Conflict of Interest or Related Parties Questionnaire

Conflict of Interest or Related Parties Questionnaire
1. Are you aware of any actual and/or pending occurrences of the following areas by SHBC elected leaders, management, or employees?
Theft, fraud, abuse or other illegal acts

YesNo
Unlawful interest in contracts, including family members (i.e. other than through the normal course of business as prohibited political activity (oral or written))

YesNo
Payment for promotion or appointment

YesNo
Abuse of political influence

YesNo
Conflict of interest

YesNo
Complaints or inquiries to Ohio Ethics Commission

YesNo
If you answered YES to any of the above questions, please provide a detailed explanation below:
2. Have you or any related party of yours had any interest, direct or indirect, in any of the following transactions to which Spring Hills Baptist Church is, was, or is to be, a party?
1. Sale, purchase, exchange, or leasing of property?

YesNo
2. Receiving or furnishing of goods, services, or facilities?

YesNo
3. Transfer or receipt of income or assets?

YesNo
4. Maintenance of bank balances as compensating balances for the benefit of another?

YesNo
Other transactions?

YesNo
3. Have you or any related party of yours been indebted to or had a receivable from Spring Hills Baptist Church? Please exclude amounts due for ordinary travel and expense advances.
YesNo
4. Do you know any related party that has misappropriated assets or committed other forms of fraud against the organization?
YesNo
5. Do you know of any person or organization that should be receiving this questionnaire?
YesNo
6. Have you or any other related party of yours had any interest, direct or indirect, in any transactions, or in any pending or incomplete transactions, to which any pension, retirement, savings, or similar plan provided by Spring Hills Baptist Church was, or is to be a party? Do not include payments to a plan or payments by the plan made pursuant to the terms of the plan.
YesNo
The answers to the forgoing questions are correctly stated to the best of my knowledge and belief.
Electronic Signature*

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Date*

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PRINTED NAME *

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Title/ Leadership Position*
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