UNIVERSITY HEALTH NETWORK- REHABILITATION INSTITUTE

VOLUNTARY INTEGRATION

BUSINESS CASE

CONFIDENTIAL DRAFT

May 12, 2011

Submitted by:

______Dr. Robert Bell Mr. Mark Rochon President and CEO President and CEO University Health Network Toronto Rehabilitation Institute

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1. Executive Summary

On June 30, 2011 Toronto Rehabilitation Institute (Toronto Rehab) and University Health Network (UHN) plan to voluntarily integrate their clinical, research and education programs and support services to become Canada’s premier academic hospital.

This integration will create a world leading health sciences centre that provides integrated programs in acute, rehabilitation, complex continuing and long-term care for adults.

The goal of integration is to improve the experiences of patients and residents through novel models of care across acute, rehabilitation, complex continuing care and long term care continuum in a wide range of clinical programs. This voluntary integration will also provide a rich environment to further Ontario’s focus on interprofessional education and teaching.

Toronto Rehab is home to one of the largest rehabilitation research programs in North America. Research strengths of Toronto Rehab will be joined with those of UHN to advance research ranging from outcomes research and evidence based practice across the care continuum to technologies that improve therapeutic interventions and support people at home. A major emphasis on rehabilitation research will continue into the future.

2. Principles and Commitments

The hospitals intend to effect the proposed integration in a manner that is as close as possible to the features of a statutory amalgamation. As such, given that in these circumstances UHN is a Special Act Corporation (University Health Network Act, 1997) and Toronto Rehab is a Letters Patent corporation, an asset transfer will be used to complete the integration.

Effective June 30, 2011 Toronto Rehab will transfer all of its right, title and interest in and to its assets to UHN and UHN will assume all of the liabilities of Toronto Rehab.

The following principles and commitments have been agreed to

 Integration will enhance quality and accessibility of rehabilitation services for patients including a focus on earlier rehabilitation services for acute patients as appropriate and informed by evidence and best practice.

 UHN will guarantee current levels of rehabilitation services. Any resulting savings from integration will be reinvested in post-acute care. While it is difficult to estimate savings at this early stage, it is anticipated that approximately $3-5M will be to be freed up for reinvestment. As a result, enhanced post acute services will soon be in place to the benefit of patients.

 UHN will guarantee that post-acute care care, commitment and partnerships currently in place through Toronto Rehab to other acute hospitals such as St. Joseph’s Health Centre, St. Michael’s Hospital, Sunnybrook Health Sciences Centre and Mt. Sinai Hospital, will be honoured. In addition, the many other partnerships with other referral partners will also

2 continue. Variances from service delivery volumes are not contemplated as a consequence of this integration.

 The new integrated organization will have a focus on research in rehabilitation. Substantial annual financial support will be provided by UHN to continue this focus. This incremental financial support will not be derived from TCLHIN operating funds.

UHN will enter a post integration project charter with TCLHIN for continued monitoring and evaluation through the HSAA accountability agreement.

3. Clinical Quality and Outcome Opportunities

The clinical teams of Toronto Rehab and UHN are very excited by the new opportunities that integration offers to enhance the quality and outcomes of care for patients, residents and their families. The expected outcomes of the integration are aligned with the Toronto Central LHIN’s key priorities that aim to act as catalysts for a broader, system-wide transformation and make a difference for people in the community:

 Reduce emergency room (ER) wait times  Reduce alternate level of care (ALC) days  Improve the value and affordability of health services  Improve access to services and outcomes for people with diabetes  Improve access to services and outcomes for people with mental illness and/or addictions

Programs of UHN are highly compatible with those of Toronto Rehab and numerous clinical and academic partnerships already exist, as shown below.

Current partnerships Clinical Area Toronto Rehab University Health Network Joint replacement and Musculoskeletal osteoarthritis rehab, trauma Arthritis Program and fractures Stroke rehab, Acquired brain injury rehab, Spinal cord Krembil Neurosciences Neurosciences injury and disease, Alzheimer Program diseases and dementia, multiple sclerosis Heart Disease, Cardiac Rehab Cardiac Peter Munk Cardiac Program and Prevention, Heart Health Geriatrics, seniors care, Medical and Community Care, Complex medical services psychogeriatrics. diabetes, Emergency, Mental Health and dialysis Addictions, dialysis Princess Margaret Cancer Pain management, palliative Program, Multi Organ Specialty programs care Transplant, Critical Care and Surgical Services, Medical

3 Current partnerships Clinical Area Toronto Rehab University Health Network Imaging and Laboratory Medicine

Integration is favoured by our mutual interests in research, inter-professional education, Neuroscience, Musculoskeletal, Cardiovascular and Geriatric care. In most of our clinical offerings we provide substantially different components of the continuum of care, suggesting that integration of services will provide our patients with more seamless service. The continuum also offers opportunity for most cost-effective care by eliminating “waiting times” at the interface between our organizations that not only degrade patient outcomes but also increase costs.

By integrating our services, we will achieve internationally leading programs in: Spinal Cord Injury and Spine Degenerative Disease, Neurovascular Treatment, Medical Complex Care, Cardiovascular Care and Malignant Hematology Rehabilitation.

Spinal Cord Injury & Spine Degenerative Disease

Following the opening of the Krembil Discovery Center in 2013 there is enormous potential for integration of research and clinical activities at and Lyndhurst Hospital. The addition of Lyndhurst’s expertise to the current acute spinal expertise at TWH would immediately create an enormous opportunity for recruitment of both clinicians and researchers interested in spinal cord injury and spine degenerative disease. Needless to say this is a crucial area of importance for clinical care and research in an aging population and we would rapidly become a world leading Spine Center.

Neurovascular Treatment

The TC LHIN focus and our mutual institutional attention to Neurovascular disease has shown both organizations that we can improve outcomes and reduce costs by bringing our Neurovascular Programs under single governance- mandating that the planning for rehabilitation and best possible outcome begins the minute that the patient is admitted with stroke or aneurysm. The movement of rehab resources “upstream” in the continuum of care will likely have its biggest impact in the treatment of neurovascular patients.

Medical Complex Care

There is no question that patients with complex medical conditions require an integrated continuum of care from the community through the ER, medical unit and back to the community. Attention to rehabilitation needs is sorely lacking in the current configuration of services. Integrating acute medical care with a focus on post-acute treatment environments and a return to monitoring in the community would be a tremendous step forward that integration of our services could enable.

4 Malignant Hematology

Leukemia, myeloma, lymphoma and bone marrow transplant patients have substantially improved survival compared to results achieved ten years ago- but we pay little or no attention to their functional outcomes. Their outcomes would be dramatically improved by integration of care and integration of medical staff.

Integrated Cardiac Program

The integration of Toronto Rehab Cardiac Rehab and the Peter Munk Cardiac Center would offer enormous opportunity for extending the current emphasis on “personalized” cardiology and “genomic prediction” of outcome. At present the proportion of patients taking advantage of cardiac rehabilitation following major incidents is less than optimal and this integration should increase referrals between our programs.

A higher level of patient satisfaction with transitions between acute, rehab and post acute care is expected to be achieved post-integration. Greater development and adoption of evidenced based care models that include acute, rehab and post acute phases will occur in each program.

Providing more effective transitions in care will increase the ability to meet and exceed quality measures such as reduced readmissions, improved patient outcomes and streamlined process improvements. We also anticipate that fewer ALC days and shorter wait times in both rehabilitation and acute care will result.

4. Education and Research

Enhanced interprofessional education programs and excellence in education for medicine, nursing, rehabilitation, occupational therapy, physical therapy and speech language pathology amongst others is expected as a result of the integration. Toronto Rehab and UHN are both leaders in interprofessional education and already work well together in this new academic domain. Integration and evaluation of education models in acute, rehab and post acute settings will be used to further this work and the expertise of our faculty, teachers and learners.

Robust teaching programs are provided at all sites. As prominent academic hospitals, a culture of learning and evaluation already exists on which to build further integrated educational programs. Organizational integration provides an enriched environment for interprofessional practice models, enhanced learner opportunities and recruitment of specialists and clinicians.

Bringing together bright research minds and state-of-the-art technology, Toronto Rehab is fast becoming a world leader in practical research aimed at helping overcome the challenges of disabling injury or illness, chronic disease or age-related conditions. Among many breakthroughs, this research has led to the development of new technologies such as a device that will allow people to be tested for sleep apnea at home, a unique handheld unit that enables hospitals to accurately audit hand hygiene compliance and the use of functional electrical stimulation to help people with spinal cord injuries regain use of their hands. Scientists and clinicians have also worked together to improve the understanding of risk factors and more effective treatments for people living with stroke, heart disease and brain injury. There are important collaborative research efforts with UHN that will serve as a foundation for the

5 development of research foci that will span the care experiences for patients, from the hospital to the community. In the fall of 2011, Toronto Rehab will unveil the world’s most advanced research facilities dedicated to rehabilitation science.

These are just a few of the exciting opportunities we see to capitalize on current research expertise and develop new research areas as a result of integration. In particular, research in outcome evaluation, evidence based care and innovative technologies will be facilitated across clinical programs. We believe that grant funding for outcomes based research will now be more achievable. UHN has already committed substantial funding to rehab research in the new organization.

As part of the integration activities, intellectual property registrations will need to be transferred from Toronto Rehab to UHN.

5. Community Engagement Plan

The community engagement strategy is composed of the following goals and approaches.

1. Inform and assist the community to understand the proposed integration using web site and other web-based tools, central information contacts, briefings, fact sheets, progress reports, newsletters and email updates

2. Consult and get feedback on analysis, options and decisions by inviting public comment and focus groups

3. Involve and work together with the community to ensure issues are considered and understood using workshop, open space meetings and focused conversations

4. Collaborate and partner with community in each aspect of the decision making including options and solutions by engaging community advisory committees at Toronto Rehab in each of the program areas and consensus building activities

5. Empower key stakeholders to become engaged in the integration by reaching out directly to them. This has included key referring hospitals, , Toronto CCAC amongst others.

A broad range of communities and stakeholders have become engaged so far including:

. employees, physicians, learners and educators, researchers, volunteers . patients, residents and families . key referring hospitals and community partners . letters to philanthropic donors and updates on Foundation websites . general public

The community engagement processes will be continuous so that we can continue to seek input on transition activities and encourage feedback and advice on what is working and what might need adjustment.

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Activities to date include:

. Over 2,000 employees receive weekly email communication updates about the integration; updates are also posted on the Toronto Rehab intranet.

. Town Hall meetings are being held at all Toronto Rehab sites. These face-to-face meetings typically attract approximately 400 employees across all sites; questions and answers will be documented, summarized and posted to the Toronto Rehab intranet for all 2000 employees to review.

. Toronto Rehab Management Forum group includes about 80 mid to senior leaders; the group meets monthly after the Board meeting where they are updated

. A Joint Toronto Rehab - UHN web site is available and loaded with updated information on the integration, questions and answers plus web enabled feedback email. Notifications via Twitter and Facebook sites have also been utilized. There have been 5500 page views of the integration on the website since it was posted at the beginning of April. This represents approx. 2500 individual visitors.

. Letters have been sent to 500 inpatients (from all programs) and to 128 Lakeside residents.

. Letters have been sent to 40 academic institutions where Toronto Rehab is affiliated, and Dr. Whiteside reached out to department heads in the Faculty

. All communications now direct people to the joint website and includes Janine Hopkins as the LHIN contact along with her contact info.

. Email communication has been sent to the communicators at TAHSN member hospitals and to other GTA rehab hospitals advising them of the integration as well as to a handful of other local hospitals (NYGH, St. Joseph’s Health Center and others)

. There will be 3 CCC Patient/Family Council meetings, at least 3 LTC resident/family meetings; and about 7 other individual program advisory group meetings (Musculoskeletal, LIFEspan, Geriatric Rehab, Complex Continuing Care, Spinal Cord Rehab and Cardiac Rehab programs) held before June 30. These face to face meetings will ensure that input can be provided barrier-free and directly to leaders from Toronto Rehab and UHN.

. A small integration announcement will be posted on the GTA Rehab Network web site that attracts thousand of people annually looking for rehab service providers in the community, local hospitals and larger facilities like Toronto Rehab.

The themes and findings from the extensive Community Consultation process detailed above will help in the development of the integration plan. Ongoing summary of community consultation feedback will be provided to the TCLHIN over the next 2 years.

By the second week in July, a report will be provided to the LHIN that highlights engagement activities, major issues raised, and consideration of feedback received. Engagement reports will be provided on a quarterly basis to the LHIN.

7 6. Access and Equity

UHN agrees that the new organization will maintain the current level of referrals and referral relationships following the integration.

UHN has confirmed with the CEO from each the following hospitals, referring volumes will be maintained:

St. Joseph's Health Care St. Michael’s Hospital Mount Sinai Hospital Sunnybrook Health Science Centre Toronto East General Hospital Humber River Regional Hospital

The majority of patients who are treated at Toronto Rehab in complex continuing care, musculoskeletal, stroke, geriatric rehab, geriatric dialysis, and geriatric psychiatry are from Toronto. In acquired brain injury and spinal cord rehab, catchment widens and includes patients from across GTA and beyond.

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For all programs other than Geriatric Psychiatry, the majority of referrals to Toronto Rehab are from acute care hospitals. In Geriatric Psychiatry, the majority of referral is from long term care homes.

As requested by the TCLHIN, the referral data is provided below. The primary referrals are University Health Network, St. Michael’s Hospital, Mt. Sinai Hospital, Sunnybrook Health Sciences Centre and St. Joseph’s Health Centre.

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7. Lakeside Long Term Care Centre

Lakeside Long Term Care Centre is a 128 bed long term care home located at 150 Dunn Avenue. It was built in 2004 and is an A home with a long waiting list. The current management contract with Extendicare Inc., a leading long term care provider, will be transferred to UHN. All outstanding compliance findings from the last inspection have been addressed with action plans.

As part of the community engagement process, there has been special attention made to ensure that the residents and families at Lakeside met directly with the CEO of UHN to talk about the integration and any issues or concerns they may have.

The Ministry has been asked to approve the transfer the LTCH license and management contract with Extendicare for Lakeside Long Term Care Centre to University Health Network. As required under the Long Term Care Homes Act a public meeting will be hosted by the MOHLTC on June 6, 2011 and UHN will be in attendance to answer questions.

8. Human Resources Plan

The following human resources principles have been established to guide the transition that will occur as a result of the integration of Toronto Rehab and UHN. A commitment to:

 Treating staff fairly and respectfully throughout the approval phase and the transition process  Regular and open communication and an opportunity for staff to provide feedback and raise questions or concerns  Minimizing involuntary lay-offs to the greatest extent possible  Respecting the collective agreements that are in place with our bargaining agent partners  Transfer service for Toronto Rehab employees to UHN at the time of integration

The integration of University Health Network and Toronto Rehab include human resources related implications that will be carefully managed, ensuring transparency, respect and supportive strategies. The employees of Toronto Rehab will become employees of UHN on July 1, 2011.

We are confident that together we will successfully address human resources transition issues. For instance, all vacancies are currently being reviewed for redeployment opportunities.

A Joint Redeployment Committee composed of management representatives from both organizations to help with the transition. There is a desire to create stability throughout the transition period and the input of committee members is very valuable in this regard.

10 Toronto Rehab has two bargaining agent partners--- Ontario Nurses Association (ONA) and Canadian Union of Public Employees (CUPE). Since both ONA and CUPE are also the bargaining agents at UHN, this will help in ensuring a smooth integration.

For non- union and management staff, consistent with the guiding principles that have been established, every effort will be made to create opportunities for redeployment and minimize involuntary lay-offs. Our goal throughout the integration is to build a welcoming and progressive work place and remain a preferred employer of choice in health care in Ontario.

9. Integration of Medical and Dental Staff

Toronto Rehab has 103 Medical and Dental Staff of whom up to 40% are already cross appointed to the Medical Staff of UHN. The annual credentialing process is currently in progress at Toronto Rehab using processes and criteria compatible with those of UHN.

All of the medical and dental staff of Toronto Rehab will be appointed to the Medical Staff of UHN as of July 1, 2011. There will be no adverse impacts on appointments or privileges of physicians from Toronto Rehab.

UHN will expand the Medical Advisory Committee to include the Medical Program Director for Rehabilitation and Complex Continuing Care.

10. Due Diligence

With legal advice, a joint Toronto Rehab-UHN Due Diligence Checklist was developed by the Toronto Rehab UHN Integration Working Group chaired by Mark Rochon and Bob Bell. Matters reviewed include corporate governance and organizational records, financial and funding matters, material contracts, real property matters, environmental matters, litigation matters, labour and employment arrangements, and intellectual property.

The general principles to the due diligence process used by the hospitals were that

 Those accountable for risks are responsible for disclosure and information exchange

 Investigate records 3 years or less unless circumstances require otherwise

 Materiality threshold will be applied so that the due diligence work will focus on identifying and mitigating any issues related to business continuity or contracts exceeding $500,000.

A Joint Due Diligence Report, certified by both CEO and CFO of Toronto Rehab and UHN, will be submitted to the Finance and Audit Committees and the Boards of both hospitals by early June.

As of the date of this plan, there has been no material items identified that would prohibit or prevent the integration of Toronto Rehab and UHN.

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11. Financial Position and Accountability

UHN will continue to meet its commitment to a balanced 11/12 budget in the post integration environment. There is no additional TCLHIN funding requested to implement the integration.

UHN will achieve all 11/12 HSAA and LSAA service accountabilities and obligations agreed and executed between Toronto Rehab and the Toronto Central LHIN.

Toronto Rehab has disclosed all matters of financial significance related to operating budget and PCOP requirements, financial statements and audit reports, working capital, cash balances, banking credit and investments, debt. Issues related to the construction of Lakeside Long Term Care Center and associated financial obligations are known.

Capital financing requirements associated with the University Centre Capital Redevelopment Project along with the AECON contract requirements have been discussed fully. This project is planned for completion by February, 2012. Ministry has agreed that the Development Accountability Agreement for the project will be assigned to UHN. We have requested that the Ministry confirm in writing that the terms and conditions for funding provided to Toronto Rehab for the University site project will be provided to UHN. The hospitals are currently working to assign contracts including financial lending agreements for this project.

Current facility assessment reports for Toronto Rehab reveal infrastructure deficiencies at the Bickle Centre. MOHLTC has provided a capital infrastructure grant however due to unforeseen issues, additional capital funding is now required. UHN will work with Ministry team to resolve this post integration.

There is no substantive operating or capital financial issues that will delay or prevent the transfer of assets and liabilities from Toronto Rehab to UHN for June 30, 2011.

12. Governance

The Board of UHN will be expanded to include three (3) elected directors from the current Board of Toronto Rehab. These directors to be treated as an initial appointment to the UHN Board and are entitled to re-appointment in accordance with the by-laws and board policies of UHN. The UHN bylaws will govern the integrated organization.

Upon completion of the transfer of assets, Toronto Rehab will continue as a corporate entity but will have no assets and no source of revenue (assuming all consent and license assignments have occurred). UHN shall become responsible for the governance of the corporation until such time as a statutory amalgamation under section 4(1) of the Public Hospitals Act is possible.

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13. Approvals from TCLHIN and Ministry

13.1 Toronto Central LHIN

On April 7, 2011 TRI and UHN formally provided the Toronto Central LHIN with notice of voluntary integration under LHSIA Section 27(3)(A) related to transferring, merging or amalgamating of services, operations or entities of Toronto Rehabilitation Institute with UHN.

It is our understanding that the TCLHIN will bring forward a Board Motion on May 30, 2011 to support the integration.

13.2 Ministry of Health and Long-Term Care

Following consultation with Ministry, we have confirmed that only legal requirement under the Public Hospital Act is a Section 4(4) approval by Toronto Rehabilitation Institute.

Toronto Rehab requests Minister’s approval under Section 4(4) to sell land, building, premises, place and any part thereof acquired or used for the purpose of a hospital to University Health Network. A legal description of hospital properties to be transferred under PHA provided in Appendix 1.

14. Timelines

 Approval of the Minister of Health and Long-Term Care... June 14, 2011

 Approval of the Board of Directors of TRI …………… June 15, 2011

 Approval of the Board of Directors of UHN ……………. June 15, 2011

 Approval of the Members of TRI by special resolution … June 15, 2011

 Closing Date for Asset Transfer…………………………… June 30, 2011

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Appendix 1: Toronto Rehabilitation Institute- Hospital Properties

PIN Site Name and LEGAL DESCRIPTION MUNICIPAL Property Square ADDRESS Footage ( excluding buildings)

10368-0470 Lyndhurst site PT LT 2 CON 2 EYS TWP OF 520 Sutherland Drive (LT) YORK AS IN CA645124 S/T & T/W CA645124; S/T NY654860; TORONTO (N 388,991 sq. ft YORK/TORONTO) , CITY OF TORONTO

10368-0469 Rumsey site PT LT 2 CON 2 EYS TWP OF 345 Rumsey Road (LT) YORK; PT LT 3 CON 2 EYS TWP OF YORK AS IN NY385308 S/T & T/W 150,282 sq. ft. NY385308; 1 FT RESERVE PL 3110 LEASIDE; S/T NY634825, NY654860; TORONTO (E YORK/N YORK) , CITY OF TORONTO

21225-0002 Hillcrest site PT LT A PL 1219 WYCHWOOD 47 Austin Terrace (LT) BRACONDALE DOVERCOURT

AS IN WA68951; CITY OF 21225-0215 93, 5654 sq. ft. TORONTO (LT) PT LT 25 CON 2 FTB TWP OF YORK AS IN TY46143; CITY 21225-0165 OF TORONTO (LT) PT LT 25 CON 2 FTB TWP OF YORK AS IN TY18428; CITY OF TORONTO 21341-0144 Bickle & Lakeside LT 78-85, 87, 89 PL 417 130 Dunn Avenue (LT) site PARKDALE; LT 1-5, 7-8 PL 1013 TORONTO; PT LT 6 PL 1013 TORONTO AS IN 25,321 sq. ft. CT206048; TORONTO, CITY OF TORONTO

21341- LT 95 PL 427 PARKDALE; 150 Dunn Avenue 0144(LT) TORONTO, CITY OF . TORONTO

21341-0142 LT 1-4 PL 1061 TORONTO; LT (LT) 69-71, 73, 75-77 PL 427

14 PIN Site Name and LEGAL DESCRIPTION MUNICIPAL Property Square ADDRESS Footage ( excluding buildings)

PARKDALE; PT LT 67-68 PL 427 PARKDALE AS IN CT206054, CT206030 EXCEPT R/W; S/T CT206054; TORONTO, CITY OF TORONTO

21208-0001 University site PCL A-1 SEC A55; PT LT A E/S 550 University (LT) MURRAY ST PL 55 TORONTO Avenue 67,518 sq. ft. PARTS 1, 2, 2A, 2B, 3 AND 9, 66R9145; S/T A PERMANENT ROW IN FAVOUR OF MOUNT SINAI HOSPITAL, IN, OVER, AND UPON SAID PT 2A, ON SAID PL 66R9145 FOR ALL PURPOSES. THE SAID ROW APPURTENANT TO LANDS NOT REGISTERED UNDER THE LAND TITLES ACT, AS MORE PARTICULARLY SET OUT IN A600644. T/W A PERMANENT ROW FOR ALL PURPOSES OVER, IN AND UPON SUCH PARTS OF LOTS B AND C, E/S OF MURRAY ST ACCORDING TO PL 1 OR 49 OR 55, AND DESIGNATED AS PARTS 4A, 5A, 5C, 6A, 7A AND 8A, ON A PL OF SURVEY OF RECORD IN THE LAND REGISTRY OFFICE FOR THE LAND TITLES DIVISION OF TORONTO AND YORK S (NO. 66) AT TORONTO, AS 66R9145. THE SAID ROW APPURTENANT TO LANDS NOT REGISTERED UNDER THE LAND TITLES ACT, AS MORE PARTICULARLY SET OUT IN A-600645. T/W A PERMANENT ROW FOR ALL PURPOSES OVER, IN AND UPON PARTS OF LOTS B AND C, E/S OF MURRAY ST, ACCORDING TO REGISTERED

15 PIN Site Name and LEGAL DESCRIPTION MUNICIPAL Property Square ADDRESS Footage ( excluding buildings)

PL 1 OR 49 OR 55, AND THOSE PARTS OF LOTS 4, 5 AND 6, ACCORDING TO REGISTERED PL NO. 170E, AS ARE DESIGNATED AS PARTS 4A, 5A, 23A, 24A, 24C, 25A, 26A AND 27A, ON A REFERENCE PL DEPOSITED IN THE LAND REGISTRY OFFICE FOR THE 21208-0287 REGISTRY DIVISION OF (LT) TORONTO (NO. 63) AS PL NO. 63R1198. T/W A PERMANENT ROW FOR ALL PURPOSES OVER, IN AND UPON PT OF LT B, E/S OF MURRAY ST IN ACCORDANCE WITH PL 1 OR 49 OR 55, AS IS DESIGNATED AS PT 2, ON A REFERENCE PL DEPOSITED IN THE REGISTRY OFFICE FOR THE REGISTRY DIVISION OF TORONTO (NO. 63) AS PL NO. 63R980. T/W AN EASEMENT FOR ALL PURPOSES, IN PERPETUITY OVER, IN AND UPON THOSE PARTS OF LOTS A AND B, E/S OF MURRAY ST, ACCORDING TO PL 1 OR 49 OR 55 AS ARE DESIGNATED AS PARTS 3A, 6A, 7A AND 8A ON A REFERENCE PL DEPOSITED IN THE LAND REGISTRY OFFICE FOR THE REGISTRY DIVISION OF TORONTO (NO. 63) AS PL 63R1198. PROVIDED THAT INGRESS AND EGRESS TO AND FROM THIS LAND FROM AND TO THE AV FROM QUEEN ST (NOW UNIVERSITY AV ABOVE REFERRED TO) IS S/T THE PROVISIONS AND TERMS OF AN AGREEMENT DATED 2ND MARCH, 1889, BTN THE UNIVERSITY OF

16 PIN Site Name and LEGAL DESCRIPTION MUNICIPAL Property Square ADDRESS Footage ( excluding buildings)

TORONTO AND THE CORPORATION OF THE CITY OF TORONTO AS SET FORTH IN THE SCHEDULE TO STATUTE OF ONTARIO, 52 VICTORIA, CAP. 53; S/T E325658 AS ASSIGNED BY E325659; ; TORONTO , CITY OF TORONTO

PT LT A E/S MURRAY ST, B E/S MURRAY ST PL 1-49-55 TORONTO PT 1 & 3, 63R980; S/T & T/W CT256194; S/T CT216363 & CT216364; CITY OF TORONTO, S/T CA663976, CA663977; S/T AN EASEMENT OVER PART OF LOTS A & B, EAST SIDE OF MURRAY ST, PLAN 1-49-55, DESIGNATED AS PARTS 1, 2, 3, 4, 5, 6 AND 7 ON PLAN 66R22892, IN FAVOUR OF ENWAVE ENERGY CORPORATION, FOR THE PURPOSE AS DESCRIBED IN AT1863839. CITY OF TORONTO.

17 Appendix 2: Memorandum of Understanding (attached)

18 Appendix 3: Decision Making Criteria for Voluntary Integration Checklist

Criteria Specifics for this voluntary integration Hospital Response Access Agreement that service levels for current rehabilitation services as per the organizations’ service accountability agreements will be Page 2 maintained or increase as a result of the integration Agreement that any planned variance in service delivery volume and/or service delivery models from the current state will adhere to Page 3 the TC LHIN Clinical Service Change Planning Process Agreement that partnerships with current HSPs will be honoured, enhanced, and monitored Page 2 Equity Agreement that service referral acceptance from all health system providers will increase or not decline Page 8,9 Community Engagement plan reflects principles and follows checklist in the Engagement Community Engagement Toolkit for Health Service Providers and Page 6 and HR the Toronto Central LHIN. Process for providing periodic progress reports to the LHIN on how Page 7 community feedback was considered and addressed. Evidence that there is an HR and labour relations plan that is being Page followed and implications have been identified and are being 10,11 addressed Health Agreement that the proposed integration will achieve enhanced Status, quality and accessibility of rehabilitation services for TC LHIN Page Clinical patients 3,4,5,6 Outcomes, Prevalence Sustainability No additional funds required from LHIN during or after integration Page 12

Balanced budget forecasted for new organization Page 12 Leadership and governance model is reasonable and endorsed by both organizations and LHIN Page 12 Risk assessment is thorough and identified risks have practical mitigations Page 11 Agreement savings derived from integration will be reinvested in post acute services Page 2 Agreement to develop and sign an integration charter with the Toronto Central LHIN for the continued monitoring and evaluation of the integration that will be an amendment to the HSAA of the Page 3 new organization

19 Appendix 4: Proposed Transfer Agreement…. (To be inserted May 13.)

20