UNIVERSITY OF LOUISVILLE BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT YEAR 7/1/2015 6/30/2016 (Please return to Jake Beamer no later than October 8, 2015. You may scan and email (Jake.Beamer@louisville.edul or return via post: Jake Beamer, Office of the President, University of Louisville, Louisville, KY 40292 Organization UNIVERSITY OF LOUISVILLE Name of Individual EM Ipv I4 A #4 Signature MESA Business Transaction with UofL 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 includejoint ventures in which either the profits or capital interest ofthe 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 (C-corporation, S?corporation, Partnership, LLC or other entity type(s), directly or indirectly, that conducts business with the UofL? If "Yes,? describe your business transaction(s) with the UofL: Page 1 of4 EM mm DE family member, in combination with other "interested personls)" own 35% of an entity (C-corporation, S-corporation, Partnership, LLC or other entity type), directly or indirectly, that conducts business with the UofL? - If ?Yes,? describe your business transaction(s) with the UofL: Do you or a family member, serve as an officer, director, trustee, or key employee or an entity that does business with the UofL? If "Yes," describe your business transaction(s) with the UofL: 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? El 0 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. If "Yes," explain: 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 the UofL? If "Yes," explain: 9. Do you have any loans to or from the UofL? El 0 if "Yes," explain. 10. Are you aware of any excess benefit transactions to report? An excess bene?t transaction is where the UofL directly or indirectly provided an economic bene?t where the value of the benefit exceeds the value of the consideration received by the UofL. Page 3 of 4 If "Yes," explain. Business and Family Relationships 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. Page 4 of 4