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Employee Annual Benefit Reporting Form

List anything of value you have received, as defined in Chapter 2.222 of the Metropolitan Code of Laws, during the previous calendar year, other than donations in connection with political campaigns made and reported in compliance with Tennessee election laws.

Benefit type may be described by reference to the following abbreviations:

  • M = Meals, food, and beverage items
  • A = Admissions, tickets to events, or other access (including parking)
  • T = Travel expense
  • O = Other (describe)

For purposes of this report, the Member is not required to list those items set forth in Section 2.222.030 C 1and 2.

Annual Benefit Reporting Form

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