Operational Plan Business Plan by xpp14690

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									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.




                                                                                                            1 of 6
                                        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




3a9f4f26-d092-4324-9f22-8815b2684911.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




3a9f4f26-d092-4324-9f22-8815b2684911.xls                                                                                                                                                                                                              Page 4 of 6
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


3a9f4f26-d092-4324-9f22-8815b2684911.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



3a9f4f26-d092-4324-9f22-8815b2684911.xls
Sched 5 One-Time Start Up                                                                                                                                                                                  Page 6 of 6

								
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