MRT Act 44 Disclosur..

lDENTlFtcATroN
oFCoNTRAcroRs
PrRsolrtruel
& RELATED
COlrmCrOnS: (See"Definitions" - page2) Any eniity who currentlyprovidesservice(s)by meansof a
ProfessionalServicesConfact to the Municipal PensionSystemof the RequestingMunicipality, pleasecomplete
all of the following:
Identify the Municipal PensionSystem(s)for which you are providing information:
Indicate all that apply with an "X'
|
| Fire PIan
**NjOjE:
For all that follow, you may answer the questions / items on a separatesheet of paper and
attach it to this Disclosure if the spaceprovided is not suffrcient. Pleasereference each question / item
you are responding to by the appropriate number. (example: REF - Iten #1.)
1. Pleaseprovide the namesand titles of all individuals providing professionalservicesto the Requesting
Municipality's pension plan(s) identified above. Also include the namesand titles of any advisors and
subcontractorsof the Contractor,identifuing them as such. After eachname provide a descriptionof the
responsibilitiesof that personwith regard to the professionalservicesbeing provided to each designated
pensionplan.
JamesP, Kennedy - President - providing pensionconsulting services
ScottRhoads- Consultant- providing pensionconsultingservices
DouglasWerley - Consultant- providing pensionconsultingservices
Randee Sekol- Actuary- Beyer Barber Company - providing consulting actuarial services
2. Pleaselist the name and title of any Affiliated Enriry and their Executive-levelEmployee(s)that require
disclosure;after eachname,includea brief descriptionof their duties. (See:Definitions)
A}ISWER- NOI\iE
3. Are any of the individuals narnedin Item 1 or Item 2 above,a currentor former official or employeeof the
RequestingMunicipality?
r)
IF 'YES', providethe nameand of the personemployed,their positionwith the municipality, and datesof
employment.
ANSWER-NO
4. Are any ofthe individuals namedin Item I or Item 2 abovea currentor former registeredFederalor State
lobbyist?
+ IF "YES", providethe nameof the individual, specifuwhetherthey area stateor federallobbyis! andthe
dateoftheir mostrecentregistration/renewal.
ANSWER-NO
NOTICE: All information providedfor items 1- 4 abovemust be updatedas changesoccur.
SinceDecemberl7^ 2009, has +heControctor ot an Affttiated Entity paid compensationto or employed
anythird party intermediary,agent,or lobbfst that is to directly or indirectly communicatewith an offrcial or
employeeof theMunicipal PensionSystemof the RequestingMunicipality (OR), any municipal official or
employeeof the Requesting Municipality in connectionwith any transactionor investrnentinvolving the
Conlractor andtheMunicipal PensionSystemof the RequestingMunicipality?
This ouestion doesnot apolv to an ofticer or employeeof the Confiactor who is acting within the scopeof
the ftrm's standard professional duties on behalf of the frm, including the actual provision of legal,
accounting engineering,real estate,or other professionaladvice, services,or assistancepursuantto the
professionalservicescontactwith municipality's pensionsystem.
+ m "lTS"' identifu: (1) whom (the third party intermediary,agent,or lobbyist) was paid the compensation
or employed by the Contractor or lfliliateil Enttty, Q) their specific duties to direcfly or indirectly
communicatewith an official or employeeof theMunicipal PensionSystemof the Requesting Municipality
(OR), any municipal offrcial or employeeof the RequestingMunicipality, (3) the official they communicated
with, and (4) the datesofthis service.
5.
A}ISWER.NO
6. SinceDecember 17tr 2009, hasthe Contructor,or any agent,officer, director or employeeofthe Contractor
solicited a contribution to any municipal officer or candidatefor municipal offrce in the Requesting
Municipality, or to the political party or political actioncommitteeofthat official or candidate?
F "YES', identif the agent, offtcer, director or employeewho madethe solicitation and the municipal
officials, qandidates,political party or political committeewho were solicited (to whom the solicitation was
made).
ANSWER-NO
7' Since December 176,2009r Has the Contructor or an Afiliated Entity made any contributions to a
municipal official or any candidatefor municipaloffice in the RequestingMunicipality?
rr) nr "lTS'' provide the name and addressof the person(s)making the contribution, the contibutor's
relationshipto the Contractor,The name and office or position of the personreceiving the contibution , the
dateofthe contribution,andthe amountofthe contibution.
ANSWER-NO
8. Does the Contactor or an Affiiaed Entity have any direct financial, commercialor businessrelationship
. with any official identified on the Lht of Municipal Offrcials, of theRequestingMunicipality?
t
['"lTS",
identifu the individual with whom the relationshipexistsand give a detailed descriptionof that
relationship.
**ll@
A written letter is required from the Requesting Municipality acknowledgingthe
relationshipand consentingto its existence.The letter mustbe attachedto this disclosure. Contact
the RequestingMunicipality to obtainthis letter andattachit to this disclosurebeforesubmission.
AI\ISWER-NO
9. Has the Contactor or M Alftliated Entily given any gifts having more than a nominal value to any official,
employee or fiduciary - specifically, those on he List of Municipal Officials of the Requesting
Municipality?
r) nt ..lT5", Providethe nameof the personconferringthe gift, the personreceivingtle gift, the office or
positionofthe personreceivingthe gift, specift what the gift was,andthe dateconferred.
ANSWER-NO
10. Disclosureofcontributions to any political entity in the CommonwealthofPennsylvania
Applicability: A "yes" responseis reouiredand full disclosureis requiredONLY WHEN ALL of the
followingapplies:
a) The contributionwas madewithin the last 5 years
b) The contributionwas madeby an offtcer, director,executiveJevelemployeeor owner ofat least50loof
the Contractor or,{Jilialed Enfu.
c) The amountofthe contributionwasat least$500andin the form of:
1. A single contributionby a personin (b.) above, Q!
2. The aggregateofall contributionsall personsin (b.) above;
d) The contributionwas for
1. Any candidatefor any public oIfice or any personwho holds an office in the Commonwealth
ofPennsylvania;
2. The political committeeof a candidatefor public office or any personthat holds an offrce in
the Commonwealthof Pennsylvania.
(ITS',
r)
provide the nameand addressof the person(s)makingthe contribution,the contributor's
nt
relationshipto the Contractor,The nameandoffice or positionof the personreceivingthe contribution(or the
political entity / party receivingthe contribution),the dateof the confibution, andthe amountof the
contribution.
ANSWER-NO
11. With respectto your provision of professionalservicesto the Municipal PensionSystemof tlre Requesting
Municipalityl
Are you awareof any apparent potentialor actualconflicts of interestwith respectto any officer, director or
employeeofthe Caztractor and offrcialsor ernployeesofthe RequestingMunicipality?
NOTE: If in the future, you becomeawareof any apparent,potential,or actualconflict of interest,
you are expectedto updatethis DisclosureForm immediatelyin writing by:
o Providing a brief synopsisofthe conflict of interest(and);
. An explanationofthe stepstukento addressthis appar€nt,potential,or actualconflict of interest.
r) n ryTS'' I'rovide a detailedexplanationof the circumstances
which provideyou with a basisto
concludethat an apparent,potential,or actualconflict of interestmay exist.
AI\{SWER-NO .
12' To the extentthat you believethat Chapter 7-A of Act 44 of 2009 requiresyou to discloseany additional
informationbeyondwhat hasbeenrequestedabove,pleaseprovidethat informationbelow or on a separate
pieceofpaper.
A}ISWER - NO ADDITIONAL INT'ORMATION REQT]IRED
Pleaseprovide the name(s)and position(s) of the person(s)participating in the completion of this Disclosure.
One of the individuals identified by the Contraaor n Item #I above must participate in completing this
Disclosureandmust sign the below verifioation attestingto the participaiionofthose individualsnamedbelow.
Name:
James P. Kennedy
Position: President
j$
w.
StcNerunp
PnnsnrNr
TITLE
Ocronnn1.2015
DATE
VentrrcATtoN
I, JamesP. Kennedy,herebystatethat I am Presidentof ThomasJ. Anderson& Associates.Inc..
and I am authorizedto makethis verification.
I herebyverifu that the facts setforth in the foregoingAct 44 DisclosureForm for Entities
Providing ProfessionalServicesto the PalmertonBoroughPensionSystem,aretrue and conect to the
bestof my knowledge,informationandbelief. I alsounderstandthat knowingly making material
misstatements
or omissionsin this forrn could subjectthe respondingContractorto the penaltiesin
Section705-A(e)ofAct 44.
I understandthat false statementshereinaremadesubjectto the penaltiesof 18P.A.C.S.$ 4904
relatingto unswomfalsification to authorities.
Signature
October
1,
2075
Date
loerunrrcnrron
or ConrRacrons
& RenreopeRsorruel
Corurnactons: (See"Definitions" - page2) Any entity who crmently providesservice(s)by meansof a
ProfessionalServicesContractto the Municipal PensionSystemofthe Reques'ng Municipality, pleasecomplete
all of the following:
Identify the Municipal PensionSystem(s)for which you are providing inforrnation:
Indicate all that apply with an "X":
[]
Non- Uniform Plan
E
Fire Plan
Police Plan
**NOTE: For all that follow, you may answerthe questions
/ items on a sqraratesheetof paper and
attach it to this Disclosure if the spaceprovided is not sufficient. Pleasereference each question / item
you are responding to by the appropriate number. (examFle: REF - Item #1.)
l.
Pleaseprovide the namesand titles of all individuals providing professionalservicesto the Requesting
Municipality's pension plan(s) identified above. Also include the namesand titles of anv advisors and
subcontractorsof the Contractor,identifring them as such. After eachnameprovide a descriptionof the
responsibilitiesof that person with regard to the professionalservicesbeing provided to eacli designated
PensionPlan'
)'?
r
fl rt
A ct/ €b
2. Pleaselist the name and title of Nry Affiiated Entity and thek Executive-levelEmptnyee(s)that require
disclosure;after eachname,includea brief descriptionoftheir duties. (See:Definitions)
c)
3. Are any of the individualsnamedin Item I or Item 2 above,a currentor former official or emploveeof the
RequestingMunicipality?
IF "YES", providethe nameof the personemployed,their positionwith the municipality, and datesof
employment.
lJO
4, Are any of the individuals namedin Item 1 or Iten 2 abovea currentor former registeredFederalor State
lobblst?
trr ('ITS"' providethe nameof the individual, specifywhetherthey area stateor federallobbyist, andthe
dateoftheir mostrecentregistration/renewal.
!;s-5er
7 | z r ' 1( / / 4
NOTICE: All information providedfor items 1- 4 abovemust be updatedaschansesoccur.
5. SinceDecemberfih 2009,haslhe Confiactoror m Affiliated Entity pudcompensation
to or employed
any third party intermediary,agent,or lobbyist that is to directly or indirectly communicatewith an official or
employeeof the lfz nicipal PensionSlxtem of the RequestingMunicipality (OR), any municipal official or
employeeof the Requesting Municipatity in connectionwith any tmnsactionor investmentinvolving the
Contractor and,the Municipal PensionSystemof the RequestingMunicipality?
This question doesnot aoplv to an officer or employeeof the Contractor who is actingwithin the scopeof
the firm's standardprofessional duties on behalf of the firm, including the actual provision of legal,
accounting,engineering,real estate,or other professionaladvice, services,or assistancepursuantto the
professionalservicescontactwith municipality's pensionsystem.
r) IF *YES"' identif: (l) whom (the third party interrnediary,agent,or lobbyist) was paid the compensation
or employed by the Contractor or Alfiliated Entity, (2) theh specific duties to directly or indirectly
cormunicate with an official or employeeof lhe Municipal Pension Systemof the RequestingMunicipality
il0
(OR), any municipal official or employeeof tho RequestingMunicipality, (3) the official they communicated
with, and(4) the datesof this semce.
6. SinceDecenber 17fr 2009, has the Confiactor, or any agent,officer, director or employeeof the Confiactor
solicited a contribution to any municipal officer or candidatefor municipal office in the Requesting
Municipality, or to the political party or political actioncommitteeofthat official or candidate?
IF "YES", identi8/ the agent, officer, director or employeewho mad.ethe solicitation and the municipal
officials, candidates,political party or political co{nmitteewho were solicited (to whom the solicitation was
made).
rulO
7. Within the past two years: Has lhe Contractor or an Affiliated Entity made any contributions to a
municipal official or any candidatefor municipal office in the RequestingMunicipality?
F (ITS'' provide the name and addressof the person(s) making the contribution, the contributor,s
relationshipto the Contractor,The nameand office or position of the personreceiving the contribution , the
dateof the contribution,andthe amountofthe contribution.
(1/O
E. Does lhe Contractor or an AfJiliated Enti\t have any direct financial, comrnercialor businessrelationship
. with any official identified on the List of Municipal officials, of the RequestingMunicipality?
t
IF "YES"' identifu the individual with whom the relatiorship existsand give a aetaiteddescriptionof that
relationship.
**l@I&
A written letter is required from the Requesting Municipality acknowledgingthe
relationshipand consentingto its existence.The letter must be attachedto this disclosure. Contact
the RequestingMunicipality to obtainthis letter andattachit to this disclosurebeforesubmission.
\ts-
.5-i'{ TtrTicHtt\
9. Since December 17*, 2009: Has the Contractor or ai AfJiliated Entity given any gifts having more than a
nominal value to any official, employeeor fiduciary - specifically,thoseon the Zist of Municipal Offtcials
of the RequestingMunicipality?
nr (lTS'' Providethe nameofthe personconferringthe gift, the personreceivingthe gift, the office or
position ofthe personreceMng the gift, specifuwhat the gift was,andthe dateconferred.
/t/ o
10. Disclosureof contributionsto anypolitical entity in the commonwealthof pennsylvania
Applicability: A "yes" responseis requiredand full disclosureis requiredONLY WIIEN ALL of the
followingapplies:
a) The contributionwasmadewithin the last 5 years (specificallysince:Decemberlsd' 2004)
b) The contributionwas madeby an offrcer, director,executive-levelemployeeor owner ofat least5oloof
the Contactor or Affiliated Entity.
c) The amountofthe contributionwas at least$500 andin the form of:
l. A singlecontributionby a personin (b.) above, e!
2, The aggregateofall contributionsall personsin (b.) above;
d) The contributionwas for
l. Any candidatefor any public office or any personwho holds an office in the Commonwealth
ofPennsylvania;
2. The political committeeofa candidatefor public ofEce or anypersontlnt holds an office in
the Commonwealthof Pennsylvania.
F (lTS'' providethe nameandaddressof the person(s)makingthe contribution,the contributor's
relationshipto the Contructot, The nameand o{fice or position of the personreceivingthe contribution(or the
political entity / party receivingthe contribution),the dateof the contribution,andthe amountofthe
contribution.
YfS
5r(
rtrrAurc\
11. With respectto your provision of professionalservicesto the Municipal Pusion Systemof the Requesting
Municipality:
Are you awareof any apparent,potential or actualconflicts of interestwith respectto any officer, director or
employeeofthe Caztractor arrdoffrcialsor employeesofthe RequestingMunicipality?
NOTE: If, in the future, you becomeawareof any apparent,potential,or actualconflict of interest,
you are expectedto updatethis Disclosure Form immediatelyin writing by:
o Providing a brief synopsisofthe conllict ofinterest (and);
' An explanationof the stepstakento addressthis apparent,potential,or actualco flict of interest.
IIt "ITS", Providea detailedexplanationof the circumstanceswhich provide you with a basisto
concludethat an apparent,potential,or actualconflict of interestmay exist.
//0
VrnlrrcATtoN
r, /, /vb A
, hereby state that I am
(Name)
,f snq
r?,LT
and
(Contractor)
I
am
,fl'l,fr
-
CO O
for
(Position)
authorized to
make
this
verification.
I hereby veriff that the facts set forth in the foregoing Act 44 DisclosureForm for Entities providing
ProfessionalServicesto Palmerton Borough Pension System are true and correct to the best of my
knowledge,information and belief. I also understandthat knowingly making material misstatementsor
omissionsin this form could subjectthe respondingContractorto the penaltiesin Section705-A(e)ofAct
44.
I understandthat false statementsherein are madesubjectto the penaltiesof 18 P.A.C.S. g 4904
relatingto unswomfalsificAtionto authorities.
Signature
r
l
/b-/ ,/ tS
2015Addendum- Required
Disclosure
FormStatements
(Reference
Question#1) tist of MRTPersonnel
PSABMunicipalRetirementTrust(MRT)- StateAssociation
and PensionOperations
Contractor
The Municipal Retirement Trust is wholly owned and operated by the PSAB and is the primary
contractor. The MRT employsseveralsub-contractedfirms to provide specific and unique servicesto
the Trust. The principal PSAB-MRT team membersare listed first, followed by those of each subcontractor.
ContractorTeamListing
PSAB Municipal RetirementTrust (MRT)
The PA StateAssociationof Boroughs and Principal Pension OperatiansContractor
Chris Cap,PSAB ExecutiveDirector - ServesasMRT Treasurer
JeffreyHeishman,Deputy ExecutiveDirector - ServesasMRT Secretary
Linda Costa,Chief OperationsOfficer - Inside/Outsidepensionservicesand CAO
JosephScott,Chief Field OperationsOfficer - Inside/Outsidepensionserviceliaison
Sub-contractorand AdvisingTeam Listing
Administrative,Accounting, Custodial,and Actuarial Companies
ThomasJ. Anderson& Associates- Trust Administrator
JamesKennedy,President- ManagesAct 205 administrativecomplianceefforts.
Brown, SchultzoSheridan & Fritz - Trust Auditor
JohnW. Bonawitz,Jr., Principal- Supervisesannualaudit functionsfor the Trust.
Hamilton & Musser - Accounting Sub-contractor
RobertMast, Shareholder- Managesaccountreporting,tax filings and fund disbursements.
Fulton Bank - Fund Depository
Tammy Snyder,VP of CorporateDevelopment- Managescheckinganddisbursementaccounts.
Morgan Stanley- Investment Market Monitor
H. JeffreyHerb, SeniorVice President- Investrnents- Servesasinvestrnentmonitor of MRT.
ThomasJ. Schatzrnan,CIMA, SeniorVice President- Investrnents- Servesasinvestnent monitor of
MRT.
Mette Evans & Woodside- Law firm providing legal counsel
Mary Alice Busby, Shareholder- Servesasthe MRT Solicitor.
P a g e1 o f 3
(Reference
Questionf 4) Listcurrentor formerregisteredFederalor Statelobbyists
Chris Cap, StateRegistered
Lobbyist(lastrenewed,11112014\Position:
PA StateAssociationof
Boroughs PSAB ExecutiveDirector
(Reference
of a directfinancial,commercial
Questionf 8) Disclosure
or business
relationship
with any municipalityor municipalofficial
Thomas Ely' PSAB Board of Directors,businesspartnerwith MonacaBoroughmunicipal official
(Reference
of contributions
Question# 10) Disclosure
to any politicalentity
Includes Contracto/s principal officers, administration staff, the MRT Trustees,and the pSABBoard of
Directors- only those memberswho made qualifyingcontributionsare listed below.
JohnDorin- PSABBoardof Directors
517NorthLoyalsock
Avenue
Montoursville,
PA 17754
Contributions:
(2014)Congressman
TomMarino- $100
RobertHasemeier- PSABBoardof Directors
1512BridgeStreet
New Cumberland,
PAI7O7O
Contributions:
(2015)RobertKline,Cumberland
CountyJudge- S75
JosephMercatili- PSABBoardof Directors
634MarionLane
MoosigPA18507
Contributions:
- 5100
(2015)We LoveMoosicCommittee
DavidPerruso- PSABBoardof Directors
2487Lincoln
Avenue
Easton,PA18042
Contributions:
- StateRepresentative
- S25
(20L2,2014lRobert
Freeman
NancvSherlock- PSABBoardof Trustees
424 WestBridgeStreet
Morrisville,
PA19067
Contributions:
- $25
(2013)StateRepresentative
lohn Galloway
- S50
(2015)StateRepresentative
StevenSantarsiero
Page3 of 3