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X false false false false false false false false false MARGARET M MCGOVERN MD PHD CHAIRPERSON 0 666560 0 130012 0 4482 0 0 0 94972 0 896026 0 0 KENNETH R SHROYER MD PHD VICE CHAIRPERSON 0 506435 0 57760 0 3450 0 0 0 71701 0 639346 0 0 RAPHAEL DAVIS MD SECRETARY 0 1038026 0 221951 0 5252 0 0 0 73969 0 1339198 0 0 CARLOS DE LOS SANTOS DIRECTOR (EFF 04/26/16) 0 110158 0 0 0 0 0 0 0 42721 0 152879 0 0 Evan Jones MD-MPH DIRECTOR 0 597378 0 542105 0 3887 0 0 0 61831 0 1205201 0 0 Mark C Henry MD DIRECTOR 0 526392 0 59866 0 3450 0 0 0 79438 0 669146 0 0 Jeffrey Trilling MD DIRECTOR 0 338958 0 3896 0 3470 0 0 0 57283 0 403607 0 0 Vincent W Yang MD PhD DIRECTOR 0 607222 0 69045 0 3450 0 0 0 58281 0 737998 0 0 Dennis Choi MD PhD DIRECTOR 0 507489 0 51565 0 3504 0 0 0 47823 0 610381 0 0 Todd Griffin MD DIRECTOR 0 539711 0 82738 0 3450 0 0 0 75877 0 701776 0 0 Patrick Sibony MD DIRECTOR 0 545781 0 63464 0 3450 0 0 0 83218 0 695913 0 0 Wesley Carrion MD DIRECTOR 0 400032 0 1411 0 6542 0 0 0 27989 0 435974 0 0 Iris A Granek MD DIRECTOR 0 280170 0 35735 0 2985 0 0 0 42063 0 360953 0 0 Ramin V Parsey MD PhD DIRECTOR 0 534700 0 56733 0 3450 0 0 0 44452 0 639335 0 0 Mark E Schweitzer MD DIRECTOR 0 707743 0 81478 0 3810 0 0 0 40019 0 833050 0 0 Mark Talamini MD DIRECTOR 0 891829 0 102232 0 3450 0 0 0 48469 0 1045980 0 0 Wayne Waltzer MD DIRECTOR 0 656927 0 357142 0 3450 0 0 0 79243 0 1096762 0 0 Peter R Brink PhD DIRECTOR (TERM 04/26/16) 0 277577 0 0 0 0 0 0 0 18721 0 296298 0 0 TONG J GAN DIRECTOR 0 632540 0 176554 0 4482 0 0 0 49732 0 863308 0 0 SAMUEL RYU DIRECTOR 0 656526 0 54670 0 18282 0 0 0 69514 0 798992 0 0 FORM 990, PART VI, QUESTION 3 SB CLINICAL PRACTICE MANAGEMENT PLAN, INC. DELEGATES CONTROL OVER VARIOUS MANAGEMENT DUTIES TO NAVIGANT CONSULTING, INC. (NAVIGANT). IN A LEADERSHIP ROLE, NAVIGANT HAS VARIOUS RESPONSIBILITIES THAT INVOLVE WORKING CLOSELY WITH THE PRESIDENT OF THE BOARD OF SB CLINICAL PRACTICE MANAGEMENT PLAN, INC. TO EFFECTIVELY MANAGE THE ORGANIZATION'S OPERATIONS ENSURING ALL SUPPORT SYSTEMS ARE OPTIMIZED, OVERSIGHT OF A BUSINESS PLAN IS MAINTAINED, AND THE MANAGEMENT PROCESS MEETS ITS ANNUAL GOALS. FORM 990, PART VI, QUESTION 11B AN ELECTRONIC VERSION OF FORM 990 WAS PROVIDED TO THE OFFICERS AND DIRECTORS PRIOR TO FILING. MANAGEMENT PERFORMS A REVIEW OF FORM 990 PRIOR TO FILING, ADDRESSING ANY QUESTIONS MADE BY THE GOVERNING BODY. FORM 990, PART VI, QUESTION 12C SB CLINICAL PRACTICE MANAGEMENT PLAN, INC. HAS ADOPTED THE SAME CONFLICT OF INTEREST POLICY AS ITS MEMBER UFPCS. THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT SB CLINICAL PRACTICE MANAGEMENT PLAN, INC.'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OF COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. COMPLIANCE WITH THIS POLICY IS MONITORED THROUGH INTERNAL PAYMENT POLICIES AND ANNUAL REPRESENTATIONS. THE REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. B. WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENT FOR GOODS AND SERVICES, FURTHER EDUCATIONAL PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. A VOTING MEMBER OF THE GOVERNING BOARD WHO HAS A COMPENSATION CONFLICT IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. IF THERE ARE VIOLATIONS TO THE POLICY, THE COMMITTEE OR GOVERNING BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, QUESTION 19 ALL GOVERNING DOCUMENTS WILL NOT BE DISCLOSED OUTSIDE OF THE ORGANIZATION. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ALSO WILL NOT BE DISCLOSED OUTSIDE OF THE ORGANIZATION. 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