Sharp Memorial Hospital

“Sharp HealthCare (FEIN 95-6077327) is the sole member of Sharp Memorial Hospital.”

“Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members.”

“Sharp Healthcare, as the sole member of the corporation, has the right to elect and remove most board members. Sharp Healthcare also retains the approval rights afforded members for certain significant transactions (e.g. dissolution or sale or transfer of all or substantially all of the assets).”

“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 Accounting & Tax, Vice President of Finance, Senior Vice President and Chief Financial Officer, and entity Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990.”

“Sharp Memorial Hospital has a written conflict of interest policy which has been reviewed and approved by the Sharp Memorial Hospital governing board. Sharp Memorial Hospital 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 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 2013.”

“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).”

“Independent Contractors are paid under Sharp HealthCare's tax identification number (95-6077327) and are reported on Sharp HealthCare's tax return.”

“The corporation shall, at all times, operate a hospital under the name Donald N. Sharp Memorial Community Hospital. The purpose of the corporation shall be to promote and to oversee the quality of care rendered in the hospital; to act as the governing board authority in matters of medical staff relations, clinical issues, credentialing, physician discipline and Joint Commission on Accreditation of Hospital requirements; and to establish policies to support those purposes.”

“Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327). This organization's allocated portion is included in Part X, Line 25.”

“Sharp Memorial Hospital employees' salaries and wages are paid under Sharp HealthCare's tax ID number (EIN 95-6077327), and as such are also reported on Sharp HealthCare's Form 990.”

“Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327) and this organization has reported zero on Form 990, Part X, Line 20 and has reported the allocated balance on Line 25.”

“Change in minimum pension liability -8,318,874. Bone Marrow Program reported on Sharp HealthCare's return 1,256,534.”

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

“Fiscal Year 2014 Community Benefits Report Section 1 An Overview of Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, Calif. The Sharp system includes four acute care hospitals; three specialty hospitals; two affiliated medical groups; 21 medical clinics; five urgent care facilities; 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 offers a full continuum of care, including: emergency care, home care, hospice care, inpatient care, long-term care, mental health care, outpatient care, primary and specialty care, rehabilitation, and urgent care. Sharp also has a Knox-Keene-licensed care service plan, Sharp Health Plan (SHP). Serving a population of approximately 3.2 million in San Diego County (SDC), as of September 30, 2014, Sharp is licensed to operate 2,087 beds, and has approximately 2,600 Sharp-affiliated physicians and nearly 17,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 beds) The largest provider of health care services in San Diego's rapidly expanding 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, women and infants and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. SCHHC is the largest provider of total joint surgeries in all of SDC. Sharp Grossmont Hospital (536 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, orthopedics, rehabilitation, robotic surgery, stroke care and women's health. Sharp Memorial Hospital (656 beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation. SMH houses San Diego's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 beds) A freestanding women's hospital specializing in obstetrics, gynecology, gynecologic oncology, and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other private hospital in California. Sharp Mesa Vista Hospital (149 beds) The largest private freestanding psychiatric hospital in California, Sharp Mesa Vista Hospital (SMV) is a premier provider of behavioral health services. Sharp McDonald Center (16 beds) Sharp McDonald Center (SMC) is San Diego County's only licensed chemical dependency recovery hospital. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH, and are referred to herein as the Sharp Metropolitan Medical Campus (SMMC). The operations of Sharp Rees-Stealy Medical Centers (SRS) are included within the not-for-profit public benefit corporation of Sharp, the parent organization. The operations of SGH are reported under the not-for-profit public benefit corporation of Grossmont Hospital Corporation. Mission Statement It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patients' expectations and are provided in a caring, convenient, cos”

“Applying high reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could become better. It begins with a culture of safety. With this learning, Sharp is now 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: Demonstrate and improve clinical excellence to set industry standards and exceed customer expectations. Keep patients, employees and physicians safe and free from harm. Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence. Create a values-driven culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp's mission and vision. Achieve financial results to ensure Sharp's ability to provide quality health care services, new technology and investment in the organization. Achieve consistent net revenue growth to enhance market dominance, sustain infrastructure improvements and support innovative development. Be an exemplary community citizen by making a difference in the community and supporting the stewardship of our environment. Awards Sharp has received the following recognition: Sharp is a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation's highest presidential honor for quality and organizational performance excellence. Sharp was the first health care system in California and eighth in the nation to receive this recognition. Sharp was recognized as one of the 2013 World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think-tank. The list highlights companies that outperform industry peers when it comes to ethical behavior. The 2013 WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was the only company in San Diego named to the list. Sharp was named the No. 1 "best integrated health care network" in California and No. 12 nationally by Modern Healthcare magazine in 2012. The rankings are part of the "Top 100 Most Highly Integrated Healthcare Networks (IHN)," a survey conducted by health care data analyst IMS Health. This was the 14th consecutive year that Sharp placed among the top in the state. Sharp HealthCare was named "Best Hospital Group" by U-T San Diego readers participating in the paper's 2014 "Best of San Diego" Readers Poll, and Sharp Rees-Stealy Medical Group was named "Best Medical Group" in 2014. SGH was named "Best Hospital," while SMH and SMBHWN were ranked second and fourth "Best Hospitals." SGH and SMH have both received MAGNET Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor bestowed by the ANCC and is accepted nationally as the gold standard in nursing excellence. SMH was re-designated in March 2013. Sharp was named one of the nation's "Most Wired" health care systems from 2012 to 2014, as well as from 1999 to 2009, by Hospitals & Health Networks magazine's annual Most Wired Survey and Benchmark Study. "Most Wired" hospitals are committed to using technology to enhance quality of care for both patients and staff. In July 2010, SMH was named the "Most Beautiful Hospital in America" by Soliant Health, one of the largest medical staffing companies in the country. With over 10,000 votes from visitors to the Soliant Health website, SMH was v”

“Sharp provides services to help every unfunded patient received in the Emergency Department (ED) find opportunities for health coverage through PointCare - a team of health coverage experts whose main product is a quick, web-based screening, enrollment and reporting technology designed to provide community members with health coverage and financial assistance options. At Sharp, patients use a simple online questionnaire through PointCare to generate personalized coverage options that are filed in their account for future reference and accessibility. The results of the questionnaire allow SHC staff to have an informed and supportive discussion about health care coverage with the patient, empowering them with options. From the inception of the program in FY 2010 through September 2014, Sharp helped guide approximately 70,200 self-pay patients through the maze of government health coverage programs while maintaining the patient's dignity throughout the process. In January, 2014 Sharp hospitals implemented an onsite process for real-time Medi-Cal eligibility determinations (Presumptive Eligibility). Sharp was the first hospital system in San Diego County to provide these services, and secured this benefit for 9,500 unfunded patients in the ED during FY 2014. In anticipation of Covered California's roll out, 28 members of Sharp's registration staff completed the State's Certified Enrollment Counselor Certification to better assist both patients and the general community navigate the Covered California website (CoveredCA.com) and plan enrollment. In addition, three Sharp hospitals - SCVMC, SGH, and SMH - qualify as covered entities for the 340B Drug Pricing Program administered by the Health Resources and Services Administration (HRSA). Hospital participation in the 340B Drug Pricing Program permits the purchase of outpatient drugs at reduced prices. The savings from this program are used to offset patient care costs for Sharp's most vulnerable patient populations, as well as to assist patient access to medications through the Patient Assistance Team. The Patient Assistance Team works hard to help those in need of assistance gain access to free or low-cost medications. Patients are identified through usage reports, or referred through case management, nursing, physicians or even other patients. If eligible, uninsured patients are offered assistance, which can help decrease readmissions resulting from lack of medication access. The team members research all options available, including programs offered by drug manufacturers, grant-based programs offered by foundations, copay assistance and other low-cost alternatives. Sharp also continues to offer ClearBalance - a specialized loan program for patients facing high medical bills. Through this collaboration with San Diego-based CSI Financial Services, both insured and uninsured patients have the opportunity to secure small bank loans in order to pay off their medical bills in low monthly payments - as low as $25 per month -preventing unpaid accounts from going to collections. Through this program, Sharp provides a more affordable alternative for patients struggling to resolve their hospital bills. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients receive assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications, as well as outpatient dialysis and nursing home stays. Through collaboration with the San Diego Rescue Mission, SCHHC, SGH and SMH discharge their chronically homeless patients to the Rescue Mission's Recuperative Care Unit, where patients not only receive follow-up medical care through Sharp in a safe environment, but also receive psychiatric care, substance abuse counseling and guidance to help get them off the street. Community Health Screenings Sharp's dedication to improving community”

“Sharp Memorial Hospital Nursing Students - 442 Nursing Group Hours - 30,680 Nursing Precepted Hours - 20,386 Ancillary Students - 318 Ancillary Hours - 62,074 Total Students - 760 Total Hours - 113,140 Sharp Mesa Vista Hospital Nursing Students - 330 Nursing Group Hours - 25,457 Nursing Precepted Hours - 3,128 Ancillary Students - 34 Ancillary Hours - 16,524 Total Students - 364 Total Hours - 45,109 Sharp HospiceCare Nursing Students - 96 Nursing Group Hours - 0 Nursing Precepted Hours - 768 Ancillary Students - 1 Ancillary Hours - 80 Total Students - 97 Total Hours - 848 Sharp HealthCare Nursing Students - 368 Nursing Group Hours - 0 Nursing Precepted Hours - 55,730 Ancillary Students - 197 Ancillary Hours - 42,531 Total Students - 565 Total Hours - 98,261 Health Sciences High and Middle College Since 2007, Sharp has been an industry partner with charter school Health Sciences High and Middle College (HSHMC) to provide students broad exposure to health care careers. Through this partnership, HSHMC students connect with Sharp team members through job shadowing to explore real world application of their school-based knowledge and skills. This collaboration prepares high school students to enter health, science and medical technology careers in the following five career pathways: biotechnology research and development, diagnostic services, health informatics, support services and therapeutic services. The HSHMC program began in 2007 with students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. HSHMC students also devote time to various SRS sites in San Diego. New in FY 2014, HSHMC students began their experience with a systemwide orientation to Sharp HealthCare and their upcoming job-shadowing activities. Throughout FY 2014, nearly 400 HSHMC students were supervised for thousands of hours on various Sharp campuses, where they rotated through instructional pods in specialty areas such as nursing, obstetrics and gynecology (OB/GYN), occupational therapy, physical therapy, behavioral health, surgical intensive care unit (SICU), medical intensive care unit (MICU), imaging, rehabilitation, laboratory services, pharmacy, engineering, pulmonary services, cardiac services and operations. The 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. HSHMC students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. Even with many of HSHMC students facing financial hardship -the free and reduced price meal (FRPM) eligibility rate is higher than the averages for SDC and California - the charter school excels in preparing students for high school graduation, college entrance and a future career. In 2014, 91 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 82 percent of students said they wanted to pursue careers in health care. In addition, HSHMC has a 99 percent graduation rate, higher than California's 80 percent state average, as well as an Academic Performance Index score of 827, exceeding the state's goal of 800. In addition, HSHMC is a U.S. News & World Report "Best High Schools" bronze award winner, a National School Safety Advocacy Council award-winning school and is recognized by the California Department of Education as a Title I Academic Achievement Award winner and a California Distinguished School. Each year, Sharp HealthCare reviews and evaluates the collaboration with HSHMC to promote long-term sustainability. Lectures and Continuing Education Sharp contributes to the academic environment of many colleges and universities in San Diego. In FY 2014, Sharp staff provided hundreds of academic hours in lectures, courses and presentations on numerous college and university campuses throughout San Diego”

“The ORI has made it a priority to seek guidance and expertise from the local and national academic community on how to effectively conduct outcomes research, with the aim of improving patient and community health. This networking has resulted in collaborative research partnerships with investigators at National University (NU) and SDSU. In addition, the ORI Student Research Intern Program offers advanced nursing and public health students an opportunity to learn about and become involved in outcomes research. Since its inception in 2011, the ORI has successfully graduated nine interns. Interns have presented ORI-sponsored posters throughout San Diego to educate students on the importance of research to develop evidence-based practice. In order to develop and promote best practices across the health care community, the ORI has conducted numerous research studies to identify the benefit and outcomes of quality patient care. This includes recently completed feasibility studies examining: * The association of perfect adherence to heart failure quality care measures for hospitalized patients with readmission and mortality rates * Sharp HospiceCare's Transitions chronic disease management program influence on advanced heart failure patient care patterns, including regular and acute care utilization (ED use, overall hospitalization rates) and costs * The association of a 90-day remote-monitoring program with acute care utilization (including readmission rates and use of ED) for underserved heart failure and Chronic Obstructive Pulmonary Disease (COPD) patients compared to a similar but untreated patient sample * The predictive capacity of evidence-based and Sharp physician-identified clinical factors for identifying patients at risk for poor blood sugar control when hospitalized The ORI has developed educational presentations that foster awareness of the importance of research for improving health outcomes; provide information on ORI study results; and provide practical information about research designs and methods to the greater health care research community. The ORI has also presented peer-reviewed abstracts of its research results and provided lectures to the health care community on innovative research designs. ORI presentations have been delivered at the Heart Failure Society of America, the Council for Advancement of Nursing Science, the Society for Obstetric Anesthesia and Perinatology, the Association of California Nurse Leaders and the American Association of Colleges of Nursing. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows (interprofessional staff) and mentors to change and improve clinical practice and patient care. This evolution in practice and care occurs through identifying a care problem, developing a plan to solve it and then incorporating this new knowledge into practice. The EBPI is part of the Consortium of Nursing Excellence, San Diego, which promotes evidence-based practice in the nursing community. The consortium is a partnership between SCVMC, SGH, SMBHWN, SMH, Scripps Health, Palomar Health, Rady Children's Hospital - San Diego, UC San Diego Health System, VA San Diego Healthcare System and Elizabeth Hospice, as well as PLNU, SDSU, Azusa Pacific University (APU) and USD. Sharp actively supports the EBPI by providing instructors and mentors, as well as administrative coordination. The San Diego EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom and structured mentorship provided throughout the program. The EBPI fellows partner with their mentors and participate in 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 the fellows in working collaboratively wit”

“Habitat for Humanity believes that every man, woman and child should have a decent, safe and affordable place to live. From January through May, nearly 100 SLAH volunteers joined this volunteer labor organization dedicated to building and repairing houses all over the world. During the effort, volunteers worked alongside construction professionals to complete a home for a selected family in need. In April, 20 SLAH volunteers helped keep the decks of the legendary USS Midway aircraft carrier clean during the USS Midway Foreign Object Damage (FOD) Walk-Down. Walking in the footsteps of sailors who have served our country, volunteers used hand tools and vacuums to clear the carrier decks and prevent debris from getting sucked into and damaging the aircraft engines. The Special Olympics program provides free, year-round sports training and competitions for children and adults with intellectual disabilities. It uses sports as an opportunity for physical fitness, social interaction, community involvement and empowerment. In April, nearly 30 SLAH volunteers attended the Special Olympics, providing competition assistance in running and long jump events and serving the athletes lunch. In support of waste reduction for a healthier environment, approximately 50 SLAH volunteers participated in Sharp HealthCare's Community Waste Collection Events in October and April. Through the events, community members and employees recycled 330 pounds of pharmaceutical waste, nearly 12 bins of electronic waste and more than 530 gallons of shredded paper documents. Volunteers assisted the attending collection agencies with set-up, clean-up, traffic control, and guiding event visitors. Sharp Humanitarian Service Program In FY 2014, the Sharp Humanitarian Service Program funded 52 Sharp employees in service programs that provide health care or other supportive services to underserved or adversely affected populations including Haiti, Guatemala, Peru, West Africa and other vulnerable areas. Sharp employees volunteered with humanitarian organizations, including Project Compassion. This nonprofit, multi-denominational medical mission organization is dedicated to the physical and spiritual needs of people and provides free medical care in communities with little to no care available. In addition, the organization builds clinics and churches, and provides assistance to orphanages. In July 2014, Sharp team members participated in Project Compassion's medical mission trip to Cameroon, West Africa, where they provided education and physical therapy care to approximately 1,500 impoverished community members. In May 2014, a Sharp team member led a three-week medical mission trip to Haiti. The team included 12 nursing and pre-med students with PLNU's LoveWorks program, which conducts mission trips across the world. The team also collaborated with Heart to Heart International, a nonprofit organization committed to improving global health with initiatives that connect people and resources to communities in need. The team worked in mobile clinics in 11 different rural mountain villages in Southeast Haiti, as well as a downtown Port-au-Prince clinic, where clinic visits are typically twice per month. Over the three weeks, the team triaged thousands of community members ranging from infants to the elderly. The team assessed patients for health conditions, dispensed prescribed medication and provided education regarding medication management and diet. The experience was not only special and rewarding for the Sharp team member, but also for the students, as it further enhanced their skills, confidence and passion for the health care field. Through Sharp's Humanitarian Service Program, another Sharp team member took a medical mission trip to Peru serving as a nurse in several of the shanty towns outside of Lima. Health care providers set up tents to treat people of all ages who were without access to health care. Because several community members were treated for parasites,”

“TOTAL Individual Volunteers - 3,167 Volunteer Hours - 292,870 Sharp volunteers spend their time within hospitals, in the community, and in support of the Sharp HealthCare Foundation, Grossmont Hospital Foundation and Coronado Hospital Foundation. Sharp employees also donate time as volunteers for the Sharp organization. Sharp employees also volunteer their time for the Cabrillo Credit Union Sharp Division Board, the Sharp and Children's MRI Board, the UCSD Medical Center/Sharp Bone Marrow Transplant Program Board, and the Grossmont Imaging LLC Board. Volunteers on Sharp's auxiliary boards and the various Sharp entity boards volunteer to provide program oversight, administration and decision making regarding financial resources. In FY 2014, 125 community members contributed their time to Sharp's boards. This section describes various Sharp volunteer programs, as well as their achievements in FY 2014. Sharp HospiceCare Volunteer Programs In FY 2014, Sharp HospiceCare provided extensive training for nearly 70 new volunteers. Because volunteers are often considering a career in the medical field, they gain important knowledge and experience. They learn how to provide valuable services to the hospice organizations, including companionship to those near the end-of-life, support for families and caregivers and help with community outreach. Before being with patients and providing administrative support activities, hospice volunteers go through an extensive, 32-hour training program to confirm their understanding of and commitment to hospice care. In FY 2014, Sharp HospiceCare also trained five teenagers through its Teen Volunteer Program. Through the program, teens are assigned special projects in the office or patient assignments at Sharp HospiceCare's LakeView and ParkView homes. The teens provide simple acts of kindness such as sitting with patients, listening to their stories, providing grooming and hygiene tasks and being a comforting presence by just holding their hand. Three nursing students from PLNU also volunteered at Sharp HospiceCare in FY 2014, offering assistance to family caregivers in private homes. The Sharp HospiceCare Memory Bear Program supports community members who have lost a loved one. Through the program, volunteers created teddy bears out of the garments from those who have passed on. The bears serve as special keepsakes and permanent reminders of the grieving family member's loved one. In FY 2014, Sharp HospiceCare volunteers devoted approximately 3,200 hours to handcraft more than 800 bears for approximately 400 families. Sharp HospiceCare recognized its volunteers by providing a monthly support group to enhance their education and training as volunteers, and by acknowledging their valuable contribution during National Volunteer Month and National Hospice Month. Sharp HospiceCare furthers its volunteer efforts through the 11th Hour Program, a special program to ensure that no patient dies alone. Through this program, patients at the end-of-life without family members by their side are accompanied by a Sharp HospiceCare volunteer. During their final moments, the volunteer sits with and comforts the patient by holding their hand, reading softly to them and simply being present. In addition, families who are present with their dying loved one may prefer the company of a volunteer to help them feel comfortable as their loved one passes away. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV) Volunteer Programs To help serve and comfort patients without family or friends to support them during their hospital stay, SMH created the Community Care Partner (CCP) program. This unique program hand-selects and trains hospital volunteers to become Community Care Partners (CCPs). The CCPs act as companions to provide comfort and help keep patients safe by notifying medical staff as needed - a task that is usually performed by a family member or friend, but often overlooked for patients who lack a companion. The CCPs p”

“In collaboration with social workers and palliative care nurses, Arts for Healing also facilitated the donation of nearly 180 blankets and quilts to patients receiving end-of-life care at SMH. Eighteen of the blankets were knitted and crocheted by patients at SMV's East County Outpatient Program, an activity that could also help reduce anxiety and depression from the patients making and donating the blankets. In FY 2014, 50 volunteers, including several students from PLNU and MC, supported Arts for Healing by facilitating art activities for patients and their loved ones. Arts for Healing also provided music at several hospital and systemwide events, including Sharp's Disaster Preparedness Expo at the Spectrum corporate office in September. Since the inception of the program in 2007, more than 50,000 patients, guests and staff have benefitted from the time and talent provided by the Arts for Healing group. In FY 2014, SMH and SMBHWN brought the Junior Volunteer Program to high school students interested in future health care careers. The program is open to 10th through 12th grade students, ages 15 years or older who maintain a minimum grade point average (GPA) of 3.25 for two full semesters. New volunteers are placed either as guest ambassadors at the concierge desk or in the upscale gift shop or boutiques. The junior volunteers enhance the patient-centered services of staff by greeting and escorting patients and families, answering visitors' questions and baking cookies to create aromatherapy and a relaxing environment for patients and visitors. Through volunteering in the gift shop or boutiques, junior volunteers learn about merchandizing and retail sales while also helping to raise funds for the SMH Auxiliary. After completing a six-month, 100-hour commitment, 11th and 12th grade volunteers have the opportunity to earn promotions into clinical units based on their good attendance, professional communication and high level of productivity. In FY 2014, 110 junior volunteers provided more than 7,800 hours of service to the program. In FY 2015, SMH and SMBHWN plan to continue expanding opportunities for the Junior Volunteer Program. Other Sharp Volunteer Efforts In FY 2014, Sharp staff donated their time and passion to a number of unique initiatives, underscoring Sharp's commitment to the health and welfare of San Diegans. Below are just a few examples of how Sharp employees participated in the community. SGH's Engineering Department volunteered in a number of initiatives in FY 2014, including This Bud's for You, a program that delivers flowers hand-picked from the campus' abundant gardens to unsuspecting patients and their loved ones. The SGH landscape team grows, cuts, bundles and delivers colorful bouquets each week, bringing an element of natural beauty to patients and visitors of both the hospital and Sharp's hospice homes. The team also regularly offers single-stem roses in a small bud vase to passers-by. In FY 2014, the team delivered a daily average of eight to 10 vases of flowers to patient rooms, with as many as 20 vases or more during peak flower season and upon additional requests. In its fourth year, This Bud's for You 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 visitors to the hospital. The Engineering Department further extends the spirit of caring through Sodexo Cares Cheers Bouquets. During their work day, the engineers keep an eye out for patients or visitors that appear to need encouragement or cheer. With help from Sodexo, the hospital's food service, housekeeping and engineering vendor, a bouquet of balloons, ribbon, a teddy bear or Sodexo football, plus an inspirational quote are quickly assembled. The gift is delivered to bring the patient or visitor comfort and joy while at the hospital. The SGH Engineering Department, landscape team, SGH Auxiliary and local businesses collaborated to bring The Shirt Off Our Backs program t”

“Established Green Teams at each entity are responsible for developing new programs that educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Sharp has also partnered with key vendors and community organizations to identify and develop new programs and initiatives to help achieve its environmental goals. Sharp also participates in San Diego's Gathering of Green Teams, a group of teams from a variety of local businesses who meet quarterly to share innovative sustainability solutions. Sharp's Environmental Policy serves to affirm its commitment to improving the health of the environment and therefore the communities it serves. According to the U.S. EPA, health care ranks as the country's second most energy intensive industry. Furthermore, the U.S. Department of Energy Information Agency states that hospitals and health care facilities account for more than eight percent of the nation's annual energy consumption and generate nearly eight percent of the country's carbon dioxide (CO2) emissions. Unlike other industries, hospitals must operate 24 hours a day, seven days a week, and must provide service during power outages, natural disasters and other emergencies. The EPA estimates 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 has responded to the need for hospitals to conserve energy and reduce carbon emissions by implementing numerous green initiatives. Some of those include: retro-commissioning of heating, ventilation and air conditioning (HVAC) systems; lighting retrofits; pipe insulations; infrastructure control initiatives; occupancy sensor installation; energy audits; and energy-efficient motor and pump replacements. In addition, in 2013 Sharp implemented a computer power management program which enables computers and monitors to go into a low-power sleep mode after a period of inactivity. Since its implementation, the program has been installed on 14,500 computers and has resulted in annual energy savings of 1.2 million kilowatt-hours (kWh). The initiative earned Sharp a Certificate of Recognition from the EPA in 2013. Sharp's energy-saving initiatives are driven by its Energy Conservation Guideline to help manage energy utilization practices throughout the system. Since 2009, these initiatives have reduced the system's energy consumption by more than 17 million kWh and 200,440 natural gas therms (unit of heat energy). As a result of its lighting retrofits alone, Sharp has saved approximately 3.9 million kWh, resulting in annual energy costs savings of more than $500,000. In total, Sharp's energy initiatives have reduced the system's carbon footprint equal to the removal of almost 17,000 metric tons of CO2 each year. In May, Sharp was named as San Diego's HealthCare 2014 Energy Champion by SDG&E in recognition of its commitment to the innovative programs it has implemented to reduce its carbon footprint. Furthering its dedication to energy efficiency, Sharp HealthCare participates in SDG&E's Major Customer Advisory Panel, a group of SDG&E's largest customers who meet quarterly to receive energy updates from SDG&E and provide feedback on important regional energy issues. All Sharp entities participate in the EPA's ES database and monitor their ES scores on a monthly basis. ES is 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, SCHH”

“Sharp also recognizes Earth Day and America Recycles Day. Each year emails are sent out that highlight Sharp's recycling efforts and accomplishments, and offer reminders for proper workplace recycling, carpooling and energy and water conservation. In April 2014, Sharp held its fifth annual systemwide All Ways Green Earth Week event, including All Ways Green fairs at each Sharp entity. During the fairs, employees learned how they can contribute to recycling, waste minimization, healthy eating practices and other sustainability efforts. Many of Sharp's key vendor partners participated in the fairs to help raise awareness of green initiatives and how Sharp HealthCare is involved in those programs. In October 2013 and April 2014, Sharp hosted two free Community Waste Collection Events where community members and employees recycled 330 pounds of pharmaceutical waste, nearly 12 bins of electronic waste and more than 530 gallons of shredded paper documents. The impact of Sharp's waste reduction programs has been significant. In FY 2014, Sharp facilities diverted over 7.5 million pounds of waste from local landfills, which equates to an overall recycling rate of 37 percent. This included, but was not limited to 111,608 pounds of waste diverted through utilization of reusable sharps and pharmaceutical waste containers at SCHHC and SMMC, as well as systemwide recycling of 270,464 pounds of hazardous and universal waste (e.g., batteries, solvents and fluorescent light bulbs), and 39,784 pounds of waste diverted through surgical device reprocessing. In the coming year, Sharp has a system goal of diverting 7.6 million pounds of waste from local landfills. Table 3 presents the waste diversion rates at Sharp HealthCare in FY 2014. Table 3: Sharp HealthCare Waste Diversion - FY 2014 Sharp Chula Vista Medical Center Recycled Waste Per Year (lbs.) - 773,131 Total Waste Per Year (lbs.) - 2,665,343 Percent Recycled - 29% Sharp Coronado Hospital and Healthcare Center Recycled Waste Per Year (lbs.) - 252,848 Total Waste Per Year (lbs.) - 1,335,244 Percent Recycled - 18% Sharp Grossmont Hospital Recycled Waste Per Year (lbs.) - 1,761,515 Total Waste Per Year (lbs.) - 4,703,949 Percent Recycled - 37% Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women and Newborns Recycled Waste Per Year (lbs.) - 2,006,597 Total Waste Per Year (lbs.) - 6,450,334 Percent Recycled - 34% Sharp Mesa Vista Hospital Recycled Waste Per Year (lbs.) - 257,739 Total Waste Per Year (lbs.) - 555,811 Percent Recycled - 46% Sharp Rees-Stealy Medical Centers Recycled Waste Per Year (lbs.) - 1,158,209 Total Waste Per Year (lbs.) - 2,743,139 Percent Recycled - 42% Sharp Corporate Sites Recycled Waste Per Year (lbs.) - 1,329,075 Total Waste Per Year (lbs.) - 2,154,748 Percent Recycled - 92% Total Sharp HealthCare Recycled Waste Per Year (lbs.) - 7,539,114 Total Waste Per Year (lbs.) - 20,608,568 Percent Recycled - 37% According to the Intergovernmental Panel on Climate Change, agriculture is responsible for 13.5 percent of greenhouse gas emissions worldwide. Sharp is committed to making eco-friendly food choices to minimize its environmental footprint. This includes a systemwide focus on its sustainable Mindful food program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. In collaboration with Sodexo, Sharp's food service vendor, Sharp's Mindful program includes Meatless Mondays, Wellness Menus, Community Supported Agriculture (CSA) fresh produce, food composting, increased recycling activities, the promotion of sugarless beverages, the use of post-consumer recycled packaging solutions and increased local and organic food purchases which are approaching 65 percent at some entities. In addition, SMH, SMV, and SCHHC created the first county-approved organic gardens and use the produce from these gardens in the meals served at the hospital cafes. Sharp has implemented many other sustainable foo”

“To further reduce the number of cars on the road Sharp's Commuter Solutions Sub-Committee continuously works to develop new programs and marketing campaigns to educate employees on the benefits of ride sharing. The committee has overseen the implementation of bike racks and designated car pool spots, as well as adding a Bicycle Commuter Benefit, which each year gives employees who bike to work up to $20 per month to use for qualified costs associated with bicycle purchase, improvement, repair and storage. Sharp furthered its support of green transportation through several bike to work initiatives in FY 2014. This included two Bike to Work Day events during which Sharp employees opted to ride their bike to work in place of driving. Sharp also participated in the fifth annual iCommute Bike to Work 2014 Corporate Challenge for the entire month of May (National Bike Month), competing with similar-sized organizations for the highest percentage of bike ridership for the month. In June, Sharp promoted National Dump the Pump Day to employees by sharing special promotions from iCommute, such as vanpool discounts and gift card drawings, for individuals who pledged to "Dump the Pump" and make greener transportation choices. Furthering the commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for more than 200 employees so that they are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an onsite presence, such as information technology support, transcription and human resources. Table 4 highlights the All Ways Green efforts at Sharp entities. Going forward, Sharp remains committed to the All Ways Green initiative and will continue to investigate opportunities to reduce its carbon footprint. Sharp's All Ways Green Committee continues to work with system employees, physicians and corporate partners to develop new and creative ways to reduce its impact on the environment and meet the goal of being an outstanding community citizen through environmental responsibility. Table 4: All Ways Green Initiatives by Sharp Entity - FY 2014 SCHHC *Energy Efficiency - Update elevators/ chillers - Energy audits - Energy-efficient chillers/motors - ES Award HVAC projects - Lighting retrofits *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Reusable sharps containers - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No smoking policy - Organic farmer's market - Organic gardens - Recycling education - Ride share promotion SCVMC *Energy Efficiency - Energy audits - Energy-efficient chillers/motors - ES participation and award eligible - HVAC projects - Lighting retrofits *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Compactor renovation - Electronic cafe menus - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No smoking policy - Organic farmer's market - Recycling education - Ride share promotion SGH *Energy Efficiency - Energy audits - ES participation - HVAC projects - Lighting retrofits - Retro-commissioning *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Electronic cafe menus - Single-serve paper napkin and plastic”

“In March, Sharp's disaster team participated in the 2014 Mass Rescue Operations Exercise (MRO) at the San Diego Mission Bay Lifeguard Headquarters. During the exercise, the San Diego Lifeguards, U.S. Coast Guard, American Red Cross (ARC), multiple response agencies, UC San Diego Health System, Palomar Health and Sharp HealthCare engaged in a maritime emergency simulation designed to practice and improve communication, water rescue, helicopter support and Emergency Medical Services (EMS) handoff of victims. In July, Sharp hosted the 5th Annual Disaster Partnership Conference at its Spectrum office location. The conference was attended by approximately 100 health care providers, county emergency personnel, Sharp HealthCare employees and community members and included speakers from SDC hospitals plus a review of lessons learned during an active shooter response exercise. In September, Sharp's disaster leadership presented to more than 900 California hospital staff, state and local officials, and key preparedness and response partners at the California Hospital Association's (CHA) 9th annual Disaster Planning for California Hospitals Conference in Sacramento, California. Presentations aimed at helping hospitals strengthen their disaster planning efforts, including how to develop a perinatal evacuation plan. Sharp's disaster leadership donated their time to multiple state and local organizations and committees in FY 2014. This included the Southern California Earthquake Alliance, the County of San Diego Emergency Medical Care Committee (EMCC) Disaster Operations and the County of San Diego Healthcare Disaster Council, a group of representatives from SDC hospitals, other health care delivery agencies, county officials, fire agencies, law enforcement, ARC and others who meet monthly to share best practices for emergency preparedness. Sharp's disaster leadership also served on the Statewide Medical Health Exercise work group that designed training materials for the 2014 California Statewide Medical Health Training and Exercise Program through the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA). The program is designed to guide local emergency outlets in developing, planning and conducting emergency responses. Furthermore, Sharp disaster leadership is part of the San Diego Patient Tracking Committee, which is in the process of designing a countywide Family Assistance Center (FAC) to aid community members in finding their loved ones during a disaster event. Sharp supports safety efforts of the state and the city through maintenance and storage of a county decontamination trailer at SGH, to be used in response to a mass decontamination event. Sharp has also arranged for the prospective storage of 24 state hospital ventilators at three Sharp hospitals. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event that the system's normal water supply is interrupted. As part of its participation in the U.S. Department of Health & Human Services (DHHS) Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp continued its involvement in the Sharp HealthCare HPP Disaster Preparedness Partnership (the Partnership). The Partnership includes SCVMC, SCHHC, SGH, SMH, SRS Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital, Kaiser Foundation Hospital, Alvarado Hospital, Paradise Valley Hospital, the Council of Community Clinics, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriffs, Marine Corps Air Station (MCAS) Miramar Fire Department and Fresenius Medical Centers. The Partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. Through”

“Sharp Best Health added healthy vending machine options on all hospital campuses, as well as healthy food items in each cafeteria and retail area. Sharp Best Health also conducts a semi-annual food and nutrition survey at each Sharp hospital and corporate office location to assess employee satisfaction of the organization's cafeteria food and customer service, including requests for feedback and suggestions for improvement. Additionally, in September, Sharp Best Health supported Fresh Fruit and Vegetable Month through the Five-A-Day Challenge, a 21-day initiative designed to motivate Sharp team members to increase their daily consumption of fruits and vegetables. In collaboration with Sodexo and Specialty Produce, Sharp Best Health offers the Green Grocers - Delivered to You program at more than 15 Sharp sites. Through the Green Grocers program, seasonally available, locally grown and organic produce can be selected online and delivered to the workplace twice a month. The program provides a convenient method for employees and their families to incorporate more fruits and vegetables into their diet. Along with supporting employee health, the purchase of locally grown produce helps support local farmers and the San Diego community. Since January 2014, Sharp team members have ordered approximately 17,024 pounds of produce through the Green Grocers program. Sharp Best Health also provides a free Nutrition Education Series to employees and family members designed to help Sharp team members develop healthier eating habits. The program includes live workshops with cooking demonstrations from registered dietitians, educational videos and blog posts. More than 30 nutrition classes were offered to Sharp employees and their families by Sharp Best Health in FY 2014. Offsite activities like hiking and walking clubs are also available to Sharp team members, family and friends. In FY 2014, Sharp Best Health organized 12 systemwide hikes with more than 80 attendees. Beginning in FY 2013, Sharp Best Health has offered annual health screenings to Sharp employees in order to raise awareness of important biometric health measures and help team members understand how to reduce their risk of related health issues. Screenings are completed in less than 15 minutes and include indicators for blood pressure, body mass index (BMI), blood sugar, tobacco use and cholesterol. In FY 2014, more than 9,400 Sharp employees participated in the screening effort, and more than 2,300 employees reduced their risk levels in at least one screening metric when compared to FY 2013 screening results. A variety of post-screening resources and tools are available for Sharp employees and their family members, including a free health coach and classes on diabetes, heart disease, smoking cessation, healthy weight and eating, physical activity and stress management. As a fun incentive for completing their health screening, Sharp Best Health provided employees with a Fitbit Zip wireless pedometer that tracks steps, distance and calories, and syncs these statistics to computers or smartphones. Sharp Best Health highly encourages its team members to utilize the Fitbit Zip to track their physical activity and achieve their personal fitness goals. On a monthly basis, Sharp Best Health provides a systemwide update on each entity's Fitbit Zip activity levels to inform team members of their progress, and encourage them to continue working toward the recommended goal of 10,000 steps per day. Since January 2014, Sharp's Fitbit Zip users have achieved a daily average of 8,260 steps. The success of Sharp Best Health's employee health screenings prompted the design and implementation of a free health screening program for the broader San Diego community (non-Sharp employees). Checking for the same health indicators included in the employee health screenings, as well as follow-up resources, Sharp team members conducted screening events at community sites throughout San Diego. Through these”

“* Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations and services for seniors; financial and other support to community clinics to assist in providing and improving access to health services; Project HELP; Project CARE; Meals on Wheels; contribution of time to Stand Down for Homeless Veterans, the San Diego Food Bank and Habitat for Humanity; financial and other support to the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community, as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers; made Sharp facilities available for use by community groups at no charge; and executive leadership and staff actively participated in numerous community organizations, committees and coalitions to improve the health of the community. See Appendix A for a listing of Sharp's involvement in community organizations. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care professionals, as well as supervision and support for students and interns, and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Economic Value of Community Benefit Provided in FY 2014 In FY 2014, Sharp provided a total of $354,271,459 in community benefit programs and services that were unreimbursed. Table 1 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Total Economic Value of Community Benefit Provided Sharp HealthCare Overall - FY 2014 *Medical Care Services Shortfall in Medi-Cal - $129,446,653 Shortfall in Medicare - $160,841,853 Shortfall in San Diego County Indigent Medical Services - $10,547,826 Shortfall in CHAMPVA/TRICARE - $2,664,033 Shortfall in Workers' Compensation - $167,061 Charity Care and Bad Debt - $41,362,966 *Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy - $2,340,135 *Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $2,090,478 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals - $4,810,454 TOTAL - $354,271,459 Table 2 shows a listing of these unreimbursed costs provided by each Sharp entity. Table 2: Total Economic Value of Community Benefit Provided By Sharp HealthCare Entities - FY 2014 Estimated FY 2014 Unreimbursed Costs Sharp Chula Vista Medical Center - $66,364,211 Sharp Coronado Hospital and Healthcare Center - $15,755,637 Sharp Grossmont Hospital - $116,587,353 Sharp Mary Birch Hospital for Women & Newborns - $17,069,286 Sharp Memorial Hospital - $126,648,487 Sharp Mesa Vista Hospital and Sharp McDonald Center - $11,714,311 Sharp Health Plan - $132,174 TOTAL FOR ALL ENTITIES - $354,271,459 Table 3 includes a summary of unreimbursed costs for each Sharp entity based on the categories specifically identified in SB 697. In FY 2013, Sharp led the community in unreimbursed medical care services among San Diego County's SB 697 hospitals and health care systems. Table 3: FY 2014 Detailed Economic Value of Community Benefit at Sharp HealthCare Entities Based on Senate Bill 697 Categories Sharp Chula Vista Medical Center *Medical Care Services - $64,”

“The results of this collaborative process significantly informed the 2013 CHNAs for each Sharp hospital, and individual hospital assessments were further supported by additional data collection and analysis and community outreach specific to the primary communities served by each Sharp hospital. Additionally, in accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2013 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns (SMBHWN), 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 2013 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2013 CHNAs for each Sharp hospital help inform current and future community benefit programs and services, especially for high-need community members. This section describes the general methodology employed for Sharp HealthCare's 2013 CHNAs. Data Collection and Analysis As the study area for both the collaborative HASD&IC 2013 CHNA and the Sharp 2013 CHNAs cover SDC, the HASD&IC 2013 CHNA process and findings significantly informed Sharp's CHNA process and as such, are described as applicable throughout the various CHNA reports. For complete details on the HASD&IC 2013 CHNA process, please visit the HASD&IC website at: http://www.hasdic.org. For the HASD&IC 2013 CHNA process, the IPH employed a rigorous methodology using both community input (primary data sources) and quantitative analysis (secondary data sources) to identify and prioritize the top health conditions in SDC. These health needs were prioritized based on the following criteria: * Has a significant prevalence in the community * Contributes significantly to the morbidity and mortality in SDC * Disproportionately impacts vulnerable communities * Reflects a need that exists throughout SDC * Can be addressed through evidence-based practices by hospitals and health care systems Quantitative data (secondary sources) for both the HASD&IC 2013 CHNA and the individual Sharp hospital CHNAs included 2011 calendar year hospital discharge data at the ZIP code level, health statistics from the San Diego County Health and Human Services Agency (HHSA), the U.S. Census Bureau, the Centers for Disease Control and Prevention and others. The variables analyzed are included in Table 1 below, and were analyzed at the ZIP code level wherever possible: Table 1: Variables Analyzed in the HASD&IC and Sharp HealthCare 2013 CHNAs *Secondary Data Variables - Inpatient Hospitalizations by Cause - Emergency Department Visits by Cause - Demographic Data (socio-economic indicators) - Mortality Data - Regional Disease-Specific Health Data (County HHSA) - Self-Reported Health Data (California Health Interview Survey) - Specialized Health Data /Reports (various) Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC's 2013 CHNA and Sharp's 2013 CHNA processes utilized the Dignity Health/Truven Community Need Index (CNI) to identify communities in SDC with the highest level of health disparities and needs. Residents in five of these high-need neighborhoods across SDC were asked to provide input in a community forum setting. For the HASD&IC 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across SDC, reaching a total of 106 community residents. In addition, IPH conducted five key”

“* Reports on activities conducted in the prior fiscal year - FY 2014 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken - FY 2015 Plan * Reports and categorizes the economic value of community benefit provided in FY 2014, according to the framework specifically identified in SB 697 * Reviews and approves a Community Benefit Plan * Distributes the Community Benefit Plan and Report to members of the Sharp Board of Directors and each of the Sharp hospital boards of directors, highlighting activities provided in the prior fiscal year as well as specific action steps to be undertaken in the upcoming fiscal year Ongoing Commitment to Collaboration In support of its ongoing commitment to working with others on addressing community health priorities to improve the health status of SDC residents, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, statewide California Hospital Association, HASD&IC, and other local collaboratives such as Combined Health Agencies and the Community Health Improvement Partners Behavioral Health Work Team. Section 4 Sharp Metropolitan Medical Campus The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Mary Birch Hospital for Women & Newborns, Sharp Memorial Hospital, Sharp Memorial Outpatient Pavilion, Sharp Mesa Vista Hospital and Sharp McDonald Center. FY 2014 Community Benefit Program Highlights SMMC provided a total of $155,432,084 in community benefit in FY 2014. See Table 1 for a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Economic Value of Community Benefit Provided Sharp Metropolitan Medical Campus - FY 2014 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2014 Unreimbursed Costs *Medical Care Services Shortfall in Medi-Cal - $50,723,145 Shortfall in Medicare - $75,018,326 Shortfall in San Diego County Indigent Medical Services - $4,642,668 Shortfall in CHAMPVA/TRICARE - $1,421,546 Shortfall in Workers' Compensation - $3,197 Charity Care and Bad Debt - $19,271,919 *Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy - $1,269,262 *Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $1,004,624 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals - $2,077,397 TOTAL - $155,432,084 Section 5 Sharp Mary Birch Hospital for Women & Newborns FY 2014 Community Benefit Program Highlights Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) provided a total of $17,069,286 in community benefit in FY 2014. See Table 1 for a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Economic Value of Community Benefit Provided Sharp Mary Birch Hospital for Women & Newborns - FY 2014 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2014 Unreimbursed Costs *Medical Care Services Shortfall in Medi-Cal - $13,997,397 Shortfall in Medicare - $552,155 Shortfall in San Diego County Indigent Medical Services - $18,376 Shortfall in CHAMPVA/TRICARE - $1,443 Shortfall in Workers' Compensation - $3,197 Charity Care and Bad Debt - $2,041,173 *Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy - $45,880 *Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $162,516 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals -”

“Adults 18 + Years 81.3% 100% *Regular Source of Medical Care Children 0 to 11 Years 98.1% 100% Children 12 to 17 Years 82.2% 100% Adults 18 + Years 85.6% 89.4% *Not Currently Insured Adults 18 to 64 Years 17.7% Source: 2011-2012 California Health Interview Survey (CHIS) Table 3: Medi-Cal (Medicaid)/Healthy Families Eligibility, Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2011 Description/Rate Medi-Cal Eligible - 6.9% Healthy Families Eligible - 0.4% Not Eligible - 92.6% Source: 2011-2012 CHIS In 2012, there were 44,391 live births in SDC. During this time, SDC overall met the HP 2020 national targets for all maternal and infant health indicators. See Table 4 for a summary of maternal and infant health indicators. In 2011 fetal mortality in SDC was 4.2 fetal deaths per 1,000 live births plus fetal deaths, also meeting the HP 2020 national target of less than 5.6 fetal deaths per 1,000 live births plus fetal deaths. Table 4: Maternal and Infant Health Indicators in SDC, 2012 Maternal and Infant Health Indicator Rate Year 2020 Target Early Prenatal Care 84.3% 77.9% Preterm Births 9.1% 11.4% Very Low Birth Weight (VLBW) Infants 1.1% 1.4% Low Birth Weight (LBW) Infants 6.4% 7.8% Infant Mortality 3.9% 6.0% Source: County of San Diego, Health and Human Services Agency (HHSA), Public Health Services, Community Health Statistics Unit and Maternal, Child and Family Health Services In 2012, all regions of SDC met every HP 2020 national target except for Very Low Birth Weight (VLBW) Infants and Infant Mortality in the central region. See Table 5 for a summary of maternal and infant health indicators by region. Table 5: Maternal and Infant Health Indicators by Region in SDC, 2012 Indicator *Prenatal Care North Coastal - 82.2% North Central - 90.9% Central - 82.8% South - 85.4% East - 80.6% North Inland - 83.8% Preterm Births North Coastal - 8.8% North Central - 8.6% Central - 10.4% South - 8.4% East - 9.2% North Inland - 9.1% VLBW Infants North Coastal - 1.0% North Central - 1.0% Central - 1.5% South - 0.9% East - 1.0% North Inland - 1.0% LBW Infants North Coastal - 5.9% North Central - 6.3% Central - 7.4% South - 6.0% East - 6.0% North Inland - 6.6% Infant Mortality North Coastal - 3.2% North Central - 2.9% Central - 6.3% South - 4.7% East - 3.4% North Inland - 3.4% Sources: County of San Diego, HHSA, Public Health Services, Community Health Statistics Unit and Maternal, Child and Family Health Service In 2011 the fetal mortality rate was 4.8 (fetal deaths per 1,000 live births plus fetal deaths) in the north coastal region, 2.8 in the north central region, 5.1 in the central region, 3.8 in the south region, 3.0 in the east region and 5.4 in the north inland region. In 2011, all SDC regions met the HP 2020 national target of less than 5.6 fetal deaths per 1,000 live births plus fetal deaths. For additional demographic and health data for communities served by SMBHWN, please refer to the SMH 2013 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments Community Benefit Planning Process In addition to the steps outlined in Section 3 regarding community benefit planning, SMBHWN: * Incorporates community priorities and community relations into its strategic plan and develops service-line-specific goals * Estimates an annual budget for community programs and services based on community needs, the previous years' experience, and current funding levels * Participates in programs and workgroups to review and implement services that improve the health status and emotional well-being of women and infants Priority Community Needs Addressed in Community Benefit Report - SMH 2013 CHNA In accordance with federal regulations, the SMH 2013 CHNA also includes needs identified for communities served by SMBHWN, 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). The SMH 2013 CHNA summarizes the processes and”

“* In 2012, preterm births were higher for male newborns when compared to female newborns, highest among Hispanic mothers when compared to mothers of other races and ethnicities, and highest for mothers ages 25 to 34 when compared to mothers in other age groups (defined as 15 to 24 years and 35 years and older). * According to the Centers for Disease Control and Prevention (CDC), maternal health conditions that are not addressed before a pregnancy can lead to complications for the mother and the infant. Several health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, maternal obesity, maternal smoking during pregnancy and maternal deficiency of folic acid. * In 2012, preterm birth affected more than 450,000 babies, or one of every nine infants born in the U.S. (CDC, 2014). * Women who deliver prematurely, experience repeated miscarriages, or develop gestational diabetes are at increased risk of complications with subsequent pregnancies, according to the CDC. * According to a report from the National Center for Health Statistics (NCHS), preterm infants are at increased risk of life-long disability and early death compared with infants born later in pregnancy. The U.S. preterm birth rate (less than 37 weeks of gestation) rose by more than one-third from the early 1980s through 2006. The first two-year decline in nearly three decades occurred from 2006 to 2008, during which the preterm birth rate decreased from 12.8 percent to 12.3 percent (NCHS, 2010). * According to a 2006 report from the Institute of Medicine (IOM), the rate of preterm births in the U.S. is a growing public health problem that has significant consequence for families, and costs society at least $26 billion per year. Further, premature and low birth weight infants (LBW) spent an average of 15 days in the hospital, compared to just over two days for healthy, full-term infants. Premature infants average about 20 outpatient medical visits compared to just 14 for full-term infants (March of Dimes, 2014). Objectives * Develop, coordinate and provide educational programs on preterm labor and births, as well as prenatal health to women in the community, including high-risk populations * Participate in community events and provide education on preterm births and prenatal health * Identify and disseminate evidence-based best practices to improve outcomes of at-risk newborns through the Sharp Neonatal Research Institute (NRI) FY 2014 Report of Activities In FY 2014, SMBHWN offered education for expecting mothers in the community, including teenagers and other high-risk populations. Free, monthly Preterm Birth Prevention classes taught approximately 120 individuals the warning signs of preterm labor and how to help prevent a premature birth. SMBHWN was actively involved in a variety of events supporting the Miracle Babies Foundation, a volunteer-driven nonprofit organization that provides support and financial assistance to families with critically ill newborns in the neonatal intensive care unit (NICU). The hospital participated in the annual Miracle Babies 5K and Masquerade Ball as well as held a silent auction, gift basket raffles, and pizza and bake sales. Through these events SMBHWN raised nearly $6,000 for Miracle Babies in FY 2014. SMBHWN also participated in the American Heart Association (AHA) Heart & Stroke Walk and provided educational resources on breastfeeding and information about the community programs and services offered at the hospital, to hundreds of community members at various events. This included the AHA Go Red for Women luncheon, Sharp's annual Women's Health Conference, and the Johnson & Johnson Health Fair. Throughout FY 2014, SMBHWN led a variety of educational classes for expecting mothers and their families, covering various aspects of prenatal care. Topics included: how one's body prepares for birth and delivery; hospital procedures; medication choices; Cesarean delivery; rel”

“* According to the American Psychological Association (APA), between nine and 16 percent of postpartum women will experience postpartum depression. Among women who have already experienced postpartum depression following a previous pregnancy, some prevalence estimates increase to 41 percent. * According to a recent study in the Journal of the American Medical Association (JAMA), one in seven women have depression in the year after they give birth (JAMA, 2013). * The days and weeks following childbirth - the postnatal period - is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. Evidence-based practices recommended for the postnatal care period include: timing of discharge from a health facility after birth, number and timing of postnatal contacts, assessment of the baby, exclusive breastfeeding, cord care, assessment of the mother, and counseling on the physiological process of recovery after birth (World Health Organization (WHO), 2013). Objectives * Provide support and education to new mothers and their families on postpartum care * Provide NICU-specific support services to new mothers and their families * Demonstrate best practices in breastfeeding and maternity care, and provide education and support to new mothers on the importance of breastfeeding FY 2014 Report of Activities In FY 2012, SMBHWN was selected from more than 200 applicants to participate in the NICHQ Best Fed Beginnings Learning Collaborative, a 22-month collaborative consisting of 90 hospitals throughout the nation. The collaboration enabled participating hospitals to exchange information and best practices in order to become a designated Baby-Friendly Hospital. Established by the United Nations Children's Fund (UNICEF) and the WHO in 1991, the Baby-Friendly Hospital Initiative (BFHI) recognizes and encourages hospitals and birthing centers that offer high-quality breastfeeding care. The BFHI has been implemented in more than 170 countries, resulting in the designation of more than 20,000 birthing facilities. SMBHWN anticipates a Baby-Friendly USA site visit in the spring of 2015, while the hospital expects to receive Baby-Friendly USA Designation in late 2015. Designation will occur through participation in the NICHQ Best Fed Beginnings Learning Collaborative, and through the implementation of evidence-based maternity care practices including but not limited to: training health care staff to properly implement a breastfeeding policy; providing education to pregnant women on the benefits of breastfeeding; demonstrating how to breastfeed and maintain lactation to new mothers; encouraging breastfeeding on demand; and referring mothers to breastfeeding support groups following discharge from the hospital. In July 2013, more than 400 registered nurses (RN) at SMBHWN started and are currently in the process of completing the required competency training to achieve Baby-Friendly USA Designation. Since 2011, the program has shown increases in the rate of exclusive breastfeeding at discharge, which is up to 57 percent on average throughout the year, compared to a baseline average of 47 percent throughout the year. In FY 2014, SMBHWN continued to offer free breastfeeding support groups to new mothers and their families. Facilitated by an experienced lactation educator, the groups met three times per week, and provided support and education to nearly 1,900 mothers about the joys and challenges of breastfeeding. SMBHWN continued to provide its weekly NICU Breastfeeding Support Group - the Mother's Milk Club - for all mothers in the community with a baby who spent any length of time in the NICU. In FY 2014, 100 mothers from the community received support and counseling for topics of concern including milk supply, latching, sleeping, the stress of having a baby who is experiencing problems and any other concerns of the group. The”

“FY 2015 Plan SMBHWN will do the following: * Continue to implement current evidence-based breastfeeding practices for new mothers and their families * Continue to offer a variety of free educational classes and outreach activities targeting new mothers and their families * Continue to offer free postpartum, breastfeeding, and new parent support groups to new mothers and their families * Continue to provide the NICU Navigator Program and the NICU Little Graduate Reunion to current and former NICU patients and their families * Implement evidence-based maternity care practices required to achieve Baby-Friendly USA Distinction 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 SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the 2013 SDC Healthcare Shortage Areas Atlas from the County of San Diego's Health and Human Services Agency (HHSA), SDC is one of 28 counties in California listed as an RN Shortage Area. * The demand for RNs and other health care personnel in the U.S. will increase due to the aging population. Nurses will be needed to educate and care for patients with various chronic conditions including diabetes and obesity. In addition, the number of individuals who have access to health care services will increase as a result of federal health insurance reform. More nurses will be needed to care for these patients (Bureau of Labor Statistics, 2012). * The Bureau of Labor Statistics (BLS) projects employment of more than 3.2 million RNs in 2022, an increase of 19 percent from 2012. RNs are projected to have the most new jobs in 2020, when compared to other health care practitioners and technical occupations in health care. * The BLS projects that home health aide demand will grow 48 percent from 2012 to 2022. As the US population ages, the demand for home health aides to provide assistance and companionship will continue to increase. The older population often has health problems and will need help with daily activities. * According to the San Diego Workforce Partnership, despite the growing demand for health care workers, employers express an "experience gap" among recent graduates as a challenge to filling open positions. While new graduates often possess the requisite academic knowledge to be hired, they lack real world experience. * The San Diego Workforce Partnership recommends programs that provide volunteer experiences to high school and post-secondary students, as on-the- job training could provide real world experience for workers. Programs that target underrepresented groups and disadvantaged students could help increase the number of culturally competent health care workers. * According to the San Diego Workforce Partnership 2013 report titled, In-Demand Jobs: A Study of the Occupational Outlook in San Diego, health care has been one of the few local industries that has experienced strong employment growth the last three to four years. The health care specialty occupations expecting to grow considerably are radiological technologists and technicians, dental assistants and RNs. * According to the California Hospital Association (CHA) report titled, Critical Roles: California's Allied Health Workforce, in the coming decades, as health professionals will be required to have a more complex set of skills, education and training programs need to evolve and innovate in order to meet the current skill demands of health employers. * According to the same report, programs supported by local hospitals make tremendous impacts on the lives of individuals, families and communities. This includes contributions of time and resources dedicated to the thousands of interns and high school students that spend time in hospitals in California each year, gaining valuable work experience and career exp”

“Section 6 Sharp Memorial Hospital FY 2014 Community Benefit Program Highlights Sharp Memorial Hospital (SMH) provided a total of $126,648,487 in community benefit in FY 2014. See Table 1 for a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Economic Value of Community Benefit Provided Sharp Memorial Hospital - FY 2014 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2014 Unreimbursed Costs *Medical Care Services Shortfall in Medi-Cal, financial support for onsite workers to process Medi-Cal eligibility forms - $35,013,334 Shortfall in Medicare - $71,495,908 Shortfall in San Diego County Indigent Medical Services - $3,770,494 Shortfall in CHAMPVA/TRICARE - $860,620 Charity Care and Bad Debt - $12,645,383 *Other Benefits for Vulnerable Populations Patient transportation, Project HELP and other assistance for the needy - $711,595 *Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $530,820 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals - $1,620,333 TOTAL - $126,648,487 Key highlights: * Unreimbursed Medical Care Services included uncompensated care for patients who are unable to pay for services; unreimbursed costs of public programs such as Medi-Cal, Medicare and San Diego County Indigent Medical Services; and financial support for onsite workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; Project HELP; contribution of time to Stand Down for Homeless Veterans, San Diego Habitat for Humanity and the San Diego Food Bank; the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information on a variety of topics; participation in community health fairs and events; support groups; health screenings for diabetes, stroke, osteoporosis, depression, blood pressure, heart disease, nutrition, body mass index (BMI), hearing, balance, and diseases or disorders of the hands, such as arthritis and tendonitis; the SMH Cancer Institute Patient Navigator program - including breast, lymphomas, head, neck, lung, colon, rectal, renal, prostate, gynecological and all other cancers; and flu vaccinations and specialized education and information for seniors offered by the SMH Senior Resource Center and Senior Health Centers. SMH donated meeting room space to community group and collaborated with local schools to promote interest in health care careers. SMH staff actively participated in community boards, committees and other civic organizations, such as the American Cancer Society (ACS), the American Heart Association (AHA), Health Sciences High and Middle College Board, American College of Healthcare Executives (ACHE), San Diego Organization of Healthcare Leaders (SOHL), Association of California Nurse Leaders (ACNL), Association of periOperative Registered Nurses (AORN), American Association of Critical-Care Nurses (AACCN), Sigma Theta Tau International Honor Society of Nursing, San Diego Association of Diabetes Educators, San Diego Eye Bank Nurses' Advisory Board, Emergency Nurses Association - San Diego Chapter, YMCA, Association for Clinical Pastoral Education (ACPE), Community Health Improvement Partners (CHIP), Hospital Association of San Diego and Imperial Counties (HASD&IC), County of San Diego Emergency Medical Care Committee (EMCC), San Diego County Stroke Consortium, San Diego Blood Bank, San Diego Healthcare Disaster Council, Gary and Mary West Senior Wellness Center, Caregiver Coalition of San Diego, San Diego County Council on Aging (SDCCOA), and various uni”

“Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology & Immunization Services Branch Community Benefit Planning Process In addition to the steps outlined in Section 3 regarding community benefit planning, SMH: * Incorporates community priorities and community relations 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 * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMH 2013 CHNA In accordance with federal regulations, the SMH 2013 CHNA also includes needs identified for communities served by SMBHWN, 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). The SMH 2013 CHNA summarizes the processes and findings for communities served by both hospital entities. Through the SMH 2013 CHNA, the following priority health needs were identified for the communities served by SMH (in alphabetical order): * Behavioral Health (Mental Health) * Cardiovascular Disease * Diabetes, Type 2 * High-Risk Pregnancy * Obesity * Senior Health (including end-of-life care) In alignment with these identified needs, the following pages detail programs that specifically address cardiovascular disease (as part of health education and wellness; includes stroke), diabetes and senior health. SMH does not have the resources to comprehensively address the elements of 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. High-risk pregnancy services are addressed at SMBHWN, a specialty hospital providing care for expectant mothers, newborns and women in SDC. Please see the SMBHWN section of this report for details on SMBHWN's activities that address this identified community need. Obesity is addressed through general nutrition and exercise education and resources provided at SMH, as well as programs that address a healthy lifestyle as part of care for heart disease, cancer, diabetes and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy clinics throughout SDC 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. In addition, through further analysis of SMH's community programs and consultation with SMH's community relations team, this section also addresses the following priority health needs for community members served by SMH: * Health education and wellness * Cancer education and patient navigator services * Prevention of unintentional injuries * Health professions education and training, and promotion of interest in health care careers * Support during the transition of care for high-risk, underserved patients with complex medical needs For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2014 Report of Activities conducted in support of the objective(s), and FY 2015 Plan of Activities. Identified Community Need: Diabetes Education and Screening Rationale references the findings of the SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2013 CHNA identified diabetes as one of six top priority health issues for community members served”

“At the Sharp Women's Health Conference, the Sharp HealthCare (SHC) Diabetes Education Program provided resources on diabetes management and nutrition. The SHC Diabetes Education Program continued to support the ADA's Step Out: Walk to Stop Diabetes held in October at Mission Bay through fundraising and team participation. Also in FY 2014, the SHC Diabetes Education Program submitted abstracts and poster presentations to national conferences on various topics, including: the safe and effective use of insulin; designing and implementing Glucometrics (measures that assess the success of inpatient glucose management); and predictors of poor blood glucose control for hospitalized diabetic patients. FY 2015 Plan SMH Diabetes Education Program will do the following: * Provide diabetes education at various community venues in SDC * Continue to support ADA's Step Out: Walk to Stop Diabetes * Keep current on resources to provide community members support of diabetes treatment and prevention * Develop relationships with community clinics to provide education and resources to community members * Explore partnerships with YMCAs in the north central region to provide education and resources to community members Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2013 CHNA identified cardiovascular disease (including cerebrovascular disease/stroke) as one of six top priority health issues for community members served by SMH. * The HASD&IC 2013 CHNA identified cardiovascular disease as one of the top four priority health issues for community members in SDC (including cerebrovascular disease/stroke). * In 2012, heart disease was the second leading cause of death and cerebrovascular disease was the fifth leading cause of death for SDC overall. Together, these conditions were responsible for nearly 30 percent of deaths in SDC. * In 2012, there were 1,003 deaths due to stroke in SDC and the age-adjusted death rate due to stroke was 30.3 per 100,000 population, lower than the HP 2020 target of 33.8 deaths per 100,000. * In 2012, there were 6,725 hospitalizations for stroke in SDC, with an age-adjusted rate of 212.3 per 100,000 population. * In 2012, there were 1,789 stroke-related ED visits in SDC. The age-adjusted rate of ED visits was 56.9 per 100,000 population. * If no changes are made in risk behavior, based on current disease rates it is projected that the total number of deaths from heart disease and stroke will increase by 38 percent by the year 2020, according to the 3-4-50 Chronic Disease in San Diego County 2010 report from the County of San Diego HHSA. * According to the same report, the most common risk factors associated with stroke include physical inactivity, obesity, hypertension, cigarette smoking, high cholesterol and diabetes. * According to the Centers for Disease Control and Prevention (CDC), stroke is the fourth leading cause of death in the U.S. and a major cause of adult disability. About 800,000 people in the U.S. have a stroke each year. Some stroke risk factors cannot be controlled, such as heredity, age, gender, and ethnicity. Others are able to be controlled, such as avoiding smoking and drinking too much alcohol, eating a balanced diet, and exercising (CDC, 2014). Objective * Provide stroke education, support and screening services for the central region of SDC FY 2014 Report of Activities Note: SMH is certified by The Joint Commission as a Primary Stroke Center (recertified in FY 2013). The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SMH is also a recipient of the American Heart Association's (AHA) Get With the Guidelines (GWTG) Gold Plus Achievement Award for Stroke, and the Target: Stroke Honor Roll Quality Achievement”

“* In 2012, influenza ranked as the 11th leading cause of death in all regions of SDC. * In 2011, rates of hospitalization among senior adults ages 65 years and older in SDC were higher than the general population due to coronary heart disease, stroke, chronic lower respiratory diseases, non-fatal unintentional injuries (including falls), overall cancer and arthritis. In 2011, 97,647 seniors ages 65 and over were hospitalized in SDC. * In 2011, 108,853 seniors were treated and discharged from SDC EDs, representing nearly one out of every three senior residents. ED discharge and hospitalization rates both increased with age. * In 2011, the top three causes of ED utilization among persons ages 65 years and older were falls, diabetes and stroke. * According to data in the San Diego County Senior Health Report: Update and Leading Indicators, significant health issues for seniors include obesity, diabetes, stroke, chronic lower respiratory diseases, influenza and pneumonia, mental health issues including dementia and Alzheimer's disease, cancer and heart disease. In addition, seniors are at high risk for falls, which is the leading cause of death due to unintentional injury (HHSA, 2013). * According to the San Diego County Senior Falls Report, adults ages 65 and older are the largest consumers of health care services, as the process of aging brings upon the need for more frequent care (HHSA, 2012). * In 2011, 68,817 calls were made to 911 for seniors in need of pre-hospital care in SDC, representing a call for one out of every five seniors. * The CDC recommends annual vaccination against influenza for the following: people ages 50 and older; adults and children with a chronic health condition; children ages six months to 19 years; pregnant women; people who live in nursing homes and other long-term care facilities; and people who live with or care for those at high risk for complications from flu, including health care workers, household contacts of persons at high risk for complications from the flu, and household contacts and caregivers of children younger than age five. * Flu clinics offered in community settings at no or low cost improve access for those who may experience transportation, cost or other barriers. * There are an estimated four million family caregivers in California, according to the California Caregiver Resource Center (CRC) (AARP Public Policy Institute, 2007). * While researchers have long known that caregiving can have harmful mental health effects for caregivers, research shows that caregiving can have serious physical health consequences as well. Seventeen percent of caregivers feel their health in general has gotten worse as a result of their caregiving responsibilities (AARP Public Policy Institute, Valuing the Invaluable, Updated November 2012). * One in five caregivers report having had training, but seek additional resources. Nearly 78 percent report needing more help and information with at least 14 specific topics related to caregiving, and caregivers in high burden situations are more likely to seek help. The top four topics of concern to caregivers are: keeping their loved one safe; managing their own stress; finding easy activities to do with their care recipient; and finding time for themselves (The National Alliance for Caregiving and AARP (2009), Caregiving in the U.S., Bethesda, MD: National Alliance for Caregiving. Washington, D.C., 2012). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * In collaboration with community partners, offer seasonal flu vaccinations for seniors and other high-risk populations * Provide health education materials at seasonal flu clinics, as well as information about additional Sharp Senior Resource Center programs * Provide education and community resources to family caregivers FY 2014 Report of Activities Sharp Senior Resource Centers meet the unique needs of senio”

“The SMH Senior Resource Center also coordinated notification of the availability and provision of seasonal flu vaccines for seniors and high-risk adults in a variety of community settings through activity reminders, collaborative outreach conducted by the flu clinic site, both paper and electronic newspaper notices and via Sharp.com. In FY 2014, the SMH Senior Resource Center and the Sharp Senior Health Centers sponsored eight community seasonal flu clinics, serving nearly 550 seniors and others with chronic illness. Seasonal flu clinics were held at the Sharp Senior Health Centers, the Senior Health Fair at Point Loma Community Presbyterian Church, the Orchard Apartments low-income senior housing, Holy Trinity Catholic Church (homeless outreach), Potiker Family Senior Residence, City Heights Senior Living, Norman Park Senior Center and the Gary and Mary West Senior Wellness Center. At many of these community sites, the SMH Senior Resource Center also provided their activity calendars detailing upcoming community events and programs, including blood pressure and flu clinics, Vials of Life and other community programs for seniors. In FY 2014, the SMH Senior Resource Center participated in the County of San Diego Aging and Independence Services (AIS) 2014 Aging Summit: Creating a Safe and Caring Community. Held at the Town & Country Resort & Convention Center, the conference focused on safety and caregiving, specifically regarding Alzheimer's disease and other dementias. Other topics included, but were not limited to self-defense, financial planning, disaster preparedness, helping the caregiver, finding the best long-term care, how technology can keep you safe and easing the burden of Alzheimer's disease. The SMH Senior Resource Center provided a resource booth at the event with information on Vials of Life, screening events and other Sharp Senior Resource Center programs for seniors and caregivers. In honor of October's California Health Care Decisions Week, the SMH Senior Resource Center participated in the SanDi-CAN end-of-life conference at Balboa Park titled Navigating End-of-Life Decisions: Planning AheadCrucial Conversations. Approximately 115 community members attended the free conference, where they received education on how to make educated and informed health care decisions from a variety of end-of-life care professionals. The conference focused on assistance for community members to plan ahead regarding burial, advance directives and financial management. In May, the SMH Senior Resource Center participated in a conference for seniors and caregivers titled Recognizing and Responding to Elder Abuse, held at Balboa Park's War Memorial Building. The conference included a resource fair and education on understanding elder abuse, manipulation, internet and social media, dating websites and recognizing and responding to scams and identity theft. In April, the SMH Senior Resource Center partnered with Sharp HospiceCare to provide a conference for seniors and their families on how to approach aging from a healthy perspective. The conference, titled Aging: Planning and Coping, was held at the La Mesa Community Center and reached approximately 110 community members. The conference provided education on a variety of topics, including: chronic care management; geriatric frailty and warning signs for specific chronic diseases; when to access care; advance care planning; understanding available resources; coping with life's transitions; and healing touch for self-care. The conference included educational presentations by a physician, psychologist and advance care planning specialist, as well as education from other experts in the field of aging and health care to help seniors effectively navigate their later years. The conference also offered free health and mental health screenings, advance care planning consultations and resource tables. Sharp Senior Health Centers are committed to providing outreach and serving underserved senio”

“Rationale references the findings of the SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2013 CHNA identified cardiovascular disease and obesity among its six priority health issues affecting members of the communities served by SMH. * According to data presented in the SMH 2013 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. Additional risk factors include alcohol use, obesity, diabetes, and genetic factors. About half of Americans (49 percent) have at least one of these three risk factors. * The HASD&IC 2013 CHNA process identified the following among top priority health conditions in SDC hospitals: diabetes, obesity, cardiovascular disease and stroke, mental health and mental disorders, unintentional injury, high-risk pregnancy, asthma, cancer, back pain, infectious disease, and respiratory diseases. * Participants in the HASD&IC 2013 CHNA community forums recommended increased health information and community health education as the most important factor in maintaining health. Participants in community forums held in Oceanside and Escondido also recommended health screenings. * Data in the HASD&IC 2013 CHNA revealed a higher rate of hospital discharges due to cardiovascular disease and obesity within SDC's more vulnerable communities (City Heights, National City, etc.). * In 2012, heart disease was the second leading cause of death for SDC and cerebrovascular disease was the fifth leading cause of death for SDC. Together, these conditions were responsible for nearly 30 percent of deaths in SDC. * In 2012, the number of arthritis-related hospitalizations in SDC totaled 10,241; an age-adjusted rate of 323.2 per 100,000 population. * In 2012, females in SDC had a higher ED discharge rate for arthritis-related diagnosis than males (579.9 and 459.7 per 100,000 population, respectively). Blacks had a higher ED discharge rate for arthritis-related diagnosis than persons of other racial or ethnic groups, and persons 65 and older had higher ED discharge rates for arthritis-related diagnosis than other persons. * According to the CDC, arthritis is the nation's most common cause of disability. An estimated 52.5 million U.S. adults (more than one in five) report doctor-diagnosed arthritis. As the U.S. population ages, these numbers are expected to increase to 67 million by 2030, and more than one-third of these adults will report arthritis-attributable activity limitations (CDC, 2012). * According to the National Institutes of Health (NIH), more than 52 million people in the U.S. either already have osteoporosis or are at high risk due to low bone mass. Along with the financial costs, osteoporosis can reduce quality of life for many people who suffer fractures. It can also affect the lives of family members and friends who serve as caregivers (NIH, 2014). * According to 2011 data from the CHIS, the self-reported obesity rate for adults ages 18 and older in SDC was 22.1 percent. * In 2011, 12.1 percent of adults ages 18 and older in SDC self-reported eating at fast-food restaurants four or more times each week (CHIS, 2011). * According to the CDC, obesity increases the risk of many health conditions, including: coronary heart disease; stroke; high blood pressure; Type 2 diabetes; various cancers; high total cholesterol; high levels of triglycerides; liver and gallbladder disease; sleep apnea and respiratory problems; osteoarthritis; mental health conditions and reproductive health complications such as infertility (CDC, 2011). * According to the CDC, obesity-related conditions include heart disease, stroke, Type 2 diabetes, and certain types of cancer. These are some of the leading causes of preventable death. The CDC reports that approximately 34.9 percent of U.S. adults are obese. Objectives * Coordinate and host a variety of health education and wellness offe”

“The Pavilion also offers the Community Health Library at the Cushman Wellness Center. The library features DVDs, CDs, books, pamphlets and access to the Internet to help patients and community members locate reliable health information in various languages. The Community Health Library is led by a consumer health librarian with a specialty in community health, as well as a store manager with expertise in health-related gifts, assisted devices and community health resources. To keep the public regularly informed of pertinent health news and information, the library publishes and distributes a quarterly newsletter, as well as a classroom community calendar for the Pavilion. In FY 2014, 450 newsletters were mailed and 150 newsletters were electronically delivered to community members each quarter. The library also collaborates with and provides resources to all Sharp entities. Community members can also learn more about the Community Health Library through Sharp.com and may contact the consumer health librarian by email, phone or through the library's webpage. In FY 2014, outreach to the local community was a high priority. The consumer health librarian presented on health literacy topics to approximately 3,000 people at a variety of community organization sites, health fairs and events. This included: talks with seniors through Jewish Family Service of San Diego and the Sharp Senior Health Center Downtown regarding how to partner with their doctors in their own medical care, how to prepare for an appointment with their doctor, and identifying reliable health websites; a nutrition lesson on ChooseMyPlate.gov for Girls with Goals to educate elementary and middle school females about the five food groups that make up the building blocks for a healthy diet; and the provision of health literacy information at the annual San Diego Earth Fair at Balboa Park, the San Diego Steps 4 Health Family Fun Day & Health Fair, the annual Sharp Women's Health Conference, and the 25th annual Women's Resource Fair hosted by the San Diego Volunteer Lawyer Program. The Women's Resource Fair is a unique event designed to provide women, children and teens in need with resources and services including applying for public benefits, confidential legal assistance, job skills, education and employment counseling, self-defense, mental health services, personal care and more. During this event, the consumer health librarian provided health resources to attendees who often lack the internet access needed to obtain such information. SMH also provided first-aid booths, health screenings and health information at numerous community-sponsored health fairs and events, including the Rock 'n' Roll Marathon, the Healthy Living Festival, Touch a Truck at Qualcomm Stadium, San Diego Earth Fair, San Diego Crew Classic, December Nights, the AHA Heart & Stroke Walk, and Finish Chelsea's Run. Various hospital departments also provided health services and education at Sharp's annual Women's Health Conference, including but not limited to: breast self-exam demonstrations; genetics and nutrition information; chair massage; acupuncture; sleep apnea assessment; pre-osteoporosis heel bone density scans; and bone health education on calcium and vitamin D requirements, exercise, and treatment and prevention. In addition, SMH provided coordination, support and related fundraising activities for various nonprofit organizations in FY 2014, including the AHA Heart & Stroke Walk, Susan G. Komen Race for the Cure , and the San Diego Blood Bank (through quarterly blood drives). To support families with children who have a loved one in the medical intensive care unit (MICU), the SMH Community Health Library created and piloted a booklet titled You Are Important! Children Visiting in the Medical Intensive Care Unit. Using colorful illustrations and age-appropriate language, the booklet helps parents prepare their children to feel more comfortable about visiting their loved one in the hospita”

“* According to the same report, the most common barriers to receiving effective breast health care access included lack of awareness and knowledge, financial barriers, cultural barriers and emotional factors, while the most common challenges in the current breast health care system included cost of care, quality of providers, lack of communication and education, and language barriers. Increased advocacy, education, funding and partnerships were among the suggestions for improving programs, services and the breast health care system overall. * Between 2006 and 2010, the female breast cancer incidence rate for women in California was 122.1 new cases per 100,000 women per year. Non-Hispanic white women experienced the highest incidence rate at 141.3 new cases per 100,000 women per year (CCR, 2013). * The breast cancer mortality rate between 2006 and 2010 for women in California was 21.8 deaths per 100,000 women per year (CCR, 2013). * According to the CDC, observational studies have shown that patient navigation in complex health systems leads to more complete, timely breast cancer care and earlier stage at diagnosis. Emerging evidence from randomized controlled trials supports this intervention in high-risk populations. * According to the CDC, cancer survivors face many physical, emotional, social, and financial problems as a result of their cancer diagnosis and treatment. Cancer survivorship affects not only the cancer patient, but also family members, friends, and neighbors who often help with daily tasks. * According to the American Cancer Society (ACS), a total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the U.S. in 2014. California is projected to have the most new cancer cases (171,730) and the highest number of deaths (57,950) (ACS, 2014). * Healthy People 2020 has multiple objectives for reducing various cancer types, with an overall cancer death rate reduction goal of 10 percent, from 179.3 cancer deaths per 100,000 in 2007 (age-adjusted to 2,000 standard population) to 161.4 deaths per 100,000 population. * According to a 2014 report from the American Cancer Society (ACS), California Cancer Facts & Figures, screening offers the ability for secondary prevention by detecting cancer early. Regular screening that allows 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. Objective * Provide cancer education, support services and patient navigation to the community FY 2014 Report of Activities In FY 2014, the SMH Cancer Institute offered a variety of educational classes and support groups, and participated in numerous community events in support of community members impacted by cancer. Approximately 2,600 community members, patients and families were reached through these efforts. Educational classes in FY 2014 reached about 1,300 patients and community members, including a Food for Life Cooking Series; Nutrition and Cancer; Breast Cancer Education; Ovarian Cancer Education; Cancer and Genetics; Exercise and Stress Management; Cancer and the Arts; Healthy Steps, a weekly exercise class focused on gentle, therapeutic exercises using the Lebed method to aid the lymphatic system and improve overall strength and flexibility; and a monthly Cancer Lunch and Learn series for individuals and families impacted by cancer, including what to expect following cancer diagnosis and treatment and family survivorship. The Cancer Institute also held two lymphedema seminars in FY 2014 providing community members with education on risk factors, steps for prevention and next steps for dealing with lymphedema. Uninsured participants at risk for or suffering from lymphedema were referred to appropriate preventive services as well as community resources for need-based com”

“* In 2012, accidents (unintentional injuries) were the sixth leading cause of death for SDC residents. * In 2012, there were 989 deaths due to unintentional injury in SDC. The region's age-adjusted death rate due to unintentional injuries was 30.5 deaths per 100,000 population. * Unintentional injuries - motor vehicle accidents, falls, pedestrian-related, firearms, fire/burns, drowning, explosion, poisoning (including drugs and alcohol, gas, cleaners and caustic substances), choking/suffocation, cut/pierce, exposure to electric current/ radiation/ fire/ smoke, natural disasters and injuries at work - are one of the leading causes of death for SDC residents of all ages, regardless of gender, race or region. * Between 2010 and 2012, nearly 3,000 San Diegans died as a result of unintentional injuries. * In 2012, there were 22,194 hospitalizations related to unintentional injury in SDC. The age-adjusted rate of hospitalizations due to unintentional injury was 692.8 per 100,000 population. * In 2012, there were 161,467 unintentional injury-related ED discharges in SDC. The age-adjusted rate of visits due to unintentional injury was 5,097.2 per 100,000 population. * Injury, including both intentional and unintentional, is the number one killer and disabler of persons ages one to 44 in California (California Department of Public Health, 2010). * According to HP 2020, 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 factors (cultural beliefs, attitudes, incentives and disincentives, laws and regulations). Objective * Offer an injury prevention program for children, adolescents and young adults throughout SDC FY 2014 Report of Activities With the partnership and financial support of the Health and Science Pipeline Initiative (HASPI), a dozen schools throughout SDC had the opportunity to provide ThinkFirst/Sharp on Survival speakers to their students. These students have an interest in pursuing careers in health care, and were provided with classroom presentations and the opportunity to participate in a half-day tour of the SMH Rehabilitation Center. Four separate presentations were provided in the city of San Diego, reaching a total of 145 at-risk teenagers. Also in FY 2014, ThinkFirst/Sharp on Survival continued to provide education to SDC's south region, educating more than 60 students on the consequences of poor decision making at Mar Vista High School. Additionally, students received presentations on physical rehabilitation careers within health care through the HASPI program. During these presentations, students also received personal testimonies from individuals, known as Voices for Injury Prevention (VIPs), with traumatic brain or SCI. FY 2015 Plan SMH will do the following: * With funding support from grants, provide educational programming and presentations for local schools and organizations * With grant funding, increase community awareness of ThinkFirst/Sharp on Survival through attendance and participation at community events and health fairs * Continue to evolve program curricula to meet the needs of health career pathway classes as part of the HASPI partnership * Grow partnership with HASPI through participation in conferences and round table events * Through the HASPI partnership, expand educational presentations to schools in North County, South Bay and Coronado * Explore further opportuniti”

“Objectives * In collaboration with local schools, colleges and universities, offer opportunities for students to explore and train for a vast array of health care professions * Provide training for local, national and international health care professionals FY 2014 Report of Activities SMH received MAGNET re-designation in 2013, the highest honor given by the American Nurses Credentialing Center (ANCC) for nursing excellence and quality patient care. SMH has also earned Planetree Patient-Centered Hospital Designation with Distinction, representing the highest level of patient-centered care. In FY 2014, SMH offered students and interns throughout SDC various placement and professional development opportunities. Approximately 440 nursing students and nearly 320 ancillary students from a variety of colleges and universities spent approximately 113,000 hours at SMH in FY 2014. Among some of the program partners were SDSU, Point Loma Nazarene University (PLNU), Azusa Pacific University (APU), California State University San Marcos (CSUSM), University of San Diego (USD), Kaplan College (KC), Palomar College, EMSTA College, Alliant International University, Boston University (BU), San Diego Mesa College (MC) and Southwestern College (SWC). Students from a variety of disciplines were represented including nursing, radiology, pharmacy, physical therapy, occupational therapy, and nutrition. SMH's Clinical Pastoral Education Program provided five chaplain residents with 1,000 hours of clinical training in FY 2014, teaching them theories and skills to help them provide exceptional spiritual care to patients and their families. Through affiliations with SWC, Palomar Community College, EMSTA College, West Med College and National College of Technical Instruction (NCTI), SMH provided both clinical training and observation hours for Emergency Medical Technician (EMT) and paramedic interns. This included 29 EMT students who spent one eight-hour shift in the emergency department (ED), and 51 paramedic interns who spent 144 hours each in clinical training in the ED. The paramedic interns also completed rotations in other hospital areas including labor and delivery, pulmonary, trauma, neonatal intensive care unit (NICU), the operating room (OR) and catheterization lab. SMH staff contributed nearly 7,700 hours of clinical training and supervision to these specialized community programs. Also in FY 2014, SMH and SGH 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 receive certification through San Diego County Emergency Medical Services (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. Additionally, throughout the year, Sharp Rehab social workers provided presentations to students and professionals throughout SDC. These presentations contributed to the advancement and improvement of rehabilitation services in the community, including a lecture to approximately 100 physical therapy students at the University of St. Augustine. SMH also provided a comprehensive two-day course in orthopedic nursing for health care professionals in the community. The course covered a variety of topics, including but not limited to peri-operative nursing, total joint replacement, trauma, bone tumors, spine, metabolic disease and complications. SMH also continued its participation in the HSHMC program to provide early professional development for students at all levels of high school. During the school year, 62 students in 9th grade, 30 students in 10th grade, 16 students in 11th grade, and 17 students in 12th grade spent more than 8,600 supervised hours between SMH and the Pavilion. A variety of hospital areas participated i”

“* Provide a two-day conference for orthopedic nurse certification * Conduct a visiting professorship to provide learning opportunities to community orthopedists, radiologists, as well as student interns and residents in the community Identified Community Need: Support During the Transition of Care Process for High-Risk, Underserved Patients With Complex Medical Needs Rationale references the findings of the SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * Community health leaders participating in the HASD&IC 2013 CHNA process strongly aligned and recommended further work in access to care, health insurance and care management with each of the priority health issues identified for SDC (cardiovascular disease, Type 2 diabetes, mental/behavioral health, and obesity). * Community members participating in the HASD&IC 2013 CHNA community forums (throughout SDC) also strongly aligned access to care and care management with maintaining health. * According to 2011 CHIS data, 22.0 percent of those 18 to 64 years of age in SDC were currently uninsured. * In 2012, 13.86 percent of the population in SDC was living below the poverty level, with 14.58 percent of those families with children. * In 2011, nearly 15 percent of families in SDC received some form of cash public assistance. * In 2012, 6.22 percent of families with children in SDC received food stamps/Supplemental Nutrition Assistance Program (SNAP)/CalFresh benefits. * According to 2011 CHIS data, 83.8 percent of adults in SDC have a usual source of care. Among these adults, 26.9 percent utilize a community clinic, government clinic or community hospital as their usual source of care. * According to 2011 CHIS data, in SDC for those 18 to 64 years of age, the most common sources of health insurance coverage include employment-based coverage (58.3 percent) and public programs (12.7 percent). * As of October 2014, the overall unemployment rate for SDC was 5.8 percent (BLS, 2014). * According to the BLS, the seasonally-adjusted September 2014 rate of persons unemployed for 27 weeks or longer was 31.9 percent. * The cost of living in California is 35 percent above the U.S. average, with health spending per capita in California growing by 5.9 percent between 1994 to 2004 (California Hospital Association Special Report, October 2011). * According to Community Health Improvement Partners (CHIP), between 2006 and 2009, demand for ED services in SDC increased by 11.9 percent, from 582,129 to 651,595 visits (CHIP, 2010). * In 2014, the health insurance benefits available under the Consolidated Omnibus Budget Reconciliation Act (COBRA) cost a single person in California between $487 and $585 per month; for three or more participants on the plan in California, COBRA costs ranged from $1,594.29 to $1,856.77 per month (2014 COBRA Self-Pay Rates, Motion Picture Industry Pension & Health Plans). * Community clinics in California have experienced rising rates of primary care clinic utilization; the number of persons utilizing the clinics increased by 27.3 percent between 2007 and 2011 (Office of Statewide Health Planning and Development, 2011). Objectives * Collaborate with community organizations to provide follow-up medical care, financial assistance, psychiatric and social services to chronically homeless individuals * Assist economically disadvantaged individuals through transportation and pharmaceutical assistance FY 2014 Report of Activities In FY 2014, SMH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the San Diego Rescue Mission, SMH discharged chronically homeless patients to the Rescue Mission's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up care through SMH in a safe environment, and also provides psychiatric care, substance abuse counseling and guidance from the Res”

“Sharp Senior Health Center Clairemont: * Community health services * Primary and comprehensive physical and mental health care services to seniors Section 7 Sharp Mesa Vista Hospital and Sharp McDonald Center FY 2014 Community Benefit Program Highlights Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC) provided $11,714,311 in community benefit in FY 2014. See Table 1 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697. Table 1: Economic Value of Community Benefit Provided Sharp Mesa Vista Hospital and Sharp McDonald Center - FY 2014 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2014 Unreimbursed Costs *Medical Care Services Shortfall in Medi-Cal - $1,712,414 Shortfall in Medicare - $2,970,263 Shortfall in San Diego County Indigent Medical Services - $853,798 Shortfall in CHAMPVA/TRICARE - $559,483 Charity Care and Bad Debt - $4,585,363 *Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy - $511,787 *Other Benefits for the Broader Community Health education and information, support groups, participation in community events, meeting room space, donations of time to community organizations and cost of fundraising for community events - $311,288 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals - $209,915 TOTAL - $11,714,311 Key highlights: * Unreimbursed Medical Care Services included uncompensated care for patients who were unable to pay for services; unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services and CHAMPVA/TRICARE; and financial support for on-site workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; free psychiatric assessments and referrals; programs to address barriers to mental health services for disadvantaged, culturally diverse urban seniors; contribution of time to Stand Down for Homeless Veterans, San Diego Habitat for Humanity and the San Diego Food Bank; the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information on a variety of behavioral health and chemical dependency topics, participation in community health and behavioral health events, and collaboration with local schools to promote interest in health care careers. SMV also offered meeting room space at no charge to community groups. In addition, staff at the hospital actively participated in community boards, committees and other civic organizations, such as Mental Health America (MHA), Residential Care Council, San Diego Suicide Prevention Council, Community Health Improvement Partners (CHIP) Behavioral Health Work Team, California Mental Health Coalition, Partners in Treatment Work Team, Association of Ambulatory Behavioral Healthcare, Employee Assistance Professionals Association (EAPA), A New PATH (Parents for Addiction, Treatment and Healing), California Board of Behavioral Health Sciences, Psychiatric Emergency Response Team (PERT) and Serving Seniors (formerly Senior Community Centers of San Diego). See Appendix A for a listing of Sharp community involvement. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Programs included education and training of health care professionals and student and intern supervision. Definition of Community * Sharp Mesa Vista Hospital is located at 7850 Vista Hill Avenue in San Diego, ZIP code 92123. * Sharp McDonald Center is located at 7989 Linda Vista Road in San Diego, ZIP code 92111. * SMV Mid-City Outpatient Pro”

“* Incorporate community priorities and community relations into their strategic plans and develop specific programmatic goals * Estimate an annual budget for community programs and services, based on community needs, the prior year's experience and current funding levels * Host a bimonthly committee to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMV 2013 CHNA and SMC 2013 CHNA Through the SMV 2013 CHNA and the SMC 2013 CHNA, mental/behavioral health was identified as a priority health need for SDC. Although additional priority health needs were identified for SDC through the 2013 CHNA process, as specialty hospital facilities providing behavioral health and chemical dependency programs and services, these additional identified health issues (cardiovascular health, diabetes, and obesity), fall outside the scope of services provided by SMV and SMC. Thus, these identified health needs are not addressed in the community benefit report for these two hospitals. In alignment with the identified need of mental/behavioral health, the following pages detail programs that specifically address: * Mental health and substance abuse education and support for the community * Improving outcomes for seniors at risk * Mental health and substance abuse education for health care professionals and students, and collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2014 Report of Activities conducted in support of the objective(s), and FY 2015 Plan of Activities. Identified Community Need: Mental Health and Substance Abuse Education for the Community Rationale references the findings of the SMV and SMC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMV and SMC 2013 CHNAs identified mental/behavioral health as the priority health issue for community members served by SMV and SMC. * The Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA identified mental/behavioral health as one of the top four priority health issues for community members in SDC. * The following conditions were identified in the SMV and SMC 2013 CHNAs as priority behavioral health issues in SDC: anxiety; trauma - particularly with San Diego's military population; mood disorders including depression and bipolar disorder; personality disorders - especially antisocial personality disorder with indigent individuals or individuals with co-occurring disorders; and chemical dependency. * Community health leaders participating in the SMV 2013 CHNA process identified stigma as a significant barrier to improving the behavioral health in SDC. * Community member input from the SMV and SMC 2013 CHNAs revealed the concern for and need for specific attention to co-occurring disorders - behavioral health disorders that include both mental health and substance abuse issues. * In general, data presented in the HASD&IC 2013 CHNA revealed a higher rate of hospital discharges due to behavioral/mental health in more vulnerable communities within SDC. * In 2012, Alzheimer's disease and suicide were the third and eighth leading causes of death for SDC, respectively. * In 2012, the age-adjusted death rate due to suicide was 12.8 deaths per 100,000, less than the HP 2020 target of 10.2 deaths per 100,000. * Mood disorders (depression, bipolar disorder), schizophrenia and other psychotic disorders, and self-inflicted injury were presented as the top three highest hospitalization rates for SDC in 2011. * In 2011, anxiety disorders, mood disorders, schizophrenia and other psychotic disorders demonstrated the highest visit rates in the ED for SDC. * In 2012, the age-adjusted rate of self-inflicted injury ED discharges in SDC was 80.5 per 100,000 population. * From 200”

“Throughout the year, SMV provided its Veterans Engaging in Supportive Treatment (VEST) program to military members and their families in order to meet the needs of veterans of the wars in Iraq and Afghanistan. The program provides a safe environment for veterans to learn effective methods for managing symptoms of post-traumatic stress disorder (PTSD) or acute stress, and includes services for spouses and family members who experience distress when their loved one returns with war- or trauma-related symptoms. VEST program team members also provide education on reducing the stigma of mental health issues in the military community as well as available resources. In addition, the VEST program continues to participate in the San Diego Military Family Collaborative, which meets monthly to discuss services for military members and their families in the community. SMV and SMC also collaborated with partners in the military community through participation in events such as the Veteran's Wellness Fair at Balboa Park and the Community Mental Health Summit at the Veterans Affairs (VA) San Diego Medical Center. SMV and SMC provided behavioral health education and resources to approximately 550 community members at these events. In FY 2014, SMV and SMC sponsored and participated in six walks to increase awareness and raise funds for mental health services, including the NAMI Walk, American Foundation for Suicide Prevention's Out of the Darkness Community Walk, Save a Life San Diego/Yellow Ribbon (for suicide prevention) Walk, National Eating Disorders Association Walk, San Diego Alzheimer's Association Annual Memory Walk and the American Heart Association's Heart & Stroke Walk. Throughout 2014, SMV attended several health and wellness fairs, conferences and events. At the Trauma Across the Lifespan Conference, SMV provided a resource booth with information and education on childhood trauma for professionals. SMV also provided information on services and intake processes at the Psychiatric Emergency Response Team Academy Resource Fair, a quarterly training event where SDC police officers are trained to be psychiatric emergency responders. SMV participated in other health fairs including the SanDi-CAN Wellness & Resource Expo and the Sharp HealthCare Behavioral Health Summit, as well as provided education and resources at the Child Mental Health Conference, the Make the Best of Your Options conference and the Coming Back with Wes Moore event. The latter event included conversations with Wes Moore, a renowned author and veteran, and local veterans to explore the challenges and triumphs facing veterans and their families. SMV also hosted a San Diego Film Festival Screening of the 1990 Robin Williams movie Awakenings at the Arclight Cinemas La Jolla to raise suicide awareness. The event included an expert group of panelists to discuss suicide and SMV provided a question and answer session following the film. SMV sponsored and participated in several events in FY 2014, benefitting organizations such as the Alzheimer's Association, Mental Health Systems, NAMI and Jewish Family Service Behavioral Health Committee. SMV also sponsored and participated in the Strut for Sobriety event benefitting A New PATH, a nonprofit organization focused on reducing the stigma associated with addictive illness through education. In addition, SMV sponsored and participated in MHA's annual Meeting of the Minds educational conference, and also sat on the MHA board, which helps guide and facilitate educational opportunities in behavioral health. SMV also hosted and participated in monthly EAPA forums which focus on increasing knowledge and education in the behavioral health professional community. In FY 2014, SMV continued its involvement in and support of an important initiative to improve housing conditions for community members living with serious, persistent mental illness. In 2012, a work team including CHIP, housing organizations and other community partners, secu”

“* Explore and expand collaborations with law enforcement and housing planning committees to provide better outcomes for community members living with mental illness and substance abuse issues * Continue serving as the media's go-to experts for information on mental health conditions and treatment * Continue to strategically align with nonprofit allies and key community partners through board and committee memberships * Through grant funding, provide additional follow up staff for at-risk patients post-discharge * Explore diversified collaboration with Gary and Mary West Senior Wellness Center to provide services to meet the unmet needs of the severely mentally ill in San Diego's downtown area, including seniors, children and adolescents * Explore working with multi-cultural groups * Expand collaborations and partnerships with community partners Identified Community Need: Improving Outcomes for Seniors at Risk Rationale references the findings of the SMV and SMC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * Key informant interviews conducted in the SMV 2013 CHNA identified Alzheimer's disease among the chief health concerns for San Diego seniors. * Attendees of community forums held during the HASD&IC 2013 CHNA process identified Alzheimer's disease and dementia as one of the top five priority health needs for SDC. * In 2012, Alzheimer's disease was listed as one of the top ten leading causes of death for SDC residents ages 65 to 84 years, and the third leading cause of death for residents ages 85 and up. * In 2011, the emergency department (ED) discharge rate for SDC seniors with a mental illness or depression diagnosis was 442.4 per 100,000 population. * In 2011, the hospitalization rate for seniors in SDC with a principal diagnosis of mental illness or depression was 625.3 per 100,000 population. * In 2012, the suicide rate for SDC seniors (ages 65 and up) was 18.4 per 100,000 population. * According to 2011 CHIS data, 5.5 percent of adults over the age of 65 in SDC thought about committing suicide in the past year. * According to 2011 CHIS data, 8.1 percent of adults over the age of 65 in SDC reported needing help for emotional/ mental health problems or alcohol-drug issues in the past year, however only 6.7 percent of adults over the age of 65 in SDC saw a health care provider for emotional mental health problems or alcohol-drug issues in the past year. * Older adults at particularly high risk for depression include those who are unmarried, widowed or lack a strong social support network (NAMI, 2009). * According to the International Journal of Geriatric Psychiatry, a study of how uninsured or publicly insured older adults with severe mental illness access mental health services in SDC revealed that older adults were more likely to access the public mental health system's Psychiatric Emergency Response Team (PERT), a combined law-enforcement and psychiatric service that responds to psychiatric-related 911 calls. Older adults were also less likely to receive follow-up care, due to both the initial site of service - and an associated lower rate of follow-up among PERT clients - as well as a lower rate of follow-up among older adult clients initiating services in other sectors (Gilmer, et al., 2009). * According to the Community Mental Health Journal, in a qualitative study of unmet mental health needs of Latino older adults in SDC, barriers to appropriate mental health care included housing, transportation and social support, as well as language and cultural barriers secondary to a lack of translators, lack of information on available services, and scarcity of providers representative of the Latino community (Barrio, et al., 2008). * According to the 2012 San Diego Association of Governments (SANDAG) Survey of Older Americans Living in San Diego County, almost half of the respondents (46 percent) either strongly or somewhat agreed that isola”

“Rationale references the findings of the SMV and SMC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * For the HASD&IC 2013 CHNA, community health leaders and key informants surveyed closely aligned care management with meeting the mental health/behavioral health needs of SDC community members. * The 2008 County of San Diego Mental Health Services Workforce Education and Training (WET) Needs Assessment revealed that the lack of a clearly defined career pathway in mental health before the graduate level of education poses a challenge to SDC's behavioral health workforce. * According to the 2008 County of San Diego Mental Health Services WET Needs Assessment, challenges in attracting and hiring mental health staff in SDC include the perceived low status of mental health careers, the under-representation of diverse cultural groups in higher education, and the intense competition for bilingual staff. * According to the same report, an important component of strengthening the mental health workforce involves increasing the relevance, effectiveness and accessibility of training and education. * A report from the San Diego Workforce Partnership in 2010 sites that despite the growing demand for health care workers, employers express an "experience gap" among recent graduates as a challenge to filling open positions. While new graduates often possess the requisite academic knowledge to be hired, they lack real world experience. * The same report recommended that programs provide volunteer experiences to high school and post-secondary students, as on-the- job training could provide real world experience for workers. Programs that target underrepresented groups and disadvantaged students could help increase the number of culturally competent health care workers. * According to a 2008 report from the World Health Organization, mental disorders create an enormous toll of suffering, disability and economic loss. Despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment. Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. Education and training of health workers is essential for mental health to be integrated successfully into primary care. * According to a California OSPHD report from September 2014, California's public mental health system suffers from a critical shortage of qualified mental health personnel to meet the needs of the diverse populations they serve. There are critical issues such as the poor distribution, lack of diversity, and under-representation of practitioners across disciplines with cultural competencies, including consumers and family members with lived experience to provide consumer and family-driven services that promote wellness, recovery and resilience. * Employment of mental health and substance abuse social workers is projected to grow 23 percent from 2012 to 2022, much faster than the average for all occupations. Employment will grow as more people seek treatment for mental illness and substance use disorders. Because drug offenders are increasingly being sent to treatment programs rather than jail, use of substance abuse treatment programs is expected to grow, increasing demand for these specialists (BLS, 2014). * According to a March 2014 report from the California Hospital Association, programs supported by local hospitals make tremendous impacts on the lives of individuals, families and communities. This includes contributions of time and resources dedicated to the thousands of interns and high school students that spend time in California hospitals each year, gaining valuable work experience and career exposure. Objectives * Provide internship and clinical training programs in psychology, social work, marriage and family therapy (MFT”

“In addition, SMV and SMC provided 15 educational offerings for behavioral health care professionals in FY 2014, including continuing education classes, conferences and trainings. SMV and SMC provided education to a variety of audiences including psychologists, psychiatrists, community physicians, social workers, nurses and other health and human service providers, as well as the community at large. Topics covered included wellness and resilience, recognizing stress, substance abuse, self-injury, dual diagnosis, eating disorders, sleep disturbances, treating depression, geriatric mental health and cultural considerations in the treatment of Latino populations. SMV staff also participated in and provided educational resources to four of San Diego's PERT police officer trainings on understanding psychiatric emergencies and community psychiatric services. SMC also hosted educational events for the EAPA and provided education and resources to approximately 20 community members each month. The presentations covered current concerns in behavioral health care, evidence-based therapies and emerging treatment models. Throughout FY 2014, staff at SMV and SMC regularly led or attended various health boards, committees, and advisory and work groups. Community and professional groups included Association of California Nurse Leaders (ACNL); San Diego Suicide Prevention Council; San Diego Military Family Collaborative; American Hospital Association's Regional Policy Board 9; American Psychiatric Nurses Association, American Nurses Association, California Hospital Association; California Mental Health Coalition; EAPA forums; Inner City Action Network; Live Well San Diego; Partners in Treatment Work Team; San Diego Mental Health Coalition; San Diego County Older Adult Council; San Diego County Alzheimer's Task Force; American Health Information Management Association; Mesa College Health Information Technology (HIT) Program Advisory Committee; Kaplan College HIT Program Advisory Committee; San Diego Health Information Association; Jewish Family Service Strategic Planning Committee-Vision Team; CHIP Behavioral Health Work Team; CHIP ILA Advisory Board and Peer Review Advisory Team; Journal for Nursing Care Quality Editorial Board; American Academy of Nursing; California Association of Marriage and Family Therapists; International Association of Eating Disorder Professionals; NAMI; MHA; HASD⁣ American Foundation for Suicide Prevention; Jewish Federation of San Diego County - Jewish Senior Services Council; Serving Seniors; ACHE; Association for Ambulatory Behavioral Healthcare; California Board of Behavioral Sciences; California Hospital Association Center for Behavioral Health; CHIP Suicide Prevention Work Team; A New PATH; and Residential Care Council. FY 2015 Plan SMV or SMC will do the following: * Offer internship programs and clinical training programs in psychology, social work, MFT, health information technology and pharmacy * Serve as a placement site for medical, nursing students, psychology, pharmacy, MFT and social work students * Provide educational offerings for behavioral health care professionals, community groups and community members * Actively participate on boards, committees, and advisory and work groups to address behavioral health issues * Continue the mental health careers curriculum within the HSHMC program, and provide students with experience in a broad range of programs including therapeutic activities services, environmental services, and health information services SMV and SMC Program and Service Highlights Sharp Mesa Vista Hospital: * Child, adolescent, adult and older adult inpatient and outpatient psychiatric and chemical dependency services * On and off-campus specialty outpatient programs treating seniors, eating disorders, trauma, chronic pain, opiate dependence and dual diagnosis * Cognitive behavioral therapy and dialectical behavioral therapy programs * Outreach to military members and their families thro”

“* Health Insurance Counseling and Advocacy Program (HICAP) * Health Volunteers Overseas * Heart to Heart International * Helen Woodward Animal Center * Helix Charter High School * Helps International * Home of Guiding Hands * Hospice-Veteran Partnership (HVP) * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * Health Sciences High and Middle College (HSHMC) Board * I Love a Clean San Diego * International Association of Eating Disorders Professionals (IAEDP) * International Lactation Consultants Association (ILCA) * International Relief Team (IRT) * Ioamai Medical Ministries * Jewish Family Service of San Diego * Jewish Federation of San Diego County - Jewish Senior Services Council * John Brockington Foundation * Journal for Nursing Care Quality Editorial Board * Kaplan College Advisory Board * Kiwanis Club of Chula Vista * Komen Latina Advisory Council * Komen Race for the Cure Committee * La Maestra Family Clinics * La Mesa Lion's Club * La Mesa Park and Recreation Foundation Board * Las Patronas * Las Primeras * March of Dimes * Meals-on-Wheels * Medical Library Group of Southern California and Arizona * Mended Hearts * Mental Health America (MHA) * Mental Health Coalition * Miracle Babies * MRI Joint Venture Board * National Alliance on Mental Illness (NAMI) * National Association of Neonatal Nurses (NANN) * National Association of Hispanic Nurses (NAHN), San Diego Chapter * National Hospice and Palliative Care Organization (NHPCO) * National Initiative for Children's Healthcare Quality (NICHQ) * National Kidney Foundation * National University (NU) * Neighborhood Healthcare Community Clinic * North County Health Project * NurseWeek * Pacific Arts Movement (Pac-Arts, formerly the San Diego Asian Film Foundation) * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Professional Oncology Network (PON) * Project CARE * Project Compassion * Public Health Nurse Advisory Board * Recovery Innovations - California * Regional Perinatal System (RPS) * Residential Care Council * Safety Net Connect * San Diego Community Action Network (SanDi-CAN) * San Diegans for Healthcare Coverage * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Brain Injury Foundation * San Diego Community Care Transitions Partnership (SDCCTP) * San Diego Center for Children * San Diego City College * San Diego City Parks and Recreation * San Diego Council on Suicide Prevention * San Diego County Breastfeeding Coalition * San Diego County Coalition for Improving End-of-Life Care (SDCCEOL) * San Diego County Council on Aging (SDCCOA) * San Diego County Emergency Medical Care Committee * San Diego County Health and Human Services Agency (HHSA) * San Diego County Perinatal Care Network * San Diego County Social Services Advisory Board * San Diego County Stroke Consortium * San Diego County Taxpayers Association * San Diego Dietetic Association Board * San Diego East County Chamber of Commerce Board * San Diego Emergency Medical Care Committee (EMCC) * San Diego Eye Bank Nurses Advisory Board * San Diego Food Bank * San Diego Half Marathon * San Diego Health Information Association * San Diego Healthcare Disaster Council * San Diego Hospice and Palliative Nurses Association (HPNA) * San Diego Housing Commission (SDHC) * San Diego Imperial Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. (The Center) * San Diego Mental Health Coalition * San Diego Mesa College (MC) * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders (SOHL), a local ACHE Chapter * San Diego Patient Safety Consortium * San Di”