q % 8 Nelson Street West, Suite 300 8, rue Nelson Quest, bureau 300 \ Brampton, ON L6X 4J2 j Brampton, (Ontario) L6X 4J2

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1 Central West LHIN I RLISS du Centre-Ouest February 1, 2016 : : q % 8 Nelson Street West, Suite 300 8, rue Nelson Quest, bureau 300 \ Brampton, ON L6X 4J2 j Brampton, (Ontario) L6X 4J2 Healthy Tel: Téléphone Change asate Fax: Sans frais Toll Free: Telecopieur: centrataestlhin.on.ca.rlisscentre-ouest.on.ca Mr. Baldev Mutta Executive Director Punjabi Community Health Services Drew Road Mississauga, ON L4TOA7 Dear..Miitta: Re: Multi-Sector Service Accountability Agreement When the Central West Local Health Integration Network (the LHIN ) and the Punjabi Community Health Services (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 second and third year of the agreement (fiscal years 2015/16 and 2016/1 7) were replicated based on 2014/15 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, F and G. Subject to HSP agreement, the MSAA will be amended with effect April 1, 2016 by adding the amended Schedules B, C, D, E, F and G (the Schedules ) that are included in Appendix 1 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 copy of this letter to cwdocumentslhins.on.ca by March 15, If you have any questions or concerns please contact Neil McIntosh by phone at (905) or by neil.mcintoshlhins.on.ca. Ontario Lcca FeaIth integration Network Réseaq local dintégration des services de santa

2 Punjabi Community Health Services re: Amendment of MSAA for 2016/17 February 1,2016 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, Sco eo Chie Ex cutive Officer End.: Appendix I Schedules B, C, D, E, F and G c: Marty Klein, President, Punjabi Community Health Services Maria Britto, Board Chair, Central West LHIN Brock Hovey, Senior Director, Health System Performance, Central West LHIN Neil Mcintosh, Director, Performance and Accountability, Central West LHIN Page 2 of 4

3 Punjabi Commnty HeaIIh Services re: ndei:t of : February i, 2016 AGREED TO AND ACCEPTED BY: By: Date: And By: mnvdjiyy /_/ 2L_ Marty K1E14 Pdldo,it I have th4jiithoiity to bind Punjabi Community Health Servtces Date: mmi Iyy Page 3 of 4

4 February Punjabi Community Health Services re: Amendment of MSAA for 2016/ APPENDIX 1 Schedules BI Total LHIN Funding Service Plan B2 Clinical Activity Summary C Reports D Directives, Guidelines, & Policies El Core Indicators E2a Clinical Activity - Detail E2(b-e) Sector Specific Indicators E3(a-e) Local Indicators & Obligations F Project Funding Agreement Template G Form of Compliance Declaration Page 4 of 4

5 Schedule B1: Total LHIN Funding LHIN Program Revenue & Expenses REVENUE LHIN Global Base Allocation HBAM Funding (CCAC only) Quality-Based Procedures (CCAC only) MOHLTC Base Allocation MOHLTC Other funding envelopes LHIN One Time MOHLTC One Time Paymaster Flow Through Service Recipient Revenue Subtotal Revenue LHIN/MOHLTC Recoveries from External/Internal Sources Donations Other Funding Sources & Other Revenue Subtotal Other Revenues TOTAL REVENUE FUND TYPE 2 EXPENSES Compensation Salaries (Worked hours + Benefit hours cost) Benefit Contributions Employee Future Benefit Compensation Physician Compensation Physician Assistant Compensation Nurse Practitioner Compensation Physiotherapist Compensation (Row 128) Chiropractor Compensation (Row 129) All Other Medical Staff Compensation Sessional Fees Row # Account: Financial (F) Reference OHRS VERSION 9.0 F F F F F F F F F to Sum of Rows 1 to 9 F 120* F 140* F 130* to 190*, 110*, [excl. F 11006, 11008, 11010, 11012, 11014, 11019, to 11090, 131*, 140*, 141*, 151*] Sum of Rows 11 to 13 Sum of Rows 10 and 14 F 31010, 31030, 31090, 35010, 35030, F to 31085, to F 305* F 390* F 390* F 380* F 350* F 390* F 390*, [excl. F 39092] F Plan Target $2,242,864 $2,242,864 $2,242,864 $1,303,761 $195,344 $53,154 Service Costs Med/Surgical Supplies & Drugs Supplies & Sundry Expenses F 460*, 465*, 560*, 565* F 4*, 5*, 6*, [excl. F 460*, 465*, 560*, 565*, 69596, 69571, 72000, 62800, 45100, 69700] $381,203 Community One Time Expense 29 F Equipment Expenses 30 F 7*, [excl. F 750*, 780* ] Amortization on Major Equip, Software License & Fees 31 F 750*, 780* Contracted Out Expense 32 F 8* $84,796 Buildings & Grounds Expenses 33 F 9*, [excl. F 950*] $224,606 Building Amortization 34 F 9* TOTAL EXPENSES FUND TYPE 2 35 Sum of Rows 17 to 34 $2,242,864 NET SURPLUS/(DEFICIT) FROM OPERATIONS 36 Row 15 minus Row 35 Amortization - Grants/Donations Revenue 37 F 131*, 141* & 151* 38 Sum of Rows 36 to 37 SURPLUS/DEFICIT Incl. Amortization of Grants/Donations FUND TYPE 3 - OTHER Total Revenue (Type 3) Total Expenses (Type 3) NET SURPLUS/(DEFICIT) FUND TYPE 3 FUND TYPE 1 - HOSPITAL Total Revenue (Type 1) Total Expenses (Type 1) NET SURPLUS/(DEFICIT) FUND TYPE 1 ALL FUND TYPES Total Revenue (All Funds) Total Expenses (All Funds) NET SURPLUS/(DEFICIT) ALL FUND TYPES Total Admin Expenses Allocated to the TPBEs Undistributed Accounting Centres Plant Operations Volunteer Services Information Systems Support General Administration Admin & Support Services Management Clinical Services Medical Resources Total Admin & Undistributed Expenses F 1* F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* Row 39 minus Row 40 F 1* F 3*, F 4*, F 5*, F 6*, F 7*, F 8*, F 9* Row 42 minus Row 43 Line 15 + line 39 + line 42 Line 16 + line 40 + line 43 Row 45 minus Row 46 82* 72 1* 72 1* 72 1* 72 1* 72 1* Sum of Rows (included in Fund Type 2 expenses above) $1,000,000 $1,000,000 $3,242,864 $3,242,864 $224,606 $44,238 $167,928 $436,772 $436,772

6 Schedule B2: Clinical Activity- Summary Service Category Budget OHRS Framework Level 3 Full-time Visits F2F, Tel.,In- Not Uniquely Hours of Care Inequivalents (FTE) House, Cont. Out Identified Service House & Recipient Contracted Out Interactions Inpatient/Resident Individuals Served Attendance Days Days by Functional Face-to-Face Centre Group Sessions (# Meal Deliveredof group sessionsnot Combined individuals) Group Participant Service Provider Attendances (Reg Interactions & Non-Reg) Service Provider Mental Health Group Interactions Sessions Case Management * , Primary Care- Clinics/Programs * , Health Promotion and Education Consumer/Survivor/Family Initiatives * CSS In-Home and Community Services (CSS IH COM) * , , ,

7 SCHEDULE C REPORTS COMMUNITY SUPPORT SERVICES Only those requirements listed below that relate to the programs and services that are funded by the LHIN will be applicable. A list of reporting requirements and related submission dates is set out below. Unless otherwise indicated, the HSP is only required to provide information that is related to the funding that is provided under this Agreement. Reports that require full entity reporting are followed by an asterisk *. OHRS/MIS Trial Balance Submission (through OHFS) Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 30, Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 31, Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 31, 2017 Supplementary Reporting - Quarterly Report (through SRI) Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2015 Supplementary Reporting Due Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2016 Supplementary Reporting Due Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2017 Supplementary Reporting Due Annual Reconciliation Report (ARR) through SRI and paper copy submission* (All HSPs must submit both paper copy ARR submission, duly signed, to the Ministry and the respective LHIN where funding is provided; soft copy to be provided through SRI) Fiscal Year Due Date ARR June 30, ARR June 30, ARR June 30, 2017

8 SCHEDULE C REPORTS COMMUNITY SUPPORT SERVICES Board Approved Audited Financial Statements * Fiscal Year June 30, June 30, June 30, 2017 Declaration of Compliance Fiscal Year June 30, June 30, June 30, June 30, 2017 Due Date Due Date Community Support Services Other Reporting Requirements Requirement Due Date French Language Service Report April 30, April 30, April 30, 2017

9 SCHEDULE C REPORTS COMMUNITY MENTAL HEALTH AND ADDICTIONS SERVICES Only those requirements listed below that relate to the programs and services that are funded by the LHIN will be applicable. A list of reporting requirements and related submission dates is set out below. Unless otherwise indicated, the HSP is only required to provide information that is related to the funding that is provided under this Agreement. Reports that require full entity reporting are followed by an asterisk *. OHRS/MIS Trial Balance Submission (through OHFS) Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 30, Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 31, Due Dates (Must pass 3c Edits) Q1 Not required Q2 October 31, Q3 January 31, Q4 May 31, 2017 Supplementary Reporting - Quarterly Report (through SRI) Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2015 Supplementary Reporting Due Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2016 Supplementary Reporting Due Due five (5) business days following Trial Balance Submission Due Date Q2 November 7, Q3 February 7, Q4 June 7, 2017 Supplementary Reporting Due Annual Reconciliation Report (ARR) through SRI and paper copy submission* (All HSPs must submit both paper copy ARR submission, duly signed, to the Ministry and the respective LHIN where funding is provided; soft copy to be provided through SRI) Fiscal Year Due Date ARR June 30, ARR June 30, ARR June 30, 2017

10 SCHEDULE C REPORTS COMMUNITY MENTAL HEALTH AND ADDICTIONS SERVICES Board Approved Audited Financial Statements * Fiscal Year June 30, June 30, June 30, 2017 Declaration of Compliance Fiscal Year June 30, June 30, June 30, June 30, 2017 Due Date Due Date Community Mental Health and Addictions Other Reporting Requirements Requirement Due Date Common Data Set for Community Last day of one month following the close of trial Mental Health Services balance reporting for Q2 and Q4 (Year-End) Q2 November 28, Q4 June 30, Q2 November 30, Q4 June 30, Q2 November 30, Q4 June 30, 2017 DATIS (Drug & Alcohol Treatment Information System) ConnexOntario Health Services Information Drug and Alcohol Helpline Ontario Problem Gambling Helpline (OPGH) Mental Health Helpline Fifteen (15) business days after end of Q1, Q2 and Q3 - Twenty (20) business days after Year- End (Q4) Q1 July 22, Q2 October 22, Q3 January 22, Q4 April 30, Q1 July 22, Q2 October 22, Q3 January 22, Q4 April 28, Q Q Q Q4 July 22, 2016 October 24, 2016 January 23, 2017 May 2, 2017 All HSPs that received funding to provide mental health and/or addictions services must sign an Organization Reporting Agreement with ConnexOntario Health Services Information, which sets out the reporting requirements. French Language Service Report April 30, April 30, April 30, 2017

11 Schedule D: Directives, Guidelines and Policies Community Support Services

12 Schedule D: Directives, Guidelines and Policies Community Mental Health and Addictions Services

13 Schedule D: Directives, Guidelines and Policies Community Mental Health and Addictions Services

14 Schedule E1: Core Indicators Performance Indicators Target Performance Standard *Balanced Budget - Fund Type 2 >=0 Proportion of Budget Spent on Administration 19.5% <=23.4% **Percentage Total Margin 0.00% >= 0% Percentage of Alternate Level of Care (ALC) days (closed cases) 8.6% <9.46% Variance Forecast to Actual Expenditures 0 < 5% Variance Forecast to Actual Units of Service 0 < 5% Service Activity by Functional Centre Number of Individuals Served Refer to Schedule E2a Refer to Schedule E2a - - Alternate Level of Care (ALC) Rate 11.5% <12.65% Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by Program/Service/Functional Centre) Client Experience Budget Spent on Administration- AS General Administration Budget Spent on Administration- AS Information Systems Support Budget Spent on Administration- AS Volunteer Services Budget Spent on Administration- AS Plant Operation * Balanced Budget Fund Type 2: HSP ' s are required to submit a balanced budget ** No negative variance is accepted for Total Margin

15 Schedule E2a: Clinical Activity- Detail OHRS Description & Functonal Centre 1 These values are provided for information purposes only. They are not Accountability Indicators. Administration and Support Services 72 1* Full-time equivalents (FTE) 72 1* Total Cost for Functional Centre 72 1* Case Management/Supportive Counselling & Services - Mental Health Full-time equivalents (FTE) Visits Individuals Served by Functional Centre Group Sessions Total Cost for Functional Centre Group Participant Attendances Case Management Addictions - Substance Abuse Full-time equivalents (FTE) Visits Individuals Served by Functional Centre Total Cost for Functional Centre MH Early Intervention Full-time equivalents (FTE) Visits Individuals Served by Functional Centre Group Sessions Total Cost for Functional Centre Group Participant Attendances Addictions Treatment-Substance Abuse Full-time equivalents (FTE) Visits Individuals Served by Functional Centre Group Sessions Total Cost for Functional Centre Group Participant Attendances Health Prom/Educ & Dev - Psycho-Geriatric Full-time equivalents (FTE) Individuals Served by Functional Centre Group Sessions Total Cost for Functional Centre Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) Visits Not Uniquely Identified Service Recipient Interactions Individuals Served by Functional Centre Total Cost for Functional Centre CSS IH - Social and Congregate Dining Target Performance Standard 2.23 n/a $436,772 n/a 4.92 n/a 2, $346,902 n/a n/a 2, $283,798 n/a 1.13 n/a $84,243 n/a n/a 1, $250,447 n/a n/a $81,305 n/a 1.00 n/a $62,511 n/a

16 Schedule E2a: Clinical Activity- Detail OHRS Description & Functonal Centre 1 These values are provided for information purposes only. They are not Accountability Indicators. Full-time equivalents (FTE) Individuals Served by Functional Centre Attendance Days Face-to-Face Total Cost for Functional Centre CSS IH - Comb. PS/HM/Respite Services Full-time equivalents (FTE) Hours of Care Individuals Served by Functional Centre Total Cost for Functional Centre CSS IH - Caregiver Support Full-time equivalents (FTE) Visits Individuals Served by Functional Centre Total Cost for Functional Centre ACTIVITY SUMMARY Ful Total Full-Time Equivalents for all F/C Vis Total Visits for all F/C No Total Not Uniquely Identified Service Recipient Interactions for all F/C Ho Total Hours of Care for all F/C IndTotal Individuals Served by Functional Centre for all F/C Att Total Attendance Days for all F/C GroTotal Group Sessions for all F/C GroTotal Group Participants for all F/C TotTotal Cost for All F/C Performance Target Standard 1.75 n/a , $104,375 n/a , $207, , $385, , ,700 1,110 1, $2,242,863 n/a n/a n/a n/a n/a n/a n/a

17 Schedule E2c: CMH&A Sector Specific Indicators Performance Indicators Target Performance Standard No Performance Indicators - - Explanatory Indicators Repeat Unplanned Emergency Visits within 30 days for Mental Health conditions Repeat Unplanned Emergency Visits within 30 days for Substance Abuse conditions Average Number of Days Waited from Referral/Application to Initial Assessment Complete Average number of days waited from Initial Assessment Complete to Service Initiation

18 Schedule E2d: CSS Sector Specific Indicators Performance Indicators Target Performance Standard No Performance Indicators - - Explanatory Indicators # Persons waiting for service (by functional centre)

19 Schedule E3d Local: CSS and MH& A Performance Obligations IHSP Strategic Direction IHSP 4 - Strategic Initiatives 2016/17 M SAA Expected Outcome 2016/17 M SAA Performance Expectation Drive Quality and Value Enabling Technology Integration Telemedicine Telemedicine The Central West LHIN will work in partnership with Working as a partner in the local health care Submit a Telemedicine progress report to the the Ontario Telemedicine Network (OTN) to leverage system contribute to improved access to acute Central West LHIN on or before March 31, the effective and appropriate utilization of care and community health care services for The report will describe progress to telemedicine technologies to improve access to care residents of the Central West LHIN. date in integrating the use of Telemedicine for Central West LHIN residents. Virtual technology technology at the health service provider. will be implemented in established clinical pathways Increased efficiencies in the health care system and healthcare services that will add value and through broader use of technology. ensure patients and providers have an enhanced experience through care delivery. Drive Quality and Value Enabling Technology Integration Mental Health and Addictions - System Access Mental Health and Addictions - System Access Enabling technologies connect patients, caregivers Mental Health and Addictions Providers will and providers along the continuum of care, which develop a streamlined system for accessing and Participate in the development, adoption and can improve care transitions, quality, health navigating mental health and addictions services implementation of the "System Access outcomes and the patient s experience. in the Central West LHIN. This system will serve Model" for Mental Health and Addictions as an entry point that matches residents to, and Services. begins care with, the right mental health and addiction treatment and support programs.

20 Schedule E3d Local: CSS and MH& A Performance Obligations IHSP Strategic Direction IHSP 4 - Strategic Initiatives 2016/17 M SAA Expected Outcome 2016/17 M SAA Performance Expectation Build Integrated HealthLinks: Health Links Health Links Networks of Care HealthLinks focuses on enhancing transitions and Health Links will seek to identify and develop The HSP will work actively with Health Links coordinating care for high needs patients to improve access individualized coordinated care plans for each lead organizations to support and advance to care, reduce avoidable hospital visits and readmissions identified complex, high needs patient, leveraging local Health Links performance objectives in the and improve the patient s experience. resources and information across the continuum of Central West LHIN. care. The Central West LHIN is committed to building on the success of Health Links to date over the next three years through: coordinated care for all identified complex patients improving individuals use of the right services a focus on upstream care to identify those at risk of becoming complex and evolving governance structures for Health Links.

21 Schedule E3d Local: CSS and MH& A Performance Obligations IHSP Strategic Direction IHSP 4 - Strategic Initiatives 2016/17 M SAA Expected Outcome 2016/17 M SAA Performance Expectation Drive Quality and Value Quality and Innovation The Central West LHIN is committed to ensuring controls and accountabilities are in place to address areas of quality of health care, patient safety and system effectiveness. Collaborating with providers and public to continue to create and sustain a culture of quality improvement across the LHIN is an essential element of the LHIN s system oversight role. The Central West LHIN will achieve this through: Monitoring the implementation of the Excellent Care for All Act and its implications for the LHIN!dvancing quality and its continuous improvement across the health care sectors Ensuring transparent plans, process and resources are dedicated to drive improvement in the quality of the health care system with particular attention to cross-sector improvement / redesign Ensuring measures, controls and accountabilities are in place and monitored that address areas of quality of the system. Accreditation All community HSPs will be accredited by a provincial or national accreditation body by March 31, Once accredited, all community HSPs will maintain accreditation on an on-going basis and provide documentation to the LHIN when accreditation is awarded. Quality Improvement The overall objective is for Quality Improvement Plans to steer health care organizations to improve the quality of services delivered to patients. Quality Improvement Plans and quality improvement processes will be developed as an area of focus within Health Service Providers in the Central West LHIN. Accreditation All community HSPs will be required to provide the following to the Central West LHIN on or before March 31, 2017, evidence of successful completion of the accreditation process including the name of the accreditation body, date of accreditation, rating and plan for participating in ongoing accreditation cycles. Quality Improvement!n annual Quality Plan that is inclusive of the HSP s improvement objectives and that demonstrates how the HSP s objectives relate to Central West LHIN system level aims for quality improvement must be submitted to the Central West LHIN on March 31, Procurement Best Practices The Central West LHIN promotes best practice in the procurement of goods and services, improving openess, fairness and transparency during the procurement process. Procurement Best Practices HSP's in the Central West LHIN that are designated in the Broader Public Sector Accountability Act, 2010 will adhere to the BPS Procurement Directive and HSPs that are not designated will be guided by the Procurement Guideline for Publicly Funded Organizations in Ontario. Local Incident Reporting T o ensure that the LHIN is informed in a timely manner about local incidents, especially if these incidents could have an impact on other health service providers, cross LHIN boundaries, or have a potential negative public profile, the Central West LHIN has developed a "Protocol for Local Incident Reporting" by HSPs. Local Incident Reporting The HSP will adhere to the "Protocol for Local Incident Reporting" issued by the Central West LHIN.

22 Schedule E3d Local: CSS and MH& A Performance Obligations IHSP Strategic Direction IHSP 4 - Strategic Initiatives 2016/17 M SAA Expected Outcome 2016/17 M SAA Performance Expectation Demonstrate System Health Equity Diversity and Health Equity Diversity and Health Equity Leadership The LHINs across the province have identified health To actively reduce health system disparities for Submit a annual summary report at the end of equity ensuring avoidable health disparities among vulnerable populations in the Central West LHIN. each fiscal year in the term of the agreement population groups are minimized wherever possible (March 31st), outlining the status of the as a key component of quality care. Given the To improve access to culturally competent health Organization s Health Equity Plan. diverse population in the Central West LHIN, this part care services. of quality care and population health is particularly salient.

23 Schedule F: Project Funding Project Funding Agreement Template Note: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. Whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider, the HSP remains accountable for the funding that is provided by the LHIN. THIS PROJECT FUNDING AGREEMENT ( PFA ) is effective as of [insert date] (the Effective Date ) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) - and - [Legal Name of the Health Service Provider] (the HSP ) WHEREAS the LHIN and the HSP entered into a service accountability agreement dated [insert date] (the SAA ) for the provision of Services and now wish to set out the terms of pursuant to which the LHIN will fund the HSP for [insert brief description of project] (the Project ); NOW THEREFORE in consideration of their respective agreements set out below and subject to the terms of the SAA, the parties covenant and a gree as follows: 1.0 Definitions. Unless otherwise specified in this PFA, capitalized words and phrases shall have the meaning set out in the SAA. When used in this PFA, the following words and phrases have the following meanings: Project Funding means the funding for the Services; Services mean the services described in Appendix A to this PFA; and Term means the period of time from the Effective Date up to and including [insert project end date]. 2.0 Relationship between the SAA and this PFA. This PFA is made subject to and hereby incorporates the terms of the SAA. On execution this PFA will be appended to the SAA as a Schedule. 3.0 The Services. The HSP agrees to provide the Services on the terms and conditions of this PFA including all of its Appendices and schedules. 4.0 Rates and Payment Process. Subject to the SAA, the Project Funding for the provision of the Services shall be as specified in Appendix A to this PFA.

24 Schedule F: Project Funding Project Funding Agreement Template 5.0 Representatives for PFA. (a) The HSP s Representative for purposes of this PFA shall be [insert name, telephone number, fax number and e -mail address.] The HSP agrees that the HSP s Representative has authority to legally bind the HSP. (b) The LHIN s Representative for purposes of this PFA shall be: [insert name, telephone number, fax number and address.] 6.0 Additional Terms and Conditions. The following additional terms and conditions are applicable to this PFA. (a) Notwithstanding any other provision in the SAA or this PFA, in the event the SAA is terminated or expires prior to the ex piration or termination of this PFA, this PFA shall continue until it expires or is terminated in accordance with its terms. (b) [insert any additional terms and conditions that are applicable to the Project] IN WITNESS WHEREOF the parties hereto have executed this PFA as of the date first above written. [insert name of HSP] By: [insert name and title] [XX] Local Health Integration Network By: [insert name and title.

25 Schedule F: Project Funding APPENDIX A: SERVICES Project Funding Agreement Template 1. DESCRIPTION OF PROJECT 2. DESCRIPTION OF SERVICES 3. OUT OF SCOPE 4. DUE DATES 5. PERFORMANCE TARGETS 6. REPORTING 7. PROJECT ASSUMPTIONS 8. PROJECT FUNDING 8.1The Project Funding for completion of this PFA is as follows: 8.2 Regardless of any other provision of this PFA, the Project Funding payable for the completion of the Services under this PFA is onetime finding and is not to exceed [X].

26 SCHEDULE G FORM OF COMPLIANCE DECLARATION DECLARATION OF COMPLIANCE Issued pursuant to the MSAA effective April 1, 2014 To: From: Date: Re: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the LHIN ). Attn: Board Chair. The Board of Directors (the Board ) of the [insert name of HSP] (the HSP ) [insert date] April 1, 2015 March 31, 2016 (the Applicable Period ) Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the MSAA between the LHIN and the HSP effective April 1, The Board has authorized me, by resolution dated [insert date], to declare to you as follows: After making inquiries of the [insert name and position of person responsible for managing the HSP on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board s knowledge and belief, the HSP has fulfilled, its obligations under the service accountability agreement (the MSAA ) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP has complied with: (i) Article 4.8 of the MSAA concerning applicable procurement practices; (ii) The Local Health System Integration Act, 2006; and (iii) The Public Sector Compensation Restraint to Protect Public Services Act, [insert name of Chair], [insert title]

27 Schedule G Form of Compliance Declaration Cont d. Appendix 1 - Exceptions [Please identify each obligation under the MSAA that the HSP did not meet during the Applicable Period, together with an explanation as to why the obligation was not met and an estimated date by which the HSP expects to be in compliance.]