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 2014.”

“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 -9,327,263. Bone Marrow Program reported on Sharp HealthCare's return 1,574,461.”

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

“Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2015 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; 22 medical centers; five urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp 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, 2015, Sharp is licensed to operate 2,088 beds and has approximately 2,600 Sharp-affiliated physicians and more than 17,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in San Diego County's rapidly expanding South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the South Bay's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women and infants, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. Sharp Grossmont Hospital (528 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, orthopedics, rehabilitation, robotic surgery, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in 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 licensed 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 (158 licensed 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 licensed 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. The operations of Sharp HospiceCare are reported within SGH. 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 ser”

“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 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: *Quality - Demonstrate and improve clinical excellence to set industry standards and exceed customer expectations. *Safety - Keep patients, employees and physicians safe and free from harm. *Service - Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence. *People - Create a values-driven culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp's mission and vision. *Finance - Achieve financial results to ensure Sharp's ability to provide quality health care services, new technology and investment in the organization. *Growth - Achieve consistent net revenue growth to enhance market dominance, sustain infrastructure improvements and support innovative development. *Community - Be an exemplary community citizen by improving the health and well-being of 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 and 2014 World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp is the only health care company in San Diego recognized in both years. 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," 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 was named "Best Hospital Group" by U-T San Diego readers participating in the paper's 2015 "Best of San Diego" Readers Poll. In 2015, SMBHWN was named "Best Hospital," while SGH and SMH were ranked second and third "Best Hospitals." Sharp Community Medical Group (SCMG) and Sharp Rees-Stealy Medical Group (SRSM) were ranked first and second, respectively, in 2015 as San Diego's "Best Medical Group." 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 redesignated in March 2013. Sharp was named one of the nation's "Most Wired" health care systems from 1999 to 2009, and again from 2012 to 2015 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 2014, SCVMC and its on-site Birch Patrick Convalescent Center became the first co-located hospital and skilled nursing facility in th”

“In 2015, Sharp was ranked fourth in the large employers category as one of the "Best Places to Work" for Information Technology (IT) professionals by the International Data Group's (IDG) Computerworld survey. The list is compiled by the following criteria: benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. In 2015, SGH and SMBHWN received a 2015 Women's Choice Award - a symbol of excellence in customer experience awarded by the collective of women. SGH was recognized as one of America's Best Hospitals for Cancer Care and SMBHWN was recognized as one of America's Best Hospitals for Obstetrics. For the third year in a row, and the fourth time in five years, Sharp HealthCare won the top spot in the Mega Employer category in the Rideshare 2015 Challenge. The month-long challenge encouraged the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or transit commutes. Powered by San Diego Association of Governments (SANDAG) and in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Patient Access to Care Programs Uninsured patients with no ability to pay and insured patients with inadequate coverage receive financial assistance for medically necessary services through Sharp's Financial Assistance Program. Sharp does not refuse any patient requiring emergency medical care. Sharp provides services to help every unfunded patient received in the 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 2015, Sharp helped guide approximately 85,910 self-pay patients through the maze of government health coverage programs while maintaining the patient's dignity throughout the process. Beginning in 2014 Sharp hospitals implemented an on-site 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 2,198 unfunded patients in the ED during FY 2015. In support of Covered California's annual open enrollment period, 14 members of Sharp's registration staff have become Certified Application Counselors in order to better assist both patients and the general community with navigating 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. 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, social work, nursing, physicians or even other patients. If eligible, uninsured patients are offered assistance, which can help decrease readmission”

“Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships, financial aid and career pipeline programs. In FY 2015, more than 4,600 student interns dedicated nearly 680,000 hours within the Sharp system. Students belonged to a variety of disciplines including nursing, allied health and professional educational programs. Sharp provided education and training programs for nursing students (e.g., critical care, medical/surgical, behavioral health, women's services and wound care) and allied health professions such as rehabilitation therapies (speech, physical, occupational and recreational therapy), pharmacy, respiratory therapy, imaging, cardiovascular, dietetics, lab, radiation therapy, surgical technology, paramedic, social work, psychology, business, health information management and public health. Students came from local community colleges such as Grossmont College, San Diego City College, San Diego Mesa College (MC) and Southwestern College (SWC); local and national university campuses such as Point Loma Nazarene University (PLNU), San Diego State University (SDSU), University of California, San Diego (UCSD), and University of San Diego (USD); and vocational schools such as Kaplan College. Table 1 presents the number of students and student hours at each of the Sharp entities in FY 2015. Table 1: Sharp HealthCare Internships - FY 2015 Sharp Chula Vista Medical Center Nursing 842 Students 60,662 Group Hours 20,398 Precepted Hours Ancillary 172 Students 37,627 Hours Total 1,014 Students 118,687 Hours Sharp Coronado Hospital and Healthcare Center Nursing 590 Students 92,510 Group Hours 3,024 Precepted Hours Ancillary 77 Students 21,127 Hours Total 667 Students 116,661 Hours Sharp Grossmont Hospital Nursing 732 Students 62,492 Group Hours 16,643 Precepted Hours Ancillary 238 Students 54,200 Hours Total 970 Students 133,335 Hours Sharp Mary Birch Hospital for Women & Newborns Nursing 207 Students 15,204 Group Hours 5,184 Precepted Hours Ancillary 15 Students 4,486 Hours Total 222 Students 24,874 Hours Sharp Memorial Hospital Nursing 404 Students 29,451 Group Hours 18,902 Precepted Hours Ancillary 310 Students 73,998 Hours Total 714 Students 122,351 Hours Sharp Mesa Vista Hospital Nursing318 Students 22,642 Group Hours 3,524 Precepted Hours Ancillary 38 Students 23,106 Hours Total 356 Students 49,272 Hours Sharp HospiceCareNursing 74 Students 674 Precepted Hours Total 74 Students 674 Hours Sharp HealthCareNursing 387 Students 60,843 Precepted Hours Ancillary 223 Students 52,947 Hours Total 610 Students 113,790 Hours Total Nursing 3,554 Students 282,961 Group Hours 129,192 Precepted Hours Ancillary 1,073 Students 267,491 Hours Total 4,627 Students 679,644 Hours Health Sciences High and Middle College Sharp is an industry partner with charter school 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. HSHMC students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. 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. Students also devote time to various SRS sites. Students begin their experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of t”

“Innovation is critical to the future of health care. The Sharp HealthCare Center for Research supports innovation through its commitment to safe, high quality research initiatives that provide valuable knowledge to the San Diego health care community, and positively impact patients and community members. Currently, more than 350 active protocols are being conducted at Sharp. The Center for Research is also seeking accreditation by the Association for the Accreditation of Human Research Protection Programs (AAHRPP) for accreditation of Sharp's HRPP. Accreditation by AAHRPP indicates that an organization follows rigorous standards for ethics, quality, and protections for human research, and acts as a public affirmation of the organization's commitment to protecting research participants. The Center for Research anticipates accreditation by March 2016. Sharp Human Research Protection Program and Institutional Review Board The Sharp Center for Research's Human Research Protection Program (HRPP) is responsible for the ethical and regulatory compliant oversight of research being conducted at Sharp. There are three components to the Center for Research's HRPP: the organization, the researchers and the Institutional Review Board (IRB). The IRB is the largest component of the HRPP and seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants are required to be reviewed by Sharp's IRB in order to protect participant safety and maintain responsible research conduct. In FY 2015, a dedicated IRB committee of 14 - including physicians, psychologists, research nurses and pharmacists - devoted hundreds of hours to the review and analysis of both ongoing and new research studies. Research is conducted on all phases of drug and device development and spans from research with newborns to older adults with Alzheimer's disease. This includes clinical trials that add to scientific knowledge and enable health care providers to learn whether a new treatment is safe and effective. Sharp conducts clinical trials in behavioral health, neonatal, cardiovascular, mechanical circulatory support, renal transplant, orthopedics, stroke and oncology, the latter of which comprises the majority of Sharp's clinical trials. The Center for Research's HRPP also provides education and support both for researchers across Sharp and the broader San Diego health and research communities on requirements regarding the protection of human research participants. As part of its mission, the Center for Research hosts quarterly meetings on relevant educational topics to the research community, including physicians, psychologists, research nurses, study coordinators and students throughout San Diego. Recent presentations have included Investigator Quality Improvement Activities; Understanding Research Noncompliance, Serious Noncompliance and Continuing Noncompliance; and Risks to Subjects - It's Not Just Physical. Sharp Outcomes Research Institute The Sharp Outcomes Research Institute (ORI) began in 2010 as a pilot initiative funded by the Sharp HealthCare Foundation. The ORI facilitates interdisciplinary research on health care practices in order to identify and promote quality patient care across the health care community. The ORI collaborates with Sharp team members by facilitating the design of patient-centered outcomes research projects; assisting with database development as well as data collection and analysis; exploring funding mechanisms for research projects; and facilitating IRB application submissions. A priority for the ORI is to seek guidance and expertise from the local and national academic community on how to effectively conduct outcomes research in order to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University (NU). The ORI has also dev”

“The San Diego Food Bank (SDFB) feeds people in need throughout SDC, advocates for the hungry, and educates the public about hunger-related issues. On 16 days between February and September 2015, 960 SLAH volunteers inspected, cleaned and sorted donated food, assembled boxes and cleaned the SDFB warehouse. For two days in March, 100 SLAH volunteers provided registration, gear-check, water stop and finish-line support at the San Diego Half Marathon. This premier race raises money for vulnerable communities including the Skinny Gene Project, a division of the J. Moss Foundation that addresses the environment-based issues that affect a person's ability to prevent diabetes. With all net proceeds going towards service projects and select charitable causes in San Diego, the race inspires volunteerism as a way to help struggling communities throughout the city. Also in March, 40 SLAH volunteers joined the Friends of Ruffin Canyon in the Ruffin Canyon Clean-Up. Located in Serra Mesa, the Ruffin Canyon Open-Space Preserve consists of 84 acres of natural open space, including native plant-life and primitive trails. The Friends of Ruffin Canyon fosters community participation in the protection of Ruffin Canyon's unique habitat. Volunteers picked up trash and debris, pulled weeds, installed native plants and helped maintain the trail. To support the nearly one million San Diegans with diabetes or prediabetes, SLAH volunteers participated in the Tour de Cure 2015, a fundraising cycling event benefitting the American Diabetes Association (ADA). For two days in April, more than 60 SLAH volunteers assisted with pre-event packet pick-up, and day-of event registration, T-shirt distribution and medical care. By volunteering their time, SLAH participants helped to ensure that more funds go toward the ADA's mission to prevent, cure and improve the lives of all people affected by diabetes. On nine days in June and July, 360 volunteers participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego to provide community-based social services to veterans without a permanent residence. Volunteers gathered at the Veteran's Village Warehouse in El Cajon and at San Diego High School where they sorted and organized clothing donations and offered companionship to more than 800 of San Diego's homeless veterans. In addition, Sharp medical doctors and nurses offered medical assistance, while Sharp pharmacists and licensed pharmacy technicians provided support, counseling and dispensing of medications. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by spinal cord injury through action sports. With support from adaptive equipment and volunteers, the award-winning series of bicoastal events empowers paraplegics and quadriplegics to experience mobility through surfing. In September, nearly 90 volunteers assisted Life Rolls On - They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. Approximately 40 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in March and the San Diego River Garden in Mission Valley in May. Activities included trail maintenance, watering, pruning and other light gardening projects. In July, SLAH volunteers joined the foundation once again for the Coastal Habitat Restoration event in Ocean Beach to help save and restore one of the last remaining coastal dune and wetland habitats in San Diego. Twenty volunteers helped remove invasive plants, watered and cared for recent plantings, and provided trail maintenance and litter removal. Sharp Humanitarian Service Program In”

“In collaboration with the founder of COMPASSION IT - a nonprofit organization and social movement that inspires compassionate actions in the daily lives of individuals around the world - a Sharp team member traveled to Botswana for a two-week mission trip. Working with the Botswana Ministry of Health, the Ministry of Education and Skills Development, various nongovernment organizations, and Botho (an organization that aims to nurture compassion), they provided compassion training to more than 500 citizens of Botswana. Audience members were from education and social service sectors, including physicians, social workers, nurses, teachers, police officers, orphanage caregivers and students. With the rising prevalence of empathy fatigue and burnout among service providers, the training supports emotional resilience, broadens perspectives and provides practical application during difficult or stressful situations. The training was based on Compassion Cultivation Training (CCT) developed by the Center for Compassion and Altruism Research and Education (CCARE) at the Stanford University School of Medicine as well as other mindfulness and self-compassion curricula, and was also supported by a Sharp IRB study. Following the mission, electronic support was provided to participants for eight weeks. In February, a Sharp team member participated in a 10-day trip to San Lucas Toliman in the highlands of southwestern Guatemala to build and renovate homes for Mayan families. This trip was organized by the Global Village volunteer program through Habitat for Humanity, a nonprofit Christian housing organization that believes everyone should have a decent, safe and affordable place to live. Three teams of six volunteers rotated between working on a rural house foundation for a Mayan couple and building smokeless stoves and latrines for eight Mayan families (including water filters and basic sanitation services). InterFACE is a volunteer group of plastic and other reconstructive surgeons, anesthesiologists, nurses, pediatricians, speech therapists, psychosocial workers and other volunteers who devote their time and expertise to offer reconstructive surgery to children in Mexico. In October, a Sharp team member joined InterFACE to provide reconstructive surgery to underprivileged children - and some adults - in Mexicali. In two days, the team provided an average of 75 surgical procedures including cleft lip and palate repair, burn reconstruction, and repair to ear, hand and other congenital or acquired deformities. During a week-long medical mission trip, a Sharp team member provided care to hundreds of impoverished residents of Cao Bang, Vietnam. The trip was organized by the Good Samaritan Medical and Dental Ministry, a nonprofit organization that provides medical, dental and optometric care to the people of Vietnam through annual summer missions. The villagers were malnourished, sick and extremely dehydrated. The medical team set up a clinic in a local elementary school where they diagnosed and treated ailments, drew labs, prescribed and provided medicine, pulled teeth and performed surgeries. With no access to clean or running water, sinks, toilets or air conditioning, the team was able to help those in need despite having limited resources. Each year, Experience Camp serves hundreds of youth across the country through one-week camps for those who have experienced the death of a parent, sibling or primary caregiver. The program helps build confidence, encourages laughter, provides emotional support and allows youth to navigate their grief through friendship, teamwork, athletics and the common bond of loss. In FY 2015, a Sharp team member served as a clinician with Experience Camp during which they developed programs to meet the emotional needs of the camp's youth as well as supported other volunteer clinicians and cabin counselors. Community Walks For the past 20 years, Sharp has proudly supported the American Heart Association (AHA) annual Sa”

“Sharp HospiceCare provided a variety of volunteer training opportunities in FY 2015. Hospice volunteers are often working towards a career in the medical field, and can gain valuable knowledge and experience through volunteering. Volunteers provide valuable services to the hospice organization and those they serve, including companionship to those near the end-of-life, support for families and caregivers and help with community outreach. Fifty-one new hospice volunteers were trained in FY 2015. Volunteers complete an extensive 32-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their patient and administrative support activities. In addition, five teenagers participated in Sharp HospiceCare's Teen Volunteer program in FY 2015, through which the teens are assigned special projects in the office or patient assignments at Sharp HospiceCare's LakeView and ParkView homes. The teens may perform grooming and hygiene tasks or provide simple acts of kindness, such as sitting with patients, listening to their stories and holding their hand. Nine nursing students from PLNU also volunteered at Sharp HospiceCare, offering assistance to family caregivers in private homes. Sharp HospiceCare provides the 11th Hour Program to ensure that no patient dies alone. Through the program, a Sharp HospiceCare volunteer accompanies patients who are in their final moments yet do not have a family member present. The volunteer offers a comforting presence by holding the patient's hand, reading softly to them and simply being by their side. Families who are present with their dying loved one may also prefer the comfort of a volunteer as their loved one passes away. Twenty-two volunteers were trained through the 11th Hour Program in FY 2015. Furthering its volunteer efforts in FY 2015, Sharp HospiceCare trained 11 volunteers in Healing Touch - a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain. After volunteers are trained in Healing Touch, they provide the therapy to family caregivers once a week while their loved one is receiving hospice care as well as a visit following the patient's death. Sharp HospiceCare is a partner in We Honor Veterans (WHV) - a national program developed by the National Hospice and Palliative Care Organization (NHPCO) in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare can achieve up to four levels of commitment in serving veterans. As current Level I partners, Sharp HospiceCare volunteers receive an additional eight hours of training that enables them to work with patients with military experience as well as provide weekly support, companionship and relief for caregivers of veterans. Once trained, the volunteers may also offer a special ceremony to veterans receiving hospice services and their family members, in which they honor them with a WHV pin and a certification of appreciation for their services. In FY 2015, volunteers held 17 pinning ceremonies for veterans receiving care at Sharp HospiceCare. Sharp HospiceCare offers the Memory Bear Program to support community members who have lost a loved one. Through the program, volunteers create 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 2015, volunteers devoted nearly 3,600 hours to handcraft approximately 900 bears for nearly 350 families. Sharp HospiceCare offers a monthly support group to enhance volunteers' education and training. Volunteers are also recognized for their valuable contribution during National Volunteer Week in April and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV) Volunteer Programs SMH created the Community Care Partner (CCP) program to serve and comfort pa”

“In FY 2015, Arts for Healing led art and music activities for hundreds of patients and community members in recognition of various holidays and systemwide events, including Saturday With Santa, a public event hosted each December by the SMH Auxiliary; Valentine's Day; Hospital Week in May; Cancer Awareness Week in June; Spiritual Care Week in October; and the Sharp Women's Health Conference in March. Additionally, in collaboration with SMMC's social workers and palliative care nurses, Arts for Healing facilitated the donation of nearly 130 blankets and quilts to patients receiving end-of-life care at SMH. Thirteen of the blankets were knitted and crocheted by patients at SMV's East County Outpatient Program, an activity that could also reduce anxiety and depression for the patients crafting and donating the blankets. In FY 2015, 42 volunteers, including several students from PLNU and MC, facilitated art activities for patients and their loved ones through Arts for Healing. Since the inception of the program in 2007, more than 60,500 patients, guests and staff have benefitted from the time and talent provided by the Arts for Healing team. Sharp Employee Volunteer Efforts In FY 2015, 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 served the community. The SGH Engineering Department engaged in a variety of volunteer initiatives in FY 2015. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting patients and their loved ones. Each week, the SGH landscape team grows, cuts, bundles and delivers colorful bouquets to 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 2015, the team delivered six to eight vases of flowers each day to patient rooms, with as many as 20 vases or more during peak flower season and upon additional requests. In addition, the team supports the SGH Senior Resource Center and Meals-on-Wheels partnership by providing floral centerpieces for their fundraising events to benefit East County seniors as well as offers roses for SGH's annual patient remembrance service. In its fifth 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 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 is quickly assembled with balloons, ribbon, a teddy bear or Sodexo football, and an inspirational quote. 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 to San Diego's needy population during the 2014 holiday season. The program collects, prepares and donates a variety of items to homeless or low-income community members - ranging from small children to adults - helping to meet their basic needs and bring them holiday joy. Volunteers for The Shirt Off Our Backs Program personally collected and filled three trucks with food and other essential items, including handmade sandwiches, water bottles, clothing, socks, shoes, hygiene kits, pet food, children's toys, towels, blankets and other household items. In its fourth year, The Shirt Off Our Backs Program is committed to bringing comfort and hope to all who express need. SGH furthered its efforts to provide for those in need during the holidays through its annual Santa's Korner giving event. For more”

“In 2009, Sharp created the All Ways Green logo to brand its environmental activities and communicate sustainability throughout Sharp and the San Diego community. Sharp's systemwide All Ways Green committee is charged with identifying, creating and evaluating opportunities and best practices in seven distinct areas: (1) energy efficiency, (2) alternative energy generation, (2) water conservation, (3) waste minimization, (4) commuter solutions, (6) green building design and (7) sustainable food practices. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Established Green Teams at each Sharp entity are responsible for developing new programs that educate and motivate Sharp employees to conserve natural resources, reuse and recycle. Energy Conservation 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 Administration 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 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 by implementing numerous green initiatives, including retro-commissioning of heating, ventilation and air conditioning (HVAC) systems; lighting retrofits; pipe insulations; infrastructure control initiatives; occupancy sensor installation; light-emitting diode (LED) light installations; energy audits; elevator modernization; and energy-efficient motor and pump replacements. In 2013, Sharp was the first health care system in San Diego to implement 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 more than 15,500 computers and has resulted in annual energy savings of approximately 1.6 million kilowatt-hours (kWh). The initiative earned Sharp a Certificate of Recognition from the EPA in 2013. In July 2015, Sharp implemented TSO Logic software to identify opportunities for replacing inefficient energy consuming hardware with energy efficiency hardware in Sharp's centralized data center. In addition, the system can detect underutilized hardware to shut down or put to sleep during periods of inactivity. This "smart software" anticipates daily usage to optimize energy efficiency. It is projected that Sharp could conservatively reduce hardware electrical consumption by more than five percent each year. Sharp remains firmly committed to identifying energy savings initiatives that bring value to the system and the community, as every dollar saved on green practices can be used to support the provision of quality health care and community-based initiatives. Sharp's energy-saving initiatives are driven by the Sharp Energy Conservation Guideline to help manage energy utilization practices throughout the system. Although there have been significant increases in energy fees over the last five years, Sharp has been able to significantly decrease energy utilization by seven percent (on a per square foot basis), resulting in energy costs savings of more than three percent. 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 2014, SDG&E named Sharp San Diego's Healthcare Energy Champion in recognition of its commitment to the innovative programs implemented to reduce its carbon footprint. Furthering”

“According to Practice Greenhealth's Healthier Hospitals Initiative (HHI), hospitals generate an average of 26 pounds of waste per staffed bed each day. To significantly reduce waste at each entity and extend the lifespan of local landfills, Sharp has created a comprehensive waste minimization program, including a systemwide, multidisciplinary Waste Management committee. The committee's purpose is to provide oversight of Sharp's waste management initiatives, including proper waste segregation and enhancing recycling efforts to divert waste and extend the lifespan of local landfills. Sharp was an early adopter in its commitment to waste diversion, and now diverts more than 39 percent of waste through recycling, donating, composting, reprocessing and reusing. In FY 2015, Sharp's waste minimization efforts resulted in more than 8.8 million pounds of waste diverted from the landfill. The following initiatives highlight Sharp's waste minimization efforts in FY 2015: * SMH and SMV collected more than 252,000 pounds of food waste for composting through participation in a food waste composting program with the local greenery. * Sharp diverted more than 2.5 million pounds of trash from the landfill by recycling nonconfidential paper, cardboard, exam table paper, plastic, aluminum cans and glass containers through Sharp's single-stream waste program. * Sharp collected, reprocessed and sterilized 42,000 pounds of surgical instruments. * Sharp implemented reusable sharps containers throughout the hospitals, which saved approximately 50,000 pounds of plastic and more than 1,800 pounds of cardboard from entering the landfill. This resulted in annual CO2 emission savings of more than 28,000 pounds and is equivalent to saving more than 2,700 gallons of gas each year. * SGH, SMH, SMBHWN and SCVMC recycled surgical blue wrap, while SCVMC recycled disposable privacy curtains, diverting more than 200,000 pounds of recycled materials from the landfill. * Employees and hospital visitors donated more than 200 pairs of eyewear to people in need, both locally and globally, through the Lion's Club Recycle Sight program. Sharp's waste minimization activities are widely recognized as being innovative and making a positive difference for the communities that Sharp serves. In FY 2015, Sharp received the following recognition: * The City of San Diego's Environmental Services Department named Sharp as one of the Recyclers of the Year in the 2015 Waste Reduction and Recycling Awards Program. * Executive Insight - a leading health care publication - highlighted new horizontal syringe/sharp drop reusable containers, which were developed by Stericycle with significant input from Sharp to reduce the likelihood of needle stick injury from needle disposal. * Sharp participated at the San Diego City Council's Ssubi Proclamation Day as part of their partnership with Ssubi is Hope - a nonprofit charity organization that collects donated expired/unusable medical equipment. Through the partnership, Sharp donated more than 43,000 pounds of equipment and supplies to support a health center in rural Uganda that provides care for more than 660,000 people living in 49 nearby villages. * SCHHC was selected to develop and display a poster at the annual International Planetree Conference titled "Contributing to a Healthy Community in Uganda - Making an Impact Locally and Internationally." Table 3 presents the waste diversion rates at Sharp HealthCare in FY 2015. Table 3: Sharp HealthCare Waste Diversion - FY 2015 Sharp Chula Vista Medical Center 893,844 Recycled Waste Per Year (lbs.) 2,813,090 Total Waste Per Year (lbs.) 32% Percent Recycled Sharp Coronado Hospital and Healthcare Center 293,519 Recycled Waste Per Year (lbs.) 1,365,903 Total Waste Per Year (lbs.) 21% Percent Recycled Sharp Grossmont Hospital 2,267,597 Recycled Waste Per Year (lbs.) 5,949,660 Total Waste Per Year (lbs.) 38% Percent Recycled Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns”

“Commuter Solutions Sharp supports ride sharing, public transit programs and other transportation efforts to reduce transportation emissions generated by Sharp and its employees. Sharp replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, saving approximately five miles per gallon. Sharp's employee parking lots offer car pool parking spaces, designated bike racks, and motorcycle spaces. Employees can also purchase discounted monthly bus passes. As part of the nationwide Electric Vehicle Project, Sharp installed 33 electric vehicle chargers (EVCs) at its corporate office location, SCVMC, and SMMC. Sharp was the first health care system in San Diego to offer EVCs, supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on foreign oil. Sharp will continue its efforts to expand EVCs at other entities. In FY 2015, Sharp's use of EVCs saved 3,700 gallons of fuel and resulted in a reduction of approximately 20,000 pounds of CO2. In partnership with the SANDAG iCommute program, Sharp offers van pool and car pool match-up opportunities to help employees find convenient ride share partners and promote sustainable commuting. Using the iCommute TripTracker, employees can also monitor the cost and carbon savings of their alternate commuting methods. In October, fifty-one organizations in SDC, representing more than 102,000 employees, participated in SANDAG's iCommute Rideshare Corporate Challenge, where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling and public transit. For the second year in a row and for the third time in four years, Sharp was awarded the top spot in the Mega Employer Category. Through the challenge, more than 700 Sharp employees reported nearly 25,000 alternative commute trips, saving more than 16,000 gallons of gasoline and approximately 340,000 pounds of CO2. Sharp's Commuter Solutions Sub-Committee continuously develops innovative and accessible programs and marketing campaigns that encourage employees to participate in ride sharing and other sustainable modes of transportation. The committee has overseen the implementation of bike racks and designated car pool spots as well as adding a Bicycle Commuter Benefit, which gives employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. Sharp also supported bicycle transportation through several bike-to-work initiatives in FY 2015. This included the county-wide Bike to Work Day event during which Sharp employees opted to ride their bike to work. During the event, Sharp Best Health provided snacks and beverages at six pit stops throughout SDC. Furthering its commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for more than 300 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription and human resources. Sharp's ongoing efforts to promote alternative commuting choices in the workplace has led to recognition as a SANDAG iCommute Diamond Award winner consistently between 2001 and 2010, and again from 2013 through 2015. Community Education and Outreach Sharp actively communicates and educates the San Diego community about its sustainability programs. In FY 2015, Sharp participated in the following outreach activities: * E-newsletters highlighting Sharp's recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling, and energy and water conservation are shared with employees throughout the year. * In April, Sharp held its sixth annual system-wide All Ways Green Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees”

“* Blue wrap recycling * Electronic cafe menus * Single-serve paper napkin and plastic cutlery dispensers * Single-stream recycling * Surgical instrument reprocessing * Recycle bins distribution * Reusable sharps containers -Education and Outreach * Earth Week activities * Environmental policy * Green Team * No smoking policy * Organic farmer's market * Recycling education * Ride share promotion Sharp System Services -Energy Efficiency * EVCs * Energy audits * Energy efficient chillers/motors * ES participation * HVAC projects * LED Lighting * Lighting retrofits * Occupancy sensors * Thermostat control software -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 patient bills and paperless payroll * Electronic and pharmaceutical waste recycling events * Green Grocer's market * Single-serve paper napkin and plastic cutlery dispensers * Single-stream recycling -Education and Outreach * Earth Week activities * Environmental policy * Green Team * No smoking policy * Recycling education * Ride share promotion SHP -Energy Efficiency * Energy audits * HVAC projects * Lighting retrofits * Occupancy sensors -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 * Water dispensers to replace bottled water -Waste Minimization * Recycle bin distribution * Recycled paper * Single-serve paper napkin and plastic cutlery dispensers * Single-stream recycling * Spring cleaning events -Education and Outreach Earth Week activities * Environmental policy * Green Team * No smoking policy * Recycling education * Ride share promotion SMH/ SMBHWN -Energy Efficiency * EVCs * Energy audits * Energy-efficient chillers/motors * ES participation * HVAC projects * LED lighting * Lighting retrofits * Occupancy sensors * Pipe insulations * Piping cross bridges * Steam trap repairs -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 * Water-efficient sterile department processing cart washer -Waste Minimization * Blue wrap recycling * Composting * Electronic cafe menus * Food waste composting * Peroxide based cleaning products * Single-serve paper napkin and plastic cutlery dispensers * Reusable sharp waste containers * Single-stream recycling * Surgical instrument reprocessing -Education and Outreach * Drought tolerant rooftop garden * Earth Week * activities * Environmental policy * Green Team * No smoking policy * Organic farmer's market * Organic gardens * Recycling education * Ride share promotion SMV/ SMC -Energy Efficiency * Air handler replacement * Energy audits * ES participation * HVAC projects * Lighting retrofits * Motor and pump replacements -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 * Composting * Single-serve paper napkin and plastic cutlery dispensers Single-stream recycling * Styrofoam elimination * 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 SRS -Energy Efficiency * Energy audits * ES participation * 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 * Low-flow systems * Mist eliminators”

“Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. Throughout FY 2015, Sharp provided education to staff, community members, and community health professionals on emergency and disaster preparedness. Sharp's disaster preparedness team offered several disaster education courses to first responders, health care providers and community members across SDC. The Hospital-Based First Receiver Awareness Course and First Receiver Operations Course were offered as a two-part series to educate and prepare hospital staff for a decontamination event. Course topics included decontamination principles and best practices; basic hazards; utilization of appropriate Personal Protective Equipment; response concepts; containment; decontamination; and recovery. A standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System was also offered by Sharp's disaster preparedness team, as well as a START (Simple Triage and Rapid Treatment) Triage/ Jump START Triage class to train emergency responders at all levels to triage a large volume of trauma victims within a short period of time. In FY 2015, Sharp's disaster leadership donated their time to state and local organizations and committees including Southern California Earthquake Alliance, County of San Diego Emergency Medical Care Committee (EMCC), the Joint Advisory Committee on Public Health Emergency Preparedness, California Hospital Association Emergency Management Advisory Committee, 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, American Red Cross and others who meet monthly to share best practices for emergency preparedness. In addition, Sharp's disaster leadership served on the Statewide Medical Health Exercise work group which is designed to guide local emergency planners in developing, planning and conducting emergency responses. Through the work group, Sharp helped design training materials, including an exercise guidebook and other resources, for the 2015 California Statewide Medical Health Training and Exercise Program through the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA). Sharp supports safety efforts of the state and the city of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to a mass decontamination event. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event the system's normal water supply is interrupted. Through participation in the U.S. Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness 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 Chula Vista, Kaiser 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 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 networking, planning, and the sharing of resources, trainings and information, the partners will be better prepared for a collaborative response to an emergency or disaster affecting SDC. In September, Sharp hosted a Disaster Preparedness E”

“Sharp Best Health included healthy vending machine options on all hospital campuses as well as healthy food items in each cafeteria and retail area. In FY 2015, Sharp Best Health implemented a new initiative called "Go, Make the Healthier Choice." This initiative color-codes the food options sold in vending machines and food service areas to help employees, visitors, and guests easily discern the nutritional value of each item. According to the color-code, green-labeled items are the healthiest options and can be consumed often; yellow-labeled items are moderately healthy and should be eaten occasionally; and red-labeled items are the least healthy options and should be eaten rarely. In partnership with Sodexo in FY 2015, Sharp Best Health launched a systemwide Mindful healthy food initiative. Through the Mindful Program, Sharp's cafeteria menus were redesigned to include sustainable, nutritious and enticing food options that foster a healthy lifestyle among patients, visitors and staff. In addition, Sharp Best Health collaborated with Sodexo and Specialty Produce to offer the Green Grocers - Delivered to You program at more than 10 Sharp work sites. Through the program, employees can order seasonally available, locally-grown and organic produce online and have it delivered to their workplace twice a month at low cost. Green Grocers - Delivered to You provides a convenient method for employees and their families to incorporate more fruits and vegetables into their diet, while the purchase of locally-grown produce helps support local farmers and is a CSA service. CSA consists of a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm. Since January 2015, Sharp team members have ordered approximately 3,000 pounds of produce through the program. Sharp Best Health continued to offer its free nutrition education series to help employees and their family members develop healthier eating habits. The program includes workshops with cooking demonstrations from registered dietitians and complementary online resources. Nearly 20 classes were offered to approximately 200 attendees through the series in FY 2015, with topics including eating healthy while not at home, managing sugar cravings and portion control. Activities, such as hiking and walking clubs are also available to Sharp team members, family and friends. In FY 2015, Sharp Best Health organized 11 systemwide hikes with more than 160 attendees. The walking clubs vary by location with either structured meeting points or various small walking groups. In 2015, Sharp Best Health received the AHA Fit-Friendly Worksites Honor Roll award (Gold Category) for the third consecutive year, which recognizes employers that promote a culture of health and physical activity in the workplace or community. Since 2013, Sharp Best Health has offered annual employee health screenings to raise awareness of important biometric health measures and help team members learn how to reduce their risk of related health issues. In FY 2015, more than 10,100 Sharp employees received screenings for blood pressure, BMI, blood sugar, tobacco use and cholesterol. Sharp Best Health also exceeded its goal of having at least 75 percent of employees participate in the 2015 screening program. Post-screening resources and tools are available for Sharp employees and their family members, including a free health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management, and managing the challenges of living with a chronic condition such as diabetes, high blood pressure, asthma or arthritis. As a fun incentive for completing their health screening, employees received a Fitbit Zip wireless pedometer that tracks steps, distance and calories and syncs these statistics to computers or smartphones. Sharp Best Health encourages team members to utilize the Fit”

“* Unreimbursed Medical Care Services included uncompensated care for patients who are unable to pay for services, and the unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services, Civilian Health and Medical Program of the U.S. Department of Veterans Affairs (CHAMPVA), and TRICARE - the regionally managed health care program for active-duty, National Guard and Reserve members, retirees, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. This also included 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; 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 and the San Diego Food Bank (SDFB); 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 and made its facilities available for use by community groups at no charge. Also, Sharp 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 students and 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 2015 In FY 2015, Sharp provided a total of $289,082,293 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 2015 SB 697 Category Programs and Services Included in SB 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal $64,584,675 Shortfall in Medicare $176,953,974 Shortfall in San Diego County Indigent Medical Services $6,153,541 Shortfall in CHAMPVA/TRICARE $7,439,083 Shortfall in Workers' Compensation $196,523 Charity Care and Bad Debt $25,830,581 Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $2,488,270 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 $2,023,606 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $3,412,040 TOTAL $289,082,293 Table 2 shows a listing of these unreimbursed costs provided by each Sharp entity and Figure 3 shows the percentage distribution by Sharp entity. Table 2: Total Economic Value of Community Benefit Provided By Sharp HealthCare Entities - FY 2015 Sharp HealthCare Entity Estimated FY 2015 Unreimbursed Costs Sharp Chula Vista Medical Center $56,723,6”

“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 or contact Lindsey Wade, Vice President, Public Policy at HASD&IC at [email protected]. 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 (socioeconomic 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 informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers and members of community-based organizations. Following consultation with the CHNA Planning Teams at each Sharp hospital, additional specific feedback from additional key informants and community residents was also collected. Community members were asked for open-ended feedback on the health issues of greatest importance to them as well as any significant barriers they face in maintaining health and well-being. Findings Through the combined analyses of the results for all of the data and information gathered, the following conditions were identified as priority health needs for the primary communities served by Sharp hospitals (listed in alphabetical order): * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * D”

“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 San Diegans for Healthcare Coverage, the San Diego Food System Alliance, Hunger Advocacy Network, 2-1-1 San Diego 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 2015 Community Benefit Program Highlights SMMC provided a total of $132,295,947 in community benefit in FY 2015. 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 2015 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal $21,276,942 Shortfall in Medicare $85,196,159 Shortfall in San Diego County Indigent Medical Services $6,080,798 Shortfall in CHAMPVA/TRICARE $4,767,147 Charity Care and Bad Debt $11,327,667 Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $1,358,211 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 $891,134 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $1,397,889 TOTAL $132,295,947 Section 5 - Sharp Mary Birch Hospital for Women & Newborns FY 2015 Community Benefit Program Highlights Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) provided a total of $3,923,260 in community benefit in FY 2015. 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 2015 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal $173,349 Shortfall in Medicare $624,805 Shortfall in CHAMPVA/TRICARE $1,282,088 Charity Care and Bad Debt $1,413,173 Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $43,124 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 $153,700 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $233,022 TOTAL $3,923,260 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 and CHAMPVA/TRICARE; and financial support for on-site workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included financial assistance for van transportation for patients to and from medical appointments, contribution of time to Stand Down for Homeless Veterans 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, support groups, participation in commun”

“Source: 2013-2014 California Health Interview Survey (CHIS) Table 3: Medi-Cal (Medicaid) Eligibility, Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2014 Description Rate Medi-Cal Eligible 28.7% Not Eligible 71.3% Source: 2013-2014 CHIS In 2013, all SDC regions met the HP 2020 national targets for prenatal care, preterm births, low birth weight (LBW) infants, very low birth weight (VLBW) infants and infant mortality. See Table 4 for a summary of maternal and infant health indicators in SDC in 2013 and Table 5 for a summary of maternal and infant health indicators by region. Table 4: Maternal and Infant Health Indicators in SDC, 2013 Maternal and Infant Health Indicator Rate Year 2020 Target Early Prenatal Care 84.7% 77.9% Preterm Births 8.3% 11.4% Very Low Birth Weight Infants 1.1% 1.4% Low Birth Weight Infants 6.4% 7.8% Infant Mortality 4.5% 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 Table 5: Maternal and Infant Health Indicators by Region in SDC, 2013 Indicator Prenatal Care North Coastal - 83.2% North Central - 91% Central - 82.6% South - 85.7% East - 81.1% North Inland - 84.7% Preterm Births North Coastal - 6.9% North Central - 8.1% Central - 8.8% South - 8.5% East - 8.8% North Inland - 8.1% VLBW Infants North Coastal - 1.08% North Central - 0.9% Central - 1.3% South - 1.1% East - 1.3% North Inland - 0.8% LBW Infants North Coastal - 5.6% North Central - 6.4% Central - 7.1% South - 6.8% East - 6.8% North Inland - 5.8% Infant Mortality North Coastal - 4.5% North Central - 4.3% Central - 5.7% South - 3.1% East - 5.6% North Inland - 4.1% Source: County of San Diego, HHSA, Public Health Services, Community Health Statistics Unit and Maternal, Child and Family Health Services There were 43,627 live births in SDC overall in 2013. In 2011, fetal mortality in SDC overall was 4.2 fetal deaths per 1,000 live births plus fetal deaths, meeting the HP 2020 national target of less than 5.6 fetal deaths per 1,000 live births plus fetal deaths. 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 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 both entities (in alphabetical order): * Behavioral Health (Mental Health) * Cardiovascular Disease * Diabetes, Type 2 * High-Risk Pregnancy * Obesity * Senior Health”

“* 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 (CDC, 2015). * In 2014, the preterm birth rate was about 9.6 percent, affecting one of every 10 infants born in the U.S. (CDC, 2014). * According to the CDC Safe Motherhood Initiative, preterm births affect more than 500,000 women and infants per year and are the leading cause of neonatal mortality in the U.S. Women who deliver prematurely, experience repeated miscarriages, or develop gestational diabetes are at increased risk of complications with subsequent pregnancies (CDC, 2015; March of Dimes, 2014). * According to a report from the National Center for Health Statistics (NCHS), preterm infants are at increased risk of lifelong 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. * Premature and 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). * The number of births per 1,000 women ages 15 to 44 (the general fertility rate) in the U.S. increased slightly in 2014 to 62.9 - the first increase since 2007. Rates rose for non-Hispanic white and Asian or Pacific Islander women, but historic lows were observed for Hispanic women and American Indian or Alaska Native women (CDC, 2015). Objectives * Develop, coordinate and provide educational programs on preterm labor and births as well as prenatal health to women in the community * Provide education as needed to high-risk populations, including pregnant teens * Educate community members about available hospital resources through participation in community events * Identify and disseminate evidence-based best practices to improve outcomes of at-risk newborns through the Sharp Neonatal Research Institute (NRI) FY 2015 Report of Activities In FY 2015, SMBHWN conducted a variety of efforts to support healthy pregnancies for expecting mothers, including teenagers and other high-risk populations, and improve outcomes for at-risk newborns. Approximately 100 participants attended free monthly Preterm Birth Prevention classes in FY 2015, where they learned about the warning signs of preterm labor and how to help prevent a premature birth. SMBHWN offered a range of other prenatal education classes to support a healthy lifestyle during pregnancy and prepare families for their arrival. Class topics included how one's body prepares for birth and delivery; sibling preparation; hospital procedures; medication choices; cesarean delivery; relaxation and breathing techniques during labor; postpartum care; breastfeeding and infant feeding; newborn characteristics and procedures; preparing for multiple births; and prenatal fitness and yoga. SMBHWN actively supported 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). In FY 2015, SMBHWN raised more than $8,800 for Miracle Babies through participation in variou”

“* According to the CDC's 2014 Breastfeeding Report Card, 63.1 percent of mothers in California were breastfeeding at six months, while only 25.4 percent were exclusively breastfeeding at six months (CDC, 2014). * In California, SDC is ranked 22nd out of 50 counties for exclusive breastfeeding (California Women, Infants and Children (WIC) Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2013). * Breastfeeding is a crucial first step in protecting the health of mothers and infants, nourishing infants and building a foundation for a healthy immune system. Hospital practices have an enormous impact on infant-feeding success and mothers who receive in-hospital support to breastfeed exclusively often continue to do so after discharge. Further, breastfeeding support aligns with the quality improvement and cost-saving strategies of the Triple Aim and Health Care Reform (California WIC Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2013). * Nearly two-thirds of women plan to exclusively breastfeed, but less than 40 percent are doing so at one month postpartum. Hospitals, health care providers, public health agencies and support groups must work together to ensure all mothers have the needed resources to breastfeed in the hospital and at home (California WIC Association and University of California, Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2013). * According to the American Psychological Association, 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 * Demonstrate best practices in breastfeeding and maternity care * Provide education and support to new mothers on the importance of breastfeeding * Provide NICU-specific support services to new mothers and their families * Provide support and education to new mothers and their families on postpartum care FY 2015 Report of Activities In 2012, SMBHWN was selected from more than 200 applicants to participate in the NICHQ Best Fed Beginnings Learning Collaborative. Consisting of 90 hospitals throughout the nation, the 22-month collaborative 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 received Baby-Friendly USA Designation in November of 2015. Designation was earned 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 im”

“SMBHWN offered parents in the San Diego community a special volunteer opportunity through the NICU Navigator Program. This unique program connects parents whose babies are currently in the NICU with other parents who previously had babies in the NICU. These experienced parents serve as NICU Navigators who volunteer their time to provide advice, encouragement, guidance to appropriate resources and help with the transition from hospital to home. The NICU Navigator Program also offers Parent Hour, an informational session designed to enhance a parent's developing relationship with his or her newborn. Parent Hour is offered free to families with a baby in the NICU and focuses on an assortment of topics, including premature growth and development; nutrition, breastfeeding and feeding mechanics; and preparing for discharge, among others. In FY 2015, more than 100 families were served between the NICU Navigator Program and Parent Hour. Through the annual NICU Little Graduate Reunion, SMBHWN offers a unique experience for patients and families who have spent time in the NICU to continue the celebration of their care long after they leave the hospital. At this annual event, young children and babies who spent more than 10 days in the NICU are invited to reunite with their medical team and celebrate with great festivities, including a bounce house and a petting zoo. Often, former patients well into their teens continue to attend the event. In FY 2015, the NICU Little Graduate Reunion reached more than 600 attendees, including former patients and their families. FY 2016 Plan SMBHWN will do the following: * Continue to implement evidence-based breastfeeding practices as a Baby-Friendly USA designated hospital * Continue to offer free postpartum, breastfeeding, and new-parent support groups to new mothers and their families * Continue to offer a variety of educational classes for 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 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 (BLS), 2012). * The BLS projects an employment of more than 3.1 million RNs in the U.S. in 2024, an increase of 16 percent from 2014. * According to the San Diego Workforce Partnership, healthcare specialty occupations expected to add employment by 12 percent (7,466 jobs) between 2013 and 2018 in San Diego County. The top six growing healthcare occupations are RNs, home health aides, nursing assistants, medical assistants and licensed vocational nurses. * 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”

“In February, SMBHWN hosted the Advances in Obstetrics and Gynecology conference, an educational event to provide community medical practitioners with the latest clinical information, research, and practical management strategies for women at all stages of life. Through the conference, more than 180 health practitioners received expert education from local, regional and international specialists on key issues in gynecology, obstetrics and neonatology. FY 2016 Plan SMBHWN will do the following: * Continue to serve as a training site for health professions students * Continue to participate in the HSHMC program * Continue to participate in local and national collaboratives and share specialty expertise at professional conferences * Offer a Continuing Medical Education (CME) conference to community clinicians SMBHWN Program and Service Highlights * Cord Blood Banking * Doula program * Gynecologic oncology * Lactation services * Labor and delivery * Level III NICU * Maternal Infant Services Unit * Mother's Milk Depot * Neonatal Research Institute * New Beginnings Boutique & Gift Shop * Obstetrical and women's triage services * Parent education programs * Perinatal Special Care Unit (High-Risk Pregnancy Care) * Prenatal Diagnostic Center * Robotic gynecologic surgery * Spiritual care and education, including Arts for Healing Program * Teen pregnancy program * Women's and infants' pathology services * Women's education programs * Women's surgery services Section 6 - Sharp Memorial Hospital FY 2015 Community Benefit Program Highlights Sharp Memorial Hospital (SMH) provided a total of $115,623,598 in community benefit in FY 2015. See Table 1 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill (SB) 697. Table 1: Economic Value of Community Benefit Provided Sharp Memorial Hospital - FY 2015 SB 697 Category Programs and Services Included in SB 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal, financial support for on-site workers to process Medi-Cal eligibility forms $19,208,729 Shortfall in Medicare $81,738,799 Shortfall in CHAMPVA/TRICARE $2,694,712 Charity Care and Bad Debt $9,778,197 Other Benefits for Vulnerable Populations Patient transportation, Project HELP and other assistance for the needy $776,122 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 $513,155 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $913,885 TOTAL $115,623,598 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 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; Project HELP; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank (SDFB); the Sharp Humanitarian Service Program; support services for discharged homeless patients in partnership with San Diego Rescue Mission (SDRM); 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, blood pressure, heart disease, nutrition, body mass index (BMI), hearing, balance, hand, musculoskeletal pain; community education and resources provided by the Laurel Amtower Cancer Institute at SMH Patient Navigator program; and flu vaccinations and specialized education and information for seniors offered by the SMH”

“Cancer and heart disease were the top two leading causes of death in SDC. See Table 4 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by SMH, please refer to the SMH 2013 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments Table 4: Leading Causes of Death in SDC, 2014 Cause of Death Number of Deaths Malignant neoplasms 4,891 Diseases of heart 4,586 Alzheimer's disease 1,316 Cerebrovascular diseases 1,155 Accidents (unintentional injuries) 1,101 Chronic lower respiratory diseases 995 Diabetes mellitus 588 Intentional self-harm (suicide) 421 Chronic liver disease and cirrhosis 319 Essential hypertension and hypertensive renal disease 314 Influenza and pneumonia 304 Parkinson's disease 268 Pneumonitis due to solids and liquids 134 Viral hepatitis 118 Nephritis, nephrotic syndrome and nephrosis 112 Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program 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 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). 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 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 Section 5 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. I”

“* Provide diabetes education and screening in the central and north central regions of SDC * Collaborate with community organizations and projects to provide diabetes education to SDC's vulnerable populations * Participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community FY 2015 Report of Activities The SMH Diabetes Education Program is recognized by the ADA for meeting national standards for excellence and quality in diabetes education. The program provides individuals with the skills needed to successfully self-manage their diabetes and live a long, healthy life and includes blood sugar monitoring, medications, insulin pump training and wound prevention. Small group and one-on-one classes are also offered in English and Spanish. In FY 2015, the SMH Diabetes Education Program provided blood glucose screenings at four events in the community, including the Jewish Family Service of San Diego Health & Wellness Fair at College Avenue Center, San Diego Crew Classic at Crown Point, December Nights in Balboa Park, and a health fair for seniors at the Point Loma Community Presbyterian Church, reaching more than 750 community members through screening and education. The SMH Diabetes Education Program screened nearly 50 people through these events and identified 16 attendees with elevated blood glucose levels. Of these identified individuals, 10 did not have a preexisting diagnosis of diabetes. 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 also continued to support the ADA's Step Out: Walk to Stop Diabetes, held in October at Mission Bay, through fundraising and team participation. The SMH Diabetes Education Program also provided a diabetes lecture to more than 1,000 attendees at the San Diego Gas & Electric (SDG&E) Health, Wellness & Safety Fair in July. The SMH Diabetes Education Program is actively involved with San Diego's renal health community. In FY 2015, the SMH Diabetes Education Program collaborated with the Balboa Institute of Transplantation to provide ongoing education and support to community members that had undergone transplant or experienced kidney disease as well as members of the professional health care community. This past year, the SHC Diabetes Education Program collaborated with Family Health Centers of San Diego (FHCSD) to conduct outreach and education to vulnerable community members in SDC's east region. Sharp Diabetes educators supported the expansion of FHCSD's Diabetes Management Care Coordination Project (DMCCP), which provides FHCSD patients with group diabetes education and encourages peer support and education from project "graduates" to current patients/project enrollees. The project monitors enrollees' A1C levels, and has proven successful outcomes in lowering and maintaining these levels through education and peer support. The SHC Diabetes Education Program supports the project through the provision of diabetes lectures at multiple FHCSD sites. In the central San Diego region, the SHC Diabetes Education Program provided a lecture on the basics of diabetes and nutrition to 40 community members at the FHCSD site in Logan Heights. Topics included physical activity, diabetes mellitus, healthy eating, self-management and goal setting. New in 2015, the SHC Diabetes Education Program provided diabetes education to food insecure adults enrolled in Feeding America San Diego's (FASD) Diabetes Wellness Project, a collaboration between University of California, San Diego's (UCSD) Student-Run Free Clinic Project, the Third Avenue Charitable Organization (TACO) and Baker Elementary School in Southeast San Diego. The Diabetes Wellness Project screens adult clinic patients with Type 2 diabetes for food insecurity, and provides them with ongoing medical treatment and diabetes management”

“* Continue to foster 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 * Continue to participate in ADA's Step Out: Walk to Stop Diabetes * Keep current on resources to provide community members support of diabetes treatment and prevention - particularly language and culturally appropriate resources * Continue to participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community * Conduct educational outpatient and inpatient symposiums for health care professionals Identified Community Need: 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 2014, heart disease was the second leading cause of death and cerebrovascular disease was the fourth leading cause of death for SDC overall (CDC, 2014). * In 2013, there were 1,114 deaths due to stroke in SDC. The age-adjusted death rate due to stroke was 33.1 per 100,000 population, which is lower than the HP 2020 target of 33.8 deaths per 100,000. * In 2013, there were 6,611 hospitalizations for stroke in SDC, with an age-adjusted rate of 203.9 per 100,000 population. * In 2013, there were 1,730 stroke-related ED visits in SDC. The age-adjusted rate of ED visits was 53.2 per 100,000 population. * According to the California Health Interview Survey (CHIS) in 2014, 5.6 percent of adults living in SDC indicated that they were ever diagnosed with heart disease. * 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 Health and Human Services (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 can 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 2015 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 AHA/American Stroke Association's (ASA) Get With the Guidelines-Stroke Gold-Plus Quality Achievement Award for excellence in stroke care as well as the Target: Stroke Honor Roll Elite designation. The AHA/ASA's GWTG is a national effort focused on ensuring that evidence-based therapies are used with stroke patients. The AHA/ASA's Target: Stroke Honor Roll designation focuses on improving the timeliness of intravenous tissue plasminogen activator (IV t-PA) administration to eligible patients. In collaboration with the SMH Senior R”

“* In the HASD&IC 2013 CHNA, analysis of hospital data revealed dementia and Alzheimer's disease to be among the top health conditions within SDC hospitals. * Attendees of community forums held during the HASD&IC 2013 CHNA process identified Alzheimer's disease and dementia as priority health needs for SDC. * In SDC in 2012, there were 374,535 residents (11.91 percent of the population) ages 65 years or older. This number is expected to nearly double by the year 2030 to 723,572. * In 2012, the leading causes of death among senior adults ages 65 years and older in SDC were cancer, heart disease, chronic lower respiratory diseases, diabetes, stroke, unintentional injuries, chronic liver disease and cirrhosis, Alzheimer's disease, Parkinson's disease, hypertension and hypertensive renal disease, influenza and pneumonia, and septicemia. * In 2014, 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, nonfatal unintentional injuries (including falls), overall cancer and arthritis. In 2011, 97,647 seniors ages 65 and over were hospitalized in SDC. * In 2012, there were 95,679 seniors ages 65 and over who were hospitalized in SDC. * In 2012, there were 108,745 seniors treated and discharged from the SDC EDs, representing nearly one out of every three senior residents in the county. * In 2012, the top three causes of ED utilization among persons ages 65 years and older in SDC 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, 2015). * 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 2012, 71,655 calls were made to 911 for seniors in need of emergency medical care, which represents a call for one out of every five seniors and the highest utilization of any other group. * 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. * 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). * Fourteen percent of caregivers who assist with medical/nursing tasks report having received some preparation or training. * Eighty-four percent of caregivers report needing more help and information about caregiving topics, most commonly, keeping their loved one safe at home, managing their own stress, and help making end-of-life decisions (Caregiving in the U.S, 2015). * In the U.S., 65.7 million car”

“The SMH Senior Resource Center provided health screenings at seven community health fairs and events, serving more than 40 members of the senior community. Screenings included stroke, diabetes, hearing and hand mobility (arthritis, carpel tunnel, trigger finger, etc.) as well as medication review in which a pharmacist reviewed attendees' medications and answered questions to support proper medication management. As a result of these screenings, 12 community members were referred to physicians for follow-up care. In addition, free monthly blood pressure screenings were provided to more than 550 members of the senior community. As a result of the blood pressure screenings, nearly 60 seniors were referred to physicians for follow-up care. Screenings took place at the Point Loma Community Presbyterian Church, Peninsula Family YMCA, the War Memorial building at Balboa Park and various other community health fairs and special events. The SMH Senior Resource Center participated in 12 community events in FY 2015, including health fairs, conferences and seminars that reached more than 2,600 attendees. Health fairs included the Sharp Senior Resource Center Senior Health & Information Fair at the Point Loma Community Presbyterian Church, the Health Fair at the Pacific Beach/Taylor Branch Library, California Telephone Access Program (CTAP) Resource Fair, the Sharp HospiceCare Resource & Education Expo at the College Avenue Baptist Church, the San Diego Regional Center Fair, the Sharp Women's Health Conference, and the Lesbian, Gay, Bisexual, and Transgender (LGBT) Senior Resource Fair. At the CTAP Resource Fair, free adaptive phones were provided to community members with disabilities including those with difficulty hearing, speaking, moving, seeing and remembering or interpreting information. The SMH Senior Resource Center also participated in the Games Day event at All Souls Episcopal Church, an annual fundraiser for the Peninsula Shepherd Center that provides information, referrals, transportation and outreach to seniors in Point Loma. In addition, the SMH Senior Resource Center provided Vials of Life and senior resources at the Juneteenth Celebrations fair at the George L. Stevens Senior Center, which focused on African American achievement and culture, as well as encouragement of self-development and respect for all cultures. In FY 2015, the SMH Senior Resource Center participated in the County of San Diego Aging and Independence Services (AIS) 2015 Vital Aging: Boosting Your Brainpower Conference. Held at the McMillin Center in Liberty Station, the conference explored how nutrition, exercise, mental stimulation and social connection affect memory, mood and cognitive functioning. The summit's keynote presentation was given by a nationally acclaimed neuropsychologist, and indoor and outdoor activities were featured. Other topics included, but were not limited to, Alzheimer's disease, food and mood, lifelong learning, exercise, and health and well-being for older adults. 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 FY 2015, the SMH Senior Resource Center participated in the SanDi-CAN end-of-life conference at the Balboa Park Club titled Planning Ahead...Crucial Conversations: Helping Families & Seniors Navigate End-of-Life Decisions. Approximately 85 community members attended the free conference, where they received education on how to make 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 and included a talk on bereavement and how to cope with loss. The SMH Senior Resource Center also participated in a conference for seniors and caregivers titled Caring for the Caregiver, held at First United Methodist Church. The con”

“Sharp Senior Health Centers participated in numerous community events in FY 2015, providing education and resources to more than 450 attendees. Events took place at the Sharp Senior Resource Center Senior Health & Information Fair at Point Loma Presbyterian Church; the Right Choices at the Right Time conference at Point Loma Community Presbyterian Church; the San Diego Community Action Network (SanDi-CAN) Planning Ahead...Crucial Conversations: Helping Families & Seniors Navigate End-of-Life Decisions conference; the SDCCOA The Golden Age of Intimacy Senior Health Fair at the War Memorial Building in Balboa Park; and St. Paul's Senior Health & Resource Fair. Throughout the year, both the SMH Senior Resource Center and Sharp Senior Health Centers maintained active relationships with numerous community organizations, including the Peninsula Shepherd Senior Center, Serving Seniors (including the Potiker Family Senior Residence and the Gary and Mary West Senior Wellness Center), Bayside Community Center, Westminster Tower (senior housing), Jewish Family Service of San Diego, Caregiver Coalition of San Diego, Adult Protective Services, Southern Caregiver Resource Center (SCRC), Alzheimer's Association, American Parkinson Disease Association, SanDi-CAN, San Diego County Council on Aging (SDCCOA), NARFE, Community Center for the Blind and Visually Impaired, CVS MinuteClinics, Aging and Disability Resource Connection and the Health Insurance Counseling and Advocacy Program (HICAP) - ensuring ongoing networking among community professionals and the provision of quality programs for seniors. The Sharp Senior Health Centers' collaboration with HICAP included the provision of biweekly counseling and education by a HICAP representative to community members at the Senior Health Center Clairemont. HICAP staff offered objective counseling on Medicare rights, benefits and insurance policy options to address seniors' questions and concerns. FY 2016 Plan The SMH Senior Resource Center and the Sharp Senior Health Centers will do the following: * Provide information, resources and support to address relevant concerns of seniors and caregivers in the community, including senior mental health issues, memory loss, advanced illness management, caregiving, senior services, nutrition, healthy aging, and balance and fall prevention * Provide community health information and resources through educational programs, monthly blood pressure clinics, and a variety of health screenings annually * Produce and distribute quarterly calendars for approximately 3,000 San Diego households, highlighting events of interest to seniors and family caregivers * Continue support of the Vials of Life program through distribution of 2,000 Vials of Life to seniors in the community * Provide seasonal flu vaccinations to the community as funding allows * Participate in community health fairs and conferences, including the SanDi-CAN end-of-life conference * In collaboration with the Caregiver Coalition of San Diego, coordinate a conference dedicated to family caregiver issues * In collaboration with Sharp HospiceCare, host an aging conference for seniors in Point Loma * In collaboration with Sharp Mesa Vista Hospital's (SMV) Senior Intensive Outpatient Program (SIOP), provide education on holiday blues and depression as well as senior behavioral health * Collaborate with Serving Seniors to provide a depression screening * Provide an Aging and Driving program in collaboration with the Alzheimer's Association and the Department of Motor Vehicles * Maintain active relationships with other organizations serving seniors in SDC, Point Loma, the county's north central and central regions, and downtown San Diego * Continue to participate in a monthly Sharp HealthCare Speaker Series at the Gary and Mary West Senior Wellness Center * Explore a collaboration with Serving Seniors and West Health Institute (WHI) * Explore opportunities for medication screenings by a pharmacist for vulnerable”

“The Sharp Memorial OPP and various departments of the hospital conduct a broad spectrum of community health education classes and support groups. In FY 2015, classrooms were booked for more than 1,500 hours and served thousands of patients and community members. Educational classes covered a variety of health and wellness topics, including integrative medicine, diabetes, stroke, cancer, fall prevention for seniors and parenting and childbirth. In addition, support groups were available for community members facing similar challenges to come together and share their personal experiences and advice for coping. Groups were held for cancer, stroke, heart transplantation, heart failure, needs of new mothers and families and support for individuals who have received bariatric surgery, including nutrition and relapse. In addition, Sharp Rehabilitation Services (Sharp Rehab) offered various support groups on the Sharp Metropolitan Medical Campus (SMMC) in FY 2015, including Women on Wheels (WOW), the Support Group for Men with SCI and the Sharp Players. WOW strives to empower women with disabilities through facilitated support groups, peer support, lectures and social events. In FY 2015, approximately 90 group members gathered monthly at the SMH Rehabilitation Center to share thoughts and emotions about their current life challenges, victories and visions. WOW also arranged special outings and events, including a tour of the San Diego Museum of Photographic Arts, birthday lunches, a summer party, and the annual Lois Herr Luncheon in honor of their group member, Lois Herr, a proud and passionate woman who suffered a spinal cord injury (SCI) and passed away in 2001. With a network of more than 185 disabled women and community partners, WOW is the only support group strictly for women with disabilities in the San Diego area. The Support Group for Men with SCI also met monthly at the SMH Rehabilitation Center and offered guest speakers and special outings in FY 2015, including a trip to a Padres game. In addition, group members offered their own peer support to SMH patients with recent injuries. The Support Group for Men with SCI served approximately 40 meeting attendees in FY 2015. The group includes an additional 80 community members involved through an electronic resource and support network. Sharp Rehab also devoted time to the HeadNorth Foundation in FY 2015, a nonprofit organization dedicated to providing essential support and guidance to those affected by SCI. Approximately 25 individuals were served through the Sharp Players weekly support group in FY 2015, which uses music and drama to facilitate emotional healing and support for individuals with a range of conditions, including brain injury, SCI, spina bifida, cerebral palsy, post-encephalitis, multiple sclerosis, amputation, mental illness, blindness, cancer and stroke. Through the group, members provided performances for approximately 200 community members at a variety of community sites in SDC, including the San Diego Brain Injury Foundation, Merrill Gardens retirement home, University City Older Adult Center, Beldon Village affordable housing and the Point Loma Community Presbyterian Church Senior Program. In addition, in January, Sharp Rehab offered a presentation titled Compassion: A Human Trait and a State, to approximately 100 seniors at the University of the Third Age event offered by the University of San Diego (USD), a three-week learning program to help community members ages 55 and older keep their minds and bodies sharp as they age. The Pavilion offers the Cushman Wellness Center Community Health Library, featuring 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 hea”

“* Continue to offer educational classes on a variety of health and wellness topics to community members * Continue to provide a variety of support groups to community members on issues such as cancer, rehabilitation, stroke, heart transplantation and heart failure * Develop and coordinate quarterly calendars and newsletters for community health education and screening events * Continue to partner with local and national organizations to provide health literacy education and resources at a variety of community sites, and share health literacy best practices with industry professionals * Continue to increase awareness of the Community Health Library and its resources * Continue to provide health education, first-aid booths and health screenings at community events, as requested by community partners * Provide coordination, support and fundraising-related activities for local nonprofit organizations Identified Community Need: Cancer Education and Patient Navigator Services Rationale references the findings of the SMH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * In the HASD&IC 2013 CHNA, various types of cancer were identified among the top priority health conditions seen in SDC hospitals. * Community members participating in the HASD&IC 2013 CHNA community forums held throughout SDC also strongly aligned access to care and care management with maintaining health. * In 2014, cancer was the leading cause of death for SDC residents. * In 2013, there were 5,030 deaths due to cancer (all types) in SDC. The age-adjusted death rate due to cancer was 155.7 deaths per 100,000 population in SDC. * From 2010 to 2013, cancer was the leading cause of death in SDC, responsible for nearly 20,000 deaths overall. * 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 the California Cancer Registry (CCR) 2014 report, California Cancer Facts & Figures, in that year, the predicted number of new cancer cases for all sites in SDC was 13,455. Expected cancer deaths in SDC for 2014 were predicted to be 4,815. * According to the ACS, a total of 1,658,370 new cancer cases and 589,430 cancer deaths were projected to occur in the U.S. in 2015. California was projected to have the most new cancer cases (172,090) and the highest number of deaths (58,180) in 2015. * By 2018, total cancer cases in SDC are expected to grow by 11.7 percent (CCR, 2013; Truven Health Analytics Market Discovery Planning). * According to the ACS 2015 Cancer Facts & Figures report, in 2015, there are an estimated 25,270 new cases of breast cancer and an estimated 4,320 breast cancer deaths for females in California. This is far higher than any other type of new cancer in the state. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, the mortality rate of breast cancer in SDC is 22.7 deaths per 100,000 women. This rate is higher than the HP2020 target of 20.7 breast cancer deaths per 100,000 women. * The 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report reveals SDC has a higher incidence rate (128.6 per 100,000) for breast cancer than the U.S. and the state of California (122.1 and 122.0, respectively). * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, in SDC there are 46.1 late-stage cases of breast cancer per 100,000 women, exceeding the HP2020 target of 42.1 cases per 100,000 women. It is expected that SDC will take approximately five years to meet the HP2020 target. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, in SDC black women have the highest death rates (27.7 per 100,000 women) and the highest”

“Monthly and bimonthly cancer support groups reached as many as 10 to 20 attendees per session in FY 2015. Support groups included Women's Cancer, Life After Cancer, Living with Advanced Cancer, Care Partner - a support group specifically for friends and family members of cancer patients, and the Young Patient's support group - the only support group in San Diego for young adult men and women with cancer. Educational classes reached nearly 250 individuals impacted by cancer. Utilizing resources and guidelines from the National Cancer Institute (NCI), American Institute for Cancer Research, ACS, and the Environmental Working Group, free nutrition classes educated participants on maintaining optimal nutrition and basic nutrition and dietary recommendations during and after breast cancer treatment. In addition, a six-week Food for Life cooking series educated participants about the power of food for cancer prevention and survival. Instructed by the Cancer Project - a program of the Physicians Committee for Responsible Medicine (PCRM) - the series included nutrition lectures, live cooking demonstrations and food tastings to help participants learn how to prepare simple and healthy meals at home. An Exercise and Stress Management class was also offered, which taught relaxation methods to allow the body to heal and easy strategies for exercising without going to the gym. Through monthly Lunch and Learn classes, individuals and families impacted by cancer received education and support on how to address the emotional aspects of new cancer diagnosis, what to expect for those with children or grandchildren at home and cancer survivorship. In addition, Cancer and the Arts classes were offered twice per month as an outlet for individuals with cancer to express themselves and improve their overall well-being through healing art activities. In April, a free physician-led Breast Cancer Education Forum was held for individuals with a recent breast cancer diagnosis. Attendees learned about the pathological wording and staging of their particular cancer type as well as various treatment options. In addition, SMH provided meeting space for four Look Good...Feel Better classes, led by the ACS, to teach women beauty techniques to manage appearance-related side effects of cancer treatment. In FY 2015, the Laurel Amtower Cancer Institute offered two free classes on Lymphedema - a condition of tissue swelling as a result of damage or blockage to the lymph system that may result from cancer treatment. Led by a certified lymphedema therapist, the classes served community members with or at risk for lymphedema and included education on steps for prevention and care if the condition is developed. Uninsured participants at risk for or suffering from lymphedema were referred to appropriate community resources for need-based compression sleeves and gauntlets. Furthermore, weekly Healthy Steps classes taught gentle, therapeutic exercise movements based on the Lebed Method to prevent lymphedema and increase range of motion for breast cancer survivors, seniors and those battling other chronic health conditions. Throughout the year, the Laurel Amtower Cancer Institute staff provided cancer education and resources to hundreds of community members at a variety of community events, including the San Diego State University (SDSU) 2015 Health Expo - The Road to Wellness; the 30th annual Linda Vista Multicultural Fair & Parade; Fiesta del Sol family festival; and the Sharp Women's Health Conference. In observance of National Cancer Survivors Day, the Laurel Amtower Cancer Institute staff held a celebratory event for three days in June to recognize cancer survivors, support cancer patients and educate the community, including a Survivorship Education class held later that month. The Laurel Amtower Cancer Institute at SMH includes the Breast Health Center and the Neuro-Oncology Center, with two designated licensed clinical social workers (LCSW), a dietician, genetics c”

“* Between 2012 and 2013, unintentional injuries accounted for 85 percent of all injury deaths among adults ages 65 and older in the U.S. (National Center for Health Statistics, 2015). * 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 and violence prevention program for children, adolescents and young adults throughout SDC FY 2015 Report of Activities With the partnership and financial support of the Health and Science Pipeline Initiative (HASPI), ThinkFirst/Sharp on Survival speakers connected with students from more than a dozen schools throughout SDC including Castle Park High School, Coronado High School, Eastlake High School and Oceanside High School as well as at-risk teenagers from San Diego High School of Science and Technology (formerly San Diego High). Reaching more than 350 students, the program offered a variety of classroom presentations, small assemblies, and personal testimonies from individuals with traumatic brain injury (TBI) or SCI, known as Voices for Injury Prevention (VIPs). Educational topics included the consequences of poor decision making, injury prevention and available careers in health care. In addition, students interested in pursuing careers in health care received a half-day tour of the SMH Rehabilitation Center. In March, the Children's Primary School in Clairemont invited ThinkFirst/Sharp on Survival to their event titled The Human Body to provide information about the brain and spinal cord as well as injury prevention. In preparation for the event, students from kindergarten through eighth grade created interactive educational displays to engage families and the local community. More than 300 community members attended the event, where they learned about a variety of topics such as the nervous system, digestive system and circulatory system. FY 2016 Plan ThinkFirst/Sharp on Survival 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 * As appropriate with funding, explore opportunities to incorporate concussion education into school and community based presentations. * Through the HASPI partnership, continue to expand educational presentations to schools in North County, South Bay and Coronado * Explore further opportunities to provide education to health care professionals and college students interested in health care careers 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 HHSA, SDC is one of 28 counties in Califo”

“SMH offered students and interns throughout SDC various placement and professional development opportunities in FY 2015. Approximately 400 nursing students and more than 300 ancillary students from a variety of colleges and universities spent more than 122,000 hours at SMH in FY 2015. Program partners included Alliant International University, Azusa Pacific University (APU), Boston University, California Northstate University, California State University Dominguez Hills (CSUDH), California State University San Marcos (CSUSM), Creighton University, EMSTA College, Kaplan College, Palomar College, Point Loma Nazarene University (PLNU), San Diego Mesa College, SDSU, Southwestern College (SWC), and USD. During the year, case management and social work team members mentored three Master of Social Work (MSW) students from the University of Southern California (USC) and the SDSU School of Social Work. In addition, SMH's Clinical Pastoral Education (CPE) Program offered clinical training to six chaplain residents, teaching them theories and skills to help them provide exceptional spiritual care to patients and their families. The CPE program also presented to 20 SDSU nursing students about the role of a chaplain. Furthermore, Sharp Rehab presented to 50 physical and occupational therapy students at the University of St. Augustine in San Marcos on adjusting to disability. Through affiliations with EMSTA College, National College of Technical Instruction, Palomar Community College, SWC, and West Med College, SMH provided both clinical training and observation hours for Emergency Medical Technician (EMT) and paramedic interns. This included 17 EMT students who spent one eight-hour shift in the ED, and 32 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 4,750 hours of clinical training and supervision to these specialized community programs in FY 2015. SMH and SGH continued to provide one of only two mobile intensive care nurse 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 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. SMH also provided a comprehensive two-day course in orthopedic nursing to approximately 50 community health care professionals. The course covered a variety of topics, including total joint replacement, foot and ankle, trauma, bone tumors, spine, mobility, pediatrics, metabolic disease and complications. In addition, Sharp hosted a European and North American Perspectives on Hip Preservation conference to provide learning opportunities to community orthopedic surgeons, radiologists, orthopedic nurses, physician assistants, physical therapists and other professionals involved in the care of patients with hip conditions as well as student interns and residents in the community. Conference topics included cemented hip arthroplasty, the state of hip preservation in Australia, case presentations and question and answer sessions. The conference featured presentations by orthopedic surgeons from Sharp as well as international experts from Germany, Austria and Switzerland. 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, 190 students in ninth through 12th grade were supervised for approximately 20,500 hours between SMH and the Pavilion. A variety of hospital areas participated in the program, including inpatient nursing, ED, laboratory”

“* According to 2014 CHIS data, in SDC for those 18 to 64 years of age, the most common sources of health insurance coverage include employment-based coverage (54.2 percent) and public programs (15.2 percent). * As of November 2015, the overall unemployment rate was 4.8 percent for SDC, falling below the unemployment rate for the state of California in December 2015 of 5.8 percent (BLS, 2015). * Between 2012 and 2014, demand for ED services in SDC increased by 3.3 percent, from 449,000 to 561,000 visits (askCHIS). * In 2015, the health insurance benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA) cost a single person in California between $511 and $625 per month; for three or more participants on the plan in California, COBRA costs ranged from $1,687 to $1,961 per month (2015 COBRA Self-Pay Rates, Motion Picture Industry Pension & Health Plans). * Between 2009 and 2014, community clinics in California have experienced rising rates of primary care clinic utilization. The number of persons utilizing the clinics increased by 5.9 percent between 2013 and 2014 (Office of Statewide Health Planning and Development, 2015). * Consistent with demand, the number of community clinics in California rose from 1,010 in 2009 to 1,289 (or 27.62 percent) in 2014 (OSPHD, 2014). 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 2015 Report of Activities In FY 2015, SMH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the SDRM, SMH discharged chronically homeless patients to the SDRM'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 SDRM's programs in order to help these patients get back on their feet. Sharp also provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Advocacy for safe discharge from the hospital is a top priority, regardless of funding. Patients receive assistance with transportation and placement; connections to community resources; and financial support for medical equipment, medications, and even outpatient dialysis and nursing home stays. In addition, clinical social work services, particularly for homeless populations, include assessment for individuals at risk for psychiatric disorders, developmental disorders and substance abuse issues. For these high-risk individuals, referrals are provided as needed for housing, medication management and supportive community services. To further assist economically disadvantaged individuals, SMMC provided more than $111,000 in FY 2015 in free medications, transportation, lodging and financial assistance through its Project HELP funds. SMH also piloted a Meds-to-Beds program in FY 2015 to bring prescribed medications directly to patients before they leave the hospital, and help increase medication adherence post-discharge. These patients face challenges with picking up their medications on their own due to costs or other access issues. FY 2016 Plan SMH will do the following: * Continue to collaborate with community organizations to provide medical care, financial assistance, clinical social work services and community resources to chronically homeless patients * Explore collaborations with Society of St. Vincent de Paul and Connections Housing to provide post-discharge housing and services to chronically homeless patients * Continue to administer Project HELP funds to those in need; evaluate program to ensure it meets needs of the population served * Continue to provide internship opportunities to graduate s”

“* 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 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), 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 Sciences, Psychiatric Emergency Response Team (PERT) and Serving Seniors. 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 * SMV is located at 7850 Vista Hill Avenue in San Diego, ZIP code 92123. * SMC is located at 7989 Linda Vista Road in San Diego, ZIP code 92111. * SMV Mid-City Outpatient Program is located at 4275 El Cajon Boulevard, Suite 100 in San Diego, ZIP code 92115; SMV East County Outpatient Program is located at 1460 East Main Street in El Cajon, ZIP code 92021. As specialty hospitals, SMV and SMC serve the community of San Diego County (SDC). The primary communities served by SMV and SMC include the City of San Diego, Chula Vista, the east region, and north inland communities surrounding Rancho Bernardo. For SMV's and SMC's 2013 Community Health Needs Assessment (CHNA) process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within SDC. The CNI identifies the severity of health disparity for every ZIP code in the United States based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by SMV with especially high need include but are not limited to East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In SDC in 2014, 98.2 percent of children ages 0 to 11, 91.5 percent of children ages 12 to 17, and 84.3 percent of adults ages 18 to 64 had health insurance - failing to meet the Healthy People 2020 (HP 2020) national targets for health insurance coverage. See Table 2 for a summary of key indicators of access to care and Table 3 for data regarding Medi-Cal eligibility. In SDC in 2014, 20.9 percent of adults ages 18 to 64 did not have a usual source of care and 14.3 percent of these a”

“* The SMV and SMC 2013 CHNAs identified 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 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 health in more vulnerable communities within SDC. * In 2014, Alzheimer's disease and suicide were the third and eighth leading causes of death for SDC, respectively (CDC, 2014). * In 2014, the age-adjusted death rate due to suicide in SDC was 12.5 deaths per 100,000, which is higher than the HP 2020 target of 10.2 deaths per 100,000. * In 2013, the age-adjusted rate of self-inflicted injury emergency department (ED) discharges in SDC was 81.2 per 100,000 population. * In 2013, there were 2,473 cases of overdose/poisoning hospitalizations in SDC and the age-adjusted rate of overdose/poisoning hospitalizations among SDC residences was 76.2 percent. * In 2013, the age-adjusted rate of overdose/poisoning-related ED visits in SDC was 163.1 per 100,000 population. County age-adjusted rates for overdose/poisoning-related ED visits were higher in females when compared to males, which is higher among Blacks when compared to other races, and higher among individuals ages 15 to 24 years when compared with other age groups. * In 2014, 40.1 percent of adults in SDC ages 18 to 64 reported an episode of binge-drinking in the past year. Additionally, 2.9 percent of teens reported an episode of binge-drinking the previous month (CHIS, 2014). * Approximately 9.2 million adults have co-occurring mental health and addition disorders in the U.S. (National Alliance on Mental Illness (NAMI), 2013). * In the U.S., approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders (NAMI, 2013). * According to HP 2020, substance abuse has a major impact on individuals, families and communities. The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental and public health problems, including teenage pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), other sexually transmitted diseases (STDs), domestic violence, child abuse, motor vehicle crashes, physical fights, crime, homicide and suicide. * In the first six months of 2014, Family Health Centers of San Diego reported a huge increase in demand for mental health service, with a 52 percent increase in mental health visits compared to the same period in 2013. The increase is attributed to the Patient Protection and Affordable Care Act's requirement that mental health care be one of 10 essential benefits all insurance policies must include starting January 1, 2014. * Serious mental illness costs America $193.2 billion in lost earnings per year and those facing serious mental illness face an increased risk of having chronic medical conditions. Objectives * Provide mental health and substance abuse e”

“In FY 2015, SMV and SMC sponsored and participated in five 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 Community Walk, San Diego Alzheimer's Association annual Walk to End Alzheimer's and the American Heart Association's Heart & Stroke Walk. Throughout 2015, SMV attended several health and wellness fairs, conferences and events. At the 20th International Summit & Training on Violence, Abuse & Trauma Across the Lifespan Conference, SMV provided a resource booth with information and education on childhood trauma to approximately 200 attendees. SMV also provided information on services and intake processes at the Psychiatric Emergency Response Team (PERT) Academy Resource Fair, a quarterly training event where SDC police officers are trained to be paired with licensed psychiatric clinicians to evaluate and assess an individual's mental health condition and needs, and, if appropriate, transport the individual to a hospital or treatment center or refer the individual to a community resource or treatment facility. SMV provided education on nutrition to 30 members of the following mental health clubhouses: Corner Clubhouse and Neighborhood House Association's Friendship Clubhouse. SMC offered free chemical dependency assessments, educational materials and community referral resources to approximately 550 community members. In addition, SMV and SMC provided stress management assessments and resources at the 2015 Sharp Women's Health Conference in March. SMV sponsored and participated in several events in FY 2015, benefitting organizations such as the Alzheimer's Association, Mental Health Systems, NAMI and Jewish Family Services Behavioral Health Committee. SMV, in partnership with the Alzheimer's Association, sponsored the Alzheimer's Association's Caregiver Conference designed for caregivers and families who are caring for and living with someone with memory loss, dementia or Alzheimer's disease. The conference provided updated information on Alzheimer's disease, medications and clinical trials as well as offered strategies for daily living and coping. In January, SMV sponsored the Jewish Family Services of San Diego resource and panel event titled Putting the Puzzle Together: Mental Health Policy and Community Options. More than 180 community members attended the event and received mental health resources as well as information from a panel of experts on the successes and challenges of mental health policy in San Diego. 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. SMV also hosted and participated in Employee Assistance Professional Association (EAPA) to increase knowledge and education in the behavioral health professional community. In FY 2015, 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 secured a three-year contract issued by the County of San Diego to establish an Independent Living Registry and an Independent Living Association (ILA). The work team developed a four-prong approach to address the challenges to safe and healthy independent living facilities (ILFs), which included a registry of participating ILFs to be a central resource for consumers, family members and health care professionals; educational curriculums for members of the ILA; peer review and accountability through site visits; and advocacy. These efforts seek to improve conditions for ILFs and the consumers housed there, help keep consumers linked with essential services and providers, and reduce crime and unnecessary arrest rates.”

“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 2014, Alzheimer's disease was listed as the third leading cause of death for SDC residents ages 65 and up. * In 2014, the suicide rate for SDC seniors in SDC was 24.4 per 100,000 population. * In 2013, the ED discharge rate for seniors in SDC with a self-inflicted injury was 14.5 per 100,000 population. * In 2013, the hospitalization rate for seniors in SDC with a self-inflicted injury was 31 per 100,000 population. * According to 2014 CHIS data, 4.8 percent of adults over the age of 65 in SDC thought about committing suicide in the past year. * According to 2014 CHIS data, six 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. Of those, only 27.5 percent sought help 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 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 UC Davis Medical Center Community-Defined Solutions for Latino Mental Health Care Disparities report, barriers addressing the unmet mental health needs of the senior Latino community in SDC include: stigma of mental illness, housing, transportation, social support, exposure to violence and masculinity 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 (UC Davis Medical Center, 2012). * 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 isolation and/or loneliness affects their quality of life, and more than one out of four (27 percent) said they suffered from emotional problems during the month before the survey was taken. * According to the 2012 SANDAG Survey of Older Americans Living in San Diego County, the greatest percentage (26 percent) of respondents indicated that medical ailments/issues were the biggest problems impacting them, including depression, mental health concerns and memory loss, among others. Objectives * Provide culturally competent outreach services to high-risk seniors in SDC's disadvantaged communities * Provide education and screening to senior community members FY 2015 Report of Activities Throughout FY 2015, SMV clinicians collaborated with Serving Seniors to provide 16 hours each week to the Gary and Mary West Senior Wellness Center for senior clients and eight hours a week at Potiker Family Senior Residence, a residential site for low-income, at-risk seniors. Seniors received a variety of early intervention services, including examination by a nurse or psychiatrist, medication, referrals or counseling to reduce the risk of h”

“Identified Community Need: Mental Health and Substance Abuse Education for Health Care Professionals and Students, and Collaboration with Local Schools to Promote Interest in Health Care Careers 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. * In 2013, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported to congress on the nation's substance abuse and mental health workforce crisis, citing high turnover rates, worker shortages, an aging workforce, stigma and inadequate compensation as contributing factors. In addition, SAMHSA asserts the need for recruiting a more diverse, younger workforce and retaining trained and qualified staff to provide for the behavioral health needs of the nation's population. * Workforce issues have an impact on the infrastructure of the growing behavioral health delivery system as the Patient Protection and Affordable Care Act seeks to integrate health services (SAMHSA, 2013). * A report from the San Diego Workforce Partnership in 2010 states 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 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 social workers is projected to grow 12 percent from 2014 to 2024, 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 (Bureau of Labor Statistics, 2015). * According to the California Hospital Association (CHA) 2014 report, titled Critical Roles: California's Allied Health Workforce Follow-Up Report, programs supported by local hospitals make tremendous impacts on the lives of individuals, families and communities. This includes time and resources dedicated to the thousands of interns and high school students spending time in California hospitals each year, gaining valuable work experience and career exposure. * In the U.S., 62 million people reside in rural or frontier counties; 75 percent of these counties have no advanced behavioral health practitioners (SAMHSA, 2015). * In 2012, the turnover rates in the addiction services workforce ranged from 18.5 percent to more than 50 percent across the U.S. (SAMHSA, 2015). Objectives * Provide internship and clinical training programs in psychology, social work, marriage and family therapy (MFT), health information technology and pharmacy * Serve as a placement site for medical, nursing, psychology, pharmacy, MFT and social work stude”

“In addition, SMV and SMC provided several educational offerings for behavioral health care professionals in FY 2015, 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 included wellness and resilience, recognizing stress, substance abuse, self-injury, dual diagnosis, eating disorders, sleep disturbances, treating depression, geriatric mental health, older adult disorders and cultural considerations in the treatment of Latino populations. SMV staff also participated in and provided educational resources on understanding psychiatric emergencies and community psychiatric services at quarterly San Diego PERT police officer trainings. SMC also hosted educational events for the EAPA where they 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. SMV also provided suicide risk assessment lectures to 40 community health professionals in August and September. In addition, SMV provided four geriatric training sessions to 100 students in the Behavioral Health Education and Training Academy, a program of the Academy for Professional Excellence at SDSU. Throughout FY 2015, 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), National Nurse Practitioner Symposium Planning Committee, Jewish Family Service Political Action Committee, San Diego County Wandering Task Force, San Diego County Older Adult Council, San Diego County Alzheimer's Task Force, Mesa College Health Information Technology (HIT) Program Advisory Committee, Community College Board of Trustees Advisory Committee, Kaplan College HIT Program Advisory Committee, San Diego Health Information Association, Mesa College Registered Health Information Administration, California Health Information Association, San Diego Suicide Prevention Council, San Diego Military Family Collaborative, San Diego Workforce Partnership, 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, American Health Information Management Association, 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 Planning Committee, HASD&IC, American Foundation for Suicide Prevention, 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 2016 Plan”

“SMV or SMC will do the following: * Offer internship and clinical training programs and/or placement for nursing, medical, psychology, social work, MFT, health information technology and pharmacy students * Provide lectures on behavioral health issues to the local academic community * 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 * Provide educational offerings for behavioral health care professionals, community groups and community members * Continue to strategically align with nonprofit allies and key community partners through board, committee and advisory memberships 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, veterans and their families through programs geared specifically toward service members, including the VA-supported Veterans Choice Program * Transportation services and complimentary lunches * Practicum programs for graduate social work and marriage and family therapy interns * Clinical supervision site for graduate psychology doctorate interns * Medication research studies Sharp McDonald Center at Sharp HealthCare: * Chemical dependency and substance abuse inpatient, residential and outpatient treatment services for teens, adults and seniors * Inpatient detoxification services * Dual-diagnosis outpatient treatment services for adults and seniors * Sober living and substance abuse education programs Sharp Mesa Vista Mid-City Outpatient Program: * Caring for adults with severe and persistent mental health issues * Individualized treatment planning and medication management * Group, family and expressive therapies * Psychiatric rehabilitation services * Transitional Age Youth programs Sharp Mesa Vista El Cajon Outpatient Program: * Adult and adolescent programs * Caring for adults with severe and persistent mental health issues * Group and expressive therapies * Individualized treatment planning and medication management * Psychiatric rehabilitation services Appendix A - Sharp HealthCare Involvement in Community Organizations The list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2015. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Adult Protective Services * Aging and Independence Services * Alzheimer's Association * American Association of Colleges of Nursing * American Association of Critical Care Nurses, San Diego Chapter * American Cancer Society * American College of Healthcare Executives (ACHE) * American Diabetes Association * American Foundation for Suicide Prevention * American Health Information Management Association * American Heart Association * American Hospital Association * American Psychiatric Nurses Association * American Red Cross of San Diego * Arc of San Diego * Asian Business Association * Association for Ambulatory Behavioral Healthcare * Association for Clinical Pastoral Education * Association of Women's Health, Obstetric and Neonatal Nurses * Azusa Pacific University * Beacon Council's Patient Safety Collaborative * Boys and Girls Club of San Diego * Bonita Business and Professional Organization * California Association of Health Plans * California Association of Hospitals and Health Systems * California Association of Marriage and Family Therapists * California Association of Physician Groups * California Board of Behavioral Health Sciences * Califor”

“* San Diego Association of Directors of Volunteer Services * San Diego Association of Governments Public Health Stakeholder Group * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Brain Injury Foundation * San Diego Coalition of Mental Health * San Diego Council on Suicide Prevention * San Diego County Breastfeeding Coalition Advisory Board * San Diego County Coalition for Improving End-of-Life Care * San Diego County Council on Aging * San Diego County Emergency Medical Care Committee * San Diego County Health and Human Services Agency * San Diego County Hospice-Veteran Partnership * San Diego County Older Adult Behavioral Health System of Care Council * San Diego County Perinatal Care Network * San Diego County Social Services Advisory Board * San Diego County Stroke Consortium * San Diego County Suicide Prevention Council * San Diego County Taxpayers Association * San Diego Covered California Collaborative * San Diego Dietetic Association Board * San Diego East County Chamber of Commerce Health Committee * San Diego Emergency Medical Care Committee * San Diego Eye Bank Nurses Advisory Board * San Diego Food Bank * San Diego Food System Alliance, Healthy Food Access Committee * San Diego Half Marathon * San Diego Health Information Association * San Diego Healthcare Disaster Council * San Diego Hospice and Palliative Nurses Association * San Diego Housing Commission * San Diego Hunger Coalition * San Diego Imperial Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. * San Diego Mental Health Coalition * San Diego Mesa College * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders, a local ACHE Chapter * San Diego Patient Safety Consortium * San Diego Physician Orders for Life-Sustaining Treatment Coalition * San Diego Regional Home Care Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego-Imperial Council of Hospital Volunteers * San Diego Regional Chamber of Commerce * San Diego Rescue Mission * San Diego Science Alliance * San Diego State University * San Ysidro High School * Santee Chamber of Commerce * SAY San Diego * Second Chance * Serving Seniors * Sigma Theta Tau International Honor Society of Nursing * Society of Trauma Nurses * South Bay Community Services * South County Action Network * South County Economic Development Council * Southern California Association of Neonatal Nurses * Southern California Earthquake Alliance * Southern Caregiver Resource Center * Special Olympics * St. Paul's Retirement Homes Foundation * St. Vincent de Paul Village * Susan G. Komen Breast Cancer Foundation * Sweetwater Union High School District * The Meeting Place * Third Avenue Charitable Organization * Trauma Center Association of America * United Service Organizations Council of San Diego * University of California, San Diego * University of San Diego * VA San Diego Healthcare System * Veterans Home of California, Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * Walk San Diego * Women, Infants and Children Program * YMCA * YWCA Becky's House * YWCA Board of Directors * YWCA Executive Committee * YWCA Finance Committee * YWCA In the Company of Women Event”