Attachment_3_CalSTRS_Disclosure_Form_600-H.pdf

Identification of Filer

Pursuant to Section 600.H. of the Teachers' Retirement Board Policy Manual, entitled "Disclosure of Campaign Contributions, Charitable Contributions, and Gifts, Recusal Requirement, and Ban on Specified Gifts" any party and its Authorized/Key Personnel who engages in business with CalSTRS for gain is required to make specific public disclosures. Contracting Entities and each of their Authorized/Key Personnel must complete and file separate forms. The below identified party or its Authorized/Key Personnel hereby make the following disclosures. (Please attach other sheets if more space is needed for disclosure and indicate enclosures.)

DISCLOSURE OF CONTRIBUTIONS AND GIFTS

Form 600-H

Authorized / Key Personnel or Person Making Disclosure:

Name of Entity / Contractor:

Investment Asset Class (Check all that apply):

Inflation Sensitive

Other

Absolute Return

Global Equity

Fixed Income

Real Estate

Private Equity

Operations

Innovation & Risk

Reported on behalf of Entity

Number Street City/Locality State/Province Zip

Mailing Address:

Telephone: E-mail Address:

Filing and Disclosure Period This disclosure of campaign contributions, charitable contributions, and gifts is in response to the following filing requirement:

Relationship Category (Please choose the one that is most appropriate to this relationship):

Non-Investment

Investment

Contractor / Consultant - Description of Service Provided:

Investment Mgr

Broker Dealer

Consultant

General Ptr

Independent Fiduciary

Other Services:

Upon submission of an initial application or proposal to do business with CalSTRS for the preceding 12-month period.

With the submission of the contract for execution (signature) to cover the interim period since the initial application.

Annual disclosure for the previous calendar year.

Form 600-H (rev. 01/2015) Ethics & Compliance

Request for Proposal 5000000660 BusinessDirect Maintenance and Operations

Volume 1 – Part 7, Attachment 3, Form 600H Disclosure of Contributions and Gifts

1. Disclosure of Campaign Contributions Disclosure of Campaign Contributions valued in excess of $250 made to or on behalf of any a) existing Teacher’s Retirement Board member, b) candidates for Board member, Controller, Treasurer, and Superintendent of Public Instruction, and c) CalSTRS officer or employee. The term “contribution” is defined in the Political Reform Act regulations, in Title 2, California Code of Regulations (CCR) section 18215. If the business is an Investment Relationship, disclosure of campaign contributions made to the Governor or candidates for the governorship must also be made, according to CalSTRS’ Campaign Contribution regulations in Title 5, CCR section 24010.

Form 600-H

Value of Contribution

Description if other than monetary Date of

Contribution Identity of Recipient of Contribution

Attachment is enclosedNothing to report

2. Disclosure of Charitable Contributions Disclosure of charitable contributions valued in excess of $250 made at the request of any Teachers’ Retirement Board member or CalSTRS officer or employee to any charitable organization.

Value of Contribution

Description of Contribution (monetary or in-kind)

Date of Contribution

Identity of Recipient of Contribution

Identity of Requester of Contribution

Attachment is enclosedNothing to report

3. Disclosure of Gifts Disclosure of gifts, including meals, entertainment, or travel, valued in excess of $50 made to any Teachers’ Retirement Board member or CalSTRS officer or employee.

Value of Gift Description of Gift Date Gift Given Identity of Recipient of Gift

Attachment is enclosedNothing to report

I have exercised all reasonable due diligence in preparing this disclosure statement on my own behalf or on behalf of the reporting entity identified above. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attachments is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signature Title

Printed Name Date Form 600-H (rev. 01/2015)

Ethics & Compliance

Request for Proposal 5000000660 BusinessDirect Maintenance and Operations

Volume 1 – Part 7, Attachment 3, Form 600H Disclosure of Contributions and Gifts