North Carolina

Aldona Zofia Wos

5 filings · 2015–2025
Governor's Crime CommissionHealth and Human Services, Department ofUNC Wilmington Trustees

Filings

2025 UNC Wilmington Trustees
Document text
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 STATE ETHICS COMMISSION 2025 STATEMENT OF ECONOMIC INTEREST ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Hon. Aldona Wos Current Employer Job Title The Institute of World Politics President Nature or Type of Business Graduate School Reason For Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job or Post-Service Filer (Specify agency and position.) Board/Commission (List complete names of all State boards on which you are serving or are being considered.) UNC Wilmington Trustees Judicial Officer, Post-Service Filer, or Judicial Officer Appointee (Specify office.) Legislator, Post-Service Filer, or Appointee to Legislative Office (Specify House or Senate.) A. Do any immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors under 18 years of age). 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. Minors are children under 18. They are emancipated by marriage, enlistment in the US military, or court order for emancipation. Full names of Adults and Emancipated Minors Relationship Employer Job Title Nature of Business Louis DeJoy Spouse United States Postal Service Postmaster General Provides postal service for the United States The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 B. List only the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. List the full name of each minor child on the Confidential Form at the end. Initials of Unemancipated Minors Relationship Employer Job Title Nature of Business Property Interests 1. As of December 31, 2024, did you or any 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 (Self plus Spouse) 100.00% Greensboro Guilford (Self plus Spouse) 100.00% Linville Avery (Self plus Spouse) 100.00% Wilmington New Hanover 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 2. At any time during 2023 or 2024, did you or any members of your immediate family sell or buy personal property worth $10,000 or more to or from the State of North Carolina? ☐ Yes ☒ No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 Financial Interests 3. As of December 31, 2024, did you or any 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 ► Include stocks held individually of in a portfolio managed by a financial services company Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: 1. the fund is publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets. Owner of Interest Full Name of Company or ticker symbol See Attachment(s) 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? These include 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 See Attachment(s) C (1). For each company or business entity identified in question 3.C. (the “Primary Company”), 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 See Attachment(s) C (2). If you know that any 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, briefly describe that business activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 4. As of December 31, 2024, were you or any members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2025 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov/seis ☒ Yes ☐ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust Louis DeJoy PO Box 10373 Greensboro, NC 27404 Aldona Wos Insurance Trust No. 1 Created The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 5. As of December 31, 2024, did you any 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. Do not disclose the amount of the debt. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) Louis DeJoy (Spouse) Commercial Bank Louis DeJoy (Spouse) Private Equity Fund Capital Commitment Louis DeJoy (Spouse) Private Equity Fund Capital Commitment 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate family during 2024. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. You must disclose your receipt of salary or wages from any governmental or private entity, including those already listed in response to other SEI questions. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security retirement, survivors, or disability benefits Recipient of Income Name of Person or Entity from Which Income Was Received Type of Business/Industry Type of Income See Attachment(s) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 Professional and Civic Relationships 7(a). During 2024, were you or any 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 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 local governments. ► Do NOT list organizations of which you are a mere member. Name of Person Position Name of Nonprofit Corporation or Organization Nature or Purpose of Organization Louis DeJoy (Spouse) Officer - President Louis DeJoy & Aldona Wos Family Foundation Charitable Louis DeJoy (Spouse) Board Member Elon University Education Louis DeJoy (Spouse) Board Member Piedmont Triad Partnership Private Leadership Organization Louis DeJoy (Spouse) Board Member Piedmont Triad Charitable Foundation - Wyndham Championship Charitable Aldona Wos (Self) Officer - Vice President Louis DeJoy & Aldona Wos Family Foundation Charitable Aldona Wos (Self) Board Member Duke University School of Law - Board of Visitors Education 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, briefly describe the nature of that business, if known or with due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business Duke University School of Law - Board of Visitors None or Not Known Elon University None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Piedmont Triad Charitable Foundation - Wyndham Championship None or Not Known Piedmont Triad Partnership None or Not Known 8. During 2024, were you or any 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ►Do not list organizations of which you are only a member and do not serve in a leadership role. Name of Person Name of Society, Organization, or Advocacy Group Leadership Position (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 9(a). List the name of each for profit business with which you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2024. Name of Person Relationship to Filer Name of Company Role of Person See Attachment(s) 9(b). If you know that any 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, 2024, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee 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 2024. ☐ 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 2024, 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 12. Are you or your employer, or any members of your immediate family, or their employers currently:  licensed by the State board or agency with which you are or will be associated or  regulated by the State board or agency with which you are or will be associated or  in a business relationship with the State board or agency 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal 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 2024, 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,  when both you and those person(s) were outside North Carolina,  under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, all three conditions must apply ☐ Yes ☒ No ► Do not report gifts given by members of your extended family. ► Do not report gifts you have previously reported 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 9 of 11 15. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you  accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting together,  when those person(s) were outside North Carolina? To answer Yes, both conditions must apply 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 filing solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ► Do not report gifts you have previously reported 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, participant, or affiliate. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value 16. Have you been appointed or considered for 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 made in 2024 with a cumulative total of more than $1,000 to the Council of State member who appointed you. Do not include contributions from immediate family members. ► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 17. Are you an appointee or prospective appointee as: 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  Utilities Commission  Wildlife Resources Commission ☐ Yes ☒ No If “No,” proceed to question 18. d. If yes, were you appointed or are you being considered for appointment to that position by a Council of State member? ☐ Yes ☒ No If “No,” proceed to question 18. e. If yes, you must indicate whether during 2024 you 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: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? ☐ Yes ☐ No ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No iii. Volunteered for campaign-related activities, including 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; or (ii) an order of expungement? ☐ Yes ☒ No Offense Date of Conviction County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? ☐ Yes ☒ No If yes, please provide that information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11 Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and belief. 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 except for the Confidential Form regarding Unemancipated Children are public records. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 04/14/2025 Signature Date Aldona Wos Printed Name
2024 UNC Wilmington Trustees
Document text
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 STATE ETHICS COMMISSION 2024 STATEMENT OF ECONOMIC INTEREST ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Hon. Aldona Wos Current Employer Job Title The Institute of World Politics President Nature or Type of Business Graduate School Reason For Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job (Specify agency and position.) Board/Commission (List complete names of all State boards on which you are serving or are being considered.) UNC Wilmington Trustees Judicial Officer or Judicial Officer Appointee(Specify office.) Legislator or Appointee to Legislative Office(Specify House or Senate.) A. Do any immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors under 18 years of age). 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. Minors are children under 18. They are emancipated by marriage, enlistment in the US military, or court order for emancipation. Full names of Adults and Emancipated Minors Relationship Employer Job Title Nature of Business Louis DeJoy Spouse United States Postal Service Postmaster General Provides postal service for the United States The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 B. List only the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. List the full name of each minor child on the Confidential Form at the end. Initials of Unemancipated Minors Relationship Employer Job Title Nature of Business Property Interests 1. As of December 31, 2023, did you or any 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 (Self plus Spouse) 100.00% Greensboro Guilford (Self plus Spouse) 100.00% Linville Avery (Self plus Spouse) 100.00% Wilmington New Hanover 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 2. At any time during 2022 or 2023, did you or any members of your immediate family sell or buy personal property worth $10,000 or more to or from the State of North Carolina? ☐ Yes ☒ No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 Financial Interests 3. As of December 31, 2023, did you or any 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 ► Include stocks held individually of in a portfolio managed by a financial services company Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: 1. the fund is publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets. Owner of Interest Full Name of Company or ticker symbol See Attachment(s) 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? These include 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 See Attachment(s) C (1). For each company or business entity identified in question 3.C. (the “Primary Company”), 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 See Attachment(s) C (2). If you know that any 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, briefly describe that business activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 4. As of December 31, 2023, were you or any members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2024 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov/seis ☒ Yes ☐ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust Louis DeJoy PO Box 10373 Greensboro, NC 27404 Aldona Wos Insurance Trust No. 1 Created The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 5. As of December 31, 2023, did you any 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. Do not disclose the amount of the debt. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) Louis DeJoy (Spouse) Commercial Bank Louis DeJoy (Spouse) Commercial Bank Louis DeJoy (Spouse) Private Equity Fund Capital Commitment Louis DeJoy (Spouse) Private Equity Fund Capital Commitment 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate family during 2023. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. You must disclose your receipt of salary or wages from any governmental or private entity, including those already listed in response to other SEI questions. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security retirement, survivors, or disability benefits Recipient of Income Name of Person or Entity from Which Income Was Received Type of Business/Industry Type of Income See Attachment(s) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 Professional and Civic Relationships 7(a). During 2023, were you or any 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 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 local governments. ► Do NOT list organizations of which you are a mere member. Name of Person Position Name of Nonprofit Corporation or Organization Nature or Purpose of Organization Louis DeJoy (Spouse) Officer - President Louis DeJoy & Aldona Wos Family Foundation Charitable Louis DeJoy (Spouse) Board Member Elon University Education Louis DeJoy (Spouse) Board Member Piedmont Triad Partnership Private Leadership Organization Louis DeJoy (Spouse) Board Member Piedmont Triad Charitable Foundation - Wyndham Championship Charitable Aldona Wos (Self) Officer - Vice President Louis DeJoy & Aldona Wos Family Foundation Charitable Aldona Wos (Self) Board Member Duke University School of Law - Board of Visitors Education 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, briefly describe the nature of that business, if known or with due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business Duke University School of Law - Board of Visitors None or Not Known Elon University None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Piedmont Triad Charitable Foundation - Wyndham Championship None or Not Known Piedmont Triad Partnership None or Not Known 8. During 2023, were you or any 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ►Do not list organizations of which you are only a member and do not serve in a leadership role. Name of Person Name of Society, Organization, or Advocacy Group Leadership Position (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 9(a). List the name of each for profit business with which you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2023. Name of Person Relationship to Filer Name of Company Role of Person See Attachment(s) 9(b). If you know that any 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, 2023, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee 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 2023. ☐ 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 2023, 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 12. Are you or your employer, or any members of your immediate family, or their employers currently:  licensed by the State board or agency with which you are or will be associated or  regulated by the State board or agency with which you are or will be associated or  in a business relationship with the State board or agency 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal 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 2023, 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,  when both you and those person(s) were outside North Carolina,  under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, all three conditions must apply ☐ Yes ☒ No ► Do not report gifts given by members of your extended family. ► Do not report gifts you have previously reported 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 9 of 11 15. During 2023, after you were appointed, employed, or filed or were nominated as a candidate, did you  accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting together,  when those person(s) were outside North Carolina? To answer Yes, both conditions must apply 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 filing solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ► Do not report gifts you have previously reported 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, participant, or affiliate. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value 16. Have you been appointed or considered for 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 made in 2023 with a cumulative total of more than $1,000 to the Council of State member who appointed you. Do not include contributions from immediate family members. ► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 17. Are you an appointee or prospective appointee as: 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  Utilities Commission  Wildlife Resources Commission ☐ Yes ☒ No If “No,” proceed to question 18. d. If yes, were you appointed or are you being considered for appointment to that position by a Council of State member? ☐ Yes ☒ No If “No,” proceed to question 18. e. If yes, you must indicate whether during 2023 you 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: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? ☐ Yes ☐ No ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No iii. Volunteered for campaign-related activities, including 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; or (ii) an order of expungement? ☐ Yes ☒ No Offense Date of Conviction County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? ☐ Yes ☒ No If yes, please provide that information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11 Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and belief. 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 except for the Confidential Form regarding Unemancipated Children are public records. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 04/11/2024 Signature Date Aldona Wos Printed Name
2023 UNC Wilmington Trustees
Document text
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 STATE ETHICS COMMISSION 2023 STATEMENT OF ECONOMIC INTEREST ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Hon. Aldona Wos Current Employer Job Title Institute of World Politics President Nature or Type of Business Graduate School Reason For Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job (Specify agency and position.) Board/Commission (List complete names of all State boards on which you are serving or are being considered.) UNC Wilmington Trustees Judicial Officer or Filing Post-Service (Specify office.) Legislator or Filing Post-Service(Specify House or Senate.) A. Do any immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors under 18 years of age). 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. Minors are children under 18. They are emancipated by marriage, enlistment in the US military, or court order for emancipation. Full names of Adults and Emancipated Minors Relationship Employer Job Title Nature of Business Louis DeJoy Spouse United States Postal Service Postmaster General Provides postal service for the United States The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 B. List only the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. List the full name of each minor child on the Confidential Form at the end. Initials of Unemancipated Minors Relationship Employer Job Title Nature of Business Property Interests 1. As of December 31, 2022, did you or any 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 (Self plus Spouse) 100.00% Greensboro Guilford (Self plus Spouse) 100.00% Linville Avery (Self plus Spouse) 100.00% Wilmington New Hanover 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 2. At any time during 2021 or 2022, did you or any members of your immediate family sell or buy personal property worth $10,000 or more to or from the State of North Carolina? ☐ Yes ☒ No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 Financial Interests 3. As of December 31, 2022, did you or any 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 interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: 1. the fund is publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets. Owner of Interest Full Name of Company or ticker symbol See Attachment(s) B. Stock options in a company or business? ☒ Yes ☐ No Owner of Stock Option Full Name of Company (Do not use a ticker symbol) See Attachment(s) C. Interests in a non-publicly owned company or business entity? These include 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 See Attachment(s) C (1). For each company or business entity identified in question 3.C. (the “Primary Company”), 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 See Attachment(s) C (2). If you know that any 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, briefly describe that business activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 4. As of December 31, 2022, were you or any members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2023 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov/seis ☒ Yes ☐ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust Louis DeJoy PO Box 10373 Greensboro, NC 27404 Aldona Wos Insurance Trust No. 1 Created The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 5. As of December 31, 2022, did you any 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. Do not disclose the amount of the debt. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) Louis DeJoy (Spouse) Commercial Bank Louis DeJoy (Spouse) Commercial Bank Louis DeJoy (Spouse) Private Equity Fund Capital Commitment Louis DeJoy (Spouse) Private Equity Fund Capital Commitment Louis DeJoy (Spouse) Private Equity Fund Capital Commitment 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate family during 2022. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. You must disclose your receipt of salary or wages from any governmental or private entity, including those already listed in response to other SEI questions. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security retirement, suvivors, or disability benefits Recipient of Income Name of Source Type of Business/Industry Type of Income See Attachment(s) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 Professional and Civic Relationships 7(a). During 2022, were you or any 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 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 local governments. ► Do NOT list organizations of which you are a mere member. Name of Person Position Name of Nonprofit Corporation or Organization Nature or Purpose of Organization Louis DeJoy (Spouse) Officer - President Louis DeJoy & Aldona Wos Family Foundation Charitable Louis DeJoy (Spouse) Board Member Elon University Education Louis DeJoy (Spouse) Board Member Piedmont Triad Partnership Private Leadership Organization Louis DeJoy (Spouse) Board Member Piedmont Triad Charitable Foundation - Wyndham Championship Charitable Aldona Wos (Self) Officer - Vice President Louis DeJoy & Aldona Wos Family Foundation Charitable Aldona Wos (Self) Board Member Duke University School of Law - Board of Visitors Education 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, briefly describe the nature of that business, if known or with due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business Duke University School of Law - Board of Visitors None or Not Known Elon University None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Louis DeJoy & Aldona Wos Family Foundation None or Not Known Piedmont Triad Charitable Foundation - Wyndham Championship None or Not Known Piedmont Triad Partnership None or Not Known 8. During 2022, were you or any 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ►Do not list organizations of which you are only a member and do not serve in a leadership role. Name of Person Name of Society, Organization, or Advocacy Group Leadership Position (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 9(a). List the name of each for profit business with which you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2022. Name of Person Relationship to Filer Name of Company Role of Person See Attachment(s) 9(b). If you know that any 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, 2022, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State See Attachment(s) 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee 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 2022. ☐ 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 2022, 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 12. Are you or your employer, or any members of your immediate family, or their employers currently:  licensed by the State board or agency with which you are or will be associated or  regulated by the State board or agency with which you are or will be associated or  in a business relationship with the State board or agency 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal 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 2022, 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,  when both you and those person(s) were outside North Carolina,  under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, all three conditions must apply ☐ Yes ☒ No ► Do not report gifts given by members of your extended family. ► Do not report gifts you have previously reported 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 9 of 11 15. During 2022, after you were appointed, employed, or filed or were nominated as a candidate, did you  accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting together,  when those person(s) were outside North Carolina? To answer Yes, both conditions must apply 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 filing solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ► Do not report gifts you have previously reported 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, participant, or affiliate. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value 16. Have you been appointed or considered for 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 made in 2022 with a cumulative total of more than $1,000 to the Council of State member who appointed you. Do not include contributions from immediate family members. ► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 17. Are you an appointee or prospective appointee as: 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  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 position by a Council of State member? ☐ Yes ☒ No If “No,” proceed to question 18. e. If so, you must indicate whether during 2022 you 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: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? ☐ Yes ☐ No ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No iii. Volunteered for campaign-related activities, including 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; or (ii) an order of expungement? ☐ Yes ☒ No Offense Date of Conviction County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? ☐ Yes ☒ No If yes, please provide that information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11 Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and belief. 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 except for the Confidential Form regarding Unemancipated Children are public records. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 03/07/2023 Signature Date Aldona Wos Printed Name
2015 Governor's Crime Commission
Document text
77%, NORTH CAROLINA STATE ETHICS COMMISSION S—— hod CS COMMISSION USE ONLY “ J} 2015 STATEMENT OF ECONOMIC INTEREST | "**&™ HSS! 919-715-2071 www. ethicscommission.nc.gov 5 APR 1S PH 5 04 FILER'S NAVE (FIRST, MIDDLE, LAST) First Name. [ wamenome | ememe [sum] Fdona CURRENT EMPLOYER. State oF Nod Carolina Secrecy - Duss NATURE OR TYPE OF BUSINESS Secrcany , DUKS REASON FOR FILING (SELECT ALL THAT APPLY) TK STATE GOVERNMENT 108 (Please speciy the agency or | ( BOARD/COMMISSION (Please ist complete name of all Which you work or are being considered) State boards on which you are serving or ore being consigered Health and titan Secvices, Deparment of Develpm ental Dal, Gunga inj Grime Commissin. Croteeods | bndan Ary Comms oy forbersnip fo Cdn, ine. Ba of GBD, Derveshe Vine rai TI JUDICIAL OFFICER (Please speci the ofice you hold) _| [J LEGISLATOR (Please speciy House or Senate) Go other immediate family members reside in your household? ves Oo When used thraughout tis form, the term Immediate family includes your spouse (unless legally separated). It also Includes members of your extended family (your and your spouse’ children, grandchildren, parents, grandacents, and | Slings, 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 full names on the Confidential Form availabe at the end ofthis document. Minors are emancipated by marriage, enlistment in the US miltary or court action for emancipation. Hm | ro | ones we | gg EMANCIPATED MINORS Loe Dedy [spome |New ead prs Avi Te [son [smear a - - The SET and any attachments, excluding the Confidential Form, are public records. Page 1.of 10 INITIALS FOR EMPLOYER JOB TITLE 1. As of December 31, 2014, did you, your spouse, or. ‘members of your immediate family: B. Lease or rent real estate or personal property ‘to.or from the State of North Carolina with a market value of $10,000 CYes KiNo 2. At any time during 2013 or 2014, 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? [ Nameotvuchassr | tameotseter | Type of Property 3 of December 31,2014, 4d you, your spouse, or members of your immediate family own any of the following financial irterests valued at $10,000 or more? A. Stock in a publicly owned company? Hyves Cite e page DA Do not st ownership interests In a videly held investment fund (inciuding mutual funds, regulated investment Ot est or pencion or deferred compensation plans) f: (1) the fund is publicly traded or its assets are widely Ds and ih neither you nor an |mmediate family member are abie to control the assets held in the mutual fund, {vestment company, or pension or deferred compensation plan TT owmerarmemt | Full Noms of company (9 not use a tker symbol) EE RN Deutocne Bank Capdol Fandmg TraiE Nan [ove bewy Pere ef ETT A lh li alba ls ey Je sm ovr Eve Lovie Den Morgay Stamey apd Tse XL €FD 5. Stock Options in a company or business? Oves ®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, arinershipa, Hmited partnerships, joint ventures, limited liability companies, limited liability partnerships, and Closely held corporations)? Yes [INo - If"No’, proceed to question 4. 3¢¢ page DA Lows Deby Avia and Andra Dede Tro Lows Dedey Family Parkverdg B-C The SEX and any attachments, excluding the Confidential Form, are public records. Page30f 10 FINANCIAL INTERESTS AVyodnnsX oa. IA 3. As of December 31, 2014, did you, your spouse, or members of your immediate family own any of the following financial Ee ome of Company (oe not ne ker smh | Lows vetey | Progen Shniesy Guped Tu TI €70 B. Stock Options in a company or business? Oves [no C. Interests in a non-publicly owned company or business. entity (including interests in sole proprietorships, ves [No - IFN, proceed to question 4 page 34 C0) For 2h nom-pabicly owned company or business ently (the “primary company’) identified in question 3.C. Ce ass ot the names of any other companies or Qusingss entities in which the primary company owns Ei iies of equity Interests valued at over $10,000, known. Ste page ‘ta ‘Non-Publicly Owned Company or Business Entity ‘Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests Th Lows, Dedoy Family Parinuccnip LC XP Logis, Inc i 4035 Pumad Paikinasy LLC Con Poperhs, UC | pote Sow, | [Deter tenant No | our apple <3) 1 you know that any company or business entity fisted In 3.C or 3.C(1) above has any material business as or asiness contracts with the State of North Carolina, of 5 regulated by the State, provide brief escrption of hat business actviy. Description of Business Activity with the State 4. As of December 31, 2014, were you, your Spouse, or members of your immediate family the beneficiaries of a vested ust with value of $10,000 or more that vies created, established, o controled by you? Do not list assets held In blind trusts. See 2015 SEI Helpful Tigs for the definitian of "Vested Trust” and “Blind Trust.” WYes [ONo Nam and Address of Trustee Your Refationshp to the Trust Tons etn ey ot A tbo | Aden os Ensues Tsk Grantor S. 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, Shucent loans, personal loans and intra-family debt. Sves Oo Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Member) Individual, ete.) Louis Dey Cmmerid Bom Lows “Be Adore Firandad Compan Lows Dew Auch ate Financed Coon par The SEX and any attachments, excluding the Confidential Form, are public records. Page aor 10 Arodnme® 05: AA i) For each non pubic owned company or busines eiity (ihe “armary company”) denied n question 3.C Fo nee of ay othe compares or BUSINES ens in Wich the primary company Wr Eko aduty interests valued at over $10,000, if known. NomPablicly Gwined Company or Business Entity | _ Other Companies in which the Primary Comparly (tha Primary Company) Gwe Security or Equity Interests CI None or Not Kaawn WWOS Asoudks, Lic wot lizadole. CoH you know hat any company or business entity sted n 3.C or 3.C(1) above as any material business ees cortrocs with tn Siac of North Carolia, or i regulated by the Sate, provide a rie Gesciption of hat business ac. ~ ‘Name of Company or Business Entity Description of Business Activity with the State None o Not Known - 4. As of December 31, 2014, were you, your Spouse, or members of your immediate family the beneficiaries of a vested et wa vaio oF $10,000 of more that was created, estabiihed, or controled by you? Do not list assets held in blind trusts. See 2015 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” dre On — See pussy gn gest =A ANS gor © on Medex ‘Name and Address of Trusteo. Description of the Trust Your Relationship to 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, od loans, personal loans and mtr. farily debt. Mes One — See omswer on Yang BW pec % gn Madhet Name of Debtor (You Spouse, Immediate Family | Type of Creditor (Commercial Bank Credit Union, Member) Individual, etc. ee ett —————— _— — Abkednme Pug tA The SEI and any attachments, excluding the Confidential Form, are public records. EngeRatad ee ee mo ree ro pee row) of an a AL reed b you your spss, of heer of + Copal sane Fedor government eiament + Military retirement + Social security income/SSDI_ Sex page 52 Sb pre—r— pre—pE— Type or Tove ot came Lows Dee New Sead Wd Compoy] Tops im [stay rics dvends | Mis ety [Ob trp, Lic [Ror cud comin [Port vm nity | Los Dugay, An Tdeons PALIN| ronal real este bs Lows D foeny nebmentt Ns | ives We PROFESSIONAL AND CIVIC RELATIONSHIPS 7(3). During 2014, were you, your spouse or members of your immediate family a director, officer, governing board kc Lome Deby Prosdont | “pair boii | Urea Lows o Bead Wie Elon Univers Tduaatin Lows Ded B Aldana 2 Was Motonn wos | vie Pasion | iy Srl Onan 7(b). If the nonprofit corporations or organizations listed above do business. with the State of North Carolina or receive Name of Norpro Corporation o Organization Semaios Stats Business or State Funding | 5¢"None or Not Known Aaononta = Lo = Li each source of income (not specic amounts) of more than £5,000 received by You, your spouse, of members of iat “family during 2014. Indude salary, wages, staeflocal government. retirement, professionel (Se J A Giwidons, renal income, business income, and other types of income required to be reported on your State and federal tox returns. Do not include income received from the following sources: » Capital gains » Federal government retirement » Military retirement » Social security income/SSDI Recipient of Income. Type of Type of Income Business/Industry 11 had no reportable income over $5,000 in 2014. Er a RE [Adon wos | On Pern tn | nent | rer Bvdends Louis Ded WP yr Parnes, lnc Investment Interest, Dvds stone won| wo bese crc [BM mse | toned eons, | PROFESSIONAL AND CIVIC RELATIONSHIPS (a). During 2014, were you, your spovse or members of your Immediate family a director, officer, governing board Te ovee, Independent contractor, or registered lobbyist of a nonprofit corporation of organization operating in he te of North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? Hives Cito - 10no" procesd to question 8. SLE, Gana on eae By ~ Ia yeye > Do not ist State boards or entities, or entities created by a political subdivision of the Ste. 15 ain chock | + Do not lst organizations of which you are a mere member. His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Puspose of Organization I ZA EE EE (5). If the nonprofit corporations of organizations listed above do business with the State of North Carolina or receive S450 funds, please provide a brief description of the nature of that business, if known or with which due diigeace could reasonably be known. ‘Name of Nonprofit Corporation or Organization Describe State Business or State Funding Ahtednmend page SA The SEI and any attachments, excluding the Confidential Form, are public records. Eset Coren source of income (not specific smounts) of mate than. $5,000 received by you, your spose: of members of your immediate family during 2014. Include salary, wages, state/local government retirement, professional fees, Te eerie! income, business income, ond other types of income required to be reparted on your State and federal tox returns. Do nat include income received from the following sources: > Capital gains » Federal government retirement » Military retirement » Social security income/SSDI Recipient of Income Type of Type of Income Business /Industry 11 nad no reportable income over $5,000 in 2014. Pony Toon] omer our | Tom woiey | 0 Gif | amen | inode PROFESSIONAL AND CIVIC RELATIONSHIPS 7(2). During 2014, were you, your spouse of members of your immediate family a director, officer, governing board TA res, Indapandént contractor, or registered lobbyist of 3 nonprofit corporation of organization operating In ee 1 North Carolina primarily for religious, charitable, Scientific, literary, public health and safety, of educational purposes? res CIN - No", proceed to question 8. $28 raga ow Rage S- Ywy + not Tt State Boards or erties, or entities created by a political subdivision of the State. {1egC \& ev + Do not lst organizations of which you are a mere member. PirmnmenY His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization (6). If the nonprofit corporations or organizations listed above Go business with the State of North Carolina or receive Lk ini 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 pare 58 The SEX and any attachments, excluding the Confidential Form, are public records. Le [2 4, were you, your spouse, or members of your immediate family a director, officer, or governing ‘board EE ar aovotocy Group ih a IEFeSt ih Mtr OVE Gh Your agency of bGard may Rives [INo [JLegisitor/udicil Officer - You are not required to complete this question if you ate ilng because +00 not lst organizations of which you are only 2 member (not serving in a leadership role). Sea. page. UA Adena WS Cone. Commins. Qovecnads Roark pbs RE EEL VOTE 9(a). List the name of each company or business with which you were associated where you or a member of your See pa QA ETE CS aba Ce I — E— RXYorect2 gy lofL Dua 2018, were Vou, Yau Spouse, or members of your [mediate fomiy 3 director, officer, or Governing Board I tne. organisation, of 50ocacy Group ith an Interest in matters over which your agency or board may Rave jurisdiction? ves [No [Legisiator/udical Officer - You are nok required to complete this question if you are fing because Vou ave 3 legsiator or a judicial oficer or you are fing 35 an appointee to those offices. +00 ot fst organizations of which you are only a member (not serving in a leadership role). Name of Society, Organization Leadership Position or Advocacy Group (Director, Officer, Board Member) Aldon 0S Cr TO dl IS OS [Mido wos [Domest Voenge Comes | Bod members a). List the name of each company or business with which you were associated where you or a member of your diate fami was an employee, director, office, partner, proprietor, or member or manager as of December 31, 2014. [Aton wes | cote] us Aso ue (0). 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, 2014, provide a brief description of that business activ. Name of Company or Business Entity Description of Business Activity with the State ot applicable (No entities listed on #92) _[XRo relationship / Not known 10. Are you a practicing attorney? Oves. Ko [CD udicial Officer/State Attorney 1f+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 2014. 0 Administrative 0 Admiralty 0 Corporate 0 criminal Decedent's Estates Environmental Otnsurance Otevor [0 Locel Government Real Property O securities [= 0 Tort ligation (including 0) Utities Regulation Other category not ted. negligence) Adkadane a3 UA The SE and any attachments, excluding the Confidential Form, are public records. OYes XNo ‘Name of Person Name of Employer 1 “Type of Relationship ES — 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? ve te Registration Expiration m—r 12. Are you or your employer, your spouse, or members of your immediate family, or their employer cent: «Licensed by the State board or employing entity with which you are or will be associated or © Related by the State hoard or employing nity with which you ae r wil b associated or © Have busines relationship with the Sate bord or employing entity with which are you are o wilbeasodated? eislapmentalDibiies Cound an Kes No Name af Porsan Norms of Erplover Type of eltonsiip Aldona Z. Wos DHHS Business Relationship Crim Comison, Governors X Yes No. [Nameofperon | Name of Employer Type of Relationship ORS Business Relationship. Toon, fas, Commission of Ver To [Namecfperon [NamecfEnsloyer Te ffelatership [Aidonaz.Wos | oHHS. Business Relationship. Partnership for Children, Inc. Board of Directors [ame ofperon [Nar of employe asin [doz wos | DwHS Business Relationship. Domestic Vience Commision [fame operon Name cfrployer [Tee offelatonshio dona Z. Wos [Bis | Business Relationship Addex fu FA 15. During 2014 (but only the time period after you were. ‘appointed, employed, or filed or were nominated as a candidate) « those person(s) were outside North Carolina and XiYes [No If “Yes, list all contributions you (NOT immediate family members) made during 2014 ‘with a cumulative total Er |X) No contribution(s) with 3 cumulative total of more than $1,000 piiotetid + State Board of Education Rives [No 4. If so, were you appointed or are you being considered for appointment to that public | (X) Yes [INo Question 16, question 18. [Yes [No i Hosted a friar af your residence or lace of usness? phone banks, event assistance, mailings, canvassing, surveying, or any other OYes [No OYes [Ne [ves CIN if yes, please provide such information below. Pursuant fo SW 7 Bc Snir, Wh Sercg 5 SRS Sones on The By now overed bd oc Ccommitéions’, Council on Eacablond Serves 0 Exceghma | Chichen, Nock Coolio. GompPie \nbrmawn Groat COIR, Liga mmo Trebampbno i, Tn d wak Safety ond Debs Toth, Free, Narn Comers Long dal. Tout, Gaphom Bone, Goisrirh acim. Coon, Bom of Thee of ho Unicreing oF North Camu, center or Pulalic Tekeasins, anh Tha Ormamegine on wr fae Dexelopmert Laffirm 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. Lalso certify that 1 have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equiabl inferest [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. acknowledge tht have read and understand N.C.G:S. 138A-26 regarding concealing o fling 0 disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138.26. Concealingor fin to disclose material information. A filing person who knowingly conceals or Knowingly fils o dislose information tha s require fo be disclosed ona statement of economic interest under this Article shall be guilty of a Class | 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. BX 1 Agree Aldona_2. wos, mD. Printed Name Ve ad [ES re Date Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. The SEI and any attachments, excluding the Confidential Form, are pubic records. Page 10 of 10
2015 Health and Human Services, Department of
Document text
77%, NORTH CAROLINA STATE ETHICS COMMISSION S—— hod CS COMMISSION USE ONLY “ J} 2015 STATEMENT OF ECONOMIC INTEREST | "**&™ HSS! 919-715-2071 www. ethicscommission.nc.gov 5 APR 1S PH 5 04 FILER'S NAVE (FIRST, MIDDLE, LAST) First Name. [ wamenome | ememe [sum] Fdona CURRENT EMPLOYER. State oF Nod Carolina Secrecy - Duss NATURE OR TYPE OF BUSINESS Secrcany , DUKS REASON FOR FILING (SELECT ALL THAT APPLY) TK STATE GOVERNMENT 108 (Please speciy the agency or | ( BOARD/COMMISSION (Please ist complete name of all Which you work or are being considered) State boards on which you are serving or ore being consigered Health and titan Secvices, Deparment of Develpm ental Dal, Gunga inj Grime Commissin. Croteeods | bndan Ary Comms oy forbersnip fo Cdn, ine. Ba of GBD, Derveshe Vine rai TI JUDICIAL OFFICER (Please speci the ofice you hold) _| [J LEGISLATOR (Please speciy House or Senate) Go other immediate family members reside in your household? ves Oo When used thraughout tis form, the term Immediate family includes your spouse (unless legally separated). It also Includes members of your extended family (your and your spouse’ children, grandchildren, parents, grandacents, and | Slings, 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 full names on the Confidential Form availabe at the end ofthis document. Minors are emancipated by marriage, enlistment in the US miltary or court action for emancipation. Hm | ro | ones we | gg EMANCIPATED MINORS Loe Dedy [spome |New ead prs Avi Te [son [smear a - - The SET and any attachments, excluding the Confidential Form, are public records. Page 1.of 10 INITIALS FOR EMPLOYER JOB TITLE 1. As of December 31, 2014, did you, your spouse, or. ‘members of your immediate family: B. Lease or rent real estate or personal property ‘to.or from the State of North Carolina with a market value of $10,000 CYes KiNo 2. At any time during 2013 or 2014, 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? [ Nameotvuchassr | tameotseter | Type of Property 3 of December 31,2014, 4d you, your spouse, or members of your immediate family own any of the following financial irterests valued at $10,000 or more? A. Stock in a publicly owned company? Hyves Cite e page DA Do not st ownership interests In a videly held investment fund (inciuding mutual funds, regulated investment Ot est or pencion or deferred compensation plans) f: (1) the fund is publicly traded or its assets are widely Ds and ih neither you nor an |mmediate family member are abie to control the assets held in the mutual fund, {vestment company, or pension or deferred compensation plan TT owmerarmemt | Full Noms of company (9 not use a tker symbol) EE RN Deutocne Bank Capdol Fandmg TraiE Nan [ove bewy Pere ef ETT A lh li alba ls ey Je sm ovr Eve Lovie Den Morgay Stamey apd Tse XL €FD 5. Stock Options in a company or business? Oves ®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, arinershipa, Hmited partnerships, joint ventures, limited liability companies, limited liability partnerships, and Closely held corporations)? Yes [INo - If"No’, proceed to question 4. 3¢¢ page DA Lows Deby Avia and Andra Dede Tro Lows Dedey Family Parkverdg B-C The SEX and any attachments, excluding the Confidential Form, are public records. Page30f 10 FINANCIAL INTERESTS AVyodnnsX oa. IA 3. As of December 31, 2014, did you, your spouse, or members of your immediate family own any of the following financial Ee ome of Company (oe not ne ker smh | Lows vetey | Progen Shniesy Guped Tu TI €70 B. Stock Options in a company or business? Oves [no C. Interests in a non-publicly owned company or business. entity (including interests in sole proprietorships, ves [No - IFN, proceed to question 4 page 34 C0) For 2h nom-pabicly owned company or business ently (the “primary company’) identified in question 3.C. Ce ass ot the names of any other companies or Qusingss entities in which the primary company owns Ei iies of equity Interests valued at over $10,000, known. Ste page ‘ta ‘Non-Publicly Owned Company or Business Entity ‘Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests Th Lows, Dedoy Family Parinuccnip LC XP Logis, Inc i 4035 Pumad Paikinasy LLC Con Poperhs, UC | pote Sow, | [Deter tenant No | our apple <3) 1 you know that any company or business entity fisted In 3.C or 3.C(1) above has any material business as or asiness contracts with the State of North Carolina, of 5 regulated by the State, provide brief escrption of hat business actviy. Description of Business Activity with the State 4. As of December 31, 2014, were you, your Spouse, or members of your immediate family the beneficiaries of a vested ust with value of $10,000 or more that vies created, established, o controled by you? Do not list assets held In blind trusts. See 2015 SEI Helpful Tigs for the definitian of "Vested Trust” and “Blind Trust.” WYes [ONo Nam and Address of Trustee Your Refationshp to the Trust Tons etn ey ot A tbo | Aden os Ensues Tsk Grantor S. 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, Shucent loans, personal loans and intra-family debt. Sves Oo Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Member) Individual, ete.) Louis Dey Cmmerid Bom Lows “Be Adore Firandad Compan Lows Dew Auch ate Financed Coon par The SEX and any attachments, excluding the Confidential Form, are public records. Page aor 10 Arodnme® 05: AA i) For each non pubic owned company or busines eiity (ihe “armary company”) denied n question 3.C Fo nee of ay othe compares or BUSINES ens in Wich the primary company Wr Eko aduty interests valued at over $10,000, if known. NomPablicly Gwined Company or Business Entity | _ Other Companies in which the Primary Comparly (tha Primary Company) Gwe Security or Equity Interests CI None or Not Kaawn WWOS Asoudks, Lic wot lizadole. CoH you know hat any company or business entity sted n 3.C or 3.C(1) above as any material business ees cortrocs with tn Siac of North Carolia, or i regulated by the Sate, provide a rie Gesciption of hat business ac. ~ ‘Name of Company or Business Entity Description of Business Activity with the State None o Not Known - 4. As of December 31, 2014, were you, your Spouse, or members of your immediate family the beneficiaries of a vested et wa vaio oF $10,000 of more that was created, estabiihed, or controled by you? Do not list assets held in blind trusts. See 2015 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” dre On — See pussy gn gest =A ANS gor © on Medex ‘Name and Address of Trusteo. Description of the Trust Your Relationship to 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, od loans, personal loans and mtr. farily debt. Mes One — See omswer on Yang BW pec % gn Madhet Name of Debtor (You Spouse, Immediate Family | Type of Creditor (Commercial Bank Credit Union, Member) Individual, etc. ee ett —————— _— — Abkednme Pug tA The SEI and any attachments, excluding the Confidential Form, are public records. EngeRatad ee ee mo ree ro pee row) of an a AL reed b you your spss, of heer of + Copal sane Fedor government eiament + Military retirement + Social security income/SSDI_ Sex page 52 Sb pre—r— pre—pE— Type or Tove ot came Lows Dee New Sead Wd Compoy] Tops im [stay rics dvends | Mis ety [Ob trp, Lic [Ror cud comin [Port vm nity | Los Dugay, An Tdeons PALIN| ronal real este bs Lows D foeny nebmentt Ns | ives We PROFESSIONAL AND CIVIC RELATIONSHIPS 7(3). During 2014, were you, your spouse or members of your immediate family a director, officer, governing board kc Lome Deby Prosdont | “pair boii | Urea Lows o Bead Wie Elon Univers Tduaatin Lows Ded B Aldana 2 Was Motonn wos | vie Pasion | iy Srl Onan 7(b). If the nonprofit corporations or organizations listed above do business. with the State of North Carolina or receive Name of Norpro Corporation o Organization Semaios Stats Business or State Funding | 5¢"None or Not Known Aaononta = Lo = Li each source of income (not specic amounts) of more than £5,000 received by You, your spouse, of members of iat “family during 2014. Indude salary, wages, staeflocal government. retirement, professionel (Se J A Giwidons, renal income, business income, and other types of income required to be reported on your State and federal tox returns. Do not include income received from the following sources: » Capital gains » Federal government retirement » Military retirement » Social security income/SSDI Recipient of Income. Type of Type of Income Business/Industry 11 had no reportable income over $5,000 in 2014. Er a RE [Adon wos | On Pern tn | nent | rer Bvdends Louis Ded WP yr Parnes, lnc Investment Interest, Dvds stone won| wo bese crc [BM mse | toned eons, | PROFESSIONAL AND CIVIC RELATIONSHIPS (a). During 2014, were you, your spovse or members of your Immediate family a director, officer, governing board Te ovee, Independent contractor, or registered lobbyist of a nonprofit corporation of organization operating in he te of North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? Hives Cito - 10no" procesd to question 8. SLE, Gana on eae By ~ Ia yeye > Do not ist State boards or entities, or entities created by a political subdivision of the Ste. 15 ain chock | + Do not lst organizations of which you are a mere member. His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Puspose of Organization I ZA EE EE (5). If the nonprofit corporations of organizations listed above do business with the State of North Carolina or receive S450 funds, please provide a brief description of the nature of that business, if known or with which due diigeace could reasonably be known. ‘Name of Nonprofit Corporation or Organization Describe State Business or State Funding Ahtednmend page SA The SEI and any attachments, excluding the Confidential Form, are public records. Eset Coren source of income (not specific smounts) of mate than. $5,000 received by you, your spose: of members of your immediate family during 2014. Include salary, wages, state/local government retirement, professional fees, Te eerie! income, business income, ond other types of income required to be reparted on your State and federal tox returns. Do nat include income received from the following sources: > Capital gains » Federal government retirement » Military retirement » Social security income/SSDI Recipient of Income Type of Type of Income Business /Industry 11 nad no reportable income over $5,000 in 2014. Pony Toon] omer our | Tom woiey | 0 Gif | amen | inode PROFESSIONAL AND CIVIC RELATIONSHIPS 7(2). During 2014, were you, your spouse of members of your immediate family a director, officer, governing board TA res, Indapandént contractor, or registered lobbyist of 3 nonprofit corporation of organization operating In ee 1 North Carolina primarily for religious, charitable, Scientific, literary, public health and safety, of educational purposes? res CIN - No", proceed to question 8. $28 raga ow Rage S- Ywy + not Tt State Boards or erties, or entities created by a political subdivision of the State. {1egC \& ev + Do not lst organizations of which you are a mere member. PirmnmenY His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization (6). If the nonprofit corporations or organizations listed above Go business with the State of North Carolina or receive Lk ini 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 pare 58 The SEX and any attachments, excluding the Confidential Form, are public records. Le [2 4, were you, your spouse, or members of your immediate family a director, officer, or governing ‘board EE ar aovotocy Group ih a IEFeSt ih Mtr OVE Gh Your agency of bGard may Rives [INo [JLegisitor/udicil Officer - You are not required to complete this question if you ate ilng because +00 not lst organizations of which you are only 2 member (not serving in a leadership role). Sea. page. UA Adena WS Cone. Commins. Qovecnads Roark pbs RE EEL VOTE 9(a). List the name of each company or business with which you were associated where you or a member of your See pa QA ETE CS aba Ce I — E— RXYorect2 gy lofL Dua 2018, were Vou, Yau Spouse, or members of your [mediate fomiy 3 director, officer, or Governing Board I tne. organisation, of 50ocacy Group ith an Interest in matters over which your agency or board may Rave jurisdiction? ves [No [Legisiator/udical Officer - You are nok required to complete this question if you are fing because Vou ave 3 legsiator or a judicial oficer or you are fing 35 an appointee to those offices. +00 ot fst organizations of which you are only a member (not serving in a leadership role). Name of Society, Organization Leadership Position or Advocacy Group (Director, Officer, Board Member) Aldon 0S Cr TO dl IS OS [Mido wos [Domest Voenge Comes | Bod members a). List the name of each company or business with which you were associated where you or a member of your diate fami was an employee, director, office, partner, proprietor, or member or manager as of December 31, 2014. [Aton wes | cote] us Aso ue (0). 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, 2014, provide a brief description of that business activ. Name of Company or Business Entity Description of Business Activity with the State ot applicable (No entities listed on #92) _[XRo relationship / Not known 10. Are you a practicing attorney? Oves. Ko [CD udicial Officer/State Attorney 1f+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 2014. 0 Administrative 0 Admiralty 0 Corporate 0 criminal Decedent's Estates Environmental Otnsurance Otevor [0 Locel Government Real Property O securities [= 0 Tort ligation (including 0) Utities Regulation Other category not ted. negligence) Adkadane a3 UA The SE and any attachments, excluding the Confidential Form, are public records. OYes XNo ‘Name of Person Name of Employer 1 “Type of Relationship ES — 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? ve te Registration Expiration m—r 12. Are you or your employer, your spouse, or members of your immediate family, or their employer cent: «Licensed by the State board or employing entity with which you are or will be associated or © Related by the State hoard or employing nity with which you ae r wil b associated or © Have busines relationship with the Sate bord or employing entity with which are you are o wilbeasodated? eislapmentalDibiies Cound an Kes No Name af Porsan Norms of Erplover Type of eltonsiip Aldona Z. Wos DHHS Business Relationship Crim Comison, Governors X Yes No. [Nameofperon | Name of Employer Type of Relationship ORS Business Relationship. Toon, fas, Commission of Ver To [Namecfperon [NamecfEnsloyer Te ffelatership [Aidonaz.Wos | oHHS. Business Relationship. Partnership for Children, Inc. Board of Directors [ame ofperon [Nar of employe asin [doz wos | DwHS Business Relationship. Domestic Vience Commision [fame operon Name cfrployer [Tee offelatonshio dona Z. Wos [Bis | Business Relationship Addex fu FA 15. During 2014 (but only the time period after you were. ‘appointed, employed, or filed or were nominated as a candidate) « those person(s) were outside North Carolina and XiYes [No If “Yes, list all contributions you (NOT immediate family members) made during 2014 ‘with a cumulative total Er |X) No contribution(s) with 3 cumulative total of more than $1,000 piiotetid + State Board of Education Rives [No 4. If so, were you appointed or are you being considered for appointment to that public | (X) Yes [INo Question 16, question 18. [Yes [No i Hosted a friar af your residence or lace of usness? phone banks, event assistance, mailings, canvassing, surveying, or any other OYes [No OYes [Ne [ves CIN if yes, please provide such information below. Pursuant fo SW 7 Bc Snir, Wh Sercg 5 SRS Sones on The By now overed bd oc Ccommitéions’, Council on Eacablond Serves 0 Exceghma | Chichen, Nock Coolio. GompPie \nbrmawn Groat COIR, Liga mmo Trebampbno i, Tn d wak Safety ond Debs Toth, Free, Narn Comers Long dal. Tout, Gaphom Bone, Goisrirh acim. Coon, Bom of Thee of ho Unicreing oF North Camu, center or Pulalic Tekeasins, anh Tha Ormamegine on wr fae Dexelopmert Laffirm 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. Lalso certify that 1 have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equiabl inferest [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. acknowledge tht have read and understand N.C.G:S. 138A-26 regarding concealing o fling 0 disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138.26. Concealingor fin to disclose material information. A filing person who knowingly conceals or Knowingly fils o dislose information tha s require fo be disclosed ona statement of economic interest under this Article shall be guilty of a Class | 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. BX 1 Agree Aldona_2. wos, mD. Printed Name Ve ad [ES re Date Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. The SEI and any attachments, excluding the Confidential Form, are pubic records. Page 10 of 10