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by Investment Management Firm Disclosure Report of Political (NJ Department of Treasury)

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Completed form should be submitted electronically to:
doi.compliance@treas.nj.gov
1
Form Effective 3/3/14
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF INVESTMENT
Disclosure Report of Political Contributions
by Investment Management Firm
Pursuant to N.J.A.C. 17:16-4.6, promulgated by the State Investment Council
(“Council”), each investment management firm seeking to provide investment
management services to the State of New Jersey is required to disclose prior to
engagement, on a form provided by the Division of Investment (the “Division”), all
political contributions and payments to political parties made or paid by the firm, its
parent company, or any other controlling person or entity, any investment management
professional associated with the firm, any political action committee controlled by any of
the above persons or entities, or any third party solicitor associated with the firm. Each
investment management firm that is engaged by the Division is further required to make
quarterly disclosures by the last day of the month following the end of each calendar
quarter during the term of the engagement; provided, however, that no report is required
for any calendar quarter in which the investment management firm has no additions or
revisions to information that was already reported in a prior report. (All terms used in
this form have the definitions set forth in the Appendix to this form.)
Name of Investment Management Firm:
Disclosure Report Period (check one):
□ Initial Report:
From:
(Two years prior to date of engagement)
Through:
(Date of engagement)
□ Quarterly Report:
From:
(First day of calendar quarter)
Through:
(Last day of calendar quarter)
Form effective 3/3/14
2
Part 1: Designation of Investment Management Professionals
Please provide, in the table below, the names of those persons who qualify as “investment
management professionals,” using the attached definition, and a brief description of the
activities that cause such person to be an investment professional (e.g., investment
manager, advisor/manager to investment management entity, financial advisor/consultant,
client development, solicitation of business, supervisor, member of executive or
management committee).
Attach additional sheets, if necessary.
Name of Investment Professional Description of Activities
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Check here if there are no changes from the investment management professionals
previously designated by the investment management firm: □
Check here if investment management professionals are listed on a separate page: □
Form effective 3/3/14
3
Part 2: List of Political Contributions and Payments to Political Parties
Please provide the requested information in the following table with respect to all
political contributions and payments to political parties made by:
1. The investment management firm, its parent company, or any other person or
entity that controls the investment management firm;
2. Any investment management professional listed in Part 1;
3. Any third party solicitor associated with the investment management firm
1
;
4. Any political action committee controlled by the investment management firm, its
parent company, or any other entity that controls the investment management
firm, or by an investment management professional of such investment
management firm or controlling entity; or
5. Any individual or entity for the 12-month period prior to such individual or entity
becoming an investment management firm, investment management professional
or third party solicitor.
Political contributions made to State officials for whom the contributor was/is entitled to
vote need not be reported, so long as such contributions did/do not exceed $250.00 per
State official per election. Payments to a political party need not be reported, so long as
such payments did/do not exceed $250.00 per political party per year. Political
contributions and payments to a political party listed on an earlier Disclosure Report need
not be restated on this Disclosure Report.
Attach additional sheets, if necessary.
Name and Address of
Person or Entity Making
Political Contribution or
Payment to Political
Party:
Name and Title of State Official or
Political Party Receiving Political
Contribution or Payment to
Political Party:
Amount and Date
of Political
Contribution or
Payment to Political
Party:
Check here if contributions or payments are listed on a separate page: □
_______________
1
A third party solicitor shall include any “indirect” solicitor known to be compensated by the “primary”
solicitor to solicit investment management business from the State or State official on behalf of the
investment management firm.
Form effective 3/3/14
4
Part 3: Exemptions from Disqualification Pursuant to N.J.A.C. 17:16-4.10
Pursuant to N.J.A.C. 17:16-4.10, an investment management firm that would otherwise
be prohibited from being engaged to provide investment management services to the
State under N.J.A.C. 17:16-4.3 shall be exempt from such prohibition if the investment
management firm demonstrates in writing that: (1) the investment management firm
discovered such contribution or payment (which contribution or payment did not exceed
$250.00) within four months of the date of contribution or payment and the contributor
obtained a return of the contribution or payment within 60 calendar days of the date of
discovery; or (2) the violation of N.J.A.C. 17:16-4 caused by such contribution or
payment was unintentional and inadvertent, and the Council determines that the
beneficiaries of the Pension and Annuity Funds, the State taxpayers, and the public are
best served by an exemption.
Only one exemption is available for each investment management professional or third
party solicitor (regardless of time period), and the investment management firm is
entitled to no more than two exemptions in any 12-month period.
Please provide the requested information in the following table with respect to all exempt
political contributions and payments to political parties.
Name and Address of
Person or Entity
Making Political
Contribution or
Payment to Political
Party:
Name and Title of State
Official or Political Party
Receiving Political
Contribution or Payment
to Political Party:
Amount and
Date of Political
Contribution or
Payment to
Political Party:
Date of
Discovery /
Date of
Return of
Political
Contribution
or Payment to
Political
Party:
Date of
Exemption:
Form effective 3/3/14
5
Part 4: Information Regarding Third Party Solicitors
Please provide in the following table the name and business address of any third party
solicitor, the services provided by the solicitor, the compensation arrangement between
the investment management firm and the solicitor for such services, and the total dollar
amount of payments made to the solicitor during the report period. The disclosure below
should include any “indirect” solicitor known to be compensated by the “primary”
solicitor to solicit investment management business from the State or a State official on
behalf of the investment management firm.
Attach additional sheets, if necessary.
Name and Business
Address of Solicitor:
Services Provided
by Solicitor:
Summary of
Terms of
Compensation
(indicate whether
payment is made
to primary or
indirect solicitor):
Total Dollar
Amount of
Payments Made to
Solicitor During
Report Period:
Check here if third party solicitors are listed on a separate page: □
Check here if supporting documentation is attached: □
Form effective 3/3/14
6
I hereby certify as an officer or authorized representative of the investment management
firm identified below that such investment management firm has not either directly or
indirectly, through or by any other person or any means whatsoever, done any act which
would violate the provisions of N.J.A.C. 17:16-4.3 or 4.4. I further certify that, to the
best of my knowledge and belief, the foregoing statements and disclosure made by me
are true, accurate and complete. I am aware that if any of the statements are willfully
false, I am subject to punishment.
Name of Investment Management Firm:
Signed:
Print Name:
Title:
Date: ________________________
Form effective 3/3/14
7
Appendix
DEFINITIONS
For purposes of this Disclosure Report, the following words and terms shall have the
following meanings, as provided in N.J.A.C. 17:16-4, unless the context clearly indicates
otherwise:
“Control” means the power to exercise a controlling influence over the management or
policies of an investment management firm or political action committee.
“Investment management firm” means one or more natural persons, corporations,
partnerships or other entities, incorporated or unincorporated, that provide investment
management services.
“Investment management professional” means:
1. Any person associated with an investment management firm who is primarily
engaged in the provision of investment management services;
2. Any person associated with an investment management firm involved in client
development or the solicitation of business from pension funds clients, including
pension fund clients that are not State Pension and Annuity Fund clients;
3. Any person associated with an investment management firm who is a supervisor
of any person described in 1 or 2 above, up through and including the Chief
Executive Office or similarly situated official; or
4. Any person associated with an investment management firm, its parent company,
or any other entity that controls the investment management firm, who is a
member of the executive or management committee of such firm or controlling
entity, or similarly situated officials, if any.
“Investment management services” means:
1. The business of making or recommending investment management decisions for
or on behalf of a State Pension and Annuity Fund;
2. The business of advising or managing a separate entity which makes or
recommends investment management decisions for or on behalf of a State
Pension and Annuity Fund, including as general partner, investment manager or
similar entity of an investment vehicle; or
3. The provision of financial advisory or consultant services to a State Pension and
Annuity Fund.
“Payment” means any gift, subscription, loan, advance, or deposit of money or anything
of value.
Form effective 3/3/14
8
“Political contribution” means any gift, subscription, loan, advance, or deposit of money
or anything of value made:
1. For the purpose of influencing any election for State office;
2. For the purpose of influencing any election for local office by a person who is
also (i) a State official or (ii) an employee or advisor of either the State or a State
official;
3. For payment of debt incurred in connection with any such election; or
4. For transition or inaugural expenses incurred by the successful candidate in any
such election.
“Political party” means any political party or political committee organized in the State,
including, without limitation, State legislative leadership committees, county committees,
and independent committees. The term “political party” does not include a Federal or
national campaign committee or a non-State political committee, even if such Federal or
national or non-State political committee makes payments or contributions to which this
subchapter would otherwise apply.
“State official” means any person (including any election or political action committee
for such person) who was, at the time of the political contribution, an incumbent,
candidate or successful candidate for Governor or for a seat in the Legislature.
Communication with a State official includes communication with the employees and
advisors of such official.
“Third party solicitor” means a third party placement agent or lobbyist who solicits
investment management business through direct or indirect communication with a State
officer, employee, or official on behalf of an investment management firm, but does not
include any person whose sole basis of compensation from the investment management
firm is the actual provision of legal, accounting, engineering, real estate, or other
professional advice, services, or assistance. The term “third party solicitor,” when used
with respect to a particular investment management firm, shall not include a third party
placement agent or lobbyist who solicits clients other than the Division to engage that
investment management firm to provide investment management services, or a third party
placement agent or lobbyist who solicits the Division on behalf of another investment
management firm.
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