The Law Requires:
Disclose each bank account, savings account, and insurance policy in which a direct financial interest was held that exceeds $24,000 at any time during the reporting period; each other item of intangible personal property in which a direct financial interest was held that exceeds $2,400 during the reporting period; the name, address, and nature of the entity; and the nature and highest value of each direct financial interest during the reporting period, RCW 42.17A.710(1)(b).
Bank Accounts (>$24,000)
In this section, report the name and address of each bank, savings and loan, credit union or other financial institution in which you or an immediate family member had an account over $24,000 at any time during the reporting period. You must also:
- identify the type of account [savings, checking, sharedraft, certificate of deposit, individual retirement account (IRA) or KEOGH if managed by the bank], etc.;
- use the Dollar Code amount that reflects the account's highest value during the period;
- use the Dollar Code to disclose how much income was generated by the account, if at least $2,400 in income was produced. If under $2,400 in income was generated, put "none" or "N/A".
Insurance Policies (>$24,000)
Give the name and address of each insurance company where you or a family member had a policy with a cash or loan value of over $24,000 during the reporting period. Also
- identify the type of policy (life, disability, annuity, etc.);
- indicate the highest value of the policy during the reporting period using the Dollar Code; and
- use the Dollar Code to disclose how much income was produced, if at least $2,400 in income was generated by the policy. If under $2,400 in income, put "none" or "N/A."
Do not list term life policies or other life insurance policies that have no cash value.
Other Investments (>$2,400)
Show the name of each company, partnership, corporation, association, government agency, etc., in which you or a family member had a financial interest worth over $2,400, including investments that were only held during a portion of the reporting period. Provide an address for investment holdings that are not listed on a major stock exchange.
This is the section in which you will show:
- stocks, bonds, securities, commodities (list each holding separately if worth over $2,400 at any time during the reporting period; it's insufficient simply to identify the brokerage house)
- employer retirement system account (if you or a family member paid into an employer-sponsored retirement system, that retirement account is a reportable asset)
- stock options held during the reporting period but not yet exercised - report the value at grant date or describe number of shares for which you hold option;
- stock options exercised during the reporting period – report the value as income received;
- stock appreciation rights,
- IRA (if investor managed, list each holding worth over $2,400; if managed by an agent, list name of manager or management company that decides how IRA money is invested)
- money market accounts (if investor managed, list each holding worth over $2,400; if managed by an agent, list name of manager or management company that decides how money is invested)
- businesses in which you or your family had less than a 10% ownership interest (if 10% or more, file F-1 Supplement)
- loans owed you or an immediate family member by individuals, candidates, political committees, businesses, associations, churches, etc. (Do not include accounts receivable due in the normal course of business)
- legal judgments due you or your family
For each item listed, you are requested to provide a description, a value code (the highest value during the period) and, if appropriate, an income amount code. Instead of a value code, you may list the highest number of shares held during the reporting period for stocks, bonds, and securities. Addresses for security holdings traded on a major exchange are not required.
Note: Each stock, bond and other intangible asset holding worth over $2,400 at any time during the reporting period, whether held for the entire reporting period or just a portion of it, must be reported in this section. If you sold an intangible asset during the period, simply select the code amount that reflects the sale price plus any other interest or dividend income generated by the asset and put that code in the Income Amount column.