Sharp Memorial Hospital

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

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

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

“The final Form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the Director of Accounting & Tax, Vice President of Finance, Senior Vice President and Chief Financial Officer, and entity Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990.”

“Sharp Memorial Hospital has a written conflict of interest policy which has been reviewed and approved by the Sharp Memorial Hospital governing board. Sharp Memorial Hospital is committed to preventing any Participant of the Corporation from gaining any personal benefit from information received or from any transaction of Sharp. One component of the written conflict of interest policy requires that Board Members, Corporate Officers, Senior Vice Presidents and Chief Executive Officer(s) submit a conflict of interest statement annually to Legal Services/Senior Vice President of Legal Services who will review all statements. In addition, all Vice Presidents and any employees in the Purchasing/Supply Chain, Audit and Compliance, and Case Management/Discharge Planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the Conflict Review Committee comprised of employees from Sharp's Legal, Compliance, and Internal Audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board Members, Corporate Officers, Senior Vice Presidents, and the Chief Executive Officer(s) shall make such disclosures directly to the Chairman of the Board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the Board Member, Corporate Officer, Senior Vice President or the Chief Executive Officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from Sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with Section 5222 of the California Corporations Code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member.”

“The Compensation 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 Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation 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 2017.”

“The Compensation 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 Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation 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 2017.”

“The organization does not make its governing documents available to the general public. Policies are considered proprietary information, however in Sharp HealthCare's publicly available Code of Conduct, Sharp outlines its Conflict of Interest policies in a user friendly manner. The annual audited financial statements of the consolidated group are published on the dacbond.com website (www.dacbond.com), are attached to the Form 990 filed for each of the Sharp hospitals, and are available upon request. The annual audited financial statements include combining schedules which disclose the financial results (Balance Sheet, Statement of Operations, Statement of Changes in Net Assets) for each entity of the consolidated group. Quarterly financial statements of Sharp's obligated group are published on the dacbond.com website (www.dacbond.com).”

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

“- Total Revenue: 444085, Related or Exempt Function Revenue: 444085, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“All other revenue - Total Revenue: 563239, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 563239;”

“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.”

“Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2018 Section 1 An Overview of Sharp HealthCare For more than 60 years, Sharp HealthCare has made a difference in the lives of San Diegans. As a not-for-profit organization, Sharp places great value on the health and wellness of our expanding community. In everything we do, we are committed to making health care better for those we serve. - Michael Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp) 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; 29 medical centers; six urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp also offers individual and group Health Maintenance Organization coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2018, Sharp is licensed to operate 2,084 beds and has more than 2,700 Sharp-affiliated physicians and 18,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in SDC's fast-growing South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women's and infant's services, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, subacute and long-term care, liver care, rehabilitation therapies, orthopedics, and hospice and emergency services. Sharp Grossmont Hospital (524 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, oncology, orthopedics, rehabilitation, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in cancer treatment, orthopedics, organ transplantation, bariatric surgery, heart care and rehabilitation. SMH also houses the county's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 licensed beds) A freestanding women's hospital specializing in labor and delivery services, high-risk pregnancy, obstetrics, gynecology, gynecologic oncology and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other hospital in California. Sharp Mesa Vista Hospital (158 licensed beds) As the most comprehensive mental health hospital in San Diego, Sharp Mesa Vista Hospital (SMV) provides behavioral health services to treat anxiety, depression, substance abuse, eating disorders, bipolar disorder and more for patients of all ages. Sharp McDonald Center (16 licensed beds) Sharp McDonald Center (SMC) is the only medically supervised substance abuse recovery center in SDC. Offering the most comprehensive hospital-based treatment program in San Diego, SMC provides services such as addiction treatment, medically supervised detoxification and rehabilitation, day treatment, outpatient and inpatient programs, and aftercare. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH and are referred to herein as the Sharp Met”

“Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * Sensitivity to operations * A reluctance to simplify * Preoccupation with failure * Deference to expertise * Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could improve. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization - Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. The seven pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: Quality. Demonstrate and improve clinical excellence and exceed customer expectations. Safety. Keep patients, employees and physicians safe and free from harm. Service. Create exceptional experiences at every touch point for patients and families, enrollees, physicians, partners and team members. People. Create a values-driven culture that attracts, retains and promotes the best people who are committed to Sharp's mission and vision. Finance. Achieve financial results to ensure Sharp's ability to deliver on its mission and vision. Growth. Achieve net revenue growth to enhance market position, sustain infrastructure improvements and support innovative development. Community. Be an exemplary public citizen by improving the health of our community and environment. Awards Below please find a selection of recognitions Sharp has received in recent years: In 2013, 2014, 2016 and 2017, Sharp was recognized as one of the "World's Most Ethical (WME) Companies" by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was ranked No. 45 out of 500 large employers on Forbes' 2017 America's Best Employers listing. In 2016, Sharp ranked No. 16 and received the No. 2 spot on the newcomer's list. In 2018, Forbes ranked Sharp No. 25 on its first-ever list of Best Employers for Women and No. 52 on its list of Best Employers for Diversity. Becker's Hospital Review recognized Sharp as one of "150 Top Places to Work in Healthcare" in 2017 and 2018. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees. From 2013 to 2018, Sharp ranked in the top 10 of the large employers category as one of the "Best Places to Work" for information technology professionals by the International Data Group's Computerworld survey. The list is compiled by evaluating a company's benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. In 2015, 2017 and 2018, Sharp ranked first for "San Diego's Best Hospital Group" in the annual San Diego Union-Tribune Readers Poll. In 2017, SMH was ranked "San Diego's Best Hospital" and, in 2018, Sharp's Weight Management Programs ranked first for "Best Weight Loss Clinic/Counseling." Sharp Community Medical Group (SCMG) was ranked "San Diego's Best Medical Group" from 2015 to 2018. Sharp Rees-Stealy Medical Group (SRSMG) was ranked "Best Hearing Aid Store" in 2018 for the second ye”

“In 2016, Sharp Best Health received the American Heart Association (AHA) Fit-Friendly Worksites Honor Roll award (Gold Category) for the fourth consecutive year, which recognizes employers that promote a culture of health and physical activity in the workplace or community. SRSMG was recognized by the Centers for Disease Control and Prevention (CDC) as a 2017 Million Hearts Hypertension Control Champion for achieving blood pressure control for at least 70 percent of its adult patients with hypertension. From 2013 to 2018, the Press Ganey organization recognized multiple Sharp entities with Guardian of Excellence Awards. Based on one year of data, this designation recognizes recipients that reach the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality. Awarded Sharp entities in the employee engagement category included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health, while SMH, SMH OPP and SMBHWN have been awarded for Patient Experience and SCHHC, SMBHWN and SMV have received awards for Physician Engagement. Press Ganey also recognized multiple Sharp entities with the Pinnacle of Excellence Award (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 categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 as well as 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, Sharp was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP has maintained a National Committee for Quality Assurance's (NCQA) Private Health Insurance Plan Rating of 4.5 out of 5 each year since 2016, making it one of the highest-rated health plans in the nation. SHP has also maintained the NCQA's highest level "Excellent" Accreditation status for service and clinical quality each year from 2013 to 2018. 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 measures. Covered California is California's official health insurance marketplace, offering individuals and small businesses the ability to purchase health coverage at federally subsidized rates. SHP earned a five-star rating - the highest possible - in Covered California's 2018 Coverage Year Quality Ratings in the categories of "Summary Quality Rating," "Getting the Right Care" and "Plan Services for Members." America's Physician Groups (APG) is a professional association, representing over 300 medical groups, independent practice associations, and integrated health care systems across the nation. APG has awarded its highest level of distinction - "Elite Status" - to SCMG and SRSMG each year from 2010 to 2018. The Women's Choice Award is a symbol of excellence in customer experience awarded by the collective voice of women. In 2018, SGH received the Women's Choice Award as one of America's Best Breast Centers, Best Stroke Centers and Best Hospitals for Heart Care. The Women's Choice Award also recognized SMH and SMBHWN in 2018 among America's Best Hospitals for Bariatric Surgery, Cancer Care, Obstetrics and Patient Experience, as well as among America's Best Breast and Stroke Centers. SCVMC was also recognized as one of America's Best Breast Centers in 2018. In addition, SCHHC has maintained its ranking as one of America's Best 100 Hospitals for Patient Experience from 2012 to 2018. Powered by the San Diego Association of Governments (SANDAG) 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 a”

“Also in FY 2018, Sharp assisted uninsured, underinsured and high-risk individuals who were unable to meet their financial responsibility after health insurance. Through the Maximum Out of Pocket Program, team members met with patients at all Sharp hospitals to help them better understand their health insurance benefits and how to access care during their hospital stay, as well as provided payment options. In FY 2018, the Maximum Out of Pocket Program made a total of more than $101,000 in adjustments to patient bills. In addition, Public Resource Specialists from Sharp's Patient Financial Services (PFS) team offered support to uninsured and underinsured patients at all Sharp hospitals in need of extra guidance on available funding options. These team members performed field calls (home visits) to patients who required assistance with completing the coverage application process after leaving the hospital. SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh - California's Supplemental Nutrition Assistance Program - prior to hospital discharge, which dramatically increased the likelihood that patients will complete CalFresh applications and receive benefits. In February 2017, Sharp's PFS team expanded CalFresh consults to the remainder of Sharp's acute care hospitals. Since 2016, more than 600 Sharp patients have been granted CalFresh benefits. In summer 2015, a pilot program was launched to evaluate eligibility for financial assistance among both insured and unfunded families with babies in the Neonatal Intensive Care Unit (NICU) at SMBHWN. This process included helping families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight apply for Supplemental Security Income (SSI) to help with the cost of care for their baby both within and outside of the hospital. The program was expanded to SCVMC and SGH in 2017, and since its inception, Public Resource Specialists have assisted more than 260 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients who lack 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. Sharp social workers provide referrals for permanent housing and collaborate with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. In addition, Sharp provides support to SSI claims by providing medical records as needed. SCHHC, SCVMC, SGH and SMH continued to collaborate with the San Diego Rescue Mission (SDRM) to provide services to chronically homeless patients. Through the partnership, Sharp discharges homeless patients to the SDRM's Recuperative Care Unit (RCU), a temporary shelter program that addresses the needs of homeless men and women who are newly released from the hospital but require further supervision. Through the RCU, patients receive case management, social work and counseling services as well as referrals for community-based medical and psychiatric services, long-term housing, and other community support programs. This collaboration between Sharp and SDRM provides a safe discharge plan for homeless individuals who require a stable living environment for their continued recovery. Sharp also continued to collaborate with Father Joe's Villages in support of the County of San Diego Aging and Independence Services' Project SOAR (Senior Options, Advocacy and Referrals). This program provides care management services to frail and disabled adults ages 60 years and older who are at risk for nursing home placement, and do not have access to nor qualify for supportive servi”

“Health Sciences High and Middle College Health Sciences High and Middle College (HSHMC) - a partnership between Sharp, a group of SDSU professors and the Grossmont-Cuyamaca Community College District - is a tuition-free, public charter high school that provides students with broad exposure to health care careers. Through this partnership, HSHMC students connect with Sharp team members through job shadowing to explore real-world applications of their school-based knowledge and skills. This collaboration prepares students to enter health, science and medical technology careers in the following five pathways: biotechnology research and development, diagnostic services, health informatics, support services and therapeutic services. The high school curriculum provides students with a variety of service-learning projects and internships focused on careers in health care. Students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. The HSHMC program began in 2007 with students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. Students also devote time to various SRSMG sites. 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 rotations, 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, Realities of Nutrition, Intro to Health Professions and Organizations, and Health and Social Injustice, among other courses. In FY 2018, 342 HSHMC students - including 100 Level I students and 242 Level II students - were supervised for more than 61,500 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology; occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; respiratory care; cardiovascular care; spiritual care; wound care; long-term care; endoscopy; engineering; nutrition; infection control; pulmonary services; maternal infant services; NICU; 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 2018, the HSHMC program graduated 151 students in its eighth full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Sixty-seven percent of HSHMC students are economically disadvantaged, and the school's free and reduced-price meal eligibility rate is higher than the average for both SDC and California. Despite these challenges, HSHMC maintains a 95 percent attendance rate and excels in preparing students for high school graduation, college entrance and a future career. In 2018, 91 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 83 percent of students said they wanted to pursue a career in health care. In addition, HSHMC has a 98.7 percent graduation rate, which is higher than the state”

“Results from post-evaluation surveys collected from these CME-accredited events showed markedly improved confidence and increased the likelihood that providers would engage with patients around food insecurity. Participants also stated an intent to change their professional behavior around recognizing and referring food insecure patients. Additionally, a longitudinal survey of providers who participated in a CME activity showed that 60 percent were interested in learning more about food insecurity and, since the education, 56 percent have followed through to employ food insecurity screening questions for their patients. Providers using food insecurity screening questions are most likely to refer to case management (43 percent) or directly to food resources in the community such as 2-1-1 San Diego, the San Diego Food Bank (Food Bank) or Feeding San Diego (FSD) (33 percent). Further, 38 percent of survey respondents believed this education has positively impacted their patients. Inspired by the CME/Community Benefit initiative, two Sharp medical groups, SCMG and SRSMG, have embarked on a group-wide approach to address food insecurity. SCMG integrated the two validated food insecurity screening questions as part of their electronic health record, and is currently exploring community partnerships to help patients address food insecurity and other social determinants of health (SDOH). In March 2018, SRSMG implemented a text push notification, including validated food insecurity screening questions, and provided case management and community resources to patients identified as food insecure. The CME/Community Benefit food insecurity initiative has both helped change how Sharp cares for its community, as well as delivered positive patient outcomes. Research Sharp Center for Research Innovation is critical to the future of health care. The Sharp Center for Research supports innovation through its commitment to protecting research participants and promoting high quality research initiatives that provide valuable knowledge to the San Diego health care community and positively impact patients and community members. The Sharp Center for Research includes the Human Research Protection Program (HRPP), which includes the Institutional Review Board (IRB) and the Outcomes Research Institute (ORI). Human Research Protection Program and Institutional Review Board The Sharp Center for Research is accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This accreditation acts as a public affirmation of the HRPP's commitment to following rigorous standards for ethics, quality and protection for human research. To date, Sharp is the only health system in SDC to receive accreditation from the AAHRPP. The Center for Research's HRPP is responsible for the ethical and regulatory compliant oversight of research conducted at Sharp and includes three components: the Sharp organization, the researchers and the IRB. As one of the key components of the HRPP, the IRB seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants must be reviewed by the IRB in order to protect participant safety and maintain responsible research conduct. In FY 2018, a dedicated IRB committee of 18 - including physicians, nurses, pharmacists and non-scientists - devoted hundreds of hours to the review and analysis of both new and ongoing research studies. Research at Sharp is conducted on all clinical phases of drug and device development, and the populations studied span the life cycle - from newborns to older adults. These clinical trials increase scientific knowledge and enable health care providers to assess the safety and effectiveness of new treatments. At any given time, Sharp participates in approximately 250 clinical trials covering many therapeutic areas, including behavioral health, emergency care, infect”

“In FY 2018, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared project results. Twenty-seven project teams, comprised of mentors and fellows, graduated from the program. Projects addressed issues in clinical practice and patient care including: bladder management in laboring patients, patient handover between caregivers, exclusive breastfeeding, healing touch in the NICU relaxation room for caregivers, prevention of pressure injuries, skin-to-skin care in the NICU, reduction of post-operative delirium, and decrease in discharge time. Volunteer Service Sharp Lends a Hand In FY 2018, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely solely on Sharp for volunteer labor; and support existing nonprofit initiatives, community activities or other programs that serve SDC. SLAH selected 23 volunteer projects for FY 2018: Food Bank; FSD; Mama's Kitchen; San Diego Wreaths Across America; USS Midway Foreign Object Damage (FOD) Walk-down; American Diabetes Association (ADA) Tour de Cure; Promises2Kids; Partnerships with Industry; Ssubi is Hope Greening for Good Project; Special Olympics Regional Fall Games, Bowling Tournament and Annual Spring Games; Habitat for Humanity ReStore; Stand Down for Homeless Veterans; Life Rolls On - They Will Surf Again; I Love a Clean San Diego's Beautify Chula Vista Day, Creek to Bay Cleanup, Clean Cities Initiative Cleanup and Coastal Cleanup Day; the San Diego River Park Foundation's Point Loma Native Plant Garden, San Diego River Garden, and Coastal Habitat Restoration; and River Kids Discovery Days - a joint effort between I Love a Clean San Diego and the San Diego River Park Foundation. More than 3,000 Sharp employees, family members and friends volunteered over 6,700 hours in support of these projects. 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 serves 370,000 San Diegans. Backpacks filled with a weekend's supply of food are provided to chronically hungry elementary school children throughout SDC, while Food Bank distribution sites provide boxes of groceries and staple food items to low-income seniors. The Food Bank distributed a total of 28 million pounds of food - the equivalent of 23.3 million meals - during its most recent FY. Over 120 SLAH volunteers gathered at the Food Bank warehouse to help inspect, clean, sort and package donated food as well as assist with assembling boxes and cleaning the facility at more than 15 events between December 2017 and September 2018. FSD, part of the Feeding America network, provides food and resources to a network of neighborhood partners in SDC serving healthy food to more than 63,000 local children, families and seniors every week. FSD relies on the generous support of individuals, corporations, foundations and community groups to sustain critical hunger-relief and nutrition programs throughout the region. Ninety SLAH volunteers helped sort food, prepare bags for distribution, and clean produce for FSD at more than 10 events during FY 2018. Established in 1990, Mama's Kitchen is a community-driven organization that enlists volunteers to help prepare and deliver nutritious meals to community members affected by acquired immunodeficiency syndrome (AIDS) or cancer who are unable to shop or cook for themselves. Mama's Kitchen strives to help its clients stay healthy, preserve their dignity, and keep their families together by providing free culturally appropriate home-delivered meals, pantry services and nutrition education. In December and February, 25 SLAH volunteers helped Mama's Kitchen serve meals to the community by preparing and packaging snack and vegetable items for delivery. In December 2017, SLA”

“SLAH participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego, to provide community-based social services to veterans without a permanent residence. Over 10 days in May, June and July, approximately 90 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, approximately 30 clinical volunteers - including Sharp-affiliated physicians and Sharp nurses, podiatry technicians, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. More than 700 veterans were served through the 2018 Stand Down for Homeless Veterans events. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by SCI. Through the organization's award-winning program, They Will Surf Again, paraplegic and quadriplegic community members can experience mobility through surfing with support from adaptive equipment and volunteers. In September, 80 SLAH volunteers assisted They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. In October 2017, 10 SLAH volunteers joined I Love a Clean San Diego and the City of Chula Vista for the 15th annual Beautify Chula Vista Day. Volunteers met at Rice Canyon in Discovery Park and assisted with watering and care of recent plantings, litter removal and additional projects to make the canyon shine. SLAH also partnered with I Love a Clean San Diego for the 16th annual Creek to Bay Cleanup in April, in celebration of Earth Day. Approximately 20 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In August, seven volunteers participated in I Love a Clean San Diego's Clean Cities Initiative Cleanup by sweeping streets along sidewalks in an Imperial Beach neighborhood. In September, 12 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including Ocean Beach Dog Beach, Chula Vista Marina View Park, Mission Trails Regional Park, Mission Bay, Lake Miramar, Cardiff Seaside Beach, Coronado City Beach and Scripps Pier in La Jolla. 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 30 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in October, November, June and August, as well as at the San Diego River Garden in Mission Valley in December, July and September. Activities included trail maintenance, watering, pruning and other light gardening projects. In May, eight SLAH volunteers joined the San Diego River Park Foundation's Coastal Habitat Restoration event in Ocean Beach. The team worked to save and restore one of the last remaining coastal dune and wetland habitats in San Diego by removing invasive plants and litter, watering and caring for recent plantings and native plants, and providing trail maintenance. In March, I Love a Clean San Diego and the San Diego River Park Foundation partnered to provide the fourth annual River Kids Discovery Days. Five SLAH volunteers participated in the free event, which provides river education and service events to teach more than 600 children and families about protecting the Earth's natural resources. In addition to these projects, Sharp expanded the SLAH program to include the coordination and promotion of a year-round blood donation effort to provide needed blood to local organizations serving the community. In FY 2018, Sharp committed to collecting at least 1,000 units of blood from Sharp employees, family and friends. Throughout the year, Sharp hosted 42 blood drives at”

“medical services, as well as donations of medical supplies, children's books, toys and sports equipment. In April, two Sharp team members joined the Alegado Foundation on a medical mission to the remote area of Sapa-Sapa in Tawi-Tawi, Philippines. Over a couple of days and alongside sixteen local agencies, including Philippine military personnel, the team provided 715 medical consultations, 209 dental treatments, 14 cataract surgeries, 75 Operation Tuli (circumcision) procedures, 518 ophthalmology and eye consultations, several cleft lip surgeries, and medications to those in need at no cost. The team also provided games, music, dancing, activities, school bags, sandals and food for the school children. For 10 days in May and June, a Sharp employee traveled to Fiji through MED 4 OUR WORLD, an organization committed to leaving a lasting impact on the communities it serves through health care, renovation and education. The 2018 MED 4 OUR WORLD team consisted of 17 volunteers, including a trauma surgeon, an anesthesiologist, Fijian anesthesiology residents, obstetrician-gynecologists (OB-GYN), a Fijian OB-GYN attending physician, medical students, registered nurses, and other health professionals. Together, the team evaluated over 100 patients and provided more than 30 procedures, including surgery for cervical, uterine and bladder cancer as well as hysterectomies and other gynecological procedures. In addition, the team assisted with the resuscitation and stabilization of premature twins post-delivery. Our One Community/Olmoti Clinic is a nonprofit organization dedicated to providing comprehensive medical care and education to the indigenous Maasai community located in a remote region of northern Tanzania. For three weeks in June, two Sharp team members and a physician treated approximately 300 men, women and children for infected bug bites, broken bones, fire-related falls, and other injuries or illnesses. The team also supported teachers at the organization's primary school, which serves 240 Maasai tribal children. In addition, Sharp and Ssubi is Hope donated more than $150,000 worth of equipment and supplies to support the work of the Olmati Clinic. For three weeks in July and August, a Sharp team member helped lead a team of six PLNU students on a mission trip to Azores, Portugal, with LoveWorks, a short-term mission program committed to sending well-trained, culturally sensitive and flexible teams of student missionaries to serve in challenging and remote areas of the world. The team provided numerous services to the Azorean community, including renovating a local church's thrift store that provides free clothing and supplies to those in need; assisting at health fairs; performing blood pressure checks; answering health-related questions; and referring individuals to local health clinics. Living Room Ministries International is a nonprofit organization dedicated to offering hope and help to rural villages in Kenya through physical, psychological and spiritual care. The organization provides hospice and community-based palliative care services to people with terminal illness, supports families with dying loved ones, and cares for those who lack love and support at the end of life. In September, a Sharp physical therapist traveled with Living Room Ministries International to provide patient care, physical therapy services, staff training and student supervision to approximately 100 Kenyans. Community Walks Heart disease is the leading cause of death in the U.S. Sharp proudly supports the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In FY 2018, more than 120 teams from entities across the Sharp system raised funds for the walk through activities such as auctions, prize drawings and a karaoke competition. In September, nearly 1,000 employees, family members and friends represented Sharp during the walk at Balboa Park. For the p”

“Lastly, SGH both sponsored and moderated a presentation on volunteer compliance, human resources and legal issues to more than 70 attendees - including volunteer program managers and leaders, community partners and hospital inter-professional peers - at CHA's California Hospital Volunteer Leadership Conference in February. Held at the Hyatt Regency in Newport Beach, the conference theme was Our Connections, Our Impact, Our Stories, which included education on the principles of volunteer administration in a health care institution, volunteer recruitment, SDOH, volunteer programs and service, the effects of health care service delivery system redesign on the volunteer sector, and retail operations. The following section describes the achievements of various Sharp volunteer programs in FY 2018. Sharp HospiceCare Volunteer Programs Sharp HospiceCare provides a variety of volunteer training opportunities that offer valuable knowledge and experience to volunteers who are often working towards a career in the medical field. Volunteers contribute to Sharp HospiceCare and those it serves by providing companionship to those near the end of life, support for families and caregivers, and assistance with community outreach. Sharp HospiceCare trained approximately 50 new volunteers in FY 2018. Volunteers completed an extensive 24-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their volunteer activities. In addition, five teenagers participated in Sharp HospiceCare's Teen Volunteer program. Through this program, teens completed special projects in Sharp HospiceCare administration, as well as assisted with patients at Sharp HospiceCare's LakeView, ParkView and BonitaView hospice homes. Tasks included grooming and hygiene activities, and simple acts of kindness such as sitting with patients, listening to their stories and holding their hand. Further, nine premedical students from SDSU, UC San Diego and CSUSM volunteered their time by supporting family caregivers in private homes. In September, Sharp Hospice shared information with 20 premedical students at SDSU regarding its volunteer opportunities to enhance the educational experience and ensure ongoing support for hospice patients and their loved ones. Sharp HospiceCare continued to provide the 11th Hour program to ensure that no patient died alone. Through the program, volunteers accompanied patients who were in their final moments of life but did not have family members present. This included holding the patient's hand, reading softly to them and simply remaining by their side. Families who were present with their dying loved one could also receive comfort from a volunteer while their loved one passed away. Twelve volunteers were trained through the 11th Hour program in FY 2018. In FY 2018, Sharp HospiceCare trained six volunteers in integrative therapies to promote relaxation and restful sleep and enhance the quality of life for Sharp HospiceCare patients and their caregivers. Integrative therapies included Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain; Reiki, a Japanese energy healing therapy in which practitioners use their hands on or above the patient's body to facilitate the healing process; aromatherapy; and hand massage. Volunteers also support Sharp HospiceCare's partnership with We Honor Veterans (WHV). WHV is a national program developed by the National Hospice and Palliative Care Organization in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide education and training that qualifies their volunteers to identify and support veteran patients and their caregivers. This includes the Vet-to-Vet Volunteer program, which pairs volunteers who have military experience with veteran patients. The program also honors veteran patients”

“At SMH, Arts for Healing typically serves patients who are receiving cancer treatment, recovering from surgery or stroke, awaiting organ transplantation, receiving palliative care, or facing life with newly acquired disabilities following catastrophic events. At SMBHWN, Arts for Healing supports mothers with high-risk pregnancies who are susceptible to stress and loneliness during extended hospital stays prior to childbirth. Music therapy is also provided in the NICU to promote development in premature babies. At SMV and SMC, Arts for Healing offers several art and music therapy groups, including groups for patients recovering from drug addiction; adolescents and adults receiving treatment for mood and anxiety disorders; and older adults receiving treatment for dementia or depression. In collaboration with SMMC's social workers and palliative care nurses, in FY 2018 Arts for Healing facilitated the donation of more than 350 handcrafted blankets and quilts for patients receiving end-of-life care at SMH and patients of the Sharp Senior Health Center Downtown. Throughout the year, Arts for Healing led art and music activities for hundreds of patients and community members in recognition of various holidays and Sharp events, including Saturday with Santa, a public event hosted each December by the SMH Auxiliary; Valentine's Day; National Hospital Week in May; Cancer Awareness activities in October and June; two Sharp blood drives; and Sharp's annual Disaster Preparedness Expo. Arts for Healing celebrated its 10th anniversary in FY 2018. Throughout the year, more than 50 volunteers and four staff members facilitated art and music activities for approximately 35,000 patients, guests and staff. Since its inception, more than 140,000 patients and their families have benefited from the time and talent provided by the program's dedicated volunteers, licensed therapists and staff. Other Sharp Community Efforts In FY 2018, Sharp engaged in a variety of community service projects to improve the well-being of community members throughout San Diego. Below are just a few examples of these efforts. According to the January 2018 WeAllCount Annual Report, there are nearly 8,600 individuals experiencing homelessness in SDC, nearly 5,000 of whom are unsheltered. This represents a decrease of six percent region-wide from 2017. Since 2011, Sharp has sponsored the Downtown San Diego Partnership's Family Reunification Program, which serves to reduce the number of homeless individuals on the streets of downtown San Diego. Through the program, homeless outreach coordinators from the Downtown San Diego Partnership's Clean & Safe Program identify homeless individuals who will be best served by traveling back home to loved ones. Family and friends are contacted to ensure that the individuals have a place to stay and the support they need to get back on their feet. Once confirmed, the outreach team provides the transportation needed to reconnect with their support system. With Sharp's help, the Family Reunification Program has reunited nearly 2,200 homeless individuals in Downtown San Diego with friends and family across the nation. The University of California, Los Angeles Center for Health Policy and Research's Elder Index states that two in five (41 percent) San Diego seniors will have to choose between buying food and paying rent. Through the Giving Tree program at the Downtown Sharp Senior Health Center, community members and staff donate gift cards to make the holidays brighter for seniors in need. In December 2017, each patient who visited the Downtown Sharp Senior Health Center left with a gift bag and a gift card to a local drug store, grocery store or restaurant. The SGH Engineering Department led a variety of volunteer initiatives in FY 2018. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting visitors, patients and staff. Through the program, the SGH landsca”

“For more than 30 years, SGH has held 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 that has been vetted and referred by local service agencies, and dedicate personal time to making the holidays the best they can be for them. 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. During the 2017 holiday season, Santa's Korner served more than 120 individuals from 36 families. For the past four years, SCVMC has supported Operation Gobble, an event started by Assemblywoman Lorena Gonzalez Fletcher that provides a turkey and fresh produce to those in need during the Thanksgiving holiday. In 2017, Operation Gobble served 40 patients from the Barnhart Cancer Center's Medical and Radiation Oncology departments. In addition, in December, SCVMC partnered with a Chula Vista chapter of Optimist International for a holiday bike giveaway. Optimist International is a worldwide volunteer organization that helps children develop to their fullest potential. In FY 2018, the holiday bike giveaway provided bicycles as holiday gifts to ten children of SCVMC cancer patients. Lastly, for the past two years, Sharp employees have supported students in need from elementary schools within the San Diego Unified School District. During their school supply drive in August, employees donated approximately 170 pounds' worth of new backpacks, binders, pens, pencils, crayons and other school supplies - more than doubling last year's efforts - to students from low-income households. All Ways Green Initiative Sharp is dedicated to minimizing adverse environmental impacts by creating healthy green practices for employees, physicians and patients. Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego's earth-friendly businesses to help identify best practices, reduce the costs of green practices, and facilitate the implementation of sustainable initiatives. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Through the All Ways Green initiative, Sharp maintains an environmentally conscious footprint and communicates sustainability throughout the organization and the San Diego community. Sharp's systemwide All Ways Green Committee is responsible for spearheading the organization's sustainability efforts. Sharp's environmental initiatives are concentrated in five domains: (1) energy efficiency, (2) water conservation, (3) waste minimization, (4) sustainable food practices, and (5) commuter solutions. Specialized committees are responsible for each of these domains (see Table 3), while established Green Teams at each Sharp entity are responsible for developing new programs at the local level to educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Table 3: All Ways Green Committees/Subcommittees and Domains Natural Resource Subcommittee Energy efficiency and water conservation Waste Minimization Committee Waste minimization Food and Nutrition Best Health Committee Sustainable food practices Commuter Solutions Subcommittee Commuter solutions To monitor progress and measure tangible results, All Ways Green utilizes a Sharp-developed report card, which trends each domain's annual performance against a baseline. The report card shows where the desired results have been achieved as well as identifies opportunities for improvement. These opportunities for improvement are used to strategically plan initiatives that engage Sharp's workforce in reducing the organization's carbon footprint. Sharp continues to invest in technology and programs that reduce c”

“In May 2018, Sharp opened the new Copley building, which houses administrative space for SRSMG along with the high-complexity, consolidated Sharp HealthCare Laboratory that services the entire Sharp system. Sharp is in the process of implementing a fuel-cell energy project at Copley, the first in the Sharp system. A fuel cell uses the chemical energy of hydrogen or another fuel to produce electricity cleanly and efficiently. Using these fuel cells could lead to a reduction of more than 90 percent in the plants' carbon dioxide emissions, while also producing large amounts of useful hydrogen. The Copley building will also be the first in the Sharp system to implement the Aircuity system, which continuously monitors environmental parameters and adjusts air supply and exhaust delivery based upon indoor contaminant levels and thermal load. This automated system samples and analyzes packets of air remotely, which are routed to a centralized suite of sensors. The system provides input to the building ventilation systems to optimize indoor environmental quality and energy efficiency. All Sharp hospitals engage in the EPA's ES database and monitor their ES scores on a monthly basis, thus following an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC and SCVMC received the ES certification in 2018 (SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, and again in 2017, while SCVMC received ES certification from 2009 to 2011, 2013, 2015, and 2017). Sharp partners with the Center for Sustainable Energy (CSE) to promote and strengthen its work with the ES. From July to August 2017, a CSE benchmarking coach worked with Sharp facility managers to identify and correct data quality issues in the measurement of Sharp's energy and water consumption. As the result of this endeavor, in December 2017, the CSE featured Sharp in a case study highlighting the organization's dedication to improving the welfare of the environment and the communities it serves. In addition, Sharp's SRSMG Downtown medical office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, one of the first medical office buildings of its kind in San Diego. In 2017, Sharp received the Environmental Stewardship Award in the large business category from the BBB, serving San Diego, Orange and Imperial counties. The award recognizes businesses that increase efforts toward a more sustainable footprint and green initiatives. In May 2017, Sharp was named San Diego's Grand Energy Champion by SDG&E in recognition of its continuous commitment to implementing energy efficiency measures. The award specifically noted the particular challenges faced by health care organizations trying to conserve energy, given the need to maintain comfortable, clean and safe environments for patients, visitors and staff, 24 hours a day, seven days a week. Table 4 outlines Sharp's numerous natural resource conservation initiatives. Table 4: Natural Resource Projects by Sharp HealthCare Entity Establish Energy and Water Use Baseline: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Energy Star Participation: SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC. Air Handler Projects: SCHHC, SMH/SMBHWN. Cogeneration Plant: SGH Drip Irrigation/Landscape Water Reduction Systems: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Drought-Tolerant Landscaping: SCHHC, SCVMC, SGH, System Offices, SHP, S”

“Single-stream Recycling: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Recycled Paper: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Blue Wrap Recycling: SCHHC, SCVMC, SGH, SMH/SMBHWN. Composting: SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC. Construction- Debris Recycling: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Electronic Cafe Menus: SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SMV/SMC. Electronic Patient Bills and Paperless Payroll: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Electronic and Pharmaceutical Waste Recycling Events: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Organic Waste Recycling (Green Waste): SCVMC, SGH. Recycle Bins Distribution: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Repurposing of Unused Medical Supplies and Equipment: SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SRSMG. Reusable Sharps Containers: SCHHC, SCVMC, SGH, SMH/SMBHWN. Single Serve Paper Napkins and Plastic Cutlery Dispensers: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Surgical Instrument Reprocessing: SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC. Replacement of Bottled Water with Spa Water: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Sustainable Food Practices Sharp offers healthy, nutritious and delicious food options to support the health of patients, employees and the community. Sharp's commitment to healthy food and nutrition sustainability practices began over seven years ago with a strategy to increase the selection of organic and sustainable food options to improve engagement. In collaboration with its food service partner Sodexo, Sharp continues to be an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers and reduce its carbon footprint. The goal of Sharp's Food and Nutrition Best Health Committee is to promote food sustainability efforts throughout the health care system and within the greater San Diego community. This includes a focus on Sharp's sustainable Mindful Food program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. Sharp's Mindful Food program includes the promotion of Meatless Mondays to reduce meat consumption; increased purchases of beef and poultry raised without the routine use of antibiotics; menus that highlight wellness options; participation in Community Supported Agriculture (CSA), a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm; increased use of locally sourced fresh, organic and sustainable food; food composting; increased recycling activities; the promotion of sugarless beverages; and the use of post-consumer recycled packaging solutions. Up to 40 percent of food in the U.S. is never eaten and instead goes to waste. In FY 2018, Sodexo teams at SCVMC and SMH were invited by the San Diego Food System Alliance and Smart Kitchens San Diego to participate in LeanPath - a pilot program funded by a City of San Diego grant to combat food waste and facilitate compliance with new composting and recycling laws. LeanPath provides an advanced food waste tracking software system to help kitchen teams measure food prior to discarding or donating in order to prevent pre-consumer food waste (waste generated in the kitchen) as well as post-consumer food waste (food the consumer throws away) from entering the landfill. Since August 2016, SMH, SMV, and SGH have collaborated with the SDRM and the Food Bank in an innovative food recovery program that donates food items that can no longer be used in Sharp's kitchens but are perfectly healthy and nutritious to more than 45 hunger-relief organizations in SDC. In addition, SCVMC's partnership with FSD and SCHHC's partnership with the Food Bank makes Sharp the fi”

“Report Card and Indicators Tracking: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Food Recovery: SCHHC, SGH, SMH/SMBHWN, SMV/SMC. Imperfect Produce: SCVMC, SMV/SMC. Composting: SCVMC, SGH, SMH/SMBHWN,SMV/SMC. Oil Recycling: SCVMC, SGH. Fryers Eliminated: SCHHC, SMH/SMBHWN, SMV/SMC. Commuter Solutions Sharp supports ride sharing, public transit programs and other transportation efforts to reduce carbon emissions generated by its facilities and employees. Sharp's Commuter Solutions Subcommittee works to develop innovative and accessible programs and marketing campaigns to educate employees about the benefits of ride sharing and other alternative modes of transportation. Sharp's ongoing efforts to promote alternative commuter choices in the workplace have led to recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 through 2018. Sharp replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, which save approximately five miles per gallon. In addition, Sharp's employee parking lots offer carpool and motorcycle parking spaces. Sharp was the first health care system in San Diego to offer electric vehicle chargers (EVCs), supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on petroleum. As part of the nationwide Electric Vehicle Project, Sharp installed EVCs at its corporate office location, SCVMC, SMMC and some SRSMG sites. Twenty-five EVCs were added at the new Copley building in 2018. Sharp will continue efforts to expand EVCs at its other entities. Sharp offers bike racks as well as a Bicycle Commuter Benefit, which gives employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. Furthermore, Sharp participates in SANDAG's annual Bike to Work Day event each May. In 2018, Sharp employees were once again among almost 10,000 San Diegans who opted to ride their bike to work. Sharp hosted several pit stops, providing food and beverages, at various sites throughout SDC. Sharp also encourages employees to participate in alternate commuting, including SANDAG's iCommute program that can match commuters in an area based on their work schedule, departure location and destination. Employees can monitor their cost and carbon savings resulting from their alternate commuting methods - such as using public transit, carpooling, vanpooling, biking, walking, or telecommuting - and log their miles in an internal tracking tool on Sharp's intranet site, which has replaced SANDAG's discontinued TripTracker. In addition, Sharp is enrolled in SANDAG's Guaranteed Ride Home program which provides commuters who carpool, vanpool, take an express bus, ride the Coaster, or bike to work three or more times a week with a taxi or a rental car in case of an emergency or being stranded at work. Further, Sharp employees can also purchase discounted monthly bus passes. 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. The annual challenge is instrumental in helping reduce traffic congestion and greenhouse gas emissions throughout the region. Furthering the commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for almost 700 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription and human resources. Sharp also provides compressed work schedule options to eligible full-time employees, which enables them to complete the basic eighty-hour biweekly work requirement in less than 10 workd”

“In FY 2018, Sharp's disaster leadership donated their time to state and local organizations and committees, including County of San Diego Emergency Medical Care Committee, California Hospital Association Emergency Management Advisory Committee, California Department of Public Health Joint Advisory Committee, Ronald McDonald House Operations Committee and San Diego County Civilian/Military Liaison Work Group. In addition, Sharp's disaster leadership participates in the County of San Diego Healthcare Disaster Coalition. Healthcare disaster coalitions are multi-agency groups of representatives who play a critical role in public safety during emergencies and disasters by assisting counties in improving mitigation, preparedness, response and recovery activities. As part of this coalition, in FY 2018, Sharp's disaster leadership led a subcommittee to review hospital evacuation planning and identify tools and best practices for dissemination to community health care professionals. Sharp's disaster leadership also continued to participate in the Statewide Medical Health Exercise Program. This 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 - is designed 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 Sharp and other SDC hospitals, health clinics and other health care services providers. 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 sharing resources, trainings and information, the partners will be better prepared for a collaborative response to an emergency or disaster affecting SDC. In FY 2018, the partnership assisted with training and education of non-hospital health care entities to better prepare them to develop emergency operations plans and responses. Sharp supports safety efforts of the State and the City of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to an event requiring mass decontamination. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event of an interruption to the system's normal water supply. In recent years, global endemic events potentially impacted public health in the San Diego community. Sharp continues to collaborate with community agencies, County of San Diego Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This allows for the delivery of uninterrupted care to the community in the face of public health threats. Employee Wellness: Sharp Best Health Sharp recognizes that improving the health of its team members benefits the health of the broader community. Since 2010, the Sharp Best Health employee wellness program has created initiatives to improve the overall health, safety, happiness and productivity of Sharp's workforce. Each Sharp hospital, SRSMC and corporate location has a dedicated Best Health committee that works to motivate team members to incorporate healthy habits into their lifestyles and support them on their journey to attain their personal health goals. Team members are encouraged to participate in a variety of workplace health initiatives ranging from fitness challenges and weight management programs to health education and events. Sharp Best Health also offers an interactive, web-base”

“In FY 2018, Sharp Best Health continued to go beyond nutrition and physical fitness to support the overall health and happiness of employees by offering a digital mindfulness and yoga training platform from the vendor Whil. Whil's program is designed to help employees manage stress and improve their well-being by offering more than 1,200 mindfulness and yoga sessions. Whil's sessions are of various lengths and skill levels, providing employees the flexibility to move at their own pace and set their own goals. Whil has also been used throughout the system as a tool during staff meetings, department huddles and shift changes. Since Whil's launch, more than 2,400 employees have become active users. Another mindfulness initiative involved a collaboration between Sharp Best Health and certified mindfulness facilitators to provide on-site mindfulness programming at six Sharp locations, including both series and drop-in classes. Throughout FY 2018, Sharp Best Health continued to provide Wellness on Wheels, a monthly educational event offered to Sharp employees to address the challenge of accessing health resources and programs during work hours. Wellness on Wheels involves "rounding" in staff lounges, hospital units, and nursing stations to promote a new and relevant subject each month. Each session includes an educational component, an interactive activity and a call to action. Wellness on Wheels brings wellness education to employees where they work, accommodating their unique schedules and dedication to patient care. Keeping the experience relevant and quick improves access to wellness resources for busy staff with complex schedules. During FY 2018, Wellness on Wheels topics included holiday food myths, essential oils, mindful eating, yoga poses for relaxation, heart health and common safety hazards. Since 2015, Sharp has provided a systemwide Mindful healthy food initiative in partnership with Sodexo. As part of the Mindful program, Sharp's cafeteria menus were redesigned to include sustainable, nutritious and enticing food options that foster a healthy lifestyle among patients, visitors and staff. In 2018, Sharp continued its partnership with Farm Fresh to You to make customizable boxes of organic, locally-grown produce available for purchase by employees. This CSA service offers a convenient method for employees and their families to incorporate more fruits and vegetables into their diet while supporting local farmers. Weight Watchers offers weight-loss services and products founded on a scientifically-based approach to weight management that encourages healthy eating, increased physical activity and other healthy lifestyle behaviors. Sharp Best Health continued its partnership with Weight Watchers to offer employees a subsidized membership rate to any Weight Watchers program. With program availability at work, in the community and online, this partnership has offered Sharp team members a variety of healthy eating and physical activity options that can be tailored to different lifestyles and schedules. At any given time during FY 2018, approximately 530 Sharp employees were actively using Weight Watchers. Since the program's inception in 2016, participating employees have lost an estimated 4,000 pounds. In addition to providing Weight Watchers at work, during FY 2018, Sharp Best Health partnered with the Sharp Rees-Stealy Center for Health Management to offer free in-person and online nutrition classes to Sharp employees through the New Weigh program. New Weigh is an eight-week weight loss program that emphasizes nutrition education and healthy lifestyle development. Program participants create a semi-structured food plan, and have access to a skilled health coach or RD to ensure continued support and accountability. During FY 2018, 240 Sharp employees completed the New Weigh program. Nearly one in six community members face the threat of hunger every day in SDC. Each month, the Food Bank distributes food to approximately 370,0”

“* 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 United States of America 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. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations, telephone reassurance calls and other services for seniors; financial and other support to community clinics to assist in providing and improving access to health services; Project HELP; Meals on Wheels; contribution of time to Stand Down for Homeless Veterans, the San Diego Food Bank and Feeding San Diego; 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 as CHNA development and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care students and professionals, as well as supervision and support for students and interns. Time was also devoted to generalizable health-related research projects that were made available to the broader health care community. Economic Value of Community Benefit Provided in FY 2018 In FY 2018, Sharp provided a total of $437,406,616 in community benefit programs and services that were unreimbursed. Table 9 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. These financial figures represent unreimbursed community benefit costs after the impact of the Medi-Cal Hospital Fee Program. Table 9: Sharp HealthCare Total Community Benefit by SB 697 Category - Estimated FY 2018 Unreimbursed Costs (see Note 1) Medical Care Services: Shortfall in Medi-Cal (see Note 2) - $129,308,822 Shortfall in Medicare (see Note 2) - $248,662,360 Shortfall in San Diego County Indigent Medical Services (CMS) (see Note 2) - $9,201,550 Shortfall in CHAMPVA/TRICARE (see Note 2) - $7,612,667 Shortfall in Workers' Compensation - $29,656 Charity Care (see Note 3) - $24,969,673 Bad Debt (see Note 3) - 6,511,004 Other Benefits for Vulnerable Populations: Patient transportation and other assistance for the needy (see Note 4) - $3,685,141 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 (see Note 4) - $1,869,835 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (see Note 4) - $5,555,908 TOTAL - $437,406,616 Table 9 Notes: Note 1 - Economic value is based on unreimbursed costs. Note 2 - Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived f”

“Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $19,025,271 Other Benefits for Vulnerable Populations - $448,871 Other Benefits for the Broader Community - $127,420 Health Research, Education and Training Programs - $177,560 Total - $19,779,122 Sharp Health Plan: Medical Care Services - $0 Other Benefits for Vulnerable Populations - $11,767 Other Benefits for the Broader Community - $47,970 Health Research, Education and Training Programs - $10,166 Total - $69,903 ALL ENTITIES: Medical Care Services - $426,295,732 Other Benefits for Vulnerable Populations - $3,685,141 Other Benefits for the Broader Community - $1,869,835 Health Research, Education and Training Programs - $5,555,908 Total - $437,406,616 Section 3 Community Benefit Planning Process Navigating the maze of health care can be daunting to say the least; and Sharp is committed to assisting community members in this process. Because it involves a loved one, the appreciation expressed is extremely meaningful. - Sara Steinhoffer, Vice President of Government Relations, Sharp HealthCare For more than 20 years, Sharp HealthCare (Sharp) has based its community benefit planning on findings from its triennial Community Health Needs Assessment (CHNA) process. CHNA findings are used in combination with the expertise in programs and services of each Sharp hospital, as well as knowledge of the populations and communities served by those hospitals, to provide a foundation for community benefit program planning and implementation. Methodology to Conduct the 2016 Sharp HealthCare Community Health Needs Assessments Sharp has been a longtime partner in the process of identifying and responding to the health needs of the San Diego community. Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations and community agencies to conduct a triennial CHNA that identifies and prioritizes health needs for San Diego County (SDC). In addition, to address the requirements for not-for-profit hospitals under the Patient Protection and Affordable Care Act, Sharp has developed CHNAs for each of its individually licensed hospitals since 2013. This process gathers both salient hospital data and the perspectives of health leaders and residents in order to identify and prioritize health needs for community members across the county, with a special focus on vulnerable populations. Further, the process seeks to highlight health needs that hospitals could impact through programs, services and collaboration. For the 2016 CHNA process, Sharp actively participated in a collaborative CHNA effort led by the Hospital Association of San Diego and Imperial Counties (HASD&IC) and in contract with the Institute for Public Health (IPH) at San Diego State University. The process and findings of the collaborative HASD&IC 2016 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs. The complete HASD&IC 2016 CHNA is available for public viewing and download at http://www.hasdic.org. To develop its individual hospital CHNAs, Sharp analyzed hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients and community members it serves. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns, as the two hospitals share a license, and report all utilization and financial data as a single entity to California's Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2016 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2016 CHNAs for each Sharp hospital help inform current and future community benefit programs and services, especially for community members facing inequities. This section describes the general methodology employed”

“* Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters * Community Clinic Visits * Demographic Data (socioeconomic 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 number of community engagement activities were conducted across SDC, as well as specific to Sharp patents, in order to provide a more comprehensive understanding of identified health needs, including their associated SDOH and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. The types of community engagement activities conducted as part of the collaborative HASD&IC 2016 CHNA included key informant interviews, facilitated discussions with care coordinators (community partner discussions), and community resident input through a Health Access and Navigation Survey In addition, Sharp contracted with IPH to collect additional community input through three primary methods: facilitated discussions, key informant interviews, and the Health Access and Navigation Survey with patients and community members. This input focused on behavioral health, cancer, cardiovascular health, diabetes, high-risk pregnancy, senior health and the needs of highly vulnerable patients and community members. In addition, Sharp conducted specific outreach to community promotores, and members of Sharp's Patient Family Advisory Councils - community members who are also current or former Sharp patients. More than 40 Sharp providers and nearly 150 Sharp patients or community members were reached through these engagement efforts. Findings The collaborative HASD&IC 2016 CHNA prioritized the top health needs for SDC through application of the following five criteria: 1. Magnitude or Prevalence 2. Severity 3. Health Disparities 4. Trends 5. Community Concern Using these criteria, IPH created a summary matrix for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, Type 2 diabetes and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. As the HASD&IC 2016 CHNA process included robust representation from the communities served by Sharp, the findings of the prioritization process applied to the same four priority health needs identified for Sharp (behavioral health, cardiovascular, Type 2 diabetes and obesity). In addition, findings from Sharp's 2016 CHNAs continued to prioritize cancer, high-risk pregnancy and senior health among the top health needs for its community. In addition, analysis of feedback from the 2016 CHNA community engagement activities identified SDOH to be a key theme among community health needs. Ten SDOH were consistently referenced across the different community engagement activities conducted in both HASD&IC's and Sharp's CHNAs. The importance of these SDOH was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these SDOH, which are listed below in order of priority. 2016 CHNA Social Determinants of Health 1. Food Inseecurity & Access to Healthy Food 2. Access to Care or Services 3. Homeless/Housing Issues 4. Physical Activity 5. Education/Knowledge 6. Cultural Competency 7. Transportation 8. Insurance Issues 9. Stigma 10.Poverty The health needs and SDOH identified in the 2”

“Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $19,025,271 Other Benefits for Vulnerable Populations - $448,871 Other Benefits for the Broader Community - $127,420 Health Research, Education and Training Programs - $177,560 Total - $19,779,122 Sharp Health Plan: Medical Care Services - $0 Other Benefits for Vulnerable Populations - $11,767 Other Benefits for the Broader Community - $47,970 Health Research, Education and Training Programs - $10,166 Total - $69,903 ALL ENTITIES: Medical Care Services - $426,295,732 Other Benefits for Vulnerable Populations - $3,685,141 Other Benefits for the Broader Community - $1,869,835 Health Research, Education and Training Programs - $5,555,908 Total - $437,406,616 Section 3 Community Benefit Planning Process Navigating the maze of health care can be daunting to say the least; and Sharp is committed to assisting community members in this process. Because it involves a loved one, the appreciation expressed is extremely meaningful. - Sara Steinhoffer, Vice President of Government Relations, Sharp HealthCare For more than 20 years, Sharp HealthCare (Sharp) has based its community benefit planning on findings from its triennial Community Health Needs Assessment (CHNA) process. CHNA findings are used in combination with the expertise in programs and services of each Sharp hospital, as well as knowledge of the populations and communities served by those hospitals, to provide a foundation for community benefit program planning and implementation. Methodology to Conduct the 2016 Sharp HealthCare Community Health Needs Assessments Sharp has been a longtime partner in the process of identifying and responding to the health needs of the San Diego community. Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations and community agencies to conduct a triennial CHNA that identifies and prioritizes health needs for San Diego County (SDC). In addition, to address the requirements for not-for-profit hospitals under the Patient Protection and Affordable Care Act, Sharp has developed CHNAs for each of its individually licensed hospitals since 2013. This process gathers both salient hospital data and the perspectives of health leaders and residents in order to identify and prioritize health needs for community members across the county, with a special focus on vulnerable populations. Further, the process seeks to highlight health needs that hospitals could impact through programs, services and collaboration. For the 2016 CHNA process, Sharp actively participated in a collaborative CHNA effort led by the Hospital Association of San Diego and Imperial Counties (HASD&IC) and in contract with the Institute for Public Health (IPH) at San Diego State University. The process and findings of the collaborative HASD&IC 2016 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs. The complete HASD&IC 2016 CHNA is available for public viewing and download at http://www.hasdic.org. To develop its individual hospital CHNAs, Sharp analyzed hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients and community members it serves. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns, as the two hospitals share a license, and report all utilization and financial data as a single entity to California's Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2016 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2016 CHNAs for each Sharp hospital help inform current and future community benefit programs and services, especially for community members facing inequities. This section describes the general methodology employed”

“* Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters * Community Clinic Visits * Demographic Data (socioeconomic 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 number of community engagement activities were conducted across SDC, as well as specific to Sharp patents, in order to provide a more comprehensive understanding of identified health needs, including their associated SDOH and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. The types of community engagement activities conducted as part of the collaborative HASD&IC 2016 CHNA included key informant interviews, facilitated discussions with care coordinators (community partner discussions), and community resident input through a Health Access and Navigation Survey In addition, Sharp contracted with IPH to collect additional community input through three primary methods: facilitated discussions, key informant interviews, and the Health Access and Navigation Survey with patients and community members. This input focused on behavioral health, cancer, cardiovascular health, diabetes, high-risk pregnancy, senior health and the needs of highly vulnerable patients and community members. In addition, Sharp conducted specific outreach to community promotores, and members of Sharp's Patient Family Advisory Councils - community members who are also current or former Sharp patients. More than 40 Sharp providers and nearly 150 Sharp patients or community members were reached through these engagement efforts. Findings The collaborative HASD&IC 2016 CHNA prioritized the top health needs for SDC through application of the following five criteria: 1. Magnitude or Prevalence 2. Severity 3. Health Disparities 4. Trends 5. Community Concern Using these criteria, IPH created a summary matrix for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, Type 2 diabetes and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. As the HASD&IC 2016 CHNA process included robust representation from the communities served by Sharp, the findings of the prioritization process applied to the same four priority health needs identified for Sharp (behavioral health, cardiovascular, Type 2 diabetes and obesity). In addition, findings from Sharp's 2016 CHNAs continued to prioritize cancer, high-risk pregnancy and senior health among the top health needs for its community. In addition, analysis of feedback from the 2016 CHNA community engagement activities identified SDOH to be a key theme among community health needs. Ten SDOH were consistently referenced across the different community engagement activities conducted in both HASD&IC's and Sharp's CHNAs. The importance of these SDOH was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these SDOH, which are listed below in order of priority. 2016 CHNA Social Determinants of Health 1. Food Inseecurity & Access to Healthy Food 2. Access to Care or Services 3. Homeless/Housing Issues 4. Physical Activity 5. Education/Knowledge 6. Cultural Competency 7. Transportation 8. Insurance Issues 9. Stigma 10.Poverty The health needs and SDOH identified in the 2”

“NOTES: Note 1 - 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. Note 2 - Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Note 3 - 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. Section 5 Sharp Mary Birch Hospital for Women & Newborns I would define community as a fellowship of people who have common goals and interests based on their current location, situation, life stage, etc....the variables are endless. Life is not meant to be lived in a vortex. - Courtney Akel, Manager of the Neonatal Intensive Care Unit, Sharp Mary Birch Hospital for Women & Newborns FY 2018 Community Benefit Program Highlights Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) provided a total of $9,761,499 in community benefit in FY 2018. See Table 38 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697). Table 38: Economic Value of Community Benefit Provided Sharp Mary Birch Hospital for Women & Newborns SB 697 Category - Estimated FY 2018 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal - $5,326,184 Shortfall in Medicare (Note 1) - $1,372,646 Shortfall in CHAMPVA/TRICARE (Note 1) - $1,209,502 Charity Care (Note 2) - $633,926 Bad Debt (Note 2) - $774,467 Other Benefits for Vulnerable Populations: Patient transportation and other assistance for the needy (Note 3) - $87,059 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 (Note 3) - $119,237 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (Note 3) - $238,478 TOTAL - $9,761,499 NOTES: Note 1 - 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. Note 2 - Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Note 3 - 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. Key highlights: * Medical Care Services included uncompensated care for patients who were unable to pay for services and unreimbursed costs of public programs, such as Medi-Cal, Medicare and CHAMPVA/TRICARE. In FY 2018 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, 2017 through June 30, 2019. This resulted in recognition of net supplemental revenues for SMBHWN totaling $32.1 million in FY 2018. These supplemental revenues were funded through SMBHWN's traditional Medi-Cal program”

“Eligibility by Federal Poverty Level: Population below or at 130% FPL - 19.5% Population below or at 138% FPL - 21.0% Population 139% to 350% FPL - 32.7% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. In SDC in 2016, 93.8 percent of children ages zero to 17, 80.3 percent of young adults ages 18 to 24, 81.1 percent of adults ages 25 to 44, 87.4 percent of adults ages 45 to 64, and 98.5 percent of seniors ages 65 and older had health insurance. Health insurance coverage for each age group was lower than the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. See Table 40 for health insurance coverage in SDC in 2016. Table 40: Health Insurance Coverage in SDC, 2016 Children 0 to 17 years: Current Rate - 93.8% HP2020 Target - 100% Young adults 18 to 24 years: Current Rate - 80.3% HP2020 Target - 100% Adults 25 to 44 years: Current Rate - 81.1% HP2020 Target - 100% Adults 45 to 64 years: Current Rate - 87.4% HP2020 Target - 100% Seniors 65+ years: Current Rate - 98.5% HP2020 Target - 100% Source: County of San Diego HHSA, Public Health Services, Community Health Statistics Unit, 2018. Demographic Profiles, 2016, and U.S. Census Bureau, American Community Survey 2012-2016. According to the California Health Interview Survey (CHIS), 25.8 percent of SDC's population was covered by Medi-Cal. See Table 41 for details. Table 41: Medi-Cal (Medicaid) Coverage in SDC, 2016-2017 Covered by Medi-Cal - 25.8% Not covered by Medi-Cal - 74.2% Source: 2016-2017 CHIS CHIS data also revealed that 11.7 percent of individuals in SDC did not have a usual place to go when sick or in need of health advice (see Table 42).1 Table 42: Regular Source of Medical Care in SDC, 2016-2017 Has a usual source of care: Current Rate - 88.3% HP2020 Target - 100% Has no usual source of care: Current Rate - 11.7% HP2020 Target - 0% Source: 2016-2017 CHIS In 2016, there were 42,654 live births in SDC overall. The 2016 fetal mortality rate was 3.2 infant deaths per 1,000 live births in the north inland region, 3.4 in the north coastal region, 3.7 in the east region and SDC overall, 3.8 in the central region, 3.9 in the north central region, and 4.3 in the south region.1 In 2016, 159 infants died before their first birthday in SDC. Infant mortality was higher among male infants (93 deaths) than female infants (66 deaths). African American/black infants had the highest mortality rate (10.7 infant deaths per 1,000 live births) when compared to infants of all other races and ethnicities. Hispanic infants had the second highest mortality rate of 4.5 deaths per 1,000 live births. In addition, there were 3,628 preterm births (less than 37 weeks gestation) in SDC during 2016. Compared to all other races and ethnicities, Hispanic mothers had the highest total number of births (16,978), 8.2 percent of which were preterm. Despite having fewer total births than Hispanic mothers (1,781), 11.6 percent of births by African American/black mothers were preterm. Similarly, although women ages 25 to 39 had the highest total number of births compared to other age groups, mothers age 40 and above were more likely to give birth preterm compared to younger age groups (45.8 percent preterm births among mothers age 40 and above compared to 15.4 percent preterm births among mothers ages 25 to 39).1 In 2016, all SDC regions met the HP2020 national targets for prenatal care, preterm births, low birth weight (LBW) infants, very low birth weight (VLBW) infants and infant mortality. See Table 43 for a summary of maternal and infant health indicators in SDC in 2016 and Table 44 for a summary of maternal and infant health indicators by region. Table 43: Maternal and Infant Health Indicators in SDC, 2016 Early Prenatal Care: Current Rate - 84.2% HP2020 Target - 77.9% Preterm Births: Current Rate - 8.5”

“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 address these health issues are provided through SMH. The community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. For additional details on SMBHWN programs that specifically address the needs identified in the 2016 CHNA, please refer to SMH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through further analysis of SMBHWN's community programs and consultation with its service line leaders and executives, this section also addresses the following priority health needs for community members served by SMBHWN: * Reducing the incidence of neonatal morbidity and mortality associated with high-risk pregnancy and preterm delivery * Meeting the needs of new mothers and their families * Health professions education and training, and collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2018 Report of Activities conducted in support of the objective(s), and FY 2019 Plan. Identified Community Need: Reducing the Incidence of Neonatal Morbidity and Mortality Associated With High-Risk Pregnancy and Preterm Delivery 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 high-risk pregnancy as one of seven priority health issues for community members served by SMBHWN. * The HASD&IC 2016 CHNA process continued to identify high-risk pregnancy among priority health conditions observed in San Diego hospitals. * As part of the SMH 2016 CHNA, discussions with Sharp social workers identified the following health-related issues or needs for high-risk pregnant women: anxiety; childcare; depression; diabetes (gestational and brittle); the emotional impact of hospitalization on both the patient and their family; high blood pressure; isolation for non-English speakers; pre-term labor requiring bed rest or hospital stay; and stress, helplessness and lack of control over one's body. * According to research presented in the SMH 2016 CHNA, risk factors for high-risk pregnancy include: advanced maternal age (ages 35 years and older) lifestyle choices such as smoking, alcohol consumption or the use of illegal drugs; medical history including prior high-risk pregnancies or deliveries, fetal genetic conditions or family history of genetic conditions; underlying conditions such as diabetes, high blood pressure, obesity and epilepsy; and multiple pregnancies. * A 2017 report from the Children's Initiative titled San Diego County Report Card on Children and Families identified the following barriers to utilization of prenatal care: financial barriers, such as a lack of health insurance; the context of care, such as biased treatment from providers or a lack of cultural competence; and issues surrounding access to care, such as transportation, difficulty obtaining an appointment or inconvenient hours. Personal attitudes and behaviors may also be barriers to obtaining prenatal care. * Proven strategies to increase the use of prenatal care include: affordable health coverage; expedited health coverage for uninsured pregnant women; insurance coverage that includes health education and risk counseling; outreach and assistance with enrolling in health coverage and accessing affordable prenatal services; use of safety net health providers;”

“The hospital offered a free, monthly Preterm Birth Prevention class, which taught approximately 200 expecting parents about the warning signs of preterm labor and how to help prevent a premature birth. Through Sharp's health and wellness partnership with the City of San Diego, SMBHWN's perinatal educator led a session of the Preterm Birth Prevention class at the Mira Mesa Branch Library in May and at the Carmel Mountain Ranch/Sabre Springs Recreation Center in September, reaching approximately 15 members of the community. Additional prenatal education was offered throughout the year on the Sharp Metropolitan Medical Campus (SMMC) as well as at the new Sharp Mary Birch Education Center in Carlsbad. Class topics included, but were not limited to: how the body prepares for birth and delivery; sibling preparation; hospital procedures; medication choices; caesarean delivery; labor comfort and relaxation skills; basic infant care; breastfeeding; preparing for multiple births; and prenatal fitness and yoga. SMBHWN continued to support Miracle Babies, a volunteer-driven nonprofit organization that provides support and financial assistance to families with critically ill newborns in the neonatal intensive care unit (NICU) as well as education, prevention and medical care to enhance the well-being of women, children and families. In FY 2018, SMBHWN raised approximately $6,200 for the organization through participation in the annual Miracle Babies 5K Walk. SMBHWN also provided financial support to March of Dimes, a nonprofit organization dedicated to preventing birth defects, premature birth and infant mortality through community and global outreach programs and research. SMBHWN provided fundraising support for the AHA 2018 San Diego Heart & Stroke Walk, while hospital leadership helped organize the annual AHA Go Red for Women Luncheon to support greater research and action to address women's heart health. In April, SMBHWN team members provided information about the hospital's community programs and services at the annual Sharp Women's Health Conference. In 2013, the Sharp Mary Birch NRI was launched to discover new, leading-edge treatments and practices in newborn care, and disseminate its research findings to improve outcomes for at-risk newborns throughout the world. Led by a multidisciplinary team of physicians, nurses, respiratory therapists, researchers and data analysts, the NRI has completed more than 30 clinical trials with over 1,800 newborns participating. This included a study demonstrating that delayed umbilical cord clamping provides babies with additional health benefits, which contributed to a recommendation by The American Congress of Obstetricians and Gynecologists to standardize the practice. The NRI values the community's perspective in shaping the future of care provided in the NICU. Through its Parent Advisory Board, parents and grandparents of infants who have been in the NICU offer the NRI their unique point of view as parents of a NICU baby, including feedback on proposed and current clinical trials to help ensure that other parents understand and feel comfortable participating in them. The NRI shares its expertise and groundbreaking research developments throughout the greater health care and research communities. In April 2018, the NRI spoke at the XVIII Update of Neonatology event in Florence, Italy, regarding umbilical cord management for newborns who may need additional support at birth. The NRI continued to offer a Bedside Ultrasound Training for Neonatologists course - a multi-week training that consists of hands-on, one-on-one training sessions and expert lectures on theoretical and practical ultrasound technique for neonatologists. Open to local, regional, national and international neonatologists, the course is one of only a few similar training programs in the country. The NRI's medical discoveries have been featured on multiple news networks, including ABC, CBS, CNN, KNSD, KPBS, KSWB, and more, while”

“* The same report indicates that in-hospital lactation support is crucial to mothers' breastfeeding success in the hospital and following discharge. 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, 2016). * According to 2015 breastfeeding data presented in the CDC's 2018 Breastfeeding Report Card, 66.7 percent of mothers in California were breastfeeding at six months, while only 26.3 percent were exclusively breastfeeding at six months (CDC, 2018). * While most women plan to breastfeed, only half of working mothers in California receive the support they need in the workplace to continue doing so. Mothers with workplace support for breastfeeding are twice as likely to be exclusively breastfeeding at three months postpartum. Lower income mothers are less likely to have workplace support for breastfeeding compared to mothers with higher incomes (CDPH, 2018). * According to a 2017 report from the California Task Force on the Status of Maternal Mental Health Care, about one in five new or expectant mothers will experience a mental health disorder during pregnancy or the first year of childbirth. Up to 50 percent of low-income mothers may be affected. * Findings from the CDPH's 2018 Maternal and Infant Health Assessment indicated that in 2015, 20.5 percent of California mothers experienced depressive symptoms during pregnancy or postpartum. Black and Latina women, women with low socioeconomic status, and Medi-Cal insured women are all at higher risk for depressive symptoms during pregnancy and the postpartum period (California Task Force on the Status of Maternal Mental Health Care, 2018). * Maternal depression is the most common pregnancy complication, occurring more frequently than gestational diabetes and preeclampsia combined. Untreated maternal mental health disorders have serious consequences, including adverse birth outcomes, impaired bonding between mother and infant, childhood behavioral problems, and increased stress on families (California Task Force on Status of Maternal Mental Health Care, 2017). * Screening for maternal mental health disorders is currently not routine, and treatment for identified cases occurs less than 15 percent of the time. Untreated maternal depression costs California an estimated $2.25 billion each year in lost income and productivity and negative health outcomes for children (California Task Force on Status of Maternal Mental Health Care, 2017). * The American Psychological Association (APA) identifies several risk factors for developing postpartum depression, including: a change in hormone levels after birth; prior experience with or family history of depression, anxiety or mental illness; stress related to caring for a newborn; having a baby who is difficult to comfort, or who has challenging sleep and hunger needs; having a baby with special needs; first-time, very young or older motherhood; emotional stressors such as the death of a loved one or family problems; financial or employment problems; and isolation or lack of social support (APA, 2016). * The "fourth trimester" refers to the transition period after childbirth when infants are adjusting to life outside the womb and mothers are adjusting to new parenthood. This critical period is marked by significant biological, psychological, and social changes, which are currently insufficiently supported. Issues may overlap and include maternal mood and emotional well-being; infant care and feeding; sexuality, contraception and birth spacing; sleep and fatigue; physical recovery from childbirth; and medications, substances and exposures. By addressing these needs, service providers can improve health across two generations. * A 2018 committee opinion paper from the American College of Obstetricians and Gynecologists titled Optimizing Postpartum Care recommends that physicians trea”

“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, and mom and baby yoga and Pilates. Additionally, SMBHWN staff devoted nearly 550 hours to daily Family Home Care classes that provided critical information and support to approximately 4,200 new mothers and family members. Topics included car seat safety, sudden infant death syndrome, shaken baby syndrome, breastfeeding, jaundice, and signs and symptoms of illness among mothers and babies. Free NICU cardiopulmonary resuscitation education was also provided to approximately 700 family and friends of the hospital's NICU babies. Scientific evidence shows that exclusive breastmilk feeding provides the healthiest start for a newborn's life, especially very premature babies. However, exclusive breastfeeding is not possible for mothers who experience challenges with breastmilk supply and feeding. Pasteurized donor human milk can make breastfeeding possible for these mothers. For more than 13 years, SMBHWN has been a donor breastmilk depot, regularly shipping donated breastmilk to the Mother's Milk Bank in San Jose, CA, where it is screened, pasteurized and distributed to community hospitals for infants whose mothers have an insufficient breastmilk supply. In 2015, SMBHWN started SDC's first Donor Breastmilk Drive to help increase the supply of breastmilk for the Mother's Milk Bank. During the FY 2018 milk drive, 30 community members donated 67 gallons of breastmilk, which is expected to provide nearly 35,000 feedings to premature infants and others with specialized health needs. To date, the annual drive has collected approximately 290 gallons of breastmilk from more than 150 donors. SMBHWN expands its support for community mothers and families through the New Beginnings Boutique & Gift Shop. Located within the hospital, the boutique provides easy access to needed supplies, such as nursing bras and breastfeeding pumps. The boutique's lactation educators are available to answer questions and provide breastfeeding resources and support to anyone who calls or visits the shop. In FY 2018, the New Beginnings Boutique & Gift Shop donated $975 in breast pump supplies to support nursing mothers at San Diego Family Care's Linda Vista Women's Clinic. In October, SMBHWN hosted its annual NICU Little Graduate Reunion at the Naval Training Center in Liberty Station. For the past 22 years, the hospital has hosted this special event for families to reunite with the team members who cared for their child during their stay in the NICU, 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. In FY 2018, more than 600 parents, grandparents, siblings and NICU graduates attended the reunion where they enjoyed food, games and activities while reuniting with SMBHWN team members. In summer 2015, SMBHWN launched a program to evaluate eligibility for Supplemental Security Income (SSI) for newborns who have been diagnosed with a disabling medical condition or extremely LBW. This benefit is offered to both unfunded patients as well as insured families to assist with the cost of care for their newborn within and outside of the hospital. Since the inception of the program, Public Resource Specialists have assisted nearly 250 families through the SSI application process. FY 2019 Plan SMBHWN will do the following: * Continue to implement evidence-based breastfeeding practices as a Baby-Friendly USA designated hospital * Continue to offer free postpartum, breastfeeding and new-parent support groups to new mothers and their families * Continue to offer a variety of educational classes for new mothers and their families * Continue to evaluate eligibility of high-risk newborns for SSI benefits and provide referrals for application assistance Identified Community Nee”

“* The U.S. Department of Health and Human Services Bureau of Health Workforce (BHW) projects that California will face a shortage of 44,500 full-time nurses by 2030 if current levels of health care are maintained ? the most severe shortage among all states (BHW, 2017). * The California Health Care Almanac reported that in 2015, 44 percent of the employed RN workforce was over the age of 50. As this age group approaches retirement, it will be critical to train younger RNs to handle the turnover (CHCF, 2017). * The BLS projects employment of more than 400,000 RNs in California in 2026, which would be an increase of 15 percent from 2016. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2018). * According to forecasts performed by the Healthforce Center at the University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12 to 17 percent by 2030. These forecasts predict that the southern border region will experience some of the highest levels of clinician shortages in the state. UCSF recommends a comprehensive and holistic targeted strategy to enhance the education pipeline, improve recruitment and retention, maximize the existing workforce, and leverage workforce data (UCSF, 2017-2018). * An increased demand for a diverse and culturally and linguistically competent workforce is projected for the health care industry. Therefore, it is important for the industry to start creating a workforce pipeline in collaboration with high schools and postsecondary educational sectors, as well as policy makers, educators, health care leaders and the local community. Long-term investment in creating mentorship, on-the-job shadowing, volunteer and internship opportunities for high school students will help prepare them for college and a career, build a strong and diverse health care workforce, and prevent future industry workforce shortages (Employer-Defined Value: Improving the Connection Between Health Care Employers and Schools to Increase Work-Based Learning Opportunities for High School Students, California Hospital Association, 2015). Objectives * Collaborate with local schools, colleges and universities to provide opportunities for students to explore and train for a variety of health care professions * 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 2018 Report of Activities In FY 2018, SMBHWN served as a training site for more than 170 nursing students as well as seven ancillary students who spent more than 19,500 hours on the SMBHWN campus. Academic institution partners included Concorde Career College, Grand Canyon University, Grossmont College, Keck Graduate Institute, MiraCosta College, Point Loma Nazarene University, San Diego State University (SDSU), Touro University, University of San Diego, University of San Francisco, University of Victoria and the U.S. Department of Veterans Affairs Dietetic Internship Program. In addition, in March, hospital leadership presented on health care administration to 25 graduate students at SDSU. In FY 2018, SMBHWN completed its 12th 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 the school year, 25 HSHMC students devoted 4,320 hours to rotations with maternal infant services, the post-anesthesia care unit, the NICU and the transport team. In September, SMBHWN collaborated with SMH to provide the Nursing Career and Professional Development Expo to support the professional development of stu”

“NOTES: Note 1 - 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. Note 2 - Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Note 3 - 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. Key highlights: * Medical Care Services included uncompensated care for patients who are unable to pay for services and unreimbursed costs of public programs, such as Medi-Cal, Medicare and CHAMPVA/TRICARE. In FY 2018, 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, 2017, through June 30, 2019. This resulted in recognition of net supplemental revenues for SMH totaling $15.0 million in FY 2018. This reimbursement helped offset prior years' unreimbursed medical care services; however, the additional funds recorded in FY 2018 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; flu vaccinations and specialized education and information for seniors offered by the SMH Senior Resource Center and Sharp Senior Health Centers; Project HELP; contribution of time to Stand Down for Homeless Veterans, Ssubi is Hope, Habitat for Humanity, Mama's Kitchen, Feeding San Diego 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 education and resources on a variety of health topics; participation in community health fairs and events; support groups; health screenings for diabetes, stroke, osteoporosis, blood pressure, mental health, body composition, hearing, hand health, musculoskeletal health; and community education and resources provided by the Laurel Amtower Cancer Institute at SMH patient navigator program. In addition, SMH donated meeting room space to community groups as well as collaborated with local schools to promote student interest in health care careers. SMH staff actively participated in community boards, committees and other civic organizations, including the Health Sciences High and Middle College (HSHMC) Board, American College of Healthcare Executives, San Diego Organization of Healthcare Leaders, Association of California Nurse Leaders, Emergency Nurses Association - San Diego Chapter, Association for Clinical Pastoral Education, San Diego County Stroke Consortium, Adult Protective Services, Serving Seniors, Community Center for the Blind and Visually Impaired, 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 HealthCare's (Sharp's) involvement in community organizations in FY 2018. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training of health care professionals, studen”

“According to the California Health Interview Survey (CHIS), 25.8 percent of SDC's population was covered by Medi-Cal. See Table 48 for details. Table 48: Medi-Cal (Medicaid) Coverage in SDC, 2016-2017 Covered by Medi-Cal - 25.8% Not covered by Medi-Cal - 74.2% Source: 2016-2017 CHIS CHIS data also revealed that 11.7 percent of individuals in SDC did not have a usual place to go when sick or in need of health advice (see Table 49).1 Table 49: Regular Source of Medical Care in SDC, 2016-2017 Has a usual source of care: Current Rate - 88.3% HP2020 Target - 100% Has no usual source of care: Current Rate - 11.7% 100% Source: 2016-2017 CHIS Cancer and diseases of the heart were the top two leading causes of death in SDC in 2016. See Table 50 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by SMH, please refer to the SMH 2016 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm. Table 50: Leading Causes of Death in SDC, 2016 Malignant Neoplasms (Overall Cancer): Number of Deaths - 5,096 Percent of Total Deaths - 24.1% Diseases of the Heart: Number of Deaths - 4,808 Percent of Total Deaths - 22.7% Alzheimer's Disease: Number of Deaths - 1,403 Percent of Total Deaths - 6.6% Cerebrovascular Diseases Number of Deaths - 1,363 Percent of Total Deaths - 6.4% Accidents/Unintentional Injuries Number of Deaths - 1,071 Percent of Total Deaths - 5.1% Chronic Lower Respiratory Diseases Number of Deaths - 1,027 Percent of Total Deaths - 4.8% Diabetes Mellitus Number of Deaths - 734 Percent of Total Deaths - 3.5% Chronic Liver Disease and Cirrhosis Number of Deaths - 412 Percent of Total Deaths - 1.9% Intentional Self-Harm (Suicide) Number of Deaths - 407 Percent of Total Deaths - 1.9% Essential Hypertension and Hypertensive Renal Disease Number of Deaths - 400 Percent of Total Deaths - 1.9% All Other Causes Number of Deaths - 4,463 Percent of Total Deaths - 21.1% Total Deaths Number of Deaths - 21,184 Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Community Health Statistics Unit, 2018 Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SMH: * Incorporates community priorities and community relations into its strategic plan and develops service-line-specific goals * Estimates an annual budget for community programs and services, based on community needs, previous years' experience and current funding levels * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMH 2016 CHNA 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 strategy - a description of SMH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation strategy 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 foll”

“* The Centers for Disease Control and Prevention (CDC) identify diabetes as the seventh leading cause of death in the U.S., as well as the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults. The number of adults diagnosed with diabetes in the U.S. has more than tripled in the last 20 years (CDC, 2017). * According to SMH diabetes discharge data, among SDC patients with a primary diagnosis of a diabetes-related ICD-10 code in 2017, 'Type 2 Diabetes Mellitus Without Complications' was the top inpatient primary diagnosis related to Type 2 diabetes for individuals ages 15 to 24. Among individuals ages 25 to 44, the top inpatient primary diagnosis was 'Type 2 Diabetes Mellitus With Hyperglycemia,' and among those ages 45 and older, the top inpatient primary diagnosis was 'Type 2 Diabetes With Diabetic Chronic Kidney Disease'. * In 2016, diabetes was the seventh leading cause of death in SDC. * In 2016, there were 734 deaths due to diabetes in SDC overall, a 3.7 percent increase when compared to 2015 (708 deaths). The age-adjusted death rate due to diabetes was 20.7 per 100,000 population. * In 2016, there were 4,132 hospitalizations due to diabetes in SDC. The age-adjusted rate of hospitalization was 120.9 per 100,000 population in 2016, which was slightly lower than the age-adjusted rate in 2015 (123.1 per 100,000 population). * In 2016, there were 5,168 diabetes-related ED discharges in SDC, an 8 percent increase from 2015 (4,783 ED discharges). The age-adjusted rate of diabetes-related ED discharges was 151.9 per 100,000 population in 2016, which was higher than the age-adjusted rate in 2015 (143.5 per 100,000 population). * According to 2016-2017 CHIS data, 8.6 percent of adults living in SDC indicated that they had ever been diagnosed with diabetes, which was lower than the state of California (9.9 percent). Diabetes rates among seniors were particularly high, with 18.8 percent of SDC adults over 65 reporting that they had ever been diagnosed with diabetes. * According to 2016-2017 CHIS data, 12.3 percent of SDC residents had been told by their doctor that they have pre- or borderline diabetes. * According to the CDC's 2017 National Diabetes Statistics Report, 87.5 percent of adults diagnosed with diabetes were overweight or obese. To prevent or delay the onset of diabetes, the CDC recommends lifestyle changes such as losing weight, eating healthier, and getting regular physical activity. * The CDC estimates that 30.3 million people in the U.S. have diabetes. Of those individuals, 1 in 4 is not aware they have the disease (CDC National Diabetes Statistics Report, 2017). * A study by the University of California, Los Angeles (UCLA) Center for Health Policy Research found that 13 million adults in California (46 percent) are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million (9 percent) have already been diagnosed with diabetes (UCLA Center for Health Policy Research, 2016). * The CDC-approved Diabetes Prevention Program (DPP) is an evidence-based, cost-effective intervention to help people decrease their risk of developing diabetes by making healthy lifestyle changes. According to the California Department of Public Health (CDPH), in 2018, California mandated the DPP be covered under Medi-Cal for all beneficiaries who have prediabetes or a high risk of developing Type 2 diabetes. By funding the DPP, California will help create partnerships between community-based organizations, private insurers, health care providers, employers, academia and government agencies with the goal to reduce the incidence of prediabetes and Type 2 diabetes statewide (CDPH, 2018). Objectives * Provide diabetes education and screening in SDC * Collaborate with community organizations and projects to provide diabetes education to SDC's vulnerable populations * Participate in local and national professional conferences to share best practices in diabetes treatment and”

“The Sharp Diabetes Education Program is an affiliate of the California Diabetes and Pregnancy Program's Sweet Success Program, which provides comprehensive technical support and education to medical personnel and community liaisons to promote improved outcomes for high-risk pregnant women with diabetes. As an affiliate, the Sharp Diabetes Education Program teaches underserved pregnant women and breastfeeding mothers with Type 1, Type 2 or gestational diabetes (diabetes developed during pregnancy) how to manage their blood sugar levels. In collaboration with community clinics, in FY 2018, the team provided these patients with a variety of education and resources to support a healthy pregnancy while diabetic. Topics covered gestational diabetes statistics; new diagnostic criteria; treatment and management of blood glucose levels; goals for blood sugar levels before and after a meal; insulin requirements; self-care practices; nutrition and meal planning; exercise and weight management; monitoring fetal movement; and the risks and complications of uncontrolled diabetes. Clinic patients also received logbooks to track and manage their blood sugar levels. In addition, the Sharp Diabetes Education Program evaluated patients' management of their blood sugar levels and collaborated with community clinics' obstetrician-gynecologists to prevent complications. At SMH, the Sharp Diabetes Education Program provided services and education to nearly 380 underserved pregnant women with diabetes. Throughout the year, the Sharp Diabetes Education Program continued to provide services and resources to meet the needs of culturally diverse populations within SDC. Educational resources included How to Live Healthy With Diabetes; What You Need to Know About Diabetes; All About Blood Glucose for People With Type 2 Diabetes; All About Carbohydrate Counting; Getting the Very Best Care for Your Diabetes; All About Insulin Resistance; All About Physical Activity With Diabetes; Gestational Diabetes Mellitus Seven-Day Menu Plan; and Food Groups. Resources were provided in Arabic, Somali, Tagalog, Vietnamese and Spanish, and food diaries and logbooks were distributed for community members to track blood sugar levels. In addition, live interpreter services were available in more than 200 languages via the Stratus Video Interpreting iPad application. Further, Sharp team members themselves received education regarding the different cultural needs of diverse communities. In FY 2018, the Sharp Diabetes Education Program supported the professional health care community through participation in various conferences and meetings. At the Liberty Station Conference Center in May, the Sharp Diabetes Education Program presented to more than 150 health professionals during Sharp's Obesity Crisis Conference titled Practical Approaches to the Care of the Obese Patient. The team's presentation covered insulin use in the obese patient, including the origin and purpose of insulin, the effects of different kinds of insulin, the significance of accurate timing of insulin administration, and treatment options. In June, the Sharp Diabetes Education Program attended the ADA's 78th Scientific Sessions conference in Orlando, Florida. The conference theme was Diabetes Breakthroughs Happen Here, which taught more than 14,000 international attendees about the most significant advances in diabetes care and research. Also in June, the Sharp Diabetes Education Program provided a poster presentation to approximately 75 attendees at Sharp's fourth annual Interprofessional Research & Innovation Conference. The presentation, titled Designing and Implementing a Competency-Based Skills Fair to Improve Home Health Nurses' Knowledge, highlighted a project aimed at improving patient care and diabetes knowledge among nurses. In addition, in August the Sharp Diabetes Education Program presented on The Diabetes Injectable Pen Laboratory - A Novel Approach to Improve Home Health Nurses' Diabetes Knowle”

“* In 2016, there were 2,371 stroke-related ED visits in SDC. The age-adjusted rate of ED visits was 68.9 per 100,000 population. * According to 2016-2017 CHIS data, an estimated 23.9 percent of adults in SDC were obese, 9.7 percent smoked cigarettes and 62.0 percent did not regularly walk for transportation, fun, or exercise. In 2016, 16.3 percent of adults in SDC reported eating fast food four or more times in the past week. * 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). * The CDC estimates that up to 80 percent of strokes are preventable through the recognition of early signs/symptoms and the elimination of stroke risk factors. * According to the CDC, healthy lifestyle choices can help prevent stroke. Behaviors that can mitigate the risk of stroke include choosing a healthy diet full of fruits and vegetables, maintaining a healthy weight, engaging in at least 2.5 hours of moderate-intensity aerobic physical activity each week, refraining from or quitting smoking, and limiting alcohol intake (CDC, 2018). Objective * Provide stroke education, support and screening services for the central region of SDC FY 2018 Report of Activities SMH is certified by the Joint Commission as an Advanced Primary Stroke Center (recertified in 2017). The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SMH is also a recipient of the American Heart Association (AHA)/American Stroke Association's (ASA) Get With The Guidelines (GWTG) - Stroke Gold Plus Quality Achievement Award for excellence in stroke care as well as the Target: Stroke Elite Honor Roll designation. The AHA/ASA's GWTG is a national effort focused on ensuring the use of evidence-based therapies to improve outcomes for stroke patients. The AHA/ASA's Target: Stroke Elite Honor Roll designation focuses on improving the timeliness of intravenous tissue plasminogen activator (IV t-PA) administration to eligible patients. In April, Sharp's systemwide stroke program participated in Strike Out Stroke Night at the Padres, held at Petco Park. This annual event is organized by the San Diego County Stroke Consortium, the HHSA, the San Diego Padres and other key partners to promote stroke awareness and celebrate stroke survivors. During the baseball game, Sharp offered stroke and blood pressure screenings, education about the warning signs of stroke and how to respond using FAST (Face, Arms, Speech, Time) - an easy way to detect and enhance responsiveness to a stroke. Free giveaways were provided throughout the evening, while stroke education was displayed on the JumboTron to the entire stadium of more than 34,600 community members. In FY 2018, SMH participated in Sharp's partnership with the City of San Diego to provide stroke education and resources to employees and residents in the city's nine districts. In May, July and August, three classes led by a stroke program nurse provided more than 20 community members with education on preventing and recognizing the signs of a stroke, emergency treatment options, and minimizing risk. The latter topic focused on education for maintaining a healthy weight, abstaining from or limiting drinking and smoking, and taking medications as directed. The lectures were held at various locations throughout San Diego, including North University Community Branch Library, Oak Park Branch Library and City Heights Recreation Center. In addition, in October, SMH provided approximately 60 community members with stroke education, including the warning signs and symptoms and what to do in the event of a stroke, at a senior health and resource fair at Point Loma Presbyterian Church. Attendees were also screened according to their personal risk factors. The SMH Rehabilitation Center continued to provide meeting space for Young Enthusias”

“* In 2016, hospitalization rates among seniors were higher than the general population due to CHD, stroke, COPD, nonfatal unintentional injuries (including falls), overall cancer and arthritis. * The top three causes of ED utilization among SDC residents ages 65 and older in 2016 were unintentional injuries, falls and arthritis/other rheumatic conditions. * Seniors in SDC use the 911 system at higher rates than any other age group. The most common complaints include general medical, altered neurological state, respiratory distress, cardiac chest pain and trauma to the extremities (HHSA, 2015). * According to the CDC, 2.8 million older adults, or more than one in four, 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, and with each fall, the chance of falling again doubles. These injuries may result in serious mobility issues and difficulty with everyday tasks or living independently. The direct medical costs for fall injuries are estimated at $31 billion annually (CDC, 2018). * In 2013, an estimated 62,000 San Diegans ages 55 and older were living with Alzheimer's disease and other dementias (ADOD), which accounted for 8.3 percent of this age group. Assuming current trends continue, by 2030, nearly 94,000 residents 55 years and older will be living with ADOD, which is a 51 percent increase from 2013 (Alzheimer's Disease and Other Dementias in San Diego County, HHSA, 2016). * In 2016, an estimated 71.4 percent of SDC residents ages 65 and older reported that they were vaccinated for influenza in the past 12 months (CHIS, 2016). In 2016, 26 of the 46 recorded influenza deaths in SDC occurred among residents ages 65 and older. The age-adjusted rate of influenza death among this group was 6.0 per 100,000 (HHSA, 2016). * Research shows that caregiving can have serious physical and mental health consequences. According to findings from the Stress in America survey described in a report titled Valuing the Invaluable, 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, updated July 2015). * According to AARP, more than 40 million people in the U.S. act as unpaid caregivers to people ages 65 and older. More than 10 million of these caregivers are Millennials with separate full- or part-time jobs, and one in three employed Millennial caregivers earns less than $30,000 per year (AARP, 2018). * According to a report from the National Alliance for Caregiving (NAC) and AARP titled Caregiving in the U.S. 2015, 60 percent of unpaid caregivers are female, and nearly 1 in 10 caregivers are ages 75 or older (AARP and NAC, 2015). * The UCLA Center for Health Policy Research conducted a study highlighting the plight of California's "hidden poor," finding 772,000 seniors who live in the gap between the FPL and the Elder Economic Security Standard. The highest proportion of seniors living in this gap includes renters, Latinos, women and grandparents raising grandchildren (Padilla-Frausto & Wallace, 2015). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * In collaboration with community partners, offer seasonal flu vaccinations for seniors and other high-risk populations * Provide education and community resources to family caregivers * Maintain and grow partnerships with community organizations to expand community outreach and provide seniors and caregivers with updated information on available services and resources FY 2018 Report of Activities Sharp Senior Resource Centers meet the unique needs of seniors and their caregivers by connecting them to a variety of free and low-cost programs and services through phone and in-person consultations. The Sharp Senior Resource Center”

“In April, the SMH Senior Resource Center collaborated with Sharp HospiceCare to host a Healthy Aging Conference at Point Loma Community Presbyterian Church. The conference educated more than 80 community members on how to plan for a healthy, safe and mindful future, as well as provided valuable resources to help manage and promote healthy aging. In June, the SMH Senior Resource Center served approximately 700 community members at the County of San Diego Aging and Independence Services (AIS) Aging Summit 2018 conference held at Town and Country San Diego. Presentation topics included health and community support, housing, social participation, transportation and dementia, as well as offered resource exhibitors, including information from the SMH Senior Resource Center on Vials of Life, health screening events and programs for seniors and caregivers. In August, the SMH Senior Resource Center offered health, wellness and community resources to nearly 90 community members at the San Diego Community Action Network (SanDi-CAN) and South County Community Action Network's Interactive Technology and Health Fair at the George L. Stevens Senior Center. The event featured presentations, an interactive resource fair, health screenings and technology. Also in August, the SMH Senior Resource Center and Sharp Senior Health Centers provided senior resources to nearly 70 community members at the Annual Aging Conference: Healthy & Safe Aging, hosted by SCVMC and Sharp HospiceCare, which was held at Fredericka Manor in Chula Vista. In October, the SMH Senior Resource Center participated in SanDi-CAN's End of Life Decisions: Crucial Conversations Navigating Your Way conference at Balboa Park. More than 30 seniors and their family members attended the free conference and resource fair where they learned how to identify their end-of-life values and goals of care and acquire the communication skills necessary to make informed health care decisions. The SMH Senior Resource Center and Sharp Senior Health Centers continued to provide seasonal flu vaccines for seniors, caregivers and high-risk adults with limited access to care in a variety of community settings through activity calendars, collaborative outreach conducted by the flu clinic site, paper and electronic newspaper notices, and Sharp.com. In FY 2018, the SMH Senior Resource Center and the Sharp Senior Health Centers sponsored five community seasonal flu clinics, serving nearly 250 seniors and other vulnerable community members with chronic illness. Flu clinics were held at the Senior Health Fair at Point Loma Community Presbyterian Church, Orchard Apartments low-income senior housing, Holy Trinity Catholic Church (homeless outreach), and Serving Seniors sites, including the Potiker Family Senior Residence and the Gary and Mary West Senior Wellness Center. At many of these sites, the SMH Senior Resource Center also provided activity calendars detailing upcoming blood pressure screenings, flu clinics and other community events and programs for seniors as well as offered Vials of Life. In addition, the Sharp Senior Health Centers provided education on advance directives and depression to flu clinic attendees. In response to the hepatitis A outbreak in San Diego, the Sharp Senior Health Centers partnered with the County of San Diego Public Health Services to provide more than 170 vaccinations to vulnerable community members, including homeless individuals, throughout the year. Locations included the San Diego County Probation Department's Work Furlough Facility; Sharp Mesa Vista outpatient facilities; Mental Health Systems; Potiker Family Senior Residence; Legal Aid Society of San Diego; Catalyst, a program serving transitional age youth with mental illness who are either homeless or at risk of homelessness; and facilities that serve individuals with mental illness, including Broadway Home and Chipper's Chalet. Sharp Senior Health Centers are committed to connecting with underserved seniors in San”

“Sharp Senior Health Centers began providing food insecurity screenings as part of annual wellness visits and nutritious resources for those in need. Sharp Senior Health Centers collaborated with the Health Insurance Counseling and Advocacy Program (HICAP), which ensures ongoing networking among community professionals and quality programs for seniors. The collaboration included the provision of ongoing counseling and education by a HICAP representative to nearly 100 community members at the Sharp Senior Health Center Clairemont. HICAP staff offered objective counseling on Medicare rights, benefits and insurance policy options to address seniors' questions and concerns. Throughout the year, 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 Manor (senior housing), Jewish Family Service of San Diego (JFS), Caregiver Coalition of San Diego, AIS, Adult Protective Services, Southern Caregiver Resource Center, Alzheimer's San Diego, SanDi-CAN, SDCCOA, National Active and Retired Federal Employees Association, Community Center for the Blind and Visually Impaired, Cabrillo Credit Union Supervisory Committee and HICAP. New connections and active relationships have been established with Paradise Village, Peninsula Family YMCA, Point Loma/Hervey Library, San Diego Square, Clairemont Lutheran Church and St. Paul's PACE. In addition, the Sharp Senior Health Centers provided internships to eight nurse practitioner students from various universities including SDSU, University of San Diego (USD) and Azusa Pacific University (APU) in FY 2018. FY 2019 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 * Provide 2,500 Vials of Life to community seniors * Provide seasonal flu vaccinations at four sites to seniors and community members who face challenges in accessing care, specifically high-risk adults * Continue to provide hepatitis A education and vaccinations in partnership with the County, as well as provide hepatitis A information to flu clinic attendees * 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 * Continue to participate in Sharp's partnership with the City of San Diego to provide senior health education and resources to employees and residents in the city's nine districts * 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 Point Loma, SDC's north central and central regions, and downtown San Diego * Continue to participate in a monthly Sharp HealthCare Speaker Series at the Gary and Mary West Senior Wellness Center * Explore a collaboration with Serving Seniors and the dental clinic at the”

“* According to data from the 2016 National Study of Children's Health, nearly one-third of children in California are obese. California has one of the highest childhood obesity rates in Western states (The State of Obesity, 2018). * According to the CDC, some of the leading causes of preventable death include obesity-related conditions, such as heart disease, stroke, Type 2 diabetes and certain types of cancer. In 2016, 39.8 percent of Americans were obese (CDC, 2017). * In 2016, the number of arthritis-related hospitalizations in SDC totaled 9,698 - an age-adjusted rate of 273.25 per 100,000 population. * According to the National Institutes of Health (NIH), more than 53 million people in the U.S. either already have osteoporosis or are at high risk due to low bone mass. Along with the financial costs, osteoporosis can reduce quality of life for many people who suffer from fractures. It can also affect the lives of family members and friends who serve as caregivers. Preventable risk factors for osteoporosis include smoking, alcohol consumption, and medication and vitamin intake (NIH, 2016-2017). * Health literacy is a key health determinant: it is one's ability to find, understand and act upon health care information whether it is communicated verbally, in writing or through technology. A recent survey by the U.S. Department of Education found that over a third of U.S. adults have basic or below-basic health literacy, while only 12 percent of Americans are proficient in health literacy (University of Pittsburgh Medical Center, 2018). * Low health literacy is linked to poor health outcomes including higher hospitalization rates and lower preventive service utilization, both of which are associated with higher health care costs. Older adults, racial/ethnic minorities, people with less than a high school degree, those with low socioeconomic status, non-native English speakers, and individuals with compromised health status are at risk for low health literacy. It is the responsibility of public health professionals, the government and health care systems to work together to improve health literacy skills (U.S. Department of Health and Human Services (DHHS), Office of Disease Prevention and Health Promotion, 2005). 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 outreach at community events * Participate in community-sponsored events and support nonprofit health organizations FY 2018 Report of Activities Throughout the year, the OPP and various SMH departments offered a range of community health education classes and support groups. In FY 2018, classrooms were booked for nearly 1,000 hours and served thousands of patients and community members. Educational classes covered various aspects of health and wellness, including diabetes, cancer, integrative medicine topics (e.g., tai chi, qi gong, reflexology, stress management, food as medicine), suicide awareness and prevention, and parenting and childbirth. Support groups provided an outlet for community members to share their personal experiences and advice for coping with various challenges, including cancer, stroke, heart transplantation, heart failure, breastfeeding, postpartum mood disorders, and nutrition and support following bariatric surgery. At the Sharp Allison deRose Rehabilitation Center, Sharp Rehabilitation Services (Sharp Rehab) offered weekly rehabilitative tai chi and adaptive yoga classes for individuals with physical limitations. Sharp Rehab also hosted free support groups, including Women on Wheels (WOW), the Sharp Players and the Men's Spinal Cord Injury (SCI) support groups. Facilitated by two Sharp Rehab social workers, the WOW support group strives to empower women with mobility impairments. In FY 2018, approximately 70 group members gathered monthly to share their thoughts and feelings about t”

“Throughout the year, SMH provided health screenings, resources and support to hundreds of individuals at community-sponsored health fairs and events. SMH's emergency medical services team provided first-aid services at the Padres Pedal the Cause: Cycling Fundraiser for Cancer Research in November and the San Diego Crew Classic in March. At the Sharp Senior Health & Information Fair in October, Sharp Rehab occupational therapists provided screenings to detect medical conditions of the hands, wrists, elbows and fingers (e.g., carpal tunnel syndrome, arthritis, dislocations). Sharp Rehab also shared information about its adaptive sports and recreation programs and community support groups at the Challenged Athletes Foundation's 24th annual Aspen Medical Products San Diego Triathlon Challenge in October, the San Diego Brain Injury Foundation Walk for Recovery in March, and the San Diego Festival of the Arts in June. In addition, SMH provided coordination, support and related fundraising activities for the 2018 AHA Heart & Stroke Walk. SMH also supported Sharp-sponsored community events in FY 2018. In October and April, employee safety team members assisted with Sharp's Drug Take Back, Document Shredding and E-Waste Event, which provided a safe and confidential opportunity to dispose of prescription drugs, paperwork and electronics. In April, various hospital departments provided community members with a range of health education and screenings during the annual Sharp Women's Health Conference. This included screenings and assessments for body fat, sleep apnea, osteoporosis and musculoskeletal conditions; integrative therapies (including acupuncture and chair massage); education on posture, sports-related injury, and repetitive strains and sprains; osteoporosis education (including calcium and Vitamin D requirements and exercise for treatment and prevention); education on heart health, breast health and building lean muscle mass through exercise and nutrition; and breast self-exam demonstrations. FY 2019 Plan SMH will do the following: * Continue to offer educational classes to the community on a variety of health and wellness topics * Continue to provide support groups for community members on issues such as cancer, rehabilitation, stroke, heart transplantation and heart failure * Develop and distribute quarterly newsletters and calendars highlighting community health education and screening events * Continue to partner with local and national organizations to provide health literacy education and resources at a variety of community sites, and share health literacy best practices with industry professionals * Continue to increase awareness of the Cushman Wellness Center Community Health Library and its resources * Provide health education, screenings and first-aid services at community events * Provide coordination, support and fundraising activities for local nonprofit organizations Identified Community Need: Cancer Education and Patient Navigator Services 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 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. * 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 f”

“* According to findings from the ACS 2018 Cancer Facts & Figures report, screening offers the ability for secondary prevention by detecting cancer early. For example, the 39 percent decrease in the female breast cancer death rate between 1989 and 2015 is attributed to improvements in early detection, namely screening and increased awareness. In addition, over the past three decades, five-year relative survival rates for all cancers combined increased by 20 percent among whites and 24 percent among blacks, reflecting earlier diagnosis for some cancers as well as improvements in treatment (ACS, 2018). * Study findings from the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile indicate a critical need for culturally competent outreach, especially for Hispanic, Middle Eastern and African American women (Susan G. Komen, 2015). * A recent study by the ACS found that 42 percent of newly diagnosed cancer cases in the U.S. are potentially avoidable. Many of the known causes of the cancer - and other noncommunicable diseases - are attributable to behavioral factors including tobacco use and excess body weight due to poor dietary habits and lack of physical activity (ACS, 2018). * The American Society of Clinical Oncology (ASCO) emphasizes the importance of patient navigators as part of a multidisciplinary oncology team with the goal of reducing mortality among underserved patients. A patient navigator may assist with various tasks, including: psychosocial support; assistance with treatment decisions; assistance with insurance issues; arrangement of transportation; coordination of additional services (i.e., fertility preservation); and tracking of interventions and outcomes. The navigator works with the patient across the care continuum, ensuring coordination and efficiency of care, and removal of barriers to care (ASCO, 2016). * According to the NIH, clinical trials, a part of clinical research, are at the heart of all medical advances. Clinical trials look at new ways to prevent, detect or treat disease by determining the safety and efficacy of a new test or treatment. Greater clinical trial enrollment benefits medical research and increases the health of future generations as well as improves disease outcomes, quality of life and health of trial participants. Objectives * Provide cancer education and support to patients and community members * Provide cancer resources and education at community events * Provide cancer patient navigation and support services to the community FY 2018 Report of Activities Note: SMH is accredited by the National Accreditation Program for Breast Centers, indicating the highest standard of care for patients with diseases of the breast. Sharp (including SMH, SGH and Sharp Chula Vista Medical Center (SCVMC)) is also accredited by the American College of Surgeons Commission on Cancer as an Integrated Network Cancer Program, demonstrating its commitment to meet rigorous standards and improve the quality of care for patients with cancer. In FY 2018, the Laurel Amtower Cancer Institute at SMH reached hundreds of community members, patients and their loved ones through the provision of various support groups and educational classes, as well as through participation in community events. Free cancer support groups provided a safe environment for more than 380 attendees to discuss their experience with cancer and tools for coping. Monthly groups were offered for friends and family members of cancer patients; individuals living with a brain tumor or brain cancer and their family and caregivers; and young cancer patients (ages 20 through early 40s). Bimonthly groups were available for individuals living with breast cancer and those with advanced cancer. Additional emotional support was offered to those with cancer through free classes focused on healing through art, movement and relaxation exercises. This included the monthly Cancer and the Arts class, which served as an outlet to cope through crea”

“One in eight women will be diagnosed with breast cancer in her lifetime. During Breast Cancer Awareness month in October, SMH hosted a special community event titled One In Eight: An Inspirational Evening for Breast Awareness to educate community members about breast health and steps to take to lower their risk of breast cancer. The free event provided approximately 40 community members with the opportunity to work with a genetic counselor to calculate personal breast cancer risk; education on healthy lifestyle habits; nutritious snacks, mini massages, and exercise, Reiki and relaxation demonstrations; and information about participation in clinical trials for breast cancer. In FY 2018, the Laurel Amtower Cancer Institute supported the educational development of 50 community health professionals through participation in continuing education conferences, including A New Era of Defining Breast Cancer in June and Advances in Lung Cancer Screening and Treatment in September. The Laurel Amtower Cancer Institute includes the Breast Health Center and the Neuro-Oncology Center, with designated licensed clinical social workers (LCSWs), nurse patient navigators, genetic counselors and dietitians who support and guide cancer patients and their families from the time of diagnosis through the course of treatment. In FY 2018, the LCSWs provided free psychosocial counseling and support as well as referrals to community organizations for more than 900 patients and family members. Nurse navigators provided ongoing guidance for patients and families impacted by all cancer diagnoses, including breast, brain and spinal tumors, leukemia and lymphomas, melanoma, sarcoma, head and neck, lung, pancreas, bladder, colorectal, renal, prostate, and gynecological. This included the facilitation of appointment scheduling; explanation of procedures and test results; provision of educational resources and supportive services; assistance with financial resources; and referrals to multiple community agencies, including but not limited to: San Diego Homecare, Mama's Kitchen, Meals on Wheels San Diego County, JFS, Cancer Angels of San Diego, Nine Girls Ask, Support for People with Oral and Head and Neck Cancer, Informed Prostate Cancer Support Group, Pancreatic Cancer Action Network, Wigs by Patti Joyce, Hair Unlimited, Women's Health Boutique, My Brighter Side boutique, Free to Breathe, San Diego Brain Tumor Foundation, American Brain Tumor Association, Shades of Pink Foundation California, Head and Neck Cancer Alliance, Oral Cancer Foundation, Leukemia and Lymphoma Society, ACS, NCI, Breast Cancer Angels, and the Cancer Project. The Sharp Cancer Centers (SCVMC, SGH and SMH) conduct oncology clinical trials to support the discovery of new and improved treatments to help individuals overcome cancer and to enhance scientific knowledge for the larger health and research communities. In FY 2018, the Sharp Cancer Centers approached and evaluated 3,680 patients for participation in oncology clinical trials. As a result, 207 patients were enrolled in cancer research studies. In FY 2018, clinical trials focused on multiple types of cancer, including but not limited to brain, breast, colon, head and neck, lung, lymphoma, melanoma, ovarian and prostate. FY 2019 Plan The Laurel Amtower Cancer Institute at SMH will do the following: * Continue to provide classes on topics including nutrition, exercise, art and relaxation for patients and community members impacted by cancer * Provide one educational class on nutrition for prostate cancer * Provide monthly lymphedema classes for patients and community members * Provide monthly ACP classes for patients and community members * Provide a brain tumor workshop for patients and community members * Continue to provide support groups for community members, patients and their loved ones, including groups for breast cancer, brain tumors and brain cancer, advanced cancer, young cancer patients, and friends and family of cancer patient”

“* 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; physical environment both at home and in the community; access to health services and systems for injury-related care; and social environment, including individual social experiences (e.g., social norms, education and victimization history), social relationships (e.g., parental monitoring and supervision of youth, peer group associations and family interactions), community environment (e.g., cohesion in schools, neighborhoods and communities) and societal factors (e.g., cultural beliefs, attitudes, incentives and disincentives, laws and regulations). Objectives * Offer an injury and violence prevention program for children, adolescents and young adults throughout SDC * Offer talks and opportunities to Health and Science Pipeline Initiative (HASPI) high school students around injury and violence prevention and health care career readiness FY 2018 Report of Activities Sharp's ThinkFirst/Sharp on Survival program is a chapter of the ThinkFirst National Injury Prevention Foundation, a nonprofit organization dedicated to preventing brain, spinal cord, and other traumatic injuries through education, research and advocacy. With the partnership and financial support of the Health and Science Pipeline Initiative (HASPI), ThinkFirst/Sharp on Survival provided injury prevention education to students from schools throughout SDC. HASPI is a collaborative network of educators, community organizations and health care industry representatives all working together to increase health and medical career awareness, improve science proficiency in schools and prepare students for future health care careers. Through the partnership and financial support from HASPI, the ThinkFirst/Sharp on Survival program offered 95 students from Mar Vista High School and Castle Park High School a variety of services including classroom presentations, small assemblies and offsite learning expos. HASPI school-site programs consisted of one- to two-hour classes that covered topics such as the modes of injury, disability awareness, and the anatomy and physiology of the brain and spinal cord. These programs were enhanced by powerful personal testimonies from individuals with traumatic brain injury (TBI) or SCI, known as Voices for Injury Prevention (VIPs). In addition, 15 Castle Park High School HASPI students interested in pursuing careers in physical rehabilitation participated in a half-day, interactive tour of the SMH Rehabilitation Center. Students rotated through five stations that provided hands-on experiences in adapted dressing techniques, wheelchair mobility and various memory and problem-solving activities used in therapy. The experience allowed them to gain a better understanding of physical rehabilitation, as well as the challenges that patients face following a life-changing event. ThinkFirst/Sharp on Survival also presented on injury prevention, TBI, SCI and disability awareness to approximately 900 college students in SDSU's Disability in Society course. The class is open to a variety of majors, enabling ThinkFirst/Sharp on Survival to reach a broad audience of young adults. After the presentation, students had the opportunity to ask questions related to the challenges nonprofit organizations face when conducting public health education and outreach. FY 2019 Plan ThinkFirst/Sharp on Survival will do the following: * With grant funding, provide educational programming and presentations for local schools and organizations * With grant funding, increase community awareness of ThinkFirst/Sharp on Survival through attendance and participation at community events and health fairs * Continue to evolve program curricula to meet the needs of health career pathway classes as part of the HASPI partnership * Grow p”

“* As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Healthcare Atlas, 2017). * The U.S. DHHS Bureau of Health Workforce (BHW) projects that California will face a shortage of 44,500 full-time nurses by 2030 if current levels of health care are maintained - the most severe shortage among all states (BHW, 2017). * The California Health Care Almanac reported that in 2015, 44 percent of the employed RN workforce was over the age of 50. As this age group approaches retirement, it will be critical to train younger RNs to handle the turnover (California Health Care Foundation (CHCF), 2017). * The BLS projects employment of more than 400,000 RNs in California in 2026, which would be an increase of 15 percent from 2016. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2018). * According to forecasts performed by the Healthforce Center at the University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12 to 17 percent by 2030. These forecasts predict that the southern border region will experience some of the highest levels of clinician shortages in the state. UCSF recommends a comprehensive and holistic targeted strategy to enhance the education pipeline, improve recruitment and retention, maximize the existing workforce, and leverage workforce data (UCSF, 2017-2018). * An increased demand for a diverse and culturally and linguistically competent workforce is projected for the health care industry. Therefore, it is important for the industry to start creating a workforce pipeline in collaboration with high schools and postsecondary educational sectors, as well as policy makers, educators, health care leaders and the local community. Long-term investment in creating mentorship, on-the-job shadowing, volunteer and internship opportunities for high school students will help prepare them for college and a career, build a strong and diverse health care workforce, and prevent future industry workforce shortages (Employer-Defined Value: Improving the Connection Between Health Care Employers and Schools to Increase Work-Based Learning Opportunities for High School Students, California Hospital Association, 2015). 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 2018 Report of Activities SMH offered students and interns throughout SDC various placement and professional development opportunities. In FY 2018, nearly 400 nursing students and 275 ancillary students from a variety of colleges and universities spent more than 116,000 hours at SMH. Program partners included Alliant International University, Arcadia University, APU, Boston University, California College San Diego, Capella University, California State University (CSU) Fresno, CSU Long Beach, California State University San Marcos, Chapman University, Concorde Career College, Creighton University, EMSTA College, George Fox University, Grand Canyon University, Grossmont College, Grossmont Health Occupations, Institute of Ultrasound Diagnostics, Iowa State University, Keck Graduate Institute, LECOM, Loma Linda University, Metropolitan State University, MiraCosta College, Mount St. Mary's University, National University, Nova Southeastern University, Palomar College, Pima Medical Institute, Point Loma Nazarene University, San Diego Fire-Rescue Department, San Diego Mesa College, San Francisco State University, San Jose State University, SDSU, Sodexo Dietetic Internship Program, South University, Southwestern College (SWC), Touro University, University of California, San Diego Extension, University of Redlands,”

“SMH is a Planetree Person-Centered Hospital Designated with Distinction, representing the highest level of person-centered care. The Planetree philosophy upholds that care should be organized first and foremost around the needs of the patient. With this recognition, SMH provides hospital tours to share its experience in person-centered care upon request from various local, national and international hospitals, nonprofit organizations and universities. Guests may use lessons learned during the tours to improve service delivery and customer experience within their own organizations. In FY 2018, SMH provided approximately 12 tours during which guests observed various hospital units as well as the Cushman Wellness Center Community Health Library to learn about the hospital's unique programs and design properties that promote person-centered care, a healing environment, workforce efficiency and effective use of technology. SMH team members also shared their expertise in the Planetree philosophy of care at the annual Planetree International Conference on Patient-Centered Care in Baltimore, Maryland. Presentations from SMH team members focused on improving staff engagement through virtual staff meetings, harnessing staff voices in ongoing improvement, and how a culture of patient safety supports a culture of patient centeredness. FY 2019 Plan SMH will do the following: * Continue to provide professional development opportunities for health professions students and interns throughout SDC * Continue to collaborate with HSHMC to provide opportunities for high school students to explore careers in health care * Continue to offer CCT and MSC courses for community health professionals * Continue to provide education and hospital tours for the local, national and international health care community on the Planetree philosophy of care * Provide continuing education lectures to community physicians, residents, interns and Navy personnel at the SMH Hip Preservation Center Identified Community Need: Support During the Transition of Care Process for High-Risk, Underserved Patients With Complex Medical Needs Rationale references the findings of the SMH 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/Care Transitions Intervention staff identified the following strategies for improving the health of SDC's vulnerable, high-risk, or medically underserved patients: coaching; educating patients about their disease and the health care system; providing education tailored to specific cultural and linguistic groups; providing transportation, support, hope and love; and providing a personal health record with resources and information about their medications. * 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 d”

“SMH supported the homeless population through a variety of other programs and services in FY 2018. This included the provision of assessments for those at risk for psychiatric and developmental disorders and substance use issues, as well as referrals for housing, medication management and supportive community services as needed. In addition, in April, SMH joined the County of San Diego's Whole Person Wellness pilot program to help provide comprehensive care management for homeless Medi-Cal beneficiaries who experience high utilization of medical services. Further, each year the SMH Auxiliary provides approximately 200 new items of clothing to homeless individuals upon discharge, in addition to funding an initiative to provide clothing to any patient who lacks clothing when leaving the hospital. SMH assists high-risk, underserved patients with transportation home from the hospital as well as with connections to community resources for food, clothing and housing. The hospital may also provide uninsured patients with financial assistance for medication and medical equipment. In FY 2018, SMMC assisted economically disadvantaged individuals through the provision of nearly $170,000 in free medications and transportation through its Project HELP program. FY 2019 Plan SMH will do the following: * Continue to collaborate with community organizations that provide medical care and case management services to the homeless * Continue to partner with the Whole Person Wellness program to provide care management to homeless Medi-Cal patients who are high users of medical services * Continue to administer funds to those in need of transportation assistance or financial support for medications * With funding from the SMH Auxiliary, provide 200 items of clothing to patients who lack usable clothing at discharge, including the homeless * Continue to provide financial assistance for prescription copayments and other personal items SMH Program and Service Highlights Sharp Memorial Hospital: * 24-hour Emergency and Trauma Center, including heliport and base station * Acute care, including a dedicated inpatient oncology unit * Bioethics consultation * Cardiovascular rehabilitation * Catheterization lab, including a hybrid procedure room * Clinical trials, including cancer, heart and vascular * Community Care Partner Program * Chest Pain Center, specializing in emergency chest pain treatment * Congestive Heart Failure Management Program * Critical care * Electrocardiogram * Electroencephalography * Health Information Ambassadors * Heart and vascular care, including mechanical circulatory support devices and heart transplantation * Heart Valve Surgery Center * Home health * Home infusion services * Hospice * Imaging services, including interventional radiology * Intensive Care Unit * Interpreter services * Laboratory services * Mindful Cafe, offering healthy and nutritious food options for patients, family and staff * Open medical records program * Organ transplantation, including kidney, heart and pancreas * Orthopedics, including joint replacement surgery * Pain Management Center * Palliative care * Pathology services * Pharmacy services for inpatients * Pre-Anesthesia Evaluation services * Robotic surgery * Senior Resource Center * Sharp Allison deRose Rehabilitation Center, including inpatient and outpatient physical, occupational and speech therapy * 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 transportation 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, licensed clinical social workers, radiation therapy, infusion services and diagnostic imaging * Cushman Wellness Center, in”

“* Other Benefits for the Broader Community included health education and information on a variety of behavioral health and chemical dependency topics, participation in community health and behavioral health events, and collaboration with local schools to promote interest in health care careers. SMV also offered meeting room space at no charge to community groups. In addition, staff at the hospital actively participated in community boards, committees and other civic organizations, such as National Alliance on Mental Illness (NAMI), Community Health Improvement Partners (CHIP) Behavioral Health Work Team, CHIP Suicide Prevention Council, San Diego Military Family Collaborative (SDMFC), San Diego Mental Health Coalition, San Diego County Older Adult Behavioral Health System of Care Council, Alzheimer's Project Safety Workgroup, Employee Assistance Professionals Association (EAPA), A New PATH (Parents for Addiction Treatment and Healing), Psychiatric Emergency Response Team (PERT) and VA (United States of America (U.S.) Department of Veterans Affairs) San Diego Mental Health Council. See Appendix A for a listing of Sharp HealthCare's (Sharp's) involvement in community organizations in FY 2018. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessment (CHNA) development and administration. * Health Research, Education and Training Programs included education and training of health care professionals and student and intern supervision. Definition of Community * SMV is located at 7850 Vista Hill Avenue in San Diego, ZIP code 92123. * SMC is located at 7989 Linda Vista Road in San Diego, ZIP code 92111. * SMV Mid-City Outpatient Programs are located at 4275 El Cajon Boulevard, Suite 100 in San Diego, ZIP code 92105; SMV East County Outpatient Programs are located at 1460 East Main Street in El Cajon, ZIP code 92021. As specialty hospitals, SMV and SMC serve the community of San Diego County (SDC). The primary communities served by SMV and SMC include the City of San Diego, Chula Vista, the east region, and north inland communities surrounding Rancho Bernardo. For SMV's and SMC's 2016 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 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 2018, there were 485,911 residents ages 65 and older in SDC, representing 14.6 percent of the population. Between 2018 and 2023, it is anticipated that SDC's senior population will grow by 22.6 percent. In 2016, 14 percent of the SDC population reported living below 100 percent of the federal poverty level (FPL). The county's unemployment rate was 7.5 percent and 5 percent of households received Supplemental Security Income. According to data from the San Diego Hunger Coalition, one in seven, or 15 percent of the SDC population experienced food insecurity. An additional one in five San Diegans were food secure but relied on supplemental nutrition assistance to support their food budget. In 2016, 21 percent of households in SDC participated in Supplemental Nutrition Assistance Program (SNAP) benefits, while 23.3 percent of those below 138 percent of the FPL were eligible for such benefits. Please refer to Table 52 for SNAP participation and eligibility in SDC. Table 52: Food Stamps/SNAP Benefit Participation and Eligibility Estimates for SDC, 2016 Food Stamps/SNAP Benefits: Households - 7.0% Families with”

“Malignant Neoplasms (Overall Cancer): Number of Deaths - 5,096 Percent of Total Deaths - 24.1% Diseases of the Heart Number of Deaths - 4,808 Percent of Total Deaths - 22.7% Alzheimer's Disease Number of Deaths - 1,403 Percent of Total Deaths - 6.6% Cerebrovascular Diseases Number of Deaths - 1,363 Percent of Total Deaths - 6.4% Accidents/Unintentional Injuries Number of Deaths - 1,071 Percent of Total Deaths - 5.1% Chronic Lower Respiratory Diseases Number of Deaths - 1,027 Percent of Total Deaths - 4.8% Diabetes Mellitus Number of Deaths - 734 Percent of Total Deaths - 3.5% Chronic Liver Disease and Cirrhosis Number of Deaths - 412 Percent of Total Deaths - 1.9% Intentional Self-Harm (Suicide) Number of Deaths - 407 Percent of Total Deaths - 1.9% Essential Hypertension and Hypertensive Renal Disease Number of Deaths - 400 Percent of Total Deaths - 1.9% All Other Causes Number of Deaths - 4,463 Percent of Total Deaths - 21.1% Total Deaths Number of Deaths - 21,184 Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Community Health Statistics Unit, 2018 Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SMV and SMC: * Incorporate community priorities and community relations into their strategic plans and develop specific programmatic goals * Estimate an annual budget for community programs and services based on community needs, the prior year's experience and current funding levels * Host a bimonthly committee to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SMV 2016 CHNA and SMC 2016 CHNA Both SMV and SMC completed their most recent CHNAs in September 2016. These CHNAs were significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In addition, this year SMV and SMC completed their most current implementation strategies - a description of programs designed to address the priority health needs identified in their 2016 CHNAs. The most recent CHNAs and implementation strategies for both SMV and SMC are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SMV 2016 CHNA and the SMC 2016 CHNA, behavioral health was identified as the number one priority health need for SDC, including the behavioral health needs specifically for seniors. Although additional priority health needs were identified for Sharp hospitals through the 2016 CHNA process, as specialty hospital facilities providing behavioral health and chemical dependency programs and services, these additional identified health issues (cardiovascular health, cancer, diabetes, obesity, etc.), fall outside the scope of services provided by SMV and SMC. Thus, these identified health needs are not addressed in the community benefit report for these two hospitals. For additional details on SMV and SMC programs that specifically address the needs identified in the 2016 CHNA, please refer to SMV's and SMC's respective implementation strategies available at http://www.sharp.com/about/community/health-needs-assessments.cfm. In alignment with the identified need of behavioral health, the following pages detail programs that specifically address: * Mental health and substance abuse education and support for the community * Improving behavioral health outcomes for seniors at risk * Mental health and substance abuse education for health care professionals and students, and collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2018 Report of Activitie”

“* Rates of homelessness and substance use among veterans continue to increase, which may contribute to suicide attempts and death. The suicide rate is higher among veterans when compared to the civilian population. The suicide rate among veterans increased more than 18 percent between 2011 and 2014 (The International Journal of Mental Health Systems, 2017). * Immediate intervention after a first episode of serious mental illness can impact future outcomes. The Behavioral Health Continuum of Care Model addresses major problems and disorders by teaching promotion of healthy choices and behaviors, prevention of risk behaviors, treatment for existing behaviors, and recovery. Cost-benefit ratio analyses of this model indicate that every $1 spent on early treatment and intervention has the potential to save between $2 and $10 in health care, criminal and juvenile justice costs, educational costs, and lost productivity (SAMHSA, 2018). Objectives * Provide behavioral health and substance use education for patients, their loved ones and the community * Support the behavioral health community through sponsorship of and participation in community events FY 2018 Report of Activities During FY 2018, SMV and SMC hosted numerous on-site community speaking engagements and workshops to increase awareness of behavioral health and substance use issues. Education addressed a variety of topics, including cognitive therapy, chemical dependency, life transitions, domestic violence and child and geriatric psychiatry. This included SMV's monthly cognitive therapy lecture series designed to educate participants about cognitive behavioral therapy - a research-based treatment approach to mood disturbances and behavior problems that is used to treat anxiety, anger, depression, panic disorder, bipolar disorder, phobias, relationship problems, grief and loss, and other difficulties that bring people to therapy. Further, in response to the need for information and support for caregivers of individuals with mental illness, SMV provided educational materials, local behavioral health resources and information on behavioral health support to family and friends in the hospital lobby through NAMI San Diego's Friends in the Lobby program. Throughout the year, SMV provided specialized services to active duty servicemembers, veterans and their families. These programs provide a safe environment for veterans to learn effective methods for managing symptoms of PTSD, acute stress disorder and mood-related disruptions. SMV's military-specific programs also decrease the use of maladaptive coping skills through evidence-based practices and include services for spouses and family members who experience distress when a loved one returns with symptoms related to the trauma of war. Team members provide education and resources to reduce the stigma surrounding behavioral health issues in the military and civilian communities. During FY 2018, SMV's military-specific programs supported more than 200 veterans and community members. In addition, SMV and SMC collaborated with partners in the military community to provide behavioral health education and resources to more than 600 community members at events throughout SDC. In October, SMV participated in a panel discussion following a screening of a documentary titled After Fire, which highlights the challenges faced by women in the military, as well as participated in a resource fair at the 2017 Women Veterans Forum titled Be the Change at San Diego State University (SDSU). In September, SMV offered behavioral health resources during a resource fair at the VA San Diego Healthcare System's sixth annual Community Mental Health Summit at Jacobs Center for Neighborhood Innovation. Further, in FY 2018, SMV provided education and resources about opportunities for participation in PTSD and depression research to physicians in the VA Trauma Program. SMV also continued to participate in the SDMFC, which meets monthly to discuss community-base”

“Throughout the year, SMV and SMC sponsored and participated in nine walks to increase awareness and raise funds for behavioral health services, including the San Diego County NAMI Walk, San Diego NEDA (National Eating Disorders Association) Walk, American Foundation for Suicide Prevention's Out of the Darkness Community Walk, Survivors of Suicide Loss and Directing Change's Walk in Remembrance with Hope, Alzheimer's San Diego's annual Walk4ALZ, McAlister Institute's Walk for Sobriety, 2017 and 2018 Heroes in Recovery 6K Run/Walk events, and the American Heart Association's (AHA) 2018 San Diego Heart & Stroke Walk. With the exception of the AHA 2018 San Diego Heart & Stroke Walk, SMV and SMC provided a booth with behavioral health resources during these events. At the Walk to End Alzheimer's, SMV offered education on Alzheimer's disease, clinical trials and community resources to more than 500 attendees. In FY 2018, 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, the County of San Diego offered a three-year contract to a work team, including SMV, CHIP, housing organizations and other community partners for the establishment of an Independent Living Registry and an Independent Living Association (ILA). Through this initiative, the work team developed a four-prong approach to address the challenges facing 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. Following the conclusion of the contract, these efforts continue to maintain quality standards and seek improvement of conditions for ILFs and the community members who reside there. This includes linking residents with essential services and providers and reducing crime and unnecessary arrest rates. The ILA is an initiative of the CHIP Behavioral Health Work Team, in which SMV is an active participant, and the registry continues to expand to include new participating ILFs. 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. SMV continues to maintain a Client Advisory Board, which obtains feedback from the hospital's outpatients, former patients and employees on how to improve programs, empower patients, promote advocacy and better serve the community. During FY 2018, members of the Client Advisory Board encouraged community members, staff, current and former 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 behavioral health. FY 2019 Plan SMV or SMC will do the following: * Continue to explore opportunities for outreach to multicultural and at-risk groups through increased community involvement and education * Continue serving as the media's go-to experts for information on behavioral health conditions and treatment * Host and provide a variety of educational events and programs for community members * Participate in community events to raise awareness and funds for behavioral health services * Participate in key behavioral health events and activities alongside patients * Explore and expand collaborations with law enforcement and housing planning committees to provide better outcomes for community members living with mental illness and substance use issues * Continue to collaborate with community providers and provide education to ILFs to improve living conditions for individuals with mental illness * Participate in Sharp's partnership with the City of San Diego to”

“* The FY 2019 Presidential Budget reduced federal funding for SAMHSA - the branch of the U.S. Department of Health and Human Services (DHHS) responsible for improving the quality and availability of behavioral health and chemical dependency treatment services nationwide - by almost $700 million compared to FY 2018. * According to a report from the California Health Care Foundation (CHCF) titled Mental Health in California: For Too Many, Care Not There, the prevalence of serious mental illness varies by income level, with lower-income individuals experiencing higher rates of mental illness (CHCF, 2018). * The same report revealed that although the number of adults with mental health coverage in California increased nearly 50 percent between 2012 and 2015 due to Medi-Cal expansion, in 2015, approximately two-thirds of Californian adults with mental illness and adolescents who experienced major depressive episodes did not receive treatment (CHCF, 2018). * Further, ED visits resulting in inpatient psychiatric admissions increased 30 percent between 2010 and 2015. More robust community behavioral health services for low-income and uninsured patients may decrease unnecessary ED use (CHCF, 2018). Objectives * Provide behavioral health and substance use screenings to the community * Provide support for members of the community impacted by behavioral health and substance use issues FY 2018 Report of Activities In FY 2018, SMV and SMC supported community members impacted by behavioral health and substance use issues by providing a variety of screenings, both on-site and in partnership with local organizations. Throughout the year, SMV psychiatric evaluation and intake teams provided approximately 16,500 free psychiatric evaluations and referrals for the general community via phone calls, walk-ins and scheduled appointments. SMC also provided extensive community outreach and support through assessments and referrals to community organizations. During FY 2018, SMC spent more than 1,500 hours offering free chemical dependency assessments, educational materials and community referral resources to more than 750 community members. The free assessments were facilitated by a licensed mental health professional, who provided individuals with recommendations for appropriate programs and levels of care. Check Your Mood Day is an annual event held in conjunction with National Depression Screening Day in October to raise behavioral health awareness, fight stigma and encourage community members to assess their emotional well-being. In FY 2018, SMV partnered with CHIP and Live Well San Diego (LWSD) to provide Check Your Mood screenings - a brief questionnaire aimed at assessing risk for depression - and resources at locations across SDC. As part of this event, SMV provided behavioral health resources and Check Your Mood screenings to 100 community members, including students at San Diego City College and seniors at Gary and Mary West Senior Wellness Center. Also in October, SMV provided 15 Check Your Mood screenings at an event held at SCVMC's Barnhart Cancer Center that benefitted homeless TAY served by Urban Street Angels. Finally, SMV offered Check Your Mood screenings as well as senior-focused behavioral health resources to 100 community seniors and family members at the Lakeside Community Center's annual Senior Health Fair. SMV and SMC also provided behavioral health screenings and resources at several community events throughout the year. SMV and SMC continued to assist in planning SCVMC's Changing Minds, Minds Matter South County Mental Health Fair, a free event during which more than 40 community partners gathered to educate South Bay community members about behavioral health challenges and raise awareness of available community services and resources. During the event, SMV and SMC provided workshops on substance use and behavioral health, as well as Check Your Mood screenings and behavioral health resources to approximately 100 community memb”

“* ED discharges related to chronic alcohol use among SDC seniors ages 65 and older increased 26.6 percent between 2012 and 2016. Compared to other age groups, this was the largest percentage increase during this time period. * The 2016 hospitalization rate for acute substance-related disorders was 12.3 per 100,000 among SDC residents over the age of 65. This is a significant decline from 2012 (47.1 per 100,000 SDC residents over the age of 65). * Certain circumstances of aging, such as loss of family and caregivers, 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 insufficiency of geriatric health practitioners, including mental health practitioners (NAMI, 2016). * According to a 2018 health policy brief by the University of California, Los Angeles (UCLA) Center for Health Policy Research, California's public mental health delivery system does not meet the needs of all older adults it serves. Deficits exist in the involvement of older adults in planning processes, outreach and service delivery, as well as workforce development and the measurement and reporting of outcomes. * Recommendations to improve access and utilization of mental health services by older adults in California include: designating distinct administrative and leadership structures at county levels; enhancing older adult outreach and documentation of unmet needs; establishing standardized training for geriatric providers; standardizing data-reporting requirements; and increasing the level of integration between medical, behavioral health, aging and substance use disorder services (UCLA, 2018). * Mental health problems in older adults are often under-identified by health care professionals. Over 20 percent of adults ages 60 and older suffer from a mental or neurological disorder. Older adults experience unique stressors such as significant ongoing loss in capacities, declining functional ability, bereavement and decline in socioeconomic status due to retirement. These stressors can result in isolation, loneliness and psychological distress, for which long-term care may be necessary (World Health Organization, 2017). * Social isolation and loneliness are associated with increased mortality in older adults, as well as adverse health effects such as dementia, increased risk for hospital readmission, and increased risk of falls. In 2014, 46 percent of women ages 75 and older lived alone and were at increased risk of social isolation, as deteriorating mental or physical health may limit a person's ability to participate in social interactions outside the home. By the time people reach the age of 85, 40 percent are living by themselves (Association of Health Care Journalists, 2017). * Behavioral and cognitive symptoms often present differently in older adults compared to younger people. 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 at-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 2018 Report of Activities Throughout FY 2018, SMV clinicians collaborated with Serving Seniors to provide more than 750 hours of clinical services to senior clients at the Gary and Mary West Senior Wellness Center. 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; and behavioral health screenings including Montreal Cognitive Assessments, which detect cognitive impairment. SM”

“In FY 2018, SMV partnered with Alzheimer's San Diego to provide a variety of screenings, behavioral health education and resources to community members. This included a conference held in March at Sharp's corporate office location in Kearny Mesa called When the Going Gets Tough: Working Through the Challenges of Dementia Together. During the conference, approximately 160 community members learned about dementia-related behavior changes, care strategies, communication techniques and medications that can help. In September, SMV sponsored Alzheimer's San Diego's Date with a Cure event at the University of San Diego's (USD's) Shiley Theatre as well as provided 450 attendees with behavioral health resources and information about participation in clinical trials. An SMV clinician also participated in a panel discussion about recent advances in Alzheimer's treatment during the event. On a monthly basis, SMV and Alzheimer's San Diego provided free memory screenings - a wellness tool that identifies possible changes in memory and cognition - to over 100 community members who were concerned about memory loss or interested in establishing a baseline to detect future changes. In addition, an SMV clinician provided training on the administration and use of the Montreal Cognitive Assessment to seven Alzheimer's San Diego staff members in June. Additionally, throughout FY 2018, SMV clinicians provided educational materials and lectures on advances in Alzheimer's research and opportunities to enroll in clinical research studies to more than 1,950 community members at locations across SDC, including Magnolia Adult Day Health Center, ActivCare Living Residential Memory Care - Bressi Ranch, Fredericka Manor Retirement Community, Point Loma Presbyterian Church, Clairemont Lutheran Church, La Mesa Community Center, Lakeside Community Center and Town and Country San Diego Convention Center. FY 2019 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 SMV's SIOP, provide education and support to community members around senior behavioral health issues * Participate in Sharp's partnership with the City of San Diego to provide senior behavioral health education and resources to employees and residents in the city's nine districts * In collaboration with Sharp Senior Health Center, provide education on holiday blues and depression as well as senior behavioral health * 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 HHSA as a strategy for addressing behavioral health needs and modifiable risk factors in SDC. * According to San Diego Workforce Partnership (SDWP), a major challenge faced by education and training programs in the health care sector is accommodating the number of clinical training hours required for students in California to become certified. In addition, training sites are limited, and those licensed in other states often cannot work in California due to stricter requirements (SDWP, 2017). * In 2017, there were 468 designated Mental Health Care Health Professional Shortage Areas (HPSAs) in California, representing approximately 6.5 million residents. The Kaiser Family Foundation estimates that 260 new practitioners would need”

“FY 2018 Report of Activities Throughout the year, SMV participated in internship and clinical training programs for trainees and students in various health care disciplines, including clinical dietary/nutrition, psychology, clinical social work, social work administration, marriage and family therapy (MFT), pharmacy, health information technology (HIT), music therapy, clinical chaplaincy, medicine and nursing. Academic institution partners included, but were not limited to: Alliant International University, Argosy University, Arizona State University, Azusa Pacific University, CSUSM, Grand Canyon University, National University, Pepperdine University, Point Loma Nazarene University (PLNU), San Diego City College, SDSU, Southwestern College, Touro University, USD, Walden University, West Coast University - Los Angeles and Western University of Health Sciences. SMV provided clinical supervision and training for 29 psychology trainees, including 12 graduate students, eight doctoral interns, three postdoctoral fellows and six psychological assistants, as well as 21 MFT, eight Master of Social Work (MSW) and three Bachelor of Social Work student interns. In addition, SMV provided a nine-month internship for a student completing a dual master's degree in Music Therapy and Professional Counseling. In FY 2018, ancillary (non-nursing) students served approximately 46,500 hours on the SMV campus, representing an increase of nearly 17,000 hours from fiscal year 2017 due to the addition of new intern, fellow and psychological assistant positions. In addition, more than 300 nursing students worked clinical rotations of six- to eight- hour shifts and spent more than 24,600 hours at SMV. Nursing students were placed in all inpatient units and several of the outpatient programs at SMV and SMC. SMV offers two clinical rotations in one day, including morning and evening shifts, and nursing students are on campus seven days a week. Including time spent with groups and individual preceptors, nursing students served nearly 26,400 hours at SMV in FY 2018. Nursing students from various universities and colleges were also provided free meeting space as needed. In FY 2018, SMV received more than 160 applications for eight doctoral intern positions available through Sharp's yearlong, American Psychological Association (APA)-accredited doctoral internship in clinical psychology. Selected interns rotated through three four-month rotations that included experience in SMV's adult inpatient and outpatient programs, as well as inpatient and outpatient senior behavioral health and child and adolescent programs. Interns also rotated through SMC. The hospitals offered these interns a unique opportunity to receive intensive training in psychological assessment and neuropsychological screening. With this training, psychology doctoral students provided approximately 360 detailed psycho-diagnostic assessments throughout the year. In addition, psychology trainees provided more than 3,000 hours of group therapy and approximately 1,980 hours of individual therapy. Psychology trainees were also integrally involved in clinical staff training as well as program development and evaluation efforts throughout the hospital. SMV had the opportunity to mentor psychology assistant trainees during FY 2018, enabling the hospital to extend the availability of clinical programming on the inpatient units to seven days per week. At SMV and SMC, psychologists, licensed marriage and family therapists and licensed clinical social workers provided nearly 33,800 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; Providing Trans-affirmative Care; Givi”

“SMV continued to collaborate with PERT through monthly meetings and community-oriented trainings. SMV staff also supported approximately 250 SDC police officers at three PERT Academy Resource Fair events. During these events, SMV team members provided officers with educational resources on understanding psychiatric emergencies and community psychiatric services. The police officers were subsequently paired with licensed mental health clinicians to help them evaluate and assess an individual's behavioral health condition and needs, and, if appropriate, transport the individual to a hospital or refer the individual to a community resource or treatment facility. Throughout FY 2018, staff at SMV and SMC regularly led or attended various community and professional health boards, committees, and advisory and work groups, including A New PATH, Alzheimer's San Diego Client Advisory Board, Alzheimer's Project Safety Workgroup, American Psychiatric Nurses Association, Association for Ambulatory Behavioral Healthcare, Association of California Nurse Leaders, Association for Contextual Behavioral Science - Aging Special Interest Group, Behavioral Health Recognition Dinner Planning Team, California Association of Marriage and Family Therapists San Diego Chapter, LWSD Check Your Mood Committee, Mesa College Health Information Technology Advisory Board Committee, CHIP Behavioral Health Work Team, CHIP ILA Advisory Board and Peer Review Advisory Team, CHIP Suicide Prevention Council, EAPA forums, HASD&IC, JFS Behavioral Health Committee, JFS Public Affairs Committee, Mental Health America Board, NAMI, PERT, PLNU, Residential Care Committee, San Diego Community College District, San Diego County Older Adult Behavioral Health System of Care Council, San Diego Dementia Consortium, San Diego Health Information Association, San Diego Mental Health Coalition, SDMFC, San Diego Psychological Association Supervision Committee, San Diego Psych-Law Society, Special Needs Trust Foundation, Transitional Age Youth Behavioral Health Services Council and VA San Diego Mental Health Council. FY 2019 Plan SMV or SMC will do the following: * Offer internship and clinical training programs and/or placement for clinical dietary/nutrition, psychology, clinical social work, social work administration, MFT, medicine, music therapy, HIT, clinical chaplains and pharmacy students * Provide lectures on behavioral health issues to the local academic community * Continue the behavioral health careers curriculum within the HSHMC program and provide students with experience in a broad range of programs including therapeutic activities services, environmental services and health information services * Provide educational offerings for behavioral health care professionals, community groups and community members * Initiate the application process for re-accreditation by the APA SMV and SMC Program and Service Highlights Sharp Mesa Vista Hospital: * Child, adolescent, adult and older adult inpatient, partial hospitalization, and outpatient psychiatric and chemical dependency services * On- and off-campus specialty outpatient programs treating seniors, eating disorders, trauma, chronic pain, opiate and prescription drug dependence and dual diagnosis * Cognitive behavioral therapy, electroconvulsive therapy, and dialectical behavioral therapy programs * Outreach to active duty military, veterans and their families through programs geared specifically toward servicemembers, including the VA-supported Veterans Choice Program * Transportation services and complimentary lunches * Practicum programs for graduate MSW and MFT interns * Clinical supervision site for graduate psychology doctoral interns * Medication research studies and clinical trials Sharp McDonald Center at Sharp HealthCare: * Chemical dependency and substance abuse inpatient and outpatient treatment services for children, teens, adults and seniors * Residential treatment services for adults and seniors * Inpatient deto”

“* Doors of Change * Downtown San Diego Partnership * East County Action Network * East County Senior Service Providers * Emergency Nurses Association - San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Family Health Centers of San Diego * Father Joe's Villages * Feeding San Diego * Friends of Scott Foundation * Gary and Mary West Senior Wellness Center * George G. Glenner Alzheimer's Family Centers, Inc. * Girl Scouts San Diego * Grossmont College Occupational Therapy Assistant Advisory Board * Grossmont College Respiratory Advisory Committee * Grossmont Healthcare District Community Grants and Sponsorships Committee * Grossmont Healthcare District Independent Citizens' Bond Oversight Committee * Grossmont Imaging LLC Board * Grossmont Union High School District * Hands United for Children * Health and Science Pipeline Initiative * Health Care Communicators Board * Health Industry Collaboration Effort, Inc. * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Healthy Chula Vista Advisory Commission * Helix Charter High School * Hidden Heroes campaign * Home Start, Inc. * Hospice and Palliative Nurses Association - San Diego Chapter * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * HSHMC Board * Hunger Advocacy Network * I Love a Clean San Diego * Inner City Action Network * Institute for Public Health, San Diego State University (IPH) * Integrative Therapies Collaborative * International Association of Eating Disorders Professionals * The Jacobs & Cushman San Diego Food Bank * Jewish Family Service of San Diego (JFS) * JFS Behavioral Health Committee * JFS Public Affairs Committee * Kiwanis Club of Bonita * La Maestra Community Health Centers * La Mesa Lion's Club * La Mesa Parks and Recreation * Lantern Crest Senior Living Advisory Board * Las Damas de San Diego International Nonprofit Organization * Las Patronas * Las Primeras * Life Rolls On * Live Well San Diego Check Your Mood Committee * Live Well San Diego - South Region * Lightbridge Hospice * Mama's Kitchen * March of Dimes * Meals on Wheels San Diego County * Meals on Wheels Greater San Diego East County Advisory Board * Mental Health America * Miracle Babies * MRI Joint Venture Board * National Active and Retired Federal Employees Association * National Alliance on Mental Illness * National Association of Hispanic Nurses, San Diego Chapter * National Association of Perinatal Social Workers * National Association of Neonatal Nurses * National Association of Orthopedic Nurses * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National University * Neighborhood Healthcare * Neighborhood House Association * North San Diego Business Chamber * Pacific Arts Movement * Palomar Community College * Paradise Village * Partnership for Smoke-Free Families * Partnerships with Industry * Peninsula Family YMCA * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Point Loma/Hervey Library * Point Loma Nazarene University * Postpartum Health Alliance * Practice Greenhealth * Promises2Kids * Psychiatric Emergency Response Team * Public Health Emergency Hospital Preparedness Program * Regional Perinatal System * Residential Care Committee * Ronald McDonald House Operations Committee * Rotary Club of Chula Vista * Rotary Club of Coronado * San Diego Association of Diabetes Educators * San Diego Association of Governments * San Diego Blood Bank * San Diego Community Action Network * San Diego Community College District * San Diego County * San Diego County Aging and Independence Services * San Diego Dietetic Association * San Diego East County Chamber of Commerce * San Diego Eye Bank Nurses' Advisory Board * San Diego Fire-Rescue Department * San Diego Food System Alliance * San Diego Freedom Ran”

“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 - 5722083;”