Sharp Memorial Hospital

“Board of Directors member,Stephen Cushman, has a family relationship with another Board of Directors member, Lori Moore.”

“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 2015.”

“Policies are considered proprietary information, however in Sharp HealthCare's publicly available Code of Conduct, Sharp outlines its Conflict of Interest policies in a user friendly manner. The annual audited financial statements of the consolidated group are published on the dacbond.com website (www.dacbond.com), are attached to the Form 990 filed for each of the Sharp hospitals, and are available upon request. The annual audited financial statements include combining schedules which disclose the financial results (Balance Sheet, Statement of Operations, Statement of Changes in Net Assets) for each entity of the consolidated group. Quarterly financial statements of Sharp's obligated group are published on the dacbond.com website (www.dacbond.com).”

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

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

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

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

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

“Change in minimum pension liability -8,086,886.”

“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 2016 Section 1 An Overview of Sharp HealthCare Sharp team members - both current and those who have come before us - have been making a difference in San Diegans' lives for more than 60 years. We have been entrusted with a great responsibility to build on this legacy, and we are honored to do all we can to make Sharp the very best it can be. I'm proud that we are always striving to make our patients, their families and our community our highest priorities. - Michael W. Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 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, 2016, Sharp is licensed to operate 2,084 beds and has more than 2,900 Sharp-affiliated physicians and 18,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in SDC's 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's and infant's services, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. Sharp Grossmont Hospital (524 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, oncology, orthopedics, rehabilitation, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation. 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 hospital in California. Sharp Mesa Vista Hospital (158 licensed beds) As the largest privately operated psychiatric hospital in San Diego, Sharp Mesa Vista Hospital (SMV) is a premier provider of behavioral health services. Sharp McDonald Center (16 licensed beds) Sharp McDonald Center (SMC) is the only medically supervised substance abuse recovery center in SDC. Offering the most comprehensive hospital-based treatment program in San Diego, SMC provides services such as addiction treatment, medically supervised detoxification and rehabilitation, day treatment, outpatient and inpatient programs, and aftercare. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported u”

“Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp HealthCare made an important decision regarding these pillars as part of its continued journey toward excellence. Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: o Sensitivity to operations o A reluctance to simplify o Preoccupation with failure o Deference to expertise o Resilience 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 Below please find a selection of recognitions Sharp has received in recent years: In 2013, 2014, and 2016 Sharp was recognized as one of the World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was ranked No. 16 out of 500 large employers on Forbes America's Best Employers 2016 list. Sharp was also given the No. 2 spot on the newcomer's list. 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 2016, Sharp ranked second in the same category, while SMH ranked second for "Best Hospital and SMBHWN and SGH ranked third and fourth. Also in 2016, Sharp Community Medical Group (SCMG) and SRS ranked first and third, respectively, as San Diego's "Best Medical Group". In 2016, SMH and SMBHWN were named on The Leapfrog Group's Top 115 Hospitals list recognizing facilities that meet the highest standards of patient safety, care quality and efficiency. SGH and SMH have both received MAGNET(r) 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 i”

“Press Ganey also recognized multiple SHC entities with the Pinnacle of Excellence AwardSM (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the Press Ganey categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013, 2015 and 2016, Press Ganey recognized SMH for patient experience. From 2013 to 2015, SHC was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP was ranked a top 100 U.S. health plan and a top three California health plan based on the National Committee for Quality Assurance's (NCQA) Private Health Insurance Rankings 2014-2015, which rated health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. SHP also received the highest level "Excellent" Accreditation status from the NCQA for the third year in a row (2013-2015). The NCQA awards accreditation status based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. SHP was also rated highest in California among reporting California Health Plans for Rating of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating of Health Promotion and Education in NCQA's 2015 Quality Compass/CAHPS survey, which provides state, regional and national benchmarks as well as individual plan performance. From 2013 to 2016, Sharp has ranked in the top 10 of the large employers category as one of the "Best Places to Work" for information technology professionals by the International Data Group's (IDG) Computerworld survey. The list is compiled using the following criteria: benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. SGH received a Women's Choice Award(r) as one of America's Best Hospitals for Cancer Care in 2015, and one of America's Best Hospitals for Obstetrics in 2016. In 2015, SMBHWN received the award as one of America's Best Hospitals for Obstetrics. The Women's Choice Award(r) is a symbol of excellence in customer experience awarded by the collective voice of women. For the third year in a row, and the fourth time in five years, Sharp won the top spot in the Mega Employer category in the San Diego Association of Government's (SANDAG's) iCommute Rideshare 2015 Challenge. The month-long challenge encouraged the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or transit commutes. Powered by SANDAG and in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Sharp was named the 2015 Medical Provider of the Year at the International Travel & Health Insurance Journal (ITIJ) Awards. The ITIJ honors companies that have made an outstanding contribution to the global travel and health insurance industry over the past year. Sharp's Global Patient Services program coordinates patient transfers and evacuations for medical emergencies from around the world to a Sharp hospital. Patient Access to Care Programs Uninsured patients without the 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 receiving care 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 desig”

“New this past year, SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh/SNAP (Supplemental Nutrition Assistance Program) benefits prior to hospital discharge, dramatically increasing the likelihood that patients complete CalFresh applications and receive benefits. In FY 2016, SGH's PFS team completed 227 CalFresh applications and 125 patients were granted CalFresh benefits. As a result of the success from this pilot, in February 2017 Sharp's PFS team will expand this program to the remaining acute care hospitals. In summer 2015, a pilot program was launched at SMBHWN to support and provide financial assistance to both insured and unfunded families with Neonatal Intensive Care Units (NICU) babies. This process included meeting with families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight, and evaluating those families for Supplemental Security Income (SSI) eligibility. The program provided assistance for the newborn's costs of care both within and outside of the hospital. Public Resource Specialists have assisted more than 60 families through the process of applying for SSI. In a targeted effort to provide exceptional care for vulnerable populations, since 2013, Sharp has participated in the Community-based Care Transitions Program (CCTP) for Medicare Fee For Service patients. The program began with the San Diego Care Transitions Partnership (SDCTP) under the Health and Human Services Agency, Aging & Independence Services (AIS), and included Scripps Health, Palomar Health, and University of California San Diego (UCSD) Health System (11 hospitals with a total of 13 campuses). The program was grant-funded for three years by the Centers for Medicare and Medicaid Services to provide comprehensive patient-centered, hospital and community-based services. The goals of CCTP included: * Improve transition from the inpatient hospital setting to community * Improve quality of care * Reduce readmissions for high risk beneficiaries * Document measurable savings to the Medicare program CCTP improves transition from hospital to home by providing patients with tools and support that promote knowledge and self-management of their condition. Sharp's Transition coaches functioned as facilitators, coaching patients and their caregivers in order to encourage self-management and direct communication between patients, caregivers and providers. The program extended for 30 days per patient and included a hospital visit, a home visit and follow-up phone calls. The CCTP program concluded in FY 2016 with the ending of the program's grant funding, and more than 40,000 patients were served collectively through the program. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. SCHHC, SGH and SMH work with the San Diego Rescue Mission (SDRM) to identify homeless patients, or patients who have exhausted other community housing resources, who have a continuing medical need after hospital discharge. Once referred to the SDRM's Recuperative Care Unit, patients receive follow-up medical care through Sharp in a safe environment, and may also receive psychiatric care, help scheduling specialty appointments, assistance with CalFresh applications, and connections to community resources including programs that support continued sobriety and residential treatment. In addition, a social worker provides referrals for permanent housing and collaborates with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessn”

“Students begin their internship experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of the HSHMC program is the entry level for all students and is conducted over an eight-week period. Through Level I, ninth-grade students shadow primarily non-nursing areas of the hospital as well as complete additional coursework in Infection Control, Medical Ethics, and Introduction to Health Professions. Level II is designed for students in grades 10 through 12 and includes enhanced patient interaction, college-level clinical rotation, and hands-on experience. Level II students are placed in a new assignment each semester for a variety of patient care experiences, and take additional health-related coursework at a community college, including Health 101, Public Health, Psychology and Abnormal Psychology, Nutrition, Intro to Health Professions, and Health and Social Injustice. In FY 2016, approximately 450 HSHMC students - including 280 Level I students and 150 Level II students - were supervised for approximately 57,600 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology (OB/GYN); occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; endoscopy; engineering; nutrition; infection control; pulmonary services; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2016, the HSHMC program graduated 153 students in its sixth full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including outcomes of students and graduates, to promote long-term sustainability. Although many HSHMC students face financial hardship - the free and reduced-price meal eligibility rate is higher than the averages for SDC and California - the charter school excels in preparing students for high school graduation, college entrance and a future career. In 2016, 90 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 88 percent of students said they wanted to pursue careers in health care. In addition, HSHMC has a 100 percent graduation rate, which is higher than California's 82.3 percent state average. HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. Each year, Classroom for the Future Foundation awards education programs across SDC in four categories: innovate, inspire, achieve and impact. HSHMC is also a 2016 U.S. News & World Report Best High Schools bronze award winner. The California Department of Education recognized HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and as a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high- and low-performing students. HSHMC was also recognized with a 2015 Model Professional Learning Community at Work(tm) Award by Solution Tree for its sustained success in raising student achievement. Professional Learning Communities are schools and districts in which educators recognize the key to improved learning for students is on-going, job-embedded learning for the adults who serve those students. HSHMC was one in approximately 200 schools and districts in the U.S. and Canada, and the first school in SDC, to receive this honor. In addition, HSHMC is a 2014 National School Safety Advocacy Council award winner. Lectures and Continuing Education Sharp contributes to the academic environment of colleges and universities throughout San Diego. In FY 2016, Sharp staff provided hundreds of academic hours in lectures, courses an”

“The HRPP provides education and support for researchers across Sharp as well as the broader San Diego health and research communities regarding requirements for the protection of human research participants. In addition, as part of its mission, the Center for Research hosts quarterly meetings on relevant educational topics for community physicians, psychologists, research nurses, study coordinators and students throughout San Diego. Recent presentations have included Investigator Quality Improvement Activities and Assessments; Understanding Research Noncompliance, Serious Noncompliance and Continuing Noncompliance; Research Community Outreach; Understanding Privacy and Confidentiality in Research; and Clinical Trials Coverage Analysis. Outcomes Research Institute (ORI) Sharp's ORI began in 2010 as a pilot initiative funded by the Sharp HealthCare Foundation. The ORI measures the long-term results of care to continue to develop and promote best practices in health care delivery. The ORI enables Sharp to develop and disseminate new knowledge to the larger health care community, and help improve the quality of care delivery across SDC. The ORI collaborates with Sharp team members to facilitate the design of patient-centered outcomes research projects; assist with study protocol development, data collection and analysis; explore funding mechanisms for research projects; and facilitate IRB application submissions. The ORI seeks guidance and expertise from the local and national academic community on how to effectively conduct outcomes research to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University. Beginning in September 2016, the ORI expanded its capabilities by adding a full-time post-doctoral clinical psychology fellowship position and a half-time practicum placement for a predoctoral graduate student. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows and mentors to change and improve clinical practice and patient care. This evolution in practice and care occurs through identifying a care problem, developing a plan to solve it and then incorporating this new knowledge into practice. The EBPI is part of the Consortium for Nursing Excellence, San Diego, which promotes evidence-based practice in the nursing community. The consortium is a partnership between Sharp, Scripps Health, Palomar Health, Rady Children's Hospital - San Diego, UC San Diego Health, VA San Diego Healthcare System (VASDHS), Elizabeth Hospice, PLNU, SDSU, APU and USD. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom and structured mentorship throughout the program. The EBPI fellows partner with their mentors and participate in a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellows through the process of evidence-based practice. Mentors also assist the fellows in working collaboratively with other key hospital leadership personnel. The nine-month program culminated with a community conference and graduation ceremony in November, at which the project results of all EBPI fellows were shared. Thirty fellows graduated from the EBPI program in FY 2016, completing projects that address the following issues in clinical practice and patient care: creating an acute care-friendly environment for altered mental status and high-risk fall patients; the effects of aromatherapy on anxiety in pediatric post-operative patients; implementing a health literacy protocol; debriefing after resuscitation; and bedside pressure mapping for ulcer prevention. Volunteer Service Sharp Lends a Hand I”

“The Food Bank feeds San Diegans in need, advocates for the hungry, and educates the public about hunger-related issues. Each month, the Food Bank distributes an average of 22 million pounds of food - equivalent to 18.6 million meals - to more than 400,000 San Diegans. Weekend backpacks full of food are provided to more than 1,400 chronically hungry schoolchildren at 31 elementary schools every Friday during the school year, and more than 8,400 low-income seniors receive a box of groceries and staple food items at 48 distribution sites throughout SDC. Over two weeks between March and August 2016, more than 330 SLAH volunteers inspected, cleaned and sorted donated food, assembled boxes and cleaned the Food Bank warehouse. For two days in March, approximately 140 SLAH volunteers provided registration, gear-check, water stop and finish-line support at the San Diego Half Marathon. This premier race raises money for local community service projects and charitable causes in San Diego, including the Skinny Gene Project; ALS Association Greater San Diego Chapter; Huntington's Disease Society of America; Make-A-Wish Foundation of San Diego; National Foundation of Autism Research; San Diego Police Officers Association; Widows and Orphans Fund; Team Red, White and Blue; Toys for Joy; Sienna's PlayGarden; Mama's Kitchen; Race Guards; and Hole Hearted. In April, SLAH partnered with I Love a Clean San Diego for the 14th annual Creek to Bay Cleanup. Approximately 25 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In September, more than 120 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including San Elijo State Beach, Miramar Lake, Mission Bay, Pacific Beach, Lake Murray, Mast Park, Eastlake and Coronado City Beach. SLAH participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego, to provide community-based social services to veterans without a permanent residence. On seven days in June, approximately 150 volunteers sorted and organized clothing donations and set up the event's clothing tent. During the two-day event in July, which served more than 900 veterans, 120 SLAH volunteers worked in the clothing tent to find suitable clothes for the homeless veterans. In addition, approximately 70 clinical volunteers - including Sharp nurses, doctors, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by SCI. Through the organization's award-winning program, They Will Surf Again, paraplegics and quadriplegics can experience mobility through surfing with support from adaptive equipment and volunteers. In September, an estimated 70 SLAH volunteers assisted They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. FSD, part of the Feeding America network, is committed to leading the community in the fight against hunger by efficiently providing access to food and nutritious meals. FSD relies on the generous support of individuals, corporations, foundations and community groups to sustain critical hunger-relief and nutrition programs throughout the region. Every week, the organization feeds more than 63,000 children, families and seniors in need. On seven days in 2016, approximately 340 SLAH volunteers contributed their time to bag, box and distribute food for FSD. 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 60 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and”

“In July, a Sharp team member joined Su Refugio Ministries - an organization dedicated to caring for orphans and widows - to assist local doctors and dentists in caring for more than one thousand residents of Tobati, Paraguay. During the ten-day mission, the team organized a community health clinic to provide medical, vision, and dental services as well as spiritual care, self-defense training for high school girls, and a social services fair. Since 2009, Experience Camp has provided one-week camps for youth throughout the U.S. 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 2016, a Sharp team member served as a clinician with Experience Camp to help develop programs to meet the emotional needs of the camp's youth and provide support for other volunteer clinicians and cabin counselors. Community Walks Heart disease is the leading cause of death in the U.S. For the past 20 years, Sharp has proudly supported the AHA annual San Diego Heart & Stroke Walk. In September 2016, approximately 1,040 walkers represented Sharp at the 2016 San Diego Heart & Stroke Walk held at Balboa Park. More than 100 teams representing entities across the Sharp system raised funds for the walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. Teams raised funds through numerous activities, such as auctions, drawings for prizes and a karaoke competition. Sharp was the No. 1 team in San Diego and the No. 2 team in the AHA Western Region Affiliates, raising more than $207,700. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community. Sharp provides many volunteer opportunities for individuals to assist with a wide variety of programs across the Sharp system. Volunteers of all ages and skill level devote their time and compassion to patients as well as the general public and are an essential element to many of Sharp's programs, events and initiatives. Sharp volunteers spend their time within hospitals and out in the community as well as in support of the foundations. On average, more than 1,830 individuals actively volunteered at Sharp each month in FY 2016, contributing a total of approximately 273,000 hours of service to Sharp and its initiatives throughout the year. This included more than 1,900 auxiliary members and thousands of individual volunteers from the San Diego community, including volunteers for Sharp's various foundations. More than 17,400 volunteer hours were dedicated to activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the average number of active volunteers per month as well as the total number of volunteer service hours provided to each Sharp entity, specifically for patient and community support. Table 2: Sharp Volunteers and Volunteer Hours - FY 2016 Average Active Volunteers per Month: Sharp Chula Vista Medical Center 374 Sharp Coronado Hospital and Healthcare Center 70 Sharp Grossmont Hospital 647 Sharp HospiceCare 76 Sharp Metropolitan Medical Campus 632 TOTAL 1,799 Total Volunteer Hours: Sharp Chula Vista Medical Center 51,877 Sharp Coronado Hospital and Healthcare Center 9,224 Sharp Grossmont Hospital 111,289 Sharp HospiceCare 11,183 Sharp Metropolitan Medical Campus 81,426 TOTAL 264,999 In support of Sharp's foundations - including the Sharp HealthCare Foundation, Grossmont Hospital Foundation and Coronado Hospital Foundation - volunteers supported various events, such as annual golf tournaments and galas. In addition, Sharp offers a systemwide Junior Volunteer Program for high school students interested in giving back to their communities and exploring future health care careers. Program requirements vary, however all require high grade point ave”

“Sharp HospiceCare volunteers also participate in the organization's partnership with We Honor Veterans (WHV) - a national program developed by the National Hospice and Palliative Care Organization (NHPCO) in collaboration with the U.S. Department of Veterans Affairs (VA) to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide veteran-centric education and training that qualifies volunteers to identify and work with veteran patients as well as provide weekly support for caregivers of veterans. This includes the Vet-to-Vet Volunteer Program, which aims to pair volunteers with military experience with veteran patients, as well as honoring veteran patients through special pinning ceremonies that present veterans with a WHV pin and certificate of appreciation for their services. In FY 2016, volunteers held nearly 70 pinning ceremonies for veterans receiving care at Sharp HospiceCare. In addition, Sharp HospiceCare continues to offer 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 individual's loved one. In FY 2016, volunteers dedicated nearly 3,000 hours to sewing more than 740 bears for approximately 280 families. Recognizing the valuable impact that volunteers have on the experience of its patients, family and caregivers, Sharp HospiceCare offers a monthly support group to enhance the skills of its volunteers. Sharp HospiceCare also honors its volunteers for their valuable contributions during National Volunteer Week in April and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV, SMC) Volunteer Programs Through the Community Care Partner (CCP) Program at SMH, hospital volunteers are hand-selected and trained to serve and comfort patients without family or friends to support them during their hospital stay. In FY 2016, the CCP volunteers devoted hundreds of hours to comforting patients through conversation, reading, writing letters, taking walks and playing games. In addition, the CCP volunteers helped keep patients safe by notifying medical staff when needs arise - a task that is usually performed by a family member or friend but often overlooked for patients who lack a companion. Since February 2010, the Cushman Wellness Center Community Health Library and the SMH Volunteer Department have offered the Health Information Ambassador Program to bring the library's services directly to patients and their families, and empower them to become involved in their health care. The Health Information Ambassadors are hospital volunteers who receive specialized training through the Community Health Library. Once trained, the volunteers ask patients at SMH, the SMH Rehabilitation Center and the perinatal special care unit at SMBHWN, if they or their family members would like to receive additional resources on their diagnosis. Information requests are brought to the consumer health librarian who then prints consumer-oriented information from quality websites, and returns the information to the patients through the Health Information Ambassadors. Patients or family members who have already conducted their own research are offered online access to a database of reliable health information. Patients and families are welcome to keep in touch with the library after discharge to ensure they have access to quality health information at home. In FY 2016, the Health Information Ambassadors visited approximately 2,000 patient rooms and filled approximately 700 information requests. At SMMC, the Arts for Healing Program uses art and music to reduce feelings of fear, stress, pain and isolation among patients facing significant medical challenges and their loved ones. The program brings a”

“The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors that appear to need encouragement or cheer. 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, and is delivered. In FY 2016, the team assembled up to eight Cheers Bouquets per month, as well as provided more than 40 bouquets to new fathers on Father's Day weekend. For the past six years, the SGH Engineering Department, landscape team, SGH Auxiliary and local businesses have collaborated to bring The Shirt Off Our Backs Program to community members in need during the holidays. Through the program, volunteers collect and donate a variety of items to help meet the basic needs of homeless or low-income children and adults. In FY 2016, volunteers filled three trucks with donated food and other essential items, including 200 handmade sandwiches, 500 water bottles, clothing, socks, shoes, hygiene kits, pet food, children's toys, towels, blankets and other household items. The SGH landscape team also created the award-winning Heart 2 Heart project through which the team places stone hearts etched with reflections around the hospital campus for patients, visitors and staff to search for and reflect upon. The Heart 2 Heart project earned the team the 2016 Spirit of Sodexo Award for North America after competing against 1,100 nominations from across all Sodexo business units in the U.S. and Canada. As the Gold Level finalist - the company's highest honor - the SGH landscape team demonstrates Sodexo's commitment to clients and customers as the heart of business. For more than 30 years, SGH has provided its annual Santa's Korner giving event to provide for those in need during the holidays. Through this effort, various hospital departments adopt a family - who has been vetted and referred by local service agencies - and dedicate personal time to making the holidays the best they can be for each family. Special holiday gifts, including grocery gift cards, clothing, toiletries, household items, movie tickets, bicycles, children's toys and a holiday meal, are purchased for the families by hospital staff using primarily their personal resources and through occasional fundraisers. Santa's Korner served 28 families - equivalent to 119 individuals - during the 2015 holiday season. In August, SGH nurses held their annual Backpack Drive in collaboration with Christie's Place, a non-profit that supports women, children and families affected by HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), to prepare children and teens for academic success. Nearly 300 backpacks were filled with school supplies and distributed to youth during a back-to-school party in Balboa Park. Similarly, the Labor and Delivery Department at SMBHWN is committed to the fight against hunger through participation in the International Relief Team's (IRT) FSD's Kids project. Based in San Diego, IRT is a relief organization providing worldwide support that combines both short-term relief efforts and long-term programs to save and change lives. Through FSD's Kids, nutritious food is provided to children in the Linda Vista Elementary School nutrition club, a group specifically for children who have been identified as homeless by the school nurse. Every week, labor and delivery team members fill backpacks with nonperishable, nutritious food that can feed a family of four over the weekend. The backpacks are also filled with weekly nutrition-related prizes to encourage students and families to learn and participate in their own nutrition as well as with occasional holiday-related gifts. Since the start of the program in May 2013, the team has dedicated more than 180 weeks of service to filling 4,500 backpacks for approximately 25 elementary school children and their families per sc”

“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. This software program has been installed on more than 16,000 computers, resulting in annual energy savings in excess of 1.6 million kilowatt-hours (kWh). This initiative earned Sharp a Certificate of Recognition from the EPA in 2013. In July 2015, Sharp implemented TSO Logic software, an innovative system that identifies opportunities for replacing inefficient hardware with energy efficient hardware in Sharp's centralized data center. In addition, the software identifies underutilized hardware, which can be permanently shut down or put to rest during periods of non-utilization. In May 2014, Sharp was named San Diego's HealthCare Energy Champion by SDG&E in recognition of the innovative programs that have been implemented to reduce its carbon footprint. Furthering its dedication to energy efficiency, Sharp participates in SDG&E's Major Customer Advisory Panel, a group of SDG&E's largest customers who meet quarterly to receive energy updates from SDG&E and provide feedback on important regional energy issues. In addition, in June 2016, Sharp joined other major San Diego hospitals in the inaugural San Diego Healthcare Sustainability Collaborative, led by SDG&E. This initiative creates a platform for San Diego health care providers to advance energy conservation practices through best practice-sharing and new technology validation, with a goal of reducing operating costs and improving the health care facility environment for patients and providers. Furthermore, SDG&E staff participate on Sharp's Natural Resource Sub-Committee to help Sharp identify opportunities to conserve energy as well as associated rebates and incentives to reduce the overall costs of these efforts. All Sharp entities participate in the EPA's ES database and monitor their ES scores on a monthly basis. ES is an international standard for energy efficiency created by the EPA. Buildings certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide without sacrificing comfort or quality. According to the EPA, buildings that qualify for the ES certification typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification in 2009, 2010, 2011, 2013 and 2015, and is expected to receive the award again for 2016. In addition, Sharp's SRS Downtown medical office building is one of the first medical office buildings in San Diego to meet Leadership in Energy and Environmental Design (LEED) silver certification specifications. In April 2016, SGH virtually eliminated dependency on electrical utility by replacing a 30-year-old cogeneration turbine generator with a new state-of-the-art Central Energy Plant (CEP). The CEP contains a 52-ton, 4.4-megawatt combustion turbine generator, which generates enough electricity to meet up to 95 percent of SGH's electrical needs and reduces greenhouse gases by up to 90 percent. The CEP also converts heat to steam for the operation of medical equipment, space heating and air conditioning. The new CEP fully complies with state and local standards for air emissions. Table 3 below highlights Sharp's energy conservation projects. Table 3: Energy Conservation Projects by Sharp HealthCare Entity Establish energy use baseline: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Energy audits - 2016: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - yes SMV/SMC - yes SRS -”

“SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Drought-tolerant plants and bark-covered ground: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Electronic low-flow faucets: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Evaluation of water utilization practices: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Faucet and toilet retrofits: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Hardscaping: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Mist eliminators: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Moisture-sensitive sprinkler controls: SCHHC - yes SCVMC - no SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - yes SMV/SMC - no SRS - no Plumbing projects to address water leaks: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Rain water collection for use in fountains: SCHHC - no SCVMC - no SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - no SMV/SMC - no SRS - no Water dispensers to replace bottled water: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Water-efficient dishwashing/ equip. washing/ chemical dispensing system: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - yes SMV/SMC - no SRS - no Waste Minimization: According to the Practice Greenhealth Healthier Hospitals Initiative (HHI), hospitals generate an average of 26 pounds of waste per staffed bed each day; approximately 15 percent of this waste is considered hazardous material. Sharp has created a comprehensive waste minimization program to significantly reduce waste at each entity and extend the lifespan of local landfills. Overseen by a systemwide, multi-disciplinary Waste Minimization Committee, the program includes proper waste segregation and enhanced recycling efforts. Sharp was an early adopter in the commitment to waste diversion and now diverts more than 40 percent of waste through recycling, donating, composting, reprocessing, and reusing programs. Sharp's waste minimization efforts have resulted in more than 4.7 thousand tons of waste diverted from the landfill (equivalent to the weight of 12 loaded Boeing 747 aircrafts). Sharp made the following achievements in waste minimization in FY 2016: * SCVMC and SGH generated nearly 44,000 pounds of green waste through the implementation of green waste recycling. * More than 2.7 million pounds of trash were diverted from the landfill through recycling of non-confidential paper, cardboard, exam table paper, plastic, aluminum cans and glass containers. * Approximately 75,000 pounds of surgical instruments were collected, reprocessed and sterilized for further use. * More than 153,000 pounds of plastic and cardboard were diverted from the landfill through the use of reusable sharps containers. * More than 200,000 pounds of surgical blue wrap (recycled at all hospital entities) and disposable privacy curtains (recycled at SCVMC) were diverted from the landfill. * Sharp continued to collaborate with Ssubi is Hope, a nonprofit charity organization that collects donated expired (though still safe and usable) medical equipment, to support a health center in rural Uganda. Ssubi is Hope has collected more than 25 tons of supplies from Sharp facilities. * Sharp continued to participate in Office Depot's GreenerOffice(tm) Delivery Service. Through the program, paper bags composed of 40 percent postconsumer recycled material are used in place of small and midsized cardboard boxes. The paper”

“SCHHC - no SCVMC - no SGH - no Sharp System Services - yes SHP - no SMH/SMBHWN - no SMV/SMC - no SRS - no Organic waste (green waste) recycling: SCHHC - no SCVMC - yes SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - no SMV/SMC - no SRS - no Recycle bins distribution: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - yes Repurposing of unused medical supplies and equipment: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - no SMH/SMBHWN - yes SMV/SMC - no SRS - yes Reusable sharps containers: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - yes SMV/SMC - no SRS - no Single serve paper napkins and plastic cutlery dispensers: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - yes SHP - yes SMH/SMBHWN - yes SMV/SMC - yes SRS - no Surgical instrument reprocessing: SCHHC - yes SCVMC - yes SGH - yes Sharp System Services - no SHP - no SMH/SMBHWN - yes SMV/SMC - yes SRS - no Sustainable Food Practices Sharp believes the promotion of healthy food choices is necessary to improve the health of patients, employees and the community. Sharp's recommitment to healthy food and sustainable nutrition practices began more than five years ago with a strategy to increase the availability of healthy food options at Sharp facilities. Since that time, Sharp, in collaboration with Sodexo - Sharp's food service partner - has been an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers to adopt healthier eating habits, combat obesity and minimize waste. The goal of Sharp's Food and Nutrition Best Health Committee is to promote its food sustainability efforts throughout the health care system and within the greater San Diego community. This includes a focus on Sharp's Mindful food program to provide education and healthy food options to improve the health of Sharp's patients, staff, community and environment. The Mindful food program includes reducing meat consumption by promoting Meatless Mondays; increased purchasing of beef and poultry raised without the routine use of antibiotics; color-coded menu labeling to highlight the healthiest food options; participation in Community Supported Agriculture (CSA) - a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm - to increase the percentage of locally sourced fresh, organic and sustainable food; food composting; increased recycling activities; promotion of sugarless beverages; and use of post-consumer recycled packaging solutions. Additional food sustainability efforts at Sharp in FY 2016 are described below: * In August, Sharp partnered with the SDRM and the Food Bank to begin an innovative food recovery program that donates imperfect, yet still edible and safe, food from its kitchens to nearly two dozen hunger relief organizations in SDC. An estimated average of 1,100 pounds of food will be donated to the community each week through the program. Sharp is the first health care system in SDC to donate food to those in need in San Diego on such a wide-scale level. * In February, Sharp launched a soup stock program which turns previously unused vegetable scraps into soup stock and saves an average of 174 pounds of food each week. * Each month, Sharp's imperfect produce program purchases an average of 700 pounds of surplus fruits and vegetables that are nutrient-rich and full of flavor but would otherwise be thrown away. * SCVMC started a food waste composting program through the Otay Landfill, joining SMH and SMV (participants through the Miramar Greenery site since 2015). Through the program, food waste is processed into a rich compost product and is provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to”

“As part of the nationwide Electric Vehicle Project, Sharp installed 34 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. The use of EVCs at Sharp has resulted in a reduction of approximately 20,000 pounds of CO2 and 3,700 gallons of fuel saved during FY 2016. Sharp will continue its efforts to expand EVCs at other entities. In its long-standing partnership with SANDAG, Sharp offers SANDAG's iCommute free online ride-matching tool, RideMatcher, to help employees find convenient carpool and vanpool partners and promote sustainable commuting. In addition, employees can use iCommute's TripTracker tool to log trips and monitor the cost and carbon savings resulting from their alternate commuting methods. In recognition of Rideshare Month every October, Sharp participates in SANDAG's iCommute Rideshare Corporate Challenge where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling, and public transit. Sixty-nine organizations in SDC, representing more than 178,000 employees, competed in the challenge in FY 2016. Sharp won the top spot in the Mega Employer category for the third year in a row and for the fourth time in five years. Through the challenge, Sharp employees logged more than 8,000 trips, reduced CO2 emissions by approximately 177 tons, and saved more than $104,000 in commuting costs. To further reduce the number of cars on the road, Sharp's Commuter Solutions Subcommittee continuously works to develop innovative accessible programs and marketing campaigns to educate employees on the benefits of ride sharing and other alternative modes of transportation. The committee has overseen the implementation of bike racks and designated car pool spots, as well as a Bicycle Commuter Benefit, which provides employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. Sharp participates in SANDAG's Bike to Work Day each year. In May 2016, Sharp employees were among nearly 10,000 San Diegans who opted to ride their bike to work. During the event, Sharp provided food and beverages at several pit stops located throughout SDC. Furthering Sharp's commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for nearly 500 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an onsite presence, such as information technology support, transcription, and human resources. Sharp also provides compressed work schedule options to eligible full-time employees enabling them to complete the basic eighty-hour biweekly work requirement in less than ten workdays, thus reducing commute costs, lowering parking demand, and helping the environment. Sharp's ongoing efforts to promote alternative commute 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 2016. Education, Communication and Community Outreach Sharp conducted the following environmental community education and outreach activities in FY 2016: * Sharp shared e-newsletters with employees throughout the year to highlight the organization's recycling efforts and accomplishments, as well as to provide reminders for proper workplace recycling, carpooling, and energy and water conservation. * In April 2016, Sharp held its annual systemwide All Ways Green(tm) Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how to help preserve the planet and its precious resources. Many of Sharp's key vendor partners particip”

“Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster-planning activities and services. In FY 2016, Sharp continued to educate staff, community members and community health professionals and partnered with numerous state and local organizations to prepare for an emergency or disaster. Sharp's emergency preparedness team offered educational courses to health care providers and first responders throughout SDC. This included a standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System, and training in Web Emergency Operations Center, a crisis information management system that provides secure real-time information sharing. In FY 2016, Sharp's emergency preparedness leadership donated their time to state and local organizations and committees including the San Diego County Civilian/Military Liaison Work Group, San Diego County Unified Disaster Council, County of San Diego Emergency Medical Care Committee (EMCC) and the California Hospital Association (CHA) Emergency Management Advisory Committee. The leadership team also led the San Diego Healthcare Disaster Coalition Subcommittee, a countywide work group that reviews hospital evacuation planning and identifies and shares best practices. In addition, Sharp's emergency preparedness leadership continued to participate in the Statewide Medical and Health Exercise Program - a work group of representatives from local, regional and state agencies including health departments, emergency medical services, environmental health departments, hospitals, law enforcement, fire services and more - to guide local emergency planners in developing, planning and conducting emergency responses. 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, UC San Diego Health, Palomar Health, 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. Sharp supports safety efforts of California 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. In September, Sharp hosted its fifth Annual Disaster Preparedness Expo to educate San Diego residents on effective disaster preparedness and response in the event of an earthquake, fire, power outage or other emergency. Held at Balboa Park, the free event provided approximately 500 community members with a variety of disaster exhibitors, demonstrations and displays, as well as education on personal and family disaster planning, and confidential document shredding from Shred-it . In recent years, global endemic events had the potential to impact public health in the local San Diego community. Sharp continues to partner with community agenc”

“* Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefit Planning at Sharp HealthCare Sharp bases its community benefit planning on its triennial community health needs assessments (CHNA) combined with the expertise in programs and services of each Sharp hospital. For details on Sharp's CHNA process please see Section 3: Community Benefit Planning Process. Listing of Community Needs Addressed in the Sharp HealthCare Community Benefit Plan and Report, FY 2016 The following community needs are addressed by one or more Sharp hospitals in this Community Benefit Report: * Access to care for individuals without a medical provider and support for high-risk, underserved and underfunded patients * Education and screening programs on health conditions, such as heart and vascular disease, stroke, cancer, diabetes, preterm delivery, unintentional injuries and behavioral health * Health education, support and screening activities for seniors * Welfare of seniors and disabled people * Special support services for hospice patients and their loved ones, and for the community * Support of community nonprofit health organizations * Education and training of community health care professionals * Student and intern supervision and support * Collaboration with local schools to promote interest in health care careers * Cancer education, patient navigation services and participation in clinical trials * Women's and prenatal health services and education * Meeting the needs of new mothers and their loved ones * Mental health and substance abuse education and support for the community Highlights of Community Benefit Provided by Sharp in FY 2016 The following are examples of community benefit programs and services provided by Sharp hospitals and entities in FY 2016. * 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, the San Diego Food Bank (Food Bank), and Feeding San Diego (FSD); 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. Sharp executive leadership and staff also 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”

“Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals - $5,019,420 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. TOTAL: $319,497,417 Table 9 shows a listing of these unreimbursed costs provided by each Sharp entity. Table 9: Total Economic Value of Community Benefit Provided By Sharp HealthCare Entities - FY 2016 Estimated FY 2016 Unreimbursed Costs: Sharp Chula Vista Medical Center - $60,805,123 Sharp Coronado Hospital and Healthcare Center - $13,791,050 Sharp Grossmont Hospital - $98,464,086 Sharp Mary Birch Hospital for Women & Newborns - $6,128,274 Sharp Memorial Hospital - $125,218,185 Sharp Mesa Vista Hospital and Sharp McDonald Center - $15,015,699 Sharp Health Plan - $75,000 TOTAL FOR ALL ENTITIES - $319,497,417 Table 10 includes a summary of unreimbursed costs for each Sharp hospital entity based on the categories specifically identified in SB 697. For a detailed summary of unreimbursed costs of community benefit provided by each Sharp entity in FY 2016, see tables presented in Sections 4 through 7. Table 10: FY 2016 Detailed Economic Value of SB Bill 697 Categories Note: Table shows Estimated FY 2016 Unreimbursed Costs and is presented by Sharp HealthCare entity and by SB 697 category. Economic value is based on unreimbursed costs. Sharp Chula Vista Medical Center: Medical Care Services - $59,362,219 Other Benefits for Vulnerable Populations - $318,613 Other Benefits for the Broader Community - $248,531 Health Research, Education and Training Programs - $875,760 Total Estimated FY 2016 Unreimbursed Costs - $60,805,123 Sharp Coronado Hospital and Healthcare Center Medical Care Services - $13,346,669 Other Benefits for Vulnerable Populations - $32,822 Other Benefits for the Broader Community - $64,013 Health Research, Education and Training Programs - $347,546 Total Estimated FY 2016 Unreimbursed Costs - $13,791,050 Sharp Grossmont Hospital: Medical Care Services - $95,687,226 Other Benefits for Vulnerable Populations - $850,000 Other Benefits for the Broader Community - $627,388 Health Research, Education and Training Programs - $1,299,472 Total Estimated FY 2016 Unreimbursed Costs - $98,464,086 Sharp Mary Birch Hospital for Women & Newborns: Medical Care Services - $5,455,562 Other Benefits for Vulnerable Populations - $51,104 Other Benefits for the Broader Community - $300,746 Health Research, Education and Training Programs - $320,862 Total Estimated FY 2016 Unreimbursed Costs - $6,128,274 Sharp Memorial Hospital: Medical Care Services - $122,118,736 Other Benefits for Vulnerable Populations - $828,317 Other Benefits for the Broader Community - $549,428 Health Research, Education and Training Programs - $1,721,704 Total Estimated FY 2016 Unreimbursed Costs - $125,218,185 Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $13,742,304 Other Benefits for Vulnerable Populations - $608,878 Other Benefits for the Broader Community - $213,934 Health Research, Education and Training Programs - $450,583 Total Estimated FY 2016 Unreimbursed Costs - $15,015,699 Sharp Health Plan: Medical Care Services - $- Other Benefits for Vulnerable Populations - $12,733 Other Benefits for the Broader Community - $58,774 Health Research, Education and Training Programs - $”

“* Acute Respiratory Infections * Asthma * Back Pain * Breast Cancer * Cardiovascular Disease * Colorectal Cancer * Dementia and Alzheimer's * Diabetes (Type 2) * High Risk Pregnancy * Lung Cancer * Mental Health/Mental Illness * Obesity * Prostate Cancer * Skin Cancer * Unintentional Injuries Sharp's 2013 CHNA process and findings were significantly informed by the collaborative HASD&IC CHNA model. Consequently, Sharp's 2016 CHNA process sought to gain further insight into the needs identified across its different hospitals in 2013, including (in alphabetical order) behavioral health, cancer, cardiovascular disease, Type 2 diabetes, high-risk pregnancy, obesity and senior health. Specific objectives of Sharp's 2016 CHNA process included: * Gather in-depth feedback to aid in the understanding of the most significant health needs impacting community members in SDC, particularly Sharp patients. * Connect the identified health needs with associated social determinants of health (SDOH) to further understand the challenges that community members and Sharp patients - particularly those in communities of high need - face in their attempts to access health care and maintain health and well-being. * Identify currently available community resources that support identified health conditions and health challenges. * Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community. Study Area Defined For the purposes of the collaborative HASD&IC 2016 CHNA, the study area is the entire County of San Diego due to a broad representation of hospitals in the area. With more than three million residents, SDC is socially and ethnically diverse. Information on key demographics, socioeconomic factors, access to care, health behaviors, and the physical environment can be found in the full HASD&IC 2016 CHNA report at: http://hasdic.org. As the study area for both the collaborative HASD&IC 2016 and Sharp 2016 CHNAs cover SDC, the HASD&IC 2016 CHNA process and findings significantly informed Sharp's CHNA process/findings, and as such, are described as applicable throughout Sharp's CHNAs. For complete details on the HASD&IC 2016 CHNA process, please visit the HASD&IC website or contact Lindsey Wade, Vice President, Public Policy at HASD&IC at [email protected]. For the collaborative HASD&IC 2016 CHNA process, the IPH employed a rigorous methodology using both community input and quantitative analysis to provide a deeper understanding of barriers to health improvement in SDC. The 2016 CHNA process began with a comprehensive scan of recent community health statistics in order to validate the regional significance of the top four health needs identified in the HASD&IC 2013 CHNA. Quantitative data for both the HASD&IC 2016 CHNA and Sharp 2016 CHNAs included 2013 OSHPD demographic data for hospital inpatient, emergency department (ED), and ambulatory care encounters to understand the hospital patient population. Clinic data was also gathered from OSHPD and incorporated in order to provide a more holistic view of health care utilization in SDC. Additional variables analyzed in the 2016 CHNA processes are included in Table 11 below; variables were analyzed at the ZIP code level wherever possible. Table 11: Data Variables in the HASD&IC and Sharp 2016 CHNAs * Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters * Community Clinic Visits * Demographic Data (socio-economic indicators) * Mortality and Morbidity Data * Regional Program Data (childhood obesity trends and community resource referral patterns) * Social Determinants of Health and Health Behaviors (education, income, insurance, physical environment, physical activity, diet and substance abuse) Based on the results of the community health statistics scan and feedback from community partners received during the 2016 CHNA planning process, a numbe”

“* Verifies the necessity for an ongoing focus on identified community needs and/or adds newly identified community needs * Reports on activities conducted in the prior fiscal year - FY 2016 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken - FY 2017 Plan * Reports and categorizes the economic value of community benefit provided in FY 2016, according to the framework specifically identified in SB 697 * Reviews and approves a Community Benefit Plan * Distributes the Community Benefit Plan and Report to members of the Sharp Board of Directors and each of the Sharp hospital boards of directors, highlighting activities provided in the prior fiscal year as well as specific action steps to be undertaken in the upcoming fiscal year * Implement community benefit activities identified for the upcoming fiscal year Ongoing Commitment to Collaboration Underscoring Sharp's ongoing commitment to collaboration in order to address community health priorities and improve the health of San Diegans, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, Association for Community Health Improvement, statewide California Hospital Association (CHA), HASD&IC, and a variety of local collaboratives including but not limited to the San Diego Hunger Coalition, the San Diego Regional Chamber of Commerce and Community Health Improvement Partners. Section 4 Sharp 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 2016 Community Benefit Program Highlights SMMC provided a total of $146,362,158 in community benefit in FY 2016. See Table 27 for a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 27: Economic Value of Community Benefit Provided - Sharp Metropolitan Medical Campus - FY 2016 Note: The table shows estimated FY 2016 unreimbursed costs and the data is presented by SB 697 category and by programs and services included in SB 697 Category Medical Care Services: Shortfall in Medi-Cal - $30,757,181 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $89,130,221 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $5,986,318 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in CHAMPVA/TRICARE - $4,224,818 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Charity Care - $7,635,912 Note: Charity care reflects the unreimbursed costs of providing services to patients wit”

“Other Benefits for Vulnerable Populations: Patient transportation and other assistance for the needy - $51,104 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. 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 - $300,746 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals - $320,862 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. TOTAL - $6,128,274 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. In FY 2015 the State of California and the Centers for Medicare and Medicaid Services approved a Medi-Cal Hospital Fee Program for the time period of January 1, 2014 through December 31, 2016. This resulted in an increased reimbursement of $13.2 million to SMBHWN. This reimbursement helped offset prior years' unreimbursed medical care services; however, the additional funds recorded in FY 2016 understate the true unreimbursed medical care services performed for the past fiscal year. * 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, Feeding San Diego, the San Diego Food Bank, Ssubi is Hope, 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 community health fairs and events, collaboration with local schools to promote interest in health care careers and donation of meeting-room space to community groups. SMBHWN staff actively participated in community boards, committees and other civic organizations, such as the American Heart Association (AHA), the American Cancer Society (ACS), the Council of Women's and Infants' Specialty Hospitals (CWISH), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), Southern California Association of Neonatal Nurses (SCANN), Perinatal Social Work Cluster, Regional Perinatal System (RPS), Sigma Theta Tau International Honor Society of Nursing, Association of California Nurse Leaders (ACNL) and the National Institute for Children's Health Quality (NICHQ) Best Fed Beginnings Learning Collaborative. See Appendix A for a listing of Sharp's involvement in community organizations in FY 2016. The category also included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Pro”

“North Coastal - 7.0% North Central - 8.2% Central - 8.9% South - 8.9% East - 8.8% North Inland - 8.1% VLBW Infants: North Coastal - 1.1% North Central - 0.9% Central - 1.4% South - 1.2% East - 1.3% North Inland - 0.8% LBW Infants: North Coastal - 5.6% North Central - 6.5% Central - 7.2% South - 6.8% East - 6.8% North Inland - 5.9% Infant Mortality: North Coastal - 4.5% North Central - 4.3% Central - 5.7% South - 3.1% East - 5.6% North Inland - 4.1% Source: 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 HP2020 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 HP2020 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 2016 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: Community Benefit Planning Process 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 (SMBHWN) 2016 CHNA SMH completed its most recent CHNA in September 2016. SMH's 2016 CHNA was significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In accordance with federal regulations, the SMH 2016 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). In addition, this year SMH completed its most current implementation plan - a description of SMH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation plan for SMH (including SMBHWN) are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SMH 2016 CHNA, the following priority health needs were identified for the communities served by both entities: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * High-Risk Pregnancy * Obesity * Senior Health SMBHWN is a specialty hospital providing care for expectant mothers and newborns as well as women's services. Therefore, in alignment with these identified needs, the following pages detail programs that specifically address high-risk pregnancy, including reducing the incidence of neonatal morbidity and mortality associated with high-risk pregnancy and preterm delivery. As a specialty hospital, SMBHWN lacks the resources to comprehensively address the elements of community education and support for cardiovascular disease, Type 2 diabetes, obesity, senior health or behavioral health. Consequently, the programs and services that a”

“* In 2013, 199 infants died before their first birthday in SDC. The infant mortality rate was 4.6 deaths per 1,000 live births, meeting the HP2020 target of less than six infant deaths per 1,000 live births. Infant mortality was higher for male infants (108 male deaths) compared to 91 female deaths. Compared to infants of other races and ethnicities, Hispanic infants had the highest mortality rate. * In 2013, there were 3,624 preterm births (less than 37 weeks gestation) in SDC. * In 2013, preterm births were higher for male newborns when compared to female newborns, highest among Hispanic mothers when compared to mothers of other races and ethnicities, and highest for mothers ages 25 to 34 when compared to mothers in other age groups (defined as 15 to 24 years and 35 years and older). * According to the Centers for Disease Control and Prevention (CDC), maternal health conditions that are not addressed before pregnancy can lead to complications for the mother and the infant. 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). * Factors associated with preterm birth include maternal age, race, socioeconomic status, tobacco and alcohol use, substance abuse, stress, high blood pressure, prior pre-term births, carrying more than one baby, infection and late prenatal care (CDC, 2015). * According to the California Health Care Almanac, being overweight increases the risk of complications during pregnancy. In 2014, about one in four California mothers was obese or morbidly obese prior to pregnancy, and an additional one in four was overweight (California Health Care Foundation, 2016). * According to March of Dimes data, the number of preterm births in the U.S. rose in 2015 for the first time in 8 years. Racial minorities continue to experience early labor at higher rates. The preterm birth rate increased from 9.57 to 9.63 percent which accounts for an additional 2,000 babies (March of Dimes, 2015). * 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). Objectives * Develop, coordinate and provide educational programs for the community on preterm labor and births, and prenatal and women's health * 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 FY 2016 Report of Activities In FY 2016, 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. Through the hospital's free monthly Preterm Birth Prevention classes, approximately 100 expecting parents learned about the warning signs of preterm labor and how to help prevent a premature birth. A range of other prenatal education classes were offered throughout the year to support a healthy lifestyle during pregnancy and prepare families for birth. Class topics included, but were not limited to: how one's body prepares for birth and delivery; sibling preparation; hospital procedures; medication choices; Caesarean delivery; labor comfort and relaxation skills; postpartum care; breastfeeding and infant feeding; preparing for multiple births; and prenatal fitness and yoga. New in FY 2016, SMBHWN launched the perinatal special care unit (PSCU) Navigator Program to support high-risk, antepartum mothers on be”

“* Continue to provide fundraising support for Miracle Babies and March of Dimes * Conduct community outreach at community health fairs and events * Continue the work of the NRI to identify and disseminate evidence-based best practices for newborn care to the health care community Identified Community Need: Meeting the Needs of New Mothers and Their Families Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to these same discussions, high-risk pregnancy patients who are unable to adopt healthy behaviors do not do so for the following reasons: challenges taking care of children or other household needs while on bed rest; cultural barriers related to food; domestic violence; financial constraints to buying healthy food; homelessness; less obligation to follow bed rest orders during surrogacy or adoption situations; perceived need and/or benefit of bed rest; and substance abuse. * Sharp social worker discussions also identified strategies to help high-risk pregnancy patients meet their needs, such as: education; empathy for what patients are experiencing; focusing on mom and baby; and strategizing with patients to deal with issues. * According to the 2015 San Diego County Report Card on Children and Families, breastfeeding enhances immunity to disease and decreases the rate and severity of infections in children, and is associated with improved development and decreased risk of childhood obesity. Mothers who breastfeed may have a reduced risk of breast, ovarian, and uterine cancers, quicker recovery time postpartum, and less work missed due to child illness (Children's Initiative, 2015). * In California, SDC is ranked 20th out of 50 counties for exclusive breastfeeding (California Women, Infants and Children (WIC) Association and University of California, Davis (UC Davis) Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2016). * Data show that mothers who experience more supportive practices (such as early breastfeeding initiation and limited supplementation) are more likely to breastfeed exclusively in the hospital and beyond. In California, 94 percent of mothers begin breastfeeding in the hospital, but 27 percent also feed their infants formula during their stay. In-hospital lactation support is crucial to mothers' breastfeeding success following discharge (California WIC Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2016). * In-hospital support is crucial to breastfeeding mothers' success. Hospitals that have instituted Baby-Friendly policies have high rates of breastfeeding, no matter where they are located or what populations they serve. (California WIC Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2016). * According to the CDC's 2016 Breastfeeding Report Card, 58.5 percent of mothers in California were breastfeeding at six months, while only 24.8 percent were exclusively breastfeeding at six months (CDC, 2016). * The American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for approximately the first six months of life, followed by continued breastfeeding with complementary foods for one year or longer (AAP, 2012). * The American Psychological Association (APA) identifies several risk factors for developing postpartum depression, including: a change in hormone levels after birth; previous experience of depression or anxiety; family history of depression or mental illness; stress involved in caring for a newborn and managing new life changes; having a baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict; having a baby with special needs; first-time motherhood, very young motherhood, or older motherhood; other emotional stres”

“SMBHWN provided specialized education and support to approximately 560 mothers in FY 2016 through its free weekly postpartum support group. Led by licensed clinical social workers, the group provided emotional support to women dealing with feelings of anxiety or depression related to challenges associated with new motherhood. Serving mothers in the community with babies of newborn age up to 12 months, the group was offered in both in the mornings and evenings to accommodate working mothers' schedules. In addition, the hospital offered four coed postpartum support group sessions in FY 2016, which engaged nearly 50 mothers and fathers in discussion about postpartum mood disorders. Throughout the year, SMBHWN offered a variety of educational classes for new mothers and their families covering numerous aspects of postpartum care, including infant sleep patterns and strategies, infant massage, mom and baby yoga, and preparing new brothers and sisters for a baby. Additionally, SMBHWN staff devoted nearly 560 hours to daily Family Home Care classes that provided critical information and support to more than 5,100 new mothers and family members. Topics included car seat safety, sudden infant death syndrome, shaken baby syndrome, signs and symptoms of illness for mothers and babies, breastfeeding and jaundice. Free NICU cardiopulmonary resuscitation (CPR) education was also offered to approximately 800 family and friends of the hospital's NICU babies. SMBHWN expands its support for community mothers and families through the New Beginnings Boutique & Gift Shop. Located within SMBHWN, the boutique not only provides convenient access to needed supplies, such as nursing bras and breastfeeding pumps, but also offers experienced lactation educators to answer questions, provides important breastfeeding resources, and offers reassurance to anyone in the community. In FY 2016 SMBHWN partnered with the San Diego Padres to support nursing moms in the community. With the opening of the Sharp Mary Birch Nursing Lounge at Petco Park, mothers now have a comfortable place to nurse their babies while still enjoying the baseball game. The lounge offers a sofa, rocking chairs, private restroom, sink, changing table, breast pump plugs, refrigerator, views of the field, and a female concierge to assist mothers as needed. SMBHWN continued to offer the NICU Navigator Program in FY 2016. Similar to the PSCU Navigator Program, this unique program provides volunteer NICU Navigators - mothers who previously had babies in the NICU - to provide resources and support for parents whose babies are currently in the NICU. 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 topics such as premature growth and development; nutrition, breastfeeding and feeding mechanics; and preparing for discharge. More than 100 families were served between the NICU and PSCU Navigator Programs and Parent Hour in FY 2016. For the past 21 years, SMBHWN has hosted a Little Graduate Reunion for babies and families who have spent time in its NICU. The event provides a special opportunity for families to reunite with the team members who cared for them during their stay, and celebrate the health of their child. The same families often return to the reunion year after year, with many of the graduates now in their teens. To accommodate growing attendance, the FY 2016 Little Graduate Reunion was held off-campus for the first time at the Naval Training Center in Liberty Station. Nearly 600 parents, grandparents, siblings and NICU graduates enjoyed a variety of activities including a bounce house, bubble station, music, face painting, photo booth, and games for all ages. In summer 2015, SMBHWN launched a pilot program to evaluate eligibility for Supplemental Security Income (SSI) for newborns who have been diagnosed w”

“* A March 2014 report from the California Hospital Association (CHA) titled Critical Roles: California's Allied Health Workforce Follow-Up Report emphasizes the importance of local hospitals providing clinical training for nurses and allied health professionals, as well as programs to support mentoring and hospital work experience for interns and high school students. In the coming decades, such programs will have a tremendous impact on the lives of individuals, families and communities as a result of dedicating time and resources to the thousands of interns and high school students who gain valuable work experience and career exposure by spending time in California hospitals. Objectives * Provide education and training for students interested in health care careers * Provide obstetrical, gynecological and neonatal education and training for health care professionals * Participate in local and national organizations to share specialty expertise and enhance learning for the broader health care community FY 2016 Report of Activities In FY 2016, SMBHWN served as a training site for nearly 200 nursing and ancillary students in the specialized areas of social work, clinical nutrition, pharmacy, lactation, obstetrics and gynecology (OB/GYN), labor and delivery, maternal and fetal medicine, and neonatal services. During the fiscal year, nursing students spent approximately 14,100 hours at SMBHWN, while ancillary students spent approximately 3,400 hours on the hospital campus. Academic institution partners included Concorde Career College, Grand Canyon University, Johns Hopkins University, Point Loma Nazarene University, San Diego State University, Touro University, University of California, San Diego Extension, University of Phoenix, University of San Diego and Western University. In FY 2016, SMBHWN completed its ninth year of participation in the Health Sciences High and Middle College (HSHMC) program, providing valuable health care experience, including job requirements and career ladder development, to ninth through 12th grade students. During a 16-week period, 36 HSHMC students devoted 4,300 hours to rotations in maternal and infant services and the post-anesthesia care unit (PACU). SMBHWN continued to learn and share its expertise with staff at other hospitals and health agencies through participation in organizations such as AWHONN, CWISH, SCANN, Perinatal Social Work Cluster, Sigma Theta Tau International Honor Society of Nursing, ACNL, RPS and the NICHQ Best Fed Beginnings Learning Collaborative. In addition, team members shared their expertise at professional conferences, including a presentation on critical event debriefing at the 2016 AWHONN California Section Conference, and education on placental and umbilical cord complications to the RPS. Education and training was also provided to hundreds of local and national health care providers, including education on evidence-based practices to community nurses interested in entering the obstetrical field and training to prepare San Diego paramedics to safely assess and treat obstetrical trauma patients. In March, SMBHWN hosted the Innovation Summit: Shaping the Future of Obstetrics, Gynecological, Neonatal and Anesthetic Care. The educational conference provided community medical practitioners with the latest clinical information, research, and practical management strategies for newborns and women at all stages of life. Approximately 120 physicians and clinicians received education on complex women's health issues, emergency response for critical obstetric conditions, management of high-risk pregnancies and newborn medical breakthroughs. FY 2017 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 SMBHWN Program and Service Highlights * Antenatal Diagnostic Ce”

“Education and training programs for students, interns and health care professionals - $1,721,704 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. TOTAL - $125,218,185 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. In FY 2015 the State of California and the Centers for Medicare and Medicaid Services approved a Medi-Cal Hospital Fee Program for the time period of January 1, 2014 through December 31, 2016. This resulted in an increased reimbursement of $15.7 million to SMH. This reimbursement helped offset prior years' unreimbursed medical care services; however, the additional funds recorded in FY 2016 understate the true unreimbursed medical care services performed for the past fiscal year. * 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, Ssubi is Hope, Feeding San Diego (FSD) and the San Diego Food Bank (Food Bank); 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 Senior Resource Center and Senior Health Centers. In addition, SMH donated meeting room space to community groups and collaborated with local schools to promote interest in health care careers. SMH staff actively participated in community boards, committees and other civic organizations, including the American Heart Association (AHA), Health Sciences High and Middle College (HSHMC) Board, American College of Healthcare Executives, San Diego Organization of Healthcare Leaders, Association of California Nurse Leaders (ACNL), Emergency Nurses Association - San Diego Chapter, Association for Clinical Pastoral Education, Community Health Improvement Partners (CHIP), Hospital Association of San Diego and Imperial Counties (HASD&IC), County of San Diego Emergency Medical Care Committee (EMCC), San Diego County Stroke Consortium, San Diego Blood Bank, Serving Seniors, Community Center for the Blind and Visually Impaired, Aging and Disability Resource Connection, Caregiver Coalition of San Diego, San Diego County Council on Aging (SDCCOA), and various universities and colleges in San Diego County (SDC). See Appendix A for a listing of Sharp's involvement in community organizations in FY 2016. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessments. * Health Research, Education and Training Programs included time devoted to education and training of health care professionals, student and intern supervision, and time devoted to generalizable health-related research projects that were made available to the broader health care community. Definition of Community * SMH is located at 7901 Frost Street i”

“SMH completed its most recent CHNA in September 2016. SMH's 2016 CHNA was significantly influenced by the collaborative HASD&IC 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In accordance with federal regulations, the SMH 2016 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). In addition, this year SMH completed its most current implementation plan - a description of SMH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation plan for SMH are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SMH 2016 CHNA, the following priority health needs were identified for the communities served by SMH: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * High-Risk Pregnancy * Obesity * Senior Health The following pages detail SMH programs, activities and services that specifically address cardiovascular disease (as part of health education and wellness; includes stroke), cancer, 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 (SMV) 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 (SRS) 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. For additional details on SMH programs that specifically address the needs identified in the 2016 CHNA, please refer to SMH's implementation plan available at http://www.sharp.com/about/community/health-needs-assessments.cfm. In addition, through further analysis of SMH's community programs and consultation with SMH's service line leaders and other team members, this section also addresses the following priority health needs for community members served by SMH: * General community health education and wellness * Prevention of unintentional injuries * Health professions education and training, and promotion of interest in health care careers * Support during the transition of care for high-risk, underserved patients with complex medical needs For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2016 Report of Activities conducted in support of the objective(s), and FY 2017 Plan. Identified Community Need: Diabetes Education, Prevention and Support Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2016 CHNA continued to identify Type 2 diabetes as one of seven top priority health issues for community members served by SMH. * The HASD&IC”

“The SMH Diabetes Education Program is recognized by the American Diabetes Association (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 and insulin pump training. Small group and one-on-one classes are also offered. At the Sharp Women's Health Conference, the Sharp HealthCare (SHC) and SRS Diabetes Education Program provided diabetes risk assessments using the ADA's Diabetes Risk Test questionnaire as well as offered resources on pre-diabetes, diabetes management and nutrition to approximately 1,000 attendees. Through fundraising and team participation, the SHC Diabetes Education Program also continued to support the ADA's Step Out Walk to Stop Diabetes held in October at the Naval Training Center Park in Point Loma. The SMH Diabetes Education Program is actively involved with San Diego's renal health community. In FY 2016, the SMH Diabetes Education Program collaborated with the Balboa Institute of Transplantation to provide ongoing education and support to community members who have undergone kidney transplant or experienced kidney disease. The SHC Diabetes Education Program continued to collaborate with Family Health Centers of San Diego (FHCSD) to provide diabetes education to FHCSD diabetes patients at multiple sites, including those in SDC's central region, through FHCSD's Diabetes Management Care Coordination Project (DMCCP. DMCCP provides FHCSD diabetes patients with weekly group health and nutrition education, healthy cooking demonstrations, physical activity including Zumba classes, one-on-one support from a nurse practitioner and encourages peer support and education from project "graduates" to current patients/project enrollees in English and Spanish. The project monitors enrollees' A1C and blood glucose levels and physical activity, and has proven successful outcomes in lowering and maintaining these levels. In the central San Diego region, the SHC Diabetes Education Program provided a lecture on the basics of diabetes and nutrition to more than 90 community members at FHCSD sites in North Park, Logan Heights and City Heights. Topics included physical activity, diabetes mellitus, healthy eating, self-management and goal setting. The SHC Diabetes Education Program continued to provide diabetes education to food insecure adults enrolled in the FSD 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 through the clinic. In addition, FSD provides Diabetes Wellness Food Boxes to project participants, in conjunction with a monthly diabetes and nutrition education course, as well as CalFresh/Supplemental Nutrition Assistance Program (SNAP) outreach. Through the project, the SHC Diabetes Education Program provided diabetes and nutrition education to more than 300 community members at both the TACO and Baker Elementary School sites. Approximately 200 participants are enrolled in the Diabetes Wellness Project, and evaluation will include pre- and post-assessment surveys for the patients regarding diabetes control, an A1C blood test and other metrics. In further efforts recognizing the connection between access to healthy food and its impact on chronic health conditions such as diabetes, throughout the year the SHC Diabetes Education Program actively supported SuperFood Drive - a San Diego-based organization that focuses on improving the health of food insecure populations through outreach, education and encouragement of healthy, nutritious food donations. In partnershi”

“FY 2017 Plan The SMH Diabetes Education Program will do the following: * Conduct diabetes education at various community venues in SDC * Continue to collaborate with FHCSD to provide and expand education to their diabetes patients through the DMCCP * Continue to provide gestational services and resources to underserved pregnant women - both at the hospital and in collaboration with community clinics * Conduct monthly diabetes prevention classes * 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 with 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 * Explore additional collaborations with FSD to assist and educate food insecure community members Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2016 CHNA identified cardiovascular disease (including cerebrovascular disease/stroke) as one of seven top priority health issues for community members served by SMH. * The HASD&IC 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of the top four priority health issues for community members in SDC. * According to data presented in the SMH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. About half of all Americans (49 percent) have at least one of these three risk factors. Additional risk factors include alcohol use, obesity, physical inactivity, poor diet, diabetes and genetic factors. * In 2013, cerebrovascular disease was the fifth leading cause of death for SDC overall. * 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 HP2020 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. This rate has been increasing since 2010. * 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 HHSA. * According to the 2012 HHSA's report titled Critical Pathways: The Disease Continuum, the most common risk factors associated with stroke include physical inactivity, tobacco use, alcohol or drug use, poor nutrition, poor medical care, stress, depression, high cholesterol and diabetes. * The National Institute of Neurological Disorders and Stroke (NINDS) reports that 25 percent of people who recover from their first stroke will have another stroke within five years (NINDS, 2016). Objective * Provide stroke education, support and screening services for the central region of SDC FY 2016 Report of Activities Note: SMH is certified by the Joint Commission as an Advanced Primary Stroke Center (recertified in FY 2015). 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”

“* Seniors participating in the SMH 2016 CHNA Health Access and Navigation Survey prioritized the following barriers to accessing health care: understanding health insurance, including confusing terms; knowing where to go for care, especially understanding when to use the ED, urgent care and primary care; using health insurance, including understanding health care costs/bills and knowing what services are covered; getting health insurance; and follow-up care, including understanding next steps and finding available appointments. * In 2015, there were 416,568 residents (13.0 percent of the population) ages 65 years or older in SDC. Between 2015 and 2020, SDC's senior population is expected to grow by 22 percent. * In 2013, Alzheimer's disease was the third leading cause of death in SDC. * In 2015, the top ten leading causes of death among senior adults ages 65 and older in SDC included (in rank order): diseases of the heart, malignant neoplasms, Alzheimer's disease, cerebrovascular diseases, chronic lower respiratory diseases, diabetes mellitus, accidents (unintentional injuries), essential hypertension and hypertensive renal disease, influenza and pneumonia, and Parkinson's disease. * In 2012, 95,679 seniors ages 65 and over were hospitalized in SDC. Hospitalization rates among this age group 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 (HHSA, 2015). * In 2012, 108,745 seniors were treated and discharged from SDC EDs, representing nearly one out of every three senior residents in SDC. The top three causes of ED utilization among SDC residents ages 65 years and older in 2012 were falls, diabetes and stroke. * 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. Seniors in SDC use the 911 system at higher rates than any other age group (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). * According to the CDC, 2.8 million older adults are treated in the ED for falls every year. One in five falls causes a serious injury, such as broken bones or a head injury. These injuries may result in serious mobility issues and difficulty with everyday tasks or living independently (CDC, 2016). * In 2013, an estimated 62,000 San Diegans age 55 years and older were living with Alzheimer's disease and other dementias (ADOD), accounting for 8.3 percent of the 55 years and older population. Assuming current trends continue, by 2030 nearly 94,000 residents 55 years and older will be living with ADOD, a 51 percent increase from 2013 (HHSA Alzheimer's Disease and Other Dementias in San Diego County, 2016). * In 2011, only 67 percent of SDC residents ages 65 and older reported being vaccinated for influenza, and the rate of influenza/pneumonia death among that group was 7.5 times higher than the county overall (HHSA, 2016) * The CDC recommends annual vaccination against influenza for specialized groups, including: people ages 50 and older; 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. * Research shows that caregiving can have serious physical and mental health consequences. Findings from the Stress in America survey show that caregivers to older relatives report poorer health and higher stress levels than the general population. Fifty-five percent of surveyed caregivers reported feeling overwhelmed by the amount of care their family member needs (AARP Public Policy Institute, Valuing the Invaluable, updated July 2015). * According to a report from the National Alliance for Caregiving and the AARP titled Caregiving in the U.S. 2015, an”

“The SMH Senior Resource Center provided health screenings to more than 110 community seniors at six health fairs and events during the year. Screenings included 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. In addition, free monthly blood pressure screenings were provided to nearly 600 members of the senior community. As a result of the blood pressure screenings, approximately 90 seniors were referred to physicians for follow-up care. Screenings took place at the Point Loma Community Presbyterian Church, Peninsula Family YMCA and the War Memorial building at Balboa Park. The SMH Senior Resource Center participated in 10 community events in FY 2016, including health fairs, conferences and seminars that reached more than 1,100 attendees. Health fair and event locations included the Johnson & Johnson employee health fair, the War Memorial Building at Balboa Park and the San Diego LGBT Community Center (The Center). 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 provided information, referrals, transportation and outreach to more than 100 seniors in Point Loma. In May, the SMH Senior Resource Center participated in the Veteran Resource Fair at the War Memorial Building in Balboa Park, presented by the San Diego County Hospice Veteran Partnership and the Caregiver Coalition of San Diego. The free event provided approximately 20 veterans, caregivers and family members with presentations on available health care services, VA San Diego Healthcare System (VASDHS) benefits enrollment and estate planning, as well as community health resources from nearly 30 vendors. In October, the SMH Senior Resource Center hosted its annual Senior Health and Safety Fair at Point Loma Community Presbyterian Church. The event offered free flu shots, health screenings and community health resources to approximately 200 seniors and family caregivers. In addition, the SMH Senior Resource Center provided Vials of Life as well as health and community resources for seniors and caregivers at the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina. In June, the SMH Senior Resource Center served approximately 400 community members at the County of San Diego Aging and Independence Services (AIS) 2016 Aging Summit: Age Well San Diego. The event included presentations on housing, transportation and mobility, civic engagement, and the aging brain as well as offered resource exhibitors, including information from the SMH Senior Resource Center on Vials of Life and screening events and programs for seniors and caregivers. In October, the SMH Senior Resource Center participated in San Diego Community Action Network's (SanDi-CAN) Crucial Conversations: Navigating Your Way conference at Balboa Park. More than 40 seniors and their family members attended the free conference, where they learned tools to identify their end-of-life values and goals of care and communication skills for making informed health care decisions. The conference included a resource fair, a screening of Being Mortal - a documentary that addresses the national dialogue around death and what matters most to patients and families - and a post-film panel discussion. The SMH Senior Resource Center also held a conference for approximately 25 seniors and caregivers titled Caring for the Caregiver at Point Loma Community Presbyterian Church. At the conference, experts from Alzheimer's San Diego and Southern Caregiver Resource Center (SCRC) provided education on the emotional issues of caregiving, how to address behaviors and enhance communication with someone with dementia, proper transfer and lift techniques, and when to consider hospice. In April, the SMH Senior Resource Center part”

“New in FY 2016, Sharp Senior Health Centers partnered with the Food Bank to host their new Senior Nutrition & Wellness Classes. Taught by the Food Bank's registered dietitian, the six-week program consisted of hour-long classes to teach seniors the fundamentals of nutrition including how to read a nutrition label, how to prepare healthy meals on a budget, and how to reduce salt and sugar intake. In addition, attendees learn exercises designed for seniors. Thirty-six seniors have graduated from the quarterly program since its inception in April 2016. In addition to receiving vital health and nutrition education, the Food Bank provides attendees free fresh produce and referrals to its food programs as needed. To date, 100 percent of graduates have reported increased consumption of fresh fruits and vegetables and engaging in moderate exercise. 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, SCRC, Alzheimer's San Diego, American Parkinson Disease Association, SanDi-CAN, SDCCOA, NARFE, Community Center for the Blind and Visually Impaired, CVS MinuteClinics, Aging and Disability Resource Connection, Parkinson's Association of San Diego, Cabrillo Credit Union Supervisory Committee 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 ongoing 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 2017 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, ACP, 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 screening opportunities * 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 the distribution of 3,000 Vials of Life to community seniors * Provide seasonal flu vaccinations to seniors and community members who face challenges in accessing care, specifically high-risk adults * 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 SMV's Senior Intensive Outpatient Program, provide education on holiday blues and depression as well as senior behavioral health * Collaborate with Serving Seniors and SMV to provide depression screenings and education * Maintain active relationships with organizations that serve 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 Servin”

“Objectives * Host educational classes and support groups for the community on a variety of health and wellness topics * Offer health literacy resources through the Cushman Wellness Center Community Health Library and through outreach at community events * Participate in community-sponsored events and support nonprofit health organizations FY 2016 Report of Activities The OPP and various SMH departments conduct a broad spectrum of community health education classes and support groups. In FY 2016, classrooms were booked for more than 1,000 hours and served thousands of patients and community members. Educational classes covered a variety of health and wellness topics, including diabetes, cancer, integrative medicine (e.g., music therapy, acupuncture, hypnosis and massage), relaxation skills, parenting and childbirth, and suicide awareness. In addition, support groups were available for community members to come together and share their personal experiences and advice for coping with various challenges. 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. Sharp Rehabilitation Services (Sharp Rehab) also offered weekly adaptive yoga classes for people with physical limitations as well as various support groups, including Women on Wheels (WOW), the Support Group for Men with Spinal Cord Injury (SCI) and the Sharp Players. Facilitated by two Sharp Rehab social workers, the WOW support group strives to empower women with mobility impairments. In FY 2016, approximately 75 group members gathered monthly at the SMH Rehabilitation Center to share their thoughts and feelings about their current life challenges, victories and visions. WOW also arranged art therapy sessions, summer parties, lunch outings and museum visits for its members. With a network of many disabled women and community partners, WOW is the only support group strictly for women with mobility impairments in SDC. The Support Group for Men with SCI also met monthly at the SMH Rehabilitation Center and offered guest speakers and special outings in FY 2016, 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 2016. The group includes an additional 100 community members involved through an electronic resource and support network. Approximately 30 individuals were served through the Sharp Players weekly support group in FY 2016, 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, 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. Also in FY 2016, Sharp Rehab offered presentations on Mindfulness Awareness and Mindful Self Compassion to community members at the La Jolla Public Library and the La Jolla Community Center. In addition, Sharp Rehab continued to devote time to the HeadNorth Foundation, a nonprofit organization dedicated to providing essential support and guidance to those affected by SCI. The OPP offers the Cushman Wellness Center Community Health Library, which features DVDs, CDs, books, pamphlets and access to the Internet to help patients and community members locate reliable health information in various languages. The Community Health Library is led by a consumer health librarian with a specialty in community health as well as a store manager with expertise”

“* The SMH 2016 CHNA identified cancer as one of seven top priority health issues for community members served by SMH. * The HASD&IC 2016 CHNA continued to identify various types of cancer among the top priority health conditions seen in SDC hospitals. * Sharp cancer navigator discussions conducted as part of the SMH 2016 CHNA process identified the following chief concerns for cancer patients in SDC: cultural differences and language barriers between patient and provider; health literacy; financial issues; knowing where to go for care; availability of reliable transportation; difficulty with end-of-life conversations; and lack of advance care directives among cancer patients. * According to data presented in the SMH 2016 CHNA, in 2015, 330 (23.5 percent) of the 1,403 SMH cancer patients who received the cancer psychosocial distress screening scored at a range of moderate to severe distress, and were referred to internal or external resources such as social workers or community cancer resources. * According to Sharp oncology data presented in the SMH 2016 CHNA, the top observed cancers at SMH in 2015 were (in rank order): breast cancer, lung cancer, colorectal cancer, skin-melanoma, and prostate cancer. * The cancer key informant interview conducted as part of the SMH 2016 CHNA process identified access to insurance, access to appropriate care, and language barriers for non-English speakers as major challenges facing oncology patients. Additional issues include financial, legal, and survivorship issues; emotional, sexual and body image issues; lack of social network leading to increased need for transportation, in-home support and other treatment-related resources; and end-of-life or palliative care issues. * The cancer key informant interview recommended the following strategies to address barriers of care for those with cancer: the provision of lay navigators, including integration of navigators into the care process; community coordinators with knowledge of hospital needs and community resources; greater hospital and community partnerships; resources to educate providers on end-of-life and palliative care issues; personnel within the health care system to identify resources and answer questions; financial assistance for co-pays, prescriptions, child care and other bills; and survivorship clinics. * As part of the SMH 2016 CHNA process, cancer support group patients participating in the Health Access and Navigation Survey suggested the following areas for improvement in cancer care: more time with doctors; more comprehensive educational groups; a navigator staff member or case manager for all oncology patients, not just newly diagnosed; help navigating health insurance options to identify the best coverage for individual needs; and tours specific to patients who have a serious illness requiring multiple treatments. * 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. * In SDC overall in 2013, 22 percent of all cancer deaths were due to lung cancer, nine percent to colorectal cancer, seven percent to female breast cancer, six percent to prostate cancer and less than one percent to cervical cancer (LiveWell San Diego, 2013). * According to a 2016 report from the American Cancer Society (ACS) and the California Department of Health titled California Cancer Facts & Figures, in 2013 there were 13,570 observed new cancer cases and 5,030 cancer deaths in SDC. * By 2018, total cancer cases in SDC are expected to grow by 11.7 percent (California Cancer Registry, 2013; Truven Health Analytics Market Discovery Planning). * According to the ACS Cancer Statistics Center, in 2016 there will be an estimated 26,730 new cases of breast cancer and 4,400 breast cancer deaths for females in California. * The age-adjusted mortality rate of breast cancer in SDC in 2013 was 20.”

“Approximately 900 individuals were reached through numerous free educational classes in FY 2016. This included a variety of classes to support nutrition for individuals with cancer. Utilizing resources and guidelines from the National Cancer Institute (NCI), American Institute for Cancer Research, ACS, and the Environmental Working Group, monthly nutrition classes educated participants on maintaining optimal nutrition during and after treatment for breast cancer. In March, a similar class was offered with a focus on nutrition before, during and after treatment for oral, head and neck cancer. Furthermore, two classes on maintaining optimal nutrition for the cancer patient were offered in May and September. The Laurel Amtower Cancer Institute offered several classes to support the emotional aspects of cancer and promote relaxation and healing, including monthly art classes, a bimonthly relaxation skills workshop, and weekly chair yoga. In addition, monthly Lunch and Learn classes helped individuals address the emotional phases of cancer, including new cancer diagnosis, what to expect with children or grandchildren at home, and expectations following cancer treatment. The Laurel Amtower Cancer Institute also continued to provide meeting space for four Look Good...Feel Better classes, which are led by the ACS to help women manage the appearance-related side effects of cancer treatment (e.g., hair loss, etc.) and increase self-confidence. Two educational classes were offered on lymphedema - an incurable but treatable medical condition caused by trauma (e.g., surgery, chemotherapy and radiation), injury, or congenital defects in the lymphatic system from which swelling can occur. Led by a certified lymphedema therapist, the classes were open to anyone in the community with or at risk of developing lymphedema as well as their caregivers and partners. Class lectures included an overview of lymphedema and information on risk reduction and treatment options. Participants also received educational resources including a guide to local medical vendors if they wished to purchase a compression gauntlet. Weekly Healthy Steps classes were also offered to promote safe exercises for those with cancer. Based on the Lebed Method, these classes taught gentle, therapeutic exercise movements to increase range of motion and prevent lymphedema for breast cancer survivors, seniors and those battling other chronic health conditions. In addition, two Exercise and Stress Management classes taught relaxation methods to help the body heal and strategies for exercising without going to the gym. Additional class offerings in FY 2016 included three physician-led Breast Cancer Education forums, which taught individuals with a recent breast cancer diagnosis about the pathological wording and staging of their particular cancer type and treatment options, as well as a class on cancer and genetics to help community members learn how genetic testing can help them plan ahead. The Laurel Amtower Cancer Institute also provided a four-session Food for Life cooking series to teach 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 - the series included nutrition lectures, live cooking demonstrations and food tastings to help participants learn how to prepare simple and healthy meals at home. Throughout the year, staff provided cancer education and resources to hundreds of community members at a variety of community events, including the ACS Making Strides Against Breast Cancer Walk; San Diego Free to Breathe Lung Cancer Run/Walk; and the Sharp Women's Health Conference. The team also participated in the eighth annual Nine Girls Ask luncheon fundraiser to support the advancement of ovarian cancer research. In addition, for three days in June, the Laurel Amtower Cancer Institute recognized National Cancer Survivors Day(r) by hosting a celebratory community”

“* In 2013, accidents (unintentional injuries) were the sixth leading cause of death for SDC overall. Unintentional injuries - motor vehicle accidents, falls, pedestrian-related, firearms, fire/burns, drowning, explosion, poisoning (including drugs and alcohol, gas, cleaners and caustic substances), choking/suffocation, cut/pierce, exposure to electric current/radiation/fire/smoke, natural disasters and injuries at work - are one of the leading causes of death for SDC residents of all ages, regardless of gender, race or region. * Between 2010 and 2013, nearly 4,000 San Diegans died as a result of unintentional injuries. * In 2013, there were 1,015 deaths due to unintentional injury in SDC. The region's age-adjusted death rate due to unintentional injury was 30.6 deaths per 100,000 population. In 2013, unintentional injury accounted for 4.9 percent of total deaths in SDC. * In 2013, there were 22,454 hospitalizations related to unintentional injury in SDC. The age-adjusted rate of hospitalizations due to unintentional injury was 691.5 per 100,000 population. * In 2013, there were 156,940 unintentional injury-related ED discharges in SDC. The age-adjusted rate of visits due to unintentional injury was 4,984.5 per 100,000 population. * Unintentional injury remains a leading cause of death for children ages 0 to 14 years. The effects of safety campaigns, educational strategies, and change in parenting practices have all had a positive impact on the safety and well-being of children in the San Diego community (HHSA, 2012). * Traumatic injury is the leading cause of death among children, with many survivors enduring the consequences of brain and spinal cord injuries. The physical, emotional, psychological and learning problems that affect injured children, along with the associated costs, make reducing traumatic injuries a high priority for health and safety advocates throughout the nation. Educational programs such as ThinkFirst increase knowledge and awareness of the causes and risk factors of brain and SCI, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2015). * According to HP2020, most events resulting in injury, disability or death are predictable and preventable. There are many risk factors for unintentional injury and violence, including individual behaviors and choices, such as alcohol use or risk-taking; the physical environment both at home and in the community; access to health services and systems created for injury-related care; and the social environment, including individual social experiences (social norms, education, victimization history), social relationships (parental monitoring and supervision of youth, peer group associations, family interactions), the community environment (cohesion in schools, neighborhoods and communities) and societal factors (cultural beliefs, attitudes, incentives and disincentives, laws and regulations). * According to the California Department of Public Health's Burden of Chronic Disease and Injury Report: California, 2013 injury, including both intentional and unintentional, is the number one killer and disabler of persons ages 1 to 44 in California. * The same report states that every year in California, injuries cause more than 16,000 deaths, 75,000 cases of permanent disability, 240,000 hospitalizations and 2.3 million ED visits. * 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). * A 2016 National Vital Statistics Report titled: Deaths: Final Data for 2014 indicates that 59.4 percent of injury deaths in the U.S. in 2014 were attributed to three causes: poisoning (26.0 percent), motor-vehicle traffic (16.9 percent), and falls (16.5 percent). In 2014, the age-adjusted rate of death from unintentional death in the U.S. was 40.5 deaths per 100,000 population (CDC, 2016). Objective * Offer an injury and vi”

“* The BLS projects an employment of more than 3.1 million RNs in the U.S. in 2024, which is an increase of 16 percent from 2014. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2014). * The BLS projects that the demand for home health aides will grow 38.1 percent from 2014 to 2024. Older individuals often have health problems and need help with daily activities. As the U.S. population ages, the demand for home health aides will continue to increase (BLS, 2014). * Total employment is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. The health care and social assistance sector is projected to increase its employment share from 12 percent in 2014 to 13.6 percent in 2024 - the fastest growing service industry. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (BLS, 2015). * A March 2014 report from the California Hospital Association (CHA) titled Critical Roles: California's Allied Health Workforce Follow-Up Report emphasizes the importance of local hospitals providing clinical training for nurses and allied health professionals, as well as programs to support mentoring and hospital work experience for interns and high school students. In the coming decades, such programs will have a tremendous impact on the lives of individuals, families and communities as a result of dedicating time and resources to the thousands of interns and high school students who gain valuable work experience and career exposure by spending time in California hospitals. Objectives * In collaboration with local schools, colleges and universities, offer opportunities for students to explore and train for a vast array of health care professions * Provide training for local, national and international health care professionals FY 2016 Report of Activities SMH offered students and interns throughout SDC various placement and professional development opportunities. In FY 2016, approximately 450 nursing students and nearly 300 ancillary students from a variety of colleges and universities spent more than 119,000 hours at SMH. Program partners included Alliant International University, Azusa Pacific University, California College San Diego, California Northstate University, Concorde Career College, Creighton University, California State University Fresno, California State University San Bernardino, California State University San Marcos, Drexel University, EMSTA College, Gettysburg College, Grand Canyon University, Grossmont College, Grossmont Health Occupations, Iowa State University, Loma Linda University, Metropolitan State University, Mira Costa College, Mount Saint Mary College, National University, Oakwood University, Palomar College, Pima Medical Institute, Point Loma Nazarene University, Platt College, Regis University, Samuel Merritt University, San Diego Continuing Education, San Diego Mesa College, SDSU, San Jose State University, Sodexo Dietetic Internships, Southwestern College, St. Catherine University, Touro University, University of Redlands, University of Puget Sound, University of San Diego (USD), University of San Francisco, University of Southern California, University of St. Augustine, University of Utah, University of Washington, Utah State University, Western University and WestMed College. The Clinical Pastoral Education (CPE) program also presented to 10 SDSU nursing students about spiritual care in the health care setting. Furthermore, Sharp Rehab provided education on SCI to 40 physical therapy students at the University of St. Augustine in San Marcos, and the Sharp Senior Health Centers provided education on bedside manner for geriatric patients to approximately 15 USD nurse practitioner students. Through affiliations with EMSTA College, Palomar Community College and SWC, SMH provided both clinical training and observation hours f”

“Rationale references the findings of the SMH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * As part of the SMH 2016 CHNA process, discussions with Sharp's Community-based Care Transitions Program (CCTP)/Care Transitions Intervention (CTI) staff identified the following strategies for improving the health of SDC's vulnerable, high-risk, or medically underserved patients: coaching; education about their disease and the health care system; education tailored to specific cultural and linguistic groups; providing transportation, support, hope, and love; and providing a personal health record with information about their medications and resources. * A key informant interview conducted as part of the SMH 2016 CHNA process identified the home environment, transportation and medication management as challenges for vulnerable patients. Recommendations included connecting patients to community resources as part of their transition from hospital to home, expediting services for discharged patients with immediate needs, and developing methods to finance hospital/community partnerships for expedited services. * The HASD&IC 2016 CHNA identified 10 SDOH that impact the four priority health needs in SDC (behavioral health, cardiovascular disease, obesity, and Type 2 diabetes). These social determinants are: food insecurity and access to healthy food; access to care or services; homeless/housing issues; physical activity; education/knowledge; cultural competency; transportation; insurance issues; stigma; and poverty. * Key informant interviews conducted as part of the HASD&IC 2016 CHNA suggested the following strategies for improving health and removing barriers to care: behavioral health prevention and stigma reduction; education on disease management and food insecurity; improving diversity and cultural competency; coordinating services across the continuum; integrating physical and mental health; and engaging case managers and patient navigators in the community and incorporating them as a routine part of the continuum of care. * Participants in the HASD&IC 2016 CHNA community partner discussions recommended strengths-based case management, greater availability of multicultural providers and translators, and better coordination of discharge procedures as strategies for improving and maintaining health in SDC. * Members of Sharp's Patient Family Advisory Council participating in the SMH 2016 CHNA's Health Access and Navigation survey identified the following top barriers to care: understanding health insurance; making an appointment for care; follow-up care and/or appointments; using health insurance; knowing where to go for care; and picking up prescriptions. Overall, these findings were aligned with feedback collected through the HASD&IC 2016 CHNA's Health Access and Navigation Survey. * As of October 2016, the overall unemployment rate was 4.8 percent for SDC, falling below the unemployment rate for the state of California in the same month of 5.5 percent (BLS, 2016). * In 2014, 30.4 percent of children and 17.7 percent of households in SDC received food stamps/Supplemental Nutrition Assistance Program (SNAP)/CalFresh benefits (CHIS, 2014). * In 2015, 17.4 percent of the population in SDC was living below the federal poverty level, with 21.7 percent of those being families with children. * In 2015, nearly 7.7 percent of families in SDC received Supplemental Security Insurance (SSI). * The Regional Taskforce for the Homeless' 2015 WeAllCount report estimated that there were 8,742 homeless individuals in SDC, roughly half of whom are unsheltered. The most commonly cited cause of homelessness was loss of a job, followed by disability, loss of a spouse, and abuse. * The Kaiser Family Foundation's 2016 Employer Health Benefits Survey indicated that the average health insurance premium for a single adult in 2016 is $536 per month, or $6,435 annually. The average health insu”

“* Sharp and Children's MRI Center * Sleep Disorders Center * Spiritual care services, including Arts for Healing and Integrative Healing * Stroke care - recognized by the AHA * Surgical services, including thoracic (lung) and head and neck surgery * Van services * Warfarin management * Weight Loss (Bariatric) Surgery * Wound and Ostomy Inpatient Center Sharp Memorial Outpatient Pavilion: * Cancer services, including nutrition and genetic counseling, nurse navigators, radiation therapy and diagnostic imaging * Cushman Wellness Center, including: * Cushman Wellness Center Community Health Library * Health assessments and screenings * Executive Health Program * Holistic therapies, including acupuncture, guided imagery, massage, reflexology and Reiki * Fitness assessments * Diabetes education and management - recognized by the ADA * Oncology Associates of San Diego * Outpatient Imaging Center, including computed tomography (CT) scan, virtual CT colonoscopy, and digital and 3-D tomosynthesis mammography * Outpatient Surgery Center, including pre-anesthesia evaluation services * Sharp Rees-Stealy Surgical Eye Consultants, including ophthalmology and optometry * Summerfelt Endoscopy Center * Vision Laser Center, including ophthalmology, diagnostic and laser treatment Sharp Senior Health Center Downtown: * Community health education programs * Community health screenings services * Primary and comprehensive physical and mental health care services to seniors Sharp Senior Health Center Clairemont: * Community health education programs * Community health screenings and services * Primary and comprehensive physical and mental health care services to seniors Section 7 Sharp Mesa Vista Hospital and Sharp McDonald Center FY 2016 Community Benefit Program Highlights Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC) provided $15,015,699 in community benefit in FY 2016. See Table 37 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill (SB) 697. Table 37: Economic Value of Community Benefit Provided - Sharp Mesa Vista Hospital and Sharp McDonald Center - FY 2016 Note: The table shows estimated FY 2016 unreimbursed costs and the data is presented by SB 697 category and by programs and services included in SB 697 Category Medical Care Services: Shortfall in Medi-Cal - $2,132,428 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $4,072,650 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $5,985,722 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in CHAMPVA/TRICARE - $682,890 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Charity Care - $693,542 Charity care ref”

“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 2016 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 of America (U.S.) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by 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 2015, 96.7 percent of children ages 0 to 11, 94.9 percent of children ages 12 to 17, and 88.9 percent of adults ages 18 to 64 had health insurance - failing to meet the Healthy People 2020 (HP2020) national targets for health insurance coverage. See Table 38 for a summary of key indicators of access to care and Table 39 for data regarding Medi-Cal eligibility. In SDC in 2015, 15.6 percent of adults ages 18 to 64 did not have a usual source of care and 12.3 percent of these adults had health insurance. In addition 22.5 percent reported fair or poor health outcomes. Further, 45.2 percent of adults ages 18 to 64 living at 200 percent below the federal poverty level (FPL) reported as food insecure. Table 38: Health Care Access in SDC, 2015 Current Health Insurance Coverage: Children 0 to 11 Years: Rate - 96.7% Year 2020 Target - 100% Children 12 to 17 Years: Rate - 94.9% Year 2020 Target - 100% Adults 18 to 64 Years: Rate - 88.9% Year 2020 Target - 100% Regular Source of Medical Care: Children 0 to 11 Years: Rate - 95.1% Year 2020 Target - 100% Children 12 to 17 Years: Rate - 84.6% Year 2020 Target - 100% Adults 18 to 64 Years: Rate - 84.4% Year 2020 Target - 89.4% Not Currently Insured: Adults 18 to 64 Years: Rate - 11.1% Source: 2014-2015 California Health Interview Survey (CHIS) Table 39: Medi-Cal (Medicaid) Eligibility, Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2015 Medi-Cal Eligible - 19.0% Not Eligible - 81.0% Source: 2014-2015 CHIS An analysis of 2015 mortality data for SDC revealed Alzheimer's disease and suicide as the third and eighth leading causes of death for SDC, respectively. Table 40 summarizes the leading causes of death in SDC. For additional demographic and health data for communities served by SMV and SMC, please refer to the 2016 CHNAs for these entities, available at http://www.sharp.com/about/community/community-health-needs-assessments Table 40: Leading Causes of Death in SDC, 2015 Malignant neoplasms - 5,059 Diseases of heart - 4,763 Alzheimer's disease - 1,404 Cerebrovascular diseases - 1,170 Accidents (unintentional injuries) - 1,071 Chronic lower respiratory diseases - 1,001 Diabetes mellitus - 713 Intentional self-harm (suicide) - 411 Chronic liver disease and cirrhosis - 391 Essential hypertension and hypertensive renal disease- 383 Influenza and pneumonia - 344 Parkinson's disease - 270 Pneumonitis due to solids and liquids - 186 Septicemia - 114 Nephritis, nephrotic syndrome and nephrosis- 98 Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Data are from the Multiple Cause of Death Files, 1999-2015, 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: Community Benefit Planning Process regarding community benefit planning”

“* Respondents of the Health Access and Navigation Survey administered during the SMV and SMC 2016 CHNA processes identified the following barriers to accessing behavioral health care: getting, using and understanding health insurance; knowing where to go for care (e.g., the emergency department (ED), etc.); and making appointments (specifically availability of appointments and wait time issues). * Key informant interviews conducted as part of the SMV and SMC 2016 CHNA processes identified the following resources that should be developed to address substance use and related issues: early prevention programs that emphasize the dangers of alcohol; increased accessibility of treatment programs; presence of psychologists in the ED to provide screening, brief intervention, and referrals; available beds for those who cannot pay; and long-term aftercare. * According to data from the Office of Statewide Health Planning and Development (OSHPD) presented in the SMV and SMC 2016 CHNAs, anxiety disorders were the top primary diagnosis for ED discharges among those ages 5 to 44 and ages 65 and older. For those ages 45 to 64, the top ED discharge for behavioral health was alcohol-related disorders, followed by anxiety and mood disorders. * In general, data analysis in the 2016 CHNAs revealed a higher rate of behavioral health hospital discharges in SDC's more vulnerable communities (Dignity Health, SanGIS, OSHPD & SpeedTrack Inc., 2015). * In 2013, the age-adjusted death rate due to suicide in SDC was 13.1 deaths per 100,000, which is higher than the HP2020 target of 10.2 deaths per 100,000. * In 2013, the age-adjusted rate of self-inflicted injury ED discharges in SDC was 81.2 per 100,000 population. * In 2013, there were 2,473 cases of overdose/poisoning hospitalizations in SDC. The age-adjusted rate of overdose/poisoning hospitalizations 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. Age-adjusted rates for overdose/poisoning-related ED visits were higher among females, Blacks and individuals ages 15 to 24 years in comparison to the broader group. * In 2015, 38.9 percent of adults in SDC ages 18 to 64 reported an episode of binge-drinking in the past year. Additionally, 6.3 percent of teens reported an episode of binge-drinking the previous month (CHIS, 2015). * Approximately 10.2 million adults have co-occurring mental health and addiction disorders in the U.S. (NAMI, 2016). * 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, 2016). * According to HP2020, 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, domestic violence, child abuse, motor vehicle crashes, physical fights, crime, homicide and suicide. Objectives * Provide mental health and substance use education for patients, their loved ones and the community * Facilitate community integration and stigma reduction through community service activities * Provide support for members of the community impacted by mental health and substance use issues FY 2016 Report of Activities To increase awareness of mental health and substance use, in FY 2016, SMV and SMC hosted numerous community speaking engagements and workshops, addressing a variety of behavioral health topics, including cognitive therapy, substance use, life transitions, domestic violence and child and geriatric psychiatry. In addition, SMV provided a monthly cognitive therapy lecture series that described an evidence-based approach for treatment of behavior problems and mood disturbances.”

“In addition, SMV educated veterans, military members and their loved ones on a variety of topics. At the Wounded Warrior's Project building, SMV offered education to approximately 200 of San Diego's homeless veterans, including self-care and maintaining mental health when physical health is compromised. At the Women Give San Diego's How to WOWW: The Ultimate Guide to Welcoming Our Women Warriors discussion event, SMV sat on the panel and educated approximately 100 community members on the challenges faced by female veterans transitioning out of the military and returning to civilian life and employment. Another topic of discussion was the importance of providing resources within local companies that can translate military expertise into various skill sets for hiring, as well as providing increased time for those transitioning out of the military. Lastly, SMV participated in the San Diego work group for the launch of the Hidden Heroes campaign, a new initiative designed to raise awareness and support for caregivers of veterans and active-duty service members. This initiative started in San Diego and provides recognition and support to caregivers of veterans and military members who have suffered from TBI, severe PTSD and other life- changing issues. Throughout the year, SMV and SMC sponsored and participated in six walks to increase awareness and raise funds for mental health services, including the San Diego County NAMI Walk at the Naval Training Center Park in Liberty Station, National Eating Disorders Association's San Diego NEDA Walk, American Foundation for Suicide Prevention's Out of the Darkness Suicide Prevention Walk, Survivors of Suicide Loss' Save a Life San Diego/Yellow Ribbon Suicide Prevention Program(r), San Diego Chapter Community Walk, Alzheimer's Association San Diego/Imperial Chapter's annual Walk to End Alzheimer's(r) and the American Heart Association's (AHA) 2016 San Diego Heart & Stroke Walk. With the exception of the AHA 2016 San Diego Heart & Stroke walk, SMV provided a booth with behavioral health resources. At the Walk to End Alzheimer's, SMV offered information on Alzheimer's disease, clinical trials and resources to more than 500 attendees. SMV also sponsored and participated in several events in FY 2016, benefitting organizations such as Alzheimer's San Diego, Mental Health Systems, NAMI, Survivors of Suicide Loss and Jewish Family Service of San Diego's (JFS) Behavioral Health Committee. In January, SMV sponsored the JFS resource and panel event titled Substance Abuse Disorder in My Family: Why Is This Happening? What Can I Do?. More than 180 community members attended the event and received mental health resources as well as information from a panel of experts on the true nature of the disease of addiction, and how families impacted by substance abuse disorder can benefit greatly from compassionate support. SMV also sponsored the Strut for Sobriety event benefitting A New PATH, a nonprofit organization focused on reducing stigma associated with addictive illness through education. In addition, SMV sponsored and participated in MHA's annual Meeting of the Minds behavioral health educational conference and resource fair at the Sheraton San Diego Hotel & Marina. The conference promoted collaboration, cooperation, and understanding related to mental health. SMV provided education on self-esteem at the conference to approximately 330 attendees. Further, SMV sponsored the Behavioral Health Recognition Dinner, which recognizes individuals who work to support community members achieve recovery without stigma. Throughout 2016, SMV and SMC attended several health and wellness fairs, conferences and events. SMV and SMC provided approximately 25 Check Your Mood screenings - a brief questionnaire aimed at assessing risk for depression - and offered behavioral health resources to approximately 1,000 attendees at the 2016 Sharp Women's Health Conference in March. In September, SMV provided behavioral health res”

“In FY 2016, 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. The ILA is an initiative of CHIP's Behavioral Health Work Team, in which SMV actively participates, and the registry continues to expand with new participating ILFs. At the ILA retreat in February, SMV provided resources and sat on a panel to discuss safe, quality housing for behavioral health patients. In addition, SMV partnered with Community Research Foundation, PERT, ILA and the CHIP Behavioral Health Work Team to improve collaboration with patients in the community, promote recovery and decrease the stigma of mental illness and co-occurring substance use problems. In FY 2016, SMV provided education and resources to transitional age youth (TAY), ages 18 to 25, with behavioral health issues to empower and support their continued health and well-being. In April, SMV hosted a croquet court to reduce stigma and provided behavioral health resources at Balboa Park for a croquet tournament benefitting Impact Young Adults, an organization that empowers young adults with mental health challenges. SMV provided behavioral health resources to approximately 50 community members at the event. In addition, SMV collaborated with Planned Parenthood to provide two classes on safe sex practices to nearly 40 attendees. Further, the program collaborated with the Consumer Center for Health Education & Advocacy to assist more than 60 TAY with insurance and legal forms and help them understand their rights. SMV's Psychiatric Rehabilitation Program is dedicated to creating possibilities for social reintegration of individuals with mental illness by involving them in community service activities. In FY 2016, this included the Client Advisory Board, where SMV outpatients provide feedback on how to improve programs, empower patients, promote advocacy and better serve the community. Client Advisory Board members and patients encouraged community members, staff, former and current patients, friends and family to join their walking team, the Mighty Mesa Vista Movers, in the annual San Diego County NAMI Walk to raise awareness and reduce stigma around mental health. New in FY 2016, SMV began support of the San Diego Rescue Mission (SDRM) through food donations three times a week. These donations totaled at an average of approximately 200 pounds of food each week since June 2016. For more than 50 years, the SDRM has helped San Diego's homeless and poor population create better lives for themselves through comprehensive programs, including services that address housing, hunger, behavioral health and other education and awareness programs. The SDRM helps homeless community members address the challenges behind their homelessness and offers the opportunity for positive, lasting change in their lives. Throughout the year, SMV provided more than 1,700 hours of free meeting space for a variety of self-help groups on a weekly basis, including Al-Anon, Hoarders Support Behavior, NAR-ANON (Narcotics Anonymous), NAR-ANON Family Group, Alcoholics Anonymous, Alcoholics Anonymous - 24-Ho”

“* Certain circumstances of aging, such as loss of family, social isolation and infirmity, can be triggers for the onset of mental illnesses, including alcoholism and serious depression, among older people. Older persons with mental illnesses also face the loss of family and other caregivers as well as the insufficiency of geriatric health practitioners, including mental health practitioners (NAMI, 2016). * According to the University of California, Davis (UC Davis) Medical Center Community-Defined Solutions for Latino Mental Health Care Disparities report, barriers to addressing the unmet mental health needs of the senior Latino community in SDC include housing, transportation, social support, exposure to violence, stigma surrounding mental illness, and cultural emphasis on masculinity. Additional barriers to meeting mental health needs include: language and cultural barriers secondary to a lack of translators, lack of information about available services, and scarcity of culturally competent medical providers (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 respondents (46 percent) either strongly or somewhat agreed that isolation and/or loneliness affects their quality of life, while more than one out of four (27 percent) respondents 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. * According to the Substance Abuse and Mental Health Services Administration (SAMHSA), behavioral and cognitive symptoms often present differently in older adults compared to younger adults. Many medications have side effects that may present as symptoms of another illness, and the interaction of multiple medications may exacerbate symptoms or cause additional health problems (SAMHSA, 2016). Objectives * Provide culturally competent outreach services to high-risk seniors in SDC's disadvantaged communities * Provide education and screening to senior community members * Collaborate with community organizations to address the behavioral health needs of SDC seniors and other community members facing inequities FY 2016 Report of Activities Throughout FY 2016, SMV clinicians collaborated with Serving Seniors to provide more than 1,000 hours of clinical services to senior clients at the Gary and Mary West Senior Wellness Center, as well as at the 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 hospitalization and homelessness, mental health screenings and Montreal Cognitive Assessments, which detect mild cognitive impairment. SMV also continued to collaborate with Potiker Family Senior Residence and the Gary and Mary West Senior Wellness Center beyond the provision of clinical services. At these sites, SMV provided free prevention and early intervention services designed to: improve the utilization and effectiveness of mental health services for high-risk, culturally diverse seniors; and address barriers to mental health services, including stigma, isolation and lack of available services. These programs were further enhanced with free education and a support group provided at the Gary and Mary West Senior Wellness Center by a student clinician. The support group met monthly to provide education and support, as well as discuss different behavioral health aging issues. Topics included depression and anxiety, coping with loss and helpful tools to support the grieving process. Throughout FY 2016, the SMV Seni”

“New in 2016, SMV SIOP reviewed grants for Alzheimer's disease research for the California Department of Public Health, as well as received grant funding to develop a book about seniors coping with life transitions. FY 2017 Plan SMV will do the following: * In collaboration with Serving Seniors, provide outreach and education to seniors without stable housing * Continue to address the behavioral health needs of high-risk, culturally diverse seniors * Through the SIOP, provide education and support to community members around senior behavioral health issues * Continue to collaborate with community organizations to address the behavioral health needs of SDC seniors and other community members facing inequities Identified Community Need: Behavioral Health and Substance Use 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 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * Key informant interviews conducted as part of the HASD&IC 2016 CHNA process recommended internship/workforce training programs with local educational institutions and the County of San Diego's Health and Human Services Agency as a strategy for addressing behavioral health needs and modifiable risk factors in SDC. * According to a 2014 labor market analysis by the SDWP, there was an increasing number of health care training providers in SDC, but a shortage of clinical training facilities where applicants can gain necessary experience. The scarcity of clinical facilities offering prerequisite training makes it increasingly difficult for employers to find qualified 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. * A March 2014 report from the California Hospital Association (CHA) titled Critical Roles: California's Allied Health Workforce Follow-Up Report emphasizes the importance of local hospitals providing clinical training for nurses and allied health professionals, as well as programs to support mentoring and hospital work experience for interns and high school students. In the coming decades, such programs will have a tremendous impact on the lives of individuals, families and communities as a result of dedicating time and resources to the thousands of interns and high school students who gain valuable work experience and career exposure by spending time in California hospitals. * According to the U.S. Bureau of Labor Statistics (BLS), employment of mental health social workers is projected to grow 19 percent from 2014 to 2024, much faster than the average for all occupations. Employment will grow as more people seek treatment for mental illness and substance use disorders. Because drug offenders are increasingly being sent to treatment programs rather than jail, use of substance abuse treatment programs is expected to grow, increasing demand for these specialists (BLS, 2015). * The BLS also projects that employment of substance abuse and behavioral disorder counselors will grow 22 percent from 2014 to 2024. Growth is expected as addiction and mental health services are increasingly covered by insurance policies. * 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”

“At SMV and SMC, psychologists, licensed MFT's and licensed clinical social workers provided over 4,600 hours of direct clinical supervision to trainees. SMV provided two hours of lectures every week for psychology doctoral interns. These lectures were also open to trainees and staff throughout the hospital. Lectures included, but were not limited to, Assessment and Treatment of Self Injurious Behaviors: The Culture of Poverty; Culturally and Clinically Competent Work With Transgendered People; Sex and Aging; Psychology of Men; Psychological Treatment of Functional Gastrointestinal Disorders; Child Abuse and Tarasoff Reporting; Assessing Psychosis in Children and Adolescents; Evaluating Personality Disorders in Adolescents; and Evaluating Complex Trauma in Children. Throughout the year, SMV provided specialized learning opportunities for its social work students. Social work students on the inpatient side attended an intensive three-day onboarding training to familiarize themselves with the hospital and social work. They shadowed SMV social workers for the first two months, before working under supervision. Students attended case presentations, inservices, staff meetings, treatment teams, huddles and more as part of their learning experience. During the second semester, social work students rotated for one to two weeks through additional units at SMV. The students also have the opportunity to shadow social workers in other parts of the Sharp system. On the outpatient side, MFT/Master of Social Work students attended quarterly two-hour trainings. SMV also continued its participation in the Health Sciences High and Middle College (HSHMC) program in FY 2016. The program provided two 11th grade and three 12th grade students with professional development opportunities within SMV's nursing units (Intensive Treatment Program, Mood Disorders, Older Adults, SIOP and Chemical Dependency Recovery) as well as nutrition services. Students spent approximately 1,000 hours at SMV, and received instruction on educational and job requirements as well as career ladder development. In April, SMV provided mental health resources to more than 700 students at the Grossmont College Health and Wellness Fair, the SDSU health fair, and the San Diego City College Health and Wellness Expo. At the SDSU 2016 Agency Internship Fair, SMV provided approximately 300 behavioral health students, graduate students and clinicians with behavioral health resources. SMV also provided two lectures to more than 65 San Diego Mesa College health information technology students in October and April. Topics included psychiatric and behavioral health, substance use, dependency record-keeping and HIPAA privacy laws. In addition, SMV and SMC provided several educational offerings for behavioral health care professionals in FY 2016, 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 use, 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 also provided suicide risk assessment lectures to 40 community health professionals and community members at the United Way of San Diego County. In addition, SMV hosted and participated in the EAPA to increase knowledge and education in the behavioral health professional community. 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 continued its collaboration with PERT,”

“* 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 2016. 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 Disability Resource Connection * Aging and Independence Services * Alzheimer's San Diego * Alzheimer's Project Safety Workgroup * Alzheimer's San Diego Client Advisory Board * American Academy of Nursing * 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 Heart Association * American Hospital Association * American Nurses Association * American Parkinson Disease Association * American Psychiatric Nurses Association * American Red Cross of San Diego * The Arc of San Diego * Arms Wide Open * Asian Business Association * Association for Ambulatory Behavioral Healthcare * Association for Clinical Pastoral Education * Association of California Nurse Leaders * Association of Women's Health, Obstetric and Neonatal Nurses * Azusa Pacific University * BAME Renaissance, Inc. (BAME CDC) * Bayside Community Center * Beacon Council's Patient Safety Collaborative * Boys and Girls Club of South County * Bonita Business and Professional Organization * Cabrillo Credit Union Sharp Division Board * Cabrillo Credit Union Supervisory Committee * 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 * California College San Diego * California Maternal Quality Care Collaborative * California Department of Public Health * California Dietetic Association, Executive Board * California Emergency Medical Services Authority * California Health Care Foundation * California Health Information Association * California Hospice and Palliative Care Association * California Hospital Association Center for Behavioral Health * California Hospital Association * California Hospital Association Emergency Management Advisory Committee * California Library Association * California Perinatal Quality Care Collaborative * California State University San Marcos * California Teratogen Information Service * Caregiver Coalition of San Diego * Caring Hearts Medical Foundation * Center for Community Solutions * Check Your Mood Committee * Chelsea's Light Foundation * Chicano Federation of San Diego County * Community Health Improvement Partners (CHIP) Behavioral Health Work Team * CHIP Health Literacy Task Force * CHIP Independent Living Association Advisory Board and Peer Review Advisory Team * CHIP Suicide Prevention Work Team * Chula Vista Chamber of Commerce * Chula Vista Police Foundation * City of Chula Vista Wellness Program * City of San Diego * City of San Diego Park & Recreation - Therapeutic Recreation Services Disabled Services Advisory Council * Combined Health Agencies * Community Center for the Blind and Visually Impaired * Community Emergency Response Team * Consortium for Nursing Excellence, San Diego * Coronado Fire Department * Coronado Public Library * Coronado SAFE (Student and Family Enrichment) * Coronado Senior Center Planning Committee * Council of Women's and Infants' Specialty Hospitals * County of San Diego Emergency Medical Services * CVS MinuteClinics * Cycle EastLake * Downtown San Diego Partnership * East County Action Networ”

“* San Diego Mesa College Advisory Board * 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 Coalition for Compassionate Care * San Diego Regional Chamber of Commerce * San Diego Regional Home Care Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego State University * San Diego Workforce Partnership * San Diego Workforce - Work Well Committee * San Ysidro High School * Santee Chamber of Commerce * SAY San Diego * Second Chance * Serving Seniors * Sharp and Children's MRI Board * Sharp and UC San Diego Health's Joint Venture Board * Sigma Theta Tau International Honor Society of Nursing * South Bay Community Services * South County Action Network * South County Economic Development Council * SuperFood Drive * Susan G. Komen Breast Cancer Foundation * Sweetwater Union High School District * The Meeting Place * Trauma Center Association of America * Union of Pan Asian Communities * University of California, San Diego * University of San Diego * University of Southern California * VA Mental Health Council * VA San Diego Healthcare System * Veterans Home of California, Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * We Honor Veterans * Women, Infants and Children Program * YMCA * YWCA Becky's House(r) * YWCA Board of Directors * YWCA Executive Committee * YWCA Finance Committee * YWCA In the Company of Women Event”