2024 ACT 44 DISCLOSURE FORM FOR ENTITIES PROVIDING
PROFESSIONAL SERVICES TO THE PENSION SYSTEM(S) OF:
COUDERSPORT BOROUGH
HEREINAFTER REFERRED TO AS THE “REQUESTING MUNICIPAL ENTITY”
CHAPTER 7-A OF ACT 44 OF 2009 MANDATES the annual disclosure of certain information by every entity (hereinafter
“Contractor”) which provides professional services under contract to one or more of the pension funds of
COUDERSPORT BOROUGH. Act 44 disclosure requirements apply to Contractors who provide professional
pension services and receive payment of any kind from the Requesting Municipal Entity’s pension fund. 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 Municipal Entity below, by December 6, 2024. If for any reason you believe
that Act 44 does not require you to complete this disclosure form, please provide a written explanation of your
reason(s), not later than 15 days following receipt of this request. As changes occur and before the next disclosure is
made, updates should be made in writing.
Return the completed disclosure to:
COUDERSPORT BOROUGH
ATTN: BEVERLY MORRIS CAO
201 SOUTH WEST STREE, COUDERSPORT PA 16915
814-274-9776
COUDYBORO@GMAIL.COM
Definitions for Disclosure
CONTRACTOR: Any person, company, or other entity that receives payments, fees, or any other form of
compensation from a municipal pension fund in exchange for rendering professional services for the benefit of the
municipal pension fund.
SUBCONTRACTOR OR ADVISOR: Anyone who is paid a fee or receives compensation from a municipal pension system
– directly or indirectly from or through a contractor.
AFFILIATED ENTITY: Any of the following: (1) A subsidiary or holding company of a lobbying firm or other
business entity owned in whole or in part by a lobbying firm; or (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 a lobbyist or lobbying firm or an affiliated entity.
CONTRIBUTIONS: As defined in section 1621 of the act of June 3rd, 1937 (P.L. 1333, No. 320), known as the
Pennsylvania Election Code.
POLITICAL COMMITTEE: As defined in section 1621of the act of June 3rd, 1937 (P.L. 1333, No. 320), known as
the Pennsylvania Election Code
EXECUTIVE LEVEL EMPLOYEE: 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 pension system; or (2) Is directly involved in the
implementation or development policies relating to pensions, investments, contracts or procurement or the conduct
of business with a municipality or municipal pension system.
2
MUNICIPAL PENSION SYSTEM: Any qualifying pension plan, under Pennsylvania state law, for any municipality
within the Commonwealth of Pennsylvania; includes the Pennsylvania Municipal Retirement System.
Example: The Police Pension Plan for the Borough of Winchesterville
MUNICIPAL PENSION SYSTEM OFFICIALS AND EMPLOYEES; MUNICIPAL OFFICIALS AND EMPLOYEES:
Specifically, those listed in Table 2 titled: “List of Pension System and Municipal Officials and Employees” on the
next page. Where applicable, includes any employee of the Requesting Municipal Entity.
PROFESSIONAL SERVICES CONTRACT: 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.
List of Municipal Officials for the Requesting Municipal Entity
CONTRACTORS: 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
“List of Municipal Officials.”
REQUESTING MUNICIPAL ENTITY: Enter below, a list of municipal officials that have any involvement in the
administration or management of the pension system – Elected Officials, Appointed Officials and Employees, Board
Members, or other Pension Committee Members (if applicable). Do not include employees that are not in a
management position or serve on a pension committee or in a decision-making position relative to this pension
system. If a category listed below is not applicable, enter “NA” in the top right box only.
TABLE 2: List of Municipal Officials and / or Employees – “List of Municipal Officials”
Elected Officials:
Name: Title: Name: Title:
Wayne Hathaway President Andrew J Dubots Mayor
Martin Fry Vice President Teresa Kiesel Tax Collector
Jack Keifer Councilmember
Dennis Goodenough Councilmember
Abigail Rossman Councilmember
Craig Miller Councilmember
Employees or Appointed Officials:
Name: Title: Name: Title:
Beverly Morris Manager/Sec/Treas
Others: Pension Committee Members (if applicable) (persons not already listed above):
Name: Title: Name: Title:
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Identification of Contractors & Related Personnel
CONTRACTORS: (Review “Definitions” on page 2 before completing this form) Any entity who currently
provides service(s) by means of a Professional Services Contract to the Municipal Pension System of the
Requesting Municipal Entity, please complete all the following:
Identify the Municipal Pension System(s) for which you are providing information:
Indicate all that apply with an “X”: Non-Uniform Plan Police Plan
Fire Plan
Instructions: For all that follow, any yes or affirmative response requires further information. Please provide this
information to the extent detailed in each question. Answer all questions below, then on a separate sheet of paper
provide the detailed information required and attach it to this Disclosure. Please refer to each question you are
responding to by the appropriate number. (Example: REF – Question #3). NOTE: Question # 1 requires a
detailed response. All information provided for items 1- 4 above must be updated as changes occur.
READ each question, put and “X” in the Yes or No Box to the left or right to respond. If necessary, provide the
information requested for a yes or affirmative answer.
YES Question NO
X
Q1: Please provide the names and titles of all individuals providing professional services to the
Requesting Municipal Entity’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 regarding the professional services being provided to
each designated pension plan.
Q2: Please list the name and title of any Affiliated Entity and their Executive-level Employee(s) that
require disclosure; after each name, include a brief description of their duties. (See: Definitions) X
Q3: Are any of the individuals named in Questions 1 and 2 above a current or former official or
employee of the Requesting Municipal Entity?
** IF “YES,” provide the name of the person employed, their position with the municipality, and dates
of employment.
X
X
Q4: Are any of the individuals named in Item 1 or Item 2 above a current or former registered Federal
or State lobbyist?
** IF “YES,” provide the name of the individual, specify whether they are a state or federal lobbyist,
and the date of their most recent registration /renewal.
Q5: Since December 17th, 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 Municipal Entity, or to the political party or political action committee of 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).
X
Q6: Within the past two years: Has the Contractor or an Affiliated Entity made any contributions to a
municipal official or any candidate for municipal office in the Requesting Municipal Entity?
** 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 of the contribution.
X
Continued next page.
X X
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YES Question NO
Q7: Since December 17th 2009, has the Contractor or an Affiliated Entity paid compensation to 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 Municipal Entity
(OR), any municipal official or employee of the Requesting Municipal Entity in connection with any
transaction or investment involving the Contractor and the Municipal Pension System of the Requesting
Municipal Entity?
This question does not apply to an officer or employee of 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
professional services contact with municipality’s pension system.
** 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 of the Municipal Pension System of the Requesting
Municipal Entity (OR), any municipal official or employee of the Requesting Municipal Entity, (3)
the official they communicated with, and (4) the dates of this service.
X
Q8: Does the Contractor or an Affiliated Entity have any direct financial, commercial, or business
relationship with any official identified on the List of Municipal Officials, of the Requesting Municipal
Entity?
** IF “YES,” identify the individual with whom the relationship exists and give a detailed description
of that relationship. NOTE: A written letter is required from the Requesting Municipal Entity
acknowledging the relationship and consenting to its existence. The letter must be attached to this
disclosure. Contact the Requesting Municipal Entity to obtain this letter and attach it to this disclosure
before submission.
X
Q9: Since December 17th, 2009: 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 Municipal Entity?
** IF “YES,” Provide the name of the person conferring the gift, the person receiving the gift, the
office or position of the person receiving the gift, specify what the gift was, and the date conferred.
X
X
Q 10: Disclosure of contributions to any political entity in the Commonwealth of Pennsylvania
Applicability: A “yes” response is required, and full disclosure is required ONLY WHEN ALL the
following applies:
a) The contribution was made within the last 5 years
b) The contribution was made by an officer, director, executive-level employee, or owner of at least
5% of the Contractor or Affiliated Entity.
c) The amount of the contribution was at least $500 and in the form of:
1. A single contribution by a person in (b.) above, OR
2. The aggregate of all contributions to 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
of Pennsylvania; or
2. The political committee of a candidate for public office or any person that holds an office
in the Commonwealth of Pennsylvania.
** 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
(or the political entity / party receiving the contribution), the date of the contribution, and the amount of
the contribution.
Continued next page.
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YES Question NO
Q11: With respect to your provision of professional services to the Municipal Pension System of the
Requesting Municipal Entity: Are you, the Contractor, aware of any apparent, potential, or actual
conflicts of interest with respect to any officer, director or employee of the Contractor and officials or
employees of the Requesting Municipal Entity?
NOTE: If, in the future, you become aware of any apparent, potential, or actual conflict of interest,
you are expected to update this Disclosure Form immediately in writing by:
• Providing a brief synopsis of the conflict of interest (and);
• An explanation of the steps taken to address this apparent, potential, or actual conflict of interest.
** IF “YES,” Provide a detailed explanation of the circumstances which provide you with a basis to
conclude that an apparent, potential, or actual conflict of interest may exist.
X
VERIFICATION
I, Amanda S. Potts, hereby state that I am the _Director, MRT Operations_ for
(Name) (Position)
_PA State Assoc. of Boroughs – Municipal Retirement Trust _and I am authorized to make this verification.
(Contractor)
I hereby verify that the facts set forth in the foregoing Act 44 Disclosure Form for Entities Providing Professional
Services to the Requesting Municipal Entity’s Pension System(s) are true and correct to the best of my knowledge,
information, and belief. I 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.
I understand that false statements herein are made subject to the penalties of 18 P.A.C.S. § 4904 relating to
unsworn falsification to authorities.

Signature

10/1/2024Date
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PSAB Municipal Retirement Trust 2024 Addendum
Required Disclosure Form Statements (updated as of 1 November 2024)
(Reference Question #1) List of MRT Personnel
PSAB Municipal Retirement Trust (MRT) – State Association and Pension Operations Contractor
The Municipal Retirement Trust is wholly owned and operated by the PSAB and is the primary contractor.
The MRT employs several subcontracted firms to provide specific and unique services to the Trust. The principal
PSAB-MRT team members are listed first, followed by those of each subcontractor.
Contractor Team Listing
PSAB Municipal Retirement Trust (MRT)
The PA State Association of Boroughs and Principal Pension Operations Contractor
Chris Cap, PSAB Executive Director – Serves as MRT Treasurer/Secretary
Joseph Scott, MRT Client Services Director – Inside/Outside pension service liaison
Amanda Potts, Director, MRT Operations
Sub-Contractor and Advising Team Listing
• Administrative, Accounting, Custodial, and Actuarial Companies
Thomas J. Anderson & Associates – Trust Administrator (optional actuarial services)
James Kennedy, President – Manages Act 205 administrative compliance efforts. TPA Administrative Services.
(TJA offers optional actuarial services through an agreement with CBiz Actuary Svcs.)
Brown Plus– Trust Auditor
John W. Bonawitz, Jr., Principal – Supervises annual audit functions for the Trust.
Hamilton & Musser – Accounting Sub-contractor
Robert Mast, Shareholder – Manages account reporting, tax filings and fund disbursements.
Fulton Bank – Fund Depository
Tammy Snyder, VP of Corporate Development – Manages checking and disbursement accounts.
Morgan Stanley – Investment Market Monitor
H. Jeffrey Herb, Senior Vice President, Investments – Serves as investment monitor of MRT.
Mette Evans & Woodside – Law firm providing legal counsel
Mary Alice Busby, Shareholder – Serves as the MRT Solicitor.
• Investment Management – Style-Specific Companies
Robeco/Boston Partners – Large Cap Value Manager
Joseph F. Feeney, CFA, CEO
Mark Donovan, CFA, – Portfolio Manager
ISHARES RUSSELL 1000 VALUE ETF – Large Cap Value Manager
Greg Savage – Portfolio Manager
Vanguard S&P 500 Index – Large Cap Core Manager
Michael Feehily – Senior Managing Director
ISHARES RUSSELL 1000 GRW ETF – Large Cap Growth Manager
Greg Savage – Portfolio Manager
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Wedge Capital Management – SMid-Cap, Core Bond Manager and Short Term Fixed
Bradley W. Horstmann, CFA, General Partner- Chief Compliance Officer
John G. Norman, Executive Vice President – Portfolio Manager – Equity
Ancora/Thelen Advisors – Small Mid Cap Manager
Dan Theleni, CFA – Portfolio Manager
Frederick DiSanto – Chairman & Chief Executive Officer
Great Lakes Advisors – Small Mid Cap Manager
Jeff Agne, CIO – Managing Director
William O. Bell, III – Director – Consultant Relations
Vanguard Extended Market ETF-Mid/Small Cap Manager
Michelle Louie, CFA – Portfolio Manager
Nick Birkett, CFA – Portfolio Manager
ISHARES RUSSELL Mid-Cap Growth – Small Mid Cap Manager
Greg Savage – Portfolio Manager
Harding Loevner – International Fund Manager
Ferrill Roll, CFA –Portfolio Manager
Lindsey Andresen – Manager, Client Management
Causeway Capital Management – International Fund Manager
Sarah Ketterer – CEO/Portfolio Manager
Eric Crabtree – Chief Client Service Officer
ISHARES MSCI EAFE ETF – International Fund Manager
Greg Savage – Portfolio Manager
Bentall Kennedy – Real Estate Manager
Michael Keating, Senior Vice President – Portfolio Manager
Josh Samilow, Vice President – Business Development and Client Relations
Intercontinental – Real Estate Manager
Peter Palandjian – Chairman and CEO
James Beloff – Senior Managing Director
C.S. McKee L.P. – Fixed Income Manager
Brian S. Allen, CFA – Senior Vice President and Chief Investment Officer – Portfolio Manager
Mark. R. Gensheimer – President
CBRE Listed Global Infrastructure
Jeremy Anagnos – Chief Investment Officer, Listed Infrastructure
Daniel Foley – Portfolio Manager
(Reference Question # 4) List current or former registered Federal or State lobbyists
Chris Cap, State Registered Lobbyist (last renewed 1/1/2023). Position: PA State Association of Boroughs –
PSAB Executive Director
(Reference Question # 10) Disclosure of contributions to any political entity
Randy Riddle – PSAB Board of Directors
$300 (2020)– Friends of Timothy Bonner PA State Representative
$250 (2023) – Mercer Co. Commissioner Campaign Ann Colman
Chuck Mummert – Trustee
$50 (2020, 2023) – David Hickernell PA State Representative