DRAFT

Virginia Conflict of Interest and Ethics Advisory Council

STATE AND LOCAL STATEMENT OF ECONOMIC INTERESTS

NAME: Amy Owens
OFFICE
HELD OR SOUGHT:
Regional Director
AGENCY NAME:
Department of Environmental Quality-Agency
ARE YOU FILING THIS FORM AS A CANDIDATE FOR ELECTION TO THIS OFFICE?
[ ] Yes [X] No
BUSINESS ADDRESS: STREET
4411 Early Road
TELEPHONE:
CITY
Harrisonburg
STATE
VA
ZIP
22801
OFFICE
540-574-7808
HOME
REDACTED
EMAIL ADDRESS: REDACTED
FIRST AND LAST NAMES OF MEMBERS OF IMMEDIATE FAMILY: Clyde Owens, Kathryn Owens

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.

Amy Owens (Electronically Signed: 1/10/2018 11:22:47 AM)   1/10/2018 11:22:47 AM
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.

SCHEDULE A

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?

Yes [] No [X]

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 from a state or local governmental or advisory agency.

Yes [] No [X]

DRAFT

State and Local Statement of Economic Interests

SCHEDULE B

PERSONAL DEBTS

NAME: Amy Owens

QUESTIONS:

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.

Yes []
No [X]
If yes, complete Table(s) 1A, 1B and/or 1C.

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.

Yes [X]
No [ ]
If yes, complete Table(s) 2A, 2B and/or 2C.

TABLES 1A, 1B, and 1C

INSTRUCTIONS:

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:

Table 1A. Creditor Categories:
SELECT APPROPRIATE CATEGORIES AMOUNT OF PERSONAL DEBT
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Table 1B. Other Business Creditors:
NAME OF CREDITOR CREDITOR'S PRINCIPAL BUSINESS ACTIVITY AMOUNT OF PERSONAL DEBT
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Table 1C. Individual Creditors:
NAME OF CREDITOR CREDITOR'S PRINCIPAL BUSINESS OR OCCUPATION AMOUNT OF PERSONAL DEBT
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable

TABLES 2A, 2B, and 2C

INSTRUCTIONS:

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:

Table 2A. Creditor Categories:
SELECT APPROPRIATE CATEGORIES AMOUNT OF PERSONAL DEBT
$5,001 to $50,000
Not Applicable
$5,001 to $50,000
Not Applicable
Not Applicable
Table 2B. Other Business Creditors:
NAME OF CREDITOR CREDITOR'S PRINCIPAL BUSINESS ACTIVITY AMOUNT OF PERSONAL DEBT
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Table 2C. Individual Creditors:
NAME OF CREDITOR CREDITOR'S PRINCIPAL BUSINESS OR OCCUPATION AMOUNT OF PERSONAL DEBT
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable

DRAFT

State and Local Statement of Economic Interests

SCHEDULE C

SECURITIES

NAME: Amy Owens

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.

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
Virginia Deferred Compensation Plan Deferred Comp MORE THAN $250,000
Virginia College Savings Plan 457 plan $5,001 to $50,000
Welltower Inc. REIT $5,001 to $50,000
Freddie Mac CMO $5,001 to $50,000
Fannie Mae CMO $5,001 to $50,000
Bristol Myers Squibb stock $5,001 to $50,000
Microchip Technology stock $5,001 to $50,000
Altria Group Inc stock $5,001 to $50,000
Lockheed Martin Corp stock $5,001 to $50,000
General Electric stock $5,001 to $50,000
Amazon Com Inc stock $50,001 to $250,000
AEP stock $50,001 to $250,000
Apple stock $50,001 to $250,000
Caterpillar inc stock $5,001 to $50,000
Dominion Energy stock $5,001 to $50,000
Kimberley Clark stock $5,001 to $50,000
Pepsico stock $5,001 to $50,000
TJX Companies stock $5,001 to $50,000
DowDuPont stock $5,001 to $50,000
Proctor& Gamble stock $5,001 to $50,000
Oakmark International Fund stock $5,001 to $50,000
American Century Value Mutual Fund $5,001 to $50,000
Metropolitan West Total Mutual Fund $5,001 to $50,000
Oakmark Equity & Income Mutual Fund $50,001 to $250,000
Parnassus Core Equity Mutual Fund $5,001 to $50,000
UDR Inc REIT $5,001 to $50,000
iShares US Technology ETF $5,001 to $50,000
Vanguard Dividend Appreciation ETF $5,001 to $50,000
Kohls stock $5,001 to $50,000
First Energy stock $5,001 to $50,000

SCHEDULE D

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?

Yes [] No [X]

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?

Yes [] No [X]

DRAFT

State and Local Statement of Economic Interests

SCHEDULE E

REAL ESTATE

NAME: Amy Owens

QUESTION:

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.

Yes [X]
No [ ]
If yes, complete the table below.

INSTRUCTIONS:

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
Beach cottage Ocean County, NJ Hess, Jean Constance, et al

SCHEDULE F

Did you receive in your capacity as an officer or employee of your agency any lodging, transportation, money, or other thing of value with a combined value exceeding $100 during the prior calendar year for: your presentation of a talk or series of talks at the same event, or participation in a meeting

OR

your attendance at a meeting, conference, or event where your attendance at the meeting, conference, or event was designed to educate you on issues relevant to your duties as an officer or employee of your agency, or to enhance your knowledge and skills relative to your duties as an officer or employee of your agency?

Yes [] No [X]

SCHEDULE G

Did you or a member of your immediate family receive from any (i) lobbyist; (ii) lobbyist’s principal; or (iii) contractor any gift or combination of gifts with a value exceeding $50 during the prior calendar year?Did you or a member of your immediate family receive from any (i) lobbyist; (ii) lobbyist’s principal; or (iii) contractor any gift or combination of gifts with a value exceeding $50 during the prior calendar year?

Yes [] No [X]

SCHEDULE H

1. Did you represent any business before any state governmental agency during the prior calendar year for which you received compensation in excess of $5,000 for such representation?

Yes [] No [X]

2. Did persons with whom you have a close financial association represent any business before any state governmental agency during the prior calendar year for which compensation was received in excess of $5,000 for such representation?

Yes [] No [X]

3. Did you or persons with whom you have a close financial association furnish services to any business operating in Virginia during the prior calendar year for which compensation was received in excess of $5,000 for such services?

Yes [] No [X]

SCHEDULE I

Do you or a member of your immediate family, separately or together, hold an interest valued in excess of $5,000 in real estate that is the subject of a contract with a governmental agency?

Yes [] No [X]
Virginia Conflict of Interest and Ethics Advisory Council