UBIT: Modifications to Income

1. Royalties and Commissions
1. Does the activity generate revenue from royalties, i.e. does the activity generate income from licensing a non-university/non-agency person or entity to market property belonging to the university/agency?
   NA Yes No
   1. If yes, describe the property being sold, the basis for determining the royalty payment (e.g., production, gross income, net profits, etc.), and the non-university/non-agency person or entity licensed to sell the property
2. Is the royalty income derived in part from the performance of services?
NA Yes No
1. If yes, explain.
3. Does the activity generate income to the university/agency in the form of commissions or a percentage of income from the sale of a non-university/non-agency entity's goods or services (e.g. a percentage of sales of outside company's pizza, magazine subscriptions, etc.)?

NA Yes No
1. If yes, describe the goods or services being sold, the payment arrangements, the non-university/non-agency person or entity involved, and who markets the goods or services.
2. Rents
1. Real Property Rents
1. Does the activity generate revenue from real property (i.e. land and/or buildings)?
NA Yes No
2. Is the amount of rent based on income or profits derived from the property?
NA Yes No
3. If yes, describe the rental arrangement or attach contract.
2. Real and Personal Property Rents
1. Does the activity generate revenue from a combination of real and personal property (i.e. equipment/furnishings)?
NA Yes No
2. If yes, indicate the percentage of total rents received attributable to the real and personal property:

Real Property
Personal Property
Total	100%

3. Describe the type of real and personal property rented, the person or group to whom the property is rented, and the purpose for which the property is rented.
3. Rendering of Services
1. Does the activity provide for tenant services in connection with the rental of real property?
NA Yes No
2. If yes, describe the nature and extent of the services (e.g., maid, food, janitorial, security, etc.) rendered to the tenants.
4. Debt-financed Property
1. If the answer to 1a or b is yes, is the rent or lease received for the use of debt-financed property (e.g., property acquired through the use of a mortgage or other indebtedness, with a current balance outstanding)?

NA Yes No
2. If yes describe the:

Debt instrument
Date of acquisition
Original amount of debt
Current balance
Expected date of retirement

3. Indicate the percentage make-up of individuals who occupy the debt-financing property on an annualized basis.

Tenants	Percentage
Students
Faculty/Staff
Other departments
Non-university/agency tenants
Total	%

3. Sponsored Research
1. Describe the person or entity for whom research is performed for a fee, and whether a governmental or other agency is involved.
2. Is the research an investigative activity done to validate a scientific hypothesis in which the university/agency is interested, the results of which are made freely available to the general public?
NA Yes No
1. If yes, briefly describe the intellectual questions posed, how these are being explored, and how the results are publicized.
3. Does the activity involve the performance of research under a clinical trial or product testing agreement incident to commercial or industrial operations? For example, ordinary testing or inspection of materials or products or designing or construction of equipment, buildings, etc.?
NA Yes No
1. If yes, please describe the nature of the research activity.
2. If yes, does the activity involve pre FDA certification testing?
NA Yes No
4. Is the research activity directly related to actual patient care or to education of students?
NA Yes No
1. If yes, please describe.