SCHEDULE 2: ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE

It is the policy of PHEO PARA ALLIANCE (the “Corporation”) that prompt disclosure be made of any actual or potential conflict of interest as soon as an individual becomes aware of such conflict. In furtherance of this policy, please complete and sign this questionnaire as an affirmation of the existence (whether or not previously disclosed) or nonexistence of any conflicts of interest. If any statement below might reasonably be applicable to you at any time from ______________ to the present, please mark the "Yes" column, and give an explanation of the conflict of interest below. Please review the attached Conflict of Interest Policy for any term that you do not understand or that is defined therein.

    I or a related party hold, directly or indirectly, a position of ownership, control, or financial interest in an outside entity from which the Corporation or its affiliate does business or otherwise has dealings.
    I or a related party render or have rendered directive, managerial, or consultative services to, or am or have been an employee of, any outside entity that does business or otherwise has dealings with the Corporation or its affiliate.
    I or a related party have accepted gifts, loans or benefits (totaling more than $25), during the past year, from an outside entity that does, or is seeking to do business with the Corporation or its affiliate.
    I have participated in management decisions concerning transactions that could personally benefit me or a related party.
  • If yes, please give full details below.
    I or a related party have been indebted to the Corporation or its affiliate at some time during the above stated period. (If yes, please note below the nature, date, terms, and amount of indebtedness.)
    The Corporation or its affiliate has been indebted to me or a related party at some time during the above stated period. (If yes, please note below the nature, date, terms, and amount of indebtedness.)
    I or a related party own an interest in a business in which the Corporation or its affiliate holds an interest that reasonably could affect the value of my interest or that of a related party’s.
    I or a related party have invested in a non-publicly traded business in which a Decision Maker of the Corporation or its affiliate either owns more than 5% of the voting stock, or in any way exercises control of the business.
    I or a related party have obtained an interest in real estate, non-publicly traded securities or other property that the Corporation or its affiliate is considering, or may reasonably consider buying or leasing.
    I or a related party am currently engaged in, or have been engaged in the last five years, in any transaction in which an economic benefit was provided to me or a related party, directly or indirectly, and the value of the economic benefit provided exceeded the value of consideration received by the Corporation or its affiliate (including the value of services performed) for providing such benefit.
    I have used the Corporation or its affiliate’s personnel, equipment, supplies, good will, or staff time for personal affairs or activities other than the Corporation or its affiliate-approved programs and purposes.
  • Please provide further explanation of any YES answers below. Also, include information on any other material conflicts of interest or related party transactions of which you are aware.
  • This field is for validation purposes and should be left unchanged.