Barbara "Jeannie" Moore

This entire document is a public record. STATE ETHICS COMMISSION 2021 STATEMENT OF ECONOMIC INTEREST NO-CHANGE FORM 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 Mrs. Barbara Moore 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.) Health and Human Services, Department of - Facility Director 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. § 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 that I have reviewed my most recently filed 2020 Statement of Economic Interest and that as of December 31, 2020, 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 03/31/2021 Signature Date Barbara Moore Printed Name

I a—— ZEN STATE ETHICS COMMISSION Date Receln Gao Recewep | dl 19 2020 STATEMENT OF ECONOMIC INTEREST | SZ NO CHANGE FORM 131520 | This entire form must be completed to fulfill NC ETHICS ogy your SEI filing obligation. Cracked for coma MISSION | scans ome | Emereginon vy Filers Nome (Fist, Middle, Last) | [Beers | Sewn | moore J | [ Reason for Fling (Complete al that apply.) State Government Job (Specify agency and postion.) | Board/Commission (Lit the complete names of all State boards on which you are serving or are being considered.) DHHS | Division of State Operated | | Health cae Facilites facili Dicestre | | Judicial Officer (Specify office.) Legislator (Specify House or Senate.) AFFIRMATION I have carefully reviewed my most recently filed Statement o Economic Interest Long Form and my responses continue to be true, correct, and compete to the best of my knowledge and belie. Ihave not transferred, and will not transfer, any asset, interest, o property for the purpose of concealing it from disclosure while retaining on equitable interest. Lunderstand that my No Change Form is a public record. Ihave read and understand the following statutes: N.C.G.S. § 1384-26. Conceaing or ailing to disclose material information. A fling person who knowingly conceals or knowingly fais to disclose Information that i required to be disclosed on a statement of economic Interest ... shall be gui of a Class 1 misdemeanor and . . . subject to disciplinary action under G.5. 1364-45. N.CG.S. § 1384-27. Penalty fo fase information A filing person who provides faise information on a statement of economic interest .. . knowing that the Information is fase s guilty of 3 Class H felony and shall be subject to disciplinary action under G.S. 138A-45 1 affirm under penalty of perjury that the foregoing is true and correct. Lobe Oven Musee S 42020 Signature 7 Date Becloocn Tenn Mocre | Printed Name ‘Submit signed, original documents only. Do not fax or e-mail this form. This entire document s a public record.

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 Mrs. Jeannie Moore 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.) Health and Human Services, Department of - ADATC 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 04/12/2019 Signature Date Jeannie Moore Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

So S77) NORTH CAROLINA STATE BOARD OF ELECTIONS Gai A AND ETHICS ENFORCEMENT cal 7 2018 STATEMENT OF ECONOMIC INTEREST PTR R—— | FRESE | TL a Pe eT on tae WJ Blackley Center Facies Director - NATURE OR TYPE OF BUSINESS B faoate -— [REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify Agency) BOARDICOMMISSION st comps name fal Site. nts ge | JUDICIAL OFFICER tspeiy Oe LEGISLATOR (pei House or Sse) The SE1 ant any stachmonts, oxluding he Confidential Form, ar public rcards. Page tot 11 |A. Do other immediate family members reside in your household? | Harmison Connor Moore son Pesan ocher {pet store Hl PROPERTY INTERESTS. N ~ 1 EE 1 I — i — Name of Lessor Name of Lessee (Renter) 1 Real Estate, Location by [everson Peper. Describe 2. At any time during 2016 or 2017 did you, your spouse. or members of your immediate family ell 10 o buy from the State of [North Carolina personal property with a macket value of $10,000 o mors? Oves No . _ Name of Purchaser Name of Sller Type of Property ee — — [FINANCIAL INTERESTS _ — JE N 3. As of December 31. 2017. id you, your spouse, or members of your immediate family own any of the following Financial ineests Valued a S10.000 a mors? LIST EACH COMPANY INDIVIDUALLY. A. Stock in publicly owned company? Ove No ~ a ~ © Dnt is ownership ners in 4 widely held neste fd including tal fds, eguloted inven: companies Owner of terest Full Name of Company (Do nol use a ieker symbol) B. Stock Options ina company or business? Dyes fo Owner of Stack Option Full Name of Company (Dn not use teker symbol) — SE » C. nteests in non-public owned corypany or busines entity (including interests in sole proprietorships, pumershig, limited porterships, foot ventures, limited lshility companies, limited liability parerships end losety held corporations)? [D¥es = No _16"No, proceed to question 4 Owner of Toterest Name of Company or Business Entity The SEt and any attachments. excluding the Confidential Form, are public records. Pago 3of 11 C1) For coh non-public owned company or busines ati he “piney company”) deified in question) Cabove, | pase isthe ames of ary ahr companies or busines nts in whic he Fiary Company 7s cures o qui rerests lust st over $10.00, kr _ So Non-Pubicls Onn Company or Business Entity (he Other Campanics in which (he Primary Company Owns Trimary Company) ort o Equi, ners Noms or Not Keown 0 yc row compen or bss tt id 30 shen bss tr es dso | business contacts i she Sa of Not Carlin, o i resulted by the Ste, provide: ie sition of ha sis avi. Name of Company or Busines Entity Description of Baines Activity with the tac 4 Avo December 31,2017 were you. our spouse or embers of your immediate Fil th bres of a ested st with a lie of $10,000 o mors tha was xa, established, or cond by you” Duos assets hl in ind uss. See 2017 3 Help Tis fo the definition of “Vested Tru” and “Blind Trt.” [O¥er - No _— T—— pe A Name and Address of Trustee Description of the Trust 7 Your Relationship to the Trust J FE J J — I ] SE 5. As of December 31,2017, did you, your spouse, or members of your mands aly have isbiltis of $10.09 o mor. excluding the morgage on our primary personal residence? Examples ocude rit ard deh. au loans, dnt sn personal [r——— | Ves No . ndividuat cc) The SEI and any attachments, excluding the Confidential Form, are public records. Page sof 11 6 Lis each suse af income nt specific amount) of ore than $5.00 esis by 0 your spouse or mersbers of your mtn frity during 2017. nude sly, wages. se ocal goverment rtemen, professional fs, honoraria, ces. vides. eal income, busines come, ad ae pes of incom ruin 0 be pore on sour Sate and fede tx rears. [I JE a EE 1 not include income recived from the lowing sources > Miltary retirement» Sociat security incomerssbt [™ Wecipent of tncome Namcofsource Tapeat Basins dors Tapeat income 31d report come or $5000 1 2017 Toavid k Moore Ir Carly Cc Jesocery sore chain alan | Barbara Moore [Wakertea [opine [sim [rroressionat aoc IVIC RELATIONSHIPS 76) During 2017, were you, your spouse o members of sour immediate family a dcetor, offer, goveming bord member, ployee independent contactor, o egisterd lobbyist of a onpeof corporstio o ganization apesasing i he St of Nort Carolina primar os eigious, charitable, scientific, tery. public heath an sy, or suction) purposes” D¥es No UN, proceed question. * 0 I St Posed o nies. or tis ces by 4 pltical sub iion of the Sse > Dn i angio of hich you are a mers mmber ame of Person ser Puiion Name af Nowprofit | Nature of Business o Purpose tpn Fn | a Orgamesion 70 1b onprofi corporations o organizations sed above do business with the Sut of North Cari or receive Ste fds, piss provide a brif description fhe nature of ht busines, if Know or ith which due ilience could ressonby be own. | Name of ongroft Corporation or Organisation Describe State usinss or State Funding The SEI and any attachments, excluding the Confidential Form, ae public records. Pages of 11 Please answer he following question as it perains 0 the following board agency: Health and Human Services, Department of 5. During 2017. sere you, your spouse, or members of your immediate family a director, officer oF goveming board membes of any society. organization, or advocacy group with a inieres in maters over which your agency or board may have jurisdiction? Ves «No ClLegiorudiial Officer - You are not required to complete this question if you ar Fillo because you are texishator ora judicial officer or you are filing as an sppoinee 0 thase offices. J Name of Person Name of Society, Organization or | Leadership Position (Director, Officer. . “Advocacy Croup ‘Board Member) (a). List the mame of cach company or business vith which you were associated where you or member of your immediate uni was an employes, director, officer, pariner, prorictr, of meambet of manager 3s of December 31, 2017, Name of Person Relationship to Filer ‘Name of Company Role of Persan 9b. i you know that any company or business entity std in 9a) above had any material business dealings or business contracts with the Sate of Norah Carolina or was regulated by the State as of Decernber 31, 2017 provide bie description of ths business Name of Company or Busines Enis TT Description of Business Activity with he State © The SEI and any attachments, excluding the Confidential Form, are public records. Page Gof 11 10. Are you a practicing atomey? {O¥es No C Judicial Officer/Sute Atiomey 15+ Yes", check each category of legal representation in which you o he la fim with which you are afaied bas eamed legal fees of more than $10,000 during 2017 . 1 Adminiraive © Admins CCorporane Clcrimins! Dscedenr's Bates Cvironmenal Otnarance Cater Local Goverment Rel Proper Osesurives [SISY 0) bors ligation (including £7 Uilites Regulation 0nher category not lied neclizence) a a 1. Daring 2017, were sou a licensed professions! (othr than en attorney) or did you provide consulting services individually or as 3 member of professional association for which you charged or were paid over $10,000 Cvs No } . Type of Business | Nature of Services Rendered Please answer the following question as i pertains to th following bosrdagency: Health and Human Services, Department of 12. Are you or your employer, your spouse or members of your immediate family, or heir employer currently. + Licensed by the Sate board or employing entity with which you are or will be associated or + Regulated by the State boand or employing entity with which you are or will be assosied or + Have u business relationship with the State board or employing enty with which you ae or will be associated? [Ves + No (Legislaor fudicial Officer - You ae not required 0 complete this question if you are ling because you are 8 legislator o judicial of eer “judicial officer” is defined i the SEI Helpful Tips) or you are filing as an oo appointee to thos offices. _ Name of Person Name of Employer (f applicable) Type of Relationship (Licensing, Regulators. Baines) The SEI and any attachments, excluding the Confidential Form, are public records. Page7of 11 15. Ate you. your spouse, or a member of suur immediate fanvily curently registered 3s a lobbyist o lobbyist principal or were you registered as such within the 12 months preceding your fing of this form? Des “No Name of Lobbyist Lobbyists Principal Date of Regiuration. Registration Expiration OTHER DISCLOSURES . i 14. During any calendar quart in 2017 (but only the time period afer you were appoioted, employed o filed or were nominsied as 3 candidate). did you ceive any ils) exceeding $200 per quarter rom a person of group of persons acting together, and. «when both you and those person) were outside North Carolina at the time ou accepted the gifs), and «the gifs were given under circumstances that would lsd a reasonable person to conclude that they were given for lobbying” Ye oN Co oo | D0 not report gill given by members of sour extended fay 5 nt report ils hat have previously been repored by you o the Deparment of the Secretary of Ste on he “Fup Report for Exempied Persons Date Tem Received Num and Address of Describe lem Received Estimated Market Value l onary) The SEI and any attachments, excluding tho Confidential Form, are public records. Page8of 11 Pls ansnr he followin question ss persis telling borden: Health and Human Serices. Department of 15. During 2017 hut oniy th te period afer sou were apne, eiploed. Fle or wer nome 5 cid) did ou hose pes) wer outside North Carolina and + he Scholasti was lated 0 your public postion? A “scholarship is grantn-ak, ther directo ndinet, 0 atend a contrence, meeting or sila cent, including tion, tre lodging, meals, and other similar specs 76s + No Cll Officer You ren reins to comple cis question i ou are ial fcr ou sre fling 3 Date or Scholarship Name and Address of I Describe Event Estimated Market Value J — L — : A —— Health and Human Services, Department of 16. Wer you appointed a ar you bin considers fo an sppoimnt 8 covered bound by the Governor or anther Council of Site member? Count of tae members are: Govern 11. Govemer Scary of Sue Sue Audio Ste Tesrer + Superintendent of Public Inston + Atomey Genera + Commissioner of Agriculture + Commision of Labo Eb Yes Ne J1¥es™ all contributions you (NOT immedise Gamiy members) made during 2017 with comune total of mors thn $1000 the Gocrnor ar othr Council of Sat member who appointed yon, Date Amount | Contributed to Tho SETand any attachments, excluding the Confidential Form, are Buble records. ~Pagesor 11 Pease answer th Following gesion ss t persis the following bord agency i Health and Homan Servis, Department of 07 Ae som an sppeinice oc prospective sppoinice to: I the bead of pip tate department e <a cet) apposed by he Governor. [¥en + ho a 10No", proceed to question. 8 Noth Caroli Supreme Court tice, Cour of Appeal. Superior or Dict Coarse: yg, © a menber ofan ot he follwing bord « ARC Commission Crass Resour Commision State Bd of Fauci » State Board of Flections. | Dns ot Erplogmen Sci. «Fosiromerial Maragement Commission | dustrial Commission [I re [I — | ON Bountot Gosemons | Ciris Commission i * Wildlife Resources Commission i; ETT ——— | 40, were son pein oar sou being comsidered Fo ppoimment 0 at poe Ces + No | 11 poston Counc Sut member” Coun of oe memes rd 0 E00 16a, prac 1 uestion | _— EE EE . } | 1 10. yn mn ct whether uring 2017 ou oot immo ml members engaged [es © No | ian of he following tise ith respect 0 o on bl of the candidate or camparzn | | | commit ot he Council of tte member who appointed Y0u 1 ur public posi | | 4 Call coniburions from mse contributors. ook possesion of sch lle erin md ante on rics one eecied om bios foe Condit Commies Contr i dened 0 Guten 16. | 6 Hosted Rondraer at your residence or ple of business? Eve © No i Volumes or campugn std cists, hich ince, tan or ted. — phone bake, vt ssisiance, mailings, cansassing. surveying. o ans other activity thoy | 0 YES Ne Bianca the camps of candies ull oo 18. Have ys ever bn convicted of clony Fo which you have noted ithe: a pardon a innocenc or i) an order of expungement eganting hi conviction? | Offense Date of Comsiction RE State of Conviction The SEI and any attachments, excluding the Confidential Form, are public records. Page 100f 11 16. Ar yo ware of any aber farina wou ive may eis he Ste ies Commission adn 300 cone yous compliance with he St Genramns Eis Act? Cer “No. 1ryes, lee provide such infomation belo. } oo ArrRMATION A afin thi the mati providd 0 hs Sno omen vrs an any ascents ert re i. complet. nd Contd Form regonding Unencipted Chen) se pol recs mi a [RTT — Th Information be gly oF Clas H felons ard shall be subjest th docs hon undks 8. 158A-d5. etal my mend and bet mmm JT JR b Barhara Jean Moore Lo rematme - Th SE and any attachments, excluding the Confidential Form, are pubic records. Pago tof 11