Andrew C. Brock

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2021 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. Andrew Coley Brock Current Employer Job Title Department of Commerce Board of Review Nature or Type of Business Employment law Reason For Filing (Complete all that apply.) 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.) Commerce, Department of - Board of Review Board of Review Judicial Officer (Specify office.) Legislator (Specify House or Senate.) A. Do other immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. List the full name of all adults and emancipated minors in your household. 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 Andrea Gentry Brock Spouse Piedmont Healthcare Physician Assistant Medical The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 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 SB Child SB Child TB Child Property Interests 1. As of December 31, 2020, 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% Mocksville Davie 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 2019 or 2020, did you or any members of your immediate family sell to or buy from the State of North Carolina personal property worth $10,000 or more? ☐ 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 10 Financial Interests 3. As of December 31, 2020, 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 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 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 None or Not Known 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 None or Not Known 4. As of December 31, 2020, 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 2021 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov ☐ Yes ☒ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 5. As of December 31, 2020, 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. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) Andrew Coley Brock (Self) auto loan 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 2020. 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. Please remember to disclose your receipt of salary or wages from any governmental or private entity. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income Andrea Gentry Brock (Spouse) Piedmont Healthcare Health Care Salary Andrew Coley Brock (Self) NC Department of Commerce Board of Review Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2020, 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. ► 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 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 None or Not Known 8. During 2020, 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 because you are a legislator or judicial officer or you are filing as an appointee to one of 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 10 9(a). List the name of each business with which you were associated where you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2020. Name of Person Relationship to Filer Name of Company Role of Person Andrea Gentry Brock Spouse Piedmont Healthcare Employee 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, 2020, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State Piedmont Healthcare Providing Health Care 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2020. ☐ 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 2020, 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 7 of 10 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 because you are a legislator or a judicial officer or you are filing as an appointee to one of 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 2020, 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 8 of 10 15. During 2020, 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 a judicial officer or you are filing as a judicial officer appointee. ► 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 2020 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 No Contributions The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 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. Governor e. If so, you must indicate whether during 2020 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 10 of 10 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 04/12/2021 Signature Date Andrew Coley Brock Printed Name

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2020 STATEMENT OF ECONOMIC INTEREST This entire form must be completed to fulfill your ethics filing obligation. ____ Checked for completion ____Scanned ______Date Incomplete Qs ____ ____ ____ ____ Supp. sent date _______ by _____ Supp. received date _________ Entered in database ______ by ______ Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Hon. Andrew Coley Brock Current Employer Job Title Department of Commerce Board of Review Nature or Type of Business Employment law Reason For Filing (Complete all that apply.) 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.) Commerce, Department of - Board of Review Board of Review Judicial Officer (Specify office.) Legislator (Specify House or Senate.) A. Do other immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. List the full name of all adults and emancipated minors in your household. 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 Andrea Gentry Brock Spouse Piedmont Healthcare Physician Assistant Medical For Staff Use Only Date Received: The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 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 SB Child SB Child TB Child Property Interests 1. As of December 31, 2019, 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% Mocksville Davie (Self plus Spouse) 100.00% Mocksville Davie 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 2018 or 2019, did you or any members of your immediate family sell to or buy from the State of North Carolina personal property worth $10,000 or more? ☐ 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 10 Financial Interests 3. As of December 31, 2019, 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 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 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 None or Not Known 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 None or Not Known 4. As of December 31, 2019, 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 2020 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” ☐ Yes ☒ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 5. As of December 31, 2019, 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. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) (Self plus Spouse) Credit Union 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 2019. 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. Please remember to disclose your receipt of salary or wages from any governmental or private entity. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income Andrea Gentry Brock (Spouse) Piedmont Healthcare Health Care Salary Andrew Coley Brock (Self) NC Department of Commerce Board of Review Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2019, 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. ► 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 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 None or Not Known 8. During 2019, 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 because you are a legislator or judicial officer or you are filing as an appointee to one of 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 10 9(a). List the name of each business with which you were associated where you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2019. Name of Person Relationship to Filer Name of Company Role of Person Andrea Gentry Brock Spouse Piedmont Healthcare Employee 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, 2019, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State Piedmont Healthcare Providing Health Care 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2019. ☐ 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 2019, 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 7 of 10 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 because you are a legislator or a judicial officer or you are filing as an appointee to one of 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 2019, 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 8 of 10 15. During 2019, 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 a judicial officer or you are filing as a judicial officer appointee. ► 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 2019 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 No Contributions The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 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. Governor e. If so, you must indicate whether during 2019 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 10 of 10 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 05/15/2020 Signature Date Andrew Coley Brock Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2019 STATEMENT OF ECONOMIC INTEREST This entire form must be completed to fulfill your ethics filing obligation. ____ Checked for completion ____Scanned ______Date Incomplete Qs ____ ____ ____ ____ Supp. sent date _______ by _____ Supp. received date _________ Entered in database ______ by ______ Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Hon. Andrew Coley Brock Current Employer Job Title Department of Commerce Board of Review Nature or Type of Business Employment law Reason For Filing (Complete all that apply.) 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.) Commerce, Department of - Board of Review Board of Review Judicial Officer (Specify office.) Legislator (Specify House or Senate.) A. Do other immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. List the full name of all adults and emancipated minors in your household. 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 Andrea Gentry Brock Spouse Piedmont Healthcare Physician Assistant Medical For Staff Use Only Date Received: The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 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 SB Child SB Child TB Child Property Interests 1. As of December 31, 2018, 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% Mocksville Davie (Self plus Spouse) 100.00% Mocksville Davie 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 2017 or 2018, did you or any members of your immediate family sell to or buy from the State of North Carolina personal property worth $10,000 or more? ☐ 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 10 Financial Interests 3. As of December 31, 2018, 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 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 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 None or Not Known 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 None or Not Known 4. As of December 31, 2018, 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 2019 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” ☐ Yes ☒ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 5. As of December 31, 2018, 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. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) (Self plus Spouse) Credit Union 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 2018. 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. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income Andrea Gentry Brock (Spouse) Piedmont Healthcare Health Care Salary Andrew Coley Brock (Self) NC Department of Commerce Board of Review Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2018, 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. ► 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 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 None or Not Known 8. During 2018, 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 because you are a legislator or judicial officer or you are filing as an appointee to one of 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 10 9(a). List the name of each business with which you were associated where you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2018. Name of Person Relationship to Filer Name of Company Role of Person Andrea Gentry Brock Spouse Piedmont Healthcare Employee 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, 2018, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State Piedmont Healthcare Providing Health Care 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2018. ☐ 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 2018, 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 7 of 10 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 because you are a legislator or a judicial officer or you are filing as an appointee to one of 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 2018, after you were (1) appointed, (2) employed, or (3) 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? ☐ 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 8 of 10 15. During 2018, after you were (1) appointed, (2) employed, or (3) 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? A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. ☐ Yes ☒ No ☐ Judicial Officer - You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. ► Do not report gifts 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 2018 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. § 163A-1411(13) 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 No Contributions The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 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  UNC Board of Governors  Utilities Commission  Wildlife Resources Commission ☒ Yes ☐ No If “No,” proceed to question 18. d. If so, were you appointed or are you being considered for appointment to that position by a Council of State member? ☒ Yes ☐ No If “No,” proceed to question 18. Governor e. If so, you must indicate whether during 2018 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 10 of 10 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. § 163A-191. 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. 163A-415. N.C.G.S. § 163A-192. 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. 163A-415. I affirm that I have reviewed my most recently filed 2018 Statement of Economic Interest and that as of December 31, 2018, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 05/15/2019 Signature Date Andrew Coley Brock Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

NORTH CAROLINA STATE ETHICS COMMISSION 2018 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Hon. andrew coley brock REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify the agency for which you work or are being considered) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) Board of Review; JUDICIAL OFFICER (Specify the office you hold) LEGISLATOR (Specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2017 Statement of Economic Interest and that as of December 31, 2017, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 1/2/2018 Signature Date andrew coley brock Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

NORTH CAROLINA STATE ETHICS COMMISSION | ro crnics commission ust oni " Pi 2017 STATEMENT OF ECONOMIC INTEREST | Do Recened 919-814-3600 wo. ethicscommission nego | 700 AN 30 MM 11: 01 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL 7 77 YOUR SET FILING OBLIGATION fC Seamed Jl Bue Sur. Sent Date o Sore. Receved bate JY. | FILE'S NAME (FIRST, MIODLE, LAST) _ _ Prefix | FirstName | Middle Name LastName sume | Aone. Covey [Baock A CURRENT EMPLOYER [08 me TR | Comsecranr NATURE OR TYPE OF BUSINESS. _Porncsi Consus TACT SE — REASON FOR FILING (COMPLETE ALL THAT APPLY) a [STATE GoveRNWENT 08 (spect Agency) 50ARD/COMMISSION (List compete name of al State E—— | boards on which you are serving or are being considered) Yr | EE oo | SeadATEe A. Be ther date fom es ee yur hr? a Ono When used throught ths orm, the term Tmmediate family nciudes your spouse (uriess legally separated). It also hclases memsers of your tended {amy (Your AMG your spousa' Chen, grandchidren, parents, grandparents, and | Sings, 3nd the Spouses of cach of those persons) wha reside in your household. | List the full name of all adults and emancipated minors n your household. A minor is a chid under 18 years od. | Niners are emancipated br Marge, ntaens nthe US Mary, ar cout oder for emancipation ° | FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER | JOBTITLE | NATURE OF EMANCIPATED MINORS | ~ 1 | ouemess butter Caer Broce. | sper Coa | Consraur | Pome Gewmy Bro] spruse THC Intend Phd Prsscnar is7. | swncne The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f 10 [B. List ONLY the initiate of atl unemancipated minors in your househald below. A minor is a hid under 18 years old Note: You must list the full name of each minor child on the Confidential Form available at the |__end of this document. = | | mumasror | retarronsnie EMPLOYER 208 TITLE NATURE OF UNEMANCIPATED | ‘BUSINESS Minors | : - = | SHB cme | oo — SEB emer | PROPERTY INTERESTS | 1 As of December 31. 2016, dd you, your spouse, or members of your immediate amily: A. Hoe an ownership interest in North Carolina real esate (including your residence) with a market vale of £10.00 or more” @es CINo | Owner of Real Estate | % Ownership Interest | Location by City Location by County » al (00 Lmadkoalle | Pave 1 . J SE 1 — 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” ives © Name of Lessor Name of Lessee 1 Real Estate, Location | If Personal Property, Renter) oy city & County “Descive 2. At any time during 2015 or 2016, did you, your spouse, or members of your immediate family sell to or buy from the Sate f orth Cargina personal property wih a market vaive of $10,000 or more? Oves (ho Name of purchaser | Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 20f 10 FINANCIAL INTERESTS 1 3. As of December 31, 2016, id you, your spouse, or members of your immediate family own any of the following financial interests valued 2t $10,000 or more? LIST EACH COMPANY INDIVIDUALLY. A. Stock in a publety owned company” ves _2fo________ S50 mt 1a oweerd eresis In a way nid ivesiment fund (inching mutasl funds, regulated ivestmert monies, or penion of sefered compensation pans) : () the fund 1 publicly trades or a assets are widely | inverse and ah nanher you no an Immediate family member are able to contol the ssets eld in th mutual fr, nvecmert companys or pension or deferred compensation pan Owner of Interest Full Name of Company (Do not use a ticker symbol) | 5 Stock Options in 2 company or business” Ove Ae Owner of Stock Option |Full Name of company (Do not use a ticker symbol) Interests 2 non-public oma company o businGes entity (including nerests in Sole propristorshis, arian, med Borers, J ventures, Imited habily Companies, [ted DALY partnersigs, and Sisal nla corporations) Coves fo tno, proceed to auestion Owner of Interest Name of Company or Business Entity € (1). For each non-publicly owned company or business entity (the “primary company”) identified in question | SE nave, rense Is the armas of ary ether compares or Business anes which the primary company awn securities or equity merists valued at ove $10,000, # nen Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company | (the Primary Company) Guns Security or Equity Interests [ #ftione or ot known | | — SE i I — — The SEI and any attachments, excluding the Confidential Form, are public records. Page 30f 10 C23 you know tht amy company or business ent ted in 3.C or 31) above tae any material business | Gains or madness coma th tn roe of Nor Carlo o 610000 on he Shore, prowde a wt | deacrgion of hae mes acy Name of Company or Business Entity Description of Business Activity with the State [Zone or ho Koown B i. | 4. As of December 21, 2016, were you, your spouse, or members of your immediate family the beneficiaries of a vested ru wi 3 valk 5 310,000 mre tat wa creme etobisnch, o comrales or vou? Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” | ves rho Name and Address of Trustee Description of the Trust Vour Relationship to the Trust 5 hs of December 31, 2016, dW you, vour spouse, or members of your Imes fal have labs of $10,000 or | ore, acu th PADRE on ot AAT Pers eda’ Exam de CHa Ad Be, Ste i, de Toone portant oar and war som fe oa One Name of Debtar (You, Spouse, Immediate Famity | Type of Creditor (Commercial Sank, Credit Union, Member) Individual, etc.) Anda Brose | Commern- Bore 6. Uist each source of income {ot specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family dunn 2016 Include salary, wages, state/local government retirement, professional fees, Komoror tees, Sudan a come. buses Mom, 37d une ep of meer fodee 10 be reporten of your Ste on fedrar tk eso ! Do ao include income received from the following sources: | > Capital gins » Federal government retirement | + itary retirement > Social security income/ 5501 | Recipient of Income Name of Source. Type of I tyweotincome | Biiness/Tndustry | 31 i ms vepartable income over £5000 m 2076 Vidas Bre [pc Ch 1 Got | Shetty Adee Beocic__ ol Mepcive | Sapatr bodren Broce Pie Tahmel Media, Mepicins | Sactey The SET and any attachments, excluding the Confidential Form, are public records. Page aor 10 PROFESSIONAL AND CIVIC RELATIONSHIPS | (a). During 2016, were you, your spouse or members of your [mmediate ferily @ director, officer, governing baard | omits enIoves, InagDendent Comttactor, o FeaRTered ObOyIS of 3 RORGYOR COTEDISNON of rg OpEratg n | th State of North Capoina primary for eluous, charable, Scenic, eran, publ health and safety, or educational | Duron? | ves Mo 16°No.” proceed to question's. | [= no Tt Sate boards or nile, or ene created by potvat bdsm of he Sate. | | > Do not fet organizations of which you are mere member. | Name of Person is Her Pasition Name of Nonprofit Nature of Business or | | = Corporation of Organization | Purpose of Organization | I RE SS E— 1 I 1 [ J | — | | 700. If the nonpront corporation or organizations sted nave do business with the State of North Carolina or receive SE fund please provi a bie 4escnpon of the notre of tha Busnes, 1 Known of ih Which dus Blkgonce could easonably be known ime of Nonprofit Corporation or Organization | Describe State Business or State Funding ane or ta Known 8. Dufng 2016, were you, your spouse, or members of your immediate family a director, officer, or governing board member of ary 50014, r3amcation, o A0vOGACY SHOUD Ah an GHEE in mater ver WHE YOu Cs or Board may Hoe hari? Dives [Me A) Legislator Judicial Officer You are not required to complete this question i you are fling because: Yo are eisator or der oer o you an Hing a5 am appaites 1 hese oes | 300 not Hest organizations of which you are ory a mermber (not serving in leadership role). Name of Person Name of Society, Organization | Leadership position | or Advocacy Group | (Director, Officer, Board ember) | The SEI and any attachments, excluding the Confidential Form, are public records. Page s of 10 5a). List the name of each company or business with which you were associated where you or a member of your immediate | INo Business Associations | ts Poo | Self | ACH so - THC Themd Medic | Healt Core legal fees of more than $10,000 during 2016. | | 11. During 2016, were you a licensed professional (other than an attorney) or did you provide consulting services. | ove ro | + PT EE A a ee , | Type of Business | Nature of Services Rendered | 12. Are you o your employer, your SOUS or members of your immediate family, o ther employer curently: « License by the State board or employing entity wath which you ae of wil be associated or + Regulated by the State board or empicying entity with which you are or will be associated or Have 2 usiness relationship with th State board or employing entity with which you are or will oe associated? Dives Do C]Lesisiator cial Officer - You re not eau to complete ths question if you are fing because You are a epiiaor or dca aficer Cyn officer 1 defined n the SEL Helpha Tips) o you re ling a5 on appointee to those offices i Name of Person Name of Employer Type of Relationship | (it applicable) (Licensing, Regulatory, Business) | Adu Bees = . 13. Are you, your spouse or 3 member of your ImEate fan curently registered 35 a loabyist or 19boy et princil, <r were you registered as such within the 12 months preceding your filing of this form? Oves 3% Name of Lobbyist Lobbyist's Principal bateof | Registration Registration Expiration OTHER DISCLOSURES | 13. During any calendar quarter n 2016 (But only the time penod after you Were appointed, employed or fled or were naminated a5 » candidate), a1 you + receive any “G(s” exceeding $200 per Quarter fram a person or group of persons acting together, and « when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and + the gi(s) ere given under circumstances that would lead 3 reasonable person to conclude that they were given |" foriobbying? 1 > aves fo 10 not report 3785 gen by members of your extended amy. | 3-00 not report aits that have previously been repartea by you to the Department of the Secretary of State on the |" Eupense report fo Exempt persone.” Date Item Received Name and Address of Donor(s) Describe Item Received | Estimated Market | Value | | The SEL and any attachments, excluding the Confidential Form, are public records. Page 70f 10 15. During 2016 (but oly the time period after you were appointed, employed, or fled or were nominated 25 a candidate) did you + accept a “scholarship” exceeding $200 fom a person o group of persons acting together and + those persons) were outside North Carolina and + the schalrship was related to your public postion? A "scholarship is a grant-in-aid, lther direct or indirect, |" to attend o conference, meeting, or similar event, including tuition, travel, loging, meals, and other | similar expenses. [1¥%es (#No [Judicial Officer - You are not required to complete this question i you are a Judicial oficer or you are filing as a ucical officer 3pporiee > 00 not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” Logisators are not required to report scholarships paid by 3 nonpartisan legislative organization of which the legislator or the General Assembly 1s a member or participant or an afflate of that organization Date of ‘Nome and Address of Donor(s) Describe Event Estimated Market scholarship Value 16. Were you appointed or are you being considered for an appaintment to a covered board by the Governor or ancther Council of Sate member? Council of State members are » Governor » Lt Governor > Secretory of State » State Auditor » State Treasurer > Superintendent of Pubic Instruction » Attorney General > Commissioner of Agricuture » Commissioner of Labor » Commissioner of Insurance Doves af | 16 "Yes", lit all contributions you (NOT immediate family members) mode during 2016 with a cumulative | total of more than $1,000 to the Governor or other Council of State member who appointed you. | » Contributions are defined in N.C.G.5. 163-278.6(6) and include, but are not imited to, “any advance, conveyance, | depos, distribution, transfer of funds, oan, payment, if, piadge or subscription of money o Anh, of value | whatsoier.” i Date Amount Contributed to 7140 contribution(s) wih a cumulative total of more than $1,000 A mere than 51.0 EE — The SEL and any attachments, excluding the Confidential Form, are public records. Page 8.of 10 17. Are you an appointee or prospective appointee to | a. the head of 2 principal state department {e.q. cabinet secretary) appointed by the | wih | Smee of a ot he loving tres econ | 2 Comal Reman Commission an { + State Board of Education { es [Je © Ste Bom of lect | Own of Emplovment Security [No procend to Enerorméntal Management Commision | Guestion 18. dust Commisson | J — | + Rules Review Commission { + Board of Transportation | ~ UR Board of Governors | ~ Unites Conmssan | ccm SW ReTot COS COMTI oo - - - | 1150, were you appointed or are you being considered for apport to that | (1 ¥es No Se vor os Sounc of Sove embers oun of Sate amour rete | Tom Te et 10] in question 16. question 18. | |e 0, you must indicate whether during 2016 you (rot immediate family 1 members) hase m aw 1th ont acts wi espe so on ehal of | [| a candme o campo commit of he Count of Save mem who ++ | oped ou 0 Your poe poem: | [ves [No 1 Collected contributions om multiple conetors, took possession of such | ins comtboboras a ond deere os sere | | contributions to the candidate or commitiee? Contributions are defined in |W Vented rrr at your vessnce o poe of boseens? ves (ne [7 ie Volutesres fr camp relates octtes, wich lade, bt are mot med | or ame Doms wi stance mg, commie sn or om | Cves Time [8.Hove you ever ren comactad of felony for which you have rot reeled ser: (1a pardon of cence: o (1) on orn of expunaemant egarong he conaons tense | outootConicton | County of conviction | state ofConition 15. reyes aware of amy ihe lors Tat 7ou Doors Toy aie te Sat ECs Commision evra You Conca vou comphapes wih to Sie Govatenens Ee eS | Dives ho yes, lease provide such information bet The SE and any attachments, excluding the Confidential Form, are public records. Pages or 10 AFFIRMATION affirm that the information provided in this Statement of Lconomic Interest and any attachments hereto are tue. complete, | To dplnary con unde 65. THA rato (oT Agree N 7 NA l= A A 30 fu 2217 Fr Bae | | Aone C Bro | | | | Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. | The SEE and any atachments, excluding the Confidentia Form, are public records. Page 100110

NORTH CAROLINA STATE ETHICS COMMISSION | ro crnics commission ust oni " Pi 2017 STATEMENT OF ECONOMIC INTEREST | Do Recened 919-814-3600 wo. ethicscommission nego | 700 AN 30 MM 11: 01 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL 7 77 YOUR SET FILING OBLIGATION fC Seamed Jl Bue Sur. Sent Date o Sore. Receved bate JY. | FILE'S NAME (FIRST, MIODLE, LAST) _ _ Prefix | FirstName | Middle Name LastName sume | Aone. Covey [Baock A CURRENT EMPLOYER [08 me TR | Comsecranr NATURE OR TYPE OF BUSINESS. _Porncsi Consus TACT SE — REASON FOR FILING (COMPLETE ALL THAT APPLY) a [STATE GoveRNWENT 08 (spect Agency) 50ARD/COMMISSION (List compete name of al State E—— | boards on which you are serving or are being considered) Yr | EE oo | SeadATEe A. Be ther date fom es ee yur hr? a Ono When used throught ths orm, the term Tmmediate family nciudes your spouse (uriess legally separated). It also hclases memsers of your tended {amy (Your AMG your spousa' Chen, grandchidren, parents, grandparents, and | Sings, 3nd the Spouses of cach of those persons) wha reside in your household. | List the full name of all adults and emancipated minors n your household. A minor is a chid under 18 years od. | Niners are emancipated br Marge, ntaens nthe US Mary, ar cout oder for emancipation ° | FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER | JOBTITLE | NATURE OF EMANCIPATED MINORS | ~ 1 | ouemess butter Caer Broce. | sper Coa | Consraur | Pome Gewmy Bro] spruse THC Intend Phd Prsscnar is7. | swncne The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f 10 [B. List ONLY the initiate of atl unemancipated minors in your househald below. A minor is a hid under 18 years old Note: You must list the full name of each minor child on the Confidential Form available at the |__end of this document. = | | mumasror | retarronsnie EMPLOYER 208 TITLE NATURE OF UNEMANCIPATED | ‘BUSINESS Minors | : - = | SHB cme | oo — SEB emer | PROPERTY INTERESTS | 1 As of December 31. 2016, dd you, your spouse, or members of your immediate amily: A. Hoe an ownership interest in North Carolina real esate (including your residence) with a market vale of £10.00 or more” @es CINo | Owner of Real Estate | % Ownership Interest | Location by City Location by County » al (00 Lmadkoalle | Pave 1 . J SE 1 — 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” ives © Name of Lessor Name of Lessee 1 Real Estate, Location | If Personal Property, Renter) oy city & County “Descive 2. At any time during 2015 or 2016, did you, your spouse, or members of your immediate family sell to or buy from the Sate f orth Cargina personal property wih a market vaive of $10,000 or more? Oves (ho Name of purchaser | Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 20f 10 FINANCIAL INTERESTS 1 3. As of December 31, 2016, id you, your spouse, or members of your immediate family own any of the following financial interests valued 2t $10,000 or more? LIST EACH COMPANY INDIVIDUALLY. A. Stock in a publety owned company” ves _2fo________ S50 mt 1a oweerd eresis In a way nid ivesiment fund (inching mutasl funds, regulated ivestmert monies, or penion of sefered compensation pans) : () the fund 1 publicly trades or a assets are widely | inverse and ah nanher you no an Immediate family member are able to contol the ssets eld in th mutual fr, nvecmert companys or pension or deferred compensation pan Owner of Interest Full Name of Company (Do not use a ticker symbol) | 5 Stock Options in 2 company or business” Ove Ae Owner of Stock Option |Full Name of company (Do not use a ticker symbol) Interests 2 non-public oma company o businGes entity (including nerests in Sole propristorshis, arian, med Borers, J ventures, Imited habily Companies, [ted DALY partnersigs, and Sisal nla corporations) Coves fo tno, proceed to auestion Owner of Interest Name of Company or Business Entity € (1). For each non-publicly owned company or business entity (the “primary company”) identified in question | SE nave, rense Is the armas of ary ether compares or Business anes which the primary company awn securities or equity merists valued at ove $10,000, # nen Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company | (the Primary Company) Guns Security or Equity Interests [ #ftione or ot known | | — SE i I — — The SEI and any attachments, excluding the Confidential Form, are public records. Page 30f 10 C23 you know tht amy company or business ent ted in 3.C or 31) above tae any material business | Gains or madness coma th tn roe of Nor Carlo o 610000 on he Shore, prowde a wt | deacrgion of hae mes acy Name of Company or Business Entity Description of Business Activity with the State [Zone or ho Koown B i. | 4. As of December 21, 2016, were you, your spouse, or members of your immediate family the beneficiaries of a vested ru wi 3 valk 5 310,000 mre tat wa creme etobisnch, o comrales or vou? Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” | ves rho Name and Address of Trustee Description of the Trust Vour Relationship to the Trust 5 hs of December 31, 2016, dW you, vour spouse, or members of your Imes fal have labs of $10,000 or | ore, acu th PADRE on ot AAT Pers eda’ Exam de CHa Ad Be, Ste i, de Toone portant oar and war som fe oa One Name of Debtar (You, Spouse, Immediate Famity | Type of Creditor (Commercial Sank, Credit Union, Member) Individual, etc.) Anda Brose | Commern- Bore 6. Uist each source of income {ot specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family dunn 2016 Include salary, wages, state/local government retirement, professional fees, Komoror tees, Sudan a come. buses Mom, 37d une ep of meer fodee 10 be reporten of your Ste on fedrar tk eso ! Do ao include income received from the following sources: | > Capital gins » Federal government retirement | + itary retirement > Social security income/ 5501 | Recipient of Income Name of Source. Type of I tyweotincome | Biiness/Tndustry | 31 i ms vepartable income over £5000 m 2076 Vidas Bre [pc Ch 1 Got | Shetty Adee Beocic__ ol Mepcive | Sapatr bodren Broce Pie Tahmel Media, Mepicins | Sactey The SET and any attachments, excluding the Confidential Form, are public records. Page aor 10 PROFESSIONAL AND CIVIC RELATIONSHIPS | (a). During 2016, were you, your spouse or members of your [mmediate ferily @ director, officer, governing baard | omits enIoves, InagDendent Comttactor, o FeaRTered ObOyIS of 3 RORGYOR COTEDISNON of rg OpEratg n | th State of North Capoina primary for eluous, charable, Scenic, eran, publ health and safety, or educational | Duron? | ves Mo 16°No.” proceed to question's. | [= no Tt Sate boards or nile, or ene created by potvat bdsm of he Sate. | | > Do not fet organizations of which you are mere member. | Name of Person is Her Pasition Name of Nonprofit Nature of Business or | | = Corporation of Organization | Purpose of Organization | I RE SS E— 1 I 1 [ J | — | | 700. If the nonpront corporation or organizations sted nave do business with the State of North Carolina or receive SE fund please provi a bie 4escnpon of the notre of tha Busnes, 1 Known of ih Which dus Blkgonce could easonably be known ime of Nonprofit Corporation or Organization | Describe State Business or State Funding ane or ta Known 8. Dufng 2016, were you, your spouse, or members of your immediate family a director, officer, or governing board member of ary 50014, r3amcation, o A0vOGACY SHOUD Ah an GHEE in mater ver WHE YOu Cs or Board may Hoe hari? Dives [Me A) Legislator Judicial Officer You are not required to complete this question i you are fling because: Yo are eisator or der oer o you an Hing a5 am appaites 1 hese oes | 300 not Hest organizations of which you are ory a mermber (not serving in leadership role). Name of Person Name of Society, Organization | Leadership position | or Advocacy Group | (Director, Officer, Board ember) | The SEI and any attachments, excluding the Confidential Form, are public records. Page s of 10 5a). List the name of each company or business with which you were associated where you or a member of your immediate | INo Business Associations | ts Poo | Self | ACH so - THC Themd Medic | Healt Core legal fees of more than $10,000 during 2016. | | 11. During 2016, were you a licensed professional (other than an attorney) or did you provide consulting services. | ove ro | + PT EE A a ee , | Type of Business | Nature of Services Rendered | 12. Are you o your employer, your SOUS or members of your immediate family, o ther employer curently: « License by the State board or employing entity wath which you ae of wil be associated or + Regulated by the State board or empicying entity with which you are or will be associated or Have 2 usiness relationship with th State board or employing entity with which you are or will oe associated? Dives Do C]Lesisiator cial Officer - You re not eau to complete ths question if you are fing because You are a epiiaor or dca aficer Cyn officer 1 defined n the SEL Helpha Tips) o you re ling a5 on appointee to those offices i Name of Person Name of Employer Type of Relationship | (it applicable) (Licensing, Regulatory, Business) | Adu Bees = . 13. Are you, your spouse or 3 member of your ImEate fan curently registered 35 a loabyist or 19boy et princil, <r were you registered as such within the 12 months preceding your filing of this form? Oves 3% Name of Lobbyist Lobbyist's Principal bateof | Registration Registration Expiration OTHER DISCLOSURES | 13. During any calendar quarter n 2016 (But only the time penod after you Were appointed, employed or fled or were naminated a5 » candidate), a1 you + receive any “G(s” exceeding $200 per Quarter fram a person or group of persons acting together, and « when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and + the gi(s) ere given under circumstances that would lead 3 reasonable person to conclude that they were given |" foriobbying? 1 > aves fo 10 not report 3785 gen by members of your extended amy. | 3-00 not report aits that have previously been repartea by you to the Department of the Secretary of State on the |" Eupense report fo Exempt persone.” Date Item Received Name and Address of Donor(s) Describe Item Received | Estimated Market | Value | | The SEL and any attachments, excluding the Confidential Form, are public records. Page 70f 10 15. During 2016 (but oly the time period after you were appointed, employed, or fled or were nominated 25 a candidate) did you + accept a “scholarship” exceeding $200 fom a person o group of persons acting together and + those persons) were outside North Carolina and + the schalrship was related to your public postion? A "scholarship is a grant-in-aid, lther direct or indirect, |" to attend o conference, meeting, or similar event, including tuition, travel, loging, meals, and other | similar expenses. [1¥%es (#No [Judicial Officer - You are not required to complete this question i you are a Judicial oficer or you are filing as a ucical officer 3pporiee > 00 not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” Logisators are not required to report scholarships paid by 3 nonpartisan legislative organization of which the legislator or the General Assembly 1s a member or participant or an afflate of that organization Date of ‘Nome and Address of Donor(s) Describe Event Estimated Market scholarship Value 16. Were you appointed or are you being considered for an appaintment to a covered board by the Governor or ancther Council of Sate member? Council of State members are » Governor » Lt Governor > Secretory of State » State Auditor » State Treasurer > Superintendent of Pubic Instruction » Attorney General > Commissioner of Agricuture » Commissioner of Labor » Commissioner of Insurance Doves af | 16 "Yes", lit all contributions you (NOT immediate family members) mode during 2016 with a cumulative | total of more than $1,000 to the Governor or other Council of State member who appointed you. | » Contributions are defined in N.C.G.5. 163-278.6(6) and include, but are not imited to, “any advance, conveyance, | depos, distribution, transfer of funds, oan, payment, if, piadge or subscription of money o Anh, of value | whatsoier.” i Date Amount Contributed to 7140 contribution(s) wih a cumulative total of more than $1,000 A mere than 51.0 EE — The SEL and any attachments, excluding the Confidential Form, are public records. Page 8.of 10 17. Are you an appointee or prospective appointee to | a. the head of 2 principal state department {e.q. cabinet secretary) appointed by the | wih | Smee of a ot he loving tres econ | 2 Comal Reman Commission an { + State Board of Education { es [Je © Ste Bom of lect | Own of Emplovment Security [No procend to Enerorméntal Management Commision | Guestion 18. dust Commisson | J — | + Rules Review Commission { + Board of Transportation | ~ UR Board of Governors | ~ Unites Conmssan | ccm SW ReTot COS COMTI oo - - - | 1150, were you appointed or are you being considered for apport to that | (1 ¥es No Se vor os Sounc of Sove embers oun of Sate amour rete | Tom Te et 10] in question 16. question 18. | |e 0, you must indicate whether during 2016 you (rot immediate family 1 members) hase m aw 1th ont acts wi espe so on ehal of | [| a candme o campo commit of he Count of Save mem who ++ | oped ou 0 Your poe poem: | [ves [No 1 Collected contributions om multiple conetors, took possession of such | ins comtboboras a ond deere os sere | | contributions to the candidate or commitiee? Contributions are defined in |W Vented rrr at your vessnce o poe of boseens? ves (ne [7 ie Volutesres fr camp relates octtes, wich lade, bt are mot med | or ame Doms wi stance mg, commie sn or om | Cves Time [8.Hove you ever ren comactad of felony for which you have rot reeled ser: (1a pardon of cence: o (1) on orn of expunaemant egarong he conaons tense | outootConicton | County of conviction | state ofConition 15. reyes aware of amy ihe lors Tat 7ou Doors Toy aie te Sat ECs Commision evra You Conca vou comphapes wih to Sie Govatenens Ee eS | Dives ho yes, lease provide such information bet The SE and any attachments, excluding the Confidential Form, are public records. Pages or 10 AFFIRMATION affirm that the information provided in this Statement of Lconomic Interest and any attachments hereto are tue. complete, | To dplnary con unde 65. THA rato (oT Agree N 7 NA l= A A 30 fu 2217 Fr Bae | | Aone C Bro | | | | Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. | The SEE and any atachments, excluding the Confidentia Form, are public records. Page 100110

i Sy NORTH CAROLINA STATE ETHICS COMMISSION | ror ETHICS COMMISSION USE ONLY " Pr 2017 STATEMENT OF ECONOMIC INTEREST | Date Received. 919-814-3600 ww. ethicscommission nc. gov : SE omen "YOUR SEI FILING OBLIGATION Sead _ ze reo Sn Senome on i — Tren cog for Th— FERS GAME (FIRST, MIDDLE, LAST) Co ] Pret | First Name widdie Name | Last Name [sun | Cocrp | Broek | Cursent evpLOvER Jos mE - Spee SAEFANT FATURE 0% TPE OF BUSINESS Borstiwe Ooustgonre REASON FOR FILING (COMPLETE ALL THAT APPLY) Rn STATE GOVERNMENT 108 (Speci Agency) SOARD/ COMMISSION (ust complete none of all Ste i | bearer en wich you are sering o oe beng considered) S— one | ieorsiaron peer rover seme I ee NE. Du other immediate family members reside in your household? OE Oe When sed troushout tis form, th term Kmmediate family includes your spouse (unless egal separated). It so Includes members of your extended amy (your 30d you spOUSe chléhen, gtamdei rer, erent, srandparits, od Sings, snd he Spouses of 450 of hse breonc) whe reside n your hessonotd. List the full name of all adults and emancipated minors in your household. A minor is 3 child under 18 years old. Minors ar crmancontt y Marine: ent 1 the U3 kort of cout order for momepoton. FULL NAME OF ADULTS & | RELATIONSHIP EMPLOYER | JOB TITLE NATURE OF ‘eANCIPATED tiNoRS. | | a! SUstness. wer. 22 cr 222 eae. ] " ese PC Dreasilla) Reesicitndser Méaca + The SEX and any attachments, excluding the Confidential Form, are public records. Page 0110 B.. List ONLY the initials of ll incmancipated minors in your household below, A minor is @ child under 16 years od. Note: You must lst the full name of each minor child on the Confidential Form available at the end of this document. he Confidential Fe INITIALS FOR | RELATIONSHIP EMPLOYER 0B TITLE NATURE OF NEMARCIPATED Ustness noms _ i SD lewen EE I — SFB lee | _— EE Tw Jews SE SR E— PROPERTY INTERESTS 1.4% of December 31, 7016, did you, your spouse, or members of your Immediate forty: 0 A. Have an ownership interest in Rath Carolin rea estate (inching your residence) with a market value of Ge Ono Owner of Real Estate| % Ownership Tnterest | Location by City Location by Canty ni Padcom bras BE ZY — | | ©. Lease or rent real estate of personal property to of from the State of North Caroling with a market value of $1000 0 mare” Oves Ge Name of Lessor T Name of Lessee | If Real Estate, Location | If Persanal Property, } | Mma | Mugits lotion | Heerorat moet. 2. At any time during 2015 or 2016, did you, your spouse, or members of your immediate family sell to or buy from the Sl eran papery wi marke vue of 310,300 ox mares Oves [@No Nome of purchaser | Name of seller Type of Propurty I The SEX and any attachments, excluding the Confidential Form, are public records. Page 20 10 FINANCIAL INTERESTS 3. As of December 31, 2016, dd you, your spouse, or members of your immediate arly own any of the allowang financial interests valued ot $40,000 or more” LIST EACH COMPANY INDIVIDUALLY, A. Stock in a pblcy owned company? ves Who oo Do rt Ist ownership interests In 0 widely feid investment fund (nciuding matuel fonds, regulated investment companies, or pension or deferred compensation plane) i: () the fund 15 pUBTETY TID or ha assets are widely ersified; and (i) neither you nor an immediate fomily member are abe to cantrol the acsets held in the mutual und, investment company. o pension o deferred compensation plan Owner of Interest |_ Full Name of Company (Do not use a ticker symbol) ©. Stack Optians in a company ar business? Oves Gtio Interests In a no-publily owe company or business entity (including interests in sole proprietarships, Borinerships, hited portnershivs, Joint ventures, ied babiy companies, Imted 1atty partnerships, and Gosely held corporations)” [ives @fflo to. mace to question 4. — Owner of Tnterest Name of Company or Business Entity © 4). For each non-publicly owned company or business entty (the "primary company”) dented in question 3. abowe, please Ist the names of ny other Comasnies of business éntics in which the primary company ons sncuriies or quit interests valued a over $10.00, known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company TY the Primary Company) OT Gama Security or Equity Interests one o Hot Known lone or tor _— ee _— — I A The SEX and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 C0. Wyo bv tht amy compo o budiess on Fed . 3. o 3 CC) owe hs ny ater ners Wame of Company or Business Entity Sri ETT A OT TR Tee EE Pra Be ee et 0 ot tasers hl i bln rst. S201 SL Mlgf, ps or 0r. eftn of Vested Tse and "Bind Tost.” Ove @ ame Err pr — Ty Your Relationship v the Trust 5. As of December 31, 2016, did you, your spouse, or members of your immediate family have liabilities of $10,000 or hy § [rma [hme beveee [ER Zor Lot ch utc of incom (rt specie amare of gts TH 5.00 Feed Uy You, Jour Spent, 1 Ts of your immediate family during 2016. Include salary, wages, state/local government retirement, professional fees, Drain inom ses J i» redrnlprhsrmer sateen + ini rons + Social security income/S501 Recipient of Income [romper Type of ot co Boe A et amet Lhe lorart Meocanci | Shears Favcasanc azo | 0h c. vac ego lec A he S53 ant any stschmente, even tho Confnmin For 308 BOBS FSSRS Page sof 10 EE —— PROFESSIONAL AND CIVIC RELATIONSHIPS 7(3). During 2016, were you. your spouse or members of your immediate fomily a director, officer, governing board member, employes, Independent Contractor, of registered 1oboyist of 3 NONBIORE Corporation o organization aperating in the State of North Carolina primar fo relgious. charitable, scientific, terary, public health and safety, or educational purposes” ves on “Ho,” prcecd to question 8. > Do not list State boards or entities, or entities created by a political subdivision of the State. TT > Do not It organizations of which you are a mere member. oo Name of Person | Wis/Her Position | Name of Nonprofit Nature of Business or - Corporation or Organization | Purpose of Organization 1 f 700). 17 the nonprofit corporations o organizations sted above do business with the State of North Carolina o receive Stat funds, please provide 3 biel Gescrption of the nature of that business, f Known or with which due dligence could reasonably be known. Nagne'af Nonprofit Corporation or Organization | Describe State Business or State Funding fone or ot Krown 6 During 2015, were you, your spouse, oF menbers of your immediate family 8 director, oficer or Governing board member of any sacity, organization, or SAvoCacY 01GB ith an nLEres in matters over which your agency or board may Rave Junsdiction’ [Ives [ino ofCegislator/ Judicial Officer - You are not required to complete this Question i you are fing becouse ou are a legislator or a Judicial afcer o you ore fing a5 an appointee to hase offices. | 00 nat ist organizations of whit yau are only » member (not serving in 3 leadership role. Name of Person Name of Society, Organization Leadership Position or Advocacy Group, (Director, Officer, Board Member) — 4 - SE The SEL and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Name of person | Relationship to Fler | Name of Company Rote of Persan ware (Sock ain - Tulrerse (NED S00 ve rg ak ay capa nes ent ted (a) above td ay Tatra bynes esis or era ye Se ood oe So Stes nit ame of Company o Business Entity Description of Business Activity with the State aa J Freep p— JET ARTI — eon ec of ve om S000 pars SHI Ep—— Cnameaty FET Er— Jian ves pfs Tie ire tail ERT S— pages of 10 12. Ave vou or yaur employer, your spouse or members of vous mediate far, or ther employer curenth: « Licensed by the State board or employing entity ith which you ae a wil be associated or + izaulatedby the State boar or employing entity with which you are or wil be associated or Have. business elaionshin with the State baard or employing entity with which you are or wll be associated? (es [IMo. []Legiltor/Nudicial Officer You re not require to complet. this question you are flag because eu are litter of Juda afer (rica olhcer is dling in the SE) Hell Tip) or vou re ing 35 on appamtee 1a hase offees Name of Person Name of Employer B Type of Relationship it applicable) (Licensing, Regulatory, Business) Autores Broce [PHC Laz leeass 3. Ar vou, your spguse or member of your mediate family currently regstered as a lobbyist a lobbyist principal, or were you ve Such within the 12 manths preceding your Hing of this. ori? Oves tho Name of Lobbyist Lobbyiet's Principal bate of Registration Registration Expiration 1 JS ER OTHER DISCLOSURES _ — 14. During any calendar quater In 2016 (bu ony the me peso ater you wer: pointed, employed or fled o were nominated a5 candida), dd you receive any "iis) exceeding $200 pr quarter from person o group of persons acting Lpether, and. when Both you and those persons) were outside North Carolina at the time yau accepted the git(s), and + the gs) were given under circumstances that would lead 3 reasonable person to conclode tha they were given or lobbying” Ove OE i ot repo GS Gee By FRR of your Seay, +00 not report aif that have previously heen reported by you to the Department of the Secretary of State on the expense Repo for Exempted Persons.” Date tem Received | Name and Address of Donar(s) | Deserib Tem Received | Estimated Market | Value The SEE and any attachments, excluding the Confidential Form, ae public records. Page 701 10 15. During 2016 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) did you « accept a “scholarship” exceeding $200 from a persan or group of persons acting together and + those person(s) were outside North Carolina and « the scholarship was related to your public position? A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. [es (Mo [Judicial Officer - You are not required to complete this question if you are a Judicial officer or you are fling as a Judicial officer appointee. » Do not report gifs that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” » Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly is a member or participant or an affiliate of that organization. Date of Name and Address of Donor(s) Describe Event Estimated Market Scholarship Value | cermrepmempreme ass 1 I E—— 16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or another Counal 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 ves [mo Xf "Yes", list all contributions you (NOT immediate family members) made during 2016 with a cumulative total of more than $1,000 to the Governor or other Council of State member who appointed you. » Contributions are defined in N.C.G.S. 163-278.6(6) and include, but are not limited to, "any advance, conveyance, deposit, distribution, transfer of funds, loan, payment, gif, pledge or subscription of money or anything of value. whatsever,” Date Amount Contributed to £1 Ho contribution(s) with cumulative total of more than $1,000 The SE and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 17. Are you an appointee or prospective appointee to: a. the head of a principal state department (c.0. cabinet secretary) appolnted by the Gavernor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge, or <. a member of any of the following boards. + ABC Commision + Coastal Resources Commission + State Board of Education Oves © + State Board of Elections + Division of Employment Security I “No proceed to + Environmental Management Commission question 18. © Industral Commission + Human Resources Commission + Rules Review Commission « Board of Transportation « UNC Board of Governors + Utities Commission + wilde Resources Commission 4 1 s0, were you appointed or are you being considered for appointment to that | (Yes [No Julc postin by 4 Counc of State member? Council of State members arc listed | 11 vo,” proceed to Ingestion 16. question 18. ©. 1150, you must indicate whether during 2016 you (nat immediate family eabers) engaged in any of the folowing activiies wilh respect 0 or an behalf of the condidate or campaign commitice of the Counc of State member who Sppointed you to your pubic positon: [IYes [INo I. Collected contributions from multiple contributors, tosk possession of such allple contributions, and transferred or deleréd those collected Contributions to the candidate or committee? Contributions are defined in auestion 16. Hosted a fandratsce at your residence or place of business?” [ives [iNo i. Volonteered for campaign-related acts, which include, but are not hed To, phe banks, event acsitance, mals, convassing, surveying, or any | (Yes (No ther ackvity tht advances the campaign of a candidate? 1 eve you ever een convicted of a felony for which you have nit received either: (1 a pardon of Innocence; or (1) an ore of expungfhent regarding that conviction? Oves oho offense Date of Conviction | County of Conviction State of Conviction 15. Are vou aware gf any other Information that you believe may assist Uh tote Ethics Commission In advising you concerning your cpfmplance wih the State Government Ethics ACL? (I¥es ho tyes, please provide such information below. The SEX and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 AFFIRMATION Vfl tho he formation provided his Statement of Econ tres ad any athens hereto ar 0s complet, and acute to the best of my knowledge ad belief lo crit that hae no transfered. nd wil nd nse, any ase, rst, o propery for the purse of once it understand thas my Statement of soso terest and any atachments or supplements thereto (ith the exception of the Confidential Form regarding Unemancipated Cider) are public second. acknowledge ha have read ad derstand N.C.G.. 138426 reganing concealing or fling 0 disclose materi) information nd CGS. 1382-27 regarding providing fe formation: | A iting perso sho knowingly consets or knowingly fis disclose information tat required tobe disclosed | on a statement of economic interest under this Article shall be guilty of a Class | misdemeanor and shall be subject Lo dicplvary action under GS. IAS. §138A-27, Penal for se information Kring ht te nfo s Fs guy of a Cas H Felony and sll be subject fo disciplinary action under | es Aas Signature pre 207 Ama Bee | Submit SIGNED, ORIGINAL documents only. Do not fax or email thisform. The SEE and any attachments, excluding the Confidential Form, are public records. Page 10010

NORTH CAROLINA STATE ETHICS COMMISSION 2016 STATEMENT OF ECONOMIC INTEREST CANDIDATE NO CHANGE FORM 2016 ELECTION FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Hon. Andrew Coley Brock REASON FOR FILING (SELECT ALL THAT APPLY) CANDIDATE For (Please specify the office for which you are running) Senate STATE GOVERNMENT JOB (Please specify the agency for which you work or are being considered) BOARD/COMMISSION (Please list complete name of all State boards on which you are serving or are being considered) JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate) Senate The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2015 Statement of Economic Interest and that as of December 31, 2015, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 2/21/2016 Signature Date Andrew Coley Brock Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

2%, NORTH CAROLINA STATE ETHICS COMMISSION Hi] Pr 2015 STATEMENT OF ECONOMIC INTEREST XE NO CHANGE FORM First Name [date Name | Last Name Aporem” Cor poCk_ REASON FOR FILING (SELECT ALL THAT APPLY) [C) STATE GOVERNMENT JOB (Please specify the agency for | [] BOARD/COMMISSION (Please list complete name of all Which you work or are being considered) State boards on which you are serving or are being considered CIIUDICIAL OFFICER (Please speciy th office you hold) _| GCEGISLATOR (Please specity House or Senate) ENATE afr that the information provided in ths Statement of Economic Interest and any attachments hereto are true, Complete, 2nd accurate o the best of my knowledge and belief. alo certity that £ have not transferred, and will ot transfer, any asset, intres_, of property forthe purpose of concealing it from disclosure whi retaining an equitable intrest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancpated Children) are public record acknowledge that 1 nave read and understand N.C.G.S. 1384-26 regarding concealing o filing to disclose material information and N.C.G.S. 138A-27 regarding providing flse information: § 138A-26. Concealing or falling to disclose material information. A fing person who knowingly conceals o knowingly ais to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shal be subject © Giscpinary action under G.5. 136-45. § 1388-27. Penalty for flse information. A ing person who provides fase information on a statement of economic intrest as required under tis Article owing tha the information is fase s quky of a Clas felony and shall be subject to disciplinary action under GS 1384s I hereby affirm that I have reviewed my most recently filed 2014 Statement of Economic Interest and that as of December 31, 3014, my responses continue to be true, correct, and complete to the best of my knowledge and bell i Anreenr Coz Baas 27 Appi 2015 Frnted Name Tote Submit SIGNED, ORIGINAL documents only. | Do not fax or email this form. Pavan This entire document is 3 public record.