# BAU FARM FOUNDATION
## Annual Conflict-of-Interest Disclosure Form

*To be completed annually by each director, officer, committee member with board-delegated powers, and key employee, and whenever a new interest arises. Return the signed form to the Secretary within 30 days of Board election, appointment, or hire, and annually thereafter no later than __________ (date).*

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### Section 1 — Person Completing This Form

| Field | Response |
|---|---|
| Full legal name | __________ |
| Position(s) with the Foundation | ☐ Director  ☐ Officer (title: ______)  ☐ Committee: ______  ☐ Key employee (title: ______) |
| Date of election / appointment / hire | __________ |
| Reporting period | Calendar year 20__ |
| Email | __________ |
| Phone | __________ |

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### Section 2 — Definitions (summary)

- **Financial Interest** — direct or indirect ownership, investment, or compensation interest (or potential interest) in any entity or individual with which the Foundation has or is considering a transaction, or a compensation arrangement with the Foundation itself.
- **Family** — spouse or domestic partner, ancestors, children, grandchildren, great-grandchildren, siblings (whole or half), and spouses of any of them.
- **Interested Person** — anyone with a Financial Interest.

Full definitions appear in Article II of the Conflict-of-Interest Policy.

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### Section 3 — Disclosures

Answer each question. If "Yes," attach details (entity, relationship, approximate value or ownership %, nature of dealings with the Foundation, date range).

**A. Ownership / investment interests.**
Do you or a Family member own, in whole or in part, or hold an investment (>5%) in any business, farm, cooperative, vendor, contractor, landlord, or other entity that transacts, or reasonably could transact, with the Foundation?
☐ No  ☐ Yes — describe: __________

**B. Compensation from the Foundation.**
Do you (or a Family member) receive, or expect to receive, compensation from the Foundation as an employee, independent contractor, consultant, or grantee?
☐ No  ☐ Yes — describe: __________

**C. Compensation from entities dealing with the Foundation.**
Do you (or a Family member) receive compensation from any organization, vendor, or grantee of the Foundation?
☐ No  ☐ Yes — describe: __________

**D. Board or advisory service elsewhere.**
Do you (or a Family member) serve as a director, officer, trustee, advisory-board member, partner, or employee of any organization that transacts, competes, or shares a mission with the Foundation (including BAU Farm Intelligence LLC, Business As Usual LLC, or other affiliated entities)?
☐ No  ☐ Yes — describe: __________

**E. Gifts, favors, or entertainment.**
In the past 12 months, have you (or a Family member) accepted from any person or entity doing business with the Foundation any gift, favor, or entertainment with a fair market value exceeding **$100** (aggregated per source)?
☐ No  ☐ Yes — describe: __________

**F. Loans and guarantees.**
Do you (or a Family member) have any outstanding loan to or from, or guarantee to or from, the Foundation or any entity described in A–D?
☐ No  ☐ Yes — describe: __________

**G. Grant applications.**
Are you (or a Family member) an applicant for, or beneficiary of, any grant, scholarship, contract, or program of the Foundation?
☐ No  ☐ Yes — describe: __________

**H. Real property or leases.**
Do you (or a Family member) own, lease, or hold rights in real property that is or may be leased to or from the Foundation, or that borders Foundation-owned or -operated property?
☐ No  ☐ Yes — describe: __________

**I. Confidential Foundation information.**
Have you used, disclosed, or benefited from any confidential Foundation information for personal or third-party gain?
☐ No  ☐ Yes — describe: __________

**J. Other interests.**
Are there any other actual, potential, or perceived conflicts of interest, or any relationships that a reasonable person could view as compromising your independent judgment, not covered above?
☐ No  ☐ Yes — describe: __________

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### Section 4 — Attachments (if any)

List all attachments providing additional detail:

1. __________
2. __________
3. __________

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### Section 5 — Certification and Signature

By signing below, I certify that:

1. I have received, read, and understand the Bylaws (Article VII) and the Conflict-of-Interest Policy of BAU Farm Foundation.
2. I agree to comply with the Policy and to disclose promptly, in writing to the Secretary, any Financial Interest or potential conflict that arises after the date of this form.
3. I understand that the Foundation is a charitable organization and that, to maintain its federal tax-exempt status, it must engage primarily in activities that accomplish its exempt purposes.
4. The disclosures in Section 3 are, to the best of my knowledge, accurate and complete as of the date signed.

____________________________  Date: __________
Signature

____________________________
Printed name

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### For Secretary's Use Only

| Field | Response |
|---|---|
| Date received | __________ |
| Reviewed by (Secretary or Governance Committee) | __________ |
| Material disclosures noted | ☐ None  ☐ Yes — reported to Board on __________ |
| Follow-up action | __________ |
| Filed in minute book | ☐ Yes — date: __________ |