CONFLICT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7/1/2016 - 6/30/2017 Printed Name: MOUJL LY Check all covered companies and note average hours spent Organization per week. UofL Foundation (ULF) F7 UofL Housing (ULH) 1? University Holdings, Inc. l? The Nucleus Real Properties, Inc. (TNRP) UofL Real Estate Foundation,'lnc. (ULREF) Pediatric Medical Office . Building, lnc. (PMOB) Lauisville Medical Center Development Corporation Other Entity(s): 9age of 5 Average hours per week: ULF-OO7299 CONFLICT or INTEREST questionnmas FISCAL YEAR 7l1f2016 5/30/2017 Printed Name: MUM. When used below, the term "affiliated persons" include the foilowing: your spouse, domestic partner, child, mother, father, brother or sister; (ii) any corporation or organization of which you are a boa rd member, an officer, a partner, participate in management or are employed by, or are directly or indirectly, a debt holder or the beneficial Owner of any ciass of equity securities; and any trust or - other estate in which you have a substantial beneficial interest or as to which you serve as a trustee or in a similar capacity. When used below, the term ?business transactions" include, but are not limited to, contracts of sale, lease, license and performance of servites, whether initiated during a Covered Company's tax year or ongoing from a prior year. Business transactions also includejoint ventures in which either the profits or capital interest of the organization and of the interested person exceeds 10%. Business Transactions with Organization 1) Do you or an affiliated person conduct business with an organization? if ?Yes," describe your business transaction(s) with the organization and, specify which one if you checked multiple organizationis above: M3 8'ch nee? He. (grit-Wed Winn haw; Oat-L Web-3 2) Do you or an affiliated person own 35% of an entity (C?corporation, Sacorporation, Partnership, LLC or other entity type), directly or indirectiy, that conducts business With an organization? it ?Yes,? describe your business transactionls) with the organization and, specify which one if you checked multiple organizationb) above: Page 2 of 5 E5 M2. ULF-OO73OO CONFLICT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7/ 1] 2016 - BI30I2017 Printed Name: I Lives} 3) Do you or an affiliated person, in combination with other affiliated person(s own 35% of an entity (Gcorporation, S?corpOration, Partnership, LLC or other entity type), directly or indirectly, that conducts business with an organization? . if ?Yes,? describe your business transactionisiwith the organization and, specify which one if you checked. multiple organizationls) above: 4) Do you or an affiliated person, serve as an officer, director, trustee, or key employeeof an entity that does business with an organization? If "Yes," describe your business transaction(s) with the organization and, specify which one if you checked multiple organization(s) above: Sealer TL 5) Do you or an affiliated person 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 an organization? if ?Yes," describe your business transaction(s) with the organization and, specify which one if you checked multiple organizati0n{s) above: 6) Did you or an affiliated person receive a compensation payment in excess of $10,000 from an organization? If "Yes," explain and, specify which one if you checked multiple organizations above: I Page 3 of 5 XE Eli XE ULF-OO7301 CONFLICT or INTEREST QUESTIONNAIRE FISCAL YEAR 7/1/2016 6/30/2017 Printed Name: 7). Did you or an affiliated person receive grants or other assistance, including provision of goods, services, or use of facilities from an organization? Grants include scholarships, fellowships, internships, prizes, and awards. if "Yes," explain and, specify which one if you checked multiple organizations above: 8) Do you have 35% Control in an entity that received grants or other assistance, including provision of goods, services, or use of facilities, frOrn an organization? if "Yes," explain and, specify which one if you checked multiple organizations above: 9) Do you have any loans to or from an organization? if "Yes,? explainand, specify which one if you checked m?ultipie organizations above: 10) Are you aware of any excess benefit transactions to? report? An excess benefit transaction is where an organization is directiy or indirectly provided an economic benefit where the value of the benefit exceeds the vaiue of the consideration received by the organization. it ?Yes," explain and, specify which one if you checked multiple organizations above: Page 4 of 5 to LEE M2. '54: tile ULF-OO7302 CONFLICT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7} 1/ 2016 - 6/30/2017 Printed Name: 11) Are you or any affiliated persons a party to, or have an interest in, any f? - pending legal proceeding involving an organization? NO . .. if Yes," explain, and if an affiliated person is involved, the identity of that affiliated person and your relationship with that person: go A49 12) Are you aware of any other events, transactions, arrangements or other i? situations that have occurred or may occur in the future that you believe should be examined by an organization' 5 governing body? If "Yes," explain and, specify which one if you checked multiple organizations above: Signature: ?mg/?fab [u 1" Date Page 5 of5 ULF-OO7303