Conflict of Interest and 990 Questionnaire

Board Members must certify receipt of, understanding of, and compliance with the District Conflict of Interest Policy which is available below.

Conflict-of-Interest-District-Policy-8-11-2023 Download

Board Members must complete the 990 Questionnaire and Conflict of Interest Certification prior to taking office, and within 10 days of any changes to be reported.

Board Member Conflict of Interest and 990 Questionnaire

"*" indicates required fields

Name*

First Last

Email*

Board Position*

Administrative year of service*

1. Do you have a business or family relationship with any other officer, director, trustee or key employee of the organization? See definitions below to help you correctly answer this question.*

Business relationship is defined as: a) One person being employed by the other in a sole proprietorship, or by an organization in which the other person is a trustee, director, officer, key employee or greater than 35% owner. b) One person transacting business with the other (other than in the ordinary course of either party’s business on the same terms as are generally offered to the public), directly or indirectly, in one or more contracts of sale, lease, license, loan, performance of services, or other transaction involving transfers of cash or property valued in excess of $10,000 in the aggregate during the organization’s tax year (indirect transactions are the transactions with an organization with which the one person is associated as a trustee, director, officer, key employee, or greater than 35% owner); or c) The two persons are each a director, trustee, officer, or greater than 10% owner in the same business or investment entity. Family relationships that need to be disclosed are: Spouse, children, sister, brother, parent, grandparent or any spouse of the foregoing.

Yes

If yes, please indicate the names of the individuals with whom you have a relationship and indicate the words "family" or "business" next to the name. No further information is required.*

2. Have you or any of your family members had any business transactions with the organization, either directly or indirectly through an organization with which you or a family member is a board member, trustee, director or owner?*

Yes

If yes, please describe the transaction and the percent ownership if it is with a company you or your family member owns.*

3. Are any of your family members employed by the organization?*

Yes

If yes, please name the employed family member.*

Signature*

Date*

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Kids Need Kiwanis

Conflict of Interest and 990 Questionnaire

Board Member Conflict of Interest and 990 Questionnaire