Conflicts of Interest Policy and IRS Form 990 Disclosure Questionnaire

Respond to all questions for the period July 1, 2023 - to the date you complete and sign this questionnaire

For Current Trustees; Non-Trustees Serving on Board Committees; Former Trustees Who Served on the Board During the Previous Five (5) Years; and University Officers Who Hold Elected Positions on the Board of Trustees.

INSTRUCTIONS:

This combined questionnaire is being sent to you to assist Xavier University in complying with the reporting requirements required in the filing of Form 990 - Return of Organization Exempt from Income Tax and in complying with the Xavier University Board of Trustees Conflicts of Interest Policy.  Form 990 and the COI require the disclosure of information relating to transactions between certain persons and Xavier University or any of its related organizations.  Your completion of this form is important to allow Xavier University to accurately and completely accomplish its annual tax filing, governance and compliance requirements.  Please answer the questions and provide descriptions as needed. Exhibit A is to assist you in completing question number 6 regarding family and business relationships. Exhibit B provides definitions of key terms.

Please complete the questionnaire and submit it by September 20, 2024.

NOTES:

• This form includes the 12 months ending June 30, 2024 as well as matters that have arisen since then up to the date you complete and sign this questionnaire.
   
• "Xavier" or "University" refers to Xavier University and its related organizations listed in the instructions, most of which solely hold title to real property.
   
• "Family Members" means your spouse, ancestors, brothers and sisters (whether whole or half blood), children (whether natural or adopted), grandchildren, great grandchildren, and spouses of brothers, sisters, children, grandchildren, and great grandchildren and any other relative residing in your household.