Bradley T. Adcock

- A a—— Grr STATE ETHICS COMMISSION Date Recaved: (he {4 7 7 2022 STATEMENT OF ECONOMIC INTEREST — Sxl 7 RECEIVED No Change Form APR 18 2020 This entire form must be completed to fulfill your SEI filing obligation. NC ETHICS COMMISSION Fler’ Name (Firs, Middle, Last) |_Bendhy [TPsmss | Bdeck |] Reason for Filing (Complete all that apply) State Government Job (Speciy agency and position.) | Board/Commission (List the complete names of al State boards on which you are serving or are being considered.) | |e AdeephinfofHony Comins Currently Serving as a Judicial Officer (Specify office.) | Currently Serving as a Legislator (spéelfy House or Senate.) Are you a CANDIDATE for a covered elected office? If Yes, specify office and District/County If, applicable: (District, Superior, or Supreme Court, Court of Clerk of Court, District Attomey, Genaral Assembly) OYes [@Ro_ “AFFIRMATION have carefull reviewed my most recently fled Statement of Economic Interest Long Form and my responses continue to be true, correct, and complete to the best of my knowledge and beif. 1 have not transferred, and wil not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable Interest Tunderstand that my No Change Form is a public record. Ihave read and understand the following statutes: N.C.G.5. § 1384-26. Concealing or fang to disclose material Information. A fing person who knowingly conceals or knowingly fais to discose Information tha i required to be disclosed on a statement of economic Interest... shal be guilty of a Class 1 misdemeanor and . . . subject to disciplinary action under G.5. 138A-45. N.C.GS. § 138A-27. Penalty for false information. A fing person who provides faise Information on a statement of economic Interest... knowing that the information is fase is uily of a Class H felony and shal be subject to discipinary action under G.5. 1364-45. T affirm under penalty of perjury that the foregoing is rue and correct. /. Geri! /8 Road Signature Lradle ~ A Printed Nam Submit signed, original documents only. Do not fax or e-mail this form. This document Is a public record

- ForSff Use Only —] Gay STATE ETHICS COMMISSION ——— Hl 2021 STATEMENT OF ECONOMIC INTEREST | & NO CHANGE FORM RECEIVED This entire form must be completed to fulfill AFR 14202 your SEI filing obligation. NCETHICS COMMISSION | | Filer's Name (First, Middle, Last) BN prefix FirstName | Middle Name Last Name. suffix A. (Brae TEoupS. Pieoek. | Reason for Filing (Complete all that apply.) [State Government Job (Spec agency and postion) | Board/Commssion (Li The complete names of al State " Boards on which you ar Serving or are being considered. AC Elke nFion Lots) Comes? Judicial Officer (Specify office.) Legislator (Specify House or Senate.) EE have carefully reviewed my most recenty fied Statement of Economic Interest Long Form and my responses continue | to be true, correct, and complete to the best of my knowledge and belief. have not transferred, and wil not transfer, any asset, interest, or property for the purpose of concealing t from disclosure whi retaining an equitable terest | esas at my ho Crag am i 3 te crs have read and understand th following statutes: N.C.G.S. § 1384-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fais to disclose information tha is required to be disclosed | 3 area of etm aT CL we a oF 5 Cle TRG — aS da | action under G.S. 1384-45. N.C.G.S. § 1383-27. Penaity for alse information. A fing person who provides false information on a statement of Econo INKEres . knowing that the | information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 1384-45. | I affirm under penalty of perjury that the foregoing is true and correct. J A 13/202 nature te Loni T dec Printed Name Submit signed, original documents only. Do not fax or e-mail this form. | This entire document is a public record.

n FOR STAFF USE ONLY FT STATE ETHICS COMMISSION Date Rect CEIVED By 2020 STATEMENT OF ECONOMIC INTEREST wr 3am NE NO CHANGE FORM Wi ceed This entire form must be completed to fulfill NC ETHICS COMMISSION your SEI filing obligation. Checked for completion Scanned Date Entereain0s by Filer's Name (First, Middle, Last) Me. [Bradle, THOMAS Adcock [1] Reason for Filing (Complete al that apply.) State Government Job (Specify agency and position) | Board/Commission (Lit the complete names of a State boards on which you are serving or are being considered.) he Lolertow Lote Conmizsis Judicial Officer (Specify office.) Legisator (Specify House or Senate. “AFFIRMATION a , | to be true, correct, and complete to the best of my knowedge 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 2n equitable Interest. Tunderstand that my No Change Form is a public record. Ihave read and understand the following statutes: N.C.G.5. § 138-26. Concealing o failing to disclose material information. A fling person who knowingly conceals or knowingly fais to disclose information that is required to be disclosed on a statement of economic interest .. shal be guilty of 3 Class 1 misdemeanor and . subject to disciplinary action under G.5. 138A.45. | N.CG.S. § 1384-27. Panay for aise 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. | Taffirm under penalty of perjury that the foregoing is true and correct. Va,7. £ Lp] S100 Signature he (Bradley T Pe Printed Nar Submit signed, original documents only. Do not fax or e-mail this form. This entire document is a public record.

or sat use ony AECEIVED S77 2) STATE ETHICS COMMISSION paiseconob: 19 201 21 : 2019 STATEMENT OF ECONOMIC INTEREST S © NCETHOS COMMISSION 2 Checked for completion (GCBsconned {chee This entire form must be completed to fulfill AI me ee mre er your ethics filing obligation. Supp. sentate by Supp. received cate entered in catabase ow Bradley [Thoms Adeoek [|] Current Employer D Rieed Blelors Cho dhed NC | Wf | Reason for Filing (Complete all that apply.) “Ace you a CANDIDATE for elected office? [] Yes [EN | If yes, for what positon are you seeking election? (Specify (Not including local or municipal office) i8ing oF ifie Sesting i ror RRO) State Government Job (Specify agency and postion.) | Board/Commission (List the complete names of all State boards on which you are serving or are being considered.) heslesbiow both Comision Judicial Officer (Specify ofice.) Legislator (specy House or Senate’ A. Do other immediate family members reside in your household? XE Oho On ths form, “immediate family” includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse's chidren, grandchildren, parents, grandparents, and siblings, and the spouses | of each of those persons) who reside in your household. | List the ull name of all adults and emancipated minors in your household. Minors are children under 18. They are emancipated by marriage, enlistment in the US miltary, or court order for emancipation. ‘Emancipated Minors The SET and any attachments, excluding the Confidential Form, are public records. Page 1.0 10 B. List only the Initial of all nemancipated minors i you household below. A ino sa hi under 18 yeas ld List the ull ame of each minor child on the Confidential Form at the end. FT Noture of Business ‘Unemancipated Property Interests 1 sof December 31, 2018, 0d you o any members of your immediate fami: A. have an ownership intrest n North Carolin rea state (including you esience) with a marke value of $10,000 armors? ove On %% Ownership Interest Location by County 5 Teses or ent rel eta o personal propery oar rom th State of North Carolina with 8 market valu of $10,000 amore? Oves EW If Real Estate, Location | 11 Personal property, City & Gounty Describe 3 At any time during 2017 or 2018, di you o any members of your immediate fal sel or buy rom the Sate of Nort Carag parsnal propery worth $10,000 or more? Oves ©6 [ Wameotpuchwser | Mameotseler | Tweoteropeny | he SET and any attachments, excluding the Confidential Form, are public records. Page 20110 | 3. Asof December 31, 2018, did you or any members of your immediate family own any of the following financial interests | Valued at $10,000 or more? List each company individually. | A stocking publicly owned company? es Ono > Do nat lst interests in a widely held Investment fund (Including mutual funds, regulated Investment companies, or pension or deferred compensation plans) If: 1. the fund s publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets | ownerorimerest [Ful Name of Company or ticker symbol [See pthhered — [ 5. Stock options in a company or business? OYes ©M6 ol am of Company (0 nt kar smo C. Interests in a non-publicly owned company or business entity? These include Interests in sole propritorships, partnerships, limited partnerships, Joint ventures, limited llailty companies, imited labilty partnerships, and Closely held corporations. [Yes [SAG- If "No," proceed to question 4. C(1). For each company or business entity identified in question 3.C. (the “Primary Company”), please lst the names of any other companies or business entities in which the Primary Company owns securities or equity interests valued at over $10,000, 1f known. Non-Publicly Owned Company or Business Entity | _ Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests The SET and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 C(2). If you know that any entity sted in 3.C or 3.0(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 | C3 None or Not known [ I 4. As of December 31, 2018, were you or any members of your immediate family the beneficiaries of a vested trust with 2 value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2019 SEI Helpful Tips for the definition of "Vested Trust” and "Blind Trust.” Ove me Name and Address of Trustee Description of the Trust 5. As of December 31, 2018, did you any members of your immediate family have abies 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. Oves HG | Name of Debtor Type of Creditor (commercial Bank, credit union, | individual, etc.) 6. List each source of income (no specific amounts) of more than $5,000 received by you or any members of your immediate family during 2013. Include salary, wages, state/loca government retirement Income, professional fees, honoraria, Interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. Do not include income received from the following sources: > Capital gains > Federal government retirement > Miltary retirement > Social security income/SSO1 Recipient of Income Type of Type of Income Business/Industry 1 had no reportable income over $5,000 in 2015. R S or 3 /S Cend Adewck [Ripe lerss Belle] Arisormr Bends haettn Deak] Vrlepo Licey |rerey, [Diels | The SEI and any attachments, excluding the Confidential Form, are public records. Page dof 10 Professional and Civic Relationships 7a). During 2015, were you o any members of your Immediate family a drector, officer, governing board member, Cmployae dependant cacir, of registered lobbyist of & non. coréraion or organization operating 1 Noh Caroma monty or vious chara, scenic, Karars, PUSIE hean and slay, or eaucations pki [Ives fo - 1 "No," proceed to question 8. > bo not Ist Sate boards or entities. +o not st organizations of which you are a mere member. Name of Nonprofit Watureor Corporation or organization | Purpose of Organization 705). the panprat corporations or organizations sed above do business wih the Stat of North Carolina or receive Site fonds, ney Sec th nar of ha business, i Know of with due gence cou easenably be known. Describe Sate Business During 2016, wer yau or any members of your Immediate aml 3 decor, officer, or governing board member of or Sckty, organism, or Mivocat grou wih an Rrest mars ove whch Your a98ncy or board may have Fnactons [ies [ING [Legislator iudicil Officer - You are not required to complete th question you are ling because eine ogsotor or sadcl Mees of fou are Hing a5 an PpOMee 5 on of tose Ofces: » Do not ls organizations of which you ae oly a member and donot seve na eadership role. Name of Society, Organization, Leadership Position or Moray Grown (Directo, Ofer, Board Member) The SET and any attachments, excluding the Confidential Form, are public records. Page sof 10 metres | omtommtorier | tameotcompony | _oseveen | rr rT 7 rrr 7° 1] rrr 7° 1] rr T° 1] rr] I rr 1 negligence) I rrr 1] rr] 12. Are you or your employer, or any members of your immediate family, or their employers curently: + 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 willbe associated or + in. business relationship with the State board or agency with which you ae or will be associated? [I¥es (96 [Legislator Judicial Officer - You are not required to complete this question you are fing because You are a legislator or a Judicial officer or you are fling as an appointee to one of hose offices Name of Employer Type of Relationship (if applicable) (Licensing, Regulatory, Business) 13. Rave you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12 months preceding your ilng of this form? Oves © Name of Lobbyist Lobbyist's Principal Date of Registration Registration Expiration 14. During 2018, after you were appointed, employed, or fled or were nominated as a candidate, did you + receive any "gifts exceeding $200 per quarter from a person or group of persons acting together, + when both you and those person(s) were outside North Caroline, + under circumstances that would lead a reasonable person to conclude the ifts were given for lobbying? To answer Yes, all three conditions must apply. Oves @%6 > Do not report gift given by members of your extended family. > Do not report gift you have previously reported on the “Expense Report for Exempted Persons.” ome sra rem fponere) | Severe eed || The SEI and any attachments, excluding the Confidential Form, are public records. Page 7f 10 5. During 2016, ahr you wer apport, amore, a ied or were nominated 5 3 canddats, 0 ou accept a “scholar” exceding $200 rete 1 your publ: psa or psn or Group O persons ang fi + wn hes parsons) were outside North Carla? To answer Ys, both conitons mst app. Ascholarship isa grant nad, ithr direct o indirect to attend conference, meeting, o similar event, Inchadog ons ave gain, mest, ana ones ilar expenses. Dives 16 Csi Offer - You are nt recur o complete this question f ou are cial fice or you re fin a2 el ois spo. + D0 nt repr it you hve previous reported on th Exper Raprt or Exempted Pros. + Leistrs re not require orport scholarships aid bya ranpartsan ile organization of whet Oe er Aosmin 3 emae porcpan, o se Date of Name and Address of Donor(s) schotaanip 6. Have you been appaied o cridered for ppaentt 3 covered board by th Govern o anther Coun of fiat] Council of sate members are: > tx Cover > seearyo sae > State Aur re — » Superintendent of bl Instruction > Atamoy General + Commisionerof Agia Commissioner of abr » Commision of nuance oe One 1Yes, lis al contributions you made n 2018 with a cumuative ota of more than £1,000 tothe Council of Cone amo wie sppoimed you. Do not inchate om ubons rom made fam members: > Conriuions re defined roady n N.C. § 163A-141(13) and include “any advance, conveyance, epost, Coton rate of ay oa, pyr, Gi, Pd of Suber fon of Sy of vl WRASORT [ome [amo] Contributed to [6 contrbution(s) with a cumulative total of more than $1,000 /3) Jo /& The Sez and any attachments, excluding the Confidential Form, ar public records. Page sor 10 17. Ave you an appoltes o prospective appoimtes as: 2. the head of a principal state department (e0., cabinet secretary) appointed by ve Covarenor 5.2 North Carolina Supreme Court Justice, Court of Appeals, Superior or District wiih ©. a member of any of the following boards: [Yes [ING + A8C Commission 1£°No, proceed to question 18. + Costa Resources Commision © Stote Board of Education © Stte Board o Hctions + Dison of Employment Securty + Environmental Management Commission + Industrial Commission + Human Resources Commission + ules Review Commision + board of Transportation + Utites Commission + Wide Resources Commission 4 11 s0, were you appointed o ae you being considered for appomment a hat | ves (ING postion by 5 Coun of State members Er ER © If 0, you must indicate whether during 2018 you engaged in any of Te {01041 CAVES Wh ToSpac o or-bahall of he condsts or capa Commie of he Counc of Site marmer who apponted you i. Colected contributions from mltile contributors, tok possesion of such ile contibutons, and. Tansered revere tose conoced Contributions t th candidat o commie’ i. osted undrasr at your residence o lace of business? Wi. Volutasred for campaign reated acti, including phone banks, overt asitance, alings, Canvassing, sy, or ony ower chy na | (Ves CIN pri 16. Have you ever been convicted o a felony or WhGh you have not received ater: () a pardon; or (1) an oder of pungent: Ove [ oftense Toateof Conviction | County of Conviction | state of conviction 19. Are you aware of any othr information that you believe may 955% the Efhics Commission n vis you Concerning your ComPaRce with th Se Goverment ones cs [W¥& [JNo If yes, please provide that information below. Rsspeinted Wh Boestpe 14 Sice Fhis 1s Ne bee 307 fe Ad do he Fengiecot T del WhRe A ComfEibotisc Yo Grvernes ChnpMOR 6/13J301 Ju ho AMovsto€ Heo. 20 The SET and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 Affirmation Toe information provided i this Statement of Economic terest and any attachments are true, complete, and accurate he set of my knowiad and bor have not transferred, and wil not transfer, any asst, interest o propery for th purpose of concealing It fom scours te reaning an curable mere [ | 1 understand that my statement of Economic ntrest and any attachments except fo the Confidential Form regarding ih Re Ti have eat a understand te following sate: N.C... § 1384-26. Concaling or aling to disclose material information. A fling person who knowingly conceals or knowingly fal to discos information tha s required to be discosed ns Chom onda G8 Loon N.C.G.S. § 138A-27. Penalty for false information. ing gn wis provides log naan on Saran of score arest ng gt hg asso oo guy of a Claws eon, a sha be inject vs Gcineny ein oman 1308-45. af under penalty of pesury Yat the foragolng trae and correct. — Lad, / Lok De 17, 0/7 Se Date Benlley, 7; eo Frinted Ram Submit signed, original documents only. Do not fax or e-mail this form. The SEY and any attachments, excluding the Confidential Form, are public records. Page 100110

A NORTH CAROLINA STATE ETHICS COMMISSION | ro eniics commission use omy #" ba 2017 STATEMENT OF ECONOMIC INTEREST = Ddte Recened 515-810-3600 on EGY Lo oo Belrnecnas for compton THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL | ; N YOUR SEI FILING OBLIGATION . Sear ee Date Entered in database (Lhe By Be Te Ter — - wn [pitame mao rama [vaste Tem Me Bradieg | Thomas | Adcocke N | a Tiere Stade of North, Carolina. Legislative Dador Te as : Gowrnor's Liaison Rast ror nies ETE oh ot 497] - er rs TEE A A : ou i. a | Office of the Governor | A. Do other immediate family members reside in your household? } B } (es [No i mts om 03 fo ols an, | EIS os ome me i 3 yg os FULL NAME OF ADULTS & RELATIONSHIP EMPLOYER 308 TITLE NATURE OF | EMANCIPATED MINORS ~ . BUSINESS ocho 0. Adel] Life T wip | NA us The SEE and any attachments, excluding the Confidential Form, re publi records. ——_— Ls ONLY the nial of ail unermandipated minors in you household below. A mir isa hid under 18 years od Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. - r———r— - { INITIALS FOR | RELATIONSHIP | EMPLOYER 308 TITLE NATUREOF | NEMARCIPATED | Business + MINORS 3 J ee—— — —_—— { i | | PROPERTY INTERESTS 1. As of Dacember 31, 2016, did you, your spouse, or members of your immediate fami: | A. Have an ownershio interest in North Carolina real estate (including your residence) with a market value of | $10,000 or more? | ] | oe ow | | owner of nest stave | on owners teres | vovmtonby city | Location by Gow | { < Ji ~~ u. | rad, "Mac : 200% | Cary | Wake e 5 1 1B fall, Adccel) 50% | OteanTsle Beadn| Bopnswick, | dan ore oct or pron per 0. Sao Coro ina makers | $1600 or mores Name of Lessor Name of Lessee If Real Estate, Location If Personal Property, | | Renters City 2 Covnty Deserve | | — LL i — : 2 At omy ime during 2015 or 2016, 63 you, you spouse, or members of your meddle family Sala or buy fam he Sie oars Cor a personal repent wih marker vio of S181008 a mores | ov we | Name of Purchaser I Name of Seller Type of Property The SEX and any attachments, excluding the Confidential Form, are public records. Page 20110 | FrnancraL interests i 3. As of December 31.2016, i you, your spouse, or members of your immediate family own any of the following financial | interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY. | stock ina pubcy owned company? Gfes OM S— > Do non Ist owners IMGTess Tn 3 widely hold veaiment fund (ncuding mutual funds, réqaated investment Companies, or pension or fefered compensation pans) if: (1) the fund is pUbIKly ade or a asses are widcly Ghverai; and (1) nether you nor an Immediate fami Tambor 9% abi 1 COMID hs assets held i the muta! ud, Invesiment Company, of pension or Glerad cmpénsation pn. Owner of Interest | Full Name of Company (Do not use ticker symbol) See Attachment £ | 1 | 5. Stock Ontons in 8 company or business? Oves Gf Emm mm | FT rrp ——" partnerships, limited partnerships, joint ventures, fmited Habilty companies, limited habiity partnerships, and | Gael hel corporations) | (Ives (No 11a," proceed to question 4 | Owner of Interest — Name of Company or Business Entity | C1). For cach non-publcy owned company a buses ent (ihe “primary company” dented in question S.C abou, plaase Ist the names of any SIRE Compas of Lusindes antics i whieh tae primary company owns secunties or equity mores valued a over $10,000, known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the primary Company) Guns Security or Equity Interests one or Not Known The SEX and any attachments, excluding the Confidential Form, are public records. Page 30f10 A Assel Managenient Corp. } | 5120 urn ice, alg NG 27612 | Por: (910) 782 9689 | F010) 783022 | ws st Com | Common Stock Holdings Greater Than $10,000 by Bradley Adcock and/or Martha Adcock on December 31, 2016 | Amgen i Apple Autozone | CBOE: Holdings ! Charles Schwab. General Dynamics Corp LyondellBasell Industry New York Community Bancorp i Sherwin-Williams Co H Toro Co 1] United Health Group Verizon H Visa } AO. Sih i Activision Blizzard i Alphabet Aluria Group AbbVie Acton ; AmeriGias Partners i Bank of the Ozarks 1 Valero | Walt Disney } Townsend Asset Management Corp fo & (hoe. Lou Ii. Abbas, PR.D., CFI" i i i Growing Enduring Wealth for Discerning Clients since 1982 BN { [7 C.(2). 1 you know that any company or business entity listed In 3.C or 3.C(1) above has any material business oman hs he ef Wr Corin, or Felted te Sak, rove a bl Seaton of hr Boast BWI " . Name of Company or Dusiness Entity | Description of Business Activity with the state Onencorbotknomn ~ oo _ _ _ _— EE 1 _— | 4. As of December 31, 2016, were you, your Spouse, or members of your immediate family the beneficiaries of a vested | 005 re ot was fated, ata sncs, or coma by 007 Da not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of "Vested Trust” and "Blind Trust.” Oves fio ame and Address of Trustee | Description of the Trust| Your Relationship to the Trust 5 sof December 31, 2006, 4 you, your spouse, o marbers of your mediate amy have abies of $10,000 r ore CAAA hE AGA oh ou At Bese Teena? AaTRS MOC HOt cord debt, Bu os, Ruder Toor, Sasson ans on an: omy Se. Clves [fo Name of Debtor (You, Spouse, immediate Family | Type of Creditor (Commercial Bank, Credit rion, on emer freon, ete 6 Unt cach source of Income (nat SpE Saunt) of ore. han $5,000 received by you, your 390us, or meres of our ImmnChte omy Twin 206. Includs sary, macs, HaKEHBG Saver rebremert, provera foes Foran hase, Andes Sn hms sea income: 38 Sr YP of mer Fares 13D repre an out Seve on edora Co er Do tt include income received from th following sources: + Capital gains + Federal government retirement + Miltary retirement + Social security income/SSD1 ement ove wm, — Recipient ot Income | Name of Source Typeot Twa of Tncame Po | Etmess/industry 1 hod 1 repertabic income ovr $5,000 1m 2016 2. J TT |B Cross Bide | CT [Companaaten, Brad Adecck SKE AC Insorance. |ekment coms thing The SEL and any attachments, excluding the Confidential Form, are public records. Page aor 10 PROFESSIONAL AND CIVIC RELATIONSHIPS 76a) During 2016, were you, your spouse or members of your immediate fomily 3 director, officer, governing board | member, employe, independent conactor,O retard abby of a ranprfit corporation of rganizaton peraing i he State of North Caraline primarily for elkious, Chankabi, scent, Ierary, BUSH: health and safety, or educational Purposes? [J¥es (No- 11 No,” proceed to question 8 Go not Tt Sate Boars enti, oF entitles created by a poltical subdwison of he State. al > Da not la organizations of which you ae 8 mere member. oo | Name of Person | His/Her Position 1 ‘Name of Nonprofit | Nature of Business or 7001, I the nonprofit. corparatians or organizations ted above do business with the State of North Caroling or — SUate funds, plaase provide a brief description of the nature of that business, If known or with which de ilgence could reasonably be knowin | Gone or ox ronn I During 2016, were you, your spouse, or members of your Immediate family a director, officer, or governing board amber f any S0clty, Organ ation, o 3A40¢acy 51045 Yh 31 IRerest in mortars over Which Your ag€ncy o board may hove arson? Oves [flo []Legisiator/udiciol Officer - You are not required to complete this question if you are Fling because Vou a a egilator or Judcal fer of You are ing as an appointee 1 those affces +00 not list organizations of which you are only a member rot serving in a leadership rol). Name of Person Name of Saciety, Organization Leadership Position or Advocacy Group. (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 “G(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, of member or manager as of December 31, 2016. | pameotverson | Relationship to Flr Nome of company _ Rou of Pyrson [5% Susiness Assoratans + T | - — = | — 7 —_ 900.1 you kn tht any company of busines any sed in 3(a) above had any material business dealings or | business contracts with the State of North Carolina or was regulated by the State as of December 31, 2016, provide a ee ot sae av. I ame of Company or Business Sty | Gescophion of sesmess Aeiiy wi ve sate | fr appt ti ens ied on 2351 10. Are you a practicing attorney? ves fo. Cauca Offcer/stae Aomey 1s", check each category of Iagl representation Which you or thew im with which you ae afiated hs earned Canoes of mere hom £13.908 rr 2006. Camis nama Comore Cicrminat [oecetonts esates FE T— Ctnsance Cltabor Coca Government eat property Ciseartes Oran Tort Wigation incuting nits Regulsion Other category not bed negligence) IL During 2016, were you 3 licensed professional (other than an attorney} or Gd you provid consulting Series ioany ar 25 emer oo profesor Esoraion or WER you €harge o ware Si over $10.0007 wre Cone Type of Business Nature of Services Rendered _ Inoorance. | Pdosery J The SEE and any attachments, excluding the Confidential Form, are public records. Page gor 10 {12 Are you or your employer, your spouse or members of your immediate family, or thir employer curently: + Licensed by the State board or employing entity with which you are or will be associate or + Regulate by the State board or enyaoying entity with which you are or will be associated or | + Have a business relationship ith the State board or employing entity with which you ae or wil be associated? [ives LiMo. []Legisiator cick Office - You ae nt required to complete ths question i you are fing because Vou are a leowlator or a jadcal afer (Judie! officer” 1s Geined in the SEF Helpful Tos) or You { Src Hing 25 an appantec to those ofces. i Name of Person Name of Employer | Type of Relationship | L (if applicable) (Licensing, Regulatory, Business) | | ere mer 5 such AP hd 12S GEA You To to am Ores fe Name of Lobbyist Lobbyist's Principal Date of Registration Registration Expiration 13. During any calendar quarter n 2016 (but only the time perad after you vere BppOIRTEd, emplayed or led or were nominated a5 » candidate). dé you + receive any "gt(s)" exceeding $200 per quarter from a person or oup of persans pcg together, ad + when both you and these person(s) were outside Kerth Carolina a th time you accepted the gifs), and + the gis) were given under creumstances that would lead @ reasonable person to conclude thot they were given Tor ebbing? Cves (0 50 not report Gs gen by members of your evtended famity. | »-00 ro report gis that have resiausly 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 i | | The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 5. rina 201 (ht any the me perc Sher you were apporied, smployed, a led o wer nominated a3 a cariaate pri cust ahah xcesding 5200 rom parse or grou of persons cng eget and escrow rete 0 your pu pon? Ascholarship* is 0 grant-n-ad, either dicect or indirect, wend Conferences meeting. or Sehor evant Incadiog tulian, travel 16431, meas and other Siar expenses | | omeor | Wem andndaremotbonor) | wserbetvem | Ssumated var | schataronip | Vowe | i | Council of State members are If “Yes”, list all contributions you (NOT immediate family members) made during 2016 with a cumulative Tor are ha 00 Gor Counc of State ame wih Sppoeed You. one I | Contributed to Th 551 and any atachments, exuding the Confidential Form, are publi records. Pages oro 17. Are you an appaintee or prospective appointee to: — Governor; or |b. a North Carolina Supreme Count Justice, Court of Appeals, Superior or District | Count nudge, or {ca member of any ofthe felling boards: i + ABC Commission t | + Coastal Resources Commission | + State Board of Education [ives eis | + State Board of Elactions | | + Dwisian of Employment Security 11t “Nos proceed to + Environmental Management Comission question 15. + industrial Commission + Human Resources Commission | + Rules Review Commission + Board of Transportation | + UNC Board of Governors | + Utites Commission |. viele Resources Commission | Nn 4. 11 0, were you appointed or ae you being considered for appointment to that | (Yes [No public position by a Counc of State member? Counc of State members are I5ted | 17 uo, "proceed to hia question 16. e150, you must indicate whether during 2016 you (rot immediate family | meriters) engaged in any of he following actives wilh respec to or an behalf of | the candicate or campaign commitee of the Council of State member who appointed you to your public positon. [CiYes CMe i Coleted contributions from multiple contibutors, took possession of such Up cantrbutons, and transiorea or divercd those collected | Contributions o the candidate or commit? Contributions are defined in | Question 16 — NS SAS i. Hosted o fundraiser a your residence or place of business? Dives Cho i volunteered for campaign-related actlics, which Include, out are not mited | 1, phone. bans, event asystance, mailings, canvassing, surveying, or any | (1¥es [No ther adv hat advances the campaign of 3 Candote? 753. Hove you ever been convicted of a felony for which you have no received either: (1) a pardon of mocence; o (1) an | order of sxpungeren regarding that camiction? Oves 516 | omeme | omer conviction | county of Conviction | _ state of Conviction _| | | 19 Are you aware of any other information thal you believe may asset the State Ethics Commission in advising you | concerning your Compliance with the State Government Ethics Act? | [ives (846 If yes, please provide such information below. | The SET and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 [ arrimarion | 1 ffm that the information provided in his Statement of Economic terest and any atachments hereto ace tre, omplte, | cee he bos of my old nd bl | als ceri that have not transferred, and will not tansfe, any ssc, interest, or property or the purpose of oncealing it | from disclosure while retaining an cquiable interest understand that my Statement of Economic Increst and any attaches os supplements thereto (with the exception of the Confidential Form regarding Unerancipad Childen) axe public record. | acknowledge that have read and understand N.C.G8. 138-26 regarding concealing or fling 10 disclose material | information and N.C G5. 1384.2 epcding proving aise informatio: § 1384-26. Concealing or failing to disclose material information. on a statement of economic interest under this Article shall be guily of a Class | misdemeanor and shall be subject | | dpi sco ander G5. 1394-39 | | A lin person who provides abe formation asm o coi ne arid under is Arle | || Keown thatthe information is fl i guilty of» Class H felony and shall be subject fo disciplinary action det GS. 138A (HT Agrees <5 £2 ~ 7 Lp ll Lez Jara £4 a, 2007 Signi 4 Gate a) T. Ade Sa Printed Name Submit SIGNED, ORIGINAL documents only. D0 not fax or email this form, _ The SEX and any attachments, excluding the Confidential Form, are public records. Page 1001 10

A NORTH CAROLINA STATE ETHICS COMMISSION | ro eniics commission use omy #" ba 2017 STATEMENT OF ECONOMIC INTEREST = Ddte Recened 515-810-3600 on EGY Lo oo Belrnecnas for compton THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL | ; N YOUR SEI FILING OBLIGATION . Sear ee Date Entered in database (Lhe By Be Te Ter — - wn [pitame mao rama [vaste Tem Me Bradieg | Thomas | Adcocke N | a Tiere Stade of North, Carolina. Legislative Dador Te as : Gowrnor's Liaison Rast ror nies ETE oh ot 497] - er rs TEE A A : ou i. a | Office of the Governor | A. Do other immediate family members reside in your household? } B } (es [No i mts om 03 fo ols an, | EIS os ome me i 3 yg os FULL NAME OF ADULTS & RELATIONSHIP EMPLOYER 308 TITLE NATURE OF | EMANCIPATED MINORS ~ . BUSINESS ocho 0. Adel] Life T wip | NA us The SEE and any attachments, excluding the Confidential Form, re publi records. ——_— Ls ONLY the nial of ail unermandipated minors in you household below. A mir isa hid under 18 years od Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. - r———r— - { INITIALS FOR | RELATIONSHIP | EMPLOYER 308 TITLE NATUREOF | NEMARCIPATED | Business + MINORS 3 J ee—— — —_—— { i | | PROPERTY INTERESTS 1. As of Dacember 31, 2016, did you, your spouse, or members of your immediate fami: | A. Have an ownershio interest in North Carolina real estate (including your residence) with a market value of | $10,000 or more? | ] | oe ow | | owner of nest stave | on owners teres | vovmtonby city | Location by Gow | { < Ji ~~ u. | rad, "Mac : 200% | Cary | Wake e 5 1 1B fall, Adccel) 50% | OteanTsle Beadn| Bopnswick, | dan ore oct or pron per 0. Sao Coro ina makers | $1600 or mores Name of Lessor Name of Lessee If Real Estate, Location If Personal Property, | | Renters City 2 Covnty Deserve | | — LL i — : 2 At omy ime during 2015 or 2016, 63 you, you spouse, or members of your meddle family Sala or buy fam he Sie oars Cor a personal repent wih marker vio of S181008 a mores | ov we | Name of Purchaser I Name of Seller Type of Property The SEX and any attachments, excluding the Confidential Form, are public records. Page 20110 | FrnancraL interests i 3. As of December 31.2016, i you, your spouse, or members of your immediate family own any of the following financial | interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY. | stock ina pubcy owned company? Gfes OM S— > Do non Ist owners IMGTess Tn 3 widely hold veaiment fund (ncuding mutual funds, réqaated investment Companies, or pension or fefered compensation pans) if: (1) the fund is pUbIKly ade or a asses are widcly Ghverai; and (1) nether you nor an Immediate fami Tambor 9% abi 1 COMID hs assets held i the muta! ud, Invesiment Company, of pension or Glerad cmpénsation pn. Owner of Interest | Full Name of Company (Do not use ticker symbol) See Attachment £ | 1 | 5. Stock Ontons in 8 company or business? Oves Gf Emm mm | FT rrp ——" partnerships, limited partnerships, joint ventures, fmited Habilty companies, limited habiity partnerships, and | Gael hel corporations) | (Ives (No 11a," proceed to question 4 | Owner of Interest — Name of Company or Business Entity | C1). For cach non-publcy owned company a buses ent (ihe “primary company” dented in question S.C abou, plaase Ist the names of any SIRE Compas of Lusindes antics i whieh tae primary company owns secunties or equity mores valued a over $10,000, known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the primary Company) Guns Security or Equity Interests one or Not Known The SEX and any attachments, excluding the Confidential Form, are public records. Page 30f10 A Assel Managenient Corp. } | 5120 urn ice, alg NG 27612 | Por: (910) 782 9689 | F010) 783022 | ws st Com | Common Stock Holdings Greater Than $10,000 by Bradley Adcock and/or Martha Adcock on December 31, 2016 | Amgen i Apple Autozone | CBOE: Holdings ! Charles Schwab. General Dynamics Corp LyondellBasell Industry New York Community Bancorp i Sherwin-Williams Co H Toro Co 1] United Health Group Verizon H Visa } AO. Sih i Activision Blizzard i Alphabet Aluria Group AbbVie Acton ; AmeriGias Partners i Bank of the Ozarks 1 Valero | Walt Disney } Townsend Asset Management Corp fo & (hoe. Lou Ii. Abbas, PR.D., CFI" i i i Growing Enduring Wealth for Discerning Clients since 1982 BN { [7 C.(2). 1 you know that any company or business entity listed In 3.C or 3.C(1) above has any material business oman hs he ef Wr Corin, or Felted te Sak, rove a bl Seaton of hr Boast BWI " . Name of Company or Dusiness Entity | Description of Business Activity with the state Onencorbotknomn ~ oo _ _ _ _— EE 1 _— | 4. As of December 31, 2016, were you, your Spouse, or members of your immediate family the beneficiaries of a vested | 005 re ot was fated, ata sncs, or coma by 007 Da not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of "Vested Trust” and "Blind Trust.” Oves fio ame and Address of Trustee | Description of the Trust| Your Relationship to the Trust 5 sof December 31, 2006, 4 you, your spouse, o marbers of your mediate amy have abies of $10,000 r ore CAAA hE AGA oh ou At Bese Teena? AaTRS MOC HOt cord debt, Bu os, Ruder Toor, Sasson ans on an: omy Se. Clves [fo Name of Debtor (You, Spouse, immediate Family | Type of Creditor (Commercial Bank, Credit rion, on emer freon, ete 6 Unt cach source of Income (nat SpE Saunt) of ore. han $5,000 received by you, your 390us, or meres of our ImmnChte omy Twin 206. Includs sary, macs, HaKEHBG Saver rebremert, provera foes Foran hase, Andes Sn hms sea income: 38 Sr YP of mer Fares 13D repre an out Seve on edora Co er Do tt include income received from th following sources: + Capital gains + Federal government retirement + Miltary retirement + Social security income/SSD1 ement ove wm, — Recipient ot Income | Name of Source Typeot Twa of Tncame Po | Etmess/industry 1 hod 1 repertabic income ovr $5,000 1m 2016 2. J TT |B Cross Bide | CT [Companaaten, Brad Adecck SKE AC Insorance. |ekment coms thing The SEL and any attachments, excluding the Confidential Form, are public records. Page aor 10 PROFESSIONAL AND CIVIC RELATIONSHIPS 76a) During 2016, were you, your spouse or members of your immediate fomily 3 director, officer, governing board | member, employe, independent conactor,O retard abby of a ranprfit corporation of rganizaton peraing i he State of North Caraline primarily for elkious, Chankabi, scent, Ierary, BUSH: health and safety, or educational Purposes? [J¥es (No- 11 No,” proceed to question 8 Go not Tt Sate Boars enti, oF entitles created by a poltical subdwison of he State. al > Da not la organizations of which you ae 8 mere member. oo | Name of Person | His/Her Position 1 ‘Name of Nonprofit | Nature of Business or 7001, I the nonprofit. corparatians or organizations ted above do business with the State of North Caroling or — SUate funds, plaase provide a brief description of the nature of that business, If known or with which de ilgence could reasonably be knowin | Gone or ox ronn I During 2016, were you, your spouse, or members of your Immediate family a director, officer, or governing board amber f any S0clty, Organ ation, o 3A40¢acy 51045 Yh 31 IRerest in mortars over Which Your ag€ncy o board may hove arson? Oves [flo []Legisiator/udiciol Officer - You are not required to complete this question if you are Fling because Vou a a egilator or Judcal fer of You are ing as an appointee 1 those affces +00 not list organizations of which you are only a member rot serving in a leadership rol). Name of Person Name of Saciety, Organization Leadership Position or Advocacy Group. (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 “G(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, of member or manager as of December 31, 2016. | pameotverson | Relationship to Flr Nome of company _ Rou of Pyrson [5% Susiness Assoratans + T | - — = | — 7 —_ 900.1 you kn tht any company of busines any sed in 3(a) above had any material business dealings or | business contracts with the State of North Carolina or was regulated by the State as of December 31, 2016, provide a ee ot sae av. I ame of Company or Business Sty | Gescophion of sesmess Aeiiy wi ve sate | fr appt ti ens ied on 2351 10. Are you a practicing attorney? ves fo. Cauca Offcer/stae Aomey 1s", check each category of Iagl representation Which you or thew im with which you ae afiated hs earned Canoes of mere hom £13.908 rr 2006. Camis nama Comore Cicrminat [oecetonts esates FE T— Ctnsance Cltabor Coca Government eat property Ciseartes Oran Tort Wigation incuting nits Regulsion Other category not bed negligence) IL During 2016, were you 3 licensed professional (other than an attorney} or Gd you provid consulting Series ioany ar 25 emer oo profesor Esoraion or WER you €harge o ware Si over $10.0007 wre Cone Type of Business Nature of Services Rendered _ Inoorance. | Pdosery J The SEE and any attachments, excluding the Confidential Form, are public records. Page gor 10 {12 Are you or your employer, your spouse or members of your immediate family, or thir employer curently: + Licensed by the State board or employing entity with which you are or will be associate or + Regulate by the State board or enyaoying entity with which you are or will be associated or | + Have a business relationship ith the State board or employing entity with which you ae or wil be associated? [ives LiMo. []Legisiator cick Office - You ae nt required to complete ths question i you are fing because Vou are a leowlator or a jadcal afer (Judie! officer” 1s Geined in the SEF Helpful Tos) or You { Src Hing 25 an appantec to those ofces. i Name of Person Name of Employer | Type of Relationship | L (if applicable) (Licensing, Regulatory, Business) | | ere mer 5 such AP hd 12S GEA You To to am Ores fe Name of Lobbyist Lobbyist's Principal Date of Registration Registration Expiration 13. During any calendar quarter n 2016 (but only the time perad after you vere BppOIRTEd, emplayed or led or were nominated a5 » candidate). dé you + receive any "gt(s)" exceeding $200 per quarter from a person or oup of persans pcg together, ad + when both you and these person(s) were outside Kerth Carolina a th time you accepted the gifs), and + the gis) were given under creumstances that would lead @ reasonable person to conclude thot they were given Tor ebbing? Cves (0 50 not report Gs gen by members of your evtended famity. | »-00 ro report gis that have resiausly 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 i | | The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 5. rina 201 (ht any the me perc Sher you were apporied, smployed, a led o wer nominated a3 a cariaate pri cust ahah xcesding 5200 rom parse or grou of persons cng eget and escrow rete 0 your pu pon? Ascholarship* is 0 grant-n-ad, either dicect or indirect, wend Conferences meeting. or Sehor evant Incadiog tulian, travel 16431, meas and other Siar expenses | | omeor | Wem andndaremotbonor) | wserbetvem | Ssumated var | schataronip | Vowe | i | Council of State members are If “Yes”, list all contributions you (NOT immediate family members) made during 2016 with a cumulative Tor are ha 00 Gor Counc of State ame wih Sppoeed You. one I | Contributed to Th 551 and any atachments, exuding the Confidential Form, are publi records. Pages oro 17. Are you an appaintee or prospective appointee to: — Governor; or |b. a North Carolina Supreme Count Justice, Court of Appeals, Superior or District | Count nudge, or {ca member of any ofthe felling boards: i + ABC Commission t | + Coastal Resources Commission | + State Board of Education [ives eis | + State Board of Elactions | | + Dwisian of Employment Security 11t “Nos proceed to + Environmental Management Comission question 15. + industrial Commission + Human Resources Commission | + Rules Review Commission + Board of Transportation | + UNC Board of Governors | + Utites Commission |. viele Resources Commission | Nn 4. 11 0, were you appointed or ae you being considered for appointment to that | (Yes [No public position by a Counc of State member? Counc of State members are I5ted | 17 uo, "proceed to hia question 16. e150, you must indicate whether during 2016 you (rot immediate family | meriters) engaged in any of he following actives wilh respec to or an behalf of | the candicate or campaign commitee of the Council of State member who appointed you to your public positon. [CiYes CMe i Coleted contributions from multiple contibutors, took possession of such Up cantrbutons, and transiorea or divercd those collected | Contributions o the candidate or commit? Contributions are defined in | Question 16 — NS SAS i. Hosted o fundraiser a your residence or place of business? Dives Cho i volunteered for campaign-related actlics, which Include, out are not mited | 1, phone. bans, event asystance, mailings, canvassing, surveying, or any | (1¥es [No ther adv hat advances the campaign of 3 Candote? 753. Hove you ever been convicted of a felony for which you have no received either: (1) a pardon of mocence; o (1) an | order of sxpungeren regarding that camiction? Oves 516 | omeme | omer conviction | county of Conviction | _ state of Conviction _| | | 19 Are you aware of any other information thal you believe may asset the State Ethics Commission in advising you | concerning your Compliance with the State Government Ethics Act? | [ives (846 If yes, please provide such information below. | The SET and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 [ arrimarion | 1 ffm that the information provided in his Statement of Economic terest and any atachments hereto ace tre, omplte, | cee he bos of my old nd bl | als ceri that have not transferred, and will not tansfe, any ssc, interest, or property or the purpose of oncealing it | from disclosure while retaining an cquiable interest understand that my Statement of Economic Increst and any attaches os supplements thereto (with the exception of the Confidential Form regarding Unerancipad Childen) axe public record. | acknowledge that have read and understand N.C.G8. 138-26 regarding concealing or fling 10 disclose material | information and N.C G5. 1384.2 epcding proving aise informatio: § 1384-26. Concealing or failing to disclose material information. on a statement of economic interest under this Article shall be guily of a Class | misdemeanor and shall be subject | | dpi sco ander G5. 1394-39 | | A lin person who provides abe formation asm o coi ne arid under is Arle | || Keown thatthe information is fl i guilty of» Class H felony and shall be subject fo disciplinary action det GS. 138A (HT Agrees <5 £2 ~ 7 Lp ll Lez Jara £4 a, 2007 Signi 4 Gate a) T. Ade Sa Printed Name Submit SIGNED, ORIGINAL documents only. D0 not fax or email this form, _ The SEX and any attachments, excluding the Confidential Form, are public records. Page 1001 10

y NORTH CAROLINA STATE ETHICS COMMISSION | ror ermics commission use ony /i'y; 2016 STATEMENT OF ECONOMIC INTEREST | eis coved 4 919-814-3600 www. ethicscommission.nc.gov ar JG hhh 1: 28 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL al lbh YOUR SEI FILING OBLIGATION —— fore Incomplete 75 Supp. Sent Ome by _ Supp. Rocowea vote erverot mn aaavase 11 wy 400 | FILER'S NAME (FIRST, MIDDLE, LAST) [pric Trt ame [Midaie Name | LastName TT sm (Me Beadiey | THpmAs Abcoet - {coment emptover 7 J0B TITLE oo | Retired I 7/2 . [aurea rv or susness | REASON FOR FILING (SELECT ALL THAT APPLY) oo oo | [J STATE GOVERNMENT 10B (Please speciiy the agency | [JSOARD/COMMISSION (lease lit complete name of all | for which you work or are being considered) State boards on which you are serving or are being i considered) oT b ee ; 7 , y i | Rppalachim sthrie Upiversily Lo | Board of Thus tees [J JUDICIAL OFFICER (Please specly the office you hold) | LEGISLATOR (lease speci House or Senate) | A. Do other Immediate Family members reside in your household? |e [ino | 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 chikiren, grandchildren, parents, arandparents, and siblings, and the spouses of cach of those persons) who reside in your household. | List the ful name of all adults and emancipated minors in your household. A minor s a hid under 1 years od. | Minors are emancipated by mariage, enlistment in the US mitary or court order for emancipation | Fut name or sours | mecarionsmp | emprover JOBTITLE | NATURE OF EMANCIPATED MINORS hail hii ~ | Business PARTIE Pl | wide | IZ 7 i I — RN EE | 1 —l m— The SEX and any attachments, excluding the Confidential Form, are public records. Page of 10 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 manage, enistment the US mibtary 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. TT INITIALS FOR | RELATIONSHIP EMPLOYER | JoBTITLE NATUREOF | UNEMANCIPATED BUSINESS | MINORS | ~ ee — — I EE RO 1 _— 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 3 market value of | £10,000 or more? | Ves LiNo i _ NE Owner of Real Estate % Ownership Interest Location by City Location by County | | Adecot: : > — F/IRETA 0 { £ + Wake _ Bpnaf mein Pecok 52% Coon Tile Bepeh | Brows wie NR SE A— 8. Lease or rent real estate or personal property 10 Cr from the State of North Caroling with a market value of £10,000 or more? [Yes [who Name of Lessor Name of Lessee | If Real Estate, Location | It Personal Property, (Renter) by City & County Describe 2 At any time during 2013 cr 2015, did you, your spouse, or members of your immediate family 52110 or buy from the State of North Caroling personal property wit a market value of $10,000 or more? [ives (uae | Nomeofpurcheser | NameofSeler | Typeofproperty The SEI and any attachments, excluding the Confidential Form, are public records. Page 20 10 | FINANCIAL INTERESTS | 3. As of December 31, 2015, did you, your spouse, or members of your mmediate family own any of the following financial treats valoed at £10,000 o more? A. StGk in a publicly owned company? [I [50 na overs rests a wildly ESTO fo Re TAT a, Tog eset 1 companies, or pansion or defered compensation plane) f- (1) the fund fs pabicy traded or 1s assets are wei versed; and (1) nother you nar an mmcdate amily mambe are able to SomIOl he assets NIE the tua nd, investment company, or pension o deferred Compensation pon Owner of Interest Full Name of Company (Da not use a ticker symbol) Jee Atachmerf . . 1 SN _ 1 . Stock Cations in a company or business? | } [ves mo Owner of Stock Option Full Name of Company (Da not use a ticker symbol) |. toteests in non-oublict owned company or business entity (including interes n sole proprietors, arinershigs, med porters, oink ventures, ied Labiy Companies, Wmited habits panei, and Cosel held Corporations)? [¥es (4% 1f “No,” proceed to question 4. Owner of Interest Name of Company or Business Entity i (1). For each non-publicty owned company or business entity (ihe “primary company”) dented in question S.C Shove, peas et Th names of my ther companies of ukinGss nies whch the mary company owns Secures o equ Interests valued at ver $10,000, 7 known Nor-publcy Owned Company or Business Entity | Other Companies in which the Primary Company | (one primary Company) Owns Security or Equity Interests A RERE_——._——-=—.— The SET and any attachments, excluding the Confidential Form, are public records. Page 3of 10 C2). If you know that any company or business entity fisted in 3.C or 3.C(1) above has any mterial business | hinge or business contract with the State of North Carolin, o is regulated by the State, provide brief | Gescrition of thet business act. | | Name of Company or Business Entity Description of Business Activity with the State | I 1 None or Not Known _ 1 I 1} rust wilh 3 valge oF 10,600 ar more that wes created estapished, or controled by you? Do not list assets held in blind trusts. See 2016 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust. [ves [mo | Name and Address of Trustee Description of the Trust Vour Relationship to the Trust FE - — | — i 15. As of December 31, 2015, did you, your spouse, or members of your immediate family have liabilities of $10,000 or ire, excluding he 514Gage on yout primary personal residence? Examples include credit card debts, uta ans, Student | | Dves [ue | Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Member) i Indiidus), ete) 6. List ach source of income (not specific amounts) of more than $5,000 receved by You, your Spouse, or members of Jour. immediate family dung 2015. Include ssary, wages, sEateocal government retirement, professional foes, State an federal to returns Do not include income received from the following sources: » Capital gains » Federal government retirement | |___> Witkary retirement » Social security income/SSDI Recplentof income || Name of Source Type of Tvpe of Income | Blainess/ Industry [711 nad no reportable income aver $5,000 in 2015. ) [BJ (BC 8), » Compe = he Le. | Iisveene soiling | ReAd Pace Chpstent Pldic [Ge(mbions tonsuihivg EE | ! EE ES NN EU The SEE and any attachments, excluding the Confidential Form, are pubic records. Page dof 10 RR — SR — - - i. | | PROFESSIONAL AND CIVIC RELATIONSHIPS i | 7(3). During 2015, were you, your spouse or members of your immediate family a director, officer, Governing board member, employee, independent contractor, o registered (obbyIs of a OTBION corporation o erganization operating the State. of Korth Carolina primarily for relious, charitable, Sent, Iterary, public health and cafeay or aducationat purposes? | | [ives Ifo,” proceed to question 8. 7550 of Tt State bards or ents, or enCes created by 3 pal sUbdNISon of te State | > 00 not list organizations of which you are @ mere member. = oo Name of Person His, Her Position Name of Nonprofit Nature of Business or | Corporation or Organization | Purpose of Organization | oT I - — 1 —— ! Ra - fr | 705). Ifthe nonprofit corporations or organizations listed above do business with the State of North Carolina or nr] State funds, please provide a brief description of the nature of that business, If Known 1 with which due Ailgonce could reasonably be known. | | Name af Nonprot Corporation or Organization | bescribe sate Business or state Funding one or Not Known 8 - - - 1 i | | 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 INet in Matters over which your agency or bosrd may Rave luisdiction? [Ives (90 [7] Legisiator/ Judicial Officer - You are not required to complete this question if you are fing because Vou 30a lator oa Judi othr o ou are Bom on nappa bee | D0 not sk rganizations of which you are only a member (not serving in a leadership role). | f Name of Person Name of Society, Organization Leadership Position or Advocacy Group (Director, Officer, Board Member) SN - | = _ | The SEX and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 | So iv mat ss comin sas yo wr ete ire yo esi yor i | amy was an employee, director, aficr, partner, proprietor o member or manager ve of December 31. S015. hime ar versa | weimonnptopier | ameotGompany | rteateamn [Ho Business Associations - If “No,” proceed fo question 10 | - = — — = 1 — TT Tepe FE Tr— Dusiness contracts with he State of North Caroling or was eguiated By the State as of December 31. 2015, provide a bef desnption of that business actiy. Name of Company or Business Entity Description of Business Activity with the State (Not applicable (No entities listed on #9a) [| No relationship / Not known 2 c= ps _ _ - — — i | 10. Are you a practicing attorney? [Yes (946 [dial Offcer/State Attorney | 1 "Yes, check each category of legal cepresentatian in which you of th Law im with which yo ae afflted has earned legal fs of mar than $10,000 during 2015. | [1 Adminstratve © admieaty [1 Corporate [Jcamina | || C1 Decadent states [Environmental [insurance [hater J tocal Government [Rest property (1securtes Ora £1 ort gation (including [bites Regulation Other category not sed. i negligence) | 11. Dung 2015, were you 3 Iicensed professional (other than an attorney) or did you provide consulting aris | | mda or a’ mr of 2 profesional sss aon for whch you Chrged of were a oer $10,0007 | @Yes [No | Type of Business Nature of Services Rendered LNs a Advisoe, ] Poklie Felpdieas Advise _ _ | The SEI and any attachments, excluding the Confidential Form, are pubic records. Page sor 10 12. Are you or your employer, your spouse or members of your immediate family, o their employer currently: + Licensed by the State board or employing entity with which you are or will be associated oF + Reguiated by the State board or employing entity with which you are or wil be associated or I + Have 2 business relationship with the State board or employing entity with which you are or wil be associated? Yes [Mo [Legislator Judicial Office - You are not required to complet this question you ae ing because vou 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 Type of Relationship (if applicable) (Licensing, Regulatory, Business) Se ————————— eee ———— 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 monihs preceding your filing of this form? Cives [who i Name of Lobbyist Lobbyist's Principal Dateof | Registration Registration Expiration OTHERDISCLOSURES SE . -_ 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 "gft(s)" exceeding $200 per quarter rom a person or group of persons acting together, and + When both you and those person(s) were outside North Caralina at the time you accepted the git(s), and + the f(s) were given under circumstances that would lead a reasonable person to conclude that they were aiven for lobbying? | | ves ws [+50 not report gits given by members of your extended family. | #00 not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” Date Item Received | Nome and Address of Donor(s) | Describe Item Received | Estimated Market | Value | rr ——————————————————————————————————— The SET and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 15. During 2015 (but only the time period after you wers appointed, employed, or fied or were nominated as a candidate) | aid you accept a “scholarship” exceeding $200 from person or group of persons acting together and || = ose pre wer sie Hors Corl and © the scholarship was related to your public postion? A “scholarship” is a grant-in-aid, either direct or indirect, Lo attend a conference, meting, or similar event, including tuition, travel, odging, meals, and other | Similar expenses. | ves rr pica ocr vou are ot requires 0 compete this uestion you ae cic fice or you re | ing as a judicial officer appointee. » D0 not report gifs that have previously been reported by you to the Department of the Secretary of Sate on the | * “Expense Report for Exempted Persons.” » Logiiatos are not recuired to report scholarships paid by a nonpartisan legislative organization of which the legisator | or the General Assembly 5 8 member or participant or 1 affate of hat organization. [™ oateor Name and Address of Donor(s) Describe Event Estimated Market Scholarship Vale | | scholarswip | 0 1 vee i L Sl _ - _ | __ _ 16. Were you appointed or are you being considered fo an appanimEnt to 2 covered board by the Governor or another Counc of State member? Council of State members ar: | | coer » Lt. Governor > Secratay of State | » State Auditor » state Treasurer » Superintendent of Pubic Instruction » Attorney General » Commissioner of Agricuture > Commissioner of Labar » Commissioner of Insurance | | es (ine 16 "Yes", list all contributions you (NOT immediate family members) made during 2015 with a cumulative Lotai of mare then $1,000 to the Governor or other Council of State member who appointed you. + Contributions are defined In N.C.G.5. 163-278.6(6) and Include, but are not Imited to, “any advance, conveyance, epost, distnbaton, wranser of unde, oan, payment, ft, pled o subscription of money or anything of value shatsoiver” | bate Amount T Contributed to | 1% contibution(s) with 2 comuative total of more than $1,000 The SEI and any attachments, excluding the Confidential Form, are public records. Page sof 10 17. Are you an appointee or prospective appointee to: | 2. the head of a princieal state department (29. cabinet secretary) appanted by the Governor or | |. a North Carolina Supreme Cour Justice, Court of Appeal, Superior or istrict | Coun udger or 2 member of any of the following boards: | + ASC Commission | + Coastal Resources Commission + State Board of Education [ives wie | * State Board of Elections | + Dison of Employment Security [1 “No” proceed to + Environmental Management Commission ‘question 18. + Industrial Commission | + Human Resources Commission | + Rules Review Commission | © Board of Transportation UNC Sort of Govern | + Utities Commission | | * Wide Resources Commision ! 4. 1 0, were you appointed o are you being considered for appoiniment to nat | Ives [1a UD: postion ys Counc of State ern? Counc of Ste Members 12 122 | 11 oor proceed to | | question 16. nr jauestonts] er 1150, you must cate whether during 2015 you (nat medias family members) engaged in any of the following activities with respect to or on behalf of ! Sh Candidate ar campaign committe of the Counc f State member who i appomtet you to your pune postion ! ICives (Ine i. Collected contributions from multiple contributors, tock possession of such | mule contributions, and ransened o Govercd tvs cotected | Contributions t the candi or COmMtee? Contriburons are seine in Question 16 | bees 1 Hosted a andrarse at your residence or ploce of business? [fives (no ] [i Valuer for campaign-refated activites, which include, bu are not nied ] | 10, phone banks, event acsstance, malig, camassing, surveying, or amy. | [Ives []No i | Other acy har Aduances te campagne » CanaSRET |= | 15. Have you ever been convict of a felony for which you have nt received ther: () a pardon of macence: or (1) an | order of Expungement regarding tht conmicions res [uns | otnse omens |G cons | scr onion i I -—L 1 -— 1 — — 19. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you | concerning a With the State Government Exncs A> [ives (98s If yes, pease provide such information below. pe ——e so EE - _ ~ j The SE and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 | arezmation afin that the information provided in his Statement of Feonomie Interest and any attachments hero are true, complete, | mt est th st my knowl a ic | | also certify that 1 have not transferred, and will not transfir, any asset, interest, or property for the purpose of concealing it | | from disclose whi reining an cquiable intrest, | understand that my Statement of Feonamic Interest and any attachments or supplements thereto (with the exception of the | | Confidential Fon regarding Uncmancipated Children) ane public record | | 1 cknowlode that | have read and understand N.C... 138A-26 regarding concealing or failing to disclose materia! i information and N.C.Gi.5. 1384-27 regarding providing fals information 1 A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed | on a statement of cconomic interest under this Article shall be guilty of a Class | misdemeanor and shall be subject | | to disciplinary action under G5. 138A-45. | | § 138427. Penalty for false information. | i A filing person who provides false information on a statement of economic interest as required under this Article | | Knowing tha the information is false i guilty of a Class H felony and shall be subject to disciplinary action under | GS. 1384-45. | i | | TA Al Lpit 7006 § oa TA | Printed Na | | i | Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. ___ oo 1 The SET and any attachments, excluding the Confidential Form, are public records. Page 10 of 10 ‘Common Stock Holdings Greater Than $10,00 by Bradley Adcock and/or Martha Adcock on December 31, 2015 ‘AmeriGas Partners, LP New York Community Bank Sherwin Williams Co Altria Group, Inc. J nosh Travelers Companies Sherwin Williams Co Apple, Inc. United Health Group Autozone ne vin ‘CBOE Holdings, Inc. AbbVie, Inc. crates sea Carn peta. Constellation Brand General Dynamics Co Gilead Sciences, Inc. CBOE Holdings, Inc. Lockheed arti cop Masinea nc New York Community Bank ——— Bank of the Ozarks General Dynamics Co Valero Energy Corp. Gilead Sciences, Inc. ir Nationa! Grd mc Lockheed Martin Corp ‘Walt Disney Co. Bank of the Ozarks TD Ameritrade Hidgs Tousen set Mamgagent Cop. Lgon E. Abbas, Ph.D., CFP

.#%. NORTH CAROLINA STATE ETHICS COMMISSION SANE. inp "41 2015 STATEMENT OF ECONOMIC INTEREST | EAS COMSSION use Dot | 919-715-2071 www ethicscommission.nc.gov | Ls anru-n00——— FILER'S NAME (FIRST, MIDDLE, LAST) Bewey rthmps |Rdeeck | CURRENT EvpLOYER J08 TITLE r= Retipes oF NATURE OR TYPE OF BUSINESS rw REASON FOR FILING (SELECT ALL THAT APPLY) [STATE GOVERNMENT J0B (Please specify the agency for | SOARD/COMMISSION (Please list complete name of al | Which you work or ae being considered) State boards on which you are serving or are being considered) Apprifchisy State Luiveesity a Beard o€ Tevstees JUDICIAL OFFICER (Pease specity the office you hod) _| JLEGISLATOR (Please spect House or Senate) Do otper mmediate family members reside n yaur household? les [No When used throughout this form, the term Immediate family includes your spouse (uniss legally separated). t also Incladss members of your extended famiy (your and your spouse's children, arandchidren, parents, grandparents, and ings, and the spouses of each of those persons) who reside in your household. (ONLY LIST THE INITIALS OF UNEMANCIPATED CHILDREN, However, you MUST submit the children's full names on the Confidential Form availabe at the end ofthis document Minors are emancipated by marriage, enlistment in the US miltary, or court action for emancipation. EMANCIPATED MINORS ‘Business peut 0 Nesde ote | Wh | Wp | ME The SEI and any attachments, excluding the Confidential Form, are public records. Page 10110 AFFIRMATION affirm that the information provided in this Statement of Economie Interest and any attachments hereto a tru, complete, | and accurate to the best of my knowledge and belief. Tals certify that I have not transferred, and will not transfer, any asst, interest, or property for the purpose of concealing it from disclosure while retaining an equiable interest | Lunderstand 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. | Tacknowledge that have read and understand N.C.G.S. 138A-26 regarding concealing or fling o disclose material | information and N.C.G.S. 138A-27 regarding providing falc information: ! | § 138A-26. Concealing or failing to disclose material information. | A filing person who knowingly conceals or knowingly fais to disclose information that i required to be disclosed ona | | statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject (0 | disciplinary action under G.S. 1384-45. §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 shal be subject to disciplinary action under G.S. 1384-45. Agree 74 oy Name . lV /R, Zo) | Signature Date Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. ‘The SEI and any attachments, excluding the Confidential Form, are public records. Page 100f 10 ATTREHMEN: A” PUBLICLY TRADED COMPANIES OWNED BY BRADLEY ADCOCK AS OF December 31, 2014 WITH INDIVIDUAL VALUES IN EXCESS OF $10,000 AbbVie Inc Abbott Laboratories Aetna, Inc AmeriGas Partners LP Apple, Inc. Canadian National Railroad Enterprise Products Partners LP Gilead Sciences, Inc. TD Ameritrade Holding CL A Union Pacific Altria Group, Inc. ConocoPhillips General Dynamics Lockheed Martin National Grid PLC NY Community Bankcorp Old dominion Freight Lines Southern Company Southwest Airlines The Travelers Companies Total INITIALS FOR RELATIONSHIP EMPLOYER JOB TITLE \TURE Of UNEMANCIPATED BUSINESS. CHILDREN PROPERTY INTERESTS 1. As of December 31, 2014, did you, your spouse, or members of your immediate family: A. Have an ownership interest in North Carolina realestate (ncuding your rescence) with a market value of $10,000 of more? Eres One % Ownership Interest Location by County Benli mems Ave] 50% | OremTiie Roh |Ropomsnick 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? Ove we Name of Lessor Name of Lessee | 1f Real Estate, Location | If Persanal Property, (Renter) by City & County Descrine 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 Carolin personal property witha market value of $10,000 o woes | ove we [ Nameorpurchaser | wmeorsemer | Type of Property The SET and any attachments, excluding the Confidential Form, are public records. Page 201 10 FINANCIAL INTERESTS 3. As of December 31, 2014, 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? Be Oto +00 not st ownership interests In @ widely held investment fund (including mutual funds, regulated investment Companies, or persion of deferred compensation plans) if: () the fund is publicly traded or its assets are widely Givaraiiea: ana (ih neither you nor an immediate family member are able to contol the assets held in the mutual fund, Investment company, or pension of deferred compensation pan. [ Owneroffmewest | Full Name of Company (00 not use a ticker symbol) [dec Atipchment A | i 1 ©. Stock Options in a company or business? Ove © 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)? ves 1 - 11°, proced to question 4. I Owner of Interest Name of Company or Business Entity The SEL and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 ir ————— (2). For each non-publcy owned company or business entity (te “primary company’) dentiied In question 3 3Bove please Ist the names of any other Companies or business enties in which the Pima corpo on: secures o equity interests values at over $10,000, know Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the Primary Company) Owns Securlty or Equity Interests Wane or Not Known (2) Ifyou know tht any company o business entity lsted in 3.C or 3.C(1) above has any material busess dealings or business contracts with the State of North Caroling, or 13 regulated oy the State, poses 2 pre: description of that business acy. ‘Name of Company or Business Entity Description of Business Activity with the State 4. As of December 31, 2014, were you, your spouse, or members of your immediate family the beneficianes of a vested rust with a ale of $10,000 or more that was created, established, or controle by you Do not list assets held in blind trusts. See 2015 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” Oves 6 Name and Address of Trustee Description of the Trust Your Relationship to the Trust 5. As of December 31, 2014, dd you, your spouse, or members of your [mimediate family have abies of 310,000 or more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, Student ans, personal loans and intra family deo. | eve ow Name of Debtor (You, Spouse, Immediate Family Type of Creditor (Commercial Bank, Credit Union, Member) Individua, etc.) | FiesT Citizens BAVK_____| Commorsin) Rw The SET and any attachments, excluding the Confidential Form, are public records. Page 4of 10 . Uist each squrce of income (ot specific amounts) of more than $5,000 received by you, your spouse, or Members of your immediate family during 2014. 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 net includa income received from the following sources: » Capital gains » Federal government retirement » Miltary retirement » Social security income/SSDI Recipient of Income Type of Type of Income Business/Industry [71 nad no reportable income over $5,000 in 2014. 5 TS Bebd Plesey |B ot mise [Tnsoemmes _ snitey [onpmarhss PROFESSIONAL AND CIVIC RELATIONSHIPS (a). Dutiag 2014, ere you, your spouse of members of your immediate family a director, offer, governing board ember. employes, indspandent contractor, or registered lobbyist of a nonprofit Corporation or organization operating in he State of Morin Carolina primary for refgious, charitable, scientific, trary, public health and safety, or educational purposes? [ives fo - 17°No, proceed to question 8. > 55 mot st State boards o entities, or entities croated by 3 poical subdivision of the State. + 00 not list organizations of which you are a mere member. His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization 7(5). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive: LO, nee oe asseraon of te neve of th, busines, Known or wih whieh due gence coud | reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known | The SE and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 & DL 2084, were vou, Your Spouse, or mares of your [mimedAtE fay 3 director, ocr ar Governing board member of any society, organization, or advocacy group with an interest in matters over which your agency or board may have jurisdiction? DIYes [9 [J Legislator udicial Officer - You are nt required to complete this question if you are filing because You are a legislator or a Judicial officer o you are fing a6 an appoee 16 tries chen D0 not list organization of which you are only @ member (not serving ina leadership role). | Name of Person Name of Society, Organization Leadership Position or Advocacy Group. (Director, Officer, Board Member) 9(a). List the name of each company or business with which you were associated where you or 8 member of your Immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2014. ion oir] ame or company | roiearrarn | 9(b). If you know that any company or business ently sted In 9(a) above had any material businoss dealings or business contracts with the State of North Carolina or was regulated by the State as of December 31, 2014, provide 4 brief | description of that business activity. Name of Company or Business Entity Description of Business Activity with the State [S1Rot applicable (No entities sted on #92) LI No relationship / Not known 10. Are you a practicing attorney? [ies [6 []udicial Offcer/State Attorney Yes", check each category of legal representation in which you or the law firm with which you are affliated has earned legal fess of more than $10,000 during 2014. J Administrative [J Admiralty [0 Corporate [J] Criminal 0) Decedent's Estates: [Environmental [linsurance Ctabor 0 Local Government [Real Property [Securities Dax Tort ligation (including 0 Utitties Regulation Other category not sted. negligence) ‘The SEI and any attachments, excluding the Confidential Form, are public records. Page 6.0f 10 1 During 2014, were you a ficensed professional (other than an attorney) or did you provide consulting services i ars professional assocation fof wich you charged or were pad over $10,007 aves ©6_ Type of Business 12. re you of your employer, your spouse or members of your immediate family, or thelr employer curently: + Licensed by the Stare boar or employing entity with which you re o wil be associated « Regulated by the State board or employing entity with which you are or will be associated or |. Hevea ms nein vo State board or employing entity vith which you are or wil be associated? Mes o [1 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 Ting as an appoints to those offices. Name of Employer Type of Relationship it applicabie) (Licensing, Regulatory, Business) 3. ve vou, your spouse or 2 member of you Immediate family currently registered 9 a abbyis o 10bbyst pina, or were you registered as such within the 12 months preceding your filing of this form? wr One Lobbyists principal Date of Registration Regtetration Expiration 5 055 110) — Ricode, 7: Peck | "ok mats 0c | ThiA03 och y ze [ I EE OTHER DISCLOSURES Ta. During any calendar quarier in 2014 (but oly the Gime period aer you were appointed, employed or fled or were Rominated a6 candidate) di you receive any “at(s" xceading $200 per quate fom a person o group of persons acting together, and © wnen both you and those person(s) were outside North Carolin at the time you accepted the gi(s), and || hints wre ven ander cumstances tht would ea reasonable prs to concude ta hey wre given for lobbying? Oves wae 50 wok report GS Give by oeroRrs of your extended omy. +o mt report gis tha have previously been reported by You to the Department of the Secretary of State on the Ce pense Report for Exempted Persons.” [Date item Received | Name and Address of Donor(s) | Describe Xm Received Estimated Market Value | The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 35; During 2014 (but only the time period aftr you were appointed, employed, or led or were nominated 2 a candidate) id you + accept a “scholarship” exceeding $200 rom a person or group of persons acting together and « those person(s) were outside North Carolina and. + he scholars was elated o your pubic positon? A “scholarship” is a grantin-aid to attend a conference, meeting, or similar event. [ves SO Lut Officer - You are not required to complete this question If you are a juicial officer or you are filing as a judical officer appointee. | > Do not report git 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 require to report scholarships paid by a nonpartisan egisative organization of which the legiiator or the General Assembly is a member or participant of an affiate of hat organisation. | Date of Name and Address of Donor(s) Describe Event Estimated Market Scholarship Value 16. Were you appointed or are you being considered for an appointment to a covered board by the Governer or another Council of State member? Council of State members are: > Governor » L1. Governor > Secretary of State: » State Auditor » State Treasurer » Superintendent of Public Instruction | > Attorney General > Commissioner of Agriculture > Commissioner of Labor » Commissioner of Insurance | whe Cte If “Yes? list all contributions you (NOT immediate family members) made during 2014 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 imitad t, “any advance, conveyance, deposi, distribution, transfer of funds, loan, payment, gift pledge or subscription of money or anything of valve kin _—_— CT RN ET [SHY contributions) with a cumulative total of more than $1,000 The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 17. Are you an appointee or prospective appointee to: a the head of a princpal state department (e. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice Court of Appeals, Superior or District Court Sudges or e. a member of any of the following boards: { + ABC Commission © Coastal Resources Commission © State Board of Equation Oves we + State Board of Elections: * Divison of Employment Security 1 “Nor, proceed to © Environmental Management Commission Question is. © Industrial Commission © Human Resources Commission © Rules Review Commission * Board of Transportation © UNC Board of Governors © Utiities Commission © Widife Resources Commission a TF so, were you appeinted or re you being considered fo appalntment to tht public | (]¥es [No postion by i Council of State member? Council of State members are ised in es roused 15 Question 16. iestion 38. 1 s0, you must Indicate whether during 2014 you (not Immediate amily members) rage in amy of the following activities with respect to or on behalf of the Canasta or Campalgh Commies of the Cound of State member who appointed Vou to your pubic poston: Oves OMe \. Collected contributions from multiple contributors, tok possession of Such exilipe contributions, and transferred o delivered those collected Contbutons To the candidate o committee? Contributions are defined in question 16. [i Hosted a fundraiser a your residence or place of business? Oves OMe i. Volunteered for campalgn-elated activities, which Include, but are not mited to, es ent castance, maings, canvassing, surveying, or any other | C1¥es CINo Sit that advances the campaign of candidate? 15. Fave you ever been convicted of a felony for which you have not recived either: (1) a pardon of innocence; or () an arr of expungement regarding that conviction? Oves 6 | oeme | ater Conviction [Coumy of Conviction 15. Are you aware of any other information that you believe may assist the SEatG Ethics Commision In advising you Concerning your compliance with the State Government ECtcs AC? [ives (9A if yes, piease provide such information below. The SEX and any attachments, excluding the Confidential Form, are pubic records. Page 9 of 10