Via . March 1, Ken Deane President and Chief Executive Officer Hôtel-Dieu Grace Hospital 1030 Ouellette Avenue Windsor ON N9A 1E1

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1 Via March 1, 2013 Ken Deane President and Chief Executive Officer Hôtel-Dieu Grace Hospital 1030 Ouellette Avenue Windsor ON N9A 1E1 Dear Mr. Deane: Re: Multi-Sectoral Service Accountability Agreement When the Erie St. Clair Local Health Integration Network (LHIN) and Hôtel-Dieu Grace Hospital (the HSP ), entered into a service accountability agreement for a three-year term effective April 1, 2011(the M-SAA ), there was insufficient information available to complete Schedules A, B and E for the third year of the term. The Erie St. Clair LHIN would now like to update the M-SAA to include the required financial, service activity and performance indicators for fiscal year to Schedules A, B and E. Subject to the HSP s agreement, the M-SAA will be amended with effect April 1, 2013, by adding the supplemental Schedules A, B and E (the Schedules ) that are included in this letter, thereby incorporating the required financial, service activity, and performance indicators for fiscal year To the extent that there are any conflicts between the current M-SAA and this amendment, the amendment will govern in respect of the Schedules. All other terms and conditions in the M-SAA will remain the same. Please indicate the HSP s acceptance of, and agreement to this amendment, by signing below and returning one copy of this letter to Stephanie Harper, Funding and Allocation Analyst at Stephanie.harper@lhins.on.ca within 2 weeks of receipt of this letter. 2

2 2. If you have any questionss or concerns, please contact Ralph Ganter, Senior Director, Health System Design and Implementation at ext The Erie St. Clair LHIN commends you and your team for yourr hard work and dedication during this process, and we look forward to maintaining a strong working relationship with you. Sincerely, Let s Make It Happen! Gary Switzer Chief Executive Officer MOHLTC/ja Attach: Schedule A1, A2, B1, B2, E1, E2a, E2d, E3 AGREED TO AND ACCEPTED BY: Hôtel-Dieu Grace Hospital By: President and Chief Executive Officer, Ken Deane I have the authority to bind Hôtel-Dieu Grace Hospital Date And By: Chair, I have the authority to bind Hôtel-Dieu Grace Hospital Date

3 HDGH MSAA Refresh 13/14 Schedules (A1)

4 HDGH MSAA Refresh 13/14 Schedules (A2)

5 Summary of Revenue & Expenses Healthcare Service Provider: Return to Main>>> Hotel Dieu Grace Hospital Supplemental: Schedule B1: Budget 2013/14 LHIN Program Revenue & Expenses Row # Account: Financial (F) Reference OHRS VERSION Budget REVENUE Funding - Local Health Integrated Networks (LHIN) 12 F $2,635,018 (Allocation) Funding - Provincial MOHLTC (Allocation) 13 F $0 Funding - MOHLTC Other funding envelopes 14 F $0 Funding - LHINs One Time 15 F $0 Funding MOHLTC One Time 16 F $0 Paymaster Flow Through 17 F $0 Service Recipient Revenue 18 F to $0 Subtotal Revenue LHIN/MOHLTC 19 Sum of Rows 12 to 18 $2,635,018 Recoveries from External/Internal Sources 20 F 120* $0 Donations 21 F 140* $0 22 F 130* to 190*, 110*, [excl. F 11006, 11008, 11010, $0 Other Funding Sources and Other Revenue 11012, 11014, 11019, to 11090, 131*, 140*, 141*, 151*] Subtotal Other Revenues 23 Sum of Rows 20 to 22 $0 TOTAL REVENUE- Fund Type 2 24 Sum of Rows 19 and 23 $2,635,018 EXPENSES Compensation Salaries and Wages (Worked + Benefit + Purchased) 27 F 31010, 31030, 31090, 35010, 35030, $1,742,213 Benefit Contributions 28 F to 31085, to $400,274 Employee Future Benefit Compensation 29 F 305* $0 Nurse Practitioner Remuneration 30 F 380* $0 Medical Staff Remuneration 31 F 390*, [excl. F 39092] $0 Sessional Fees 32 F $360,112 Service Costs Med/Surgical Supplies and Drugs 34 F 460*, 465*, 560*, 565* $0 Supplies and Sundry Expenses (excl. Med/Surg Supplies 35 F 4*, 5*, 6*, [excl. F 460*, 465*, 560*, 565*, 69596, $132,419 & Drugs) 69571, 72000, 62800, 45100, 69700] Community One Time Expense 36 F $0 Equipment Expenses 37 F 7*, [excl. F 750*, 780* ] $0 Amortization on Major Equip and Software License and 38 F 750*, 780* $0 Fees Contracted Out Expense 39 F 8* $0 Buildings and Grounds Expenses 40 F 9*, [excl. F 950*] $0 Building Amortization 41 F 9* $0 TOTAL EXPENSES Fund Type 2 42 Sum of Rows 27 to 41 $2,635,018 NET SURPLUS/(DEFICIT) FROM OPERATIONS 43 Row 24 minus Row 42 $0 Amortization - Grants/Donations Revenue 44 F 131*, 141* & 151* $0 SURPLUS/DEFICIT Including Amortization of Grants/Donations 45 Sum of Rows 43 to 44 $0 FUND TYPE 3 - OTHER Total Revenue (Type 3) 47 F 1* $0 Total Expenses (Type 3) 48 F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* $0 NET SURPLUS/(DEFICIT) FUND TYPE 3 49 Row 47 minus Row 48 $0 FUND TYPE 1 - HOSPITAL Total Revenue (Type 1) 51 F 1* $0 Total Expenses (Type 1) 52 F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* $0 NET SURPLUS/(DEFICIT) FUND TYPE 1 53 Row 51 minus Row 52 $0 ALL FUND TYPES Total Revenue (All Funds) 55 Line 13 + line 32 + line 35 $2,635,018 Total Expenses (All Funds) 56 Line 28 + line 33 + line 36 $2,635,018 NET SURPLUS/(DEFICIT) ALL FUND TYPES 57 Row 55 minus Row 56 $0 Total Administration Expenses Allocated to the TPBEs Undistributed Accounting Centres 59 82* $0 Administration and Support Services * $209,696 Management Clinical Services $0 Medical Resources $0 Total Administrative & Undistributed Expenses (Included in fund type 2 expenses above) 63 Sum of Rows (included in Fund Type 2 expenses above $209,696 HDGH MSAA Refresh 13/14 Schedules (B1)

6 Activity Summary Healthcare Service Provider: Return to Main Page Hotel Dieu Grace Hospital Supplemental: Schedule B2 Budget 2013/14 Service Category Budget OHRS Fram ew ork Level 3 Visits F2F, Tel.,In- House, Cont. Out Not Hours of Uniquely Care In- Identified House & Service Contracted Recipient Out Interactions Individuals Inpatient/Re Served by sident Days Functional Centre Group Sessions (# of group sessionsnot individuals) Attendance Days Faceto-Face Meal Delivered- Combined Mental Health Sessions Group P articipant Attendance s (Reg & Non-Reg) Service Service Provider Provider Group Interactions Interactions (All Time (All Time Intervals) Intervals) Total Case Management Total COM Primary Care Totals COM Crisis Intervention , , Total COM Day/Night Care Sub-Total COM In-Home Health Care Sub-Total COM Private/Home School Sub-Total COM Publicly Funded Schools Sub-total COM Mental Health/Addictions Total In-Home Care Sub-total COM In-Home Support Services COM Private/Home School Support - Personal Services COM - Respite Service Total In Home Support Services Sub-Total COM Residential-Mental Health Sub-Total COM Residential-Addictions Sub-total Residential Hospice- End of Life (EOL) Total COM Residential Services Total COM Health Promotion and Education Total COM Consumer/Survivor/Family Initiatives Total COM Information and Referral Service Total Provincial Health System Development Total CSS In-Home and Community Services (CSS IH COM) Total CSS-ABI Services Total CSS Community Support Initiatives Total Other Initiatives 72 5* Total Activity- LHIN Managed , , HDGH MSAA Refresh 13/14 Schedules (B2)

7 HDGH MSAA Refresh 13/14 Schedules (E1)

8 Service Activity Indicators All Sectors Healthcare Service Provider: Return to Main Page Hotel Dieu Grace Hospital Supplemental: Schedule E2a Service Activity Indicators-All Sectors OHRS Description & Functional Centre COM Crisis Intervention - Mental Health Full-time equivalents (FTE) Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre Mental Health Sessions TOTAL FUNCTIONAL CENTRES & CHC p p p y y Full-time equivalents (FTE) Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre Mental Health Sessions Target Performance Standard 19 N/A 17, , $2,211,261 N/A N/A 17, , $2,635,018 N/A HDGH MSAA Refresh 13/14 Schedules (E2a)

9 Sector Specific Indicators CSS Sector Healthcare Service Provider: Hotel Dieu Grace Hospital Supplemental Schedule E2d : CSS Specific Indicators Accountability Indicators Target Performance Standard Percentage ALC Days 9.0% <14.5% Average number of days waited for First Service (by functional centre - Mental Health TBD TBD Explanatory Indicators Repeat Unscheduled Emergency Visits within 30 days for Mental Health Conditions 16.9 Repeat Unscheduled Emergency Visits within 30 days for Substance Abuse Conditions 17.2 Number of Persons Waiting for Service (by functional centre - Mental Health ) TBD HDGH MSAA Refresh 13/14 Schedules (E2d)

10 LHIN Local Indicators LHIN Specific Healthcare Service Provider: Hotel Dieu Grace Hospital Supplemental Schedule E3: LHIN Local Indicators Target Performance Standard Sector: Mental Health and Addiction - - Activity Explanatory Indicator Measure/Obligation Health service provider will work collaboratively with the Erie St. Clair LHIN and community partners to enhance the capacity for patient flow, chronic disease management and HealthLinks. Target Performance Standard Sector: Mental Health and Addiction - - Activity Measure/Obligation Explanatory Indicator Provide quarterly service descriptions and changes to Connex Ontario. Display Connex Ontario number/information for Mental Health,Addiction and Problem Gambling where the public can view.crisis clients will receive contact (phone or appointment face to face) no later than 4 business days from the first point of access/call. The provider will report to the ESC LHIN service volumes as requested.funding for the Police/Mental Health Team (COAST/HELP) will not be diverted to other programs. The program resources will be maintained by the provider and volumes of service will be reported to the ESC LHIN as requested. ED Psychiatric Assessment Nurse/Team Current Health Human Resources for crisis/psychiatric assessment services in the ED will not be diverted to other programs. As per repeat ED Mental Health and Addictions ( repeat visits within 30 days) each provider is responsible for working with the ESC LHIN and collaboratively with other community providers to address the needs of repeat MH/Addiction ED clients. Service volumes and risk mitigation strategies will be reported to the ESC LHIN on a quarterly basis (no later than 30 days after the end of a fiscal quarter). HDGH MSAA Refresh 13/14 Schedules (E3)