Disclosure Form

I hereby acknowledge that I have read and understand the Conflict of Interest Policy of Endaoment, a California nonprofit public benefit corporation. I agree to abide by its terms and uphold the highest standards of integrity and stewardship in my role. I understand that Endaoment operates with a commitment to transparency, ethical conduct, and compliance in all its activities to maintain trust and confidence in its mission of facilitating charitable donations. As such, I recognize the importance of adhering to these policies to ensure that Endaoment continues to meet its philanthropic goals and maintain its status as a trusted and effective nonprofit organization focused on tax-exempt purposes.

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Personal Information

• Name: [Your Full Name]

• Position/Title: [Your Position/Title at Endaoment]

• Department/Unit: [Your Department or Unit]

• Date: [Date of Submission]

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Disclosure Statement

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1. Personal and Family Business Relationships

• Description: Detail any personal, family, or business relationships that you or your family members have with Endaoment. Include the nature and extent of these relationships.

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2. Ownership Interests

• Entities: List any entities in which you or your family members hold ownership interests that might present a conflict of interest with Endaoment.

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3. Positions of Influence

• Roles: Identify any positions of influence you or your family members hold in other organizations that do business with or compete with Endaoment.

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4. Charitable Engagements

• Organizations: Disclose any fiduciary roles or significant contributions you or your family members make to charitable organizations that may receive support from or provide support to Endaoment.

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5. Other Relevant Relationships

• Details: Provide information about any other relationships or situations that might constitute a conflict of interest or be perceived as such.

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Financial Interests

• Details: Describe any financial interests or benefits that you or your family might have that are related to Endaoment’s activities.

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Involvement in Decision-Making

• Details: Explain your role in decision-making processes at Endaoment related to any of the disclosed conflicts.

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Action Taken

• Mitigation Measures: Describe any measures you have taken or will take to mitigate any potential conflicts of interest.

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Declaration

I declare that the information provided is true and complete to the best of my knowledge and I commit to update this disclosure promptly should any relevant changes in my circumstances occur. I understand that failure to disclose or properly manage a conflict of interest may result in disciplinary action up to and including termination.

• Signature: [Your Signature]

• Date: [Date of Signing]

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For Office Use Only

• Received By: [Name of the Ethics Officer/HR Representative]

• Date Received: [Date of Receipt]

• Review and Comments:

  • [Comments or actions taken by the reviewing officer]

Please return the completed form to the Endaoment Ethics Office at ethics@endaoment.org.