Anthony "Andy" Terry Lancaster
Governor, Office of theLabor, Department ofTryon Palace Commission
Filings
2025 Labor, Department of
Document text
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10
STATE ETHICS COMMISSION
2025 STATEMENT OF ECONOMIC
INTEREST
ELECTRONIC FILING
This entire form must be completed to fulfill
your ethics filing obligation.
Filer’s Name (First, Middle, Last)
Prefix First Name Middle Name Last Name Suffix
Mr. Anthony Lancaster
Current Employer Job Title
NCDOL Special Assistant to the Commissioner for External Affairs
Nature or Type of Business
External affairs
Reason For Filing (Complete all that apply.)
Are you a CANDIDATE for
elected office?
☐ Yes ☒ No If yes, for what position are you seeking election? (Specify
name of office seeking in box below.)
Do you currently hold this
position?
☐ Yes ☐ No
State Government Job or Post-Service Filer (Specify
agency and position.)
Board/Commission (List complete names of all State boards
on which you are serving or are being considered.)
Labor, Department of - Special Assistant to the
Commissioner for External Affairs
Judicial Officer, Post-Service Filer, or Judicial Officer
Appointee (Specify office.)
Legislator, Post-Service Filer, or Appointee to Legislative
Office (Specify House or Senate.)
A. Do any immediate family members reside in your household?
☒ Yes ☐ No
On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors
under 18 years of age). It also includes members of your extended family (your and your spouse’s children,
grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your
household.
List the full name of all adults and emancipated minors in your household. Minors are children under 18. They are
emancipated by marriage, enlistment in the US military, or court order for emancipation.
Full names of Adults and
Emancipated Minors
Relationship Employer Job Title Nature of Business
Cameron Edward Lancaster Child Dunkin Donuts Cashier Doughnuts
Kim Hubbard Lancaster Spouse Grifols HR Compliance
Manager
Pharmaceutical
manufacturing
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
Property Interests
1. As of December 31, 2024, did you or any members of your immediate family:
A. have an ownership interest in North Carolina real estate (including your residence) with a market value of
$10,000 or more?
☒ Yes ☐ No
Owner of Real Estate % Ownership Interest Location by City Location by County
(Self plus Spouse) 100.00% Raleigh Wake
B. lease or rent real estate or personal property to or from the State of North Carolina with a market value of
$10,000 or more?
☐ Yes ☒ No
Name of Lessor Name of Lessee
(Renter)
If Real Estate, Location
by City & County
If Personal Property,
Describe
2. At any time during 2023 or 2024, did you or any members of your immediate family sell or buy personal property
worth $10,000 or more to or from the State of North Carolina?
☐ Yes ☒ No
Name of Purchaser Name of Seller Type of Property
The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10
Financial Interests
3. As of December 31, 2024, did you or any members of your immediate family own any of the following financial
interests valued at $10,000 or more? List each company individually.
A. Stock in a publicly owned company?
☒ Yes ☐ No
► Include stocks held individually of in a portfolio managed by a financial services company
Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or
pension or deferred compensation plans) if:
1. the fund is publicly traded or its assets are widely diversified; and
2. neither you nor an immediate family member are able to control the underlying assets.
Owner of Interest Full Name of Company or ticker symbol
Kim Hubbard Lancaster (Spouse) AmerisourceBergen
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, 2024, were you or any members of your immediate family the beneficiaries of a vested trust with
a value of $10,000 or more that you created, established, or controlled?
Do not list assets held in blind trusts. See 2025 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.”
https://ethics.nc.gov/seis
☐ Yes ☒ No
Name and Address of Trustee Description of the Trust Your Relationship to the Trust
The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10
5. As of December 31, 2024, did you any members of your immediate family have liabilities of $10,000 or more, excluding
the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student loans,
personal loans and intra-family debt. Do not disclose the amount of the debt.
☐ Yes ☒ No
Name of Debtor Type of Creditor (commercial Bank, credit union,
individual, etc.)
6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your
immediate family during 2024. Include salary, wages, state/local government retirement income, professional fees,
honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and
federal tax returns. You must disclose your receipt of salary or wages from any governmental or private
entity, including those already listed in response to other SEI questions.
Do not include income received from the following sources:
► Capital gains ► Federal government retirement
► Military retirement ► Social security retirement, survivors, or disability benefits
Recipient of Income Name of Person or Entity
from Which Income Was
Received
Type of
Business/Industry
Type of Income
Anthony Lancaster (Self) Majority Strategies Mail vendor Salary
Cameron Edward Lancaster
(Child)
Dunkin Donuts Doughnuts Salary
Kim Hubbard Lancaster
(Spouse)
Grifols Pharmaceutical Salary
The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10
Professional and Civic Relationships
7(a). During 2024, were you or any members of your immediate family a director, officer, governing board member,
employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in North
Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes?
☒ Yes ☐ No - If “No,” proceed to question 8.
► Do NOT list State boards or entities, or entities created by local governments.
► Do NOT list organizations of which you are a mere member.
Name of Person Position Name of Nonprofit
Corporation or Organization
Nature or
Purpose of Organization
Anthony Lancaster (Self) Board Member Community of Hope Ministries Food pantry
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
Community of Hope Ministries None or Not Known
8. During 2024, were you or any members of your immediate family a director, officer, or governing board member of
any society, organization, or advocacy group with an interest in matters over which your agency or board may have
jurisdiction?
☐ Yes ☒ No ☐ Legislator/Judicial Officer -You are not required to complete this question if you are filing solely
because you are a legislator or judicial officer or as a candidate or appointee to those offices.
►Do not list organizations of which you are only a member and do not serve in a leadership role.
Name of Person Name of Society, Organization,
or Advocacy Group
Leadership Position
(Director, Officer, Board Member)
The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10
9(a). List the name of each for profit business with which you or a member of your immediate family was an employee,
director, officer, partner, proprietor, or member or manager as of December 31, 2024.
Name of Person Relationship to Filer Name of Company Role of Person
Anthony Lancaster Self Majority Strategies Manager
Cameron Edward Lancaster Child Dunkin Donuts Employee
Kim Hubbard Lancaster Spouse Grifols Manager
9(b). If you know that any entity listed in 9(a) above had any material business dealings or business contracts with the
State of North Carolina or was regulated by the State as of December 31, 2024, briefly describe that activity.
Name of Company or Business Entity Description of Business Activity with the State
Dunkin Donuts None or Not Known
Grifols None or Not Known
Majority Strategies None or Not Known
10. Are you a practicing attorney?
☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee Attorney
If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned
legal fees of more than $10,000 during 2024.
☐ Administrative ☐ Admiralty ☐ Corporate ☐ Criminal
☐ Decedent’s Estates ☐ Environmental ☐ Insurance ☐ Labor
☐ Local Government ☐ Real Property ☐ Securities ☐ Tax
☐ Tort litigation (including
negligence)
☐ Utilities Regulation ☐ Other category not listed
11. During 2024, were you a licensed professional (other than an attorney) or did you provide consulting services
individually or as a member of a professional association for which you charged or were paid over $10,000?
☐ Yes ☒ No
Type of Business Nature of Services Rendered
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 solely
because you are a legislator or judicial officer or as a candidate or appointee to those offices.
Name of Person Name of Employer
(if applicable)
Type of Relationship
(Licensing, Regulatory, Business)
13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12
months preceding your filing of this form?
☐ Yes ☒ No
Name of Lobbyist Lobbyist’s Principal Date of
Registration
Registration
Expiration
Other Disclosures
14. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you
receive any “gift(s)” exceeding $200 per quarter from a person or group of persons acting together,
when both you and those person(s) were outside North Carolina,
under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying?
To answer Yes, all three conditions must apply
☐ Yes ☒ No
► Do not report gifts given by members of your extended family.
► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.”
Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market
Value
The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10
15. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you
accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting
together,
when those person(s) were outside North Carolina?
To answer Yes, both conditions must apply
A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar
event, including tuition, travel, lodging, meals, and other similar expenses.
☐ Yes ☒ No ☐ Judicial Officer - You are not required to complete this question if you are filing solely because you
are a legislator or judicial officer or as a candidate or appointee to those offices.
► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.”
► Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator
or the General Assembly is a member, participant, or affiliate.
Date of
Scholarship
Name and Address of Donor(s) Describe Event Estimated Market
Value
16. Have you been appointed or considered for appointment to a covered board by the Governor or another Council of
State member?
Council of State members are:
► Governor ► Lt. Governor ► Secretary of State
► State Auditor ► State Treasurer ► Superintendent of Public Instruction
► Attorney General ► Commissioner of Agriculture ► Commissioner of Labor
► Commissioner of Insurance
☐ Yes ☒ No
If “Yes,” list all contributions you made in 2024 with a cumulative total of more than $1,000 to the Council
of State member who appointed you. Do not include contributions from immediate family members.
► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “any advance, conveyance, deposit,
distribution, transfer of funds, loan, payment, gift, pledge or subscription of money or anything of value
whatsoever.”
Date Amount Contributed to
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 yes, were you appointed or are you being considered for appointment to that
position by a Council of State member?
☐ Yes ☒ No
If “No,” proceed to
question 18.
e. If yes, you must indicate whether during 2024 you engaged in any of the following
activities with respect to or on behalf of the candidate or campaign committee of
the Council of State member who appointed you:
i. Collected contributions from multiple contributors, took possession of such
multiple contributions, and transferred or delivered those collected
contributions to the candidate or committee?
☐ Yes ☐ No
ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No
iii. Volunteered for campaign-related activities, including phone banks, event
assistance, mailings, canvassing, surveying, or any other activity that advances
the campaign of a candidate? ☐ Yes ☐ No
18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon; or (ii) an order of
expungement?
☐ Yes ☒ No
Offense Date of Conviction County of Conviction State of Conviction
19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you
concerning your compliance with the State Government Ethics Act?
☐ Yes ☒ No If yes, please provide that information below.
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 08/12/2025
Signature Date
Anthony Lancaster
Printed Name
2025 Labor, Department of
Document text
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10
STATE ETHICS COMMISSION
2025 STATEMENT OF ECONOMIC
INTEREST
ELECTRONIC FILING
This entire form must be completed to fulfill
your ethics filing obligation.
Filer’s Name (First, Middle, Last)
Prefix First Name Middle Name Last Name Suffix
Mr. Anthony Lancaster
Current Employer Job Title
NCDOL Communications Director
Nature or Type of Business
Communications Director for the NC Department of Labor.
Reason For Filing (Complete all that apply.)
Are you a CANDIDATE for
elected office?
☐ Yes ☒ No If yes, for what position are you seeking election? (Specify
name of office seeking in box below.)
Do you currently hold this
position?
☐ Yes ☐ No
State Government Job or Post-Service Filer (Specify
agency and position.)
Board/Commission (List complete names of all State boards
on which you are serving or are being considered.)
Labor, Department of - Communications Director
Judicial Officer, Post-Service Filer, or Judicial Officer
Appointee (Specify office.)
Legislator, Post-Service Filer, or Appointee to Legislative
Office (Specify House or Senate.)
A. Do any immediate family members reside in your household?
☒ Yes ☐ No
On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors
under 18 years of age). It also includes members of your extended family (your and your spouse’s children,
grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) who reside in your
household.
List the full name of all adults and emancipated minors in your household. Minors are children under 18. They are
emancipated by marriage, enlistment in the US military, or court order for emancipation.
Full names of Adults and
Emancipated Minors
Relationship Employer Job Title Nature of Business
Cameron Edward Lancaster Child Dunkin Donuts Cashier Doughnuts
Kim Hubbard Lancaster Spouse Grifols HR Compliance
Manager
Pharmaceutical
manufacturing
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
Property Interests
1. As of December 31, 2024, did you or any members of your immediate family:
A. have an ownership interest in North Carolina real estate (including your residence) with a market value of
$10,000 or more?
☒ Yes ☐ No
Owner of Real Estate % Ownership Interest Location by City Location by County
(Self plus Spouse) 100.00% Raleigh Wake
B. lease or rent real estate or personal property to or from the State of North Carolina with a market value of
$10,000 or more?
☐ Yes ☒ No
Name of Lessor Name of Lessee
(Renter)
If Real Estate, Location
by City & County
If Personal Property,
Describe
2. At any time during 2023 or 2024, did you or any members of your immediate family sell or buy personal property
worth $10,000 or more to or from the State of North Carolina?
☐ Yes ☒ No
Name of Purchaser Name of Seller Type of Property
The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10
Financial Interests
3. As of December 31, 2024, did you or any members of your immediate family own any of the following financial
interests valued at $10,000 or more? List each company individually.
A. Stock in a publicly owned company?
☒ Yes ☐ No
► Include stocks held individually of in a portfolio managed by a financial services company
Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or
pension or deferred compensation plans) if:
1. the fund is publicly traded or its assets are widely diversified; and
2. neither you nor an immediate family member are able to control the underlying assets.
Owner of Interest Full Name of Company or ticker symbol
Kim Hubbard Lancaster (Spouse) AmerisourceBergen
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, 2024, were you or any members of your immediate family the beneficiaries of a vested trust with
a value of $10,000 or more that you created, established, or controlled?
Do not list assets held in blind trusts. See 2025 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.”
https://ethics.nc.gov/seis
☐ Yes ☒ No
Name and Address of Trustee Description of the Trust Your Relationship to the Trust
The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10
5. As of December 31, 2024, did you any members of your immediate family have liabilities of $10,000 or more, excluding
the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student loans,
personal loans and intra-family debt. Do not disclose the amount of the debt.
☐ Yes ☒ No
Name of Debtor Type of Creditor (commercial Bank, credit union,
individual, etc.)
6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your
immediate family during 2024. Include salary, wages, state/local government retirement income, professional fees,
honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and
federal tax returns. You must disclose your receipt of salary or wages from any governmental or private
entity, including those already listed in response to other SEI questions.
Do not include income received from the following sources:
► Capital gains ► Federal government retirement
► Military retirement ► Social security retirement, survivors, or disability benefits
Recipient of Income Name of Person or Entity
from Which Income Was
Received
Type of
Business/Industry
Type of Income
Anthony Lancaster (Self) Majority Strategies Mail vendor Salary
Cameron Edward Lancaster
(Child)
Dunkin Donuts Doughnuts Salary
Kim Hubbard Lancaster
(Spouse)
Grifols Pharmaceutical Salary
The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10
Professional and Civic Relationships
7(a). During 2024, were you or any members of your immediate family a director, officer, governing board member,
employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in North
Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes?
☒ Yes ☐ No - If “No,” proceed to question 8.
► Do NOT list State boards or entities, or entities created by local governments.
► Do NOT list organizations of which you are a mere member.
Name of Person Position Name of Nonprofit
Corporation or Organization
Nature or
Purpose of Organization
Anthony Lancaster (Self) Board Member Community of Hope Ministries Food pantry
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
Community of Hope Ministries None or Not Known
8. During 2024, were you or any members of your immediate family a director, officer, or governing board member of
any society, organization, or advocacy group with an interest in matters over which your agency or board may have
jurisdiction?
☐ Yes ☒ No ☐ Legislator/Judicial Officer -You are not required to complete this question if you are filing solely
because you are a legislator or judicial officer or as a candidate or appointee to those offices.
►Do not list organizations of which you are only a member and do not serve in a leadership role.
Name of Person Name of Society, Organization,
or Advocacy Group
Leadership Position
(Director, Officer, Board Member)
The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10
9(a). List the name of each for profit business with which you or a member of your immediate family was an employee,
director, officer, partner, proprietor, or member or manager as of December 31, 2024.
Name of Person Relationship to Filer Name of Company Role of Person
Anthony Lancaster Self Majority Strategies Manager
Cameron Edward Lancaster Child Dunkin Donuts Employee
Kim Hubbard Lancaster Spouse Grifols Manager
9(b). If you know that any entity listed in 9(a) above had any material business dealings or business contracts with the
State of North Carolina or was regulated by the State as of December 31, 2024, briefly describe that activity.
Name of Company or Business Entity Description of Business Activity with the State
Dunkin Donuts None or Not Known
Grifols None or Not Known
Majority Strategies None or Not Known
10. Are you a practicing attorney?
☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee Attorney
If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned
legal fees of more than $10,000 during 2024.
☐ Administrative ☐ Admiralty ☐ Corporate ☐ Criminal
☐ Decedent’s Estates ☐ Environmental ☐ Insurance ☐ Labor
☐ Local Government ☐ Real Property ☐ Securities ☐ Tax
☐ Tort litigation (including
negligence)
☐ Utilities Regulation ☐ Other category not listed
11. During 2024, were you a licensed professional (other than an attorney) or did you provide consulting services
individually or as a member of a professional association for which you charged or were paid over $10,000?
☐ Yes ☒ No
Type of Business Nature of Services Rendered
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 solely
because you are a legislator or judicial officer or as a candidate or appointee to those offices.
Name of Person Name of Employer
(if applicable)
Type of Relationship
(Licensing, Regulatory, Business)
13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12
months preceding your filing of this form?
☐ Yes ☒ No
Name of Lobbyist Lobbyist’s Principal Date of
Registration
Registration
Expiration
Other Disclosures
14. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you
receive any “gift(s)” exceeding $200 per quarter from a person or group of persons acting together,
when both you and those person(s) were outside North Carolina,
under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying?
To answer Yes, all three conditions must apply
☐ Yes ☒ No
► Do not report gifts given by members of your extended family.
► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.”
Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market
Value
The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10
15. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you
accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting
together,
when those person(s) were outside North Carolina?
To answer Yes, both conditions must apply
A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar
event, including tuition, travel, lodging, meals, and other similar expenses.
☐ Yes ☒ No ☐ Judicial Officer - You are not required to complete this question if you are filing solely because you
are a legislator or judicial officer or as a candidate or appointee to those offices.
► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.”
► Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator
or the General Assembly is a member, participant, or affiliate.
Date of
Scholarship
Name and Address of Donor(s) Describe Event Estimated Market
Value
16. Have you been appointed or considered for appointment to a covered board by the Governor or another Council of
State member?
Council of State members are:
► Governor ► Lt. Governor ► Secretary of State
► State Auditor ► State Treasurer ► Superintendent of Public Instruction
► Attorney General ► Commissioner of Agriculture ► Commissioner of Labor
► Commissioner of Insurance
☐ Yes ☒ No
If “Yes,” list all contributions you made in 2024 with a cumulative total of more than $1,000 to the Council
of State member who appointed you. Do not include contributions from immediate family members.
► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “any advance, conveyance, deposit,
distribution, transfer of funds, loan, payment, gift, pledge or subscription of money or anything of value
whatsoever.”
Date Amount Contributed to
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 yes, were you appointed or are you being considered for appointment to that
position by a Council of State member?
☐ Yes ☒ No
If “No,” proceed to
question 18.
e. If yes, you must indicate whether during 2024 you engaged in any of the following
activities with respect to or on behalf of the candidate or campaign committee of
the Council of State member who appointed you:
i. Collected contributions from multiple contributors, took possession of such
multiple contributions, and transferred or delivered those collected
contributions to the candidate or committee?
☐ Yes ☐ No
ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No
iii. Volunteered for campaign-related activities, including phone banks, event
assistance, mailings, canvassing, surveying, or any other activity that advances
the campaign of a candidate? ☐ Yes ☐ No
18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon; or (ii) an order of
expungement?
☐ Yes ☒ No
Offense Date of Conviction County of Conviction State of Conviction
19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you
concerning your compliance with the State Government Ethics Act?
☐ Yes ☒ No If yes, please provide that information below.
The SEI and any attachments, excluding the Confidential Form, are public records. Page 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 01/15/2025
Signature Date
Anthony Lancaster
Printed Name
2020 Tryon Palace Commission
Document text
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
Anthony Lancaster
Current Employer Job Title
BCHL Strategic Partners Sr. Partner
Nature or Type of Business
Consulting
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.)
Tryon Palace Commission
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
Brittany Lancaster Child Student
Cameron Lancaster Child Student
Kim Lancaster Spouse AmeriSource
Bergen
HR Pharmaceutical
distribution
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
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% Raleigh Wake
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
Kim Lancaster (Spouse) AmeriSource Bergen
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.)
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
Anthony Lancaster (Self) BCHL Strategic Partners Consulting Salary
Kim Lancaster (Spouse) AmeriSource Bergen Pharma 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
Anthony Lancaster (Self) Board Member Community of Hope Nonprofit
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
No Business Associations
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
None or 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 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.
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 06/12/2020
Signature Date
Anthony Lancaster
Printed Name
Submit signed, original documents only. Do not fax or e-mail this form.
2019 Tryon Palace Commission
Document text
This entire document is a public record.
STATE ETHICS COMMISSION
2019 STATEMENT OF ECONOMIC
INTEREST
NO-CHANGE FORM
This entire form must be completed to fulfill your
ethics filing obligation.
FOR STAFF USE ONLY
Date Received:
Checked for completion ______
Scanned _______ Date______
Entered in DB ____by______
Filer’s Name (First, Middle, Last)
Prefix First Name Middle Name Last Name Suffix
Anthony Lancaster
Reason for Filing (Complete all that apply.)
State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State
boards on which you are serving or are being
considered.)
Tryon Palace Commission
Judicial Officer (Specify office.) Legislator (Specify House or Senate.)
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 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 02/21/2019
Signature Date
Anthony Lancaster
Printed Name
Submit signed, original documents only. Do not fax or e-mail this form.
2018 Tryon Palace Commission
Document text
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
Andy Lancaster
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)
Tryon Palace 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 3/2/2018
Signature Date
Andy Lancaster
Printed Name
The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of
2
2017 Tryon Palace Commission
Document text
NORTH CAROLINA STATE ETHICS COMMISSION
2017 STATEMENT OF ECONOMIC INTEREST
NO CHANGE FORM
FILER'S NAME (FIRST, MIDDLE, LAST)
Prefix First Name Middle Name Last Name Suffix
Andy Lancaster
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)
Tryon Palace 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 2016 Statement of Economic Interest and that as of December 31,
2016, my responses continue to be true, correct, and complete to the best of my knowledge and belief.
I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the
information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the
best of my knowledge and belief.
Filed Electronically 4/10/2017
Signature Date
Andy Lancaster
Printed Name
The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of
2
2016 Tryon Palace Commission
Document text
COMPLETE THIS FORM AND MAIL SIGNED, ORIGINAL TO
STATE ETHICS COMMISSION, 1324 MAIL SERVICE CENTER, RALEIGH, NC 27699-1324
NORTH CAROLINA STATE ETHICS COMMISSION
2016 STATEMENT OF ECONOMIC INTEREST
919-814-3600 www.ethicscommission.nc.gov
FILER'S NAME (FIRST, MIDDLE, LAST)
Prefix First Name Middle Name Last Name Suffix
Mr. Andy Lancaster
CURRENT EMPLOYER JOB TITLE
McGuireWoods Consulting VP MWCAdvocacy
NATURE OR TYPE OF BUSINESS
Advocacy
REASON FOR FILING (SELECT ALL THAT APPLY)
STATE GOVERNMENT JOB (Please specify the agency for
which you work or are being considered)
BOARD/COMMISSION (Please list complete name of all
State boards on which you are serving or are being considered)
Tryon Palace Commission;
JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate)
The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of
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
Kim Lancaster Spouse AmerisourceBergen HR Specialist Pharmacutical
Distribution
B. List ONLY the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. Minors
are emancipated by marriage, enlistment in the US military or court order for emancipation.
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, 2015, 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
Andy & Kim Lancaster 100 Raleigh Wake
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
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2. At any time during 2014 or 2015 , 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, 2015, did you, your spouse, or members of your immediate family own any of the following financial interests
valued at $10,000 or more?
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)
Kim Lancaster AmerisourceBergen
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
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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, 2015, 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 2016 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, 2015, 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.)
Andy & Kim Lancaster FAFSA
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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 2015. 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 2015.
Andy Lancaster State of NC; MWCAdvocacy Advocacy Salary
Kim Lancaster AmerisourceBergen Pharmacutical Distribution Salary
PROFESSIONAL AND CIVIC RELATIONSHIPS
7(a). During 2015, were you, your spouse or members of your immediate family a director, officer, governing board member,
employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in the State of North
Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes?
Yes No If "No", proceed to question 8.
Do not list State boards or entities, or entities created by a political subdivision of the State.
Do not list organizations of which you are a mere member.
Name of Person His/Her Position Name of Nonprofit
Corporation or Organization
Nature of Business or Purpose
of Organization
7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds,
please provide a brief description of the nature of that business, if known or with which due diligence could reasonably be known.
Name of Nonprofit Corporation or Organization Describe State Business or State Funding
None or Not Known
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Please answer the following question as it pertains to the following board/agency:
Tryon Palace Commission
8. During 2015, 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, 2015.
Name of Person Relationship to Filer Name of Company Role of Person
No Business Associations
Andy Lancaster Same MWCAdvocacy VP
Kim Lancaster Spouse AmerisourceBergen HR
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, 2015, 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 2015.
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.
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11. During 2015, 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:
Tryon Palace 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
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14. During any calendar quarter in 2015 (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:
Tryon Palace Commission
15. During 2015 (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
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Please answer the following question as it pertains to the following board/agency:
Tryon Palace 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 2015 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
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Please answer the following question as it pertains to the following board/agency:
Tryon Palace 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 2015 you (not immediate family members) engaged
in any of the following activities with respect to or on behalf of the candidate or campaign
committee of the Council of State member who appointed you to your public position:
i. Collected contributions from multiple contributors, took possession of such multiple
contributions, and transferred or delivered those collected contributions to the candidate
or committee? Contributions are defined in question 16.
Yes No
ii. Hosted a fundraiser at your residence or place of business? Yes No
iii. Volunteered for campaign-related activities, which include, but are not limited to,
phone banks, event assistance, mailings, canvassing, surveying, or any other activity that
advances the campaign of a candidate?
Yes No
18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon of innocence; or (ii) an order of
expungement regarding that conviction?
Yes No
Offense Date of Conviction County of Conviction State of Conviction
The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of
11
19. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you concerning your
compliance with the State Government Ethics Act?
Yes No If yes, please provide such information below.
AFFIRMATION
I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and
accurate to the best of my knowledge and belief.
I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from
disclosure while retaining an equitable interest.
I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the
Confidential Form regarding Unemancipated Children) are public record.
I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information
and N.C.G.S. 138A-27 regarding providing false information:
§ 138A-26. Concealing or failing to disclose material information.
A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a
statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary
action under G.S. 138A-45.
§ 138A-27. Penalty for false information.
A filing person who provides false information on a statement of economic interest as required under this Article knowing that
the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45.
I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the
information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the
best of my knowledge and belief.
Filed Electronically 12/19/2016
Signature Date
Andy Lancaster
Printed Name
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2015 Governor, Office of the
Document text
PsN NORTH CAROLINA STATE ETHICS COMMISSION
A "#2015 STATEMENT OF ECONOMIC INTEREST FOR ETHICS COMMISSION USE ory
919-715-2071 www. ethicscommission.nc.gov
205 APR 10 PY 2: 59
FILER'S NAME (FIRST, MIDDLE, LAST)
First Name [ widdie name | Last Name [ sunx |
-
ers —— 1]
CURRENT EMPLOYER 208 TITLE
Lobe oo Date ar Zderg.vemrarl Ady
NATURE OR TYPE OF BUSINESS
Lat rg ctepemg hd Fe
| REASON FOR FILING (SELECT ALL THAT APPLY)
| 7] STATE GOVERNMENT JOB (Please specify the agency for | [] BOARD/COMMISSION (Please list complete name of all
‘hich you work or are being considered) State boards on which you are serving or are being
Considereo
»
Corr secre
CJ UDICIAL OFFICER (Please specy th office you hod) _| CJ LEGISLATOR (Please specify House or Senate)
1
0 hr immediate family members reside in your household?
Eves Oho
When used throughout tis form, the term Immediate famity includes your spouse (uness legally separate). It also
nciades members of your extanded fam (Your and your spouses CHCTEn, orandenidren, parents, oandparents, and
Sings, and the spouses of each of hose. parsons) who reside in your housenold.
ONLY LIST THE INITIALS OF UNEMANCIPATED CHILDREN. However, you MUST submit the children's full names on the
Confidential Form avaiabe a the end of this document.
Minors sre emancipated by marrage, enlistment nthe US miltay, or court action for emancipation.
EMANCIPATED MINORS ‘Business
fa fameibs
En Ei i Es Si
The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f 10
as on orion Fr TTT]
-
"
Ger re
mers rer osmion b 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
Oves fio
Name of Lessee | If Real Estate, Location | If Personal Property,
(Renter) by City & County Describe
2. At any time during 2013 or 2014, did you, your spouse, or members of your immediate family sell to or buy from the
‘State of North Carolina personal property with a market value of $10,000 or more?
es fe
LE — —
FINANCIAL INTERESTS
3s of December 21, 2014, 0d you, your spouse, or members of your Immediate family own any of the following financial
rkerests valued at £10,000 or more?
A. Stock in a publicly owned company?
gles Ono
Do nat lst 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
Ghvaranea; and (1) pear you nor an Immediate family member are able o control the assets held n the mutual fund,
{ecient company, o pension of deferred compensation pan.
Oviner of Tnterest Full Name of Company (Da not use a ticker symbol)
on Lsiny Fer Aerrsoorce Doe rpea
®. Stock Options in a company or business?
Clves [FiNo
‘Owner of Stock Option Full Name of Company (Do not use a ticker symbol)
Interests 1.2 non-aublcy owned company or business entity (including interests in sole proprietorship,
Parinerahip, IMIGed portharsnps, Jom ventures, mied abil companies, imited 1abity partnerships, and
Gosely eld corporations)?
ves No - 1°No", proceed to question 4.
Owner of Interest ‘Name of Company or Business Entity
The SEI and any attachments, excluding the Confidential Form, re public records. Page 30f 10
C0 For sa re pally owe compamy or usin any She “primary capa) Gariied in question 3.
i pesmeo t es o ry otpr opane of SESS eres wh he PRAT COPAY OWS
Secunia eqoky nieve valued of ove $30,000 own:
Nom_Publicly Owned Company or Business Entity | Other Companies which the Primary Company
Go rimary Compa’ owas Security or Eau Toterests
one or Nat Known
7
C23 you know tk ary company o business emit ted 1 3.C or 3.CC3) abave hs amy material business
Clinger oun conaces wih 80 See of North Corolle o 1 SuBIEd othe Shae, provide be
asepon of tho ness aEty. ee
Nome of Company or Business Entity | Description of Business Activity with the State
None or Not Known ~
4. As of December 31, 2014, were you, your spouse, or members of your immediate family the beneficiaries of a vested
210150 or ors tot wa crested, crane of cruaned 3 vouh
Do not list assets held in blind trusts. See 2015 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.”
OYes No
5. As of December 31, 2014, did you, your spouse, or members of your {mmediate family have labilties of $10,000 or
re ange ch your moans persons Tesdences Brompes code rod ard des, ata lore,
Sool oars an te Toy dot
Des Ono
Nome of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union,
er mbar fnaidony, ses
Fon « Fon Lorinser Forenr foro i
(yo fom Ppt Go fans
The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10
ost cach source of Income (rot speciic amounts) of more. than £5,000 received by you, Your Spouse, or members of
Jour Immediate family uring 2014. Inclde. salary, Wages, stoc/local goverment. reCrement, professional fees,
Fomor tare: vdenda, venta come, busingss Income, an other types of Income required to be reported on your
State and federal to returns
Do sat Include Income received from the following sources:
> Capital gains > Federal government retirement
> Miltary retirement > Social security income/SSDI
Recipient of Income ‘Name of Source Type of Type of Income
Business/ Industry
11 hod no reportable income over $5,000 mn 2014.
ZA Ske Epc [even en Ep
on dpsiriter | fugesioaree Boge lo,
PROFESSIONAL AND CIVIC RELATIONSHIPS
7(a). During 2014, were you, your spouse or members of your immediate family a director, officer, governing board
iehber, EmpoYeC, Indspendent cintfacor, or regatered obeyist of 2 nonprofit Corporation or organiation operating n
he State of Noth Carolia primary fo religious, chantable scientific Ierary, pubic heath and safety, or educational
purposes? re
ives fo + 16°No", proceed to question 8.
> 5 no Tot Sete boards or ene, o entibes rested by 3 povtical subdvison of i State
> Do not ls organizations of which you are a mere member.
His Her Position Name of Nonprofit Nature of Business or
Corporation or Organization | Purpose of Organization
706). If the nonprofi. corporations or organizations stad above do business with the State of North Carolina or receive
State funds, please provide » bie description of the nature of that busines, If known or with which due gence could
Teasonably be knw.
Name of Nonprofit Corporation or Organization | Describe State Business or State Funding
[J None or Not Known
The SEI and any attachment, excluding the Confidential Form, are public records. Pages of 10
8. During 2014, were you, your spouse, or members of your immediate family a director, officer, or governing board
Toy ys
Lh
wr
Dyes pall [] Legislator/Judicial Officer - You are not required to complete this question if you are filing because
A AE eh
Do not list organizations of which you are only a member (not serving in 2 leadership role).
Nae of Soci, Grgmizton prer——
‘or Advocacy Group. (Director, Officer, Board Member)
FT TIT, ROTI AJ
immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2014.
[pT AT J T— Tr
TTR
z
ST a Sogn es ry Td 3) oe ry Tr Bers dein
Ee et ee
oe pA
scp of Bsns Acti ith he ste
[rep p—
Ta ——
3 SET Sg 0 ST AOE 0 0 AN SH00
legal fees of more than $10,000 during 2014.
Frpm— Conary Frym— To
[Decedent's Estates [J Environmental [nsurance Otavor
[J Local Government JReal Property [J Securities Ovex
[J Tort litigation (including 0) Utilities Regulation [] Other category not listed.
11. During 2014, were you a licensed professional (other than an attorney) or did you provide consulting services
aly or 3.3 TBE 3 fs S3aCaton for WIG Yo Cage a wre pis over $100007
OYes [No
tare of servis Rensres
12. Are you or your employer, your spouse or members of your immediate family, or their employer currently:
7 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 busipess relationship with the State board or employing entity with which you are or will be associated?
Dives re 0) Legislator Judicial Officer - You are not required to complete this question If you are ling because
You are a lgisiator or » Judical officer (3udicil officer” i defined in the SEI Helpful Tips) or you are
/ Hing as an appointee to those offices.
Name of Employer Type of Relationship
(if applicable) (Licensing, Regulatory, Business)
13. Are you, your spouse or @ member of your Immediate family currently registered as 3 lobbyist o lobbyist principal, or
were you registered as such within the 12 months preceding your filing of this form?
Oves ito
Name of Lobbyist Lobbyist's Principal Date of Registration
Registration Expiration
OTHER DISCLOSURES
14. During any calendar quarter in 2014 (hut only the time period after you were appointed, employed or fled or were
nominated a5 3 candidote), 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 gI(s) were given under circumstances thet would ead a reasonable person to conclude tha they were given for
lobbying?
Oves
»Do not report gifts given by members of your extended family.
D0 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.”
Eimated are vee
The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10
[15 Dui 2a oom opr har our pps, lors, ir wre roe 33 onan
an
cet scolarstio” xcedin $200 fom pra group of persons aig gener an
ven rt were ste er Cor
iene,
Ce fo Dc Ofc our rot eve compte i ution yur it fer yo re
EE T———
ee sn Er
Legatrs ra ot our ert shri db rng gis raat of whic te gitar or
Date of Name and Address of Donor(s)
16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or another
Breet
| Count of See armas sr:
cover p— —
» rey Gon» Conmisonrot Arcus» Conmnoner tor
Commies of race
ave Fe
It ves", list all contributions you (NOT immediate family members) made during 2014 with a cumulative total
rare thn F130 CBAs ly members) made during 204s wis
deposit, distribution, transfer of funds, loan, payment, gift, pledge or subscription of money or anything of value
whatsoever.”
we | mem | comma
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. 3 North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court
Judge; or
. a member of any of the following boards:
ABC Commission
Coastal Resources Commission
State Board of Education Oves pio
State Board of Elections
Division of Employment Security 1 No, procesd to
Environmental Management Commission question 18.
Industrial Commission
Human Resources Commission
Rules Review Commission
Board of Transportation
UNC Board of Governors
Utiities Comission
Wildife Resources Commission oo
d. If so, were you appointed or are you being considered for appointment to that public | (1Yes (JNo
position by 3 Council of State member? Council of State members are listed in Te reser
question 16. question 38.
e. 150, you must indicate whether during 2014 you (not immediate family members)
engaged in any of the following activities with respect to or on behalf of the
candidate or campaign committe of the Counc of State member who appointed
You to your public positon
Oves ONo
i. Collected contributions from multiple contributors, took possession of such
multiple contributions, and transferred or delivered those collected contributions
0 the candidate or committee? Contributions are defined in question 16.
il. Hosted a fundraiser at your residence or place of business? Oves ONo
Ii. Volunteered for campaign-related activities, which include, but are not limited to,
phone banks, event assistance, mailings, canvassing, surveying, or any other | (]¥es [JNo
activity that advances the campaign of a candidate?
18. Have you ever been convicted of a felony for which you have not received either: (1) a pardon of innocence; or (i) an
order of expungement regarding that conviction?
Oves Ano
—— Date of Conviction | County of Conviction State of Conviction
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 AC?
Ces [rfNo if yes, please provide such information below.
C——————————————————————
‘The SET and any attachments, excluding the Confidential Form, are public records. Page 9 of 10
AFFIRMATION
Tht he formation provided ns Seen of Economie tre nd ary tachment Pert rr, oto.
nd cera he ek my Know nd ee
ats cony tha ave so cnerd, snd wil os nse, any set, nest, property othe purpose of cocealing
Tom ine whi eign cout ben.
understand tht my Stent of Economie crest and an tachment o supplements bec (vith he exception the
Contaanial For egnding Unrnpated Cue se ib rece
Yocknovedge that hav ead and wertond N.C... 1354.2 eating concealing or lingo disclose teria
CS eprom ovis one omen
§ 138A-26. Concealing or failing to disclose material information.
A fling peso who Knowingly concer knowingly iso disclose informacion tht eur 0 be ico on’
ma of eons dns Ale hal be Bly of Cl sont sho
mary sem onder G5 AAAS
§138A.27. Penal or fae information.
A ling son wh provide alse information an item of conic cet sequined nde tis Ack
knowing thatthe information i fase i guilty of a Class H felony and shall be subject to disciplinary action under G.S.
ae
Ltn TT omnes
Printed Name
ef LS or se mim
Signature ell A]
Submit SIGNED, ORIGINAL documents ol.
Do not fax or email this form.
FY. 985m my OVERS iG SR GTS AFR UB TRS Page 100110