Virginia Conflict of Interest and Ethics Advisory Council

GENERAL ASSEMBLY STATEMENT OF ECONOMIC INTERESTS

NAME: M. Keith Hodges
OFFICE OR POSITION HELD OR SOUGHT: HOUSE OF DELEGATES		DISTRICT NO. 98	ARE YOU FILING THIS FORM AS A CANDIDATE FOR ELECTION TO THIS OFFICE? [X] Yes [ ] No
BUSINESS ADDRESS:	STREET 7453 Hargett Blvd			TELEPHONE:
	CITY Gloucester	STATE VA	ZIP 23061	OFFICE 804-277-9801	HOME REDACTED
EMAIL ADDRESS: REDACTED
FIRST AND LAST NAMES OF MEMBERS OF IMMEDIATE FAMILY: Shelley W. Hodges Chloe G. Hodges Ella D. Hodges

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.

AFFIRMATION

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: 2/1/2019 9:21:54 AM)		2/1/2019 9:21:54 AM
Signature of Member/Member-elect/Candidate		Date

Any legislator 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 and shall be subject to disciplinary action for such violations by the house in which the legislator sits.

General Assembly Statement of Economic Interests

SCHEDULE A

OFFICES, DIRECTORSHIPS, AND EMPLOYMENT

NAME: M. Keith Hodges

QUESTIONS:

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 [X]

No [ ]

If yes, complete the table for each such 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.

Yes [X]

No [ ]

If yes, complete the table for each such employer.

INSTRUCTIONS:

Disclose each:

Business of which you or a member of your immediate family is an officer or director and receives remuneration, benefits, or compensation for service as an officer or director
Employer paying you or a member of your immediate family salary or wages in excess of $5,000 annually

NAME OF BUSINESS OR EMPLOYER	LOCATION OF BUSINESS OR EMPLOYER (CITY OR COUNTY, AND STATE)	POSITION HELD	BY WHOM	OFFICE OR DIRECTORSHIP OR EMPLOYMENT
Poquoson Pharmacy	498 Wythe Creek Road Poquoson VA 23662	Vice-President	M. Keith Hodges	OFFICE OR DIRECTORSHIP
Gloucester Pharmacy	7453 Hargett Blvd.	Pharmacist in Charge	M. Keith Hodges	OFFICE OR DIRECTORSHIP
Gloucester Pharmacy	7453 Hargett Blvd Gloucester, VA 23061	President	M. Keith Hodges	OFFICE OR DIRECTORSHIP
EPIC Pharmacies	50 Scott Adam Road Cockeysville, MD 21030	Board Member	M. Keith Hodges	OFFICE OR DIRECTORSHIP
Gloucester Pharmacy	7453 Hargett Blvd.	Buyer	Shelley W. Hodges	EMPLOYMENT

SCHEDULE B

1. Do you owe more than $5,000 to any one creditor, including any contingent debt to any one creditor?

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?

General Assembly Statement of Economic Interests

SCHEDULE C

SECURITIES

NAME: M. Keith Hodges

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.

“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.

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
Xenith Bankshares	Stocks	$5,001 to $50,000
BB&T	Stocks	$5,001 to $50,000
Virginia Pre-Paid Education	Stocks, Mutual Funds, Bonds	$50,001 to $250,000
Dominion Power	Stocks	$5,001 to $50,000

General Assembly Statement of Economic Interests

SCHEDULE D

BUSINESS INTERESTS AND RENTAL PROPERTY

NAME: M. Keith Hodges

QUESTIONS:

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?

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.

Yes [X]

No [ ]

If yes, complete Table 1.

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?

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]

If yes, complete Table 2.

Table 1: Business Interests

INSTRUCTIONS:

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
West Point Acquisition Corp.	7453 Hargett Blvd Gloucester, VA 23016	MORE THAN $250,000
York Drug Inc.	498 Wythe Creek Road Poquoson, VA	$50,001 to $250,000

General Assembly Statement of Economic Interests

SCHEDULE E

REAL ESTATE

NAME: M. Keith Hodges

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:

Your principal residence
Any real estate disclosed on Schedule D

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
York River Waterfront	King and Queen, VA, USA	M. Keith Hodges and Shelley W. Hodges

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

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?

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?

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?

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?

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?

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?

SCHEDULE J

1. Have you or a member of your immediate family registered as a lobbyist with the Secretary of the Commonwealth during the prior calendar year?

2. Did you or a member of your immediate family registered as a lobbyist relationship during the prior calendar year?