Travel (1) Working Sessions Hosting and Hospitality (3) Professional Development (2) Other Travel. Total Travel
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1 Official Administrator and Executive Expense Report Name Brian Stevenson Title Chief Program Officer, Capital Management Location Calgary Expenses submitted during the month of November 2015 Travel (1) Month-Year Source Document Purpose Airfare Meals Accommodation Other Travel Total Travel Professional Development (2) Working Sessions Hosting and Hospitality (3) Other (4) Nov-15 P-Card Meetings Nov-15 Expense Claim Meetings Nov-15 Direct Billing Meetings Total $ 804 $ 86 $ 150 $ 89 $ 1,129 $ - $ - $ - Total for the Month $ 1,129 Maximum daily single meal expense claimed in the month $ 54 2 people Maximum daily base hotel rate claimed in the month $ 134 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. Car allowance and any other employment benefits reported in the annual financial statements are excluded from this report
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7 Claimant Name Claimant Title Claimant Location STEVENSON, BRIAN Chief Program Officer, Capital Management AHS Public Disclosure Expense Claims Expense Claim Total Calgary Expense Date Business reason Expense Expense Type Amount From Location Location To Location Justification # of days 9/28/2015 To attend AHS Master Planning meeting Mileage 2.02 SSP UAH (one way) To attend AHS Master Planning meeting 1 4 # of Attendees Attendee Name(s) Trip Distance 10/6/2015 To attend Joint Capital Steering Committee Mileage 6.06 SSP AI offices (round trip) 10/8/2015 To attend CCP Executive Steering Committee Mileage 6.06 SSP AI offices (round trip) 11/3/2015 To attend Joint Capital Steering Committee Mileage 6.06 SSP AI offices (round trip) To attend Joint Capital Steering Committee To attend CCP Executive Steering Committee To attend Joint Capital Steering Committee 11/5/2015 Travel to Grande Paririe to attend GPRH Capital Project Meeting AB - Other Zones Meals - Dinner- Service Recipient Travel to Grande Paririe to attend GPRH Capital Project Meeting (Sabrina McCormack also attended but Brian is not submitting her meal costs for reimbursement) 11/6/2015 Travel to Grande Paririe to attend GPRH Meals Per Travel to Grande Paririe to attend GPRH Capital Project Meeting Diem Capital Project Meeting.Lunch 11/9/2015 To attend CapM Edmonton Zone Staff Mileage 2.02 UAH SSP (one way) To attend CapM Edmonton Zone Staff Engagment Session Engagment Session 11/19/2015 To attend CCP Executive Steering Committee Mileage 6.06 SSP AI offices (round trip) To attend CCP Executive Steering Committee 11/23/2015 Travel to Calgary to attend CapM Calgary Zone Meals Per Travel to Calgary to attend CapM Calgary Staff Engagement Session Diem Zone Staff Engagement Session.Breakfast & Lunch 11/24/2015 To attend CapM Central Zone Staff Mileage 3.03 SSP RAH (round Engagement Session trip) Approver(s) for the claim Approval Status Approval Date To attend CapM Central Zone Staff Engagement Session Brian Stevenson, Mike Linn RHODES, DEBORAH Approve 11-Dec-15
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9 Executive Expenses Report Direct Billing Summary Purpose of This Form: The purpose of this form is to report expenses incurred on behalf of a designated Executive and paid for by a third party vendor. The information will be used for public disclosure reporting. Expenses Paid Directly to Third Party Vendors: AHS may have established accounts with certain vendors used to book travel and other expenses that are billed directly to AHS. Examples include but are not limited to hotels, travel agencies, car rental agencies, conferences, courses and expenses reimbursed from a petty cash fund. 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 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) Enter all expenses pertaining to professional development such as conferences and courses, etc. Enter all expenses paid by AHS not mentioned above. Copies of invoices and other relevant back up must be attached, approvals for hosting events/working sessions that exceeds $600 must be provided. Information will be used for reporting purposes only. A personal cheque must be attached to cover expenses deemed ineligible. Indicate whether you have expenses to report in this section for this reporting period: YES Name : Brian Stevenson Reporting Period for the Month of : Nov-15 DD-MMM-YY Payment Method Category Description/Purpose of the Expense Name of Vendor Amount Paid 28-Oct-15 Direct Billing Airline Ticket Nov 5/15 - Edmonton to Grande Prairie round trip - Mtg with physicians and clinical staff re:gprh Capital Project Marlin Travel Nov-15 Direct Billing Airline Ticket Nov 23/15 - Edmonton to Calgary round trip - Capital Management Calgary Zone staff engagement session Marlin Travel Direct Billing Choose from Drop-down List Marlin Travel - Direct Billing Choose from Drop-down List Marlin Travel - Direct Billing Choose from Drop-down List Marlin Travel - Total Paid in the Month $
10 MARLIN TRAVEL O-O PERCY HUNT TRAVELGROUP INC MAIN FLOOR, TH ST. EDMONTON, AB T5K 1G8 GST Reg#: Branch: Agent: To: ALBERTA HEALTH SERVICES SUITE 800, NORTH TOWER ST EDMONTON AB CA T5J 3E4 Invoice Number Date: Page: Our Reference: October 28, /2 I N V O I C E For MR BRIAN L STEVENSON Thursday, November 5, 2015 Air WESTJET AIRLINES From: EDMONTON INTL AB To: GRANDE PRAIRIE Stops: 0 Arrival: 05Nov15 WESTJET ENCO WESTJET CONFIRMATIO Flight: :05 PM Equipment: 05:19 PM M CLASS DH4 Mile(s) Flown: 247
11 To: ALBERTA HEALTH SERVICES SUITE 800, NORTH TOWER ST EDMONTON AB CA T5J 3E4 Invoice Number: Date: Page: Our Reference: October 28, /2 I N V O I C E Friday, November 6, 2015 Air WESTJET AIRLINES From: GRANDE PRAIRIE To: EDMONTON INTL AB Stops: 0 Arrival: 06Nov15 WESTJET ENCO WESTJET CONFIRMATION Flight: :35 PM Equipment: 04:41 PM Q CLASS DH4 Mile(s) Flown: 247 Cost: TK Total: Tax: Ticket Total: Grand Total: Less Credit Card Payments: Credit / Balance Due To This Invoice: Total Balance Due: I HAVE BEEN OFFERED TRAVEL INSURANCE AND HAVE ACCEPTED:...DECLINED:... DOCUMENTATION REQUIRED:VALID PASSPORT...VISA..TOURIST CARD.....PROOF OF CANADIAN CITIZENSHIP AND PHOTO ID... OTHER... PLEASE RECONFIRM ALL FLIGHTS BETWEEN 48 AND 72 HOURS PRIOR TO EACH DEPARTURE DIRECTLY WITH THE AIRLINE. CLIENTS FOR THE PRINCIPAL SUM $ UNDER GROUP POLICY GTRMM UNDERWRITTEN BY MANULIFE FINANCIAL 24 HOUR EMERGENCY HELP DESK WITHIN CANADA OR USA CALL OUTSIDE OF TOLL FREE AREA CALL COLLECT PLEASE QUOTE ACCESS CODE 2EC0 OUR PRIVACY POLICY CAN BE FOUND AT
12 MARLIN TRAVEL O-O PERCY HUNT TRAVELGROUP INC MAIN FLOOR, TH ST. EDMONTON, AB T5K 1G8 GST Reg#: Branch: Agent: To: ALBERTA HEALTH SERVICES SUITE 800, NORTH TOWER ST EDMONTON AB CA T5J 3E4 Invoice Numbe Date: Page: Our Reference: 1/2 I N V O I C E For MR BRIAN L STEVENSON Monday, November 23, 2015 Air AIR CANADA From: EDMONTON INTL AB To: CALGARY AB Stops: 0 Arrival: 23Nov15 Seat(s): 12F AIR CANADA E Flight: :20 AM Equipment: 07:14 AM V CLASS D8 (300 SERIES) Mile(s) Flown: 163 Air WESTJET AIRLINES Flight: 255 M CLASS From: CALGARY AB 04:28 PM Equipment: 73W To: EDMONTON INTL AB 05:20 PM Stops: 0 Arrival: 23Nov15 SEAT SELECTION IS AVAILABLE ONLINE 24 HOURS PRIOR TO DEPARTURE Mile(s) Flown: 163 Cost: TKT- TKT- E-TKT E-TKT Tax: Ticket Total: Tax: Ticket Total:
13 To: ALBERTA HEALTH SERVICES SUITE 800, NORTH TOWER ST EDMONTON AB CA T5J 3E4 Invoice Number: Date: Page: Our Reference: November 13, /2 I N V O I C E Total: Grand Total: Less Credit Card Payments: Credit / Balance Due To This Invoice: Total Balance Due: I HAVE BEEN OFFERED TRAVEL INSURANCE AND HAVE ACCEPTED:...DECLINED:... DOCUMENTATION REQUIRED:VALID PASSPORT...VISA..TOURIST CARD.....PROOF OF CANADIAN CITIZENSHIP AND PHOTO ID... OTHER... PLEASE RECONFIRM ALL FLIGHTS BETWEEN 48 AND 72 HOURS PRIOR TO EACH DEPARTURE DIRECTLY WITH THE AIRLINE. CLIENTS FOR THE PRINCIPAL SUM $ UNDER GROUP POLICY GTRMM UNDERWRITTEN BY MANULIFE FINANCIAL 24 HOUR EMERGENCY HELP DESK WITHIN CANADA OR USA CALL OUTSIDE OF TOLL FREE AREA CALL COLLECT PLEASE QUOTE ACCESS CODE 2EC0 OUR PRIVACY POLICY CAN BE FOUND AT
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