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

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

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.

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.

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.

Guide Level III

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
Appendix B

I Purpose

The purpose of this guide is to provide Level III 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 III air carrier.

II. Authority for the Collection of Statistics

The statistics outlined in this booklet are collected under the authority of the Statistics Act - Statutes ofCanada 1985, 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

Satement 10, Unit Toll Services, Revenue Operating Statistics

Statement 12, Charter Services, Revenue Operating Statistics

Introduction

Statement 10 is to be filed by every Level  III air carrier operating domestic or international  unit toll (scheduled) air services.  If you have scheduled helicopter services, please contact the Aviation Statistics Centre for instructions.

Statement 12 is to be filed by every Level  III air carrier operating domestic or international charter air services.

Both Statements 10 and 12 are to be filed annually on a calendar year basis, and are due April 1.

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

Carrier Name and Quarter

Report the name of the carrier and the year being reported.

Imperial or Metric

Statements 10 and 12 can be completed in metric or imperial units. The units used should be clearly identified in the appropriate box on the statement. The unit of measurement checked should be used consistently throughout the report.

Authorized Officer and Telephone Number

Print the name and telephone number of the officer authorized to complete the statement.

Area of Operation

For each area of operation (see Appendix B), it is only required to have one line of data for all fixed wing operations and one line for helicopter operations. It is no longer necessary to create a section for each route or licence, or to report by aircraft make (e.g., A320, C120) within a section.

Please refer to the definition of each area of operation contained in Appendix B.

For each Area of Operation, please complete the following:

Passenger Revenue

Passenger revenue is the revenue derived from the transportation of passengers. Passenger revenue should be reported to the nearest dollar and should exclude the Air Transportation Tax and the Goods and Services Tax (GST).

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.

Goods Revenue

Report revenue earned from the transportation of enplaned goods (see definition below).  Goods Revenue should be reported to the nearest dollar, and should exclude the Goods and Services Tax (GST).

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.

Aircraft Type

Report fixed wing (F) and helicopter (H) operations separately. If you have scheduled helicopter operations, please contact the Aviation Statistics Centre for instructions.

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.

Passenger-Miles/Passenger-Kilometres 

Passenger-Miles/Passenger-Kilometres indicates the number of revenue passengers carried on each flight stage multiplied by the number of miles/kilometres flown on that stage (refer to the example in Appendix B for calculation of passenger-miles/passenger-kilometres).

Goods Ton-miles/Tonne-kilometres

Goods ton-miles/tonne-kilometres represents the number of tons/tonnes of goods carried on each flight stage multiplied by the number of miles/kilometres flown on that stage (see Appendix B).

IV. Instructions for Completing Statement 20, Balance Sheet

Introduction

Statement 20 is to be filed by every Level III air carrier. The filing is annual and the statement should be completed and returned by April 30.  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 III air carrier. The filing is annual and the statement should be completed and returned by April 30.  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

Revenues reported for passengers and goods on Unit Toll and Charter services should match the respective totals reported on Statements 10 and 12 for the same period.

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 above 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,

General services and administration (Field 440) (Concluded)

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 480 - 540 and 490 - 550)

Please indicate whether litres or gallons are used, using 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 580 - 680 and 590 - 690) 

Employment expenses in this section should not include benefits such as employer contribution to pension, medical benefits etc., and should not include any layover expenses for flight and cabin crews.

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

Please enter an estimated breakdown by Province/Territory (or International sector) of EmploymentExpenses.

Capital gains or losses (Field 850)

Gains or losses involved in retiring operating property and equipment, aircraft equipment, expendable parts, miscellaneous materials and supplies and other assets, when they are sold or otherwise retired from service as part of a general program and not as incidental sales performed as a service to others.  Also included here are gains or losses made on investments in securities.

Interest and discount income (Field 860)

Interest income from all sources and cash discounts on purchase of materials and supplies.

Interest expense (Field 870)

Interest on all classes of debt including premiums, discounts and expenses on short-term obligations, amortization of premium discounts and expenses on short-term and long-term obligations.

Miscellaneous non-operating income and expense (Field 880)

Revenues and expenses attributable to financing or other activities that are extraneous to and not an integral part of air transportation activities undertaken by this carrier, or its incidental services.  These could include a) dividend income, b) the balance of all income or losses from affiliated companies reimbursed to the carrier (because this is a non-consolidated income statement, each carrier reports as if it has a minority interest in any affiliated company, even if it is a majority owner), c) foreign exchange adjustments, d) special items (such as restructuring expenses) which do not occur on a regular basis.  Staff reduction expenses should be included in the operating expenses as a general administration expense.

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 III air carriers. The reference date for this report is October 15, 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 III Air Carriers

Level III air carriers are those that, in each of the two years preceding the reporting year, derived a gross revenues of more than $1,000,000 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 III 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	April 1
21	Statement of Revenues and Expenses	Annually	April 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.

Appendix B

Area of Operation

This refers to the region where an air carrier provided transportation services, categorized as follows:

• a) Domestic - includes operations between points in Canada;
• b) Transborder - includes operations between a point(s) in Canada and a point(s) in the United States (including Puerto Rico, Hawaii and Alaska);
• c) Transatlantic - includes operations between a point(s) in Canada and a point(s) in Europe, Africa and/or the Middle East;
• d) Southern - includes operations between a point(s) in Canada and a point(s) in Bermuda, the Caribbean, Mexico, Central America and South America;
• e) Pacific and Orient - includes operations between a point(s) in Canada and a point(s) in Asia and Australia;
• f) Other Foreign - includes operations between points outside of Canada.

Passenger-Miles/Passenger-Kilometres or Goods Ton-Miles/Goods Tonne-Kilometres

Passenger-kilometres (or goods tonne-kilometres) indicates the number of revenue passengers carried (or tonnes of goods) on each flight stage multiplied by the number of kilometres flown on that stage. The following example indicates the correct method of calculation:

Flights from A to B to C to D

Flight Stage	Number of passengers carried over segment, or	Distance Between Points		Passenger- Miles, or	Passenger- Kilometres, or
	Ton(ne)s of goods	Miles	Km	Goods Ton- Miles	Goods Tonne- Kilometres
A to B	5	100	161	500	805
B to C	4	200	322	800	1,288
C to D	2	150	241	300	482
Total				1,600	2,575

Total number of passenger-miles (goods tonne-miles) for the flights covering A to B through C to D = 1,600 (or2,575 passenger-kilometres (goods tonne-kilometres)).

Guide Level II

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	Quarterly
Statement 12, Charter Services, Revenue Operating Statistics	Quarterly
Statement 20, Balance Sheet	Annual
Statement 21, Statement of Revenues and Expenses	Quarterly & 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
Appendix B

I Purpose

The purpose of this guide is to provide Level II 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 II air carrier.

II. Authority for the Collection of Statistics

The statistics outlined in this booklet are collected under the authority of the Statistics Act - Statutes ofCanada 1985, 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

Satement 10, Unit Toll Services, Revenue Operating Statistics

Statement 12, Charter Services, Revenue Operating Statistics

Introduction

Statement 10 is to be filed by every Level II air carrier operating domestic or international unit toll (scheduled) air services. If you have scheduled helicopter services, please contact the Aviation Statistics Centre for instructions.

Statement 12 is to be filed by every Level II air carrier operating domestic or international charter air services.

Both Statements 10 and 12 are to be filed quarterly on a calendar year basis, and are due 60 days after the end of the quarter.

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

Carrier Name and Year

Report the name of the carrier and the year being reported.

Imperial or Metric

Statements 10 and 12 can be completed in metric or imperial units. The units used should be clearly identified in the appropriate box on the statement. The unit of measurement checked should be used consistently throughout the report.

Authorized Officer and Telephone Number

Print the name and telephone number of the officer authorized to complete the statement.

Area of Operation

For each area of operation (see Appendix B), it is only required to have one line of data for all fixed wing operations and one line for helicopter operations. It is no longer necessary to create a section for each route or licence, or to report by aircraft make (e.g., A320, C120) within a section.

Please refer to the definition of each area of operation contained in Appendix B.

Note re: charter helicopter services (Statement 12)

For helicopter (rotating wing) services only, the following fields are not required on Statement 12:

• passenger miles/passenger kilometres;
• goods ton-miles/tonne-kilometres;
• passengers enplaned;
• goods enplaned.

For each Area of Operation, please complete the following:

Passenger Revenue

Passenger revenue is the revenue derived from the transportation of passengers. Passenger revenue should be reported to the nearest dollar and should exclude the Air Transportation Tax and the Goods and Services Tax (GST).

Passengers Enplaned (not required for chartered helicopter services)

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.

Goods Revenue

Report revenue earned from the transportation of enplaned goods (see definition below). Goods Revenue should be reported to the nearest dollar, and should exclude the Goods and Services Tax (GST).

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.

Aircraft Type

Report fixed wing (F) and helicopter (H) operations separately If you have scheduled helicopter operations, please contact the Aviation Statistics Centre for instructions.

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 block hours flown to the nearest hour.

Passenger-Miles/Passenger-Kilometres (not required for chartered helicopter services)

Passenger-Miles/Passenger-Kilometres indicates the number of revenue passengers carried on each flight stage multiplied by the number of miles/kilometres flown on that stage. (refer to the example in Appendix B for calculation of passenger-miles/passenger-kilometres).

Goods Ton-miles/Tonne-kilometres (not required for chartered helicopter services)

Goods ton-miles/tonne-kilometres represents the number of tons/tonnes of goods carried on each flight stage multiplied by the number of miles/kilometres flown on that stage (see Appendix B).

Available Seat-miles/Seat-kilometres (Statement 10 only)

Available seat-miles/seat-kilometres shows the aircraft miles/kilometres flown on each flight stage multiplied by the number of seats available for use on that stage.

Available Ton-miles/Tonne-kilometres (Statement 10 only)

This is the combined total number of tons/tonnes available for the transportation of passengers and goods (as defined above) multiplied by the number of miles/kilometres that this capacity is flown.

IV. Instructions for Completing Statement 20, Balance Sheet

Introduction

Statement 20 is to be filed by every Level II air carrier. The filing is annual and the statement should be completed and returned by March 31. 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 Balance Sheet.

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

Introduction

Statement 21 is to be filed by every Level II air carrier, on a quarterly and annual basis.**

The quarterly statement should be completed and returned 60 days after the end of the quarter.

For the annual report, you may use data for your financial year (which should coincide with Statement 20, Balance Sheet.

** Section III annual expense analysis ( St. 21, page 2 fields 920-1360 ) is to be completed annually only. The totals reported on this page should match what is reported in section II on page 1 (for instance, field 980 (total aircraft operations) should match field 390 ( aircraft operations) on page 1).

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

Revenues reported for passengers and goods on Unit Toll and Charter services should match the respective totals reported on Statements 10 and 12 for the same period.

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 above activities.

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

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.

In-flight service (Field 410)

Includes cabin crew salaries & benefits and expenses, passenger food and supplies, passenger liability insurance, and interrupted trip expense.

Aircraft and traffic servicing (Field 420)

Includes 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 (Field 430)

Includes reservations, city ticket offices and other sales expenses, passenger and cargo commissions, advertising and publicity.

General administrative expense (Field 440)

Includes 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 480 - 540 and 490 - 550) (quarterly only)

Please indicate whether litres or gallons are used, using 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 580 - 680 and 590 - 690) (quarterly only)

Employment expenses in this section should not include benefits such as employer contribution to pension, medical benefits etc. or layover expenses such as hotels and meals.

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

Please enter an estimated breakdown by Province/Territory (or International sector) of Employment Expenses.

Capital gains or losses (Field 850)

Gains or losses involved in retiring operating property and equipment, aircraft equipment, expendable parts, miscellaneous materials and supplies and other assets, when they are sold or otherwise retired from service as part of a general program and not as incidental sales performed as a service to others. Also included here are gains or losses made on investments in securities.

Interest and discount income (Field 860)

Interest income from all sources and cash discounts on purchase of materials and supplies.

Interest expense (Field 870)

Interest on all classes of debt including premiums, discounts and expenses on short-term obligations, amortization of premium discounts and expenses on short-term and long-term obligations.

Miscellaneous non-operating income and expense (Field 880)

Revenues and expenses attributable to financing or other activities that are extraneous to and not an integral part of air transportation activities undertaken by this carrier, or its incidental services. These could include a) dividend income, b) the balance of all income or losses from affiliated companies reimbursed to the carrier (because this is a non-consolidated income statement, each carrier reports as if it has a minority interest in any affiliated company, even if it is a majority owner), c) foreign exchange adjustments, d) special items (such as restructuring expenses) which do not occur on a regular basis. Staff reduction expenses should be included in the operating expenses as a general administration expense.

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 II air carriers. The reference date for this report is October 15, 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 II Air Carriers

Level II air carriers are those that, in each of the two years preceding the reporting year, carried one million or more revenue passengers, thirty thousand or more tonnes of revenue goods or both.

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 instructions.

Level II Filing Requirements^*

{PRIVATE }Statement No.	Title	Periodicity	Due Date
10	Unit Toll Services, Revenue Operating Statistics	Quarterly	Within 60 days of the last day of quarter
12	Charter Services, Revenue Operating Statistics	Quarterly	Within 60 days of the last day of quarter
20	Balance Sheet	Annually	March 31
21	Statement of Revenues and Expenses	Quarterly Annually	Within 60 days of last day of quarter March 31
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.

Appendix B

Area of Operation

This refers to the region where an air carrier provided transportation services, categorized as follows:

• a) Domestic - includes operations between points in Canada;
• b) Transborder - includes operations between a point(s) in Canada and a point(s) in the United States (including Puerto Rico, Hawaii and Alaska);
• c) Transatlantic - includes operations between a point(s) in Canada and a point(s) in Europe, Africa and/or the Middle East;
• d) Southern - includes operations between a point(s) in Canada and a point(s) in Bermuda, the Caribbean, Mexico, Central America and South America;
• e) Pacific and Orient - includes operations between a point(s) in Canada and a point(s) in Asia and Australia;
• f) Other Foreign - includes operations between points outside of Canada.

Passenger-Miles/Passenger-Kilometres or Goods Ton-Miles/Goods Tonne-Kilometres

Passenger-kilometres (or goods tonne-kilometres) indicates the number of revenue passengers carried (or tonnes of goods) on each flight stage multiplied by the number of kilometres flown on that stage. The following example indicates the correct method of calculation:

Flights from A to B to C to D

Flight Stage	Number of passengers carried over segment, or	Distance Between Points		Passenger- Miles, or	Passenger- Kilometres, or
	Ton(ne)s of goods	Miles	Km	Goods Ton- Miles	Goods Tonne- Kilometres
A to B	5	100	161	500	805
B to C	4	200	322	800	1,288
C to D	2	150	241	300	482
Total				1,600	2,575

Total number of passenger-miles (goods tonne-miles) for the flights covering A to B through C to D = 1,600 (or2,575 passenger-kilometres (goods tonne-kilometres)).

Statement 4 (II)

Statement 4 (II) is to be filed by air carrier that already file statement 3 (I,II)

Contact: Odile Lefebvre (613) 951-0140

October 5, 2000

Table of contents

General Description of Survey
Authority and Participat1on
Effective Date of Instructions
Recording of Data
Submission of Forms
Example for Recording Data

General Description of Survey

Statement 4 (II) is concerned with airport activity data for those Level II carriers required to file Statement 3 (I,II). In those situations, where Statement 4 (II) must be completed, the reporting carrier must submit the number of enplaned and deplaned revenue passengers¹ and the number of aircraft departures quarterly. These data must be submitted for all airports where unit toll services are provided, with the exception of those airports for which operations are reported on Statement 6 (I,F). The completed Statement 4 (II) forms are to be filed with the Aviation Statistics Centre within 30 days after the end of the reference quarter.

Authority and Participation

To reduce response burden and to provide consistent statistics, Statistics Canada, under section 12 of the Statistics Act, has entered into a data sharing agreement with Transport Canada covering federally regulated carriers. Statistics Canada is collecting the information for itself pursuant to the Statistic Act and on behalf of Transport Canada pursuant to the Canada Transportation Act and the Carriers and Transportation Undertakings Information Regulations, thus satisfying the requirements of the Regulations to provide this type of information to Transport Canada.

Under this authority, Reporting level II, III, IV and V Canadian carriers must file Statement 4 (II,III,IV,V,F) for all their unit toll services (domestic or international). Level II carriers who enplane 300,000 or more revenue passengers in each of the two years immediately preceding the reporting year must file Statement 3 (I,II) and are required to file Statement 4 (II) instead of Statement 4 (II,III,IV,V,F).

Effective Date of Instructions

The Coupon Passenger Origin and Destination Report is to be filed according to these reporting instructions for operations performed after December 31, 1992.

Recording of Data

An explanation of each Field on Statement 4 (II) follows:

Carrier Name - The full name of the carrier filing this report shall be written in the space provided.

Carrier Code - The carrier code to be used in the Official Airline Guide (OAG) code.Those carriers that do not appear in the OAG shall leave this field blank.

Year - These cells are to be completed with the four digits for the year to which the report relates.

Quarter - This cell is to be completed with a number to identify the quarter to which the report relates. The quarters must be entered as follows:

• 1 - first quarter (January - March)
• 2 - second quarter (April - June)
• 3 - third quarter (July - September)
• 4 - fourth quarter (October - December)

Airport Name - Refers to the full name of the airport served.

Airport Code - Refers to the three letter code assigned in the Official Airline Guide (OAG). The last position of this field should be left blank. If no OAGcode exists, leave this field blank.

Enplaned Revenue Passengers - Refers to the number of revenue passengers enplaned or embarked during the quarter, at each airport.

Deplaned Revenue Passengers - Refers to the number of revenue passengers deplaned or disembarked during the quarter, at each airport.

Number of Departing Flights - Refers to the number of aircraft departures of passengers flights during the quarter, at each airport. Do not include ferry flights.

Total - Refers to the total number of enplaned passengers, the total number of deplaned passengers and the total number of departing passenger flights.

Authorized Officer & Telephone Number - The officer employed by the carrier who is responsible for the completion of this statement should print his/her name, complete phone number and FAX number if applicable in the space provided at the bottom of the form.

Submission of Forms

The complete Statement 4 (II) forms are to be submitted within 30 days after the end of the reference quarter to the following address:

Aviation Statistics Centre
Statistics Canada
Ottawa, Ontario
Canada
K1A 0N9
Tel.: (613) 951-0151

A supply of return envelopes and Statement 4 (II,III,IV,V,F) forms will be provided on request by contacting the Aviation Statistics Centre by telephone at (613) 951-0151 or by Fax: at (613) 951-0010.

Example for Recording Data

Suppose that a carrier called Air Carrier Inc. operates unit toll services at four airports:

• Toronto/Lester B. Pearson (YYZ)
• Montréal/Dorval (YUL)
• Ottawa (YOW)
• Québec (YQB)

If we assume that during the first quarter of 2000, Air Carrier Inc. had the following activity:

• 115 passengers enplaned and 126 deplaned at YYZ
• 20 passengers enplaned and 33 deplaned at YUL
• 315 passengers enplaned and 323 deplaned at YOW
• 15 passengers enplaned and 25 deplaned at YQB

• 20 flight departures were recorded at YYZ
• 10 flight departures were recorded at YUL
• 35 flight departures were recorded at YOW
• 11 flight departures were recorded at YQB

The above information would be entered on Statement 4 (II) as shown on page 4 attached.

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Note:

1. Revenue Passenger - In the case of unit toll transportation, it represents an enplaned passenger for whom the carrier receives remuneration of at least 25% of the basic fare.