Grossmont Hospital Foundation

“The personnel committee of sharp healthcare retains an independent compensation consulting firm to review the total compensation paid to executive management (ceo/president, executive vice president of hospital operations, and senior vice presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the personnel committee of the board of directors by the independent consultant. The personnel committee is comprised of board members who are not physicians and who are not compensated in any way by the organization. The personnel committee approves the total compensation for the president/chief executive officer and reviews and approves the compensation and compensation salary ranges for the remainder of the executive team. The personnel committee presents its decision to the board of directors. The personnel committee retains minutes of its meetings. The compensation and benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the compensation and benefits department and is presented to the president/chief executive officer, the executive vice president of hospital operations and the appropriate senior vice president for review and approval. The compensation study was last conducted in november/december 2016.”

“Grossmont hospital corporation (fein 33-0449527) has the right to elect directors to grossmont hospital foundation's governing body.”

“Grossmont hospital corporation (fein 33-0449527) approves changes to grossmont hospital foundation's bylaws and approves the election of grossmont hospital foundation board members.”

“The final form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the director of tax & accounting, vice president of finance, senior vice president and chief financial officer, and entity executive director. Additionally, the organization contracts with ernst & young, an independent accounting firm, for review of the form 990.”

“Grossmont hospital foundation has a written conflict of interest policy which has been reviewed and approved by the grossmont hospital foundation governing board. Grossmont hospital foundation is committed to preventing any participant of the corporation from gaining any personal benefit from information received or from any transaction of sharp. One component of the written conflict of interest policy requires that board members, corporate officers, senior vice presidents and chief executive officer(s) submit a conflict of interest statement annually to legal services/senior vice president of legal services who will review all statements. In addition, all vice presidents and any employees in the purchasing/supply chain, audit and compliance, and case management/discharge planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the conflict review committee comprised of employees from sharp's legal, compliance, and internal audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board members, corporate officers, senior vice presidents, and the chief executive officer(s) shall make such disclosures directly to the chairman of the board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the board member, corporate officer, senior vice president or the chief executive officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with section 5222 of the california corporations code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member.”

“The organization does not make its governing documents available to the general public. POLICIES ARE CONSIDERED PROPRIETARY INFORMATION, HOWEVER IN SHARP HEALTHCARE'S PUBLICLY AVAILABLE CODE OF CONDUCT, SHARP OUTLINES ITS CONFLICT OF INTEREST POLICIES IN A USER FRIENDLY MANNER. THE ANNUAL AUDITED FINANCIAL STATEMENTS OF THE CONSOLIDATED GROUP ARE PUBLISHED ON THE DACBOND.COM WEBSITE (WWW.DACBOND.COM), ARE ATTACHED TO THE FORM 990 FILED FOR EACH OF THE SHARP HOSPITALS, AND ARE AVAILABLE UPON REQUEST. THE ANNUAL AUDITED FINANCIAL STATEMENTS INCLUDE COMBINING SCHEDULES WHICH DISCLOSE THE FINANCIAL RESULTS (BALANCE SHEET, STATEMENT OF OPERATIONS, STATEMENT OF CHANGES IN NET ASSETS) FOR EACH ENTITY OF THE CONSOLIDATED GROUP. QUARTERLY FINANCIAL STATEMENTS OF SHARP'S OBLIGATED GROUP ARE PUBLISHED ON THE DACBOND.COM WEBSITE (WWW.DACBOND.COM).”

“The purpose of this corporation is to provide assistance and support to Grossmont Hospital Corporation in the development of high quality, accessible and affordable inpatient and outpatient services.”

“Grossmont hospital foundation employees' salaries and wages are paid under grossmont hospital corporation's tax id number (ein 33-0449527), and as such are also reported on grossmont hospital corporation's form 990.”

“Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2017 Section 1 An Overview of Sharp HealthCare We're an organization filled with passionate, determined and caring people, who have grown our health care system into the remarkable place that it is. Each day, these professionals recognize and celebrate the purpose of their work and the impact it has on our neighbors, friends and family in the community. - Michael W. Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 24 medical centers; five urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp also offers individual and group Health Maintenance Organization (HMO) coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2017, Sharp is licensed to operate 2,084 beds and has more than 2,600 Sharp-affiliated physicians and 18,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in SDC's fast-growing South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women's and infant's services, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, sub-acute and long-term care, liver care, rehabilitation therapies, orthopedics, and hospice and emergency services. Sharp Grossmont Hospital (524 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, oncology, orthopedics, rehabilitation, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in cancer treatment, orthopedics, organ transplantation, bariatric surgery, heart care and rehabilitation. SMH also houses the county's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 licensed beds) A freestanding women's hospital specializing in labor and delivery services, high-risk pregnancy, obstetrics, gynecology, gynecologic oncology and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other hospital in California. Sharp Mesa Vista Hospital (158 licensed beds) As the most comprehensive mental health hospital in San Diego, Sharp Mesa Vista Hospital (SMV) provides behavioral health services to treat anxiety, depression, substance abuse, eating disorders, bipolar disorder and more for patients of all ages. Sharp McDonald Center (16 licensed beds) Sharp McDonald Center (SMC) is the only medically supervised substance abuse recovery center in SDC. Offering the most comprehensive hospital-based treatment program in San Diego, SMC provides services such as addiction treatment, medically supervised detoxification and rehabilitation, day treatment, outpatient and inpatient programs, and aftercare. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH and are r”

“Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * Sensitivity to operations * A reluctance to simplify * Preoccupation with failure * Deference to expertise * Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could improve. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization - Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. The seven pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: 1. Demonstrate and improve clinical excellence and exceed customer expectations. 2. Keep patients, employees and physicians safe and free from harm. 3. Create exceptional experiences at every touch point for patients and families, enrollees, physicians, partners and team members. 4. Create a values-driven culture that attracts, retains and promotes the best people who are committed to Sharp's mission and vision. 5. Achieve financial results to ensure Sharp's ability to deliver on its mission and vision. 6. Achieve net revenue growth to enhance market position, sustain infrastructure improvements and support innovative development. 7. Be an exemplary public citizen by improving the health of our community and environment. Awards Below please find a selection of recognitions Sharp has received in recent years: In 2013, 2014, 2016 and 2017, Sharp was recognized as one of the "World's Most Ethical (WME) Companies" by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was ranked No. 45 out of 500 large employers on Forbes' 2017 America's Best Employers listing. In 2016, Sharp ranked No. 16 and received the No. 2 spot on the newcomer's list. Sharp was also ranked No. 52 out of 250 organizations on Forbes' 2017 America's Best Employers for Diversity and was the only hospital system listed in San Diego. In 2017, Sharp was recognized as one of "150 Top Places to Work in Healthcare" by Becker's Hospital Review. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees. In 2015 and 2017, Sharp ranked first for "San Diego's Best Hospital Group" in the annual San Diego Union-Tribune Readers Poll. Sharp ranked second in this category in 2016. SMH ranked first for "San Diego's Best Hospital" in 2017 while ranking second in this category in 2016. Also in 2016, SMBHWN and SGH ranked third and fourth, respectively, for "San Diego's Best Hospital." From 2015 to 2017, Sharp Community Medical Group (SCMG) ranked first as "San Diego's Best Medical Group." In 2016, SRSMG ranked third for "San Diego's Best Medical Group" and was recognized as "San Diego's Best Hearing Aid Store" in 2017. In 2016 and 2017, SMBHWN was named to The Leapfrog Group's Top Hospitals list, which recognizes facilities that meet the highest standards of patient safety, care quality and efficiency. In 2016, SMH was also recognized as a Top Hospital. SGH, SMH and SMBHWN received MAGNET(”

“Press Ganey also recognized multiple SHC entities with the Pinnacle of Excellence Award(r) (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the Press Ganey categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 and 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, SHC was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP's 2016-2017 National Committee for Quality Assurance's (NCQA) Private Health Insurance Rankings rating increased from a 4 to 4.5 out of 5, making it one of the highest-rated health plans in the nation. SHP was also ranked a top 100 U.S. health plan and a top three California health plan from 2014 to 2015, which rated health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. SHP also received the highest level "Excellent" Accreditation status from the NCQA each year from 2013 to 2015. The NCQA awards accreditation status is based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. In addition, SHP was rated highest in California among reporting California health plans in the rating categories of Rating of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating of Health Promotion and Education in NCQA's 2015 Quality Compass/CAHPS survey, which provides state, regional and national benchmarks as well as individual plan performance. From 2013 to 2017, Sharp ranked in the top 10 of the large employers category as one of the "Best Places to Work" for information technology professionals by the International Data Group's Computerworld survey. The list is compiled by evaluating a company's benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. The Women's Choice Award(r) is a symbol of excellence in customer experience awarded by the collective voice of women. SGH received a Women's Choice Award(r) as one of America's Best Hospitals for Cancer Care in 2015, Obstetrics in 2016 and Heart Care in 2017. SMH and SGH received a Women's Choice Award(r) as one of America's Best Stroke Centers in 2017. In 2015, SMBHWN received the award as one of America's Best Hospitals for Obstetrics. The Women's Choice Award(r) also ranked SCHHC, SCVMC and SMH amongst America's 100 Best Hospitals for Patient Experience in 2017. In addition, SMH received the award as one of America's Best Hospitals for Bariatric Surgery in 2017. For the fourth year in a row, and the fifth time in six years, Sharp won the top spot in the Mega Employer category in the San Diego Association of Governments' (SANDAG) iCommute 2016 Rideshare Corporate Challenge. The annual month-long challenge encourages the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or transit commutes. Powered by SANDAG and in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Sharp was named the 2015 Medical Provider of the Year at the International Travel & Health Insurance Journal (ITIJ) Awards. The ITIJ honors companies that have made an outstanding contribution to the global travel and health insurance industry over the past year. Sharp's Global Patient Services program coordinates patient transfers and evacuations for medical emergencies from around the world to a Sharp hospital. Global Healthcare Exchange (GHX) recognized Sharp as one of the 2016 GHX "Best 50" Supply Chains in No”

“SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh, the Supplemental Nutrition Assistance Program in California, prior to hospital discharge, dramatically increasing the likelihood that patients complete CalFresh applications and receive benefits. In FY 2017, SGH's PFS team completed 687 CalFresh applications and 405 patients were granted CalFresh benefits. In February 2017, Sharp's PFS team expanded this program to the remainder of Sharp's acute care hospitals. In summer 2015, a pilot program was launched at SMBHWN to evaluate both insured and unfunded families with Neonatal Intensive Care Unit (NICU) babies for financial assistance. This process included helping families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight apply for Supplemental Security Income (SSI) to help with the cost of care for their newborn both within and outside of the hospital. Public Resource Specialists have assisted more than 150 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. SCHHC, SGH and SMH work with the San Diego Rescue Mission (SDRM) to identify homeless patients, or patients who have exhausted other community housing resources, who have a continuing medical need after hospital discharge. Once referred to the SDRM's Recuperative Care Unit, patients receive follow-up medical care through Sharp in a safe environment, and may also receive psychiatric care, assistance scheduling specialty appointments, support with CalFresh applications, and connections to community resources, including programs that support continued sobriety and residential treatment. In addition, a social worker provides referrals for permanent housing and collaborates with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. Sharp is committed to providing medical records to support an SSI claim free of charge. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships and career pipeline programs. In FY 2017, nearly 4,600 student interns dedicated more than 650,000 hours within the Sharp system. Sharp provided education and training for students in a variety of disciplines, including nursing students (e.g., critical care, medical/surgical, behavioral health, women's services, cardiac services and hospice) and allied health professions such as rehabilitation therapies (speech, physical and occupational therapy), pharmacy, respiratory therapy, imaging, cardiovascular, dietetics, lab, radiation therapy, surgical technology, paramedic, social work, psychology, business, health information management and public health. Students came from local community colleges, such as Grossmont College, San Diego City College, San Diego Mesa College and Southwestern College (SWC); local and national universities such as Point Loma Nazarene University (PLNU), San Diego State University (SDSU), University of California (UC), San Diego, and University of San Diego (USD); and vocational schools such as Concorde Career College. Table 1 presents the total number of students and student hours at each Sharp entity in FY 2017. Table 1: Sharp HealthCare Internships - FY 2017 Sharp Chula Vista Medical Center: Students - 804, Hours - 135,872 Sharp Coronado Hospital and Healthcare Center: Students - 663,”

“In FY 2017, 432 HSHMC students - including 162 Level I students and 270 Level II students - were supervised for more than 97,700 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology; occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; endoscopy; engineering; nutrition; infection control; pulmonary services; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2017, the HSHMC program graduated 161 students in its seventh full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Although many HSHMC students face financial hardship - the free and reduced-price meal eligibility rate is higher than the averages for SDC and California - the school excels in preparing students for high school graduation, college entrance and a future career. In 2017, 90 percent of the HSHMC graduating class went on to attend two- or four-year college, while 80 percent of students said they wanted to pursue a career in health care. In addition, HSHMC has a 98.7 percent graduation rate, which is higher than California's 83.2 percent state average. HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. Each year, the Classroom for the Future Foundation awards education programs across SDC in four categories: innovate, inspire, achieve and impact. HSHMC was also recognized as a U.S. News & World Report Best High Schools bronze award winner in 2014, 2016 and 2017. The California Department of Education recognized HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and as a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high- and low-performing students. HSHMC was also recognized with a 2015 Model Professional Learning Community at Work(tm) Award by Solution Tree for its sustained success in raising student achievement. Professional Learning Communities are schools and districts in which educators recognize the key to improved learning for students is ongoing, job-embedded education for the adults who serve those students. HSHMC was one in approximately 200 schools and districts in the U.S. and Canada - and the first school in SDC - to receive this honor. In addition, HSHMC was a 2014 National School Safety Advocacy Council award winner. Lectures and Continuing Education Sharp contributes to the academic development of students at colleges and universities throughout San Diego. In FY 2017, Sharp staff provided hundreds of hours in guest lectures and presentations on numerous health care topics. Lecture topics included stroke treatment techniques; health information technology (HIT); diabetes; spiritual care in the health care setting; a variety of health administration topics; electronic medical records, clinical informatics and change management; spinal cord injury (SCI); and topics related to end-of-life care, including advance care planning, Physician Orders for Life-Sustaining Treatment, hospice, palliative care, bereavement, bioethics and goals of care. Lectures were delivered to students at San Diego Mesa College, SDSU, USD, Azusa Pacific University (APU), California State University San Marcos (CSUSM) and the University of St. Augustine. These students were enrolled in a variety of programs, including nursing, nurse practitioner, physical therapy, medical assisting, HIT, health care informatics and public health. Sharp's Continuing Medical Education (CME) Department is accredit”

“The ORI seeks guidance and expertise from the local and national academic community on how to effectively conduct outcomes research to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University. In addition, in FY 2017, ORI research studies were presented at various professional conferences, including the Health Care Systems Research Network Conference in San Diego, the Cardiovascular Disease and Stroke Scientific Sessions in Arlington, Virginia, and the Academy Health Annual Research Meeting in New Orleans, Louisiana. Presentations included Utilizing Data Analytics and Innovation Partnerships to Reduce Hospital Readmissions; Influence of Ethnic and Gender Diversity in Quality of Care for Patients Receiving Treatment for Acute Myocardial Infarction; and Impact of Behavioral Health Data in Improving Prediction of Hospital Patient Readmissions. Beginning in September 2016, the ORI expanded its capabilities by adding a full-time postdoctoral clinical psychology fellowship position and a half-time practicum placement for a predoctoral graduate student. Based on the successful contributions of these programs, the ORI has hired a full-time clinical psychologist, renewed the graduate student practicum placement, and will offer new research training experiences for three psychology undergraduate students in FY 2018. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows and mentors to change and improve clinical practice and patient care through identifying a care problem, developing a plan to solve it and incorporating this new knowledge into practice. The EBPI is part of the Consortium for Nursing Excellence, San Diego, which promotes evidence-based practices in the nursing community. The consortium is a partnership between Sharp, Scripps Health, Palomar Health, Rady Children's Hospital - San Diego, UC San Diego Health, U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, Elizabeth Hospice, PLNU, SDSU, APU and USD. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom, and structured mentorship throughout the program. EBPI fellows and mentors partner with one another through a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellows through the process of evidence-based practice. Mentors also assist fellows in working collaboratively with other key hospital leadership personnel. In FY 2017, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared project results. Forty-six attendees, including 23 fellows and 23 mentors, graduated from the program. Projects addressed the following issues in clinical practice and patient care: post-operative spine mobilization; reduction of anxiety for hospitalized patients undergoing caesarean section; nurse-physician rounding; the impact of wall art in the psychiatric intensive care unit; early mobilization in the adult trauma population; the impact of education on cell phone cleaning among NICU visitors and staff; and improving discharge timeliness. Volunteer Service Sharp Lends a Hand In FY 2017, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely solely on Sharp for volunteer labor; and support existing nonprofit initiatives, community activities or other programs that serve SDC. Nineteen projects were selected for FY 2017: San Diego Food Bank (Food Bank);”

“Promises2Kids provides current and former foster youth in SDC with the tools, opportunities and guidance they need to grow into healthy, happy and successful adults. In June and July, 20 SLAH volunteers supported the Guardian Scholars and Camp Connect programs by assembling goody bags, packing boxes, and assisting with inventory, as well as assembling care packages for college students raised in the foster care system. The Ssubi is Hope Greening for Good project collects discarded but safe and usable supplies from U.S. hospitals and distributes them to clinics around the world that have little or no medical resources. In addition to providing life-changing and life-saving services to people in underserved countries, the project has protected the environment by keeping more than one million pounds of medical surplus out of local landfills. On 20 days between October 2016 and September 2017, 265 SLAH volunteers joined the Greening for Good project to evaluate, sort, label and prepare medical materials for shipment. The Special Olympics Southern California - San Diego County program offers free, year-round sports training and competition for children and adults with intellectual disabilities. In May 2017, 25 SLAH volunteers supported the program's basketball competition during the Regional Spring Games at Carlsbad High School. Volunteers served as athlete escorts as well as assisted with score-keeping, time-keeping and the awards ceremony. In addition to building homes in partnership with local people in need, San Diego Habitat for Humanity operates two ReStore retail centers with a wide variety of new or gently used building materials and home furnishings for public purchase. The ReStore centers provide affordable merchandise to customers while helping fund the construction of Habitat homes throughout SDC. On two days in August and September, 20 volunteers organized donated items and took inventory of stock for the Mission Valley ReStore retail center. SLAH participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego, to provide community-based social services to veterans without a permanent residence. Over 10 days in June and July, approximately 120 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, approximately 60 clinical volunteers - including Sharp-affiliated physicians and Sharp nurses, podiatry technicians, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. More than 900 veterans were served through the 2017 Stand Down for Homeless Veterans events. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by SCI. Through the organization's award-winning program, They Will Surf Again, paraplegic and quadriplegic community members can experience mobility through surfing with support from adaptive equipment and volunteers. In September, an estimated 60 SLAH volunteers assisted They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. In celebration of Earth Day, in April, SLAH partnered with I Love a Clean San Diego for the 15th annual Creek to Bay Cleanup. Approximately 35 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In September, 11 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including Ocean Beach Dog Beach, Chula Vista Marina View Park, Mission Trails Regional Park, Pacific Beach, San Dieguito Lagoon, Los Penasquitos Canyon, San Diego River and Coronado City Beach. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocea”

“Random Acts of Kindness Life (RAKlife) is a nonprofit organization dedicated to developing a global culture that incorporates random acts of kindness into daily life to help those less fortunate around the world. For 10 days in April, a Sharp team member participated in a RAKlife trip to the Mai Chau District in Northwestern Vietnam, where the team built a small house and a clean water basin for a local family. In February, another Sharp team member visited Vietnam for two weeks through Prisoners of Hope, a ministry offered through the Rock Church Global Outreach program. The mission team provided a variety of medical and optometry services for approximately 1,190 medical patients and 800 optometry patients, including prisoners, orphans, the disabled, and those living in poverty. Since 1934, Liga International (The Flying Doctors of Mercy) has provided free health care and education to the people of the Mexican state of Sinaloa. In March and April, a Sharp nurse traveled to the city of El Fuerte, Sinaloa, to assist with admitting, operating and recovery for approximately 30 local patient surgeries. In May, a Sharp nurse participated in a 10-day mission trip to Lima, Peru, through CardioStart International - a global volunteer organization that brings specialized cardiac care teams to underserved regions. The team, which included a cardiac surgeon, anesthesiologist, cardiologist, respiratory therapist, nurses and support staff, performed surgery for eight children with congenital heart defects as well as provided advanced cardiac education to help local medical teams improve surgical outcomes and patient care. Also in May, a Sharp team member helped co-lead a team of eight PLNU students on a mission trip to Armenia with LoveWorks, a short-term mission program committed to sending well-trained, culturally sensitive and flexible teams of student missionaries to serve in challenging and remote areas of the world. The team provided numerous services to Armenian families, including: donating clothing to the impoverished; repainting local schools; helping a local church move to a larger facility; and encouraging local churches in their ministry to women, children and teens. Community Walks Heart disease is the leading cause of death in the U.S. For the past 21 years, Sharp has proudly supported the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In September 2017, approximately 960 walkers represented Sharp at the 2017 San Diego Heart & Stroke Walk held at Balboa Park. More than 120 teams, representing entities across the Sharp system, raised funds for the walk through numerous activities, such as auctions, drawings for prizes and a karaoke competition. Sharp has maintained its position as the No. 1 team in San Diego for the past 21 years and was the No. 2 team in the AHA Western States Affiliate for the third year in a row, raising more than $217,700 and setting a SHC fundraising record. To date, Sharp has raised more than $3 million through its San Diego Heart & Stroke Walk fundraising efforts. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community and help make a difference in the lives of others. Sharp provides many volunteer opportunities for individuals to assist with a wide variety of programs, events and initiatives across the Sharp system. Volunteers of all ages and skill level devote their time and compassion to patients within Sharp's hospitals, community events for the general public, and activities supporting Sharp's various foundations. On average, more than 1,780 individuals actively volunteered at Sharp each month in FY 2017, contributing a total of nearly 253,900 hours of service to Sharp and its initiatives. This included more than 1,900 auxiliary members and thousands of individual volunteers from the San Diego community, including volunteers for Sharp's foundations. Near”

“Sharp HospiceCare continued to provide the 11th Hour program to ensure that no patient died alone. Through the program, volunteers accompanied patients who were in their final moments of life but did not have family members present. This included holding the patient's hand, reading softly to them and simply remaining by their side. Families who were present with their dying loved one could also receive comfort from a volunteer as their loved one passed away. Ten volunteers were trained through the 11th Hour program in FY 2017. In FY 2017, Sharp HospiceCare trained 12 volunteers in integrative therapies to promote relaxation and restful sleep and enhance the quality of life for Sharp HospiceCare patients and their caregivers. Integrative therapies included Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain; Reiki, a Japanese energy healing therapy in which practitioners use their hands on or above the patient's body to facilitate the healing process; aromatherapy; and hand massage. Volunteers help support Sharp HospiceCare's partnership with We Honor Veterans (WHV). WHV is a national program developed by the National Hospice and Palliative Care Organization in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide education and training that qualifies their volunteers to identify and support veteran patients and their caregivers. This includes the Vet-to-Vet Volunteer program, which aims to pair volunteers who have military experience with veteran patients, as well as honors veteran patients through special pinning ceremonies. In FY 2017, Sharp HospiceCare held two pinning ceremonies during which volunteers presented a WHV pin and a certificate of appreciation to approximately 90 Sharp HospiceCare veteran patients as well as more than 50 veteran community members. Sharp HospiceCare continued to offer the Memory Bear program to support community members who have lost a loved one. Through the program, volunteers created teddy bears out of the garments of those who have passed on, which served as special keepsakes and permanent reminders of the grieving individual's loved one. In FY 2017, volunteers dedicated nearly 2,700 hours to sewing more than 670 bears for approximately 240 families. Sharp HospiceCare recognizes the valuable impact that volunteers have on the experience of its patients, family and caregivers. In light of this recognition, Sharp HospiceCare offered a monthly continuing education support group to enhance the skills of its volunteers. In addition, Sharp HospiceCare honored its volunteers during National Volunteer Week in April, and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV, SMC) Volunteer Programs Through the Community Care Partner (CCP) program at SMH, hospital volunteers are hand-selected and trained to serve and comfort patients without family or friends present during their hospital stay. Activities may include reading, writing letters, taking walks, playing games, or simply comforting patients through conversation. In addition, CCP volunteers help keep patients safe by notifying medical staff when needs arise - a task that is usually performed by a family member or friend but often overlooked for patients who lack a companion. In FY 2017, 9 CCP volunteers devoted nearly 600 hours to approximately 460 patient visits. The Cushman Wellness Center Community Health Library and SMH Volunteer Department continued to offer the Health Information Ambassador program in FY 2017. Serving SMH, the SMH Rehabilitation Center and SMBHWN's perinatal special care unit, the program brings the library's services directly to patients and family members and empowers them to become involved in their own health care. Through the program, hospital volunteers receive specialized”

“According to the January 2017 WeAllCount Annual Report, there were 9,116 individuals experiencing homelessness in SDC, which represents an increase of 5 percent region-wide from 2016. Since 2011, Sharp has sponsored the Downtown San Diego Partnership's Family Reunification Program, which serves to reduce the number of homeless individuals on the streets of Downtown. Through the program, homeless outreach coordinators from the Downtown San Diego Partnership's Clean & Safe Program identify homeless individuals who will be best served by traveling back home to loved ones. Family and friends are contacted to ensure that the individuals have a place to stay and the support they need to get back on their feet. Once confirmed, the outreach team provides the transportation needed to reconnect with their support system. With Sharp's help, the Family Reunification Program has reunited more than 1,000 homeless individuals in Downtown San Diego with friends and family across the nation. Diapers are expensive - a month's supply can cost up to $100 per child - and cannot be purchased with CalFresh or Women, Infants, and Children (WIC) benefits. As a result, parents with limited economic resources may change diapers less frequently than recommended and unintentionally place their infant at risk. In FY 2017, Sharp worked with Assemblywoman Lorena Gonzalez, SDG&E and hundreds of organizations and citizens across San Diego to help struggling families cope with a serious challenge - the cost of diapers - by donating diapers to the Food Bank's new Diaper Bank Program. The Diaper Drive, hosted by SDG&E, netted more than 27,000 diapers for families in need, nearly tripling the goal of 10,000 diapers. Sharp employees showed their support for this cause by donating more than 6,500 diapers. The SGH Engineering Department led a variety of volunteer initiatives in FY 2017. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting visitors, patients and staff. Through the program, the SGH landscape team grows, cuts, bundles and delivers colorful bouquets to patient rooms as well as offers single-stem roses in a small bud vase to passers-by. In FY 2017, the team delivered three to four vases of flowers with an inspirational quote each week, with as many as eight vases or more during peak flower season and upon additional requests. In addition, nearly 40 vases of flowers were delivered to new mothers in the hospital on Mother's Day. This Bud's for You also supports the SGH Senior Resource Center and Meals on Wheels partnership by providing floral centerpieces for their fundraising events to benefit East County seniors, as well as offers roses for SGH's annual patient remembrance service. Now in its seventh year, the program has become a natural part of the landscape team's day - an act that is simply part of what they do to enhance the experience of hospital visitors. The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors that appear to need encouragement or cheer, as well as to recognize patient birthdays, anniversaries and other special moments. With help from Sodexo - the hospital's food service, housekeeping and engineering vendor - a bouquet is quickly assembled (with balloons, ribbon, a Sodexo Care Bear and/or football) and delivered to the individual. In FY 2017, the team assembled up to 10 Cheers Bouquets per month, including bouquets for more than 40 new fathers on Father's Day weekend. For the past seven years, the SGH Engineering Department, landscape team and Auxiliary have collaborated with local businesses to bring The Shirt Off Our Backs Program to community members in need during the holidays. Through the program, volunteers collect and donate a variety of items to help meet the basic needs of homeless or low-income children and adults. In FY 2017, volunteers filled two trucks with”

“All Ways Green Initiative As San Diego's largest private employer and leading health care provider, Sharp has long been committed to improving the health of the environment and therefore the communities it serves. Sharp recognizes the connection between a healthy environment and individual health and well-being, and is dedicated to minimizing adverse environmental impacts by creating healthy green practices for employees, physicians and patients. Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego's Earth-friendly businesses to help identify best practices, reduce the costs of green practices, and facilitate the implementation of sustainable initiatives. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Through the All Ways Green(tm) initiative, Sharp maintains an environmentally conscious footprint and communicates sustainability throughout the organization and the San Diego community. Sharp's systemwide All Ways Green Committee is responsible for spearheading the organization's green efforts. Sharp's active environmental initiatives are concentrated in five domains: (1) energy efficiency, (2) water conservation,(3) waste minimization, (4), commuter solutions, and (5) sustainable food practices. Specialized committees/subcommittees are responsible for each of these domains (see Table 3), while established Green Teams at each Sharp entity are responsiblefor developing new programs that educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Table 3: All Ways Green(tm) Committees/Subcommittees and Domains Natural Resource Subcommittee- Energy efficiency and water conservation Waste Minimization Committee - Waste minimization Food and Nutrition Best Health Committee - Sustainable food practices Commuter Solutions Subcommittee - Commuter solutions To monitor progress and measure tangible results, All Ways Green(tm) utilizes a customized report card, which evaluates each domain's annual performance against a baseline. The report card is designed to show where the desired results have been achieved and where improvements are still needed. Entity Green Teams utilize the report card to communicate the initiative results to all staff and to establish more effective sustainability practices. Sharp's goals and accomplishments within each All Ways Green committee/subcommittee and domain are described below. Natural Resource Conservation According to the EPA, health care ranks as the country's second most energy intensive industry, and hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the U.S. Sharp's goal is to optimize the use of electricity, gas and water across its facilities, identify and evaluate opportunities for improvement, implement initiatives in the most cost-effective manner, and track progress. The EPA states that 30 percent of the health care sector's current energy use could be reduced without sacrificing quality of care through a shift toward energy efficiency and use of renewable energy sources. Sharp's Natural Resource Subcommittee has responded to this challenge by implementing numerous energy and water conservation initiatives, including infrastructure changes and adopting best practices to ensure its facilities are optimally operated while monitoring and measuring energy and water consumption. The Natural Resource Subcommittee also educates employees about the energy-conscious behaviors that can be practiced in the workplace and at home to promote continuous energy and water savings. In FY 2017, Sharp extended its commitment to environmental best practices in information technology. New software was installed on 10 data center air conditioner units, resulting in more efficient cooling of the data center and a 16 percent decrease in power usage for these devi”

“All Sharp hospitals engage in the EPA's ES database and monitor their ES scores on a monthly basis, thus following an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC and SCVMC received the ES certification in 2017 (SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification from 2009 to 2011, 2013 and 2015). In addition, Sharp's SRSMG Downtown medical office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, one of the first medical office buildings in San Diego of its kind. Additional energy conservation initiatives at Sharp are outlined in Table 4. Table 4: Natural Resource Projects by Sharp HealthCare Entity Establish Energy and Water Use Baseline - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG ES Participation - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC Air Handler Projects - SCHHC, SMH/SMBHWN Cogeneration Plant - SGH Drip Irrigation/ Landscape Water Reduction Systems - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Drought-tolerant Landscaping - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Electric Vehicle Charging Stations - SCVMC, System Offices, SMH/SMBHWN, SRSMG Electronic/Low-flow Faucets - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Energy-efficient Kitchen/Cafe Appliances - SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN Energy-efficient Chillers/ Motors - SCHHC, SCVMC, System Offices, SMH/SMBHWN Faucets and Toilet Retrofits - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Heating, Ventilation and Air Conditioning projects- SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Natural Resource Project - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Light-emitting Diode (LED) - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Occupancy Sensors - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Retrofits - SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Mist Eliminators - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Moisture-sensitive Sprinkler Controls - SCHHC, SGH, SMH/SMBHWN Plumbing Projects to Address Water Leaks - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Thermostat Control Software - System Services Water Dispensers to Replace Water Bottles - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Water-efficient Dishwashing/ Equipment Washing/ Chemical Dispensing System - SCHHC, SCVMC, SGH, SMH/SMBHWN Waste Minimization U.S. hospitals generate an average of 26 pounds of waste per staffed bed each day, approximately 15 percent of which is considered hazardous material. Sharp is committed to significantly reducing waste at each entity and extending the lifespan of local landfills. Sharp's Waste Minimization Committee provides oversight of systemwide waste minimization initiatives including proper waste segregation and enhancing recycling efforts. Sharp made the following achievements in waste minimization in FY 2017: * Sharp increased purchases of 100 percent recycled goods at all sites. * Sharp proactively recycled more than 350 tons of construction debris from its two major building projects at SCVMC and SRSMG Rancho Bernardo. * SGH and SCVMC implemented green waste recycling through which they generated more than 125,000 p”

“The goal of Sharp's Food and Nutrition Best Health Committee is to promote food sustainability efforts throughout the health care system and within the greater San Diego community. This includes a focus on Sharp's sustainable Mindful Food program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. Sharp's Mindful Food program includes the promotion of Meatless Mondays to reduce meat consumption; increased purchases of beef and poultry raised without the routine use of antibiotics; menus that highlight wellness options; participation in Community Supported Agriculture (CSA), a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm; increased use of locally sourced fresh, organic and sustainable food; food composting; increased recycling activities; the promotion of sugarless beverages; and the use of post-consumer recycled packaging solutions. Additional sustainability initiatives implemented by Sharp are described below. * Since August 2016, SMH, SMV, and SGH have collaborated with the SDRM and the Food Bank in an innovative food recovery program that donates food items that can no longer be used in Sharp's kitchens but are perfectly healthy and nutritious to more than 45 hunger relief organizations in SDC. In addition, SCVMC and SCHHC recently partnered with FSD, making Sharp the first health care system in the county to donate food to San Diego's needy at such a wide-scale level. Food recovery efforts benefit the local community by ensuring access to nutritious meals for the food insecure, while also enabling Sharp to save on waste disposal costs and keep food out of landfills. In 2017, Sharp donated 18,300 pounds of food to these safety-net organizations. * In FY 2017, Sharp's composting programs diverted approximately 442,000 pounds of waste from landfills. SMMC was the first group of hospitals in SDC to participate in the city's food scraps composting program in 2012. In 2017, the program expanded to SCVMC with its engagement of the City of Chula Vista. Also in 2017, SGH collaborated with Resource Management Group recycling center to begin a composting program. Through these programs, food waste at these three Sharp sites is processed into a rich compost product and provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water and helping the environment by recycling valuable organic materials. According to the City of San Diego, such waste diversion programs contribute to the extension of the landfill's lifespan from 2012 to at least 2022. * Launched in 2016, a soup stock program at SMH turns previously unused vegetable scraps into soup stock and saves, on average, 174 pounds of food each week. In addition, SCHHC saves an average of 45 pounds of food through its soup stock program. * In 2017, Sharp's imperfect produce program purchased more than 20,000 pounds of less-than-perfect fruits and vegetables per month that are nutrient-rich and full of flavor but would have been thrown away by Sharp's food vendors. The imperfect produce program is currently in effect at SCVMC with plans to expand across the system. * In 2017, Sharp's cooking oil recycling program collected more than 6,000 pounds of oil, which is converted into safe biodiesel oil. * SCHHC, SMH and SMV continued to operate the first county-approved hospital-based organic gardens. Produce from the gardens is used in meals served at the hospital cafes. * Sharp's waste-mindful operations, including self-audit checklists, continue to help kitchen teams reduce their carbon footprint between food preparation and cleanup. In recognition of these initiatives, the San Diego Food System Alliance awarded Sharp a”

“Sharp also encourages employees to participate in the SANDAG iCommute RideMatcher vanpool and carpool program, which can help employees find convenient ride share partners and promote sustainable commuting. Using iCommute's TripTracker, employees can monitor the cost and carbon savings resulting from their alternate commuting methods. In addition, Sharp is enrolled in SANDAG's Guaranteed Ride Home program, which provides commuters who carpool, vanpool, take an express bus, ride the Coaster, or bike to work three or more times a week with a taxi or a rental car in case of an emergency or being stranded at work. In recognition of Rideshare Month every October, Sharp participates in SANDAG's iCommute Rideshare Corporate Challenge where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling and public transit. In FY 2017, 84 organizations in SDC - representing more than 200,000 employees - competed in the challenge. Sharp won the top spot in the Mega Employer category for the fourth year in a row and for the fifth time in six years. The annual challenge is instrumental in helping reduce traffic congestion and greenhouse gas emissions throughout the region. Furthering the commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for almost 500 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription, and human resources. Sharp also provides compressed work schedule options to eligible full-time employees, which enables them to complete the basic eighty-hour biweekly work requirement in less than 10 workdays and thus reduces commute costs, lowers parking demand, and helps the environment. Sharp's ongoing efforts to promote alternative commute choices in the workplace has led to recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 through 2017. Community Education and Outreach Sharp actively educates the community about its sustainability programs. In FY 2017, Sharp participated in the following outreach activities: * Sharp published e-newsletters for employees highlighting its recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling, and energy and water conservation. * Sharp held its sixth annual systemwide All Ways Green(tm) Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how they can decrease water, energy and resource consumption, divert waste through recycling, and reduce their carbon footprint by using alternative transportation at work and home. Many of Sharp's key vendors participated in the fairs to help raise awareness of green initiatives and how Sharp is involved in those programs. * Sharp held a community recycling event that included free e-waste recycling and confidential document destruction. The event also included the U.S. Drug Enforcement Agency's Drug Take Back Program, which provides a safe, convenient, and responsible method of drug disposal and educates the general public about the potential for prescription medication abuse. * In recognition of America Recycles Day, Sharp created a video for all Sharp employees to view on the intranet. The video highlights that every employee can make a difference by recycling as well as shows how recyclables are sorted at the local processing facility instead of being disposed of in the landfill. * Sharp participates in San Diego County's Hazmat Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC. Additional community environmental education and outreach initiatives at Sharp are highlighted in Table 8. Table 8: Environmental Community Education and Outreach by Sharp H”

“Sharp supports safety efforts of the state and the city of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to a mass decontamination event. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event of an interruption to the system's normal water supply. In September, Sharp hosted its sixth annual Disaster Preparedness Expo to educate San Diego residents on effective disaster preparedness and response in the event of an earthquake, fire, power outage or other emergency. Held at Liberty Station, the free event provided more than 700 community members with a variety of disaster exhibitors, demonstrations and displays as well as education on personal and family disaster planning. In recent years, endemic events occurring across the globe have had the potential to impact public health in the local San Diego community. Sharp has continued to partner with community agencies, County of San Diego Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This preparation has allowed for the continued delivery of uninterrupted care to the community in the face of public health threats. Employee Wellness: Sharp Best Health Sharp recognizes that improving the health of its team members benefits the health of the broader community. Since 2010, the Sharp Best Health employee wellness program has created wellness initiatives to improve the overall health, safety, happiness and productivity of Sharp's workforce. Each Sharp hospital, SRSMG and corporate location has a dedicated Best Health committee that works to motivate team members to incorporate healthy habits into their lifestyles and support them on their journey to attain their personal health goals. Team members are encouraged to participate in a variety of workplace health initiatives ranging from fitness challenges and weight management programs to health education and events. Sharp Best Health also offers an interactive web-based health portal where employees can create a wellness plan and track their progress. Since 2013, Sharp Best Health has offered annual employee health screenings to raise individual awareness of important biometric health measures, educate team members on reducing the risk of related health issues, and encourage employees to track changes in their metrics over time. In FY 2017, nearly 10,000 employees received health screenings for blood pressure, cholesterol, body mass index, blood sugar and tobacco use. Post-screening resources and tools are available for Sharp employees and their family members, including free access to a health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management, and managing the challenges of living with a chronic condition such as diabetes, high blood pressure, asthma or arthritis. The AHA recommends walking 10,000 steps a day to help improve or maintain a healthy lifestyle. To align with this goal, Sharp Best Health encourages team members to use a Fitbit Zip(tm) wireless pedometer to track their steps, distance, calories burned, sleep patterns and more. By syncing these statistics to computers or smartphones, the Fitbit Zips(tm) can inspire team members to achieve their personal fitness goals one step at a time. Throughout the year, Sharp Best Health held both entity-specific and systemwide Fitbit Step Challenges to encourage team members to set personal goals and compete for prizes. During FY 2017, more than 700 participants across the Sharp system walked the equivalent of 57,080 miles. Since the Fitbit Zip(tm) program's inception in 2014, participating employees have increased their average total steps by 22 percent. Additionally, to promote safety along with increased physical activity, Sharp Best Health updated Sharp's acceptable”

“Weight Watchers(r) offers weight-loss services and products founded on a scientifically based approach to weight management that encourages healthy eating, increased physical activity and healthy weight management behaviors. Sharp Best Health continued its partnership with Weight Watchers(r) to offer Sharp team members a subsidized membership rate to any Weight Watchers(r) program. With program availability at work, in the community and online, this partnership has offered Sharp team members a variety of healthy-eating and physical-activity options that can be tailored to different lifestyles and schedules. At any given time during FY 2017, approximately 720 Sharp employees were actively using Weight Watchers(r). Since the program was deployed in 2016, participating employees have lost an estimated 3,000 pounds. In addition to providing Weight Watchers(r) at work, during FY 2017 Sharp Best Health partnered with the Sharp Rees-Stealy Center for Health Management to offer free in-person and online nutrition classes to Sharp employees through the New Weigh program. New Weigh is an eight-week weight loss program that emphasizes nutrition education and healthy lifestyle development. Program participants create a semi-structured food plan, and have access to a skilled health coach or registered dietitian to ensure continued support and accountability. During FY 2017, 210 Sharp employees completed the New Weigh program. Nearly one in six community members face the threat of hunger every day in SDC. Each month, the Food Bank distributes food to approximately 370,000 children and families, active duty military, and fixed income seniors living in poverty. For more than a decade, Sharp has supported the Food Bank's tremendous efforts through a holiday food drive. During the 2016 holiday season, Sharp Best Health and Sharp Community Benefit collaborated to take this effort a step further. In partnership with SuperFood Drive - a San Diego-based organization committed to educating the community about the health benefits of eating nutrient-dense superfoods and ensuring the accessibility of healthy food to all - Sharp transformed its traditional food drives to "superfood drives," encouraging nonperishable food donations that are also nutritious, sustaining and essential for a healthy life. Through the six-week holiday superfood drive at locations throughout the Sharp system, Sharp doubled its number of food drive sites from earlier holiday seasons, and collected more than 3,000 pounds of nutritious food - an increase of 90 percent compared to previous years. In addition, Sharp team members donated nearly $2,900 through a new Sharp Virtual Food Drive specifically benefiting the Food Bank. Combined, these donations and funds provided nearly 16,000 healthy meals for San Diegans in need of assistance with putting food on the table during the 2016 holiday season. Section 2 Executive Summary It's important to me that Sharp HealthCare promotes policies that improve access to health care, because we all deserve an opportunity to live the healthiest life we can. - Sara Steinhoffer, Vice President of Government Relations, Sharp HealthCare This Executive Summary provides an overview of community benefit planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefit Plan and Report, and a summary of community benefit programs and services provided by Sharp in Fiscal Year 2017 (FY 2017) (October 1, 2016, through September 30, 2017). In addition, the summary reports the economic value of community benefit provided by Sharp, according to the framework specifically identified in Senate Bill 697 (SB 697), for the following entities: * Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefit Planning at Sha”

“Table 9: Sharp HealthCare Total Community Benefit - FY 2017 (Economic value is based on unreimbursed costs) Medical Care Services: Shortfall in Medi-Cal - $140,198,987 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $222,539,275 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $7,999,688 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in CHAMPVA/TRICARE - $6,179,147 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Workers' Compensation - $53,553 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Charity Care - $22,033,461 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Bad Debt - $7,489,410 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Other Benefits for Vulnerable Populations, Broader Community, and Health Research, Education and Training Programs: Patient transportation and other assistance for the needy - $2,803,035 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $1,680,320 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Education and training programs for students, interns and health care professionals - $4,330,246 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted fro”

“Methodology to Conduct the 2016 Sharp HealthCare Community Health Needs Assessments Sharp has been a longtime partner in the process of identifying and responding to the health needs of the San Diego community. Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations and community agencies to conduct a triennial CHNA that identifies and prioritizes health needs for San Diego County (SDC). In addition, to address the requirements for not-for-profit hospitals under the Patient Protection and Affordable Care Act, Sharp has developed CHNAs for each of its individually licensed hospitals since 2013. This process gathers both salient hospital data and the perspectives of health leaders and residents in order to identify and prioritize health needs for community members across the county, with a special focus on vulnerable populations. Further, the process seeks to highlight health needs that hospitals could impact through programs, services and collaboration. For the 2016 CHNA process, Sharp actively participated in a collaborative CHNA effort led by the Hospital Association of San Diego and Imperial Counties (HASD&IC) and in contract with the Institute for Public Health (IPH) at San Diego State University. The process and findings of the collaborative HASD&IC 2016 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs. The complete HASD&IC 2016 CHNA is available for public viewing and download at http://www.hasdic.org. To develop its individual hospital CHNAs, Sharp analyzed hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients and community members it serves. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns, as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2016 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2016 CHNAs for each Sharp hospital help inform current and future community benefit programs and services, especially for community members facing inequities. This section describes the general methodology employed for Sharp HealthCare's 2016 CHNAs. CHNA Committee The HASD&IC Board of Directors convened a CHNA Committee to plan and implement the collaborative 2016 CHNA process. The CHNA Committee includes representatives from all seven participating hospitals and health care systems: * Kaiser Foundation Hospitals - San Diego * Palomar Health * Rady Children's Hospital - San Diego * Scripps Health (Chair) * Sharp HealthCare (Vice Chair) * Tri-City Medical Center * University of California (UC), San Diego Health CHNA Objectives In response to community feedback on the 2013 CHNA process and findings, and in recognition of the challenges that health providers, community organizations and residents face in their efforts to prevent, diagnose and manage chronic conditions, the HASD&IC 2016 CHNA process focused on gaining deeper insight into the top health needs identified for SDC through the 2013 CHNA process. Sharp's 2013 CHNA process and findings were significantly informed by the collaborative HASD&IC CHNA model. Consequently, Sharp's 2016 CHNA process sought to gain further insight into the needs identified across its different hospitals in 2013, including (in alphabetical order) behavioral health, cancer, cardiovascular disease, Type 2 diabetes, high-risk pregnancy, obesity and senior health. Specific objectives of Sharp's 2016 CHNA process included: * Gather in-depth feedback to aid in the understanding of the most significant health needs impacting community members in SDC, particularly Sharp patients. * Connect the identifi”

“Using these criteria, IPH created a summary matrix for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, Type 2 diabetes and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. As the HASD&IC 2016 CHNA process included robust representation from the communities served by Sharp, the findings of the prioritization process applied to the same four priority health needs identified for Sharp (behavioral health, cardiovascular, Type 2 diabetes and obesity). In addition, findings from Sharp's 2016 CHNAs continued to prioritize cancer, high-risk pregnancy and senior health among the top health needs for its community. In addition, analysis of feedback from the 2016 CHNA community engagement activities identified SDOH to be a key theme among community health needs. Ten SDOH were consistently referenced across the different community engagement activities conducted in both HASD&IC's and Sharp's CHNAs. The importance of these SDOH was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these SDOH. Ongoing Commitment to Collaboration Underscoring Sharp's ongoing commitment to collaboration in order to address community health priorities and improve the health of San Diegans, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, Association for Community Health Improvement, statewide California Hospital Association, HASD&IC, and a variety of local collaboratives including but not limited to the San Diego Hunger Coalition, the San Diego Regional Chamber of Commerce and Community Health Improvement Partners. Section 4 Sharp Grossmont Hospital Community is really about vibrant connections between people; the people that live near us, the people we serve on a daily basis, and the people that provide our services all working together to shape life moments for each person. - Scott Evans, Chief Executive Officer, Sharp Grossmont Hospital FY 2017 Community Benefit Program Highlights Sharp Grossmont Hospital (SGH) provided $118,063,679 in community benefit in Fiscal Year 2017 (FY 2017). See Table 22 for a summary of unreimbursed costs based on the categories identified in Senate Bill (SB 697), for the distribution of SGH's community benefit among those categories. Table 22: Economic Value of Community Benefit Provided Sharp Grossmont Hospital - Estimated FY 2017 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal - $42,806,043 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $62,806,884 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $162,019 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the spe”

“* Other Benefits for the Broader Community included health education and information on a variety of topics; support groups; participation in community health fairs and events; health screenings for stroke, blood pressure, diabetes, fall prevention, hand, lung function and carotid artery disease; community education and resources provided by the SGH cancer patient navigator program; and specialized education and flu vaccinations offered through the SGH Senior Resource Center. SGH also collaborated with local schools to promote interest in health care careers and donated meeting room space to community groups. SGH staff actively participated in community boards, committees, and civic organizations, including but not limited to the County of San Diego Aging and Independence Services (AIS), Association of California Nurse Leaders (ACNL), Neighborhood Healthcare, Meals on Wheels San Diego County East County Advisory Board, Caregiver Coalition of San Diego (the Caregiver Education Committee), Partnership for Smoke-Free Families, San Diego County Breastfeeding Coalition Advisory Board, the Beacon Council's Patient Safety Collaborative, East County Action Network (ECAN), East County Senior Service Providers (ECSSP), Hospital Association of San Diego and Imperial Counties (HASD&IC), the local chapter of Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), California Association of Hospitals and Health Systems (CAHHS) Committee on Volunteer Services and Directors' Coordinating Council, San Diego Association of Directors of Volunteer Services, Emergency Nurses Association, California Society for Clinical Social Work Professionals, Santee-Lakeside Rotary Club, Grossmont Healthcare District Community Grants and Sponsorships Committee, John A. Davis Family YMCA Board of Management, Santee Chamber of Commerce, Angels Foster Family Network, La Mesa Parks and Recreation, and Lantern Crest Senior Living Advisory Board. See Appendix A for a listing of Sharp HealthCare's (Sharp's or SHC's) community involvement. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training for health care professionals, student and intern supervision and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Definition of Community SGH is located at 5555 Grossmont Center Drive in La Mesa, ZIP code 91942. The community served by SGH includes the entire east region of San Diego County (SDC), including the subregional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. For SGH's 2016 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by SGH with especially high need include, but are not limited to, Lemon Grove, Spring Valley and El Cajon. Description of Community Health In SDC's east region in 2016, 100 percent of surveyed children ages zero to 11 and 100 percent of surveyed children ages 12 to 17 had health insurance coverage, which meet the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. 96.5 percent of surveyed adults ages 18 to 64 had”

“Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SGH: * Incorporates community priorities and community input into its strategic plan and develops service line-specific goals * Estimates an annual budget for community programs and services based on community needs, previous years' experience and current funding levels * Prepares and distributes a monthly report of community activities to its board of directors, describing community benefit programs provided, such as education, screenings and flu vaccinations * Prepares and distributes information on community benefit programs and services through its foundation and community newsletters * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SGH 2016 CHNA SGH completed its most recent CHNA in September 2016. SGH's 2016 CHNA was significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In addition, this year SGH completed its most current implementation strategy - a description of SGH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation strategy for SGH are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SGH 2016 CHNA, the following priority health needs were identified for the communities served by SGH: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * Obesity * Senior Health In alignment with these identified needs, the following pages detail programs that specifically address cardiovascular disease, diabetes and senior health. SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH lacks the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH. There are also programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy Medical Group (SRSMG) clinics throughout SDC - including SDC's east region - provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. For additional details on SGH programs that specifically address the needs identified in the 2016 CHNA, please refer to SGH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through further analysis of SGH's community programs and in consultation with SGH service line leaders and community relations team members, this section also addresses the following priority health needs for community members served by SGH: * General community health education and”

“In FY 2017, the SGH Stroke Center provided stroke education and screenings at 12 community events in SDC's east region. During the events, the team provided more than 430 community members with information about stroke risk factors, warning signs, and appropriate interventions, including arrival at the hospital within early onset of symptoms. In addition, nearly 150 community members received blood pressure checks or stroke screenings, 20 of whom were referred for a follow-up. During the screenings, the SGH Stroke Center identified risk factors as well as provided education, and advised behavior modification, including smoking cessation, weight loss and stress reduction. Events were held at various community sites, including but not limited to: the Spring into Healthy Living event at the McGrath Family YMCA; Health Fair and Flu Shot event at the Jewish Family Service of San Diego (JFS) College Avenue Center; ECSSP's 18th annual East County Senior Health Fair at the La Mesa Community Center; La Mesa Police Department's fifth annual Safety Fair at the La Mesa Community Center; the Dr. William C. Herrick Community Health Care Library; the San Diego East County Chamber of Commerce's Health Fair Saturday at Grossmont Center; Grossmont Healthcare District Conference Center; and the Lakeside Fire Department Open House at Lakeside Fire Station 2. In September, Sharp's systemwide Stroke Program participated in Strike Out Stroke Night at the Padres, held at Petco Park. This annual event is organized by the San Diego County Stroke Consortium, the HHSA, the San Diego Padres and other key partners to promote stroke awareness and celebrate stroke survivors. During the baseball game, Sharp offered stroke and blood pressure screenings, education about the warning signs of stroke and how to respond using FAST (Face, Arms, Speech, Time) - an easy way to remember the sudden signs of stroke. Free giveaways were provided throughout the evening, while stroke education was displayed on the JumboTron to the entire stadium of more than 39,000 community members. In addition, the SGH Stroke Center provided stroke education and screenings of personal risk factors for stroke with pulse checks to more than 200 attendees at the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina in April. Educational topics included different types of strokes, how to identify risk factors for stroke, strategies for risk reduction and stroke recognition. In collaboration with the SGH Senior Resource Center, the SGH Stroke Center and a Sharp interventional neuroradiologist presented on the recent advances in the treatment of stroke and provided resources to nearly 30 community members at the Dr. William C. Herrick Community Health Care Library in May. The SGH Stroke Center also conducted personal health interviews, blood pressure and pulse checks, and provided education on emergency treatment for stroke, prevention and warning signs, and how to respond using FAST. In addition, from October to January, the SGH Stroke Center provided stroke education to nearly 40 homeless community members. Individuals received education on stroke signs and symptoms and how to respond FAST as well as FAST stroke cards, free inspirational books and food. In FY 2017, the SGH Outpatient Rehabilitation Department offered a Stroke Communication Support Group for stroke survivors and their family members twice a month that focused on brain injury survivors with aphasia or other speech or language difficulties. Topics included games to improve visual skills, language stimulation, listening activities and social interaction. The support group is sponsored by Young Enthusiastic Stroke Survivors. Approximately five community members attended each session. SGH also actively participated in the quarterly San Diego County Stroke Consortium, a collaborative effort to improve stroke care and discuss issues impacting stroke care in SDC. Additionally, SGH continued collaborating with”

“* According to the CDC, heart disease kills approximately 610,000 people annually, and is the leading cause of death for both men and women (CDC, 2015). * In their 2017 statistical update, the AHA reported that in 2014, cardiovascular disease was listed as the underlying cause of death for 30.8 percent of all deaths in the U.S. * According to new blood pressure guidelines championed by the AHA, an estimated 46 percent of U.S. adults now have hypertension (AHA, 2017). Objectives * Provide heart and vascular education and screening services for the community, with an emphasis on adults, women and seniors * Provide expertise in cardiovascular care to community health care professionals through participation in professional conferences and collaboratives * Participate in programs to improve the care and outcomes of individuals with heart and vascular disease FY 2017 Report of Activities In FY 2017, SGH's Cardiac Rehabilitation Department provided education and support to patients and community members impacted by congestive heart failure (CHF). A free, monthly CHF class and support group provided nearly 120 individuals with a supportive environment to discuss various topics about living well with CHF. A free Heart and Vascular Risk Factors Education class was offered twice a month to individuals who were hospitalized within the last six months due to select heart conditions, reaching more than 200 individuals. SGH's Cardiac Training Center and Cardiac Rehabilitation Departments participated in a variety of community events throughout San Diego in FY 2017. Together, they offered community members free blood pressure screenings, cardiopulmonary resuscitation (CPR) demonstrations, and cardiac health education and resources, including prevention, symptom recognition, evaluation and treatment. Events included the Sharp Disaster Preparedness Expo, Sharp's free Sweetheart Heartsaver CPR course and dinner for couples, Coronado High School health fair, Celebrando Latinas, the AHA Heart & Stroke Walk and the annual Sharp Women's Health Conference. In addition, the Cardiac Rehabilitation team collaborated with the SGH Senior Resource Center to educate nearly 20 seniors at the Herrick Community Health Care Library about the importance of exercise and nutrition to maintain a healthy heart in February. Further, the Cardiac Rehabilitation team provided free flu shots to more than 15 community seniors during a flu clinic held at the hospital in October. In April, SGH held its annual Heart Health Expo to help community members live long, heart-healthy lives through the provision of information on strategies for heart disease prevention as well as the latest treatments for heart disease, weakened arteries, and more. The free community event featured a heart-healthy breakfast and health screenings for blood pressure, cholesterol and glucose. Exhibitor tables highlighted various hospital services including nutrition, cardiac rehabilitation, heart and vascular, stroke, and senior services, as well as local organizations to connect attendees to community resources, including the AHA, Mended Hearts, San Diego Oasis and John A. Davis Family YMCA. In addition, SGH offered education on appropriate treatment options for heart-related conditions - including self-dissolving stents to help open blocked blood vessels and minimally invasive techniques for treating aneurysms - from cardiovascular care experts. A question-and-answer session was also offered to encourage individuals to ask heart health questions. In honor of National CPR and Automated External Defibrillator (AED) Awareness Week in June, the Cardiac Training Center invited children ages 10 and older from the community to a free CPR/AED class and demonstration at Briercrest Park in La Mesa. During the event, the Cardiac Training Center provided free CPR lessons and CPR/AED educational materials to help raise awareness and increase bystander response rates in cardiac emergencies. Throughout FY 2017, S”

“* According to data presented in the SGH 2016 CHNA, diabetes is a major cause of heart disease and stroke. The CDC also identifies diabetes as a leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults in the U.S. (CDC, 2014). * According to diabetes data analyzed in the SGH 2016 CHNA process, among SDC patients with a primary diagnosis of a diabetes-related ICD-9 code in 2013, 'Diabetes...Uncontrolled' was the top inpatient primary diagnosis related to Type 2 diabetes for individuals ages 15 to 24 and ages 45 and older. Among individuals ages 25 to 44, the top inpatient primary diagnosis was 'Abnormal Glucose Tolerance of Mother with Delivery,' followed by 'Diabetes...Uncontrolled.' * In 2015, diabetes was the seventh leading cause of death in SDC's east region. * In 2015, there were 135 deaths due to diabetes in SDC's east region. The region's age-adjusted death rate due to diabetes was 24.2 per 100,000 population, higher than the overall SDC age-adjusted rate (21.0 deaths per 100,000 population). * In 2015, there were 865 hospitalizations due to diabetes in SDC's east region. The age-adjusted rate of hospitalizations for diabetes was 170.3 per 100,000 population. This rate was the second highest among all SDC regions and higher than the age-adjusted rate of hospitalization for SDC overall (123.1 per 100,000 population). * In 2015, there were 918 diabetes-related ED discharges in SDC's east region. The age-adjusted rate of diabetes-related ED discharges was 183.1 per 100,000 population. This was the second highest rate among all SDC regions and was higher than the age-adjusted rate for SDC overall (143.5 per 100,000 population). * According to the 2016 CHIS, 10.2 percent of adults living in SDC's east region indicated that they had ever been diagnosed with diabetes, which was higher than SDC overall (7.8 percent) and the state of California (9.1 percent). Diabetes rates among seniors were particularly high, with 22.3 percent of east region adults over 65 reporting that they had ever been diagnosed with diabetes. * According to 2016 CHIS data, 16.2 percent of residents in the east region had been told by their doctor that they have pre- or borderline diabetes, compared to 11.7 percent of residents in SDC overall. * According to the 2012 report from HHSA titled Critical Pathways: The Disease Continuum, the most common behavioral and social risk factors associated with Type 2 diabetes include substance use, physical inactivity, poor nutrition, poor medical care and irregular health checks (e.g., A1C, dental, eye and foot). * According to the CDC's 2017 National Diabetes Statistics Report, 87.5 percent of adults diagnosed with diabetes were overweight or obese. To prevent or delay the onset of diabetes, the CDC recommends lifestyle changes such as losing weight, eating healthier, and getting regular physical activity. * A study by the University of California, Los Angeles (UCLA) Center for Health Policy Research found that 13 million adults in California (46 percent) are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million (9 percent) have already been diagnosed with diabetes (UCLA Center for Health Policy Research, 2016). * The CDC estimates that 30.2 million people in the U.S. have diabetes. Of those individuals, 23 million have been diagnosed while 7.2 million are undiagnosed (National Diabetes Statistics Report, 2017). * According to the CDC, prevention efforts such as the Diabetes Prevention Program can cut the risk of developing diabetes by more than half. However California has been slow to devote state money to such programs. A report by the California State Auditor found that in 2012-2013, California's per capita funding for diabetes prevention was the lowest in the nation at just three cents per person (California State Auditor, 2015). * According to the American Diabetes Association (ADA), diabetes treatment costs California approximately”

“In FY 2017, the SHC Diabetes Education Program continued to provide services and resources to meet the needs of San Diego's newly immigrated Iraqi Chaldean population. The program facilitated translation as well as provided resources to better assist Chaldean cultural needs. Educational resources included How to Live Healthy With Diabetes; What You Need to Know About Diabetes; All About Blood Glucose for People With Type 2 Diabetes; All About Carbohydrate Counting; Getting the Very Best Care for Your Diabetes; All About Insulin Resistance; All About Physical Activity With Diabetes; Gestational Diabetes Mellitus Seven-Day Menu Plan; Food Groups; and Arabic language materials about pregnancy. Handouts were provided in Arabic, Somali, Tagalog, Vietnamese and Spanish, and live interpreter services were available in more than 200 languages via the Stratus Video Interpreting iPad application. The team also distributed food diaries and logbooks for blood sugar level tracking to these community members. Further, Sharp team members received education regarding the different cultural needs of these diverse communities. In FY 2017, the SHC Diabetes Education Program supported the professional health care community through participation in the ADA's 77th Scientific Sessions conference at the San Diego Convention Center. The conference theme was Experience New Horizons in Diabetes, which taught more than 13,000 international attendees about the most significant advances in diabetes care and research. During the conference, the SHC Diabetes Education Program shared an abstract titled Clinical Dashboard to Evaluate and Monitor Institutional Quality and Effectiveness of Diabetes Crisis Management. The abstract was designed to help frontline caregivers decrease variations in care and measure the effectiveness of improving the application of the diabetes crisis algorithm in order to better treat serious metabolic complications of diabetes. The SHC Diabetes Education Program improved the dashboard by adding variables such as the time spent in the emergency room, the time to start insulin infusion, and the transfer time from the intensive care unit. Further, in FY 2017 the SHC Diabetes Education program provided diabetes education to nurse practitioner students at SDSU, while the SGH Diabetes Education Program mentored a dietitian intern from the San Diego Women, Infants and Children (WIC) program. FY 2018 Plan The SGH Diabetes Education Program will do the following: * Provide community members with prediabetes and diabetes information at various community venues in SDC's east region * Explore additional collaborations to assist and educate food insecure community members * Participate in Sharp's partnership with the City of San Diego to provide diabetes education and resources to employees and residents in the city's nine districts * Continue to foster relationships and collaborate with FHCSD to provide education and resources to their diabetic patients * Continue to provide gestational services and resources to underserved pregnant women, both at the hospital and in collaboration with community clinics * Participate in Tour de Cure - the ADA's signature fundraising event to fight diabetes and its burdens * Maintain up-to-date resources to support community members with diabetes treatment and prevention, particularly foreign language and culturally appropriate resources for diverse populations * Continue to participate in local and national professional conferences - including those held by the ADA, American Association of Diabetes Educators and the San Diego Association of Diabetes Educators - to share best practices in diabetes treatment and control with the broader health care community * Conduct educational outpatient and inpatient symposiums for health care professionals Identified Community Need: Health Education, Screening and Support for Seniors Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent”

“* According to a report from the National Alliance for Caregiving (NAC) and the AARP titled Caregiving in the U.S. 2015, an estimated 34.2 million adults have provided unpaid care to an adult age 50 or older in the past 12 months. In addition, 60 percent of unpaid caregivers are female, and nearly 1 in 10 caregivers are ages 75 or older (AARP and NAC, 2015). * The UCLA Center for Health Policy Research conducted a study highlighting the plight of California's "hidden poor," finding 772,000 seniors who live in the gap between the FPL and the Elder Economic Security Standard. The highest proportion of seniors living in this gap includes renters, Latinos, women, and grandparents raising grandchildren (Padilla-Frausto, & Wallace, 2015). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * Provide daily telephone reassurance/safety check calls to ensure the safety of homebound seniors and disabled adults in SDC's east region * In collaboration with community partners, offer seasonal flu vaccination clinics at convenient locations for seniors and high-risk adults in the community * Serve as a referral resource to additional support services in the community for senior residents in SDC's east region * Provide education and community resources to caregivers * Maintain and grow partnerships with community organizations to expand community outreach and provide community members with updated information on available services and resources FY 2017 Report of Activities Sharp Senior Resource Centers meet the unique needs of seniors and their caregivers by connecting them to a variety of free and low-cost programs and services through email, phone and in-person consultations. The Sharp Senior Resource Centers' compassionate staff and volunteers provide personalized support and clear, accurate information regarding health education and screenings, community referrals and caregiver resources. In FY 2017, the SGH Senior Resource Center developed and mailed quarterly calendars of its programs and services to more than 6,900 households in SDC's east region, as well as distributed approximately 4,000 Vials of Life, which are small vinyl sleeves that can be magnetically placed on a refrigerator to provide emergency personnel with critical medical information for seniors and disabled people. The SGH Senior Resource Center provides a telephone reassurance and safety check program for isolated or homebound seniors and disabled community members living in SDC's east region. Through the program, SGH Senior Resource Center staff and volunteers place daily computerized phone calls to participants at regularly scheduled times. In the event that staff members do not connect with participants, a phone call is placed to family members or friends to ensure the participant's safety. In FY 2017, staff placed more than 4,700 phone calls to approximately 15 seniors and disabled community members, as well as more than 50 follow-up phone calls to family and friends. In FY 2017, the SGH Senior Resource Center reached more than 640 community members through more than 30 free health education programs held on the SGH campus and at the Grossmont HealthCare District Conference Center in SDC's east region. Programs were presented by experts from community organizations as well as Sharp professionals with expertise in physical therapy, diabetes, bereavement, finance, nutrition, nursing, advance care planning (ACP), and rehabilitation. Educational topics included ACP, tools and resources for caregivers, diabetes, Medicare, memory loss, coping with grief and bereavement, tax planning, healthy eating in the new year, heart health, caring for someone with dementia, osteoporosis and preventing fractures, wills and trusts, maintaining a healthy voice, reverse mortgages and gift annuities, home and memory care, finding reliable health information, understanding hospice and how to ta”

“Throughout the year, the SGH Senior Resource Center both hosted and participated in health fairs and events throughout SDC's east region. This included the provision of blood pressure screenings and educational resources to more than 1,000 community seniors and caregivers at the Lakeside Community Center, Meadowbrook Mobile Home Estates in Santee, Meadows Mobile Home Park in El Cajon, George L. Stevens Senior Center, La Mesa Community Center, San Diego LGBT Community Center, JFS College Avenue Center, La Vida Real senior community, Grossmont Center, First United Methodist Church, McGrath Family YMCA in Spring Valley and SGH. New in FY 2017, the SGH Senior Resource Center provided four educational sessions on senior services, telephone reassurance calls and Vials of Life to approximately 60 firefighters from the Barona, El Cajon, Santee and Sycuan Fire Departments. The SGH Senior Resource Center coordinated these sessions for the fire departments, which included education from the AIS on elder abuse, mandated reporting requirements and services available through the HHSA. In addition, Alzheimer's San Diego provided education on dementia and information on communication, behaviors and more at the event. Beginning in June, the SGH Senior Resource Center sponsored the Grossmont Mall Walkers, a free fitness program to encourage physical activity among community adults and seniors. Every Saturday, participants gathered at Grossmont Center to walk around the mall and perform gentle exercises led by an instructor from the SGH Senior Resource Center intended to improve balance and strength, and maintain a healthy lifestyle. In FY 2017, more than 470 community members joined the Grossmont Mall Walkers. Throughout FY 2017, the SGH Senior Resource Center continued to coordinate the notification of availability and provision of seasonal flu vaccines in selected community settings. Seniors, caregivers and high-risk adults with limited access to care were alerted through activity calendars, collaborative outreach conducted by the flu clinic site, Sharp.com and paper and electronic newspaper notices. In FY 2017, the SGH Senior Resource Center provided more than 500 seasonal flu vaccinations to high-risk adults with limited access to health care, including seniors without transportation, those with chronic illnesses and caregivers. Vaccinations were offered at 12 community sites, including the Lemon Grove Senior Center, JFS College Avenue Center, La Mesa Community Center, Lakeside Community Center, Journey Community Church, Salvation Army of El Cajon, La Mesa Adult Enrichment Center, food banks in Santee and Spring Valley, and SGH. In addition to providing flu vaccinations at these sites, the SGH Senior Resource Center offered activity calendars detailing upcoming blood pressure and flu clinics, health screenings and community senior programs as well as provided Vials of Life and information regarding telephone reassurance calls. At the food banks, the SGH Senior Resource Center provided vaccines not only to seniors, but also to pregnant women and high-risk community members, many of whom were uninsured or had limited access to transportation. Throughout the year, the SGH Senior Resource Center maintained active relationships with organizations that enhance professional networking and provide quality programming for seniors in SDC's east region. Organizations included the Caregiver Coalition of San Diego (the Caregiver Education Committee), ECAN, ECSSP, AIS Health Promotion Committee and Meals on Wheels Greater San Diego East County Advisory Board. FY 2018 Plan SGH Senior Resource Center will do the following: * Provide resources and support to address relevant concerns of community seniors and caregivers through in-person and phone consultations * Provide community health information and resources through educational programs, monthly blood pressure clinics and a minimum of five health screenings * Collaborate with Sharp experts and community”

“* There were 921 deaths due to cancer (all types) in SDC's east region in 2015. The region's age-adjusted death rate due to cancer was 166.9 deaths per 100,000 population, which is higher than the overall SDC age-adjusted rate of 148.3 per 100,000 population and higher than the HP2020 target of 161.4 deaths per 100,000 population. * In 2015, the east region's age-adjusted death rates were higher than the rates for SDC overall for at least 14 different cancers. * In 2015, 20 percent of all cancer deaths in SDC's east region were due to lung cancer, 9 percent to colorectal cancer, 9 percent to female breast cancer, 6 percent to prostate cancer, 6 percent to pancreatic cancer, and 5 percent to female reproductive cancer (Live Well San Diego, 2015). * By 2018, total cancer cases in SDC are expected to grow by 11.7 percent (California Cancer Registry, 2013; Truven Health Analytics Market Discovery Planning). * According to the American Cancer Society (ACS) Cancer Statistics Center, in 2017 there will be an estimated 27,980 new cases of breast cancer and 4,400 breast cancer deaths for females in California. * In 2015, the age-adjusted mortality rate of breast cancer in the east region was 28.0 per 100,000 population. In SDC overall, the rate was 19.4 per 100,000 population. This represented a 24 percent increase from 2014 and exceeded the HP2020 target of 20.7 breast cancer deaths per 100,000 women. * According to the 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile, in SDC there were 46.1 late-stage cases of breast cancer per 100,000 women, exceeding the HP2020 target of 42.1 cases per 100,000 women. The report projects that SDC will meet the HP2020 target within five years. * The 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile also reported that, in 2013, breast cancer mortality rates in SDC were highest among African American women, at 27.7 deaths per 100,000 women. This exceeded the mortality rate for Caucasian (23.9), Latina (17.3), and Asian/Pacific Islander (13.2). * According to the ACS 2017 California Cancer Facts & Figures report, 72.4 percent of breast cancer cases among non-Hispanic white women in SDC were diagnosed at an early stage, compared with 69.3 percent of African American cases, 68.1 percent of Hispanic cases and 70.4 percent of Asian/Pacific Islander breast cancer cases. Data suggests that early detection resources are needed in minority communities. * According to 2015-2016 CHIS data, 85.7 percent of women in SDC's east region ages 50 to 74 reported having a mammogram in the past two years. This exceeds the HP2020 target of 81.1 percent for breast cancer screenings. Approximately 4.9 percent of SDC east region women in this age range reported that they have never had a mammogram. * According to the findings of the ACS 2017 California Cancer Facts & Figures report, screening offers the ability for secondary prevention by detecting cancer early. Regular screenings that allow for the early detection and removal of precancerous growth are known to reduce mortality for cancers of the cervix, colon, and rectum. Five-year relative survival rates for common cancers are 93 to 100 percent if they are discovered before having spread beyond the organ where the cancer began. * Study findings from the 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile indicate a critical need for culturally competent outreach, especially for Hispanic, Middle Eastern, and African American women (Susan G. Komen, 2015). * The American Society of Clinical Oncology (ASCO) emphasizes the importance of patient navigators as part of a multidisciplinary oncology team with the goal of reducing mortality among underserved patients. Some of the tasks a patient navigator may assist with include: psychosocial support; assistance with treatment decisions; assistance with insurance issues; arrangement of transportation; coordination of additional services (i.e., fertility preservatio”

“The SGH Cancer Center continued to host educational classes at no cost for patients and community members facing cancer. Through the monthly Survivorship Lunch and Learn series, community members, patients and families were invited to hear local experts speak about a unique cancer-related topic each month, such as managing Scanxiety (anxiety associated with upcoming cancer tests and results); communicating with loved ones; the importance of exercise in preventing cancer recurrence; energy healing therapies; creating memories and leaving a legacy; and lifestyle tips for cancer prevention. Attendees were also invited to participate in a question-and-answer session while enjoying a complimentary lunch. The series reached an average of 8 to 12 individuals per session in FY 2017. The SGH Cancer Center also provided meeting space for the ACS' Look Good Feel Better classes, which teach women techniques to manage the appearance-related side effects of cancer treatment (e.g., hair loss, etc.) and boost self-confidence. Classes included a complimentary makeup kit and instruction from a licensed beauty professional on makeup application, skin care, and wearing wigs and headwear. Five classes were offered at the SGH Cancer Center in FY 2017, reaching 32 women. Throughout the year, the SGH Cancer Center offered free workshops for patients and community members. This included free monthly ACP workshops provided in collaboration with Sharp's ACP program. Led by a trained ACP facilitator, the workshops provided more than 15 community members with an overview of the ACP process, basic tools to help define their personal health care choices, communication tips to begin the conversation with loved ones, and guidance on completing an advance health care directive. The SGH Cancer Center also offered a workshop focused on relaxation and quieting the mind to help cancer patients and their loved ones manage the stress, anxiety and difficult emotions that may accompany a cancer diagnosis. In addition, a Managing Sleep and Fatigue Workshop offered patients and family members strategies to help relax, improve sleep and manage persistent fatigue, which is a common side effect both during and after cancer treatment. Further, a quarterly Chemo Brain Workshop: Improving Memory and Concentration was offered to patients experiencing memory problems related to chemotherapy and other cancer treatments. The workshops provided more than 40 community members with tips and strategies to help manage and improve memory during and after cancer treatment. To help guide and support patients and their families before, during and after the course of treatment, the SGH Cancer Center team offered a licensed clinical social worker (LCSW), a certified dietitian, genetics counselors and cancer patient navigators for breast and various other cancers. The LCSW offers psychosocial services (assessments, crisis intervention, counseling, bereavement, cognitive behavioral therapy and stress management), support group leadership, and advocacy and resources for transportation, palliative care and hospice, food and financial assistance. In FY 2017, this included improving patient and family connections to community services, such as the ACS, San Diego Brain Tumor Foundation, Leukemia and Lymphoma Society, Lung Cancer Alliance, Mama's Kitchen, 2-1-1 San Diego (2-1-1), JFS, FSD, and the Food Bank's Breast Cancer Case Management program, as well as other food and financial assistance programs. The LCSW served more than 260 patients and family members in FY 2017, while an additional 33 community members contacted the LCSW for consultation regarding support groups and other SGH Cancer Center services and community resources. The breast health navigator is an RN certified in breast health who personally assists breast cancer patients and their families with navigating the health care system. The breast health navigator offers support, guidance, education, financial assistance referrals and r”

“* Provide education and resources to the community with patient navigators for breast, colon, brain and gynecologic cancers as well as cancer patients with complex care needs * Continue to connect individuals to services and community resources to help them manage their illness * In collaboration with the Sharp ACP program, continue to provide an ACP workshop to assist patients and community members with cancer, and their loved ones, in completing an advance health care directive * Provide legacy planning workshops on various topics, including creating memory boxes, scrapbooks, writing a life story and ethical wills * Screen and enroll cancer patients in clinical trials for research studies * Provide educational information on cancers and available treatments through community residents and community physician lectures * Provide internships to National University Radiation Therapy students * Offer a multi-session couples communication workshop Provide support groups and education for the Chaldean and Middle-Eastern communities * Provide a free seminar to educate community members about lifestyle choices for reducing breast cancer risk * Continue to partner with community clinics to share best practices in the care of cancer patients and to help patients establish medical services * Continue to share cancer information, including prevention and awareness with community members through social media Identified Community Need: Women's, Prenatal and Postpartum Health Services and Education Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC 2016 CHNA continued to identify high-risk pregnancy as one of the top 15 priority health conditions seen in SDC hospitals. * In 2013, SDC's east region had 438 low birth weight (LBW) births, which was 6.8 percent of total births for the region. LBW infants were more likely to be female than male. For infants of black mothers, 11 percent of births were LBW, which is the highest percentage when compared to mothers of other races and ethnicities. * In 2013, 36 infants died before their first birthday in SDC's east region. The infant mortality rate was 5.6 infant deaths per 1,000 live births, which is higher than the infant mortality rate for SDC overall (4.5 infant deaths per 1,000 live births). * There were 891 hospitalizations due to maternal complications in SDC's east region in 2015. The east region's age-adjusted rate was 382.4 per 100,000 population, which was higher than the age-adjusted rate for SDC overall (370.0 per 100,000 population). * In 2013, 5,217 live births received early prenatal care in SDC's east region, which translates to 81.1 percent of all live births in the region. This was slightly lower than the percentage of live births receiving early prenatal care in SDC overall (84.8 percent), and the lowest among all SDC regions. * Strategies that have been shown to increase the use of prenatal care include: affordable health coverage; expedited health coverage for uninsured pregnant women; comprehensive insurance packages including health education and risk counseling; accessible and affordable prenatal services; use of safety net providers such as community clinics and Federally Qualified Health Centers; outreach to enroll women in health coverage and connect them with prenatal services; culturally and linguistically appropriate prenatal services; evidence-based home visiting programs for high-risk pregnant women; trained and certified doulas and community health workers to provide health education, coaching and support; evidence-based group care approaches to reduce costs and enhance the content of care; and transportation assistance such as vouchers for taxis or public transit (Children's Initiative, 2015). * Breastfeeding enhances immunity to disease and decreases the rate and severity of infections in children, and is associated with improved development”

“The SGH Women's Health Center also supported the community through participation in the Sharp Women's Health Conference in April. The SGH Women's Health Center offered information on women's health including labor and delivery, prenatal care, obstetrics/gynecology care, neonatal intensive care options and more to 1,000 attendees. In addition, SGH continued to host an annual neonatal intensive care unit (NICU) Reunion event to offer a unique experience for patients and families whose babies have spent time in the NICU, and celebrate their care long after they leave the hospital. The event reached more than 150 former NICU patients and their families, and included a variety of activities such as face painting, a photo booth (including framed pictures for the families), games, and arts and crafts. The SGH Women's Health Center has implemented several critical process improvements to increase breastfeeding rates among new mothers and continues to explore and participate in opportunities to share these best practices with the broader health care community. This began in 2012 with implementation of the 10 Steps to Successful Breastfeeding initiative, and continued through various other quality strategies to promote exclusive breastfeeding and exclusive breast milk in the NICU. In addition, educational resources provided at community clinics and in the hospital's childbirth education classes have been updated to reflect best practices in breastfeeding for mothers and their families. NICU nurses also continued to encourage mothers to use a pump log to document and increase accountability of their 24-hour breast milk volumes. Early intervention strategies were incorporated to promote the establishment of breast milk in the first couple of weeks. The SGH Women's Health Center also continued to track mothers of premature infants 28 to 34 weeks who established breast milk supply at two weeks. As a result of these comprehensive efforts, the SGH Women's Health Center increased the exclusive breastfeeding rate at discharge for newborns from 49 percent in 2011 to 59 percent in 2017. In addition, in 2015, the SGH Prenatal Clinic joined the Breastfeeding-Friendly Community Health Centers project (BFCHC) - an initiative of SDC's LWSD and funded through a grant from the First 5 Commission of San Diego. Through the BFCHC collaboration, the SGH Prenatal Clinic was selected out of six participating clinics as the pilot clinic to help establish Baby-Friendly USA guidelines around breastfeeding during the prenatal period and after discharge, and support other prenatal clinics in achieving Baby-Friendly USA standards. Though the pilot program ended in 2016, SGH continues its collaboration in the BFCHC to ensure sustainability of the model. The SGH Prenatal Clinic offers a variety of prenatal support for high-risk and underserved women in SDC. Throughout FY 2017, SGH Prenatal Clinic midwives provided in-kind help at Neighborhood Health Centers in El Cajon to support the underserved population in SDC's east region. This included more than 1,360 hours of care for pregnant women five days per week. The SGH Prenatal Clinic also continued to participate in the California Department of Public Health Comprehensive Perinatal Services Program to offer comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits. Services included health education, nutritional guidance, and psychological and social issue support as well as translation services for non-English-speaking women. Nutrition classes were offered as part of this effort in order to reduce the number of women who meet the criteria for gestational diabetes. Women with a current diabetes diagnosis were referred to the SGH Diabetes Education Program, while those with nutrition issues were referred to an SGH registered dietician or the SGH Diabetes Education Program as appropriate. At-risk women with elevate body mass indices (BMIs) received education and glucome”

“* In 2015, cancer was the leading cause of death and heart disease was the second leading cause of death for SDC's east region. * According to 2016 CHIS data, the self-reported obesity rate for adults ages 18 and older in SDC's east region was 36.6 percent, which is higher than the rate for SDC overall of 25.3 percent. * In 2016, 17.9 percent of adults ages 18 and older in SDC's east region self-reported eating at fast-food restaurants four or more times each week, which is higher than the rate for SDC overall of 16.3 percent (CHIS, 2016). * Obesity increases the risk of many health conditions, including: CHD, stroke, Type 2 diabetes, and various cancers. Obesity is also linked to environmental factors, such as accessibility and affordability of fresh foods, park availability, social cohesion and neighborhood safety (UCLA Center for Health Policy Research, 2015). * According to the CDC, some of the leading causes of preventable death include obesity-related conditions, such as heart disease, stroke, Type 2 diabetes, and certain types of cancer. In In 2015-2016, 39.8 percent of Americans were obese (CDC, 2017). Objectives * Provide a variety of health and wellness education and services at events and sites throughout the community * Offer health and wellness education to the community through various media outlets FY 2017 Report of Activities Throughout FY 2017, SGH participated in community events, offered presentations at neighborhood sites, and partnered with local media sources to educate community members about a variety of health and wellness topics. In April, staff from a range of hospital departments participated in Sharp's annual Women's Health Conference, where they offered wellness education and services to approximately 1,000 attendees. This included nutrition education, recipes, healthy food samples, answering nutrition-related questions, and a presentation titled Revive Your Eating Experience from an SGH RD. At the conference, SGH also provided more than 110 community members with osteoporosis heel screenings, education on calcium and vitamin D requirements, and exercise tips for osteoporosis treatment and prevention. In addition, hand screenings were provided at the conference, which included evaluations and recommendations for hand pain and discomfort. Furthermore, SGH conducted three blood drives where nearly 120 SGH team members donated more than 100 pints of blood. In May, SGH provided education on infection prevention to 200 seniors and their families at the 18th annual ECSSP Senior Health Fair at the La Mesa Community Center. SGH also participated in the Project Homeless Connect event sponsored by the Grossmont Healthcare District and Grossmont Center in June to offer needed services to the homeless. During this one-day event at The Rock Church in El Cajon, SGH provided information about hepatitis A vaccinations as well as information about local food banks to 140 homeless community members. Approximately 20 attendees received hepatitis A vaccines at the event. In addition, at an event in August held at St. John's Church in El Cajon, SGH provided education about the benefits of pursuing a nursing career to 300 Syrian and Afghan refugees. In FY 2017, SGH RDs offered approximately 1,000 community members nutrition handouts and healthy food samples, as well as answered nutrition-related questions at a health fair at Sempra/San Diego Gas & Electric and SGH's Heart Health Expo. In January, an SGH RD presented on eating well in the new year to approximately 50 community members at the SGH Senior Resource Center. An SGH RD also attended Health Fair Saturday at Grossmont Center, providing approximately 50 attendees with nutrition handouts and healthy food samples, as well as answering nutrition-related questions. In October, an SGH security team member presented on active shooter awareness including information and tips on how to respond in the event of an active shooter incident, and provided a question-and-answer”

“* In 2015, there were 3,893 hospitalizations related to unintentional injury in SDC's east region. The age-adjusted rate of hospitalizations was 738.6 per 100,000 population, which was above the county age-adjusted average of 586.0 per 100,000 population. * In 2015, there were 28,640 ED discharges related to unintentional injury in SDC's east region. The age-adjusted rate for the east region was 6,032.1 per 100,000 population, which was the second highest of all regions and above the SDC age-adjusted rate (5,017.7 ED visits per 100,000 population). * Unintentional injury was the leading cause of death for children ages zero to 14 years in 2015. The effects of safety campaigns, educational strategies, and change in parenting practices have all had a positive impact on the safety and well-being of children in the San Diego community (HHSA, 2012). * Traumatic injury is the leading cause of death among children, with many survivors enduring the consequences of brain and spinal cord injuries. The physical, emotional, psychological and learning problems that affect injured children, along with the associated costs, make reducing traumatic injuries a high priority for health and safety advocates throughout the nation. Educational programs like ThinkFirst increase knowledge and awareness of the causes and risk factors of brain and spinal cord injury, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2015). * According to HP2020, most events resulting in injury, disability or death are predictable and preventable. There are many risk factors for unintentional injury and violence, including individual behaviors and choices, such as alcohol use or risk-taking; the physical environment both at home and in the community; access to health services and systems created for injury-related care; and the social environment, including individual social experiences (social norms, education, victimization history), social relationships (parental monitoring and supervision of youth, peer group associations, family interactions), the community environment (cohesion in schools, neighborhoods and communities) and societal-level factors (cultural beliefs, attitudes, incentives and disincentives, laws and regulations). * The California Department of Public Health's Burden of Chronic Disease and Injury Report: California, 2013 indicates that unintentional injuries are the leading cause of death in children and adults ages one to 44 in California. * The same report states that injuries cause more than 16,000 deaths, 75,000 cases of permanent disability, 240,000 hospitalizations, and 2.3 million ED visits annually in California. * In 2014, unintentional injuries accounted for 84 percent of all injury deaths among adults ages 65 and older in the U.S. (National Center for Health Statistics, 2016). * A 2016 National Vital Statistics Report titled Deaths: Final Data for 2014 indicates that 59.4 percent of injury deaths in the U.S. in 2014 were attributed to three causes: poisoning (26 percent), motor-vehicle accidents (16.9 percent), and falls (16.5 percent). In 2014, the age-adjusted rate of death from unintentional injury in the U.S. was 40.5 deaths per 100,000 population (CDC, 2016). Objective * Offer an injury and violence prevention program for children, adolescents and young adults in SDC's east region FY 2017 Report of Activities In FY 2017, ThinkFirst/Sharp on Survival provided injury prevention education to more than 450 Health and Science Pipeline Initiative (HASPI) students from high schools in SDC's east region. Through the partnership and financial support from HASPI, the ThinkFirst/Sharp on Survival program offered east region schools a variety of services related to HASPI's main goals of increasing health and medical career awareness and improving science proficiency in school. These services included classroom presentations, small assemblies, offsite learning expos, and the opportunity to particip”

“* Explore additional opportunities for educating HASPI students in Imperial County Identified Community Need: Health Professions Education and Training, and Collaboration with Local Schools to Promote Interest in Health Care Careers Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the 2017 San Diego Workforce Partnership (SDWP) Health Care Priority Sector report, the health care industry in SDC experienced a 44 percent increase in employment growth between 2006 and 2016, higher than the 38 percent growth rate seen by the state of California (SDWP, 2017). * The same report indicated that the six fastest-growing health care occupations in SDC between 2013 and 2016 were physician's assistants (22 percent), medical assistants (18 percent), health care social workers (15 percent), home health aides (13 percent), licensed vocational nurses (12 percent), and medical and clinical lab technicians (11 percent). RNs accounted for 1,366 added jobs during this period, which was the largest increase in total jobs among all health care occupations (SDWP, 2017). * The Health Care Priority Sector report also found that health care employers identified RNs, physicians and surgeons, and health technicians as the most difficult positions to fill. The most frequently cited reason for hiring difficulties were lack of experience, small applicant pools, and insufficient non-technical skills (SDWP, 2017). * A 2014 SDWP labor market analysis indicated an increase in the number of health care training providers in SDC, but a shortage of clinical training facilities where applicants can gain necessary experience. The scarcity of clinical facilities offering prerequisite training has made it increasingly difficult for employers to find qualified workers. * The 2017 SDWP Nonprofit Sector Employment Trends and Career Opportunities report recommends that nonprofit sector health care training and education programs in SDC emphasize soft skills such as being a team player, interpersonal and communication skills, big-picture thinking with the ability to plan and forecast, problem solving, and the ability to adapt to a variety of situations. It also recommends incorporating more training on data management and technology into curriculums in order for graduates to meet the needs of this increasingly data-driven sector. * In its Employment Projections - 2016-2026 report, the U.S. Bureau of Labor Statistics (BLS) projects that health care support occupations and health care practitioners/ technical occupations will contribute about one-fifth of all new jobs and account for almost half of the 30 fastest-growing occupations. There are several factors leading to the increased demand for these professions, including: projected population growth in the next decade; aging of the U.S. population; greater numbers of people living with chronic conditions, such as diabetes or obesity; improvements in medicine and technology; and federal health insurance reform, which has increased the total number of Americans with health insurance coverage (BLS, 2016). * Total employment in California is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. The health care and social assistance sector is expected to be the fastest-growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (BLS, 2015). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Healthcare Atlas, 2017). * As of 2015, the California Health Care Almanac reported that 44 percent of the employed RN workforce was over the age of 50. As this age group moves away from patient care and approaches”

“SGH also continued its participation in the HSHMC program in FY 2017, providing early professional development for 106 students in 9th through 12th grades. Students spent approximately 34,560 hours shadowing staff in various areas throughout the hospital, including but not limited to progressive care units, food and nutritional services, oncology, acute care medical-surgical nursing, sterile processing, supply distribution, engineering, occupational and physical rehabilitation, endoscopy, women's health, cardiology, pharmacy, medical intensive care unit, surgical intensive care unit, and the concierge as well as SRSMG family practice, podiatry, specialty areas, and primary care. In addition, SGH staff provided students instruction on educational requirements, career ladder development and job requirements. At the end of the academic year, SGH staff provided the students, their loved ones, community leaders and hospital mentors with a symposium that showcased the lessons learned throughout the program. In FY 2017, SGH developed and launched its new pilot program, HealthCare Towne, a field trip designed to build the health care workforce of tomorrow through an early outreach program for middle and junior high school students. This event encouraged students to connect what they learn in the classroom to real-life career opportunities in health care. Healthcare Towne has four major components that include: world of work, the puzzle room, scenario tour and in-the-round activity. The first component, world of work, empowered students to develop self-awareness by exploring their strengths, interests and values. Students were divided into three groups, solving three different scenarios. In the puzzle room, students collaborated to diagnose a hypothetical patient before they arrived at the hospital by interpreting clues to find the answer and reveal the next piece. In the scenario room, students learned about and walked through clinical areas where the patient would receive care, including the ambulance bay, ED, operating room, catheterization laboratory, imaging, and intensive care unit. During the final component, students applied clues, lab results, and what they learned throughout the day to help fully diagnose the patient with several conditions. In September 2017, 31 local junior high students participated in HealthCare Towne. During the event, parents of the students were able to observe the diagnoses process and were educated separately by SGH staff on teenage suicide. SGH sponsored Ethics in Business, a program of the San Diego East County Chamber of Commerce and the GUHSD Career Technical Education Department. The program is designed to train high school students to become principled leaders and includes business, education and community leaders. SGH assisted in facilitating the event, which had approximately 200 high school student attendees. SGH and SMH continued to provide one of only two mobile intensive care nurse (MICN) training programs in SDC. Together, the hospitals offered extensive six-week training programs for San Diego base station emergency nurses. Participants received certification through the County EMS upon successful completion of a 48-hour classroom component, a passing score of 85 percent or higher on the County EMS final examination of SDC protocols, and completion of mandatory ride-along hours in a paramedic unit. In addition, as a radio base station, the Sharp Prehospital/EMS department provided two continuing education Joint Base Regional Care Conferences for EMS personnel and MICN trained RNs in SDC. FY 2018 Plan SGH will do the following: * In collaboration with GUHSD, participate in the HESI * Continue to participate in the HSHMC program * Continue to provide internship and professional development opportunities to college and university students throughout San Diego * Continue to collaborate with local universities to provide professional development lectures for students * Develop an elementary”

“Objectives * Connect high-risk, underfunded patients and community members to local resources and organizations for low-cost medical equipment, housing options and follow-up care * Assist economically disadvantaged individuals through transportation and financial assistance for pharmaceuticals * Collaborate with community organizations to provide services to chronically homeless individuals * Through the CTI program, provide high-risk, under- and unfunded patients with health coaching, support and resources that address SDOH to ensure a safe transition home and maintained health and safety FY 2017 Report of Activities In FY 2017, SGH continued to provide post-acute care facilitation for high-risk patients, including individuals who were homeless or without a safe home environment. Individuals received referrals to and assistance from a variety of local resources and organizations. These groups provided support with transportation, placement, medical equipment, medications, outpatient dialysis and nursing home stays. SGH referred high-risk patients, families, and community members to churches, shelters and other community resources for food, safe shelter and other resources. For unemployed, uninsured and underinsured patients, or for those who simply cannot afford the expense of a wheelchair, walker or cane due to a fixed income, SGH has committed to improving access to DME for high-risk patients upon discharge. SGH case managers and social workers actively recruited DME donations from the community, providing nearly 200 DME items to patients in need in 2017. To assist economically disadvantaged individuals, SGH provided more than $173,200 in free medications, transportation, lodging and financial assistance through its Project HELP funds. These funds assisted more than 6,860 individuals in FY 2017. In addition, SGH pharmacists assisted more than 460 economically disadvantaged patients with more than 1,420 outpatient prescriptions valued at approximately $340,570. In addition, SGH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the SDRM, SGH discharged chronically homeless patients to the SDRM's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up care through SGH in a safe space, and also provides psychiatric care, substance abuse counseling and guidance from the SDRM's programs in order to help these patients get back on their feet. Beginning in 2014, SGH piloted the CTI program for its high-risk, vulnerable populations, including Medi-Cal, Medi-Cal pending/presumptive, self-pay, no-pay, refugee populations, homeless and Medicare A or B only patients. Modeled after the countywide Community Care Transitions Program established by the Centers for Medicare & Medicaid Services to serve the Medicare fee-for-service patient population at risk for readmission, the CTI program provides 30-day coaching by an RN or medical social worker at no cost to vulnerable patients who are identified through a comprehensive risk assessment tool. The assessment tool evaluates patients for multiple factors including isolation, co-occurring health issues, food insecurity, behavioral health issues, and other conditions that impact their health and safety. The project team is a collaborative effort between various team members across Sharp, including nurses, case managers and disease specialists as well as team members of SHC community benefit, Patient Financial Services (PFS), SGH's Senior Resource Center, and others. The team ensures that vulnerable patients are connected with community resources and support to safely transition home, and keep them safe and healthy in the community. Partnerships with community organizations connect these patients to critical social services upon discharge, and have included FSD, Food Bank, 2-1-1, FHCSD, various churches, and refugee and other social support organizations. This outreach”

“CTI patients referred to 2-1-1 are assessed on a variety of measures such as housing, nutrition, primary care, health management, social support, activities of daily living, ambulance use, transportation, income and employment. The risk assessment tool has identified the top needs as housing, food assistance and primary care services. Funded by the Grossmont Hospital Foundation, the CTI program's partnership with 2-1-1 continues to successfully demonstrate the value of SDOH support for high-risk patients post hospital discharge. Since the inception of the partnership in March 2016, 111 patients have been referred to 2-1-1 and patients that have completed the CTI program with 2-1-1 Health Navigation experienced a 91 percent decrease in vulnerability related to SDOH. In its second year of implementation, the partnership with 2-1-1 continued to demonstrate dramatic decreases in vulnerability in the domains of nutrition, housing and safety. In addition, the partnership has had a significant impact on readmission rates among participants. The overall readmission rate for CTI patients who completed the 2-1-1 Health Navigation Program was 9.5 percent and, most importantly, survey outcomes revealed that 92 percent of CTI patients expressed confidence in the care plan to manage their health following completion of the 2-1-1 Health Navigation Program. These outcomes support the ultimate goal of the CTI program - to empower patients and community members with resources and skills to maintain their health and well-being. The CTI program has continued to receive local and national recognition. In 2017, the CTI program was highlighted at the Association of Community Health Improvement's (the community health branch of the American Hospital Association (AhA)) National Conference and Healthcare Without Harm's Community Benefit Innovators Workshop (part of the CleanMed 2017 Conference & Exposition). The program also was a featured poster presentation at the AhA Annual Leadership Summit's Journey Ahead. In addition, CTI was selected to be part of the AhA's Health Research and Educational Trust/Robert Wood Johnson Foundation Culture of Health Learning Collaborative, and was featured as a best practice case study in the project's national report titled A Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health. Further, the CTI team continues to receive requests from health systems and health care organizations locally and throughout the country to share the program's structure, lessons learned and best practices for potential replication and implementation. The CTI model of care/partnership with 2-1-1 has also been replicated at locations in SDC, including UC San Diego Health and Rady Children's Hospital. FY 2018 Plan SGH will do the following: * Continue to provide post-acute care facilitation to high-risk patients * Continue and expand the DME donations project to improve access to necessary medical equipment for high-risk patients who cannot afford DME * Continue to administer Project HELP funds to those in need * Continue to collaborate with community organizations to provide medical care, financial assistance, and psychiatric and social services to chronically homeless patients * Continue to provide high-risk, Medi-Cal and unfunded patients with CTI health coaches and connection to resources, including resources to address food insecurity, housing, and other SDOH * Maintain and strengthen partnerships with FSD and 2-1-1 to strengthen the services of the CTI program and support expansion of the program * Explore opportunities to improve communication with community clinics SGH Program and Service Highlights * 24-hour emergency room and critical care center, with heliport and paramedic base station - designated STEMI Center * Acute care * Ambulatory Care Center * Breast Imaging Center, including mammography * Cardiac Training Center * CTI program * David and Donna Long Center for Cancer Treatment, including clinical”

“According to the CNI, communities served by Sharp HospiceCare with especially high need include, but are not limited to, East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In SDC overall, there were 397,674 residents (12.3 percent of the SDC population) ages 65 years or older in 2015. Of those, about 23.5 percent were living alone. By 2030, this age group is expected to increase to 723,572 in SDC. In SDC in 2016, 99.7 percent of surveyed children ages zero to 11, 99.5 percent of surveyed children ages 12 to 17, and 90.8 percent of surveyed adults ages 18 to 64 had health insurance, which fall short of the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. In SDC in 2016, 14.5 percent of adults ages 18 to 64 did not have a usual source of care and 10.6 percent of these adults had health insurance. In addition, 25.3 percent of adults without a usual source of care reported fair or poor health outcomes. See Table 26 for a summary of key indicators of access to care and Table 27 for data regarding Medi-Cal eligibility. Table 26: Health Care Access in SDC, 2016 Current Health Insurance Coverage: Children 0 to 11 Years: Rate - 99.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 99.5%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 90.8%, HP2020 Target - 100% Regular Source of Medical Care: Children 0 to 11 Years: Rate - 96.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 74.1%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 85.5%, HP2020 Target - 89.4% Not Currently Insured: Adults 18 to 64 Years: Rate - 9.2%, HP2020 Target - N/A Source: 2016 California Health Interview Survey (CHIS) Table 27: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2016 Medi-Cal Eligible - 13.9% Not Eligible - 86.1% Source: 2016 CHIS. This information is sourced from the 2016 California Health Interview Survey (CHIS) Health Profile for SDC, provided by the University of California Los Angeles Center for Health Policy Research. Starting in 2013, the California state budget required children enrolled in the Healthy Families Program to transition enrollment into Medi-Cal. Formerly, this table included Healthy Family eligibility in San Diego County using pre-ACA data. The Affordable Care Act now determines financial eligibility for Medi-Cal using Modified-Adjusted Gross Income, based on income and number of persons in the household Cancer and coronary heart disease were the top two leading causes of death in SDC in 2015. See Table 28 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by Sharp HospiceCare, please refer to the Sharp Memorial Hospital (SMH) 2016 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm, which includes data for the primary communities served by Sharp HospiceCare. Table 28: Leading Causes of Death in SDC, 2015 Overall Cancer: Number of Deaths - 5,025, Percent of Total Deaths - 24.3% Coronary Heart Disease: Number of Deaths - 2,898, Percent of Total Deaths - 14.0% Alzheimer's Disease and Related Dementias: Number of Deaths - 2,482, Percent of Total Deaths - 12.0% Unintentional Injuries: Number of Deaths - 1,190, Percent of Total Deaths - 5.8% Stroke: Number of Deaths - 1,162, Percent of Total Deaths - 5.6% Chronic Obstructive Pulmonary Disease/Chronic Lower Respiratory Diseases: Number of Deaths - 973, Percent of Total Deaths - 4.7% Overall Hypertensive Diseases: Number of Deaths - 733, Percent of Total Deaths - 3.5% Diabetes: Number of Deaths - 708, Percent of Total Deaths - 3.4% Overdose/Poisoning: Number of Deaths - 360, Percent of Total Deaths - 1.7% Suicide: Number of Deaths - 342, Percent of Total Deaths - 1.7% All Other Causes: Number of Deaths - 4,795, Percent of Total Deaths - 23.2% Total Deaths: Number of Deaths - 20,668, Percent of Total Death”

“* According to the Family Caregiver Alliance, in 2014, there were an estimated 3.4 million family caregivers in California. Research shows that caregiving can have serious physical and mental health consequences. Findings from the Stress in America survey, described in a report titled Valuing the Invaluable, show that individuals who serve as caregivers to older relatives report poorer health and higher stress levels than the general population. (American Association of Retired Persons (AARP) Public Policy Institute, updated July 2015). * About six in 10 caregivers assist with medical/nursing tasks for their loved one, and 42 percent of these caregivers are performing those tasks without any formal training. According to Caregiving in the U.S. 2015, 84 percent of caregivers report that they could use more information or help on caregiving topics. The top four topics of concern for caregivers are keeping their loved one safe at home; managing their own emotional or physical stress; making end-of-life decisions; and managing their loved ones' challenging behaviors (AARP and National Alliance for Caregiving, 2015). * According to the Institute on Aging, about 14.9 million Americans are caring for someone with dementia. Caregiver interventions that have shown to successfully improve the health and well-being of dementia caregivers include providing education around how to manage dementia-related symptoms, improving social support for caregivers, and providing caregivers with respite care from caregiver duties (Alzheimer's Association, 2016). * In 2013, 140,000 Californians were served by hospice. Nearly 80 percent of hospice patients were ages 71 and older. At the current rate of use, the number of hospice patients is projected to more than double between 2013 and 2040 and it is projected that in 2040, 88 percent of hospice patients will be 71 and older (2015 California Health Care Almanac Beds for Boomers report). Objectives * Provide education and outreach to the San Diego community concerning advanced illness management (AIM) and end-of-life care * Collaborate with community organizations to provide education and outreach to community members, caregivers and loved ones * Support the unique AIM and end-of-life care needs of military veterans and their families FY 2017 Report of Activities Sharp HospiceCare supports the San Diego community in the areas of end-of-life care, aging and caregiving through participation in a variety of local organizations including SDCCEOLC, SDRHCC, San Diego County HVP, San Diego Chapter of the HPNA, San Diego POLST Coalition/SDCCC, San Diego County Medical Society Bioethics Commission, Caregiver Coalition of San Diego, SanDi-CAN, NorCAN, SoCAN and ECSSP. In partnership with these and other community organizations, in FY 2017, Sharp HospiceCare provided more than 2,500 community members with free education and outreach on a variety of end-of-life and AIM topics, including hospice, palliative care and caregiving, at community health fairs, conferences and other events. Locations included churches, senior living centers, and community health agencies and organizations throughout SDC. In October, Sharp HospiceCare participated in a community conference at the Balboa Park Club titled Planning Ahead: Crucial Conversations, hosted by SanDi-CAN, HHSA and San Diego Park and Recreation. The free event provided more than 60 seniors and family members with tools to help them identify their end-of-life values and goals of care, and learn the communication skills necessary to make informed health care planning decisions. Attendees also learned about California's End of Life Option Act, a law enacted in 2016 that permits terminally ill adult patients to request and receive doctor-prescribed medication to end life. In April, Sharp HospiceCare partnered with the Sharp Senior Resource Centers to provide two aging conferences for community seniors, family members and caregivers, tiled Planning for Physical, Mental and”

“In FY 2017, Sharp HospiceCare conducted a variety of veteran recognition activities as part of its WHV commitment. In honor of Veteran's Day, Sharp HospiceCare celebrated patients who served in the U.S. military by holding 22 flag ceremonies throughout the month of November. During the ceremonies, fellow veterans presented patients with a U.S. flag that had been flown on the USS Midway aircraft carrier. In addition, Sharp HospiceCare held two pinning ceremonies in FY 2017 during which volunteers presented a WHV pin and a certificate of appreciation to approximately 90 Sharp HospiceCare veteran patients as well as more than 50 veteran community members. In December, Sharp HospiceCare participated in additional community events to honor the nation's veterans, including the Spirit of '45 Pearl Harbor 75th anniversary commemoration on the USS Midway and the annual Wreaths Across America wreath-laying ceremony at Fort Rosecrans National Cemetery. Sharp HospiceCare furthered its WHV commitment through the provision of veteran-specific community education and outreach in FY 2017. In June, Sharp HospiceCare hosted the Veterans Recognition, Education and Resource Fair at the Balboa Park Club. The free event included education on post-traumatic stress disorder (PTSD), caregiver support and health care as well as a recognition ceremony and community resource tables for approximately 50 community veterans and their family members. In honor of Veteran's Day in November, Sharp HospiceCare provided education and resources to approximately 50 community members at the Honoring Our Veterans event hosted by the El Cajon City Council Veterans Commission. In September, Sharp HospiceCare participated in the WHV Partner Appreciation Event as part of the 2017 NHPCO Interdisciplinary Conference held at the San Diego Marriott Marquis and Marina. Reaching approximately 100 community veterans and professionals, the free event provided a panel discussion and resource tables, including information from Sharp HospiceCare on how organizations can partner to create an HVP (a coalition of VA facilities and community hospices working together to ensure excellent end-of-life care for veterans and their families). Sharp HospiceCare has been a member of the San Diego County HVP since 2010. Through the partnership, the VA San Diego Healthcare System and San Diego's community hospice organizations collaborate to promote quality care for veterans with a life-limiting illness as well as serve as a voice and resource for veterans and their families. In October, Sharp HospiceCare, the San Diego County HVP and the Caregiver Coalition of San Diego hosted the Veterans Resource Fair at the Silverado Encinitas Memory Care Community. The free event provided veterans, family members and caregivers with community resources, presentations on available health care services, and an appreciation ceremony to honor attending veterans for their service. Sharp HospiceCare continued to participate on SCRC's Operation Family Caregiver advisory board. Operation Family Caregiver equips families of returning service members and veterans with the skills they need to adjust to life after military service. This includes free training and mentorship programs for caregivers of pre- and post- 9/11 service members and veterans with a range of service-related conditions, including traumatic brain injury, amputation, anxiety, depression, PTSD and more. Sharp HospiceCare continued to provide a wig donation program in FY 2017. Through the program, Sharp HospiceCare receives new, unused wigs from manufacturers and cleans and styles the wigs for donation to individuals experiencing hair loss as a result of cancer treatment or other illnesses. Sharp HospiceCare team members offer private wig appointments for community members to select their wig and receive personalized wig fitting, styling and maintenance instructions. Surplus wigs are donated to other departments throughout Sharp, including cancer pati”

“* The CDC describes numerous barriers to ACP, including lack of awareness, denial of death and dying, denial of being in a circumstance in which we are unable to make our own decisions and speak for ourselves, confusion between whether to choose palliative care or continue with life-prolonging treatments, and cultural differences (CDC, 2012). * According to the CDC, planning for the end of life is increasingly being viewed as a public health issue, given its potential to prevent unnecessary suffering and to support an individual's decisions and preferences related to the end of life. In addition, the CDC recognizes the public health opportunity to educate Americans, and especially older adults, about ACP and to improve their quality of care at the end of life (CDC, 2012). * A 2014 Consumer Reports survey of 2,015 adults suggests that Americans would prefer to die at home: 86 percent said they would consider receiving end-of-life-care at home, but just 36 percent said the same about getting that care in a hospital. Despite this, about 60 percent of Americans die in acute care hospitals, 20 percent in nursing homes and only 20 percent at home (Stanford School of Medicine, Palliative Care). Objectives * Provide education, engagement and consultation for community members on ACP and POLST * Educate community health care professionals on ACP and POLST * Empower community members to make informed health care decisions FY 2017 Report of Activities SHC offers a free and confidential ACP program to support community members as they consider their future health care options. Facilitated by Sharp HospiceCare, the ACP program empowers adults of any age and health status to explore and document their beliefs, values and goals as they relate to health care. The program consists of three stages. Stage one, community engagement, focuses on bringing awareness to healthy community members about the importance of ACP. This stage includes basic education and resources, identification of an appropriate health care agent, and completion of an advance directive. Stage two, disease-specific outreach, focuses on education for community members with a progressive chronic illness, including decline in functional status, co-morbidities, potential for hospitalization and caregiver issues. With a goal of anticipating future needs as health declines, this stage focuses on developing a written plan that identifies goals of care, and involves the health care agent and loved ones. The third stage, late-life illness outreach, targets those with a disease prognosis of one year or less. Under these circumstances, specific or urgent decisions must be made and converted into medical orders that will guide the health care provider's actions and remain consistent with goals of care. The focus of this stage is to assist the individual or appointed health care agent with navigating complex medical decisions related to immediate life-sustaining or prolonging measures, including completion of the POLST form, a medical order designed for individuals with advanced progressive or terminal illness that identifies the appropriate informed substitute decision maker as well as care and treatment preference when important health care decisions need to be made. Since 2014, SHC has offered the Sharp HealthCare Advance Directive to guide the public in outlining their health care decisions. The document is publicly available on Sharp's website in both English and Spanish, and uses easy-to-read language to describe what an advance directive is and how and why to complete one. The form allows individuals to put their health care wishes into writing and to appropriately sign the advance directive. With this witnessed signature, the advance directive becomes a legal document that identifies the appropriate informed substitute decision maker, and serves as a tool for health care decision-making. Additional contact information is provided for community members who are interested in speaki”

“Since FY 2016, Sharp's ACP team has partnered with San Diego Health Connect, AIS, Health Services Advisory Group, County of San Diego Emergency Medical Services, and various health care providers in SDC to ensure that community providers have access to POLST forms through the San Diego Healthcare Information Exchange, a countywide program that securely connects health care providers and patients to private health information exchanges. The Sharp HospiceCare ACP team participates in this initiative - funded by the California Health Care Foundation (CHCF) and supported by the CCCC and California Emergency Medical Services Authority (EMSA) - to create an electronic POLST registry (POLST eRegistry). When a paper POLST form is not readily available during an emergency, the patient's care may be hindered or conflict with their wishes. The POLST eRegistry will improve access to critical information through a cloud-based registry for completed POLST forms to be securely submitted and retrieved. FY 2018 Plan Sharp HospiceCare will do the following: * Provide free ACP and POLST education and outreach to community members through phone and in-person consultations * Collaborate with community organizations to provide educational classes and events to raise community awareness of ACP * In collaboration with SDCCC and SDCCEOLC, provide community events to promote the importance of ACP in honor of NHDD * Continue to provide ACP education and outreach to local, state and national health care professionals * Continue to serve as a community resource regarding the End of Life Option Act * Continue to collaborate with community partners to provide community members with access to advance directive and POLST forms through the San Diego Healthcare Information Exchange * Continue to participate in the CHCF's POLST eRegistry initiative with CCCC and EMSA Identified Community Need: Health Professions and Student Education and Training, and Volunteer Training Rationale references the findings of the SHC 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * Total employment in California is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. The health care and social assistance sector is expected to be the fastest-growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (U.S. Bureau of Labor Statistics (BLS), 2015). * In its Employment Projections - 2016-2026 report, the BLS projects that health care support occupations and health care practitioners/technical occupations will contribute about one-fifth of all new jobs and account for almost half of the 30 fastest-growing occupations. There are several factors leading to the increased demand for these professions, including: projected population growth in the next decade; aging of the U.S. population; greater numbers of people living with chronic conditions, such as diabetes or obesity; improvements in medicine and technology; and federal health insurance reform, which has increased the total number of Americans with health insurance coverage (BLS, 2016). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (Office of Statewide Health Planning and Development Healthcare Atlas, 2017). * The BLS projects employment of more than 300,000 registered nurses (RNs) in California in 2024, which would be an increase of 17 percent from 2014. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2014). * According to the HPNA, professional nurses play a leading role as members of the palliative care and hospice teams, and across the continuum of care”

“Sharp's ACP team supports San Diego's future health care workforce through classroom-based lectures designed to enhance students' understanding of hospice and palliative care. In FY 2017, the team provided introductory education to approximately 450 students, including nursing students from Azusa Pacific University, University of San Diego and CSUSM; social work students from SDSU; and students from San Diego Mesa College. Topics included ACP, POLST, goals of care, hospice, palliative care, bioethics and bereavement. Sharp HospiceCare leadership provided education, training and outreach to local, state and national health professionals throughout the year. These efforts sought to guide industry professionals in achieving person-centered, coordinated care through the advancement of innovative hospice and palliative care initiatives. Audiences included the Center to Advance Palliative Care; Advances in Palliative Care Conference; Baylor Scott & White Health; Athena Health; American Case Management Association - Southern California Chapter; National Symposium for Palliative Care; California Department of Health Care Services; CCCC Annual Summit; CSU Institute for Palliative Care National Symposium; SDCCC and CSU Institute for Palliative Care Conference; and the 2017 NHPCO Interdisciplinary Conference. Presentation topics included palliative care, AIM, geriatric cognitive and functional decline; prognostication, successful aging, and ACP. In July, Sharp HospiceCare hosted a continuing education conference titled Advanced Illness Management: The Right Care at the Right Time. The free conference educated approximately 100 physicians, nurses, social workers, chaplains, bereavement counselors and other interested health care providers on the importance of having an organized approach to AIM for patients and their families; how to identify patients who are appropriate for AIM; and how to develop practical steps to improve AIM and palliative care in the emergency department. Sharp HospiceCare provided education, resources and support for additional Sharp-sponsored conferences in FY 2017, including the Sharp Rees-Stealy Medical Group and Sharp Community Medical Group annual conferences, Sharp HealthCare Neuro-Oncology Conference, Sharp HealthCare Cardiovascular Conference, Sharp HealthCare Pulmonary Conference and the SGH eighth annual Heart and Vascular Conference. These conferences provided evidence-based continuing education for more than 1,000 community health providers. Further, in FY 2017, Sharp HospiceCare leadership continued to serve on the board and as a state hospice representative for NHPCO and CHAPCA. Sharp HospiceCare continued to offer volunteer training opportunities in FY 2017 in order to provide valuable knowledge and experience to volunteers who are often working towards a career in the medical field. Volunteers supported Sharp HospiceCare and those it serves by providing companionship to those near the end of life, support for families and caregivers, and help with community outreach. Sharp HospiceCare trained approximately 50 new volunteers in FY 2017. In addition, seven teenagers were trained through Sharp HospiceCare's Teen Volunteer Program, which provides teens with opportunities to participate in special projects in Sharp HospiceCare administration or at Sharp HospiceCare's LakeView, ParkView and BonitaView hospice homes. Volunteer opportunities were also extended to seven premedical students from SDSU, University of California, San Diego and CSUSM, who assisted family caregivers in private homes. Ten volunteers participated in Sharp HospiceCare's 11th Hour Program in FY 2017. Through this special program, volunteers accompanied end-of-life patients without family members present during their final moments as well as comforted family members who were present while their loved one passed away. In addition, approximately 12 volunteers were trained to provide integrative therapies, including Healing Touch, Reiki, a”

“Objectives * Provide bereavement education, resources, counseling and support to community members who have lost loved ones * Provide individuals and their families with referrals to community services * Provide the Memory Bear program to support community members who have lost loved ones FY 2017 Report of Activities Throughout FY 2017, Sharp HospiceCare offered a variety of bereavement service options to help grieving community members learn effective ways to cope with the loss of a loved one. Services included professional bereavement counseling for individuals and families as well as free community education, support groups and monthly newsletter mailings. In FY 2017, Sharp HospiceCare devoted nearly 2,200 hours to home, office and phone counseling with people who have lost loved ones, providing them with bereavement counseling services from licensed clinical therapists with specific training in grief and loss. Sharp HospiceCare's bereavement counselors also provided referrals to community counselors, mental health services, bereavement support services and other community resources as needed. Sharp HospiceCare continued to offer the Healing After Loss and the Widow's and Widower's bereavement support groups, which reached approximately 260 community members in FY 2017. Offered quarterly, the groups consisted of eight-week sessions facilitated by skilled mental health care professionals with a specialization in the needs of the bereaved. The Healing After Loss support group focused on addressing the concerns of adults who were grieving the loss of a loved one. Weekly themes included Introduction to the Grief Process; Strategies for Coping with Grief; Communicating with Family and Friends; Experiencing Anger in Grief; Guilt, Regret and Forgiveness; Differentiating Natural Grief and Depression; Use of Ceremony and Ritual to Promote Healing; and Who Am I Now?/What Does Healing Look Like?. The Widow's and Widower's support group addressed concerns of men and women who lost their spouse or partner. Participants had the opportunity to share their emotional challenges and learn coping skills from group members facing similar life situations. In May, Sharp HospiceCare offered support to adults who were grieving the loss of a parent through two Remembering Our Parents classes. Held at the Peninsula Family YMCA and the Grossmont Healthcare District, the presentations helped approximately 20 community members recognize the nature of their loss, identify strategies to help them cope with grief, and discover a sense of hope as Mother's Day and Father's Day approached. In October, a workshop titled Nurturing the Mind, Body and Soul provided strategies for self-care, self-compassion and healing following the death of a loved one to approximately 30 community members at Sharp's corporate office location. Additional bereavement support in FY 2017 was offered to residents of Golden Age Garden apartments and staff at BO-beau kitchen & garden and Coaster Bar & Grill restaurants. Sharp HospiceCare supported approximately 120 community members grieving the loss of a loved one during the 2016 holiday season. In November, Sharp HospiceCare held its annual Healing Through the Holidays event at Sharp's system office, which included presentations on understanding grief, improving coping skills, exploring the spiritual meaning of the holidays in the face of grief, and reviving hope. Two similar events titled Coping with Grief During the Holiday Season were held at the Coronado Public Library in November and at the Grossmont Health Care District in December. These events provided practical suggestions for community members to cope with the painful feelings of loss that often arise during the holidays. Additionally, Sharp HospiceCare provided a Support During the Holiday Season bereavement support group on two days in December, which focused on developing coping skills to promote healing, as well as remembering your loved ones, through the holidays. Sha”

“* CHIP Health Literacy San Diego Task Force * CHIP Independent Living Association Advisory Board and Peer Review Advisory Team * CHIP Suicide Prevention Council * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Police Foundation * City of Chula Vista Wellness Program * City of San Diego * City of San Diego Park & Recreation - Therapeutic Recreation Services Disabled Services Advisory Council * Community Center for the Blind and Visually Impaired * Community Emergency Response Team * Consortium for Nursing Excellence, San Diego * Coronado Fire Department * Coronado Public Library * Coronado SAFE (Student and Family Enrichment) * Coronado Senior Center Planning Committee * Doors of Change * Downtown San Diego Partnership * East County Action Network * East County Senior Service Providers * Emergency Nurses Association - San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Family Health Centers of San Diego * Feeding San Diego * Friends of Scott Foundation * Gary and Mary West Senior Wellness Center * George G. Glenner Alzheimer's Family Centers, Inc. * Girl Scouts San Diego * Greater San Diego East County Advisory Board * Grossmont College * Grossmont College Occupational Therapy Assistant Advisory Board * Grossmont College Respiratory Advisory Committee * Grossmont Healthcare District Community Grants and Sponsorships Committee * Grossmont Healthcare District Independent Citizens' Bond Oversight Committee * Grossmont Imaging LLC Board * Grossmont Union High School District * Hands United for Children * Health Care Communicators Board * Health Industry Collaboration Effort, Inc. * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Helix Charter High School * Hidden Heroes Campaign Committee * Home Start, Inc. * Hospice and Palliative Nurses Association - San Diego Chapter * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * HSHMC Board * Hunger Advocacy Network * I Love a Clean San Diego * Inner City Action Network * International Association of Eating Disorders Professionals * The Jacobs & Cushman San Diego Food Bank * Jewish Family Service of San Diego (JFS) * JFS Behavioral Health Committee * JFS Public Affairs Committee * John A. Davis Family YMCA Board of Management * Kitchens for Good * Kiwanis Club of Bonita * La Maestra Community Health Centers * La Mesa Lion's Club * La Mesa Parks and Recreation * Lantern Crest Senior Living Advisory Board * Las Damas de San Diego International Nonprofit Organization * Las Patronas * Las Primeras * Life Rolls On Foundation * Live Well San Diego Check Your Mood Committee * Mama's Kitchen * March of Dimes * Meals on Wheels San Diego County * Meals on Wheels San Diego County East County Advisory Board * Mental Health America * Miracle Babies * MRI Joint Venture Board * National Active and Retired Federal Employees Association * National Alliance on Mental Illness * National Association of Hispanic Nurses, San Diego Chapter * National Association of Neonatal Nurses * National Association of Orthopedic Nurses * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National Kidney Foundation * National University * Neighborhood Healthcare * Neighborhood House Association * North County Community Action Network * North San Diego Business Chamber * Pacific Arts Movement * Palomar Community College * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Point Loma Nazarene University * Practice Greenhealth * Promises2Kids * Psychiatric Emergency Response Team * Regional Perinatal System * Residential Care Committee * Ronald McDonald House Operations Committee * Rotary Club of Chula Vista * Rotary Club of Coronado * San Diego Association of Diabe”

“Form 5471 has been filed on behalf of Grossmont Hospital Foundation by Sharp HealthCare (FEIN 95-6077327).”