board finance & audit committee...

2016 01 25 - Board Finance and Audit Committee - DRAFT Agenda - v1

1

BOARD FINANCE & AUDIT COMMITTEE MEETING

DATE: January 25, 2016 TIME: 10:30am – 12:30pm

PLACE: Labelle Boardroom

AGENDA

TIM

E

TO

PIC

SP

EA

KER

PO

LIC

Y

REFER

EN

CE

PO

LIC

Y

FO

RM

ULA

TIO

N

DEC

IS

IO

N-

MA

KIN

G

MO

NITO

RIN

G

IN

FO

RM

ATIO

N

/ E

DU

CA

TIO

N

10:30 1.0 Declaration of Conflict Maria Barrados √

Joint Meeting with CSQS

10:30-10:55 2.0 Scorecard Review Deryl Rasquinha/ Catherine Butler

√

Finance Committee Meeting

11:00-11:15

3.0 Approval of Agenda for January 25, 2016 Maria Barrados √

4.0 Approval of Minutes from December 7, 2015 Maria Barrados √

Consent Agenda – assumed approved unless any member of Finance Committee and/or Audit Committee wishes to discuss

Core Business

11:15-12:30 5.0 Update on LHIN Discussion (Funding) Marc Sougavinski √

6.0 FY 2015-16 Year-End Audit Service Plan – Deloitte Doreen Hume (guest) √

7.0 Monthly Financial Results & YE Projection Deryl Rasquinha √

CONFIDENTIAL

DRAFT

Champlain

Board Scorecard

January 2016

(Data as of December 2015)

Champlain

Operational Dashboard

2

Client

Financial

Quality

People

Client Trends Dec-14 Target / Baseline Nov-15 Dec-15 FY 2015/16

Referral Volume 4099 4400 4815 4030 4600

Intake queue wait time 39 10* 9 10 15

1385 Fully Waitlisted 0 0 360

618 Partially Waitlisted 0 0 245Total PT Clients Waitlisted 104 N/A 10 7 130

Total OT Clients Waitlisted 675 N/A 7 3 228

Total PSS Clients Waitlisted

*Note: Intake Queue Target was updated from 21 days to 10 days, beginning July 2015

People Trends 2014/15 Q3 Target / Baseline 2015/16 Q2 2015/16 Q3 FY 2015/16

Staff Turnover 4.2% 8.5% 6.4% 8.6% N/A

Dec-14 Target / Baseline Nov-15 Dec-15 FY 2015/16

Absenteeism annualized rate 10.0 9 days 12.4 12.7 N/A

Staff WSIB Reported Incidents 1 1 0 0 0.6

Quality Trends Dec-14 Target / Baseline Nov-15 Dec-15 FY 2015/16

Service Wait-time Community (90th

Percentile Days Waiting)**56 21 days 36 23 66.2

2014/15 Q3 Target / Baseline 2015/16 Q2 2015/16 Q3 FY 2015/16

5 day wait time – Complex PSS* 80.5% 95% 75.7% 83.8% 75.6%5 day wait time – nursing* 93.4% 95% 93.9% 93.7% 93.8%

Sep-14 Oct-15 Nov-15 FY 2015/16

Client Complaints Resolution Time* 8.8 20 days 26.4 26.2 27.8


Client Experience* 92.8% 94.5% 92.8% 92.0% 92.0%*QIP Metrics

** MSAA Metrics

Financial TrendsFYTD Target

(as at Oct 2015)Dec-15

Dec 2015

Variance vs.

Plan

FY 2015/16

Variance vs.

Plan

FY 2015/16

Projected Deficit

Tracking to Budget Targets +$0k -$781k -$781k -$1,626k -$4.0M

Champlain

3

Financial People

Client Trends Definition Discussion Questions

Referral Volume

The count of new referrals to the CCAC during the time period. Only referrals that initiate Case Management intake Assessments are counted in this indicator.

Is CCAC demand increasing? Is it from hospitals, physicians, or community?

Intake queue wait time

90th percentile days waited from the client’s referral date to the date of the Intake Assessment.

How is client risk being managed for clients waiting for service? What options exist to streamline intake?

Total Personal Support Services (PSS) Clients Waitlisted

A snapshot view of the count of the number of PSS clients on the waitlist as at the end of the month, divided by those who are fully waitlisted (having no PSS service), and those that are partially waitlisted (having some PSS service, but assessed for needing more).

What is being done to manage client risk?

Total Physiotherapy (PT) Clients Waitlisted

A snapshot view of the count of the number of PT clients on the waitlist as at the end of the month

How are client risks being managed?

Total Occupational Therapy (OT) Clients Waitlisted

A snapshot view of the count of the number of OT clients on the waitlist as at the end of the month

How are client risks being managed?


Service Wait-timeCommunity (90th

Percentile Days Waiting)

Wait time from client intake / application date for referrals sourced from the community (e.g. Family, Self) to receiving the first direct care service visit, where the client is an adult client on Home Care services. The 90th percentile focuses on ensuring that 90% of clients will receive a visit in the targeted time frame, or better.

Should service eligibility or service guidelines be reviewed/reduced? What advocacy should the Board engage in?

5 day wait time –Complex PersonalSupport Services (PSS)

Measures the percent of clients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date to the 1st PSS Visit Date for the episode of care. Clients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a clients discharge is delayed from hospital due to complications)

How have Quality Improvement Plan (QIP) action plans improved performance?

5 day wait time -Nursing

Measures the percent of clients whose 1st Nursing visit was achieved within 5 days, from Service Authorization Date to the 1st Nursing Visit Date for the episode of care. Clients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a clients discharge is delayed from hospital due to complications)

How have QIP action plans improved performance?

Client Complaints Resolution Time

Measures the number of days for a complaint to be resolved with the client, from the time the complaint was recorded.

How are we doing with addressing clients’ needs and/or resolving issues?

Client Experience Measures the percent positive rating for overall satisfaction with care. How have Person Driven Care action plans improved client experience?


Tracking to Budget targetsNet surplus/deficit as calculated by Revenue minus Expenses, as per plan.

Are we tracking to budget plans? Are our cost/clients to plan? Is demand for service to expectations? What additional actions if any, are required at this time?


Staff Turnover Rate at which employees leave an organization. Calculated as number of permanent employees who terminate or cease employment, divided by the average number of permanent employees on staff

If not as expected, what is the underlying cause and mitigating action plan?

Staff Turnover within 6 months

Rate at which employees leave an organization within the first 6 months of hire.


Absenteeism annualizedRate

Total number of sick hours, paid and unpaid for all permanent and temporary staff (excludes casuals), divided by number of permanent staff.


Staff Workplace Safety & Insurance Board (WSIB) Reported Incidents

The count of WSIB claims submitted per month.If not as expected, what is the underlying cause and mitigating action plan?

Client Quality

Operational Dashboard: Glossary

Champlain

Person Driven Care

Engaged & Proactive People

Sustainable Health Care

4

Strategic Dashboard

Person Driven Care Trends Dec-14 Target / Baseline Nov-15 Dec-15 FY 2015/16

Hospital Transition- % RRN client contact

within 24 hours52% 90% 85% 66% 77%

Safety in Home - reassessment of complex

clients with PSS service within Guidelines

of Care

92% 80% 87% 85% 87%

Avg # of RAI-HCs completed per month per

CC*11.2 30 20.0 17.7 20.2

# of visits (external) to the Caregiver

Exchange ResourceN/A

Actuals / Monthly

Target126 / 211 156 / 215 1340 / 1810


Patient Centred Appointment metric 88.3.% 85.0% 87.5% 87.8% 87.8%

Engaged & Proactive People Trends Dec-14 Target / Baseline Nov-15 Dec-15 FY 2015/16

% completion of monthly mandatory

training for full-time staff98.8% 95% N/A N/A 81.0%

Healthline Visits 42,143 45,000 47,093 39,767 46,134

Earned Media Coverage 22 18 / month 16 8 20

Website visits 4,626 6,000 6,991 5,151 6,491

204/15 Q3 Target / Baseline 2015/16 Q2 2015/16 Q3FY 2015/16 (as

at end of Q1)

Performance Agreements completed

YTD54.6% 95% 19.2% 47.6% N/A

Sustainable Health Care Trends Sep-15 Target / Baseline Aug-15 Sep-15 2015/16 YTD

ALC Rate*** 12.8% 12.70% 12.7% 13.6% 12.3%

2014/15 Q1 2015/16 Q1 2015/16 Q1 FY 2015/16

Very High and High MAPLe Score %

supported by Champlain CCAC,

compared to Provincial Averages

51.8%

(2)Top Quartile

59.9%

(1)

59.9%

(1)

53.5%

(1)

Jun-14 Jun-15 Jun-15

LTCH LOS *Ministry Source 3.0 2.5 years 2.7 2.7 N/A

2014/15 Q1 2015/16 Q1 2015/16 Q1 FY 2015/16

2.0Long Stay

Top Quartile*1.3 1.3 1.3

7.3Short Stay

Top Quartile**7.0 7.0 7.0

Dec-14 Nov-15 Dec-15 FY 2015/16

# CSS Referrals per Month 357 400 438 600 414

% Clinic Visit Utilization 23.7% 25% 29.5% 30.0% 29.0%

Ranking relative to other CCACs for

average cost/client across all client

groups

*Champlain is ranked consistently amongst the highest MAPLe proportion provincially. ; Long Stay populations using

provincial reference rates.

** Champlain continues to increase special programs, such as NPWT and CHIPP programs, impacting avg. cost; Short Stay

Champlain

Person Driven Care Engaged & Proactive People

Sustainable Health System


Hospital Transition- % RRN contact within 24 hours

Percent of clients whose 1st RRN visit occurred within 1 day from the hospital discharge date to the 1st RRN contact date, either through a telephone assessment visit, or face to face visit

How has RRN intervention helped reduce ED visits and hospital readmissions? What activities are being undertaken to increase performance?

Safety in Home - reassessment of complex clients with PSS service within Standards of Care guidelines

Percent of complex clients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months.

With the growth of complex clients, are we appropriately monitoring their safety/status? Have CELS events changed?

Avg # of RAI-HCs completed per month per CC*

The average number of RAI-HCs completed by care coordinators in the Community and Congregate Care Teams per month, normalized to a 20 workday month

Are we creating efficiencies in processes to allow for CCs to complete the Ax?

# of visits (external) to the Caregiver Exchange Resource

The count of site visits during the periodHow are we informing clients and caregivers of the resource?

Client check-ins per month per CC (Retirement Home Setting) *Developmental Metric

The average number of client check-ins completed by staff per month, for staff in retirement home settings.

Are the staff reaching out to our clients? Are client check-ins achieving desired outcomes?

Patient Centred Appointment metric

Measures the satisfaction of clients’ experience with the scheduling of the care visits

Are schedules for clients person centered?

Trends Definition Discussion Questions

% completion of monthly mandatory training for full-time staff

The count of fulltime staff who complete mandatory training as a total of all fulltime staff required to complete the training

What may be causing staff not to complete training?

Healthline Visits The count of site visits during the period, to Healthline.

Has awareness of CCAC improved to plan? Are clients able to find information they are looking for in Healthline?

Earned Media Coverage The count of stories in the media (Television, Radio, Newspapers) where the CCAC is mentioned

Has awareness of CCAC improved to plan? What is the nature of the coverage and impact on CCAC reputation?

Website visits The count of site visits to the Champlain CCAC public website.

Has awareness of CCAC improved to plan? Are clients able to find information they are looking for?

Performance Agreements completed when due

FYTD percent of staff whose performance appraisal is completed on time.

Is staff development being appropriately managed?


ALC Rate New Indicator: Counts the total ALC bed days as a percentage of Total Bed days, during the period. Includes sub-acute (rehab and complex care bed and counts patients not yet discharged).

Are our programs appropriately supporting LHIN-Wide ALC targets? What if any additional actions are required to improve performance?

Very High & High MAPLe Score % supported by Champlain CCAC

The proportion of CCAC clients assessed by a RAI-HC, with a MAPLe Score of High or Very High, out of the total number of clients with a RAI-HC assessment.

What is the financial impact of sustaining higher needs clients? What effects does this have for provincial HBAM funding/

Ranking relative to other CCACs for average cost/client across all client groups

Using the LHIN Benchmark report, average costs per patient are reported by population group. Ranking can be achieved through the comparison of average cost per patient, across peers.

Are we delivering appropriate service levels to different client populations (HBAM neutral or positive) and properly balancing cost & client risk/safety?

# of CSS Referrals per month Count of the number of referrals made to CSS Agencies within the period. (g. Adult Day Program, Assisted Living, Acquired brain injury, Respite/PSS for Seniors, Supportive Housing, Transportation)

Are we increasing CCAC-CSS collaboration to plan? Are there opportunities for greater collaboration?

% Clinic Visit Utilization Percent of Clinic Visits out of total Visit Nursing and Clinic Nursing Visits

Strategic Dashboard: Glossary

Minutes – Champlain CCAC Finance Committee & Audit Committee – December 7, 2015

Champlain Community Care Access Centre Centre d’accès aux soins communautaires de Champlain

Head Office 4200 Labelle Street Suite 100 Ottawa ON K1J 1J8 Siège social 4200, rue Labelle Bureau 100 Ottawa ON K1J 1J8

Tel/Tél : 613 745 5525 866-994-8124 Fax/Téléc : 613 745 1422

www.champlain.ccac-ont.ca

MINUTES Finance and Audit Committee

Held December 7, 2015

Champlain CCAC Head Office

BOARD COMMITTEE

MEMBERS

(FINANCE):

Maria Barrados

Robert D’Aoust

Michel Parent

Chair

FINANCE REGRETS:

BOARD COMMITTEE

MEMBERS (CSQS):

Melody Isinger

Denise Alcock

Andrée Durieux-Smith

Sherryl Smith

Chair

Ex-officio member

By phone

CSQS REGRETS Abebe Engdasaw

STAFF PRESENT: Marc Sougavinski

Sara Bisson

Ashley Haugh

Deryl Rasquinha

Chief Executive Officer

Corporate Controller

Executive Assistant

Vice-President, Performance and Strategy

CSQS STAFF PRESENT

FOR JOINT PORTION

OF MEETING:

Catherine Butler Vice-President, Clinical Care

RECORDER: Ashley Haugh Executive Assistant

GUEST

AGENDA ITEM ACTION TO BE TAKEN

1.0 Declaration of Conflict

There was no declaration of conflict.

2

Minutes – Champlain CCAC Finance Committee & Audit Committee, December 7, 2015

2.0 Scorecard Review

The Committees discussed the November scorecard (October data):

Demand for CCAC services continues to increase past projected

volumes and financial forecasts.

Significant progress has been made on service wait times in the

community, although the metrics still remains red. The goal is to meet

the provincial target of 21 days (90% receiving service within 21 days)

by March 31, 2016.

The five day wait time for complex PSS continues to improve. A

recently implemented internal process improvement should assist in the

improvement of this metrics. Staff are closely monitoring the wait

times.

At the end of October/year-to-date, the CCAC is in a balanced position,

but increasing service volumes will put the organization in a deficit

position next month. Staff continues to closely monitor the situation and

investigate efficiency measures. Budget constraint measures such as

restricted travel outside of Champlain are being reinforced. On the

clinical care side, reassessments have increased, but this can lead to

increased service requirements. Where patients need more service after

reassessments, care coordinators are being asked to review if the

incremental service is needed immediately or if it can be wait listed.

Some other clinical care areas being examined for efficiencies include:

o Patients with two PSS visits daily and whether visits can be

shortened to focus on core CCAC funded tasks, additional time

could then be used to increase the number of visits during the day

per PSS worker.

o Having a PSS worker in a congregate care setting for an eight hour

shift, however, this would require PSS worker changes for some

patients reducing continuity of care during the transition period.

The Champlain LHIN is aware of the financial situation and staff

continues to discuss potential relief measures related to the base budget

figures as well as one-time funding.

Patient acuity continues to increase – in June 2015 56% of Champlain

CCAC patients were high acuity, the number has now increased to

approximately 60%.

Absenteeism has increased and People Services is analyzing the data to

determine root causes.

The Caregiver Exchange is an Ontario Association of Community Care

Access Centres (OACCAC) website, Champlain is working with the

OACCAC and other CCACs to increase content and attract more site

visits.

Training and education rates will increase as the organization prepares

for the December 2016 on-site accreditation survey. Training will be

spaced to limit the impact on patients.

The percentage of Performance Agreements completed is increasing. Due to the new Care Model introduced in early 2015 which saw a large

3


number of staff switch managers, there was a pause on completing assessments to allow managers to get to know their new staff.

The system wide Alternate Level of Care (ALC) of 13% is slightly above the 12.7% target. The CCAC’s contribution to this is through Hospital to Home (H2H). H2H is being refreshed at several hospitals including The Ottawa Hospital; H2H volumes need to be balanced with financial limitations. This metrics is closely being monitored by staff.

Discussion included:

There is sometimes changes in past reporting on the scorecard, staff will

work to ensure figures remain static.

It is expected the current increase in referrals and service volumes will

continue.

The Champlain CCAC continues to support higher and higher acuity

patients in the community which is good for the patient and the health

system, but is more costly for the CCAC.

Staff are working with other partners regarding the Syrian Refugees

expected over the coming months and years. Expenses related to Syrian

Refugees are being tracked and will most likely be reimbursed by the

provincial and/or federal government.

CCACs are expected to balance every year. If there is surplus the

funding is recouped by MOHLTC, if there is a deficit it needs to be

repaid by the CCAC in the next year’s budget.

Staff continues to work with LHIN and other partners to take a regional

approach to using vacant beds in all parts of the health system for

respite, Alternate Level of Care patients, etc.

3.0 Approval of Agenda

It was moved by Robert D’Aoust, seconded by Michel Parent and agreed to

approve the agenda.

CARRIED

5.0 Approval of Minutes It was moved by Michel Parent, seconded by Robert D’Aoust and agreed to approve the minutes of the November 9, 2015 meeting as amended.

CARRIED

6.0 October 2015 Financial Results and Year-End Projection There was a $1M deficit for the month of October which eliminated the year-to-date surplus accumulated in the previous months. The deficit is largely due to increased service volumes. Assuming ongoing high referrals, the CCAC could have a year-end deficit from $1-3M. CCACs are expected to balance at year-end, if there is a deficit it must be repaid within the next year’s funding envelope. Staff continue to seek efficiency measures in all areas of operations. The

4


Champlain Local Health Integration Network (LHIN) is aware of the current financial situation. Discussion included:

Service volumes are expected to stay at high level; which is beyond current 2015-2016 funding levels and the projected base budget increase of 0.5% for 2016-2017.

As part of the 2016-2017 budget efficiency measures, the CCAC will ask for funding for a lean consultant to find further efficiency opportunities.

Recognizing that any deficit will need to be repaid next year and the projected 2015-2016 year-end deficit is $1-$3M, the committee discussed its tolerance level for the deficit. Discussion will continue at the Board.

The differences between the costs per client in the Office of the Auditor General of Ontario (OAGO) annual report and Champlain’s figures.

o Champlain’s figures, taken from province wide LHIN reporting, takes into account patient populations, differences in Service Provider Organization (SPO) rates, etc.

ACTION: Provide more

information to the committee on

Champlain’s costs per patient.

7.0 Annual Community Accountability Planning Submission (CAPS) Submission

The Committee discussed the CAPS/ 2016-2017 budget submission:

Demand for CCAC services and the acuity of patients continues to increase.

The CCAC must submit a balanced budget to the Champlain LHIN, regardless of demand pressures.

The Champlain LHIN has projected the CCAC will received a 0.5% base budget increase in 2016-2017. This will not cover the anticipated service volumes and increasing operating expenses.

As the budget is developed, need to take into consideration MOHLTC and LHIN priorities; the OAGO report, Multi-Sectoral Service Accountability Agreement (MSAA) targets, Quality Improvement Plan (QIP) targets, etc.

Not knowing the structural changes that may be made by MOHLTC also makes forecasting difficult.

The Committee reviewed the CAPS: o Key assumptions

Revenue increase Anticipated deficit carryover Costs

o Efficiencies Efficiency programs Lean consultation

Assuming demand for services continues at current volumes, there is projected to be a $7M gap in funding versus anticipated client demand.

ACTIONS: Updates will be

made to the CAPS presentation

to clearly show increase in

patient acuity, etc.

5


Discussion included:

With CCAC services provided in the home and community, there is not the same awareness of the CCAC reaching capacity compared to a hospital stating all beds are full. There will be an increased focus on communicating capacity to all system partners.

The Supplies and Equipment Request for Proposal resulted in savings for the CCAC. There is a moratorium on tendering of other clinical care services so the CCAC is not able to fully benefit from a competitive market in other areas of purchased patient services.

SPOs can also play a role in finding efficiencies.

A deficit can be justified if it results from an investment in the current year that will yield savings the next. If there are no savings anticipated from the deficit, the committee feels the target should be in the lower part of the range.

It was moved by Michel Parent, seconded by Robert D’Aoust and agreed to recommend the Board approve the 2016-2017 CAPS submission based on the presentation.

CARRIED

8.0 One Time and Ongoing Expenses

The Committee reviewed and discussed budget and forecasting at the Champlain CCAC:

Purchased patient services is the largest part of the budget.

The number of patients is almost equally divided between long stay and short stay patients. However, the long stay patients account for 86% of the purchased service costs.

The CCAC must balance at year-end. Surplus is recouped by MOHLTC while deficits must be repaid by the CCAC in the next year.

While there are many mechanisms to arrive at a balanced position, whether in a surplus or deficit position approaching year-end, many solutions of financial significance take time to be implemented. The nature of the CCAC’s business does not allow for paid financial corrections in short periods of time. .

Staff seek operational efficiencies before impacting patient care.

Potential activities to arrive at a balanced budget when facing a deficit include: elimination of discretionary spending, not filling staff vacancies/reducing casual and overtime hours, wait listing, reduction of care plans, etc.

Potential activities to arrive at a balanced budget when facing a surplus: one time clinical care expenses, one time administrative expenses, additional staffing, etc.

9.0 In-Camera It was moved by Michel Parent, seconded by Robert D’Aoust and agreed to move in-camera.

CARRIED

6


Sara Bisson, Corporate Controller, will be on leave for a portion of 2016. The Committee thanked her for her dedication to the Finance and Audit Committee and welcomes her return in late 2016. It was moved by Robert D’Aoust, seconded by Michel Parent and agreed to adjourn the meeting.

CARRIED

CONFIRMED: __________________________________________ MARIA BARRADOS, CHAIR

Champlain Community Care Access Centre

2016 Audit Plan

For the year ending March 31, 2016 Presented to the Finance Committee and Audit Committee Janaury 25, 2016

Private and Confidential December 18, 2015 Members of the Finance Committee and Audit Committee Champlain Community Care Access Centre 4200 Labelle Street, Suite 100 Ottawa, Ontario K1J 1J8 To the Members of the Finance Committee and Audit Committee: We are pleased to submit our plan for the audit of the 2016 financial statements of the Champlain Community Care Access Centre (the “CCAC”). The attached document presents an overview of our audit plan and reporting responsibilities, an outline of the key areas of our audit focus, our client service team and our proposed fees. We take particular care to ensure that the Finance Committee and Audit Committee (collectively referred to as the “Committee”) is fully appraised of all significant developments and issues that arise during the audit and that these are formally communicated to you on a timely basis. At the conclusion of our audit, we will formally report to the Committee, in writing, setting out all reportable matters and any critical and sensitive issues addressed during the audit. In addition, we endeavour to keep Management and the Committee abreast of significant developments in relevant accounting standards and regulatory matters. We are committed to providing the CCAC with the best possible service. Our final audit approach and procedures will take into consideration any of your specific requests you may have and any additional areas of risk that you feel require special emphasis in our audit. We look forward to discussing this report and answer any questions that you may have at your convenience. This report has been provided to the Committee of the CCAC on a confidential basis. It is intended solely for the use of the Committee to assist it in discharging its responsibilities with respect to the financial statements and is not intended for any other purpose. We accept no responsibility or obligation to any third party who may rely on this report. Yours very truly,

Chartered Professional Accountants Licensed Public Accountants

Deloitte LLPWorld Exchange Plaza 100 Queen Street Suite 1600 Ottawa ON K1P 5T8 Canada Tel: (613) 236-2442 Fax: (613) 563-3461 www.deloitte.ca

© Deloitte LLP and affiliated entities. 2016 Audit Service Plan Champlain Community Care Access Centre

Table of contents

Audit plan ....................................................................................................................... 1

Areas of audit focus ...................................................................................................... 4

Materiality....................................................................................................................... 6

Timelines and deliverables .......................................................................................... 7

Reportable matters ....................................................................................................... 8

Client service team ....................................................................................................... 9

Fees ................................................................................................................................ 10

Appendix 1 – Reporting responsibilities .................................................................... 11

Appendix 2 – Standard-setting update ....................................................................... 13

Appendix 3 – Deloitte Portal ........................................................................................ 17

© Deloitte LLP and affiliated entities. 2016 Audit Service Plan 1 Champlain Community Care Access Centre

Audit plan

Audit scope

Our detailed audit plan is designed to enable us to provide an opinion on the March 31, 2016 financial statements of the Champlain Community Care Access Centre (the “CCAC”). Our plan will focus on a top-down assessment of key financial and operational controls adopted by the CCAC to manage the risks that may have a significant impact on the financial statements. Our audit is not specifically directed to addressing the effectiveness or efficiency of ongoing operations or ensuring compliance with all regulatory and legislative requirements. To the extent we become aware of significant matters as a bi-product of our audit, we will ensure those are brought to the attention of the Finance Committee and Audit Committee (collectively referred to as the « Committee »). Preliminary audit planning

Before we begin any audit procedures, we compile information from a variety of sources, including discussions with Management to identify specific risk factors and areas of the CCAC’s financial reporting process that may require special attention. This risk assessment takes into account:

Key business developments (internal and external);

Discussions with Management, with emphasis on major areas of sensitivity;

Current business, regulatory and accounting pronouncements and developments;

Key Management strategies and business plans;

Areas of significant judgment and risk; and

Matters requiring additional specialist review.

Based on our assessment of these matters in the context of our knowledge of the CCAC, we develop our audit plan to reflect our understanding of the key risks to be addressed in the audit process and the audit methodology to be employed, including our determination of materiality and the scope of the work to be undertaken. Internal controls

Management is responsible for preparing the financial statements in accordance with Canadian Public Sector Accounting Standards for Government Not-for-Profit Organizations (PSAS-GNPO). In this regard, Management is also responsible for establishing internal controls to provide reasonable assurance around the reliability of the financial reporting process, the effectiveness and efficiency of operations, and compliance with applicable laws and regulations.

As auditors, we are required to understand the CCAC’s internal controls as they relate to the financial accounting and reporting process. We are required to undertake an assessment of the design of key controls for the CCAC including entity wide processes, significant transaction flow processes and information technology processes, regardless of whether we intend to rely on such controls in conducting our audit, as well as determine if the controls identified exist and are implemented. The primary objective of these procedures is to identify any areas of risk that may be inherent in these processes so that we can appropriately plan the nature and extent of our audit tests.


We undertake an assessment which gives consideration to individual transactions, system potential errors and internal controls. The approach includes identifying major business cycles within the CCAC’s operations including:

Significant account balances and classes of transactions;

Specific financial risks or potential errors with respect to each significant account balance and class of transaction which may result in the misstatement of financial reports or the misappropriation of assets; and

The CCAC’s response to those specific risks; i.e., the key elements of the internal control structure, which are designed to prevent those errors from occurring or to detect them should they occur.

Controls related to significant transaction flows

Our plan includes an annual review of the design and implementation of key controls of significant transaction flows and testing the effectiveness of those controls using a 3 year rotation plan (summarized below). As noted below, we plan to continue to take a control reliance approach for the expenditure (inclusive of fixed assets acquisition) and payroll transaction flows.

Transaction Flow Design and

Implementation

Testing Effectiveness of

Controls

Financial Reporting and Closing

Revenue

Expenditure 2014/2017

Payroll 2013/2016

Fixed Assets (acquisitions) 2014/2017

Fraud and error

Canadian Audit Standard (CAS) 240, The Auditor's Responsibilities Relating to Fraud in an Audit of Financial Statements, includes a requirement for audit procedures directed at testing for fraud. The objective of these procedures is as follows:

To identify any fraud or error risk factors that may increase the risk that the financial statements could be materially misstated; and,

To address any factors identified in a manner sufficient to obtain reasonable assurance that the financial statements are free from any material misstatements arising from fraud or error.

Specific audit procedures which we will perform to address this issue include:

Risk assessments at the planning stage.

Specific enquiries of Management, the Committee and others within the CCAC whether they have knowledge of any actual, suspected or alleged fraud.

Obtain an understanding of how the Committee exercise oversight of Management's processes for identifying and responding to the risks of fraud in the entity and the internal control that Management has established to mitigate these risks.

Procedures to address the risk of management override of controls.

Procedures around revenue recognition, presumed by professional standards to be a risk factor.

Focused review of accounting estimates/judgement areas and Related Parties Transaction.

Testing of mitigating controls and additional substantive testing as required.


Full consideration of the qualitative effects of each misstatement or potential misstatement identified – amount, nature and direction to determine whether any indications of fraudulent financial reporting exist.

Fraud and the role of the Finance Committee and Audit Committee

Those charged with governance of an entity, in particular the Committee, in its oversight of the financial reporting process, have responsibility for the entity’s systems for monitoring risk, financial reporting and compliance with the law. This includes the oversight of the entity’s process for identifying the risks of fraud in the CCAC, and of the internal control the entity has established to mitigate specific fraud risks identified.

As your auditors we are required to make the following enquiries of the Committee:

1. Does the Committee have any knowledge of any actual, suspected or alleged fraud affecting the CCAC?

2. Has the role the Committee exercises in oversight of (a) management’s processes for identifying and responding to risks of fraud and error and (b) the internal controls that management established to mitigate these risks, changed during the year?

3. Is it still the view of the Committee that the risks of fraud are low at the CCAC?

Reporting Responsibilities

Appendix 1 contains the reporting responsibilities of: CCAC’s management, the Finance Committee & Audit Committee, and the Auditors with regards to the financial audit.

Future Financial Reporting Standards We have included, in Appendix 2, the Deloitte Standard-Setting update which provides an overview of upcoming changes in accounting and auditing standards.

Resources

Appendix 3 contains resources that may be of interest to the Committee.


Areas of audit focus

Our audit procedures are designed to focus on areas that we deem to be of the most significant audit risk. Critical audit areas where the risk of material misstatement is considered significant include those account balances or transactions that typically involve a considerable degree of estimation or judgment and/or are inherently difficult to audit due to the nature of the balance and extent of reliable audit evidence that is available.

Our areas of audit focus for the 2016 audit are identified below.

Area of Audit Focus Objective Audit Response

Management Override and Revenue Recognition

Management is in a unique position to perpetrate fraud because of management’s ability to directly or indirectly manipulate accounting records and prepare fraudulent financial statements by overriding controls that otherwise appear to be operating effectively

An auditor conducting an audit in accordance with Canadian Auditing Standards (CAS) is responsible for obtaining reasonable assurance that the financial statements taken as a whole are free from material misstatement, whether caused by fraud or error. Owing to the inherent limitations of an audit, there is an unavoidable risk that some material misstatements of the financial statements may not be detected, even though the audit is properly planned and performed in accordance with CAS.

Management override and revenue recognition are considered to be presumed fraud risks for all entities in accordance with Canadian generally accepted auditing standards.

Our audit tests the appropriateness of journal entries recorded in the general ledger and other adjustments made in the preparation of financial statements.

We will obtain an understanding of the business rationale for significant transactions that we become aware of that are outside of the normal course of business, or that otherwise appear to be unusual given our understanding of the CCAC and its environment.

We will review accounting estimates for biases and evaluate whether the circumstances producing the bias, if any, represented a risk of material misstatement due to fraud.

Estimates Ensure that estimates are valid and accurately recorded and disclosed as appropriate in the financial statements.

We will obtain:

An understanding of significant management estimates and judgment areas in the preparation of the 2016 financial statements. Estimates and areas of judgment include: useful life of capital assets, collectability of accounts receivable, legal accruals, the amount of certain accrued liabilities and potential contingencies.

An understanding of management’s approach to determining the estimates and will assess the reasonableness and appropriateness based on our knowledge of the CCAC, independent estimates and other audit work performed.

Compare actual historical experience to estimates and models employed in such calculations and evaluate the adequacy.


Area of Audit Focus Objective Audit Response

Expenditures including payroll

Ensure the cut off of expenses is appropriate and where applicable in accordance with funding agreements

Control reliance approach.

We will perform substantive tests of detail on a sample of transactions to ensure they are valid and in accordance with the terms of applicable agreements.

We will perform testing around the cut off of expenses on a sample of transactions to ensure they are recorded in the correct period.

Specific items Ensure that specific events or transactions are appropriately accounted for and/or disclosed in the financial statements

Excise tax: We will obtain an update on the status of the excise tax on personal support services from management as well as involve Paul Corriveau (Deloitte indirect tax specialist) in order to ensure that any developments are appropriately reflected in the financial statements.

Change in the Community Financial Policy used in the preparation of the CCAC Annual Reconciliation Report: The Ministry of Health and Long-Term Care provides guidance with regards to the preparation of the CCAC Annual Reconciliation Report. In its 2015 update, the Community Financial Policy now excludes contingent liabilities from the scope of funded expenses. We will review the implications to the financial statements.


Materiality

We are required as auditors to set a materiality level that provides reasonable assurance that material errors will be detected during our testing and that the financial statements, taken as a whole, present fairly the financial position and results of operations of the CCAC. In the context of financial reporting, materiality refers to the magnitude of an omission or misstatement of accounting information that, in light of the surrounding circumstances, makes it probable that the judgment of a reasonable person relying on the information would have been influenced, or a decision changed, by the omission or misstatement. As the financial statements involve summarized information and estimation, materiality is an essential element of generally accepted auditing standards and aids the auditor in determining the scope of testing and the determination of the overall fairness of the financial statement presentation.

The quantitative determination of materiality is a matter of professional judgment. Qualitative factors are also considered in the determination of materiality. As a matter of policy we will strongly encourage Management to adjust, without regard to materiality, all known errors discovered in the course of our work.

Assessing the effect of misstatements on the financial statements:

Nature and cause

Significance, both individually and in total

Known error versus likely misstatements

Qualitative factors

Qualitative guidelines

Impact on business and decisions

Systemic versus isolated

Impact on compliance with loan covenants, contractual agreements, etc.

Fraud indicators

Other – impact on related processes, calculations, related party transactions, etc.

Our preliminary estimate of materiality for planning purposes is $3,760,000, which is based on 1.6% of budgeted 2016 revenue of approximately $235 million. This materiality level will be revised based on the CCAC’s final revenue figures as at March 31, 2016.

Based on this estimated materiality level, we expect that our gap will be set at $760,000 (20%), thereby providing us with a monetary precision of $3,000,000. The gap is that level of error that we expect to find during the audit. The minimum threshold for setting the gap is 10% of materiality. The higher the gap, the lower our monetary precision, which results in more substantive testing.

All differences in excess of 5% of materiality (i.e. $188,000), which are noted during an audit are accumulated and discussed with management to determine if adjustments are required to the financial statements. Details of any adjusted and/or unadjusted amounts in excess of $188,000 are reported to the Committee at the end of the audit.


Timelines and deliverables

Our timelines for the audit and formal communications with the Committee are summarized below:

Our Deliverables Timing

1. Conduct interim fieldwork Week of December 14, 2015

2. Present the audit plan January 25, 2016

3. Conduct year-end fieldwork Week of May 2, 2016

4. Draft reports to Management for their review May 27, 2016

5. Confirmation of our independence and reporting on non-audit services and relationships;

June 2016

6. Present our audit results, including any reportable matters thereon; and

June 13, 2016

7. Our draft report on the financial statements. June 13, 2016


Reportable matters

To the extent we become aware of them during our audit, we will bring the following matters to the attention of the Committee: Reportable Matters Comments

1. Significant weaknesses in internal control.

2. Illegal or possibly illegal acts.

3. Fraud or possible fraud identified through the audit process.

4. Significant transactions inconsistent with ordinary business, including fraud or possible fraud.

5. Unusual related party transactions.

6. New significant accounting principles or policies.

7. Significant accounting policies in controversial or emerging areas, or those unique to the industry.

8. Acceptable alternative policies and methods, and the acceptability of a particular accounting policy or method used by management.

9. Timing of significant transactions that affect the recognition of revenues or avoid recognition of expenses.

10. Disagreements with Management or concerns regarding the honesty and integrity of Management.

11. Management consultation with other accountants about significant auditing/accounting matters.

12. Unusual transactions that significantly increase the risk of loss.

13. Non-compliance with regulatory requirements.

14. Major issues discussed with Management that influence the audit appointment.

15. Management’s judgments and accounting estimates.

16. Misstatements, including corrected and uncorrected errors.

17. Difficulties encountered during the audit.

18. Limitations placed on our scope.


Client service team

Paul Corriveau Senior Manager Commodity Tax

Maxime Puech Senior Manager

Audit

Senior Auditor Valérie Renaud

Field Staff

Doreen Hume Lead Engagement

Partner

Lisa Purdy National Healthcare

Leader


Appendix 1 – Reporting responsibilities

CCAC Management

The preparation of financial statements is the responsibility of Management. Management also has the responsibility for, among other things:

Preparing the financial statements;

Maintaining an effective internal control environment;

Safeguarding assets;

Preventing and detecting fraud and error;

The proper recording of transactions in accordance with PSAS-GNPO in the accounting records;

Making appropriate accounting estimates;

Selecting and applying appropriate accounting and disclosure policies;

The timely and accurate disclosure of financial results;

Reporting results on a fair and consistent basis; and

Maintaining compliance with regulatory and legal requirements.

Finance Committee and Audit Committee

The CCAC’s Committee is responsible for:

Reviewing and recommending for approval the financial statements and financial disclosures;

Reviewing any proposed changes in accounting policies and key estimates and judgments of Management;

Preventing and detecting fraud and error

Ensuring, in its oversight role that the CCAC established and maintains internal control systems, including fraud prevention and detection controls to provide reasonable assurance with regard to reliability of financial reporting processes;

Approving auditor remuneration and services provided by the auditors; and

Ensuring, in its oversight role effective and timely financial reporting and communications to the Board of Directors.

Our reporting responsibilities

The purpose of our engagement is to audit the financial statements of the CCAC for the 2016 fiscal year, and to express an opinion on the fairness of presentation, in all material respects, of the financial statements in accordance with PSAS-GNPO. Our ability to express an opinion and the wording of the opinion will, of course, depend on the facts and circumstances as of the date of our report.


Our audit will be conducted in accordance with Canadian generally accepted auditing standards. An audit is performed to obtain reasonable but not absolute assurance as to whether the financial statements are free of material misstatement. Owing to the inherent limitations of an audit, there is an unavoidable risk that some misstatements of the financial statements will not be detected, even though the audit is properly planned and performed. In particular, our audit addresses certain key controls within the financial reporting process. It is not specifically directed to addressing the effectiveness or efficiency of ongoing operations or ensuring compliance with all regulatory and legislative requirements. To the extent we become aware of significant matters as a byproduct of our audit, we will of course ensure those are brought to the attention of the Committee.

Our audit will include:

Reviewing the effectiveness and reliability of certain internal financial reporting controls;

Assessing the risk of fraud and error as well as the risk that the financial statements may contain misstatements that, individually or in aggregate, are material to the financial statements taken as a whole;

Examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements; and

Assessing accounting principles, estimates and financial statement disclosures


Appendix 2 – Standard-setting update

Effective Dates for New Standards Public Sector Accounting

Topic Summary of new standard Effective for

Restructuring Transactions, Section PS 3430

This Section establishes standards on how to account for and report restructuring transactions by both transferors and recipients of assets and/or liabilities, together with related program or operating responsibilities.

Fiscal years beginning on or after April 1, 2018. Earlier adoption is permitted.

Related Party Disclosures, Section PS 2200

This Section defines a related party and establishes disclosures required for related party transactions. It is expected that reasonable efforts would be made to identify related party transactions. This may involve adopting policies and procedures designed to ensure that these transactions are appropriately identified, measured and disclosed in the financial statements. Only those transactions that have or could have a material financial effect on the financial statements are disclosed.


Assets, Section PS 3210

This Section provides guidance for applying the definition of assets and establishes general disclosure standards for assets; but does not include standards for recognition and disclosure of specific types of assets, which are dealt with in other Handbook Sections.


Contingent Assets, Section PS 3320

This Section: defines and establishes disclosure

standards on contingent assets; but does not include disclosure

standards for specific types of contingent assets.

Contingent assets are possible assets arising from existing conditions or situations involving uncertainty. That uncertainty will ultimately be resolved when one or more future events not wholly within the public sector entity's control occurs or fails to occur. Resolution of the uncertainty will confirm the existence or non-existence of an asset.



Topic Summary of new standard Effective for

Contractual Rights, Section PS 3380

This Section: defines and establishes disclosure

standards on contractual rights; but does not include disclosure

standards for specific types of contractual rights; and

does not include those contractual rights to exchange one asset for another where revenue does not arise.

Contractual rights are rights to economic resources arising from contracts or agreements that will result in both an asset and revenue in the future.


Inter-entity Transactions, Section PS 3420

This Section establishes standards on how to account for and report transactions between public sector entities that comprise a government's reporting entity from both a provider and recipient perspective.


Effective Dates for Canadian Assurance Standards – Final Standards

Topic Effective for

CSRS 4460, Reports on Supplementary Matters Arising from an Audit or Review Engagement

At its meeting on March 10-11, 2014, the AASB approved Canadian Standard on Related Services (CSRS) 4460, Reports on Supplementary Matters Arising from an Audit or a Review Engagement. In this regard, the AASB concluded that changes made in finalizing the standard were not significantly different from the proposals in the ED and, therefore, no re-exposure was necessary.

The CSRS addresses reporting on supplementary matters to a third party, such as a regulator (often referred to as “derivative reporting”). As part of the proposals, the AASB plans to withdraw the following Assurance and Related Services Guidelines: AuG-4, Services on Matters Relating to Solvency; and AuG-13, Special Reports on Regulated Financial Institutions.

On June 2, 2014, the AASB Issued a Basis of Conclusions document with respect to CSRS 4460.

Most recently, in October 2014, CPA Canada issued an Audit Alert to raise awareness about CSRS 4460.

Reports dated on or after April 1, 2016


Canadian Assurance Standards – Exposure Drafts

Topic Issued on

On September 2, 2015, the Auditing and Assurance Standards Board (AASB) issued an Exposure Draft that proposes a new standard that would replace existing standards dealing with audits and reviews of compliance with agreements, statutes and regulations. Stakeholders are encouraged to submit their comments by December 23, 2015.

The AASB proposes, subject to comments received following exposure, to issue Canadian Standard on Assurance Engagements (CSAE) 3530, Reports on Compliance with Agreements, Statutes and Regulations, which would replace:

Section 5800, Special Reports – Introduction;

Section 5815, Special Reports – Auditor’s Reports on Compliance with Agreements, Statutes and Regulations; and

Section 8600, Reviews of Compliance with Agreements and Regulations.

Exposure draft issued on September 2, 2015

On August 21, 2015, the Auditing and Assurance Standards Board (AASB) issued an Exposure Draft that proposes to adopt limited changes to international standards necessary to resolve actual or perceived inconsistencies or to clarify key aspects of proposed revisions to the IESBA Code of Ethics. Stakeholders are encouraged to submit their comments by September 30, 2015.

The Auditing and Assurance Standards Board (AASB) proposes to adopt with appropriate amendments, if any, proposed limited changes to International Standards on Auditing (ISAs) and International Standard on Quality Control 1 (ISQC 1):

ISA 220, Quality Control for an Audit of Financial Statements;

ISA 240, The Auditor’s Responsibilities Relating to Fraud in an Audit of Financial Statements;

ISA 250, Consideration of Laws and Regulations in an Audit of Financial Statements;

ISA 260 (Revised), Communication with Those Charged with Governance;

ISA 450, Evaluation of Misstatements Identified During the Audit; and

ISQC 1, Quality Control for Firms that Perform Audits and Reviews of Financial Statements, and Other Assurance and Related Services Engagements,

Issued by the International Auditing and Assurance Standards Board (IAASB). The AASB proposes to make the same limited changes to the corresponding Canadian Auditing Standards (CASs) and Canadian Standard on Quality Control 1 (CSQC 1).

The IAASB also proposes limited changes to:

International Standard on Review Engagements (ISRE) 2400 (Revised), Engagements to Review Historical Financial Statements; and

International Standard on Assurance Engagements (ISAE) 3402, Assurance Reports on Controls at a Service Organization.

Exposure draft issued on August 21, 2015


Statement of Principles, Improvements to Not-for-Profit Standards in the private sector [SOP]

Recent activities - May 2015

Most recently, at its meeting on May 25-26, 2015, the AcSB reaffirmed its commitment to continue: (i) to maintain a separate set of standards for not-for-profit organizations in the private sector that addresses transactions and circumstances unique to this sector; (ii) with the improvements process to review the standards in Part III of the Handbook and update the standards as necessary; and (iii) to work in collaboration with the PSAB, with the objective of achieving consistency between private and public sector standards for not-for-profit organizations when appropriate. The AcSB also approved the creation of a standing not-for-profit organizations advisory committee to assist the Board with its standards improvements initiatives, as well as providing input on other standard- setting matters of interest to private sector not-for-profit organizations. An invitation soliciting interest will be posted shortly. In addition, at its meeting on May 25-26, 2015, the AcSB approved two new projects: (i) Accounting Standards Improvements, and (ii) Contributions – Revenue Recognition and Related Matters to address all of the 15 Principles relating to private sector standards that were proposed in the April 2013 joint AcSB/PSAB SOP. The AcSB decided to conduct the first project in two phases. The first phase of the project will address whether and how to amend the standards regarding the accounting for capital assets other than the size exemption, but including collections of works of arts and historical treasures and the disclosure of related party transactions and allocated expenses (Principles 5, 6, 8, 9, 12 and 15). The second phase of the project will address whether and how to amend Section 4450, Reporting Controlled and Related Entities by Not-for-Profit Organizations, regarding how to account for controlled not-for-profit organizations and profit-oriented enterprises (Principles 10 and 11). This phase of the project would also address the proposals related to the presentation and disclosure of expenses (Principle 14). With respect to the second project, the AcSB will conduct further research on the recognition of revenue from contributions (Principles 1 to 4). This project will also address the implications of the deliberations relating to the size exemption for capital assets (Principle 7) and financial statement presentation (Principle 13).

Champlain CCAC Financial Results – Executive Summary

For the nine months ended December 31, 2015

OVERVIEW This executive summary covers Champlain CCAC’s financial results for the period ending December 31, 2015

BUDGET ASSUMPTIONS AND UPDATES The F2015/16 budget has been restated to reflect a base increase of 1.0% (i.e. $2.3M) confirmed by the LHIN. This is approximately $1M less

than the original budget assumption of a 1.5% base increase. Prior month’s budgets and actuals have not been restated – budget changes were

made prospectively from August until March 31, 2016. Purchased clinical services budgets were reduced to reflect current spend patterns,

however this decrease is offset by additional PSW wage enhancement funding added. The only other changes were a reduction in Health Links

budget and an increase to anticipated legal fees. Updates to revenue assumptions can be found in Appendix I.

CONDENSED OPERATING STATEMENT

1 Month 1 Month 1 Month December YTD YTD YTD YTD Total

Actuals Budget Variance

%Var to

Budget Actuals Budget Variance

%Var to

Budget Budget

REVENUE

Base Funding $19,827,586 $20,065,264 ($237,678) (1.18%) $173,363,682 $173,815,376 ($451,694) (0.26%) $233,401,895

One-Time Funding $91,563 $84,219 $7,344 8.72% $884,272 $818,434 $65,838 8.04% $1,067,232

BTI & Other Funding $9,879 $4,667 $5,212 111.68% $311,834 $46,019 $265,815 577.62% $523,019

TOTAL REVENUE $19,929,028 $20,154,150 ($225,122) (1.12%) $174,559,788 $174,679,829 ($120,041) (0.07%) $234,992,146

EXPENSES

Purchased Client Services $14,437,599 $13,744,379 ($693,220) (5.04%) $122,786,252 $120,022,781 ($2,763,471) (2.30%) $161,050,999

Other Community Services $487,767 $485,219 ($2,548) (0.53%) $4,356,844 $4,347,536 ($9,308) (0.21%) $5,796,326

Care Coordination and I&R $3,720,871 $3,719,615 ($1,256) (0.03%) $31,526,294 $32,577,802 $1,051,508 3.23% $43,936,298

Direct Care $686,089 $685,899 ($190) (0.03%) $5,386,555 $6,003,401 $616,846 10.27% $8,108,233

Administration $1,378,183 $1,519,038 $140,855 9.27% $12,129,425 $11,728,309 ($401,116) (3.42%) $16,100,290

TOTAL EXPENSES $20,710,509 $20,154,150 ($556,359) (2.76%) $176,185,370 $174,679,829 ($1,505,541) (0.86%) $234,992,146

TOTAL SURPLUS/(DEFICIT) ($781,481) $0 ($781,481) (3.88%) ($1,625,582) $0 ($1,625,582) (0.93%) $0

FINANCIAL ANALYSIS (material variances of +/- $50,000 and 1% will be explained) December: Revenue Base funding: Negative variance in base funding revenue against budget for the month of December

of $237K is due to adjustments of prior months’ revenue accruals for both PD funding (CCO) of $143K and PT funding of $100K. Both of these revenue accrual reversals are due to updated information regarding actual funding to be received by year end (CCO) and number of clients to be served (PT).

BTI and Other funding: Revenue is matched to expenses – originally budgeted in Q4 (timing variance and no

impact to bottom line). Expenses Purchased Client Services: Continued higher demand than anticipated for PSS and Nursing Services. In addition,

the impact of the therapies waitlist release is reflected in these statements. Administration: Deficit due to BTI expense incurred, originally budgeted in Q4: However, corresponding

revenue matched and no impact to bottom line. YTD: Revenue Base funding: Negative variance in base funding revenue against budget YTD is mainly due to

adjustments of prior months’ revenue accruals due to more recent funding information received.

One-time funding: Small surplus due to unbudgeted one-time funding received (matched to expenses). BTI & Other funding: Revenue is matched to expenses – originally budgeted in Q4 (timing variance and no

impact to bottom line). Expenses Purchased Client Services: Higher demand than anticipated for PSS and Nursing Services. Care Coordination and I&R: Surplus due to numerous vacancies in earlier part of this year. These savings are

slightly offset by fewer recoveries received (positions budgeted (transitional navigators)) with expected recoveries from other agencies (WSIB and Kemptville Hospital for employees for whom we receive reimbursement).

Direct Care: Surplus due to numerous vacancies in internal therapies and nursing initiatives. Many of these vacancies have been filled, which is why the month is showing as being on

target. However, the cumulative impact of previous months’ vacancies continues to leave us in a YTD surplus position.

Administration: Deficit due to significant legal fees expensed in July, October SSO expense (offset by one-time funding) as well as a November BTI expense (originally budgeted for Q4, but will be offsetting BTI funding). These expenses are offset by surpluses caused by timing variances and small savings in other administration expense lines.

Note: the Statement of Financial Position (Balance Sheet) can be found in Appendix II.

ADDITIONAL COMMENTS

April 15 May 15 June 15 July 15 August 15 September 15 October 15 November 15 December 15 January 16 February 16 March 16

PSS 6,122,335 6,317,179 6,552,824 6,820,633 7,006,082 7,017,312 7,509,932 7,525,298 7,534,236

PSS wage enhancement 359,032 369,863 388,626 398,880 2,164,182 786,635 842,845 844,750 844,239

Nursing 3,528,209 3,712,323 3,936,678 3,409,884 3,530,305 3,797,500 3,946,333 3,903,872 3,722,385

Allied Health - Home 687,787 649,188 777,993 732,520 672,309 772,681 835,370 842,094 783,105

Allied Health - School 438,891 421,860 341,600 5,890 347 362,651 519,287 493,563 355,272

Supplies and Equipment 1,130,433 1,143,693 1,227,219 1,273,244 1,167,082 1,230,449 1,303,709 1,190,692 1,292,718

Total 12,266,687 12,614,106 13,224,940 12,641,051 14,540,307 13,967,228 14,957,476 14,800,269 14,531,955

Budget 12,377,307 12,749,854 13,118,734 13,217,888 14,216,285 13,529,917 13,975,927 13,772,042 13,830,533 13,757,730 13,426,611 14,095,475

$-

$2.0

$4.0

$6.0

$8.0

$10.0

$12.0

$14.0

$16.0

Mill

ion

s

15/16 Purchased Clinical Care - Spend Rate

Summary

The Patient Capacity charts below show that, overall, the Actual Clients served exceeded the Budgeted Capacity of clients in October, November, and December. Although some of the individual areas shown below are not above the budgeted capacity in the months of October, November, and December, the deficit year to date is a result of the cumulative impact of previous months’ excess of Actual Clients served over the Budgeted Capacity in the areas noted. This trend is expected to continue to fiscal year end. Client acuity of clients on CCAC service remains the highest in the province, requiring more services per client to address increasing client risk. If demand continues at current rate, the projected YE deficit is in the range of $4 - 4.5M. With the mild mitigation activities initiated in late November, and if the request to keep unspent PT funds is approved (roughly $600K), the amended YE forecast is in the range of $3.5 - $4M deficit. More drastic waitlist activities can be undertaken, but this would jeopardize performance metrics gains made and more importantly destabilize the gains made in promoting system flow and supporting more clients in their place of preference being in their homes. A LHIN-CCAC board level discussion has been initiated in December to see if such a step is warranted. The CCAC has also requested the LHIN to consider additional funding to address the projected deficit.

CCAC Patient Capacity (Budgeted Number of Clients vs. Actual Client Counts)

Appendix I – Revenue Confirmations and Variances to Budget PURPOSE The Champlain CCAC has a fiduciary obligation to balance its budget each fiscal year. This log keeps track of changes to in year funding

(both one time and base) as a means of understanding the variance in funding introduced over the year.

Balancing annual budgets is challenging not only due to changes in revenue assumptions, but also by variations in client demand and

acuity as well as factors impacting other partners which impact CCAC operations.

Measures in place to manage the budget are limited to operational efficiencies and introducing service waitlists or transferring clients to

other community services.

FUNDING CONFIRMATIONS RECEIVED

Date Funding changes Impact to budget presented on monthly

Financial statements

2015/2016 2015/2016 Budget reflects a planning increase of 1.0% as

confirmed by the LHIN, representing $2.4M (original budget assumption was 1.5% = $3.3M)

N/A: budget refresh (Aug/15) reflects confirmed funding

27-Mar-15 Received funding letter confirming one-time allocation of

$192,600 for the Health Links Initiative. N/A: budget refresh (Aug/15) reflects

confirmed funding

30-Apr-15 Received funding letter confirming that SSO base funding and related expenses will be reassigned to another CSS

agency to better align with strategic objectives.

N/A: exact amount to be recovered is not yet determined, however expenses will also

reduce by the same amount.



8-May-15 Received funding letter confirming additional base funding of $100,000 and a one-time allocation of $35,000 for SSO.

TBD: if additional funding is not available, SSO expenses will be reduced.

17-Jun-15 Received funding confirmation from the Ministry of

Government and Consumer Services for $686,000 (over 2 years) to support the Health Hub at Home Pilot Project.

This project will be tracked separately from operational funding. Targets must also be

met to avoid claw back by the Ministry.

25-Jun-15

Received funding letter confirming additional base funding of $4,897,000 for year 2 PSW wage enhancement. This

funding will provide an additional $1.84/hour to providers to support a wage increase for PSWs up to $19/hour.


9-Jul-15

Received funding letter confirming base HSRF funding for 14/15 of $1,881,176. This funding relates entirely to the

HBAM component of HSFR: QBP funding remains the same as 13/14 (no impact to budget)


August 25, 2015 Received funding letter confirming one-time allocation of

$129,900 for the Health Links Initiative. N/A: budget refresh (Aug/15) reflects

confirmed funding

August 26, 2015 Received funding letter confirming one-time allocation of $150,000 for the adoption of the Assessment of Urgency

Algorithm. +$150K, but with offsetting expenses



August 26, 2015 Received funding letter confirming base funding of $488,200 to support changes in complex nursing

regulations.


August 28, 2015

Received funding letter confirming base funding of $92,000 and one-time funding of $68,000 to provide bilingual

specialized services to stroke survivors in the Stormont, Dundas and Glengarry Counties, as well as Akwesasne. Base

funding will annualize to $215,500 in 2016/17.

+$160K, but with offsetting expenses

September 11, 2015 Received confirmation of one-time funding of $372,700 for

Prescott Russell Health Link. N/A: budget refresh (Aug/15) reflects

confirmed funding

September 11, 2015 Received confirmation of one-time funding of $32,800

Community Care lead +$33K, but with offsetting expenses

September 29, 2015 Received confirmation of one-time funding of $147,100 for

the renewal of SSO Licensing +$147K, but with offsetting expenses

October 2, 2015 Received confirmation of one-time funding of $21,250 for

the extension of French SSO Resource +$21K, but with offsetting expenses

November 10, 2015 Received confirmation of one-time funding of $105,000 to

support collaborative efforts to improve discharge from acute to community.

+105K, but with offsetting expenses

November 11, 2015 Received confirmation of one-time funding of $20,000 to

extend the Community Care lead (Integration of home and community care)

+$20K, but with offsetting expenses

November 12, 2015 Received confirmation of recovery of base funding of

$33,906 (annualized to $90,000) for the transfer of a Share Point Support Resource to Carefor. (See April 30th letter)

-$34K, but reduction in expenses

Appendix II – Statement of Financial Position

December 31 2015 November 30 2015 March 31 2015

ASSETS

CURRENT ASSETS

Cash $15,257,391 $16,940,006 $14,981,223

Accounts Receivable 611,675 433,199 1,172,455

Prepaid Expenses 8,680 14,284 134,339

15,877,746 17,387,489 16,288,017

CAPITAL ASSETS 1,063,121 1,172,665 1,673,398

16,940,867 $18,560,154 $17,961,415

LIABILITIES

CURRENT LIABILITIES

Accounts Payable and Accrued Liabilities $13,490,305 $12,840,298 $13,565,539

Due to MOHLTC 4,013,023 5,383,097 2,722,478

17,503,328 18,223,395 16,288,017

LONG-TERM LIABILITIES

Deferred Contributions - Capital Assets 1,063,121 1,172,665 1,673,398

18,566,449 19,396,060 1,673,398

NET ASSETSCarry-over 13/14 - (283,399)Operational (1,632,223) (842,520) 283,399

Other Programs (seperate funding) 6,641 6,614

(1,625,582) (835,906) -

16,940,867 $18,560,154 $17,961,415

CHAMPLAIN COMMUNITY CARE ACCESS CENTRE

BALANCE SHEET

Champlain CCAC

Board Financial Statement

for the Nine Months Ending December 31, 2015

1 Month 1 Month 1 Month YTD YTD YTD TotalActuals Budget Variance Actuals Budget Variance Budget

REVENUE

Base Funding (19,827,586) (20,065,264) (237,678) (173,363,682) (173,815,376) (451,694) (233,401,895)

One-Time Funding (91,563) (84,219) 7,344 (884,272) (818,434) 65,838 (1,067,232)

BTI (206,553) (4,019) 202,534 (467,019)

Other (9,879) (4,667) 5,213 (105,281) (42,000) 63,281 (56,000)

Total Revenue (19,929,028) (20,154,150) (225,122) (174,559,788) (174,679,829) (120,042) (234,992,146)

EXPENSES

Clinical Care

Purchased Services

Personal Support Services 8,378,475 8,007,832 (370,643) 69,404,883 68,929,893 (474,990) 92,548,605

Visit Nursing (includes dialysis) 2,482,956 2,339,291 (143,665) 22,752,467 21,394,395 (1,358,072) 28,313,393

Visit Nursing - Clinic 447,094 460,092 12,998 4,082,083 3,855,439 (226,644) 5,210,816

Nursing Shifts 792,335 730,554 (61,782) 6,652,939 6,253,404 (399,536) 8,523,845

Community - OT 326,237 290,908 (35,329) 2,789,006 2,507,728 (281,278) 3,379,158

Community - PT 364,503 335,487 (29,016) 3,146,309 3,091,997 (54,312) 4,095,839

Community - Speech 16,177 21,508 5,331 179,994 163,852 (16,142) 227,817

School - OT 189,586 163,266 (26,320) 1,483,340 1,544,288 60,948 2,145,564

School - PT 38,716 40,723 2,007 374,464 376,666 2,202 512,048

School - Speech 126,970 103,883 (23,087) 1,081,560 1,046,261 (35,299) 1,494,848

Social Work 40,441 41,194 753 326,263 315,449 (10,814) 437,998

Nutrition 35,747 41,663 5,916 311,476 346,821 35,345 476,293

Hospice 377,254 374,598 (2,656) 3,345,784 3,361,630 15,846 4,485,424

Aphasia 20,833 20,833 187,500 187,500 250,000

Medical Supplies 1,186,322 1,144,674 (41,648) 10,040,337 10,025,360 (14,977) 13,441,734

Medical Equipment 106,396 109,458 3,062 918,904 936,934 18,030 1,260,343

Recoveries (21,458) (15,208) 6,249 (111,061) (136,875) (25,814) (182,500)

Other 16,782 18,842 2,060 176,847 169,575 (7,272) 226,100

Total Purchased Services 14,925,366 14,229,598 (695,768) 127,143,096 124,370,317 (2,772,779) 166,847,325

Internal Therapies

Wages 321,073 317,581 (3,492) 2,429,492 2,689,402 259,910 3,603,116

Benefits 91,480 71,715 (19,765) 755,571 713,486 (42,085) 997,691

Travel 20,549 19,280 (1,269) 151,830 173,520 21,690 241,000

General Administration Costs 3,095 2,667 (429) 30,931 19,500 (11,431) 24,500

Total Internal Therapies 436,198 411,243 (24,955) 3,367,824 3,595,908 228,084 4,866,307

Care Coordination

Wages 2,867,275 2,863,219 (4,056) 23,695,042 24,269,183 574,141 32,443,261

Benefits 680,380 689,911 9,531 6,200,479 6,670,991 470,512 9,266,411

Travel 39,302 44,000 4,698 326,793 396,000 69,207 550,000

Page 1 of 6

Champlain CCAC




Professional Service 2,083 2,083 18,750 18,750 25,000

Office Supplies 1,864 4,583 2,719 19,718 41,247 21,529 55,000

Printing 11,136 6,000 (5,136) 87,567 42,000 (45,567) 100,000

Photocopy Charges 4,547 9,000 4,453 61,911 84,500 22,589 110,000

Delivery & Courier 978 1,667 689 10,691 15,003 4,312 20,000

Courses/Training/Conferences 5,247 2,166 (3,081) 21,830 19,494 (2,336) 26,000

Equipment Maintenance

Minor Equipment 83 83 750 750 1,000

Wireless Service 2,960 9,000 6,040 81,865 84,500 2,635 110,000

Recoveries (42,249) (68,580) (26,331) (263,370) (483,240) (219,870) (644,320)

Health Links (HL & HLA1) 48,203 54,344 6,142 472,076 537,981 65,905 695,603

Other 375 375 1,224 3,375 2,151 4,500

Total Care Coordination 3,619,643 3,617,852 (1,791) 30,715,827 31,700,533 984,707 42,762,455

Nursing Initiatives

Wages 198,137 214,705 16,568 1,552,440 1,816,327 263,887 2,432,390

Benefits 44,729 45,451 722 384,892 461,666 76,774 631,036

Travel 7,025 14,000 6,975 81,695 126,000 44,305 175,000

Recoveries (1,382) 1,382

Other 500 500 1,085 3,500 2,415 3,500

Total Nursing Initiatives and Geriatric Assessment 249,891 274,656 24,765 2,018,731 2,407,493 388,762 3,241,926

Information & Referral

Wages 81,037 80,129 (908) 637,107 681,059 43,952 906,311

Benefits 20,191 21,554 1,363 172,777 195,490 22,713 266,532

Travel 80 80 584 720 136 1,000

Other

Total for Information & Referral 101,228 101,763 535 810,468 877,269 66,801 1,173,843

Total Clinical Care 19,332,326 18,635,112 (697,214) 164,055,945 162,951,520 (1,104,425) 218,891,856

ADMINISTRATION

Executive Office

Wages 95,506 96,080 574 840,345 812,700 (27,645) 1,078,813

Benefits 16,823 17,831 1,008 190,484 161,447 (29,037) 236,393

Travel 1,447 1,250 (197) 13,923 11,250 (2,673) 15,000

Legal Services 152,500 152,500 606,064 157,500 (448,564) 310,000

Consultants 58,293 2,500 (55,793) 5,000

Membership (OACCAC) 31,134 30,833 (301) 284,208 277,497 (6,711) 370,000

Minor Equipment

Meeting Expenses 76 292 216 275 2,628 2,353 3,500

Printed Matter & Subscriptions 167 167 1,503 1,503 2,000

Page 2 of 6

Champlain CCAC




Board Expenses 1,200 3,000 1,800 14,513 20,500 5,987 27,500

Recoveries (342) 342 (3,075) 3,075

Other 292 292 2,628 2,628 3,500

Total for Executive Office 145,845 302,245 156,400 2,005,030 1,450,153 (554,877) 2,051,706

Performance and Strategy

Business Intelligence

Wages 45,538 37,146 (8,392) 348,626 314,203 (34,423) 420,003

Benefits 9,664 7,896 (1,768) 84,794 76,129 (8,665) 107,865

Travel 350 350 123 1,150 1,027 1,500

Other 500 500 1,000

Recoveries

Total for Business Intelligence 55,202 45,392 (9,810) 433,544 391,982 (41,562) 530,368

Quality & Program Evaluation

Wages 23,308 28,155 4,847 228,530 237,930 9,400 339,021

Benefits 5,883 8,878 2,995 98,573 87,637 (10,936) 124,767

Travel 1,131 2,000 869 1,289 3,600 2,311 4,000

Other 314 17,600 17,286 16,981 67,900 50,919 97,250

Recoveries (2,000) 2,000

Total for Quality & Program Evaluation 30,635 56,633 25,998 343,372 397,067 53,695 565,038

PMO and Service Provider Programs

Wages 38,983 42,608 3,625 330,376 360,403 30,027 478,415

Benefits 7,201 8,784 1,583 73,054 87,849 14,795 123,472

Travel 913 (913) 2,594 1,500 (1,094) 3,000

Other 250 250 500

Recoveries

Total for PMO and Service Provider Programs 47,097 51,392 4,295 406,024 450,002 43,978 605,387

Finance and Payroll

Wages 51,628 52,240 612 444,169 442,923 (1,246) 587,621

Benefits 11,193 11,434 241 114,224 116,576 2,352 161,080

Travel 380 250 (130) 669 750 81 1,000

Insurance 5,383 6,731 1,348 57,195 60,580 3,385 80,773

Audit Services 2,750 2,750 24,750 24,750 33,000

Other 173 333 160 1,949 3,000 1,051 4,000

Recoveries (735) 735

Total for Finance and Payroll 71,507 73,738 2,231 642,221 648,579 6,358 867,474

Page 3 of 6

Champlain CCAC




Facilities

Wages 16,628 15,006 (1,622) 118,713 127,526 8,813 169,210

Benefits 2,817 3,204 387 30,760 29,743 (1,017) 40,995

Travel 201 500 299 3,175 4,500 1,325 6,000

Office Supplies & Services 279 918 639 2,915 8,262 5,347 11,000

Postage, courier & photocopy services 98 (98) 16,852 16,664 (188) 25,000

Building Occupancy 195,032 208,822 13,790 1,813,646 1,879,398 65,752 2,505,864

Office Renovations 7,596 14,000 6,404 50,593 132,000 81,407 190,000

Utilities 3,792 4,800 1,008 28,792 41,200 12,408 55,000

Building & Grounds - Other

Misc Supplies/Repairs/Cleaning 4,293 5,833 1,540 48,604 52,497 3,893 70,000

Equipment Maintenance-Plant 498 5,221 4,723 44,675 46,541 1,866 60,000

Furniture & Equipment Purchases (Capital Asset)

Leasehold Improvement Purchases (Capital Asset) 5,613 (5,613)

Other 1,476 1,666 190 13,284 20,826 7,542 29,500

Recoveries (7,124) (430) 6,694 (151,034) (125,290) 25,744 (243,000)

Total for Facilities 225,586 259,540 33,954 2,026,586 2,233,867 207,281 2,919,569

IT & System Communications

Wages 150,258 150,643 385 1,227,761 1,277,844 50,083 1,699,327

Benefits 29,330 32,069 2,739 311,365 329,993 18,628 458,049

Travel 1,044 2,000 956 8,581 18,000 9,419 24,000

Telephone & System Communications 39,660 37,635 (2,025) 329,686 343,707 14,021 458,612

Telephone Supplies 4,360 3,500 (860) 9,847 30,500 20,653 41,000

Telephone Maintenance & Licenses 103,749 114,000 10,251 124,000

Telephone System Consultant 5,000 5,000 12,657 15,000 2,343 20,000

Equipment Maintenance 940 (940) 20,072 28,000 7,928 30,000

Software Maintenance & Licenses 5,020 24,500 19,480 388,709 250,900 (137,809) 284,400

System Development Consultant/CHRIS Development 24,300 11,000 (13,300) 106,195 111,500 5,305 146,010

Computer Supplies 4,308 5,500 1,192 15,777 53,500 37,723 72,000

Other Equipment Rentals

BTI 206,553 4,019 (202,534) 467,019

BTI Refresh/Growth 3,000 3,000 3,846 49,000 45,154 60,000

CCAC eHealth Program 142,720 140,865 (1,855) 1,284,481 1,267,785 (16,696) 1,690,381

Renovations 890 2,000 1,110 7,086 19,000 11,914 25,000

Other 3,501 7,100 3,599 23,616 58,780 35,164 81,100

Recoveries (2,128) (1,500) 628 (7,298) (13,500) (6,202) (18,000)

Equipment Purchases (Capital Asset) 126,162 (126,162)

Net Gain or Loss on Disposal

Total for IT & System Communications 404,204 423,312 19,108 4,178,842 3,958,028 (220,814) 5,662,898

Page 4 of 6

Champlain CCAC




Health Information

Wages 15,435 15,908 473 113,926 135,018 21,092 179,084

Benefits 3,550 3,785 235 36,228 35,101 (1,127) 48,412

Travel 200 200 251 1,900 1,649 2,500

Equipment Maintenance

Shredding & Document Destruction 1,250 1,250 3,646 11,250 7,604 15,000

Scanning Services 300 300 2,066 900 (1,166) 1,000

Storage 3,878 3,333 (545) 40,453 29,997 (10,456) 40,000

Other

Recoveries (222) 222 (1,880) 1,880

Total for Health Information 22,641 24,776 2,135 194,690 214,166 19,476 285,996

Total Performance and Strategy 856,873 934,783 77,911 8,225,278 8,293,691 68,413 11,436,730

People and Stakeholder Engagement

People Services

Wages 66,680 61,472 (5,208) 496,823 519,966 23,143 690,227

Benefits 12,202 12,630 428 111,428 128,916 17,488 178,934

Travel 636 833 197 6,883 7,497 614 10,000

Consultants - HR 1,294 2,292 998 14,054 20,628 6,574 27,500

Labour Relations 423 6,667 6,244 18,835 60,003 41,168 80,000

Occupational Health & Safety 188,568 75,000 (113,568) 207,265 93,184 (114,081) 100,000

Advertising 1,435 1,000 (435) 36,294 47,000 10,706 50,000

Employee Assistance Plan 21,534 22,500 966 30,000

Staff Appreciation 600 1,364 764 31,786 50,912 19,126 55,000

Other

Recoveries

Total People Services 271,837 161,258 (110,579) 944,900 950,606 5,706 1,221,661

Organizational Development

Wages 45,929 38,008 (7,921) 326,924 321,493 (5,431) 428,183

Benefits 8,717 10,041 1,324 97,823 97,426 (397) 139,176

Travel 35 292 257 1,260 2,626 1,366 3,500

Courses/Training/Conferences 2,793 6,000 3,207 46,731 59,000 12,269 79,400

Other 12,000 12,000 187 36,000 35,813 48,000

Recoveries (572) 572 (1,122) 1,122

Total Organizational Development 56,902 66,341 9,439 471,804 516,545 44,741 698,259

Stakeholder Engagement

Wages 37,418 39,111 1,693 327,934 330,821 2,887 439,145

Benefits 7,569 8,299 730 78,861 81,485 2,624 114,289

Travel 26 500 474 1,053 6,000 4,947 7,500

Page 5 of 6

Champlain CCAC




Public Relations 1,714 5,000 3,286 63,980 81,500 17,520 106,000

Translation/Consultants 1,500 1,500 6,229 17,500 11,271 25,000

Other 4,355 (4,355)

Recoveries

Total Stakeholder Engagement 46,727 54,410 7,683 480,831 517,306 36,475 691,934

Total People and Stakeholder Engagement 375,466 282,009 (93,457) 1,899,116 1,984,457 85,341 2,611,854

Total Administration 1,378,183 1,519,037 140,854 12,129,425 11,728,301 (397,962) 16,100,290

Total Expenses 20,710,509 20,154,150 (556,360) 176,185,370 174,679,821 (1,505,549) 234,992,146

Surplus/(Deficit) 781,481 781,481 1,625,582 1,625,582

Page 6 of 6

board finance & audit committee...

Documents