Via . March 1, Kelly Stack Executive Director Essex Community Services 35 Victoria Avenue, Unit 7 Essex, ON N8M 1M4. Dear Ms.

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1 Via March 1, 2013 Kelly Stack Executive Director 35 Victoria Avenue, Unit 7 Essex, ON N8M 1M4 Dear Ms. Stack: Re: Multi-Sectoral Service Accountability Agreement When the Erie St. Clair Local Health Integration Network (LHIN) and the (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 questions 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 your 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/vad Attach: Schedule A1, A2, B1, B2, E1, E2a, E2d, E3 AGREED TO AND ACCEPTED BY: By: Executive Director, Kelly Stack I have the authority to bind Date And By: Chair, I have the authority to bind Date

3 MSAA Refresh 13/14 Schedules (A1)

4 Population and Geography Narratives Return to Main Page Client Population Seniors and over Disabled individuals (physical & mental) Low Income individuals Low Income Isolated Seniors and individuals Isolated Diabetics Seniors and individuals Diabe cs We have noticed a large climb in the low income population that are seeking our services. As we are not funded for this catchement area, we serve as many as we can and base it on a high priority need, (specialist appointments, children, necessities of life) We have noticed a large climb in the low income population that are seeking our services. As we are not funded for this catchement area, we serve as many as we can and base Our it senior on a population high priority is also need, increasing (specialist and appointments, as such demand children, for our services, necessi es especially of life) transportation is very high. Our senior population is also increasing and as such demand for our services, especially transportation is very high. Supplemental: Schedule A2: Population and Geography Narratives Geography Served Municipality of Essex, including, Essex Center, Harrow Center, McGregor Center, Colchester North, Colchester South, as well as serving into Cottam, Woodslee, NorthRidge, Maidstone, OldCastle and OldCastle far ourskirts and far of Kingsville. ourskirts of Kingsville. Municipality of Essex, including, Essex Center, Harrow Center, McGregor Center, Colchester North, Colchester South, as well as serving into Cottam, Woodslee, NorthRidge, Maidstone, We have offices in Essex, McGregor and Harrow. We are open in Essex on Mon-Thur from 8:30-4pm and Friday from 8:30-2pm. We have offices in Essex, McGregor and Harrow. We are open in Essex on Mon Thur from 8:30 4pm and Friday from 8:30 2pm. Our buses run 5 days a week with various hours. Saturdays are for emergency/specialists only. Our buses run 5 days a week with various hours. Saturdays are for emergency/specialists only. MSAA Refresh 13/14 Schedules (A2)

5 Summary of Revenue & Expenses Return to Main>>> 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 $176,160 (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 $42,500 Subtotal Revenue LHIN/MOHLTC 19 Sum of Rows 12 to 18 $218,660 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 $218,660 EXPENSES Compensation Salaries and Wages (Worked + Benefit + Purchased) 27 F 31010, 31030, 31090, 35010, 35030, $122,500 Benefit Contributions 28 F to 31085, to $14,559 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 $0 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, $7,500 & Drugs) 69571, 72000, 62800, 45100, 69700] Community One Time Expense 36 F $0 Equipment Expenses 37 F 7*, [excl. F 750*, 780* ] $57,601 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*] $16,500 Building Amortization 41 F 9* $0 TOTAL EXPENSES Fund Type 2 42 Sum of Rows 27 to 41 $218,660 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* $55,000 Total Expenses (Type 3) 48 F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* $55,000 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 $273,660 Total Expenses (All Funds) 56 Line 28 + line 33 + line 36 $273,660 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 * $17,500 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 $17,500 MSAA Refresh 13/14 Schedules (B1)

6 Activity Summary Return to Main Page Supplemental: Schedule B2 Budget 2013/14 Service Category Budget OHRS Framework 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 gro up sessionsnot individuals) Attendance Days Faceto-Face M eal Delivered- Combined Mental Health Sessions Group Participant Attendance s (Reg & Non-Reg) Service Service Provider Provider Gro up 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 , MSAA Refresh 13/14 Schedules (B2)

7 Core Indicators All Sectors Return to Main Page Supplemental: Schedule E1 CORE INDICATORS- All Sectors Accountability Indicators Target Performance Standard % Total Margin 0.00 >=0% Fund Type 2- Balanced Budget $0 0 Proportion of Budget Spent on Administration 8.0% < 10% Variance Forecast to Actual Expenditures 0.0% < 5% Variance Forecast to Actual Units of Service 0.0% < 5% Explanatory Indicators Cost per Unit Service (by Functional Centre - Transportation ) $ 16 Cost per Individual Served (by program/service) $ 549 Cost per Unit Service (by Functional Centre - Social and Safety ) $ 3 Cost per Individual Served (by program/service) $ 125 Cost per Unit Service (by Functional Centre - Foot Care Services ) $ 9 Cost per Individual Served (by program/service) $ 23 > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. MSAA Refresh 13/14 Schedules (E1)

8 Service Activity Indicators All Sectors Return to Main Page Supplemental: Schedule E2a Service Activity Indicators-All Sectors COM IH - Transportation - Client COM IH - Visiting - Social and Safety Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre COM IH - Foot Care Services Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre TOTAL FUNCTIONAL CENTRES & CHC Full-time equivalents (FTE) Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre OHRS Description & Functional Centre Target Performance Standard Full-time equivalents (FTE) Visits F2F, Tel.,In-House, Cont. Out Individuals Served by Functional Centre Total Cost for Functional Centre p p p y y 5.00 N/A 12, $177,160 N/A 1, $7,500 N/A 1, $16,500 N/A 5.00 N/A 15, $218,660 N/A MSAA Refresh 13/14 Schedules (E2a)

9 Sector Specific Indicators CSS Sector 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 ) Average number of days waited for First Service (by functional centre ) Average number of days waited for First Service (by functional centre ) 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) MSAA Refresh 13/14 Schedules (E2d)

10 LHIN Local Indicators LHIN Specific Supplemental Schedule E3: LHIN Local Indicators Target Performance Standard Sector: Community Support Service - - 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: Activity - - Measure/Obligation MSAA Refresh 13/14 Schedules (E3)