disclosures: 011c3b414b09d5d877efbe7b687d496ae67f5f0b5944af3ea9bdd9c53c77803a
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| 011c3b414b09d5d877efbe7b687d496ae67f5f0b5944af3ea9bdd9c53c77803a | 2022/Owusu_Michael_11.15.22_7(b).pdf | 2022 | Michael OWOSU | DMH | DISCLOSURE BY STATE EMPLOYEE OF FINANCIAL INTEREST IN A STATE CONTRACT AND CERTIFICATION BY HEAD OF CONTRACTING AGENCY RECEIVED AS REQUIRED BY G. L. c. 268A, ยง 7(b) STATE ETHICS COMMISSION STATE EMPLOYEE INFORMATION 2022 NOV 14 PM 12:47 Name of state employee: Michael OWOSU Title/ Position Mintal health worker If you are a state employee because a state agency has contracted with your company or Fill in this box organization, please provide the name and address of the company or organization. if it applies to you. Agency/ Department DMH Agency Address worcester Recovery Center and Hospital 309 Belmontst. Workster ma 01609 Office phone: Office e-mail: michael.Y.owusu.@mass.gov Check one: Elected or Non-elected Starting date as a state employee. 10/24/22 ELECTED, COMPENSATED STATE EMPLOYEE BOX # 1 I am an elected, compensated state employee, other than a state Senator or a state Representative. STATEMENT #1: I had one of the following financial interests in a contract made by a state Select either agency before I was elected to my compensated state employee position. I will continue to STATEMENT #1 or have this financial interest in a state contract. OR STATEMENT #2. STATEMENT #2: I will have a new financial interest in a contract made by a state agency. Write an X My financial interest in a state contract is: beside your financial interest. I have a non-elected, compensated state employee position. A state agency has a contract with me. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. I work for a company or organization that has a contract with a state agency, and 1 am a "key employee" because the contract identifies me by name or it is otherwise clear that the state has contracted for my services in particular. NON-ELECTED, COMPENSATED STATE EMPLOYEE BOX # 2 I am a non-elected, compensated state employee. Select either STATEMENT # 1: I had one of the following financial interests in a contract made by a state STATEMENT #1 or agency before I took a position as a non-elected state employee. I will continue to have this financial interest in a state contract. STATEMENT #2. Write an X My financial interest in a state contract is: beside your financial interest. A state agency has a contract with me, but not an employment contract. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. - OR -- STATEMENT # 2: I will have a new financial interest in a contract made by a state agency. My financial interest in a state contract is: I have a non-elected, compensated state employee position. A state agency has a contract with me. I have a financial benefit or obligation because of a contract that a state agency has with another person or an entity, such as a company or organization. I work for a company or organization that has a contract with a state agency, and I am a "key employee" because the contract identifies me by name or it is otherwise clear that the state has contracted for my services in particular. FINANCIAL INTEREST IN A STATE CONTRACT Name and address UMASS Chan MC dicalschool of state agency that made the contract SSNILaKe Ave. worcester ma 01655 "My State Agency" is the state agency that I serve as a state employee. The "contracting agency" is the state agency that made the contract. Please put in an X My State Agency is not the contracting agency. to confirm these facts. My State Agency does not regulate the activities of the contracting agency. In my work for my State Agency, I do not participate in or have official responsibility for any of the activities of the contracting agency. The contract was made after public notice or through competitive bidding. ANSWER THE QUESTION IN THIS BOX IF THE CONTRACT IS BETWEEN THE STATE AND YOU. FILL IN - Please explain what the contract is for. THIS BOX TO provide direct caic services toa OR THE BOX highly psychiatrically an behaviorally BELOW compro MISC d ado rescent population, including forensics, I am particularly skilled ANSWER THE QUESTIONS IN THIS BOX IF THE CONTRACT IS BETWEEN THE STATE AND ANOTHER PERSON OR ENTITY. this with FILL IN - Please identify the person or entity that has the contract with the state agency. popila FIOR - What is your relationship to the person or entity? THIS BOX - What is the contract for? OR THE BOX UMASS Chan medicalschoo / ABOVE direct care per diem staff member FOR CONTRACTS FOR PERSONAL SERVICES ONLY: | 2022/Owusu_Michael_11.15.22_7(b).pdf |