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Operating Schedule Template document sample
Document Sample
INSTRUCTIONS ON HOW TO COMPLETE THE BUSINESS AND OPERATIONAL PLAN
FUNDING APPLICATION TEMPLATE
Schedule 1 - Business Plan: 5 Year Financial Forecast
The costs in this Schedule are derived from the individual Fiscal Year Summaries (Schedule 2's).
Schedule 2 - Operational Plan: Summary
Amounts in this Schedule are a roll-up of information from the other 3 Schedules (i.e., Schedules 3 to 5)
If Excel is used the embedded formulas will automatically populate the columns in this worksheet.
Schedule 3 - Operational Plan: Human Resources
This Schedule captures information and related costs for interdisciplinary professionals who will be
providing direct services to patients and for any administrative positions required to support them.
The salary scales for the interdisciplinary positions represent the maximum amount of funding the
ministry is prepared to provide. Staff should be remunerated at a level below the maximum so
that the Family Health Team can retain flexibility in later periods to adjust for merit increases,
raises, etc.
Schedule 4 - Operational Plan: Other Overhead Costs
These costs represent the annual, on-going costs associated with operations and will likely need to
be pro-rated for the first fiscal year.
Items listed in the attached template are samples of potential costs but the list is not inclusive nor is
it meant to indicate that funding must be requested for each item listed.
Schedule 5 - Operational Plan: Start Up/One-Time Costs
This worksheet captures information on those one-time costs associated with getting your FHT up
and running. Requirements will vary from FHT to FHT depending on individual circumstances.
General
The Operational Plan template (i.e., Schedules 2 to 5) can be used for separate fiscal periods by simply
inserting the relevant time period in each worksheet heading. Then the total for each fiscal period can
be used to enter into the Business Plan 5 Year Financial Forecast template. NOTE: Only the annual
totals of the Ministry Funding Request column should be included in this worksheet, e.g. the Total Cost
less Community Partner Contributions and Other Sources of Funding.
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Ministry of Health and Long-Term Care
Funding Application Template: Business Plan
5 Year Financial Forecast
Schedule 1: Business Plan Year 1 Year 2 Year 3 Year 4 Year 5
[Insert start date] 1-Apr-06 1-Apr-07 1-Apr-08 1-Apr-09
to to to to to
31-Mar-06 31-Mar-07 31-Mar-08 31-Mar-09 31-Mar-10
Human Resources
Other Overhead Costs
Sub Total Operating $ $ $ $ $
Start Up/One-Time Costs
Total Costs $ $ $ $ $
Year 1 - Human Resources and Other Overhead Costs should be pro-rated to reflect actual time period of funding.
2 of 6
Ministry of Health and Long-Term Care
Family Health Team
Funding Application Template: Operational Plan
For the Period
[Insert start date to March 31, 2006
(1) (2) (3) (4)
Schedule 2 - Operational Plan (Summary) Ministry Community Other
Total Funding Partner Sources of
Costs Request Contributions Funding
(2+3+4) "M" "C" "O"
Human Resources [Schedule 2]
Other Overhead Costs [Schedule 3]
Sub Total Operating $ $ $ $
One-Time Start Up Costs [Schedule 4]
Total Costs $ $ $ $
Funding Component Legend:
"M" = Funding components requested from Ministry
"C" = Funding components provided by community partner contributions
"O" = Funding components provided by other sources
Column 1 - Total Financial requirements for the fiscal period
Column 2 - Net request from Ministry (Col. 1 - (Col. 3 + Col. 4)
Column 3 - Municipality, Hospital, CCAC, Private, etc.
Column 4 - current MOHLTC, other provincial or federal funding
8f614a1f-2465-4817-8ed3-9b9bcd6a4452.xls
Sch 2 - OpPlan Summary 3 of 6
Ministry of Health and Long-Term Care
Family Health Team
Funding Application Template: Operational Plan
For the Period
[Insert start date] to March 31, 2006
Maximum (1) (2) (3) (4)
Schedule 3 - Operational Plan (Human Resources) Position Annual Method Ministry Community Other
Complement Salary of Total Funding Partner Sources of
Professional and Other Staff (FTE) 1 Per FTE 2 Remuneration 3 Costs Request Contributions Funding
(2+3+4) "M" "C" "O"
4
(a) Non-Physician Personnel:
1)
2)
3)
4)
5)
6)
7)
8)
Sub Total Non-Physician Personnel $ $ $ $
5
(b) Physician Personnel:
1)
2)
3)
4)
5)
6)
7)
8)
Sub Total Physician Personnel $ $ $ $
(c) Total Non-Physician & Physician Salaries $ $ $ $
(d) Benefits @ 20% $ $ $ $
(e) Total [to Schedule 1] $ $ $ $
1
Position Complement determined on basis of 40 hours per week
2
Maximum Annual Salary per FTE - refer to Appendix A, "Salary Benchmarks for Interdisciplinary Health Care Providers" in the Guide to Interdisciplinary Provider Compensation regarding Ministry funding compensation levels per interdisciplinary position
3
Method of Remuneration - indentify basis of remuneration (salary, sessional or other) for each position
4
Non-Physician Personnel - health care providers other than Physicians and management and administrative staff
5
Physician Personnel - complete this section only if physician providers are to be remunerated on a salaried basis
Funding Component Legend:
"M" = Funding components requested from Ministry
"C" = Funding components provided by community partner contributions
"O" = Funding components provided by other sources
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Sched 3 - OpPlan HR
Ministry of Health and Long-Term Care
Family Health Team
Funding Application Template: Operational Plan
For the Period
[Insert start date] to March 31, 2006
(1) (2) (3) (4)
Schedule 4 - Operational Plan (Other Overhead Costs) Ministry Community Other
Total Funding Partner Sources of
Costs Request Contributions Funding
(2+3+4) "M" "C" "O"
1
Equipment Lease(s)
Equipment Service Contract(s) 1
Legal Fees
Audit Fees
Liability Insurance 2
Maintenance of Premises
Medical Supplies
Office Supplies
Staff Training and Development
Rent
Telephone
Travel
Other (please describe)
Total Other Overhead Costs [to Schedule 1] $ $ $ $
1
Equipment Lease and Service Contracts - please submit separate detailed listing in support of total annual cost.
2
Insurance - do not include professional liability insurance premiums
Funding Component Legend:
"M" = Funding components requested from Ministry
"C" = Funding components provided by community partner contributions
"O" = Funding components provided by other sources
8f614a1f-2465-4817-8ed3-9b9bcd6a4452.xls Page 5 of 6
Sch 4 OpPlan Other Overhead
Ministry of Health and Long-Term Care
Family Health Team
Funding Application Template: Operational Plan
Start-up/One-Time Costs
For the Period
[Insert start date] to March 31, 2006
(1) (2) (3) (4)
Schedule 5 - Operational Plan (Start Up/One-Time Costs) Ministry Community Other
Total Funding Partner Sources of
Price 3 Qty/Area (sq. ft.) Costs Request Contributions Funding
(2+3+4) "M" "C" "O"
1
(a) Clinical Equipment:
(b) Administrative Equipment/Furnishings
2
(c) Leasehold Improvements/Renovations
4
(d) Other (please decribe)
Total Start Up/One-Time Costs [to Schedule 1] $ $ $ $
1
Clinical equipment - provide a separate listing of requirements by provider type, e.g. Nurse Practitioner
2 Renovations/Leasehold Improvements - provide the renovated area in square feet in the Quantity column.
3 Shipping and applicable taxes should be included in the estimate
4 Practice Moving Costs - provide your transportation costs, and the address of the old and new practices.
Funding Component Legend:
"M" = Funding components requested from Ministry
"C" = Funding components provided by community partner contributions
"O" = Funding components provided by other sources
8f614a1f-2465-4817-8ed3-9b9bcd6a4452.xls
Sched 5 One-Time Start Up Page 6 of 6
