Compensation Statement
Associated Faculty -Academic Clinician Assistant Professor of Clinical ________ Associate Professor of Clinical _______ Professor of Clinical _________ [Date]
John Doe, M.D. 123 Park Place
Philadelphia, PA 12345 Dear ___________: I am pleased to provide a breakdown of your estimated compensation for the fiscal year ending June 30, 200_. These figures represent annual rates. You will receive your compensation in accordance with the payroll schedules of the University of Pennsylvania and prorated for the time period worked. Non-University sources of compensation are estimated below. If there is any change in the amount of non-University compensation, you are required to immediately report such change to me so that your total compensation can be reviewed and adjusted as needed. Base Salary FY0_ CPUP Supplemental Compensation † Other Non-University Compensation* Target Practice Plan Incentive (attached) †† Projected Total Compensation (FY0_) **
†
$_____________ $_____________ $_____________ $_____________ $_____________
Can be adjusted year to year *Includes VA, HHMI, CHOP, or other approved affiliate clinical activity †† You may be eligible for additional incentive compensation as established by the department’s incentive plan. **Assumes achievement of target incentive.
If you have any questions, please contact me. Sincerely,
_________________________ Chair of Department I accept this compensation statement as outlined above. ________________________ Signature cc: Arthur H. Rubenstein, MBBCh Department Business Administrator _____________ Date
Revised, November 2005