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
(.lake.Beamer@louisville.edu} or return via post: Jake Beamer, O?ice of the President,
University of Louisville, Louisville, KY 40292

Organization UNIVERSITY OF LOUISVILLE
Name of Individual Rug-1iSignature A. ?st. M'K?1tm 
lb! xx? ??res: 

Business Transaction with UofL u?

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 include joint ventures in which either the pro?ts or capital interest of the UofL and

of the interested person exceeds 10%.

it ?Yes,? describe your business transaction(s) with the UofL:

2. Do you or a family member own 35% of an entity (ti-corporation, corporation, Partnership, LLC or

other entity type(s), directly or indirectly, that conducts business with the UofL?

1: If "Yes,? describe your business transaction(s) with the UofL:

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3. Do you or a family member, in combination with other "interested person(s)" 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:

4. Do you or a family member, serve as an of?cer, director, trustee, or key employee or an entity 
that does business with the UofL?

- If "Yes,? describe your business transactionls) with the UofL:

ownership interest in excess of 5% of a partnership or professional corporation) that conducts

5. Do you or a family member serve as a partner, member, or shareholder of an entity (with El 
business with the UofL?

I If ?Yes,? describe your business transaction(s) with the UofL:

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6. Did a family member receive a compensation payment in excess of $10,000 from the UofL? 

- if "Yes," explain:

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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. a

I 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 Uoft? E:

if explain.

10. Are you aware of any excess bene?t transactions to report? An excess bene?t transaction is [x
where the UofL directly or indirectly provided an economic bene?t where the value of the
bene?t exceeds the value of the consideration received by the UofL.

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- If "Yes," explain.

Business and Family Relationships with Interested Persons

11. Do you have a family or business relationship with any other of?cer, director, trustee, or key 
employee of the UofL?

For each family and business relationship, identify the persons and indicate family or business
relationship.

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