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HELD OR SOUGHT: HOUSE OF DELEGATES
I certify that I completed ethics training as required by § 30-129.1. [X] Yes [ ] No
Pursuant to § 30-129.1, although there is no penalty for your failure to attend the full or refresher orientation session, attendance is mandatory under the Code and you must disclose your attendance on this form.
This Statement of Economic Interests will be available to the public via the searchable database on the Virgina Conflict of Interest and Ethics Advisory Council website, as required by § 30-356.
REPORT TO THE BEST OF INFORMATION AND BELIEF Information required on this Statement must be provided on the basis of the best knowledge, information, and belief of the individual filing the Statement as of the date of this report.
In accordance with the rules of the house in which I [shall] serve, if I receive a request that this disclosure statement be corrected, augmented, or revised in any respect, I hereby pledge that I shall respond promptly to the request. I understand that if a determination is made that the statement is insufficient, I will satisfy such request or be subjected to disciplinary action of my house.
I swear or affirm that the information provided on this statement is full, true, and correct to the best of my knowledge.
M. Keith Hodges (Electronically Signed: 1/15/2017 4:46:14 PM) | 1/15/2017 4:46:14 PM | |
Signature of Member/Member-elect/Candidate | Date |
DRAFT
1. Do you or a member of your immediate family receive remuneration, benefits, or compensation for service as an officer or director of a business?
2. Do you or a member of your immediate family receive salary or wages in excess of $5,000 annually from any employer? DO NOT INCLUDE salary received as a member of the General Assembly pursuant to § 30-19.11.
NAME OF BUSINESS OR EMPLOYER | LOCATION OF BUSINESS OR EMPLOYER (CITY OR COUNTY, AND STATE) | POSITION HELD | BY WHOM | OFFICE OR DIRECTORSHIP OR EMPLOYMENT |
Gloucester Pharmacy | 7453 Hargett Blvd. | President | M. Keith Hodges | EMPLOYMENT |
Gloucester Pharmacy | 7453 Hargett Blvd. | President | M. Keith Hodges | OFFICE OR DIRECTORSHIP |
Poquoson Pharmacy | 498 Wythe Creek Road Poquoson VA 23662 | Vice-President | M. Keith Hodges | OFFICE OR DIRECTORSHIP |
EPIC Pharmacies | 50 Scott Adam Road Cockeysville, MD 21030 | Board Member | M. Keith Hodges | OFFICE OR DIRECTORSHIP |
DRAFT
1. Do you owe more than $5,000 to any one creditor, including any contingent debt to any one creditor?
DO NOT INCLUDE any debt owed to any government or any loan secured by a recorded lien on property if such lien is at least equal to the value of the loan.
2. Does a member of your immediate family owe more than $5,000 to any one creditor, including any contingent debt to any one creditor?
DO NOT INCLUDE any debt owed to any government or any loan secured by a recorded lien on property if such lien is at least equal to the value of the loan.
Disclose personal debts, including contingent debts, owed by you to each category of creditor by selecting the appropriate category listed in TABLE 1A. To calculate the amount of personal debt to disclose for each category of creditor, include all debts owed to creditors within each category, but DO NOT INCLUDE any debt owed to any one creditor in an amount of $5,000 or less.
If you owe a personal debt to a business creditor that is not included in any category of creditor listed in TABLE 1A, disclose such debt in TABLE 1B. List the name of the business creditor and its principal business activity.
If you owe a personal debt to an individual creditor, disclose such debt in TABLE 1C. Identify the name of the individual creditor and his principal business or occupation.
If you owe a personal debt jointly with another person who is not a member of your immediate family, disclose only your share of the debt.
If you owe a personal debt jointly with a member of your immediate family, disclose any such debt in TABLE 1A, 1B, or 1C, as appropriate, as if you are solely liable for the total amount of the debt, and DO NOT DISLCOSE such debt in TABLE 2A, 2B, or 2C.
DO NOT REPORT:
My personal debts are as follows:
SELECT APPROPRIATE CATEGORIES | AMOUNT OF PERSONAL DEBT |
Not Applicable | |
$5,001 to $50,000 | |
Not Applicable | |
Not Applicable | |
Not Applicable |
NAME OF CREDITOR | CREDITOR'S PRINCIPAL BUSINESS ACTIVITY | AMOUNT OF PERSONAL DEBT |
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable |
NAME OF CREDITOR | CREDITOR'S PRINCIPAL BUSINESS OR OCCUPATION | AMOUNT OF PERSONAL DEBT |
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable |
Disclose personal debts, including contingent debts, owed by a member of your immediate family to each category of creditor by selecting the appropriate category listed in TABLE 2A. To calculate the amount of personal debt to disclose for each category of creditor, include all debts owed to creditors within each category, but DO NOT INCLUDE any debt owed to any one creditor in an amount of $5,000 or less.
If a member of your immediate family owes a personal debt to a business creditor that is not included in any category of creditor listed in TABLE 2A, disclose such debt in TABLE 2B. List the name of the business creditor and its principal business activity.
If a member of your immediate family owes a personal debt to an individual creditor, disclose such debt in TABLE 2C. Identify the name of the individual creditor and his principal business or occupation.
If a member of your immediate family owes a personal debt jointly with another person not yourself who is not a member of your immediate family, disclose only his share of the debt.
If you owe a personal debt jointly with a member of your immediate family, report any such debt in TABLE 1A, 1B, or 1C, as appropriate, as if you are solely liable for the total amount of the debt, and DO NOT DISCLOSE such debt in TABLE 2A, 2B, or 2C.
DO NOT REPORT:
The personal debts of members of my immediate family are as follows:
SELECT APPROPRIATE CATEGORIES | AMOUNT OF PERSONAL DEBT |
Not Applicable | |
$5,001 to $50,000 | |
Not Applicable | |
Not Applicable | |
Not Applicable |
NAME OF CREDITOR | CREDITOR'S PRINCIPAL BUSINESS ACTIVITY | AMOUNT OF PERSONAL DEBT |
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable |
NAME OF CREDITOR | CREDITOR'S PRINCIPAL BUSINESS OR OCCUPATION | AMOUNT OF PERSONAL DEBT |
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable | ||
Not Applicable |
DRAFT
Do you or a member of your immediate family, separately or together, own securities valued in excess of $5,000 invested in one business or Virginia governmental entity?
INCLUDE securities held in (i) trusts; (ii) individual retirement arrangements (IRAs); (iii) defined contribution plans, including plans established in accordance with sections 401, 403, or 457 of the Internal Revenue Code; and (iv) any other type of investment account.
INCLUDE securities not held in your name or the name of a member of your immediate family if you or a member of your immediate family retains the right to control such securities or the right to receive the income from such securities.
Disclose each business or Virginia governmental entity in which you or a member of your immediate family, separately or together, own securities valued in excess of $5,000.
INCLUDE securities held in (i) trusts; (ii) individual retirement arrangements (IRAs); (iii) defined contribution plans, including plans established in accordance with sections 401, 403, or 457 of the Internal Revenue Code; and (iv) any other type of investment account.
INCLUDE securities not held in your name or the name of a member of your immediate family if you or a member of your immediate family retains the right to control such securities or the right to receive the income from such securities.
DRAFT
List the issuer and type of each security. List separately each security held in an IRA, defined contribution plan, or other type of investment account, if such security is valued in excess of $5,000.
For defined contribution plans administered by the Commonwealth or its political subdivisions, list the administering agency as the issuer of the security, unless the security is held in a self-directed brokerage account, in which case list the issuer of the security.
NAME OF ISSUER OF SECURITY | TYPE OF SECURITY (STOCKS, BONDS, MUTUAL FUNDS, IRA, ETC.) | VALUE OF SECURITY |
Wells Fargo | Mutual Funds | $50,001 to $250,000 |
American Funds | Mutual Funds | $50,001 to $250,000 |
Virginia Education Savings Trust | Mutual Fund, Stocks | $5,001 to $50,000 |
Virginia Pre-Paid Education | Stocks, Mutual Funds, Bonds | $50,001 to $250,000 |
Xenith Bankshares | Stocks | $5,001 to $50,000 |
Dominion Power | Stocks | $5,001 to $50,000 |
BB&T | Stocks | $5,001 to $50,000 |
DRAFT
1. Do you or a member of your immediate family own, separately or together, a business that has a value in excess of $5,000?
OR
Do you or a member of your immediate family, separately or together, have an interest in a business and the interest owned by you or a member of your immediate family has a value in excess of $5,000? DO NOT INCLUDE any securities disclosed on Schedule C.
2. Do you or a member of your immediate family own, separately or together, a rental property that has a value in excess of $5,000?
OR
Do you or a member of your immediate family, separately or together, have an interest in a rental property and the interest owned by you or a member of your immediate family has a value in excess of $5,000?
Disclose each business owned by you or a member of your immediate family with a value in excess of $5,000 and each interest in a business owned by you or a member of your immediate family with a value in excess of $5,000. DO NOT REPORT any securities disclosed on Schedule C.
If the business is owned or operated under a trade, partnership, or corporate name, list that name. If the business is not owned or operated under a trade, partnership, or corporate name, describe the nature of the business.
NAME OF BUSINESS OR NATURE OF BUSINESS | LOCATION OF BUSINESS (CITY OR COUNTY, STATE, AND COUNTRY) | GROSS INCOME |
Gloucester Pharmacy | 7453 Hargett Blvd Gloucester, VA 23016 | MORE THAN $250,000 |
Poquoson Pharmacy | 498 Wythe Creek Road Poquoson, VA | $50,000 or LESS |
DRAFT
Do you or a member of your immediate family, separately or together, hold an interest valued at more than $5,000 in real property? DO NOT INCLUDE your principal residence or any real estate disclosed on Schedule D. INCLUDE real estate held in trust.
Disclose all real estate in which you or a member of your immediate family holds an interest valued at more than $5,000. List each parcel individually. INCLUDE real estate held in trust.
DO NOT REPORT:
List only the city or county, state, and country where each real estate is located. DO NOT LIST any street addresses. No addresses will be redacted from this schedule.
List the name or names in which the real estate is owned or recorded. If you or a member of your immediate family holds an interest in the real estate but it is owned or recorded in a name other than your name or your immediate family member's name, list that name.
TYPE OF REAL ESTATE | LOCATION OF REAL ESTATE (CITY OR COUNTY, STATE, AND COUNTRY) | NAME OR NAMES IN WHICH REAL ESTATE IS OWNED OR RECORDED |
Waterfront Property York River | King and Queen County, VA | M. Keith & Shelley W. Hodges |
DRAFT
Did you receive in your capacity as a legislator any lodging, transportation, money, or other thing of value with a combined value exceeding $100 during the prior calendar year for:
DO NOT INCLUDE:
INCLUDE a payment if you donated it to a charity and claimed or plan to claim it as a charitable deduction on your taxes.
Disclose any lodging, transportation, money, or other thing of value received that does not satisfy the criteria listed above as a gift on Schedule G.
Disclose each source from which you received in your capacity as a legislator lodging, transportation, money, or any other thing of value with a combined value exceeding $100 for:
SOURCE OF PAYMENT | DESCRIPTION OF EVENT | LOCATION OF EVENT (CITY OR COUNTY, STATE, AND COUNTRY) | DATE(S) OF EVENT | TOTAL VALUE | CHECK IF YOU RECEIVED A TRAVEL WAIVER FROM THE COUNCIL FOR THIS EVENT |
Total banquet & AV costs divided by number of attendees) | Governor's Summit for Rural Prosperity | Irvington, VA | 09/26/2016 | 150.83 | N/A |