StatCan WxT | Collaborative open source project led by the Government of Canada

Archived - Census of Trusteed Pension Funds 2010

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

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

This is a mandatory survey.

To return completed questionnaire either:

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

If you have questions:

Call (613) 951-4092
E-mail: tpfc@statcan.gc.ca

Si vous préférez ce questionnaire en français, veuillez cocher

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

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

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

Yes – Please complete the remainder of the questionnaire and return it to Statistics Canada.
No – Please elaborate
- Fund closed (MM-YYYY)
- Fund is deposited in total with an insurance company under an insurance company contract
- Other, please specify
  
  Please provide your name (bottom of this page), complete question 8 and return the questionnaire to Statistics Canada.

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

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

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

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

Name of person completing questionnaire (please print)

Telephone ()

Fax ()

E-mail address

Thank you for your cooperation

Section A: Administrative Data

1. Year of Inauguration of This Fund

2. Fund Fiscal Year End (MM-DD)

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

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

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

4. Insurance Company Holdings

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

If yes, what is the amount involved?

Market value $ (omit cents)

5. Members Covered

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

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

6. Contributory Status(for the majority of members)

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

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

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

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

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

Book (cost) value of previous year’s assets

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

$ (omit cents)

Section B: Receipts and Disbursements

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

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

Indicate year end used:

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

Receipts and Net Realized Gains

Note: Do not include any unrealized gains.

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

Disbursements and Net Realized Losses

Note: Do not include any unrealized losses.

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

Section C: Assets

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

Report as of December 31, 2010 if possible.

Indicate year end used:

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

Pooled, mutual and investment funds:

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

Equities:

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

Bonds/Debentures:

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

Mortgages:

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

Real estate (including petroleum and natural gas properties)

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

Cash, deposits, short-term:

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

Miscellaneous:

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

Total assets (total of lines 300 to 372)

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

Deduct: Debts and payables

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

Net assets (line 380 less line 390)

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

Thank you for your cooperation

Archived - Census of Trusteed Pension Funds 2010 Notes / Instructions to Respondents

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

Definitions

Trusteed Pension Fund:

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

More Than One Pension Fund in Operation:

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

Terminated Plans - Dormant Funds:

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

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

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

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

Funds $10 million and over in assets at book value

Section A: Administrative Data

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

Members covered (Question 5):

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

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

Section B: Receipts and Disbursements

Receipts and Net Realized Gains

(Note: Do not include an unrealized gains)

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

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

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

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

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

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

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

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

Disbursements and Net Realized Losses

(Note: Do not include unrealized losses)

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

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

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

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

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

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

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

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

Section C: Assets

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

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

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

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

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

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

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

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

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

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

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

The concordance table for the electronic questionnaire

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

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

Table 2 Residential Care Facilities Survey Concordance for the electronic questionnaire

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

The concordance table for the paper questionnaire

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

Table 1 Residential Care Facilities Survey Concordance for the paper questionnaire

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

The concordance table

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

Residential Care Facilities Survey Concordance Table

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

Residential Care Facilities Survey – 2011 – Short Form

Guide
Instructions and Definitions

Survey Information

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

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

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

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

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

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

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

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

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

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

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

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

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

When completing the survey

Please keep a copy of the completed questionnaire for your own records.
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.
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.
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).
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)
Ontario	Care in a Long–term care home	Type II (i.e., medical and professional nursing supervision, etc.) or Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
Manitoba	Personal Care Level 1	Room and board with custodial care
	Personal Care Level 2	Room and board with custodial care
	Personal Care Level 3	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
	Personal Care Level 4	Type II (i.e., medical and professional nursing supervision, etc.)
	Hospital Acute Care Level Equivalent	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
	Hospital/Extended Care Facility Equivalent	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
Saskatchewan	Supervisory care	Room and board with custodial care
	Limited personal care	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
	Intensive personal or nursing care	Type II (i.e., medical and professional nursing supervision, etc.)
	Long–term restorative or palliative care	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
Alberta	Assisted Living – Level 3	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs) or Type II (i.e., medical and professional nursing supervision, etc.)
	Assisted Living – Level 4	Type II (i.e., medical and professional nursing supervision, etc.)
	Facility Living	Type II (i.e., medical and professional nursing supervision, etc.) or Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
British Columbia	Registered Assisted Living Facilities	Type I care (care less than 90 minutes per day)
	Licensed facilities under the Community Care and Assisted Living Act, including hospice and convalescent care facilities	Type II care (personal care for a total of 1½ – 2 ½ hours in a 24 hour day, with medical and professional nursing supervision)
	Residential Care and Private Hospitals under the Hospital Act (not included in this survey)	Type III care (minimum of 2½ hours of individual therapeutic and/or medical care per day)
	Stand–alone residential care facilities under the Hospital Act	Higher Type care (substantially more nursing and/or medical care than described above, generally in acute care)
Yukon Territory	Level 1	Room and board with custodial care
	Level 2	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
	Level 3	Type II (i.e., medical and professional nursing supervision, etc.)
	Level 4	Type III (i.e., medical management, skilled nursing care, etc.)
	Level 5	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
Northwest Territory	Level I	Room and board with custodial care
	Level II	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
	Level III	Type II (i.e., medical and professional nursing supervision, etc.)
	Level IV	Type III (i.e., medical management, skilled nursing care, etc.)
	Level V	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type
Nunavut	Level I	Room and board with custodial care
	Level II	Type I (i.e., supervision and/or assistance with daily living and meeting psycho–social needs)
	Level III	Type II (i.e., medical and professional nursing supervision, etc.)
	Level IV	Type III (i.e., medical management, skilled nursing care, etc.)
	Level V	Type III (i.e., medical management, skilled nursing care, etc.) or Higher Type

Residential Care Facilities Survey – 2011GuideInstructions and Definitions