Appendix G: Conflict of Interest Disclosure Form

Conflict of Interest Form

Conflict of Interest Form

Annual Conflict-of-Interest Disclosure – Foothills Unitarian Church – Board of Trustees

The Board expects all its members to carry out their duties with undivided loyalty to the congregation and its mission. A conflict of interest exists whenever a Board member has interests or duties that may hinder or appear to hinder the Board member from fulfilling this duty. Conflicts of interest arise when the Board member:

stands to gain or lose financially because of an action of the congregation in which he or she has a decision-making role;
has a fiduciary duty or close personal or business relationship to any person or corporation that stands to gain or lose because of their action;
holds a substantial property interest or position in a corporation, business, or other organization that stands to gain or lose because of their action;
cannot set aside his or her personal preferences as an individual consumer of the congregation’s services to act in behalf of the whole congregation and its mission; or
faces any other situation that creates or appears to create divided or conflicting loyalties.

The questions below are intended to guide your personal review of potential conflicts. Keep in mind that a conflict may relate to you, your spouse, a family member, or to business interests or associates, summarized inclusively as “you” in these questions.

Yes	No
		Do you have a financial interest in an organization that provides goods or services to Foothills Unitarian Church (FUC)?
		Are you an employee, manager, or consultant to an organization that does business with FUC?
		Have you accepted a gift or other benefit from an organization that does, or seeks to do, business with FUC?
		Are you indebted to FUC?
		Is FUC indebted to you?
		After reviewing the potential conflicts described above, are there challenges or concerns that you foresee?

If you answered yes to any of these questions, please provide further details:

__________________________________

Signature Date

Note: Board policy requires its members to annually disclose in writing all existing or foreseeable conflicts of interest. Disclosure forms will be kept by the Secretary and made available to any member of the Board who asks to see them