OFFICE OF THE GOVERNOR - Legislature of Guam. No. 35GL-19... · 2019-03-11 · EDUCATION NoD NoD SCHOOL (Name, City and State) DATES OF ATTENDANCE High School 1996-2000 Bishop Diego

LOURDf:.S A. LLON CUERREIZO ~\AGA HAGA • GOVERNOR

March 7, 2019

Honorable Telena Cruz Nelson Acting Speaker

UFISINAN I 1\1AGA'HAGA OFFICE OF THE GOVERNOR

}OSHC1\ f. TENORIO SIGUNDO /\\AGA'LAHI • LIEUTENANT GOVERNOR

35 bl-/?)-62- /'2-Speaker Tina Rose Muna !ames

I Mina'trentai Singko Na Liheslaturan Guahan Guam Congress Building MAI 0 B 2019

TJme )0:3j t°fl ()PM

Received By: le 163 Chalan Santo Papa Hagatna, Guam 96932

RE: Board Appointment

Dear Madame Speaker:

By virtue of the authority vested in me pursuant to the Organic Act of Guam and the local laws applicable to the fo llowing position, I am pleased to transmit the fo llowing appointment and supporting documents for:

APPOINTEE:

POSITION:

TERM LENGTH:

Michael J Um, MD

Member, Board of Trustees Guam Memorial Hospital Authority

To fill the unexpired Term of Valentino Perez (Term to expire on April 14, 2020)

The appointment is subject to the consent of I Liheslaturan Guahan. Please schedule a hearing at your earliest convenience.

cc: Lt. Governor of Guam

Senseramente,

~Jh___; LOURDES A. LEON GUERRERO I Maga 'hagan Guahan Governor of Guam

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Note that the Legislature has taken steps to ensure that any protected personal identifying information has been redacted or excluded in whole or in part in order to protect the privacy of any individual(s) whose information has been included as part of this transmittal.

Doc. No. 35GL-19-0212.

March 7, 2019

Michael J Um, MD

Dear Dr. Um:

Pursuant to my authority under 10 GCA § 80105, I am appointing you to serve as a

MEMBER, GUAM MEMORIAL HOSPITAL AUTHORITY BOARD OF TRUSTEES (To fill the unexpired term of Valentino G. Perez; Term to expire on April 14, 2020)

Appointing you to this position comes with great responsibility because you will have a vital role to perform which will place many demands on your time and energy. Integrity and honesty are virtues that I prioritize for my Administration to exemplify, and I know that you will do the same while in service to the people of Guam. Your responsibilities shall be significant and consequential. I trust that you will fulfill your duties and set a standard for others to follow.

I appreciate your willingness to serve in this position, and I am confident that your time will be spent in a manner to improve the island of Guam.

This appointment is subject to the advice and consent of I Liheslaturan Guahan. If you have any questions or concerns, please contact the Office of the Governor.

cc: Lt. Governor of Guam

Senseramente,

k~ LOURDES A. LEON GUERRERO I Maga 'hagan Guahan Governor of Guam


Doc. No. 35GL-19-0212.

LOURDES A. LEON GUERRERO JOSHUA F. TENORIO Governor Lieutenant Governor

OFFICE OF THE GOVERNOR OF GUAM

Nomination and Appointment Information Sheet

The following information is required for submission to the Speaker of I Liheslaturan Guahan in accordance with Title 4, Guam Code Annotated Section 2103

NOMINEE INFORMATION Last Name First Name

UM MICHAEL

Mailing Address

City State

- -Phone E-mail Address -Position to which Appointment is Made

Member, Board of Trustees, Guam Memorial Hospital Authority

Are you a citizen of the United States? Yes 0

If no, are you authorized to work in the United States? Yes D

EDUCATION

NoD

NoD

SCHOOL (Name, City and State) DATES OF

ATTENDANCE High School 1996-2000 Bishop Diego HS, Santa Barbara, CA

College 2000-2005 UC Berkeley, Berkeley, CA

Graduate School 2008-2012 Saint Louis University School of Medicine, St. I ni1i~ MO

Other Degree

PAGE 1OF7

Middle Initial

J

Apartment/Unit#

Zip Code -

TYPE OF DEGREE YEAR

EARNED

High school 2000 diploma

BA English, 2005 Integrative Rinlnn\/

MD 2012


Doc. No. 35GL-19-0212.

EMPLOYMENT HISTORY Name of Present/Last Employer and Mailing Address Position Title

One Love Pediatrics physician-owner 744 N. Marine Corps Dr.

Dates Held C211 Upper Tuman, GU 96913 9/2016-present

Previous Employer and Mailing Address Position Title

Guam Memorial Hospital Authority Pediatric Hospitalist 850 Gov Camacho Rd

Dates Held Tamuning, GU 96913

1/2016-present


UCSF Benioff Children's Hospital Urgent Care Physician 747 52nd St

Dates Held Oakland, CA 94609

7/2015-10/2015


Pediatric Evening Referral Clinic Urgent Care Physician 2999 Regent Street #325

Dates Held Berkeley, CA 94 705

7/2015-10/2015 (Has since moved)


UCSF Benioff Children's Hospital Pediatric Resident 747 52nd St

Dates Held Oakland, CA 94609

7/2012-7/2015

PRIOR GOVERNMENT OF GUAM SERVICE Agency or Department Name Position Title

N/A N/A

Address Phone No. Dates Held

N/A N/A N/A

Agency or Department Name Position Title


PAGE 2 OF 7


Doc. No. 35GL-19-0212.

PRIOR GOVERNMENT SERVICE (EXCLUDING GOVERNMENT OF GUAM) Agency or Department Name Position Title

N/A N/A


N/A N/A N/A

Agency or Department Name Position Title


TRAINING

INSTITUTE/SEMINARS/ON-THE-JOB TRAINING DATE

TeamSTEPPS 2/22/16-2/23/16

AWARDS

List all educational, professional, civic awards, and recognition for public service:

N/A

PROFESSIONAL INVOLVEMENT List involvement on a local/national/international level. List organizations, activities participated in, and offices held: ..

Member of Guam Medical Association Board certified member of American Academy of Pediatrics

PAGE 3 OF 7


Doc. No. 35GL-19-0212.

COMMUNITY/ CIVIC INVOLVEMENT

List organizations, activities participated in, and offices held:

Make-A-Wish Guam & CNMI: medical advisor and advocate, 2018-present

Guam Korean Chamber of Commerce: founding member, vice-president, 2018-present

GMH Bylaws Commitee: committee chair, 2017-present

GMHVA Angels in Need charity fund: founder/physician consultant, 2016-present

PUBLICATIONS AND PRESENTATIONS

List any published articles, papers delivered at professional meetings, etc.:

NIA

MILITARY SERVICE (Please attach Form DD-214)

BRANCH DATES OF SERVICE RANK AT

TYPE OF DISCHARGE DISCHARGE

NIA NIA NIA NIA

OTHER INFORMATION

{1) Have you ever been found guilty of a felony in any court, whether within or without the United States?

YesD No0 If so, please specify in detail:-----------------

Address of the Court: __________________________ _

Date(s) of Conviction: __________________________ _

Specific Infraction Committed: _______________________ ~

PAGE 4 OF 7


Doc. No. 35GL-19-0212.

(2) Have you ever been declared mentally incompetent by any court, whether within or without the United States?

VesO No(ZI If so, please specify in detail the reasons and facts related to such declaration:

(3) Have you ever been found not guilty or not punishable in any criminal proceedings by reason of insanity?

VesO No0

(4) Have you ever been confined to a mental institution for any reason?

VesO No0 If so, please specify in why the appointing authority believes you that you are

not suffering from any mental illness or affliction:

PAGE 5 OF 7


Doc. No. 35GL-19-0212.

LOURDES A. LEON GUERRERO Governor

OFFICE OF THE GOVERNOR OF GUAM

Statement of Financial Interests (Required by 4 G.C.A. §13104.1)

TO: The Honorable Lourdes A. Leon Guerrero Governor of Guam

FROM:

Ricardo J. Bordallo Governor's Complex Adelup, Guam 96910

Michael Um

D I have no financial interest in any business

lZJ I do have interest(s) in the following business(es):

Guam Memorial Hospital Employee

One Love Pediatrics Owner

Signature

PAGE 6 OF 7

Date

JOSHUA F. TENORIO Lieutenant Governor


Doc. No. 35GL-19-0212.

AFFIDAVIT/ DECLARATION UNDER PENALTY OF PERJURY I, the undersigned, do hereby depose and say that: (1) I have read and reviewed the information contained in the attached Appointment/Nomination letter from the Governor of Guam; (2) that the matters contained in the Appointment/Nomination letter, together with all attachments thereto, are true and correct and that I am competent to testify to said matters; and (3) that this Declaration is made for the purpose of complying with the requirements of 4 G.C.A. Section 2103.5.

I declare under penalty of perjury under the laws of Guam (4 G.C.A. Section 4308) that the foregoing is true and correct.

Print Name and Signature Date

PAGE 7 OF 7


Doc. No. 35GL-19-0212.

Government of Guam GUAM POLICE DEPARTMENT

RECORDS & IDENTIFICATION SECTION P.O. Box 23909

Guam Main Facility, Guam 96921

February I I, 20 19

SUBJECT: CRIMINAL HISTORY RECORD

NAME: Michael Jung-Bae UM

ATE OF BIRTH: FINGERPRINT#:

• he individual has no record of criminal conviction(s) in GPD files that ar object to Guam law and rules and regulations of the Department.

****************NOTHING FOLLOWS*****************

- THIS IN RMAT!ON MAYBE LIMITED TO A LOCAL CRIMINAL OFFENSE ONLY AND IS NOT INTENDED FOR USE FOR ANY LOCAL STATE, 0 FEDERAL LAW 6NFORCEMENT AGENCY. .

The absence of an original GUAM POLICE

seal invalidates this police clearance. kt:\ ' ISW Ol/ll7119

By Directi~

STEPHEN C. IGNACIO Acting Chief of Police


Doc. No. 35GL-19-0212.

SUPERIOR COURT OF GUAM Guam Judicial Center • 120 West O'Brien Drive • Hagatna, Guam 96910

Telephone (671) 475-3370/475-3449

Fax (671) 472-2856

DANIELLE T. ROSETE Clerk of Court

Name: MICHAEL JUNG-BAE UM

SS#: ID# Date of Birth

CERTIFICATE OF SEARCH

The undersigned Clerk hereby certifies the following results of a diligent search of the records of this Court:

Criminal Cases: Civil Cases:

A. tx1 No Case Found A. w No Case Found

B. I. Criminal Case No. B. I. Civil Case No .

2. Criminal Case No . 2. Civil Case No.

3. Criminal Case No. 3. Civil Case No .



Criminal Record: Page 1 of 1 Civil Record: Page 1 of 1

Request for further information may be addressed at the Records Division of the Superior Court of Guam, Guam Judicial

Center, 120 West O ' Brien Drive, Hagatfia, Guam. Hours of operation are Monday - Friday, 8:00 a.m. to 5:00 p.m.

Closed Saturday, Sunday and local/federal holidays. Court Clearances are Non-Refundable.

Dated: 03/06/2019

The absence of an original Court Seal

invalidates this document

DANIELLET.

BY:

Prepared By: J BR


Doc. No. 35GL-19-0212.

MICHAEL UM~ MD

EDUCATION

SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE Doctor of Medicine

UNIVERSITY OF CALIFORNIA AT BERKELEY

ST. LOUIS, MO. 2012

BERKELEY, CA. 2005 Bachelor of Arts in English Literature, Bachelor of Arts in Integrative Biology

INTERNSHIP AND RESIDENCY

UCSF BENIOFF CHILDREN'S HOSPITAL OAKLAND Formerly Children's Hospital and Research Center Oakland

Pediatric Resident

ONE LOVE PEDIATRICS, LLC

Owner

GUAM MEMORIAL HOSPITAL

Pediatric Hospitalist

EMPLOYMENT

UCSF BENIOFF CHILDREN'S HOSPITAL OAKLAND

Urgent Care physician

PEDIATRIC EVENING REFERRAL CLINIC

Urgent Care physicisn

OAKLAND, CA. 2012-2015

UPPER TUMON, GU 2016-PRESENT

TAMUNING, GU 2016-PRESENT

OAKLAND, CA 2015

OAKLAND, CA 2015

VOLUNTEER EXPERIENCE/PROJECTS

MAKE-A-WISH GUAM & CNMI

Medical advisor and advocate

GUAM KOREAN CHAMBER OF COMMERCE

Founding member, vice-president

GMH BYLAWS COMMITTEE

Committee Chair

ANGELS IN NEED CHARITY FUND

Founder/physician consultant


TUMON, GU 2018-PRESENT



LICENSES AND CERTIFICATIONS


Doc. No. 35GL-19-0212.

Pediatric board certified in Oct 2015

Pediatric advanced life support, recertified in 2018

Guam medical license, exp 2019

California state medical license, exp 2020

Drug Enforcement Administration license, exp 2020

PROFESSIONAL MEMBERSHIPS

Guam Medical Association, member since 2015

American Academy of Pediatrics, member since 2012


Doc. No. 35GL-19-0212.

Documents

OFFICE OF THE GOVERNOR - Legislature of Guam. No. 35GL-19... · 2019-03-11 · EDUCATION NoD NoD SCHOOL (Name, City and State) DATES OF ATTENDANCE High School 1996-2000 Bishop Diego