Fillable Form 2021: DUE: February 28, 2020 Interests F (City of Milwaukee)

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Form 2021: DUE: February 28, 2020 Interests F (City of Milwaukee)

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M
2020
Statement of
Economic
Interests
F
orm
DUE: February
28,
2021
ilwaukee strives to maintain a reputation for
good government and high ethical
s
tand
ar
d
s
.
Each emplo
yee
,
official, and
board/commission
member can support this reputation through conduc
t
that shows integrity and concern for public
in
t
er
es
t
.
Ethical behavior involves using good judgmen
t
and common
sense
in performing duties and
r
es
p
onsib
ili
t
ie
s
.
All emplo
yees
,
officials and
board/commission
members are covered by the City Code of
E
t
hic
s
,
found in the Milwaukee Code Ordinance (MCO),
Chapter
30
3
,
which describes standards of conduc
t
and conflicts of
in
t
er
es
t
.
The Milwaukee Common
Council determines which individuals are required
t
o
file the Statement of Economic Interest pursuant
t
o
Chapter
30
3
.
These
persons include:
• All elected city officials
• City
employees
identified by department heads as
having discretionary
p
o
w
ers
• Members and nominees of designated boards and
commissions
• Candidates for elective office
The Ethics Board takes the information you provide
in
the Statement of Economic Interests
s
er
iou
s
l
y
.
Each
form is checked when it arrives for comple
t
ion
.
Each
year the Board conducts a random review
of the entire f
iling
.
Some
forms may be returned for
clarification or comple
t
ion
.
The Statement of Economic Interests form is a
public
record as defined by the Wisconsin Public Records
l
a
w
,
S
e
c
.
1
9
.
3
1-3
9
,
W
i
s
.
S
ta
t
s
.
T
r
adi
t
ion
all
y
,
r
e
que
s
t
s
to view the Statements are received by the
E
t
hic
s
Board shortly after the February 28 filing deadline
.
Occasionally requests are made for
S
ta
t
emen
t
s
fr
om
previous
years
.
Any member of the public may
request a copy or inspection of your Statement of
Economic Interests
form
.
The fees and
penalties
for filing the Statement of
Economic
Interests Form after the February 28th
due date are as
follows:
• $25 if 11
days
or more late
• $5 per day if more than 30
days
late, up to a
maximum
of
$100
in daily late
fees
Late fees must
accompany
any late
filings
or your
statement will not be accepted.
See s.
3
0
3-
11
-
2a
,
Milwaukee Code
of Ordinances
Employees,
city
officials
and board/commission
members
who have not filed Statement of
Economic
Interests
Forms
within 45
days
of
t
he
deadline may be referred to the City Attorney for
charges
in Municipal Court, with a conviction
subject
to a forfeiture of $250 to $1,000 and
imprisonment
for failure to pay the forfeiture of
1
0
to 40 days.
See s.
3
0
3-
11
-
2d
,
Milwaukee Code
of
Ordinances
To view the City of Milwaukee Ethics Code and
t
he
Board of Ethics
Rules
and
P
r
o
c
e
dur
es
,
visit our
w
e
b
site at www
.mil
w
a
uk
ee
.
g
o
v
/
et
hics
.
If you have
any
que
s
t
ion
s
,
please
contact the City of
M
ilw
a
uk
ee
Ethics Board Office at (
4
1
4
)
286-86
4
1
.
Thank you,
Your Milwaukee Ethics Board
Patricia Hintz – CHAIR
Bradley Kalscheur
–
VICE
CHAIR
Whitney Maus
Michael Kruse
Clarence Nicholas
Kathleen Johnson
Emily Mueller
(SEE REVERSE FOR LOCAL AND STATE
ETHICS
GUIDELINES)
(Rev.
12/20
)
LOCAL G
U
ID
E
L
IN
E
S
As you go about your official duties, please keep
these general guidelines in mind:
• A city employee or official should not accept
anything of value that could appear to influence
his/her public duties.
• A city employee or official should not accept
anything of value that could appear to be a reward
for action taken in his/her public duties.
• A city employee or official must report any gift or
entertainment totaling more than $50 received during
the year.
• A city employee or official should not use his/her
public position for personal gain or for the gain of
immediate family members or for organizations in
which he/she has an interest.
• A city employee or official should not use workplace
information that is unavailable to the public, for
personal gain.
• Contracts of more than $3,000 between a city
employee or official and the city are prohibited
without written disclosure to the Ethics Board and to
the contracting department.
• A city employee or official should not represent
persons, for compensation, before city departments,
commissions, or boards unless as part of his/her
official duties or at a recorded open hearing.
• For 12 months after leaving city employment, an
employee or official may not represent, for
compensation, persons before city departments,
commissions or boards related to his/her former
position.
These comments are only a general description of
parts of the Ethics code itself. The actual statutes,
rules, and opinion summaries, as well as the Ethics
Board itself, should be consulted when questions
arise. The complete text of the ethics code can be
found in Chapter 303 of the Milwaukee Code of
Ordinances. City departments also have copies of the
code for posting.
STATE
G
U
I
DE
LI
N
E
S
Many city officials are also covered by the
requirements for Local Officials put forth in the
Wisconsin State Statutes. The State Code of Ethics for
Local Officials does not apply to all city employees and
officials. Section 19.59 of the Wisconsin Statutes
cover:
• Elected officials
• Individuals appointed to a position for a
specified term
• Individuals who serve in a position at the pleasure
of the Mayor or Common Council
Positions within City government that fit this definition
are not only covered by local ethics code but also
have responsibilities to conform to the requirements
of the State of Wisconsin Ethics Code for Local
Officials as well.
We are attaching State Ethics Form 219, which offers
guidelines on gifts and entertainment.
Please take a few moments to review it. Our Board
recommends that you keep it on file for future
reference. If you have any questions regarding the
State Guidelines for Local Officials please contact the
State of Wisconsin Government Accountability Board
at (608) 266-8123
.
Ethics Board
INS
T
R
U
C
T
IO
NS
Statement of Economic Interests
General filing information:
•
The information sought in this form is required by Chapter
303, Milwaukee Code of Ordinances.
•
Attach additional pages if necessary.
•
Go to the Ethics Board website at
www.milwaukee.gov/ethics
for extra forms and instructions.
•
Questions?
Email
ethics@milwaukee.gov
or call
(
4
1
4
)
286-86
4
1
.
Definitions:
•
“Immediate family member” means your spouse and any
child, step-child, parent or parent-in-law who receives more
than one-half of his or her support from you or from whom you
receive more than one-half of your support.
•
“Income” means gross income before deductions and
depreciation, from whatever source derived, as defined by the
Internal Revenue Code, but excludes dividends and interest.
Part 1 – Sources of Income For calendar year 2020
A. EMPLOYERS. List each EMPLOYER from which you and your immediate family received
$1,000 or more in 2020.
LIST:
•
each employer from which you and your immediate
family member received $1,000 or more during
the year
•
City of Milwaukee, if applicable
DO NOT LIST:
•
An individual (unless the individual was a lobbyist, your
employer, or acting on behalf of a business or organization)
B. OTHER SOURCES OF INCOME. List other sources from which you or your immediate family
received income of $1,000 or more in 2020.
LIST:
•
any entity from which you or your immediate
family has received income of $1,000
•
Social Security payments
•
an entity from which you or your family received
retirement benefits
•
an entity from which you or your family received
directors fees
DO NOT LIST:
•
the source of dividends or interest
•
the source of insurance benefits, inheritances, scholarships (if
no teaching or services were required in return)
•
a decedent’s estate
•
a political contribution that has been reported to the Election
Commission
•
an individual (unless the individual was a lobbyist, your employer,
or acting on behalf of a business or organization)
Part 2 – Business
For any BUSINESS that is a partnership, limited liability company, Subchapter S, or Subchapter C corporation in which you or your
immediate family, directly or indirectly, separately or together, owned or controlled at least 10% interest and from which you or
your immediate family has received $1,000 or more during 2020, list the name of the business and identity of each payer of $1,000
or more to the business, as of December 31, 2020.
LIST:
• partnership (general, limited or limited liability)
• corporation (regardless of tax status and including
service corporations)
• limited liability company (LLC)
DO NOT LIST:
• an individual (unless the individual was a lobbyist, your
employer, or acting on behalf of a business or organization)
• a decedent’s estate
Part 3 – Investments
List stocks, bonds, notes or other investments you and your immediate family held (minimum $5,000)
as of December 31, 2020.
LIST THE NAME OF EACH:
• stock and stock option
• bond
• note or other evidence of indebtedness
• sponsor of mutual fund and money market fund (i.e.
Fidelity or Janus Fund)
• security issued by the State of Wisconsin or by local
governmental entities within Wisconsin
• any of the above held directly or:
o in a deferred compensation plan, profit sharing plan,
or pension plan whose investments you or your
immediate family direct
o in an individual retirement account (IRA)
o in a trust in which you or your immediate family
member has beneficial use
o held for you by a corporation, partnership, or other
entity which you or your immediate family member
controls
EXPLANATIONS
DO NOT LIST:
• savings accounts
• checking accounts
• certificates of deposit
• annuities
• insurance contracts
• securities issued by the federal government or a government
outside Wisconsin
• securities in a company in which you and your immediate
family’s total interest is valued at less than $5,000
List the security by name. For example, list “Harley
Davidson” or “IBM.” Do NOT list “deferred compensation plan”
or “IRA” or “Charles Schwabb,” since these terms do not
identify the securities within the deferred compensation plan,
IRA, or brokerage account.
Name of sponsor of mutual fund or money market fund:
List the sponsor name only, NOT each separate fund within
each mutual fund or money market. Combine the value of all
within each sponsor name.
To determine whether an investment meets the $5,000
minimum for reporting add the total value of all types of
securities you and your immediate family held in an individual
business or other entity.
Investments held by a corporation, partnership or other
entity which you and your immediate family control:
Investments must be listed (if aggregating $5,000 or more) if
they are owned by another entity which you and your
immediate family control (i.e. have more than 50% of
outstanding voting interests or have a majority of the directors
or managers of the entity).
Investments held in a trust: List the name of each security
valued at $5,000 or more, held in a trust created by you or in
which you have a vested beneficial interest.
Investments held in a Tax Qualified Account: If an
investment is owned in a tax qualified account (a deferred
compensation plan, profit-sharing plan, or pension plan), you
must list the name of the security only if you or a member of
your immediate family controls the selection of that
security in your account. (If the individual investments in
your plan are selected by someone other than you, such as an
investment advisor or plan trustee, then you do not have to list
the individual securities in that plan.) Because you control
investments in your Individual Retirement Account (IRA), you
must list individual securities held by your IRA.
City of Milwaukee Deferred Compensation Plan: This plan is
not directed by the employee unless you have the PCRA
(Personal Choice Retirement Account). If you are involved in
the PCRA you must list the name of each security valued at
$5,000 or more.
Wisconsin Governmental Securities: Any security issued by
the State of Wisconsin or by local governmental entities within
Wisconsin.
Part 4 – Real Estate
List specific location of REAL ESTATE in Milwaukee, Ozaukee, Racine, Washington and Waukesha
counties (except your principal residence) in which you or your immediate family hold at least 10%
interest which is valued at $5,000 or more as of December 31, 2020.
LIST:
• real estate you or your immediate family owned directly or
through: (a) partnership; (b) a corporation; (c) a trust; or
(d) other enterprise
DO NOT LIST:
• your principal residence unless it was used for the conduct of
a business or for rental purpose
Part 5 – Creditors
List each creditor to whom you and your immediate family owed $5,000 or more as of
December 31, 2020.
LIST:
• each creditor (for personal and business debts, including
mortgages) if you or a family member was personally liable
for the debt
• your portion of any partnership debts
Part 6 – Associations
List every organization with which you are associated and the nature of your association with that
organization as of December 31, 2020.
LIST THE NAME OF EACH:
• business, labor union, association, cooperative, or
other organization with which you were associated
and the nature of your association, i.e. officer,
member, director, authorized representative,
or agent
• non-profit social or community service organizations
• Bar Association
DO NOT LIST:
• charitable organizations (entities to which a contribution is tax
deductible, i.e. American Red Cross)
• political organizations (entities whose primary purpose is to
influence voting)
• trusts
• federal, state, or local governmental agencies
Part 7 – Gifts
List individuals and organizations that, directly or indirectly, provided you with ENTERTAINMENT or GIFTS
totaling more than $50 in 2020. You may disclose gifts throughout the year on the gift/honoraria/payment of
expenses form. Additional forms are available on the Ethics Board website at www.milwaukee.gov/ethics.
If you
have filed a disclosure form for 2020 mark the box “yes”. If you have filed disclosure forms throughout the year
with the Board, you are not required to list them again on this statement.
A “gift”
includes
any
mone
y
,
pr
op
er
ty
,
f
a
v
or
,
s
er
v
ic
e
,
en
t
er
tainmen
t
,
travel, or payment furnished
without
valuable
c
on
sidera
t
ion
.
I
ncludes
tickets to
sporting
or theatrical
e
v
en
t
s
,
golfing
f
ee
s
,
pr
i
z
e
s
,
samples
and
promotional
i
t
em
s
,
items from sales
r
epre
s
en
ta
t
i
v
e
s
,
or a part of business pr
omot
ion
s
,
and similar
i
t
em
s
.
A “gift”
does
not
include
political
contributions
reported to the Election Commission, or
meal
s
,
b
e
v
er
age
s
,
i
t
em
s
,
or lodging that an individual
o
ff
ers as hospitality at his or her own e
xp
en
s
e
,
and
not
as
a business
e
xp
en
s
e
,
for reasons unrelated to
your
holding a city office or
p
o
si
t
ion
.
Do not list:
gifts from your
sp
ou
s
e
,
child,
par
en
t
,
br
other
,
sis
t
er
,
grandchild,
gr
andparen
t
,
a
un
t
,
uncle
,
nie
c
e
,
nephe
w
,
f
ianc
é(
e
),
par
en
t
-in
-l
a
w
,
gr
andparen
t
-in
-l
a
w
,
br
other
-in
-l
a
w
,
or
sister-in-law
Part 8 – Honoraria and Payment of Expenses
List, for 2020, sources of HONORARIA and payment of EXPENSES more than $50 related to your city duties as
provided for in Chapter 303-9-2a, MCO. You may disclose honoraria or payment of expenses throughout the year
on the gift/honoraria/payment of expenses form. Additional forms are available for printing on the Ethics Board
website at www.milwaukee.gov/ethics. If you have filed a disclosure form for 2020, mark the box “yes.” If you
have filed disclosure forms throughout the year with the Board, you are not required to list them again on this
statement.
LIST :
• each individual or organization from which you received
lodging, transportation, meals, expenses, or honoraria
having a total value of more than $50, for attendance at a
conference, presentation of a talk, participation in a
meeting, or for a published work about issues initiated by
or affecting city government or city agencies
DO NOT LIST:
• information about lodging, transportation, meals, money
or any other thing of pecuniary value if:
o you returned it within 30 days
o you received it from the agency of which your
city public office is a part
o you received it from a source already listed in
Part 1 or Part 2
o you already reported the payment to the Ethics
Board as a matter of public record
o the expense is unrelated to holding public office
and did not arise from holding public office
Ethics Board
Please sign and date your form and list your daytime telephone number. Clearly indicate if your daytime telephone
number is your “home” telephone number. In the event of a public records request, your “home” telephone number
will not be disclosed, if clearly marked.
Mail, email or fax completed form to:
City of Milwaukee Ethics Board
200 East Wells Street, Room 205
Milwaukee, WI 53202
Due: February 28, 2021
ethics@milwaukee.gov
Fax: (414) 286-3456
PLEASE NOTE: Forms filed after the due date may be subject to late filing fees.
If you email the form, you will receive confirmation of receipt. If you do not receive a confirmation, contact the Ethics
Board Office at (414) 286-8641.
If you fax the form, keep the original and do not mail it to the Ethics Board. Keep a copy of your completed form for
your records.
For questions regarding the City of Milwaukee Ethics Code please contact the City of Milwaukee
Ethics Board Office at (414) 286-8641 or visit our web site at www.milwaukee.gov/ethics.
Ethics Board
Statement of Economic Interests
For Office Use Only
E-MAIL, MAIL OR FAX TO:
City of Milwaukee Ethics Board, 200 E. Wells Street, Room 205, Milwaukee, WI 53202
ethics@milwaukee.gov
• Fax: (414) 286-3456
Due February 28, 2021
Filed in 2021 for Calendar Year 2020 – Print legibly in black ink or type
Name: ___________________________________________ Do you live in the City of Milwaukee? ☐ Yes ☐ No
City Position: _________________________________________________________________________________
(include department, title, board, commission, elective office if applicable)
SEE THE INSTRUCTION SHEET FOR EXPLANATIONS, EXAMPLES AND EXCEPTIONS.
Part 1 – Sources of Income For calendar year 2020
A. List each EMPLOYER from which you and your immediate family received $1,000 or more during 2020 (e.g., City of Milw.).
Name of Payer
City and
S
t
a
t
e
Nature of Business
Self (S) or
Family
(F
)
B. List other sources of income from which you or your immediate family received income of $1,000 or more in 2020.
City and
S
t
a
t
e
Nature of Business
Part 2 – Business As of December 31, 2020
For any payer listed
above
that is a
partnership,
limited liability
company, Subchapter
S or
Subchapter
C
corporation
in
which
you
or
your
immediate
family
has a
1
0%
or greater interest, list the IDENTITY OF
EACH PAYER
of
$1,000
to such
partnership, LLC,
Sub-S or Sub-C
corporation
(see
instructions
for certain
payers
which do not have to be listed).
Name of Payer
Name of Business Receiving Payment
Nature of Business
City and State
Part 3 – Investments As of December 31, 2020
List stocks, bonds, notes or other investments you and your immediate family held ($5,000 or more).
Name of each
Security
or Mutual
Fund
Sponsor
TYPE
OF SECURITY - ☑ ONE
AMOUNT - ☑ ONE
Stock, Options,
Futures
Bond,
No
t
e
WI Gov’t.
Sect.
Mutual
Funds
or
Money
M
ark
et
$
5
,
000
-
$5
0
,
000
more than
$5
0
,
000
(Rev. 12/20)
Part 4 –
Real
Estate
As
of December
31,
2020
List
specific location
of
REAL ESTATE
in Milwaukee,
Ozaukee, Racine, Washington
and
Waukesha counties
(except your
principal
residence) in
which you
or
your
immediate
family hold
at least
10%
interest
which
is
valued
at $5,000 or more.
Street Address
C
oun
t
y
Type
of Property
Nature of
I
n
t
e
r
e
s
t
Part 5 – Creditors
As
of December
31,
2020
List each
CREDITOR
to whom
you
and
your
immediate
family
owed $5,000 or more on December
31,
2020.
Creditor ($5,000 or more)
City and
S
t
a
t
e
$5,000 - $50,000 (check
✓
)
more than $50,000 (check
✓
)
Part 6 – Associations
As
of December
31,
2020
List
every organization
with which
you
are
associated
and the nature of
your
association.
Name of Organization
City and
S
t
a
t
e
Nature of
Association
(e.g., member,
officer,
dire
c
t
or)
Part 7 – Gifts During calendar year 2020
List
individuals
and
organizations
that
provided you
with
ENTERTAINMENT
or
GIFTS
more than $50 in 2020.
Name of Provider
City and
S
t
a
t
e
Description
of Gift
Approx.
Value
Did
you
file
any separate
gift
reporting forms
in
2020?
☐ Yes ☐ No
Part 8 –
Honoraria
and Payment of Expenses During calendar year 2020
List
sources
of
HONORARIA
and
payment
of
EXPENSES
of more than $50 related to
your
city duties, for 2020.
P
a
y
e
r
Approximate
Value of Expenses
Amount
of Honorarium
Circumstances
of Receipt
Did
you file any separate honoraria/payment of expense disclosures
in
2020?
☐ Yes ☐ No
I
have
read the
accompanying instructions and certify
that the
information contained
in
this Statement
of
Economic Interests is
true, complete
and correct
to the
best
of
my knowledge, information and belief.
If
any
part
has been
left
blank,
I
have done so intentionally because
there is
nothing
to
report. Typing your name on
the
line below constitutes your signature
of
this document. Please sign and
date
your form and
list your
daytime telephone number and
e-mail
address. Clearly indicate
if
your daytime telephone number
or e-mail
address is your home
telephone
number
or
home
e-mail
address.
In the
event
of a
public records request,
all
information required by
law will be released.
Signature D
ate
Da
y
t
ime
telephone number Is this
your home
telephone number? ☐ Yes ☐ No
E-mail address Is this
your home
e-mail address? ☐ Yes ☐ No
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Form 2021: DUE: February 28, 2020 Interests F (City of Milwaukee)

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