search_index: sfi.db/disclosures, 24d9a169b72740f6fa186ea403e69c500f916e16393c58b14f839aab61dbfb4f
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| sfi.db/disclosures | 24d9a169b72740f6fa186ea403e69c500f916e16393c58b14f839aab61dbfb4f | 2019/Strom,_Cherylann_2.5.19_-_6.pdf | 2019-01-01T00:00:00 | 1 | DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL INTEREST AND DETERMINATION BY APPOINTING AUTHORITY AS REQUIRED BY G. L. c. 268A, § 6 STATE EMPLOYEE INFORMATION Name: Cherylann Strom Title or Position: Ongoing SW A/B State Agency: Department of Children and Families Agency Address: 690 Mechanic St, Suite 100, Leominster MA 01453 Office Phone: 978-353-3848 Office E-mail: Cherylann.strom@massmail.state.na.us My duties require me to participate in a particular matter, and I may not participate because of a financial interest that I am disclosing here. I request a determination from my appointing authority about how I should proceed. PARTICULAR MATTER Particular matter Please describe the particular matter. E.g., a judicial or other I am working as an Emergency Mental Health Clinician outside of my regularly scheduled work proceeding, application, hours with the DCF. This outside work sometimes involves the same clients as those involved with submission, request DCF, however, I refuse all cases involving clients I know through working with DCF. for a ruling or other determination, contract, claim, controversy, charge, accusation, arrest, decision, determination, or finding. Your required Please describe the task you are required to perform with respect to the particular matter. participation in the particular matter: Working as an Emergency Mental Health Clinician sometimes involves the same clients E.g., approval, as those involved with the DCF, however, I refuse all cases involving clients I know disapproval, decision, recommendation, through working with DCF. rendering advice, investigation, other. FINANCIAL INTEREST IN THE PARTICULAR MATTER Write an X by all that apply. I have a financial interest in the matter. I My immediate family member has a financial interest in the matter. _X_ My business partner has a financial interest in the matter. I am an officer, director, trustee, partner or employee of a business organization, and the business organization has a financial interest in the matter. I am negotiating or have made an arrangement concerning future employment with a person or organization, and the person or organization has a financial interest in the matter. Financial interest Please explain the financial interest and include a dollar amount if you know it. in the matter Community Healthlink, my other employer, services clients of DCF. I have no financial interest. Employee signature: Can Date: 2-5-19 DETERMINATION BY APPOINTING OFFICIAL APPOINTING AUTHORITY INFORMATION Name of Appointing Authority: Lori Sherburne Title or Position: Area Director Agency/Department: Department of Children and Families Agency Address: 690 Mechanic St, Suite 100 Leominster, MA 01453 Office Phone: 978-353-3601 Office E-mail Lorisherburne@state.ma.us DETERMINATION Determination by As appointing official, as required by G.L. c. 268A, § 6, I have reviewed the particular matter and the appointing authority: financial interest identified above by a state employee. Write an X I am assigning the particular matter to another employee, or by your selection. I am assuming responsibility for the particular matter, or I have determined that the financial interest is not so substantial as to be deemed likely to affect the integrity of the services which the Commonwealth may expect from the employee. Appointing Authority signature: Lor Sherburn Date: 2/4/19 Comment: |