Summary: REPA For: Bianco Year and Period: 2004-09/01/03-08/31/04 Departmental Approver: Brandt,Barbara F Collegiate Approver: Bock,Terry L |
| Code of Conduct
| Outside Consulting, Service Activities, and Other Work
| Conflict of Interest
repa@egms.umn.edu
| An earlier answer indicated that, during the REPA reporting period 09/01/03-08/31/04 or the next 12 months, you, a member of your immediate family, or an associated entity (e.g., a trust) had or expect to have:
| A financial interest from or in a business that relates to your University activities and that equals or exceeds either: income of $10,000 or equity interest valued at $10,000 or representing 5% ownership.
| A board position at a business that supports your University research.
| An executive position in a business that engages in commercial or research activities that relate to your University activities.
| Answer the following questions as they relate to financial and business interests engaged in during the REPA reporting period 09/01/03-08/31/04 or expected to be engaged in during the next 12 months, as identifed above.
| What financial and business interests do and do not need to be reported?
| How should I answer these questions if I am filing this REPA for Patents, Technology, and Marketing purposes?
| Royalties
| 1:Have you received or will you receive, or be entitled to receive, royalties from the University or from another academic institution's royalty-sharing policy?
| To which royalties does this question refer?
| Yes |  | No
|  | For instances where the above answer is Yes, did you or will you:
| a) Assign students, postdoctoral fellows, or other trainees to research projects related to activities for which you have received, will receive, or will be entitled to receive royalties?
| Yes No
| b) Participate in funded or unfunded research on a technology, process or product development related to the activities for which you have received, will receive, or will be entitled to receive royalties?
| Yes No
| Financial Interests
| What do "business" and "financial interest" mean?
| What if I'm not sure about financial interests for the next 12 months?
| 2: Regarding the previous or expected financial interest from or in a business that relates to your University activities, does that business provide funds (gifts or sponsored support) for your University research?
| Yes |  | No
|  | For instances where the above answer is Yes, did you or will you:
| a) Assign students, postdoctoral fellows, or other trainees to projects supported by those funds?
| Yes No
| b) Participate in research using those funds?
| Yes No
| 3: Regarding the previous or expected financial interest from or in a business that relates to your University activities, was or will that interest be of a nature other than consulting income and/or publishing royalties?
| Note: Answer No if your financial interest is limited to consulting income and/or publishing royalties, and there is no other relationship between the business(es) for which you consult or from which you receive royalties and your University work.
| To which royalties does this question refer?
| Yes |  | No
|  | For instances where the above answer is Yes, did you or will you:
| a) Assign students, postdoctoral fellows, or other trainees to instructional projects related to that business?
| Yes No
| b) Participate in clinical trials or evaluation or development of a technology, process, or product owned or controlled by that business?
| Yes No
| c) Make professional referrals to that business while acting in the context of your University duties?
| Yes No
| d) Take administrative action on behalf of the University with respect to any University-affiliated organization that is related to that business?
| Yes No
| e) Take administrative action on behalf of the University with respect to any supported research activity that is related to that business?
| Yes No
The above questions that you just answered were related to financial interests. An earlier answer indicated that you (or a member of your immediate family or an associated entity) also had or expect to have business interests. Note: When providing supplemental disclosure information in the box below, remember to include information about financial and business interests.
| Supplemental Information
| For each earlier Yes answer, as identified above:
| Identify the entities in which you previously had or expect to have a financial or business interest;
| Describe the nature of your previous interests or expected interests (e.g., royalties, equity interest, consulting income, executive position, member of the board of directors or advisory board);
| Explain the relationship between your previous interests or expected interests and your University responsibilities;
| Describe any previous involvement or expected involvement by students, and whether you serve as their primary advisor; and
| Explain the mechanisms that have been or will be instituted to minimize the chances of conflict of interest occurring.
| (limit 1950 characters)
| I am a consultant for Pfizer and hold quity in the company. I am on Johnson and Johnson's board. Occasionally I conduct research for these companies. I am CEO of a company that creates imaging software.
| Relationships between Financial or Business Interests and Sponsored Projects
| Are any of your previous or expected financial or business interests related to your sponsored projects?
| Yes No
| If Yes, please list the sponsored projects below. List only those projects that relate to financial or business interests disclosed in this REPA.
| Identify the financial or business interest to which this sponsored project is related.
| Project Title
Funding Source
Principal Investigator
Project Dates (mm/dd/yy format)
Annual Support $
| Identify the financial or business interest to which this sponsored project is related.
| Project Title
Funding Source
Principal Investigator
Project Dates (mm/dd/yy format)
Annual Support $
| To detail more than one sponsored project, click Next Sponsored Project to add another data entry table.