4316Ukrainian Home for the Aged (Ivan Franko Home) 2016-17 ...

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

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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


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)


Schedule D: Directives , Guidlelines and PoliciesCommunity Support Services2016-2017Health Service Provider: Ukrainian Home for the Aged (Ivan Franko Home)


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


Schedule E2a: Clinical Activity- Detail2016-2017


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


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)


Schedule E3a Local: All2016-2017



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:

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rd o

f Dire

ctor

sof

the

[inse

rt na

me

of L

HIN

] Loc

al H

ealth

Inte

grat

ion

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wor

k (th

e “L

HIN

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Attn

: B

oard

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ir.

From

: Th

e B

oard

of D

irect

ors

(the

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rd”)

of t

he [i

nser

t nam

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HSP

] (th

e “H

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Dat

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sert

date

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Re:

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201

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ch 3

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ess

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apita

lized

term

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the

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etw

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the

LHIN

and

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HSP

effe

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as a

utho

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n of

per

son

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anag

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bas

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to th

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of th

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now

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as fu

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tabi

lity

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e “M

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in e

ffect

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ing

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licab

le

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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)

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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.

____

____

____

____

____

____

____

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[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

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ase

iden

tify

each

obl

igat

ion

unde

r the

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at th

e H

SP d

id n

ot m

eet d

urin

g th

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plic

able

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toge

ther

with

an

expl

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as to

why

the

oblig

atio

n w

as

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et a

nd a

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timat

ed d

ate

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hich

the

HS

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xpec

ts to

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ianc

e.]

M-S

AA

Ref

resh

201

6-20

1716

of 1

6

4316Ukrainian Home for the Aged (Ivan Franko Home) 2016-17 ...

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