CONFLICT .OF INTEREST QUESTIONNAIRE .. 5/30/2017 Printed Name: Organization UofL Foundation (ULF) Uofl. Housing (ULH) University Holdings, Inc.- tum.) The Nucleus Rea! Propert_ies,_ lhc, (TNRP) Real. Estate Inc. Pediatric M?dicai Office Building,_lnc_. (PMQB) L?uisville Medica! Center Development (me99) Other Entit?s): M106 73/ 124 Check at! covared companies and note average'hours spent hears per I week: r. r. Page 1 of5 ULF-OO7329 CONFLICT or INTEREST QUESTIONNAIRE - 6/30/2017 tr: 1 Woe? UM When used below, the te'ri'n ?af?liated persons? include the following: your spouse, domestic partner, child, mother, father, brother or sister; (ii) any corporation or organizaticin ofwhich you area board member, an officer, a partner, partitipate in management or are employed by, or are directly or indirectly, a debt holder or the beneficial owner of any ciassof equity securities; and any trust or other estate in Which you have a substantial bene?cial interest or as to which you serve as a trustee or in a similar capacity. When used beiow, the term "business transactions" include, but are not limited to, centracits of sale, lease, licenseand performance of services, whether initiated during a Covered Company's tax Year-or ongoing from a prior year. Business transactions aiso inciude joint ventures in which either the profits "or capital interest "of the. organiZation and of the-interested person? exceeds 10%. BUSiness Transactions with .Qrganization 1] Do you or an af?liated person conduct business with an organization? If i"res," describe your business transactionis] with the organization and, specify which one if you checked multiple o'rganizatiO'n(s) above: 2) DO. you Oran affiliated person own 35% of an entity (chorporation, S-corporation, Partnership, LLC .or other entity type), directiy or indirectly, that conducts business with an organization? if ?Yes," descrihevoiir business transaction($i with the organization and, specify which one if you checked muitiple organization(s) above: Page 2 of 5 LES ULF-OO733O con?ict OF INTEREST QUESTIONNAIRE 7/1/2016 - 6/30/2017 79M 3) Do you or an af?liated person, in combination with other af?iiated person(s)" own 35% of an entity (CZ?corporation, S-corporation, Partnership, or other entity type), directly or indirectly, that conducts business with an organization? If "Yes," describe your bLiSiness transa.ction(s.) with the organization and, specify which one if you checked muitiple organiza?tioniS) above: 4} Doyou or an af?liated person, serve as an officer, director, trustee, or key employee of an entity that does business with an organization? 1 If ?Yes," describe your business transactionis) with the organization and, specify which one if you Checked muitipie organization(s) above: 5.) Do you or an af?liated person serve as a partner, member, or shatehoider of an entity (with -'Oani2rShip interest in excess of 5% of a partnership or professional corporation) that Conducts buSiness' with an Organization? if describe your business transaction(s) with the organization and, specify which one if you checked multiple Organizatitmis) above: Did you .or an affiliated person receive a compensation payment in excess'oi? $10,000 from an organization? If ?Yes," explain and, specify which one if YOU. Cheeked multiple organizations. above: Page 3 of 5 Lease o, 1g ULF-OO7331 CONFLICT OF QUESTIONNAIRE FISCAL YEAR 7/112015 - '6/3012017? 7) Did you or ?an af?liated 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 from 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 eXplain and, specify which one if you checked multiple organizations abcwe: 10) Are you aWare of any excess bene?t transactions to report? An excess bene?t transaCtion is where an organization is directly or'ind'irectlv provided an eponomicbene?t Where the value of the bene?t-exceeds the value of the consideration received by the organization. 'lf ?Yes," explain and, specify which one if you checked multiple organizations above: Page 4 of 5 32:3 res ENE game 1 assoc. rs? Xe ULF-OO7332 OF INTEREST QU ESTIONNMRE FISCAL YEAR 7/1/2016 5/30/2017 P3333 V2 Nag WRAP 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?iiated person and your relationship with that person: 12) Are you aware of am,I other events, transactions, arrangements or other situations that have occurred 0r may 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 organizationsabove: Signature: ?m I Date; .0. Page 5 of 5 YES. NO ?No ULF-OO7333 i 1.