At the center of its management is the USHPA Board of Directors. There are twenty elected regional directors, five directors-at-large, and one Ex Officio director who convene twice a year and vote on policy decisions. Elected directors, apportioned by the population of the USHPA regions, serve for two-year terms; at-larges, appointed by the elected directors, serve for a single year term. Each year, in the fall, the USHPA Board elects its officers. They are the president, vice president, secretary, and treasurer and make up the USHPA Executive Committee. Between meetings of the board, the EC is empowered to act on behalf of the board of directors for many decisions that may come up between the semi-annual meetings. This structure permits ongoing decisions to be made in the conduct of the Association's business and provides continuity.