Confidential when completed; The data reported on this questionnaire are protected under the Statistics Act and will be treated in strict confidence, used for statistical purposes and published in aggregate form only.

Collected under the authority of the Statistics Act. Revised Statutes of Canada, 1985, Chapter S19 (22).

This is a mandatory survey.

To return completed questionnaire either:

  • Use enclosed postage paid envelope;
  • Address your own envelope to:
    Pensions and Wealth Surveys Section
    Income Statistics Division
    Statistics Canada
    170 Tunney's Pasture Driveway
    Ottawa, Ontario K1A 0T6
  • Fax to: (613) 951-4296
    (Note : Data sent by facsimile may be at risk of disclosure during the transmission process.)

If you have questions:

Si vous préférez ce questionnaire en français, veuillez cocher

(Please make any necessary changes in above name or mailing address; add the name of the fund if missing.)

Please complete and return the questionnaire by May 31, 2011.

1. Does this organization operate, either by sponsoring or managing, the trusteed pension fund named at the top of this page? For a definition of a trusteed pension fund, please refer to "Definitions" on the "Notes/Instructions".

  • Yes – Please complete the remainder of the questionnaire and return it to Statistics Canada.
  • No – Please elaborate
    • Fund closed (MM-YYYY)
    • Fund is deposited in total with an insurance company under an insurance company contract
    • Other, please specify

      Please provide your name (bottom of this page), complete question 8 and return the questionnaire to Statistics Canada.

2. If this pension fund participates in a master trust fund, indicate the name of this master trust:

Please complete Section A (Administrative Data) and Section B (Receipts and Disbursements) and return this document to Statistics Canada.
The information for Section C (Assets) will be provided by the master trust.

3. If it is necessary to obtain the financial data on this pension fund from a trustee outside your company, please complete the following authorization notice, as well as Section A (Administrative Data) and the employee and employer contribution information requested in Section B, and forward this document to the trustee or return it to Statistics Canada for forwarding.

  • Authorization Notice (to be completed only if item 3 above applies)
     
  • This is to authorize (contact name), (telephone number) to supply Statistics Canada with the information requested in Sections B and C of the questionnaire "Census of Trusteed Pension Funds 2010". We understand that the information will be treated as strictly confidential and used only in compiling aggregates.
     
  • (Name of company)
  • (Date)
  • (Signature)
  • (Title)

Name of person completing questionnaire (please print)

Telephone ()

Fax ()

E-mail address

Thank you for your cooperation

Section A: Administrative Data

1. Year of Inauguration of This Fund

2. Fund Fiscal Year End (MM-DD)

3. Investment Decision made by (check one or more)

Note: If a committee is actively involved in directing the investments, indicate which of the following are represented on the committee.

  • (a) Trustee(s)
  • (b) Employer (includes investment staff of the employer and public sector funds whose investment is governed by legislation)
  • (c) Outside investment counsel
  • (d) Employee (plan members)
  • (e) Other (specify)

4. Insurance Company Holdings

Is any of the money in this pension fund invested with or managed by an insurance company?
(If part of a master trust, consider only money associated with this participant.)

  • Yes
  • No

If yes, what is the amount involved?

  • Market value $ (omit cents)

5. Members Covered

Note: Should be as of same time period as assets, preferably December 31.

  • (a) Number of employed plan members (including employees on temporary lay-off)
    Indicate year end used:
    • December 31, 2010
    • Other year end between April 1, 2010 and March 31, 2011
  • (b) Number of additional persons having equity in the fund ( e.g. retired persons receiving pension, persons who will receive deferred pension, etc. )
    Indicate year end used:
    • December 31, 2010
    • Other year end between April 1, 2010 and March 31, 2011

6. Contributory Status(for the majority of members)

Are the majority of members required to contribute to the pension fund?

  • Yes
  • No

7. Type of Plan (for the majority of employed members participating in the fund – check one only)

  • (a) Defined benefit / flat benefit
  • (b) Defined contribution (money purchase/profit sharing)
  • (c) Combination of above or as selected by employee
  • (d) Other (specify)

8. Plan Registration Number(s)* (of all plans included in this fund)
(If space insufficient, attach another page.)

* Number used by Canada Revenue Agency (CRA). Also provide the number used by the provincial pension regulatory authority or the Office of the Superintendent of Financial Institutions (OSFI), if different from the Plan registration number.

Book (cost) value of previous year’s assets

Report the net book (cost) value of assets for the year end occurring between April 1, 2009 and March 31, 2010.

  • $ (omit cents)

Section B: Receipts and Disbursements

* Note: If total assets at book value are less than $10,000,000 please see Instructions Sheet before completing Sections B and C.

Report for one year period ending December 31, 2010 if possible.

Indicate year end used:

  • December 31, 2010
  • Other year end between April 1, 2010 and March 31, 2011

Receipts and Net Realized Gains

Note: Do not include any unrealized gains.

  • Contributions:
    • employee $ (omit cents)
    • employer $ (omit cents)
  • Investment income (interest, dividends, etc. ) $ (omit cents)
  • Net realized profit on sale of securities $ (omit cents)
  • Transfers from other pension plans (specify) $ (omit cents)
  • Other receipts and gains (specify) $ (omit cents)
  • Total receipts and gains (total of lines 100 to 105) $ (omit cents)

Disbursements and Net Realized Losses

Note: Do not include any unrealized losses.

  • Pension payments out of fund to retirees and beneficiaries $ (omit cents)
  • Cost of pensions purchased $ (omit cents)
  • Cash withdrawals (including transfers to other plans) $ (omit cents)
  • Administration costs (if charged against fund) $ (omit cents)
  • Net realized loss on sale of securities $ (omit cents)
  • Refund of surplus in the fund $ (omit cents)
  • Other disbursements and losses (specify) $ (omit cents)
  • Total disbursements and losses (total of lines 200 to 206) $ (omit cents)

Section C: Assets

* Note: Detailed asset portfolio is essential for master trust funds (see instructions). Asset detail is not necessary for the participant accounts.

Report as of December 31, 2010 if possible.

Indicate year end used:

  • December 31, 2010
  • Other year end between April 1, 2010 and March 31, 2011

Pooled, mutual and investment funds:

  • Book (cost) value $ (omit cents)
    • Canadian equity fund
    • Canadian bond fund (fixed income)
    • Canadian mortgage fund
    • Canadian real estate fund
    • Canadian money market fund
    • foreign fund
    • other Canadian fund (specify)
  • Market value $ (omit cents)
    • Canadian equity fund
    • Canadian bond fund (fixed income)
    • Canadian mortgage fund
    • Canadian real estate fund
    • Canadian money market fund
    • foreign fund
    • other Canadian fund (specify)

Equities:

  • Book (cost) value $ (omit cents)
    • Canadian common and preferred stocks
    • foreign common and preferred stocks:
      • United States
      • other
  • Market value $ (omit cents)
    • Canadian common and preferred stocks
    • foreign common and preferred stocks:
      • United States
      • other

Bonds/Debentures:

  • Book (cost) value $ (omit cents)
    • federal
    • provincial
    • municipal
    • other Canadian (corporate)
    • foreign
  • Market value $ (omit cents)
    • federal
    • provincial
    • municipal
    • other Canadian (corporate)
    • foreign

Mortgages:

  • Book (cost) value $ (omit cents)
    • residential
    • non-residential
  • Market value $ (omit cents)
    • residential
    • non-residential

Real estate (including petroleum and natural gas properties)

  • Book (cost) value $ (omit cents)
  • Market value $ (omit cents)

Cash, deposits, short-term:

  • Book (cost) value $ (omit cents)
    • cash, deposits, GICs
    • Government of Canada t-bills
    • foreign short-term investments
    • other Canadian short-term paper
  • Market value $ (omit cents)
    • cash, deposits, GICs
    • Government of Canada t-bills
    • foreign short-term investments
    • other Canadian short-term paper

Miscellaneous:

  • Book (cost) value $ (omit cents)
    • accrued interest and dividends receivable
    • accounts receivable
    • other assets (specify)
  • Market value $ (omit cents)
    • accrued interest and dividends receivable
    • accounts receivable
    • other assets (specify)

Total assets (total of lines 300 to 372)

  • Book (cost) value $ (omit cents)
  • Market value $ (omit cents)

Deduct: Debts and payables

  • Book (cost) value $ (omit cents)
  • Market value $ (omit cents)

Net assets (line 380 less line 390)

  • Book (cost) value $ (omit cents)
  • Market value $ (omit cents)

Thank you for your cooperation

  • If you have any questions or require assistance in completing this questionnaire please contact us at 613-951-7647 or by email at: tpfc@statcan.gc.ca. Collect calls will be accepted.
  • We can also be reached by fax at 613-951-4296. Please note that the security of the information sent by facsimile cannot be guaranteed during the transmission process.
  • For the questionnaire items that request you to "specify", please state the items explicitly.

Definitions

Trusteed Pension Fund:

For purposes of this survey, a trusteed pension fund is a fund which all or a portion of the assets are managed by a trustee. The trustee has legal responsibility for the investment of assets, receipt of contributions and payment of pension benefits. The trustee can be: individuals (at least three), a trust company or incorporated pension fund society. The trustee holds title to the assets of the fund in accordance with a written trust agreement for the benefit of the plan members. Also included are funds held under an arrangement administered by federal or provincial governments. Excluded are funds deposited in total with an insurance company under an insurance company contract.

More Than One Pension Fund in Operation:

If your organization operates more than one trusteed pension fund, please complete a separate report for each.  However, consolidated or master trust funds are treated as single funds in this survey.  A master trust fund is a consolidated pension fund established by a large enterprise with a number of different pension plans for various parts of its operations.  The contributions for these plans are deposited into this fund and the assets for each plan are in the form of units of the fund.

Terminated Plans - Dormant Funds:

Dormant funds, i.e. residual assets remaining in a trusteed fund after a plan has been terminated and to which no further contributions are payable, are to be reported in this survey until all assets have been liquidated, distributed and the fund has been completely closed out.

Funds with less than $10 million in assets at book value

According to our records we have estimated your pension fund to have a book value of less than $10,000,000 as of December 31, 2010; therefore, we have provided you with a short form questionnaire. Please complete the entire questionnaire and return it to Statistics Canada. For instructions with regards to Section A: Administrative Data see below.

If the book value of your pension fund exceeds $10,000,000, please contact us to at 613-951-4092 or by e-mail at: tpfc@statcan.gc.ca to obtain a long form questionnaire.

Funds $10 million and over in assets at book value

Section A: Administrative Data

Insurance company holdings (Question 4): For the plan registration numbers reported in question 8, if any of the assets are invested in an insurance company product, answer yes and report the amount.

Members covered (Question 5):

  • (a) Number of employed plan members: Report the number of members (at December 31 or plan year end) for whom contributions are being made, or if the person is temporarily not working, for whom contributions will likely be made in the future.
  • (b) Number of additional persons having equity in the fund: Do not include people for whom annuities have been purchased and who no longer have equity in the fund.

Book (Cost) Value of Previous Year’s Assets: If Book (cost) value of previous year’s assets is unavailable, please report the market value and enter ‘MV’ following the amount reported.

Section B: Receipts and Disbursements

Receipts and Net Realized Gains

(Note: Do not include an unrealized gains)

Employee contributions (line 100): Include both required and voluntary contributions.

Employer contributions (line 101): Report the actual dollar amount contributed. Include amounts for special payments for unfunded liability, etc. Deduct any credits or surpluses used to reduce required contributions.

Investment income (line 102): Report total investment income on an accrued basis, if possible.  Include interest income from bonds, mortgages, deposits, short-term notes, dividend income from equities, real estate income, income from securities lending and pooled investment income. If possible, report gross investment income on this line and report any investment expenses associated with investment income on line 203.

Net realized profit on sale of securities (line 103): Profit is calculated by deducting the sale price from the purchase price. Subtract losses from gains. If the amount is positive, report on line 103 and if negative, report as a net loss, on line 204. Include gains from settled derivatives transactions, on line 103 and losses from settled derivative transactions on line 204.

Transfers from other pension plans (line 104): These transfers would result from the merger of two or more plans, the transfer of assets of one or more members from another pension plan or change of funding instrument ( e.g. from an insurance company contract to a trust arrangement). Specify the origin of these transfers.

For master trusts do not include transfers from one plan held by the master trust into another plan held by the same master trust.

Other receipts and gains (line 105): Currency exchange gains for investments that have not been sold but have been revalued in Canadian dollars should be reported here.

For master trusts do not include receipts that are received from an investment account held by the same master trust.

Disbursements and Net Realized Losses

(Note: Do not include unrealized losses)

Pension payments out of fund to retirees and beneficiaries (line 200): Include, if applicable, the lump sum settlements made in lieu of a pension at retirement.  Do not include cash withdrawals for such things as death, termination, etc. ; these amounts should be reported as cash withdrawals, line 202.

Cost of pensions purchased (line 201): This is the cost of purchasing annuities, most commonly from an insurance company.

Cash withdrawals (including transfers to other plans) (line 202): Include cash amounts withdrawn due to death, termination of employment, discontinuation of the plan or change of funding instrument ( e.g. from a trust arrangement to an insurance company contract). Transfers result from the merger of two or more plans, the transfer of assets of one or more members to another pension plan, etc . The transfer of monies, on behalf of terminating plan members, to a Registered Retirement Savings Plan, a Deferred Profit Sharing Plan or another Registered Pension Plan should also be included here.

Administration costs(line 203): Include any investment expenses not netted from investment income and membership services (i.e., benefit administration and delivery) expenses charged to the fund.

Net realized loss on sale of securities (line 204): See Net realized profit on sale of securities, line 103.

Other disbursements and losses (line 206):Report loss resulting from change in currency exchange here (see Other receipts and gains, line 105).

For master trusts do not include disbursements from the master trust that are received into an investment account held by the same master trust.

Note: The difference between Total receipts and gains (line 110) and Total disbursements and losses (line 210) is referred to as net income. The net income, when added to the book (cost) value of previous year’s assets should equal the net assets book (cost) value (Section C, line 400) for the current year.

Section C: Assets

Asset detail – report both book (cost) and market values

Foreign investments: Foreign property has the same meaning as defined in Canada’s income tax act.  Investments in foreign property are to be reported on lines 305, 321, 322, 334 or 362, depending on the asset class in which the money is invested. Foreign property  investments can include; investments in units of a foreign pooled fund; investments in publicly traded foreign stocks or private equity investments in foreign corporations; investments in bonds or a debenture issued by a non-Canadian resident and deposits in a bank or similar institution outside Canada.  Investments expressed in foreign currency but situated in Canada are not considered foreign.

Pooled, mutual and investment funds (lines 300 to 306): Include investments in funds which pool the monies of several investors and which are sold on a unit basis. This includes insurance industry segregated pooled funds. The category of foreign fund takes precedence over other pooled funds. If, for example, a fund is both foreign and money market it should be reported as a foreign fund.  Canadian funds may be partially invested outside Canada.  If any assets are listed on line 306, please provide a description of the assets being reported using the specify field.

Equities (lines 320 to 332):  Include investments in publicly traded stocks and private equity investments in Canadian (line 320) or foreign (line 321 and 322) corporations.

Bonds / Debentures (lines 330 to 334): Include bonds maturing in less than 12 months. Federal bonds (line 330) include only direct issues by the Canadian federal government. Canada Mortgage and Housing Corporation (CMHC) mortgage bonds and NHA Mortgage-Backed Securities insured by the CMHC as well as bonds issued by other federal government businesses are to be recorded under other Canadian (corporate) (line 333). Provincial and Municipal bonds (lines 331 and 332) include both direct issues of those levels of government as well as bonds guaranteed by their government business enterprises. In other Canadian (corporate)(line 333) include bonds and debentures issued by Canadian corporations and non-guaranteed issues of government business enterprises.  Convertible bonds should also be reported as other Canadian (corporate) and not with equities. In foreign (line 334) include bonds issued by the International Bank for Reconstruction and Development, the Inter-American, Caribbean and Asian Development Banks.

Mortgages (lines 340 and 341): These are conventional mortgage loans which are granted to borrowers to finance the purchase of properties with the underlying property secured as collateral for the loan. Report loans granted to borrowers to finance the purchase of residential properties on line 340.  Report loans granted to businesses to finance the purchase of commercial properties as non-residential on line 341.

Real estate (line 350): Report investments in real estate, including petroleum and natural gas properties. Investments in real estate funds or REITs are to be reported in line 303.

Cash, deposits, GICs (line 360): Include cash on hand and deposits in chartered banks and trust and mortgage loan companies. Bank term deposits and GICs should also be included on line 360.

Other Canadian short-term paper (line 363): Includes provincial and municipal t-bills, banker’s acceptances, discount notes, promissory notes, call loans, interest bearing notes, bearer demand notes and other financial and commercial paper issued by corporations and provincial and municipal governments.

Other assets (line 372): Include fair value of unsettled derivative contracts with a positive position on this line and any other assets not reported elsewhere.  Please provide a description of the asset being reported using the specify field.

Debts and payables (line 390):  Include the fair value of unsettled derivative contracts with a negative position on this line.

The concordance table for the electronic questionnaire

The concordance table is an internal document to Statistics Canada used to map data from residential care facilities’ financial statements to corresponding cells in the questionnaire. The publication of those documents aims at providing a better understanding of the concepts of the survey to researchers and the general public. Respondents to the questionnaire may also use the table to complete their questionnaire from their financial statements or other financial data.

The concordance table is made of an alphabetical list of line items frequently found in the income statements of Residential Care Facilities (RCF). These items are mapped to the corresponding cell (line and column) of the electronic questionnaire. The items are provided in both official languages. However, some items were not translated because they are specific to certain provinces.

Table 2 Residential Care Facilities Survey Concordance for the electronic questionnaire

Table 2 Residential Care Facilities Survey Concordance for the electronic questionnaire
Income Statement - Item Short Form Section Long Form Electronic Questionnaire Cell Short Form Electronic Questionnaire Cell
AADAC - Alberta Alcohol & Drug Abuse Commission Income Question 18, line (c) Question 15, line (c)
Academic & Social Service General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Accrual General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Activation Supervisors Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Activity Attendants Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Activity Co-ordinator Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Activity Director Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Activity Supplies Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Activity Workers Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Addiction Counsellors Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Adjuvant (see editing inst. Page 21) Direct Care Question 15, line (e) column 1 OR Question 15, line (f), column 1 Question 14, line (a), column 1
ADS (Air Dispatch Service) General Services Question 16, line (a), column 2 Question 14, line (b), column 2
ADS (Air Dispatch Service) Income Question 18, line (i) Question 15, line (i)
Adult day Care Income Question 18, line (e) Question 15, line (e)
Aides (Health Care Nursing Aides) Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
AIDS Activity Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Ambulance General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Amortization (expense) Other (sect L) Question 17, line (a), column 2 Question 14, line (c), column 2
Amortization (Revenue) Income Question 18, line (e) Question 15, line (e)
Amortization of deferred contributions related to capital assets DO NOT USE DO NOT USE DO NOT USE
Ancillary Revenues Income Question 18, line (i) Question 15, line (i)
Art Therapy Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Arts & Recreation Director Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Assaultive Unit Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Assistant Director of Nursing (A.D.O.N) Direct Care Question 15, line (a), column 1 Question 14, line (a), column 1
Attendant Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Auto Insurance General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Bad Debts General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Bank Charges (including interest paid by facility) General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Bank Interest (received by facility) Income Question 18, line (i) Question 15, line (i)
BC Housing Management Corporation (BCHMC) Income Question 18, line (b) Question 15, line (b)
Beautician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Behaviour Therapist Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Benefits General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Bookkeeper & Audit General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Building Occupancy Other (sect L) Question 17, line (a), column 2 Question 14, line (c), column 2
Burial General Services Question 16, line (e), column 2 Question 14, line (b), column 2
C.P.P. Canada Pension Plan General Services Question 16, line (a), column 2 Question 14, line (b), column 2
C.S.C - Correctional Services Canada Income Question 18, line (e) Question 15, line (e)
Cable General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Canteen General Services Question 16, line (b), column 2 Question 14, line (b), column 2
Cap Fees Income Question 18, line (f) Question 15, line (f)
Capital Assessment Program General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Capital Costs - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Insurance General Services Question 17, line (a), column 2 Question 14, line (c), column 2
Capital Interest Income Question 18, line (e) Question 15, line (e)
Capital Interest Other (sect L) Question 17, line (a), column 2 Question 14, line (c), column 2
Capital Purchases - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Taxes Other (sect L) Question 17, line (a), column 2 Question 14, line (c), column 2
Care Giver/Special Care Aide Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Central Dispatch Stores General Services Question 16, line (a), column 2 Question 14, line (b), column 2
CFSA (Child & Family Services Act.)/Childrens Aid Income Question 18, line (b) Question 15, line (b)
Chaplain Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Child Care Counsellor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Child Care Worker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Child Therapist Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Children & Family Services Income Question 18, line (b) Question 15, line (b)
Children Aids Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Christian Science Nursing Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
City, for example homeless shelters Income Question 18, line (d) Question 15, line (d)
Cleaning General Services Question 16, line (c), column 2 Question 14, line (b), column 2
Clerical Support Direct Care Question 16, line (a), column 2 Question 14, line (b), column 2
Clinical Record General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Clothing Direct Care Question 15, line (i), column 2 Question 14, line (a), column 2
CMHA (Canada Mental Health Association) Income Question 18, line (e) Question 15, line (e)
CMHC (Centre Mortgage Housing Corporation) Income Question 18, line (e) Question 15, line (e)
Coach Operator General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Comfort Allowance Direct Care/Income If Expense: Question 15, line (i), column 2 If Revenue: Question 15, line (i) If Expense: Question 14, line (a), column 2 If Revenue: Question 15, line (i)
Community Living Income Question 18, line (b) Question 15, line (b)
Community Placement General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Community Safety & Correctional Services except Manitoba Income Question 18, line (c) Question 15, line (c)
COMSOC (Ministry of Community & Social Services) (ON) Income Question 18, line (b) Question 15, line (b)
Conference Expense General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Convalescent and Observation beds DO NOT USE DO NOT USE DO NOT USE
Convention General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Co-Ordinator Income Question 18, line (e) Question 15, line (e)
Counselling Staff Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Counsellors Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Craft Direct Care Question 15, line (e) column 2 Question 14, line (a), column 2
Craft Supervisor Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Crown agencies Income Question 18, line (c) Question 15, line (c)
D.I.A (Dept of Indian affairs) Income Question 18, line (e) Question 15, line (e)
Dental Clinic Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Dentist Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Department of Health (DOH) Income Question 18, line (a) Question 15, line (a)
Department of Justice, Provincial Income Question 18, line (c) Question 15, line (c)
Depreciation Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
DFNFA (DIAND(Department of Indian Affairs and Northern Development)/First Nations Funding Agreement) Income Question 18, line (e) Question 15, line (e)
Dietician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Director of Care (D.O.C.) Direct Care Question 15, line (a), column 1 Question 14, line (a), column 1
Director of Nursing Direct Care Question 15, line (a), column 1 Question 14, line (a), column 1
Disability Pension Income Question 18, line (c) Question 15, line (c)
Doctor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Doctor Retainer Fees Direct Care Question 15, line (f) column 2 Question 14, line (a), column 2
DOH (Dept of Health) Income Question 18, line (a) Question 15, line (a)
Donations Expenses Question 16, line (e), column 2 Question 14, line (b), column 2
Donations Income Question 18, line (e) Question 15, line (e)
Driver General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Drug Income Income Question 18, line (i) Question 15, line (i)
Dues General Services Question 16, line (a), column 2 Question 14, line (b), column 2
DVA (Dept of Veteran Affairs) Income Question 18, line (e) Question 15, line (e)
Early Incentive Bonus Income Question 18, line (i) Question 15, line (i)
ECG Technician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Education - Staff General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Education & Rec Activity Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
EEG Technician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Emergency Nursing Care Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Employment Benefit General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Equipment General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Equipment, rented or leased, specified - should go into that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, were applicable Other (section) Question 17, line (a), column 2 Question 14, line (c), column 2
Equipment, rented or leased, unspecified Income Question 18, line (e) Question 15, line (e)
Executive Director General Services Question 16, line (a), column 1 Question 14, line (b), column 1
Family & Community Services Income Question 18, line (b) Question 15, line (b)
Family Allowance Income Question 18, line (e) Question 15, line (e)
Family Allowance Benefit (FAB) Income Question 18, line (b) Question 15, line (b)
Family Benefits Allowance (FBA) Income Question 18, line (b) Question 15, line (b)
Farm Manager General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Farm Operator General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Federal Subsidies Income Question 18, line (e) Question 15, line (e)
Fitness Consultant Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Food Recoveries if listed as income Income Question 18, line (i) Question 15, line (i)
Foot Care Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Freight General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Fringe Benefit General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Fundraising General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Fundraising Income Question 18, line (i) Question 15, line (i)
Funeral General Services Question 16, line (e), column 2 Question 14, line (b), column 2
General Welfare Assistance (GWA) Income Question 18, line (e) Question 15, line (e)
General Workers (helpers) Direct Care or General Services Question 15, line (f), column 1 OR Question 16, line (e), column 1 Question 14, line (a), column 1 OR Question 14, line (b), column 1
Geriatric Aids Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
GIS (Guaranteed Income Supplement) Income Question 18, line (e) Question 15, line (e)
Graduate Nurse Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Grants - except Capital Grants (see above) Income Question 18, line (e) Question 15, line (e)
Grooming Expenses Direct Care Question 15, line (f) column 2 Question 14, line (a), column 2
Ground & Gardens General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Group Home Co-Ordinator General Services Question 16, line (a), column 1 Question 14, line (b), column 1
Group Home Parent Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Group Therapist Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Group Workers Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
GST Rebates NOT INCLUDED Not applicable DO NOT USE DO NOT USE
Hairdresser Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Health & Community Services Income Question 18, line (a) Question 15, line (a)
Health Authority (HA) Income Question 18, line (a) Question 15, line (a)
Health Care Aides (H.C.A.) Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
HIP (Health Insurance Program) Income Question 18, line (a) Question 15, line (a)
Home Physician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Homemaker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Homes for Special Care (Ministry of Health-HSC) Income Question 18, line (a) Question 15, line (a)
Honorarium General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Hospital Insurance Plan (HIP) Income Question 18, line (a) Question 15, line (a)
House Mother Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
House Parent Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
ICBC (Insurance Corporation of B.C.) Income Question 18, line (c) Question 15, line (c)
ICFS (Indian Child & Family Services) Income Question 18, line (e) Question 15, line (e)
Improvement General Services Question 16, line (d), column 2 Question 14, line (b), column 2
In lieu of Salaries and Wages appropriate cell appropriate cell
Incontinent Supplies Direct Care Question 15, line (i), column 2 Question 14, line (a), column 2
Indian Affairs Income Question 18, line (e) Question 15, line (e)
Indirect Wages Salaries and Wages appropriate cell appropriate cell
Ineligible Space (when it is the same value in both income & expenses) DO NOT USE DO NOT USE DO NOT USE
In-Service Co-Ordinator General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Instructors (Medical) Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Insurance, other than auto Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
Interest (Bank) Income Question 18, line (i) Question 15, line (i)
Investment Income Income Question 18, line (e) Question 15, line (e)
Jointex NS Municipal Income Question 18, line (d) Question 15, line (d)
Justice Income Question 18, line (c) Question 15, line (c)
Lab Technician Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Legal General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Leisure Counsellor Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
LHIN - Local Health Integration Network (Ontario) Income Question 18, line (a) Question 15, line (a)
Library General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Life Skills Worker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Longterm Care Income Question 18, line (a) Question 15, line (a)
Look Assistance Grant Alberta Income Question 18, line (c) Question 15, line (c)
Maintenance General Services Question 16, line (d), column 1 Question 14, line (b), column 1
Management Fee General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Massage Therapist Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Material Management General Services Question 16, line (a), column 2 Question 14, line (b), column 2
MCFS (Ministry of Child & Family Services) Income Question 18, line (b) Question 15, line (b)
MCSS, COMSOC in Ontario (Ministry of Community & Social Services) Income Question 18, line (b) Question 15, line (b)
Meals on Wheels Income Question 18, line (i) Question 15, line (i)
Medical Director / Medical Advisor General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Medical Secretary General Services Question 16, line (a), column 1 Question 14, line (b), column 1
Medical Services Insurance Plan (MSIP) Income Question 18, line (a) Question 15, line (a)
Mentally Retarded Counsellor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
MHR (Ministry of Human Resources) Income Question 18, line (c) Question 15, line (c)
Ministry of Children & Families Income Question 18, line (b) Question 15, line (b)
Ministry of Community & Social Services (COMSOC in Ontario, MCSS elsewhere) Income Question 18, line (b) Question 15, line (b)
Ministry of Health (MOH) Income Question 18, line (a) Question 15, line (a)
Ministry of Housing Income Question 18, line (c) Question 15, line (c)
Ministry of Mental Health Income Question 18, line (a) Question 15, line (a)
Ministry of the Attorney General Income Question 18, line (c) Question 15, line (c)
MMAH (Ministry of Municipal Affairs & Housing) Income Question 18, line (c) Question 15, line (c)
Mortgage Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
Multilateral Framework for Labour Market Agreements for Persons with Disabilities Income Question 18, line (e) Question 15, line (e)
Municipal Affair (Alberta) Income Question 18, line (c) Question 15, line (c)
Municipal Taxes Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
Music Therapy Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Night Security General Services Question 16, line (d), column 1 Question 14, line (b), column 1
Nurse Assistant Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Nurse Practitioner Direct Care Question 15, line (a), column 1 Question 14, line (a), column 1
Nurses Aids Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Nursing Attendants Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Nursing Education Salaries (larger facilities only) General Services Question 16, line (e), column 1 Question 14, line (b), column 1
Nursing Manuals Direct Care Question 15, line (i), column 2 Question 14, line (a), column 2
Nursing students Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Nursing Supervisor Direct Care Question 15, line (a), column 1 Question 14, line (a), column 1
Nutritionist General Services Question 16, line (b), column 1 Question 14, line (b), column 2
ODSP (Ontario Disability Support Program) Income Question 18, line (b) Question 15, line (b)
Office Expense General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Old Age Pension Income Question 18, line (e) Question 15, line (e)
Old Age Pension (OAP) Income Question 18, line (e) Question 15, line (e)
Ontario Works Income Question 18, line (b) Question 15, line (b)
Operations Supplies General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Orderlies Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Outreach Program General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Overtime Expenses Question 16, line (a), column 2 Question 14, line (b), column 2
Pastoral Co-Ordinator General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Pay Equity Expenses Question 15, line (f) column 1 Question 14, line (a), column 2
Personal Care Workers Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Personal Enrichment Team Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Personal Needs Direct Care Question 15, line (i), column 2 Question 14, line (a), column 2
Personal Needs Allowance Income Question 18, line (i) Question 15, line (i)
Persons with Developmental Disabilities Board(PDD) Income Question 18, line (b) Question 15, line (b)
Pharmacist Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Physiotherapy Aide Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Pier Diem Income largest income source largest income source
Placing Agencies Income Question 18, line (e) Question 15, line (e)
Premium pay Expenses Question 16, line (a), column 2 Question 14, line (b), column 2
Program Allowance Direct Care Question 15, line (f) column 2 Question 14, line (a), column 2
Program Co-Ordinator Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Program Director Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Program Expenses Direct Care Question 15, line (f) column 2 Question 14, line (a), column 2
Program Worker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Property Manager General Services Question 16, line (d), column 1 Question 14, line (b), column 1
Provincial Government Subsidy - Health Income Question 18, line (a) Question 15, line (a)
Provincial Government Subsidy - Social Services Income Question 18, line (b) Question 15, line (b)
Provincial Welfare Assistance Employment Programs Income Question 18, line (b) Question 15, line (b)
Psychiatrist Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Psychologist Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Public Relations General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Public Trustee Income /DOC Question 18, line (c) Question 15, line (c)
Purchased Drugs (sometimes called pharmacist services) Direct Care Question 15, line (g), column 2 Question 14, line (a), column 2
Purchasing General Services Question 16, line (a), column 2 Question 14, line (b), column 2
R.N.A. / Registered Nursing Assistant Direct Care Question 15, line (b), column 1 Question 14, line (a), column 1
Receptionist General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Recoverable other then Food Income Question 18, line (e) Question 15, line (e)
Recoveries for Food Income Question 15, line (i) Question 15, line (i)
Recreational Therapist Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Recruitment General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Refunds Income If source is unknown: Question 15, line (i) If source is unknown: Question 15, line (i)
Regional Health Authority Income Question 18, line (a) Question 15, line (a)
Regional Municipality of Ottawa - Carleton (RMOC) Income Question 18, line (d) Question 15, line (d)
Rehabilitation Supervisor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Reimbursed Expenses Other Expenses minus from appropriate cell or minus from Question 16, line (a), cloumn 2 minus from appropriate cell or minus from Question 14, line (b), column 2
Relief (part-time or casual staff) Salaries and Wages appropriate cell appropriate cell
Religious Services General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Renovations General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Rent Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
Rented or leased equipment  - specified - should go in that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, where applicable appropriate cell appropriate cell
Rented or leased equipment if unspecified Other (section L) Question 17, line (a), column 2 Question 14, line (c), column 2
Repair General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Replacement General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Residential Social & Recreational Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Residential Social Services Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Resident Attendant Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Resident Counsellor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Resident Services Income Question 18, line (i) Question 15, line (i)
Restorative Aide Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Retainer Fee General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Room and Board Income Question 18, line (f) Question 15, line (f)
Room Differential Income Question 18, line (g) Question 15, line (g)
S.E.D.P. (Saskatchewan Employment Program) Income Question 18, line (b) Question 15, line (b)
School divisions Income Question 18, line (i) Question 15, line (i)
Seamstress General Services Question 16, line (c), column 1 Question 14, line (b), column 1
Secretary General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Services Income Question 18, line (e) Question 15, line (e)
Shelter Worker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Shift Premium Salaries and Wages appropriate cell appropriate cell
Snow Removal General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Social Services Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Social Worker Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Solicitor General Income Question 18, line (e) Question 15, line (e)
SPD Aid (Sterile processing department) General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Special Care Aide Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Special Education Teacher Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Speech Therapist Direct Care Question 15, line (d), column 1 Question 14, line (a), column 1
Stipends/contract (fixed amount paid for service) Other Expenses appropriate cell appropriate cell
Stores General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Subsidy  Income Question 18, line (e) Question 15, line (e)
Supervisor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Supervisor Activation Direct Care Question 15, line (e) column 1 Question 14, line (a), column 1
Supervisor Social Support Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Supervisor Staff Div. Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Supplementary needs Direct Care-General Services Question 15, line (i), column 2 Question 14, line (a), column 2
Support Aids Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Support Care Attendants Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Support Family Payments General Services Question 16, line (a), column 2 Question 14, line (b), column 1
Support Staff Direct Care appropriate cell Question 14, line (a), column 1 OR Question 14, line (b), column 1
Switchboard General Services Question 16, line (a), column 1 Question 14, line (b), column 1
Tax refunds, rebates-do not use DO NOT USE DO NOT USE DO NOT USE
Taxes   Question 17, line (a), column 2 Question 14, line (c), column 2
Teachers (for residentsfor example school children) Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Teachers (for staff) (only larger facilities would employee teachers to train staff; otherwise purchased service) General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Technicians (Lab, X-Ray,ECG, EEG) Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Telephone General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Training General Services Question 16, line (e), column 2 Question 14, line (b), column 2
Transition House Counsellor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Transportation General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Travel General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Travel if specified as related to another expense category should be put in that expense category's cell General Services appropriate cell appropriate cell
Treatment Director Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Typist General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Unemployment Insurance General Services Question 16, line (a), column 2 Question 14, line (b), column 2
Unspecified Recoveries if listed as expense Expenses Question 16, line (a), column 2 Question 14, line (b), column 2
Unspecified Recoveries if listed as income Income Question 18, line (i) Question 15, line (i)
Utilities (heat, hydro, water, natural gas) General Services Question 16, line (d), column 2 Question 14, line (b), column 2
Vacation Pay Salaries and Wages appropiate cell appropiate cell
Volunteer Co-Ordinator Salaries (Fees) General Services Question 16, line (a), column 1 Question 14, line (b), column 1
VRDP Vocational Rehabilitation Disabled Persons (Fed. Contribution for Alcohol and Drug Programs) Income Question 18, line (e) Question 15, line (e)
Ward Aids Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Ward Clerk General Services Question 16, line (a), column 1 Question 14, line (b), column 1
Welfare Assistance Income Question 18, line (b) Question 15, line (b)
Work Supervisor Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
X-Ray Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1
Youth Workers Direct Care Question 15, line (f) column 1 Question 14, line (a), column 1

The concordance table for the paper questionnaire

The concordance table is an internal document to Statistics Canada used to map data from residential care facilities’ financial statements to corresponding cells in the questionnaire. The publication of those documents aims at providing a better understanding of the concepts of the survey to researchers and the general public. Respondents to the questionnaire may also use the table to complete their questionnaire from their financial statements or other financial data.

The concordance table is made of an alphabetical list of line items frequently found in the income statements of Residential Care Facilities (RCF). These items are mapped to the corresponding cell of the questionnaire. The items are provided in both official languages. However, some items were not translated because they are specific to certain provinces.

Table 1 Residential Care Facilities Survey Concordance for the paper questionnaire

Table 1 Residential Care Facilities Survey Concordance for the paper questionnaire
Income Statement - Item Short Form Section Long Form Cell Number (paper) Short Form Cell Number (Paper
AADAC - Alberta Alcohol & Drug Abuse Commission Income 503 503
Academic & Social Service General Services 442 462
Accrual General Services 442 462
Activation Supervisors Direct Care 417 432
Activity Attendants Direct Care 417 432
Activity Co-ordinator Direct Care 417 432
Activity Director Direct Care 417 432
Activity Supplies Direct Care 417 432
Activity Workers Direct Care 417 432
Addiction Counsellors Direct Care 423 432
Adjuvant (see editing inst. Page 21) Direct Care 417 or 423 432
ADS (Air Dispatch Service) General Services 442 462
ADS (Air Dispatch Service) Income 509 509
Adult day Care Income 505 505
Aides (Health Care Nursing Aides) Direct Care 423 432
AIDS Activity Direct Care 417 432
Ambulance General Services 442 462
Amortization (expense) Other (sect L) 483 483
Amortization (Revenue) Income 505 505
Amortization of deferred contributions related to capital assets DO NOT USE DO NOT USE DO NOT USE
Ancillary Revenues Income 509 509
Art Therapy Direct Care 417 432
Arts & Recreation Director Direct Care 417 432
Assaultive Unit Direct Care 423 432
Assistant Director of Nursing (A.D.O.N) Direct Care 401 432
Attendant Direct Care 423 432
Auto Insurance General Services 442 462
Bad Debts General Services 442 462
Bank Charges (including interest paid by facility) General Services 442 462
Bank Interest (received by facility) Income 509 509
BC Housing Management Corporation (BCHMC) Income 502 502
Beautician Direct Care 423 432
Behaviour Therapist Direct Care 414 432
Benefits General Services 442 462
Bookkeeper & Audit General Services 442 462
Building Occupancy Other (sect L) 483 483
Burial General Services 459 462
C.P.P. Canada Pension Plan General Services 442 462
C.S.C - Correctional Services Canada Income 505 505
Cable General Services 442 462
Canteen General Services 445 462
Cap Fees Income 506 506
Capital Assessment Program General Services 442 462
Capital Costs - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Insurance General Services 483 483
Capital Interest Income 505 505
Capital Interest Other (sect L) 483 483
Capital Purchases - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Taxes Other (sect L) 483 483
Care Giver/Special Care Aide Direct Care 423 432
Central Dispatch Stores General Services 442 462
CFSA (Child & Family Services Act.)/Childrens Aid Income 502 502
Chaplain Direct Care 423 432
Child Care Counsellor Direct Care 423 432
Child Care Worker Direct Care 423 432
Child Therapist Direct Care 414 432
Children & Family Services Income 502 502
Children Aids Direct Care 423 432
Christian Science Nursing Direct Care 423 432
City, for example homeless shelters Income 504 504
Cleaning General Services 450 462
Clerical Support Direct Care 442 462
Clinical Record General Services 442 462
Clothing Direct Care 430 433
CMHA (Canada Mental Health Association) Income 505 505
CMHC (Centre Mortgage Housing Corporation) Income 505 505
Coach Operator General Services 458 461
Comfort Allowance Direct Care/Income 430 or 509 433 or 509
Community Living Income 502 502
Community Placement General Services 459 462
Community Safety & Correctional Services except Manitoba Income 503 503
COMSOC (Ministry of Community & Social Services) (ON) Income 502 502
Conference Expense General Services 442 462
Convalescent and Observation beds DO NOT USE DO NOT USE DO NOT USE
Convention General Services 442 462
Co-Ordinator Income 505 505
Counselling Staff Direct Care 423 432
Counsellors Direct Care 423 432
Craft Direct Care 418 433
Craft Supervisor Direct Care 417 432
Crown agencies Income 503 503
D.I.A (Dept of Indian affairs) Income 505 505
Dental Clinic Direct Care 423 432
Dentist Direct Care 423 432
Department of Health (DOH) Income 501 501
Department of Justice, Provincial  Income 503 503
Depreciation Other (section L) 483 483
DFNFA (DIAND(Department of Indian Affairs and Northern Development)/First Nations Funding Agreement) Income 505 505
Dietician Direct Care 423 432
Director of Care (D.O.C.) Direct Care 401 432
Director of Nursing Direct Care 401 432
Disability Pension Income 503 503
Doctor Direct Care 423 432
Doctor Retainer Fees Direct Care 424 433
DOH (Dept of Health) Income 501 501
Donations Expenses 459 462
Donations Income 505 505
Driver General Services 458 461
Drug Income Income 509 509
Dues General Services 442 462
DVA (Dept of Veteran Affairs) Income 505 505
Early Incentive Bonus Income 509 509
ECG Technician Direct Care 423 432
Education - Staff General Services 458 461
Education & Rec Activity Direct Care 417 432
EEG Technician Direct Care 423 432
Emergency Nursing Care Direct Care 423 432
Employment Benefit General Services 442 462
Equipment General Services 456 462
Equipment, rented or leased, specified - should go into that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, were applicable Other (section) 483 483
Equipment, rented or leased, unspecified Income 505 505
Executive Director General Services 441 461
Family & Community Services Income 502 502
Family Allowance Income 505 505
Family Allowance Benefit (FAB) Income 502 502
Family Benefits Allowance (FBA) Income 502 502
Farm Manager General Services 458 461
Farm Operator General Services 458 461
Federal Subsidies Income 505 505
Fitness Consultant Direct Care 417 432
Food Recoveries if listed as income Income 509 509
Foot Care Direct Care 423 432
Freight General Services 442 462
Fringe Benefit General Services 442 462
Fundraising General Services 459 462
Fundraising Income 509 509
Funeral General Services 459 462
General Welfare Assistance (GWA) Income 505 505
General Workers (helpers) Direct Care or General Services 423 or 458 432 or 461
Geriatric Aids Direct Care 423 432
GIS (Guaranteed Income Supplement) Income 505 505
Graduate Nurse Direct Care 423 432
Grants - except Capital Grants (see above) Income 505 505
Grooming Expenses Direct Care 424 433
Ground & Gardens General Services 456 462
Group Home Co-Ordinator General Services 441 461
Group Home Parent Direct Care 423 432
Group Therapist Direct Care 414 432
Group Workers Direct Care 423 432
GST Rebates NOT INCLUDED Not applicable  DO NOT USE DO NOT USE
Hairdresser Direct Care 423 432
Health & Community Services Income 501 501
Health Authority (HA) Income 501 501
Health Care Aides (H.C.A.) Direct Care 423 432
HIP (Health Insurance Program) Income 501 501
Home Physician Direct Care 423 432
Homemaker Direct Care 423 432
Homes for Special Care (Ministry of Health-HSC) Income 501 501
Honorarium General Services 442 462
Hospital Insurance Plan (HIP) Income 501 501
House Mother Direct Care 423 432
House Parent Direct Care 423 432
ICBC (Insurance Corporation of B.C.) Income 503 503
ICFS (Indian Child & Family Services) Income 505 505
Improvement General Services 456 462
In lieu of  Salaries and Wages appropriate cell appropriate cell
Incontinent Supplies Direct Care 430 433
Indian Affairs Income 505 505
Indirect Wages Salaries and Wages appropriate cell appropriate cell
Ineligible Space (when it is the same value in both income & expenses) DO NOT USE DO NOT USE DO NOT USE
In-Service Co-Ordinator General Services 458 461
Instructors (Medical) Direct Care 423 432
Insurance, other than auto Other (section L) 483 483
Interest (Bank) Income 509 509
Investment Income Income 505 505
Jointex NS Municipal Income 504 504
Justice Income 503 503
Lab Technician Direct Care 423 432
Legal  General Services 442 462
Leisure Counsellor Direct Care 417 432
LHIN - Local Health Integration Network (Ontario) Income 501 501
Library General Services 442 462
Life Skills Worker Direct Care 423 432
Longterm Care Income 501 501
Look Assistance Grant Alberta Income 503 503
Maintenance  General Services 455 461
Management Fee General Services 442 462
Massage Therapist Direct Care 414 432
Material Management General Services 442 462
MCFS (Ministry of Child & Family Services) Income 502 502
MCSS, COMSOC in Ontario (Ministry of Community & Social Services) Income 502 502
Meals on Wheels Income 509 509
Medical Director / Medical Advisor General Services 442 462
Medical Secretary General Services 441 461
Medical Services Insurance Plan (MSIP) Income 501 501
Mentally Retarded Counsellor Direct Care 423 432
MHR (Ministry of Human Resources) Income 503 503
Ministry of Children & Families Income 502 502
Ministry of Community & Social Services (COMSOC in Ontario, MCSS elsewhere) Income 502 502
Ministry of Health (MOH) Income 501 501
Ministry of Housing Income 503 503
Ministry of Mental Health Income 501 501
Ministry of the Attorney General Income 503 503
MMAH (Ministry of Municipal Affairs & Housing) Income 503 503
Mortgage Other (section L) 483 483
Multilateral Framework for Labour Market Agreements for Persons with Disabilities Income 505 505
Municipal Affair (Alberta) Income 503 503
Municipal Taxes Other (section L) 483 483
Music Therapy Direct Care 417 432
Night Security General Services 455 461
Nurse Assistant Direct Care 423 432
Nurse Practitioner  Direct Care 401 432
Nurses Aids Direct Care 423 432
Nursing Attendants Direct Care 423 432
Nursing Education Salaries (larger facilities only) General Services 458 461
Nursing Manuals Direct Care 430 433
Nursing students Direct Care 423 432
Nursing Supervisor  Direct Care 401 432
Nutritionist General Services 444 462
ODSP (Ontario Disability Support Program) Income 502 502
Office Expense General Services 442 462
Old Age Pension  Income 505 505
Old Age Pension (OAP) Income 505 505
Ontario Works Income 502 502
Operations Supplies General Services 442 462
Orderlies Direct Care 423 432
Outreach Program General Services 459 462
Overtime Expenses 442 462
Pastoral Co-Ordinator General Services 442 462
Pay Equity Expenses 423 433
Personal Care Workers Direct Care 423 432
Personal Enrichment Team Direct Care 423 432
Personal Needs Direct Care 430 433
Personal Needs Allowance Income 509 509
Persons with Developmental Disabilities Board(PDD) Income 502 502
Pharmacist Direct Care 423 432
Physiotherapy Aide Direct Care 414 432
Pier Diem Income largest income source largest income source
Placing Agencies Income 505 505
Premium pay Expenses 442 462
Program Allowance Direct Care 424 433
Program Co-Ordinator Direct Care 423 432
Program Director Direct Care 423 432
Program Expenses Direct Care 424 433
Program Worker Direct Care 423 432
Property Manager General Services 455 461
Provincial Government Subsidy - Health Income 501 501
Provincial Government Subsidy - Social Services Income 502 502
Provincial Welfare Assistance Employment Programs Income 502 502
Psychiatrist Direct Care 423 432
Psychologist Direct Care 423 432
Public Relations  General Services 442 462
Public Trustee Income /DOC 503 503
Purchased Drugs (sometimes called pharmacist services) Direct Care 426 433
Purchasing General Services 442 462
R.N.A. / Registered Nursing Assistant Direct Care 405 432
Receptionist General Services 442 462
Recoverable other then Food Income 505 505
Recoveries for Food Income 509 509
Recreational Therapist Direct Care 417 432
Recruitment General Services 459 462
Refunds Income 509 if not stated from where 509 if not stated from where
Regional Health Authority Income 501 501
Regional Municipality of Ottawa - Carleton (RMOC) Income 504 504
Rehabilitation Supervisor Direct Care 423 432
Reimbursed Expenses Other Expenses minus from appropriate cell or minus from 442 minus from appropriate cell or minus from 463
Relief (part-time or casual staff) Salaries and Wages appropriate cell appropriate cell
Religious Services General Services 442 462
Renovations  General Services 459 462
Rent Other (section L) 483 483
Rented or leased equipment  - specified - should go in that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, where applicable appropriate cell appropriate cell
Rented or leased equipment if unspecified Other (section L) 483 483
Repair General Services 456 462
Replacement General Services 456 462
Residential Social & Recreational Direct Care 423 432
Residential Social Services Direct Care 423 432
Resident Attendant Direct Care 423 432
Resident Counsellor Direct Care 423 432
Resident Services Income 509 509
Restorative Aide Direct Care 423 432
Retainer Fee General Services 442 462
Room and Board Income 506 506
Room Differential Income 507 507
S.E.D.P. (Saskatchewan Employment Program) Income 502 502
School divisions Income 509 509
Seamstress General Services 449 461
Secretary General Services 442 462
Services Income 505 505
Shelter Worker Direct Care 423 432
Shift Premium Salaries and Wages appropriate cell appropriate cell
Snow Removal General Services 456 462
Social Services Direct Care 423 432
Social Worker Direct Care 423 432
Solicitor General Income 505 505
SPD Aid (Sterile processing department) General Services 442 462
Special Care Aide Direct Care 423 432
Special Education Teacher Direct Care 423 432
Speech Therapist Direct Care 414 432
Stipends/contract (fixed amount paid for service) Other Expenses appropriate cell appropriate cell
Stores  General Services 442 462
Subsidy  Income 505 505
Supervisor Direct Care 423 432
Supervisor Activation Direct Care 417 432
Supervisor Social Support Direct Care 423 432
Supervisor Staff Div. Direct Care 423 432
Supplementary needs Direct Care-General Services 430 433
Support Aids Direct Care 423 432
Support Care Attendants Direct Care 423 432
Support Family Payments General Services 442 461
Support Staff Direct Care appropriate cell 432 or 461
Switchboard General Services 441 461
Tax refunds, rebates-do not use DO NOT USE DO NOT USE DO NOT USE
Taxes   483 483
Teachers (for residentsfor example school children)  Direct Care 423 432
Teachers (for staff) (only larger facilities would employee teachers to train staff; otherwise purchased service) General Services 459 462
Technicians (Lab, X-Ray,ECG, EEG) Direct Care 423 432
Telephone General Services 442 462
Training  General Services 459 462
Transition House Counsellor Direct Care 423 432
Transportation General Services 442 462
Travel General Services 442 462
Travel if specified as related to another expense category should be put in that expense category's cell General Services appropriate cell appropriate cell
Treatment Director Direct Care 423 432
Typist General Services 442 462
Unemployment Insurance General Services 442 462
Unspecified Recoveries if listed as expense Expenses 442 462
Unspecified Recoveries if listed as income Income 509 509
Utilities (heat, hydro, water, natural gas) General Services 456 462
Vacation Pay Salaries and Wages appropiate cell appropiate cell
Volunteer Co-Ordinator Salaries (Fees) General Services 441 461
VRDP Vocational Rehabilitation Disabled Persons (Fed. Contribution for Alcohol and Drug Programs) Income 505 505
Ward Aids Direct Care 423 432
Ward Clerk General Services 441 461
Welfare Assistance Income 502 502
Work Supervisor Direct Care 423 432
X-Ray Direct Care 423 432
Youth Workers Direct Care 423 432

The concordance table

The concordance table is an internal document to Statistics Canada used to map data from residential care facilities’ financial statements to corresponding cells in the questionnaire. The publication of those documents aims at providing a better understanding of the concepts of the survey to researchers and the general public. Respondents to the questionnaire may also use the table to complete their questionnaire from their financial statements or other financial data.

The concordance table is made of an alphabetical list of line items frequently found in the income statements of RCF. These items are mapped to the corresponding cell of the questionnaire. Conversely, the list of cell is mapped to the corresponding line items. The items are provided in both official languages. However, some items were not translated because they are specific to certain provinces.

Residential Care Facilities Survey Concordance Table

Residential Care Facilities Survey Concordance Table
Income Statement - Item Short Form Section Long Form Cell Number Short Form Cell Number
AADAC - Alberta Alcohol & Drug Abuse Commission Income 503 503
Academic & Social Service General Services 442 462
Accrual General Services 442 462
Activation Supervisors Direct Care 417 432
Activity Attendants Direct Care 417 432
Activity Co-ordinator Direct Care 417 432
Activity Director Direct Care 417 432
Activity Supplies Direct Care 417 432
Activity Workers Direct Care 417 432
Addiction Counsellors Direct Care 423 432
Adjuvant (see editing inst. Page 21) Direct Care 417 or 423 432
ADS (Air Dispatch Service) General Services 442 462
ADS (Air Dispatch Service) Income 509 509
Adult day Care Income 505 505
Aides (Health Care Nursing Aides) Direct Care 423 432
AIDS Activity Direct Care 417 432
Ambulance General Services 442 462
Amortization (expense) Other (sect L) 483 483
Amortization (Revenue) Income 505 505
Amortization of deferred contributions related to capital assets DO NOT USE DO NOT USE DO NOT USE
Ancillary Revenues Income 509 509
Art Therapy Direct Care 417 432
Arts & Recreation Director Direct Care 417 432
Assaultive Unit Direct Care 423 432
Assistant Director of Nursing (A.D.O.N) Direct Care 401 432
Attendant Direct Care 423 432
Auto Insurance General Services 442 462
Bad Debts General Services 442 462
Bank Charges (including interest paid by facility) General Services 442 462
Bank Interest (received by facility) Income 509 509
BC Housing Management Corporation (BCHMC) Income 502 502
Beautician Direct Care 423 432
Behaviour Therapist Direct Care 414 432
Benefits General Services 442 462
Bookkeeper & Audit General Services 442 462
Building Occupancy Other (sect L) 483 483
Burial General Services 459 462
C.P.P. Canada Pension Plan General Services 442 462
C.S.C - Correctional Services Canada Income 505 505
Cable General Services 442 462
Canteen General Services 445 462
Cap Fees Income 506 506
Capital Assessment Program General Services 442 462
Capital Costs - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Insurance General Services 483 483
Capital Interest Income 505 505
Capital Interest Other (sect L) 483 483
Capital Purchases - Should be excluded not applicable DO NOT USE DO NOT USE
Capital Taxes Other (sect L) 483 483
Care Giver/Special Care Aide Direct Care 423 432
Central Dispatch Stores General Services 442 462
CFSA (Child & Family Services Act.)/Childrens Aid Income 502 502
Chaplain Direct Care 423 432
Child Care Counsellor Direct Care 423 432
Child Care Worker Direct Care 423 432
Child Therapist Direct Care 414 432
Children & Family Services Income 502 502
Children Aids Direct Care 423 432
Christian Science Nursing Direct Care 423 432
City, for example homeless shelters Income 504 504
Cleaning General Services 450 462
Clerical Support Direct Care 442 462
Clinical Record General Services 442 462
Clothing Direct Care 430 433
CMHA (Canada Mental Health Association) Income 505 505
CMHC (Centre Mortgage Housing Corporation) Income 505 505
Coach Operator General Services 458 461
Comfort Allowance Direct Care/Income 430 or 509 433 or 509
Community Living Income 502 502
Community Placement General Services 459 462
Community Safety & Correctional Services except Manitoba Income 503 503
COMSOC (Ministry of Community & Social Services) (ON) Income 502 502
Conference Expense General Services 442 462
Convalescent and Observation beds DO NOT USE DO NOT USE DO NOT USE
Convention General Services 442 462
Co-Ordinator Income 505 505
Counselling Staff Direct Care 423 432
Counsellors Direct Care 423 432
Craft Direct Care 418 433
Craft Supervisor Direct Care 417 432
Crown agencies Income 503 503
D.I.A (Dept of Indian affairs) Income 505 505
Dental Clinic Direct Care 423 432
Dentist Direct Care 423 432
Department of Health (DOH) Income 501 501
Department of Justice, Provincial  Income 503 503
Depreciation Other (section L) 483 483
DFNFA (DIAND(Department of Indian Affairs and Northern Development)/First Nations Funding Agreement) Income 505 505
Dietician Direct Care 423 432
Director of Care (D.O.C.) Direct Care 401 432
Director of Nursing Direct Care 401 432
Disability Pension Income 503 503
Doctor Direct Care 423 432
Doctor Retainer Fees Direct Care 424 433
DOH (Dept of Health) Income 501 501
Donations Expenses 459 462
Donations Income 505 505
Driver General Services 458 461
Drug Income Income 509 509
Dues General Services 442 462
DVA (Dept of Veteran Affairs) Income 505 505
Early Incentive Bonus Income 509 509
ECG Technician Direct Care 423 432
Education - Staff General Services 458 461
Education & Rec Activity Direct Care 417 432
EEG Technician Direct Care 423 432
Emergency Nursing Care Direct Care 423 432
Employment Benefit General Services 442 462
Equipment General Services 456 462
Equipment, rented or leased, specified - should go into that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, were applicable Other (section) 483 483
Equipment, rented or leased, unspecified Income 505 505
Executive Director General Services 441 461
Family & Community Services Income 502 502
Family Allowance Income 505 505
Family Allowance Benefit (FAB) Income 502 502
Family Benefits Allowance (FBA) Income 502 502
Farm Manager General Services 458 461
Farm Operator General Services 458 461
Federal Subsidies Income 505 505
Fitness Consultant Direct Care 417 432
Food Recoveries if listed as income Income 509 509
Foot Care Direct Care 423 432
Freight General Services 442 462
Fringe Benefit General Services 442 462
Fundraising General Services 459 462
Fundraising Income 509 509
Funeral General Services 459 462
General Welfare Assistance (GWA) Income 505 505
General Workers (helpers) Direct Care or General Services 423 or 458 432 or 461
Geriatric Aids Direct Care 423 432
GIS (Guaranteed Income Supplement) Income 505 505
Graduate Nurse Direct Care 423 432
Grants - except Capital Grants (see above) Income 505 505
Grooming Expenses Direct Care 424 433
Ground & Gardens General Services 456 462
Group Home Co-Ordinator General Services 441 461
Group Home Parent Direct Care 423 432
Group Therapist Direct Care 414 432
Group Workers Direct Care 423 432
GST Rebates NOT INCLUDED Not applicable  DO NOT USE DO NOT USE
Hairdresser Direct Care 423 432
Health & Community Services Income 501 501
Health Authority (HA) Income 501 501
Health Care Aides (H.C.A.) Direct Care 423 432
HIP (Health Insurance Program) Income 501 501
Home Physician Direct Care 423 432
Homemaker Direct Care 423 432
Homes for Special Care (Ministry of Health-HSC) Income 501 501
Honorarium General Services 442 462
Hospital Insurance Plan (HIP) Income 501 501
House Mother Direct Care 423 432
House Parent Direct Care 423 432
ICBC (Insurance Corporation of B.C.) Income 503 503
ICFS (Indian Child & Family Services) Income 505 505
Improvement General Services 456 462
In lieu of  Salaries and Wages appropriate cell appropriate cell
Incontinent Supplies Direct Care 430 433
Indian Affairs Income 505 505
Indirect Wages Salaries and Wages appropriate cell appropriate cell
Ineligible Space (when it is the same value in both income & expenses) DO NOT USE DO NOT USE DO NOT USE
In-Service Co-Ordinator General Services 458 461
Instructors (Medical) Direct Care 423 432
Insurance, other than auto Other (section L) 483 483
Interest (Bank) Income 509 509
Investment Income Income 505 505
Jointex NS Municipal Income 504 504
Justice Income 503 503
Lab Technician Direct Care 423 432
Legal  General Services 442 462
Leisure Counsellor Direct Care 417 432
LHIN - Local Health Integration Network (Ontario) Income 501 501
Library General Services 442 462
Life Skills Worker Direct Care 423 432
Longterm Care Income 501 501
Look Assistance Grant Alberta Income 503 503
Maintenance  General Services 455 461
Management Fee General Services 442 462
Massage Therapist Direct Care 414 432
Material Management General Services 442 462
MCFS (Ministry of Child & Family Services) Income 502 502
MCSS, COMSOC in Ontario (Ministry of Community & Social Services) Income 502 502
Meals on Wheels Income 509 509
Medical Director / Medical Advisor General Services 442 462
Medical Secretary General Services 441 461
Medical Services Insurance Plan (MSIP) Income 501 501
Mentally Retarded Counsellor Direct Care 423 432
MHR (Ministry of Human Resources) Income 503 503
Ministry of Children & Families Income 502 502
Ministry of Community & Social Services (COMSOC in Ontario, MCSS elsewhere) Income 502 502
Ministry of Health (MOH) Income 501 501
Ministry of Housing Income 503 503
Ministry of Mental Health Income 501 501
Ministry of the Attorney General Income 503 503
MMAH (Ministry of Municipal Affairs & Housing) Income 503 503
Mortgage Other (section L) 483 483
Multilateral Framework for Labour Market Agreements for Persons with Disabilities Income 505 505
Municipal Affair (Alberta) Income 503 503
Municipal Taxes Other (section L) 483 483
Music Therapy Direct Care 417 432
Night Security General Services 455 461
Nurse Assistant Direct Care 423 432
Nurse Practitioner  Direct Care 401 432
Nurses Aids Direct Care 423 432
Nursing Attendants Direct Care 423 432
Nursing Education Salaries (larger facilities only) General Services 458 461
Nursing Manuals Direct Care 430 433
Nursing students Direct Care 423 432
Nursing Supervisor  Direct Care 401 432
Nutritionist General Services 444 462
ODSP (Ontario Disability Support Program) Income 502 502
Office Expense General Services 442 462
Old Age Pension  Income 505 505
Old Age Pension (OAP) Income 505 505
Ontario Works Income 502 502
Operations Supplies General Services 442 462
Orderlies Direct Care 423 432
Outreach Program General Services 459 462
Overtime Expenses 442 462
Pastoral Co-Ordinator General Services 442 462
Pay Equity Expenses 423 433
Personal Care Workers Direct Care 423 432
Personal Enrichment Team Direct Care 423 432
Personal Needs Direct Care 430 433
Personal Needs Allowance Income 509 509
Persons with Developmental Disabilities Board(PDD) Income 502 502
Pharmacist Direct Care 423 432
Physiotherapy Aide Direct Care 414 432
Pier Diem Income largest income source largest income source
Placing Agencies Income 505 505
Premium pay Expenses 442 462
Program Allowance Direct Care 424 433
Program Co-Ordinator Direct Care 423 432
Program Director Direct Care 423 432
Program Expenses Direct Care 424 433
Program Worker Direct Care 423 432
Property Manager General Services 455 461
Provincial Government Subsidy - Health Income 501 501
Provincial Government Subsidy - Social Services Income 502 502
Provincial Welfare Assistance Employment Programs Income 502 502
Psychiatrist Direct Care 423 432
Psychologist Direct Care 423 432
Public Relations  General Services 442 462
Public Trustee Income /DOC 503 503
Purchased Drugs (sometimes called pharmacist services) Direct Care 426 433
Purchasing General Services 442 462
R.N.A. / Registered Nursing Assistant Direct Care 405 432
Receptionist General Services 442 462
Recoverable other then Food Income 505 505
Recoveries for Food Income 509 509
Recreational Therapist Direct Care 417 432
Recruitment General Services 459 462
Refunds Income 509 if not stated from where 509 if not stated from where
Regional Health Authority Income 501 501
Regional Municipality of Ottawa - Carleton (RMOC) Income 504 504
Rehabilitation Supervisor Direct Care 423 432
Reimbursed Expenses Other Expenses minus from appropriate cell or minus from 442 minus from appropriate cell or minus from 463
Relief (part-time or casual staff) Salaries and Wages appropriate cell appropriate cell
Religious Services General Services 442 462
Renovations  General Services 459 462
Rent Other (section L) 483 483
Rented or leased equipment  - specified - should go in that expenses category's cell (such as a van for transporting residents to recreation activities) Expenses, where applicable appropriate cell appropriate cell
Rented or leased equipment if unspecified Other (section L) 483 483
Repair General Services 456 462
Replacement General Services 456 462
Residential Social & Recreational Direct Care 423 432
Residential Social Services Direct Care 423 432
Resident Attendant Direct Care 423 432
Resident Counsellor Direct Care 423 432
Resident Services Income 509 509
Restorative Aide Direct Care 423 432
Retainer Fee General Services 442 462
Room and Board Income 506 506
Room Differential Income 507 507
S.E.D.P. (Saskatchewan Employment Program) Income 502 502
School divisions Income 509 509
Seamstress General Services 449 461
Secretary General Services 442 462
Services Income 505 505
Shelter Worker Direct Care 423 432
Shift Premium Salaries and Wages appropriate cell appropriate cell
Snow Removal General Services 456 462
Social Services Direct Care 423 432
Social Worker Direct Care 423 432
Solicitor General Income 505 505
SPD Aid (Sterile processing department) General Services 442 462
Special Care Aide Direct Care 423 432
Special Education Teacher Direct Care 423 432
Speech Therapist Direct Care 414 432
Stipends/contract (fixed amount paid for service) Other Expenses appropriate cell appropriate cell
Stores  General Services 442 462
Subsidy  Income 505 505
Supervisor Direct Care 423 432
Supervisor Activation Direct Care 417 432
Supervisor Social Support Direct Care 423 432
Supervisor Staff Div. Direct Care 423 432
Supplementary needs Direct Care-General Services 430 433
Support Aids Direct Care 423 432
Support Care Attendants Direct Care 423 432
Support Family Payments General Services 442 461
Support Staff Direct Care appropriate cell 432 or 461
Switchboard General Services 441 461
Tax refunds, rebates-do not use DO NOT USE DO NOT USE DO NOT USE
Taxes   483 483
Teachers (for residentsfor example school children)  Direct Care 423 432
Teachers (for staff) (only larger facilities would employee teachers to train staff; otherwise purchased service) General Services 459 462
Technicians (Lab, X-Ray,ECG, EEG) Direct Care 423 432
Telephone General Services 442 462
Training  General Services 459 462
Transition House Counsellor Direct Care 423 432
Transportation General Services 442 462
Travel General Services 442 462
Travel if specified as related to another expense category should be put in that expense category's cell General Services appropriate cell appropriate cell
Treatment Director Direct Care 423 432
Typist General Services 442 462
Unemployment Insurance General Services 442 462
Unspecified Recoveries if listed as expense Expenses 442 462
Unspecified Recoveries if listed as income Income 509 509
Utilities (heat, hydro, water, natural gas) General Services 456 462
Vacation Pay Salaries and Wages appropiate cell appropiate cell
Volunteer Co-Ordinator Salaries (Fees) General Services 441 461
VRDP Vocational Rehabilitation Disabled Persons (Fed. Contribution for Alcohol and Drug Programs) Income 505 505
Ward Aids Direct Care 423 432
Ward Clerk General Services 441 461
Welfare Assistance Income 502 502
Work Supervisor Direct Care 423 432
X-Ray Direct Care 423 432
Youth Workers Direct Care 423 432

Residential Care Facilities Survey – 2011 – Short Form

Guide
Instructions and Definitions

Survey Information

Survey purpose:
This survey collects social, financial and operating data required to produce statistics for your industry.

Coverage:
Please complete a questionnaire for the operation and location described on the label. You should only report for those facilities located in Canada.

Confidentiality:
Statistics Canada is prohibited by law from releasing any information from this survey which would identify any person, business, or organisation, unless consent has been given by the respondent or as permitted by the Statistics Act. The information from this survey will be treated in strict confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation.

Data-sharing agreements
To reduce respondent burden, Statistics Canada has entered into data sharing agreements with provincial and territorial statistical agencies and other government and non-government organizations, which must keep the data confidential and use them only for statistical purposes. Statistics Canada wll only share data from this survey with those organizations that have demonstrated a requirement to use the data.

Section 11 of the Statistics Act provides for the sharing of information with provincial and territorial statistical agencies that meet certain conditions. These agencies must have the legislative authority to collect the same information, on a mandatory basis, and the legislation must provide substantially the same provisions for confidentiality and penalties for disclosure of confidential information as the Statistics Act. Because these agencies have the legal authority to compel businesses to provide the same information, consent is not requested and businesses may not object to the sharing of the data.

For this survey, there are Section 11 agreements with the provincial and territorial statistical agencies of Newfoundland and Labrador, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, and the Yukon.

The shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.

Section 12 of the Statistics Act provides for the sharing of information with federal, provincial or territorial government organizations or non-government organizations. Under Section 12, you may refuse to share your information with any of these organizations by writing a letter of objection to the Chief Statistician and returning it with the completed questionnaire. Please specify the organizations with which you do not want to share your data.

For this survey, there are Section 12 agreements with the statistical agencies of Prince Edward Island, the Northwest Territories and Nunavut, and with the Canadian Institute for Health Information, Health Canada, and the Public Health Agency of Canada.

For agreements with provincial and territorial government organizations, the shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.

Record linkages
To enhance the data from this survey, Statistics Canada may combine it with information from other surveys or from administrative sources.

Return of questionnaire:
Please complete and return your questionnaire within 30 days of receipt. Please note that audited data is not required for this survey. Please send the completed questionnaire in the enclosed envelope or by facsimile toll-free to 1 888 883-7999.

Do you have any questions? Do you need another questionnaire?

For assistance and information please call: 1 800 565-1685

When completing the survey

  1. Please keep a copy of the completed questionnaire for your own records.

  2. Statistics Canada survey staff would be pleased to discuss alternatives that would make completing this survey easier for you. Such alternatives could include:

    1. completing the survey electronically using our secure electronic version of the survey;
    2. providing Statistics Canada with an electronic version of your financial statements or listings of facilities using our electronic file transfer service rather than mailing this documentation;
    3. providing Statistics Canada with a spreadsheet on disk rather than completing the paper questionnaire;
    4. completing the survey by paper instead of electronically;
    5. completing the survey over the telephone with the assistance of Statistics Canada staff;
    6. providing financial statements rather than completing the RCF Survey financial questions.
  3. If you have prepared a report of statistical and financial data for regional boards or provincial government ministries, with equivalent information, you may send a copy of the report instead of completing the same items on the RCF Survey questionnaire. Please complete the cover page of the RCF Survey and return it with the report to Statistics Canada.
  4. You may provide financial statements instead of completing sections J, K, L and M of the questionnaire by sending the information by mail at the address below or facsimile toll-free to 1 888 883-7999. Please enclose the questionnaire with your financial statements.

    Statistics Canada
    Operations and Integration Division
    Distribution Centre - SC-0702
    150 Tunney’s Pasture Driveway
    Ottawa, ON K1A 0T6

    Statistics Canada advises that there could be a risk of disclosure during mailing or facsimile. However, under receipt, Statistics Canada will provide the guaranteed level of protection afforded to all information collected under the authority of the Statistics Act. If you wish to send us your financial statements, please ensure that you completed the cover page and sections A to I of the questionnaire and send us the following information attached to your financial statements: Legal Name of facility, Business Name, Mailing address, Province or Territory, Name of the facility contact, business number and questionnaire identification number (found on the label, starts with Q).
  5. If this facility is administered by a central agency or is a multiple facility set-up, please indicate the reporting arrangements and the name, address and number of beds of each facility involved in the administrative entity. This will enable Statistics Canada to modify the mail-out for the next year and thereby eliminate duplicate reporting and additional respondent burden.

Cover Page

Label

Please correct the legal name, business name, contact information shown on the pre–printed label, using the corresponding boxes below the label.

Facility information

Please provide the name and contact information for the primary contact person for this facility.

Name of person completing the questionnaire

Please provide the name and contact information for the primary contact person for this survey. It can be the same person as the facility contact.

Instructions for page 2

Reporting Instructions

Read carefully all instructions and definitions in this booklet and on the questionnaire.

  • When precise figures are not available, please provide your best estimates. Please DO NOT wait for your financial statements before completing the survey.
  • Please DO NOT include commas, decimals or special symbols ($, #, % etc) in your report.
  • All dollar amounts should be reported in CANADIAN DOLLARS ($ CDN) and should be rounded to the nearest dollar (e.g. $5,400.40 should be rounded to $5,400).

To report items not specified on the questionnaire, use lines designated as "Other" and provide supplementary information.

A. Administrative characteristics

1. Type of organization
Place a check mark in the circle beside the option that best describes the legal organization of this business.

Sole proprietorship – An unincorporated business wholly owned by one person. In most cases, this person manages the business and consequently is the owner manager.

Partnership – A form of business organization in which two or more persons are co–owners without becoming incorporated. They agree to contribute assets or other resources to the business, and to share its profits, losses and debts.

Incorporated company – A business legally constituted with share capital that, after registering with the proper authorities, constitutes a body corporate legally distinct from the partners or stockholders.

Co–operative – A group of persons who share certain assets and operations to enable access, at a lower cost,, to the means of production, distribution, credit or other activity for the mutual benefit and risk of its members. Each member has equal rights and accountability according to the principal of "one member, one vote".

Joint venture – A business organization where two or more persons or entities form an association to jointly carry out an industrial or commercial activity, or decide to share resources and control these jointly, for the purposes of a specific project rather than as an ongoing business. The expectation is that the persons or entities involved share in the costs and benefits.

Government business entity – A business corporation in which the state holds controlling interest, and is operating in the commercial market. This does not include Crown corporations.

Government – A not–for–profit entity financed and controlled by a ministry, department, agency, autonomous organization, board, commission or fund of the federal, provincial, territorial or local government and not operated in the commercial market.

Non–profit organization – Organization usually formed for social, economic, educational, religious, philanthropic or health purposes in which there is normally no transferable ownership interest and which does not carry on business with a view to distribution or use of any profits for the pecuniary gain of its members or grantors.

2. GST number
Please provide the first nine (9) digits of this facility’s GST Registered Account Number (also known as the Business Number).

The GST Registered Account Number will be used to verify the information about this facility currently held on Statistics Canada’s Business Register.

3. Reporting Arrangements
Please provide the count of facilities that this you are including on this report. If you are reporting for more than one facility, please return a list of facilities, addresses and number of beds for each facility that you have included data for with this report. You can also return the printout list of facilities with any updates clearly indicated.

4. Fiscal period
For the purpose of this survey, please report information for your 12–month fiscal period for which the final day occurred on or between April 1, 2010 and March 31, 2011. For example, if your fiscal period ended December 31, 2010 , please report for the period January 1, 2010 to December 31, 2010 .

5. Type of Ownership
Refers to the person, group of persons, agency or corporate body who is the registered owner according to the deed or statute.

Proprietary – applies to a facility owned by an individual or group. These are private organizations and/or corporations operating for a profit.

Religious – applies to a facility owned and operated by a religious organization on a non–profit basis.

Lay – applies to a facility owned and operated by a voluntary lay body on a non–profit basis. This category excludes facilities maintained by industrial or commercial corporations (see proprietary).

Municipal – applies to a facility owned and operated by a city, county, municipality or other municipal government, or by another body which is empowered to levy taxes or to otherwise operate after the fashion of a municipality.

Provincial or territorial – applies to a facility owned by a branch, division, agency or department of a provincial or territorial government.

Federal – applies to a facility operated by a department or agency of the Government of Canada, e.g. Veterans’ Affairs, Health Canada or National Defence.

Regional Health Authority, Board, District, Corporation – applies to those facilities owned and operated by a regional governance structure responsible for the continuum of health services for defined geographic regions.

B. Number of beds as of the last day of the fiscal period

6. Number of beds (including respite beds)

Licensed or approved – the number of beds licensed or approved by provincial or municipal authorities. Report all beds, even if some are not in use at the present time. This includes licensed respite beds.

Staffed and in operation – report only the number of beds available for use. Include those occupied and any vacant beds to which you could have admitted residents at the end of the fiscal year reported. This amount does not have to agree with the approved complement. This includes licensed respite beds.

Characteristics of residents

This includes all residents temporarily absent on this date but who were registered in your facility and for whom a bed was assigned.

Instructions for page 3

C. Total days of care during reporting period (by responsibility for payment)

A day of care is the period of service to a resident between the census taking hours on two successive days. The total days of care are the number of days of care in the reporting period or year. A facility of four beds and 100 percent occupancy would report total days of care as (4 x 365) 1,460. A facility of four beds in which one bed was not occupied for 31 days during the year would report total days of care as 1,429. This could be calculated as [(4 x 365) – 31] or counting each day that each bed was occupied [(1 x 365) + (1 x 365) + (1 x 365) + (1 x 334)]. If unable to provide a breakdown, please estimate, or if unable to estimate then report days under major funding agency.

Line a. Days charged to a Provincial or Territorial Government Health Program or Department.

Line b. Days charged to a Provincial or Territorial Government Social Service Program or Department.

Line c. Days charged to another Provincial or Territorial Department other than Health or Social Services, e.g. crown agencies such as Alcohol and Drug Commissions.

Line d. Days charged to a municipality, regional or district administration.

Line e. All days not reported above, including residents who pay for their own care directly or through private insurance and those paid for by Workers’ Compensation Board, Department of Veterans’ Affairs, etc.

D. Movement of residents

Line a. In facility on the first day of the fiscal period – the count of all the residents who were assigned a bed at 00:01 hours, the first day of the fiscal period. Include any resident who was temporarily absent from the facility on this date, e.g., visiting relatives or residents transferred to other institutions such as hospitals, but who had not been formally discharged.

Line b. Admissions – the total number of new residents accepted into the facility during the fiscal year reported. This involves the allocation of a bed to a resident. An admission is registered each time a person is formally admitted.

Line c. Total under care – the total of those in the facility (on the books) at the beginning of the fiscal period, plus all admissions during the year.

Line d. Discharge – the total of all residents who were discharged from the facility during the fiscal year.

Line e. Death – the cessation of life of a resident during the fiscal year.

Line f. Total separations – the total of discharges and deaths.

Line g. In facility on the last day of the fiscal period – the count of all residents registered in the facility at 24:00 hours, the last day of the fiscal period. Includes residents temporarily out of the facility who had not been formally discharged.

E. Age and sex of residentss in facility on the last day of the fiscal period

Count each resident once only, and assign them to the appropriate columns according to their age and sex grouping.

Instructions for page 4

F. Types of care

Counting each resident once only, please assign all residents in your facility to one of the types of care. This should be based on the type of care the resident was receiving on the last day of the fiscal period.

For temporarily absent residents, indicate the type of care these residents usually receive in this facility.

Line a. Room and board – for those residents paying only for the use of a room. No services or type of care are received.

Line b. Room and board with guidance/counselling – this is the minimum amount of care possible in a facility. Usually includes basic counselling and assistance with social problems. Most residents of facilities for emotionally–disturbed children and for alcohol and drug will be in this category.

Line c. Room and board with custodial care – minor supervision required.

Line d. Type I Care – that required by a person who is ambulatory and/or independently mobile, who has decreased physical and/or mental faculties, and who requires primarily supervision and/or some assistance with activities of daily living and provision for meeting psycho–social needs through social and recreational services. The period of time during which care is required is indeterminate and related to the individual condition but is less than 90 minutes in a 24 hour day. Many facilities for the developmentally delayed will have most of their residents in this category.

Line e. Type II Care – that required by a person with a relatively stabilised (physical or mental) chronic disease or functional disability. They have reached the apparent limit of recovery, and are not likely to change in the near future. They have relatively little need for the diagnostic and therapeutic services of a hospital, but require personal care for a total of 1 ½– 2 ½ hours in a 24 hour day, with medical and professional nursing supervision and provision for meeting psychosocial needs.

Line f. Type III Care – that required by a person who is chronically ill and/or has a functional disability (physical or mental), whose acute phase of illness is over, whose vital processes may or may not be stable, whose potential for rehabilitation may be limited. These residents require a range of therapeutic services, medical management and skilled nursing care plus provision for meeting psychosocial needs. A minimum of 2½ hours of individual therapeutic and/or medical care is required in a 24–hour day.

Line g. Higher type care – report here those persons who need substantially more nursing and/or medical care than described above. It is assumed that there would be very few residents who would be receiving care of this type. Care above TYPE III is usually provided in a hospital setting.

Refer to Appendix 1 for the list of provincial equivalencies of type of care.

G. Principal characteristics of residents in facility on the last day of the fiscal period

Counting each resident once only, please group them according to the most appropriate principal characteristic.

Line a. Aged – Residents are in the facility mainly because of old age (65+). They may have some other related disabilities associated with ageing, but for the purpose of this survey, consider the principal characteristic as aged.

Line b. Physically challenged/disabled – Residents are in a facility primarily because of bodily dysfunctions (e.g. blind, deaf, loss of limbs, etc.)

Line c. Developmentally delayed – Residents are slow or limited in intellectual or emotional development or academic progress.

Line d. Psychiatrically–disabled adults – Includes ex–psychiatric patients, individuals with a chronic mental illness or those convalescing from a mental illness.

Line e. Emotionally–disturbed children – Children with behaviour disorders that require specialised treatment.

Line f. Addictions – Residents require treatment for problems with alcohol or drug addiction.

Line g. Transients – Persons requiring short–term respite who are without a home due to an emergency or a continuing situation.

Line h. Other – Includes residents who do not fit in any of the other categories, e.g. unmarried mothers, children requiring shelter who do not fit in any of the other categories, etc.

Note – Only hostels providing at least a counselling level of care fall into scope for the RCF survey. Hostels providing only hotel or room and board should not be included. If your facility falls into the latter category, please state this on the cover page and return this survey.

Instructions for page 5

Personnel

Personnel employed – Persons on the payroll of the facility on the last day of the fiscal period.

Exclude voluntary and contract workers for whom no salaries are recorded. Also exclude persons paid on a fee for services basis (doctors or dentists on call, etc.). Report this as an expense in Section I.

Personnel employed on the last day of the fiscal period. – Columns 1 & 2

Report only the number of "full–time" and "part–time" staff employed. Do not use full–time equivalencies unless actual figures are unavailable. Exclude casual employees from the first two columns. Casual employees refers to those employed on a non–continuing or irregular basis, such as those who temporarily relieve regular employees on vacation or sick leave or those who are hired temporarily for such casual jobs as snow removal, office overload, etc.

Full–time – refers to persons employed on a full–time basis, i.e. regularly employed throughout the facility’s full work week.

Part–time – refers to persons employed on a part–time basis, i.e. regularly employed on selected days or partial days in the facility’s work week.

The owner/operator of a small facility may be the only person working full–time. If this is the case, write ‘1’ full–time employee on line 40. Hours should then be split to reflect the approximate time spent in Direct care for residents, line 38 and General services, line 39. Report remuneration in Section I.

When an employee fills more than one position, that individual is to be recorded once only under the category of employment in which the major portion of time is spent.

Total accumulated hours paid during the reporting period – Column 3

Include total hours paid for all full–time, part–time and casual employees who have had salaries or wages paid to them by the facility. Hours covering paid holiday time and other paid leave are to be included for all categories of personnel. Do not include hours for contractual employees.

ROUND OFF FRACTIONS AND REPORT WHOLE NUMBERS ONLY.

H. Personnel

Line a. Direct Care Services – Show here all the personnel whose time is spent mainly with the residents, giving assistance, nursing care, guidance or any other forms of personal help directly to the residents. This would include registered nurses, nursing assistants, dieticians, therapists, recreation staff, nursing aides, health care aides, counsellors, child care workers, orderlies, social workers, graduate nurses, etc.

Line b. General Services – Report here information on all other personnel of the facility who provide indirect services and who are not shown on line 1 above.

This includes persons involved in the administration of the facility (including unit/ward clerks), kitchen/food services, housekeeping, laundry, plant operation, maintenance and security. Only report data relating to the personnel who carry out these functions in residential care facilities.

Include outreach workers employed by the facility but providing services outside of the facility in the community.

I. Expenses

Report on this page the total revenue of the facility for the most recent fiscal year that ended at any time between April 1, 2010 and March 31, 2011. Capital costs are to be excluded.
REPORT IN DOLLARS ONLY, OMITTING CENTS.

Line a. Direct Care Service

Column 1 Salaries and Wages
Amount should correspond with details in Section H concerning personnel and paid hours; if hours have been reported on a line in Section H, there should be a corresponding dollar value reported in Section II and vice versa.

Column 2 All Other Expenses
Report any expenses, other than salaries and wages, related to a specific area or department. Include any amounts paid to persons as a fee for service (doctors not on staff, etc.). Also include drugs, medical and surgical supplies and the cost of all other supplies and services involved in the direct care of residents.

Line b. General Services

Column 1
Amount should correspond with details in section H, line 2, concerning personnel and paid hours.

Column 2
This would include expenses related to administration (including employee benefits), kitchen/food services, housekeeping, laundry, utilities, maintenance and security and all other costs of general services which cannot be allocated to direct care of residents.
Where the facility has arranged for any service, e.g., dietary, housekeeping, maintenance, to be provided by an independent outside company as a "purchased service" – the total costs of such service should be shown in column 2 and no costs shown in the salaries and wages column. Please note such "purchased services" on the Supplementary Information page.

Line c. Other expenses
Please report here:

  • Any interest on loans, notes, mortgages, etc.
  • Business taxes, land and realty taxes, etc. (EXCLUDE income tax).
  • Overhead charged to the facility for Head Office management.
  • Depreciation for the 12 month period for buildings, furniture and equipment, land improvements, automobiles, etc.
  • Rent or leased costs of building and/or equipment.
  • Insurance premiums, licences and fees paid to government or other regulatory bodies, etc.

Report on this page the total revenue of the facility for the most recent fiscal year that ended at any time between April 1, 2010 and March 31, 2011.

Revenues from accommodation should represent the majority of the income.
REPORT IN DOLLARS ONLY, OMITTING CENTS.

Instructions for page 6

J. Source of Revenue

Line a. Provincial Health Department or Ministry (Provincial Health Insurance Plan) – where Provincial Health Insurance provides coverage for standard ward accommodation for an eligible resident, record the income earned from such a Plan, e.g. Ministry or Department of Health or Long Term Care.

Line b. Provincial Social Services Department or Ministry (Provincial Social Services Plan) – report all amounts earned from Provincial Government Social Service Programs or Departments, e.g. Dept. of Social Services, Dept. of Social Services and Community Health (AB.), Community and Social Services (ON.), Community Services and Corrections (MB.), etc.

Line c. Other Provincial Department or Ministry – report amounts earned from a provincial department or agency other than Health or Social Services, e.g. crown agencies such as alcohol/drug commissions.

Line d. Municipalities, Regional or District Administrations – include all amounts earned from municipalities, regional or district administrations on behalf of residents.

Line e. All Other – include all amounts for accommodation earned from sources other than described (lines 45–48) including earnings from Federal Government departments or agencies, Workers’ Compensation Boards, Department of Veterans’ Affairs, etc. Also include any grants or donations received by the facility.

Line f. Residents – Co–insurance or Self–pay – record all amounts to be paid by residents personally or by private insurance companies as their share of the standard ward rate.

Line g. Differential – Preferred Accommodation – record all amounts earned from persons occupying semi–private and private rooms for which an additional charge over and above standard ward rate is charged.

Line h. Total earnings for accommodation – sum lines 45 to 51.

Line i. Sundry Earnings – record here all other earnings not attributable to basic accommodation. This would include such items as:

  • Physical therapy
  • Special duty nursing
  • Hairdressing or barber services
  • Laundry, dry cleaning
  • Employee or guest meals
  • Vending machines, telephone
  • Day care
  • Sale of crafts
  • Etc.

Appendix 1

Type of Care Equivalences
Province Provincial Level / Type of care Type of care equivalencies for the survey
For more detailed information, please refer to section F of the Guide
All Most children's and alcohol and drug facilities Room and board with guidance / counselling with respect to social, employment, addiction problems, or parental guidance with skilled counselling
Newfoundland and Labrador
Personal functions		 Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
Level 3 Type III (i.e., medical management, skilled nursing care, etc.)
Level 4 Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Mental/Sensory/Perceptual Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
Level 3 Type III (i.e., medical management, skilled nursing care, etc.)
Level 4 Higher Type
Prince Edward Island Level I Room and board with custodial care
Level II Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level IV Type II (i.e., medical and professional nursing supervision, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Nova Scotia Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Care in Residential Care Facilities Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Adult Residential Centres Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Group Homes and Developmental Residences Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Regional Rehabilitation Centres Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
or Type II (i.e., medical and professional nursing supervision, etc.)
New Brunswick Level I Room and board with custodial care
Level Type II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Care in a Nursing home Type III (i.e., medical management, skilled nursing care, etc.)
Care in a Hospital extended care Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Ontario Care in a Retirement home Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in a Long–term care home Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Manitoba Personal Care Level 1 Room and board with custodial care
Personal Care Level 2 Room and board with custodial care
Personal Care Level 3 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Personal Care Level 4 Type II (i.e., medical and professional nursing supervision, etc.)
Hospital Acute Care Level Equivalent Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Hospital/Extended Care Facility Equivalent Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Saskatchewan Supervisory care Room and board with custodial care
Limited personal care Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Intensive personal or nursing care Type II (i.e., medical and professional nursing supervision, etc.)
Long–term restorative or palliative care Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Alberta Assisted Living – Level 3 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
or Type II (i.e., medical and professional nursing supervision, etc.)
Assisted Living – Level 4 Type II (i.e., medical and professional nursing supervision, etc.)
Facility Living Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
British Columbia Registered Assisted Living Facilities Type I care (care less than 90 minutes per day)
Licensed facilities under the Community Care and Assisted Living Act, including hospice and convalescent care facilities Type II care (personal care for a total of 1½ – 2 ½ hours in a 24 hour day, with medical and professional nursing supervision)
Residential Care and Private Hospitals under the Hospital Act (not included in this survey) Type III care (minimum of 2½ hours of
individual therapeutic and/or medical care per day)
Stand–alone residential care facilities under the Hospital Act Higher Type care (substantially more nursing and/or medical care than described above, generally in acute care)
Yukon Territory Level 1 Room and board with custodial care
Level 2 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 3 Type II (i.e., medical and professional nursing supervision, etc.)
Level 4 Type III (i.e., medical management, skilled nursing care, etc.)
Level 5 Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Northwest Territory Level I Room and board with custodial care
Level II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Nunavut Level I Room and board with custodial care
Level II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type

Residential Care Facilities Survey – 2011GuideInstructions and Definitions

Guide
Instructions and Definitions

Survey Information

Survey purpose:
This survey collects social, financial and operating data required to produce statistics for your industry.

Coverage:
Please complete a questionnaire for the operation and location described on the label. You should only report for those facilities located in Canada.

Confidentiality:
Statistics Canada is prohibited by law from releasing any information from this survey which would identify any person, business, or organisation, unless consent has been given by the respondent or as permitted by the Statistics Act. The information from this survey will be treated in strict confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation.

Data-sharing agreements
To reduce respondent burden, Statistics Canada has entered into data sharing agreements with provincial and territorial statistical agencies and other government and non-government organizations, which must keep the data confidential and use them only for statistical purposes. Statistics Canada wll only share data from this survey with those organizations that have demonstrated a requirement to use the data.

Section 11 of the Statistics Act provides for the sharing of information with provincial and territorial statistical agencies that meet certain conditions. These agencies must have the legislative authority to collect the same information, on a mandatory basis, and the legislation must provide substantially the same provisions for confidentiality and penalties for disclosure of confidential information as the Statistics Act. Because these agencies have the legal authority to compel businesses to provide the same information, consent is not requested and businesses may not object to the sharing of the data.

For this survey, there are Section 11 agreements with the provincial and territorial statistical agencies of Newfoundland and Labrador, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, and the Yukon.

The shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.

Section 12 of the Statistics Act provides for the sharing of information with federal, provincial or territorial government organizations or non-government organizations. Under Section 12, you may refuse to share your information with any of these organizations by writing a letter of objection to the Chief Statistician and returning it with the completed questionnaire. Please specify the organizations with which you do not want to share your data.

For this survey, there are Section 12 agreements with the statistical agencies of Prince Edward Island, the Northwest Territories and Nunavut, and with the Canadian Institute for Health Information, Health Canada, and the Public Health Agency of Canada.

For agreements with provincial and territorial government organizations, the shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.

Record linkages
To enhance the data from this survey, Statistics Canada may combine it with information from other surveys or from administrative sources.

Return of questionnaire:
Please complete and return your questionnaire within 30 days of receipt. Please note that audited data is not required for this survey. Please send the completed questionnaire in the enclosed envelope or by facsimile toll-free to 1 888 883-7999.

Do you have any questions? Do you need another questionnaire?

For assistance and information please call: 1 800 565-1685

When completing the survey

  1. Please keep a copy of the completed questionnaire for your own records.

  2. Statistics Canada survey staff would be pleased to discuss alternatives that would make completing this survey easier for you. Such alternatives could include:

    1. completing the survey electronically using our secure electronic version of the survey;
    2. providing Statistics Canada with an electronic version of your financial statements or listings of facilities using our electronic file transfer service rather than mailing this documentation;
    3. providing Statistics Canada with a spreadsheet on disk rather than completing the paper questionnaire;
    4. completing the survey by paper instead of electronically;
    5. completing the survey over the telephone with the assistance of Statistics Canada staff;
    6. providing financial statements rather than completing the RCF Survey financial questions.
  3. If you have prepared a report of statistical and financial data for regional boards or provincial government ministries, with equivalent information, you may send a copy of the report instead of completing the same items on the RCF Survey questionnaire. Please complete the cover page of the RCF Survey and return it with the report to Statistics Canada.
  4. You may provide financial statements instead of completing sections J, K, L and M of the questionnaire by sending the information by mail at the address below or facsimile toll-free to 1 888 883-7999. Please enclose the questionnaire with your financial statements.

    Statistics Canada
    Operations and Integration Division
    Distribution Centre - SC-0702
    150 Tunney’s Pasture Driveway
    Ottawa, ON K1A 0T6

    Statistics Canada advises that there could be a risk of disclosure during mailing or facsimile. However, under receipt, Statistics Canada will provide the guaranteed level of protection afforded to all information collected under the authority of the Statistics Act. If you wish to send us your financial statements, please ensure that you completed the cover page and sections A to I of the questionnaire and send us the following information attached to your financial statements: Legal Name of facility, Business Name, Mailing address, Province or Territory, Name of the facility contact, business number and questionnaire identification number (found on the label, starts with Q).
  5. If this facility is administered by a central agency or is a multiple facility set-up, please indicate the reporting arrangements and the name, address and number of beds of each facility involved in the administrative entity. This will enable Statistics Canada to modify the mail-out for the next year and thereby eliminate duplicate reporting and additional respondent burden.

Cover Page

Label

Please correct the legal name, business name, contact information shown on the pre–printed label, using the corresponding boxes below the label.

Facility information

Please provide the name and contact information for the primary contact person for this facility.

Name of person completing the questionnaire

Please provide the name and contact information for the primary contact person for this survey. It can be the same person as the facility contact.

Instructions for page 2

Reporting Instructions

Read carefully all instructions and definitions in this booklet and on the questionnaire.

  • When precise figures are not available, please provide your best estimates. Please DO NOT wait for your financial statements before completing the survey.
  • Please DO NOT include commas, decimals or special symbols ($, #, % etc) in your report.
  • All dollar amounts should be reported in CANADIAN DOLLARS ($ CDN) and should be rounded to the nearest dollar (e.g. $5,400.40 should be rounded to $5,400).

To report items not specified on the questionnaire, use lines designated as "Other" and provide supplementary information.

A. Administrative characteristics

1. Type of organization
Place a check mark in the circle beside the option that best describes the legal organization of this business.

Sole proprietorship – An unincorporated business wholly owned by one person. In most cases, this person manages the business and consequently is the owner manager.

Partnership – A form of business organization in which two or more persons are co–owners without becoming incorporated. They agree to contribute assets or other resources to the business, and to share its profits, losses and debts.

Incorporated company – A business legally constituted with share capital that, after registering with the proper authorities, constitutes a body corporate legally distinct from the partners or stockholders.

Co–operative – A group of persons who share certain assets and operations to enable access, at a lower cost,, to the means of production, distribution, credit or other activity for the mutual benefit and risk of its members. Each member has equal rights and accountability according to the principal of "one member, one vote".

Joint venture – A business organization where two or more persons or entities form an association to jointly carry out an industrial or commercial activity, or decide to share resources and control these jointly, for the purposes of a specific project rather than as an ongoing business. The expectation is that the persons or entities involved share in the costs and benefits.

Government business entity – A business corporation in which the state holds controlling interest, and is operating in the commercial market. This does not include Crown corporations.

Government – A not–for–profit entity financed and controlled by a ministry, department, agency, autonomous organization, board, commission or fund of the federal, provincial, territorial or local government and not operated in the commercial market.

Non–profit organization – Organization usually formed for social, economic, educational, religious, philanthropic or health purposes in which there is normally no transferable ownership interest and which does not carry on business with a view to distribution or use of any profits for the pecuniary gain of its members or grantors.

2. GST number
Please provide the first nine (9) digits of this facility’s GST Registered Account Number (also known as the Business Number).

The GST Registered Account Number will be used to verify the information about this facility currently held on Statistics Canada’s Business Register.

3. Reporting Arrangements
Please provide the count of facilities that this you are including on this report. If you are reporting for more than one facility, please return a list of facilities, addresses and number of beds for each facility that you have included data for with this report. You can also return the printout list of facilities with any updates clearly indicated.

4. Fiscal period
For the purpose of this survey, please report information for your 12–month fiscal period for which the final day occurred on or between April 1, 2010 and March 31, 2011. For example, if your fiscal period ended December 31, 2010 , please report for the period January 1, 2010 to December 31, 2010 .

5. Type of Ownership
Refers to the person, group of persons, agency or corporate body who is the registered owner according to the deed or statute.

Proprietary – applies to a facility owned by an individual or group. These are private organizations and/or corporations operating for a profit.

Religious – applies to a facility owned and operated by a religious organization on a non–profit basis.

Lay – applies to a facility owned and operated by a voluntary lay body on a non–profit basis. This category excludes facilities maintained by industrial or commercial corporations (see proprietary).

Municipal – applies to a facility owned and operated by a city, county, municipality or other municipal government, or by another body which is empowered to levy taxes or to otherwise operate after the fashion of a municipality.

Provincial or territorial – applies to a facility owned by a branch, division, agency or department of a provincial or territorial government.

Federal – applies to a facility operated by a department or agency of the Government of Canada, e.g. Veterans’ Affairs, Health Canada or National Defence.

Regional Health Authority, Board, District, Corporation – applies to those facilities owned and operated by a regional governance structure responsible for the continuum of health services for defined geographic regions.

B. Number of beds as of the last day of the fiscal period

6. Number of beds (including respite beds)

Licensed or approved – the number of beds licensed or approved by provincial or municipal authorities. Report all beds, even if some are not in use at the present time. This includes licensed respite beds.

Staffed and in operation – report only the number of beds available for use. Include those occupied and any vacant beds to which you could have admitted residents at the end of the fiscal year reported. This amount does not have to agree with the approved complement. This includes licensed respite beds.

Characteristics of residents

This includes all residents temporarily absent on this date but who were registered in your facility and for whom a bed was assigned.

Instructions for page 3

C. Total days of care during reporting period (by responsibility for payment)

A day of care is the period of service to a resident between the census taking hours on two successive days. The total days of care are the number of days of care in the reporting period or year. A facility of four beds and 100 percent occupancy would report total days of care as (4 x 365) 1,460. A facility of four beds in which one bed was not occupied for 31 days during the year would report total days of care as 1,429. This could be calculated as [(4 x 365) – 31] or counting each day that each bed was occupied [(1 x 365) + (1 x 365) + (1 x 365) + (1 x 334)]. If unable to provide a breakdown, please estimate, or if unable to estimate then report days under major funding agency.

Line a. Days charged to a Provincial or Territorial Government Health Program or Department.

Line b. Days charged to a Provincial or Territorial Government Social Service Program or Department.

Line c. Days charged to another Provincial or Territorial Department other than Health or Social Services, e.g. crown agencies such as Alcohol and Drug Commissions.

Line d.ÁDays charged to a municipality, regional or district administration.

Line e. All days not reported above, including residents who pay for their own care directly or through private insurance and those paid for by Workers’ Compensation Board, Department of Veterans’ Affairs, etc.

D. Movement of residents

Line a. In facility on the first day of the fiscal period – the count of all the residents who were assigned a bed at 00:01 hours, the first day of the fiscal period. Include any resident who was temporarily absent from the facility on this date, e.g., visiting relatives or residents transferred to other institutions such as hospitals, but who had not been formally discharged.

Line b. Admissions – the total number of new residents accepted into the facility during the fiscal year reported. This involves the allocation of a bed to a resident. An admission is registered each time a person is formally admitted.

Line c. Total under care – the total of those in the facility (on the books) at the beginning of the fiscal period, plus all admissions during the year.

Line d. Discharge – the total of all residents who were discharged from the facility during the fiscal year.

Line e. Death – the cessation of life of a resident during the fiscal year.

Line f. Total separations – the total of discharges and deaths.

Line g. In facility on the last day of the fiscal period – the count of all residents registered in the facility at 24:00 hours, the last day of the fiscal period. Includes residents temporarily out of the facility who had not been formally discharged.

E. Age and sex of residentss in facility on the last day of the fiscal period

Count each resident once only, and assign them to the appropriate columns according to their age and sex grouping.

Instructions for page 4

F. Types of care

Counting each resident once only, please assign all residents in your facility to one of the types of care. This should be based on the type of care the resident was receiving on the last day of the fiscal period.

For temporarily absent residents, indicate the type of care these residents usually receive in this facility.

Line a. Room and board – for those residents paying only for the use of a room. No services or type of care are received.

Line b. Room and board with guidance/counselling – this is the minimum amount of care possible in a facility. Usually includes basic counselling and assistance with social problems. Most residents of facilities for emotionally–disturbed children and for alcohol and drug will be in this category.

Line c. Room and board with custodial care – minor supervision required.

Line d. Type I Care – that required by a person who is ambulatory and/or independently mobile, who has decreased physical and/or mental faculties, and who requires primarily supervision and/or some assistance with activities of daily living and provision for meeting psycho–social needs through social and recreational services. The period of time during which care is required is indeterminate and related to the individual condition but is less than 90 minutes in a 24 hour day. Many facilities for the developmentally delayed will have most of their residents in this category.

Line e. Type II Care – that required by a person with a relatively stabilised (physical or mental) chronic disease or functional disability. They have reached the apparent limit of recovery, and are not likely to change in the near future. They have relatively little need for the diagnostic and therapeutic services of a hospital, but require personal care for a total of 1 ½ – 2 ½ hours in a 24 hour day, with medical and professional nursing supervision and provision for meeting psychosocial needs.

Line f. Type III Care – that required by a person who is chronically ill and/or has a functional disability (physical or mental), whose acute phase of illness is over, whose vital processes may or may not be stable, whose potential for rehabilitation may be limited. These residents require a range of therapeutic services, medical management and skilled nursing care plus provision for meeting psychosocial needs. A minimum of 2½ hours of individual therapeutic and/or medical care is required in a 24–hour day.

Line g. Higher type care – report here those persons who need substantially more nursing and/or medical care than described above. It is assumed that there would be very few residents who would be receiving care of this type. Care above TYPE III is usually provided in a hospital setting.

Refer to Appendix 1 for the list of provincial equivalencies of type of care.

G. Principal characteristics of residents in facility on the last day of the fiscal period

Counting each resident once only, please group them according to the most appropriate principal characteristic.

Line a. Aged – Residents are in the facility mainly because of old age (65+). They may have some other related disabilities associated with ageing, but for the purpose of this survey, consider the principal characteristic as aged.

Line b. Physically challenged/disabled – Residents are in a facility primarily because of bodily dysfunctions (e.g. blind, deaf, loss of limbs, etc.)

Line c. Developmentally delayed – Residents are slow or limited in intellectual or emotional development or academic progress.

Line d. Psychiatrically–disabled adults – Includes ex–psychiatric patients, individuals with a chronic mental illness or those convalescing from a mental illness.

Line e. Emotionally–disturbed children – Children with behaviour disorders that require specialised treatment.

Line f. Addictions – Residents require treatment for problems with alcohol or drug addiction.

Line g. Transients – Persons requiring short–term respite who are without a home due to an emergency or a continuing situation.

Line h. Other – Includes residents who do not fit in any of the other categories, e.g. unmarried mothers, children requiring shelter who do not fit in any of the other categories, etc.

Note – Only hostels providing at least a counselling level of care fall into scope for the RCF survey. Hostels providing only hotel or room and board should not be included. If your facility falls into the latter category, please state this on the cover page and return this survey.

Instructions for page 5

Personnel

Personnel employed – Persons on the payroll of the facility on the last day of the fiscal period.

Exclude voluntary and contract workers for whom no salaries are recorded. Also exclude persons paid on a fee for services basis (doctors or dentists on call, etc.). Report this as an expense in Section I.

Personnel employed on the last day of the fiscal period. – Columns 1 & 2

Report only the number of "full–time" and "part–time" staff employed. Do not use full–time equivalencies unless actual figures are unavailable. Exclude casual employees from the first two columns. Casual employees refers to those employed on a non–continuing or irregular basis, such as those who temporarily relieve regular employees on vacation or sick leave or those who are hired temporarily for such casual jobs as snow removal, office overload, etc.

Full–time – refers to persons employed on a full–time basis, i.e. regularly employed throughout the facility’s full work week.

Part–time – refers to persons employed on a part–time basis, i.e. regularly employed on selected days or partial days in the facility’s work week.

The owner/operator of a small facility may be the only person working full–time. If this is the case, write ‘1’ full–time employee on line 40. Hours should then be split to reflect the approximate time spent in Direct care for residents, line 38 and General services, line 39. Report remuneration in Section I.

When an employee fills more than one position, that individual is to be recorded once only under the category of employment in which the major portion of time is spent.

Total accumulated hours paid during the reporting period – Column 3

Include total hours paid for all full–time, part–time and casual employees who have had salaries or wages paid to them by the facility. Hours covering paid holiday time and other paid leave are to be included for all categories of personnel. Do not include hours for contractual employees.

H. Direct care to residents

Report all personnel whose time is mainly spent with the residents, giving assistance, nursing care, guidance or any other forms of personal help directly to the residents. The majority of facilities will report most of their direct care personnel on line f.

Line a. Registered nurses – staff who have graduated from a recognised formal nursing educational program and have qualified to practise nursing as registered nurses according to appropriate provincial legislation. Depending on the size of the facility, this may include the Director of Nursing, the Assistant Director of Nursing, supervisors and general-duty nursing staff who qualify as registered nurses. In facilities where the Director of Nursing also acts as the Administrator of the facility, report data for this person under Administration, Section I, line a.

Line b. Registered qualified nursing assistants / licensed practical nurses – are persons authorised to function as nursing assistants according to appropriate provincial legislation.

Line c. Physiotherapists/Occupational therapists – a physiotherapist is qualified to practise by meeting the requirements of the Canadian Physiotherapy Association or equivalent standards. They are responsible for the maintenance and improvement of the functional capacity of a resident through procedures including exercise, massage and manipulation. An occupational therapist is qualified to practise by meeting the requirements of the Canadian Association of Occupational Therapists. They are responsible for the maintenance and improvement of the functional capacity of the resident through the practice of activities of daily living and the development of vocational and manual skills.

Line d. Other therapists – includes speech therapists, child therapists, behaviour therapists, group therapists, etc.

Line e. Activity/recreation staff – staff involved in setting up or maintaining a program of social activities, recreation, or hobbies for the residents.

Line f. Other direct care staff – includes nursing aides, health-care aides, dieticians, counsellors, child-care workers, orderlies, social workers, graduate nurses, chaplain, etc.

I. General services

Report here all other personnel of the facility who provided indirect services on the last day of the fiscal period, and who are not shown in Section H, lines a.-g. above.

Line a. Administration – the person(s) providing administrative direction, and also performing functions such as admitting, personnel, payroll, accounting, purchasing, switchboard operations, public relations, etc. Only report data relating to the personnel who carry out these functions in residential care facilities.

Line b. Dietary – the persons involved in the requisitioning, storage, preparation and distribution of food to meet the normal and therapeutic nutritional needs of residents and for other food services provided by the facility. This will include the operation of a cafeteria.

Line c. Housekeeping, laundry – the staff involved in maintaining a sanitary environment including those who process soiled linen, receive, repair, store, distribute, control and supply clean linen and wearing apparel, as required by residents and staff of the facility.

Line d. Plant operation, maintenance and security – staff involved in the provision, distribution and monitoring of water, light, heat, power and other building service systems throughout the physical plant. This includes services of a janitor. Also include those who are responsible for the servicing and repairing of the physical plant, and those who protect property, persons and residents.

Line e. Other – report here any other General Services personnel and hours not reported above and please specify the nature of the service. Include outreach workers employed by the facility but providing services outside of the facility in the community.

Instructions for page 6

Expenses

On this page report details of the cost of operating and maintaining the facility for the most recent fiscal year that ended at any time between April 1, 2011 and March 31, 2012. Capital costs are to be excluded.
REPORT IN DOLLARS ONLY, OMITTING CENTS.
You may provide financial statements instead of completing sections J, K, L and M of the questionnaire. If you wish to send us your financial statements, please follow the instructions in point 4 of the section “When completing the survey” found on page 6 of this guide.

J. Direct care to residents expenses

Column 1 Salaries and Wages
Amount should correspond with details in Section H concerning personnel and paid hours; if hours have been reported on a line in Section H, there should be a corresponding dollar value reported in Section II and vice versa.

Column 2 All Other Expenses
Report any expenses, other than salaries and wages, related to a specific area or department. Include any amounts paid to persons as a fee for service (doctors not on staff, etc.). Also include drugs, medical and surgical supplies and the cost of all other supplies and services involved in the direct care of residents.

Line 42. General Services

Column 1
Amount should correspond with details in section H, line 2, concerning personnel and paid hours.

Column 2
This would include expenses related to administration (including employee benefits), kitchen/food services, housekeeping, laundry, utilities, maintenance and security and all other costs of general services which cannot be allocated to direct care of residents.
Where the facility has arranged for any service, e.g., dietary, housekeeping, maintenance, to be provided by an independent outside company as a "purchased service" – the total costs of such service should be shown in column 2 and no costs shown in the salaries and wages column. Please note such "purchased services" on the Supplementary Information page.

Line g. Drugs – report here all drugs used throughout the facility, as well as medicines, anaesthetic gases, oxygen and other medical gases, intravenous solutions, etc., dispensed by prescriptions or otherwise.

Line h. Medical and Surgical Supplies – included in this category are items used in the treatment and examination of residents such as sutures, dressings, clinical thermometers, sterile supplies, catheters, needles and syringes, etc.

Line i. Other Supplies – report here the total cost of all other supplies and expenses of services involved in the direct care of residents which were not reported on lines c.-h. (column 2).

K. General services expenses

Where the facility has arranged for any services, e.g. dietary, housekeeping, maintenance, to be provided by an independent outside company as a “purchased service” – the total costs of such service should be shown in column 2 and not the salaries and wages column regarding such purchased service. Please note such “purchased services” in the space provided for supplementary information.

Line a. Administration – Report here the costs of providing administrative direction and for carrying out business office and personnel functions of the facility including admitting, personnel, payroll, public relations, purchasing, stores, switchboard operations and chaplaincy. In column 2 give the total costs to the employer of all types of employee benefits, such as Canada Pension Plan, Employment Insurance, Provincial Health Insurance Plan, Workers’ Compensation, Group Life and Group Pension Plans.Also include, if applicable, honorariums paid to members of the Board and/or Medical Advisory Committee, and legal, audit and collection fees.

Line b. Dietary – the costs for the requisitioning, storage, preparation and distribution of food to meet the normal or therapeutic nutritional needs of residents and other food services provided by the facility. This will include the operation of a cafeteria. Report in column 2 the costs of food, dishwashing supplies, paper products, dishes, cutlery, etc.

Line c. Housekeeping, laundry – the costs for maintaining a sanitary environment, including the costs of processing soiled linen and for receiving, repairing, storing, distributing, controlling and supplying clean linen and wearing apparel, as required for residents and staff of the facility.

Line d. Plant operation, maintenance and security – the costs for the provision, distribution and monitoring of water, light, heat, power and other building service systems throughout the physical plant, and for servicing and repairing the physical plant; also includes costs incurred for the protection of property, persons and residents.

Line e. Other – report here all other costs of general services which were not reported on lines a. - d.

L. Other expenses

Please report here:

  • Any interest on loans, notes, mortgages, etc.
  • Business taxes, land and realty taxes, etc. (EXCLUDE income tax).
  • Overhead charged to the facility for Head Office management.
  • Depreciation for the 12 month period for buildings, furniture and equipment, land improvements, automobiles, etc.
  • Rent or leased costs of building and/or equipment.
  • Insurance premiums, licences and fees paid to government or other regulatory bodies, etc.

Instructions for page 7

Report on this page the total revenue of the facility for the most recent fiscal year that ended at any time between April 1, 2010 and March 31, 2011.

Revenues from accommodation should represent the majority of the income.
REPORT IN DOLLARS ONLY, OMITTING CENTS.

M. Source of Revenue

Line a. Provincial Health Department or Ministry (Provincial Health Insurance Plan) – where Provincial Health Insurance provides coverage for standard ward accommodation for an eligible resident, record the income earned from such a Plan, e.g. Ministry or Department of Health or Long Term Care.

Line b. Provincial Social Services Department or Ministry (Provincial Social Services Plan) – report all amounts earned from Provincial Government Social Service Programs or Departments, e.g. Dept. of Social Services, Dept. of Social Services and Community Health (AB.), Community and Social Services (ON.), Community Services and Corrections (MB.), etc.

Line c. Other Provincial Department or Ministry – report amounts earned from a provincial department or agency other than Health or Social Services, e.g. crown agencies such as alcohol/drug commissions.

Line d. Municipalities, Regional or District Administrations – include all amounts earned from municipalities, regional or district administrations on behalf of residents.

Line e. All Other – include all amounts for accommodation earned from sources other than described (lines 45–48) including earnings from Federal Government departments or agencies, Workers’ Compensation Boards, Department of Veterans’ Affairs, etc. Also include any grants or donations received by the facility.

Line f. Residents – Co–insurance or Self–pay – record all amounts to be paid by residents personally or by private insurance companies as their share of the standard ward rate.

Line g. Differential – Preferred Accommodation – record all amounts earned from persons occupying semi–private and private rooms for which an additional charge over and above standard ward rate is charged.

Line h. Total earnings for accommodation – sum lines 45 to 51.

Line i. Sundry Earnings – record here all other earnings not attributable to basic accommodation. This would include such items as:

  • Physical therapy
  • Special duty nursing
  • Hairdressing or barber services
  • Laundry, dry cleaning
  • Employee or guest meals
  • Vending machines, telephone
  • Day care
  • Sale of crafts
  • Etc.

Appendix 1

Type of Care Equivalences
Province Provincial Level / Type of care Type of care equivalencies for the survey
For more detailed information, please refer to section F of the Guide
All Most children's and alcohol and drug facilities Room and board with guidance / counselling with respect to social, employment, addiction problems, or parental guidance with skilled counselling
Newfoundland and Labrador
Personal functions		 Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
Level 3 Type III (i.e., medical management, skilled nursing care, etc.)
Level 4 Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Mental/Sensory/Perceptual Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
Level 3 Type III (i.e., medical management, skilled nursing care, etc.)
Level 4 Higher Type
Prince Edward Island Level I Room and board with custodial care
Level II Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level IV Type II (i.e., medical and professional nursing supervision, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Nova Scotia Room and board with custodial care Room and board with custodial care
Level 1 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 2 Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Care in Residential Care Facilities Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Adult Residential Centres Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Group Homes and Developmental Residences Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in Regional Rehabilitation Centres Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
or Type II (i.e., medical and professional nursing supervision, etc.)
New Brunswick Level I Room and board with custodial care
Level Type II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Care in a Nursing home Type III (i.e., medical management, skilled nursing care, etc.)
Care in a Hospital extended care Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Ontario Care in a Retirement home Room and board with custodial care
or Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Care in a Long–term care home Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Manitoba Personal Care Level 1 Room and board with custodial care
Personal Care Level 2 Room and board with custodial care
Personal Care Level 3 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Personal Care Level 4 Type II (i.e., medical and professional nursing supervision, etc.)
Hospital Acute Care Level Equivalent Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Hospital/Extended Care Facility Equivalent Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Saskatchewan Supervisory care Room and board with custodial care
Limited personal care Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Intensive personal or nursing care Type II (i.e., medical and professional nursing supervision, etc.)
Long–term restorative or palliative care Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Alberta Assisted Living – Level 3 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
or Type II (i.e., medical and professional nursing supervision, etc.)
Assisted Living – Level 4 Type II (i.e., medical and professional nursing supervision, etc.)
Facility Living Type II (i.e., medical and professional nursing supervision, etc.)
or Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
British Columbia Registered Assisted Living Facilities Type I care (care less than 90 minutes per day)
Licensed facilities under the Community Care and Assisted Living Act, including hospice and convalescent care facilities Type II care (personal care for a total of 1½ – 2 ½ hours in a 24 hour day, with medical and professional nursing supervision)
Residential Care and Private Hospitals under the Hospital Act (not included in this survey) Type III care (minimum of 2½ hours of
individual therapeutic and/or medical care per day)
Stand–alone residential care facilities under the Hospital Act Higher Type care (substantially more nursing and/or medical care than described above, generally in acute care)
Yukon Territory Level 1 Room and board with custodial care
Level 2 Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level 3 Type II (i.e., medical and professional nursing supervision, etc.)
Level 4 Type III (i.e., medical management, skilled nursing care, etc.)
Level 5 Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Northwest Territory Level I Room and board with custodial care
Level II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type
Nunavut Level I Room and board with custodial care
Level II Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
Level III Type II (i.e., medical and professional nursing supervision, etc.)
Level IV Type III (i.e., medical management, skilled nursing care, etc.)
Level V Type III (i.e., medical management, skilled nursing care, etc.)
or Higher Type

Reporting Guide for Level IV Air Carriers - Statements 10, 12, 20, 21, 30

Guide Level IV

Aviation Statistics Centre – June 2000

All statements described in this reporting guide are to be returned to:

Statistics Canada
The Aviation Statistics Centre
Room 1506, Main Bldg.
120 Parkdale Ave.
Ottawa, ON K1A 0T6

For further information or assistance, please call (collect) 613-951-0125.

This package contains instructions for the completion of:

Form Frequency
Statement 10, Unit Toll Services, Revenue Operating Statistics Annual
Statement 12, Charter Services, Revenue Operating Statistics Annual
Statement 20, Balance Sheet Annual
Statement 21, Statement of Revenues and Expenses Annual
Statement 30, Fleet Report Annual

Table of contents

I. Purpose
II. Authority for the Collection of Statistics
III. Instructions for Completing
IV. Instructions for Completing Statement 20, Balance Sheet
V. Instructions for Completing Statement 21, Statement of Revenues and Expenses
VI. Instructions for Completing Statement 30, Fleet Report
Appendix A

I Purpose

The purpose of this guide is to provide Level IV air carriers with the instructions necessary to complete the filing requirements for operational and financial statistics with the Aviation Statistics Centre.

Please refer to Appendix A for the definition of a Level IV air carrier.

II. Authority for the Collection of Statistics

The statistics outlined in this booklet are collected under the authority the Statistics Act – Statutes of Canada1985, chapter S19 and the Canada Transportation Act, Section 50.

Unit Toll (Scheduled) Services

The transportation of passengers or goods, or both, by aircraft where the air carrier operating the aircraft, or its agent, sells seats or cargo space, or both, on a per seat or per unit of weight or volume basis directly to members of the public. It excludes charter transportation.

If you perform unit toll service, a Statement 10 report is required.

Charter Services

The transportation of passengers or goods, or both, by aircraft where a person other than the air carrier operating the aircraft, or its agent, contracted a block of seats or portion of cargo capacity for that person's own use or for resale in whole or in units to members of the public. A complete list of activities which are specialty and therefore not subject to filing requirements as charter can be found in the Transport Canada document entitled "Starting a Commercial Air Service", TP 8880. The specialty activities firefighting and helilogging are not included as charter, and the movement of people and goods to a firefighting site is not included as charter, but the movement of people and goods to logging or helilogging site is included as charter. Air ambulance is included as a charter service.

If you perform charter service, a Statement 12 report is required.

If you perform both unit toll and charter service, both Statement 10 and 12 reports are required.

III. Instructions for Completing:

Statement 10, Unit Toll Services, Revenue Operating Statistics

Statement 12, Charter Services, Revenue Operating Statistics

Introduction

Statement 10 and 12 reporting requirements for Level IV carriers have been reduced to the questions shown on the cover letter accompanying this package. Definitions of the required items are given below. Complete the "Statement 10" section for unit toll service and the "Section 12" area for charter service.

This information should be filed on a calendar year basis and returned to the Aviation Statistics Centre before April 1.

If no service was provided during the year, a 'nil' report must be filed.

Hours Flown

Hours flown refers to block hours or the number of hours which elapsed between the time the aircraft started to move to commence a flight and the time the aircraft came to its final stop after the conclusion of a flight. Report the total number of hours flown to the nearest hour.

Passengers Enplaned

Passengers enplaned refers to revenue passengers, (including redemptions for frequent flyer travel programs), who board an aircraft and surrender one or more flight coupons or other documents good for transportation over the itinerary specified in these coupons or documents.

Enplaned Goods (not required for chartered helicopter services)

Enplaned goods includes priority freight, freight, mail and excess baggage for which revenue is obtained. Enplaned goods should be reported to the nearest pound/kilogram.

IV. Instructions for Completing Statement 20, Balance Sheet

Introduction

Statement 20 is to be filed by every Level IV air carrier. The filing is annual and the statement should be completed and returned by May 1. In order to simplify reporting, you may use data for your financial year.

The Balance Sheet should be calculated and completed according to generally accepted accounting principles. Please contact the Aviation Statistics Centre for clarification of fields not described below.

Current Assets (Field 10)

Includes cash, special deposits (i.e. deposits for payment of current obligations (not more than one year)), notes and accounts receivable.

Investments and Special Funds (Field 20)

Includes investments in associated companies, other investments and special funds.

Deferred Charges (Field 170)

Includes long term prepayments, unamortized discount and expense on debt, property acquisition adjustment, other intangibles and other deferred charges.

Current Liabilities (Field 190)

Includes current notes payable, accounts payable general, collections as agents (traffic and other), associated companies and/or shareholders, current portion of long term debt, current obligations under capital lease, accrued salaries and wages, accrued taxes, dividends payable, air travel plan liability, unearned transportation revenue, and other current liabilities.

Authorized Officer and Telephone Number

Print the name and telephone number of the officer authorized by the air carrier to complete the BalanceSheet.

V. Instructions for Completing Statement 21, Statement of Revenues and Expenses

Introduction

Statement 21 is to be filed by every Level IV air carrier. The filing is annual and the statement should becompleted and returned by May 1. In order to simplify reporting, you may use data for your financial year(which should coincide with Statement 20, Balance Sheet).

Please contact the Aviation Statistics Centre for clarification of fields not described below.

Carrier Name and Year

The name of the carrier and the year being reported should be entered on the statement.

Section I - Revenues

For Unit Tol revenue, carrier must split the revenue between passenger revenue and goods revenue. For charter revenue: in cases where it is difficult to split passenger revenue and goods revenue:

  1. report goods revenue only for an all cargo charter leg or if a separate charge has been levied for the carriage of goods,
  2. where there has been no separate goods charge, goods revenue may be included under passenger revenue.

Incidental air transport related revenue-net (Field 90)

Revenues less expenses from non-flying services incidental to air transport including a) aircraft fuel and oil sales; b) maintenance and aircraft ramp handling service etc. for other carriers; c) commissions (or sales revenue minus payments to the carrier that does the flying) received for the sale of transportation which takes place on other carriers; d) revenue received for the provision of aircraft to other carriers for operations which take place under their control.

Incidental air transport related revenue-gross (Field 100)

Revenues from the abov activities.

Estimated Percentage Revenue by Area of Operation (Fields 120 - 240 and 250 - 370)

Carriers are required to enter an estimated percentage breakdown by Province/Territory (or International) of passenger and goods revenue. Revenues should be attributed to the geographic area where the carrier's sales representative or agent, who made the sale was located.

Section II - Expenses

For field 380 to field 460, inclusive, please report gross remuneration (salaries and benefits).

Maintenance - ground property and equipment (Field 380)

Expenses, both direct and indirect, incurred in the repair and upkeep of ground property and equipment to meet operating and safety standards.

Aircraft Operations (Field 390)

Expenses incurred directly in the in-flight operation of aircraft or in the holding of aircraft and aircraft personnel in readiness for assignment to an in-flight status. (e.g. flight crew salaries & benefits and expenses, aircraft fuel and oil, landing and navigation fees, aircraft insurance, aircraft rental)

Maintenance – flight equipment (Field 400)

Expenses, both direct and indirect, incurred in the repair and upkeep of flight equipment required to meet operating and safety standards.

General services and administration (Field 440)

This term includes expenses of a general corporate nature as well as those incurred in performing activities which contribute to more than a single operating function. These include the following.

In-flight service expenses:
cabin crew salaries & benefits and expenses, passenger food and supplies, passenger liability insurance, and interrupted trip expense,
Aircraft and traffic servicing expenses:
expenses incurred on the ground incident to scheduling or preparing aircraft for arrival and takeoff, and expenses incurred in both enplaning and deplaning passenger and cargo traffic,
Promotion and sales expenses:
reservations, city ticket offices and other sales expenses, passenger and cargo commissions, advertising and publicity,
General administrative expenses:
general financial accounting activities, administrative salaries & benefits and expenses, property taxes and building rentals, communications purchased, purchasing activities, representation at law and other general operational administration.

Depreciation (Field 450)

Includes all charges to expense incurred in normal wear and tear on property and equipment which have not been replaced by current repair, as well as losses in serviceability occasioned by popular demand or by action of public authority.

Fuel and Oil Expenses (Fields 560 and 570)

Please indicate whether litres or gallons are used, using the check box 470.
If the fuel consumed is supplied by the customer, an estimate may be made of fuel used based on hours flown and an approximate cost provided based on prevailing market rates.

Employment Expenses (Fields 700 and 710)

Employment expenses in this section should not include benefits such as employer contribution to pension, medical benefits etc.

Estimated Percentage of Salaries Paid by Area (Fields 720 - 840)

Carriers are required to enter an estimated breakdown by Province/Territory (or International) ofEmployment Expenses.

Authorized Officer and Telephone Number

Print the name and telephone number of the officer authorized by the air carrier to complete the Statement of Revenues and Expenses.

Important:

When completing Statement 21, please note the following:

Net income or net loss (Field 910) represents the result of several fields:

Field 110,
Field 460,
Field 890 (which could be a positive or negative value),
Field 900 (which could be a positive or negative value).

where,
Field 110 = the sum of Fields 10 to 90.
Field 460 = the sum of Fields 380 to 450.
Field 890 = the sum of Fields 850 to 880.

VI. Instructions for Completing Statement 30, Fleet Report

Introduction

Statement 30 is to be filed annually by Level IV air carriers. The reference date for this report is October15, and the statement should be returned to the Aviation Statistics Centre within 30 days of this date.

All aircraft in a carrier's possession and control (whether under capital lease, operational lease or owned) are to be reported. This includes aircraft in both active and temporarily inactive status providing they had a valid Certificate of Airworthiness at some time during the preceding year.

After filing the statement once, a computer printout of the most recent Statement 30 will be sent to you. If the printout shows an aircraft which is no longer available for operations, the aircraft is to be deleted by putting a bar through the appropriate line. If the computer printout does not include aircraft which were available to the carrier for operation, these aircraft are to be added by completing the required information in the appropriate spaces.

Name, Address and Telephone Number

Please verify and correct your carrier name, address and telephone number.

Fleet Last Reported

Aircraft Type is the description of a particular type of aircraft which identifies the manufacturer and model number, e.g. DHC-6 or PA-23.

Registration Markings indicate the skin markings on an aircraft, e.g. FABC, as provided by Aviation Licensing, Transport Canada.

Changes to Fleet as Last Reported

If there are no changes to the details of an aircraft, the appropriate space should be checked with a cross mark (X). If there are changes they should be indicated.

Additions and Deletions to Fleet

If there is an addition to a carrier's fleet, the details for the additional aircraft should be entered in the space provided. The aircraft should not be added if it was purchased solely for resale and was not intended for use in the commercial air services of the air carrier.

If there is an aircraft which is no longer available for operations, it is to be deleted by putting a bar through the appropriate line.

APPENDIX A

Definition of Level IV Air Carriers

Level IV air carriers are those that, in each of the two years preceding the reporting year, derived gross revenues of five hundred thousand dollars or more from their licensed air services.

Note: For any carriers involved in a situation (unit toll or charter) where 1) they sell seats and/or cargo space while another carrier operates the service, or 2) they operate a service where seats and/or cargo space has been sold by another carrier, please contact the Aviation Statistics Centre for special instructions.

Level IV Filing Requirements*
{PRIVATE }Statement No. Title Periodicity Due Date
10 Unit Toll Services, Revenue Operating Statistics Annually April 1
12 Charter Services, Revenue Operating Statistics Annually April 1
20 Balance Sheet Annually May 1
21 Statement of Revenues and Expenses Annually May 1
30 Fleet Report Annually Within 30 days afterOctober 15
* Carriers wishing to file data in magnetic tape or diskette format should contact the Aviation Statistics Centre, Ottawa (Ontario), K1A 0T6, to acquire appropriate record layouts.

2011 Residential Care Facilities Survey – Short Form

Si vous préférez recevoir ce questionnaire en français, veuillez cocher

Confidential when completed

This annual survey is conducted under the authority of the Statistics Act, Revised Statutes of Canada 1985, Chapter S19.

Completion of this questionnaire is a legal requirement under the Statistics Act.

Correct mailing address information if necessary using the corresponding boxes below:
Legal Name:
Business Name:
Mailing Address:
City:
Province/Territory:
Postal Code:
Language Preference:
1 English
2 French
Last name of facility contact:
First name of facility contact:
Title of facility contact:

Confidentiality:
Statistics Canada is prohibited by law from releasing any information from this survey which would identify any person, business, or organisation, unless consent has been given by the respondent or as permitted by the Statistics Act. The information from this survey will be treated in strict confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation.

Data Sharing Agreement:
To reduce the respondent burden, Statistics Canada has entered into data-sharing agreements with provincial and territorial statistical agencies and other government and non-government organizations, which must keep the data confidential and use them only for statistical purposes. Information on data-sharing agreements and record linkages can be found in the guide accompanying the questionnaire.

Survey purpose:
This survey collects social, financial and operating data required to produce statistics for your industry.

Coverage:
Please complete a questionnaire for the operation and location described on the label. You should only report for those facilities located in Canada.

Return of questionnaire:
Please complete and return your questionnaire within 30 days of receipt. Please note that audited data is not required for this survey. Please send the completed questionnaire in the enclosed envelope or by facsimile toll-free to 1 888 883-7999.
Statistics Canada advises you that there could be a risk of disclosure during facsimile or other electronic transmission. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.

Do you have any questions? Do you need another questionnaire? For assistance and information please call: 1 800 565-1685

Name of person completing this questionnaire:
Last Name: (please print)
First Name:
Telephone:
Area Code
Number
Extension:
Facsimile:
Area Code
Number
Title:
Email address:

Facility Characteristics

Reporting Instructions:

  • Please DO NOT wait for audited financial statements before completing the survey.
  • When precise figures are not available, please provide your best estimate.
  • Please DO NOT include commas, decimals or special symbols ($,#,%, etc.) with your report.
  • Please consult the reporting guides at www.statcan.gc.ca/ for additional information.

A. Administrative characteristics

Section contains administrative questions regarding the reporting of your facilities.

1. Please indicate your type or organization (Check one only).

1 Sole proprietorship
2 Partnership
3 Incorporated company
4 Co-operative
5 Joint venture
6 Government business entity
7 Government
8 Non-profit organization

2. Does your business have a GST Registration Account Number or a Business Number (BN)?:

1Yes > If yes, please report your GST number or Business Number.
3 No.

3. Are you reporting for more than one facility on this questionnaire?
For facilities that operate more than one location under a single legal entity and for which a single consolidated income statement only is available, please answer ‘Yes’ and report for the number of locations. If you are reporting for one or more facilities that are distinct legal entities with individual income statement, please answer ‘No’ and respond individually for each facility. If you have questions on this, please refer to the guide or contact us at 1-800-565-1685.

1 Yes > If yes, please report the number of location you are reporting with this form.
3 No.

4. Please indicate your fiscal period.

For the purpose of this survey, please report information for your 12-month fiscal period for which the final day occurred on or between April 1, 2011 and March 31, 2012. For example, if your fiscal period ended December 31, 2011, please report for the period January 1, 2011 to December 31, 2011.

From
Year
Month
Day

To
Year
Month
Day

5. Please indicate your type of ownership (Check one only).

Proprietary
Religious
Lay (i.e., not for profit, non-profit voluntary associations, societies)
Municipal
Provincial or Territorial
Federal
Regional Health Authority, Board, District, Corporation

B. Number of beds as of the last day of the fiscal period

6. Please report the number of beds licensed or approved by provincial or municipal authorities and the number of beds available for use.

Licensed or approved
Staffed and in operation (in use or vacant)

Number of beds (including respite beds)

Characteristics of Residents

C. Total days of care (by responsibility for payment)

7. Please report the number of days of care by responsibility of payment.

Number of Days

a. Provincial Health Department or Ministry (i.e., Provincial Health Insurance Plan, Regional Health Authority)
b. Provincial Social Services Department or Ministry (i.e., Provincial Social Services Plan)
c. Other Provincial Department or Ministry (specify)
d. Municipalities, regional or district administration
e. All other, including federal government and self-pay by residents
f. Total days (Sum of boxes 131 to 135)

D. Movement of residents

8. Please report the number of residents in each of the following categories.

Number of Residents

a. In facility on the first day of the fiscal period
b. Admissions during reporting period
c. Total under care (Box 151 plus 152)
d. Discharges during reporting period
e. Deaths during reporting period
f. Total separations (Box 154 plus 155)
g. In facility on the last day of the fiscal period (Box 153 minus 156)
* Box 157 must agree with boxes 221, 240 and 272.

E. Age and sex of residents in facility on the last day of the fiscal period

9. Please report the number of residents for each of the following age and sex grouping.

Number of Residents
Male
Female

Age Groups (Count each person once only)
a. Less than 10 years
b. 10 to 17 years
c. 18 to 44 years
d. 45 to 64 years
e. 65 to 69 years
f. 70 to 74 years
g. 75 to 79 years
h. 80 to 84 years
i. 85 years and over
j.Total residents
(Sum of lines for males)
(Sum of lines for females)
10.Grand Total Residents

* Box 221 must agree with boxes 157, 240 and 272.

F. Type of care

11. Please report the number of residents per type of care received on the last day of the fiscal period. (Count each person once only)

Number of Residents

a. Room and board only
b. Room and board with guidance/counselling with respect to social, employment, addiction problems, or parental guidance with skilled counselling (i.e., child care homes)
c. Room and board with custodial care and/or special school, sheltered workshop, etc.
d. Type I (i.e., supervision and/or assistance with daily living and meeting psycho-social needs)
e. Type II (i.e., medical and professional nursing supervision, etc.)
f. Type III (i.e., medical management, skilled nursing care, etc.)
g. Higher type
h. Total residents (Sum of boxes 228 to 238)
*Box 240 must agree with boxes 157, 221 and 272.

G. Principal characteristics of residents in facility on the last day of the fiscal period

12. Please report the number of residents by the most appropriate principal characteristic. (Count each person once only)

Number of Residents

a. Aged (65 years of age and over)
b. Physically Challenged and/or Disabled
c. Developmentally Delayed
d. Psychiatrically Disabled
e. Emotionally Disturbed Children
f. Addictions
g. Transients
h. Others (specify)
i. Total residents (Sum of boxes 261 to 271)
* Box 272 must agree with boxes 157, 221 and 240.

Personnel and Expenses

– Do not include contract staff or professionals paid by an outside source. You may provide financial statements instead of completing the financial questions. Please indicate your questionnaire identification number on your financial statements. Ensure page 1 and sections A through H are completed.

H. Personnel

13. Please report all personnel whose time is mainly spent with the residents for direct care and those offering general services in the following categories.

Hours reported for salaries and wages should have corresponding dollar values in Section I.

Personnel employed on the last day of the fiscal period (excluding casuals)
Full-time
Part-time

Total accumulated paid hours during reporting period (including casuals)

a. Direct Care Services
b. General Services (see definitions)
c. Total (Sum of lines a. and b.)

I. Expenses

14. Please report the costs of operating and maintaining the facility that can be attributed to the following categories.

Dollar values reported for salaries and wages should have corresponding hours reported in Section H.
Financial information should be reported for the most recent fiscal year that ended at any time between April 1, 2010 and March 31, 2011. (Round to nearest dollar)
When precise figures are not available, please provide your best estimates.

Salaries and wages
All other expenses
Total

a. Direct Care Services
b. General Services (include all employee benefits in box 462)
c. Other expenses (includes interest, rent, taxes, overhead (head office), depreciation, etc.)
d. Total Expenses (Sum of lines a. to c.)

Revenue

– You may provide financial statements instead of completing the financial questions. Please indicate your questionnaire identification number on your financial statements. Ensure page 1 and sections A through H are completed.

J. Source of Revenue

15. Please report the revenues by their source.

Financial information should be reported for the most recent fiscal year that ended at anytime between April 1, 2011 and March 31, 2012. (Round to nearest dollar)
When precise figures are not available, please provide your best estimates.

Accommodations

Amount

a. Provincial Health Department or Ministry (i.e., Provincial Health Insurance Plan, Regional Health Authority)
b. Provincial Social Services Department or Ministry (i.e., Provincial Social Services Plan)
c. Other Provincial Department or Ministry (specify)
d. Municipalities, regional or district administrations
e. All other (i.e., federal government and W.C.B.)
f. Residents – co-insurance or self-pay
g. Differential – preferred accommodation
h. Total revenue from accommodation (Sum of boxes 501 to 507)
i. Other Sundry earnings
j. TOTAL REVENUE (Sum of boxes 508 and 509)
k. Surplus (Box 510 minus box 497)
l. Deficit (Box 497 minus box 510)

Thank you for completing this questionnaire.

1.How long did you spend collecting the data and completing this form?
hours
minutes

2. Comments?
We invite you to assist us in improving the survey. Your comments and general remarks would be greatly appreciated:

Lost the postpaid envelope?
Please call us at 1 800 565-1685.

2011 Residential Care Facilities Survey

Si vous préférez recevoir ce questionnaire en français, veuillez cocher

Confidential when completed

This annual survey is conducted under the authority of the Statistics Act, Revised Statutes of Canada 1985, Chapter S19.
Completion of this questionnaire is a legal requirement under the Statistics Act.

Correct mailing address information if necessary using the corresponding boxes below:
Legal Name:
Business Name:
Mailing Address:
City:
Province/Territory:
Postal Code:
Language Preference:
1 English
2 French
Last name of facility contact:
First name of facility contact:
Title of facility contact:

Confidentiality:
Statistics Canada is prohibited by law from releasing any information from this survey which would identify any person, business, or organisation, unless consent has been given by the respondent or as permitted by the Statistics Act. The information from this survey will be treated in strict confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation.

Data Sharing Agreement:
To reduce the respondent burden, Statistics Canada has entered into datasharing agreements with provincial and territorial statistical agencies and other government and non-government organizations, which must keep the data confidential and use them only for statistical purposes. Information on data-sharing agreements and record linkages can be found in the guide accompanying the questionnaire.

Survey purpose:
This survey collects social, financial and operating data required to produce statistics for your industry.

Coverage:
Please complete a questionnaire for the operation and location described on the label. You should only report for those facilities located in Canada.

Return of questionnaire:
Please complete and return your questionnaire within 30 days of receipt Please note that audited data is not required for this survey. Please send the completed questionnaire in the enclosed envelope or by facsimile toll-free to 1 888 883-7999.
Statistics Canada advises you that there could be a risk of disclosure during facsimile or other electronic transmission. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.

Do you have any questions? Do you need another questionnaire?
For assistance and information please call: 1 800 565-1685

Name of person completing this questionnaire:
Last Name: (please print)
First Name:
Telephone:
Area Code
Number
Extension:
Facsimile:
Area Code
Number
Title:
Email address:

Facility Characteristics

Reporting Instructions:

  • Please DO NOT wait for audited financial statements before completing the survey.
  • When precise figures are not available, please provide your best estimate.
  • Please DO NOT include commas, decimals or special symbols ($,#,%, etc.) with your report.
  • Please consult the reporting guides at www.statcan.gc.ca/ for additional information.

A. Administrative reporting

Section contains administrative questions regarding the reporting of your facilities.

1. Please indicate your type of organization (Check one only).

1 Sole proprietorship
2 Partnership
3 Incorporated company
4 Co-operative
5 Joint venture
6 Government business entity
7 Government
8 Non-profit organization

2. Does your business have a GST Registration Account Number or a Business Number (BN)?

1 Yes > If yes, please report your GST number or Business Number
3 No

3. Are you reporting for more than one facility on this questionnaire?
For facilities that operate more than one location under a single legal entity and for which a single consolidated income statement only is available,please answer ‘Yes’ and report for the number of locations. If you are reporting for one or more facilities that are distinct legal entities withindividual income statement, please answer ‘No’ and respond individually for each facility. If you have questions on this, please refer to the guideor contact us at 1-800-565-1685.

1 Yes > If yes, please report the number of facilities you are reporting for with this form
3 No

4. Please indicate your fiscal period.
For the purpose of this survey, please report information for your 12-month fiscal period for which the final day occured on or between April 1, 2011 and March 31, 2012. For example, if your fiscal period ended December 31, 2011, please report for the period January 1, 2011 to December 31, 2011.

From
Day
Month
Year

To
Day
Month
Year

5. Please indicate your type of ownership (Check one only).
Proprietary
Religious
Lay (i.e., not for profit, non-profit voluntary associations, societies)
Municipal
Provincial or Territorial
Federal
Regional Health Authority, Board, District, Corporation

B. Number of beds as of the last day of the fiscal period

6. Please report the number of beds licensed or approved by provincial or municipal authorities and the number of beds available for use.

Licensed or approved
Staffed and in operation (in use or vacant)

Number of beds (including respite beds)

Characteristics of Residents

C. Total days of care (by responsibility for payment)

7. Please report the number of days of care by responsibility of payment.

Number of Days

a. Provincial Health Department or Ministry (i.e., Provincial Health Insurance Plan, Regional Health Authority)
b. Provincial Social Services Department or Ministry (i.e., Provincial Social Services Plan)
c. Other Provincial Department or Ministry (specify)
d. Municipalities, regional or district administration
e. All other, including federal government and self-pay by residents
f. Total days (sum of boxes 131 to 135)

D. Movement of residents

8. Please report the number of residents in each of the following categories.

Number of Residents

a. In facility on the first day of the fiscal period
b. Admissions during reporting period
c. Total under care (Box 151 plus 152)
d. Discharges during reporting period
e. Deaths during reporting period
f. Total separations (Box 154 plus 155)
g. In facility on the last day of the fiscal period (Box 153 minus 156)
*Box 157 must agree with boxes 221, 240 and 272.

E. Age and sex of residents in facility on the last day of the fiscal period

9. Please report the number of residents for each of the following age and sex grouping

Number of Residents
Male
Female

Age Groups (Count each person once only)
a. Less than 10 years
b. 10 to 17 years
c. 18 to 44 years
d. 45 to 64 years
e. 65 to 69 years
f. 70 to 74 years
g. 75 to 79 years
h.80 to 84 years
i. 85 years and over
j. Total residents
(Sum of lines for males)
(Sum od lines for females)
10. Grand Total Residents
*Box 221 must agree with boxes 157, 240 and 272.

F. Type of care

Please report the number of residents per type of care received on the last day of the fiscal period. (Count each person once only)

Number of Residents

21. Room and board only
22. Room and board with guidance/counselling with respect to social, employment, addiction problems,or parental guidance with skilled counselling (i.e., child care homes)
23. Room and board with custodial care and/or special school, sheltered workshop, etc.
24. Type I (i.e., supervision and/or assistance with daily living and meeting psycho-social needs)
25. Type II (i.e., medical and professional nursing supervision, etc.)
26. Type III (i.e., medical management, skilled nursing care, etc.)
27. Higher type
28. Total residents (Sum of boxes 228 to 238)
*Box 240 must agree with boxes 157, 221 and 272.

G. Principal characteristics of residents in facility on the last day of the fiscal period

12. Please report the number of residents by the most appropriate principal characteristic.(Count each person once only)

Number of Residents

a. Aged (65 years of age and over)
b. Physically Challenged and/or Disabled
c. Developmentally Delayed
d. Psychiatrically Disabled
e. Emotionally Disturbed Children
f. Addictions
g. Transients
h. Others (specify)
i. Total residents (Sum of boxes 261 to 271)
* Box 272 must agree with boxes 157, 221 and 240.

Personnel

– Do not include contract staff or professionals paid by an outside source

H. Direct care to residents

13. Please report all personnel whose time is mainly spent on direct care to residents in the following categories.

Hours reported for salaries and wages should have corresponding dollar values in Section J.

Personnel employed on the last day of the fiscal period (excluding casuals)
Full-time
Part-time

Total accumulated paid hours during reporting period (including casuals)

a. Registered nurses
b. Registered qualified nursing assistants/licensed practical nurses
c. Physiotherapists/occupational therapists
d. Other therapists (specify)
e. Activity/recreation staff
f. Other direct care staff not included above (specify)
g. Total direct care staff (Sum of lines a. to f.)

I. General services

14. Please report all other personnel offering general services in the following categories.

Hours reported for salaries and wages should have corresponding dollar values in Section K.

Personnel employed on the last day of the fiscal period (excluding casuals)
Full-time
Part-time

Total accumulated paid hours during reporting period (including casuals)

a. Administration (Include Unit/Ward Clerks)
b. Dietary (i.e., kitchen/food services)
c. Housekeeping /laundry
d. Plant operation, maintenance and security (i.e., janitorial services)
e. Other general services staff (specify)
f. Total general services staff (Sum of lines a. and e.)
g. TOTAL STAFF (Sum of lines 13.g. and 14.f.)

Expenses

– You may provide financial statements instead of completing the financial questions. Please indicate your questionnaire identification number on your financial statements. Ensure pages 1, 2, 3, 4 and 5 are completed.

J. Direct care to residents expenses

15. Please report the costs of operating and maintaining the facility that are attributed to direct care to residents in the following categories.

Dollar values reported for salaries and wages in Sections J and K should have correspondinghours reported in Sections H and I.
Financial information should be reported for the most recent fiscal year that ended at any time between April 1, 2011 and March 31, 2012. (Round to nearest dollar)
When precise figures are not available, please provide your best estimates.

Salaries and wages
All other expenses
Total

a. Registered nurses
b. Registered qualified nursing assistants/licensed practical nurses
c. Physiotherapists/occupational therapists
d. Other therapists (specify)
e. Activity/recreation staff
f. Other direct care staff not included above (specify)
g. Drugs (include oxygen/medical gases)
h. Medical and surgical supplies
i. Other supplies (specify)
j. Total - direct care expenses (Sum of lines a. to i.)

K. General services expenses

16. Please report the costs of operating and maintaining the facility that are attributed to general services in the following categories.

a. Administration (include all employee benefits in the middle box)
b. Dietary (i.e., kitchen/food services)
c. Housekeeping/laundry
d. Plant operation, maintenance and security (i.e., janitorial services)
e. Other (specify)
f. Total - general services expenses (Sum of lines a. to e.)

L. Other expenses

17. Please report all other expenses such as interests and taxes.

a. Other (includes interest, rent, taxes, overhead (head office), depreciation, etc.)
b. TOTAL EXPENSES (Sum of lines 15.j. + 16.f. + 17.a.)

Revenue

– You may provide financial statements instead of completing the financial questions. Please indicate your questionnaire identification number on your financial statements. Ensure pages 1, 2, 3, 4 and 5 are completed.

M. Source of Revenue

18. Please report the revenues by their source.

Financial information should be reported for the most recent fiscal year that ended at anytime between April 1, 2011 and March 31, 2012. (Round to nearest dollar)
When precise figures are not available, please provide your best estimates.

Accommodations

Amount

a. Provincial Health Department or Ministry (i.e., Provincial Health Insurance Plan, Regional Health Authority)
b. Provincial Social Services Department or Ministry (i.e., Provincial Social Services Plan)
c. Other Provincial Department or Ministry (specify)
d. Municipalities, regional or district administrations
e. All other (i.e., federal government and W.C.B.)
f. Residents – co–insurance or self–pay
g. Differential – preferred accommodation
h. Total revenue from accommodation (Sum of boxes 501 to 507)
i. Other Sundry earnings
j. TOTAL REVENUE (Sum of boxes 508 and 509)
k. Surplus (Box 510 minus box 497)
l. Deficit (Box 497 minus box 510)

Thank you for completing this questionnaire.

1.How long did you spend collecting the data and completing this form?
hours
minutes

2. Comments?
We invite you to assist us in improving the survey. Your comments and general remarks would be greatly appreciated:

Lost the postpaid envelope?
Please call us at 1 800 565-1685.

Subscribe to
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