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Michele Lahey Expense Summary 2007-2008

Functional Centre: 201.9000.71110101090171125200002

CATEGORY

Travel- Travel-Out of Accounting Local/Parking Province Taxi Miscellaneous Meals

Period InvQice Number 624IQOOO 62414000 6~410001 69500000 69o0000Q GST Total Comments

APR-08 TRA YEL-25JAN07 7,223.94 !.36 7,225.30 MAYO CLINIC JAN 23-25/07 APR-08 REIMBURSE-28FE807 102.57 6.15 108.72 CAR EXPENSES FEB01-28/07 APR-08 REIMBURSE-21 MAR07 96.74 502.42 231.36 42.45 872.97 V. TRON DINNERJMILE/EXTRA (QUEBEC) FEB16-MAR21/07 APR-08 REIMBURSE-3 1 MAR07 33.07 1.98 35.05 CAR EXPENSES MAR01-31/07 MAY-08 TRA VEL-20APR07 300.87 16.48 317.35 CAPHC BOARD RETREAT, TORONTO, APR19-i0/07 MAY-08 TRA VEL-26APR07 537.76 30.79 568.55 CHILD SUMMIT -OTT A W A-APR25-26/07 MAY-08 REIMBURSE-JOAPR07 137.28 1,778.21 114.93 2,030.42 CAR EXPENSES APR01-J0/07 MAY-08 REIMBURSE-JOAPR07-2 38.64 74.52 872.30 51.18 1,036.64 MEALS/GIFTS/PARK APR07-J0/07 JUN-08 REIMBURSE-29MAY07 37.74 51.89 333.85 775.18 46.51 1,245.17 MEALS/GIFTS/PARK/CAB APR07&30; MA Y03-24/07 JUN-08 REIMBURSE-3lrv1A Y07 1,220.58 73.23 1,293.81 CAR ALLOWANCE MAY 2007 JUN-08 REIMBURSE-29JUN07 53.77 28.30 239.04 8.03 18.25 347.39 G1FTS/PARKINGfTAXVFUEL MAYJO-JUN29/07

I st Quarter Total 1,720.39 8,564.99 80.19 2,425.62 l ,886.87 403.31 $ 15,081.37

Total to Date 1,720.39 8,564.99 80.19 2,425.62 1,886.87 403.31 $ 15,081.37

M. Lahey

APPLICANT COPY

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Capital Health EDF!ONTON AREA

DATE:

To:

FROM:

Copv:

Re:

April10, 2007

Sheila Weatherill

Michele T. Lahey~

Allaudin Merali

Expenses - Mayo Visit

Executive Vice President & Chief Operating Officer- Health Services

Gp.PITAL HEAI.if.! RECEIVED

APR 1 3 2007

Attached please find a summary of expenses for my visit to the Mayo Clinic on January 23-25, 2007. You had previously indicated that Capital Health will reimburse me for these expenses.

Thank you.

Capital Health Corporate Office 1J2.07 Walter M~ckenzie CE!!ntre, 8440-112 Street, Edmonton, Alberta T6G 287

(780) 407·1671 (Fax) 407-1675 email : m/ahey@cha.ab.ca

www.capitalhearth.ca

APPLICANT COPY

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•· -=-

Name: Michele Lahey

Travel & Employee Expense Claim Form (In Canadian Dollars)

1 Employee Number: ! ' I Union Name:

Position: Executive Vice President & COO- Health Services I Department: SPCORP

Business Phone: 407-1 671 I Period From: January 23 to January 25, 2007

Expenses Paid (please attach receipts). Do not include amounts paid by .Capital Health or reimbursed I reimbursable by h . . C I h h anot er orgamzatlon. om~ ete details on t e ot er side of the form

Bal Unit Location Functional Centre Account Non-Canadian Canadian$ ¥"ifGST Rate (including e.g. 201 e.g. 9000 e.g. 71135050044 e.g. 69500001 Currency GST) included

201 9000 71110101090 sg5eggog... $7,225.30

b 'l.'-1.\Y ouv -~~~~ -

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t A~ R \72007

" ~~oUNTS A.t' less Cash Advance PA'V""~a' ~'!. J,

Total $7,225.30

The information on this form is collected under section 4 of the Regional Health Authorities (Ministerial) Regulation and will be used to process your claim . .

I hereby certify that the expenses listed above were incurred on C~pital Health business and have not been previously claimed by me or on my behalf from Capital Health or other organization.

Employee Signature:

(Signature)

Approved By: (Prlrrt name)

(Signature)

NOTE:

Date:

President & CEO - Capital Health

/ . .:<. .. u?

Phone# 407-8008

Date -AP~ 13 Phone#

Date

0

0

0

0

0

0

0

D

Expense claim must be properly authorized and must be supported by original receipts or a copy as certified by the approver. The approver must initial individual items that are not supported by original invoices or do not have all the required supporting documents to indicate approval without support. Unsupported claims over $1,000 require level'4 approval.

GST amounts included in the expense claims will be calculated by Accounts Payable.

For all employees on the payroll system, expense reimbursements will be deposited to employee bank account.

For physicians, contracted employees and those not paid through the payroll system, expense reimbursements will be mailed through th€ internal mail system.

See the other side of this form for expense claim limits.

Approved claim form with receipts should be sent to Accounts Payable (Capital Health Centre, North Tower - 10th Fl. , 10030 - · 107 Street, Edmonton, AB T5J 3E4)

Out of proVince expenses also require approval of Chief Operaffng Officer or Vice President.

i -0313 March, 2006

APPLICANT COPY

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EXPENSE CLAIM DETAILS

Date Particulars Accomm.$ Meal$ Registration $ Transportation $ Other$ Mileage

km Expenses re Mayo Clinic Visit as attacheded

.

.

Total km

*(or alternate rate as outlined in Section 2- Travel below)@ $0.43*

Totals I I I EXPENSE LIMITS

1 . Meal Allowances When traveling on Capit~l Health business, the employee may be reimbursed at the Per Diem meal allowance of:

Breakfast $8.00 (if the departure time is earlier or the return time is later than 7:00 a.m.) Lunch $10.00 (if the departure time is earlier or the return time is later than 1:00 p.m.) Dinner $17.00 (if the departure time is earlier or the return time is later than 7:00 p.m.)

For meal expenses that exceed the above amounts, the supervisor may approve higher amounts, with receipts, provided these are reasonable. Meal expenses must be supported by restaurant receipt (not just credit card receipt) and information on either the names of the individuals or organizations whose representatives attended the lunch/dinner meeting. '

2. Travel Use of personal automobile- From March 1, 2006, reimbursement at the rate of $0.43 per km for the first 15,000 kilometers of approved travel in a fiscal year (April1 to March 31)·and $0.40 for each kilometer there after (except where collective agreement specifies otherwise). Business car insurance is reimbursable up to $260 per year with receipts in accordance with Capital Health Policy. Effective March 1, 2006, out of scope employees required to provide a vehicle as a condition of employment and meeting the following requirements on a regular and continuing basis as approved by an authorized manager. 1. Monthly travel in excess of 340 kilometers; or 2. Monthly expense equivalent to four (4) return cab fares at $20 one way; or 3. Daily requirements to utilize personal vehicle in the course of duties -reimbursed at $0.50 per kilometer. If union contract rate differs from $0.43 then contract rate must be used. Includes all forms of transportation costs, including taxis and buses for local travel. Driving to and from work is not considered business travel and cannot be claimed.

3. Advance Travel advance may be requested provided travel expenses are likely to exceed $500.

APPLICANT COPY

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Summary of Expenses

Michele Lahey

Rochester, MN

January 23-25, 2007

Travel:

Airport Transfer Airport Transfer

Accommodation:

/ A23 US Funds • $23 US Funds

/ Marriott Rochester "' $538.28 US Funds Marriott Rochester ./$5.00 US Funds

Meals:

Lunch Dinner Lunch Snack Coffee Dinner Coffee

./$31.70 US Funds ./$31.29 US Funds /$9.42 US Funds /$2.99 US Funds /$124.82 US Funds /$8.19 US Funds

Paid to Mayo Clinic:

January 23 January 25

(@ 1.211041 = $27.85 Cdn) ,/ (@ 1.210062 = $27.83 Cdn) /

January 23-25(@ 1.210745 = $651.72 Cdn) v' January 26 (@ 1.212000 = $6.06 Cdn) /

January 23 January 24 January 24 January 24 January 24 January 24 January 25

$28.89 Cdn ;;14. o ') (@ 1.211041 = $38.39 Cdn) ../ (@ 1.211041 = $37.89 Cdn) , (@ 1.211041 = $11.41 Cdn) 1

(@1.211041=$3.62Cdn) / (@ 1.210062 = $151.04 Cdn) v (@ 1.210062 = $9.91 Cdn) /

~.ooo us Funds(@ 1.210984 = $6,054.92 Cdn) (Jan 24/07) ..$555 US Funds(@ 1.153 = $639.91 Cdn) (March 30/07)

/Reverse Charge- $404 US Funds(@ 1.148861 = $464.14 Cdn) 1

Total Amount Paid: $5,151 US Funds ($6,054.92 + $639.91 - $464.14 = $6,230~9 Cdn)

TOTAL TO BE REIMBURSED: $7 225.30 CON

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NO BACON WATR PRRIER 17oz 3.99 SUBTOT.AL 25.97

TAX 1 '73 AMOUNT 27.70 ******* *******

SUBTOTAL 25.97 TAX 1 '73 AMOUNT $27 . 70

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APPLICANT COPY

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~arrtott ROCHESTER

MAYO CLIMIC AREA

307 'LAHEY/MICHELE/MS ROOM NAME

NSQN TYPE

01/23 STATETAX 01/24 OAKROOM 01/24 AQUAF'INA 01/24 MOVIES· 01/24 ROOM 01/24 STATETAX 01/25 AQUAFINA 01/25 CCARD-BK

5ETTLED TO:

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1577 307 1 MOVIE

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1 BTL

VISA

101 S. W. First Avenue Rochester, MN 55902 (507) 280-6000 {507) 280-853f Fax Marriott com

GUEST FOLIO

219.00 01/25/07 06:45 10114 RATE OEPAAT TIME ACCT# . 01/23/07 14:39

. ARRIVE

PASSPORT:

PAYMENT .

. 24.09 31.29 2.50

15.81 219.00 24.09

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TIME

538 . 28 I,.L.~ .•

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WANT YOUR FINAL HOTEL BILL BY EMAIL? JUST ASK THE FRONT DESK!

.,\\arrtott. ROCHESTER

MAYO CLINIC AREA

101 SW. First Avenue Rochester, MN 55902 {507) 280-6000 (507} 280-8531 Fax Marriott.com

This statement is your only receipt. You. have agreed to pay in cash or by approved persot~ar c:heck.or to authorize us to chatg~ you.r credit card forafl llmounts tharg!CI to you. The amount shown in the credits column oppos;te any cred it card e.ntry In the reference column above Wfll bot! charged to the credit card number set forth above. (The credi t card company will bill in the usual manne r.) If ior any reason the cred1t ~rd company does not make payment on this account. you will owe: 1.15 such amount. Jfyou are direct billed, in t~e everrt pa'Y"'ent is not n"'ade within 25days after check-out, you will ow~ us interest from the check-out date O:'l. any un!)aid amou!'lt at the rate. of l.So/c per month (ANNUAL RATE 18%), or the maximum allowed by law, plus the reasonable cost of collection, Including attomey fees.

Signature X

FOR RESERVATIONS AT ANY MARRIOTT HOTEL, CALL (800) 228 9290

r--·--------·~ . .r..·-

APPLICANT COPY

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.\\arrloff.· ROOf ESTEll

MAYO CUNlC AREA

307 LAHEY/MICHELE/MS ROOM NAME

NSQN

L ADDRESS

01 23 ROOM 01/23 STATETAX 01/24 OAKROOM 01/24 AQUAFINA

3 ' 307' 1

1577 307 1 . MOVIE

219.QO 01/25/07 RA.TE; DEPART

01/23/07 ARRIVE

PASSPORT:

PAYMENT

2 . 24.09 31.29 2.50

15.81 219.00 24.09

101 S.W. First Avenue Rochester, MN 55902 (507) 280-6000 (507) 280-8531 Fax Marriott com GUEST FOLIO

12:00 10114 TIME ACCf#

14:39 Tll•fE

MR#:

'01/24 MOVIES 01/24 ROOM 01/24 STATETAX 01/25 BK CARD

3.07' 1 307' 1

$535.78

TO BE SETTLED TO: VISA CURRENT BALANCE .00

THANK YOU FOR CHOOSING MARRIOTT! TO EXPEDITE YOUR CHECK-OUT, PLEASE CALL THE FRONT DESK, OR PRESS •M.ENU• ON YOUR TV REMOTE CONTROL TO ACCESS VIDEO CHECK-OUT.

- - -- ---- ------- ---- EXP. REPORT SUMMARY ------ - --- - - ----- --01/23 ROOM · 219.00

STATETAX 24.09

01124 OAKROOM ' AQUAFINA

MOVIES ROOM STATETAX

31.29 2.50

15.81 219.00 24.09

WANT YOUR FINAL HOTEL BILL BY EMAIL? JUST ASK THE FRONT DESK!

.,\\arrtott ROCHESTER

MAYO CLINIC AREA

101 S.W. First Avenue Rochester, MN 55902 (507) 280-6000 (507) 280-8531 Fax Marriott. com

This statem~t ts your only rec.eipt. You have agreed to pay fn QSh ot by apProved personal chec.k or to authorize us to charge your credit c11rd for all amounts ch.erged. to yo1.1. The amount s hown in the credits column opposite any credit card entry ir. the re ference column a bove wlll be c:harged to the ue.dit card number set forth above. (The credit card company w1ll bill in t he. us ual manner.) lffor a ny rea5on th~ credit catd company does not make payment on this atttiun~ yo u will owe us such amount. "you are di r~t billed, ln the event payment Is not made wrthin 25 days after check-out, ycu will owe u.s interest from the check-out date on any unpaid amount zt the. rate of lS~ per month (ANNUAL RAT E 18%), or the maximum allowed by Jaw. plus the reasonable cost of colledion, including attorney fees.

Signature X -------------------------------

FOR RESERVATIONS AT ANY MARRIOTT HOTEL, CALL (800) 228 9290

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APPLICANT COPY

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