AHS Board and Executive Expense Report Name Gregory Cummings Title Chief Zone Officer, North Zone Location Westlock Expenses submitted during the month of April 2019 Travel (1) Working Sessions Professional Hosting and Source Other Total Development Hospitality Other MMM-YY Document Purpose Airfare Meals Accommodation Travel Travel (2) (3) (4) Apr-19 P-Card Meetings 1,304 150 1,454 Apr-19 Expense Claim Meetings 438 438 Apr-19 Direct Billing Meetings 2,462 2,462 Total $ 2,462 $ 438 $ 1,304 $ 150 $ 4,354 $ - $ - $ - Total for the Month $ 4,354 Maximum daily single meal expense claimed in the month $ 24 Maximum daily base hotel rate claimed in the month $ 144 Non economy air travel in the month $ - 1) Travel expenses Includes local and out of province/country travel expenses. Other travel includes items such as taxis, parking mileage, car rental and other expenses related to travel. 2) Professional Development Includes conference, seminar and course registration fees and material 3) Hosting and Hospitality expenses Hospitality and Hosting expenses may be incurred to advance AHS' mission, vision and values. For example, may include working lunches with staff and prospective employees meetings with government officials, dignitaries, public interest groups, donors other public or private organizations. 4) Other Other expenses include expenses incurred in the normal course of business that are required for work purposes. May include small item technology purchases, books, etc. 5) Remuneration, Allowances Reported in the Financial Statements Car allowance, honoraria, meeting fees, and any other employment benefits reported in the annual financial statements are excluded from this report. AHS Public Disclosure P-Card Claimant Claimant Title Claimant Expense Name Location Claim Total CUMMINGS, Chief Zone Officer, North Westlock $ 1,453.73 GREGORY Zone Expense Date Business reason Expense Expense Type Amount From To Justification # of # of Attendee Trip Location Location Location days Attendees Name(s) Distance 3/31/2019 Accommodations in Bonnyville AMH and AB - North Accommodations $ 289.94 2 ED Collaboration Meetings Zone 4/3/2019 Accommodations in Edmonton for NZ AB - Other Accommodations $ 113.89 Stayed at airport evening before for early 1 Indigenous Health Visioning Day Zones morning flight to Grande Prairie. 4/4/2019 AHS 10 year anniversary events with Dr. AB - North Accommodations $ 153.81 Attended Indigenous Health Visioning Day (April 1 Yui in Grande Prairie Zone 3) and stayed for AHS 10 year anniversary events with Dr. Yui on April 4th. 4/4/2019 NZ Indigenous Health Visioning Day - AB - Other Parking - Lot or $ 50.00 1 Parking in Edmonton Zones Parkade 4/5/2019 NZ PCN Governance Committee in AB - Other Accommodations $ 113.89 1 Edmonton Zones 4/5/2019 NZ PCN Governance Committee in AB - Other Parking - Lot or $ 25.00 Attended NZ PCN Meeting at the Renaissance 1 Edmonton Zones Parkade Hotel at the Edmonton Airport. Receipt is used to exit the parking lot and must not have gotten it back. 4/9/2019 Fort McMurray OBP & Staff Meetings AB - Other Parking - Lot or $ 75.00 1 Zones Parkade 4/10/2019 Fort McMurray OBP Meeting AB - North Accommodations $ 303.02 OBP Meeting with Sharon Lehr and Abbey 2 Zone Birch. Stayed extra day for additional meetings with staff. 4/10/2019 Accommodations in Edmonton - AB - Other Accommodations $ 177.67 1 Provincial Primary Care Network Zones 4/11/2019 Accommodations in Sherwood Park - Tour AB - Other Accommodations $ 151.51 1 of Strathcona NP Program Zones Approver(s) for the claim Approval Status Approval Date GORDON, DEBORAH A Approve 26-Apr-19 AHS Public Disclosure Expense Claims Claimant Claimant Title Claimant Expense Claim Name Location Total CUMMINGS, Chief Zone Officer, North Westlock $ 438.50 GREGORY Zone Expense Date Business reason Expense Expense Type Amount From To Justification # of # of Attendee Trip Location Location Location days Attendees Name(s) Distance 3/31/2019 St. Paul AMH & ED Collaboration Meeting AB - North Meals Per Diem $ 24.00 1 Zone 4/1/2019 St. Paul AMH & ED Collaboration Meeting AB - North Meals Per Diem $ 47.50 1 Zone 4/2/2019 St. Paul AMH & ED Collaboration Meeting AB - North Meals Per Diem $ 47.50 1 Zone 4/3/2019 NZ Indigenous Health Visioning Day in AB - North Meals Per Diem $ 47.50 1 Edmonton Zone 4/4/2019 AHS 10 year anniversary events with Dr. AB - North Meals Per Diem $ 47.50 Toured the new GPRH with Dr. Yui and then 1 Yui in Grande Prairie Zone celebrated AHS 10 Year Anniversary with 4/5/2019 NZ PCN Governance Committee in AB - Other Meals Per Diem $ 34.50 1 Edmonton Zones 4/7/2019 Fort McMurray OBP Meeting AB - North Meals Per Diem $ 24.00 Travel evening before for the OBP Meeting. 1 Zone 4/8/2019 Fort McMurray OBP Meeting AB - North Meals Per Diem $ 47.50 OBP meeting at NLRHC with Sharon Lehr 1 Zone and Abbey Birch 4/9/2019 Site / Staff Meetings at Fort McMurray AB - North Meals Per Diem $ 47.50 Worked from Fort McMurray for the day 1 Zone 4/10/2019 Provincial PCN Meetings in Edmonton AB - Other Meals Per Diem $ 47.50 Meetings at Alberta Health with physician 1 Zones leads as well as the Provincial PCN Committee Meeting 4/11/2019 Starthcona NP Model -Toured the AB - Other Meals Per Diem $ 23.50 Toured the Strathcona Hospital with Cindy 1 Strathcona Hospital Zones Harmata and Tracy Smith to learn more about their NP program. Approver(s) for the claim Approval Status Approval Date GORDON, DEBORAH A Approve 26-Apr-19 Expense Report Direct Bill Summary Purpose of This Form: The purpose of this form is to report expenses incurred on behalf of a designated Executive or an AHS Board Member and paid for by a third party vendor. The information will be used for public disclosure reporting. Expenses Paid Directly to Third Party Vendors: AHS may have established accounts with certain vendors used to book travel and other expenses that are billed directly to AHS. Examples include but are not limited to hotels, travel agencies, car rental agencies, conferences, courses and expenses reimbursed from a petty cash fund. It is mandatory to include in monthly reports these expenses that pertain to each member. AHS is required to disclose expenses for all applicable receipts and back up must be attached. Direct Bill Report Enter all items related to expenses incurred while conducting AHS business and paid for via a third party vendor (i.e. accommodations, airline tickets, car rentals, hosting events and working sessions) Enter all expenses pertaining to professional development such as conferences and courses, etc. Enter all expenses paid by AHS not mentioned above. Copies of invoices and other relevant back up must be attached, approvals for hosting events/working sessions that exceeds $600 must be provided. Information will be used for reporting purposes only. A personal cheque must be attached to cover expenses deemed ineligible. Indicate whether you have expenses to report in this section for this reporting period: YES Name : Gregory Cummings Reporting Period for the Month of : Apr-19 DD-MMM-YYYY Payment Method Category Description/Purpose of the Expense Name of Vendor Amount Paid Flight to Grande Prairie for Indigenous Health Planning meeting and 22-Mar-2019 Direct Billing Airline Ticket to attend the 10 year Anniversay event with Dr. Yui. (Air Canada Marlin Travel 473.96 Ticket # ) Flight to Fort McMurray for OBP Meeting. (Air Canada Ticket 27-Mar-2019 Direct Billing Airline Ticket Marlin Travel 488.96 Flight to Calgary for Indigenous Health Strategy Steering Committee. 3-Apr-2019 Direct Billing Airline Ticket Marlin Travel 371.96 (Air Canada Ticket 8-Apr-2019 Direct Billing Airline Ticket Flight Victoria for Prevention of Violence in the Workplace Meeting Marlin Travel 349.96 Flight High Level for Beaver First Nation meeting with Dr. Yui. 8-Apr-2019 Direct Billing Airline Ticket Rationale - Cost is more than policy amount being that there is only Marlin Travel 777.00 one airline carrier to High Level Total Paid in the Month $ 2,461.84 Vision Travel DT Ontario-West Inc , , Canada www.visiontravel.ca GST Reg : 723782728 RT 0001 E-Ticket Receipt Ticket Number: Issuing Airline: AC Issued: 22Mar19 Invoice: Agency Ref.: Customer Number: Sales Person: IATA Number: Customer Ref.: N/A Passenger(s): CUMMINGS/GREGORY AIR - Wednesday, April 3 2019 Air Canada Flight AC8363 Economy Class - Seat Assigned at Check-in Depart Edmonton, Alberta Arrive Grande Prairie, Alberta Edmonton International Airport Grande Prairie'Municipal Airport 06:55 AM Wednesday, April 3 2019 08:08 AM Wednesday, April 3 2019 Duration: 1 hour(s) and 13 minute(s) Non-stop Status: Confirmed - Air Canada Booking Reference: Operated By: AIR CANADA EXPRESS - JAZZ Online Check In: Available 24 hours prior Baggage Allowance: 0 Piece(s) Remarks: PLEASE CHECK IN WITH AIR CANADA EXPRESS - JAZZ Fare Basis: W10WLATG Not Valid Before: 03Apr Not Valid After: 03Apr AIR - Thursday, April 4 2019 Air Canada Flight AC8368 Economy Class - Seat Assigned at Check-in Depart Grande Prairie, Alberta Arrive Edmonton, Alberta Grande Prairie'Municipal Airport Edmonton International Airport 07:10 PM Thursday, April 4 2019 08:20 PM Thursday, April 4 2019 Duration: 1 hour(s) and 10 minute(s) Non-stop Status: Confirmed - Air Canada Booking Reference: Operated By: AIR CANADA EXPRESS - JAZZ Online Check In: Available 24 hours prior Baggage Allowance: 0 Piece(s) Remarks: PLEASE CHECK IN WITH AIR CANADA EXPRESS - JAZZ Fare Basis: W10ZLATG Not Valid Before: 04Apr Not Valid After: 04Apr Fare Form of payment: Credit Card CA- Endorsements / NONE restrictions: Fare calculation: AC ONLY-NONREF-CHGFEE AB HEAL TH SERVICES COF 3APR YEA AC YQU Q9.00Q3.00 185.00AC YEA Q9.00Q3.00 195.00CAD404.00END Fare: CAD 473.96 Equivalent amount paid: Positive identification required for airport check in Notice: Transportation and other services provided by the carrier are subject to conditions of contract and other important notices.