GGH Board of Directors Annual General Meeting Tuesday June ... · Liz Sandals . It is recommended...

GGH Board of Directors

Annual General Meeting

Tuesday June 23, 2020

Via WebEx - Details in meeting request

MISSION: To provide the highest quality care and experience for patientsand their families

a) Summary of Motions

1 min 3. Chair RemarksD. Mills

Information

a) Approval of Agenda - June 23, 2020

b) Approval of Minutes - June 25, 2019

4a. Agenda - AGM June 23, 2020 FINAL.doc

1 min 4. Approval of Agenda and Consent AgendaD. Mills

Decision

a) Board Chair and CEO ReportD. Mills/M. Walker

5a. Annual General Meeting Board Chair andCEO Report - June 2020 final.docx

15minutes

5. Annual Reports

Decision

1 min 1. Welcome and Call to OrderD. Mills

Information

1 min 2. Declaration of Conflict of InterestD. Mills

Information

3a. AGM Motion Summary Sheet - June 23,2020.doc

4b. AGM Minutes - June 2019 FINAL.doc

GGH Annual General Meeting GGH Annual General Meeting - June 23, 2020- June 23, 2020

AGENDAAGENDA

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b) Chief of Staff ReportJ. Caspers

c) Medical Staff Association ReportI. Phillips

d) Volunteer Association ReportM. Walker

e) Foundation of GGH ReportS. Bone

5b. Annual General Meeting CoS Report - June2020 final.doc

5c. MSA Annual General Meeting Report - June2020 FINAL.docx

5d. GGH Volunteer Association Annual GeneralMeeting Report - June 2020 FINAL.docx

a) Audited Financial Report - Appointment of Auditors

b) GGH 2020 Audit Results Report

c) Audited Finanical Statements - March 31, 2020

6a. Audit Committee Report for AGM - March 31,2020l.docx

6b. Guelph General Hospital 2020 Audit ResultsReport Final Communication with Governance(GGH) - FY20 21 FINAL.pdf

5 min 6. Audit Committee ReportD. Kennedy

Decision

2 min 7. Election of DirectorsD. Mills

Decision

5e. Annual General Meeting Foundation - June2020 FINAL.docx

6c. Guelph General Hospital FinanicalStatements DRAFT FINAL.PDF

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7. Election of Directors - June 23, 2020.doc

2 min 8. Thanks and Recognition of Outgoing MembersD. Mills

Information

1 min 9. Other BusinessD. Mills

Information

1 min Decision10. Meeting AdjournmentD. Mills

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ANNUAL MEETING JUNE 23, 2020

SUMMARY OF RECOMMENDED MOTIONS Agenda and Consent

a) Summary of Motions b) Approval of Agenda – June 23, 2020 c) Approval of Meeting Minutes – June 25, 2019

It is recommended that the Board of Directors approve Agenda and Consent Agenda as presented.

Annual Reports

a) Board Chair and President and CEO Report b) Chief of Staff Report c) Medical Staff Association Report d) Volunteer Association Report e) Foundation of GGH Report

It is recommended that the Board of Directors approve Annual

Reports for Information.

Audited Financial Statements and Appointment of Auditors

a) Audit Results Report It is recommended the Board of Directors approves the Deloitte

Guelph General Hospital 2020 Audit Results Report for 2019/20 as

presented.

b) Financial Statements

It recommended the Board of Directors approves the Deloitte Guelph

General Hospital Audited 2019/20 Financial Statements as presented.

c) Auditors

Item 3a

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It is recommended that the Board of Directors approves Deloitte as the Auditor for Guelph General Hospital for 2020-2021

Election of Directors

a) Appointments and Re-appointments It is recommended the Board of Directors approves the following re-appointments for a three-year term ending in June 2023: Sara Sayyad Kathy Wilkie Dale Mills Liz Sandals It is recommended that the Board of Directors approves the following appointment for one-year term ending in June 2021: Dr. Ken McKenzie

Adjournment

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Item 4a

AGENDA – ANNUAL MEETING Board of Directors

Tuesday June 23, 2020 6:00 p.m.

Via WebEx

AGENDA ITEM LEAD ACTION TIME

1. Welcome and Call to Order D. Mills 1 min

2. Declaration of Conflict of Interest D. Mills Information 1 min

3. Chair’s Remarks

a) Summary of Motions D. Mills Information 1 min

4. Approval of Agenda and Consent Agenda:

a) Approval of Agenda – June 23, 2020 b) Approval of Board Meeting Minutes –

June 25, 2019

D. Mills

Decision 1 min

5.

Annual Reports a) Board Chair and President and CEO

Report b) Chief of Staff Report c) Medical Staff Association Report d) Volunteer Association Report e) Foundation of GGH Report

D. Mills/

M. Walker J. Caspers

Dr. I. Phillips M. Walker S. Bone

Decision

15 min

6.

Audit Committee a) Audited Financial Report – Appointment

of the Auditors b) GGH 2020 Audit Results Report c) Audited Financial Statements – March

31, 2020

D. Kennedy Decision 10 min

7. Election of Directors D. Mills Decision 2 min

8. Thanks and Recognition of Outgoing Members D. Mills Information 10 min

9. Other Business D. Mills Information 1 min

10. Meeting Adjournment D. Mills Decision

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Item 4b

MINUTES OF THE ANNUAL MEETING OF THE MEMBERS, GUELPH GENERAL HOSPITAL

TUESDAY, JUNE 25, 2019 BOARDROOM Present: D. Kennedy – Chair, T. Campbell, J. Caspers, B. Cowan, F. Edward, D.

Forestell, S. Hoey, R. Hubers, J. Kaufman, D. Mills, T. Sehl, S. Sayyed, M. Skinner, M. Stanley, M. Walker, and L. Robinson - Recorder

Regrets: S. Bone, I. Philips, K. Wilkie, Guests: L. Sandals, G. Webb, 1. WELCOME The members were welcomed the Annual General Meeting at 6:55 p.m. 2. CONFLICT OF INTEREST No conflicts of interest were declared. 3. CHAIR REMARKS There were no remarks from the Chair.

a) Summary of Motions 4. APPROVAL OF AGENDA AND CONSENT AGENDA

a) Approval of Agenda – June 25, 2019 b) Approval of Minutes – June 28, 2018

It was MOVED by F. Edward SECONDED by T. Sehl, that the Board of Directors

approve the agenda and consent agenda as presented. CARRIED. 5. ANNUAL REPORTS

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Item 4b

a) Board Chair and President and CEO Report

D. Mills and M. Walker referred to the Report from the Board Chair and CEO included in the package. D. Mills commented on GGH’s significant growth and that funding has not kept up with the growth. He commended the senior leadership team on the fantastic work they’ve done. D. Mills thanked all of the Staff, Professional Staff, Volunteers, our Foundation, Partners and Board members for their ongoing commitment and support that resulted in another successful year.

M. Walker supported D. Mills comments and that the Board for their on-going commitment and contributions.

b) Report of the Chief of Staff

J. Caspers referred to the Report of the Chief of Staff included in the package. J. Caspers expressed thanks to the members of the Medical Advisory Committee, the Professional Staff, Senior Management Team, and the Board of Directors for their knowledge, enthusiasm, willingness and support of our many demanding endeavours. J. Caspers highlighted some of the achievements of the medical staff. A special thank-you was provided to Dr. S. Hoey for working with her over the past year.

c) Report of the Medical Staff Association Dr. S. Hoey referred to the Report from the Professional Staff Association

included in the package. Dr. S. Hoey thanked the Board and the GGH Senior leadership team. He indicated GGH is fortunate to have such dedicated and compassionate individuals that support the medical staff as much as they do. Leadership and the Professional staff work well together.

d) Report of the Guelph General Hospital Volunteer Association On behalf of the Volunteer Association, M. Walker referred to the Report of the

Volunteer Association included in the package. She expressed thanks to the Volunteers for their ongoing commitment to GGH and all their hard work through-out the year. It was noted the main lobby greeter was a great addition as well as the donations they have made over the year. Specifically the gift of $250,000 pledge to the capital campaign was recognised.

e) Report of the Foundation of Guelph General Hospital

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Item 4b

M. Walker referred to the Report of the Foundation included in the package highlighting that the Foundation raised more in 2019/2020 than they have ever raised in the Foundations 32 year history.

The Board of Directors expressed thanks to S. Bone and the Foundation for their ongoing efforts and support, and recognized the value their contributions bring to the hospital. It was MOVED by S. Sayyad , SECONDED by F. Edward, that the Board of Directors approve the Report from the Board Chair and CEO; the Chief of Staff, the Professional Staff Association; the Guelph General Hospital Volunteer Association and the Foundation of Guelph General Hospital for information as presented. CARRIED.

6. AUDITED FINANCIAL STATEMENTS AND APPOINTMENT OF AUDITORS D. Kennedy referred to the Audited Financial Statements ending March 31, 2019

included in the package. The Auditor’s Report noted it is was clean audit for this fiscal year.

It was MOVED by T. Sehl, SECONDED by T. Campbell that the Board of Directors

approve Deloitte as the auditor for Guelph General Hospital for 2019/2020. CARRIED.

7. ELECTION OF DIRECTORS

D. Mills referenced the Election of Directors document included in the package.

Re-appointments

It was MOVED by D. Mills, SECONDED by B. Cowan the Board of Directors

of Guelph General Hospital recommends the following re-appointment for a

two-year term ending in June 2021:

Rena Hubers

Janet Kaufman

It was MOVED by D. Mills, SECONDED by S. Sayyad the Board of Directors

of Guelph General Hospital recommends the following re-appointment for a

three-year term ending in June 2022:

Edward Fraser

Ted Sehl

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Item 4b

New Appointments

It was MOVED by D. Mills, SECONDED F. Edward by that the Board of

Directors of Guelph General Hospital recommends the following

appointment for a three-year term ending in June 2022 pending clear

vulnerable sector check.

Dr. Joan Chan

One-Year Appointment

It was MOVED by D. Mills, SECONDED by D. Forestell that the Board of Directors of Guelph General Hospital recommends the following appointment for a one-year term ending in June 2020: Dr. Ian Philips It was MOVED by D. Mills, SECONDED by B. Cowan that the Board of Directors of Guelph General Hospital recommends the following appointment for a one-year term ending in June 2020 pending references and clear vulnerable sector check: Liz Sandals It was MOVED by D. Mills, SECONDED by M. Stanley that The Board of Directors of Guelph General Hospital recommends the following appointment for the Quality Committee pending references and clear vulnerable sector check: Leslie Fleming

8. GGH Revised By-Law

D. Mills referenced the revised GGH by-law included in the package. M. Walker thanked J. Caspers, Dr. S. Hoey and the Board for all the long hours and hard work that went into the revised By-Law.

It was MOVED by D. Mills, SECONDED by T. Campbell that the Board of

Directors approve the revised GGH By-law (1-13) as presented.

8. THANKS AND RECOGNITION TO OUTGOING MEMBERS On behalf of the Board of Directors, D. Mills gave words of thanks to Dr. S. Hoey for

his contributions to the Board, the Committees and the Medical Staff Association.

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Item 4b

D. Mills spoke of C. Bevan-Stewart who could not be present with kind words of thanks on behalf of the Board.

Members expressed thanks to both Dr. S. Hoey and C. Bevan-Stewart. OTHER BUSINESS No other business was declared. ADJOURNMENT It was MOVED by T. Campbell that the meeting be adjourned at 7:24 p.m. ______________________________ ___________________________ Chair – D. Kennedy Secretary – M. Walker

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ANNUAL GENERAL MEETING 2019/20 REPORT OF BOARD CHAIR AND THE PRESIDENT AND CEO

June 23, 2020

Looking back over the past year it’s difficult not to focus on the COVID-19 pandemic and the incredible impact it has had. It has tested the Hospital, our staff, our patients and society as a whole. However, the vast majority of the past year was not spent focused on this unprecedented crisis. Instead, there were many achievements of which to be proud.

During 2019/20 we continued to feel the impact of our rapidly growing community. The City of Guelph remains one of the fastest growing cities in Canada and in 2017 had the highest population growth in Ontario. From 2015 to 2019 the population growth in Guelph was 7.5%. This growth is not expected to slow. Guelph General Hospital continues to be challenged by this accelerated growth.

For most of 2019/20, once again we operated more beds than we were staffed or budgeted for just to meet the increasing demand for our services. At the same time, patients coming to our Emergency Department were more complex and many more needed to be admitted. Despite the pressures we faced, GGH had the best Emergency Department wait times in the Waterloo Wellington and 7th overall in the province. We remained committed to our mission “to provide the highest quality care and experience to patients and their families.”

GGH remains a leader in operational efficiency with the lowest acute cost per weighted case (2018/19) among large community hospitals (12.6% lower than the average for this peer group). In other words, GGH is the most cost-efficient large community hospital in the province.

Throughout the year we continued to work with our community partners as we officially formed the Guelph and Area Ontario Health Team with a goal to improve the health of our community.

Highlights related to the achievement of our Strategic Priorities

Provide the safest and highest quality care The year began with a celebration. Our Patient and Family Advisory Council marked its first year at GGH. With well-attended monthly meetings, it is supporting the integration of the patient and/or family member perspective into GGH’s decision-making processes and services at both the program and organizational level. Its goal is, “to create an environment where our advisors, patients and their families and

hospital staff work together as partners to improve the quality and safety of hospital care and experience.”

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The hospital standardized mortality ratio (HSMR) is an important measure to improve patient safety and quality of care in Canadian hospitals. Once again GGH excelled and we ranked fifth in all of Canada.

Hospital staff weren’t the only ones gathering information from first-hand experience. In June 2019, the Hospital began offering tours and information sessions to expectant moms. The monthly Open House not only provides a tour of the Family Birthing Unit but also includes a chance to speak with community partners to find out how their programs support new moms and their family. The events have been extremely well received with lots of positive feedback from those attending. Unfortunately, our Open House has been on hold due to the pandemic;

however, we are still offering our online video tour of our birthing area.

Since 1992 GGH has been providing a stellar bariatric program with excellent results. The program is life-changing and has contributed to improving health and quality of life of many people. Our compassionate interdisciplinary team of experts including nurses, dieticians, social workers, psychologists, endocrinologists, and surgeons continue to work with patients who suffer from obesity and obesity-related diseases to help them achieve an improved quality of life. Over 400 patients were provided with this life-changing surgery.

Support our Exceptional Staff Once again, our staff and Professional Staff have demonstrated their compassion as they delivered excellent health care alongside our patients. GGH is a special place; by working together we get excellent results. Despite the challenges that we faced throughout the year such as managing over capacity, limited funding and the early days of the COVID-19 pandemic, together we have saved lives and

contributed to the health of our community. We are very proud to be part of this amazing team.

Create a coordinated high quality system of care with our partners. Guelph and Area OHT In the Fall, the Province rolled out plans to implement a new model of organizing and delivering health care that better connected patients and providers in their communities to improve patient outcomes. Guelph General Hospital is a core member of what would become the Guelph & Area Ontario Health Team (G&A OHT).

It is one of the first 24 Ontario Health Teams approved out of more than 150 expressions of interest. Our significant role in the evolution of our OHT continues to this day. We were so pleased to have the opportunity to work with our physician partners in the development of the Guelph and Area Physician Association that will provide a mechanism for the clinicians’ voice in G&AOHT’s work. One of the early planned objectives was the development of a G&A OHT common strategic plan; however, that was put on hold in March due to the pandemic. Trillium Gift of Life Early in 2020, the Hospital was recognized by Trillium Gift of Life Network, Ontario’s organ and tissue donation and transplantation agency, for the hospital’s outstanding efforts to integrate organ and tissue donation into quality end-of-life care. GGH was presented with the Provincial

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Conversion Rate Award for meeting or exceeding the target for the percentage of potential organ donors (patients who die in a hospital setting and are deemed medically suitable for donation) who went on to become actual donors. We’re proud of our team’s success in helping loved ones work through such a difficult time in their lives. It really is a team effort. Emergency Preparedness From celebration planning to disaster planning, the month of May 2019 tested our preparedness for crisis not once but twice. First, GGH participated in a Waterloo Wellington-wide, Code Orange table-top exercise. The exercise involved multiple hospitals, Guelph Wellington Emergency Medical System (EMS) and the Waterloo Wellington Local Health Integration Network all connected via the Ontario Telemedicine Network. The scenario simulated a bus accident with 33 victims on Highway 124 just outside of Guelph. Two weeks later we held a Chemical Decontamination Exercise with our partners, the Guelph Fire Department. This code was based out of our Emergency Department with nine “patients” requiring decontamination from a chemical exposure from a tractor trailer rollover. There was good feedback from both exercises with valuable lessons learned. COVID-19 Begins March 2020 Around the same time, news of a “novel coronavirus” became more and more urgent. What started halfway around the world was spreading quickly. Still, no one could have fully anticipated the profound impact it was to have both around the world and right in our backyard. On March 16, the first local case was confirmed. Since then, nothing has been the same except for one thing: the safety of our staff and patients remains paramount. We have gone to extraordinary lengths to keep that commitment. We took what we learned from our other test exercises as we faced the COVID-19 pandemic head on. Our Emergency Incident Management System team continues to do an incredible job in managing the COVID-19 pandemic. We are proud of what we’ve done and what we’ll continue to do. Now more than ever, GGH is like a family and families do their best to keep each other safe and protected. COVID-19 Assessment Centre On March 23, our collaborative local health system launched the COVID-19 Assessment Centre, first on Delhi Street and now at the Victoria Road Recreation Centre. Key partners include Wellington Dufferin Guelph Public Health, Guelph Wellington EMS, Guelph General Hospital and the Guelph Family Health Team. Now, several weeks later, close to 8,000 tests have been completed. Our collective team is doing an amazing job.

Sustain our Financial Health With the increased pressure for more acute hospital services and operation of unfunded beds along with the impact of COVID-19 pandemic on revenues and expenses in March, GGH ended the year March 31, 2020 with an operating deficit of $1,063,886 on a $162M budget (0.66%). When adjusted for HSAA the deficit is reduced to $371,995 on a $159M budget (.23%). We continue to be one of the most cost-efficient community hospitals in the province.

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Last year we submitted redevelopment projects to the MOHLTC Capital Investment Branch. One focused on enlarging our Emergency Department (ED) and moving our Emergency Mental Health and Additions Short Stay Unit upstairs. The second project was focused on the redevelopment of our Special Care Nursery (SCN) that will enlarge the space and promote family centered care. This year GGH received Stage 3 approval for the SCN and we are still waiting for approvals for the ED from the MOHLTC.

Thanks to our Donors – Improving Quality We could not provide excellent care or achieve excellent results without the support of our GGH Foundation and donors. 2019/202 was an incredible year for our Foundation with more than $5 million raised.

In what turned out to be a blessing with the recent turn of events, our Bob Ireland Family ICU received new high-tech beds in June 2019. One of their many ground-breaking features is they can actually lower the risk of ventilator-acquired pneumonia in patients. This has turned out to be so crucial in the current battle with COVID-19. The beds, at a cost of almost $50,000 each, were bought with donations raised during the Foundation’s 2019 Black Tie Bingo gala. Donors do directly impact the quality of care at the hospital.

Around the same time, thanks to our donors, we took delivery of a new, state-of-the-art mammography machine, one of the first in Canada. The new machine has significant advantages over the one it replaced. In particular, the new machine is able to create 3D images of the breast and any abnormality found within. With the increased ability to view smaller lumps or shadows, an earlier diagnosis is possible. It also significantly reduces the number of “false positive” results which is a huge benefit to patients.

A big thank-you also goes out to our Volunteer Association who continue to give their time and financial support to improve patient care and experiences. The Guelph General Hospital Volunteer Association provided support in over 25 different areas/departments throughout the hospital and recorded 15,864.5 signed-in volunteer hours this year. We could not provide excellent care without them and we are fortunate and privileged that they chose GGH.

We are privileged to be working with so many very talented and dedicated people who make GGH such a great place to work and receive care. We want to thank all of the staff, professional staff, volunteers, our Foundation, donors and partners for their ongoing commitment and support. We look forward to our continued work together to improve the health and lives of our Guelph community.

Dale Mills Marianne Walker Chair, Board of Directors President and CEO

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Item 5b

2020 Annual General Meeting

REPORT OF THE CHIEF OF STAFF

The following summarizes the significant contributions and activities of the Chief of Staff and the Medical Advisory Committee in promoting the highest level of quality care and performance at Guelph General Hospital during the 2019-2020 fiscal year. The Professional Staff is exceedingly proud of changes in processes and procedures at GGH which have made our hospital an enviable place to work. The Professional Staff are fortunate to be working with a Senior Team who respects the unique challenges that we face in the hospital environment and are open to discussion and improvement opportunities.

It has been a truly unimaginable year – hard weeks followed by hard months. The 2019-2020 fiscal year has been ripped apart by the worldwide pandemic, the economic downturn, the racial divides and surfacing tensions. Our GGH Professional Staff focus from late February to the present has been on the marshalling of our resources to recognize, diagnose and treat COVID successfully in our hospital and community while not allowing ourselves to miss other presenting diagnoses in our patients. Medicine will never be practiced the same way again. Perhaps that is a good thing as we see opportunities for change and improvement in a medical system that demands transformation.

The MAC has met weekly since March, 2020.

Great accomplishments of 2019-20:

the establishment of the COVID Assessment Clinic in cooperation with the Guelph Family Health Team

the formation of the Guelph and Area Physicians Association (GAPA) to serve as a voice of the physician population

The invaluable contribution of the Professional Staff to the gestation and birth of the Guelph and Area Ontario Health Team

Patient Keeper, a web-based platform working with our current EMR (Meditech) system was initiated to improve patient care, medication safety and information sharing.

Emergency Preparedness – education was undertaken on a monthly basis to improve physician understanding and participation of in-hospital Codes

Bariatric cases were increased with the help of a marketing firm and physicians eager to increase their caseload to meet the service demands

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Item 5b

In January 2020: GGH received the Provincial Conversion Rate Award for “outstanding efforts to integrate organ and tissue donation into quality end-of-life care in 2018-19”

The City of Guelph agreed to support the 3 projects in the Foundation campaign with a $4.5 million contribution over 6 years

The Foundation achieved remarkable goals with greater than expected gifts from the major donors towards ED Mental Health expansion, the Special Care Nursey project and technology and equipment throughout the hospital

the ED P4R results – stellar as always!

the initiation and successful completion of our second year of a web-based reapplication process for Professional Staff and the planning for an initial application process.

the MAC has continued to make the Opioid Crisis a priority in our discussions;

Continuing excellence in monthly MAC presentations on metrics, challenges and achievements in each department;

all Professional Staff with privileges at GGH have completed an education module on mental health and Vanessa’s law;

The Guelph General Hospital By-Law was completed and approved

CMARS

A tremendous milestone was reached in the implementation of the CMaRS reapplication platform. This initiative has eased the burden on administration and physicians alike and has led to a more accurate and accessible system of monitoring and approving reapplications.

Professional Staff Recognition

Each month, Professional Staff who have been recognized through internal accolades or through the Foundation, ‘Seen and Heard in Guelph’ or through letters to GGH are recognized at the MAC.

Quality Reports

The MAC continues to highlight a monthly status report from a designated department on their patient care metrics, advancements and future planning. Departmental Chiefs have initiated a monthly Departmental presentation to the Board with their Clinical Manager to review current directions, successes and challenges.

Financial Planning

Professional Staff and medical leadership have been regularly apprised regarding the Hospital Accountability Planning Submission (HAPS), the Hospital Service Accountability Agreement (HSAA), QBP (Quality Based Procedures) funding processes at the Board, MAC and PSA meetings. MAC strategic initiatives are linked to improving our financial status. of 69

Item 5b

Regional Chiefs of Staff

Liaison with other LHIN Chiefs of Staff is maintained through monthly meetings up to February 2020 where long-term planning and strategy for improved patient care was the priority. LHIN representation was at the table. This group has developed a LHIN-wide approach to common problems encountered by hospitals throughout the region. During the COVID pandemic, the Joint Chiefs of Staff are meeting weekly.

Clinical Human Resource Plan 2020

This incredibly important project was interrupted by the COVID demands but will be completed as the environment settles.

Significant 2020-2021 Objectives

As we make our way through the new experience of COVID, we are still working to provide the highest quality of patient care.

The MAC will be essentially unchanged next year aside from the loss of Dr. Ian Phillips who has completed his term on the Executive of the Medical Staff and Dr. Kayal Thevathasan and Ms. Carol Bennett who have chosen to step down from their respective roles of Chief of Pediatrics and Chief of Midwifery. We sincerely thank them for all that they have offered to us over the past three years respectively.

The MAC will continue to support the GGH Administration in reaching financial stability now and in the future and attempt to understand barriers to optimal performance.

The MAC has set additional strategic priorities in addition to supporting the GGH Strategic Plan: ---- Support the Clinical Human Resource Plan for professional Staff to ensure that GGH has a fully operational PS team now and in the future

Actively endorse, promote and engage in the Guelph General Hospital’s initiation of Patient Keeper,

Help healthcare providers improve patient care and financial performance. Continue to advocate for responsible and appropriate use of opioids. To maintain our stellar performance enabling the Trillium Gift of Life Program to be

successful in GGH

The Chief of Staff, MAC and Professional Staff sincerely thank Ms. Katie Bedo, Ms. Lindsay Orosz and Ms. Lindy Robinson, Administrative Assistants, for their knowledge, enthusiasm, willingness and support of our many demanding endeavours.

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Item 5c

2019-20 Guelph General Hospital Professional Staff Association Presidents’

Annual Report

June 23, 2020

This Annual General Meeting of the Guelph General Hospital Board, brings to a conclusion my 3 year

term as an executive of the GGH Professional Staff Association. Twelve years ago I fulfilled this same

obligation. I find these experiences both educational and enlightening. Being an executive of the PSA

requires a commitment to representing the physicians’ interests while maintaining the primary goal of

health care in our community. I would like to take this opportunity to illustrate some of the highlights

from the past year.

While acting as the President of the PSA, I was fortunate to become a founding member of the newly

formed Guelph and Area Physicians Association (GAPA). I worked closely with my friends and colleagues

in the Family Health Team. Together we formed this association of physicians with the underlying goal

of providing sound medical guidance to the development and implementation of health care policies in

our region. Our vision was to provide help and support to the evolving development of the Guelph and

Area Ontario Health Team. The structure of the GAPA executive has been created to include 3

consistent representatives from the hospital medical staff. This will ensure a cooperative approach with

our community physicians to address issues and needs in the future.

The ability, due to my position in the PSA and GAPA, to be involved in the Guelph and Area Ontario

Health Team Strategic Governance Council, has provided myself with invaluable insight as to how health

care delivery in our region may look in the years to come. I have taken pride representing the physicians

from the Guelph General Hospital at this table. I am confident that the coordination of hospital based

physicians and community physicians will provide opportunities for efficiency and safer patient care.

The collective voice of physicians, provided through GAPA, will hopefully have direct input into

discussions at the highest levels within our emerging Ontario Health team. I would like to take this

opportunity to recognize and express my appreciation to Marianne and the many others from GGH

Administration who were involved in the successful application and formation of the Guelph and Area

Ontario Health Team.

Over the last year the Professional Staff Association has formalized a transparent approach to spending

the collected PSA funds. The disbursement of these funds is intended to improve the work environment

for the Professional Staff. These work site upgrades are for projects that may fall outside the direct

responsibility of the Hospital itself. The first completed example is the refurbishing of the Physicians OR

Lounge. I am confident this process of allocating funds for capital expenditure will continue to improve

our surroundings and improve morale overall.

The last three years may have provided educational and enlightened opportunities, but the last three

months have been challenging and frustrating. The PSA was decisive and cooperative in the hospital

wide reduction of services initiated March 15. The response illustrated the Professional Staffs’ concern

and uncertainty regarding the Covid pandemic. During this unique time I have canvassed and consulted

widely with the medical staff regarding their personal opinions and suggestions of how best to deliver

care within the restrictions provided. The persistent theme amongst my colleagues was how can we

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Item 5c

increase and best provide care to patients while maintaining safety (from Covid) to our peers and co-

workers at GGH. The Covid Pandemic has altered our approach to medical care. Let us always respect

the threat of the virus in our workplace, but let it not compromise the care we deliver to those patients

in need within our community.

In conclusion, I would like to express my gratitude to the Professional Staff at Guelph General Hospital

for allowing me to represent their interests. I would like to thank the members of the Medical Advisory

Committee for the unrelenting commitment in these troubled times. I would also like to specifically

thank Katie Bedo, Professional Staff and Credentialing Assistant. Katies’ organizational help and input is

the only way my responsibility could be honored and still maintain a clinical practice. I believe I leave

the Professional Staff Association Executive in the exceptional hands of my colleagues, Dr. Ken

Mckenzie, Dr. Hamid Nasser and Dr. Phil Harvey.

Dr. Ian Phillips

President Professional Staff Association

Guelph General Hospital

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Item 5d

Volunteer Association Annual General Meeting Report

Statistics and Demographics

The Guelph General Hospital Volunteer Association provides support in over 25 different areas/departments throughout the hospital and recorded 15,864.5 signed-in volunteer hours this year.

This time does not include work performed at home for committee meetings, board meetings, knitting afghans, etc. and was divided as follows:

Patient Care (9,277.5 hours) including Baby Snuggling, CT Scan, Day Surgery, Diagnostic Imaging, Emergency, Family Birthing Unit, Hospital Elder Life Program (HELP), Look Good Feel Better, Main Lobby Greeter, Patient Survey, Patient Visiting, Spiritual Care and Stroke Survivors.

Retail Hours (3,544 hours) including Retail Selling, Merchandise Buying, and Window and Shelf Displays in the Courtyard Boutique.

Administration Hours (1,463 hours) including Volunteer Association Board of Directors, Administration, Clinical Pathways, Diabetes Education, Foundation Office, Spiritual Care Advisory Council, Laboratory, Patient & Family Advisory Council, and Volunteer Resources.

Volunteer Association Fundraising Hours (1,652 hours) including Book Sales, HELPP Lottery, and Raffles.

As of March 31/20, we have 305 active volunteers, of which 150 new volunteers were on boarded in the year.

Of the active volunteers, 43.6% are adults, 11.8% are high school students and 44.6% are university/college students.

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Item 5d

Volunteer Association Revenue

Financial data is provided for the GGH Volunteer Association’s fiscal year, Jan 1 – Dec 31/19.

Total Revenue: $190,671

$156,517 from Courtyard Boutique Gift Shop sales $20,575 from Vendors in the Lobby throughout the year $6,500 from H.E.L.P.P. Lottery • $5,977 from Fundraising Events (Book Sale, Beer Fridge Raffle and Quilt Raffles) $5,000 pledged Tim Horton’s sales $812 Donations received

Volunteer Association Donations

Donation to the Foundation of GGH - A $60,000 donation was made as part of our pledge to the GGH Capital Campaign, and the funds were directed to the purchase of an ICU Glidescope intubation unit with adult blades, Ambulatory Care ceiling light, and 6 lead vests for the Operating Rooms.

43.6%

11.8%

44.6%

Volunteers by Age Group

Adults High School Students University/College Students

One-time Volunteer Requests

One-time requests were made for volunteers:

To remove old sleep lab files

For a Foundation photo shoot

For Tour de Guelph

To decorate Smile Cookies

New Programs

1. Having a baby at GGH – volunteers greet families, direct them to Auditorium for displays and escort them to the 6th floor

2. Bariatric clinic volunteer – due to increase in Bariatric program, a volunteer provides support at direction of staff

Total 305 Volunteers

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Item 5d

GGH Volunteer Association Board Members:

Past-President: Dianne Steinke

President: Kathy Ridings

Vice-President: John Steggles

Recording Secretary: Jessica Lagassie (pending

installation)

Director of Finance: Marion Loree

Director of Business Affairs: Matt Shanks (pending

installation)

Director: Jan Hurd

Director: Vacant

We will be

recognized as

people helping

people,

making a

difference to

those around

us.

Vision Statement

Guelph

General

Hospital

Volunteers are

dedicated to

patient

centered care

by providing

non-medical

support and

services for

patients, staff,

and visitors in

a positive

environment.

We will ensure

all of our

activities and

interactions

are done with

a spirit of

compassion,

cooperation,

teamwork and

respect.

Mission Statement

Patient Experience Fund – a new program offering funds up to $500 for any staff member or volunteer to purchase items that directly benefit the patient experience at GGH. 8 applications totalling $2,500 from 6 different departments were funded this year.

Education Bursary - A $500 bursary was given to a nursing student at Conestoga College through McMaster University. This student must live in Guelph and or Wellington County and have the highest academic standing in the Collaborative BScN Program.

Nurses Week Banner - $200 was donated to purchase a banner to celebrate Nurses Week.

Pledge to the Foundation of GGH

In 2017 the GGH Volunteer Association pledged $250,000 to The Foundation of GGH - Capital Campaign. To date we have contributed $149,650.

Thank you for your continued support of the Volunteer Association.

Respectfully submitted,

Kathy Ridings

President

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Item 5e

HIGHLIGHTS OF THE 2019-2020 YEAR Looking back over the past year it’s difficult not to focus on the COVID-19 pandemic and the incredible impact it has had. However, the vast majority of the past year was not spent focused on this unprecedented crisis and there are many achievements of which to be proud. Every dollar spent on patient care equipment comes from a donor, so our community truly helps us save lives and improve health. Our donors were exceptionally generous. Inspired by the important hospital projects we needed to make possible, and supported by the Foundation team, they contributed more than $5.1 million, leading to our most successful fundraising year in our 33-year history. And on top of this, donors committed more than $7 million additional dollars for future projects. Here are just a few of the projects our donors funded:

New replacement steam sterilizers for the Hospital’s Medical Device Reprocessing Department.

Specialized beds to help critically ill patients in the Bob Ireland Family Intensive Care Unit.

Incubator warmers for each of the delivery rooms in the Rotary Club of Guelph Family Birthing Unit.

Three new laparoscopic towers, used by our surgeons to perform minimally invasive “laparoscopic” surgeries.

New portable cardiac monitors that can be quickly wheeled into the delivery room.

A new suite of cystoscopes, used to help diagnose and treat underlying conditions of the urethra, bladder and kidneys including tumours, stones or cancers.

In total, we provided $2.3 million for urgently needed equipment. Additional donor funds remain with the Foundation, dedicated for the hospital’s medication safety and centralized cardiac monitoring system projects as they move forward. We are grateful to our donors for continuing to give GGH staff the tools that will help them do the best job possible in caring for our community.

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Item 5e

The Together, We Care campaign continued to be our fundraising focus. We celebrated an incredible $4.5 million commitment from the City of Guelph in the Fall, and announced and celebrated gifts from the Jarrell Family and the Guelph General Hospital Volunteer Association. Leadership of the campaign was announced publicly, and we transitioned from Linda Hasenfratz to Susan Frasson as chair. Two new members of cabinet were welcomed – Wayne Bricknell and Cam Guthrie. We finalized our Case Statement, highlighting our three pillars: expand emergency services; invest in innovative technologies; and give babies and families the best start possible. These projects will make an exceptional difference to the care we are able to provide to our community at GGH. The goal of the campaign was increased to $34 million, and at the end of March, we were well on our way, having secured $25.3 million. Close to $7 million has been already transferred to the Hospital to fund equipment as part of the Innovative Technologies pillar. We were honoured to receive bequests from nine individuals, including two who were members of our Heritage Society (meaning they had let us know of their intentions before they died). Our Circle of Life program continued to grow, this year raising $395,345 from 99 member families. For 2019-2020, the group chose to put their funds towards eight ventilators, helping our most critically ill patients in the Bob Ireland Family Intensive Care Unit. They have been ordered and are on their way. They will replace old ventilators that are 20 years old and at their end-of life. This year, we raised more than half a million dollars from events including a record-high 30 third-party events and a record-high Tour de Guelph. We were exceptionally fortunate that Black Tie Bingo was held on March 7, 2020 – the last Saturday before the pandemic was declared. It too achieved record-high results, netting $300,000. Our direct marketing program raised close to $475,000, a whopping 40% increase over last year. $130,000 of this came in the last two weeks of the year, in support of our COVID-19 Critical Response Fund. In addition, we added a new January Renewal mailing this year in order to re-activate lapsed donors. This generated approximately 50 donations, raising $18,195, including $10,000 from a grateful patient. In addition to our fundraising focus, our two other strategic directions are: Develop an Educated and Engaged Community and Increase Efficiency to Increase Impact. Our marketing-communications program saw us enhance our messaging on social and mainstream media and with our e-newsletter, driving community members to our website. We continued to tell stories that helped convey impact – stories of donors, patients, equipment purchased, and staff.

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Item 5e

We made some changes to focus on efficiency related to our technology, implementing bar code scanning, one-step receipting and a connector from online giving portals to our database. These steps are all in alignment with the Board’s 2019 retreat, which focused on technology and data. During the year, we welcomed a new Board member, Christina Crowley-Arklie. At the 2020 AGM, we will welcome Mike Henley to the Board, and say goodbye to Jeff Watson, Samir Patel and Barb Turley-McIntyre. After a couple of years of transition, we had a stable year on the staffing side. We have definitely hit our stride with the current staff team: Rob Cameron, Jennifer Duggan, Alex Madott, Matt Peltomaki, Khatera Rashidi, Elizabeth Stewart, Sarah Zinger. I am grateful to them for their hard work and dedication to our mission, our donors and our Hospital. Of course, volunteers are also an integral part of our success. We are served by many volunteers – our board, campaign volunteers, office volunteers and event volunteers – and are most grateful for the service provided by all. AND IN CONCLUSION A key reason we’re able to raise money is the care and compassion patients receive at GGH. Our fund-raising success is a reflection of the great team of people who work at Guelph General, and the care that they provide. We’re grateful always, and especially now as COVID-19 highlights the critical role played by our front-line workers and those who support them. Sincere thanks to all our donors, our board members, other volunteers and Foundation staff who believe in our mission and moving it forward. Respectfully submitted, Suzanne Bone CEO

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Item 6a

Annual Meeting 2020-2021

Audited Financial Report

RECOMMENDATION:

1. Audit Results Report It is recommended the Board of Directors approves the Deloitte Guelph General

Hospital 2020 Audit Results Report for 2019/20 as presented.

2. Financial Statements

It recommended the Board of Directors approves the Deloitte Guelph General

Hospital Audited 2019/20 Financial Statements as presented.

3. Auditors

It is recommended that the Board of Directors approves Deloitte as the Auditor for Guelph General Hospital for 2020-2021

INTRODUCTION

The March 31, 2020 Financial Statements contain an unqualified Auditor’s Report. The Audited Financial Statements are attached for information. A high level summary of the statements is provided below.

STATEMENT OF OPERATIONS

The Statement of operations (Revenue, Expenses and Fund Balance) on page 4 shows a deficit of $1,063,987 for 2019/2020 ($2,317,173 deficit in 2018/2019). It should be noted that these statements include items relating to building capital and interest on long-term debt that are not included in the Hospital-Service Accountability Agreement (H-SAA) statements (amortization of deferred grants and donations and amortization of capital), adjusting for these items results in a deficit of $372,096 ($1,575,309 deficit in 2018/19).

$956,218 of QBP and priority program revenues were deferred at year-end as the Ministry of Health and Long-Term Care has not yet clearly indicated that these revenues may be used to offset COVID-19 expenditures. Had these revenues been recognized, the H-SAA deficit of $372,096 would have improved to a surplus of $584,122.

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Item 6a

REVENUE

The Ministry of Health and Long-Term Care operating funding of $125.2 million was an increase of 3.36% compared to the prior year ($121.1 million 2018/2019).

Total revenue increased 3.42% from $155.6 million in 2018/2019 to $161.0 million in 2019/2020.

EXPENSE

Operating expenses in 2019/20 were $162.0 million ($158.0 million in 2018/19), which is a 2.57% increase over last year. Causes for operating expense increases relate to increases in salary and wages of 3.3% or $2.0M (related to union contracts and non-union annual increases), medical staff remuneration (3.1% or 0.7M), and building/equipment depreciation (11.1% or $0.8M). The medical staff remuneration increase is primarily related to increases in physician funding and is offset by an increase in patient revenue from other payment sources. The depreciation expense increase is primarily related to needed increased investments in building and equipment.

STATEMENT OF FINANCIAL POSITION (BALANCE SHEET)

The Statement of financial position reflects a working capital deficit of $7.8 million ($7.6 million deficit in 2018/19) and a current ratio of 0.70 (0.70 in 2018/19). Had QBP and priority program funding been fully recognized the current ratio would be 0.73. The current ratio was under the 2019/20 H-SAA target of 0.80.

The Hospital’s cash position at year-end remains strong at $6.6 million ($6.9 million in 2018/19). The decrease was primarily due to the operating deficit.

STATEMENT OF CASH FLOWS

The Statement of cash flows shows the sources and applications of cash. It highlights where cash was received or used for operating activities, financing activities and investment activities.

Total acquisition of capital assets for the year was approximately $7.4 million ($4.9 million in 2018/19). These acquisitions were funded in part by the Foundation, Ministry of Health and other capital grants of $3.8 million ($3.1 million in 2018/19) and non-cash net depreciation funds of $3.1 million ($2.5 million in 2018/19). The Hospital did not require any new long-term debt financing and in fact made payments of $500,000 against existing debt during the year ($500,000 in 2018/19).

NOTES TO THE FINANCIAL STATEMENTS

The Notes to the Financial Statements provide additional disclosure of accounting policies, Revenue and Expense and Balance Sheet items. Note 17 summarizes the impact of COVID-19 on hospital operations which have been significant. There are no other significant items in the notes.

APPOINTMENT OF AUDITORS FOR 2020-2021

It is recommended that the Board of Directors approve Deloitte as the Auditor for Guelph General Hospital for 2020-2021.

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Item 6a

It is recommended that the Board of Directors approves Deloitte as the Auditor for Guelph General Hospital for 2020-2021.

Respectfully Submitted,

David Kennedy Chair, Audit Committee

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00

Guelph General Hospital Report to The Audit Committee on the 2020 audit June 17, 2020

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Dear Audit Committee Members:

Report on audited annual financial statements As agreed in our engagement letter, we have performed an audit of the financial statements of Guelph General Hospital (the “Hospital”) as of and for the year ended March 31, 2020, in accordance with Canadian generally accepted auditing standards (“GAAS”) and expect to issue our audit report thereon when approved by the Board of Directors.

This report summarizes our findings during the audit. Our audit has been conducted in accordance with the Audit Plan that was presented to the Audit Committee members at the meeting on November 21, 2019.

We provide our consent for the Hospital to post the Independent Auditor’s Report for the audited financial statements of the Hospital on the Hospital’s website.

Use of our report This report is intended solely for the information and use of the Audit Committee, management and others within Guelph General Hospital and is not intended to be, and should not be, used by anyone other than these specified parties. Accordingly, we disclaim any responsibility to any other party who may rely on it.

We would like to express our appreciation for the cooperation we received from the officers and employees of Guelph General Hospital with whom we worked to discharge our responsibilities.

We look forward to discussing this report summarizing the outcome of our audit with you and answering any questions you may have.

Yours very truly,

Chartered Professional Accountants Licensed Public Accountants

Deloitte LLP 195 Joseph Street Kitchener ON N2G 1J6 Canada

Tel: 519-650-7600 Fax: 519-650-7601 www.deloitte.ca

June 17, 2020

To the Audit Committee Members of Guelph General Hospital

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Guelph General Hospital | Table of contents

i © Deloitte LLP and affiliated entities

Table of contents

Our audit explained 1

Audit risks 4

Significant accounting practices, judgments and estimates 7

Other reportable matters 8

Appendix 1 – Independence 10

Appendix 2 – Draft management representation letter 12

Appendix 3 – Communication requirements 17

Appendix 4 – Deloitte resources a click away 19

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Guelph General Hospital | Our audit explained

1 © Deloitte LLP and affiliated entities

Our audit explained This report summarizes the main findings arising from our audit:

Audit scope and terms of engagement We have been asked to perform an audit of the Hospital’s financial statements (the “financial statements”) in accordance with Canadian public sector accounting standards (“PSAS”) as at and for the year ended March 31, 2020. Our audit was conducted in accordance with Canadian Generally Accepted Auditing Standards (“Canadian GAAS”). The terms and conditions of our engagement, including our responsibilities for any additional audit-related services you have asked us to provide, are described in the engagement letter dated November 21, 2019, which was signed on behalf of the Audit Committee and management.

Audit risks Through our risk assessment process, we have identified the significant audit risks. These risks of material misstatement and related audit responses are discussed in the Audit risks section of this report. There have been no changes to the Audit risks from those reported to the Audit Committee in the Audit Plan.

Materiality We are responsible for providing reasonable assurance that your financial statements as a whole are free from material misstatement. Materiality levels are determined on the basis of budgeted expenses. Our materiality for the year ended March 31, 2020 was $3,700,000 (2019 -$3,700,000). We have informed The Audit Committee of all uncorrected misstatements greater than a clearly trivial amount of $185,000 and any misstatements that are, in our judgment, qualitatively material. In accordance with Canadian GAAS, we asked that any misstatements be corrected.

Audit fees We communicated our proposed audit fees in our audit plan. There have been no changes to our proposed fee.

Scope and terms of engagement Materiality Significant audit risks Audit fees

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Status and outstanding matters We expect to be in a position to render our audit opinion on the financial statements of the Hospital following approval of the financial statements by the Board of Directors and the completion of the following outstanding procedures:

Minor documentation items; and Receipt of signed management representation letter.

Uncorrected misstatements There were no misstatements identified in the current year.

Going concern Management has completed its assessment of the ability of the Hospital to continue as a going concern and in making its assessment did not identify any material uncertainties related to events or conditions that may cast significant doubt upon the Hospital's ability to continue as a going concern. We agree with management’s assessment.

Business Insights During the course of our audit, we examined the accounting procedures and internal controls employed by the Hospital.

Password security controls do not meet industry standards. Although the Hospital’s policy for password controls is sufficient, limitations of the Meditech system prevent successful implementation of the policy. A single sign-on authentication process is scheduled for implementation during the fiscal year ended March 31, 2021, which will address all of these limitations.

Uncorrected disclosure misstatements There are no uncorrected disclosure misstatements aggregated by us during the current engagement and pertaining to the latest period presented to report.

Status and outstanding

mattersGoing concern Business

insightsUncorrected

misstatementsUncorrected disclosure

misstatements

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Fraud risk A summary of the results of our audit procedures designed to address the risk of material misstatement in the financial statements relating to fraud is provided in the Significant audit risks section of this report. Based on the audit evidence obtained, our assessment of the risks of material misstatement due to fraud remain appropriate.

Independence We have developed appropriate safeguards and procedures to eliminate threats to our independence or to reduce them to an acceptable level. You have requested that we report all relationships and other relevant matters that, in our professional judgment, may reasonably be thought to bear on our independence and confirmed our independence to the Audit Committee for the year ended March 31, 2020 in Appendix 1.

Significant accounting practices, judgments and estimates The significant accounting practices, judgments and estimates include:

Useful lives of capital assets and the valuation of capital assets Estimates of accounts receivable collectability and allowance for doubtful accounts Revenue recognition Deferred revenue Payroll related accruals Estimation of employee future benefits

Our assessment of these items is included in the Significant accounting practices, judgments and estimates section of this report.

Conclusion In accordance with Canadian GAAS, our audit is designed to enable us to express an opinion on the fairness of the presentation of the Hospital's annual financial statements prepared in accordance with PSAS. No restrictions have been placed on the scope of our audit. In performing the audit, we were given full and complete access to the accounting records, supporting documentation and other information requested. We intend to issue an unmodified audit report on the financial statements of the Hospital for the year ended March 31, 2020 once the outstanding items referred to above are completed satisfactorily and the financial statements are approved by the Board of Directors.

Fraud riskSignificant accounting practices, judgments

and estimatesIndependence Conclusion

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Guelph General Hospital | Audit risks


Audit risks The audit risks identified as part of our risk assessment, together with our responses and conclusions, are described below.

MoHLTC/LHIN revenue recognition1

Audit risk Our audit response Audit results

Assurance standards include the presumption of a fraud risk involving improper revenue recognition. For Ontario hospitals, there is a risk around the completeness, validity and measurement of revenue, deferred revenue, and funding repayable to Ministry of Health and Long-term Care (MOHLTC) or Local Health Integration Network that is increasingly performance based. This significant risk also represents a fraud risk for the 2020 audit. Significant judgments and estimates

Estimates impacting the amounts recognized as revenue, deferred revenue, and/or funding repayable to Ministry of Health and Long-Term Care and/or the Local Health Integration Network may be based on estimated performance metrics where estimated achievement of performance may involve some uncertainty.

Evaluated design and implementation of key controls over completeness, validity and measurement of revenue. Issued confirmations of funding to the Ministry of Health and Cancer Care Ontario as well as other material externally restricted funding. Tested reconciliations of performance based revenue through review of agreements and testing of underlying data on performance. Tested the revenue recognition associated with one-time funding agreements. Performed a retrospective review of the actual outcome of prior year estimates and deferrals. Reviewed compliance with Accountability Agreement with the Local Health Integration Network. Tested amortization of deferred capital contributions

We concluded that the internal controls were designed and implemented appropriately. We obtained sufficient audit evidence to conclude that there were no material misstatements.

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Management override of controls1


Assurance standards include the presumption of a significant risk of management override of controls. 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. Significant judgments and estimates

Accounts receivable (allowance for doubtful accounts and estimated accrual amounts). Capital assets, MoHLTC receivables and payables, and deferred capital grants and contributions (recording and amortization). Accounts payable and accrued liabilities (estimated accrued amounts). Employee future benefits (actuarial assumptions).

Our audit tested the appropriateness of journal entries recorded in the general ledger and other adjustments made in the preparation of financial statements We obtained 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 Hospital and its environment We reviewed accounting estimates for bias and evaluated whether the circumstances producing the bias, if any, represent a risk of material misstatement Experienced Deloitte personnel were assigned to the testing and review of journal entries and areas of estimates, and Professional skepticism was maintained throughout the audit.

We obtained sufficient audit evidence to conclude that there were no material misstatements or evidence of fraud.

Employee future benefits


Risk relates to the completeness of employee future benefits liabilities and expenses as well as the use of appropriate assumptions and data for accounting estimates.

Evaluated the actuarial report including assumptions and data upon which estimates are based. Ensured financial statement disclosures are in accordance with PSAS. Tested the supporting assumptions and underlying data for estimates. Evaluated the outcome of the prior year estimates and accruals.

We obtained sufficient audit evidence to conclude that there were no material misstatements.

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Accounts payable and accrued liabilities


Risk relates to completeness of accounts payable and accrued liabilities due to cut-off and the use of assumptions in the determination of estimates.

Tested disbursements subsequent to year-end to determine the reasonableness of accounts payable and accrued liabilities. Tested the supporting assumptions and underlying data for accruals. Reviewed the outcome of prior year estimates and accruals.


Payroll


Risk relates to the accuracy of payroll expense.

Tested payroll and withholding accounts on a sample basis. Tested the conversion to the new scheduling system Kronos. Reviewed controls in place to support the conversion process. Tested the design and implementation of controls before and after the conversion.


Board and Senior Management expenses


Risk relates to the validity of Board and Management expense submissions, in light of heightened Board and public interest.

On a sample basis, tested expense reports for validity and proper approvals.


Contingencies


Risk relates to the completeness of the accounting and disclosure of contingencies.

Evaluated analysis prepared by management identifying any contingencies through review of board meetings, review of legal invoices and discussions with management. Confirmed with legal counsel. Reviewed financial statement disclosure.


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Guelph General Hospital | Significant accounting practices, judgments and estimates


Significant accounting practices, judgments and estimates The accounting policies described below are those that are most important to the portrayal of the Hospital’s financial condition and financial performance.

In the course of our audit of the financial statements, we considered the qualitative aspects of the financial reporting process, including items that have a significant impact on the relevance, reliability, comparability and understandability of the information included in the financial statements.

Changes in accounting policies and/or adoption of new accounting standards During the year ended March 31, 2020, there were no significant changes in previously adopted accounting policies or their application at the Hospital.

Significant accounting policies In our judgment, the significant accounting practices and policies, selected and applied by management are, in all material respects, acceptable under PSAS and are appropriate to the particular circumstances of the Hospital.

Management judgment and accounting estimates Accounting estimates are an integral part of the financial statements prepared by management and are based on management’s current judgments. These judgments are normally based on knowledge and experience about past and current events, assumptions about future events and interpretations of the financial reporting standards.

During the year ended March 31, 2020, management advised us that there were no significant changes in accounting estimates or in judgments relating to the application of the accounting policies.

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Guelph General Hospital | Other reportable matters


Other reportable matters The following summarizes the status and findings of key aspects of our audit. In the appendices to this report, we have provided additional information related to certain matters we committed to report to the Audit Committee as part of the audit plan.

Comment

Changes to the audit plan

The audit was conducted in accordance with our audit plan, which was communicated to The Audit Committee. We confirm that there have been no significant amendments to the audit scope and approach communicated in the audit plan.

COVID-19 considerations

On March 11, 2020, the World Health Organization characterized the outbreak of a strain of the novel corona virus (“COVID-19”) as a pandemic which has resulted in a series of public health and emergency measures that have been put into place to combat the spread of the virus. The duration and impact of the COVID-19 pandemic is unknown at this time and it is not possible to reliably estimate the impact that the severity and length of the pandemic will have on the financial results and condition of the Hospital in future periods.

To assess the impact these economic events may have on our audit, we performed the following procedures:

Enquiry of Hospital Management regarding the impact of recent economicconditions on their financial results or future financial results, such as:- Pandemic response expenditures incurred to March 31, 2020;- Pandemic response expenditures incurred to date in fiscal 2021;- Net financial impact of pandemic response expenditures and estimated

provincial funding;- Changes in demand for Hospital services to March 31, 2020; and- Anticipated changes in demand for Hospital services in fiscal 2021 and

beyond Considered the effect of recent events on our risk assessment and planned audit

procedures

Please refer to Note 17 in the financial statements for additional note disclosure relating to this event.

Significant difficulties encountered in performing the audit

We did not encounter any significant difficulties while performing the audit. There were no significant delays in receiving information from management required for the audit nor was there an unnecessarily brief timetable in which to complete the audit.

Related party transactions

Related party transactions are disclosed in Note 12 to the financial statements. We have not identified any related party transactions that were not in the normal course of operations and that involved significant judgments by management concerning measurement or disclosure.

Disagreements with management

In the course of our audit, we did not encounter any disagreements with management about matters that individually or in the aggregate could be significant to the financial statements.

Consultation with other accountants

Management has informed us that the Hospital has not consulted with other accountants about auditing or accounting matters.

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Guelph General Hospital | Other reportable matters


Comment

Legal and regulatory compliance

Our limited procedures did not identify any areas of material non-compliance with laws and regulations by the Hospital.

Post-balance sheet events

At the date of finalizing this report, we are not aware of any significant post balance sheet events.

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Guelph General Hospital | Appendix 1 – Independence


Appendix 1 – Independence

June 17, 2020

Private and confidential

Members of the Audit Committee Guelph General Hospital

Dear Audit Committee Members:

We have been engaged to audit the financial statements of Guelph General Hospital (the “Hospital”) for the year ending March 31, 2020.

You have requested that we communicate in writing with you regarding our compliance with relevant ethical requirements regarding independence as well as all relationships and other matters between the Hospital, our Firm and network firms that, in our professional judgment, may reasonably be thought to bear on our independence. You have also requested us to communicate the related safeguards that have been applied to eliminate identified threats to independence or reduce them to an acceptable level.

We have considered relevant rules and related interpretations prescribed by the appropriate provincial institute / ordre and applicable legislation, covering such matters as:

(a) holding a financial interest, either directly or indirectly, in a client;(b) holding a position, either directly or indirectly, that gives the right or responsibility to exert significant

influence over the financial or accounting policies of a client;(c) personal or business relationships of immediate family, close relatives, partners or retired partners,

either directly or indirectly, with a client;(d) economic dependence on a client; and(e) provision of services in addition to the audit engagement.

We confirm to you that the engagement team and others in the firm as appropriate, the firm and, when applicable, network firms have complied with relevant ethical requirements regarding independence.

We have prepared the following comments to facilitate our discussion with you regarding independence matters arising since May 23, 2019, the date of our last letter.

We are not aware of any relationships between the Hospital and our Firm, including any network firms that, in our professional judgment, may reasonably be thought to bear on independence, that have occurred from May 23, 2019 to June 17, 2020.

We hereby confirm that we are independent with respect to the Hospital within the meaning of the Rules of Professional Conduct of the Chartered Professional Accountants of Ontario as of June 17, 2020.

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Guelph General Hospital | Appendix 1 – Independence


This report is intended solely for the use of the Audit Committee, the Board of Directors, management, and others within the Hospital and should not be used for any other purposes.

We look forward to discussing with you the matters addressed in this letter at our upcoming meeting.

Yours very truly,

Chartered Professional Accountants Licensed Public Accountants

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Guelph General Hospital | Appendix 2 – Draft management representation letter


Appendix 2 – Draft management representation letter

June 23, 2020 Deloitte LLP 195 Joseph Street Kitchener ON N2G 1J6 Dear Sirs: Subject: Financial statements of Guelph General Hospital (the “Hospital”) for the year ended

March 31, 2020 This representation letter is provided in connection with the audit by Deloitte LLP (“Deloitte” or “you”) of the financial statements of Guelph General Hospital (the “Hospital” or “we” or “us”) for the year ended March 31, 2020, and a summary of significant accounting policies and other explanatory information (the “Financial Statements”) for the purpose of expressing an opinion as to whether the Financial Statements present fairly, in all material respects, the financial position, results of operations, and cash flows of the Hospital in accordance with Public Sector Accounting Standards (“PSAS”). We confirm that, to the best of our knowledge and belief, having made such inquiries as we considered necessary for the purpose of appropriately informing ourselves: Financial statements 1. We have fulfilled our responsibilities as set out in the terms of the engagement letter between the

Hospital and Deloitte dated November 21, 2019 for the preparation of the Financial Statements in accordance with PSAS. In particular, the Financial Statements are fairly presented, in all material respects, and present the financial position of the Hospital as at March 31, 2020 and the results of its operations, change in its net assets and cash flows for the year then ended in accordance with PSAS.

2. Significant assumptions used in making estimates, including those measured at fair value, are reasonable.

In preparing the Financial Statements in accordance with PSAS, management makes judgments and assumptions about the future and uses estimates. The completeness and appropriateness of the disclosures related to estimates are in accordance with PSAS. The Hospital has appropriately disclosed in the Financial Statements the nature of measurement uncertainties that are material, including all estimates where it is reasonably possible that the estimate will change in the near term and the effect of the change could be material to the Financial Statements.

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The measurement methods, including the related assumptions and models, used in determining the estimates, including fair value, were appropriate, reasonable and consistently applied in accordance with PSAS and appropriately reflect management's intent and ability to carry out specific courses of action on behalf of the entity. No events have occurred subsequent to March 31, 2020 that require adjustment to the estimates and disclosures included in the Financial Statements. There are no changes in management’s method of determining significant estimates in the current year.

3. The Organization has identified all related parties in accordance with Section PS 2200, Related Party Disclosures (“PS 2200”). Management has made the appropriate disclosures with respect to its related party transactions in accordance with PS 2200.

4. We have determined that the Financial Statements are complete as of June 23, 2020 as this is the date when there are no changes to the Financial Statements (including disclosures) planned or expected; all final adjusting journal entries have been reflected in the Financial Statements and the Financial Statements have been approved in accordance with our process to finalize financial statements.

5. We have completed our review of events after March 31, 2020 and up to the date of this letter. All events subsequent to the date of the Financial Statements and for which PSAS requires adjustment or disclosure have been adjusted or disclosed. Accounting estimates and disclosures included in the Financial Statements that are impacted by subsequent events have been appropriately adjusted.

6. The Financial Statements are free of material errors and omissions.

Internal Controls 7. We acknowledge our responsibility for the design, implementation and maintenance of internal control to

prevent and detect fraud and error.

8. We have disclosed to you all known deficiencies in the design or operation of internal control over financial reporting identified as part of our evaluation, including separately disclosing to you all such deficiencies that we believe to be significant deficiencies in internal control over financial reporting.

Information provided 9. We have provided you with:

a. Access to all information of which we are aware that is relevant to the preparation of the Financial Statements, such as records, documentation and other matters. All financial statements and other financial information provided to you accurately reflect the activities and expenses of the Hospital and do not reflect any activities or expenses of any other person or entity;

b. All relevant information as well as additional information that you have requested from us for the purpose of the audit;

c. Unrestricted access to persons within the entity from whom you determined it necessary to obtain audit evidence; and,

d. All minutes of the meetings of directors and committees of directors, or summaries of actions of recent meetings for which minutes have not yet been prepared. All significant board and committee actions are included in the summaries.

Except where otherwise stated below, immaterial matters less than $185,000 collectively are not considered to be exceptions that require disclosure for the purpose of the following representations. This amount is not necessarily indicative of amounts that would require adjustment to or disclosure in the Financial Statements.

10. All transactions have been properly recorded in the accounting records and are reflected in the Financial Statements.

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11. We have disclosed to you the results of our assessment of the risk that the Financial Statements may be materially misstated as a result of fraud.

12. We have no knowledge of any information in relation to fraud or suspected fraud that we are aware of

and that affects the entity and involves:

a. Management; b. Employees who have significant roles in internal control; or c. Others where the fraud could have a material effect on the Financial Statements.

13. We have no knowledge of any information in relation to allegations of actual, suspected or alleged fraud,

or illegal or suspected illegal acts affecting the Hospital.

14. We have disclosed to you all communications from regulatory agencies concerning non-compliance with or deficiencies in financial reporting practices and all known instances of non-compliance or suspected non-compliance with laws and regulations whose effects should be considered when preparing the Financial Statements.

15. We have disclosed to you the identity of the entity’s related parties and all the related party relationships and transactions of which we are aware, including guarantees, non-monetary transactions and transactions for no consideration and participation in a defined benefit plan that shares risks between group entities.

16. We have disclosed to you all known, actual or possible litigation and claims, whether or not they have been discussed with our lawyers, whose effects should be considered when preparing the Financial Statements. As appropriate, these items have been disclosed and accounted for in the Financial Statements in accordance with PSAS.

Independence matters For purposes of the following paragraphs, “Deloitte” shall mean Deloitte LLP and Deloitte Touche Tohmatsu Limited, including related member firms and affiliates.

17. Prior to the Hospital having any substantive employment conversations with a former or current Deloitte engagement team member, the Hospital has held discussions with Deloitte and obtained approval from the Finance and Audit Committee.

18. We have ensured that all non-audit services provided to the Organization have been pre-approved by the Finance and Audit Committee. Further, we have adhered to all regulatory requirements regarding the provision of non-audit services by Deloitte to the Organization in accordance with applicable laws, regulations and rules that apply to the Organization, including the Audit Committee approval requirements.

19. We have ensured that all services performed by Deloitte with respect to this engagement have been pre-approved by the Finance and Audit Committee in accordance with its established approval policies and procedures.

Other matters 20. The Hospital has satisfactory title to and control over all assets, and there are no liens or encumbrances

on such assets. We have disclosed to you and in the Financial Statements all assets that have been pledged as collateral.

21. We have disclosed to you all liabilities, provisions, contingent liabilities and contingent assets, including those associated with guarantees, whether written or oral, and they are appropriately reflected in the Financial Statements.

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22. We have disclosed to you, and the Hospital has complied with all aspects of contractual agreements that could have a material effect on the Financial Statements in the event of non-compliance, including all covenants, conditions or other requirements of all outstanding debt.

23. The following have been properly recorded and, when appropriate, adequately disclosed and presented in the Financial Statements:

a. losses arising from sale and purchase commitments; b. agreements to buy back assets previously sold; c. provisions for future removal and site restoration costs; d. financial instruments with significant individual or group concentration of credit risk, and related

maximum credit risk exposure; e. arrangements with financial institutions involving compensating balances or other arrangements

involving restriction on cash balances and line-of-credit or similar arrangements; f. all impaired loans receivable; and g. loans that have been restructured to provide a reduction or deferral of interest or principal payments

because of borrower financial difficulties.

24. We have disclosed to you all the documents that we expect to issue that may comprise other information, in the context of CAS 720, The Auditor's Responsibilities Relating to Other Information in Documents Containing Audited Financial Statements.

Plans or intentions affecting carrying value/classification of assets and liabilities 25. We have disclosed to you all plans or intentions that may materially affect the carrying value or

classification of assets and liabilities reflected in the Financial Statements.

Environmental liabilities/contingencies 26. We have considered the effect of environmental matters on the Hospital and have disclosed to you all

liabilities, provisions or contingencies arising from environmental matters. All liabilities, provisions, contingencies and commitments arising from environmental matters, and the effect of environmental matters on the carrying values of the relevant assets are recognized, measured and disclosed, as appropriate, in the Financial Statements.

Liabilities for contaminated sites 27. We have evaluated all of our properties that we own or accept responsibility, and have not identified any

sites in which contamination exceeds an environmental standard.

Loans and receivables 28. The Hospital is responsible for determining and maintaining the adequacy of the allowance for doubtful

notes, loans, and accounts receivable, as well as estimates used to determine such amounts. Management believes the allowance is adequate to absorb currently estimated bad debts in the account balance.

Inventories 29. Provision has been made to reduce inventories to estimated net realizable value when that amount is

lower than cost. All reversals of write-down of inventories, arising from an increase in net realizable value, have been recognized as a reduction in the amount of inventories recognized as an expense in the period in which the reversal occurred. All inventories are the property of the Hospital and do not include any items consigned to it, any items billed to customers, or any items for which the liability has not been recorded.

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Employee future benefits 30. Employee future benefit costs, assets, and obligations, as applicable, have been properly recorded and

adequately disclosed in the Financial Statements including those arising under termination arrangements. We believe that the actuarial assumptions and methods used to measure defined benefit plan assets, liabilities and costs for financial statement purposes are appropriate in the circumstances.

31. We have disclosed to you any intentions of terminating any of our pension plans or withdrawing from the multi-employer plan that could result in an effective termination or reportable event for any of the plans. We have disclosed to you any occurrences that could result in the termination of any of our pension or multi-employer plans to which we contribute.

32. We are unable to determine the possibility of a withdrawal liability in a multi-employer benefit plan.

33. We do not plan to make frequent amendments to our pension or other postretirement benefit plans.

Deferred revenue 34. Management believes that all revenues deferred to future periods appropriately reflect the best estimate

of services to be performed in future periods for cash collected prior to March 31, 2020, and available for use in future periods.

Revenues 35. Management believes that all revenues recognized during the year have been earned and reflect the best

estimate of services performed in the current year.

Tangible capital assets 36. We have assessed the useful lives of tangible capital assets and have determined all tangible capital

assets to have a long term service potential to the Hospital and therefore do not require a write down.

Controlled and related entities 37. The Hospital has properly recorded and disclosed in the Financial Statements controlled and related

entities. Investments 38. The Hospital does not hold any investments in Master Asset Vehicle notes (which replaced third party

non-bank asset-backed commercial paper).

Due to the Ministry of Health and Long-Term Care and the Central Local Health Integration Network 39. Funds received from the Ministry of Health and Long-Term Care and the Central Local Health Integration

Network for which revenue recognition has been deferred to a future period represents funding where criteria for revenue recognition has not been completely achieved.

Yours very truly, Guelph General Hospital Marianne Walker President and CEO Gavin Webb Vice President CFO/CIO

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Guelph General Hospital | Appendix 3 – Communication requirements


Appendix 3 – Communication requirements Required communication Reference Refer to this report or document

described below

Audit Service Plan

1. Our responsibilities under Canadian GAAS, including forming and expressing an opinion on the financial statements

CAS1 260.14 Engagement letter

2. An overview of the overall audit strategy CAS 260.15 Audit plan communicated on November 21, 2019

Year End Communication

3. Significant accounting policies, practices, unusual transactions, and our related conclusions

CAS 260.16 a. Significant Accounting practices, judgments and estimates

4. Alternative treatments for accounting policies and practices that have been discussed with management during the current audit period


5. Management judgments and accounting estimates


6. Significant difficulties, if any, encountered during the audit

CAS 260.16 b. No significant difficulties to report.

7. Material written communications between management and us, including management representation letters

CAS 260.16 c. Management representation letter

8. Other matters that are significant to the oversight of the financial reporting process

CAS 260.16d. No other matters to report.

9. Modifications to our opinion(s) CAS 260.A18 We will issue an unmodified opinion.

10. Our views of significant accounting or auditing matters for which management consulted with other accountants and about which we have concerns

CAS 260.A19 No matters to report

11. Significant matters discussed with management

CAS 260.A.19 No matters to report

12. Illegal or possibly illegal acts that come to our attention

CAS 250.23 We are not aware of any illegal acts.

13. Significant deficiencies in internal control, if any, identified by us in the conduct of the audit of the financial statements

CAS 265 No deficiencies to report.

1 CAS: Canadian Auditing Standards – CAS are issued by the Auditing and Assurance Standards Board of CPA Canada

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Guelph General Hospital | Appendix 3 – Communication requirements


Required communication Reference Refer to this report or document described below

Year End Communication

14. Uncorrected misstatements and disclosure items

CAS 450.12-13 In accordance with Canadian GAAS, we request that all misstatements be corrected. No uncorrected misstatements and uncorrected disclosure items to report.

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Guelph General Hospital | Appendix 4 – Deloitte resources a click away


Appendix 4 – Deloitte resources a click away At Deloitte, we are devoted to excellence in the provision of professional services and advice, always focused on client service. We have developed a series of resources, which contain relevant and timely information.

Centre for Corporate Governance (www.corpgov.deloitte.ca)

Directors CEO/CFO Controllers

The Centre for Corporate Governance is designed to provide members of Boards and audit commitees with a single point of access to current developments, Deloitte perspectives, learning material, best practices, reference materials and other useful information related to corporate governance.

Centre for financial reporting (www.cfr.deloitte.ca)

Directors CEO/CFO Controller Financial reporting team

Web site designed by Deloitte to provide the most comprehensive information on the web about financial reporting frameworks used in Canada.

Financial Reporting Insights (www.iasplus.com/fri)

CFO Controller Financial reporting team

Monthly electronic communications that helps you to stay on top of standard-setting initiatives impacting financial reporting in Canada.

On the board's agenda Directors CEO/CFO

Bi-monthly publication examining a key topic in detail, including the perspectives of a Deloitte professional with deep expertise in the subject matter as well as the views of an experienced external director.

State of change (www.iasplus.com/StateOfChange)

CFO VP Finance Controller Financial reporting team

Bi-monthly newsletter providing insights into key trends, developments, issues and challenges facing the not-for-profit sector in Canada, with a Deloitte point of view.

Deloitte Financial Reporting Update (www.deloitte.com/ca/update)


Learning webcasts offered throughout the year featuring our professionals discussing critical issues that affect your business.

COVID-19 (https://www2.deloitte.com/ca/en/pages/about-deloitte/topics/combating-covid-19-with-resilience.html)


COVID-19 resources.

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Financial statements of Guelph General Hospital

March 31, 2020

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Independent Auditor’s Report 1-2

Statement of financial position 3

Statement of operations 4

Statement of change in net assets 5

Statement of cash flows 6

Notes to the financial statements 7–14

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Independent Auditor’s Report

To the Chair and Members of the Board of Directors of Guelph General Hospital

Opinion We have audited the financial statements of Guelph General Hospital (the “Hospital”), which comprise the statement of financial position as at March 31, 2020, and the statements of operations, change in net assets and cash flows for the year then ended, and notes to the financial statements, including a summary of significant accounting policies (collectively referred to as the “financial statements”).

In our opinion, the accompanying financial statements present fairly, in all material respects, the financial position of the Hospital as at March 31, 2020, and the results of its operations, change in net assets, and its cash flows for the year then ended in accordance with Canadian public sector accounting standards (“PSAS”).

Basis for Opinion We conducted our audit in accordance with Canadian generally accepted auditing standards (“Canadian GAAS”). Our responsibilities under those standards are further described in the Auditor’s Responsibilities for the Audit of the Financial Statements section of our report. We are independent of the Hospital in accordance with the ethical requirements that are relevant to our audit of the financial statements in Canada, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Responsibilities of Management and Those Charged with Governance for the Financial Statements Management is responsible for the preparation and fair presentation of the financial statements in accordance with PSAS, and for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, management is responsible for assessing the Hospital’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless management either intends to liquidate the Hospital or to cease operations, or has no realistic alternative but to do so.

Those charged with governance are responsible for overseeing the Hospital’s financial reporting process.

Auditor’s Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with Canadian GAAS will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Deloitte LLP 195 Joseph Street Kitchener ON N2G 1J6 Canada Tel: 519-650-7600 Fax: 519-650-7601 www.deloitte.ca

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As part of an audit in accordance with Canadian GAAS, we exercise professional judgment and maintain professional skepticism throughout the audit. We also:

• Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

• Obtain an understanding of internal control relevant to the audit 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 Hospital’s internal control.

• Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management.

• Conclude on the appropriateness of management’s use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Hospital’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Hospital to cease to continue as a going concern.

• Evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation.

We communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit.

Chartered Professional Accountants Licensed Public Accountants [DATE]

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Guelph General HospitalStatement of financial positionAs at March 31, 2020

2020 2019Notes $ $

AssetsCurrent assets

Cash 6,649,675 6,929,189 Short term investments 2,095,891 2,054,417 Accounts receivable 3 6,006,571 5,584,123 Inventories 1,344,984 1,151,960 Prepaid expenses and deposits 2,043,021 1,663,870

18,140,142 17,383,559

Capital assets 4 67,354,004 69,460,982 85,494,146 86,844,541

LiabilitiesCurrent liabilities

Accounts payable and accrued liabilities 5 25,488,210 24,466,088 Current portion of long-term debt 6 458,342 500,000

25,946,552 24,966,088 Long-term debt 6 229,173 687,515 Deferred capital donations 7 6,953,309 6,925,557 Deferred capital grants 8 44,121,221 45,196,503 Employee future benefits 9 6,319,400 6,080,400

83,569,655 83,856,063

Contingent liabilities 14

Commitments 15

Net assets 1,924,491 2,988,478 85,494,146 86,844,541

The accompanying notes are an integral part of the financial statements.

Approved by the Board

___________________________________ Director

___________________________________ Director

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Guelph General HospitalStatement of operationsYear ended March 31, 2020

2020 2019$ $

RevenueMinistry of Health and Long-Term Care operating

funding 125,199,644 121,124,361 Patient revenue from other payment sources 18,239,611 17,289,025 Differential and copayment revenue 2,225,032 2,245,275 Recoveries and miscellaneous revenue 10,492,134 10,412,143 Amortization of deferred grants and donations –

equipment 2,514,630 2,344,741 Amortization of deferred grants and donations –

buildings 2,287,364 2,223,399 160,958,415 155,638,944

ExpensesSalaries and wages 73,708,120 71,679,329

Employee benefits 22,064,407 21,951,661 Medical staff remuneration 23,461,058 22,758,652 Medical/surgical supplies 10,404,570 10,149,428 Drugs and medical gases 5,327,609 5,170,014 Supplies and other expense 19,152,470 19,134,228 Amortization of equipment 4,924,913 4,147,542 Amortization of buildings 2,979,255 2,965,263

162,022,402 157,956,117

Excess of expenses over revenue (1,063,987) (2,317,173)


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Guelph General HospitalStatement of change in net assetsYear ended March 31, 2020

2020 2019Invested in Invested in

capital assets capital assets(Note 10) Unrestricted Total (Note 10) Unrestricted Total

$ $ $ $ $ $

Net assets, beginning of year 17,338,922 (14,350,444) 2,988,478 16,297,770 (10,992,119) 5,305,651 Excess of revenue over

expenses before amortization — 2,038,187 2,038,187 — 227,492 227,492 Amortization of equipment (4,924,913) — (4,924,913) (4,147,542) — (4,147,542) Amortization of buildings (2,979,255) — (2,979,255) (2,965,263) — (2,965,263) Amortization of deferred grants

and donations - equipment 2,514,630 — 2,514,630 2,344,741 — 2,344,741 Amortization of deferred grants — —

and donations - buildings 2,287,364 2,287,364 2,223,399 — 2,223,399 14,236,748 (12,312,257) 1,924,491 13,753,105 (10,764,627) 2,988,478

Purchase of capital assets, net ofdisposals 5,797,190 (5,797,190) — 6,644,632 (6,644,632) —

Amounts funded from deferredcontributions and restricted funds (3,754,464) 3,754,464 — (3,058,815) 3,058,815 —

Net assets, end of year 16,279,474 (14,354,983) 1,924,491 17,338,922 (14,350,444) 2,988,478


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Guelph General HospitalStatement of cash flowsYear ended March 31, 2020

2020 2019Notes $ $

Operating activitiesExcess of expenses over revenue (1,063,987) (2,317,173) Items not affecting cash

Amortization of capital assets 7,904,168 7,112,805 Amortization of deferred capital grants

and donations (4,801,994) (4,568,140) Changes in non-cash operating working

capital items 11 1,585,630 408,735 Change in employee future benefits 9 239,000 267,200

3,862,817 903,427

Investing activitiesAcquisition of capital assets (7,355,321) (4,862,304) Acquisition of investment (41,474) (40,682)

(7,396,795) (4,902,986)

Financing activitiesLong-term debt repayments (500,000) (500,000) Deferred capital donations received 7 2,228,679 2,612,676 Deferred capital grants received 8 1,525,785 446,139

3,254,464 2,558,815

Change in cash (279,514) (1,440,744) Cash, beginning of year 6,929,189 8,369,933 Cash, end of year 6,649,675 6,929,189


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Guelph General Hospital Notes to the financial statements March 31, 2020

Page 7

1. Purpose of the organization

Guelph General Hospital (the “Hospital”) is a comprehensive acute care facility providing a full range of services to the residents of Guelph and Wellington County. The Hospital is incorporated without share capital under the Corporations Act (Ontario) and is a registered charity under the Income Tax Act (Canada) and accordingly is exempt from income taxes, provided certain requirements of the Income Tax Act are met. The Hospital is located at 115 Delhi Street, Guelph, Ontario, Canada.

Under the Health Insurance Act and the regulations thereto, the Hospital is funded primarily by the Province of Ontario in accordance with budget arrangements established by the Waterloo Wellington Local Health Integration Network (“WWLHIN”) and the Ministry of Health & Long-Term Care (“MOHLTC”).

2. Significant accounting policies

The financial statements have been prepared by management in accordance with Canadian public sector accounting standards for government not-for-profit organizations including the 4200 series of standards, as issued by the Public Sector Accounting Board and reflect the following significant accounting policies:

Revenue recognition

Under the Health Insurance Act and Regulations thereto, the Hospital is primarily funded by the Province of Ontario. Operating grants are recorded as revenue in the year to which they relate.

To the extent which MOHLTC funding has been received with the stipulated requirement that the Hospital provides specific services, and these services have not yet been provided, the funding is deferred until such time as the services are performed and the monies spent. In the event that the services are not performed in accordance with the funding requirements, the funds received in excess of monies spent could be recovered by the MOHLTC.

Operating contributions are recognized as revenue when received or receivable if the amount to be received can be reasonably estimated and collection is reasonably assured. Capital contributions externally restricted for the purchase of capital assets are deferred and amortized into revenue on a straight-line basis at a rate corresponding with the amortization rate of the related capital assets.

Revenue from other agencies, patients, special programs and other sources is recognized when the service is provided.

Classification of financial instruments

All financial instruments reported on the statement of financial position of the Hospital are measured as follows:

Cash Amortized cost Short-term investments Amortized cost Accounts receivable Amortized cost Accounts payable and accrued liabilities Amortized cost Long-term debt Amortized cost

The Hospital initially recognizes financial instruments at fair value and subsequently measures them at amortized cost using the effective interest rate method, less any impairment losses. Transaction costs are added to the carrying value of the instrument.

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Page 8

2. Significant accounting policies (continued)

Inventories

Inventories are valued at the lower of average cost and replacement cost, with cost being determined on a first-in, first-out basis.

Capital assets

Capital assets are recorded at acquisition cost. Amortization is provided on a straight-line basis and is based on the estimated useful service lives of the assets as follows:

Buildings 20-50 years

Equipment 3-20 years

Upon completion, costs in capital projects work-in-progress are reclassified to the appropriate capital asset amount and amortization is commenced when the asset is operational.

Impairment of long-lived assets

Long-lived assets such as buildings and equipment are tested for recoverability whenever events or changes in circumstances indicate that their carrying amount may not be recoverable. When a capital asset no longer has any long-term service potential to the Hospital, the excess of its net carrying amount over any residual value is recognized as an expense in the statement of operations. When a capital asset’s carrying amount is written down, a corresponding amount of any unamortized deferred contributions related to the capital asset is recognized as revenue, provided that all restrictions have been complied with.

Employee future benefits

The Hospital accrues its obligations for employee benefit plans. The cost of non-pension postretirement and post-employment benefits earned by employees is actuarially determined using the projected benefit method prorated on service and management’s best estimate of retirement ages of employees and expected health care costs.

Adjustments arising from plan amendments are recognized in the year that the plan amendments occur. Actuarial gains or losses are amortized over the average remaining service period of the active employees.

The Hospital accrues its obligations under employee defined benefit dental and health care plans, and the related costs as the employees render the services necessary to earn the future benefits as described in Note 9.

The Hospital is an employer member of the Healthcare of Ontario Pension Plan, which is a multi employer, defined benefit pension plan. As recommended by Public Sector Accounting Standards, the Hospital has adopted defined contribution plan accounting principles for this Plan because insufficient information is available to apply defined benefit plan accounting principles.

Vacation pay

Vacation pay is accrued for employees as entitlement to these payments is earned and is drawn down as entitlements are used.

Accumulated sick leave credits

Certain employees have accumulated sick leave credits and are entitled to receive special payments upon separation or retirement. These amounts are included in accounts payable and accrued liabilities. Payments are charged to the liability.

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Page 9

2. Significant accounting policies (continued)

Deferred capital grants

Capital grants received by the Hospital are deferred and amortized on a straight-line basis at a rate corresponding with the amortization rate for the related assets purchased.

Deferred capital donations

Donations received by the Hospital for capital purchases are deferred and amortized on a straight-line basis at a rate corresponding with the amortization rate for the related assets purchased.

Use of estimates

The preparation of financial statements in accordance with Canadian public sector accounting standards for government not-for-profit organizations requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements, and the reported amounts of revenue and expenses during the reporting period. Significant areas requiring the use of management estimates include the determination of the useful lives of capital assets and the valuation of capital assets, estimates of accounts receivable collectability and allowance for doubtful accounts, accrued liabilities, revenue recognition, deferred revenue and the estimation of future employee benefits. Actual results could differ from management’s best estimates as additional information becomes available in the future. These estimates and assumptions are reviewed periodically and as adjustments become necessary they are reported in earnings in the periods in which they are known.

The revenue recognized from the MOHLTC and the WWLHIN requires some estimation. The Hospital has entered into accountability agreements that set out the rights and obligations of the parties in respect of funding provided to the Hospital by the MOHLTC and WWLHIN for the years ended March 31, 2020 and 2019. The accountability agreements set out certain performance standards and obligations that establish acceptable results for the Hospital’s performance in a number of areas.

If the Hospital does not meet its performance standards or obligations, the MOHLTC and the WWLHIN have the right to adjust funding received by the Hospital. Neither the MOHLTC nor WWLHIN are required to communicate certain funding adjustments until after submission of year end data. Since this data is not submitted until after the completion of the financial statements, the amount of the MOHLTC/WWLHIN funding received during a year may be increased or decreased subsequent to year end. The amount of revenue recognized in these financial statements represents management’s best estimates of amounts that have been earned during the year.

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3. Accounts receivable 2020 2019

$ $

Ontario Ministry of Health and Long-Term Care 494,730 431,745 Cancer Care Ontario 216,192 322,993 Insurers and patients 3,409,203 3,318,700 The Foundation of the Guelph General Hospital 172,642 114,930 Non-patients 1,244,568 747,202 HST 415,487 512,902 Other 730,068 635,167

6,682,890 6,083,639 Provision for uncollectible accounts (676,319) (499,516)

6,006,571 5,584,123

4. Capital assets 2020 2019

Accumulated Net book Net bookCost amortization value value

$ $ $ $

Land 1 — 1 1 Buildings 101,913,610 49,498,990 52,414,620 54,445,485 Equipment 88,871,800 74,194,654 14,677,146 14,412,070

190,785,411 123,693,644 67,091,767 68,857,556 Capital projects

Work-in-progress 262,237 — 262,237 603,426 191,047,648 123,693,644 67,354,004 69,460,982

Additions to capital assets included in accounts payable and accrued liabilities at year-end are $224,107 (2019 - $1,782,328).

5. Accounts payable and accrued liabilities

2020 2019$ $

Accrued salaries and benefits 11,025,601 10,518,462 Accounts payable and other accrued liabilities 10,050,139 10,645,275 Deferred revenue 4,412,470 3,302,351

25,488,210 24,466,088

6. Bank indebtedness

The Hospital has negotiated financing with its bank that provides a demand operating line of credit of $7,000,000 with an interest rate to be calculated at the Prime Rate minus 0.75% per annum. At March 31, 2020 the Hospital was not utilizing the demand operating line of credit.

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6. Bank indebtedness (continued)

The Hospital has negotiated financing with its bank for two unsecured term loans of $1,500,000 each with interest rates to be calculated at the Prime Rate minus 0.6% per annum or the BA rate (1.23% at March 31, 2020) plus 0.65%. Interest expense on long-term debt of $25,076 (2019 - $36,702) was incurred during the year. The expected principal repayments on the long-term debt for the next two years are as follows:

$

2021 458,342 2022 229,173

687,515

7. Deferred capital donations 2020 2019

$ $

Balance, beginning of year 6,925,557 6,214,378 Donation received 2,228,679 2,612,676

Less: amortization (2,200,927) (1,901,497) Balance, end of year 6,953,309 6,925,557

8. Deferred capital grants

2020 2019$ $

Balance, beginning of year 45,196,503 47,417,007 Capital grants received 1,525,785 446,139

Less: amortization (2,601,067) (2,666,643) Balance, end of year 44,121,221 45,196,503

9. Employee future benefits

The Hospital has an unfunded defined benefit dental and health care plan providing the majority of its employees and retirees with post-retirement benefits. The most recent actuarial valuation for the Hospital was performed March 31, 2019.

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9. Employee future benefits (continued)

At March 31, the Hospital’s liability associated with the benefit plan is as follows:

2020 2019$ $

Accrued benefit obligation 5,881,200 5,917,700 Unamortized actuarial gains 438,200 162,700

Employee future benefit liability 6,319,400 6,080,400

The significant actuarial assumptions adopted in estimating the Hospital’s accrued benefit obligation are as follows:

2020 2019$ $

Discount rate to determine net benefit cost 2.90% 3.20%

Dental cost trend rates 3.00% 3.00%Extended healthcare trend rates 5.25% 5.25%Long-term general inflation rate 2.00% 2.00%

Expected average remaining service life of employees 13 years 13 years

The dental cost and extended healthcare trend rates assume a constant trend rate until 2023, after which both trend rates change to reach a rate of 4.75% in 2029.

Included in the statement of operations is an amount of $239,000 (2019 - $267,200) regarding employee future benefits. This amount is comprised of:

2020 2019$ $

Current service costs 308,300 307,600 Amortization of actuarial losses 43,400 79,400 Post-retirement benefit interest expense 176,400 203,000 Expected benefits payment (289,100) (322,800)

239,000 267,200

10. Net assets invested in capital assets

2020 2019$ $

Capital assets (Note 4) 67,354,004 69,460,982 Less amounts financed by

Deferred capital donations (Note 7) (6,953,309) (6,925,557) Deferred capital grants (Note 8) (44,121,221) (45,196,503)

16,279,474 17,338,922

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11. Changes in non-cash operating working capital items

2020 2019$ $

Change in assets Accounts receivable (422,448) (534,945) Inventories (193,024) (6,339) Prepaid expenses and deposits (379,151) (138,980)

(994,623) (680,264) Change in liabilities

Accounts payable and accrued liabilities 2,580,253 1,088,999 1,585,630 408,735

12. Related party transactions

The Foundation of Guelph General Hospital (the “Foundation”), an independent organization,raises funds and holds resources for the benefit of the Hospital. The amounts received from theFoundation include both donor restricted and unrestricted funds for capital purposes and minorequipment. The Foundation donated $2,278,767 (2019 - $2,699,886) during the year;$2,228,679 for capital (2019 - $2,612,676) and the remaining for operations. In addition, anamount of $172,642 (2019 - $171,202) due from the Foundation is included in accountsreceivable.

13. Pension plan

Substantially all of the employees of the Hospital are eligible to be members of the Healthcareof Ontario Pension Plan, which is a multi-employer final average pay contributory pension plan.Employer contributions made to the plan during the year by the Hospital amounted to$6,281,770 (2019 - $6,105,152). These amounts are included in employee benefits expense inthe statement of operations.

14. Contingent liabilities

(a) Due to the nature of its operations, the Hospital is periodically subject to lawsuits in whichthe Hospital is a defendant, as well as grievances filed by its various unions. In the opinionof management, there are no current lawsuits and/or grievances where the ultimateresolution will have a material effect on the Hospital’s financial position or results ofoperations.

(b) The Hospital participates in the Healthcare Insurance Reciprocal of Canada (“HIROC”), aregistered Reciprocal pursuant to provincial Insurance Acts which permit persons toexchange with other persons reciprocal contracts of indemnity insurance. HIROC facilitatesthe provision of liability insurance coverage to health care organizations in the provinces ofOntario, Manitoba, Saskatchewan and Newfoundland. Subscribers pay annual premiums,which are actuarially determined, and are subject to assessment for losses in excess ofsuch premiums, if any, experienced by the group of subscribers for the years in which theywere a subscriber. No such assessments have been made to March 31, 2020.

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15. Commitments

To reduce the Hospital’s exposure to fluctuations in the price paid for electricity and natural gas,the Hospital enters into contracts to purchase electricity and natural gas at fixed prices. Therewere no such contracts outstanding at March 31, 2020.

16. Financial instruments and risk management

The Hospital manages its exposure to the risks associated with financial instruments that havethe potential to affect its operating and financial performance in accordance with its RiskManagement Policy. The objective of the policy is to reduce the volatility in cash flow andearnings. The Board of Directors monitors compliance with the risk management policies andreviews risk management policies and procedures on an annual basis.

Credit risk

Credit risk relates to the potential that one party to a financial instrument will fail to discharge an obligation and incur a financial loss. The Hospital is exposed to credit risk through its collection of patient receivables. The Hospital is not exposed to a concentration of credit from its accounts receivable due to the number and diversity of patient accounts.

Interest rate risk

The long-term debt bears interest at a variable rate and as such is subject to fluctuations in interest rates.

17. Pandemic Response

On March 11, 2020, the World Health Organization characterized the outbreak of a strain of thenovel corona virus (“COVID-19”) as a pandemic which has resulted in a series of public healthand emergency measures that have been put into place to combat the spread of the virus.

As a result of the COVID-19 pandemic, the Hospital experienced a change in the demand for itsservices and incurred unbudgeted pandemic response expenditures. The Hospital has trackedexpenditures related to its pandemic response and will apply for reimbursement of hospital-incurred expenditures once Provincial processes for such reimbursement are finalized. Anyrecoveries that may be received in the future will be recognized in the period in which approvalis obtained.

The duration and impact of the COVID-19 pandemic is unknown at this time and it is notpossible to reliably estimate the impact that the severity and length of the pandemic will haveon the financial results and condition of the Hospital in future periods.

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Item 7a

REPORT OF THE NOMINATING COMMITTEE BOARD OF DIRECTORS ANNUAL MEETING

June 23, 2020 FOR ACTION It is recommended the Board of Directors approves the following re-appointments for a three-year term ending in June 2023: Sara Sayyad Kathy Wilkie Dale Mills Liz Sandals It is recommended that the Board of Directors approves the following appointment for one-year term ending in June 2021: Dr. Ken McKenzie In light of the pandemic, a replacement for Brian Cowan will be recruited in the fall. Advanced skills in system integration and board governance will be the focus. Dale Mills Chair, Nominating Committee

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