SCHOOL ETHICS COMMISSION
PERSONAL DISCLOSURE STATEMENT
For Calendar Year 2018
SECTION I. Personal Information
First Name: Ammu
Middle Name: (optional)
Last Name: Kirtane
School Address: 568 Piermont Road
City: Demarest
State: NJ
Zip:07627
Position: Board Member
School District or Charter School: Demarest School District
County: BERGEN
Spouse Information (if applicable)
First Name: Ajay
Middle Name:
Last Name: Kirtane
Name: Ammu Kirtane
RELATIVE DISCLOSURE STATEMENT
SECTION II. Relative Information
1. Is any person related to you, or related to you by marriage, employed by the school district or a charter school in which you hold office or are employed? If you are an employee of the NJSBA, is any person so related to you employed by any school district or charter school? If yes, please provide the information requested below. If no so certify.
I answer no to this question.
2. Are you or is any person related to you or related to you by marriage, a party to a contract with your school district or a charter school? If you are an employee of the NJSBA, are you or is any person so related to you, a party to a contract with any school district? If yes, please provide the information requested below. If no so certify.
I answer no to this question.
3. Do you or does any relative receive compensation from or have any interest in any business which is a party to a contract with the school district or charter school in which you hold office or are employed? If you are an employee of the NJSBA, do you or does any relative receive compensation from or hold an interest in any business which is a party to a contract with any district? If yes, provide the name of each business and if applicable, school district. If no so certify.
I answer no to this question.
Name: Ammu Kirtane
FINANCIAL DISCLOSURE STATEMENT
Based on your financial information for calendar year 2017
This Financial Disclosure Statement is required annually of all school officials in accordance with N.J.S.A. 18A:12-21 et seq., The School Ethics Act. The Act requires that information pertain to the preceding calendar year. The Financial Disclosure Statement must be filed by April 30th of each year or within 30 days of assuming office or position if newly elected or appointed. This statement is a public record. Before completing this statement, read all instructions and definitions.
SECTION III. Financial Information
If the information has changed from the preceding calendar year, it is recommended that the official also provide financial information which is current as of five days prior to the date of this filing.1. List the name and address of each source of income, earned or unearned, from which you or a member of your immediate family received in excess of $2,000. If a publicly traded security is the source of income, the security need not be reported unless you or a member of your immediate family has an interest in the business organization. If you are a district employee, be sure to list the district board or charter school as a source of income. Client fees received through a business need not be separately reported.
| Name of Source | Address of Source | Name of Recipient | Relationship |
|---|---|---|---|
| Columbia Presbyterian Medical Center | 630 West 168th Street, New York, NY 10032 | Ajay Kirtane | Spouse |
| Promedica International CME | 300 Carlsbad Village Dr. Suite 108A-326, Carlsbad, CA 92008 | Ajay Kirtane | Spouse |
| China Interventional Therapeutics | Beijing, China | Ajay Kirtane | Spouse |
| The Mount Sinai School of Medicine | One Gustave L. Levy Place, Box 1662, New York, NY 10029 | Ajay Kirtane | Spouse |
| American Medical Association | 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611 | Ajay Kirtane | Spouse |
| Cone Health | 1200 North Elm Street, Greensboro, NC 27401 | Ajay Kirtane | Spouse |
| Catholic Health Services of Long Island | 992 North Village Ave., Rockville Centre, NY 11570 | Ajay Kirtane | Spouse |
2. List the name and address of each source of fees/honorariums or gifts/reimbursements or prepaid expenses having an aggregate amount exceeding $250 from any single source, excluding relatives, received by you or an immediate family member. Be sure to list any reimbursement received from the district or charter school for such things as conference attendance, tuition/dues reimbursement, personal appearances, speeches, or writing.
| Name of Source | Address of Source | Name of Recipient | Relationship |
|---|---|---|---|
| Oregon Health & Science University Foundation | 1121 SW Salmon St #100, Portland, OR 97205 | Ajay Kirtane | Spouse |
| Society for Cardiovascular Angiography and Interventions | 1100 17th St NW #330, Washington, DC 20036 | Ajay Kirtane | Spouse |
| Leerink Partners | 299 Park Ave, New York, NY 10017 | Ajay Kirtane | Spouse |
| Axon Advisors | 1350 Avenue of the Americas, New York, NY 10019 | Ajay Kirtane | Spouse |
| Hartzler Interventional Cardiology Symposium | 4401 Wornall Rd, Kansas City, MO | Ajay Kirtane | Spouse |
| St. Lukes Mid America Heart Institute | 4401 Wornall Rd, Kansas City, MO 64111 | Ajay Kirtane | Spouse |
| Westchester Medical Center | 100 Woods Rd, Valhalla, NY 10595 | Ajay Kirtane | Spouse |
| University of Maryland Medical Center | 22. S. Greene St. Baltimore, MD 21201-1595 | Ajay Kirtane | Spouse |
| Cardiovascular Research Foundation | 1700 Broadway, New York, NY 10019 | Ajay Kirtane | Spouse |
| Numerof & Associates | Four CityPlace Drive, Suite 430 St. Louis, MO 63141-7062 | Ajay Kirtane | Spouse |
| Oppenheimer & Co., Inc | 85 Broad St, New York, NY 10004 | Ajay Kirtane | Spouse |
| Yale University | 333 Cedar Street New Haven, CT | Ajay Kirtane | Spouse |
| California Pacific Medical Center | Castro St & Duboce Ave, San Francisco, CA 94114 | Ajay Kirtane | Spouse |
| Northwell Health | Great Neck, NY | Ajay Kirtane | Spouse |
| American College of Cardiology | 2400 N St NW, Washington, DC 20037 | Ajay Kirtane | Spouse |
| Valley Hospital | 223 N. Van Dien Avenue Ridgewood, NJ 07450 | Ajay Kirtane | Spouse |
| SAI MedPartners | 4970 Demoss Rd #300 Reading, PA 19606 | Ajay Kirtane | Spouse |
| Maimonides Medical Center | 4802 10th Ave, Brooklyn, NY 11219 | Ajay Kirtane | Spouse |
| Sinomed | 2nd Floor, TEDA Biopharm Res, Building B, #5 4th St, TEDA, Tianjin, China | Ajay Kirtane | Spouse |
3. List the name and address of all business organizations in which you or a member of your immediate family held an interest during the preceding calendar year.
Not Applicable
SECTION IV. Certification
I understand that this certification constitutes my representation of the accuracy of its contents. I hereby certify that these disclosure statements contain no willful misstatement or omission of material fact and constitute a full disclosure with respect to all matters required by N.J.S.A. 18A:12-21 et seq. I am aware that if I fail to file a statement or if I file a statement containing information that I know to be false, I shall be subject to disciplinary action up to and including removal pursuant to N.J.S.A. 18A:12-29.
Certified by:
Ammu Kirtane
Date:01/25/2018