SALARY ADMINISTRATION Con?ict of Commitment and Outside Professional Activities of Health Sciences Compensation Plan Participants ANNUAL HEALTH SCIENCES COMPENSATION PLAN REPORTING FORM FOR CATEGORY I II COMPENSATED OUTSIDE PROFESSIONAL ACTIVITIES Fiscal Yw Ending June 30, 2017 In accordance with APM - 671. all Compensation Plan participants are required to complete this form not later than APM - 671 Faculty Member Name (Print) Academic Title HS Clinical Professor Dr. Kevin Murphy Department RMAS Category I of Days or II Name of Outside Entity Description of Services Provided Role consultant, speaker, employee, shareholder) Compensation Dollars in Thousands Check Ie? column if income earned did not exceed the threshold of earned exceeded threshold, enter amount earned in rizht column. . [f income income earned did not exceed the threshold Income earned exceeded threshold Ur or to? Prat/Lo of. EC 225 WMMW Weaver/MW DDCIDD Total Days Total income calmed 99996669999999 I did not engage in Category I or ii activities during the reporting period. 7 Total income earned did not exceed the earnings threshold. Sciences Compensation Plan, the School of certify that I have complied with the provisions of the University of California Health Health Sciences Compensation Plan Implementation Procedures, and my departmental guidelines for the Plan regarding limitations on the retention of earnings, and time spent in Outside Professional Activities. The department Chair?s signature af?rms the form was received and reviewed- Corrective actions should be implemented for time reports (days) that are above the annual limit and for unapproved Category I activities. Faculty Member 13?le ?me/1871?} N.B.: Information disclosed herein is a pulyic under the Celiriirnizil?ublit Records Act 7/1/14 hynature SALARY ADMINISTRATION .- APM Con?ict of Commitment and Outside Activities of APFENDIX Iicaith Sciences Compensation Plan Participants PRIOR FCRM FUR OUTSIDE ACTIVITIES (CATEGORY if) Munich I uncut Mm ?:12 Pieasc piint For each Catcgoryl compensatcd outside professional activity in which you wish to engage in outside professional activitics answer the following questions. Attach separate slicers, ifnecessmy, TYPO activity in which you will be involved: thgmi?cttihct Executive/managerial role: Salaried employee: Outside teaching 01' research Other potcntial of commitm entzw (has? ?description. A hcbus' nest/ayency/m-gan aticm?p cup/individ1 TMW fhwiMi: WM a) Mia Mimi/H Activities/products/scrviccs of entity describcd tibcvc: (3&9 Nature of 320111 1clationship to entity named cbovc (check all that apply): Founder/cc-foundci: Owner: Consultant: Board membergw Saiaricdw cmpicyce:w Stockholder/partnership interest: Equity/myalty interest: Oihci,p1case explain: Descripticn of the: nature. of your participation. E11 this activity, including, if you wish possible hcnc?cial outcomes to mcas of meawh, indusu'y, and pub it: saw . Mai and?w Beginning/ending month/year you could be involved in this activity: I 2?0 Fiscai yca1(s) fox which sacking '3 29W ?2'9 are generally for one ?scal year but may be granted for a longer term not to i?iw years. ibumitic income must be submitted annually. Estinmt?cd1mmherofdays= involvement during ?scaiuyem 3?2 Do you wish to take a full? or part-time [cave while engaged, in this activity-?2? Approval granted through fiscal ycar ending June 301 Request .4, (w -rww?wf ?31? 14:35:! Department Chan Ew- ?133110 .. Dean Date kiwi/m Chancclicr Dcsigncc Date: Faculty Member gig in 7 7/1/14 SA LARY ADMINISTRATION APM - 671 Con?ict 0110011111151th and Outside Activities of APPENDIX Health Sciences Compensation Plan Participants PRIOR FORM F0131 OUTSIDE ACTIVITIES I) l?ppw 1 WW [211mm Mm {Apptzegrm For each Categoryl compensated outside professional activity in which you. wish to engage in outside professional aetivlties answer the following questions. Attach separate sheets, if necessary. Type of activity in which you will be involved: 11115111111115 Executivelmanagerial relax Salaried 11111111031111: Outside teaching: or 1115111116111 aetivity: Other potential conflict of commitment: General defy-1111i? ofthe bummsi/a "easy/01 gdnnation/groupfmd1v1cl1ml vices of entity described 1111111111: MAW (:0me ?as Nature. 111' 5111111 mimirmship to entity 1111111116 ?illiwe (check all that apply): 1311111311111111111111111111: - . (3111111117: Causal-taut: ?mm membergn "Salaried employee: Stackhoider/pa?nership interest: Equily/xoyalty Olin-11', please explain: Desciiption of the 1111mm of your participation in this activity, including, if you. wish possible beng?cial outcomes to areas of .1115 "arch, industry, 111 11 public 5c1'vic11: 14511211.; 14 WW 11ml. Mmatc gap/111m! @1341}; 41111199151?! Beginning/ending month/yam yau could be involeQii this activity: [213! 2-9 lilacizl 1111111 (3) for which seeking approval; 29!? 102* mfAQprovals 1211111111 135C111 year hut may bx: granted for 11 1011911101111 1101111 11111-111111}If 1" V1. yenrs.?111zsidc imam: reports 11111111 be submi?cd -.11111111ally Estimated number of days: invalvemant during fiscal-?year appointment ?llv?l Do you wish 101111111 a ?ll? 111' part-time, leave while; engaged 111 this 11111111111519 Approval granted through fiscal year ending June 30, Request dei?ed:m 1" ?if We? Wwfiwwr1,1313, 11"" Elm/i 9 Dean - (:wa Date?- 151-111: Chancellor or Chancel lor's Desigh?e Date a: I Faculty Member 11,1111 11? 7/1/14 Page 20 SALARY ADMINISTRATION Conflict of Commitment and Outside Professional Activities of Health Sciences Compensation Plan Participants ANNUAL HEALTH SCIENCES COMPENSATION PLAN REPORTING FORNI FOR CATEGORY I II COMPENSATED OUTSIDE PROFESSIONAL ACTIVITIES Fiscal Year Ending June 30, can In accordance with APM - 67l, all Compensation Plan participants are required to complete this form not later than APM - 67l APPENDIX Faculty Member Name (Print) chim Moreno, Academic Title HS Pm?c Department {atom s. Category I or II of Days Name of Outside Entity 1: Description of Services Provided l?W? . Cam?vgkf 40580 Role consultant, speaker, employee, shareholder) swab-(M Compensation Dollars in 'l?liousands Check [Lf? column ifincome med did not exceed of$_ earned exceeded threshold on cr amount earned in right column. [/?inmmte Income earned did not exceed the threshold Income earned exceeded threshold as new at 5mm a, Po Marmara" I 699909696969 Panama Total Dam Total income earned Total income med did not exceed the earnings threshold. I did not engage in Category I or II activities during the reporting period. Sciences Compensation Plan, the School of Plan Implementation Procedures, and my depanmental guidelines I certify that I have complied with the provisions of the University of California Health Health Sciences Compensation limitations on the retention of earnings, and time spent in Outside Professional Activities. for the Plan regarding Dang?), [g N.B.: Informatioh disclosed item/?it a public record under the California Public Records Act 7/1/14 The department chair's si t] Ek\ be: gnature affirms the form was received and reviewed. Corrective actions should be implemented for time reports (days) that are above the annual limit and for unapproved Category 1 activities. A Chair Signature": 4" I Date g- 2% 1/