ACT 44 DISCLOSURE FORM FOR ENTITIES PROVIDING BOROUGH OF SINKING SPRING PENSION SYSTEM  PROFESSIONAL SERVICES TO THE  CHAPTER 7-A OF ACT 44 OF 2009 MANDATES the annual disclosure of certain information by every entity (hereinafter "Contractor") which is a party to a professional services contract with one of the pension funds of BOROUGH OF SINKING SPRING (hereinafter the Requesting Municipality"). Act 44 disclosure requirements apply to Contractors who provide professional pension services and receive payment of any kind from the Requesting Municipality's pension fund. The Requesting Municipality has determined that your company falls under the requirements of Act 44 and must complete this disclosure form. You are expected to submit this completed form, to the Requesting Municipality below, by December 1.2 2023. If, for any reason you believe that Act 44 does not require you to complete this disclosure form, pleasé  provide a written explanation of your reason(s) by November 15.2023.  RETURN COMPLETED DISCLOSURE TO:  Borough of Sinking Spring Attn: Elizabeth Eagelman 3940 Penn Avenue Sinking Spring, PA 19608 (610)678-4903 eagelman@sinkingspringboro.org  REQUIRED UPDATES:  Where noted, information in this form must be updated in writing as changes occur.  1    DEFINITIONS FOR DISCLOSURE  TERM:  DEFINITION:  Any person, company, or other entity that receives payments, fees, or any otheri form of compensation from a municipal pension fund in exchange for rendering professional services fori the benefit of the pension system - directly or indirectly from or through a contractor. 1. Asubsidiary or holding company of al lobbying firm or other business entity owned in whole or in part by al lobbying firm. 2. An organization recognized by the Internal Revenue Service as a tax-exempt organization under section 501(c) of the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. $501 (c)) established by al lobbyist or lobbying firm or an affiliated entity. As defined in section 1621 of the act of. June 3rd, 1937 (P.L. 1333, No. As defined in section 1621of the act of June 3rd, 1937 (P.L. 1333, No. Any employee or person or the person's affiliated entity who: 1. Can affect or influence the outcome of the person's or affiliated entity's actions, policies, or decisions relating to pensions and the conduct of business with a municipality or a municipal 2. Isd directly involved in the implementation or development policies relating to pensions, investments, contracts or procurement or the conduct of business with a municipality or Any qualifying pension plan, under Pennsylvania state law, for any Example: the Police Pension Plan for the Borough of Winchesterville Municipal Officials and Employees" on the next page. Where  CONTRACTOR  municipal pension fund.  SUBCONTRACTOR OR ADVISOR Anyone who is paid ai fee or receives compensation from a municipal  Any of the following:  AFFILIATED ENTITY  CONTRIBUTIONS POLITICAL COMMITTEE  320), known as the Pennsylvania Election Code 320), known as the Pennsylvania Election Code  EXECUTIVE LEVEL EMPLOYEE  pension system; or  municipal pension system.  MUNICIPAL PENSION SYSTEM municipality within the Commonwealth of Pennsylvania; includes the  Pennsylvania Municipal Retirement System.  MUNICIPAL PENSION SYSTEM MUNICIPAL OFFICIALS AND EMPLOYEES PROFESSIONAL SERVICES CONTRACT  OFFICIALS AND EMPLOYEES; Specifically, those listed in TABLE 2 titled: "List of Pension System and  applicable, includes any employee oft the  Requesting Municipality.  A contract to which the municipal pension system is a party that is: (1) for the purchase of professional services including investment services, legal services, real estate services, and other consulting services; and, (2) not subject to a requirement that the lowest bid be accepted.  2    List of Municipal Officials for the Requesting Municipality  Certain requests for information in this form will refer to a "List of Municipal Officials."  To assist you in preparing your answers, you should consider the following names to be a complete list of pension system and municipal officials and employees. Throughout this Disclosure Form, the below  names will be referred to as the "ListofMunicipal Officials."  Electted Officials Gary Cirulli = Mayor  Tracy Peterson - Council President H. David: Miller - Council Vice-President Robert Metzgar - Council Member Denise Stine- - Council Member Patrick Giambalvo - Council Member Brian Hoffa - Council Member Lisa Gantner- = Council Member Appointed Officials  Michael Hart - Borough Manager Charles Haws - Solicitor  3    DENTIFICATION OF CONTRACTORS & RELATED PERSONNEL  CONTRACTORS: (See "Definitions". - page 2) Any entity who currently provides service(s) by means ofa Professional Services Contract to the Municipal Pension System of the Requesting Municipality, please complete  all oft the following:  Identify the Municipal Pension System(s) for which you are providing information: Indicate all that apply with an X": X Non- Uniform Plan  Police Plan  Fire Plan  **NOTE: For all that follow, you may answer the questions /items on a separate sheet of paper and attach it to this Disclosure ift the space provided is not sufficient. Please reference each question/item 1. Please provide the names and titles of all individuals providing professional services to the Requesting Municipality's pension plan(s) identified above. Also include the names and titles of any advisors and subcontractors of the Contractor, identifying them as such. After each name provide a description of the responsibilities of that person with regard to the professional services being provided to each designated  you are responding to by the appropriate number. (example: REF. -] Item #1.)  pension plan.  Jerry Witt-acting solely in his capacity as Client Service Manager with Principal Life  2. Please list the name and title of any Affiliated Entity and their Executive-level Employee(s) that require disclosure; after each name, include al briefd description of their duties. (See: Definitions)  N/A  3. Are any oft the individuals named in] Item 1 or Item 2 above, a current or former official or employee ofthe IF "YES",provide the name and oft thej person employed, their position with the municipality, and dates of  Requesting Municipality? employment. No lobbyist? No  4. Are any oft the individuals named in Item 1 or Item 2 above a current or former registered Federal or State IF "YES", provide the name oft thei individual, specify whether they are a state or federal lobbyist, and the  date oftheir most recent registration. /renewal.  NOTICE: All information provided fori items 1-4 4 above must be updated as changes occur.  4    5. Since December 17th 2009, has the Contractor or an. Affiliated Entity paid compensation to or employed any third party intermediary, agent, or lobbyist thati is to directly or indirectly communicate with an official or employee oft the Municipal Pension System oft the Requesting Municipality (OR), any municipal official or employee of the Requesting Municipality in connection with any transaction or investment involving the This question does not apply to an officer or employee oft the Contractor who is acting within the scope of the firm's standard professional duties on behalf of the firm, including the actual provision of legal, accounting, engineering, real estate, or other professional advice, services, or assistance pursuant to the IF "YES", identify: (1) whom (the third party intermediary, agent, or lobbyist) was paid the compensation or employed by the Contractor or Affiliated Entity, (2) their specific duties to directly or indirectly communicate with an official or employee oft the Municipal Pension System of the Requesting Municipality (OR), any municipal official or employee of thel Requesting Municipality, (3) the official they communicated  Contractor and thel Municipal Pension System oft thel Requesting Municipality?  professional services contact with municipality's pension system.  with, and (4) the dates oft this service.  No  6. Since December 17th 2009, has the Contractor, or any agent, officer, director or employee oft the Contractor solicited a contribution to any municipal officer or candidate for municipal office in the Requesting Municipality, or to the political party or political action committee oft that official or candidate? IF "YES", identify the agent, officer, director or employee who made the solicitation and the municipal officials, candidates, political party or political committee who were solicited (to whom the solicitation was  made). No  7. Since December 17", 2009: Has the Contractor or an Affiliated Entity made any contributions to a municipal official or any candidate for municipal office in the Requesting Municipality? IF "YES", provide the name and address of the person(s) making the contribution, the contributor's relationship to the Contractor, The name and office or position of the person receiving the contribution, , the  date of the contribution, and the amount oft the contribution.  No  8. Does the Contractor or an. Affiliated Entity have any direct financial, commercial or business relationship with any official identified on the. List ofl Municipal Officials, oft thel Requesting Municipality? IF "YES", identify the individual with whom the relationship exists and give a detailed description of that **NOTE: A written letter is required from the Requesting Municipality acknowledging the relationship and consenting to its existence. Thel letter must be attached to this disclosure. Contact the Requesting Municipality to obtain this letter and attach it to this disclosure before submission.  relationship.  No  5    9. Has the Contractor or an. Affiliated. Entity given any gifts having more than a nominal value to any official, employee or fiduciary - specifically, those on the List of Municipal Officials of the Requesting IF "YES", Provide the name oft thej person conferring the gift, the person: receiving the gift, the office or position oft the person receiving the gift, specify what the gift was, and the date conferred.  Municipality?  No  10. Disclosure of contributions to any political entity int the Commonwealth of Pennsylvania Applicability: A "yes" response is required and full disclosure is required ONLY WHEN ALL oft the a) The contribution was: made within the last 5 years (specifically since: December 18h 2004) b) The contribution was made by an officer, director, executive-level employee or owner of at least 5% of  following applies:  the Contractor or Affiliated Entity.  The amount oft the contribution was at least $500 and in the form of: 1. A single contribution by aj person in (b.) above, OR 2. The aggregate ofall contributions all persons in (b.) above;  d) The contribution was: for  1. Any candidate for any public office or any person who holds an office in the Commonwealth 2. Thej political committee ofa candidate for public office or any. person that holds an officei in IF"YES", provide the name and address oft thej person(s): making the contribution, the contributor's relationship to the Contractor, The name and office or position oft the person: receiving the contribution (or the political entity /party receiving the contribution), the date oft the contribution, and the amount oft the  ofPennsylvania;  the Commonwealth of Pennsylvania.  contribution. No Municipality:  11. With respect to your provision of professional services to the Municipal Pension System of the Requesting Are you aware of any apparent, potential or actual conflicts of interest with respect to any officer, director or employee oft the Contractor and officials or employees oft thel Requesting Municipality? NOTE: If, in the future, you become aware of any apparent, potential, or actual conflict ofi interest, you are expected to update this Disclosure Form immediately in writing by: Providing al brief synopsis of the conflict of interest (and); An explanation of the steps taken to address this apparent, potential, or actual conflict ofi interest. IF"YES", Provide a detailed explanation of the circumstances which provide you with al basis to  conclude that an apparent, potential, or actual conflict ofi interest may exist.  No  12. To the extent that you believe that Chapter 7-A of Act 44 of 2009 requires you to disclose any additional information beyond what has been requested above, please provide that information below or on a separate  piece ofp paper. N/A  6    Please provide the name(s) and position(s) of the person(s) participating in the completion of this Disclosure. One of the individuals identified by the Contractor in Item #1 above must participate in completing this Disclosure and must sign the below verification attesting to thej participation of those individuals named below.  Name:Jerry Witt  Position: Client Service Manager  fryb  SIGNATURE CLIENT SERVICE MANAGER TITLE 10/30/2023 DATE  7    VERIFIÇATION  I, Jerry Witt, hereby state that I am Client Service Manager  for  Principal Life Insurance Company and I am authorized to make this verification. Ihereby verify that the facts set forth in the foregoing Act 44 Disclosure Form for Entities Providing Professional Services to Borough of Sinking Spring Pension System are true and correct to the best of my knowledge, information and belief. Ia also understand that knowingly making material misstatements or omissions in this form could subject the responding Contractor to the penalties in Section 705-A(e) of Act  44.  Iunderstand that false statements herein are made subject to the penalties of 18 P.A.C.S. $ 4904  relating to unsworn falsification to authorities.  fyb  Signature  10/30/2023  Date  8