Name Dr. Francois Belanger

Title VP, Quality & Chief Medical Officer (Acting)

Location Calgary

Expenses submitted during the month of February 2016

MMM-YY

Source

Document Purpose Airfare Meals Accommodation

Other

Travel

Total

Travel

Professional

Development

(2)

Working

Sessions

Hosting and

Hospitality

(3)

Other

(4)

Feb-16 P-Card Meetings 1,289 1,291 2,580

Feb-16 Expense Claim Meetings 138 162 300

Feb-16 Direct Billing Meetings 1,927 1,927

Total 1,927$ 138$ 1,289$ 1,453$ 4,807$ -$ -$ -$

Total for

the Month $ 4,807

Maximum daily single meal expense claimed in the month 21$

Maximum daily base hotel rate claimed in the month 164$

Non economy air travel in the month -$

1) Travel expenses

Includes local and out of province/country travel expenses. Other travel includes items such as

taxis, parking mileage, car rental and other expenses related to travel.

2) Professional Development

Includes conference, seminar and course registration fees and material

3) Hosting and Hospitality expenses

Hospitality and Hosting expenses may be incurred to advance AHS' mission, vision and values. For example, may include working lunches with staff and prospective employees

meetings with government officials, dignitaries, public interest groups, donors other public or private organizations.

4) Other

Other expenses include expenses incurred in the normal course of business that are required for work purposes. May include small item technology purchases, books, etc.

5) Remuneration, Allowances Reported in the Financial Statements

Car allowance, honoraria, meeting fees, and any other employment benefits reported in the annual financial statements are excluded from this report.

Travel (1)

AHS Board and Executive Expense Report

                                                                         AHS Public Disclosure Expense ClaimsClaimant Name Claimant Title Claimant Location Expense

Claim Total

BELANGER,

FRANCOIS

VP Quality & Chief Medical

Officer (Acting)

Calgary 299.83

Expense Date Amount From Location To 

Location

Justification # of

days

# of

Attendees

Attendee

Name(s)

Trip

Distance

1/24/2016 39.15 1/25/2016 -B/Fast

& Dinner

26-Jan-2016-B/Fast

2

1/24/2016 12.63 Southport

Tower

Calgary

Internation

1 25

1/26/2016 12.63 Calgary

International

Southport

Tower

1 25

1/28/2016 25.25 Southport

Tower

Calgary

Internation

al Airport

Southport Tower to

Calgary

International Airport

1 50

2/1/2016 12.63 Southport

Tower

Calgary

Internation

1 25

2/1/2016 59.90 01-Feb-16- Dinner

02-Feb-16-B/Fast &

Dinner

03-Feb-16-B/Fast

3

2/3/2016 12.63 Calgary

International

Southport

Tower

1 25

2/8/2016 29.95 08-Feb-2016-Dinner

09-Feb-2016- B/Fast

2

2/8/2016 12.63 Southport

Tower

Calgary

Internation

1 25

2/9/2016 12.63 Calgary

International

Airport

Southport

Tower

1 25

2/11/2016 25.25 Southport

Tower

Calgary

Internation

al Airport

Return travel to

Calgary

International Airport

1 50

2/17/2016 10.10 Southport

Tower

Calgary Co-

Op, 1130-

11 Avenue

Southport Tower to

1130-11 Avenue

SW, Calgary - Return

1 20

2/18/2016 25.25 Southport

Tower

Calgary

Internation

al Airport

Southport Tower to

Calgary

International Airport

1 50

2/18/2016 9.20 B/Fast 1

YIU, VERNA Approve 26-Feb-16

Announcement re Naloxone in Pharmacies with

Health Minister

Mileage

AH-AMA Negotiations Strategy and IMIT meeting -

Edmonton

Mileage

AH-AMA Negotiations and IMIT mtgs - Edmonton Meals Per

DiemApprover(s) for the claim Approval Status Approval

Date

O'Brien Policy Forum and ELT meetings in Edmonton Meals Per

Diem

O'Brien Policy Forum and ELT in Edmonton Mileage

Return from O'Brien Policy Forum and ELT in

Edmonton

Mileage

Health Capital Projects and Mazankowski event Mileage

Travel to Edmonton - Public Board Meeting Mileage

Meetings in Edmonton - Alberta Clinicians Council, Mileage

Meetings in Edmonton - Alberta Clinician's Council,

CMOH, ELT, AARP, PPEC

Meals Per

Diem

Return from Edmonton meetings - Alberta Clinicians Mileage

Business reason Expense

Location

Expense

Type

Meetings in Edmonton - Patient First, Orientation,

AARP Funding, ELT

Meals Per

Diem

Travel to Edmonton for meetings - Patient First, Mileage

Return from Edmonton for meetings - Patient First, Mileage

Purpose of This Form:

The information will be used for public disclosure reporting.

Expenses Paid Directly to Third Party Vendors:

Examples include but are not limited to hotels, travel agencies, car rental agencies, conferences, courses and expenses reimbursed from a petty cash fund.

l Indicate whether you have expenses to report in this section for this reporting period:

Name : Reporting Period for the Month of :

Total Paid in the Month

$372.38

l Information will be used for reporting purposes only.

Expense Report Direct Bill Summary

The purpose of this form is to report expenses incurred on behalf of a designated Executive or an AHS Board Member and paid for by a third party vendor.

AHS may have established accounts with certain vendors used to book travel and other expenses that are billed directly to AHS.

It is mandatory to include in monthly reports these expenses that pertain to each member. AHS is required to disclose expenses for all

applicable receipts and back up must be attached.

Direct Bill Report

l Enter all items related to expenses incurred while conducting AHS business and paid for via a third party vendor

(i.e. accommodations, airline tickets, car rentals, hosting events and working sessions)

l Enter all expenses pertaining to professional development such as conferences and courses, etc.

l Enter all expenses paid by AHS not mentioned above.

l Copies of invoices and other relevant back up must be attached, approvals for hosting events/working sessions that exceeds $600 must be provided.

l A personal cheque must be attached to cover expenses deemed ineligible.

YES

Francois Belanger Feb-16

DD-MMM-YYYY Payment Method Category Description/Purpose of the Expense Name of Vendor Amount Paid

$1,926.90

11-Feb-16 Direct Billing Airline TicketReturn AC/WJ flight (Calgary-Edmonton)-Capital Health Projects Sr

Exec mtg, Mazankowski event - Feb 11

11-Feb-16 Direct Billing Airline TicketChange Fee WJ flight (Edmonton-Calgary)-Capital Health Projects Sr

Exec mtg, Mazankowski event - Feb 11Marlin Travel $50.00

17-Feb-16 Direct Billing Airline TicketReturn AC flight (Calgary-Edmonton)-AH-AMA Negotiations, IMIT EC

Special Mtg - Feb 18Marlin Travel

$180.12

$372.38

$231.54

03-Feb-16 Direct Billing Airline Ticket One way W/J flight (Edmonton-Calgary) - PPEC meeting - Feb 3 Marlin Travel

08-Feb-16 Direct Billing Airline TicketReturn AC flight (Calgary-Edmonton)- IHE/O'Brien Policy Forum,

AH/AHS Exec Team mtg, Executive Leadership mtg, Feb 8-9 Marlin Travel

Marlin Travel

$360.24Marlin Travel

01-Feb-16 Direct Billing Airline TicketReturn AC/WJ flight (Calgary-Edmonton) - Alberta Clinicians Council,

AH meetings, CMOH interview, Executive Leadership Team mtg,

AARP, and Jt AH/AHS Executive Team mtg, PPEC - Feb 1, 2, 3

Marlin Travel $360.24

28-Jan-16 Direct Billing Airline Ticket Return AC flight (Calgary-Edmonton)- Public Board Meeting, Jan 28