Compensation Statement Associated Faculty – Academic Clinician Assistant Professor/Associate Professor/Professor [Date] John Doe, M.D. 123 Park Place Philadelphia, PA 12345 Dear ___________: I am pleased to provide a breakdown of your compensation for the period [insert dates ____ 1, 20__ through June 30, 20__]. These figures represent annual rates. You will receive your compensation in accordance with the payroll schedule of the University of Pennsylvania and prorated for the time period worked. Faculty Salary1,2 $_______________ Base Salary Supplement2 $_______________ Base Salary $_______________ Administrative Stipend2,3 (insert position title and dates of appointment) Total Annual Salary $_______________ $_______________ Target Incentive: (plan attached)2,3 $_______________ (Optional): The attached lists the projected sources of funding for your FY (insert fiscal year) _ salary If you have any questions, please contact me. Sincerely, _________________________ Chair of Department I accept this compensation statement as outlined above. ________________________ Signature cc: _____________ Date Department Business Administrator Note: Definitions of categories of compensation are available at: http://somapps.med.upenn.edu/fapd/documents/ext00191.pdf 1 Usually minimum for the rank; salary in effect as of date of statement; may be adjusted as of July 1 Can be adjusted year to year 3 If applicable 2