Common use of Specific Reporting Requirements Clause in Contracts

Specific Reporting Requirements. The Service Provider will provide the following specific reporting: Service Provider’s certificate of Prior to or incorporation/amalgamation, concurrent Format as required AHS Contract constating documents (e.g. articles of with the by AHS Manager incorporation, bylaws, memorandum execution of of association, etc.), Alberta Health this facility ID, and Canada Revenue Agreement Agency charitable number, if applicable Certified Declaration by the Service Provider confirming the ownership and control regarding the Service Provider and Facility contemplated by the HFA and regulations Copies of all applications and Accreditations obtained A certificate evidencing the Service Provider’s registration and good standing with Alberta Worker’s Compensation Board or a copy of the letter of exemption from the Alberta Workers’ Compensation Board if the Service Provider is exempt from the requirements of the Worker’s Compensation Act (Alberta) List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Prior to or concurrent with the execution of this Agreement Format as required by AHS AHS Contract Manager Service Provider’s Business Continuity and Disaster Recovery Plans Client / Procedure Information Complications (intra-operative and postoperative, including mortality rates and nosocomial infections, reported by procedure type) Immediately Format as required by AHS Infection Prevention and Control, Contract Manager National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements, as per Appendix 1 At a minimum of at least monthly within 15 days after month-end Submission method and standard format as defined by AHS Health Records (NACRS), as set out in Schedule “F”, Appendix 1 List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Annually Format as required by AHS AHS Contract Manager Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH A copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. At request by AHS Format as required by AHS Requestor authorized by Contract Manager Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Contract Manager Aggregate Information Unplanned hospital admissions from Facility to AHS acute care facility Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Post operative hospital emergency department visits and/or admissions Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Any departure of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Immediate reporting of individual incident Format as required by AHS AHS Contract Manager Financial Reports (specifics set out below this table, entitled “Financial Reports”) Annually (Within 180 days of the Service Provider’s Fiscal Year end) Format as required by AHS and contact information for Finance Director (BAS) provided by AHS Finance Director (BAS) Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH Quality Report on quality metrics, which must include: 1. Wait times (Decision To Treat/Ready To Treat to OR date) 2. Operating Room duration 3. Transfers to Acute Care from CSF via EMS 4. Code 66/Code Blue cases 5. Transfusions 6. Infections within 30 days 7. Re-admissions within 30 days 8. Return to OR within 30 days 9. Mortality within 30 days Quarterly (or Monthly at request of AHS)

Specific Reporting Requirements. The Service Provider will provide the following specific reporting: Service Provider’s certificate of Prior to or incorporation/amalgamation, concurrent Format as required AHS Contract constating documents (e.g. articles of with the by AHS Manager incorporation, bylaws, memorandum execution of of association, etc.), Alberta Health this facility ID, and Canada Revenue Agreement Agency charitable number, if applicable Certified Declaration by the Service Provider confirming the ownership and control regarding the Service Provider and Facility contemplated by the HFA and regulations Copies of all applications and Accreditations obtained A certificate evidencing the Service Provider’s registration and good standing with Alberta Worker’s Compensation Board or a copy of the letter of exemption from the Alberta Workers’ Compensation Board if the Service Provider is exempt from the requirements of the Worker’s Compensation Act (Alberta) List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Prior to or concurrent with the execution of this Agreement Format as required by AHS AHS Contract Manager Service Provider’s Business Continuity and Disaster Recovery Plans Client / Procedure Information Complications (intra-operative and postoperative, including mortality rates and nosocomial infections, reported by procedure type) Immediately Format as required by AHS Infection Prevention and Control, Contract Manager National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements, as per Appendix 1 At a minimum of at least monthly within 15 days after month-end Submission method and standard format as defined by AHS Health Records (NACRS), as set out in Schedule “F”, Appendix 1 List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Annually Format as required by AHS AHS Contract Manager Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH A copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. At request by AHS Format as required by AHS Requestor authorized by Contract Manager Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Contract Manager Aggregate Information Unplanned hospital admissions from Facility to AHS acute care facility Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Post operative hospital emergency department visits and/or admissions Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Any departure of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Immediate reporting of individual incident Format as required by AHS AHS Contract Manager Financial Reports (specifics set out below this table, entitled “Financial Reports”) Annually (Within 180 days of the Service Provider’s Fiscal Year end) Format as required by AHS and contact information for Finance Director (BAS) provided by AHS Finance Director (BAS) Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH Quality Report on quality metrics, which must include: 1. Wait times (Decision To Treat/Ready To Treat to OR date) 2. Operating Room duration 3. Transfers to Acute Care from CSF via EMS 4. Code 66/Code Blue cases 5. Transfusions 6. Infections within 30 days 7. Re-admissions within 30 days 8. Return to OR within 30 days 9. Mortality within 30 days Quarterly (or Monthly at request of AHS)

Specific Reporting Requirements. The Service Provider will provide the following specific reportingreporting and any supporting documentation where necessary: Service Provider’s certificate Certificate of Prior to or AHS incorporation/amalgamation, concurrent Format as required AHS Contract constating documents (e.g. articles of with the by AHS Manager incorporation, bylaws, memorandum execution of of association, etc.), Alberta Health this facility ID, and Canada Revenue Agreement Agency charitable number, if and applicable immediately upon any Certified Declaration by the Service changes or Provider confirming the ownership updates to and control regarding the Service documentation Provider and Facility contemplated by the HFA and regulations Copies of all applicable applications and Accreditations obtained A certificate Certificate evidencing the Service Provider’s registration and good standing with Alberta Worker’s Compensation Board or a copy of the letter of exemption from the Alberta Workers’ Compensation Board if the Service Provider is exempt from the requirements of the Worker’s Compensation Act (Alberta) Contact information for the CEO (or equivalent) and the Medical Director for the organization. Include: Title, First Name/Last Name, Phone, and Email List of Staff who are also AHS employees or employees clinical and nonclinical staff (referred to as “Concurrent Staff”) Prior engaged in the delivery of insured services to or concurrent with clients within the execution of this Agreement Format as facility. Confirm current certification, professional licensing, and registration where required by AHS AHS Contract Manager Service Provider’s Business Continuity and Disaster Recovery Plans Client / Procedure Information Complications (intra-operative and postoperative, including mortality rates and nosocomial infections, reported by procedure type) Immediately Format as required by AHS Infection Prevention Immediate reporting of individual incident; and Control, Contract Manager National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements, as per Appendix 1 At a minimum of at least monthly within 15 days after month-end Submission method and standard format as defined by AHS Health Records (NACRS), as set out in Schedule “F”, Appendix 1 List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Annually quarterly reporting ofaggregate data Format as required by AHS AHS Contract Manager Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH A copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. At request by AHS Format as required by AHS Requestor authorized by Contract Manager Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Contract Manager Aggregate Information Unplanned hospital admissions from Facility to AHS acute care facility Immediate reporting of individual incident; annual quarterly reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Post operative hospital emergency department visits and/or admissions Immediate reporting of individual incident; annual quarterly reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Any departure of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Reportable Incidents Immediate reporting of individual incident In accordance with process described in Schedule C AHS and Alberta Health incident; quarterly reporting of aggregate data (Government of Alberta) National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements Monthly within 15 days after month-end As set out in Schedule “F”, Appendix 1 Submission method and standard format as defined by AHS AHS Health Records (NACRS) Copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. Upon AHS request Format as required by AHS AHS Contract Manager Submission of pre-operative criteria and process for selection Annually Format as required by AHS AHS Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Financial Information Financial Reports (specifics set out below this table, entitled “Financial Reports”) Annually (Within 180 90 days of the Service Provider’s Fiscal Year end) Format as required by AHS and contact information for Finance Director (BAS) provided by AHS Finance Director (BAS) Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH Quality Report on quality metrics, which must include: 1. Wait times (Decision To Treat/Ready To Treat to OR date) 2. Operating Room duration 3. Transfers to Acute Care from CSF via EMS 4. Code 66/Code Blue cases 5. Transfusions 6. Infections within 30 days 7. Re-admissions within 30 days 8. Return to OR within 30 days 9. Mortality within 30 days Quarterly (or Monthly at request of AHS)AHS Quality

Specific Reporting Requirements. The Service Provider will provide the following specific reporting: Service Provider’s certificate of Prior to or incorporation/amalgamation, concurrent Format as required AHS Contract constating documents (e.g. articles of with the by AHS Manager incorporation, bylaws, memorandum execution of of association, etc.), Alberta Health this facility ID, and Canada Revenue Agreement Agency charitable number, if applicable Certified Declaration by the Service Provider confirming the ownership and control regarding the Service Provider and Facility contemplated by the HFA and regulations Copies of all applications and Accreditations obtained A certificate evidencing the Service Provider’s registration and good standing with Alberta Worker’s Compensation Board or a copy of the letter of exemption from the Alberta Workers’ Compensation Board if the Service Provider is exempt from the requirements of the Worker’s Compensation Act (Alberta) List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Prior to or concurrent with the execution of this Agreement Format as required by AHS AHS Contract Manager Service Provider’s Business Continuity and Disaster Recovery Plans Client / Procedure Information Complications (intra-operative and postoperative, including mortality rates and nosocomial infections, reported by procedure type) Immediately Format as required by AHS Infection Prevention and Control, Contract Manager National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements, as per Appendix 1 At a minimum of at least monthly within 15 days after month-end Submission method and standard format as defined by AHS Health Records (NACRS), as set out in Schedule “F”, Appendix 1 List of Staff Practitioners who are also AHS employees or employees (referred to as “Concurrent Staff”) Medical Staff Annually Format as required by AHS AHS Contract Manager Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH A copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. At request by AHS Format as required by AHS Requestor authorized by Contract Manager Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Contract Manager Aggregate Information Unplanned hospital admissions from Facility to AHS acute care facility Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Post operative hospital emergency department visits and/or admissions Immediate reporting of individual incident; annual reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Any departure of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Immediate reporting of individual incident Format as required by AHS AHS Contract Manager Financial Reports (specifics set out below this table, entitled “Financial Reports”) Annually (Within 180 days of the Service Provider’s Fiscal Year end) Format as required by AHS and contact information for Finance Director (BAS) provided by AHS Finance Director (BAS) Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH Quality Report on quality metrics, which must include: 1. Wait times (Decision To Treat/Ready To Treat to OR date) 2. Operating Room duration 3. Transfers to Acute Care from CSF via EMS 4. Code 66/Code Blue cases 5. Transfusions 6. Infections within 30 days 7. Re-admissions within 30 days 8. Return to OR within 30 days 9. Mortality within 30 days Quarterly (or Monthly at request of AHS)

Specific Reporting Requirements. The Service Provider will provide the following specific reportingreporting and any supporting documentation where necessary: Service Provider’s certificate Certificate of Prior to or incorporation/amalgamation, constating concurrent with Format as required by AHS Contract constating documents (e.g. articles of with the by AHS Manager incorporation, the execution of AHS bylaws, memorandum execution of of association, this Agreement etc.), Alberta Health this facility ID, and and Canada Revenue Agreement Agency charitable immediately number, if applicable upon any changes or Certified Declaration by the Service updates to Provider confirming the ownership and documentation control regarding the Service Provider and Facility contemplated by the HFA and regulations Copies of all applicable applications and Accreditations obtained A certificate Certificate evidencing the Service Provider’s registration and good standing with Alberta Worker’s Compensation Board or a copy of the letter of exemption from the Alberta Workers’ Compensation Board if the Service Provider is exempt from the requirements of the Worker’s Compensation Act (Alberta) Contact information for the CEO (or equivalent) and the Medical Director for the organization. Include: Title, First Name/Last Name, Phone, and Email List of Staff who are also AHS employees or employees clinical and nonclinical staff (referred to as “Concurrent Staff”) Prior engaged in the delivery of insured services to or concurrent with Patients within the execution of this Agreement Format as facility. Confirm current certification, professional licensing, and registration where required by AHS AHS Contract Manager Service Provider’s Business Continuity and Disaster Recovery Plans Client Patient / Procedure Information Complications (intra-operative and postoperative, including mortality rates and nosocomial infections, reported by procedure type) Immediately Format as required by AHS Infection Prevention Immediate reporting of individual incident; and Control, Contract Manager National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements, as per Appendix 1 At a minimum quarterly reporting of at least monthly within 15 days after month-end Submission method and standard format as defined by AHS Health Records (NACRS), as set out in Schedule “F”, Appendix 1 List of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Annually aggregate data Format as required by AHS AHS Contract Manager Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH A copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. At request by AHS Format as required by AHS Requestor authorized by Contract Manager Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Contract Manager Aggregate Information Unplanned hospital admissions from Facility to AHS acute care facility Immediate reporting of individual incident; annual quarterly reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Post operative hospital emergency department visits and/or admissions Immediate reporting of individual incident; annual quarterly reporting of aggregate data Standard format provided by AHS, per Schedule C AHS Contract Manager and Alberta Health (Government of Alberta) Any departure of Staff who are also AHS employees or employees (referred to as “Concurrent Staff”) Reportable Incidents Immediate reporting of individual incident incident; quarterly reporting of aggregate data In accordance with process described in Schedule C AHS and Alberta Health (Government of Alberta) National Ambulatory Care Reporting System (NACRS) and Billing Information Requirements Monthly within 15 days after month-end As set out in Schedule “F”, Appendix 1 Submission method AHS Health Records (NACRS) and standard format as defined by AHS Copy of the patient chart including each anesthetic record, operating room nursing record and recovery room record during the Term. Upon AHS request Format as required by AHS AHS Contract Manager Submission of pre-operative criteria and process for selection Annually Format as required by AHS AHS Reporting required regarding enhanced medical goods and services Annually Format as required under the Health Facilities Regulation AHS Financial Information Financial Reports (specifics set out below this table, entitled “Financial Reports”) Annually (Within 180 90 days of the Service Provider’s Fiscal Year end) Format as required by AHS and contact information for Finance Director (BAS) provided by AHS Finance Director (BAS) Reportable Incidents In accordance with timeframes set out in Schedule C In accordance with process described in Schedule C Contract Manager and AH Quality Report on quality metrics, which must include: 1. Wait times (Decision To Treat/Ready To Treat to OR date) 2. Operating Room duration 3. Transfers to Acute Care from CSF via EMS 4. Code 66/Code Blue cases 5. Transfusions 6. Infections within 30 days 7. Re-admissions within 30 days 8. Return to OR within 30 days 9. Mortality within 30 days Quarterly (or Monthly at request of AHS)AHS Quality