, organization, or advocacy group with an inerest in mattérs over wich your agendy of boird may Pave lain Des Ko. J ieoiiator ical Officer - You re no reauied to comple tis question If you are fing because You are a egsitor or fica Ofer or you ae ing 5 an appa to those occ 00 not st organizations of which you are only a member (not serving in a leadership role) Name of Person Name of Society, Organization Leadership Position or Advocacy Group (Director, officer, Board Member) S(a). Lt the name of each company or business with which you were associated where you or 8 member of your immediate family was an employee, director, office, partner, proprietor, or member or manager as of December 31, 2014. |__Mameofperson | Relationship to iter Name of Company Do Business Associations os. dent, po . mo Melee] serge] Anke [ylonee, | S(b). If you know that any company or business entity listed in 9(a) above had any material business dealings or business. contracts with he State of North Carolina or was egUIAted by the Sate 5 Of DeCuber 31 2014, provide s ber Gescrpion of that business ory: Name of Company or Business Entity Description of Business Activity with the State [J Not applicable (No entities listed on #9a) [] No relationship / Not known Bf te (LLC Way no ttkeial [wringer dealings wil St ever, Racker pervect opmpane Millennine, pleafl Mav] Punide dAaqusitic Sevvitn dv Medic acd puowdens ia NC, 10. Ae you practicing attorney? paren T DOYes No C1 udicil Officer/State Atormey 1 Yes", check each category of legl representation in wich you or the law fin with which you are affiited has eamed | legal fees of more than $10,000 during 2014. Claminstrative Dinara Corporate Ccominat [becedent's Estates ClEnvronmentat Citesurance Dtabor [J Locel Government Rest Property Cisecurtes Ore Cort ligation (including 0 ries Regulation [other category not ised. negligence) “The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 individually o as a member of a professional association for which you charged or were paid aver $16,005" ** "> Oves Fo Type of Business Nature of Services Rendered 12. Are you or your employer, your spouse or members of your immediate family, o their employer currently: + Licensed by the State board or employing entity with which you are or will be associated or + Regulated by the State board or employing entity with which you are or will be associated or ¢ + Have a business relationship with the State board or employing entity with which you are or will be associated? res No [J Legsitornusicial officer - Yau are not required to compete this question if you are filing because You are a legisator or a judicial officer ("Judicial officer 1 defined in the SEI Helpful Te) or yo ore. filing as an appointee to those offices. Name of Employer Type of Relationship (i applicable) (Licensing, Regulatory, Business) Rem MAC [Bthnke, which 1 Lowa Millen | 13. Are you, your spouse or a member of your immediate family currently registered as a lobbyist or lobbyist principal, or were you registered as such within the 12 months preceding your filing of this form? Oves Mio Name of Lobbyist Lobbyist's Principal Date of Registration Registration Expiration OTHER DISCLOSURES 14. During any calendar quarter in 2014 (but only the time period after you were appointed, employed or fied or were nominated as 4 candidate), 6d you + receive any “gift(s)" exceeding $200 per quarter from a person or group of persons acting together, and. + when both you and those person) were outside North Carolina at the time you accepted the git(s), and + the gif(s) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? OYes (no 50 not report gifs Given by members of your extended family. 00 not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” [ome tem Roce | Name nd arse of poner ese em Rca | ecient ve | ‘The SE and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 Yes ©fNo [Judicial Officer - You are not required to complete this question if you are a judicial officer or you are TI RTTTr—— mw ae Oves no If “Yes”, list all contributions you (NOT immediate family members) made during 2014 with a cumulative total deposit, distribution, transfer of funds, loan, payment, gift, pledge or ‘subscription of money or anything of value whatsoever.” -— TS BT S— corsa BE S— 2. the head of a principal state department (e.9, cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or a member of any of the following boards: + ABC Commission + Coastal Resources Commission + State Board of Education Oves Hino + State Board of Elections. + Division of Employment Security If “No”, proceed to + Environmental Management Commission question is. + Industrial Comission + Human Resources Commission + Rules Review Commission + Board of Transportation + UNC Bord of Governors + tities Commission + Widife Resources Commission . If so, were you appointed or are you being considered for appointment to that public | [Ives [JNo 1 position by a Counc of State member? Council of Sate members are sted m It won, proceed to question 16. ton 5. 2. 10, you must indicate whether during 2014 you (not immediate family members) engaged. inany of the following actives with respect to.or on behalf of the candidate or campaign committee of the Counc of State member ho appainted You to your public position: 1. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions. to the candidate or committee? Contributions are defined in Question 16. i. Hosted a fundraiser at your residence or place of business? OvYes OMe i. Volunteered for campaign-related activites, which include, but are not ited to, phone banks, event assistance, malings, canvassing, surveying, or any other | (J¥es [INo activity that advances the campsign of a candidate’ 18: Have you ever been convicted of a felony for which you have not received either: (1) a pardon of innocence; or (i) am order of expungement regarding that conviction? Oves Pino : Offense | Date of Conviction | County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the State EChics Commission in advising you concerning your compliance with the State Goverment Ethics ACT < CYes No If yes, please provide such information below, r Thad Seld, VanThaqpq 16 driver ang = p qrrerkons (egarding amy viet vespewies to ql and (2 The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 Se —_—— AFFIKMA LON iam that th information provided in his Statement of Economic Interest and any attachments hereto ar rae, comple, and accurate to the best of my knowledge and belicf. Ho erty that have not transferred. and will ot transfer, any asset, interest, or propery forthe purpose of concealing i from disclosure while retaining an equitable interest. ondersand tat my Statement of Economic Interest and any attachments or supplements thereto (with the exception ofthe Confidential Form regarding Unemancipated Children) are public record. Lacknowledge that | have read and understand N.C.G.S. 38-26 regarding concealing or filing to disclose material information and N.C.G.S. 138-27 regarding providing false information: | § 138-26. Concealing or failing to disclose material information . | 2 Ming person who knowingly conceals or knowingly ais to disclose information tht is required fo be disclosed on a. | statement of economic interest under his Arle shall be guilty of Class 1 misdemeanor and shal be subject 15 disciplinary action under G.S. 138A-45 § 1384-27. Penalty for false information AA filing person who provides false information on a statement of economic interest a requir under his Article Knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary ction under GS. 1384.45. 3 P51 Agree _ Annem Merete _— — _- Printed Name, ~~ fond y—— tel telt$ | | Signature I Date | ‘Submit SIGNED; ORIGINAL: documents ony: Do not fax or email this form. Bi The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 10