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Virginia Conflict of Interest and Ethics Advisory Council

STATE AND LOCAL STATEMENT OF ECONOMIC INTERESTS

NAME: Tom S. Perriello
OFFICE
HELD OR SOUGHT:
Governor
AGENCY NAME:
Statewide Candidate
ARE YOU FILING THIS FORM AS A CANDIDATE FOR ELECTION TO THIS OFFICE?
[X] Yes [ ] No
BUSINESS ADDRESS: STREET
5520 Cherokee Ave
TELEPHONE:
CITY
Alexandria
STATE
VA
ZIP
22312
OFFICE
571-733-0474
HOME
REDACTED
EMAIL ADDRESS: REDACTED
FIRST AND LAST NAMES OF MEMBERS OF IMMEDIATE FAMILY: None

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.

AFFIRMATION

I swear or affirm that the information provided on this statement is full, true, and correct to the best of my knowledge.

Tom S. Perriello (Electronically Signed: 3/29/2017 3:58:23 PM)   3/29/2017 3:58:23 PM
Signature of Officer or Employee   Date
Any filer who knowingly and intentionally makes a false statement of a material fact on the Statement of Economic Interests is guilty of a Class 5 felony.

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State and Local Statement of Economic Interests

SCHEDULE C

SECURITIES

NAME: Tom S. Perriello

QUESTION:

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.

Yes [X]
No [ ]
If yes, complete the table for each such security.

INSTRUCTIONS:

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.

“Securities" INCLUDES:
  • Stocks
  • Bonds
  • Mutual funds
  • Limited partnerships
  • Commodity futures contracts
“Securities" EXCLUDES:
  • Defined benefit plans, including pension plans
  • Certificates of deposit
  • Money market funds
  • Annuity contracts
  • Insurance policies
  • Securities issued by the U.S. government or other government securities not issued by the Commonwealth or its political subdivisions.

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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
Davenport Mutual Fund, Small Cap Focus $5,001 to $50,000
Davenport Mutual Fund Value & Income $5,001 to $50,000
Vanguard Target Retirement 2045 $5,001 to $50,000
Vanguard 500 Index Fund $5,001 to $50,000
FLUOR Corp Equities $5,001 to $50,000
Mastercard Class A Equities $5,001 to $50,000
Gilead Sciences Equities $5,001 to $50,000
Starbucks Equities $5,001 to $50,000
PIMCO Mutual Fund $5,001 to $50,000
Vanguard Target Retirement fund 2040 $50,001 to $250,000
Thrift Savings Plan Government Fund $5,001 to $50,000

Virginia Conflict of Interest and Ethics Advisory Council