Compensation Statement
Associated Faculty – Academic Clinician Part-time
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.
Base Salary1
$_______________
Administrative Stipend2
(insert position title and dates of appointment)
$_______________
Total Annual Salary
$_______________
Target Incentive: (plan attached)Error! Bookmark not
$_______________
defined.
(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:
Department Business Administrator
Note: Definitions of categories of compensation are available at:
http://somapps.med.upenn.edu/fapd/documents/ext00191.pdf
1
2
salary in effect as of date of statement; may be adjusted as of July 1
If applicable
_____________
Date