COLUMBIA UNIVERS ITY IN THE CITY OF NEW VO R K OFFICE OF TIH GENER AL COUNSEL January 22, 2010 By E-Mail Mr. Brian Downey Brian Downey@finance-l'ep.senate.gov Dear Mr. Downey: We are writing in response to Senator Grassley's letter of Dece mber 7, 2009 to Laurie Flynn, Executive Director of the TeenScreen National Center for Mental Health Checkups at Columbia U niversity ("the Center"), requesting information on industry funding provided to the Center from January 2006 to the present. We appreciate your agl'eeing to extend the date for Columbia's response to J anuary 22, 2010. The December 7 letter defines industry fundin g as "any transfer of value, including but not limited to grants, donations, and sponsorship for meetings or progra ms, etc." from "pharmaceutical, medical device compa nies, foundations established by these companies or the insurance industry." We can affirm that it is the Center's policy not to accept industr y funding, and tha t the Center has not done so during the period covered by Senator Grassley's letter . The Center is not a n incorporate d legal entity in its own right; it operates within the Depar tment of Psychiatry of Columbia's College of Physicians and Surgeons. The Ce nter is funded almost entirely by gifts from the Carmel Hill Fund, a private family found ation . The Carmel H ill Fund was not established by and, to our knowledge, is not funded by pharmaceutical or medical device co mpanies, their foundations, 01' the ins urance industr y. The Carmel Hill Fund provides funding for the Ce nter directly to Columbia and indirectly through the Research Foundation for Mental Hygiene ("RFMH"), a private not-for-profit corporation t hat is also involved in t he TeenScreen program.l RFMH uses its Carmel Hill funds to pay for certain expenses of TeenScreen. 1 RFMH's s tated mission is to s upport the research and training objectives of the New Yor k State Department of Me nta l Hygiene and its component agencies. 412 Low Memorial Library M ~il Code 4308 535 WeSt 116th Street New York, NY 10027 We h ave pl'ovided below Columbia's responses to the five numbered questions on page s 2?3 of t he December 7 letter. The questions are in italics, followed by our responses: 1) Please describe the policies for accepting industry funding and whether or not TeenScreen allows companies to place restrictions or provide guidance on how funding will be spent. It is the Center's policy not to accept industry funding. 2) If TeenScreen allows companies 1,0 place restrictions on indrtstry funding, then please explain all restrictions and I or guidance for each transfer of value from industry. For every transfer of value with a restriction, please provide the following infonnation: year of transfer, name of cOlnpany, and restriction placed on funding. Not app licable because the Center does not accept industry funding. 3) Please explain what policies, if any that TeenScreen plans to adopt to ens ure transparency of funding in order to pro vide a greater public trust in the independence of your organization. The Ce nter's policy on accepta nce of industry funding is stated on t he Ce nter's website as follows: "The center accepts no fund ing from the phannaceutical industry and does not advocate for any specific treatment. JJ The Ce nter's website also states that the Ce nte r is supported by the Carmel Hill Fund a nd contains inform ation on "National TeenScreen Support," with a pie ch art of TeenScreen funding sources. The pie chart shows that 98% of the Center's funding comes from family and suicide prevention foundations, 1% from individuals and 1% from corporate giving. 4) Please explain your policies on disclosure of outside inc01ne by your top executi ves and board members. As noted above, t he Center is not incorporated, and t herefore does not have a board or board members. The Executive Director of Teen Screen, Laurie Flynn, directs the activities of t he Ce nter . Ms. Flynn is subj ect to Columbia University's 2 conflict of interest policies and procedures, under which she submits an annual disclosure form , described below. With respect to interests in organizations other t han Columbia, the disclosure form asks the employee to disclose whether he or she is the sale proprietor, or a dil'ector, trustee, officer, general or limited partner, sh areholder , managing 01' limi ted lia bility member, consultant or employee of any organization other than the University. For any such relationship, the em ployee is asked to provide explanatory information, including the nature/activities of the organization, whether the employee receives any compensation in connection with his or her activities and the amount of such compensation, the approximate value of the employee's financial interest in the organization, his or her title and/or role and activities, an estimate of the time spent on activities for the organization, and any other information that may be helpful in understanding the organization. The disclos ure form also asks whethe r the employee (or a ny fam ily member, or any family-related entity) has been a party to a transaction or had a business relationship with the University during t he past twelve months, or expects to do so within the next twelve months. If the a nswer is yes, the employee is aske d to describe the transaction or relationship, including the nature of the tra nsaction or relationship, school or department involved, funds involved, other parties involved including other U niversity personnel, and a ny other information that m ay be helpful in understanding the transaction or relationship. The disclos ure form also asks whether the e mployee has used during the past twelve months, or expects to use during the next twelve months, a ny University facilities, equipment, clerical services, intellectual property, or the services of Columbia stude nts or employees or the Uni versity's name to support his or her activities outside of the University. Ifso, the form asks for an explanation of the nature of the u se of the facilities, property, or services, including the individuals involved and any other pertinent information. The disclos ure form asks for various other kinds of information as well, but these que stions do not re late to outsi de activities 01' income. During the period in questio n, Ms. Flynn also submitted annual disclosure forms through the University system for disclosure of research-related financial interests. None of these forms disclosed any outside financial interests . Leslie McGuire, Deputy Executive Director of t he Ce nter, is not a Columbia em ployee; she is employed a nd paid by RFMH. Beca use Ms. McGuire is not a Columbia employee, she is not subject to Columbia's conflict of interest disclosure policies. Ms. McGuire is subject to RFMH's conflict of interest policy. Dr. Mark Olfson, a Columbia faculty member who is named on the Ce nter's website as 3 policies. Ms. McGuire is subject to RFMH's conflict of interest policy. Dr. Mark Olfson, a Columbia faculty member who is named on the Center's website as Scientific Director , serves solely in an advisory capacity with respect to Center activities and has no role as a n executive or in the management of the Center. In t his limited role, h e devotes about two hours a week to advising a junior researcher who is performing research at the Center. 5) Please prouide the disclosures of outside income filed with your organizations by your top executives and board members. Ms. Flynn's conflict of interest disclosure forms submitted since January 2006 are attached to t his lette r . Also attached are Ms. Flynn's 2008 and 2009 annual research conflict of interest disclosure forms. Please note that these disclosures are obtained ?mID Columbia personnel unde r a qualified assurance of confidentiality. We ask that, to the extent possible, you preserve the confidentiality of the information we have provided with this letter, disclosing it only as necessary to the Committee's objectives. * * * Please let u s know if you have any questions on this information . Sincerely, Susan K. Rushing Associate General 1691:";4 4 12/ 14/2009 Columbia University Office of Internal. Columbia University Office of Internal Audit Surveys jS ro'NSe Responses: 2007?08 Annual Conflicts of Interest Disclosure Statement View Response: 50 83 ~I ~ ~ id Token 10 Date Stamp 2008-05-1613:44:00 IP Address Your Name: Laurie Flynn University Position: Director of Administration Are you the sole proprietor, or a No [ N] director, trustee, officer, general or limted partner, shareholder, managing or limited liability merrber, consultant or employee of any organization other than the University? Select your role: Please list the organization/s in relation to the role chosen in the question directly above . Organization/s: Are there additional relationships No answer [] with outside entities other than the University? Select your role: Please list the organization/s in relation to the role chosen in the question directly above. Orga nizat ion/s: Are there additional relationships No answer [] with outside entities other than the University ? Select your role: Please list the organizat ion/s in relation to the role chosen in the question directly above. Organization/s: Are there additional relationships No answer [] with outside entities other than the University ? Select your role: Please list the organization/s in relation to the role chosen in the question directly above. Organization/s: Additional Information (please ...columbia.edu/ .. ./browse.php 1/12 12/14/2009 Columbia University Office of Internal ... include the nature/activities of the organ ization, whethe r you receive any compensation in connection w ith you r act ivities and the armunt of such compensation, the approximate va lue of your financial interest in the organization, your title and/or role and activities, an estimate of the time that you spend o n your activities for the organization and any other informat ion that may be helpful in understanding the organization): Has any family member been No [N] employed by the University during the past twelve rmnths? If yes, please provide the name and position. Name: Position ( include school and/or department): Relationship to you and additional information ( is the person a student/is he or she currently emp loyed): Are the re additional family No answer [] rrembers who have been emp loyed by the University during the past twelve rronths who have not been listed above? If yes, please provide the name and position. Narre: Position (inc lude school and/or departrrent): Relationship to you and add itiona l information (is the perso n a student/is he or she curre ntly employed): Are there additiona l family No answe r [] rrembers who have been emplo yed by the University during the past twelve rronths who have not been listed above? If yes, please provide the narre and position. Name: Position (inc lud e school and/or department): ...colu mbia.edu/ .../browse. php 2/12 12/14/2009 Relationship to you and additional information (is the person a student/is he or she currentlyef1l)loyed): Columbia University Office of Internal, .. Are there additional family No answer [] merrbers who have been employed by the Universit y during the past twelve rronths who have not been listed above? If yes, plea se provide the narre and position, Narre: Position (include school and/or departrrent): Relationship to you and additional information (is the person a student/is he or she currentlyerrployed): Additional Information: Do you expect any fanily No (N) member to be el'1l'loyed by the University during the next twelve rronths? If yes, please provide the name and position. Name: Position (include school and/or depa rtrrent): Relationship to you and additional information (is the person a st udent/is he or she currently efT1Jloyed): Are there additional family No answer [J rrembers who you expect to be employed by the Univers ity during the next twelve m:>nths who have not been listed above? If yes, please provide the narre and position. Narre: Posit ion ( include schoo l and/or departrrent): Relationship t o you and additional inforrrat ion ( is the person a student/is he or she cu rrently e fT1J loyed ): Are there additional family No answer [] rrembers who you expect to be employed by the University during the next twelve rronths who have not been listed above? ... columbla.edu/ .. ./browse.php 3/12 12/14/2009 Columbia University Office of Internal ... If yes, please provide the name and position, Name: Position (include school and/or department): Relationship to you and additional inforrll3tion (is the person a student/is he or she currently employed): Are there additional family No answer [] members who you expect to be e~loyed by the University during the next twelve rronths who have not been listed above? If yes, please provide the name and position. Name: Position (include school and/or depa rtment): Relationship to you and additional information (is the person a student/is he or she currently employed): Additional Information: Have you, any family member, or No [N] any family- related entity I been a party to a transaction or had a business relationship with the University during the past twelve m:>nths? If yes, please provide the name and position. Name: Position: Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family No answer [] members or any family-related entities (including you) which have been a party to a transaction or had a business relationship with the University during the past twelve ITK)nths? ... columbia.edu/ .../browse.php 4/12 Columbia University Office of Intemal ... 12/14/2009 If yes, please provide the name and posit ion . Name: Posit ion: Description of T ransaction or Re lationship (inc lude nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or re lationship ): Are there additiona l family No answer [] members or any family- re lated ent ities (inc luding you) wh ich have been a party to a transaction or had a business re lat ionsh ip with the University during the past twelve months? If yes, please provide the name and position. Name: Position: Description of Transaction or Relationship (include nature of transaction or relat ionship, schoo l or department invo lved, funds involved, other parties involved includ ing other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family No answer [J members or any family-related ent ities (inc luding you) which have been a party to a transact ion or had a business relationship with the University during the past twelve rTPnths? If yes, please provide the name and position . Name: Position: Description of Transaction or Relationship (inc lude natu re of transaction or relationship, schoo l or department involved, funds involved, other parties ...columbia.edu/ .../browse.php 5/12 12/14/2009 involved including other University personnel, and any other information that may be helpfu l in understanding the transaction or relationship) : Additiona l Information : Columbia University Office of Internal ... Do you expect that you, any No [N] Family member, or any familyrelated entity, wi ll be a party to a transaction or have a business relationship with the University during the next twelve ITOnths? If yes, plea se provide the name and position. Name: Position: Description of Transaction or Relationship (include nature of transaction or relationship, school o r department involved, fund s invo lved, other parties involved inc luding other University personnel, and any other info rmation that may be helpful in understanding the transac t ion or relat ionship): Are there additional family No answer [] merrbers, or any farrily-related entities (including you) which wi ll be a party to a transaction or have a business relationship with the University during the next twelve rronths? If yes, please provide the name and pos ition. Name: Position: Description of Transaction or Relationship (inc lude nature of transaction or re lationship, schoo l or department involved, funds involved, other parties invo lved including other University personnel, and any other infonnation that rray be helpful in understanding the transaction or relationship): Are there additional family No answer [] merrbers, or any farrily-related entities (including you) which will be a party to a transaction or have a business relationship with the University during the next ...columbia .edu/ .. ./browse. php 6/12 12/14/2009 twelve m:mths? If yes, please provide the name and position. - Columbia University Office of Internal ... Name: Position: Description of T ransaction or Relationship (inc lude nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in unde rsta nding the transac tion or relationship): Are there additional family No answer [J members, or any family-related entities (inc luding you) whic h will be a party to a transaction or have a business relationship w ith the University during the next twelve m:>nths? If yes, please provide the narne and position. Name: Position: Description of Transaction or Relationship (inc lude nature of transaction or relationship, schoo l or departrrent involved, fund s involved, other parties involved Including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Additional Information: Have you, any family member, or No [N] any family-related entity received any personal benefit as a resu lt of any transact ion or relationship which relate s to your activities for the University during the past twelve rronths? Nature of benefit: Narre of person: Description of Transaction or Relationship (inctude nature of transaction or relationship, schoo l or departrrent involved, funds involved, other parties Involved including other ...eolu mbla.edu/ .../browse. php 7/12 12/14/2009 Columbia University Office of Internal ... University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family No answer [] members, or any family-related entities (including you) which received any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the past twelve months? Nature of benefit: Name of person: Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved includ ing other University personnel, and any other infOrrn::ltion that may be helpful in understanding the transaction or relationship) : Are there additional family No answer [] members, or any family-related entities (including you) which received any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the past twelve months? Nature of benefit: Name of person: Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other inforrn::ltion that may be helpful in understanding the transaction or relat ionship): Are there additional famly No answer [] members, or any family-related entities (including you) which received any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the past twelve months? Nature of benefit: Name of person: ... colu mbia.edu/ .. ./browse,php 8/12 Columbia University Office of Internal ... 12/14/2009 Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Additional Information: Do you expect that you, any No [N] family member, or any familyrelated entity will receive any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the next twelve months? Nature of benefit: Name of person : Description of Transaction or Relationship (include nature of transaction or relationship, school or departrrent involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family No answer [] merrbers or family-related entities (including you) which will receive any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the next twelve months? Nature of benefit: Narre of person: Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family No answer [] merrbers or family- related entities (including you ) which will receive any personal benefit as ...columbia.edu/.. ./browse.php 9/12 12/14/2009 Columbia University Office of Internal ... a resu lt of any transaction or re lationship which relates to your activities for the University during the next twelve rronths? Nature of benefit: Name of person: Description of Transact ion or Relationship (include nat ure of transaction or relationship, sc hool or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationsh ip): Are there additional family No answer [] members or family-related ent ities (including you) which will receive any personal benefit as a result of any transaction or relationship whic h relates to your activities for the University during the next twelve rronths? Nature of benefit: Name of person: Description of Transact ion or Relationship (inc lude nature of transaction or relationship, sc hool or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Additional Information Have you during the past twelve No [N] rronths used Columbia facilities, equipme nt, clerical serv ices, intellectual property, or the services of Colurrbia students or employees or the University's name to support y our activities outside of the University? If yes, please explain the nature of the use of the facilities, property or serv ices, including the individuals involved and any other pertinent information. 00 you expect during the next No [N] twelve rronths to use Columbia facilities, equipment, clerical services, intellectual property, or ...columbia,edu/.../browse.php 10/12 12/14/2009 Columbia University Office of Internal ... the selVices of Columbia students or employees or the University's narre to support your activ ities outs id e of the University? If yes, please explain the nature of the use of the facilities, property or serv ices, inc luding the individuals involved and any other pertinent information. Are you presently debarred, No [N] suspended, proposed for debarrrent, declared ineligible, or voluntarily exc luded from transact ions by any government (federal, state or local) department or agency? If yes, please exp lain the circumstances. With in t he past three years, No [N] have you been convicted of or had a civ il judgment rendered against you for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federa l, state or loc al) transact ion or contract in connection with a public transaction, vio lat ion of federal or state antitrust statutes, or commiss ion of errbezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiv ing sto len property? If yes, please explain the circumstances. Are you presently indicted for or No [N] otherwise criminally or civilly charged by a government (federa l, state or local) entity with corrmission of any of the offenses enumerated above? If yes, please explain the circumstances. Within the past three years, No [N] have you had one or rrore public transactions (fede ral, state or local) telT11inated for cause or default? If yes, please explain the circumstances. I certify that I understand my Laurie M. Flynn ...colu mbia .edu/ .. ./browse.php 11/12 12/14/2009 Columbia University Office of Internal ... obligations under the Policies and that I have accurately and fully cOrT1Jleted this disclosure form. I w ill prol1l>tly notify the University's Department of Internal Audit if any changes occur which would cause the answer to any of the above questions or the above certification to be no longer accurate. Please sign the disclosure statement and confirm the Certification by typing your name be low: { Close Window P!"lPSut'veyor Version 1.01 ...colu mbia.eduj .../browse, php 12/12 12/ 14/2009 Internal Audit ? Conflict of Interest Internal Audit - Con flict of Interest Bro wse respo n ses Vi ew res p o n se: 2962 I ~~ I (C)@ id Token ID Completed Y Date started 0001-01-01 12:00:00 Date last action 2009-05-0714:53:14 Date subm itte d 2009-05-0714 :53:14 IP address Referring URL First Name and Last Name: Laurie Flynn University Position : Director of Administration Are you the sole proprietor, or a No [N] director, trustee, officer, genera l or limited partner, shareholder, managing or limited liability member, consu ltant or employee of any organization other than the University? Select your ro le: Please list the organizatlon/s in relation to the role chosen in the question directly above. Organ ization/s: Are there additional relatio nships No answer [] with outside entities other than the University? Select your role: Please list the organization/s in relation to the r ole chosen in the question directly above . Org aniza t ion/s : Are there additional re la tionships with outside ent ities other than the University? Select your role: Please Ust the organization/s In r e lation to the role chosen in the question directly above. No answer [] Organizat ion/s : Are there additional relationships with outside entities othe r than the No answer [] secure.cumc.columbia.edu/ ...fadmin.p... 1/ 11 12/14/2009 University? Internal Audit - Confl ict of Interest Select your role: Please list the organization/s in relation to the role chosen in the question directly above. Organization!s: For every question answered yes above, provide the following Additional Information (please include the nature/activ ities of the organization, whether you receive any compensation in connection with your activities and the amount of suc h compensation, the approximate value of your financial Interest in the organization, your title and/or role and activities, an estimate of the time that you spend on your activities for the organization and any other information that may be helpful in understa nding the organization): Has any family member been No [N] employed by the University during the J2AH twelve months? If yes, please provide the name of the family member. Name: University Position of family member (include school and/or department): Relationship to you and additional information (is the person a studenl/is he or she currently employed): Are there addit iona l family No answer (] rrembers who have been employed by the University during the .rut?! twe lve mont h s? If yes, plea se provide the name of the family member. Name: Univer sity Position of family member (include school and/o r department): Relationship to you and additional in forma tion (is the person a studenl/is he or she currently employed): Are there additional family No answer [] rrerrbers who have been em;:>loyed by the University during the past twelve months? If yes, please provide the name of the family member. Name: University Position of family member (include schoo l and/or department): secure.cumc.colu mbla.edu/ .. ./admin.p... 2/11 12/14/2009 Relationship to you and additional Information (is the person a student/is he or she currently employed): Internal Audit ~ Conflict of Interest Are there add itional family No answer [J merTbers who have been ell1'loyed by the University during the ~ twelve months? If yes, please proylde the name of the family member. Name: University Position of fam ily member (include school and/or departme nt): Relationship to you and additional Information (Is the person a student/is he or she currently employed): Additional Information Do you expect any farrily No [N] member to be efllJ10yed by the University during the nex t twelve months? If yes, please provide the name of the family member. Name: University Position of fanily member (inetude school and/or department): Relationship to you and any additional Information (is the person a student): Are t here add it iona l fami ly No answer [] members w ho you expect to be employed by the University during t he MX.t twelve rmnths who have not been listed above? If yes, please provide the name of the family member. Name: University Position o f family rrember (include school and/or department): Relationship to you and any additional Information (is the person a student): Are there additional family No answer [] members who you expect to be employed by t he University during the D?Xt twelve rmnths who have not been list ed secure.cumc.col umbla.edu/ .. ./admin.p... 3/ 11 12/14/2009 above? If yes, please provide the name of the family member. Name: Internal Audit ? Conflict of Interest Univers it y Pos itio n of fanily me mber (include school and/or department): Relationship to you and any addition al Information (is the person a student): Are there add it io nal family No answer [] members who yo u expec t to be employe d by the Univers ity during the ru:.xt twe lve ITOnths who have not bee n list ed above? If yes, please provide the name of the family member. Name: University Position o f family membe r (i nclude school and/or depa rt me nt): Relationship to you and any additional information (1s the person a student): Additional Information : Have you (or any family member, or No [N] any family-related entity) been a party to a transaction or had a bUSiness relationship with the University during the ~ twelve months? If yes, please provide the name of person or entity. Name: Position of person or entity: Description of Transaction or Relationsh ip (include nature of transaction or relationship, school or department Involved, funds Involved, other pa r ties Involved including other UniverSity personnel, and any other information that may be helpful in understanding the transaction or rela tionship): Are there additional family members No answe r [ ] or any family-related entities (including you) which have been a party to a transaction or had a business relationship with the univerSity during the pa s t twelve months? I f yes, please provide the name of person or entity. secure.cumc.col umbla .edu/ .. ./admin. p... 4/11 12/14/2009 Internal Audit - Conflict of Interest Name: Pos ition of person or entity : Description of Tra nsaction or Relationship (include nature of transaction or relationship, school or department involved, funds Involved, other parties invol v ed including other university personnel, and any other information that may be helpful in understanding the transaction or relationship) ; Are there additional famil y members No answer [] or any family-related enti ties (including you) which have been a party to a transaction or had a business relationship with the University during th e past twelve months? If yes, please provide the name of person or entity, Nal'Tle: Position of person or entity: Description of Transaction or RelationshIp (Include nature of transaction or relationship, school or department involved, funds invol v ed, othe r parties involved including other University personnel, and any other information that may be helpfu l in u nderstanding the transaction or relations hip): Are there additional family members No answer [] or any famHy-related entities (including you) which have been a party to a transaction or had a business relationship with the University during the past twelve months? If yes, please provide the name of person or entity. Name : Posit ion of person or entity: Description of Transaction or Relationship (Include nature of transaction or relationship, school or department involved, funds invol v ed, other parties involved Including other University personnel, and any other in formati on that may be helpful In understanding the transaction or rei a tionship) : Add itional Info rmation: Do you expect that you , any famity No [N] member, or an y family-related entity, will be a party to a tra nsaction or have a business relationship with the University during the ne xt twelve months? secure.cumc.columbia.edu/ .../admin. p... 5/11 12/14/2009 If y es, please provide the name of person or entity . Name : Position of person or entity: Internal Audit - ConfHet of Interest Description of Transaction or Rela tionship (include nature of transaction or r elationship, school or depa rtm ent involved, funds involved, other parties invo lved including other University personnel , and any other Information that may be helpful in understanding the transaction or relationship) : Are there additional family members, No answer [] or any family-related entities (including you) which will be a party to a transaction or have a business relationship with the Univer sity during the next twelve months? If yes, please provide the name of person or entity. Name : Position of person ~r entity: Description of Transaction or Relationship (include nature of transaction or relationship, school or depa rt m ent involved, funds involved, other parties involved including other University personnel, and any other information t hat may be helpful in understa nding the transaction or relationship): Are there additional family membe rs, No answer [] or any family-related entities (including you) which will be a party to a t ransaction or have a business relationship with the University during the next twelve months? If yes , please prov ide the name of person or entity. Name: Position of person or entity: Description of Transaction or Relationship (include nature of transaction or relationship, school or depa rtm ent Involved , funds inv olved, other parties involved including other University personnel, and any other information that may be helpful In understand ing the tra n saction or relationship) : Are there additional family members, or any fami ly - related entities (including you) which will be a pa rty to a transaction or have a business relationship with the University during the next twelve months? No answer [] If yes, please provide the name of secure.cumc.columbia.edu/ .. ./admin.p ... 6/11 12/14/2009 person or entity. Internal Audit? Conflict of Interest Name: Position of person or entity: Description of Transaction or Relationship (include nature of transaction or relationship, schoo l or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship) : Additional Information: Have you (or any family member, or No [N] any family-related entity) received any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the twelve months? un Nature of benefit for person or entity: Name of person or entity: Description of Transaction or Relationship (include nature of transactio n or relationship, school or department involved, funds involved, other parties Involved including other University personnel, and any other Information that may be helpful in understanding the transaction or relationship): Are there additional family members, or any family-related entities (Including you) which received any personal benefit as a result of any transaction or re lationship which relates to your activities for the University during the ~ twelve months? Nature of benefit for person or entity : Name of person or entity: Description of Transaction or Relationship (include nature of transaction or relationship, school or department involved, funds involved, other parties involved including other University per sonnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family member s, or any family-related entities (Including you) which received any personal benefit as a r esult of any transaction or relationship which relates to your activities for the University during the DAJ.! twelve months? 5eCure.cumc.columbia. edu/ .. ./admin .p... No answer [J No answer [] 7/ 11 12/ 14/2009 Nature of benefit for person or entity : Name of person or entity: Internal Audit - Conflict of Interest Description of Transaction or Relationship (include nature of transaction or relationship, schoo l or department involved, funds involved, other pa rties inv olved including other University pe r sonnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional fami ly m embers, No answer [] or any family-related entities (including you) which recei v ed any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the past twelve months? Nature of benefit for person or entity : Name of person or entity: Descrip tion of Transaction or Relationship (include nature of transaction or relation ship, school or department involved , funds involved, other parties involved including other University person nel, and any other information that may be helpful in understanding the transaction or relationship): Additional I nformation: Do you expect that you, any family No [N] member, or any family-re lated entity will receive any pe rs ona l benefit as a result of any transaction or relationship which re lates to your activities for the University during the next twelve months? Nature of benefit for person or entity: Name of person or entity: Description of Transaction or Relationship (include na t ure of transaction or relationship, school or depa rtm ent involved, funds Involved, other pa rties involved including other University personnel, and any ot her info r mation that may be helpfu l in understanding the transaction or relationship): Are there additional family members No answer [] or family - related entitles (Includ ing you) which will receive any personal benefit as a result of any transaction or relationship which relates to your activ ities for the University during the next twe lve months? Nature of benefit for person or entity: secure.cumc.columbla.edu/ .. ./admin. p... 8/11 12/14/2009 Name of person or entity: Description of Transaction or Relationship (include nature of tra nsaction or relationship, school or Internal Audit? Confljct of Interest department involved, funds involved , other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or rela tionship): Are there additional family members No answer [] or family-related entities (including you) which win receive any personal benefit as a result of any transa cti on or relationship which relates to your activities for the university during the next twelve months? Nature of benefit for person or entity : Name of person or entity: Description of Tra nsaction or Relationship (include nature of transaction or relations hip, school or department involved, funds involved, other parties involved including other University personnel, and any other information that may be helpful in understanding the transaction or relationship): Are there additional family members No answer [] or family-related entities (including you) which will receive any personal benefit as a result of any transaction or relationship which relates to your activities for the University during the next twelve months? Nature of benefit for person or entity ; Name of person or entity: Description of Transaction or Relationship ( include nature of tra nsaction or relationship, school or department involved, funds involved, other parties Involved including other Univer sity personnel, and any other information that may be helpful in understanding the transaction or relationship): Additional Information: Have you during the past twelve No [N] months used Columbia facilities, equipment, clerical services, intellectual property, or the services of Columbia students or employees or the University'S name to support your activities outside of the UniverSity? If yes, please explain the nature of the use of the faCilities, property, or se rvices, including the Individuals involved and any other pertinent information. secure.cumc.columbia.edu/ .. ./admin. p... 9/11 12/14/2009 Internal Audit - Conflict of Interest Do you expect during the n ext No [N] twelve months to use Columbia faci lities, equipment, clerical services, intellectual property, or the services of Columbia stu dents or employees or the Univ ersity's name to support your activities outside of the U.niversity? If yes, please expla in the nature of the use of the facilit ies, property or serv ic es, including the individuals involved and any other pertinent information. Are you presently debarred, No [N] suspended, proposed for debarment, declared ineligible, or voluntarily excluded from transactio ns by any government (federal, state or local) department or agency? If yes, please expla in the circumstances. Within the past three yea r s, have No [N] you been convicted of or had a civil judgment rendered agai nst you for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract in connection with a public transaction, violation of federal or state antitrust statutes, or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, ma k ing false statements, or receiving stolen property? If yes, please expla in the circumstances. Are you presently ind ic ted fo r No [N] or otherwise criminally or civ illy charged by a government (federal, state or local) entity with co rrmission of any of the offenses enu me rate d above? If yes, please explain the circumstances. With in the past three years, No [N] have you had one or /TO re public t ransactions (federal, state or local) terminated for cause or default? If yes, please explain the circumstances. Type Na me : laurie M. Flynn secure.cumc.columbia.edu/ .../admin.p... 10/ 11 12/14/2009 o Internal Audit - Conflict of Interest LimeS urvey Vef510n ...?.Ub 1t1 DoMt. to 1.72 (5731) ~ime S urvey secure.cu me,columbla .edu/ .../admin. p... 11/11 Columbia Univers ity's RASCAL - Research Administration System I~ I I L Columbia University HEALTH SCIENCES DIVISION ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM Dlsclo,:;~re fori~!ynn Te lephone Numberjj JL II UNI lI lfz oo3 DepartmentllS64 - PSYCHIATRY Addres! 1 NOTE: AU underlined words are explained In the definition section, These questions apply to your current activities and any activities anticipated during the next 12 months. 1.00 you, or does any member of your ~ or an Associated Entity have or receive a Significant Financial Intergst In or from any Business which is supporting Sponsored Research by either a restricted gift or a sponsored project through the office of Grants and Contracts, Columbia Innovation Enterprise, or the Office of Clinical Trials in which you are involved? NO 2.00 you participate in research, including any clinical trial, that is Technology owned or contractually obligated to a Byslness in which you, any member of your fimilv.., or an Assgciated Entity has a Significant Fjnancial Interest, other than royalties and/or licensing fees under Institutional agreement? NO 3,00 you hold any Execytiye Position in any for-profit Business engaged in commercial or research activities of a biomedical nature? NO 4.Have you participated in or otherwise influenced the selection by the University of a contractor, vendor, or supplier of goods or services in or from which you, any member of your .Ea.miJ.v. or an Associated Entity has had or received a Sjgnifinnt Financial Interest? NO S,Have you assigned any student, postdoctoral fellow or other trainee, Officer, support staff or other individual to a project sponsored by a Business in or from which you, any member of your ~ or an AssQciated Entity has had or received a Sjgnjficant Fjnancial Interest? NO 6.Have you participated in or otherwise influenced any University transaction to buy, sell, lease, or license real or intellectual property to or from any Business In or from which you, a member of your .Eilm.lJ..v.., or an Associated Entity has had or received a Significant Financial Intered? NO 7,Have you taken any administrative action within the University which Is likely to benefit a Bysiness in which you, any member of your fimi1v. or an Associated Entity has a Significant Financial Interest? NO 8.00 you serve on the Board of Directors or Scientific Advisory Board of any Business? NO 9 ,1f YES, do you or does any member of your fi.mil..v. or an Assgclated Entity receive Sponsored Research support from that Business by either a restricted gift or it sponsored project through the Office of Grants and Contracts, Columbia Innovation Enterprise or the Office of Clinical Trials? NO If yOu have answered YES to itny of the questions set forth above, yOu must write an explanation indicating sepitrately for each Business or Activity: Ii: https:Ilv.'WW.rascal.columbia.edui ... showNotes=N&&coi Headcrld=215799&&coiForrnld= 14&&irbProlocolName=&& windowty pe=popup[ 121 1512009 J I ;54:52 AM) Columbia Un iversity's RASCA L - Research Admi nistration System A RASCAL programming fix took effect on October 12, 2009, Users accessing or printing the archived content on this form after submission bu t prio r to the fix would have seen the same questions and answers, but introductory and/or certification language In the original form may have be en omitted or IncolTectly displayed, hl1PS:llwww,rascaLcolumbia.edllf...showNotes=N&&coiHeaderld=2 15799&&coiFormld"'-14&& irbProtocoINamc=&& windowtype=popup[ 12/ 1512009 J 1;54;52 AM] Columbia Uni versity's RASCA L - Research Administration System Columbia University COLLEGE OF PHYSICIANS AND SURGEONS ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM I I Telephone Numberl - Disclosure fo~ ILaurie Flyn~ II II UNl i!If2003 Department ilS64 - PSYCHIATRY Addressl I I I I D.t, ,",+ 5/27/2009 . I II These questions apply to your current activities and any activities anticipated during the next 12 months. NOTE: All underlined words are explained in the definition section. 1. Do you, or does any member of your EimiJ:t., or an Associated Entity have or receive a Significant Fjnanclal Interest in or from any Business which is supporting Sponsored Research by either a restricted gift or a sponsored project through the office of Grants and Contracts, Columbia Innovation Enterprise, or the Office of Clinical Trials in which you arc Involved? NO 2. Do you participate in research, including any clinical trial, that Is Technology owned or contractually obligated to a Business in which you, any member of your ~ or an Associated Entjty has a Significant financial Interest, other than royalties and/or licensing fees under institutional agreement? NO 3. 00 you hold any Executiye Posjtjon In any for-profit Byslness engaged in commercial or research activities of a biomedical nature? NO 4. Have you participated In or otherwise influenced the selection by the University of a contractor, vendor, or supplier of goods or services in or from which you, any member of your fJ.milv. or an Associated Entity has had or received a Signjficant Financial IoSeu:s:t1 NO 5. Have you assigned any student, postdoctoral fellow or other trainee, Officer, support staff or other individual to a project sponsored by a Business in or from which you, any member of your ~ or an Associated Entity has had or received a 5;iooifis;J:ol EioJ:DS;iJ:1 l!lll[f&l? NO 6. Have you pllrticipated In or otherwise influenced lIny University transaction to buy, sell, lease, or license real or intellectual property to or from any Bysiness in or from which you, a member of your ~ or an Auoclaled Entjty has had or received a Signifjcaol fjnandal Inlerest? NO 7. Have you taken any administrative action within the University which is likely to benefit a Busines& in which you, any member of your fim.ilv. or an Auodatcd Entjty has a 5;jgnjfjs;aot fjnaocjalloleres17 NO B. Do you serve on the Board of Directors or Scientific Advisory Board of any Bu&IOen? NO 9. Do you, or does lIny member Of your ~ or an A&s:ocjated Entity have or receive a Signirlcaol Financial Interest in or from any Bysjneu in any way related to your c:Hnlc:al or teac:hing responsibilities at Columbia? [Remuneration requiring disclosure does NOT Include reimbursement for travel expenses, if limited to payment for legitimate professional speaking and consulting engagements.) NO 10.Are you a member or a "Speaker's Bureau" or other list of speakers approved by a sponsoring Bu&inl&& or its agent to give a presentation concerning the products or services of that Bysioen? NO ~ https:llwww.raseal.oolumbia.edul ...?showNotes=N&&ooiHeaderld=28457I &&coiFonnld=5&&irbProtoooIName=&& windowtype=popup[ 12115/2009 J 1;55;41 AM 1 Colu mbia University's RASCAL? Research Admin istration System If you have answered YES to any of the que stions set forth above, you must write an explanation indicating separately for each Business or Activity: A RASCAL p r ogramming fix took effect on October 12, 2009. Users accessing or printing the archived content on this form after submission but prior to the fix would have seen the same questions and answers, but intr oductory and/or certification language in the or iginal form m ay h ave been omitted or Incorrectly displayed. https:llwww.rascal.columb ia.edul...?showNotes=N&&coiHeade rl d'" 284571&&coiFormld=5&&irbProlocoI Name"'&&windowtype"'popup[ 1211512009 II: S5 :41 AM]