UNIVERSITY OF LOUISVILLE BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT

YEAR 7/1/2016 - 6/30/2017

Organization

 

UNIVERSITY OF LOUISVILLE



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Name of individual  Ci 

Signature 


Business Transaction with 

1.- Other than an employment relationship,



do you or a family member conduct business with the UofL?

Business transactions include, but are not limited to'contracts of sale, lease, license and performance
of services, whether initiated during the UofL tax year or ongoing from a prior year. Business
transactions also include joint ventures in which either the profits or capital interest of the UofL and

of the interested person exceeds 10%.

if ?Yes,? describe your business transaction(s) with the UofL:

2. Do you or a family member own 35% of an entity {ti-corporation, S-corporation, Partnership, LLC or
other entity typeIs), directly or indirectly, that conducts business with the UofL?

- If "Yes," describe your business

transaction(s) with the UofL:

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3. Do you are family member, in combination with other "interested personis)" own 35% of an 
entity (C?corporation, S-corporation, Partnership, LLC or otherentity type), directly or indirectly,
that conducts business with the UofL? 

El

0 if "Yes," describe your business transactionis) with the UofL:

4. Do you or a family member, serve as an of?cer, director, trustee, or key employee or an entity 
that does business with the UofL?

if "Yes," describe your bdsiness transactionis) with the UofL:

5. Do you or a family member serve as a partner, member, or shareholder of an entity (with? 
ownership interest in access of 5% of a partnership or professional corporation) that conducts
business with the UofL? i 

if ?Yes,? describe your business transactionis) with the UofL:

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6. Did a family member receive a compensation payment in excess of $10,000 from the UofL?

- If "Yes," explain:

7. Did you or a family member receive grants or other assistance, including provision of goods,
services, or use of facilities from the UofL? Grants include scholarships, fellowships, internships,
prizes, and awards.

0. if "Yes," explain:

8. Do you have 35% control in an entity that received grants or other assistance, inciuding provision
of goods, services, or use of facilities from the UofL?

If "Yes," explain:

9. Do you have any loans to or from the UofL?

If "Yes," explain.

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Yes No

10. Are you aware of any excess bene?t transactions to report? An excess benefit transaction is 
where the UofL directly or indirectly provided an economic bene?t where the value of the
bene?t exceeds the value of the consideration received by the UofL.

- if "Yes," explain.

Business and Family Relationshigs with Interested Persons

11. Do you have a family or business relationship with any other officer, director, trustee, or key 
employee of the UofL?

For each family and business relationship, identify the persons and indicate family or business
relationship-

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