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700 Dorval Drive, Suite 500 Oakville, ON L6K 3V3 Tel: 905 337-7131 • Fax: 905 337-8330 Toll Free: 1 866 371-5446 www.mississaugahaltonlhin.on.ca
700 Dorval Drive, bureau 500 Oakville, ON L6K 3V3 Téléphone : 905 337-7131 Sans frais : 1 866 371-5446 Télécopieur : 905 337-8330 www.mississaugahaltonlhin.on.ca
February 19, 2016
Electronic Delivery Only
Ms. Terry Tonkovich Ukrainian Home for the Aged (Ivan Franko Home) Executive Director 3058 Winston Churchill Boulevard Mississauga ON L5L 3J1
Dear Ms. Tonkovich,
Re: 2014-17 Multi-Sector Service Accountability Agreement
When the Mississauga Halton Local Health Integration Network (the “LHIN”) and the Ukrainian Home for the Aged (Ivan Franko Home) (the “HSP”) entered into a service accountability agreement for a three-year term effective April 1, 2014 (the “MSAA”), the budgeted financial data, service activities and performance indicators for the third year of the agreement (fiscal year 2016/17) were replicated based on 2015/16 planning assumptions. The LHIN would now like to update the MSAA to include the required financial, service activity and performance expectations for 2016/17 fiscal year to Schedules B, C, D, E and G.
Subject to HSP’s agreement, the MSAA will be amended with effect April 1, 2016, by adding the amended Schedules B, C, D, E and G (the “Schedules”) that are attached to this letter.
To the extent that there are any conflicts between the current MSAA and this amendment, the amendment will govern in respect of the Schedules. All other terms and conditions in the MSAA will remain the same.
Please indicate the HSP’s acceptance of, and agreement to this amendment, by signing below and returning one original copy of this letter to the Mississauga Halton LHIN to the attention of Darlene Parent, Administrative Assistant, by March 25, 2016. If you have any questions or concerns, please contact Jeanny Lau, Lead, Health System Performance at [email protected].
The LHIN appreciates you and your team’s collaboration and hard work during this 2016/17 MSAA refresh process. We look forward to maintaining a strong working relationship with you.
Sincerely,
Graeme Goebelle Bill MacLeod Board Chair Chief Executive Officer Mississauga Halton LHIN Mississauga Halton LHIN
c: George Horhota, President, Board of Directors, Ukrainian Home for the Aged (Ivan Franko Home) Judy Bowyer, Sr. Director, Health System Performance, Mississauga Halton LHIN Dale McGregor, Sr. Director, Finance and Chief Financial Officer, Mississauga Halton LHIN
encl.: Schedules B, C, D, E and G
AGREED TO AND ACCEPTED BY:
Ukrainian Home for the Aged (Ivan Franko Home)
By:
______________________________________________ _________________ Terry Tonkovich, Executive Director Date
I have the authority to bind Ukrainian Home for the Aged (Ivan Franko Home)
And By:
______________________________________________ _________________ George Horhota, President, Board of Directors Date
I have the authority to bind Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 2 of 16
Schedule B1: Total LHIN Funding2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
LHIN Program Revenue & Expenses Row # Account: Financial (F) Reference OHRS VERSION 9.0 2016-2017
Plan Target
REVENUELHIN Global Base Allocation 1 F 11006 $373,867 HBAM Funding (CCAC only) 2 F 11005 $0Quality-Based Procedures (CCAC only) 3 F 11004 $0MOHLTC Base Allocation 4 F 11010 $0MOHLTC Other funding envelopes 5 F 11014 $0LHIN One Time 6 F 11008 $0MOHLTC One Time 7 F 11012 $0Paymaster Flow Through 8 F 11019 $0Service Recipient Revenue 9 F 11050 to 11090 $15,000
Subtotal Revenue LHIN/MOHLTC 10 Sum of Rows 1 to 9 $388,867 Recoveries from External/Internal Sources 11 F 120* $0Donations 12 F 140* $0Other Funding Sources & Other Revenue 13 F 130* to 190*, 110*, [excl. F 11006, 11008, 11010, 11012, 11014, 11019,
11050 to 11090, 131*, 140*, 141*, 151*]$0
Subtotal Other Revenues 14 Sum of Rows 11 to 13 $0TOTAL REVENUE FUND TYPE 2 15 Sum of Rows 10 and 14 $388,867 EXPENSESCompensation
Salaries (Worked hours + Benefit hours cost) 17 F 31010, 31030, 31090, 35010, 35030, 35090 $350,804 Benefit Contributions 18 F 31040 to 31085 , 35040 to 35085 $28,063 Employee Future Benefit Compensation 19 F 305* $0Physician Compensation 20 F 390* $0Physician Assistant Compensation 21 F 390* $0Nurse Practitioner Compensation 22 F 380* $0Physiotherapist Compensation (Row 128) 23 F 350* $0Chiropractor Compensation (Row 129) 24 F 390* $0All Other Medical Staff Compensation 25 F 390*, [excl. F 39092] $0Sessional Fees 26 F 39092 $0
Service CostsMed/Surgical Supplies & Drugs 27 F 460*, 465*, 560*, 565* $0Supplies & Sundry Expenses 28 F 4*, 5*, 6*,
[excl. F 460*, 465*, 560*, 565*, 69596, 69571, 72000, 62800, 45100, 69700]$10,000
Community One Time Expense 29 F 69596 $0Equipment Expenses 30 F 7*, [excl. F 750*, 780* ] $0Amortization on Major Equip, Software License & Fees 31 F 750* , 780* $0Contracted Out Expense 32 F 8* $0Buildings & Grounds Expenses 33 F 9*, [excl. F 950*] $0Building Amortization 34 F 9* $0
TOTAL EXPENSES FUND TYPE 2 35 Sum of Rows 17 to 34 $388,867 NET SURPLUS/(DEFICIT) FROM OPERATIONS 36 Row 15 minus Row 35 $0
Amortization - Grants/Donations Revenue 37 F 131*, 141* & 151* $0SURPLUS/DEFICIT Incl. Amortization of Grants/Donations 38 Sum of Rows 36 to 37 $0FUND TYPE 3 - OTHER
Total Revenue (Type 3) 39 F 1* $1,255,000 Total Expenses (Type 3) 40 F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* $1,255,000
NET SURPLUS/(DEFICIT) FUND TYPE 3 41 Row 39 minus Row 40 $0FUND TYPE 1 - HOSPITAL
Total Revenue (Type 1) 42 F 1* $0Total Expenses (Type 1) 43 F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* $0
NET SURPLUS/(DEFICIT) FUND TYPE 1 44 Row 42 minus Row 43 $0ALL FUND TYPES
Total Revenue (All Funds) 45 Line 15 + line 39 + line 42 $1,643,867 Total Expenses (All Funds) 46 Line 16 + line 40 + line 43 $1,643,867
NET SURPLUS/(DEFICIT) ALL FUND TYPES 47 Row 45 minus Row 46 $0Total Admin Expenses Allocated to the TPBEs
Undistributed Accounting Centres 48 82* $0Plant Operations 49 72 1* $0Volunteer Services 50 72 1* $0Information Systems Support 51 72 1* $0General Administration 52 72 1* $44,000 Admin & Support Services 53 72 1* $44,000 Management Clinical Services 54 72 5 05 $0Medical Resources 55 72 5 07 $0
Total Admin & Undistributed Expenses 56 Sum of Rows 46-50 (included in Fund Type 2 expenses above) $44,000
M-SAA Refresh 2016-2017 3 of 16
Sche
dule
B2:
Cl
inic
al A
ctiv
ity- S
umm
ary
2016
-201
7
Heal
th S
ervi
ce P
rovi
der:
Ukr
aini
an H
ome
for t
he A
ged
(Ivan
Fra
nko
Hom
e)
Serv
ice
Cat
egor
y 20
16-2
017
Bud
get
OH
RS
Fram
ewor
k Le
vel 3
Full-
time
equi
vale
nts
(FTE
)Vi
sits
F2F
, Tel
.,In-
Hous
e, C
ont.
Out
Not U
niqu
ely
Iden
tifie
d Se
rvic
e R
ecip
ient
In
tera
ctio
ns
Hour
s of
Car
e In
-Ho
use
&
Con
trac
ted
Out
Inpa
tient
/Res
iden
t Da
ysIn
divi
dual
s Se
rved
by
Fun
ctio
nal
Cen
tre
Atte
ndan
ce D
ays
Face
-to-F
ace
Gro
up S
essi
ons
(#
of g
roup
ses
sion
s-
not i
ndiv
idua
ls)
Mea
l Del
iver
ed-
Com
bine
dG
roup
Par
ticip
ant
Atte
ndan
ces
(Reg
&
Non
-Reg
)
Serv
ice
Prov
ider
In
tera
ctio
nsSe
rvic
e Pr
ovid
er
Gro
up
Inte
ract
ions
Men
tal H
ealth
Se
ssio
ns
CSS
In-H
ome
and
Com
mun
ity S
ervi
ces
(CSS
IH C
OM
)72
5 8
2*9.
000
00
5,47
590
7,80
00
00
00
0
M-S
AA
Ref
resh
201
6-20
174
of 1
6
Schedule C: ReportsCommunity Support Services2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 5 of 16
Schedule C: ReportsCommunity Support Services2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 6 of 16
Schedule D: Directives , Guidlelines and PoliciesCommunity Support Services2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 7 of 16
Schedule E1: Core Indicators2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
16-17
Performance Indicators 2016-2017Target
Performance Standard
*Balanced Budget - Fund Type 2 $0 >=0
Proportion of Budget Spent on Administration 11.3% <=13.6%
**Percentage Total Margin 0.00% >= 0%
Percentage of Alternate Level of Care (ALC) days (closed cases) - -
Variance Forecast to Actual Expenditures 0 < 5%
Variance Forecast to Actual Units of Service 0 < 5%
Service Activity by Functional Centre Refer to Schedule E2a -
Number of Individuals Served Refer to Schedule E2a -
Alternate Level of Care (ALC) Rate - -
Explanatory Indicators
Budget Spent on Administration- AS Information Systems Support 72 1 25
Budget Spent on Administration- AS General Administration 72 1 10
Client Experience
Cost per Individual Served (by Program/Service/Functional Centre)
Cost per Unit Service (by Functional Centre)
Budget Spent on Administration- AS Volunteer Services 72 1 40
* Balanced Budget Fund Type 2: HSP's are required to submit a balanced budget** No negative variance is accepted for Total Margin
Budget Spent on Administration- AS Plant Operation 72 1 55
M-SAA Refresh 2016-2017 8 of 16
Schedule E2a: Clinical Activity- Detail2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
Target Performance Standard
Administration and Support Services 72 1*Full-time equivalents (FTE) 72 1* 1.00 n/a
Total Cost for Functional Centre 72 1* $44,000 n/a CSS IH - Social and Congregate Dining 72 5 82 12 Full-time equivalents (FTE) 72 5 82 12 1.00 n/a Individuals Served by Functional Centre 72 5 82 12 75 60 - 90 Attendance Days Face-to-Face 72 5 82 12 7,800 7410 - 8190 Total Cost for Functional Centre 72 5 82 12 $25,565 n/a CSS IH - Assisted Living Services 72 5 82 45 Full-time equivalents (FTE) 72 5 82 45 8.00 n/a Inpatient/Resident Days 72 5 82 45 5,475 5201 - 5749 Individuals Served by Functional Centre 72 5 82 45 15 12 - 18 Total Cost for Functional Centre 72 5 82 45 $319,302 n/a ACTIVITY SUMMARY Ful 10.00 n/a
Inp 5,475 5201 - 5749
Ind 90 72 - 108
Att 7,800 7410 - 8190
Tot $388,867 n/a
Total Cost for All F/C
Total Individuals Served by Functional Centre for all F/C
Total Attendance Days for all F/C
Total Full-Time Equivalents for all F/C
Total Inpatient/Resident Days for all F/C
1These values are provided for information purposes only. They are not Accountability Indicators.
OHRS Description & Functonal Centre 2016-2017
M-SAA Refresh 2016-2017 9 of 16
Schedule E2d: CSS Sector Specific Indicators2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
16-17
Performance Indicators 2016-2017Target
Performance Standard
No Performance Indicators - -
Explanatory Indicators
# Persons waiting for service (by functional centre)
M-SAA Refresh 2016-2017 10 of 16
Schedule E3a Local: All2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 11 of 16
Schedule E3a Local: All2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 12 of 16
Schedule E3a Local: All2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 13 of 16
Schedule E3a Local: All2016-2017
Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)
M-SAA Refresh 2016-2017 14 of 16
Sche
dule
G:
Dec
lara
tion
of C
ompl
ianc
e20
16-2
017
Heal
th S
ervi
ce P
rovi
der:
Ukr
aini
an H
ome
for t
he A
ged
(Ivan
Fra
nko
Hom
e)
DEC
LAR
ATIO
N O
F C
OM
PLIA
NC
EIs
sued
pur
suan
t to
the
M-S
AA e
ffect
ive
April
1, 2
014
To:
The
Boa
rd o
f Dire
ctor
sof
the
[inse
rt na
me
of L
HIN
] Loc
al H
ealth
Inte
grat
ion
Net
wor
k (th
e “L
HIN
”).
Attn
: B
oard
Cha
ir.
From
: Th
e B
oard
of D
irect
ors
(the
“Boa
rd”)
of t
he [i
nser
t nam
e of
HSP
] (th
e “H
SP”)
Dat
e:[in
sert
date
]
Re:
[inse
rt da
te ra
nge
-Apr
il 1,
201
X –
Mar
ch 3
1, 2
01x]
(the
“App
licab
le P
erio
d”)
Unl
ess
othe
rwis
e de
fined
in th
is d
ecla
ratio
n, c
apita
lized
term
s ha
ve th
e sa
me
mea
ning
as
set o
ut in
the
M-S
AA b
etw
een
the
LHIN
and
the
HSP
effe
ctiv
e Ap
ril 1
, 20
14.
The
Boa
rd h
as a
utho
rized
me,
by
reso
lutio
n da
ted
[inse
rt da
te],
to d
ecla
re to
you
as
follo
ws:
Afte
r mak
ing
inqu
iries
of t
he [i
nser
t nam
e an
d po
sitio
n of
per
son
resp
onsi
ble
for m
anag
ing
the
HSP
on
a da
y to
day
bas
is, e
.g. t
he C
hief
Exe
cutiv
e O
ffice
or t
he
Exe
cutiv
e D
irect
or] a
nd o
ther
app
ropr
iate
offi
cers
of t
he H
SP
and
sub
ject
to a
ny e
xcep
tions
iden
tifie
d on
App
endi
x 1
to th
is D
ecla
ratio
n of
Com
plia
nce,
to th
e be
st
of th
e B
oard
’s k
now
ledg
e an
d be
lief,
the
HS
P h
as fu
lfille
d, it
s ob
ligat
ions
und
er th
e se
rvic
e ac
coun
tabi
lity
agre
emen
t (th
e “M
-SA
A”)
in e
ffect
dur
ing
the
App
licab
le
Per
iod.
With
out l
imiti
ng th
e ge
nera
lity
of th
e fo
rego
ing,
the
HS
P h
as c
ompl
ied
with
:
(i)A
rticl
e 4.
8 of
the
M-S
AA
con
cern
ing
appl
icab
le p
rocu
rem
ent p
ract
ices
;(ii
)Th
eLo
cal H
ealth
Sys
tem
Inte
grat
ion
Act,
2006
; and
(iii)
The
Pub
lic S
ecto
r Com
pens
atio
n R
estra
int t
o P
rote
ct P
ublic
Ser
vice
s A
ct, 2
010.
____
____
____
____
____
____
____
___
[inse
rt na
me
of C
hair]
, [in
sert
title
]
M-S
AA
Ref
resh
201
6-20
1715
of 1
6
Sche
dule
G:
Dec
lara
tion
of C
ompl
ianc
e20
16-2
017
Heal
th S
ervi
ce P
rovi
der:
Ukr
aini
an H
ome
for t
he A
ged
(Ivan
Fra
nko
Hom
e)
Sche
dule
G –
Form
of C
ompl
ianc
e D
ecla
ratio
n C
ont’d
.
Appe
ndix
1 -
Exce
ptio
ns
[Ple
ase
iden
tify
each
obl
igat
ion
unde
r the
MSA
A th
at th
e H
SP d
id n
ot m
eet d
urin
g th
e Ap
plic
able
Per
iod,
toge
ther
with
an
expl
anat
ion
as to
why
the
oblig
atio
n w
as
not m
et a
nd a
n es
timat
ed d
ate
by w
hich
the
HS
P e
xpec
ts to
be
in c
ompl
ianc
e.]
M-S
AA
Ref
resh
201
6-20
1716
of 1
6