ACT DrsclosuRE ronErumnEs 44 Fonnn PRovlollc PnorrsstoNAl Senvrcrs rHE ro Hue uesvrLrE BonoucH's Peruslorrr Sysrevr

CHeprBR or Acr 44 or 2009MANDATES annualdisclosure certaininformationby everyentity 7-A the of (hereinafter services contractwith one of the pension "Contractor") which is a party to a professional funds of HucHrsvILLE Bonoucn (hereinafter "RequestingMunicipality"). Act 44 disclosure the
requirementsapply io Contraclars who provide professionalpeusion selices arid receive paymcnt of any kind from the Requesting Municiiality's pensionfund. The Requesting Municipality has determined

that your company falls under the requirementsof Act 44 and must complete this disclosure form. You are expected to submit this completed form, to the Requesting Municipality below, by November 1, 2011. If, for any reason you believe that Act 44 does not require you to complete this disclosure form, pleaseprovide a written explanationof your reason(s) October 25.2011. by

RETURN COMPLETED

Hughesville Borough Attn: Dolores Mover B

147S. 5thStreet 570-584-2041 hughesborosec@comcast.net

Where noted, information in this form must be updatedin writing as changesoccur.

FoR DerrrurnoNs DrsclosuRr

1.

Certain requestsfor information in this form will refer to a 66list of Municipal Officials." To assistyou in preparing your answers,you should considerthe fotrlowing rurmesto 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 $List of Municipal Officials." WalterReed Mayor. Berger Borough Jeffrey Council President Vice-President/Personnel AndrewMook- Borough Council Committee Michael-Borough Council Tem Pro Curtis MaryBurns Council Member/ Chair Personnel Committee Member James Savage Council Richard Smith Councit Member

lorrunrrcATtoN or CorurRAcroRs lRrroPensoruruel & Re

COnfneCfORSi(See"Definitions"- page Anyentitywho currently 2) provides service(s) means a by of Professional Services Contract theMunicipalPension to System theRequesting of Municipality,please complete all of thefollowing: Identify the Municipal Pension System(s) which you are providinginformation: for Indicateall that apply with an "X": E Non- uniform ptan E poticeplan

FirePtan

**NOTE: For all that follow, you may answerthe questions items on a separate / sheetof paperand attach it to this Disclosure if the spaceprovided is not sufficient. Pleasereferenceeach question/ item you are respondingto by the appropriatenumber. (example: REF - Item #1.) 1. Please providethe namesand titles of all individuals providingprofessional services the Requesting to Municipality's pension plan(s)identifiedabove. Also includethe namesand titles of any advisors and subcontractors the Contractor, of identifing them as such. After eachnameprovidea description the of responsibilities that person of with regardto the professional services beingprovidedto eachdesignated pension plan.
Robert Hall - President, advisor and service for R. J. Hall Company,Inc. Phil Harmon - advisor and service for R. J. Hall Companyr lnc. Terry Lee Kennedy, Sr. - service for R. J. Hall Companyr lnc. Christina Purkey - administrative assistantfor R. J. Hall Company, Inc. SuzanneElbin - subcontractor, regional service representativefor Principal Financial Group Christine J. Robb - subcontractor, service agent for Principal Financial Group Lana Vroom - subcontractor, service agent for Principal Financial Group Kristen Augustine - subcontractor, actuary from Beyer-Barber Company Laura McDonald - subcontractor, actuary from Beyer-Barber Company Randee Sekol - subcontractor, actuary from Beyer-Barber Company

2. Please list the name and title of any Affiliated Entity and their Executive-level Employee(s) that require disclosure;after eachname,include a brief descriptionof their duties. (See:Definitions) No 3. Are any of the individualsnamedin Item 1 or Item 2 above,a currentor former official or employeeof the Requesting Municipality? r) IF *YES', provide the nameand of the personemployed,their position with the municipalify, and datesof employment. No

4. Are any of the individuals named in Item 1 or Item 2 above a current or former registeredFederalor State lobbyist? r) IF "YES', provide the nameof the individual, speci! whetherthey are a stateor federallobbyist,and the dateof their most recentregistration/renewal. No

NOTICE: All information provided for items 1- 4 above must be updated as chansesoccur. Since December l7'n 2009, has the Contractol or an Alfiliated Entity paid compensationto or employed any third party intermediary, agent,or lobbyist that is to directly or indirectly communicate with an official or employee of the Municipal Pension System of the Requesting Municipality (OR), any municipal official or employeeof the Requesting Municipality in connectionwith any transactionor investmentinvolving the Contractor and the Municipal PensionSystemof the Requesting Municipality? This question does not anplv to an officer or employeeof the Contractor who is acting within the scopeof the firm's standard professional duties on behalf of the firm, including the actual provision of legal, accounting,engineering,real estate,or other professionaladvice, services,or assistance pursuant to the professional services contactwith municipality's pensionsystem. t IF'YES', identifu: (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 communicatewith an official or employeeof the Municipal Pension Systemof the Requesting Municipality (OR), any municipal official or employeeof the Requesting Municipality, (3) the official they communicated with, and (4) the datesof this service. 5. No

6. Since December lTth 2009, has the Contractor, or any agent, officer, director or employee of 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 committeeof that official or candidate? t IF "YES", identifo the agent, officer, director or employee who made the solicitation and the municipal political party or political committee who were solicited (to whom the solicitation was officials, candidates, made). No

7. Since December l7th, 2009: Has the Contractor or an Affilioted Entity made any contributions to a municipal official or any candidate municipal office in the Requesting Municipality? for r) IF "YES", provide the name and address of the person(s) making the contribution, the contributor's relationshipto the Contractor,The name and office or position of the personreceiving the contribution , the dateof the contribution,and the amountof the contribution.

No

8. Does the Contractor or an Aftiliated Entity have any direct financial, commercial or businessrelationship with any official identified on the List of Manicipal OfJicials, of the Requesting Municipality? -) IF *YES', identif the individual with whom the relationshipexists and give a detaileddescriptionof that relationship. **@' A written letter is required from the Requesting Municipality acknowledgingthe relationshipand consenting its existence. The letter must be attached this disclosure. Contact to to the Requesting Municipality to obtain this letter and attachit to this disclosurebeforesubmission.

No

9. Hasthe Controctoror anAffiinted Entity given any gifts havingmorethan a nominalvalueto any official, employeeor fiduciary - specifically, those on the List of Municipal Of/iciak of the Requesting Municipality? r) IF "YES', Provide name theperson the of conferring gift, theperson the receiving gift, theofficeor the positionof the person receiving gift, specif, whatthe gift was,andthe dateconferred. the No

10. Disclosure contributions anypoliticalentityin theCommonwealth Pennsylvania of to of Applicabilit;r:A "yes"response required full disclosure required is and is ONLY WHEN ALL of the following applies: a) Thecontribution made was within the last5 years(specifically since:December 2004) 18'n b) Thecontribution madeby an officer,director, was executive-level employee ownerof at least5%o or of the Contractor or Afliliated Entity. c) Theamount thecontribution at least of was $500andin theform of: 1. A single contribution a person (b.) above,$ by in 2. Theaggregate all contributions of allpersons (b.) above; in d) Thecontribution for was 1. Any candidate any publicoffice or any person for who holdsan office in the Commonwealth of Pennsylvania; 2. Thepoliticalcommittee a candidate publicofficeor anyperson holdsanoffice in of for that theCommonwealth Pennsylvania. of r) IF "YES', provide name address theperson(s) the and of making contribution, contributor's the the relationship tothe Contractor,The name officeor position theperson and (or of receiving contribution the the politicalentity partyreceiving contribution), dateof thecontribution, theamount the I the the and of contribution.
NO

11. With respectto your provision of professionalservicesto the Municipal PensionSystemof the Requesting Municipality: Are you aware of any apparent,potential or actual conflicts of interest with respectto any officer, director or employeeof the Contractor andofficials or employees the Requesting Municipality? of you becomeaware of any apparent, NOTE: If, in the future, potential,or actualconflict of interest, you are expected updatethis Disclosure Form immediatelyin writing by: to o Providing a brief synopsisof the conflict of interest(and); o An explanationof the stepstakento address potential,or actualconflict of interest. this apparent, r) IF "YES', Providea detailedexplanationof the circumstances which provide you with a basisto potential,or actualconflict of interestmay exist. concludethat an apparent,

No

12. To the extentthat you believe that Chapter 7-A of Act 44 of 2009requires to disclose additional you any information beyond whathasbeenrequested please above, providethat information belowor on a separate pieceofpaper.
No

Pleaseprovide the name(s)and position(s)of the person(s) participatingin the completionof this Disclosure. One of the individuals identified by the Contractor in Item #1 above must participatein completingthis Disclosure mustsignthe belowverificationattesting the participation thoseindividuals and to of named below.

Name:Robert Hall Position:President Name: Position: Name: Position:

Name: Position: Name: Position: Name: Position:

TITLE

VenrncRnott
I, RobertHall, herebystate that I am President the R. J. Hall Company, for Inc., andI am authorized to makethis verification. I herebyverif that the facts set forth in the foregoingAct 44 DisclosureForm for Entities Providing Professional Services Hughesville Borough PensionSystemare true and correctto the best of my to knowledge, informationand belief. I also understand knowingly makingmaterialmisstatements that or omissions this form couldsubject responding in the Contractor the penalties Section to in 705-A(e)of Act 44. I understand falsestatements that hereinare madesubjectto the penalties 18 P.A.C.S.$ 4904 of relatingto unswornfalsification to authorities.