DCRI COMMERCIAL RELATIONSHIPS TRACKING FORM COI Reporting is based on the previous year and anticipated relationships for the coming year. Please report information for the calendar year 2014 and anticipated income for 2015. For audit purposes, please keep conflict of interest/financial records for three years after the conclusion of the award. How to Use This Form: 1) Save the document on your drive. 2) Enter the Year (e.g. 2014/2015), your Name, Title and Address in the appropriate fields. 3) Make sure you save your version on your drive. 4) Then Click on File, click Protect Document, in the drop-down menu click Restrict Editing. In the column to the right at the bottom click unprotect. 5) Click on the appropriate checkboxes. 6) Save your updated version on your drive 7) Send an email to DCRI Corporate Communications (DCRI-Comms@dm.duke.edu) with your COI attached for posting on our DCRI website. Editing the Document (Necessary only when you have to add companies not on the form): 1) Scroll down to the last page to the blank rows and enter the company name(s) on the company field(s). 2) Enter new information. 3) Click on the appropriate checkboxes on your new listing and save. 4) Make sure you save your version on your drive. Column Explanations: (1) Funding is provided for my effort in research grants or contracts for multi-center projects in which I serve as either the Chairman, Co-Chairman, Executive or Steering Committee member or I am involved as a DCRI faculty leader for specific aspects in a project. A check in this column denotes that I am involved in such a research contract. Payments for the work performed for these contracts are made to the. A portion of my salary as a faculty member, representative of % effort on the project, is supported by these funds. research grant company supports the expenses associated with projects in the DUHS that are under my direction. (3) I provide educational activities or deliver occasional lectures that generate revenue company. All revenues from these activities are paid to the. None of it is taken for personal income. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (4) I receive personal income outside of my salary for consulting or other services (Including CME) company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (5) I receive personal income outside of my salary for consulting or other non-cme services company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. personally receive royalties in excess of $5,000 per year company. (7) I, or an immediate member of my family, have equity (with shareholder voting privileges) in this company of either > $5,000 or > 1%. page 1 of 10; 10/01/2012
DCRI COMMERCIAL RELATIONSHIPS TRACKING FORM Year(s): 2016-2017 Name: Dr. Ann Marie Navar Title: Assistant Professor of Medicine Address: 2400 Pratt St., NP.8011 Please complete the applicable rows in the following table. Monetary amounts are on an annual basis. Lectures for CME) for >$5K/1% Abbott Laboratories AbbVie Abiomed Achillion Acorda Therapeutics, Inc AGA Medical Alcon Altarum Amerigroup Corp. Amgen, Amylin, Anadys Angel Medical Systems, 2 of 10;10/01/2010
Lectures for CME) for >$5K/1% Aptus Endosystems, ARCA Biopharma Ardea Biosciences, Astellas Pharma US AstraZeneca Atritech Baxter Bayer US (Bayer AG/Bayer in Japan subsidiaries) Bayer HealthCare (formerly Berlex Labs) Bellerophon Therapeutics BioCryst Biomarin Biomarker Factory Biscardia, Boehringer Ingelheim Boston Scientific Bristol Myers Squibb 3 of 10;10/01/2010
Lectures for CME) for >$5K/1% CardioDx, Cardiovascular Systems, Cardioxyl Cempra, Cerexa, Charles River Laboratories Cochrane Collaboration Critical Diagnostics CSL Limited Cubist Daiichi Sankyo Co. Limited Dr. Reddy s Laboratories LTD Drip Drop Durata Therapeutics Edwards Lifesciences Elesvier Eli Lilly & EOCI Pharmacomm Ltd. 4 of 10;10/01/2010
Lectures for CME) for >$5K/1% Evalve, Exelixis, F2G, Ltd. Ferring Genentech General Electric Healthcare Genzyme Gilead Sciences, Glaxo SmithKline (GSK) HeartFlow Helsinn Healthcare Hologic, Idera Pharmaceutical, INC Inimex International Stem Cell Iris Molecular Diagnostics Janssen Pharmaceutica Products 5 of 10;10/01/2010
Lectures for CME) for >$5K/1% Janssen and Development, LLC Johnson & Johnson Johnson & Johnson Pharmaceutical & Development KAI Kaiser Permanente Life Masters Supported Self Care, Lilly Luitpold, MAQUET Cardiovascular LLC (formerly Boston Scientific Cardiac & Vascular) Medafor, Medtronic Vascular, (formerly Medtronic AVE) Medtronic, Merck & Co. Merck Group Merck Laboratories 6 of 10;10/01/2010
Lectures for CME) for >$5K/1% Merck Sharp & Dohme I.A. Miracor Medical Systems Molecular Insight Murdock Mylan Laboratories, Novartis Pharmaceutical Ophthotech OrbusNeich Orexigen Therapeutics, Ortho-McNeil- Janssen, OSI Eyetech Otsuka America Pharmaceutical Oxygen Biotherapeutics PENTAX Medical 7 of 10;10/01/2010
Lectures for CME) for >$5K/1% Perosphere, Pfizer Pharmacyclics Pharmos Portola Pharmaceutical Progenics Protalix Purdue Pharma Reata Regado Biosciences, Regeneron, Revalesio Corp Roche Diagnostic Corp. Roche Group Roche Molecular Systems, RTI Health Solutions Sage Therapeutics Sanofi-Aventis Santaris Pharma A/S 8 of 10;10/01/2010
Lectures for CME) for >$5K/1% Schering-Plough Scios, Seaside Therapeutics Somahlution, Svelte Medical Sytems, Tacere Therapeutics Takeda Pharmaceutical Co. Tethys Bioscience TEVA industries The Medicines Thoratec Versartis, Vertex, Volcano Westat 9 of 10;10/01/2010
Lectures for CME) for >$5K/1% Column Explanations: (1) Funding is provided for my effort in research grants or contracts for multi-center projects in which I serve as either the Chairman, Co-Chairman, Executive or Steering Committee member or I am involved as a DCRI faculty leader for specific aspects in a project. A check in this column denotes that I am involved in such a research contract. Payments for the work performed for these contracts are made to the. A portion of my salary as a faculty member, representative of % effort on the project, is supported by these funds. research grant company supports the expenses associated with projects in the DUHS that are under my direction. (3) I provide educational activities or deliver occasional lectures that generate revenue company. All revenues from these activities are paid to the. None of it is taken for personal income. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (4) I receive personal income outside of my salary for consulting or other services (Including CME) company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (5) I receive personal income outside of my salary for consulting or other non-cme services company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. personally receive royalties in excess of $5,000 per year company. (7) I, or an immediate member of my family, have equity (with shareholder voting privileges) in this company of either > $5,000 or > 1%. 10 of 10;10/01/2010