Annual Report

Patient- Centred Innovation

2011 2012 1 Patient-centred innovation. It is a state of mind in which we believe the health care Of the several roles I fulfil at HSN, the one that is most fulfilling and motivating is that Message system should revolve around the patient, not the other way around. It is a philosophy Report from of ED physician. Nothing is more satisfying for me than meeting with patients directly and approach that constantly examines and refines what we do and how we do it, and playing an active role in addressing their health care needs. I see every shift I always with the patient’s best interests at heart. Patient-centred innovation must be work in the ED as an opportunity to both learn and teach. We do that by asking such from the the foundation on which the pillars of our institution are based: highest quality care, the Chief of questions as “What can we learn from this situation? What can we do to improve the research, teaching and health promotion. It is a daunting task to be truly patient- outcome for our patient? How can this help the next patient we see?” centred in a field that is systematic, multi-faceted, evidence-based, highly regulated Board Chair and with very little - if any - margin for error. But it is a mindset that we have embraced Staff and Vice That is where patient-centred innovation starts. It’s born out of a desire to make this past year at Health Sciences North (HSN). people well again, fostered by a willingness to be curious and think of all possible and President President of options, and it grows by retaining and sharing that knowledge. Ultimately, patient- The timing was ideal. There were seismic shifts in the health care landscape centred innovation succeeds by having the right people and creating the right over the past year, locally and provincially. The Drummond Report, the provincial environment. and CEO government’s Health Care Action Plan, the Excellent Care for All Act and the Medical and budget all placed greater emphasis on health care that is patient-centred, effective, This past year, HSN made several strides in fostering that environment, thanks to the cost-efficient, and timely, with greater scrutiny and accountability of how dedication and skill of our staff, and the addition of 23 new physicians and specialists provide that care and use public resources. At the same time, ongoing challenges Academic to . We also hired approximately 240 other health professionals this persisted including high numbers of Alternate Level of Care (ALC) patients, long past year, from nurses to clinicians to therapists. Our staff are skilled and committed wait times in our (ED), and slow access to some surgical Affairs to exploring new ways of making care better for our patients. Dr. Denis Roy, President and CEO procedures and diagnostic tests. and Russ Boyles, Board Chair Among the measures put in place this year to make our care more innovative and We responded. We put in place new measures of accountability and transparency patient-friendly was the development of a Quality Improvement Plan outlining key within the governance and administrative levels of the institution. We developed new areas targeted for improvement, including a reduction in wait times and improvements programs and methods of delivering care that are more responsive to the needs of in control practices. patients, especially in the areas of outpatient care, chronic disease management, seniors’ and emergency care. Whether that innovation occurred at the bedside or the Dr. Chris Bourdon, Chief of Staff One of the most significant advances in patient-centred innovation this year occurred boardroom, our people performed with great skill, dedication and professionalism. and Vice President of Medical and when the provincial government approved our Learners Space Capital Project. This Academic Affairs project will allow HSN to accommodate more medical learners than ever before. The centrepiece of the Learners Space is a Simulation Centre, housing the latest in teaching technology, such as state-of-the-art medical mannequins and other simulators. Perhaps the single largest innovation chronic disease live a more healthy and witnessed this year was the unveiling independent lifestyle. We are creating Both learners and existing staff will have access to the Simulation Centre to learn or of a new identity and approach to a Learners Space which will allow us perfect various skills and procedures. It’s the health care field’s equivalent of a flight health care for our institution, an to teach and train medical students simulator, and the presence of a Simulation Centre is proven to improve outcomes identity directly related to our drive and other learners in surroundings and reduce complications for patients. towards patient-centred innovation. that will foster continuous learning and Health Sciences North/Horizon Santé- improvement. As a front-line physician, I see first-hand the challenges facing our health care system. Nord reflects how we’ve grown as But I also see a remarkable drive and determination on the part of everyone at HSN to an institution, and how we embrace There is no doubt substantial challenges meet those challenges through innovative thinking and a willingness to embrace and innovation in patient care, research, remain, both for HSN specifically, and enact change for the benefit of our patients. I am very honoured to be part of the team teaching and health promotion of the for the health care system in general. at HSN. highest calibre. Our new identity also But even in these areas of challenge, sends a clear message to health care progress is being made as we re- professionals of all disciplines who share examine and redesign how we do things this mindset: we are a destination of to make our care more responsive to the choice that will encourage you to use needs of our patients. your skills to their full potential, and pursue new ways of providing care for We are very proud of what has the benefit of our patients. been accomplished this past year Dr. Chris Bourdon at HSN. The drive to be innovative It is an approach that is working. and patient-centred, and having This past year was one of the best people of the highest calibre and for recruiting physicians to Greater commitment to excellence, has been Sudbury. New programs, procedures key to our successes this year. With the and technologies were introduced this combination of innovative people and year at HSN, innovations that in some innovative thinking, we are confident we Dr. Kevan Saidi, who performed the first computer-navigated orthopaedic Dr. Denis Roy cases have never been done before in will meet any challenge that lies ahead. biopsy of its kind in North America: “As a surgeon, I was thrilled to be part other parts of Ontario or Canada. of this innovative procedure and to have the support of the . Most We are redesigning how we care for our importantly, our patient received access to a procedure that’s only available in patients with the Sudbury Outpatient a few centres in the world.” Centre where we can help people with Russ Boyles

2 3 Four Pillars Patient-Centred Care HSN undertook an extensive survey of our patients, which led to the creation of our Patient Declaration of Values. It identifies and articulates four key values which will of HSN serve as our guide as we continue our efforts to be patient-centred in our care. These values include treating our patients and their families with respect, having our patients actively involved in their care, sharing important health care information with our patients, and accommodating any questions or concerns they may have.

The experience of care, as perceived by the patient and family, is an important factor in health care quality and safety. One way this is being determined is through the creation of a CEO Patient Advisory Council. The purpose of the Council is to empower patients to take an active role in improving the patient experience by providing feedback and solutions to challenges that affect patients. HSN will also create Patient Advisory Councils at the program level. Through the development of these councils, we will invite patients to work with us as partners to improve quality of care and safety across the organization and enrich the patient experience at HSN.

HSN is moving forward with an Organizational Excellence initiative to enhance the quality of patient care services. Based on LEAN methodology, the program will use the patient’s journey across the organization to evaluate and improve all components of care delivery. The goal of these improvements, designed by staff and One of Sudbury’s new surgeons, Dr. Antonio Caycedo, performs the first microsurgery biopsy of physicians, will be to its kind in northeastern Ontario. improve the coordination of care, patient flow and access so as to exceed our patients’ and staff expectations of quality, safety and A new Heart Failure Infusion Clinic was Our Cardiac Program’s STEMI Bypass value. These improvements will enable us to better serve our community as a whole, established for patients with congestive protocol, initiated in 2010, continued The four pillars of our institution while improving each patient and family’s experience and level of satisfaction. heart failure. This new service allows to produce potentially life-saving (patient-centred care, research, David Schram, Heart Failure clinicians to provide enhanced care, results. Under the protocol, people teaching and health promotion) A special emphasis was placed this year on seniors’ care. HSN introduced many monitoring and health promotion for with a suspected heart attack are Infusion Clinic patient: “This define how we will move forward new services designed to make our care more senior-friendly. They include the Acute patients while reducing readmission assessed on the scene by specially- Care for the Elderly (ACE) and Hospital Elder Life Program (HELP) which encourage program is keeping me mobile rates to hospital. trained paramedics. If a heart attack is to ensure that the health care greater stimulation, mobility and independence for seniors while in hospital. We also and out of hospital. Since I began confirmed, the patient is rushed directly system continues to revolve introduced the Geriatric Emergency Management (GEM) and ED Outreach programs my infusions, I feel a lot better. I 2011-12 was a banner year for patient- to HSN’s Cardiac Catheterization Lab, around providing quality patient that provide special assistance to seniors requiring the care of our ED. We will soon centred innovation in our surgical by-passing the ED. With this new be launching a Continued Care and Virtual Ward service that will see HSN staff feel twenty years younger.” program. Surgical teams at HSN protocol, HSN is surpassing provincial care. Here are some ways we are provide enhanced in-home follow-up care for seniors who have been discharged performed procedures never done benchmarks for access to cardiac care. demonstrating key innovations in the home. before in Ontario or Canada, using HSN patients experience an average provision of patient care. new technologies, techniques and treatment time of 24 minutes from the HSN introduced new innovative programs for the management of chronic diseases. equipment. These procedures were time they enter HSN to the time they Crucial to the success of this care model was the redevelopment of the former minimally invasive, leading to better receive an angioplasty. The provincial Memorial Site as the new Sudbury Outpatient Centre. The Centre houses our outcomes and faster recovery times for benchmark treatment time is 90 Diabetes Care Service which caters to patients with complex conditions linked to our patients. minutes. diabetes such as obesity, kidney and heart disease. HSN’s new Bariatric Assessment and Referral Program can also be found at the Sudbury Outpatient Centre. It provides consultation and post-surgical care for patients who undergo bariatric .

4 5 Research HSN has significantly expanded its of the Best Intellectual Property Award at the TiEQuest 2011 Awards in Toronto. research capacity and activities, under The diagnostic tool developed by RNA Diagnostics Inc. has been licensed for use in the leadership of Dr. Francisco Diaz- clinical trials in Italy and Germany. Mitoma, Vice President of Research. Dr. Diaz-Mitoma successfully recruited This past year, a research paper authored by the Supportive Care Research a number of researchers, who are Unit was selected for publication. The paper describes the Unit’s development of developing various projects, with a a nutritional referral priority rating tool for cancer patients. Since publication of the special emphasis on chronic conditions paper, the Unit has received numerous requests from other health care institutions and infectious diseases. seeking permission to use the rating tool in clinical practice.

In support of its expanded research A clinician neuropsychologist with the Northeast Cancer Centre, Dr. Matias Mariani, mandate, HSN created the Advanced won an award from the Brain Tumour Foundation of Canada for his work with patients Medical Research Institute of Canada, who are having difficulties with brain function during cancer treatment. Dr. Mariani or AMRIC. An affiliated research assesses patients who are experiencing neurological, cognitive or psychological program of HSN, AMRIC is an advanced changes as a result of their cancer and its treatment. medical research institute focused on addressing the priority health issues In the area of evaluative research, a Registered Nurse at HSN, Carol Cameletti, was of the north by conducting targeted invited to attend an upcoming international nursing conference in Israel to give a research that is widely disseminated presentation on the links between the advent of electronic health, front line nursing and translated into clinical practice and and improved patient care. commercial application.

AMRIC will create a community that brings together researchers, employees, Training exercise in the NEO Natal using infant medical mannequin industry, clinicians, partners and and infant ventilator. regulators to ensure the dissemination of knowledge and uptake of promising therapeutics targeting the health priorities of cancer, infectious and Teaching chronic diseases. “It is the vision of the people Provincial government approval and funding for the Learners Space Capital Project was the cornerstone achievement for HSN’s development as an academic health who conceived this service, the HSN works with key healthcare partners sciences centre. dedication of the people who including and . This allows students built it and the commitment of the The 20,000 square feet of newly constructed and renovated space complete with a of these institutions greater access to Simulation Centre, will greatly enhance HSN’s teaching capacity. The Learners Space oncologists and staff that will provide HSN’s research expertise, which will will feature classrooms, video teleconferencing rooms, seminar rooms, on-call rooms, the care that is certain to make it a benefit both patient care and potential a learners’ lounge and individual work stations. At the core of the Learners Space recruiting of health care professionals. success.” Dr. Julie Bowen, Radiation project is the Simulation Centre where the latest in simulation technology including Oncologist at the Northeast Cancer medical mannequins will be available to learners. Construction of the Simulation Researchers associated with the Centre is underway at the Sudbury Outpatient Centre. Centre, on the opening of a new Northeast Cancer Centre enjoyed a successful year. The Ontario linear accelerator suite at Sault Area A teaching demonstration was staged for HSN employees, local school children, and government announced a $1,000,000 Hospital. the general public during the CPR Week Challenge in February. Under the leadership investment in Cancer Therapeutics of the Intensive Care Unit and Emergency Preparedness, employees and the public Research Initiative (CTRI), led by Dr. were invited to learn the new simplified code for CPR and practice those skills on Hoyun Lee. The goal of CTRI is to medical mannequins. Participants were also taught how to use Automated External investigate the pharmaceutical and Defibrillators, such as those found in public spaces. HSN also developed wallet cards cancer-fighting potential of compounds describing the new simplified protocol for administering CPR. from the boreal forest of northeastern Ontario. Staff at HSN also hosted an Symposium for health care workers with a special interest in emergency and trauma medicine. Topics discussed included RNA Diagnostics Inc., a research the unique challenges facing trauma units in rural and smaller hospitals, and best enterprise co-founded by Dr. Amadeo practices for dealing with and asthma attacks in an emergency setting. Parissenti, received $100,000 in funding to further develop the diagnostic The Mental Health and Addictions Program hosted a conference that brought process that helps physicians determine together experts to explore best practices for employing people with mental illness, which patients are most likely to benefit and promote public awareness of the need for more community and employment from chemotherapy. RNA Diagnostics supports for people with mental illness. By sharing knowledge and educating the Inc. also won best new business public about realities and myths surrounding mental illness, our Mental Health venture, best venture in the health- and Addictions Program is helping people with mental illness lead healthier, more care field, and was named co-winner productive lives in the community.

6 7 Year in Review

HSN’s Emergency Department treats 58,000 patients each year. HAVEN Anniversary The HAVEN program (HIV AIDS Extended Network) marked its 20th anniversary. Services provided by HAVEN include medical assessment, diagnostic and lab tests, nursing care, medication management and education, dietary education, counselling, access to clinical research and support in accessing community services.

Stroke Program Designation HSN’s Program was designated a Regional Stroke Centre by the province. In partnership with the Independence Centre and Network, HSN launched a new Stroke Re-Check Clinic where stroke patients receive outpatient follow-up care for up to a year after being discharged from hospital.

Health Promotion ED Process Improvement Project With innovative patient-centred care as our flag mast, we devoted much time and effort to positive health promotion. The time-honoured mindset of “an ounce Our ED underwent a review of all its processes with the goal of improving the care “Nocturnal dialysis has changed my of prevention is worth a pound of cure” shaped our thinking this past year when experience for patients. The process improvement initiative resulted in a redesign life,” says Monique Ratelle, a patient we launched new services in the areas of outpatient care and chronic disease of the physical layout of the department where new See and Treat and Cardiac Observation areas were established, a patient-flow coordinator was created, and using in-home dialysis available management. triage and treatment procedures were streamlined. through HSN. “Feeling good has Our Mental Health and Addictions Centre at Cedar Street houses many outpatient become addictive for me, and I services which feature extensive education components that enable our patients to don’t mind dialysis now compared better manage their conditions. By promoting best practices for healthy living, we are Surgical Innovations to when I was doing conventional equipping our patients to enjoy a better quality of life with fewer episodes requiring Dr. Fabio Luison and Dr. John Snider successfully implanted a NeuRx Diaphragm hospital care. Pacing System in the victim of a motor vehicle accident. Damage to the patient’s dialysis at the hospital three times a spinal cord prevented him from properly breathing on his own. The surgery marked week for over 25 years.” The Centre for Life is another key component to HSN’s healthy living promotion. the first time in Canada outside of British Columbia that the procedure has been Housed at the Centre for Life are the Cardiac Rehabilitation Program, the Pulmonary performed on a spinal cord injury patient. Rehabilitation Program and the Adult Asthma Clinic. The first computer-navigated orthopaedic biopsy of its kind in North America was Our Family and Child Program introduced a Pediatric Asthma Clinic led by a Nurse performed by Dr. Kevan Saidi, using new software which acted like a GPS, using real Practitioner in consultation with pediatricians which provides children and their time 3-D images to guide the surgical team to the best location, within millimetres, to families with information and best practices for the management of asthma. By remove the tissue needed for the biopsy. promoting asthma self-management, this new service can help improve the quality of life for children with asthma and prevent or minimize the risk of short-term and long- HSN also welcomed Dr. Patrick Allison, an orthopaedic surgeon with a specialty term complications from asthma. in orthopaedic trauma surgery. Prior to Dr. Allison’s arrival, pelvic fracture patients requiring surgery were transferred to Toronto. With the arrival of Dr. Allison and other President and CEO, Dr. Denis Roy, served as Honorary Chair of the 2011 Vital Signs specially trained physicians and surgeons, trauma transfers to Toronto have been Report of the Sudbury Community Foundation. This year’s report placed a special reduced. emphasis on health care, specifically mental health and children’s care. The Vital Signs Report is used as a valuable resource tool to identify priorities and strategies to improve the overall health and well-being of the community. MORE OB The MORE OB (Managing Obstetrical Risk Efficiently) initiative was introduced in In another effort to promote healthy living, HSN partnered with Eastlink TV to produce HSN’s Birthing Centre. The goal of MORE OB is to improve patient safety for mothers a bi-monthly program called “Your Health.” The program features experts from HSN in labour and their babies, improve standards and performance in the Birthing Centre, and other health care providers in the community. Topics this past year included and standardize professional skills for all healthcare providers and staff working in seniors’ care, cardiac care, and asthma and allergies management. obstetrics.

8 9 MRI Lean Project “Under and Never Screened Project” to This past year was a successful one for fundraising at HSN thanks to the efforts of increase screening rates for breast and Fundraising the HSN Foundation, the Northern Cancer Foundation (NCF) and the HSN Volunteer The Magnetic Resonance Imaging (MRI) department embarked on a LEAN colorectal cancers among First Nations Association. management process to improve access and wait times for patients. As a result of men and women. this exercise, the 90th percentile wait time (the maximum amount of days in which The HSN Foundation hosted and participated in numerous special events on behalf of 9 out of 10 patients received their MRI scan) fell from 109 days in August of 2011 to 25 In partnership with four First Nations HSN, including Greater Sudbury’s Dragonboat Festival, Chip In For Charity, Mystery days in March of 2012. organizations, HSN launched and Fine Dining, and the Hard Times Charity Funspiel and Dance. Funds will go northeastern Ontario’s only Fetal towards vital medical equipment and patient care services. Key fundraising priorities Alcohol Spectrum Disorder Diagnostic for this coming year will include construction and equipment for the Learners Space Voices for Women Clinic. The new Clinic will provide early project. HSN opened the Voices for Women centre this year. Located in downtown Sudbury, assessment and diagnosis of children the Centre provides ongoing support and counselling for women who have with FASD, and link children and their The NCF hosted numerous fundraising initiatives in support of leading-edge cancer experienced . families with existing community-based research, education and patient care initiatives for the Northeast. Annual events treatment programs for this disorder. included Ride for Dad, Strokes for Hope and the much acclaimed Luncheon of Hope. In addition to these events, a number of community partnerships have fostered Music Therapy Program The Supportive Care program partnered with Maison Vale Hospice to offer the first Music Therapy program of its kind in the Sudbury-Manitoulin District. The program is designed for palliative care and cancer patients, as well as patients with Alzheimer’s and Parkinson’s disease. A Music Therapist uses singing, instrument playing, song writing, movement and art to promote and restore physical, emotional and spiritual health. Shelley McKewn, parent of a child with Fetal Alcohol Spectrum Disorder, on the opening of a new FASD Diagnostic Clinic at HSN: “To have this diagnosis and early treatment capability means my daughter will be successful. She will reach her potential.” Community Threat Assessment Protocol Diagnostic Imaging Outpatient Clinic The Mental Health and Addictions HSN opened a new, community-based diagnostic imaging outpatient clinic providing program participated in a new x-ray and ultrasound imaging. The new clinic is the first of its kind in Greater Sudbury Community Threat Assessment Protocol to be directly connected to the hospital’s Picture Archiving and Communication to ensure schools are safe for students System (PACS) as well as the Electronic Medical Record (Meditech) system, which is and staff. Under the Protocol, school used by several hospitals in northeastern Ontario. boards, police and community partners will share information, advice and support, and develop a response plan in Children from three schools helped launch the Volunteer Association’s Pennies for Campaign. Breast Cancer Services situations where student behaviour may A new Breast Screening and Assessment Service (BSAS) was created by pose a risk to others. consolidating the Ontario Breast Screening Program, the Breast Diagnostic and additional fundraisers including highschool blitzes, Miners for Cancer and Laurentian Assessment Unit, and Diagnostic Imaging Breast Services. Through BSAS, all breast University’s annual Airbandz for Cancer. These events helped fund over $600,000 in screening and diagnostic services up to the point of surgery will now be located at the Accreditation research activities for Northeast Cancer Centre researchers. Sudbury Outpatient Centre. HSN was successfully accredited earlier this year by Accreditation Canada. This past year, the HSN Volunteer Association committed $100,000 to various The formal Accreditation exercise is equipment, programs and services at HSN. The Volunteer Association launched the Northeast Cancer Centre and an important tool in helping identify Pennies for Pediatrics Campaign which aims to raise $100,000 by December 31, 2012 quality improvement initiatives across for children who need care at HSN. Sault Area Hospital the organization. Surveyors highlighted The Northeast Cancer Centre, in partnership with Sault Area Hospital (SAH) opened a HSN’s continued commitment to the HSN teamed up with Radio Station Kicx 91.7 FM to launch the Kicx for Kids one-of-a-kind treatment facility in Ontario. A new linear accelerator is now operational provision of safe quality care and Campaign. The goal is to raise $250,000 in five years for pediatric care at HSN. The at the SAH to provide radiation therapy to approximately 450 cancer patients a year service to our patients. Of the evaluation campaign has already raised $100,000 in only eight months. from the Algoma District. standards measured in the survey, HSN received a 94% compliance rate. First Nations Health The Northeast Cancer Centre partnered with seven First Nations health organizations, the Sudbury & District Health Unit, and the Canadian Cancer Society to launch the 10 11 To the Members Independent We have audited the accompanying financial statements of Health Sciences North, which comprise the statement of financial position as at March 31, 2012, the statements of operations, changes in deficiency in net assets and cash flows for the Auditors’ year then ended, and notes, comprising a summary of significant accounting policies Report and other explanatory information. Management’s Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with Canadian generally accepted accounting principles, and for such internal control as management determines is necessary to enable the Revenue M$ % preparation of financial statements that are free from material misstatement, whether due to fraud or error. NELHIN and MOHLTC 299.1 69.9%

Cancer Care Ontario 32.8 7.7% Auditors’ Responsibility Specifically funded programs 29.2 6.8% Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with Canadian generally accepted Patient services 29.8 7.0% auditing standards. Those standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the Other 26.7 6.2% financial statements are free from material misstatement. Amortization - deferred capital 10.4 2.4% An audit involves performing procedures to obtain audit evidence about the amounts contributions for equipment and disclosures in the financial statements. The procedures selected depend on our judgment, including the assessment of the risks of material misstatement of the 428.1 100.0% financial statements, whether due to fraud or error. In making those risk assessments, we consider internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

Opinion In our opinion, the financial statements present fairly, in all material respects, the financial position of Health Sciences North, as at March 31, 2012, and its results of operations and its cash flows for the year then ended in accordance with Canadian generally accepted accounting principles. Expenses M$ % Salaries and wages 198.7 46.0%

Employee benefits 56.7 13.1%

Medical staff remuneration 25.9 6.0%

KPMG LLP Supplies and other 53.0 12.3% Chartered Accountants, Licensed Public Accountants Medical and surgical 29.3 6.8% June 12, 2012 Sudbury, Canada Drugs 17.3 4.0%

Specifically funded programs 29.3 6.8%

Amortization - equipment 21.4 5.0%

431.6 100.0% 12 13 Statement of Operations Statement of Financial Positions Year ended March 31, 2012, with Year ended March 31, 2012, with comparative figures for 2011 comparative figures for 2011 (in thousands of dollars) 2012 2011 (in thousands of dollars) 2012 2011 Revenue Assets

NELHIN and MOHLTC $ 299,079 285,961 Current assets: Cancer Care Ontario 32,815 31,035 Accounts receivable $ 23,343 34,451 Specifically funded programs 29,231 26,128 Inventories 3,845 3,456 Patient services 29,822 28,880 Prepayments 7,3 3 5 5,871 Other 26,739 27,9 37 34,523 43,778 Amortization - deferred capital 10,450 11,787 contributions for equipment Restricted assets 1,688 1,490 428,136 411,728 Expenses Long-term receivables 8,005 8,647 Salaries and wages 198,794 191,020 Capital assets 376,483 391,032 Employee benefits 56,742 53,121 $ 420,699 444,947 Medical staff remuneration 25,860 23,978 Liabilities and Net Assets Supplies and other 52,968 52,329 Current liabilities: Medical and surgical 29,273 27,986 Bank indebtedness $ 38,197 48,377 Drugs 17,311 16,805 Accounts payable and accrued 92,029 88,000 Specifically funded programs 29,282 26,063 liabilities Amortization - equipment 21,361 23,308 Current portion of long-term 51 165 431,591 414,610 obligations Deficiency of revenue over expenses (3,455) (2,882) 130,277 136,542 before the undernoted Deferred contributions 2,578 2,338 Amortization - buildings (10,850) (11,425) Deferred capital contributions 327,524 342,418 Amortization - deferred capital 9,137 9,229 Long-term obligations 11,665 9,826 contributions for buildings Deficiency in net assets (51,345) (46,177) Deficiency of revenue over expenses $ (5,168) (5,078) Contingencies $ 420,699 444,947

On behalf of the Board:

Russ Boyles, Director

Jean-Marc Spencer, Director

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