Statement of Disclosure of Interest Help and FAQs

ss-8004

ss-8005


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If you have any questions, contact

Tennessee Ethics Commission
(615) 741-7959
E-mail ethics.counsel@tn.gov

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NIC, TN - TN.gov Help Desk
(615) 313-0300 or 1-866-8TN-EGOV
E-mail help@egovtn.org

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About Sources of Income "Part A" (ss-8004)

For purposes of this provision, income shall be reported for the calendar year in which it is received. "Major sources of private income" include, but are not limited to, offices, directorships and salaried employment. No dollar amounts need to be stated; however, you must list the name and address of each source of income, except for sources of income received from a security listed on the New York Stock Exchange, American Stock Exchange or NASDAQ or from income received from investments with a federal or state chartered bank. You may list only the name of the entity in lieu of the name of the address of the entity. For income derived from the ownership of a business enterprise's securities, you may list the name of the enterprise in lieu of any investment brokerage firm or other fiduciary that may possess or manage the securities on your or your spouse's behalf. For income derived from a mutual fund, you may list the name of the mutual fund in lieu of the business enterprise securities owned by the mutual fund. You are not required to disclose any client list or customer list, or to list the address of any investment property.

“Private income” refers to any income you or your spouse receive in excess of $200 per annum from a non-governmental source. If you are employed by the State of Tennessee or a local government do not report your government compensation.

The term “private income” includes, but is not limited to:

  • Bank and Bond Interest
  • Business Income
  • Capital Gains
  • Clinical Practice Income
  • Income from Employment
  • Income from Contractual Relationships
  • Directorships
  • Dividends from stocks and securities (but not the principal which is reported in the investment question following)
  • Compensated Fiduciary Positions (Trusteeships, Conservatorships…etc.)
  • Honoraria
  • Lecture Fees
  • Payments from Annuities, Settlements…etc.
  • Rental income
  • Research Grants
  • Research Foundation Income
  • Retirement Income
  • Trust Income (but not the principal which is reported in the investment question)

This list is not exhaustive, but merely exemplary. If you or your spouse have other income that is not listed here but meets the requirements of this section, you are required to list them.

The term “private income” does not include monies received directly by inheritance or gift. The term does include, however, the income produced by an investment which has been received by inheritance or gift.

As a general rule, if the receipts are reportable to the IRS as private income, then they must be listed on the form.

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About Sources of Income "Part B" (ss-8004)

“Private income” refers to any income your minor child(ren) residing with you receive in excess of $1,000 per annum from a non-governmental source. If employed by the State of Tennessee or a local government do not report the government compensation.

The term “private income” includes, but is not limited to:

  • Bank and Bond Interest
  • Business Income
  • Capital Gains
  • Clinical Practice Income
  • Income from Employment
  • Income from Contractual Relationships
  • Directorships
  • Dividends from stocks and securities (but not the principal which is reported in the investment question following)
  • Compensated Fiduciary Positions (Trusteeships, Conservatorships…etc.)
  • Honoraria
  • Lecture Fees
  • Payments from Annuities, Settlements…etc.
  • Rental income
  • Research Grants
  • Research Foundation Income
  • Retirement Income
  • Trust Income (but not the principal which is reported in the investment question)

This list is not exhaustive, but merely exemplary. If your minor child(ren) residing with you have other income that is not listed here but meets the requirements of this section, you are required to list them.

The term “private income” does not include monies received directly by inheritance or gift. The term does include, however, the income produced by an investment which has been received by inheritance or gift.

As a general rule, if the receipts are reportable to the IRS as private income, then they must be listed on the form.

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About Positions Held (ss-8004)

Positions with the federal government, religious, social, fraternal or political entities, and those solely of an honorary nature, do not require disclosure.

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About Investments (ss-8004)

The name of the corporation or organization must be listed but no dollar amounts or percentages of the investment need be stated.

For the purposes of this question, the following items must be listed as investments if held by you, your spouse or minor child(ren) residing with you:

  • 401K, 403(b) and 457 plans
  • Annuities
  • Bonds
  • Certificates of Deposit (interest in excess of $1000 must be reported in the income question above)
  • College Savings Programs
  • State Deferred Compensation Plans
  • Estates
  • Stocks and securities (dividends in excess of $1000 must be reported in the income question above)
  • IRAs
  • Keogh Plans
  • Limited Liability Corporations (LLCs)
  • Mutual Funds in IRAs
  • Mutual Funds not in IRAs
  • Notes (investments)
  • Pensions
  • Real Estate (But not your primary or secondary residence)
  • Retirement Plans for States other than Tennessee
  • Real Estate Investment Trusts (REITs)
  • TIAA-CREF Supplemental Retirement Plans
  • Treasury Notes
  • Blind Trusts
  • Warrants
  • Zero Coupon Bonds

This list is not exhaustive but merely exemplary. If you have holdings that are not mentioned but do meet the dollar amount requirements, they must be listed in question 6. Also, where there are investments managed by entities other than yourself, spouse or minor child(ren) residing with you (such as mutual funds or 401Ks), list the entity managing the account and the type of investment but not the corporations to which the money has been distributed. Do not report holdings that are less than ten thousand dollars ($10,000) in value or five percent (5%) of the total capital.

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About Lobbying (ss-8004)

Also list any firm engaged in compensated lobbying in which you, your spouse or minor children residing with you hold any interest. Explain the terms of any such employment, the subject matters lobbied and/or the measures to be supported or opposed.

If you, your spouse, or minor child(ren) residing with you are associated with a compensated lobbyist, you must provide the name(s) of the entities for which the associate lobbies.

If you, your spouse or minor child(ren) have any interest in any lobbying firm, you must list the name of the entity. Do not report interests in employers of lobbyists, e.g., do not report interests in public corporations or other entities that may engage a lobbyist.

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About Professional Services (ss-8004)

For the purpose of this question, you must list the general areas of interests of your (or your spouse’s) clients if you (or your spouse) engage in any profession licensed by the State of Tennessee. You are not, however, required to list your clients or to otherwise furnish personal information about your clients. These professions include, but are not limited to:

  • Architecture
  • Audiology
  • Chiropractic
  • Dentistry
  • Law
  • Massage Therapy
  • Midwifery
  • Nursing
  • Optometry
  • Pharmacology
  • Physical Therapy
  • Podiatry
  • Public Accounting
  • Veterinary Medicine

This list is not exclusive. If you or your spouse practice a profession not listed but that does require you to obtain a license to practice in the State of Tennessee, you are required to list the general areas of your clients’ interests.

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About Loans (ss-8004)

Loans need not be disclosed on this report if they are:

  1. From your immediate family (spouse, parent, sibling or child);
  2. From a federally insured financial institution or made in accordance with existing law in the ordinary course of doing business of making loans. The loan must bear the usual and customary rate of interest, be made on a basis which assures repayment, evidenced by a written instrument and subject to a due date or amortization schedule;
  3. Secured by a recorded security interest in collateral, bearing the usual and customary interest rate of the lender made on a basis which assures repayment; evidenced by a written instrument and subject to a due date or amortization schedule;
  4. From a partnership in which you have at least ten percent (10%) partnership interest;
  5. From a corporation in which more than fifty percent (50%) of the outstanding voting shares are owned by you or by your immediate family (spouse, parent, sibling or child).

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ss-8005 Additional Instructions

  • A “local elected official” is any county, municipal, school, utility board member or other district or precinct office that is filled by voters (e.g., an elected office) as defined in T.C.A. § 2-10-102 (13)(A).
  • Candidates and appointees to such positions must complete the form.
  • State officials who must complete ss-8005 are the following:
    • District attorneys general and  public defenders for each judicial district and the Executive Director of the District Attorneys General Conference as well as the Attorney General and reporter;
    • Each supreme court justice, each judge of the court of criminal appeals, each judge of the court of appeals and the administrative director of the courts;
    • Each member of the state election commission, the state election coordinator and members of the registry of election finance;
    • Each director of the Tennessee regulatory authority;
    • Each delegate to a constitutional convention called to consider a new constitution or amendments to the Constitution of Tennessee;
    • Members of the Board of Probation and Parole, members and the Executive Director of the Alcoholic Beverage Commission and Members of the Tennessee Ethics Commission; and
    • The Chancellor of the Board of Regents and the president of each college or university governed by the Board of Regents (excluding directors of Tennessee technology centers) and the President of the University of Tennessee and the chancellor of each separate branch or campus of the University of Tennessee.

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About Sources of Income (ss-8005)

For purposes of this provision, income shall be reported for the calendar year in which it is received. "Major sources of private income" include, but are not limited to, offices, directorships and salaried employment. No dollar amounts need to be stated; however, you must list the name of each source of income. For income derived from the ownership of a business enterprise's securities, you may list the name of the enterprise in lieu of any investment brokerage firm or other fiduciary that may possess or manage the securities on your or your spouse's behalf. For income derived from a mutual fund, you may list the name of the mutual fund in lieu of the business enterprise securities owned by the mutual fund. You are not required to disclose any client list or customer list, or to list the address of any investment property. Investment property should be listed in the Investments section. Rental income in excess of $1000 from investment property should be listed in the income section.

“Private income” refers to any income you, your spouse, or your minor child(ren) residing with you receive in excess of $1,000 per annum from a non-governmental source.  If you are employed by the State of Tennessee or a local government do not report your government compensation.

The type and source of income should be specified. It is not sufficient to list "interest" or "honoraria". It should be listed as "Interest from ABC Bank CD" or "Dividends from XYZ corporation" or "Honoraria from ABC Association."

The term “private income” includes, but is not limited to:

  • Bank and Bond Interest
  • Business Income
  • Capital Gains
  • Clinical Practice Income
  • Income from Employment
  • Income from Contractual Relationships
  • Directorships
  • Dividends from stocks and securities (but not the principal which is reported in the investment question following)
  • Compensated Fiduciary Positions (Trusteeships, Conservatorships…etc.)
  • Honoraria
  • Lecture Fees
  • Payments from Annuities, Settlements…etc.
  • Rental  income
  • Research Grants
  • Residual income from publications, copyrights, patents, etc
  • Research Foundation Income
  • Retirement Income
  • Trust Income (but not the principal which is reported in the investment question)

This list is not exhaustive, but merely exemplary.  If you, your spouse or minor child(ren) residing with you have other income that is not listed here but meets the requirements of this section, you are required to list them. 

The term “private income” does not include monies received directly by inheritance or gift.  The term does include, however, the income produced by an investment which has been received by inheritance or gift.

As a general rule, if the receipts are reportable to the IRS as private income, then they must be listed on the form.

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About Investments (ss-8005)

You should give the name of all businesses or organizations in which you have invested money in excess of $10,000, but no dollar amounts or percentages of the investment need be stated.

If you have made investments through a third person or entity, and you have the legal power to direct in which specific stocks or other investments the third person or entity should invest your money, then you must list the specific stocks or other investments in which your money is invested. This is true regardless of whether you have exercised the power to direct such investments.

If you invest through a third person or entity, and you have no legal power to specify in which stocks or other investments the third person or entity must invest your money, then you need only list the name of the person or entity through which you invest. Examples of such investments would be 401(k) and 403(b) accounts and mutual funds.

For the purposes of this question, the following items must be listed as investments if held by you, your spouse or minor child(ren) residing with you:

  • 401(k), 403(b) and 457 plans
  • Annuities
  • Bonds
  • Certificates of Deposit (interest in excess of $1000 must be reported in the income question above)
  • College Savings Programs
  • State Deferred Compensation Plans
  • Estates
  • Stocks and securities (dividends in excess of $1000 must be reported in the income question above)
  • IRAs
  • Keogh Plans
  • Limited Liability Corporations (LLCs)
  • Mutual Funds in IRAs
  • Mutual Funds not in IRAs
  • Notes (investments)
  • Pensions
  • Real Estate (But not your primary or secondary residence. List city, county, and state)
  • Real Estate Investment Trusts (REITs)
  • Retirement Plans for States other than Tennessee
  • TIAA-CREF Supplemental Retirement Plans
  • Treasury Notes
  • Blind Trusts
  • Warrants
  • Zero Coupon Bonds

This list is not exhaustive but merely exemplary.  If you have holdings that are not mentioned but do meet the dollar amount requirements, they must be listed in question 6.  Also, where there are investments managed by entities other than yourself, spouse or minor child(ren) residing with you (such as mutual funds or 401Ks), list the entity managing the account and the type of investment but not the corporations to which the money has been distributed.   Do not report holdings that are less than ten thousand dollars ($10,000) in value or five percent (5%) of the total capital.

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About Lobbying (ss-8005)

Also, list any firm engaged in compensated lobbying in which you, your spouse or minor children residing with you hold any interest. Explain the terms of any such employment, the subject matters lobbied and/or the measures to be supported or opposed.

If you, your spouse, or minor child(ren) residing with you are associated with a compensated lobbyist, you must provide the name(s) of the entities for which the associate lobbies.

If you, your spouse or minor child(ren) have any interest in any lobbying firm, you must list the name of the entity. Do not report interests in employers of lobbyists, e.g., do not report interests in public corporations or other entities that may engage a lobbyist.

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About Professional Services (ss-8005)

For the purpose of this question, you must list the general areas of interests of your (or your spouse’s) clients if you (or your spouse) engage in any profession licensed by the State of Tennessee.  You are not, however, required to list your clients or to otherwise furnish personal information about your clients.  These professions include, but are not limited to:

  • Architecture
  • Audiology
  • Chiropractic
  • Dentistry
  • Insurance
  • Law
  • Massage Therapy
  • Midwifery
  • Nursing
  • Optometry
  • Pharmacology
  • Physical Therapy
  • Podiatry
  • Public Accounting
  • Teaching
  • Veterinary Medicine

This list is not exclusive.  If you or your spouse practice a profession not listed but that does require you to obtain a license to practice in the State of Tennessee, you are required to list the general areas of your clients’ interests.

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About Loans (ss-8005)

Loans need not be disclosed on this report if they are:

  1. From your immediate family (spouse, parent, sibling or child);
  2. From a federally insured financial institution or made in accordance with existing law in the ordinary course of doing business of making loans. The loan must bear the usual and customary rate of interest, be made on a basis which assures repayment, evidenced by a written instrument and subject to a due date or amortization schedule;
  3. Secured by a recorded security interest in collateral, bearing the usual and customary interest rate of the lender made on a basis which assures repayment; evidenced by a written instrument and subject to a due date or amortization schedule;
  4. From a partnership in which you have at least ten percent (10%) partnership interest;
  5. From a corporation in which more than fifty percent (50%) of the outstanding voting shares are owned by you or by your immediate family (spouse, parent, sibling or child).

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