Adam Brian Lancaster

, NORTH CAROLINA STATE ETHICS COMMISSION | ror Emmis commission use ony / 2017 STATEMENT OF ECONOMIC INTEREST | (ices £2 919-814-3600 wen. thicscommission.nc.gov ni AR 13 MIE 59 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL Creche for conviction "YOUR SEI FILING OBLIGATION Sinlee Cate Tocompiete 75 — Supp. Sent Ome [a Supp. Record Date _ mere n database [op [Ficer's name (RST, MIDDLE, LAST) [Prefix | First Name | Middle Name Last Name sutrix CURRENT EMPLOYER 108 1H1LE oo NCO WEB DEVELOPFR | NATURE OR TYPE OF BUSINESS oo [Feromtion veconioar | REASON FOR FILING (COMPLETE ALL THAT APPLY) RB 1 ‘STATE GOVERNMENT JOB (Specify Agency and Position) | BOARD/COMMISSION (List complete name of al State ph boards on which you are serving or are being considered; JUDICIAL OFFICER (Spey Office) _ | LEGISLATOR (Spectty House or Senate) _ A. Do other immediate family members reside in your housenold? Kves [(INo i When used throughout ths 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, grardchidren, parents, grandparents, and Sibknge, and the spoitses of each of those persons) who reside in your household. List 7 full name of all adults and emancipated minors in your household. A minor is 3 hid under 18 years oid. Minors are emancipated by marriage, enlistment n the US miitary, or court order for emancipation | FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER 108 TITLE NATURE OF EMANCIPATED MINORS | | I BUSINESS | Kavua sts Lancaster = oar ue | eawanc The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f 10 Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. ~ . ~ ~ Inrmas For | RELATIONSHIP empover sostme | wamomeor KM N “omvanen | ” HoL son | a To : J PROPERTY INTERESTS | A. Have an ownership interest in North Carolina real estate {including your residence) with a market value of Hes Ono Owner of Real Estate | % Ownership Interest | Location by City Location by County OAM BE 0 | oss i al ! : . =” -_ B. Lease or rent real estate or personal property to or from the State of North Carolina with a market value of 1 io | Opes pL So Co BN me of tes Tremor) rior a Capon | 1 ern vo 2. At any tare during 2015 or 2016, did you, your spouse, or members of your immediate family sell to or buy from the Oves Who Name of Purchaser | Name of Seller Type of Property | FINANCIAL INTERESTS 3. As of December 31, 2016, 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? +00 mai i Bohersip teres ns widely held investment und (nlading mutual funds, Tegusied ivestment Comparias, of pansion of Geferd compensation plans) 1: () the fund & public traded or a assets aro widely Giversad; and () nether You nor an mad ate omy member an abe to control the assets ned n he mutual fond, nvesmant company. or pension ar deferred compensation pian. Owner of Interest _ Full Name of Company (00 not use a ticker symbol) I —_— [0 Dves dw I Ownerof Stock Option _____ | Full Name of Company (Da not use a ticker symbol) C. Interests in 2 non-publicly owned company or business entity (including Interests in sole proprictorships, Sarinershipe Imad parershps, JOITk ventures, Need labity companies, Imited 10DURY partnerships, and Sosa held corporations? ves Pio 17%” proceed to question 4 (1: For cach nan publicly cna company or business enty (ihe “primary company”) dented in question $1€ anove, planet lt th names of any other Companies of busmess entities im whch the primary company Guns secures or squty interests valued a over $10,000, known Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company "(the Primary Company) | owns Security or Equity Interests (0) None or Not Known an - — — - _ — 1 - - The SEX and any attachments, excluding the Confidential Form, are pubic records. Page 3 of 10 € (2). If you know that any company or business entity listed in 3.C or 3.C(1) above has any material business aoa bo ot an roy Se ey ed S.C CU he ry Ter ue Soir byes nia ; TE wy parm Tp RTI 1] None or Not Known ET +. As of December 31, 2016, were you, your spouse, or members of your [mmediate family the beneficiaries of a vested | Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” | Owes Mo Name and Address of Trustee Description of the Trust Your Relationship to the Trust | more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student Wes One te wel SpE r— oi rr ADAM BRIAN LANCASTER AME? ~ CREDIT CARD | EE oo nat nla income recived rom he following source: wo [AU — ray aman ey eam semn recmientat reams || Wamaatsowes re tweet ines rr — GoumaenT | speaty The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 N |proressions. AND CIVIC RELATIONSHIPS | 7(a). During 2016, were you, your spouse or members of your immediate family a director, officer, governing board Te Erevan Wore rom corto pats aoa ee Ee ar. aia: pos rest eaten stots | purposes? [¥en [Xoo ihe" proces to question. To Do not list State boards or entities, or entities created by a political subdivision of the State. a i aR Oe ame af person wiser position | __ Mame of Nonprofit | Nature of Business or Compara or orgamitation | Purpore of Orpamieatien Ty We ronal spores arpazaoTs te above da Busnes with ihe Sate of eth Crain or Feces ee beet vst of 6 are of ok res, iron o wit whch Gu 43ers coi [Eerie Name of Nonprofit Corporation or Organization | __ Describe State Business or State Funding | one or ot Known 1 ee 5. During 2016, were you, your spouse, or members of your immediate family a director, officer, or governing board ED a tae aro we CT Sor eo St ox vr oy ame [Yes Hino [7] Legislator/Judicial Officer - You are not required to complete this question if you are filing because H 'you are a legislator or a judicial officer or you are filing as an appointee to those offices. Do at it argaisations of which yo re nly a meer (ot serving i aes ole. prep r— Name of Society, Organization Leadership Position way (Director: Ofeer, Board ember) I The SEL and any attachments, excluing the Confidential Form, ave public records. Pages of 10 '3(a). List the name of each company or business with which you were associated where you of member of your immediate family was an employee, director, officer, partner, proprietor, of member or manager s of December 31, 2016. Name of person | Relationship to Filer | Nome of Company | Rolef person | [Ne Business Associations 1910). 1 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, 2016, orovide 3 ref description of that business activ. | Name of Company or Business Entity | Description of Business Activity with the State | Not applicable (No entities sted on #9a) 10. Are you a practicing attomey? Gives pve Chute farsa Atamey | 1 “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 2016. £] Administrative 1 Admiraity : 0) Corporate Criminal [] Decedent's Estates. [} Environmental {7} Insurance [Labor | Local Government 11 Real Property 7) Securities Oar | [vor tigation Goctuding [] Uti Regulation [J Other category not listed negligence) 1. During 2016, were you a licensed professional (other than an attorney) or did you provide consulting services Individually or #5 s member of a professional assaciation for which you charged or were oid aver $10,000 Cives (Xie Type of Business Nature of Services Rendered The SET and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 37. yoo your amplagers you spaess or embers vow Wein ois oF the aloe come: + 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 RAE ha St ont or CTA A WR WEA o0 ars 05) ARE [Ives Jifho ] Logmlator/ uta Officer - Yrs re. mt requires to complete: hi aeacin you are ling because roar 5 agitator of Juels sod hte” aad the SEk re or vou Name of Person Name of Employer Type of Relationship tf appiicabier Licensing, Rogulatory, Business) rp re See ST To eer or adder were you registered as such within the 12 months preceding your filing of this form? Oves Mo Name of Lobbyist Lobbyist's Principal | oateot Registration | | registration | “Ehpraton [owen orscrosures CT os Dh SHR SI OSE Tonos Hoe PP Tod ware SR SA 8 Feo Nae a omit 3 vou rere vs “GHEY encoun S200 per uae fom person o ou of gers ety Souter, od « when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and + Dg rr RA PI te Thad WI LHR predoii ves if » Do not report gts given by members of your extended family. =) 5 2 a A et ge ir) Sete oR ra 8 THORN SB of St om a Pte) eeprom eae The SEL and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 15. During 2016 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) dui vou accept “scholarship” exceeding $200 from a person or group of persons acting together and © those person(s) were outside North Carolina and the scholar ws related to your pubic postion? A “scholarship* s a grant-in-aid, either direct or indirect, | tana a Conference; mating, or mila event inclusion, rave, Ioaging, meals and other | Shar expenses. ves Jo Cubical Offer You ae nt required to complet ths cesta you are a utc offeror yo are | ng as pact ster appoints n Do not repart its that have previously been reported by you t the Department of the Secretary of State on the | “Expense Report for Exempted Persons.” + Legiators are not required to report scholarships paid by @ nonpartisan legislative organization of which the lgisator | or the General Assembly is a member or participant or an affiliate of that organization. Date of | Nome and Address of Donor(s) Describe Event Estimated Market Scholarship | Vale FT Sper Tp —SYP PRR op-mem————| Counc of rate member? | Council of State members are: » Govemor » tt. Governor » Secretory of state Le ste wir + State Treasurer + Superintendent of Public Instruction » Attorney General » Commissioner of Agriculture » Commissioner of Labor i » Commissioner of insurance fives Jno If “Yes”, list all contributions you (NOT immediate family members) made during 2016 with a cumulative Totar of more then $1,000 6 the Governor or other Council of State member who appointed you +» Contributions are defined in N.C.G 5. 163-278.6(6) and include, but are not Imied to, “any advance, conveyance, | | epost, distribution, transter of funds, 1oan, payment, gi, pledge or subscription of money or anbing of value whatsoever,” Date Amount I Contributed to No contrtionts) wit 3 a e—— The SEX and any attachments, excluding the Confidential Form, are pubic records. Pages of 10 | 17. Are you an appointee or prospective appointee to a. the head of a principal state department c.g. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District out usa, or | c. a member of any of the following boards: + ABC Commission © Coastal Resources Commission + State €oard of Education ives Yn ~ State Board of Elections + Division of Employment Security It “Nos proceed to + Environmental Management Commission question 18. + Industral Commision | © Human Resources Commission © Rules Review Commission + Board of Transportation | + UNC Board of Governors | © Unites Commission + Widite Resources Commission SN i. 4. If s0, were you appointed or are you being considered for appointment to that | (Yes [No public postion by & Counc of State member? Council of State members ae I5ted | 1 "mo, proceed to i auesnion 16. ats ‘e. If 50, you must indicate whether during 2016 you (not immediate family li ener) engaged n any of the folowing activ ies with respect 0 or on behalf of | , The cancdate or campaign committee of the Counc of State member who | : appoined you to your pubic postion | [Ces (No \. Collected contribution from mtipie contributors, took possession of such g multiple contributions, and transferred or delivered those collected | | Contributions to the Candidate of commatee? Contributions are defined in | Guestin 16 i. Hosted a fundraiser at your residence or place of business? [J¥es [No 4. Volunteerad for campign elated actwities, which include, but are not mica to, phone banks, event assistance, mailings, canvassing, surveying, or any [Ces [INo ther acy that advances the campaign 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) an order of expungement rearcing that conviction? | DOves Xr | offense Date of Conviction | County of Conviction | _ State of Conviction 19. Are you aware of any other information that you belleve may assist the State EXhics Commission n advising you Concerning your compiance with the State Government Ethic Ac? ves Jo yes, pose provide sch formation bon. i The SEI and any attachments, excluding the Confidential Form, are public records. Page of 10 AFFIRMATION afin that the information provided in this Statement of Esonomic Interest and any attachments hereto are rue, comple and accurate to the best of my knowledge and belief ako certify tht | have not transferred, and wil not transfer, any asset, interest, or property fo the purpose of concealing it rom disclosure whi retaining an equitable intrest. J understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) we public record acknowledge that 1 have read and understand N C.€1.5. 138A.26 regarding concealing or ling to disclose material formation and N.C.G.5. 138A-27 regarding providing fuse information § 138A-26. Concealing or failing to disclose material information. 1] on a statement of sconomic interest under his Atle shal be guilty of a Class | misdemeanor and shall be subject to disciplinary action under GS. 1383-43 | § 1387-27, Penalty for alse information | A iing person wha provides fils information on statement of coma interes as required under this Aticle knowing that th information is fais i gui of a Clas H felons and shall be subject 0 disciplinary action under GS. 135A45, Kae ! 4-12-20 Signatare Bate ADM Ben CANCASTER, Printed Name | Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. _ The SEI and any attachments, excluding the Confidential Form, are public records. Page 100f 10

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 Mr. Adam Brian Lancaster CURRENT EMPLOYER JOB TITLE Dept. of Information Technology Senior DevOps Architect NATURE OR TYPE OF BUSINESS Information Technology 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) Information Technology, Dept of 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 Kayla Sims Lancaster Spouse City of Raleigh Emergency Telecommunicator Public Safety / Emergency Dispatch Operations 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 NTM Step-Son n/a n/a n/a KJM Step-Daughter n/a n/a n/a HOL Son 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 Adam & Kayla 100 Garner Johnston 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) B. Stock Options in a company or business? Yes No Owner of Stock Option Full Name of Company (Do not use a ticker symbol) 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 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.) American Express Credit Card Citi Bank Credit Card Discover Credit Card State Employees' Credit Union Credit Union 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. Adam Brian Lancaster State of North Carolina State Government Regular Salary Kayla Sims Lancaster BB&T Banking Regular Salary 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 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: Information Technology, Dept of 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 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 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. 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 Please answer the following question as it pertains to the following board/agency: Information Technology, Dept of 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) The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 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 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 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: Information Technology, Dept of 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 Please answer the following question as it pertains to the following board/agency: Information Technology, Dept of 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: Information Technology, Dept of 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. 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 2/5/2018 Signature Date Adam Brian Lancaster Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11