disclosures: 025efbbc973a82815e0f22368a7e835eb5412360051ac298494203d3a08c528d
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| 025efbbc973a82815e0f22368a7e835eb5412360051ac298494203d3a08c528d | 2017/GrayCarruthersKaren1.3.17.pdf | 2017 | Karen Gray Carruthers | DISCLOSURE BY STATE EMPLOYEE OF A FINANCIAL INTEREST IN A CONTRACT WITH THE DEPARTMENT OF CHILDREN AND FAMILIES AS REQUIRED BY 930 CMR 6.05(2)(b) RECEIVED STATE ETHICS COMMISSION STATE EMPLOYEE INFORMATION Name of state 2017 JAN 3 PM 12: 39 employee: Karen Gray Carruthers Title/ Position Administrative Magistrate Agency: Department of Public Health Bureau of Health Professions Licensure Agency address: 239 Causeway Street, Suite 500, 5th Floor Boston, MA 02114 I am a state employee, and I also have agreed to serve as a foster parent, guardian, or pre-adoptive or adoptive parent, or to serve in a comparable status. The Department of Children and Families ("DCF") has a contract or agreement with me or with another person or organization relating to the service I am providing. I am disclosing that I receive financial benefits and/ or have financial obligations because of the contract or agreement made by DCF. FINANCIAL INTEREST IN A DCF CONTRACT I have an agreement to serve as: Foster parent; Guardian; Please write an X beside your answer. Pre-adoptive parent; Adoptive parent; Other. Please explain. . My agreement is with: Please write an X DCF directly; beside your answer, and provide any A person or organization that has a contract with DCF. requested information. - Please provide the name and address of the person or organization. PLEASE DO NOT PROVIDE INFORMATION BELOW ABOUT THE IDENTITY OF THE CHILD. Please refer to the child as "the child" or "the foster child," etc. In the answers below, please provide a dollar amount, if possible. Please identify any Do you receive, e.g., a subsidy or benefits, compensation, reimbursement of expenses, or a financial benefit you clothing allowance? receive because of your service. We anticipate receiving the standard subsidy, reimbursement of expenses and clothing allowance as deemed appropriate by DCF. Who provides these financial benefits to The financial benefits will be provided by DCF. you? Include the name and address. Massachusetts Department of Children and Families 600 Washington Street Boston, MA 02111 Arlington Area Office 30 Mystic St. Arlington, MA 02474 (781) 641-8500 Please identify any Did you agree to accept any financial obligation, e.g., to maintain homeowner's insurance? financial obligation you have accepted in No. (We already maintain homeowner's insurance.) connection with this service. Employee signature: KCgC Date: January 3, 2017 Attach additional pages if necessary. File copy with: State Ethics Commission One Ashburton Place, Room 619 Boston, MA 02108 Form revised February, 2012 | 2017/GrayCarruthersKaren1.3.17.pdf |