{Rev. 09/2015) STATEMENT OF ECONOMIC INTERESTS Virginia Conflict of Interest and Ethics Advisory Council NAME / } Candidate for Election to this office? YES NO OFFICE OR POSITION HELD OR SOUGHT } (C V f - ( "fr If O i AGENCY/BUSINESS NAME PHONE 7 AGENCY/BUSINESS ADDRESS 2_-€ < // S CITY STATE ZIP NAMES OF MEMBERS OF IMMEDIATE FAMILY <(U COMPLETE ITEMS 1 THROUGH 10. REFER TO SCHEDULES ONLY IF DIRECTED. Return Schedules only if needed to complete Statement. You may attach additional explanatory information. 1. Offices and Directorships. Are you or a member of your immediate family a paid officer or paid director of a business? If yes, complete ScheduleA 2. Personal Liabilities. Do you or a member of your immediate family owe more than $5,000 to any one creditor including contingent liabilities? (Exclude debts to any government and loans secured by recorded liens on property at least equal in value to the loan.) If yes, complete Schedule B 3. Securities. Do you or a member of your immediate family, directly or indirectly, separately or together, own securities valued in excess of $5,000 invested in one business? Account for mutual funds, limited partnerships and trusts. If yes, complete Schedule C 4. Payment for Talks, Meetings, and Publications. During the past six months did you receive in your capacity as an officer or employee of your agency lodging, transportation, money, or anything else of value with a combined value exceeding $200 (i) for a single talk, meeting, or published work or (ii) for a meeting, conference, or event where your attendance at the meeting, conference, or event was designed to (a) educate you on issues relevant to your duties as an officer or employee of your agency or (b) enhance your knowledge and skills relative to your duties as an officer or employee of your agency ? If yes, complete Schedule D 5. Gifts. During the past six months did a business, government, or individual other than a relative or personal friend (i) furnish you or a member of your immediate family with any gift or entertainment at a single event, and the value received exceeded $50 or (ii) furnish you or a member of your immediate family with gifts or entertainment in any combination and the total value received exceeded $100, and for which you or the member of your immediate family neither paid nor rendered services in exchange? Account for entertainment events only if the average value per person attending the event exceeded $50, Account for all business entertainment (except if related to the private profession or occupation of you or the member of your immediate family who received such business entertainment) even if unrelated to your official duties. If yes, complete Schedule E D YES D YES YES D YES NO D NO D YES NO Ethics-3117 Page _ of _
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{Rev. 09/2015)
STATEMENT OF ECONOMIC INTERESTSVirginia Conflict of Interest and Ethics Advisory Council
NAME
/ }
Candidate forElection to this office?
YES NO
OFFICE OR POSITIONHELD OR SOUGHT
}(C V
f- ( "fr If O i
AGENCY/BUSINESS NAME PHONE
7AGENCY/BUSINESS ADDRESS
2_-€ < // SCITY STATE ZIP
NAMES OF MEMBERS OF IMMEDIATE FAMILY
<(U
COMPLETE ITEMS 1 THROUGH 10. REFER TO SCHEDULES ONLY IF DIRECTED.Return Schedules only if needed to complete Statement.
You may attach additional explanatory information.
1. Offices and Directorships.Are you or a member of your immediate family a paid officer or paid director of a business?
If yes, complete Schedule A
2. Personal Liabilities.Do you or a member of your immediate family owe more than $5,000 to any one creditor including contingent liabilities?(Exclude debts to any government and loans secured by recorded liens on property at least equal in value to the loan.)
If yes, complete Schedule B
3. Securities.Do you or a member of your immediate family, directly or indirectly, separately or together, own securities valued inexcess of $5,000 invested in one business? Account for mutual funds, limited partnerships and trusts.
If yes, complete Schedule C
4. Payment for Talks, Meetings, and Publications.During the past six months did you receive in your capacity as an officer or employee of your agency lodging,transportation, money, or anything else of value with a combined value exceeding $200 (i) for a single talk, meeting, orpublished work or (ii) for a meeting, conference, or event where your attendance at the meeting, conference, or eventwas designed to (a) educate you on issues relevant to your duties as an officer or employee of your agency or (b)enhance your knowledge and skills relative to your duties as an officer or employee of your agency ?
If yes, complete Schedule D
5. Gifts.During the past six months did a business, government, or individual other than a relative or personal friend (i) furnishyou or a member of your immediate family with any gift or entertainment at a single event, and the value receivedexceeded $50 or (ii) furnish you or a member of your immediate family with gifts or entertainment in any combinationand the total value received exceeded $100, and for which you or the member of your immediate family neither paid norrendered services in exchange? Account for entertainment events only if the average value per person attending theevent exceeded $50, Account for all business entertainment (except if related to the private profession or occupation ofyou or the member of your immediate family who received such business entertainment) even if unrelated to yourofficial duties.
If yes, complete Schedule E
DYES
DYES
YES
DYES
NO
DNO
DYES NO
Ethics-3117Page _ of _
6. Salary and Wages.List each employer that pays you or a member of your immediate family salary or wages in excess of $5,000 annually.(Exclude state or local government or advisory agencies.) If no reportable salary or wages, check here Q
Statements of Economic Interests are open for public inspection.
7. Business Interests.Do you or a member of your immediate family, separately or together, operate your own business, or own or control an yES NOinterest in excess of $5,000 in a business?
tf yes, complete Schedule F
8. Payments for Representation and Other Services.
8A. Did you represent, excluding activity defined as lobbying in § 2.2-419. any businesses before any state governmentalagencies, excluding courts or judges, for which you received total compensation during the past six months in excess yESof $1,000, excluding compensation for other services to such businesses and representation consisting solely of thefiling of mandatory papers and subsequent representation regarding the mandatory papers? (Officers and employeesof local governmental and advisory agencies do NOT need to answer this question or complete Schedule G-1.)If yes, complete Schedule G-1
8B. Subject to the same exceptions as in 8A, did persons with whom you have a close financial association (partners,associates or others) represent, excluding activity defined as lobbying in § 2 2-419. any businesses before any state yf-S NOgovernmental agency for which total compensation was received during the past six months in excess of $1,000?(Officers and employees of local governmental and advisory agencies do NOT need to answer this question orcomplete Schedule G-2.)If yes, complete Schedule G-2
8C. Did you or persons with whom you have a close financial association furnish services to businesses operating inVirginia pursuant to an agreement between you and such businesses, or between persons with whom you have a close YES NOfinancial association and such businesses for which total compensation in excess of $1,000 was received during thepast six months? Services reported under this provision shall not include services involving Ihe representation ofbusinesses that are reported under item 8A or 8B.If yes, complete Schedule G-3
9 Real Estate.
9A. State Officers and Employees.Do you or a member of your immediate family hold an interest, including a partnership interest, valued at more than$5.000 or more in real property (other than your principal residence) for which you have not already listed the full YES NOaddress on Schedule F? Account for real estate held in trust.If yes, complete Schedule H-1
9B. Local Officers and Employees.Do you or a member of your immediate family hold an interest, including a partnership interest, or option, easement, orland contract, valued at more than $5,000 in real property (other than your principal residence) for which you have not YES NOalready listed in the full address on Schedule F? Account for real estate held in trust.If yes, complete Schedule H-2
10. Real Estate Contracts with Governmental AgenciesDo you or a member of your immediate family hold an interest valued at more than $5,000 in real estate, including acorporate, partnership, or trust interest, option, easement, or land contract, which real estate is the subject of a yps NOcontract, whether pending or completed within the past six months, with a governmental agency? If the real estatecontract provides for the leasing of the property to a governmental agency, do you or a member of your immediatefamily hold an interest in the real estate valued at more than $1,000? Account for all such contracts whether or notyour interest is reported in Schedule F, H-1, or H-2. This requirement to disclose an interest in a lease does not applyto an interest derived through an ownership interest in a business unless the ownership exceeds three percent of thetotal equity of the business.If yes, complete Schedule I
AFFIRMATION BY ALL FILERS.
1 swear or affirm that the foregoing
Signature 7
Oppf 1 V€d
Ethics-3117 T?}&
information is full, true and
laTnTFs"
correct to the best of my
U/ / / / I
Date
knowledge.
5
Page _ of _
Statement of Economic Interests
SCHEDULE CSECURITIES
NAME: I I YY\A
OFFICE OR POSITION HELD OR SOUGHT: u (
"SECURITIES" INCLUDES stocks, bonds, mutual "SECURITIES" EXCLUDES certificates of deposit,funds, limited partnerships, and commodity futures money market funds, annuity contracts, and insurancecontracts. policies.
Identify each business or Virginia governmental entity in which you or a member of your immediate family,directly or indirectly, separately or together, own securities valued in excess of $5,000. Name each issuerand type of security individually.
Do not list U.S. Bonds or other government securities not issued by the Commonwealth of Virginia or itsauthorities, agencies, or local governments. Do not list organizations that do not do business in thisCommonwealth, but most major businesses conduct business in Virginia. Account for securities held intrust.
If no reportable securities, check here
NAME OF ISSUER
( <, <^ - M~
TYPE OF SECURITY
(STOCKS, BONDS. MUTUAL FUNDS, ETC.) 5,001 to50,000
D
D
TTfl c~ In m * \srfr } nD
D
D
D
D
D
nnnn
CHECK ONE
50,001to
250,000
D
D
nnD
nn
nnnnD
n
More than250,000
nnn
nn
nnnnnnnn
Ethics-3117Page _ of _
Statement of Economic Interests
SCHEDULE DPAYMENT FOR TALKS, MEETINGS, AND PUBLICATIONS
NAME:
OFFICE OR POSITION HELD OR SOUGHT:
List each source from which you received during the past six months in your capacity as ar/officer or employee of youragency lodging, transportation, money, or any other thing of value with combined value exceeding $200 (i) for yourpresentation of a single talk, participation in one meeting, or publication of a work or (ii) for your attendance at a meeting,conference, or event where your attendance at the meeting, conference, or event w#s designed to (a) educate you onissues relevant to your duties as an officer or employee of your agency or (b) enharxie your knowledge and skills relativeto your duties as an officer or employee of your agency. Any lodging, transportation, money, or other thing of valuereceived by an officer or employee that does not satisfy the provisions of clause $, (ii) (a), or (ii) (b) shall be listed as a gifton Schedule E..
List payments or reimbursements by an advisory or governmental agjSncy only for meetings or travel outside theCommonwealth.
List a payment even if you donated it to charity.
Do not list information about payment if you returned it within 60underItem 6 or from a source of income listed on Schedule F.
If no payment must be listed, check here .
rays or if you received it from an employer already listed
PAYER
/
APPROXIMATEVALUE /
CIRCUMSTANCESTYPE OF PAYMENT
(e.g. honoraria, travelreimbursement, etc.)
Ethics-3117Page _ of _
PORTFOLIO APPRAISAL
TIMOTHY AND BETH LOVAIN
CONSOLIDATED INVESTMENTS
SO-Nov-15
Name of Issuer
VANGUARD SPECIALIZED PORTFOLIOS DIVIDEND A
UNDISCOVERED MANAGERS BEHAVIORAL VALUE FD
FIDELITY LOW PRICED STOCK FUND
T ROWE PRICE MID-CAP GROWTH
CAPITAL WORLD GROWTH & INCOME FUND CLASS F-2
CAUSEWAY INTL VALUE FUND (INST CLASS)
EUROPACIFIC GROWTH FUND CLASS F-2
NEW PERSPECTIVE FUND CLASS F-2
NEW WORLD FUND CLASS F-2
SMALL-CAP WORLD FUND CLASS F-2
AMCAP FUND CLASS F-2
AMERICAN MUTUAL FUND CLASS F-2
FIDELITY CONTRA FUND
FUNDAMENTAL INVESTORS CLASS F-2
JP MORGAN VALUE ADVANTAGE FUND INSTITUTION
THE GROWTH FUND OF AMERICA CLASS F-2
THE NEW ECONOMY FUND CLASS F-2
VANGUARD EQUITY INCOME FUND ADMIRAL SHARES
WASHINGTON MUTUAL INVESTORS FUND CLASS F-2
AMERICAN BALANCED FUND CLASS F-2
T ROWE PRICE CAPITAL APPRECIATION
THE INCOME FUND OF AMERICA CLASS F-2
T ROWE PRICE REAL ESTATE
VANGUARD ENERGY FUND ADMIRAL SHARES
LORD ABBETT HIGH YIELD FUND CLASS 1
METROPOLITAN WEST TOTAL RETURN BOND FUND C
AMERICAN HIGH INCOME MUNICIPAL BOND FUND C
THE TAX-EXEMPT FUND OF VIRGINIA CLASS F-2
Federated Treasury MMkt
Pershing Government MMkt
Type of Entity
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Investment Co.
Type of Security
ETF
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
Mutual Fund
$1 - $50,000
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
$50,001 -
$250,000
X
X
X
X
X
XX
X
X
X
X
$250,000+
Statement of Economic Interests
SCHEDULE H-2REAL ESTATE—LOCAL OFFICERS AND EMPLOYEES ONLY
NAME: M
OFFICE OR POSITION HELD OR SOUGHT:
List real estate other than your principal residence in which you or a member of your immediate family holds an interest,including a partnership interest or option, easement, or land contract, valued at more than $5,000. Each parcel shall belisted individually. Also list the names of any co-owners of such property, if applicable.
LIST EACH LOCATION {STATE,AND COUNTY OR CITY) WHERE
YOU OWN REAL ESTATE
}k/ Ov^io^^n kev/VvdCo^^i-^v/ VA
f^f kX^~ C-Joi-Vv^y
M >V
DESCRIBE THE TYPE OF REAL ESTATEYOU OWN IN EACH LOCATION
(BUSINESS, RECREATIONAL, APARTMENT,COMMERCIAL, OPEN LAND, ETC.)
V t CV^Cf4/OH«J^
f e e v'em-bj ^t^i tJi
IF THE REAL ESTATE ISOWNED OR RECORDED IN ANAME OTHER THAN YOUR
OWN, LIST THAT NAME.
LIST THE NAMES OFANY CO-OWNERS, IF
APPLICABLE
/•i wVWev nrv e-Wc v*->*" ,i"y~_ A , * « tsi•^Ws-fr-a-fc^j^ «~
M<r*"£*^ W«ifcr« /
Ethics-3117Page _ of _
•
•
Statement of Economic Interests
SCHEDULE IREAL ESTATE CONTRACTS WITH GOVERNMENTAL AGENCIES
NAME:
OFFICE OR POSITION HELD OR SOUGHT:
List all contracts, whether pending or completed within the past six months, with a governmental agency for the sale orexchange of real estate in which you or a member of your immediate family holds an interest, including a corporate,partnership or trust interest, option, easement, or land contract, valued at more than $10,000- List all contracts with agovernmental agency for the lease of real estate in which you or a member of your impnediate family holds such aninterest valued at more than $1,000. This requirement to disclose an interest in a leaSye does not apply to an interestderived through an ownership interest in a business unless the ownership interest creeds three percent of the totalequity of the business.
State officers and employees report contracts with state agencies.
Local officers and employees report contracts with local agencies.
List your real estate interest and the person or entity, including the type of e/ifity, which is party to the contract. Describeany management role and the percentage ownership interest you or your/tfnmediate family member has in the real estateor entity.
List each governmental agency which is party to/ftie contract and indicate the county or city where the real estate islocated.
7State the annual income from the contract, and the amount, if any, of income you or any immediate family memberderives annually from th/contract.
Page _ of _Ethics-3117
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