UNIVERSITY OF LOUISVILLE BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT Year 7/1/2015 - 6/30/2016 Organization UNIVERSITY OF LOUISVILLE Name of Individual {If Signature Business Transaction with 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 profits or capital interest of the UofL and of the interested person exceeds 10%. I If "Yes,? describe your business transactionls} with the UofLfamily member own 35% of an entity (IE-corporation, S?corporation, Partnership, LLC or other entity typelsl, directly or indirectly, that conducts business with the UofL? I If "Yes," describe your business transactionls} with the UofL: Page 1 of II 3. Do you or a family member, in combination with other "interested personlsl" own 35% of an entity S?corporation, Partnership, LLC or other entity type], directly or indirectly, that conducts business with the UofL? I If "Yes," describe your business transaction{s} with the UofLfamily member, serve as an officer, director, trustee, or key employee or an entity that does business with the UofL? 4- If "Yes," describe your business transactionls} with the UofL: 5. 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? II If "Yes," describe your business transaction{s] with the UofL: Page 2 of 4 El ll 6. Did a family member receive a compensation payment in excess of $10,000 from the UofL? I 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. I it ?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? I if "Yes," explain: 9. Do you have any loans to or from the UofL? I If "Yes," explain. 10. Are you aware of any excess bene?t transactions to report? An excess benefit 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 EIEI l:l :l I If "Yes," explain. Business and Familv Relationships with Interested Persons 11. Do you have a famili,f 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 CI Beamer,Jake From: Sent: To: Subject: Beamer,Jake Friday, March 11, 2016 10:42 AM 'Prather, Jody MD' RE: BOT Conflict of Interest Forms 2015-16 No, I’ll just amend the form for the current year and include this email as a reference.  Thank you,    Jake      From: Prather, Jody MD [mailto:drprather@hmh.net]   Sent: Friday, March 11, 2016 7:55 AM  To: jake.beamer@louisville.edu  Subject: RE: BOT Conflict of Interest Forms 2015‐16    Jake,  I appreciate your help with this.  There are no changes from last year.   Do I need to sign and send something in?  JP    From: jake.beamer@louisville.edu [mailto:jake.beamer@louisville.edu] Sent: Thursday, March 10, 2016 5:11 PM To: Prather, Jody MD Subject: RE: BOT Conflict of Interest Forms 2015-16   Jody,     I’ve attached your form from last year for reference.  If you have no changes to it, I’m happy to amend it for the current  year.  Just let me know.  Thanks,    Jake    From: Beamer,Jake   Sent: Thursday, March 10, 2016 4:48 PM  To: 'Abrams, Marie' ; Allen, Victoria ; 'Steve Campbell'  ; Craig Greenberg ; Jody Prather   Cc: leslie.strohm@louisville.edu  Subject: BOT Conflict of Interest Forms 2015‐16    Trustees,     Our records indicate we have not received your Conflict of Interest Forms for 2015‐16.  If this is a mistake, we apologize,  but ask that you complete and return the attached form to me via email as soon as possible.   Thank you,    Jake    Jake Beamer  1 Boards Liaison  Assistant to the Chief of Staff  Office of the President  University of Louisville  502‐852‐5795 (o)  502‐494‐2637 (c)       2