1. Who should be completing this survey? 
   
   This survey is intended to be completed by municipal treasurers in consultation with other municipal staff involved in health services. 

1. What is meant by "municipal spending"?
   
   Please include spending from municipal revenue sources, not any provincial funding provided for these services. 
    
2. What are the Financial Information Returns (FIRs)? 
   
   The Financial Information Return provides a standardized reporting of a municipality’s financial activities in the previous fiscal year (January to December). Section 294 (1) of the Municipal Act states that “the treasurer of a municipality shall in each year provide the Minister with a return containing information designated by the Minister with respect to the financial affairs of the municipality”. This takes the form of the annual Financial Information Return (FIR). 
   
   For more information on the FIRs please visit: https://efis.fma.csc.gov.on.ca/fir/index.php/en/financial-information-return-en/  
    
3. What operating and capital figures from the FIR should be reported in this section?
    

   Question 4: Schedule 40, Line 1010, Column 11 

   Question 5: Schedule 51, Line 1010, Column 11 

   Question 7: Schedule 40, Line 1030, Column 11 

   Question 8: Schedule 51, Line 1030, Column 11 
    

4. Which operating and capital figures should be reported for long-term care? 
   
   In the FIR, long-term care spending is reported as part of Line 1220 Assistance to Seniors. However, other seniors’ programs may be reported as part of this line in your municipality. Please consult with relevant staff within your municipality to confirm your contributions to long-term care operating and capital funding. 
    
5. How should upper and lower tiers respond to these questions?
   
   Please complete the survey based on the contributions your specific municipality makes to these services. If you are an upper tier municipality, do not include contributions made directly by lower tier municipalities. If you are a lower tier municipality, do not include any levies made to upper tier municipalities, only the specific spending done by your municipality on these services locally. Upper-tier and single-tier municipalities should also complete the questions relevant to municipal cost-sharing with the province (Questions 6 & 9). 

1. What is Local Share
   
   Hospitals must fund 10% of their construction costs and 100% of ineligible costs. Municipalities may contribute to this funding which is known as the "Local Share".  If your municipality has made contributions to your local hospital(s) over the past 5 years, please complete this section with the amounts contributed in each year. If your municipality did not make contributions in each of the given years, please enter 0 on the applicable lines.  

1. What is meant by "Other Health Services"?

This section intends to clarify what municipalities are reporting on Line 1098 in the FIRs. Please report the amount of spending from municipal revenue sources in Question 23 and provide context on what this spending is for in Question 24. 

1. What are considered “health supports”? 
   
   For the purposes of this survey, health supports could include nurses, paramedics, mental health workers, or other health professionals providing services in settings including homeless shelters or community housing, or through street outreach to homeless populations. If you are uncertain whether a support your municipality funds in these settings would be considered a health support, please include the amount anyways and provide additional clarification about the service in Question 43.  
    
2. What if my municipality contributes to these categories but we do report them in the Health Services category in the FIRs? 
   
   If contributions to these categories are reported by your municipality in the Health Services category of the FIR, please do not report the amount, but provide comments to indicate this in Question 43. 

1. What counts as an in-kind contribution to health services? 
   
   An in-kind contribution is a non-financial contribution to support health services in your community. Some examples that municipalities have undertaken in Ontario include providing rent-free or reduced-rent space in municipal buildings for health services, designating clinics as municipal facilities to give them relief from property taxes, or offering concierge services to connect new health workers and their families with the community. If you are unsure about whether a non-financial initiative your municipality is undertaking would be considered an in-kind contribution, we encourage you to please describe it in this section anyways.  

1. What is the Heads and Beds Levy? 
   
   The “Heads and Beds Levy” is the payment in lieu of taxes that the province makes for facilities such as colleges, universities, hospitals, and prisons. This payment is made to the local municipalities and is charged at $75 per head/bed.  
    
2. What legislation governs the Heads and Beds Levy? 
   
   You can find out more about the Heads and Beds Levy in the Municipal Act, 2001 section 323. 
    
3. How is the Heads and Beds Levy relevant to municipal health services? 
   
   AMO has a long-standing position that the Heads and Beds Levy should be increased. The current rate has been in place since 1987 and has not kept up with the rate of inflation. While the Heads and Beds Levy is calculated based on more than just hospitals, we are interested in looking at what is received by municipalities through this levy in comparison with the contributions of municipalities to hospitals and other health services above their required cost-share or in areas that typically fall under provincial jurisdiction. 
    
4. Do all municipalities receive the Heads and Beds Levy? 
   
   If your municipality does not have a hospital, post-secondary education institution, or prison you may not receive the Heads and Beds Levy. If you do not receive this levy, please indicate 0 in the survey. 

1. What does a follow-up interview entail? 
   
   AMO will be conducting follow-up interviews with interested municipalities to gain additional insights on municipal spending on health services. These interviews will be 30 minutes in length and will be conducted through a video call using Microsoft Teams. These interviews are optional and are an opportunity for interested municipalities to provide more context on municipal contributions to health in your community, including anecdotes or unique initiatives being undertaken that cannot be captured in the survey format.
    
2. Who will/can be involved in follow-up interviews? 
   
   The follow-up interviews will be conducted by AMO staff. We would like to interview anyone who was involved in the completion of the survey and welcome interview participants to invite additional representatives from the municipality that you believe would provide helpful insights on the health contributions being made by your municipality.