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Page 1 of 4 Print Statement Go to Main Intro Go to Page 2 of 4 LEGISLATOR'S FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2019 NOTE: Before completing this Disclosure Statement, please carefully read the enclosed instructions. If additional space is needed, please duplicate this form as necessary and staple all pages together. A completed form must contain an original signature or a self-signed digital certificate on page 4; a facsimile, photocopy or stamp signature is not acceptable. Questions should be directed to Legislative Counsel at (609) 847-3901. The completed disclosure form is due May 15, 2020 and should be sent to: Joint Legislative Committee on Ethical Standards, 2nd Floor, State House Annex, Room 210, PO Box 068, Trenton, New Jersey 08625-0068. PRINT NAME Holly T Schepisi CHECK APPROPRIATE HOUSE: Senate General Assembly ■ Provide the following information for yourself, your spouse and minor children (unless otherwise indicated) for calendar year 2019. Please note that a minor child is a child under the age of 18. For each entry, mark the box of the appropriate recipient. When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000 - $24,999.99; 3=$25,000 - $49,999.99; 4=$50,000 or more. EARNED INCOME: List the name, address and amount for each source of earned income. (Earned income includes salaries, bonuses, royalties, commissions, profit sharing, fees, pensions and Social Security.) I. Name of Employer Address of Employer Amount Code 1 2 3 4 Self Spouse Child Holy Name Medical Center 718 Teaneck Road, Teaneck, NJ ■ ■ (clear) 1) Huntington Bailey, LLP 373 Kinderkamack Road, Westwood, NJ 07675 ■ ■ (clear) 2) Schepisi & Associates, LLC 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear) 3) State of NJ Trenton, NJ ■ ■ (clear) 4) Carnelian Developers, LLC 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear) 5) See page 1A of 4 for Additional Earned Income (delete page 1A) UNEARNED INCOME: List the name, address and amount for each source of unearned income. (Unearned income includes rents, dividends and income from investments, trusts and estates.) II. A. RENTS Property Address Tenant Name Amount Code 1 2 3 4 Self Spouse Child Bergen Concepts, LLC Waldwick, NJ ■ ■ (clear) 1) (clear) 2) (clear) 3) (clear) 4) Add Click button on left to add additional UNEARNED INCOME (RENTS).
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Print StatementGo to Main Intro Go to Page 2 of 4
LEGISLATOR'S FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2019
NOTE: Before completing this Disclosure Statement, please carefully read the enclosed instructions. If additional space is needed, please duplicate this form as necessary and staple all pages together. A completed form must contain an original signature or a self-signed digital certificate on page 4; a facsimile, photocopy or stamp signature is not acceptable. Questions should be directed to Legislative Counsel at (609) 847-3901. The completed disclosure form is due May 15, 2020 and should be sent to: Joint Legislative Committee on Ethical Standards, 2nd Floor, State House Annex, Room 210, PO Box 068, Trenton, New Jersey 08625-0068.
PRINT NAMEHolly T Schepisi CHECK APPROPRIATE HOUSE: Senate General Assembly■
Provide the following information for yourself, your spouse and minor children (unless otherwise indicated) for calendar year 2019. Please note that a minor child is a child under the age of 18. For each entry, mark the box of the appropriate recipient. When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000 - $24,999.99; 3=$25,000 - $49,999.99; 4=$50,000 or more.
EARNED INCOME: List the name, address and amount for each source of earned income. (Earned income includes salaries, bonuses, royalties, commissions, profit sharing, fees, pensions and Social Security.)
I.
Name of Employer Address of EmployerAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
Holy Name Medical Center 718 Teaneck Road, Teaneck, NJ ■ ■ (clear)1)Huntington Bailey, LLP 373 Kinderkamack Road, Westwood, NJ 07675 ■ ■ (clear)2)Schepisi & Associates, LLC 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear)3)State of NJ Trenton, NJ ■ ■ (clear)4)Carnelian Developers, LLC 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear)5)
See page 1A of 4 for Additional Earned Income (delete page 1A)
UNEARNED INCOME: List the name, address and amount for each source of unearned income. (Unearned income includes rents, dividends and income from investments, trusts and estates.)
II.
A. RENTS
Property Address Tenant NameAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
Bergen Concepts, LLC Waldwick, NJ ■ ■ (clear)1)(clear)2)(clear)3)(clear)4)
Add Click button on left to add additional UNEARNED INCOME (RENTS).
ADDITIONAL EARNED INCOME Return to Section I
EARNED INCOME: List the name, address and amount for each source of earned income. (Earned income includes salaries, bonuses, royalties, commissions, profit sharing, fees, pensions and Social Security.)
I.
Name of Employer Address of EmployerAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000-$24,999.99; 3=$25,000-$49,999.99; 4=$50,000 or more.
Bergen Concepts, LLC Waldwick, NJ ■ ■ (clear)6)Elevated Structures, LLC Old Tappan, NJ ■ ■ (clear)7)Orange Flood Control, LLC Old Tappan, NJ ■ ■ (clear)8)
(clear)9)(clear)10)(clear)11)(clear)12)(clear)13)(clear)14)(clear)15)(clear)16)(clear)17)(clear)18)(clear)19)(clear)20)(clear)21)(clear)22)(clear)23)(clear)24)(clear)25)(clear)26)(clear)27)(clear)28)(clear)29)(clear)30)
Page 1A of 4: Additional Earned Income
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When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000-$24,999.99; 3=$25,000-$49,999.99; 4=$50,000 or more.B. DIVIDENDS
Name AddressAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
TD Bank Westwood, NJ ■ ■■ (clear)1)Prudential Life ■ ■ (clear)2)Allianz Life Insurance Pittsburgh, PA ■ ■ (clear)3)TD Ameritrade Paramus, NJ ■ ■■ (clear)4)
Add Click button on left to add additional UNEARNED INCOME (DIVIDENDS).
C. INCOME from investments, trusts and estates (including capital gains).
Name AddressAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
Valley National Bank UTMA River Vale, NJ ■ ■ (clear)1)Merrill Lynch Paramus, NJ ■ ■ (clear)2)ConnectOne Bank Englewood Cliffs, NJ ■ ■ (clear)3)TD Ameritrade Paramus, NJ ■ ■■ (clear)4)
See page 2B of 4 for Additional Unearned Income (INCOME from investments, trusts and estates (including capital gains)) (delete page 2B)
Name & Nature of Honorarium or Fee AddressAmount
Code1 2 3 4
Self
Spou
se
HONORARIA and FEES: List the name, address, nature and amount for each source of honorarium or fee received by you or your spouse for personal appearances, speeches or writings.
III.
(clear)1)(clear)2)(clear)3)(clear)4)
Add Click button on left to add additional HONORARIA and FEES.
REIMBURSEMENTS or PREPAID EXPENSES for TRAVEL, LODGING or SUBSISTENCE: List the name, address, nature and amount for each source of reimbursement or prepaid expense and indicate whether source is a profit (P), nonprofit (N), or governmental (G) entity.
IV.
Name & Nature of Reimbursement or Prepaid Expense AddressAmount
Code1 2 3 4
Self
Spou
se
Chi
ld Check Source
P N GCampaign Expenses - EFO Schepisi for Assembly 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear)1) ■
Business Expenses - Elevated Structures, LLC Old Tappan, NJ ■ ■ (clear)2) ■
Business Expenses - Schepisi & Associates, LLC 754 Tiffany Avenue, River Vale, NJ 07675 ■ ■ (clear)3) ■
Business Expenses - SB One Bank ■ ■ (clear)4) ■
Add Click button on left to add additional REIMBURSEMENTS or PREPAID EXPENSES for TRAVEL, LODGING or SUBSISTENCE.
ADDITIONAL UNEARNED INCOME Return to Section II-C(INCOME from investments, trusts and estates (including capital gains))
C. INCOME from investments, trusts and estates (including capital gains).
Name AddressAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000-$24,999.99; 3=$25,000-$49,999.99; 4=$50,000 or more.
Renco SR Realty Englewood Cliffs, NJ ■ ■ (clear)5)Homaro Inc. Englewood Cliffs, NJ ■ ■ (clear)6)Estate of Anthony Schepisi Englewood Cliffs, NJ ■ ■ (clear)7)Bergen Concepts, LLC Waldwick, NJ ■ ■ (clear)8)Valley National Bank River Vale, NJ ■ ■■ (clear)9)SB One Bank Oradell, NJ ■ ■■ (clear)10)Prudential ■ ■ (clear)11)TD Bank Westwood, NJ ■ ■■ (clear)12)
(clear)13)(clear)14)(clear)15)(clear)16)(clear)17)(clear)18)(clear)19)(clear)20)(clear)21)(clear)22)(clear)23)(clear)24)(clear)25)(clear)26)(clear)27)(clear)28)(clear)29)(clear)30)
Page 2B of 4: Additional Unearned Income (INCOME from investments, trusts and estates (including capital gains))
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GIFTS: List the name, address, nature and amount for each source of gift to you, your spouse or minor child from a named donor connected to the legislative process.
V.
Name & Nature of Gift AddressAmount
Code1 2 3 4
Self
Spou
se
Chi
ld
When an amount is requested, use the following numerical code: 1=less than $10,000; 2=$10,000-$24,999.99; 3=$25,000-$49,999.99; 4=$50,000 or more.
(clear)1)(clear)2)(clear)3)(clear)4)
Add Click button on left to add additional GIFTS.
LIABILITIES: List the name and address of each creditor for you or your spouse and the nature and amount of each liability except for liabilities which are: (a) less than $15,000 and owed to a relative; (b) less than $3,000 and owed to any other person; (c) loans secured by a personal motor vehicle or household furniture or appliances; or (d) revolving charge accounts.
VI.
Name & Nature of Liability AddressAmount
Code1 2 3 4
Self
Spou
se
Valley National Bank - Primary Mortgage River Vale, NJ ■ ■■ (clear)1)TD Bank - Home Equity Loan Westwood, NJ ■ ■■ (clear)2)
(clear)3)(clear)4)
Add Click button on left to add additional LIABILITIES.
FORGIVEN LIABILITIES: List the name and address of each former creditor for you or your spouse and the nature and amount of each forgiven liability which would have been required to be reported pursuant to VI above had it not been forgiven.
VII.
Name & Nature of Forgiven Liability AddressAmount
Code1 2 3 4
Self
Spou
se
(clear)1)(clear)2)(clear)3)(clear)4)
Add Click button on left to add additional FORGIVEN LIABILITIES.
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BUSINESS ORGANIZATIONS: List the name and address of all business organizations in which you or your spouse held an interest.VIII.
Name Address Self
Spou
se
Schepisi & Associates, LLC River Vale, NJ ■ (clear)1)Carnelian Developers, LLC River Vale, NJ ■■ (clear)2)Renco SR Realty, Inc. Englewood Cliffs, NJ ■ (clear)3)Homaro, Inc. Englewood Cliffs, NJ ■ (clear)4)
See page 4A of 4 for Additional Business Organizations (delete page 4A)
OFFICES, TRUSTEESHIPS, OR DIRECTORSHIPS: List the title of each position held by you or your spouse in any firm, corporation, association, partnership or business and the name and address of the entity in which the position was held.
IX.
Position Held Name & Address of Entity Self
Spou
se
Managing Member Schepisi & Associates, LLC, River Vale, NJ ■ (clear)1)Managing Member Carnelian Developers, LLC ■ (clear)2)Trustee & President NJ Chapter of Fordham Law Alumni Association ■ (clear)3)Trustee Bergen Community College Foundation ■ (clear)4)
Add Click button on left to add additional OFFICES, TRUSTEESHIPS, OR DIRECTORSHIPS.
REAL ESTATE: Provide the address and a brief description for all real property in New Jersey in which you, your spouse, or minor child held an interest.
X.
Property Address Description of Property Self
Spou
se
Chi
ld
754 Tiffany Avenue, River Vale, NJ 07675 Primary Residence ■■ (clear)1)Renco SR Realty owns certain properties in Saddle River, NJ Buildable lots ■ (clear)2)Homaro owns an interest in Tojo Realty which owns property in Hillsdale, NJ Restaurant and two apartments ■ (clear)3)I am the beneficiary of a family trust that holds interests in real property in Holmdel, Saddle River, Hillsdale and Englewood Cliffs, NJ ■ (clear)4)
Add Click button on left to add additional REAL ESTATE.
I certify that the above information is correct and complete to the best of my knowledge. (In addition to this statement, you have a continuing obligation to report any termination or assumption of public employment of yourself or your spouse within 30 days, which report shall be an addendum to this statement.)
Signature of Member or Self-signed digital certificate Submit via Email
Date
ADDITIONAL BUSINESS ORGANIZATIONS Return to Section VIII
BUSINESS ORGANIZATIONS: List the name and address of all business organizations in which you or your spouse held an interest.VIII.
Name Address Self
Spou
se
Bergen Concepts, LLC Waldwick, NJ ■ (clear)5)VidaFlo NJ, LLC Hoboken, NJ ■ (clear)6)
(clear)7)(clear)8)(clear)9)(clear)10)(clear)11)(clear)12)(clear)13)(clear)14)(clear)15)(clear)16)(clear)17)(clear)18)(clear)19)(clear)20)(clear)21)(clear)22)(clear)23)(clear)24)(clear)25)(clear)26)(clear)27)(clear)28)(clear)29)(clear)30)
Page 4A of 4: Additional Business Organizations
