UNIVERSITY OF BOARD OF TRUSTEES CONFLICT OF INTEREST STATEMENT
YEAR 7/1/2015 - 6/30/2016

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Organization OF LOUISVILLE

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Name of individual .. 205 f? 3 <5 ?3 N?w 

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Business Transaction with Uo?.
1. Other than an empioyment reiationship, do you or a family member conduct business with the UofL?
Business transactions inciude, but are not limited to contracts of sale, lease, iicense and performance
of services, whether initiated during the Uofi. 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%.

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

2. Do you or a famiiy 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 Uoit?

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

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3.

Do you or a famiiy member, in combination with other -"interested person(s)? own 35% ofah
entity (ti-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 Uoft?

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

Do you or a famiiy member serve as a partner, member, or shareholder of an entity (with
ownership interest in excess of 5% of a partnership or professionai corporation) that conducts
business with the UofL?

if ?Yes,? describe your business transaction(s) with the Uoft:

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

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 inciude schoiarships, feilowships, internships,
prizes, and awards. 

If "Yes," expiain:

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," expiain:

9. Do you have any loans to or from the UofL? 

if ?Yes," explain.

10. Are you aware of any excess benefit transactions to report? An excess benefit transaction is 
where the UofL directly or indirectiy provided an economic benefit where the vaiue oftbe
benefit 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 officer, director, trustee, or key 
empioyee of the UofL?

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

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