disclosures: 02e499e17a6ef3ff19034f4ee6de325f3eeb20535599c2f9e482da44ae84db54
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| 02e499e17a6ef3ff19034f4ee6de325f3eeb20535599c2f9e482da44ae84db54 | 2017/Horgan,_Julie_8.24.17_-_CMR_6.07.pdf | 2017 | Julie Horgan | DMH | %S6=8 Page ID:ETHICS-COMMISION From: AUG-24-2017 12:45 PM xDISCLOSURE BY STATE EMPLOYEE IN A CONTRACT TO PROVIDE PURSUANT TO 930 CMR 6.07 2017 AUG 24 PM COMMISSION 3:32 STATE EMPLOYEE INFORMATION Name of state Julie Horgan employee: Title/ Position: Clinical risk manager Agency/Department: DMH Agency Address: Solomon Carter Fuller 85 East Newton St. Boston, MA Office phone: 617-305-9911 Office e-mail Julie.Horgan@Massmail.state.ma.us I am a state employee, and I seek to have a financial interest in a contract or agreement made by a state agency listed below, or by a provider or organization funded by a state agency listed below: A state agency within the following Executive Offices: Executive Office of Health and Human Services, including the Human Service Transportation Office; Executive Office of Public Safety and Security, Executive Office of Elder Affairs, Executive Office of Veteran's Services, or A sheriff's office. The purpose of the contract is: To provide personal services to a person or persons who receive services from, or have services paid for by, these state agencies; or To provide educational services to people who work for these state agencies or for providers or organizations funded by these state agencies. I seek approval of the arrangement from the agency for which I serve as a state employee and from the state agency above that made the contract. FINANCIAL INTEREST IN A CONTRACT WITH A STATE AGENCY PLEASE CHECK OFF ONE OF THE THREE STATEMENTS BELOW AND PROVIDE THE REQUESTED INFORMATION. 1) Service to a state agency I will provide personal or educational services to a state agency listed above. Please identify the state agency and also the Executive Office it is in, if applicable. ? 'd 8778 °N Aug. 24. 2017 12:40PM R=95% Page:003 From: AUG-24-2017 12:45 PM 2) Service to a provider or I will provide personal or educational services to a provider or organization funded by a state organization agency listed above. Please provide the name and address of the provider or organization. Please identify the state agency that funds the provider or organization, and also the Executive Office it is in, if applicable. 3) Service to a person or persons I will provide personal services directly to a person or persons who receive services from, or have services paid for by, a state agency listed above. Please identify the state agency that provides services to, or pays for services for, the person or persons, and also the Executive Office it is in, if applicable. The BEST Team is funded by DMA, Dept. of Medical Assistance, and MBHP(a form of Mass Health). Please describe the Please provide information about the type of personal or educational services you will provide. services you will Please do not include the name of any individual who receives services. provide. I would be going to emergency rooms such as Carney Hospital and Children's Hospital and assessing people who are in psychiatric crisis. These are people who might be suicidal, psychotic, and/or unable to care for themselves. I would make a determination about what services they need-such as psychiatric unit or outpatient services. Some of these people will be DMH clients. What will you be The pay is ?$25.60 an hour. I'm looking to work 2 weekend days a month. paid, or what other financial interest will you have? Employee signature Date: 8/9/2017 Jah Holye APPROVAL BY AGENCY YOU SERVE AS A STATE EMPLOYEE Name and title of appointing authority Office phone Patricin Kenny - DMH Aren Director, Metro Boston E 'd 6878 No. Aug. 24. 2017 12:40PM R=95% Page:004 IDETHCS-COMMISION From: AUG-24-2017 12:45 PM Office e-mail Signature by By that I have reviewed the facts that the state employee has signing here, I indicate Kenny state. US appointing authority disclosed above and approve the arrangement proposed by the state employee. Date: (Patricin Kennef 8/21/17 APPROVAL BY AGENCY THAT MADE THE CONTRACT (IF DIFFERENT) Name and title of person giving approval at the state agency that made the contract Office phone Office e-mail Signature by person By signing here, I indicate that I have reviewed the facts that the state employee has giving approval disclosed above and approve the arrangement proposed by the state employee. Date: Attach additional pages if necessary. File with: State Ethics Commission One Ashburton Place, Room 619 Boston, MA 02108 Form revised February, 2012 1 di 6878 *ON Aug. 24. 2017 12:40PM | 2017/Horgan,_Julie_8.24.17_-_CMR_6.07.pdf |