Conflict of Interest Disclosure

FY17 Determination of Independence of CLM Board of Directors
and Disclosure of Financial Interest

Purpose:
This questionnaire of members of the Board of Directors (Board) for the Children’s League of Massachusetts (CLM) identifies the Independence of the Board and discloses any financial interest that members of the Board may have with entities that have business relationships with CLM. CLM may rely on information presented in this document in determining the independence of members of its Board and as part of its process for monitoring for any potential conflicts of interest. This questionnaire shall be submitted annually to members of the CLM Board.  It shall remain confidential, open to inspection by the public only as required by Massachusetts or federal law or regulation.

Definitions:

Family Member: The family of an individual includes only his/her spouse, ancestors, siblings, children (natural or adopted), grandchildren, great grandchildren, and spouses siblings, children, grandchildren, and great grandchildren, or any other person (whether or not related by blood or marriage) residing in the same household.

Financial Interest:A person has a financial interest if the person has, directly or indirectly, through business, investment, or family:

  • An ownership or investment interest in any entity with which the association has a transaction or arrangement,
  • A compensation arrangement with the association or with any entity or individual with which the association has a transaction or arrangement, or
  • A potential ownership or investment interest in, or compensation arrangement with, any entity or individual with which the association is negotiating a transaction or arrangement

Related Organization: An organization that stands in one or more of the following relationships to the filing organization:

  • Parent – an organization that controls the filing organization
  • Subsidiary – an organization controlled by the filing organization
  • Brother/Sister – an organization controlled by the same person or persons that control the filing organization

Taxable Year: The period between January 1 and December 31 of a given year.

FY17 Conflict of Interest Form

  • Signature:

    As a member of the Board of Directors of the Children's League of Massachusetts, Inc., I certify that the information provided in this Annual Disclosure of Financial Interests is to the best of my knowledge a complete and accurate statement of all financial activities and arrangements related to CLM.