CANDIDATE NORTH CAROLINA STATE ETHICS COMMISSION 2012 STATEMENT OF ECONOMIC INTEREST FOR OFFICE USE ONLY RECEIVED 919-715-2071 vu ethlescommission.ne. gov MAR 16 2012 STATE ETHICS COMMISSION LES NAME (RST, MIDDLE, AST) First name Wadia name Tas name Som Joe | Douglas Ford | MAILING ADORESS, CY, STATE, iba Address: city State ze | T4® Pawley Drive | Charlotte Ne B24 HOME ADORESS, Gy, STATE, ZiPsw Bef same 2s nating Adress ‘address Saeco state Zp [ cunnewr emPcoveR JOB TLE Self Em ployed Consultant NATURE OF BUSINESS. Business Consulting DAYTIME PHONE NUMBER ALTERNATE PHONE NUMBER 104-400 - 2 845 E-NAIL ADDRESS Joetaford @ gmail. com REASON FOR FILING (SELECT ALL THAT APPLY) {stare covemme 08 (eas spect ne agency or mie you no Ci eoarorcoumrssion (rene tn a aor on whch you are seas) [CJouosciae orrices pase speay he ae you ho) ‘Bi catsaton noe sect ie egw ach — Ha Sante) Senate. | Bethe immediate fami members resem your hevsehls™ Bayes C0 Fauve RELATIONS cnecoven ea [Deborah L Ford | spouse —_|iwntnont Sermces | Sales Coordinetoy | merchant seruices [rivity WW. ford | chitd a a pion of judicial ofcers (nccting lets or pges ofthe Gavel Court of tice, etic ateys, and ler of cout), arene olin or aeekng 9 etd "Amma fy es sr eke ly rae) ir a popes fede ly nd Yue nl chen, teen, Tons an caine, 380 te Spas of eth of hace ear) ‘This entire document and any attachments are public record Campaign Finance weec. UR COUNTY MAR 12 7010 as OF cirteae Page 1 of 9‘$40,000 PLUS DISCLOSURES 1F you, your spouse, or members of your ummesiate family have assets or iaolites with a mar at value ofa lost $10,009 In the folowing cetegores, Bless prevce be “equested information as Decerber 31" ee ‘of the preceding year unless another time period is specfed i the Question De not st the velue of those assets or lait. Do not ist assets or Hablitiasneld ina bina trust* establishes by or forthe benefit of you or an immediate fan member. 3. De you, your spause, or members of your immediate famiy nave an ownership interest in North Carina rea! estate with @ merket value f $10,000 or ves Ln ancora SS een Gaanner esa Pg ee oa 100% Charlotte, Mecklenburg eo cereal me ae Ove Be eee eras manned iebaug aie |. Win the pcecesing twa years, have you, your spause, or members Of your mediate feriy sold to ar Lough fram Je Stake personal property wi @ ‘market value ar $10,000 6 more? Ove Bono “Tyne of Property “4 o you, Your spouse, or members oF your immediate femy currenUy lease ar ent to a rom_the State personal property wit 2 market vaiue of $10,000 Dre fv ame of Lessor Type of Property | eee —— wan} 2 20 oe51a}, Bo you, your spouse, or members of your immediate family wn interests (generally stock) valued at $10,000 or mare in a publiely owned compen? Ores no Oo nai Ist ownersi nterests in widely Ted investment fund (lacluding mutual Funds, reguated Investment companies, Gr pension a Gerd compensation plans) () the fund is publely tree or Rs asscts are widely aversiied and (i) either you no an Invmediate fannly member are able fo control the assets held in the matual ind, Investment compa. or pension or deferred compensaon pa ‘Owner of Interest Full Name of Company (06 not use a ticker symbol) 5(8) Ba you, your spouse, or members of your immediate famly hold stack eations valued at $10,000 er more in company or Business? Cyes Ta no ‘Owner of Stock Option Full Name of Company (Do not use a ticker symbol) ‘(2). De you, your spouse, or members of your ummadlate family have fnancia! Business entky(inelucing interest in sole proprietorships, porters, lied partnershps, and closely Held corporations)? Cores Bano Interests valued at $10,000 or more ina non-publisy ewnes company or artnershins, Joint ventures, Imted labilty companies, imea labilty Name of Business Entity (0) For e20h of those non-publley owned companies or business enttias dentifed in question 6(a) (the “primary company"), please ist the names of any tstner companies in whieh the ptmary combany ows Secunties ar equty interests valued at ever $10,000, If krown. ‘Non-Publicly Owned Company (Gne Primary company) ‘Other Companies in which the Primary Company ‘Owns Security or Equity Interests WB nore or net kn NERLEIEUAG CORY MAR 12 23 ‘es Feat Page 3 or 9(c.f you iow that any compary or business entity Ista in 6() or () above has any material Business dealings or DUsNeSS contracts wien the State, or ‘iregulaed bythe Slate, sre 0 oe desenptiono that business ct 7 | "Name of Company or Business Entity i Description of Business Activity with the State DR none or Not known 7, re you, your spouse, or members f your immediate fa or contaled by you? Ore Kno De not fst lind trusts” ly the Benernaries ofa vested trust with o vole of $10,000 or more thats created, established, Name and Address Description of the Trust 8. Bo you, your spouse, o- members of your mmedlate family nave 8 uabilty (debe) of $20,000 or more, exsuting indebtedness (mortgage) on your primary personal rescence? Examples include credit ced ets, auto loans, and rudent ans Bes C1 wo Name of Debtor (You, use, Immediate Family Member) Type of Creditar (Commercial Bank, Cr ‘Union, Individual, etc.) 1. OTHER DISCLOSURES 918). During tie preceding calendar yeor, were you, your spouse or members of your Immediate famiy @ director, officer, governing beard member, fempoyee, indepencent contractor, or registered lobbyist of @ nangroft Corporation or orgenteation operating in the State primany Yor resgius, charktabe, ‘scent itarary, pubic heaity ang safer, or educational purposes? Bre On 1 Do rot lik State Board or eniies, or enlties created by a policalsubaivsion of the State bo not ist organizations of which you area mere member or subscriber, ame of Person ier Poaion Joe! D. Ford Board Member [Stratford Richarckan Vaca] Health and Wellness | Joel O- ford Board Member| Char [Charlotte tousing Auth |APfurdable Housing | l This entire document record. ESET COUNTY Page 40f9 wan 2 207 ates Me eeJott). tthe usted nonprofit cnrporatns or organizations do business with the State or receve State funds, please provide a bret description ofthe nature of {rat ausines, # enowm, ofan wien due ahigence could reasonaty be known [Name of Nonprofit Corperation or Organization Describe State Business or State Funding 1 None or Not Keown Charlotle Housing uthonty Grants ard Housing Tax Credits UR Rm 4 10, Us al sources of income (not spectic amounts) of mara than $5,000 received by you, your spouse, or members of your immediate family during the preceding calendar year. Include salary. wases..state/local coveriment retirement, arofessional fees, honoraria, interest, dividends, rental ‘De nat include income recelves from the following sources: » capital gains > Federal government revrement > military reurement Social security income/SSO1 Recipient of income ‘Name of Source Type of Business/ Industry Type of Income thas ne reperatle wicome ever $5,000 n the preceding calendar year. Joel _D. Ford | Duke Energy Ubi Hes Professional fees Deborah b ford PAR OME tices [ferchant Services | Wages 11. Are yous practeng axorey? Doves Bil no (1) suaicial omcersstate attorney It Yes, check each category of legal repcesentation In which you or the law firm with whicn you are associated has earned legal fees of $10,000 or more ‘uring the praceaing ealenca” yaar D teminsratie Dama Di expoate Di coma TE cececen's estates 1 eoweonmentas 1 tasuronce D tater Di tect covenant Drea reseny Di secures Ow ces) Uwates negulacion oOo Cane eter ad tere anon crane 1 ot enn lap f04 a $10,000 oremrecurng me 12. Are you (1) a Ncensee professional (ther than an attorney) oF co you provice consulting services incivdually or as 8 member OF & professional ‘tinction amd (2) ds you charge or were you paid aver $10,000 for those fervices aurng the preceding calendar Veer? res Dv ‘Type of Business Consulting Business De lopment This entire document and any attachments ae Page sore[ 13. are you or your emotover, your spouse ar members af your tmmeate fay, or their employer + ucenana ny tne State board or employing entity with which you are or will Be assoetsted oF + Regulated by the State boord or employing ennity with which you are or wil be associated oF + Have atusiness reltinshio with the State board or employing entity with which you ae or will De associates? Cres PX no C1 tecisitorsusica omcer - vou are not requires to complete this question f you are ling because you are a fesilator ora jude cffeer Chudieloficer is defined in foatrate 1) or you are fling 35 an appointee to those offices Person Name of Employer Type of Relationship (Ct applicable) (Licensing, Regulatory, Business) 14, During the preceding calendar year, were you, your spouse, or members of your immediate family @clrector,oce, or governing board member of ony Society, organization, or advocacy grous mien ned an interest pertarning to subject mater areas over whiEN Your agency or board may have Jursaicton? [ves Cl no Di tesisatorsiuacal oricer ~ You are not required to complete this question If you are Ming because you area legislator oro uct aicer or you are Sling as an enpomte to those afces ‘Da nat iat organizations of which you are oniya member (nets eadersNp Foe) ame of son [Name of Society, Organization Leadership Position on Advocacy Group (Director, Officer, Board Member) TS, Hove you ever Been convicied ofa felony for which you have nt raceved ether (i) @ pardon of innaconice or (1) an Order of expungement regarding that Ore Ki to Offense I Date of Conviction ‘County of Conviction ‘State of Conviction 16. Ounng any calender quarter in the prececina year (but only the Eine pored after you were sppaInted, employed or fled oF were nominated 35 cancveate), 8 yoo + receive any gifts) exceeding $200 per quarter rom 2 person er group of persons acting together, and ‘+ wen both you and those person(s) were autside North Carina atthe tne you accepted the gs), and + the f(s) were given under arcumsrances tnat would lea6 a reasonable person to conciuce that they were given for lobbying? Ove Bi ne ‘Do nat repr QA given by mernbers of your extended family. > bo not report gts that have previously deen reported by you to the Deparment of the Secretary of State onthe “Expense Report for Exempted Persons. Date Ttem Recelved Name and Address of Don ) Describe Ttem Received Estimated Market Value ‘This entire document and any attachments are public recor Page 6 of 9 MAR 12 1 tea UF etn17, Dung the preceding year (but only he time pared aRer you were apaointed, employed, oF filet or were nominated es @candite) nave you 1+ accepted a “scholarship” exceeding $200 frm » person oF group et persons acting tagetner and 1+ ene8e parsons) were outsice North Carcina and + the scholarship was related to your puble postion? A “scholarship” Is grant-in-ald to attend a conference, meeting, or similar event. ves DR mo [suc orrcer You ae nt requires to complete tvs esto f you ae 2 Jud officer or you ae ing as 9 yucca ofcer appointee Do not report Gis that have previously bean reported by vou to the Deparment of the Secretary of State on the "Expense Repar for Exempted Persons.” Legislators are not required to cepore scholarships paid by & nonpartisan legsiauve organization of which the legislator or the General Assembly 's 8 ‘member or partlzant of a afi ate ofthat organization, Date of Scholarship ‘Name and Address of Donor(s) Describe Event estimated Market Value 18, Are you or @ member of your immediate family currently registred as al 12 monche? nyist 9 IoBBYSt principal or were you registered as such within te preceding ‘Lobbyists Principal Registration Expiration 19(9), Ust the name of each business with which you are associted where’ arin, propretor, or member or manager. ‘you or a member of your immadiate lartly = an employee, aectar, oMicer, Name of Person Relationship to Filer ‘Name of Company ole of Person (One tusiners Associations Yoe\_D. ford self Te Network Group | Director 15(0). you know that any company or Business entity ated in 19(a) above has any material Business Gealnge or business Contracts with the Stave, oF 1s Feguated'by the State, provide e bre! description ef that business actly, ‘Name of Company oF Business Entity Description of Business Activity with the state i ner aerate no entities ate on #198) Be no sasenein not wn “This entire document and any attachments are public record. HECITENERC COUNTY wan i 2 2002 aes arte Page? of20, Disa Councn of state memter appoint you to or recommend you for apaointrrent to @ Bowed covered by he » Governse > Ls Governer » Secretary of state > State Auator » State Treasurer > Superintendent of Publ > atvorney Genera) > Commissioner of agreuture 1» Commssioner of Labor commissioner et insurance 21%" teal contrbuatons you net immedi farm members) mae during the preceang calendar ye wha ‘the Council of State member who appointed you. > ear a Zi Eves Act? Council State members are le Instruction imulative total of more than $1,000 to ‘Contributions oe defined in W.C.G.S, 165-278.6(6) and vclode, But are FOE Nmed to, "any advance, conveyance, Gepost, aetibulon, Wanwiar TRG, Joan, payment gi, pledge o” subscription of maney of anyuna oF value wmaksoever.” Date ‘Amount Contributed to TR No contrbution(s) wth 2 cumulative total of more than 43,008 21, Are you now, 0° are you a prospective eppointee to ‘2 the read ofa prncipa state department (2.9. cabinet secretary) appolne by the Governor’ OF . a Noth Caron Supreme Court Justee, Court of Angeals, Superior or District Court Judge; oF a member af any af the flowing boards: + RBC Commission 1 Coast Resources Commission 1 State Board of Eacation {State toed of Elections + Employment Securty Commission ‘+ Environmental Management Commission + Industral Commission state Personne! Commission Board of Transportation UNC Boate ef Governors + Ubities Commission 1+ wale Recourzes Commission Dyes Bano IT°No", proceed to question 22. “If so, more you appointed to, oF are you being considered fer, appointment to yaur public postin by a| Counc of State Member (Governor, Li. Governor, Secretary of State, State Auditor, State Treasurer, ‘Superntendont of Phe Instracuon, atervey Gereral, Commissione’ of Agrculture, Commissioner of ator, 9° Commissioner of Insurance)? Ores Cae TE"No", proceed to question 22, “e150, vou must indieate whether during the preceding calendar year you (nat immediate faraly members) engeged in ny of the following actvties with respect to or on Beha ofthe candidate O ‘Campaign commites of tie Caunel of State member wha apponted You to your pubic postion I Galected cantnoutions tam maltipe contrieutors, tack possession or such mulliple contrautlons, ‘Src transferred or celverecthase colected cortrisutns to te candidate or commice? Contributions ae defined in N.C.6.5. 183-278.0(6) ana include, Dut are not hnted to, “any Sovanee, conveyance, cepose, isrbaton, wanser of fUnds, loan, abyment, QI, pledge Subscription of money or anything of value whatsoever.” 1 Hoste a fureraser at your rescence or place of business? Over Cine 1H volunteered or campaigns actives, which ielade, bu are noe ted 6, gone Danks, rent asitancs, mings, canvas, surveying, or any ater setivly tat aavanezs he campagn |] yes C] no Sretconacate? MELDING HOUT ‘This entice document and any attachments are public recor wag 12-000 os32, ME you aware of any other formation tat you Beleve may assist ie State Eimies Commission im aaveing you cnee-ning yaur compliance wih be Stace Governmenc Ethcy ACD y [Ove Rw [AFFIRMATION | affirm that the information provided inthis Statement of Economic Inlerest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. | also cerity that | have not transferred, and will not transfer, any asset, inlerest, oF property or the purpose of concealing it from disclosure hile retaining an equitable interest. | understand that my Statement of Economic Interest and any attachments or supplements thereto are public record | acknowledge that | have read and understand N.C.G.S. 1984-26 regarding concealing or fling to disclose material information and N.C.G.S. 138.27 regarding providing false information: § 138A.26, Concealing or failing to disclose material information. Aflling person who knowingly conceal economic interest under this ticle shall be guily of a Class 1 misdemeanor and shall be subject to aisciplinary action under G.S. 1384-45, (2006-201, s. 1.) '§ 1388-27. Penalty for false information, {A fling person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guily of a Class H felony and shall be subject to disciplinary action under G.S. 138A-48. (2006-201, s. 1.) | 31Kgree Sec bse \ **Notarization is no longer required’ Printed Name Gwe 2 2 soars Yaa fir— Submit SIGNED, ORIGINAL documents, You must fle this form atthe same place you file your notice of candidacy. DO NOT ile this form with the State Ethies Commission MECKLENGLAG CONT This antira document ny attachments are public record. aR 2m WN arm ae eciiva