UNIVERSITY OF LOUISVILLE BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT YEAR tit/201s Gf30l2016 {Please return to Joke Beams-r no later than October 3 2015. You may scam and email (ma'eamer?ouisyill?) or return via post: Joke Reamer, Office of the President, University of Lauisvilie, KY 40292 Organization UNIVERSITY OF LOUISVILLE Name of Individual ?0359er (Mn-1'1 5 Signature [fa?3&1 if 0 Lay??1 I: 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. transactions also include joint ventures in which either the profits or capital interest of the UofL and of the interested person exceeds 10%. If "Yes," de5cribe your business transactionlsl with the UofL: my i-excricnlr teem. cruciate we? {we MQILMQT *family member own 35% of an entity (Cncorporation. Secorporation, Partnership, LLC or other entity typels}, directly or indirectly, that conducts business with the UofL? I If "Yes,? describe your business transactionls) with the UofL: Page 1 of 4 Elev-d seemed BEBE-EEL-BLZ BPIBI resale SIBZIBEIXEIEI 3. Do you or a family member, in combination with other "interested personis)? own 35% of an entity (it-corporation, Sjcorpnration, Partnership, LLC brother entity type), directly or indirectly, that conducts business with the UofL? I if "Yes," describe your business trensactionls) with the UefL: 4. Do you or a family member, serve as an of?cen director, trustee, or key employee or an entity that does business with the UofL? Ir lf ?Yes, describe your business trensectlonis) with the UofL: Carnot (12.family member serve as a perms-r, member, or shareholder of an entityr (with ownership interest in excess of 5% of a partnership or professional corporation) that conducts business with the UofL? . If ?Yes." describe your business transactionis) with the LlofL: Page 2 of 4 PBIEB BEND EntiEiI EIBEHEBXBB I If "Yes," explain. 6. Did a family member receive a compensation payment in exces: of $10,000 from the UofL? [j M- i If "Yes,? explain: 7. Did you or a family member receive grants or other assistance, including provision of goods, services, or use of facilitles from the UofL? Grants include scholarships, fellowships, internships, IE prizes, and awards. in lf"Yes"explain: 30A it a (Lott-Q4 (Mm/?aij 6 8. Do you have 35% control in an entity that received grants or other assistance, including provision FE 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. where the UofL directly or indirectly provided an economic bene?t where the value of the 10. Are you aware of any excess benefit transactions to report? An excess benefit transaction is bene?t exceeds the value of the consideration received by the UofL. Page 3 of 4 BEND EnviEiI