OF LOUISVILLE BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT YEAR 7] 112015 5/39/2911? Organization UNIVERSITY OF LOUISVILLE Name of Individual n/I/Jr?m Signatu re jut Business Transaction with UofL 1. Other than an empioyment reiationship, 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 ongomg from a prior year. Business transactions also include joint ventures in which either the profits or capital interest of the Unit and of the interested person exceeds 10%. i If ?Yes,? ?escrihe your business transactionis) with the UofL: 2. Do you or a family member own 35% of an entity {EC?corporation, S-corporation, Partnership, LLC or other entity type(s), directly or indirectly, that conducts business with the Uoft? a if "Yes,? describe yorur business transactionis) with the UofL: Page 1- cf 4 fig 3. Do you or a family member, in combination with other ?interested personlsl? own 35% of an entity {C?cmporation, S-corporation, Partnership, LLC or other entity type), directly or indirectly. that conducts business with the UofL? If "Yes," describe your business transactionis) with the :10sz 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 business transactionis) with the ?10sz 5. Do you or a family member serve as a partner, member, or shareholder of an entity {with ownership interest in excess of 5% of a partnership or professional corporation} that conducts business with the UofL? If "Yes," describe your business transaction(s) with the UofL: Page 2 of 4 6. Did a family member receive a compensation payment in excess of $10,000 from the UofL? a if "Yes," explain: 7. Did you or a family member receive grants or other assistance, including provision of goods, sewrces, or use of facilities from the UofL? Grants inctude scholarships, fellowships, internships, prizes, and awards. I if ?Yes," explain: 8. Do you have 35% control in an entity that ?ac?'iiadg'rahi? or other brows-ion of goods, services, or use of faculties from the UofL? 0 If "Yes," explain: 9. Do you have any loans to or from the UofL? - if "Yes," explain. 10. Are you aware of any excess bene?t transactions to report? An excess bene?t transaction is where the UofL directly or indirectly provided an economic benefit where the value of the benefit exceeds the value of the consideration received by the UofL. Page 3 ref-1 a If "Yes,? expiain. Business and Family Reiationships with Interested Persons 11. Do you have a family or business reiationship with any other of?cer, director, trustee, or key employee of the UofL? For each famib,r and business relationship, identify the persons and indicate family or business reiations?nip. Page 4 of 4