Anna V. Stearns

wsRECEIVED OZER ’ (aie) STATE ETHICS COMMISSION APR - 12018 <7 RE. 2019 STATEMENT OF ECONOMIC 0 hd INTEREST oo 27 Creches for compen This entire form must be completed to fulfill 3% scmes By Rome your ethics filing obligation. Incomplete Qs Supp. sent ate or Supp. receeg cote entered in database or Filer's Name (First, Middle, Last) bro [Frsthame | MiadieName [LastName [sum | ms. Anca Virginia earn [| Nature or Type of Business Reason For Fiing (Complete al that apply.) State Government ob (Speciy agency and position) | Board/ Commission (Ust complete names of al State boards | lees on which you are serving or are being considered.) _ Lo NE Huan Relations Comenisson Judicial Officer (Specify office.) Legishator (Specify House or Senate.) ‘A. Do other immediate family members reside in your household? : Oves fo On this form, "immediate family includes your spouse (unless legally separated). It aio includes members of your Crtensed family (your and yout spouse's chikiren, grandchildren, parents, grandparents, and sidings, and the spouses of cach 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 inthe US miltary, or court order for emancipation. | Full names of Adults and | Relationship Employer Job Title Nature of Business ‘Emancipated Minors —] The SEI and any attachments, excluding the Confidential Form, are public records. Page 10f 10 .. Uist only the initials of ail unemanipsted minors in your household below. A minor is 2 hid under 18 years od. List the full name of each minor child on the Confidential Form at the end. | Initials of Relationship Employer Job Title [rors | Unemancipated 1. As of December 31, 2018, id you or any members of your Immediate family: A. have an ownership interest in North Carolin real estate (including your residence) with a market value of $10,000 or mare? Ove ®fo | owner of Real Estate | % Ownership Interest Location by City | _ Location by County [ I A A 5. lease or ren real estate or personal property to o from the State of North Carolina with a market value of $10,000 or more? Oves © Name of Lessor Name of Lessee | If Real Estate, Location | If Personal Property, (Renter) by City & County Describe 2. Atany time during 2017 or 2018, id you or any members of your immediate family sll to or buy from the State of North Carolina persona property wrth $10,000 o more? Oves @No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 20110 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? Oves rho 0 not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferrd compensation plans) I: 1. the fund is publicly traded or is assets are widely diversified; and 2. neither you nor a immediate fomily member ae able o control the underlying assets. [ ownerofimerest | Full Nameof Company or ticker symbol | 5. Stock options in 2 company or business? Oves fo Owner of Stock option Full Name of Company (Do not use a ticker symbol) 1 | C. Interests in a non-publicly owned company or business entity? These include interests in sole proprietorships, partnerships, imited partnerships, Joint ventures, limited abil companies, mite abity partnersnizs, and Closely neld corporations. Yes (Ro - If “No,” proceed to question 4. [ ownerorimeen | Name of Company o Business Entity € (1). For each company or business entity Identiied in question 3.. (the “Primary Company”), please Ist | the names of any other companies or business entiles in which th Primary Company ows Securities or cauty interests valved at over $10,000, f known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests None or not known The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 C2). 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 Carolin, or i regulated by the State, briefly describe tha business actvy. Name of Company or Business Entity Description of Business Activity with the State CJ 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 | Value of $10,000 or more that you created, established, or controled? 0 not list assets held in bind trusts. See 2019 SEI Helpful Tos for the definition of “Vested Trust” and "Blind Trust.” Oves &No Name and Address of Trustee Description of the Trust Your Relationship to the Trust 5. As of December 31, 2018, did you any members of your immediate family have labiltes 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 deb. Yes Ono Type of Creditor (commercial Bank, credit union, | individual, etc.) Anna_SHeay | Shident lan | 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate famiy during 2015. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, didends, rental Income, business income, and other types required to be reported on State and federal tax returns. 00 mot include income received from the following sources ‘ > Capital gains > Federal goverment retirement > Miltary retirement > Social security income/SSO1 Recipient of Income Name of Source Type of Type of Income | Business/ Industry | C11 had no reportable income over $5,000 n 201. The SEI and any attachments, excluding the Confidential Form, are public records. Page 40f 10 Professional and Civic Relationships 70) uring 2018, were you or any members of your Immediate family 3 drecir, offer, governing board member, Corayee eran contactor, of repre SOS of 8 ORDIOR Corpora for SONS Sperating n Norn Cia may fo ree, chaneame: sentie, erars, PUSH neat and sfc, of caucanona PUSSes bo not fs Sate boards or ences. > Do not is organizations of which you ae a mere member. Name of Nonprofit Nature or Corporation or Organization | Purpose of organization 700). 1 he ronprfit corporations or organizations [sed above do business with th State of Nari Carona o receive Site fund, i Sess th hare of ht bosess, Know o wth Gus GHgence oui essonaby be Know | Name of Nonprofit Corporation or Organization Describe tate Business | 5 None ar Not Known | During 2016, wee yay oF any TerSes o your ede ar 3 rede, Teer, 0 Governg Board memeer of or Shay, Organon, or Hivecay gros wh a meres m rer over which You acy of osrd may nave pub ves No (Legislator Judicial Officer - You are not required to complete tis question i you are ling because Tou oe a pean or Tal oees of vou are my 1 apPaTESE 0 oe of ote Seen D0 not is organizations of which you ae oly a member and o na seve in a leadership roe. Name of saciey, organization, Leadership positon or Ravocsty crows (Director, officer: Board Member) The SEE and any attachments, excluding the Confidential Form, are public records. Page sof 10 [0] Not applicable (No entities listed on #9a) [Yes [INo [Fudicial Officer/State Attorney Oves ®ho 12. Are you or your employer, or any members of your immediate family, or their employers currently: | + icensed by the State boar o agency with which you are or wil be associated or + regulated by th State board or agency with which you are or wil be associated or + In business relationship with the State board or agency with which you are or will be associated? [Yes [No [JLegislator/Judicial Officer - You are not required to complete this question if you are filing because ou are a legislator or 3 Judal fice or you are ling as an appointee to ane of those offices. Name of Employer Type of Relationship if applicable) (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered 25 3 lobbyist or lobbyist principal within the 12 months preceding your fing of tis form? Oves &fo Lobbyist’ principal Date of Registration Registration Expiration Other Disclosures 16. During 2018, afer you were appointed, employed, o fled or were nominated s a candidate, did you « receive any "git(s)" exceeding $200 per quarter from person or group of persons acting together, + when bath you and those person(s) were outside North Carona, + under circumstances that would lead reasonable person to conclude the gifts were given fo 106Bying? To answer Yes, all three conditions must apply. Ove @fo > Bo not report gifs given by members of your extended family. > Do not report gifs you have previously reported on the "Expense Report for Exempted Persons.” [ Date Item Received | Name and Address of Donor(s) | Describe Item Received | empgpneer | | I T [ [ [ T I I The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 15. During 2018, afer you were appointed, employed, ar fed or were nominated os a candidate, did you accept “scholarship excesding $200 related to your public POSin from person or group of parsons aC together, + when those person(s) were outside North Coroina? To answer ves, both conditions must apy. | A “scholarship? Is a grant-in-ald, either direct or Indirect, to attend a conference, meating, or similar ven, tnchading tuion, wravel, 1643ing, meats, and other Similar expenses. [ves No [Judicial Officer - You are not required to complete this question If you are judicial officer or you are Ting 33 judicial officer appoiice. Do not report its you have previously reported on the “Expense Report for Exemped Persons.” + Legilotors are nt recuired to report schlarhigs paid by a nonpartisan legislative organization of whch te legislator of the General Assembly 1 8 mermoer, partipant, or ofate. Date of | Name and Address of Donor(s) senotarsnin | | TT 1 | 16. Hove you been appointed or considered for appantment to a covered board by the Govern or another Councl of State member? Council of State members are: > Governor > ut. Governor > Secretary of Sate » state Auditor » State Treasurer > Superintendent of Public Instruction » Attorney General » Commissioner of Agriculture» Commissioner of Labor » Commissioner of Insurance es Ono 16 "Yes, ist all contributions you made in 2018 with a cumulative total of more than $1,000 o the Council 21 State member who appointed you. Do not include contributions from Immediate family members. + Contributions ar defied broadly in N.C.G.5. § 163A-1411(13) nd include “any advance, conveyance, deposi, Coon, ante of tnd, ah, payment, aif, pleage of subseripan of maney or SERA of valve hatsoser _ Date I ‘Amount I Contributed to No contrbution(s) with a cumulative total of more than $1,000 | I A—— 7 The SEX and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 17. Are you an appointee or prospective appointee as: 5. the head of 2 principal sate department (e.3, cabinet secretary) appointed by the | Governor; or 5. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court ude; or <. a member of any of the following boards: + ABC Commission + Coastal Resources Commission + State Board of Education @¥es [INo + State Board of Elections + Division of Employment Security It “Nos proceed to + Environmental Management Comission question 18. + Industris Comission + Human Resources Commission + Rules Review Commission + Board of Transportation + UNC Board of Governors + Utiies Commission + Wife Resources Commission a. 1f 50, were you appointed o are you being considered for appointment to that | (Wes [INo postion by 5 Counc of State member? none question 18. e. If 50, you must indicate whether during 2018 you engaged in any of the following activities with respect to or on benal of the candidate or campaign committee of the Council of State member who appointed you i. Collected contributions from multiple contrioutors, took possession of such | (J¥es [No multiple contributions, and transfered or delivered those collected Contributions to the candidate or committee? | il Hosted a fundraiser at your residence or place of business? [Oves ho iil. Volunteered for campaign-related activities, including phone banks, event | assistance, malings, canvassing, surveying, or any ather activity that advances | (1 Yes fio the campaign of » candidate? | 18. Have you ever been convicted of felony for which you have nat received either: (1) a pardon; or (I) an order of expungement? Oves fo [omens | woot Comvition | County of Conviction | _ state of Conviction rr 1 1 | 15. Are you aware of any other information that you bellve may assist the Ethics Commission in advising you Concerning your compliance with the State Government EUs Act? Dives [No Ifyes, please provide that information below. The SEX and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 prem— “The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate I Piranesi ER ——— ants tag Serena cts I da ER ctor the Content For ern A. 5 631, Concent or og discs tel formation. a — ee ee metas ds Soa SoS ot ee IS — | onl ves, ttm at vv revit oy itn fed 01 Steen of Econ rst ad at oof December 3, a a sn bo noes sd sev a HSS HT te ein trade: % sh /i1q LLL Sut signe, oii sosuments any. Base tor ell ti form. The SEI and an attachments, excluding the Confidential Form, are public ecards. sesesvotio

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 Anna V. Stearns 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) Human Relations Commission; 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 6/1/2018 Signature Date Anna V. Stearns Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

COMPLETE THIS FORM AND MAIL SIGNED, ORIGINAL TO STATE ETHICS COMMISSION, 1324 MAIL SERVICE CENTER, RALEIGH, NC 27699-1324 NORTH CAROLINA STATE ETHICS COMMISSION 2017 STATEMENT OF ECONOMIC INTEREST 919-814-3600 www.ncsbe.gov/Ethics/SEI FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Anna V. Stearns CURRENT EMPLOYER JOB TITLE General Assembly Legislative Assistant NATURE OR TYPE OF BUSINESS Government REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify Agency) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) Human Relations Commission; JUDICIAL OFFICER (Specify Office) LEGISLATOR (Specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 A. Do other immediate family members reside in your household? Yes No When used throughout this form, the term Immediate family includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your household. List the full name of all adults and emancipated minors in your household. A minor is a child under 18 years old. Minors are emancipated by marriage, enlistment in the US military, or court order for emancipation. FULL NAME OF ADULTS & EMANCIPATED MINORS RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS B. List ONLY the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. INITIALS FOR UNEMANCIPATED CHILDREN RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS PROPERTY INTERESTS 1. As of December 31, 2016, did you, your spouse, or members of your immediate family: A. Have an ownership interest in North Carolina real estate (including your residence) with a market value of $10,000 or more? Yes No Owner of Real Estate % Ownership Interest Location by City Location by County B. Lease or rent real estate or personal property to or from the State of North Carolina with a market value of $10,000 or more? Yes No Name of Lessor Name of Lessee (Renter) If Real Estate, Location by City & County If Personal Property, Describe The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 2. At any time during 2015 or 2016 , did you, your spouse, or members of your immediate family sell to or buy from the State of North Carolina personal property with a market value of $10,000 or more? Yes No Name of Purchaser Name of Seller Type of Property FINANCIAL INTERESTS 3. As of December 31, 2016, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY A. Stock in a publicly owned company? Yes No Do not list ownership interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: (i) the fund is publicly traded or its assets are widely diversified; and (ii) neither you nor an immediate family member are able to control the assets held in the mutual fund, investment company, or pension or deferred compensation plan. Owner of Interest Full Name of Company (Do not use a ticker symbol) B. Stock Options in a company or business? Yes No Owner of Stock Option Full Name of Company (Do not use a ticker symbol) C. Interests in a non-publicly owned company or business entity (including interests in sole proprietorships, partnerships, limited partnerships, joint ventures, limited liability companies, limited liability partnerships, and closely held corporations)? Yes No If "No", proceed to question 4. Owner of Interest Name of Company or Business Entity The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 C (1). For each non-publicly owned company or business entity (the “primary company”) identified in question 3.C above, please list the names of any other companies or business entities in which the primary company owns securities or equity interests valued at over $10,000, if known. Non-Publicly Owned Company or Business Entity (the Primary Company) Other Companies in which the Primary Company Owns Security or Equity Interests None or Not Known C (2). If you know that any company or business entity listed in 3.C or 3.C(1) above has any material business dealings or business contracts with the State of North Carolina, or is regulated by the State, provide a brief description of that business activity. Name of Company or Business Entity Description of Business Activity with the State None or Not Known 4. As of December 31, 2016, were you, your spouse, or members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that was created, established, or controlled by you? Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” Yes No Name and Address of Trustee Description of the Trust Your Relationship to the Trust 5. As of December 31, 2016, did you, your spouse, or members of your immediate family have liabilities of $10,000 or more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student loans, personal loans and intra-family debt. Yes No Name of Debtor (You, Spouse, Immediate Family Member) Type of Creditor (Commercial Bank, Credit Union, Individual, etc.) Self Auto Loan Self Student Loans Self Credit Card Debt The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family during 2016. Include salary, wages, state/local government retirement, professional fees, honoraria, interest, dividends, rental income, business income, and other types of income required to be reported on your State and federal tax returns. Do not include income received from the following sources: Capital gains Federal government retirement Military retirement Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income I had no reportable income over $5,000 in 2016. Self NC Gen. Assembly Government Salary Self Turner for NC House Consulting Self-Employment Parent Human Bookkeeping Accounting Salary PROFESSIONAL AND CIVIC RELATIONSHIPS 7(a). During 2016, were you, your spouse or members of your immediate family a director, officer, governing board member, employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in the State of North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? Yes No If "No", proceed to question 8. Do not list State boards or entities, or entities created by a political subdivision of the State. Do not list organizations of which you are a mere member. Name of Person His/Her Position Name of Nonprofit Corporation or Organization Nature of Business or Purpose of Organization Self Director An Equal Voice, Inc. Electoral Advocacy 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, please provide a brief description of the nature of that business, if known or with which due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 Please answer the following question as it pertains to the following board/agency: Human Relations Commission 8. During 2016, were you, your spouse, or members of your immediate family a director, officer, or governing board member of any society, organization, or advocacy group with an interest in matters over which your agency or board may have jurisdiction? Yes No Legislator/Judicial Officer - You are not required to complete this question if you are filing because you are a legislator or a judicial officer or you are filing as an appointee to those offices. Do not list organizations of which you are only a member (not serving in a leadership role). Name of Person Name of Society, Organization or Advocacy Group Leadership Position (Director, Officer, Board Member) 9(a). List the name of each company or business with which you were associated where you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2016. Name of Person Relationship to Filer Name of Company Role of Person No Business Associations Rosemary Stearns Parent Human Bookkeeping Managing Bookkeeper 9(b). If you know that any company or business entity listed in 9(a) above had any material business dealings or business contracts with the State of North Carolina or was regulated by the State as of December 31, 2016, provide a brief description of that business activity. Name of Company or Business Entity Description of Business Activity with the State Not applicable (No entities listed on #9a) No relationship / Not known 10. Are you a practicing attorney? Yes No Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2016. Administrative Admiralty Corporate Criminal Decedent’s Estates Environmental Insurance Labor Local Government Real Property Securities Tax Tort litigation (including negligence) Utilities Regulation Other category not listed. The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 11. During 2016, were you a licensed professional (other than an attorney) or did you provide consulting services individually or as a member of a professional association for which you charged or were paid over $10,000? Yes No Type of Business Nature of Services Rendered Please answer the following question as it pertains to the following board/agency: Human Relations Commission 12. Are you or your employer, your spouse or members of your immediate family, or their employer currently: • Licensed by the State board or employing entity with which you are or will be associated or • Regulated by the State board or employing entity with which you are or will be associated or • Have a business relationship with the State board or employing entity with which you are or will be associated? Yes No Legislator/Judicial Officer - You are not required to complete this question if you are filing because you are a legislator or a judicial officer (“judicial officer” is defined in the SEI Helpful Tips) or you are filing as an appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Are you, your spouse, or a member of your immediate family currently registered as a lobbyist or lobbyist principal or were you registered as such within the 12 months preceding your filing of this form? Yes No Name of Lobbyist Lobbyist’s Principal Date of Registration Registration Expiration OTHER DISCLOSURES The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 14. During any calendar quarter in 2016 (but only the time period after you were appointed, employed or filed or were nominated as a candidate), did you • receive any gift(s) exceeding $200 per quarter from a person or group of persons acting together, and • when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and • the gift(s) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? Yes No Do not report gifts given by members of your extended family. Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the "Expense Report for Exempted Persons." Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market Value Please answer the following question as it pertains to the following board/agency: Human Relations Commission 15. During 2016 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) did you • accepted a “scholarship” exceeding $200 from a person or group of persons acting together and • those person(s) were outside North Carolina and • the scholarship was related to your public position? A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. Yes No Judicial Officer - You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly is a member or participant or an affiliate of that organization. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 Please answer the following question as it pertains to the following board/agency: Human Relations Commission 16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or another Council of State member? Council of State members are: • Governor • Lt. Governor • Secretary of State • State Auditor • State Treasurer • Superintendent of Public Instruction • Attorney General • Commissioner of Agriculture • Commissioner of Labor • Commissioner of Insurance Yes No If “Yes”, list all contributions you (NOT immediate family members) made during 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, gift, pledge or subscription of money or anything of value whatsoever.” Date Amount Contributed to No contribution(s) with a cumulative total of more than $1,000 The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 11 Please answer the following question as it pertains to the following board/agency: Human Relations Commission 17. Are you an appointee or prospective appointee to: a. the head of a principal state department (e.g. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or c. a member of any of the following boards: • ABC Commission • Coastal Resources Commission • State Board of Education • State Board of Elections • Division of Employment Security • Environmental Management Commission • Industrial Commission • Human Resources Commission • Rules Review Commission • Board of Transportation • UNC Board of Governors • Utilities Commission • Wildlife Resources Commission Yes No If "No", proceed to question 18. d. If so, were you appointed or are you being considered for appointment to that public position by a Council of State member? Council of State members are listed in question 16. Yes No If "No", proceed to question 18. e. If so, you must indicate whether during 2016 you (not immediate family members) engaged in any of the following activities with respect to or on behalf of the candidate or campaign committee of the Council of State member who appointed you to your public position: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? Contributions are defined in question 16. Yes No ii. Hosted a fundraiser at your residence or place of business? Yes No iii. Volunteered for campaign-related activities, which include, but are not limited to, phone banks, event assistance, mailings, canvassing, surveying, or any other activity that advances the campaign of a candidate? Yes No 18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon of innocence; or (ii) an order of expungement regarding that conviction? Yes No Offense Date of Conviction County of Conviction State of Conviction The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 19. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? Yes No If yes, please provide such information below. AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I Agree Signature Date Anna V. Stearns Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11