CONFUCT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7/1/2016 - 6?30/2017 Printed Name: 6! when?, QQS-RA mi?) Average Check all covered companies and note average hours spent hours per Organization week: UofL i Foundation - (ULF) - - I Uo?. Housing (om) University I Holdings, Inc. The Nucleus r? . i Rea! Properties, UofLReai . i Estate Foundation, Inc. (ULREF) Pediatric - 1 Medical Of?ce Building, Inc. (PMOB) . . Medical Center Development Corporation Other Entiwis): .Pagelofs ULF-OO7314 CONFLICT OF INTEREST (1U FISCAL YEAR 7/1/2016 - 6/30/2017? Printed Name: C, MO i When used below, the term "affiliated persons" include the following: your spouse, domestic partner, chiid, mother, father, brother or sister; (ii) any corporation or organization of which you area board member, an officer, a partner, participate in management or are employed by, or are directly or indirectly, a debt holder or the bene?ciai owner of any class 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 services, whether initiated during 3 Covered Company?s tax year or ongoing from a prior year. Business transactions-also include Joint ventures in which either the profits or capital interest of the organization and of the interested person exceeds 10%. Business transactions with Organization X55. 1) Do you or an af?iiated person conduct 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: . 1?55 2) Do you or an af?liated person own 35% of an entity [ti-corporation, S~corporation, Partnership, LLC or other entity type), directly or indirectly, that conducts business with an organization? $413 If "Yes," describe your business transaction(s) with the organization and, specify which one if you checked multiple organization(s) abdve: Page 2 of 5 ULF-OO7315 CONFLICT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7/1/2016? Printed vii-lame: 6 Ct\ ?on? 3) Do you or an af?iiated person, in combination with other aft? hated person(s)" own 35% of an entity (ii-corporation, S-corporation, Partnership, LLC or other entity type), directly or indirectiy, that conducts business with an organization? if "Yes," describe your business transaction(sl with the organization and, specify which one if you checked multiple organizationis) above: 4) Do you or an affiliated person, serve as an of?cer, director, trustee, or key employee of 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 organizationis) above: im06,LLcperson 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 transactionis} with the organization and, specify which one if you checked multiple organization(s) above: 6) Did you or an af?liated person receive a compensation payment in excess of $10,000 from an organization? If "Yes," explain and,'specify which one if you checked muitlple organizations above: Page 71% ULF-OO7316 CONFLICT OF INTEREST QUESTIONNAIRE FISCAL YEAR 7/1/2016 - 630/2017 Printed Name: 6702130.?? affiliated person receive grants or other assistance, including provision of goods, services, or use of facilities from an organization? Grants include scholarships, feliowships, 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 from an organization? if f?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,? explain and, specify which one if you checked muitipie organizations above: 10) Are you aware of any excess bene?t transactions to report? An excess bene?t transaction is where an organization is directly or indirectly provided an economic benefit where the value of the bene?t exceeds the value of the consideration received by the organization. If "Yes," explain and, specify which one if you checked multiple organizations above: Page 4 of5 1155. ?g 15 ULF-OO7317 CONFLICT OF INTEREST QUESTIONNAIRE YEAR 7! 1/2016 - Par: c- Qua-mm 11) Are you or any af?liated persons a party to, or have an interest in, any pending legal proceeding involving an organization? if Yes," explain, and if an affiliated person is involved, the identity of that af?liated person and your relationship with that person: 12) Are you aware of any other events, transactions, arrangements or other situations that have occurred or mayr occur in the future that you believe should be examined by an organization's governing body? if ?Yes," explain and, specify which one if you checked multiple organizations above: Signature: #5 LQW Date: L?f l?3 Page 5 of 5 Eli-S. X125. 7