Compensation Statement
Associated Faculty – Academic Clinician Part-time
With External Appointment (VA)
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. For the portion of your salary paid through the University of
Pennsylvania, you will receive your compensation in accordance with the payroll schedule of the University of
Pennsylvania and prorated for the time period worked.
Base Salary1,2
$_____________
Administrative Stipend 1,2,3
(insert position title and dates of appointment)
$_____________
Total Annual Salary
$_____________
Target Incentive (plan attached)1,2,3
$_____________
(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
Can be adjusted year to year
A portion of the salary____ (insert salary) projected to be paid for fiscal year ____ (insert fiscal year) is through
the VA. If there is any change in the salary paid through the VA, you are required to immediately report such
change to me so that your total compensation can be reviewed and adjusted as needed. .
3
If applicable
2