Board of Directors Conflict of Interest Disclosure Form
(Hospitals and Health Systems)

Summary

This template is intended to be used by boards of directors at large nonprofit hospitals and health systems to disclose potential conflicts of interest. This template assumes the organization is a 501(c)(3) charitable organization, but it can be modified to apply to non-charitable organizations. This template includes practical guidance and drafting notes. This template is intended to safeguard the integrity and reputation of the healthcare organization by fostering the proper and unbiased conduct of all board activities. This disclosure form complements and can be used in conjunction with Conflict of Interest Policy for Directors and Officers (Healthcare Organization). For additional, related forms regarding conflicts of interest, see also Conflict of Interest Policy for Medical Staff (Healthcare Organization), Conflict of Interest Questionnaire for Employees (Healthcare Organization), and Conflict of Interest Questionnaire for Directors and Officers (Healthcare Organization). For a template healthcare organization code of conduct, see Code of Conduct (Hospitals and Health Systems).