FORD MOTOR COMPANY/HENRY FORD HEALTH SYSTEM CONNECTED HEALTH CHALLENGE (the “Challenge“)
NO PURCHASE OR PAYMENT NECESSARY TO ENTER OR TO WIN. A PURCHASE WILL NOT IMPROVE YOUR CHANCES OF WINNING. VOID WHERE PROHIBITED.
SPONSORS: The sponsors of this Challenge are Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI 48202 and Ford Motor Company, 1 American Rd, Dearborn, MI 48126 (“Sponsors“).
ADMINISTRATOR: The administrator of the Challenge is Henry Ford Innovation Institute, 2799 W Grand Blvd, Detroit, MI 48202 (“Administrator“)
CHALLENGE DESCRIPTION: The Challenge begins at 12:01 AM Eastern Time on December 1, 2015 and ends at 11:59 Eastern Time on June 30, 2016 (“Challenge Period“). Submissions will be accepted between 12:01 AM Eastern Time on TBD and 11:59 PM Eastern Time on February 20, 2016 (“Submission Period”). Entry into the Challenge does not constitute entry into any other challenge or promotion, including, without limitation, other similar challenges or promotions offered by Sponsors. By participating in the Challenge, each entrant unconditionally accepts and agrees to comply with and abide by these Official Rules and the decisions of Sponsors and/or the individual judges, which shall be final and binding in all respects.
The Challenge is open only to the following Contestants:
(i) Individuals who are at least 18 years of age at the time of entry; and are legal residents of the United States (including the District of Columbia) or a country where such challenges are allowed by the laws of such country and the United States; are not a “Specially Designated National or Blocked Person” as designated by the U.S. Department of Treasury’s office of Foreign Assets Control from time to time or otherwise identified by any government or legal authority as a person with whom Henry Ford Health System or any of its Affiliates is prohibited from transacting business; and are employees of the Henry Ford Health System, Henry Ford Medical Group, or Health Alliance Plan or are members of the Medical Staff of Henry Ford Health System, or are employees of Ford Motor Company.
(ii) Teams of up to four (4) eligible individuals where each team member meets the eligibility requirements for individuals
Contestants must commit to making themselves available at the Finalist Judging Event to be tentatively held at Henry Ford Innovation Institute in Detroit, Michigan on TBD.
HOW TO ENTER: To enter go to the website located at www.henryfordinnovation.com/healtchareonwheels the “Challenge Website“), complete the Official Entry Form, and submit your Submission according to the instructions posted on the Challenge Website and the Submission Requirements. You may enter either alone or as part of a team. Teams must include no more than four (4) people and each team member must be clearly identified on the team’s Official Entry Form to be eligible. Each Submission entered into the Challenge must meet the “Submission Requirements” described by the challenge Sponsors (any Submission that, in Sponsors’ sole discretion, violates the following criteria will be disqualified). Once a submission is made, a team is prohibited from making any changes or alterations to the product described in its submission until the evaluation of the entries is completed.
The app challenge will have a two-phase review process.
Phase 1: All submissions will be required to submit the following materials via the challenge website:
- Title of the app
- Names, positions, contact information & key accomplishments of team members
- Problem statement (400 words or less)
- 10-slide deck explaining the proposed solution, including information about:
o Problem description
o App features
o Target users
o Example use cases
o Product development plan
o Marketing plan
o Business model
- Mockups, drawings, or prototype
- Completion of Ford-HFHS Joint Invention Disclosure/Licensing Agreement Form
Up to top 10 app ideas from Phase 1 will be invited to participate in Phase 2 (final phase). The challenge organizers may recommend pairing multiple submissions with similar ideas in a single submission for Phase 2.
Phase 2: Phase 2 will comprise of two steps: (1) prototype app development for online submission followed by (2) a finalist pitch event.
The finalists will be asked to develop their product ideas into apps for submission. Submitted apps will include the following software component(s):
Smartphone: All submitted apps MUST be functioning native (iOS or Android) apps or web apps that run on or mobile browsers.
Wearable: The app may include a software component for leveraging health/biometric data collected from wearable devices (commercial or clinical). The app may also power the wearable device for delivering alerts and notifications to the driver as pertinent to the proposed solution.
Vehicle: The app may include a software component for leveraging driving behavior/state data collected from the vehicle. The app may also connect to the vehicle over Bluetooth to integrate a number of useful features – for instance, interacting with the app using voice commands and through radio and steering wheel buttons for safe and convenient in-vehicle use, and receiving select vehicle data (e.g., speed, GPS, etc.)
What to create: Contestants will upload the following final submission materials to the challenge website:
- A functioning native or web app which may also interact with a wearable device and/or the vehicle
- A video (in MP4 format) demonstrating the working app
- One or more screenshots of the app
- A URL to access app (if a web app), or an uploaded .ipa file (if a native iOS app) or an uploaded .apk file (if a native Android app) for testing and judging
Platforms: iOS or Android native apps and web apps that run on mobile browsers.
New & Existing Apps: The submitted app must be newly developed and can leverage only certain preexisting commercial/open source solutions; for instance the solution may use a companion-phone app for Apple Watch or Android Wear to access biometric data, or an open source vehicle interface like OpenXC to access vehicle data. In case the solution utilizes a preexisting app or software, the submitted app must contain newly developed software that leverages the preexisting solution for implementing the proposed product idea.
Finalist Pitch Event:
Each finalist team will have the opportunity to pitch their idea to a panel of judges, representing HFII, HFHS, Ford Motor Company, and outside technical and investment experts, at a live event held at HFII. The pitches will consist of:
- 10 minute audio-visual assisted pitch
- 5 minutes of questions and answers from a panel of expert judges
Concepts submitted by contestants may not be subject to previous patent filings held by Henry Ford Health System and contestants may not have had previous business development support from HFII concerning the subject innovation.
REPRESENTATIONS AND WARRANTIES/INDEMNIFICATION: By participating in the Challenge, each entrant represents, warrants, and covenants as follows: (a) entrant is the sole author, creator, and owner of the Submission; (b) the Submission is not the subject of any actual or threatened litigation or claim; (c) the Submission does not and will not violate or infringe upon the intellectual property rights, privacy rights, publicity rights, or other legal rights of any third party; (d) the Submission does not and will not contain any harmful computer code (sometimes referred to as “malware,” “viruses” or “worms”); and (e) the Submission, and entrants use of the Submission, does not and will not violate any applicable laws or regulations, including, without limitation, applicable export control laws and regulations of the U.S. and other jurisdictions. If the Submission includes any third party works (such as third party content or open source code), entrant must be able to provide, upon Sponsors and/or Administrator’s request, all appropriate licenses and releases for such third party works. In the event entrant cannot provide all required licenses and releases, Sponsors reserve the right, in Sponsors’ sole discretion, to disqualify the applicable Submission, or seek to secure the licenses and releases for Sponsors’ benefit and allow the applicable Submission to remain in the Challenge. Entrants will indemnify, defend, and hold harmless Sponsors and Administrator from and against all third party claims, actions, or proceedings of any kind and from any and all damages, liabilities, costs, and expenses relating to or arising from entrant’s Submission or any breach or alleged breach of any of the representations, warranties, and covenants of entrant hereunder. Sponsors and/or Administrator reserve the right to disqualify any Submission that Sponsors and/or Administrator, in their sole discretion, deems to violate these Official Rules.
INTELECTUAL PROPERTY POLICY: Inventions developed by employees of HFHS and HAP will be subject to the HFHS Intellectual Property Policy, described in Appendix D. Sponsors hold exclusive proprietary interest in all Intellectual Property, including inventions, creations, discoveries, to the extent the Intellectual Property is made, conceived, developed, contributed to, improved or derived as a result of an entrant’s contractual, employment, appointment or other relationship with Sponsors. All entrants must review and abide by the terms of the Sponsors’ Intellectual Property Policy. Inventions covered under the policy are eligible for submission and must be disclosed according to HFHS’s Invention Disclosure Form, described in Appendix E. Sponsors will hold exclusive proprietary interest in all Inventions submitted and in all revenue, profits and Net Proceeds generated as a result of commercialization of a Submission, which will be shared with the entrant as per the Sponsors’ Intellectual Property Policy. However, prize money awarded by the Challenge shall not be deemed Net Proceeds and will be paid directly to entrant.
PUBLICITY RELEASE: By participating in the Challenge, in addition to any other grants granted herein or which may be granted in any other agreement entered into between Sponsors, on the one hand, and any entrant in the Challenge, on the other hand, each entrant hereby irrevocably (a) grants to Sponsors the right to use such entrant’s name, likeness, image, and biographical information in any and all media for any purpose, including, without limitation, advertising and promotional purposes relating to the Challenge and (b) releases Sponsors from any liability with respect thereto.
WINNER SELECTION/EVALUATION CRITERIA:
Phase 1: The challenge organizers will narrow down the field of contestants to a group of no more than 10 finalist teams. Entries will be evaluated according to the following criteria:
- Innovation and unique qualities of innovation
- Potential to impact health outcomes
- User appeal and In-vehicle user experience
- Usability, design, and feasibility of innovation
- Potential for widespread commercial adoption and scale
The process for selecting the finalists in Phase 1 will be as follows:
- Online Judging
- Expert Panel composed of 5 to 10 judges
- Slide deck, problem statement, and mock-up/drawings reviewed online
- Quantitative/qualitative scores submitted online
- Top 10 teams selected to participate in the prototype app development phase for online submission followed by a Finalist Pitch event at HFII (Phase 2)
Phase 2: Online submission:
The process for evaluating the online submission will be as follows:
- Online Judging
- Expert Panel composed of 5 to 10 judges
- App prototype downloaded, installed, tested and reviewed by judges
- Demo video downloaded and reviewed by judges
- Quantitative/qualitative scores submitted online
App prototypes will be evaluated according to the following criteria:
Implementation of the idea
Submissions will be evaluated for their completeness of the prototype and how well the proposed idea was executed in the implementation.
Strong submissions will provide user interfaces tailored to assist drivers in managing their healthcare needs in a safe and effective way.
Strong submissions will include strategies for optimizing power usage and wireless connectivity on wearable devices while meeting the application requirement.
Data Collection and Depth of Use
Submissions will be evaluated for their depth of use of data collected from the wearable and/or vehicle. Strong submissions will propose novel methods or leverage existing methods for collection and fusion of data from multiple sources.
Higher scores will be assigned to those solutions that stress upon automated data capture and analysis vs. self-report and minimize the amount of additional infrastructure required, thus lowering the barrier to entry for users and providing an unobtrusive, transparent user experience.
Finally, the proposed solution should outline how the data collected from these various sources could be transformed into meaningful clinical information for integration into care delivery or hypothesis-driven clinical research.
User Privacy and Security
Strong submissions will consider the challenges of user privacy and security in collecting and/or transmitting sensitive user information (e.g., health record, biometric data, and vehicle data) that may potentially identify the user in case of a breach. The proposed solution should include novel techniques or leverage existing techniques for risk mitigation and privacy preservation.
Finalist Pitch Event:
Judges will score live pitches according to a number of qualitative and quantitative criteria, outlined above in the online submission step, and will use cumulative scores and conversations about team performance to select a winner, if justified in HFII and FMC’s sole judgment.
The evaluation criteria are to be applied in the sole discretion of Sponsors and the individual reviewers. By participating in the Challenge, each entrant into the Challenge acknowledges and agrees that such evaluations may differ from person to person and agrees to be bound by and not challenge the final decisions of Sponsors and the individual reviewers.
NOTICE TO FINALISTS AND WINNERS: Attempts to notify potential Finalists will be made using the contact information provided on the Finalist’s Official Entry Form. Sponsors are not responsible for e-mail or other communication problems of any kind. If, despite reasonable efforts, a potential Finalist does not respond within five (5) days of the first notification attempt (or a shorter time as exigencies may require), or if the notification is returned as unclaimed or undeliverable to such potential Finalist, such potential Finalist will forfeit his or her rights and an alternate Finalist may be selected.
Prize winners, if justified in HFII’s and FMC’s sole judgment, will be notified either in person at the live judging event held at Henry Ford Innovation Institute on TBD or via contact information provided on the winner’s Official Entry Form. Sponsors are not responsible for e-mail or other communication problems of any kind. If, despite reasonable efforts, a potential winner does not respond within five (5) business days of the first notification attempt (or a shorter time as exigencies may require), or if the notification is returned as unclaimed or undeliverable to such potential winner, such potential Finalist will forfeit his or her prize and an alternate winner may be selected, if justified in HFII’s sole judgment.
If any potential Finalist or prize winner is found to be ineligible, or if he or she has not complied with these Official Rules or declines the applicable prize for any reason prior to award, such potential Finalist or prize winner will be disqualified and an alternate Finalist or winner may be selected, if justified in HFII’s sole judgment.
ANTICIPATED NUMBER OF ENTRANTS: Many will enter, ten (10) submissions will be selected as Finalists. Three (3) Finalists will be selected as prize-winners. Actual odds of winning depend on the number of eligible entries received. Sponsors cannot accurately predict the number of entrants who will participate in the Challenge.
PRIZEs AND CONDITIONS:
Sponsors will select three (3) winners of the competition and will award the following prizes, if justified in HFII and FMC’s sole judgment:
- Grand Prize: $5,000
- First Runner-Up: $3,000
- Second Runner-Up: $2,000
The potential winner may be required to execute an Affidavit of Eligibility, a Liability Release and (where imposing such condition is legal) a Publicity Release (collectively “Prize Claim Documents). If a winner fails or refuses to sign and return all Prize Claim Documents within five (5) days of Sponsors’ request (or a shorter time as exigencies may require), the winner may be disqualified and an alternate winner may be selected, if justified in HFII’s sole judgment. No more than the advertised number of prizes will be awarded. Prizes will be delivered only to an address in the U.S. No cash alternative or substitution or transfer of prizes will be allowed, except Sponsors reserve the right in their sole discretion to substitute prizes of comparable value, in whole or in part, for any reason. THE WINNERS ARE RESPONSIBLE FOR REPORTING AND PAYING ANY INCOME TAXES OR OTHER TAXES THAT MAY APPLY TO ACCEPTING A PRIZE; SPONSOR IS NOT RESPONSIBLE FOR AND WILL NOT PAY ANY SUCH TAXES.
DATES/DEADLINES: Because of the unique nature and scope of the Challenge, Sponsors reserve the right, in addition to those other rights reserved herein, to modify any dates or deadlines set forth in these Official Rules or otherwise governing the Challenge. If, as determined by the Sponsors, too few submissions are received to deem the Challenge sufficiently competitive, the Sponsors may extend the submission period and modify judging dates and deadlines. Competitors will be notified of such changes according to the contact information provided in their submissions.
GENERAL LIABILITY RELEASE/FORCE MAJEURE: Each entrant agrees that Sponsors (a) shall not be responsible or liable for any losses, damages, or injuries of any kind (including death) resulting from participation in the Challenge or any Challenge-related activity, or from entrants’ acceptance, receipt, possession, use, or misuse of any prize, and (b) have not made any warranty, representation, or guarantee, express or implied, in fact or in law, with respect to any prize, including, without limitation, regarding such prize’s merchantability or fitness for a particular purpose. Entrants will indemnify, defend, and hold harmless Sponsors from and against all third party claims, actions, or proceedings of any kind and from any and all damages, liabilities, costs, and expenses relating to or arising from entrant’s participation in the Challenge. Sponsors assume no responsibility for any damage to an entrant’s computer system which is occasioned by accessing the Website or other Challenge-related websites or participating in the Challenge, or for any computer system, phone line, hardware, software, or program malfunctions, or other errors, failures, delayed computer transmissions, or network connections that are human or technical in nature. Without limiting the generality of the foregoing, Sponsors are not responsible for incomplete, illegible, misdirected, misprinted, late, lost, postage-due, damaged, or stolen entries or prize notifications; or for lost, interrupted, inaccessible, or unavailable networks, servers, satellites, Internet Service Providers, websites, or other connections; or for miscommunications, failed, jumbled, scrambled, delayed, or misdirected computer, telephone, cable transmissions or other communications; or for any technical malfunctions, failures, difficulties, or other errors of any kind or nature; or for the incorrect or inaccurate capture of information, or the failure to capture any information. Sponsors reserve the right in their sole discretion to disqualify any individual who is found to be tampering with the entry process or the operation of the Challenge or Website or other Challenge-related websites, to be acting in violation of these Official Rules, or to be acting in an unsportsmanlike or disruptive manner, or with the intent to disrupt or undermine the legitimate operation of the Challenge, or to annoy, abuse, threaten, or harass any other person, and Sponsors reserve the right to seek damages and other remedies from any such person to the fullest extent permitted by law. In the event an insufficient number of eligible entries are received or Sponsors are prevented from awarding the prize or continuing with the Challenge as contemplated herein by any event beyond its control, including, without limitation, fire, flood, natural or man-made epidemic, earthquake, explosion, labor dispute or strike, act of God or public enemy, satellite or equipment failure, riot or civil disturbance, terrorist threat or activity, war (declared or undeclared) or any federal state or local government law, order, or regulation, public health crisis, order of any court or jurisdiction, or other cause not reasonably within Sponsors’ control (“Force Majeure“), Sponsors shall have the right to modify, suspend, or terminate the Challenge. If the Challenge is terminated for Force Majeure before expiration of the Challenge Period, Sponsors will (if reasonably practicable) select a winner, if justified in HFII’s sole judgment, from all eligible, non-suspect entries received as of the date of the event giving rise to the termination. These Official Rules cannot be modified or amended in any way except in a written document issued in accordance with the law by a duly authorized representative of Sponsors. The invalidity or unenforceability of any provision of these Official Rules shall not affect the validity or enforceability of any other provision. In the event that any provision is determined to be invalid or otherwise unenforceable or illegal, these Official Rules shall otherwise remain in effect and shall be construed in accordance with their terms as if the invalid or illegal provision were not contained herein.
GOVERNING LAW/JURISDICTION: All issues and questions concerning the construction, validity, interpretation, and enforceability of these Official Rules or the rights and obligations of entrants OR Sponsors in connection with the Challenge shall be governed by and construed in accordance with the laws of the State of MICHIGAN without giving effect to any choice of law or conflict of laws rules or provisions and subject exclusively to the jurisdicition of the courts in the state of michigan. Any legal claims arising from or relating to the Challenge or these Official Rules must be brought in the federal or state courts located in DETROIT, MICHIGAN.
WINNERS LIST/OFFICIAL RULES: To obtain any legally-required winners list (after the conclusion of the Challenge) or a copy of these Official Rules, send a self-addressed envelope with the proper postage affixed to: Henry Ford Innovation Institute, 2799 West Grand Boulevard, Detroit, MI 48202. Please specify “winners list” or “Official Rules” and the name of the specific Challenge in your request.
Appendix D: Henry Ford Health System Intellectual Property Policy
HENRY FORD HEALTH SYSTEM
BOARD OF TRUSTEES
ITEM: HFHS Intellectual Property Policy
The Henry Ford Health System Intellectual Property Policy updates the Patent Policy approved by the Henry Ford Hospital Board of Trustees in October 1978 and revised in November 1995. It was developed by an Ad Hoc Intellectual Property Committee with the assistance of Corporate Legal Affairs. It will be managed under the auspices of the Vice President & Chief Innovation Officer.
As used in this Policy, Henry Ford Health System or HFHS means the Henry Ford Health System and all affiliated entities and institutions.
ACTION: Resolution RESOLVED,
Henry Ford Health System hereby adopts the following Intellectual Property Policy:
PURPOSE. This Intellectual Property Policy supports the Mission of Henry Ford Health System through the promotion of its clinical care, research, and related business activities that leads to improved health, prevention of disease and the improved diagnosis and treatment of disease. This Intellectual Property Policy is specifically designed:
(1) to encourage the development of intellectual property by Creators of Henry Ford Health System;
(2) to enable inventions or discoveries or innovations of Henry Ford Health System to be utilized to benefit the public;
(3) to safeguard the Intellectual Property of Henry Ford Health System so that it may receive appropriate protection in accordance with the law; and
(4) to provide for equitable distribution of ownership and royalty interests among Creators, Henry Ford Health System and, when applicable, a sponsor or licensee.
This policy establishes guidelines for (1) determining the interests of Henry Ford Health System, Creators, sponsors and licensees with regard to all types and forms of ideas, inventions, developments, discoveries, refinements, conceptions, innovations, know-how and improvements, including but not limited to computer software programs, computer logic and computer systems and databases including the goodwill associated therewith (collectively referred to in this Policy as “Intellectual Property”) arising out of the conduct of research activities at or associated with HFHS and/or created or produced by Creators as a result of scientific investigation; (2) the commercialization and protection of such Intellectual Property through patents copyrights and other means for technology transfer; and (3) the financial arrangements and royalty distribution methods with respect to the license, sale, marketing, and distribution of Intellectual Property .
In general, books and articles of a primarily professional or scholarly nature are not included within the purview of this Policy. All Intellectual Property, or other confidential or proprietary information created by HFHS employees within the scope of their employment or by third parties pursuant to consulting or other contractual arrangements shall be owned by HFHS but are not subject to the Distribution of Proceeds provision of this Policy; all revenue from such shall be retained by HFHS.
APPLICABILITY. This policy applies to all individuals who satisfy both of the following requirements:
(1) are full or part-time Henry Ford Health System employees, trainees, students or volunteers, or have a contractual or appointment relationship with Henry Ford Health System and/or its operating divisions, including all categories of the Medical Staffs of Henry Ford Health System hospitals and medical centers; and
(2) receive financial support from Henry Ford Health System or from private or governmental entities and sponsors, or use Henry Ford Health System resources (including, but not limited to, the facilities, material, equipment, staff, intellectual property or time of Henry Ford Health System) to develop Intellectual Property.
Individuals meeting the applicability requirements set forth above are referred to in this Policy as “Creators”.
All Creators must comply with this Policy and the procedures promulgated hereunder, as the same may be amended or revised from time to time, as a condition of their participating in their work and/or research at Henry Ford Health System, and/or their respective use of Henry Ford Health System resources.
ENFORCEMENT AND ADMINISTRATION. The Chief Executive Officer of Henry Ford Health System shall have authority for the administration of this Policy. The Chief Executive Officer shall delegate authority for procedural implementation of this Policy to an appropriate corporate administrative officer called the Vice President & Chief Innovation Officer. An Intellectual Property Committee (the “Committee”) shall be appointed and serve at the pleasure of the Chief Executive Officer. Membership on the Committee shall reflect the broad interests of Henry Ford Health System. The Committee shall report to the Vice President & Chief Innovation Officer and will have such duties as described in the Procedures for Implementation of the Henry Ford Health System Intellectual Property Policy.
OWNERSHIP OF INTELLECTUAL PROPERTY. Henry Ford Health System holds exclusive proprietary interest in all Intellectual Property created by Creators, as well as all profits generated as a result of commercialization of such Intellectual Property, to the extent the Intellectual Property is developed, refined, made, conceived, discovered, improved, contributed to, derived, or enhanced as a result of an Individual’s contractual, employment, appointment or other relationship with Henry Ford Health System or use of Henry Ford Health System resources. Ownership of Intellectual Property that results from sponsored and/or collaborative research or other agreement between HFHS and a third party shall be subject to negotiation with the sponsor and/or other party and governed by the terms and conditions of the contracts and agreements with the sponsor or other third party.
DISTRIBUTION OF PROCEEDS. Net Proceeds derived by Henry Ford Health System from the commercialization of Intellectual Property shall be shared with the Creator on the basis of a determination made by Henry Ford Health System in its sole discretion. “Net Proceeds” is defined in the Procedures for Implementation of the Henry Ford Health System Intellectual Property Policy.. Generally, Net Proceeds shall be distributed as follows: 50% distributed to the Creator, and the remaining 50% distributed to Henry Ford Health System. In the event that there is more than one Creator from Henry Ford Health System, then 50% of the Net Proceeds shall be distributed to the Creators in proportion to their respective contributions, and the remaining 50% retained by Henry Ford Health System.
This Policy shall be effective upon approval by the Executive Committee of the Board of Trustees.
This Policy may be changed at any time at the discretion of the Board of Trustees or the Executive Committee thereof.
Approved by Executive Committee of the Board of Trustees of Henry Ford Health System on _________________________.
Appendix E: Henry Ford Health System Invention Disclosure
HENRY FORD HEALTH SYSTEM
RECORD OF INVENTION AND INVENTION DISCLOSURE
Please indicate your job title: Physician _____ Resident _____ Bioscientific Staff _____ Nurse _____
Fellow _____ Intern _____ Student _____ Other ________________________________________
The purpose of this disclosure is to gather information so that any rights to the invention you describe herein may be appropriately protected. The information you provide will also help to document the earliest date of your invention if a question as to priority of inventorship should arise.
In addition, please note that rights to a patent may be seriously compromised by describing the invention (e.g., experimental methods and/or results), either orally, in writing or by display to someone other than a Henry Ford Health System employee or co-inventor. Therefore, if you plan to give a seminar or poster session or submit an abstract or paper that describes concepts or experimental results related to your invention, please inform the Intellectual Property Committee well in advance so that appropriate measures may be taken to protect your invention.
1. TITLE OR SUBJECT OF INVENTION OR DISCOVERY
2. INVENTOR(S) FULL NAME(S) (print/type) DEPT/EXTENSION CITIZENSHIP
HOME ADDRESS(ES) in order listed above
3. DATE OF FIRST CONCEPTION of the invention or discovery
4. FIRST REDUCTION TO PRACTICE
a. Date of first successful test:
b. By whom was first successful test made?
c. Location of record of that test:
d. Who witnessed that test?
e. Who witnessed the record of that test?
f. Result of that test
g. Date of first successful test in USA, if different from 5a.
5. FIRST ACT(s) TO ESTABLISH CONCEPTION (other than written description/drawing)
6. FIRST WRITTEN DESCRIPTION OR DRAWING of the invention
b. Location of that first description of drawing
7. FIRST DISCLOSURE TO ANOTHER WITHIN HENRY FORD HEALTH SYSTEM
b. To whom was disclosure made?
c. Location or record of first disclosure:
8. Has your invention been described orally or in writing to any person other than Henry Ford Health System employee or co-inventor? If so,
b. To whom was disclosure made?
c. Location or record of first disclosure:
d. Was Confidentiality Agreement signed by that entity? Yes/No? If yes, attach a copy hereto.
9. Have any specific embodiments of your invention (e.g. peptide, protein, cells, antibodies, DNA preparations, etc.) been distributed to persons other than Henry Ford Health System employees or co-inventors?
If yes, what and to whom?
10. Has a PAPER or ABSTRACT DESCRIBING THIS INVENTION been submitted for publication? If so, projected journal and publication date:
Please attach a copy of the manuscript.
11. Has a SEMINAR or POSTER SESSION BEEN SCHEDULED for future presentation?
Yes No If yes, where/when?
12. COMMERCIAL STATUS OF INVENTION
a. Has the invention been commercialized?
b. If yes, by whom and date of first sale:
13. Additional remarks
14. FUNDING USED TO SUPPORT THIS INVENTION
a. Is it possible that governmental funds were used? (Note grant number(s)
b. Were any private funds used to support invention? (Note from whom
The undersigned hereby acknowledges and agrees to the terms of the Henry Ford Health System Intellectual Property Policy and Procedures. In consideration of the undersigned’s employment relationship with Henry Ford Health System, and subject to any prior agreements with Henry Ford Health System, this invention is assigned to Henry Ford Health System, together with all patents covering said invention.
15. SIGNATURE(s) of INVENTOR(s) Percent of
This document, including the attached memorandum, consisting of page(s) was read and understood by me on the date opposite my name.
16. DETAILED DESCRIPTION of the INVENTION: Attach additional pages with a full discussion of the following points:
a. A brief abstract;
b. The purpose of the invention, (i.e., the problem attacked);
c. A detailed description of the invention, (i.e., the solution to the problem attacked);
d. The advantage provided by the invention;
e. Commercial significance of that advantage;
f. The closest known prior publications and prior uses, if any.
Any pertinent references cited either in the disclosure, in a manuscript or in a preprint should be appended.
Signature of Witness: Date