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, the governing body is notified, 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 2019.”

“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: 418654, Related or Exempt Function Revenue: 418654, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“All other revenue - Total Revenue: 426836, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 426836;”

“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 2019 Submitted to: Office of Statewide Health Planning and Development Healthcare Information Division - Accounting and Reporting Systems Section 400 R Street, Room 250 Sacramento, CA 95811 Section 1 An Overview of Sharp HealthCare The people of San Diego County place tremendous trust in Sharp HealthCare to deliver extraordinary care in some of life's most vulnerable moments. As a not-for-profit organization, we honor that trust daily and help pay it back by investing in community benefit programs that improve health outcomes for our entire region. This is the commitment we've made to our community over the past six decades serving as San Diego's health care leader and the role we look forward to serving for many years to come. - Chris Howard, 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; 28 medical centers; five urgent care centers; three skilled nursing facilities (SNF); 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, 2019, 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 region, 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 region 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 behavioral health hospital in San Diego, Sharp Mesa Vista Hospital (SMV) provides 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”

“Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp made an important decision regarding these pillars as part of its continued journey toward excellence. Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * 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 Enhance market position and drive 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. 31 on Forbes' 2019 listing of Best Employers in California, as well as No. 58 on its list of Best Employers for Women and No. 201 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. In 2019, Sharp ranked No. 33 in the large employer category as one of the "Best Places to Work" for information technology (IT) professionals by the International Data Group's Computerworld survey. Sharp was also ranked in the top 10 on this list from 2013 to 2018. The list is compiled by evaluating a company's benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. In 2019, SMH and SCVMC were recognized on Newsweek's first ever list of the top 1,000 hospitals worldwide. Among all United States (U.S.) hospitals included in the ranking, SMH was ranked No. 89 and SCVMC was ranked No. 137. In 2015 and 2017 to 2019, Sharp was ranked "”

“Sharp was named the 2017 Outstanding Recycling Program by California Resource Recovery Association (CRRA) - California's statewide recycling association - for its innovative waste-minimization initiatives. As the oldest and one of the largest nonprofit recycling organizations in the country, CRRA is dedicated to achieving environmental sustainability in and beyond California through zero waste strategies, including product stewardship, waste prevention, reuse, recycling and composting. Sharp was one of nine awardees in San Diego to receive a 2018 EMIES UnWasted Food award by the San Diego Food System Alliance for its collaboration as an innovator and early adopter with upstream "unusual but usable" procurement, soup stock program, organic gardens, animal feed and composting. Sharp was also recognized in 2016 for developing best practices in waste prevention, composting, recycling, food donation and source reduction efforts in partnership with the Sodexo Food and Nutrition team. SRSMG was recognized by the Centers for Disease Control and Prevention as a 2017 Million Hearts Hypertension Control Champion for achieving blood pressure control for at least 70% of its adult patients with hypertension. From 2013 to 2019, the Press Ganey organization recognized multiple Sharp entities with Guardian of Excellence Awards(r). 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, Sharp Memorial Outpatient Pavilion (OPP), SMV, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health, while SCHHC, 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(r) (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. Between 2013 and 2019, Press Ganey recognized SMH five times 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 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 four out of five-star rating in Covered California's 2020 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 2019. The Women's Choice Award(r) is a symbol of excellence in customer experience awarded by the collective voice of women. In 2019, SGH received the Women's Choice Award(r) as one of America's Best Hospitals for Heart Care. The Wom”

“In addition, three Sharp hospitals - SCVMC, SGH and SMH - qualify as covered entities for the 340B Drug Pricing Program administered by the U.S. Department of Health and Human Services (DHHS) Health Resources and Services Administration. Hospitals participating in the 340B Drug Pricing Program are permitted to purchase outpatient drugs at reduced prices. The savings generated by this program are used to offset patient care costs for Sharp's most vulnerable patient populations, as well as to assist with patient access to medications through Sharp's Patient Assistance Program. The Patient Assistance Program at Sharp helps those in need of assistance gain access to free or low-cost medications. Patients are referred by population health teams, physicians, pharmacists, case managers, social workers, nurses or even other patients, as well as may be identified through usage reports. Team members research all available options for these patients, including programs offered by drug manufacturers, grant-based programs offered by foundations, co-pay assistance and other low-cost alternatives. Eligible patients receive assistance that may help reduce readmissions and the need for frequent medical services resulting from a lack of access to medication. In FY 2019, the Patient Assistance Program helped under- and uninsured patients access more than $5 million worth of prescriptions. Also in FY 2019, Sharp assisted underinsured and vulnerable 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 2019, the Maximum Out of Pocket Program made a total of more than $385,000 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 about 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. Since FY 2016, SGH's PFS team has 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. These consultations have dramatically increased the likelihood that patients 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. More than 720 Sharp patients have been granted CalFresh benefits as a result of this effort. 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 280 families through the SSI application process. City of San Diego Partnership In 2018, Sharp and the City of San Diego began a three-year partnership designed to help improve the health and wellness of residents in all nine San Diego City Council Districts. As the Official Health and Wellness Partner of the City of San Diego, Sharp provides a wide variety of classes and workshops at district libraries and recreation centers. The partnership drew on findings from Sharp's community health needs assessment (CHNA), which helped id”

“Ancillary: Students - 238 Hours - 66,927 Total: Students - 576 Hours - 112,853 Sharp Mesa Vista Hospital: Nursing: Students - 335 Group Hours - 24,796 Precepted Hours - 2,582 Midlevel Practitioner: Students - 1 Hours - 160 Ancillary: Students - 48 Hours - 33,975 Total: Students - 384 Hours - 61,513 Sharp HospiceCare: Nursing: Students - 4 Group Hours - 0 Precepted Hours - 332 Midlevel Practitioner: Students - 0 Hours - 0 Ancillary: Students - 1 Hours - 200 Total: Students - 5 Hours - 532 Sharp HealthCare: Total Nursing: Students - 2,712 Group Hours - 213,468 Precepted Hours - 101,929 Midlevel Practitioner: Students - 20 Hours - 2,666 Ancillary: Students - 914 Hours - 261,846 Total: Students - 3,646 Hours - 579,909 In addition, Sharp offers a graduate-level Clinical Pastoral Education program, which teaches students clinical theories and skills to provide spiritual care to patients and their families. In FY 2019, the program supervised six chaplain residents and five chaplain interns on the campuses of SGH, SMBHWN, SMH, SMV and Sharp Home Health services. In addition, more than 100 Sharp Clinical Pastoral Education program graduates attended three professional chaplains' educational events hosted by Sharp's Spiritual Care and Education Department as part of their continued education and development. These events were held throughout the year and included Healing Stories from Traditions of World Religions: Buddhist Stories, Praying for Miracles and Sharing our Spiritual Practices. Further, these graduates of Sharp's Clinical Pastoral Education program now serve various health care institutions and hospices within San Diego. Sharp also provides specialized classes to prepare future preceptors for their mentoring role. Through the Precepting With Pride Class, nurses and respiratory care practitioners who are new to the role of precepting learn about the essential components of role modeling and educating. Sharp's Advanced Preceptor Class for Nursing supports the continued development of more experienced nurse preceptors. In addition, new nurse mentors and mentees attend an orientation program designed to describe their unique roles and promote a successful precepting experience. 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. HSHMC students are given the opportunity to 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 grad”

“Sharp's Continuing Medical Education (CME) Department has received Accreditation with Commendation by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians, as well as by the Accreditation Council for Pharmacy Education to provide continuing pharmacy education. Sharp's CME Department provides evidence-based and clinically relevant professional development opportunities to help practicing physicians and pharmacists improve patient safety and enhance clinical outcomes. In FY 2019, Sharp's CME Department invested more than 1,500 hours in live and online CME activities for San Diego health care providers. This included conferences on cardiology, oncology, diabetes, integrated healing, urgent care and patient safety, as well as presentations on suicide prevention, food insecurity, physician leadership, sepsis, infection prevention, opioid usage and advances in lung cancer. Beyond conferences, CME develops and implements online learning modules as well as performance improvement projects to inspire clinicians and teams to improve their practice and optimize patient care. As a result of provider demand, 56 online CME modules were made available in FY 2019 - a 68% increase in modules from FY 2018. Additionally, CME partnered with Sharp's Lean Six Sigma team as well as Sharp-affiliated physicians to complete 15 performance improvement projects. Each year, Sharp's CME Department identifies and addresses a public health priority in compliance with its Accreditation with Commendation. In FY 2019, the CME Department continued to collaborate with the Community Benefit team to address the FY 2018 identified public health issue: food insecurity. Together, CME and Community Benefit educated and engaged Sharp-affiliated physicians, pharmacists and employees on the impact of food insecurity on health, as well as assessed patients for food insecurity and referred them to community resources. Four online educational modules were developed in collaboration with the San Diego Hunger Coalition and are actively viewed by community providers. The CME and Community Benefit food insecurity initiative has helped change how Sharp cares for its community, as well as delivered positive patient outcomes. To address the FY 2019 public health priority of dementia, the CME Department developed a comprehensive needs assessment demonstrating the need for dementia training aimed at primary care providers. The CME Department collaborated with community organizations, including Champions for Health and the Alzheimer's Project Clinical Roundtable, to develop education and clinical guidelines focused on addressing dementia in SDC. This concerted effort reached over 300 clinicians, as well as led to countless additional non-CME educational strategy meetings with internal and external stakeholders, and important conversations regarding dementia patients at Sharp. In addition, the Alzheimer's Project Clinical Roundtable Physician Guidelines were converted into an online CME activity. In further support of this project, the department provided four hours of live and online CME activities for San Diego health care providers, as well as more than 50 hours of planning and development with providers. This included grand rounds at both SGH and SCHHC, and a panel discussion at SCMG's Annual CME Conference, where the Alzheimer's Project Clinical Roundtable exhibited and promoted its clinical guidelines. In addition, SRSMG's Clinical Guidelines committee utilized the Alzheimer's Project Clinical Roundtable's clinical guidelines to update their dementia guidelines. Results from post-evaluation surveys collected from these CME-accredited events showed markedly increased confidence in treating patients with Alzheimer's disease and other related dementias. Participants also stated an intent to change their professional behavior, and the belief that this education would positively impact their patients. Research Sharp Center f”

“The ORI shares its research studies with other community health and research professionals. In FY 2019, this included a study titled Detecting Atrial Fibrillation in the Emergency Department in Patients with Cardiac Implantable Electronic Devices, published in The Journal of Emergency Medicine, as well as a presentation titled Prediction of Acute Care Utilization for Patients with Hematologic Malignancies, provided at the American Society of Clinical Oncology Quality Care Symposium in San Diego. Since September 2016, the ORI has expanded its contributions to research, education and clinical service through SMH's Integrated Behavioral Health/Cardiac program - an initiative that integrates psychological services for patients of SMH's Heart Transplant and Mechanical Circulatory Support units, including pre-surgical psychological candidacy assessments as well as psychological testing, consultation, and ongoing treatment. The program provides opportunities for ongoing outcomes research, including the contribution of publications and presentations to support the broader health and research communities in the psychosocial management of heart failure patients. These research opportunities are extended to advanced graduate students in clinical psychology through yearlong practicum training experiences. In FY 2019, this innovative program fostered the continued implementation of three ongoing heart failure studies, and as of October 2019, has enabled the creation and funding of a new full-time psychologist staff position. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows and mentors to change and improve clinical practice and patient care through identifying a care problem, developing a plan to solve it and incorporating this new knowledge into practice. The EBPI is part of the Consortium for Nursing Excellence, San Diego, which promotes the use of evidence-based practices in the nursing community. The consortium is a partnership between Sharp, Rady Children's Hospital - San Diego, UC San Diego Health, U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, Kaiser Permanente, Elizabeth Hospice, PLNU, SDSU, APU and USD. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom, and structured mentorship throughout the program. EBPI fellows and mentors partner with one another through a variety of learning strategies. Mentors facilitate and support fellows as they navigate the hospital system and implement the processes of evidence-based practice change. Mentors also assist fellows in working collaboratively with key hospital leadership personnel. In FY 2019, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared their 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: spinal cord injury protocols to improve discharge preparedness; patient communication boards as a bedside handoff tool; music therapy to reduce anxiety in breastfeeding mothers; changes in checking gastric residuals in tube fed babies for quicker full feeds; immunization protocols in liver pre-transplant patients; and development and education on a new evidence-based program for increased patient mobility. Volunteer Service Sharp Lends a Hand In FY 2019, 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 ot”

“Promises2Kids provides current and former foster youth in SDC with the tools, opportunities and guidance they need to grow into healthy, happy and successful adults. In November and December, nearly 30 SLAH volunteers supported the organization's annual Holiday Gift Drive by wrapping gift collection bins, assisting with inventory, and sorting and preparing gifts to distribute to foster youth. The Ssubi is Hope Greening for Good project collects discarded but safe and usable supplies from U.S. hospitals and distributes them to clinics around the world that have little or no medical resources. In addition to providing life-changing and life-saving services to people in underserved countries, the project has protected the environment by keeping more than one million pounds (lbs.) of medical surplus out of local landfills. At two events in July and August, more than 15 SLAH volunteers joined the Greening for Good project to evaluate, sort, label and prepare medical materials for shipment. The Special Olympics Southern California - San Diego County program offers free, year-round sports training and competition for children and adults with intellectual disabilities. In May, 20 SLAH volunteers supported the 2019 Annual Spring Games at Carlsbad High School. Volunteers served as timers and scorekeepers during the bocce competition, cheered on the athletes and participated in the awards ceremonies. In addition to building homes in partnership with local people in need, San Diego Habitat for Humanity operates three ReStore retail centers with a wide variety of new or gently used building materials and home furnishings for public purchase. The ReStore centers provide affordable merchandise to customers while helping fund the construction of Habitat for Humanity homes throughout SDC. At eight events in November, January, March and May, 35 volunteers organized donated items and took inventory of stock for the Kearny Mesa and National City ReStore retail centers. 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. During eight days in May and June, approximately 60 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, pharmaceutical services were provided by six Sharp-affiliated pharmacists and licensed pharmacy technicians. More than 750 veterans were served through the 2019 Stand Down for Homeless Veterans events. The Life Rolls On Foundation is dedicated to improving the quality of life for people living with various disabilities. 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, more than 85 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. The Surfrider Foundation is dedicated to the protection and enjoyment of the world's oceans, waves and beaches through a powerful activist network. Since 2017, the Surfrider Foundation has helped remove more than 31,000 lbs. of trash from local beaches. Data collected at these events is used to determine the primary local sources of pollution, and create education and policies to prevent trash from ever reaching the beach. In August, 20 SLAH volunteers participated in a beach cleanup event at Belmont Park in Mission Bay where they helped pick up trash and complete data sheets detailing what they collected. In November 2018, nearly 15 SLAH volunteers joined I Love a Clean San Diego for Storm Drain Stenciling Day. Volunteers met at Mountain View Community Center to stencil a pollution prevention message above neighborhood storm drains educating the public that no pollutants or trash should g”

“For nearly two weeks in November, the Woolsey and Hill Fires burned nearly 100,000 acres of land in Los Angeles and Ventura counties, destroying more than 1,600 structures and forcing almost 300,000 evacuations. A response effort by the American Red Cross drew volunteers and other local organizations to bring meals, shelter, supplies and health care to affected community members. One Sharp volunteer worked more than 160 hours as the only nurse at an American Red Cross shelter in Malibu. In December, a Sharp nurse participated in a medical mission to Santo Domingo, Dominican Republic through CardioStart International - a global volunteer organization that brings specialized cardiac care teams to underserved regions. The team, which consisted of cardiac surgeons, cardiologists, perfusionists (health care professionals who operate heart-lung machines during surgery), nurses, respiratory therapists and a specialized ultrasound technician, performed surgery on five children with congenital heart defects as well as provided advanced cardiac education to help local medical teams improve surgical outcomes and patient care. Venture to Heal Medical Missions is a local nonprofit organization founded by a Sharp nurse that coordinates trips to Vietnam and the Philippines to provide health care, supplies and education to thousands of people in underserved, rural communities. For two weeks in January, the nurse and a fellow Sharp pharmacist as well as other San Diego nurses, physician assistants, emergency medical technicians and lay volunteers convened at a rural clinic in the Philippines that had recently been impacted by a typhoon. The team provided acute management of skin, soft tissue and upper respiratory tract infections, as well as treatment for metabolic disorders such as diabetes and hypertension, to more than 1,300 people. In March, a Sharp nurse volunteered in Quito, Ecuador as part of a medical mission trip with Timmy Global Health, a nonprofit organization that expands access to health care by directly supporting community-based project sites. More than 470 local patients were served by the medical team which included one doctor, three nurses and 19 students. The medical team treated and assisted patients with parasitic infections, general pain, vision loss, hypertension, dry or irritated eyes and gastritis - an inflammation of the protective lining of the stomach. Also in March, a Sharp employee accompanied a team of students, nurses, physical therapists, occupational therapists and doctors on a medical mission to Ecuador sponsored by Franciscan University of Steubenville. With a mission to care for the whole person, the team provided medical treatment for acute diseases, as well as education on how to care for and prevent future complications. In April 2019, a Sharp nurse participated in a surgical service trip facilitated by Helps International, a community of volunteers dedicated to bringing agricultural and community development, education and health care to rural Guatemala. The Sharp nurse spent 10 days working on the eye surgery team alongside various other medical professionals to perform oculoplastic (reconstructive procedures involving the orbit, eyelids, tear ducts and face), strabismus (crossed eyes) and cataract surgeries. Another Sharp nurse accompanied a team of 25 medical professionals to the impoverished, indigenous community of Patzun, Guatemala through Friends With Purpose - a nonprofit organization dedicated to providing medical care and community development in underserved communities around the world. The team consisted of surgeons, physician's assistants, operating room technicians, nurses and autoclave technicians. For eight days in May, the volunteers provided surgical services to patients, many of whom had never received medical care. In July 2019, Next Generation Mission partnered with Legacy Church San Diego and a Jamaican youth organization to provide help, entertainment and hope on a mission servin”

“Sharp offers a systemwide Junior Volunteer Program for high school students interested in giving back to their communities and exploring future health care careers. The program requires a high grade point average and a long-term commitment of at least 100 hours. The Junior Volunteer Program supports workforce development by introducing students to careers in health care, including clinical and ancillary support services. The junior volunteers enhance patient-centered care through hospitality, such as greeting and escorting patients and families, answering questions, and creating a welcoming and relaxing environment for guests. Through volunteering in the gift shops and thrift store, students learn about merchandising, fundraising and retail sales. At the inpatient units, they are exposed to clinical experiences that provide a glimpse into potential future careers. Junior volunteers also have the opportunity to help raise funds for hospital programs and provide clerical support to hospital departments. In FY 2019, nearly 530 high school students contributed more than 54,800 hours to the Junior Volunteer Program. This included 90 junior volunteers who provided more than 5,660 hours of service at SMH and SMBHWN; more than 270 junior volunteers who dedicated more than 17,620 hours of service at SCVMC; and nearly 280 junior volunteers who contributed more than 33,700 hours of service at SGH. In addition, Sharp's various entity boards include volunteers who provide program oversight, administration and decision-making regarding the organization's financial resources. In FY 2019, more than 120 volunteers contributed time to Sharp's boards. Sharp employees also donate time as volunteers for the Sharp organization, including service on the Board of Directors of San Diego Imaging - Chula Vista, Sharp and Children's MRI, Grossmont Imaging LLC Board, and Sharp and UC San Diego Health's Joint Venture, which oversees the operations of their joint Liver Transplantation and Bone Marrow Transplant Programs. Lastly, in September, SGH presented on the successful impact of volunteer-led events on employee engagement to volunteer program managers and leaders, community partners, and hospital professionals at the AHA's Association for Health Care Volunteer Resources Professionals Annual Conference & Exposition. Held at the Hyatt Regency in Dallas, Texas, the conference theme was Educate, Empower and Inspire, which included education on the principles of volunteer administration in a health care institution, volunteer recruitment, volunteer programs and service, the effects of health care service delivery system redesign on the volunteer sector, and retail operations. At the same conference, the SGH Volunteer Auxiliary's Thrift Korral Resale Boutique received the Retail Excellence Program Award - recognition of a retail shop in a health care setting that has achieved exemplary results, and has demonstrated substantial benefit to the recipients, the health care organization, the community and the volunteers providing the service. The following section describes the achievements of various Sharp volunteer programs in FY 2019. 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 are essential to the hospice team - they provide significant relief to those near the end of life and their families and caregivers, as well as valuable clerical and community support activities for the hospice organization. Sharp HospiceCare trained 36 new volunteers in FY 2019. Volunteers completed an extensive 24-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their volunteer activities. Volunteers provided a variety of nonmedical services at patient homes, SNF and hospitals, and Sharp HospiceCare's LakeView, ParkView and BonitaView”

“The Cushman Wellness Center Community Health Library and SMH Volunteer Department continued to offer the Health Information Ambassador program in FY 2019. Serving SMH, the SMH Rehabilitation Center and SMBHWN's perinatal special care unit, the program brings the library's services directly to patients and family members, which both helps to improve their health literacy and empower them to become involved in their own health care. Through the program, hospital volunteers are specially trained to become Health Information Ambassadors who are responsible for bringing diagnosis-related resources to patients and family members upon request. The consumer health librarian receives these requests, then uses reputable health websites to gather consumer-oriented information for the Health Information Ambassadors to return to the patient or their family members. Following their hospital stay, patients and families are invited to access an online database of reliable health information as well as to keep in touch with the library to ensure ongoing receipt of quality health information at home. Throughout the year, the Health Information Ambassadors visited more than 2,400 patient rooms and filled nearly 875 information requests. In addition, to address the vast number of Americans demonstrating basic or below health literacy, the consumer health librarian continued to provide a pamphlet titled Health Literacy 101 as a resource for the Health Information Ambassadors as they communicate with patients about their diagnosis. The pamphlet emphasizes the importance of verbally explaining a patient's diagnosis to them and describes a protocol to help improve their understanding of their medical information. Established in 2007, the Arts for Healing program at SMMC uses art and music to reduce feelings of fear, stress, pain and isolation among patients facing significant medical challenges and their loved ones. The program brings a variety of activities to patients at their bedside - including painting, beading, creative writing, card-making, seasonal crafts, scrapbooking, quilting, music and drumming - to improve emotional and spiritual health and promote a faster recovery. The program also engages visitors and members of the community during hospital and community events. Funded completely by donations, Arts for Healing is led by Sharp's Spiritual Care and Education Department and is implemented with help from licensed music and art therapists as well as a team of trained volunteers. 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 SMBHWN's NICU to promote the development of premature babies. At SMV and SMC, Arts for Healing offers several art and music therapy groups, including those for adolescents and adults receiving treatment for substance use, mood and anxiety disorders, as well as older adults receiving treatment for dementia or depression. In collaboration with SMMC's social workers and palliative care nurses, in FY 2019, Arts for Healing facilitated the donation of 50 handcrafted blankets and quilts for patients receiving end-of-life care at SMH. 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. In FY 2019, Arts for Healing cultivated a partnership with the San”

“The SGH Engineering Department continued to provide 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 landscaping team grows, cuts, bundles and delivers colorful bouquets to patient rooms as well as offers single-stem roses in a small bud vase to passers-by. Each week during FY 2019, the team delivered three vases of flowers along with an inspirational quote, as well as at least six vases during peak flower season and upon additional requests. In addition, nearly 40 vases of flowers were delivered to new mothers staying in the hospital on Mother's Day. This Bud's for You also supports the SGH Senior Resource Center and Meals on Wheels partnership by providing floral centerpieces for fundraising events benefitting seniors in SDC's east region, as well as offering roses for SGH's annual patient remembrance service. Now in its ninth year, the program has become a natural part of the landscape team's day - an act that is simply part of what they do to enhance the experience of hospital visitors and community members. The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors who appear to need encouragement, cheer or get well wishes, as well as to recognize patient birthdays, anniversaries and other special moments. The engineers quickly assemble and deliver a bouquet of balloons, ribbon, a Sodexo stuffed bear or football, and a chocolate pastry created by SGH and Sodexo chefs. In FY 2019, the team assembled up to four Cheers Bouquets per month, including bouquets for more than 40 new fathers on Father's Day weekend. In collaboration with Christie's Place - a nonprofit organization that supports women, children and families affected by human immunodeficiency virus or AIDS - since 2014, SGH nurses have engaged employees throughout the hospital in an annual backpack drive to prepare children and teens for academic success. Team members from a variety of departments help assemble backpacks with school supplies and personal notes wishing the students all the best for the coming school year. Each year, the team distributes more than 160 backpacks to youth during a back-to-school party at Balboa Park. 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. Using primarily their personal resources, as well as support from occasional fundraisers, hospital staff purchase special holiday gifts for the families, including grocery gift cards, clothing, toiletries, household items, movie tickets, bicycles, children's toys and a holiday meal. During the 2018 holiday season, Santa's Korner served more than 120 individuals from 36 families. All Ways Green Initiative Sharp has a long-standing dedication to minimizing adverse environmental impacts by creating and promoting healthy, green practices for employees, physicians and patients. Through education, outreach and collaboration with San Diego's earth-friendly businesses, Sharp works to identify best practices in sustainability, and implement and reduce the costs of these initiatives. Sharp's Environmental Policy guides the identification and implementation of green practices within the health care system, while its All Ways Green initiative fosters a culture of environmental responsibility throughout the organization and the San Diego community. Sharp's systemwide All Ways Green Committee spearheads 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”

“In 2017, Sharp installed new software on 10 air conditioning units in the data center at its corporate office, resulting in more efficient cooling and a 16% decrease in power usage. In addition, new virtual environments replaced more than 150 devices in the data center, further reducing power and cooling needs for the building. In 2018, Sharp opened the new Copley building which houses administrative space for SRSMG, as well as the complex, consolidated Sharp HealthCare Laboratory that services the entire Sharp system. To reduce the Copley building's CO2 emissions, Sharp restored the original fuel cell that came with the building upon purchase, making it the first Sharp location to use fuel cell energy. A fuel cell uses the chemical energy of hydrogen or another fuel to produce clean and efficient electricity, which could help reduce the Copley building's CO2 emissions by more than 90% while self-generating over 3 million kWh of electricity per year. In 2019, fluorescent light bulbs were replaced with high-performance light-emitting diode (LED) bulbs at multiple Sharp sites as part of a systemwide LED lighting retrofit project. The new LED lighting is projected to decrease energy usage by 55%. It is also rated to meet and exceed the requirements established by California's Title 24 Building Energy Efficiency Standards and the federal Occupational Safety and Health Administration. Since implementation, retrofits have been completed at SRSMC, SCVMC, SMMC, SCHHC and Sharp's system offices. Also in 2019, a set-point temperature (an agreed upon temperature that a building will meet) project was completed throughout Sharp's facilities in order to standardize, optimize, maintain, and enforce temperature and lighting schedules during occupied and unoccupied hours. Research indicates that increasing cooling temperature set-points and decreasing heating temperature set-points by two degrees Fahrenheit decreases energy use by approximately 1% and 5%, respectively. In January 2020, Sharp will open the new Ocean View Tower on the SCVMC campus which has been designed to meet the organization's sustainability goals. The Ocean View Tower will be approximately 12% more efficient than Cal-Green requirements (California's mandatory green building standards code) and is projected to reduce annual CO2 emissions by nearly 250,000 lbs. compared to buildings of similar square footage. This will be achieved through the installation of high-efficiency boilers, the use of more efficient heating, ventilation and air-conditioning systems (HVAC) in non-patient care areas, and the use of LED lighting during the approximately three-year construction process. In addition, the installation of a cool roof (a roof designed to reflect more sunlight and absorb less heat than a standard roof) on the Ocean View Tower will further reduce energy consumption. 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% of similar buildings nationwide without sacrifices in comfort or quality. According to the EPA, buildings that qualify for ES certification typically use 35% 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 earned the ES certification in 2019. SCHHC previously earned ES certification in 2007, each year from 2010 to 2013, and in 2017 and 2018. SCVMC previously earned ES certification from 2009 to 2011, as well as in 2013 and from 2015 to 2018. In addition, the SRSMC Downtown office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, making it one of the first medical office buildings of its ki”

“* Sharp donated more than 146,000 lbs. of computer equipment in place of utilizing e-waste disposal. * Sharp diverted more than 84,000 lbs. of plastic and cardboard from the landfill through the use of reusable sharps containers. * Sharp has significantly reduced paper waste through electronic bill pay, cloud-based document storage, and office supply reuse and repurpose programs. * SRSMC Sorrento Mesa and Mira Mesa locations stopped purchasing cups and paper goods for breakrooms and encourages staff to bring their own reusable containers to minimize waste. * Sharp continued to participate in San Diego County's Hazmat Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC. Sharp was named the 2017 Outstanding Recycling Program by CRRA for its innovative waste minimization initiatives. In addition, the City of San Diego's Environmental Services Department named Sharp as one of the Recyclers of the Year in its 2016 Waste Reduction and Recycling Awards Program. Table 5: Sharp HealthCare Waste Diversion - FY 2019 Sharp HealthCare Entity Total Waste Per Year (lbs.) Diverted Waste Per Year (lbs.) Percent Diverted Sharp Chula Vista Medical Center 2,704,702 613,897 22.7% Sharp Coronado Hospital and Healthcare Center 1,550,841 348,539 22.5% Sharp Grossmont Hospital 4,644,954 731,831 15.8% Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns 6,327,171 1,477,862 23.4% Sharp Mesa Vista Hospital 613,948 177,186 28.9% Sharp Rees-Stealy Medical Centers 1,838,897 333,916 18.2% System Offices 1,840,544 658,632 35.8% Total Sharp HealthCare 19,521,057 4,341,863 22.2% Table 6: Waste Minimization Efforts by Sharp HealthCare Entity Waste Minimization Project Establish Waste Diversion Baseline: SCHHC SCVMC SGH System Offices SHP SMH/ SMBHWN SMV/ SMC SRSMG 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 Waste Minimization Project: SCHHC SCVMC SGH System Offices SHP SMH/ SMBHWN SMV/ SMC SRSMG 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's commitment to sustainable food practices began more than eight years ago with a strategy to increase the selection of nutritious, organic and sustainable food items at each of its facilities. In collaboration with Sodexo - its food service partner - Sharp remains an innovator and early adopter of a variety of sustainable and healthy food practices that enhance the health of patients, employees, the community and the environment. Sharp's Food and Nutrition Best Health Committee supports these efforts by promoting food sustainability awareness throughout the health care system and within the greater San Diego community. Sharp's Mindful food program is a key component of the organization's effort to increase the consumption of healthy foods in its cafeterias while reducing”

“Sharp is an active member of San Diego's Nutrition in Healthcare Leadership Team. The group of more than a dozen SDC hospitals and health care systems collaborates to ensure that all food and beverages served by the county's hospitals are healthy, fresh, affordable, and produced in a manner that supports the local economy, environment and community. In addition, Sharp continues to participate in Practice Greenhealth's Healthier Food Challenge. Through the program, Sharp commits to reducing its purchase of animal protein and increasing its purchase of locally grown food and sustainable animal proteins (grass-fed, antibiotic- and hormone-free beef and cage-free chicken). In FY 2019, Sharp reduced animal protein purchases by almost 32%, and increased sustainable animal protein purchases by more than 60%, compared to FY 2014. As a recipient of the 2018 EMIES UnWasted Food award, Sharp was recognized by the San Diego Food System Alliance for its collaboration as an innovator and early adopter of food waste prevention and recovery programs. The award is designed to honor the 1996 Federal Bill Emerson Good Samaritan Food Donation Act, which encourages food donation to nonprofit organizations by protecting donors from liability. Sharp previously earned this award in 2016. Sharp and Sodexo remain committed to food sustainability efforts that improve both individual and environmental health. Sharp's sustainable food initiatives are outlined in Table 7. Table 7: Sustainable Food Projects by Sharp HealthCare Entity Sustainable Food Project 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: SCHHC 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 CO2 emissions generated by the organization and its employees. Sharp's Commuter Solutions Subcommittee develops innovative and accessible programs and marketing campaigns to educate employees on the benefits of ride sharing and other environmentally friendly modes of transportation. Sharp's ongoing efforts to promote alternative commuter choices in the workplace have led to its recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 to 2019. Sharp replaced high 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), helping to reduce carbon emissions and dependence on petroleum by supporting the creation of a national EVC infrastructure. As part of the nationwide Electric Vehicle Project, Sharp has installed EVCs at its corporate office location, Copley building, SCVMC, SMMC and some SRSMC sites. Sharp will continue to expand EVCs at its other entities. Sharp encourages employees to participate in alternative commuting methods such as public transit, carpooling, vanpooling, biking, walking and telecommuting. Employees are encouraged to participate in SANDAG's iCommute program, which provides ride-sharing matches based on a commuter's work schedule, departure location and destination. In addition, Sharp has 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 becoming stranded at work. Sharp employees can also purchase discounted monthly bus passes. Employees can monitor the cost and carbon savings from their alternative commuting methods by logging their miles in an internal tracking tool on Sharp's intranet site. Sharp provides bi”

“Sharp is an active member of San Diego's Nutrition in Healthcare Leadership Team. The group of more than a dozen SDC hospitals and health care systems collaborates to ensure that all food and beverages served by the county's hospitals are healthy, fresh, affordable, and produced in a manner that supports the local economy, environment and community. In addition, Sharp continues to participate in Practice Greenhealth's Healthier Food Challenge. Through the program, Sharp commits to reducing its purchase of animal protein and increasing its purchase of locally grown food and sustainable animal proteins (grass-fed, antibiotic- and hormone-free beef and cage-free chicken). In FY 2019, Sharp reduced animal protein purchases by almost 32%, and increased sustainable animal protein purchases by more than 60%, compared to FY 2014. As a recipient of the 2018 EMIES UnWasted Food award, Sharp was recognized by the San Diego Food System Alliance for its collaboration as an innovator and early adopter of food waste prevention and recovery programs. The award is designed to honor the 1996 Federal Bill Emerson Good Samaritan Food Donation Act, which encourages food donation to nonprofit organizations by protecting donors from liability. Sharp previously earned this award in 2016. Sharp and Sodexo remain committed to food sustainability efforts that improve both individual and environmental health. Sharp's sustainable food initiatives are outlined in Table 7. Table 7: Sustainable Food Projects by Sharp HealthCare Entity Sustainable Food Project 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: SCHHC 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 CO2 emissions generated by the organization and its employees. Sharp's Commuter Solutions Subcommittee develops innovative and accessible programs and marketing campaigns to educate employees on the benefits of ride sharing and other environmentally friendly modes of transportation. Sharp's ongoing efforts to promote alternative commuter choices in the workplace have led to its recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 to 2019. Sharp replaced high 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), helping to reduce carbon emissions and dependence on petroleum by supporting the creation of a national EVC infrastructure. As part of the nationwide Electric Vehicle Project, Sharp has installed EVCs at its corporate office location, Copley building, SCVMC, SMMC and some SRSMC sites. Sharp will continue to expand EVCs at its other entities. Sharp encourages employees to participate in alternative commuting methods such as public transit, carpooling, vanpooling, biking, walking and telecommuting. Employees are encouraged to participate in SANDAG's iCommute program, which provides ride-sharing matches based on a commuter's work schedule, departure location and destination. In addition, Sharp has 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 becoming stranded at work. Sharp employees can also purchase discounted monthly bus passes. Employees can monitor the cost and carbon savings from their alternative commuting methods by logging their miles in an internal tracking tool on Sharp's intranet site. Sharp provides bi”

“Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. In FY 2019, Sharp provided disaster preparedness education to staff, community members and community health professionals, as well as collaborated with numerous state and local organizations to prepare the community for a potential emergency or disaster. Sharp's disaster preparedness team offered several training programs to first responders and community health care providers throughout SDC. This included a standardized, on-scene federal emergency management training for hospital leaders titled National Incident Management System/Incident Command System/Hospital Incident Command System (HICS) as well as a training focused specifically on HICS, an incident management system that can be used by hospitals to manage threats, planned events or emergencies. A training course was also offered on the WebEOC (Web Emergency Operations Center) crisis information management system, which provides real-time information sharing between health care systems and outside agencies during a disaster. In addition, in June Sharp's disaster leadership provided education about personal disaster preparedness at the County of San Diego's Vital Aging 2019 event at the San Diego Convention Center. In FY 2019, 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. Sharp's disaster leadership also participates in the County of San Diego Healthcare Disaster Coalition - a multi-agency group of representatives who assist the county in improving mitigation, preparedness, response and recovery activities during emergencies and disasters. As part of this coalition, in FY 2019, Sharp's disaster leadership led a subcommittee to review hospital emergency food and water supply planning and identify tools and best practices to disseminate to community health care professionals. Further, Sharp's disaster leadership 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 DHHS Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes Sharp as well as SDC hospitals, health clinics and other health 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. In FY 2019, the Sharp HealthCare HPP Disaster Preparedness Partnership continued to network as well as provide resources, trainings and information to prepare non-hospital entities in SDC for a collaborative response to an emergency or disaster. Sharp supports the safety efforts of California and the City of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to an event requiring mass decontamination. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that will last up to 96 hours in the event of an interruption to the system's normal water supply. At any time, global endemic events have the potential to impact public health in SDC. Sharp continues to collaborate”

“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, SRSMG site and system office location has a dedicated Best Health committee that works to motivate team members to incorporate healthy habits into their lifestyles and support them on their journey to attain their personal health goals. Team members are encouraged to participate in a variety of workplace health initiatives ranging from fitness challenges and weight management programs to health education and events. Sharp Best Health also offers an interactive, web-based health portal where employees can create a wellness plan and track their progress. Since 2013, Sharp Best Health has offered annual employee health screenings to raise individual awareness of important biometric health measures, educate team members on reducing the risk of related health issues, and encourage employees to track changes in their metrics over time. In FY 2019, nearly 9,000 employees received health screenings for blood pressure, cholesterol, body mass index, blood sugar and tobacco use. Post-screening resources and tools are available for Sharp employees and their family members. This includes free access to a health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management and managing the challenges of living with a chronic condition, such as diabetes, high blood pressure, asthma or arthritis. The AHA recommends walking 10,000 steps a day to promote overall health. To align with this goal, in FY 2019, Sharp Best Health introduced a new app-based program called Move More Rewards, which encourages team members to use digital activity monitors to track their steps, distance, calories burned, sleep patterns and more. By syncing statistics to computers or smartphones, these devices help inspire team members to achieve their personal fitness goals. Throughout the year, Sharp Best Health held both entity-specific and systemwide activity challenges to encourage team members to set personal goals and compete for prizes. During FY 2019, more than 2,300 participants across the Sharp system participated in Move More Rewards, walking an average of 8,900 steps per day. In addition, Sharp's acceptable footwear policy permits employees to wear walking shoes each day of the week at Sharp system offices to promote safety along with increased physical activity. Sharp Best Health participated in community health events throughout the year, including American Heart Month, Breast Cancer Awareness Month, National Nutrition Month, National Health and Fitness Month, National Fresh Fruits & Vegetables Month, National Safety Month, National Stress Management Month and National Walking Month. In addition, Sharp Best Health encouraged employees to hold walking meetings as a heart-healthy alternative to standard meetings. Sharp Best Health also partnered with the San Diego Humane Society to provide free animal-based stress relief events at select Sharp locations. The events provided valuable human interaction for sheltered dogs and puppies, while promoting stress relief and physical activity for Sharp employees. Sharp Best Health provided on-site health and fitness classes and workshops for employees throughout FY 2019. This included workshops led by registered dietitians (RDs) on topics such as engaging in and sustaining healthy eating habits, strategies for managing cravings, intuitive eating, calorie counting, and the impact of sleep, stress and aging on health. Sharp Best Health also offered recipe demonstrations to encourage healthy meal preparation at home. Educational programs also included classes on cultivating compassion for the self and others,”

“In 2019, Sharp continued its partnership with Farm Fresh to You to give Sharp employees discounted access to customizable boxes of organic, locally grown produce. 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. In FY 2019, Sharp Best Health partnered with First Class Vending to provide "micro markets" for Sharp sites experiencing challenges with access to healthy food, such as locations without cafe or cafeteria services, and those that lack healthy options for night shift staff. The new micro markets have increased the availability of healthy food, beverage and snack items for clinical teams regardless of where and when they work. WW (formerly Weight Watchers(r)) offers weight-loss services and products founded on a scientifically based approach to weight management that encourages healthy eating, increased physical activity and other healthy lifestyle behaviors. Sharp Best Health continued its partnership with WW to offer employees a subsidized membership rate to any WW 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 2019, approximately 510 Sharp employees were actively using WW. Since the program's inception in 2016, participating employees have lost an estimated 4,800 lbs. In addition to providing WW at work, during FY 2019, Sharp Best Health continued to partner 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 2019, 147 Sharp employees completed the New Weigh program. Nearly 1 in 6 community members face the threat of hunger every day in SDC. Each month, the Food Bank distributes food to approximately 350,000 children and families, active-duty military and fixed-income seniors living in poverty. For more than a decade, Sharp has used holiday food drives to support the Food Bank's tremendous efforts, and in recent years, Sharp Best Health has transformed these events into superfood drives. Throughout the 2018 holiday season, Sharp team members were encouraged to donate nutritious and sustaining superfoods, helping to ensure the accessibility of healthy food to San Diegans in need. Through the six-week holiday superfood drive, locations throughout the Sharp system collected more than 3,900 lbs. of nutritious food for the Food Bank. In addition, Sharp team members donated nearly $3,200 through a Sharp Virtual Food Drive specifically benefiting the Food Bank. Combined, these donations and funds provided nearly 16,000 healthy meals for San Diegans in need of assistance with putting food on the table during the holidays. Section 2 Executive Summary Being an exceptional community citizen means being an ambassador for fellow community members and our environment. It's about making a difference in the lives of others and for further generations to come. - Alison Fleury, Senior Vice President of Business Development, Sharp HealthCare This Executive Summary provides an overview of community benefit planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefit Plan and Report, and a summary of community benefit programs and services provided by Sharp in fiscal year (FY) 2019 (October 1, 2018, through September 30, 2019). In addition, the summary reports the economic value of community benefit provided by Sharp, according to the framework specifically identified in Senate Bill 697”

“* 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 2019 (Note 1) In FY 2019, Sharp provided a total of $462,155,993 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 - FY 2019 - Estimated FY 2019 Unreimbursed Costs by SB 697 Category and by Programs and Services Included in SB 697 Medical Care Services: Shortfall in Medi-Cal (Note 2) - $114,640,309 Shortfall in Medicare (Note 2) - $287,489,453 Shortfall in CMS (Note 2) - $7,847,426 Shortfall in CHAMPVA/TRICARE (Note 2) -$10,680,124 Shortfall in Workers' Compensation - $34,161 Charity Care (Note 3) - $23,858,025 Bad Debt (Note 3) - $6,515,480 Other Benefits for Vulnerable Populations (Note 4): Patient transportation and other assistance for the vulnerable - $3,430,960 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 5) - $1,844,731 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals (Note 5) - $5,815,324 TOTAL - $462,155,993 TABLE 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 - 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 4 - "Vulnerable populations" means any population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal, Medicare, California Children's Services Program, or county indigent programs. https://oshpd.ca.gov/ml/v1/resources/document?rs:path=/Data-And-Reports/Documents/Submit/Hospital-Community-Benefit-Plans/SB697-Report-to-the-Legislature-Community-Benefit.pdf. Note 5 - 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 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 supplemental revenues totaling $189.8 million and quality assurance fees and pledges totaling $100.8 million in FY 2019. The net FY 2019 impact of the program totaling $89.0 million reduced the amount of unreimbursed medical care service for the Medi-Cal population. This reimbursement helped offset prior years' unreimbursed medical care services, however the additional funds recorded in FY 2019 understate the true unreimbursed medical care ser”

“One of the more recent ways in which Sharp is assisting the community through its community benefit is providing real data about health in the community. Community organizations can use this easily accessed, local data to augment their ability to buttress their applications for funding and otherwise help them fulfill their missions. Through this type of mutual reinforcement, efforts to improve the health of our community multiply exponentially. 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. Sharp utilizes its CHNA findings 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. This section describes Sharp's most recent CHNA process and findings, which were completed in September 2019. Sharp HealthCare 2019 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 hospital data and the perspectives of community health leaders and residents in order to identify and prioritize health needs for residents across the county, with a special focus on community members facing inequities. Further, the process seeks to highlight community health needs that Sharp hospitals could impact through programs, services and collaboration. For the 2019 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 (SDSU). The complete HASD&IC 2019 CHNA is available for public viewing and download at https://hasdic.org/2019-chna/. The methodology and findings of the collaborative HASD&IC 2019 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs, thus, both CHNA processes are described throughout this section. The HASD&IC 2019 CHNA was implemented and managed by a standing CHNA Committee comprised of representatives from seven hospitals and health systems: * Kaiser Foundation Hospital - San Diego * Palomar Health * Rady Children's Hospital - San Diego * Scripps Health (Chair) * Sharp HealthCare (Vice Chair) * Tri-City Medical Center * UC San Diego Health To develop its individual hospital CHNAs, Sharp analyzed its own hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients, providers and community members served by Sharp. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2019 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 2019 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2019 CHNAs for each Sharp hospital help inform current and future community benefit programs, services and partnerships, particularly for community members who face inequities. This section describes the general methodology employed for Sharp's 2019 CHNAs, including applicable”

“Data from national and state-wide data sets were analyzed including SDC mortality and morbidity data, and data related to SDOH. In addition, Kaiser Permanente consolidated data from several national and state-wide data sets related to a variety of health conditions and SDOH in SDC, and conducted a comprehensive statistical analysis to identify those SDOH that were most predictive of negative health outcomes. Kaiser Permanente then created a web-based data platform (chna.org/kp) to post these analyses for use in the CHNA. In addition, Sharp inpatient and emergency department data, as well as Sharp Cancer Registry Data were analyzed for Sharp's 2019 CHNAs into the Sharp 2019 CHNA analyses. Community Engagement HASD&IC 2019 CHNA community engagement activities included focus groups, key informant interviews, and an online survey designed for stakeholders from every region of SDC, all age groups, and numerous racial and ethnic groups. Collaboration with the County of San Diego Health & Human Services Agency, Public Health Services was vital to this process. A total of 579 individuals participated in the 2019 CHNA: 138 community residents and 441 leaders and experts. In addition, Sharp contracted separately with the IPH at SDSU to conduct multiple community engagement activities to collect input specifically from Sharp providers as well as from patients and community members served by Sharp hospitals. This input focused on behavioral health, cancer, diabetes, maternal and prenatal care, aging concerns (formerly termed senior health), and the needs of patients and community members facing inequities. These additional efforts included focus groups and key informant interviews involving 50 Sharp providers and 14 patients/community members. Further, IPH created case studies with the intent of representing a "typical" patient experience within Sharp. The case studies focused specifically on breast cancer and high-risk pregnancy. Lastly, the Sharp 2019 CHNA community engagement process included a robust online survey conducted through the Sharp Insight Community. The Sharp Insight Community is a private, online environment for Sharp patients and their families, community members, Sharp employees and Sharp-affiliated physicians. The 2019 CHNA Sharp Insight Community online survey sought to obtain feedback on the top health and social needs faced by SDC community members, as well as assess their awareness of community outreach programs offered by Sharp. The online survey also gave participants the opportunity to provide specific suggestions for Sharp to improve community health and well-being. A total of 380 community members completed the online survey. Prioritization The CHNA Committee collectively reviewed the quantitative and qualitative data and findings. Several criteria were applied to the data to determine which health conditions were of the highest priority in SDC. These criteria included: the severity of the need; the magnitude/scale of the need; disparities or inequities; and change over time. Those health conditions and SDOH that met the largest number of criteria were then selected as top priority community health needs. As the HASD&IC 2019 CHNA process included robust representation from the communities served by Sharp, this prioritization process was replicated for Sharp's 2019 CHNAs. Findings In addition, an underlying theme of stigma and the barriers it creates arose across 2019 CHNA community engagement activities. For instance, stigma impacts the way in which people access needed services that address SDOH, which consequentially impacts their ability to maintain and manage health conditions. These same findings were supported through both the quantitative analyses and community engagement activities conducted specifically as part of Sharp's 2019 CHNA process. In addition, Maternal and Prenatal Care, including High-Risk Pregnancy, was also identified as a community health need during Sharp's 2019 CHNA process. Community A”

“* Reports on activities conducted in the prior fiscal year (FY) - FY 2019 Report of Activities * Develops a plan for the upcoming FY, including specific steps to be undertaken - FY 2020 Plan * Reports and categorizes the economic value of community benefit provided in FY 2019, according to the framework specifically identified in Senate Bill 697 * Reviews and approves a community benefit plan * Distributes the Community Benefit Plan and Report Executive Summary to members of the Sharp Board of Directors and each of the Sharp hospital boards of directors * Share the Community Benefit Plan and Report process and findings through presentations across Sharp, including to management, entity boards and committees, and others upon request * Implement community benefit activities identified for the upcoming FY Ongoing Commitment to Collaboration Underscoring Sharp's ongoing commitment to collaboration in order to address community health priorities and improve the health of San Diegans, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, Association for Community Health Improvement, statewide California Hospital Association, HASD&IC, and a variety of local collaboratives including but not limited to the San Diego Hunger Coalition, the San Diego Regional Chamber of Commerce, 2-1-1 and the Community Information Exchange at 2-1-1. Section 4 Sharp Metropolitan Medical Campus The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Mary Birch Hospital for Women & Newborns, Sharp Memorial Hospital, Sharp Memorial Outpatient Pavilion, Sharp Mesa Vista Hospital and Sharp McDonald Center. Fiscal Year (FY) 2019 Community Benefit Program Highlights SMMC provided a total of $202,492,501 in community benefit in fiscal year FY 2019. See Table 36 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697), for the distribution of SMMC's community benefit among those categories. Table 36: Economic Value of Community Benefit Provided Sharp Metropolitan Medical Campus - FY 2019 by SB 697 Category, Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal (Note 1) - $47,740,531 Shortfall in Medicare (Note 1) - $123,080,208 Shortfall in County Medical Services (CMS) (Note 1) - $7,565,768 Shortfall in CHAMPVA/TRICARE (Note 1) - $5,668,478 Shortfall in Workers' Compensation - $19,140 Charity Care (Note 2) - $9,706,327 Bad Debt (Note 2) - $4,088,478 Other Benefits for Vulnerable Populations (Note 3): Patient transportation and other assistance for the vulnerable - $1,609,550 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 - $918,971 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (Note 4) - $2,095,050 TOTAL - $202,492,501 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 - "Vulnerable populations" means any population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal, Medicare, California Children's Services Program, or county indigent programs. https://oshpd.ca.gov/ml/v1/resources/document?rs:path=/Data-And-Reports/Documents/Submit/Hospital-Community-Benefit-Plans/SB697-Report-to-the-Legislature-Community”

“* Other Benefits for the Broader Community included health education and information on a variety of maternal and prenatal care topics, support groups, participation in community health fairs and events, and collaboration with local schools to promote interest in health care careers. SMBHWN staff actively participated in community boards, committees and other civic organizations, such as the American Heart Association (AHA), Council of Women's and Infants' Specialty Hospitals (CWISH), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), Perinatal Social Work Cluster, March of Dimes and the National Institute for Children's Health Quality (NICHQ) Best Fed Beginnings Learning Collaborative. See Appendix A for a listing of Sharp's involvement in community organizations in FY 2019. The category also included costs associated with planning and operating community benefit programs, such as community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training for health care professionals, student and intern supervision, and generalizable health-related research projects that were made available to the broader health care community. Definition of Community SMBHWN is located at 3003 Health Center Drive in San Diego, ZIP code 92123. As a specialty hospital, SMBHWN serves all of San Diego County (SDC); however, the primary communities served by the hospital include the City of San Diego, Chula Vista, the east region and the north inland communities surrounding Rancho Bernardo. See Appendix B for a map of community and region boundaries. For Sharp Memorial Hospital's (SMH's) 2019 CHNA process (which included the processes and findings addressing needs identified for communities served by SMBHWN), the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify communities with greater health disparity within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States (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 SMBHWN with especially high need include, but are not limited to, Southeast San Diego, East San Diego, City Heights, Linda Vista and Downtown San Diego. Description of Community Health In 2019, there were 585,707 women ages 18 to 44 residing in SDC, representing 17.5% of the population. Between 2019 and 2024, it is anticipated that the number of women of childbearing age in SDC will decline by 0.4%. In 2017, 13.3% of the SDC population reported living below 100% of the federal poverty level (FPL). The county's unemployment rate was 6.8% and 5.0% of households received Supplemental Security Income (SSI). According to data from the San Diego Hunger Coalition, 1 in 7, or 14% of SDC's population experienced food insecurity in 2017. An additional 1 in 5 San Diegans were food secure but relied on supplemental nutrition assistance to support their food budget. In 2017, 7.2% of households in SDC participated in Supplemental Nutrition Assistance Program (SNAP) benefits, while 19.9% of the population lived at or below 138% FPL and were eligible for the program. Please refer to Table 38 for SNAP participation and eligibility in SDC. Table 38: Food Stamps/SNAP Benefit Participation and Eligibility Estimates for SDC, 2017 Food Stamps/SNAP Benefits: Households - 7.2% Families with Children - 6.9% Eligibility by FPL: Population =130% FPL - 18.5% Population =138% FPL - 19.9% Population 139% - 350% FPL - 32.2% In SDC in 2017, 94.6% of children ages 0 to 18, 82.7% of young adults ages 19 to 25, 84.0% of adults ages 26 to 44, and 89.1% of adults ages 45 to 64 had health insurance. Health insurance coverage for each age group was lower t”

“LBW Infants: Central - 6.9% East - 6.1% North Central - 6.8 North Coastal - 5.9% North Inland - 6.4% South - 6.8% Infant Mortality: Central - 4.0% East - 3.3% North Central - 4.3% North Coastal - 3.0% North Inland - 2.3% South - 4.7% For additional demographic and health data for communities served by SMBHWN, please refer to the SMH 2019 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SMBHWN: * Incorporates community priorities and community relations into its strategic plan and develops service line-specific goals * Estimates an annual budget for community programs and services based on community needs, the previous years' experience and current funding levels * Participates in programs and workgroups to review and implement services that improve the health status and emotional well-being of women and infants Priority Community Needs Addressed in Community Benefit Report - SMH 2019 Community Health Needs Assessment SMH completed its most recent CHNA in September 2019. SMH's 2019 CHNA was significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2019 CHNA process and findings. Please refer to Section 3: Community Benefit Planning Process for a detailed description of Sharp's 2019 CHNA process and findings. In accordance with federal regulations, the SMH 2019 CHNA also includes needs identified for communities served by SMBHWN, as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). In addition, this year SMH completed its most current implementation strategy - a description of programs designed to address the priority health needs identified in the 2019 CHNA. Again, in alignment with federal regulations, the SMH 2019 implementation strategy includes programs and services provided by SMBHWN. The SMH 2019 CHNA and implementation strategy are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SMH 2019 CHNA, the following priority health needs were identified for the communities served by SMH and SMBHWN (listed in alphabetical order): * Access to Health Care * Aging Concerns * Behavioral Health (including Substance Use) * Cancer * Chronic Health Conditions (e.g., Cardiovascular Disease, Diabetes and Obesity) * Community and Social Support * Economic Security * Education * Homelessness and Housing Instability * Maternal and Prenatal Care, including High-Risk Pregnancy * Unintentional Injury and Violence SMBHWN is a specialty hospital providing care for expectant mothers and newborns as well as women's services. Therefore, in alignment with these identified needs, the following pages detail programs that specifically address maternal and prenatal care, including high-risk pregnancy. This section also describes programs that address access to health care, community and social support, economic security and education. Please refer to Section 1 (Overview): Patient Access to Care Programs for additional entity and systemwide programs designed to address access to health care. As a specialty hospital, SMBHWN lacks the resources to comprehensively address the elements of community education and support for the remaining identified needs. Consequently, the programs and services that address these health issues are provided through SMH. Please refer to Section 6 of this report for details on those programs. The community education and support elements of behavioral health (including substance use) 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 substance use services in SDC. Please refer to Section 6 of this report for deta”

“* According to the Centers for Disease Control and Prevention (CDC), health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, obesity and heart disease, smoking during pregnancy and high blood pressure (CDC, 2018). * According to 2018 CHIS data, 24.7% of women ages 18 to 65 years in SDC were obese (Body Mass Index > 30), lower than the state of California overall (27.2%). * According to the CDC, being overweight increases the risk of pregnancy complications, including preeclampsia, gestational diabetes, stillbirth and cesarean delivery (CDC, 2018). * Factors associated with preterm birth include maternal age, race, socioeconomic status, tobacco use, substance use, stress, prior preterm births, carrying more than one baby, and infection (CDC, 2019). * According to March of Dimes data, the rate of preterm births - the largest contributor to infant death in the U.S. - increased for the fourth consecutive year in 2018 to 10.0%. Racial disparities related to early labor persist: 11.3% of American Indian/Alaska Native babies and 13.6% of black babies were born preterm. Black women are 49% more likely to deliver preterm compared to women of all other racial/ethnic groups (March of Dimes, 2019). * In 2018, the average societal cost of a preterm birth in California was $75,000, including medical care for premature children, maternal delivery costs, early intervention services, special education services and lost productivity (March of Dimes, 2019). * Strategies for reducing preterm birth and maternal death include protecting comprehensive health care coverage for moms and children; providing women with affordable, quality public health insurance programs; extending Medicaid coverage to postpartum women; expanding group prenatal care; researching the causes of maternal death; addressing racial disparities in health outcomes for moms and babies; removing barriers to care in underserved communities; and investing in public health promotion programs that focus on moms and babies (March of Dimes, 2019). Objectives * Develop, coordinate and provide educational programs for the community on maternal and prenatal care topics, including preterm labor and births * Provide education as needed to community members who are susceptible to high-risk pregnancy * Educate community members about available hospital resources through participation in community events * Identify and disseminate evidence-based best practices to improve outcomes of at-risk newborns through the Sharp Mary Birch Neonatal Research Institute (NRI) FY 2019 Report of Activities In FY 2019, SMBHWN conducted a variety of efforts to support healthy pregnancies for expectant mothers, including teenagers and other high-risk populations, and improve outcomes for at-risk newborns. The hospital offered a free, monthly Preterm Birth Prevention class, which taught approximately 80 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 three sessions of the Preterm Birth Prevention class at community sites in SDC, including the Mission Valley Branch Library in April, the Valencia Park/Malcolm X Branch Library in June, and the Otay Mesa - Nestor Branch Library in September. In addition, in April, SMBHWN taught a free, four-class Child Birth Preparation series for community members at the North Park Branch Library. Additional prenatal education was offered throughout the year on the Sharp Metropolitan Medical Campus as well as at the Sharp Mary Birch Education Center in Carlsbad. New in FY 2019, this included six free Planning for Pregnancy events, which provided pre-pregnancy education to more than 100 community members. Topics included preparing for pregnancy, tips for conceiving, and becoming pregnant following a previous pregnancy loss, as well as when to see a speciali”

“The NRI has received funding support from personal donations as well as from various foundations and organizations, including Gerber Foundation, Thrasher Research Fund, Little Giraffe Foundation, Alexander and Eva Nemeth Foundation, Cushman Foundation, and Will Rogers Institute. In addition, the NRI has received four grants from the NIH, including most recently in July 2018 to support its leadership of an international, multi-hospital (including Sharp Grossmont Hospital) study on umbilical cord milking and its benefits to the long-term health of infants who need resuscitation at birth. This is the largest and most comprehensive study of its kind with the potential to improve how babies are cared for worldwide. In addition to its groundbreaking research, the NRI works closely with SMBHWN's Nemeth NICU Follow-Up Clinic, which provides neurodevelopmental assessments, testing and early interventions to promote optimal growth and success for babies born preterm or with other conditions that place them at risk for developmental delay. The services and interventions provided by the Nemeth NICU Follow-Up Clinic help validate the results of the NRI's innovative research studies. FY 2020 Plan SMBHWN will do the following: * Continue to offer monthly Preterm Birth Prevention classes at the hospital * Provide at least one Preterm Birth Prevention class at a community site in SDC * Continue to provide fundraising support for March of Dimes * Provide education and outreach at community health fairs and events * Continue the work of the NRI to identify and disseminate evidence-based best practices for newborn care to the health care community Identified Community Need: Maternal Care - Meeting the Needs of New Mothers and their Families Rationale references the findings of the SMH 2019 CHNA, HASD&IC 2019 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SMH 2019 CHNA identified maternal and prenatal care, including high-risk pregnancy, as one of the priority health needs affecting members of the communities served by SMH. * As part of Sharp's 2019 CHNAs, facilitated discussions with SMBHWN case managers, social workers and a nurse educator identified the following health conditions that impact Sharp's maternal and prenatal patients: diabetes; preterm pregnancies; short interval pregnancies; substance use; and mood disorders, including postpartum depression and anxiety. Discussions also identified the following SDOH affecting their patients: limited access to behavioral health services, even for the insured; lack of access to transportation; and economic stress related to childcare and maternity leave. * Participants also identified the following strategies to improve women's health: build awareness of the importance of preconception and prenatal care; establish more options for home health care for postpartum women; increase lactation consulting and services; increase availability of translation services; create an interdisciplinary care team; provide inpatient and outpatient behavioral health services; and improve communication between physicians and pharmacists. * Further, participants in the Sharp Insight Community survey conducted during Sharp's 2019 CHNAs provided the following suggestions specific to maternal and infant care to improve community health: offer fun preventative care opportunities, such as outdoor activities to promote healthy diets or mother/mother-to-be informational events with a socializing component; provide prenatal care and delivery for mothers who cannot afford it; and advocate for improved access for the underserved, such as insurance coverage, particularly for stigmatized services like behavioral or sexual health. * In 2017, SDC ranked 18th out of 50 California counties for in-hospital exclusive breastfeeding at 78.9% (California Women, Infants, Children (WIC) Association and University of California (UC) Davis Human Lactation Center, A Policy Update on California”

“FY 2019 Report of Activities In November 2015, SMBHWN received Baby-Friendly USA Designation through the Baby-Friendly Hospital Initiative - a global program launched by the World Health Organization and the United Nations Children's Fund to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding. The hospital earned the five-year designation through participation in the NICHQ Best Fed Beginnings Learning Collaborative, supported by the CDC, and through implementation of the 10 Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. SMBHWN received this designation in partnership with First 5 San Diego, which provided grant funding needed to fulfill the staff training hours required for the designation. The Baby-Friendly USA Designation requires specific competency training for registered nurses (RNs) who work with both mothers and babies. At the close of FY 2019, 97% of the RNs currently employed by SMBHWN had completed this training who were required to do so, while the remaining 3% were in progress with their training. In total, more than 430 SMBHWN RNs have completed Baby-Friendly USA competency training from the time the hospital was designated. Since SMBHWN started its Baby-Friendly journey in 2011, the rate of exclusive breastfeeding at discharge has increased from a baseline average of 47% to a current rate of 60%. In FY 2019, SMBHWN served nearly 1,700 new mothers through a free breastfeeding support group. Facilitated by an experienced lactation educator, the group was offered three times per week to teach participants techniques to improve breastfeeding and allow participants to share their personal breastfeeding joys and challenges. SMBHWN continued to offer the Baby and Me Time support group to ensure new parents safely transition from giving birth at the hospital to returning home. Understanding that it can be difficult to retain information received at the hospital, this free, weekly support group provides valuable resources to help new parents adjust once leaving the hospital. The group provides an opportunity to share the experiences and responsibilities of new parenthood as well as develop new friendships. All parents from the community are invited to participate in Baby and Me Time, which includes a mix of working moms, military families with a parent stationed overseas, single parents and stay-at-home parents. Serving more than 180 new parents in FY 2019, this unique group has evolved into a community-centered place of support during an often-challenging time. SMBHWN provided specialized education and support during the year through free postpartum support groups led by licensed clinical social workers. A weekly group provided emotional support to mothers in the community with babies of newborn age up to 12 months who were dealing with feelings of anxiety or depression related to the challenges associated with new motherhood. A range of topics were addressed during the groups, including feelings of isolation, parenting struggles, postpartum mood disorders, how to seek support, professional referrals, and coping strategies. Understanding that postpartum depression and anxiety can also affect fathers, SMBHWN offered a monthly postpartum support group for couples. Together, the hospital's postpartum support groups engaged nearly 470 parents in FY 2019. Throughout the year, SMBHWN offered a variety of educational classes for new mothers and their families covering numerous aspects of postpartum care, including infant sleep patterns and strategies, infant massage, mom and baby yoga and Pilates, and the body's recovery process following pregnancy and birth. Additionally, SMBHWN staff devoted approximately 500 hours to daily Family Home Care classes that provided critical information and support to nearly 4,000 new mothers and family members. Topics included car seat safety, sudden infant dea”

“SDOH affecting members of the communities served by SMH. * According to the results of the Sharp Insight Community survey conducted during Sharp's 2019 CHNAs, 31% of respondents ranked education, including access, health literacy, workforce development and economic mobility, among the top five SDOH with the greatest impact on their community. * According to participants in a focus group conducted during the HASD&IC 2019 CHNA, when residents are unable to achieve higher levels of education, individual and community health are impacted in the following ways: limited or low-wage employment opportunities for those with low educational attainment; constant stress related to housing or food among families who are not economically secure, which contributes to poor health; and limited career mobility in low-wage jobs, creating little potential for promotions or higher wages. * The San Diego Workforce Partnership (SDWP) reported that, in 2018, there were 157,756 people employed in the health care sector in SDC, accounting for 9% of all jobs countywide (SDWP, 2019). * According to a 2017 report from the SDWP titled San Diego's Priority Sectors: An Update on Labor Force and Training Needs, the health care industry in SDC experienced net employment growth of 40.4% between 2006 and 2016 - considerably higher than the growth rate in the state of California (27%) and the nation (21%) (SDWP, 2017). * The report also found that health care employers identified RNs, physicians and surgeons, and health technologists and technicians as the most difficult positions to fill. The most frequently cited reasons for hiring difficulties were lack of experience, small applicant pools and insufficient non-technical skills (SDWP, 2017). * According to 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, the health care industry is facing significant changes due to uncertainty related to legislation and technology, as well as the growing demand for services to support California's aging population (SDWP, 2017). * Total employment in California is projected to grow 10.7% between 2016 and 2026, reflecting an increase of 1.9 million jobs statewide over the decade. The health care and social assistance sector is expected to be the fastest growing industry in California, with 24.9% growth anticipated (California Employment Development Department, 2018). * In its Employment Projections - 2018-2028 report, the U.S. Bureau of Labor Statistics (BLS) projects that health care support occupations and health care practitioners/ technical occupations will contribute about 30% of all new jobs and account for 18 of the 30 fastest growing occupations. Increased demand for health care services for an aging population and people with chronic conditions will drive much of the expected employment growth (BLS, 2019). * As of 2018, SDC was one of 28 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Registered Nurse Shortage Areas Update, 2019). * The U.S. Department of Health and Human Services Bureau of Health Workforce (BHW) projects that the demand for RNs in California will increase 71% by 2030 if current levels of health care are maintained. The report projects that California will need to hire an additional 26,270 nurses to meet the demand (BHW, 2018). * According to forecasting performed by the Healthforce Center at University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12% to 17% 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 exis”

“In FY 2019, SMBHWN continued to share its expertise in women's and newborn care with local and national health professionals. In September, a nurse from SMBHWN represented the hospital at the annual CWISH Conference in Denver, Colorado through participation on a panel discussion focused on best practices in leadership rounding. In addition, SMBHWN team members participated in organizations such as March of Dimes, AWHONN, Perinatal Social Work Cluster and the NICHQ Best Fed Beginnings Learning Collaborative. FY 2020 Plan SMBHWN will do the following: * Continue to collaborate with colleges and universities on internships, externships and other professional training opportunities for students * Continue to participate in the HSHMC program * Provide a career development fair for current and future nurses * Continue to participate in local and national collaboratives and share specialty expertise at professional conferences SMBHWN Program and Service Highlights * Breastmilk donor program in collaboration with the Mother's Milk Bank * Classes, events and physician referral through 1-800-82-SHARP * Cord blood banking (private and public) * Doula program * FollowMyHealth(r), a secure online patient website that gives patients convenient, 24-hour access to their personal health information * Gynecologic oncology * High-risk pregnancy care (Perinatal Special Care Unit) * Hearing screening program (inpatient and outpatient) * Lactation services (inpatient and outpatient) * Labor and delivery * Level III NICU * Maternal Infant Services Unit * Nemeth NICU Follow-Up Clinic * NRI * Newborn critical congenital heart disease screenings * New Beginnings Boutique & Gift Shop * Obstetrical and women's triage services * Postpartum support groups * Pregnancy, childbirth and parent education programs * Prenatal/Antenatal Diagnostic Center * Sharp Baby mobile pregnancy tracking app and education platform * Spiritual care services, including Arts for Healing program * Women's and infants' pathology services * Women's surgery, including minimally invasive robotic gynecology surgery Section 6 Sharp Memorial Hospital To me, being an exceptional community citizen means that no one is a stranger. Each patient receives equal care, respect, and consideration because our community thrives when we flourish together. - Tim Smith, Chief Executive Officer, Sharp Memorial Hospital Fiscal Year (FY) 2019 Community Benefit Program Highlights Sharp Memorial Hospital (SMH) provided a total of $173,689,097 in community benefit in FY 2019. See Table 44 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697), for the distribution of SMH's community benefit among those categories. Table 44: Economic Value of Community Benefit Provided, Sharp Memorial Hospital - FY 2019 by SB 697 Category, Estimated FY 2019 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal, financial support for on-site workers to process Medi-Cal eligibility forms (Note 1) - $44,673,377 Shortfall in Medicare (Note 1) - $110,728,941 Shortfall in County Medical Services (CMS) (Note 1) - $189,544 Shortfall in CHAMPVA/TRICARE (Note 1) - $2,927,795 Charity Care (Note 2) - $8,293,817 Bad Debt (Note 2) - $3,496,283 Other Benefits for Vulnerable Populations (Note 3): Patient transportation, Project HELP and other assistance for the vulnerable (Note 4) - $1,119,056 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 4) - $586,135 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals (Note 4) - $1,674,149 TOTAL - $173,689,097 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 syst”

“Definition of Community * SMH is located at 7901 Frost Street in San Diego, ZIP code 92123. * Sharp Memorial Outpatient Pavilion (OPP) is located at 3075 Health Center Drive in San Diego, ZIP code 92123. * Clairemont Senior Health Center is located at 4320 Genesee Ave., Suite 104 in San Diego, ZIP code 92117 * Downtown Senior Health Center is located at 956 10th Ave. in San Diego, ZIP code 92101 SMH serves all of San Diego County (SDC); however, the primary communities served by the hospital include the City of San Diego, Chula Vista, SDC's east region and the North Inland communities surrounding Rancho Bernardo. See Appendix B for a map of community and region boundaries in SDC. For SMH's 2019 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify communities with greater health disparity within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States (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 SMH with especially high need include, but are not limited to, East San Diego, City Heights, Linda Vista, the College Area and Downtown San Diego. Description of Community Health In 2019, there were 504,267 residents ages 65 and older in SDC, representing 15.1% of the population. Between 2019 and 2024, it is anticipated that SDC's senior population will grow by 22.4%. In 2017, 13.3% of the SDC population reported living below 100% of the federal poverty level (FPL). The county's unemployment rate was 6.8% and 5.0% of households received Supplemental Security Income. According to data from the San Diego Hunger Coalition, 1 in 7, or 14% of SDC's population experienced food insecurity in 2017. An additional 1 in 5 San Diegans were food secure but relied on supplemental nutrition assistance to support their food budget. In 2017, 7.2% of households in SDC participated in Supplemental Nutrition Assistance Program (SNAP) benefits, while 19.9% of the population lived at or below 138% FPL and were eligible for the program. Please refer to Table 45 for SNAP participation and eligibility in SDC. Table 45: Food Stamps/SNAP Benefit Participation and Eligibility Estimates for SDC, 2017 Food Stamps/SNAP Benefits: Households - 7.2% Families with Children - 6.9% Eligibility by FPL: Population =130% FPL - 18.5% Population =138% FPL - 19.9% Population 139% - 350% FPL - 32.2% In SDC in 2017, 94.6% of children ages 0 to 18, 82.7% of young adults ages 19 to 25, 84.0% of adults ages 26 to 44, 89.1% of adults ages 45 to 64, and 98.5% 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% health insurance coverage for all individuals under age 65. See Table 46 for health insurance coverage in SDC in 2017. Table 46: Health Insurance Coverage in SDC, 2017 Children 0 to 18 years: Rate - 94.6% HP2020 Target - 100% Young adults 19 to 25 years: Rate - 82.7% HP2020 Target - 100% Adults 26 to 44 years: Rate - 84.0% HP2020 Target - 100% Adults 45 to 64 years: Rate - 89.1% HP2020 Target - 100% Seniors 65+ years: Rate - 98.5% HP2020 Target - 100% According to the California Health Interview Survey (CHIS), in 2018, 28.9% of SDC's population was covered by Medi-Cal. See Table 47 for details. Table 47: Medi-Cal (Medicaid) Coverage in SDC, 2018 Covered by Medi-Cal - 28.9% Not covered by Medi-Cal - 71.1% CHIS data also revealed that 10.3% of individuals in SDC did not have a usual place to go when sick or in need of health advice (see Table 48). Table 48: Regular Source of Medical Care in SDC, 2018 Has a usual source of care: Rate - 89.7% HP2020 Target - 100% Has no usual source of care: Rate - 10.3% HP2020 Target - 0% Cancer and diseases o”

“The following pages detail SMH programs, activities and services that specifically address aging concerns, cancer, chronic health conditions, community and social support (these programs also help address access to health care, economic security and homelessness and housing instability), education and unintentional injury. Please refer to Section 1 (Overview): Patient Access to Care Programs for additional entity and systemwide programs designed to address access to health care. SMH does not have the resources to comprehensively address the identified need of behavioral health (including substance use). Consequently, this identified need is addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and substance use services in SDC. Please refer to Section 11 of this report for details on those programs. SMH and SMV are conveniently located on the Sharp Metropolitan Medical Campus (SMMC). The identified need of maternal and prenatal care, including high-risk pregnancy, is addressed at SMBHWN, a specialty hospital providing care for women, newborns and expectant mothers in SDC, also located on the SMMC campus. Please see Section 5 of this report for details on SMBHWN's services that address this identified community need. Obesity is addressed through general nutrition and exercise education and resources provided at SMH as well as programs that address a healthy lifestyle as part of care for heart disease, cancer, diabetes and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Group (SRSMG) clinics throughout SDC provide community members structured weight management and health education programs such as smoking cessation and stress management, long-term support for weight management and fat loss, and personalized weight-loss programs. For additional details on SMH programs that specifically address the needs identified in the 2019 CHNA, please refer to SMH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2019 Report of Activities conducted in support of the objective(s), and FY 2020 Plan. Identified Community Need: Diabetes Education, Prevention and Support Rationale references the findings of the SMH 2019 CHNA, HASD&IC 2019 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC and SMH 2019 CHNAs identified chronic conditions, including diabetes, as one of the priority health needs affecting members of the communities served by SMH. * Data analysis in the SMH 2019 CHNA revealed a higher volume of hospital discharges due to Type 2 diabetes in communities within SDC facing greater socioeconomic challenges. * According to data presented in the HASD&IC 2019 CHNA, rates of emergency department (ED) visits for diabetes in SDC increased 7.2% from 2014 to 2016, with the most significant increases in individuals ages 27 to 44 (13.9%) and those identified as black/African American (15.1%). * According to data presented in the SMH 2019 CHNA, in 2017, the top three ED and inpatient Type 2 diabetes diagnoses at SMH included Type 2 diabetes (uncomplicated), Type 2 diabetes with Chronic Kidney Disease, and Type 2 diabetes with hyperglycemia (high blood sugar). * According to the results of the Sharp Insight Community survey conducted during Sharp's 2019 CHNAs, 51.0% of respondents ranked diabetes (Types 1 and 2) among the top five health conditions with the greatest impact on overall community health in SDC. * Focus groups and key informant interviews conducted as part of the HASD&IC and SMH 2019 CHNAs identified numerous barriers to care for chronic conditions such as diabetes, including lack of access to healthy food; lack of transportati”

“FY 2019 Report of Activities The SMH Diabetes Education Program is recognized by the American Diabetes Association (ADA) for meeting national standards for excellence and quality in diabetes education covering blood sugar monitoring, medication and nutritional counseling as well as insulin pump and other device training. The program is led by certified diabetes educators who provide individuals and their support systems with the skills needed to successfully self-manage various conditions, including prediabetes, gestational diabetes (diabetes developed during pregnancy), and Type 1 and Type 2 diabetes. Small group and one-on-one education options are offered in English and Spanish. In FY 2019, the Sharp Diabetes Education Program (Sharp's systemwide diabetes program) offered diabetes education and support to approximately 1,000 attendees at the Sharp Women's Health Conference. This included diabetes risk assessments using the ADA's Diabetes Risk Test questionnaire as well as resources on the different types of diabetes; diabetes prevention; signs, symptoms and complications of diabetes; the connection between diabetes and CVD; nutrition and reading food labels; exercise; medication; and diabetes self-management. Also during the conference, a Sharp diabetes expert presented on the prevention and management of Type 2 diabetes, including helpful diets, physical activity and the power of lifestyle change. In addition, the Sharp Diabetes Education Program provided fundraising and team participation for the San Diego Heart & Stroke Walk at Balboa Park in September. The SMH Diabetes Education Program provided education and lectures to a variety of community groups in FY 2019. In November, the SMH Diabetes Education Program educated nearly 15 seniors on diabetes and the power of lifestyle change at the Peninsula Family YMCA in Point Loma. At Point Loma Nazarene University's (PLNU's) Festival of Health event, the SMH Diabetes Education Program provided health education in English and Spanish, as well as diabetes risk assessments using ADA's Diabetes Risk Test questionnaire to 20 community members. Through Sharp's partnership with the City of San Diego, the SMH Diabetes Education Program discussed exercise and diabetes as well as navigating the road to health with 10 community members at the Lopez Ridge Recreation Center in March. In addition, the SMH Diabetes Education Program presented on how to check blood sugar levels as well as the latest in diabetes medication and nutrition to more than 20 seniors at Balboa Park in April. Also in April, the SMH Diabetes Education Program educated 10 community members at OPP's Cushman Wellness Center on using a holistic approach to manage diabetes, diabetes risk factors and ways to reduce risk. The SMH Diabetes Education Program is actively involved with San Diego's renal health community. In FY 2019, the program collaborated with the Balboa Institute of Transplantation and the Sharp Kidney and Pancreas Transplant Program to provide ongoing diabetes education and support to more than 150 community members who are either anticipating or have undergone kidney transplant or have experienced kidney disease. In addition, the Sharp Diabetes Education Program continued to collaborate with Family Health Centers of San Diego (FHCSD) to provide education to patients with diabetes at multiple FHCSD sitesth el ything on SSI program?ilar to NICU navigators in next section.o vulnerable populatiosn? , including those in the central region of SDC, through the organization's Diabetes Management Care Coordination Project (DMCCP). Through DMCCP, Sharp's diabetes educators provide weekly group health and nutrition education, healthy cooking demonstrations, physical activity classes, and one-on-one support from a nurse practitioner to the clinics' diabetes patients. Further, project "graduates" offer peer support and education to current enrollees in both English and Spanish. The project monitors participants' physical”

“In November, the Sharp Diabetes Education Program hosted a diabetes conference for physicians, nurses, pharmacists, laboratorians, clinical and managerial leaders and other community health professionals interested in optimizing inpatient diabetes care. The conference provided 150 participants with specific tools and strategies for creating a culture that supports and encourages emerging therapeutic trends in glycemic management in a hospital setting. Topics included treating patients with Type 2 diabetes; cardiovascular risk for patients with Type 1 or Type 2 diabetes; new insulin products and their potential benefits; metabolism and weight loss in those using insulin; automated insulin infusion algorithms; and insulin pumps and continuous glucose monitoring. In addition, in FY 2019 the Sharp Diabetes Education Program provided diabetes education - including the different types of diabetes, diagnoses, current technology and medication, and careers in diabetes education - to more than 20 nurse practitioner students at San Diego State University (SDSU), as well as mentored two dietetic interns from the San Diego Women, Infants, and Children program. Lastly, the Sharp Diabetes Education Program presented on diabetes and exercise to approximately 10 students at the PLNU School of Nursing's Health Promotion Center at the Church of the Nazarene in Mid-City, as well as provided diabetes education to approximately 10 Azusa Pacific University (APU) nursing students. FY 2020 Plan The SMH and Sharp Diabetes Education Programs will do the following: * Provide community members with prediabetes and diabetes information at various community venues in the central and north central regions of SDC * Explore collaborations to assist and educate food insecure community members * Participate in Sharp's partnership with the City of San Diego to provide diabetes education and resources to residents in the city's nine districts * Explore additional opportunities to provide community-based diabetes education classes * Continue to collaborate with FHCSD to provide education and resources to their patients with diabetes * Continue to provide gestational diabetes services and resources to underserved pregnant and breastfeeding women, both at the hospital and in collaboration with community clinics * Participate in Tour de Cure - the ADA's signature fundraising event to fight diabetes - as well as the San Diego Heart & Stroke Walk * Maintain up-to-date resources to provide community members support with diabetes treatment and prevention, particularly foreign language and culturally appropriate resources for diverse populations * Continue to participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community * Conduct educational symposiums for health care professionals focused on improving outpatient and inpatient diabetes care * Continue to host a diabetes conference for health care professionals * Explore collaboration with SMH's Cardiac Rehab and Cardiac transplant teams to offer quarterly diabetes education to community members * Explore collaborations with community service organizations that focus on diabetes prevention and care * Partner with community physicians to help them improve patient outcomes using technology, including insulin pumps and blood glucose monitors Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SMH 2019 CHNA, HASD&IC 2019 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC and SMH 2019 CHNAs identified chronic conditions (including CVD and cerebrovascular diseases/stroke) as one of the priority health needs affecting members of the communities served by SMH. * According to data presented in the HASD&IC 2019 CHNA, rates of ED visits for stroke in SDC increased 11.0% from 2014 to 2016, with the most significant increases in”

“During Stroke Awareness Month in May, Sharp's systemwide stroke program participated in Stroke Awareness Day at the Padres, held at Petco Park. This annual event is organized by the San Diego County Stroke Consortium, the County of San Diego HHSA, the San Diego Padres and other key partners to promote stroke prevention, awareness and recovery, as well as 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 B.E. F.A.S.T. (Balance, Eyes, Face, Arms, Speech, Time) - an easy technique to detect and enhance responsiveness to a stroke. Giveaways were provided throughout the evening, while stroke education was displayed on the Jumbotron to the entire stadium of nearly 30,000 community members. In FY 2019, SMH participated in Sharp's partnership with the City of San Diego to provide stroke education and resources to residents in the city's nine districts. In March and July, three classes led by a stroke program nurse provided 50 community members with education on risk factors, treatment options, and preventing and recognizing the signs of a stroke. Lecture locations included Logan Heights Branch Library, Balboa Park Senior Lounge and Serra Mesa-Kearny Mesa Branch Library. In addition, in October, SMH provided more than 110 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 Community Presbyterian Church. At the event, approximately 25 attendees were screened according to their personal risk factors. The SMH Stroke Program also collaborated with the Sharp Grossmont Hospital (SGH) Senior Resource Center to provide stroke education and resources to seniors in February. Through this collaboration, the SMH Stroke Program and a Sharp-affiliated vascular neurologist delivered a presentation on emergency treatment for stroke and strategies to prevent a stroke, as well as provided stroke resources to approximately 30 community members at Point Loma Community Presbyterian Church in May. The SMH Stroke Program also conducted personal health interviews as well as blood pressure and pulse checks for 11 seniors at the event. The SMH Rehabilitation Center continued to provide meeting space for Young Enthusiastic Stroke Survivors (YESS), a free monthly support group for survivors of stroke and head injuries and their loved ones, as well as professionals and educators. Educational topics included brain function, coping skills, adjustment, disaster preparedness, driving, health and wellness, medications, stress management, family and intimacy, work and school re-entry, and support. More than 20 community members attended the YESS support group each month in FY 2019. In addition, SMH actively participated in the quarterly San Diego County Stroke Consortium, a collaborative effort with other SDC hospitals to improve stroke care and discuss issues impacting stroke care in SDC. SMH also continued its 14-year collaboration with the County of San Diego Emergency Medical Services (EMS) to provide data for the SDC stroke registry. FY 2020 Plan SMH Stroke Program will do the following: * Provided stroke screening and education at events in SDC, including those targeting seniors and high-risk adults * Continue to provide a community presentation on stroke education and prevention featuring a Sharp-affiliated physician * Provide education for individuals with identified stroke risk factors * Continue to participate in Stroke Awareness Day at the Padres * Continue to participate in Sharp's partnership with the City of San Diego to provide stroke education and resources to residents in the city's nine districts * Continue to offer stroke support groups through the SMH Rehabilitation Center * Continue to participate in the San Diego County Stroke Consortium * Continue to provide data to the SDC stroke registry Identified Comm”

“* According to the CDC, 2.8 million older adults are treated in the ED for falls every year. One in five falls causes a serious injury, such as broken bones or a head injury, and each fall doubles the chance of falling again. 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 2015, more than 84,400 San Diegans ages 55 and older were living with Alzheimer's disease and related dementias (ADRD), which accounted for 10.7% of this age group. Assuming current trends continue, by 2030, nearly 115,000 residents 55 years and older will be living with ADRD, representing a 36.5% increase from 2015 (Alzheimer's Disease and Related Dementias in San Diego County, 2018). * In 2017, 69.4% of the influenza hospitalizations and 75 of the 90 influenza deaths in SDC occurred among residents ages 65 and older. The age-adjusted rate of influenza death among this group was 16.2 per 100,000 population. * According to the California Department of Aging (CDA), in 2019, 11.1% of SDC residents ages 60 and older were considered low income, and 17.1% were eligible for Medi-Cal coverage. In addition, 17.5% of SDC seniors were identified as living alone (CDA, 2019). * According to research published in Health Affairs, an estimated 15 million family caregivers in the U.S. provide unpaid care for a loved one with dementia. Caregiver burden and fatigue can result in increased use of hospital and emergency services for dementia patients (Slaboda et al, 2018). * The same study identified the following as the biggest challenges facing family caregivers of individuals with dementia: dealing with memory loss and the disease's impact; handling the stress and emotional toll; having patience with their loved one; handling mood swings or behavior changes; and managing daily activities, including bathing, bathroom, dressing and meals (Slaboda et al, 2018). * 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 1 in 3 employed Millennial caregivers earns less than $30,000 per year (AARP, 2018). 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 2019 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 Centers' compassionate staff and volunteers provide personalized support and clear, accurate information regarding health education and screenings, community referrals and caregiver resources. In FY 2019, the SMH Senior Resource Center developed and mailed quarterly calendars of its programs and services to more than 3,300 households in San Diego, as well as distributed 2,700 Vials of Life, which are small vinyl sleeves that can be magnetically placed on a refrigerator to provide emergency personnel with critical medical information for seniors and people with disabilities. In FY 2019, the SMH Senior Resource Center provided approximately 30 free health education programs to more than 500 community seniors, caregivers and loved ones of the elderly. Programs were presented by experts from community organizations as well as Sharp professionals with expertise in clinical nutrition, exercise physiology, di”

“In October, the SMH Senior Resource Center participated in the San Diego Community Action Network's (SanDi-CAN's) End of Life Decisions: Planning Ahead...Learn How to Ensure Your Decision Will be Honored conference at Balboa Park. Nearly 50 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. In July, the SMH Senior Resource Center offered health, wellness and community resources to more than 100 community members at SanDi-CAN and South County Community Action Network's Interactive Technology and Health Fair at the Jackie Robinson YMCA. The event featured informational presentations, an interactive resource fair, health screenings and new technology. In September, the SMH Senior Resource Center provided senior resources to nearly 90 community members at the (SDCCOA's) Healthy Aging in a Changing World event, held at First United Methodist Church. Further, seniors, caregivers, individuals who are homeless or at risk of homelessness, individuals with chronic illnesses, and vulnerable adults with limited access to care, including those without transportation, were notified about flu vaccine events through activity calendars, collaborative outreach conducted by the flu clinic site, sharp.com, and paper and electronic newspaper notices. In FY 2019, the SMH Senior Resource Center and the Sharp Senior Health Centers sponsored five community seasonal flu clinics, serving more than 210 seniors and other vulnerable community members. Flu clinics were held at the Senior Health & Information 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 and Sharp Senior Health Centers provided Vials of Life, information on advance health care directives (advance directives) and depression, and activity calendars detailing upcoming blood pressure screenings, flu clinics and other community events and programs for seniors. In FY 2019, the Sharp Senior Health Centers collaborated with SMV to provide a physician-led presentation on medications and memory loss as well as two memory loss screenings, serving approximately 20 community members. The Sharp Senior Health Centers also collaborated with the SMH Senior Resource Center throughout the year to provide hearing screenings to more than 20 seniors. Throughout the year, the Sharp Senior Health Centers presented at Sharp's Aging in America events at multiple Sharp locations, including SMH, OPP, Sharp Coronado Hospital and Healthcare Center, SGH and Sharp Chula Vista Medical Center (SCVMC). Topics included signs and symptoms that an older adult may need help, aging statistics and available resources, and how to best manage care. More than 70 community providers, including office staff, managers, registered nurses (RNs) and licensed vocational nurses attended the events. Sharp Senior Health Centers are committed to connecting with underserved seniors in SDC through educational presentations and the provision of referrals to community resources and support services. Throughout FY 2019, referrals for housing, transportation, food, behavioral health, social services, senior centers and other community resources were provided to more than 1,000 community seniors at the San Diego Square Senior Apartments, Westminster Manor Apartment Homes, Potiker Family Senior Residence, and the Gary and Mary West Senior Wellness Center as part of a Sharp Speaker Series. Presentations at these sites included memory care; insurance; Medicare benefits (including drug plans and open enrollment); Medi-Cal; Vials of Life; Alzheimer's disease; dementia; depression; fall prevent”

“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), JFS, Caregiver Coalition, 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, Paradise Village, Peninsula Family YMCA, Point Loma/Hervey Library, San Diego Square, Clairemont Lutheran Church, St. Paul's PACE, St. Peter's by the Sea Lutheran Church, Downtown San Diego Silvercrest Residence and HICAP. In addition, the Sharp Senior Health Centers provided internships to four nurse practitioner students from various universities including SDSU, University of San Diego (USD) and APU in FY 2019. Further, a licensed clinical social worker (LCSW) with Sharp Senior Health Centers provided Sharp Health News (Sharp's online news center) with expert advice on when older adults may need help. FY 2020 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 community seniors and caregivers, including senior behavioral 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 3,300 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 vulnerable adults * Participate in community health fairs and conferences, including the SanDi-CAN end-of-life conference * In collaboration with the Caregiver Coalition, coordinate a conference dedicated to family caregiver issues * In collaboration with Sharp HospiceCare, host an aging conference for seniors in Point Loma * 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 depression, senior behavioral health, and loneliness and isolation * Continue to collaborate with Serving Seniors and SMV to provide memory 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 Speaker Series at the Gary and Mary West Senior Wellness Center * Explore opportunities to provide medication screenings by a pharmacist for vulnerable seniors * Expand programs offered to senior residences in the downtown area * Continue to collaborate with the Food Bank to provide quarterly Senior Nutrition & Wellness Classes at both Sharp Senior Health Center locations * Provide quarterly educational presentations to community seniors at Sharp Senior Health Center Clairemont and Potiker Family Senior Residence * Continue to serve lunch to community seniors at Serving Seniors * Explore educational opportunities with Paradise Village Retirement Community * Provide free education to new Medicare enrollees at various SDC locations, including Pacific Beach and North Park * Provide a presentation to community members in collaboration with Harmony Home Medical * Explore”

“* 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, 2018). * According to research published in the Internet Journal of Allied Health Sciences and Practice, approximately 80 million adults in the U.S. have limited health literacy. Limited health literacy is associated with poor health outcomes, including more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications properly; poorer ability to interpret drug labels and health messages; and poorer overall health status among the elderly, including higher mortality rates (McDonald & Shenkman, 2018). 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 2019 Report of Activities In FY 2019, the OPP and various departments at SMH reached more than 3,400 patients and community members through free health education classes and support groups. This included approximately 1,200 program hours booked on-site at the SMMC campus as well as several opportunities provided at community sites. On-site classes covered various aspects of health and wellness, including diabetes, cancer, integrative medicine topics (e.g., yoga, meditation, food as medicine), 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 only support group in SDC for women with mobility impairments - as well as the Sharp Players and Men's Spinal Cord Injury (SCI) support groups. Twenty-five individuals participated in the Sharp Players weekly support group in FY 2019, which uses music and drama to facilitate emotional healing and support for individuals with a range of conditions, including brain injury, SCI, spina bifida, cerebral palsy, post-encephalitis, multiple sclerosis, amputation, mental illness, blindness, cancer and stroke. Throughout the year, members performed for approximately 175 community members at St. Paul's Villa assisted living community, SDBIF, Merrill Gardens Senior Living and the Point Loma Community Presbyterian Church senior program. Further, the monthly Men's SCI support group offered guest speakers and special outings for its members in FY 2019, including a trip to a Padres game. Group members also offered their own peer support to recently injured patients at SMH. The group served approximately 75 meeting attendees in FY 2019 and included an additional 100 community members through an electronic resource and support network. As the official health and wellness partner of the City of San Diego, SMH hosted educational classes at sites within the SDC community. Classes included A Brief Introduction to Suicide Prevention, held at the North University Community Branch Library in September, as well as Barriers and Motivations to Exercise in Older”

“SMH also supported a variety of Sharp-sponsored community events in FY 2019. At the Sharp Senior Resource Centers' 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). In April, the employee safety team participated in Sharp's Drug Take Back, Document Shredding and E-Waste Event at SCVMC, which provided a safe and confidential opportunity for community members to dispose of unwanted prescription drugs, paperwork and electronics. In May, various hospital departments provided community members with a range of health education and screenings during the annual Sharp Women's Health Conference. Offerings included cancer-related education and resources; osteoporosis education and screenings; wellness services, including acupuncture, chair massage and body composition testing; sports medicine and physical therapy services, including musculoskeletal screenings, posture education and walking and footwear analysis; and obstructive sleep apnea assessments. Further, in August, SMH phlebotomists supported SMBHWN's efforts to collect breastmilk for infants in need during the 2019 Donor Breastmilk Drive. Team members drew blood from breast milk donors that would be shipped to the San Jose Mother's Milk Bank and screened for safety. FY 2020 Plan SMH will do the following: * Continue to offer educational classes at the SMMC on a variety of health and wellness topics for community members * As part of Sharp's wellness partnership with the City of San Diego, provide educational classes at community sites throughout SDC * 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 to inform the community of health education and screening opportunities * 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 2019 CHNA, HASD&IC 2019 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC and SMH 2019 CHNAs identified cancer as one of the priority health needs affecting members of the communities served by SMH. * According to data presented in the HASD&IC 2019 CHNA, cancer was the leading cause of death in SDC in 2016. * Focus groups conducted as part of the HASD&IC 2019 CHNA identified cancer as a condition that many members of the community fear, particularly brain, colon and breast cancers. Participants also described barriers to receiving cancer screenings and treatment, including stigma surrounding a cancer diagnosis; fear about immigration status, particularly for asylum seekers; financial burdens, even for those with health insurance; and practical issues such as transportation to medical appointments. * According to the results of the Sharp Insight Community survey conducted during Sharp's 2019 CHNAs, 67% of respondents ranked cancer among the top five health conditions with the greatest impact on overall community health in SDC. * As part of the SMH 2019 CHNA, focus groups comprised of Sharp cancer patient navigators and clinical social workers identified the following health conditions and SDOH related to cancer: chronic diseases such as asthma or heart disease, which are often connected to stress; care challenges associated with behaviora”

“FY 2019 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. The Cancer Centers of Sharp HealthCare (Cancer Centers of Sharp), which includes SMH, SGH and SCVMC, are 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 2019, the Laurel Amtower Cancer Institute at SMH reached hundreds of community members, patients and their loved ones through various support groups, educational classes, community events, and patient navigation and other support services. Free cancer support groups provided a safe environment for nearly 300 attendees to discuss their experience with cancer and learn coping strategies. Monthly groups were offered for friends and family members of cancer patients; patients and survivors of head and neck cancer; individuals living with a brain tumor or brain cancer and their family and caregivers; and young cancer patients (ages 20 through early 40s), including a group for those in cancer stages 0-3, and a group for young patients in advanced stages of the disease. In addition, bimonthly groups were available for individuals living with breast cancer and those with advanced cancer. The Laurel Amtower Cancer Institute led several free classes addressing the mental and emotional well-being of individuals impacted by cancer, serving approximately 350 attendees in FY 2019. This included the monthly Cancer and the Arts class, which provided an outlet to cope with cancer through creativity and art, as well as the weekly Relaxation Skills and Chair Yoga workshop, which taught physical and mental exercises to help release cancer-related stress. New in FY 2019, a class titled Cancer and Stress 101 was offered in April and June which provided information and practical tools to help those with cancer, cancer survivors and family members manage the stress that commonly accompanies a cancer diagnosis. In addition, cancer patients, survivors and caregivers attended free, monthly Lunch and Learn workshops designed to address the emotional aspects of cancer. This included a workshop for those newly diagnosed with cancer as well as a workshop for individuals undergoing or nearing the completion of treatment. Throughout the year, approximately 100 individuals attended classes designed to support one's nutritional needs during cancer. This included free, twice-monthly nutrition classes for attendees who were either currently receiving or recently finished treatment for breast cancer as well as their family and friends. Developed by a registered dietitian with certification in oncology nutrition, the classes provided education about nutrition and healthy eating both during and after breast cancer treatment, addressed diet- and nutrition-related questions and concerns unique to those with breast cancer, and shared current diet and physical activity guidelines and strategies to support positive behavior change. In January, May and September, the Laurel Amtower Cancer Institute led a similar free community class focused on nutrition before, during and after treatment for any type of cancer. The class provided cancer patients and their family and friends with basic nutrition guidelines, meal planning strategies and dietary recommendations to manage the side effects of treatment. In FY 2019, The Laurel Amtower Cancer Institute continued to provide free monthly educational classes on lymphedema - the swelling of a body part due to fluid accumulation from obstructed, impaired or absent lymphatic vessels. Led by a certified lymphedema therapist, the classes were open to anyone in the community with or at risk of developing lymphedema, as well as their caregivers and partners. Approximately 40 individuals attended the classes in FY 201”

“The Laurel Amtower Cancer Institute includes the Breast Health Center and the Neuro-Oncology Center, with designated 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 2019, the LCSWs provided free psychosocial counseling and support as well as referrals to community organizations to more than 3,000 patients and family members. Nurse navigators provided ongoing guidance for patients and families impacted by all cancer diagnoses, including breast, brain and spinal tumors, lymphomas and myeloma, melanoma, sarcoma, head and neck, lung, pancreas, stomach, bladder, colorectal, renal, prostate, testicular 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, National Cancer Institute, Breast Cancer Angels and the Cancer Project. Throughout the year, the Laurel Amtower Cancer Institute provided a dedicated oncology transport van to assist cancer patients in need of transportation to and from their treatment appointments during afternoon hours. More than 300 patient trips were provided in FY 2019. The Cancer Centers of Sharp 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 2019, the Cancer Centers of Sharp approached and evaluated 480 patients for participation in oncology clinical trials, of which were enrolled in cancer research studies. In FY 2019, clinical trials focused on multiple types of cancer, including but not limited to: brain, breast, colon, head and neck, spinal cord, lung, lymphoma, melanoma, ovarian and prostate. FY 2020 Plan The Laurel Amtower Cancer Institute at SMH will do the following: * Continue to provide classes on topics including nutrition, exercise, anxiety and stress management for patients and community members impacted by 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, head and neck cancers, advanced cancer, young cancer patients, and friends and family of cancer patients * Explore the provision of a support group focused on spirituality and cancer * Host a free community event to educate community members about breast health in recognition of Breast Cancer Awareness Month in October * Continue to provide cancer education and resources at community health fairs and events * Participate in oncology-related continuing education opportunities for community physicians and other health care professionals * Through philanthropic support, extend transportation services for cancer patients in need of assistance to and from treatment appointments * Continue to conduct clinical trials to discover cancer treatments and inform the broader health and research community * Continue to seek funding to support the Laurel Amtower Ca”

“* 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). * Traumatic injury is the leading cause of death among children, with many survivors enduring the consequences of brain injury and SCI. The physical, emotional, psychological and learning problems that affect injured children, along with the associated costs, make reducing traumatic injuries a high priority for health and safety advocates throughout the nation. Educational programs like ThinkFirst increase knowledge and awareness of the causes and risk factors of brain injury and SCI, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2019). Objectives * Offer an injury and violence prevention program for children, adolescents and young adults throughout SDC * Provide presentations and opportunities to Health and Science Pipeline Initiative (HASPI) high school students around injury and violence prevention and health care career readiness FY 2019 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. HASPI is a network of educators, community organizations and health care industry representatives who collaborate to increase awareness of health and medical career opportunities, improve science proficiency in schools and prepare students for future health care careers. With the partnership and financial support of HASPI, in FY 2019 ThinkFirst/Sharp on Survival provided injury prevention education to nearly 750 students from schools throughout SDC, including San Ysidro High School, Bayfront Charter High School, Castle Park High School, Mar Vista High School, San Diego High School of Science and Technology, e3 Civic High School, Rancho Buena Vista High School and Oceanside High School. Education was provided through classroom presentations, assemblies and off-site learning expos. HASPI school-site programs consisted of one- to two-hour classes that covered topics such as the modes of injury (i.e., automobile accidents, violence and sports/recreation), 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, 12 HASPI students from Sweetwater High School with an interest in pursuing careers in physical rehabilitation participated in a half-day, interactive tour of the SMH Rehabilitation Center. Students rotated through three stations that provided hands-on practice in adaptive dressing techniques, wheelchair mobility, and various memory and problem-solving activities used in therapy. The experience provided students with a better understanding of physical rehabilitation and the challenges that patients might face following an injury. In October, ThinkFirst/Sharp on Survival participated in the Walk & Roll Abilities Festival at the Marina View Park in Chula Vista. Organized by a former ThinkFirst/Sharp on Survival VIP, the annual event benefits the Gurmilan Foundation wh”

“* The report also found that health care employers identified RNs, physicians and surgeons, and health technologists and technicians as the most difficult positions to fill. The most frequently cited reasons for hiring difficulties were lack of experience, small applicant pools, and insufficient non-technical skills (SDWP, 2017). * According to 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, the health care industry is facing significant changes due to uncertainty related to legislation and technology, as well as the growing demand for services to support California's aging population (SDWP, 2017). * Total employment in California is projected to grow 10.7% between 2016 and 2026, reflecting an increase of 1.9 million jobs statewide over the decade. The health care and social assistance sector is expected to be the fastest growing industry in California, with 24.9% growth anticipated (California Employment Development Department (EDD), 2018). * In its Employment Projections - 2018-2028 report, the U.S. Bureau of Labor Statistics (BLS) projects that health care support occupations and health care practitioners/ technical occupations will contribute about 30% of all new jobs and account for 18 of the 30 fastest growing occupations. Increased demand for health care services for an aging population and people with chronic conditions will drive much of the expected employment growth (BLS, 2019). * As of 2018, SDC was one of 28 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Registered Nurse Shortage Areas Update, 2019). * The U.S. Department of Health and Human Services Bureau of Health Workforce (BHW) projects that the demand for RNs in California will increase 71% by 2030 if current levels of health care are maintained. The report projects that California will need to hire an additional 26,270 nurses to meet the demand (BHW, 2018). * According to forecasting performed by the Healthforce Center at University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12% to 17% 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). * According to a report from the California Health Care Foundation (CHCF) titled California Physician Supply: Headed for a Drought?, the total supply of active patient care physicians in California declined slightly between 2013 and 2015, a trend that appears to be driven by the aging of the physician workforce. In SDC, nearly a quarter of practicing physicians were ages 60 and older in 2015 (CHCF, 2018). * The same report found that 32% of California's active patient care physicians were primary care physicians. In SDC, there were 112.3 specialty physicians practicing per 100,000 residents in 2015, compared to 49.8 primary care physicians per 100,000 residents (CHCF, 2018). * According to a report from PolicyLink, a national research institute dedicated to advancing economic and social equity, building a diverse health care workforce in California - one that reflects the state's racial, ethnic and linguistic diversity - is a critical strategy for increasing access to culturally and linguistically appropriate services, eliminating racial and ethnic health inequities, improving the quality of care and reducing preventable costs (Building an Inclusive Health Workforce in California: A Statewide Policy Agenda, 2018). * A report by the California Future Health Workforce Commission (CFHWC) titled Meeting the Demand for H”

“In September, SMH collaborated with SMBHWN and SMV to provide the SMMC Nursing Career Development Fair. Held at the OPP, the annual event supports the professional development of students who are interested in pursuing a career in nursing as well as nurses within the community. The fair provided approximately 100 attendees with advice and coaching from professional nurses as well as information on financial aid and scholarships, clinical certifications, student loan forgiveness and medical library services. In addition, representatives from California and other state universities offered information about their nursing and allied health programs. SMH continued to participate in the Health Sciences High and Middle College (HSHMC) program to provide early professional development for high school students. During the school year, 51 students in ninth through 12th grade were supervised for approximately 11,000 hours between SMH and the OPP. Students shadowed staff in a variety of hospital departments, including radiology, laboratory, endoscopy, cardiac rehabilitation, case management, patient transport, administration, ED, pharmacy and the cafeteria. Students also learned about the hospital's commitment to person-centered care and the culture of a professional work environment. In addition to placement at SMH, seven HSHMC students devoted 1,500 hours to shadowing team members at SRSMG's San Diego facility located adjacent to SMMC. Sharp Rehab provided free professional development opportunities for community and Sharp professionals in FY 2019, including a Compassion Cultivation Training (CCT) course and Mindful Self-Compassion (MSC) course. Developed by the Center for Compassion and Altruism Research and Education at the Stanford University School of Medicine, CCT is a nine-week course designed to help professionals develop compassion for themselves and others. Through lectures, guided exercises and group discussions, CCT can improve communication, increase resilience to stress and enhance feelings of well-being. Designed by professionals at the University of Texas and Harvard Medical School - Cambridge Health Alliance, MSC is an eight-week course that teaches mindfulness, self-kindness and self-compassion skills to help health professionals recognize difficult situations and respond with greater stress resilience. In addition, Sharp Rehab led Compassion-Based Training: Promoting Well-Being and Preventing Burnout, a six-week course to help health professionals develop skills to cope with the challenging demands of today's health care environment. Approximately 30 health professionals received training through these courses in FY 2019. In FY 2019, SMH provided planning support and speakers for Sharp's annual Obesity Crisis Conference. Held in May at Liberty Station, the 2019 conference focused on practical approaches to the care of patients with obesity and attracted more than 200 community health professionals. Three SMH nurses provided expertise during the conference, including a presentation about current health and fitness apps, and participation in a panel on exercise and motivation. In addition, in September, an SMH team member helped moderate a panel on human trafficking for more than 300 community professionals - including law enforcement, social workers, behavioral health specialists, and other advocates against sexual assault - during the 8th annual SART (Sexual Assault Response Team) Summit Multi-Disciplinary Conference held at the Hyatt Regency Mission Bay Spa & Marina. 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 expertise in person-centered care upon request from various local, national and international hospitals, nonprofit organizations and universities. Gue”

“* According to a report from the 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. Although the number of adults with mental health coverage in California increased nearly 50% between 2012 and 2015 because of 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). * According to the same report, ED visits resulting in inpatient psychiatric admissions increased 30% from 2010 to 2015. More robust community behavioral health services for low-income and uninsured patients may decrease unnecessary ED use (CHCF, 2018). Objectives * Collaborate with community organizations to provide follow-up medical care, financial assistance, and psychiatric and social services to chronically homeless individuals * Assist economically disadvantaged individuals through transportation and pharmaceutical assistance FY 2019 Report of Activities SMH provides post-acute care facilitation for vulnerable patients, including individuals who experience homelessness or lack a safe home environment. Advocacy for safe discharge from the hospital is a top priority, regardless of funding. In FY 2019, SMH provided 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, SMH continued to participate in 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. 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. Each year the SMH Auxiliary provides approximately 200 new items of clothing to patients who lack usable clothing at discharge, including homeless individuals, trauma patients from the ED and any other patient who lacks clothing when leaving the hospital. The hospital may also provide uninsured patients with financial assistance for medication and medical equipment. In FY 2019, SMMC assisted economically disadvantaged individuals through the provision of approximately $105,000 in free medications and transportation through its Project HELP program. Further, Sharp's Patient Access Services team provides robust services to assist with access to care and health insurance coverage for patients at all Sharp hospitals, including patients of SMH. Please refer to Section 1 (Overview): Patient Access to Care Programs for more information on these programs and services. New in FY 2019, SMH joined Sharp's systemwide pilot partnership with 2-1-1 San Diego's CIE to better understand and address the SDOH that influence the health and well-being of their patients. Research continues to underscore that SDOH - the conditions where people live, learn, work and play - have a significant impact on the ability for community members to access care and maintain their health. SMH joined the CIE pilot partnership in order to provide more informed, holistic care to patients with SDOH needs, and to connect them directly to community resources specifically for those needs. More than 70 CIE community partners - including health care, food banks, housing and other social service agencies - use an integrated technology platform to support proactive, holistic, person-centered care. Shared community member records enable CIE partners to evaluate an individual's SDOH needs and current use of community programs and services, and to make direct referrals to critical, community-based resources. Beginning in fall 2019, SMH's case managers and social workers received training on CIE as a tool to s”

“* Summerfelt Endoscopy Center * Vision Laser Center, including ophthalmology, diagnostic and laser treatment Sharp Senior Health Center Downtown: * Community health education programs * Community health screening services * Primary and comprehensive physical and mental health care services for seniors Sharp Senior Health Center Clairemont: * Community health education programs * Community health screening services * Outpatient pulmonary clinic * Primary and comprehensive physical and mental health care services for seniors Section 7 Sharp Mesa Vista Hospital and Sharp McDonald Center Each time we provide a free lecture, meet with community partners or sit on a new committee sharing the stories of our patients and their path to recovery, not only do we give back but we receive a true benefit as well. Giving back to the larger community of San Diego is our responsibility. - Dara Schwartz, Clinical Program Developer, SMV Fiscal Year (FY) 2019 Community Benefit Program Highlights Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC) provided $22,926,238 in community benefit in FY 2019. See Table 50 for a summary of unreimbursed costs based on the categories specifically identified in Senate Bill 697 (SB 697) for the distribution of SMV and SMC's community benefit among those categories. Table 50: Economic Value of Community Benefit Provided, Sharp Mesa Vista Hospital and Sharp McDonald Center - FY 2019 by SB 697 Category, Estimated FY 2019 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal - $2,285,898 Shortfall in Medicare - $10,958,082 Shortfall in County Medical Services (CMS) - $7,376,224 Shortfall in CHAMPVA/TRICARE - $955,177 Shortfall in Workers' Compensation - $19,140 Charity Care - $669,437 Bad Debt - $(87,714) Other Benefits for Vulnerable Populations: Patient transportation and other assistance for the vulnerable - $451,050 Other Benefits for the Broader Community: Health education and information, support groups, participation in community events, meeting room space, donations of time to community organizations and cost of fundraising for community events - $119,155 Health Research, Education and Training Programs: Education and training programs for students, interns and health care professionals - $179,789 TOTAL -$22,926,238 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 - "Vulnerable populations" means any population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal, Medicare, California Children's Services Program, or county indigent programs. https://oshpd.ca.gov/ml/v1/resources/document?rs:path=/Data-And-Reports/Documents/Submit/Hospital-Community-Benefit-Plans/SB697-Report-to-the-Legislature-Community-Benefit.pdf. Note 4: 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, CMS and CHAMPVA/TRICARE. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; free psychiatric assessments and r”

“In SDC in 2017, 94.6% of children ages 18 and under, 82.7% of young adults ages 19 to 25, 84.0% of adults ages 26 to 44, 89.1% of adults ages 45 to 64, and 98.5% of seniors ages 65 and older had health insurance.132 Health insurance coverage for each age group was lower than the Healthy People 2020 (HP2020) national target of 100% health insurance coverage for all individuals under age 65.135 See Table 52 for health insurance coverage in SDC in 2017. Table 52: Health Insurance Coverage in SDC, 2017132 Description Current Health Insurance Coverage Children 0 to 17 Years: Rate - 94.6% Year 2020 Target - 100% Young adults 18 to 24 years: Rate - 82.7% Year 2020 Target - 100% Adults 25 to 44 years: Rate - 84.0% Year 2020 Target - 100% Adults 45 to 64 years: Rate - 89.1% Year 2020 Target - 100% Seniors 65+ years: Rate - 98.5% Year 2020 Target - 100% According to the California Health Interview Survey (CHIS), in 2018, 28.9% of SDC's population was covered by Medi-Cal.136 See Table 53 for details. Table 53: Medi-Cal (Medicaid) Coverage in SDC, 2018 Covered by Medi-Cal - 28.9% Not covered by Medi-Cal - 71.1% CHIS data also revealed that 10.3% of individuals in SDC did not have a usual place to go when sick or in need of health advice (see Table 54).136 Table 54: Regular Source of Medical Care in SDC, 2018 Has a usual source of care Rate - 89.7% HP2020 Target -100% Has no usual source of care Rate - 10.3% HP2020 Target - 0% In 2018, 26.7% of adults ages 18 to 64 reported needing help for emotional or mental health problems or use of alcohol or other substances. Of those needing help, 64.4% received treatment. Overall, 22.0% of SDC adults ages 18 to 64 reported seeing a health care provider for mental-emotional or substance use issues. Among SDC seniors, 10.0% of those surveyed in 2018 reported needing help for mental, emotional or substance use issues in the past year.136 In 2017, 6,344 individuals in SDC visited the emergency department (ED) for a self-inflicted injury, an age-adjusted rate of 192.1 per 100,000 population. This included 188 seniors (an age-adjusted rate of 40.5 per 100,000 population), of whom 98 were hospitalized (21.1 per 100,000 population). During the same year, the age-adjusted suicide rate in SDC was 12.5 per 100,000 population, or 428 deaths. Among seniors, the rate of suicide was nearly double (24.6 deaths per 100,000 population).132 Both rates are higher than the HP2020 target rate of no more than 10.2 deaths per 100,000 population. An analysis of 2017 mortality data for SDC revealed Alzheimer's disease and suicide to be the third and ninth leading causes of death for SDC, respectively.137 See Table 55 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by SMV and SMC, please refer to the 2019 CHNAs for these entities, available at http://www.sharp.com/about/community/community-health-needs-assessments.cfm. Table 55: Leading Causes of Death in SDC, 2017137 Malignant Neoplasms (Overall Cancer): Number of Deaths - 5,033 Percent of Total Deaths - 23.2% Diseases of the Heart: Number of Deaths - 4,764 Percent of Total Deaths - 21.9% Alzheimer's Disease: Number of Deaths - 1,450 Percent of Total Deaths - 6.7% Cerebrovascular Diseases: Number of Deaths - 1,376 Percent of Total Deaths - 6.3% Accidents/Unintentional Injuries: Number of Deaths - 1,188 Percent of Total Deaths - 5.5% Chronic Lower Respiratory Diseases: Number of Deaths - 1,025 Percent of Total Deaths - 4.7% Diabetes Mellitus: Number of Deaths - 799 Percent of Total Deaths - 3.7% Essential Hypertension and Hypertensive Renal Disease: Number of Deaths - 469 Percent of Total Deaths - 2.2% Intentional Self-Harm (Suicide): Number of Deaths - 428 Percent of Total Deaths - 2.0% Influenza and Pneumonia: Number of Deaths - 393 Percent of Total Deaths - 1.8% All Other Causes: Number of Deaths - 4,807 Percent of Total Deaths - 22.1% Total Deaths: Number of Deaths - 21,732 Percent of Total Deaths - 100.0%”

“* The following health conditions were identified in the HASD&IC 2019 CHNA as priority behavioral health issues among individuals of all age groups in SDC: mood disorders; post-traumatic stress disorder (PTSD) and trauma; substance use disorder and suicide or self-harm. * The HASD&IC 2019 CHNA also identified the following priority behavioral issues for children and youth: mood disorders, specifically anxiety; alcohol and other substance use; suicide and self-harm; and trauma. * In addition, the HASD&IC 2019 CHNA identified the following priority behavioral issues for seniors: Alzheimer's disease; dementia; mood disorders, particularly anxiety and depression; and schizophrenia. * Participants in the Sharp Insight Community survey conducted during Sharp's 2019 CHNAs ranked behavioral/mental health as the second most important health condition affecting community members. * In addition, only a minority of survey respondents (6%) were very familiar with Sharp's behavioral health support groups, indicating a missed opportunity to support community members with behavioral health issues. This is of particular concern for younger adults ages 25 to 44, who were most likely to select behavioral/mental health as a priority health condition but indicated that they were 'not at all familiar' with Sharp's behavioral health support group offerings. * Further, survey respondents ages 25 to 44 were significantly more likely than other age groups to select stigma as one of the five most important social determinants of health (SDOH) impacting their community. Research illustrates that although stigma can exist in a variety of contexts, it is one of the largest barriers for individuals who may seek or engage in treatment for behavioral health conditions. * According to data presented in the SMV 2019 CHNA, in 2017, 11.2% of inpatient discharges at SMV were seniors ages 65 and older, 56.3% were adults ages 27 to 64, 15.8% were Transitional Age Youth (TAY) and 16.7% were children 17 and under. * This analysis also indicated that 48.4% of inpatient discharges for TAY at SMV in 2017 had a principal diagnosis classified as a mood disorder, 20.7% as a substance-related disorder, and 17.8% as schizophrenia or other psychotic disorders. * Further, 26.1% of children and the majority (52.0%) of TAY discharged from SMV in 2017 had co-occurring behavioral health and substance use diagnoses. * In general, data analysis in the SMV and SMC 2019 CHNAs revealed a higher volume of behavioral health hospital discharges in communities facing greater socioeconomic challenges throughout SDC.138 * According to 2018 CHIS data, 16.1% of adults in SDC have ever seriously thought about committing suicide, a 71.3% increase from 2014 (9.4%). * In 2017, there were 998 hospitalizations due to overdose/poisoning in SDC. The age-adjusted rate of hospitalizations due to overdose/poisoning was 28.4 per 100,000 population. * In 2017, the age-adjusted rate of overdose/poisoning-related ED visits in SDC was 172.1 per 100,000 population. Age-adjusted rates for overdose/poisoning-related ED visits were higher among males, individuals of other race and individuals ages 15 to 24 years in comparison among groups. * In 2017, California's state mental health authority provided treatment to 104,410 adolescents ages 13 to 17, representing 15.1% of all individuals treated by the state (Substance Abuse and Mental Health Services Administration (SAMHSA), 2018). * In 2018, 14.4% of U.S. adolescents experienced a major depressive episode, of whom an estimated 41.4% received treatment for depression (SAMHSA, 2019). * SAMHSA estimates that, in 2018, approximately 12.4 million adults in the U.S. had co-occurring mental health and substance use disorders (SAMHSA, 2019). * According to HP2020, the effects of substance use contribute to costly social, physical, mental and public health problems, including teenage pregnancy, sexually transmitted diseases, motor vehicle accidents, physical fights, suicid”

“In FY 2019, SMV provided a specialized TAY Program to provide community services and support for young adults, ages 18 to 26, with behavioral health issues. Through the TAY Program, SMV offered education and resources to empower and support the continued health and well-being of these young adults. In June, SMV provided behavioral health resources to approximately 100 community members and TAY during an event focused on destigmatizing mental health called Music. Art. Tacos. at Queen Bee's Music and Cultural Center in North Park. The event was sponsored by Urban Street Angels, an organization that provides emergency overnight shelter, supportive housing and job training opportunities to homeless San Diego youth. SMV also provided education and resources to 50 TAY at the Oasis Clubhouse youth center's Ducky Awards and Community College Health Resource Fair events. SMV's TAY Program also includes the Sustainable Early Episode Clinic (SEEC), which is designed to offer early intervention and ongoing support to TAY with newly diagnosed schizophrenia or schizoaffective disorder and their families. SMV and SMC provided a variety of behavioral health educational opportunities and resources to community groups throughout the year. Through Sharp's partnership with the City of San Diego, SMV and SMC clinicians delivered five lectures on various topics, covering the following topics: the basics of behavioral health; cultural perceptions and beliefs around behavioral health; the link between opioids and mental health; and overcoming mental illness in conjunction with substance use. Lectures were delivered to approximately 40 community members at Serra Mesa Recreation Center, San Ysidro Community Activity Center, Mary Hollis Center at the San Diego Central Library and Pacific Beach/Taylor Library. In FY 2019, SMV and SMC provided behavioral health education, resources and presentations to approximately 1,100 community members through participation in health and wellness fairs, conferences and events. This included the Mental Health Resource Fair at the San Diego Central Library; Community Alliance for Healthy Minds' 12th annual Forum for Healthy Minds at California State University San Marcos (CSUSM); the Caregiver Coalition of San Diego's (Caregiver Coalition's) Caring for an Adult Loved One Living with Mental Health Challenges conference at Saint Gregory the Great Catholic Church; the Gender Odyssey San Diego conference at the San Diego Marriott Mission Valley; the Jewish Family Service of San Diego (JFS) Behavioral Health Committee's annual Behavioral Health Panel and Luncheon; County of San Diego Health and Human Services Agency's (HHSA's) 14th annual Recovery Happens event at Waterfront Park; and the fourth annual Critical Issues in Child and Adolescent Mental Health Conference at the Doubletree Hotel in Mission Valley. In addition, in February and March, SMC staff hosted educational events focused on Medication Assisted Treatment (MAT) - the combination of behavioral therapy and medication to treat substance use disorders - for approximately 50 behavioral health clinicians, including case managers and social workers, during MAT Roadshow events held at San Diego City College, Sharp Chula Vista Medical Center (SCVMC) and Alvarado Parkway Institute. A child psychologist also presented to approximately 60 members of the Sweetwater Union High School District Parent Advisory Group at Rancho Del Rey Middle School on topics including adolescent brain development and recognizing behavioral health concerns in teens and young adults. Throughout the year, SMV provided behavioral health education to the community through interviews with local news outlets, including KUSI News, KSON, CBS 8 San Diego, and KPBS. Interview topics included pathways to recovery for individuals struggling with addiction; a new blood test to predict the onset of Alzheimer's disease; bullying prevention and coping skills; "Dry January" and controlling alcohol intake; a new”

“* Participate in key behavioral health events and activities alongside patients * Explore and expand collaborations with 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 Identified Community Need: Behavioral Health and Substance Use Screenings and Community and Social Support Rationale references the findings of the SMV and SMC 2019 CHNAs, HASD&IC 2019 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC, SMV and SMC 2019 CHNAs identified behavioral health (including substance use) as one of the priority health needs affecting community members in SDC. * The following health conditions were identified in the HASD&IC 2019 CHNA as priority behavioral health issues among individuals of all age groups in SDC: mood disorders, PTSD and trauma, substance use disorder, and suicide and self-harm. * The HASD&IC, SMV and SMC 2019 CHNA processes identified the following barriers to accessing behavioral health care: availability of needed services and appointments; insurance issues; logistical problems getting to appointments; and economic security, including inability to pay co-pays and deductibles. * In addition, the following types of care were identified as especially difficult to access: urgent care services for crisis situations; inpatient psychiatric beds and substance use facilities; and transitional programs and services following discharge from the hospital. * A focus group conducted with the SMC Aftercare Support Group as part of Sharp's 2019 CHNA process identified numerous barriers to behavioral health care, including the need for more low-cost or free, easily and immediately accessible drug treatment programs, as well as issues related to cost or difficulty obtaining health insurance. Participants also described challenges related to post-discharge care for all health conditions, including lack of adequate support at home, navigating denied insurance claims, and medication management. * Participants in the Sharp Insight Community survey conducted as part of Sharp's 2019 CHNA process ranked behavioral health as the second most important health condition affecting community members. * In addition, only 6% of survey respondents were very familiar with Sharp's behavioral health support groups, indicating a missed opportunity for Sharp to provide support to community members with behavioral health issues. * Participants in community engagement activities conducted during Sharp's 2019 CHNA process identified the following strategies and resources to address behavioral health issues: wider availability of substance use programs; increasing education for health care providers related to addiction, including when and how to intervene, holistic pain management alternatives, and training focused on compassion and empathy; offering senior-focused forums led by health advocates to provide information on health issues and assistance navigating the health care system; implementing faster delivery of behavioral health care, particularly referrals for individuals in need of hospitalization; advocating for improved access and insurance coverage for the underserved; and offering a greater variety of behavioral health services, including classes tailored to specific behavioral health issues. * Data presented in the HASD&IC 2019 CHNA identified steep increases in the rates of ED visits (559.3%) and inpatient discharges (195.1%) for chronic substance use in SDC between 2014 and 2016. * According to data presented in the SMV 2019 CHNA, in 2017, 11.2% of inpatient discharges at SMV were seniors ages 65 and older, 56.3% were adults ages 27 to 64, 15.8% were TAY and 16.7% were children 17 and under. * In addition, 46.6% of inpatient discharges at SMV in 2017 had co-occurring”

“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 50 community partners gathered to educate south region 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 behavioral health resources to approximately 150 community members. SMV and SMC also offered Check Your Mood screenings, hourly mindfulness circles and behavioral health resources to approximately 1,000 attendees at the 2019 Sharp Women's Health Conference in May. SMV clinicians also presented at the conference on multiple topics, including reducing caregiver stress; achieving balance in work, life and love; and Alzheimer's, dementia and strategies for brain health. Throughout the year, SMV offered a variety of support groups for community members with behavioral health challenges. A weekly Mood Disorders support group was available for individuals, family and friends impacted by depression, bipolar disorder, PTSD or anxiety. A National Association of Anorexia Nervosa and Associated Disorders support group was also offered weekly for individuals and families affected by an eating disorder. Further, a biweekly Dialectical Behavioral Therapy (DBT) support group helped attendees develop coping skills to manage severe emotional reactions, intense anxiety, impulsivity, self-harm, suicidal thoughts and high-conflict relationships. More than 400 community members attended these support groups in FY 2019. SMV further supported the community by providing free space for a variety of self-help groups to meet each week. The hospital's meeting spaces were booked for more than 2,000 hours in FY 2019 for groups including Narcotics Anonymous (NA), the NA Family group, Alcoholics Anonymous (AA), Al-Anon, AA Dual Diagnosis, Cocaine Anonymous, Pills Anonymous, Project SMILE 12 Step Recovery Workshop, SMART Recovery San Diego, Co-Dependents Anonymous, Depression and Bipolar Support Alliance, Obsessive Compulsive Disorder support group, Hoarders Working support group, Shyness and Social Anxiety group, San Diego Phobia Foundation, Concerned United Birthparents, the California Board of Registered Nursing's Nursing support group, A New PATH, and the SMV and SMC Aftercare and Lifetime Support meetings. An average of 440 community members received support from these groups each week during FY 2019. For more than 50 years, the San Diego Rescue Mission (SDRM) has helped homeless individuals in San Diego create better lives for themselves through comprehensive programs, including services that address housing, hunger, behavioral health and other education and awareness programs. SMV continued to donate food to the SDRM three times each week to help support approximately 400 men, women and children living in the shelter. Each month during FY 2019, SMV collected and donated approximately 650 pounds of food for the SDRM. In addition, SMV works with Sharp's Patient Access Services team to connect patients to critical insurance and financial resources that help reduce economic barriers to behavioral health care. Sharp's Patient Access Services team provides robust services to assist with access to care and health insurance coverage for patients at all Sharp hospitals, including patients of SMV. Please refer to Section 1 (Overview): Patient Access to Care Programs for more information on these programs and services. New in FY 2019, SMV and SMC joined Sharp's systemwide pilot partnership with 2-1-1 San Diego's Community Information Exchange (CIE) to better understand and address the SDOH that influence the health and well-being of their patients. Research continues to underscore that SDOH - the conditions where people live, lear”

“* A focus group conducted with the SMC Aftercare Support Group as part of Sharp's 2019 CHNA process identified opioid misuse as a growing issue within the senior population. Participants identified a common scenario where a senior is prescribed pain medication for a chronic issue such as back pain, becomes dependent on that medication, and dependence progresses into an addiction. * These same focus group participants also identified the following health issues to be of special concern for seniors: behavioral health, arthritis, limited mobility, chronic pain, Alzheimer's disease, social isolation and food insecurity. * In 2017, Alzheimer's disease was the third leading cause of death in SDC, the fourth leading cause of death in California, and the sixth leading cause of death in the U.S. (County of San Diego HHSA, 2019; CDC, 2019). * In 2017, adults ages 65 and older experienced the highest rates of hospitalization for Alzheimer's disease, mood disorders and schizophrenia when compared to all other age groups in SDC. * In 2015, more than 84,400 San Diegans ages 55 and older were living with Alzheimer's disease and related dementias (ADRD), which accounted for 10.7% of this age group. Assuming current trends continue, by 2030, nearly 115,000 residents 55 years and older will be living with ADRD, representing a 36.5% increase from 2015 (Alzheimer's Disease and Related Dementias in San Diego County, 2018). * According to 2018 CHIS data, 8.4% of SDC adults over the age of 65 thought about committing suicide in the past year. From 2016-2018, 69.3% of SDC seniors who reported having mental/emotional or substance use issues sought help for those issues. * ED visits for alcohol-related disorders among SDC seniors increased 58.0% between 2013 and 2017. This was the largest percentage increase among all age groups over the five-year period. * The 2017 hospitalization rate for acute substance-related disorders was 8.0 per 100,000 among SDC residents over the age of 65. This is a significant decline from 2013 (42.9 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 seniors. Seniors 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, the state's public mental health delivery system does not meet the needs of all seniors 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 behavioral health services by California seniors 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). * Behavioral health problems in older adults are often under-identified by health care professionals. Older adults experience unique stressors (e.g., declining functional ability or socioeconomic status, and bereavement), which can result in isolation, loneliness and psychological distress that necessitate long-term care (World Health Organization, 2017). * According to research presented by the National Institute on Aging (NIA), social isolation and loneliness have been linked to a variety of physical and mental conditions, including high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline,”

“Throughout the year, SMV's SIOP provided behavioral health resources, memory screenings, and information about the hospital's senior services at numerous senior health fairs and community events in SDC, including Sharp Senior Resource Centers' Senior Health and Resource Fair at Point Loma Community Presbyterian Church; SCHHC's Spring into Health event at John D. Spreckels Center and Bowling Green (Spreckels Center); the JFS Health Fair and Flu Shot Event at JFS College Avenue Senior Center and San Diego LGBT (Lesbian, Gay, Bisexual and Transgender) Community Center's 13th annual Senior Resource Fair. In FY 2019, more than 300 seniors and their family members were reached through the SIOP's participation in these community events. SMV's SIOP both provided behavioral health resources and presented at senior health-focused conferences throughout SDC, serving nearly 2,100 community members in FY 2019. Events included: Sharp Senior Resource Centers' and Sharp HospiceCare's annual aging conferences titled Health and Wellness in Aging: Know Your Options at La Mesa Community Center, Elks Lodge in Chula Vista and Point Loma Community Presbyterian Church; Sharp Women's Health Conference at the Sheraton San Diego Hotel & Marina; and the County of San Diego Aging and Independence Services' Vital Aging 2019: Live Well to Age Well events at the San Diego Convention Center and California Center for the Arts in Escondido. At these conferences, SIOP clinicians presented on a variety of topics, including stress management; healthy, mindful aging; and dementia and brain health. SMV also participated in the Sharp-sponsored Union-Tribune PRIME Expo at Town and Country San Diego in October. At this event, SMV offered resources related to behavioral health, Alzheimer's research and enrollment in clinical trials to approximately 10,000 conference attendees. In FY 2019, SMV partnered with Alzheimer's San Diego to provide a variety of screenings, behavioral health education and resources to community members. In May, SMV provided a resource table to 150 attendees at Carlsbad Library following a panel discussion on the link between Alzheimer's and genetics that was co-sponsored by Alzheimer's San Diego and the Caregiver Coalition. In August, SMV sponsored Alzheimer's San Diego's Date with a Cure event at Irwin M. Jacobs Qualcomm Hall as well as provided 500 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. In September, SMV partnered with Alzheimer's San Diego to present a screening of Turning Point, an award-winning documentary capturing the drama and dedication of scientists and clinical trial volunteers who are working to make Alzheimer's a distant memory. Approximately 100 community members attended the event at Sharp's corporate office location, which also included a panel discussion on Alzheimer's research featuring an SMV clinician. 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 nearly 160 community members who were concerned about memory loss or interested in establishing a baseline to detect future changes. Additionally, throughout FY 2019, SMV clinicians provided educational materials and lectures on advances in Alzheimer's research and opportunities to enroll in clinical research studies to approximately 1,200 community members at locations across SDC, including Glenner Town Square, Carlsbad Tri-City Wellness Center, San Diego Convention Center, California Center for the Arts in Escondido, Spreckels Center, Poway Branch Library, Sharp Rees-Stealy Rancho Bernardo, San Diego City College, Fredericka Manor Retirement Community, Point Loma Community Presbyterian Church, La Mesa Community Center, Sharp Grossmont Hospital Senior Resource Center, and Gary and Mary West”

“* As of September 2019, there were 544 designated Mental Health Care Health Professional Shortage Areas (HPSAs) in California, representing approximately 7.9 million residents. The Kaiser Family Foundation estimates that 405 new practitioners would need to be added to the behavioral health workforce in order to remove HPSA designation from all areas (Kaiser Family Foundation, 2019). * A report titled California's Current and Future Behavioral Health Workforce indicates that many psychiatrists statewide are aging out of the workforce, contributing to a projected 34% decline in the number of practicing psychiatrists between 2016 and 2028. Action is needed to increase diversity in the field of incoming behavioral health care workers, particularly among psychiatrists and psychologists. To ensure that California's diverse population receives culturally, racially, ethnically and linguistically appropriate behavioral health services, increased racial and ethnic diversity as well as greater female representation among providers is necessary (Healthforce Center at University of California, San Francisco (UCSF), 2018). * The same report emphasizes the following strategies for improving access to behavioral health care treatment in California: greater cultural competency in the delivery of behavioral health care; adequate geographical distribution of facilities and training programs across the state; and increased provider participation in both public and private health insurance plans (Healthforce Center at UCSF, 2018). * A report from the University of Washington's Center for Health Workforce Studies describes numerous challenges contributing to the nation's behavioral health workforce crisis, including the aging of certain occupations; low compensation and perceptions of low status for jobs requiring less formal education; and high burnout and stress due to the nature of the work (Center for Health Workforce Studies, 2016). * According to a 2017 report from the National Council for Behavioral Health, the pool of psychiatrists working with public sector and insured populations declined by 10% between 2003 and 2013, for reasons including aging of the current workforce, low reimbursement rates, burnout, burdensome documentation requirements and regulatory restrictions that make it difficult to coordinate care. In addition, the supply of psychiatrists who work in inpatient and outpatient psychiatric facilities has declined significantly, with 40% of psychiatrists now practicing in cash-only private practices. * According to the U.S. Bureau of Labor Statistics (BLS), employment of behavioral health social workers is projected to grow 11% from 2018 to 2028, much faster than the average for all occupations. Employment of substance use, behavioral disorder and mental health counselors is anticipated to increase 22%. Demand for employment in these occupations is expected to increase as greater numbers of people seek treatment for mental illness and substance use disorders, and as insurance policies provide greater coverage for addiction and behavioral health services (BLS, 2019). * As the criminal justice system increasingly recognizes treatment for substance use disorders as a cost-effective alternative to incarceration, use of substance use programs is likely to increase as states opt to sentence offenders experiencing drug and substance use issues to treatment and counseling services rather than jail (BLS, 2019). Objectives * Collaborate with local schools to provide opportunities for students to explore health care professions * Collaborate with the behavioral health community - including other behavioral health educational institutions - to provide education and training for health care professionals FY 2019 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 wo”

“Throughout the year, SMV provided specialized learning opportunities for its MSW students. MSW students working with inpatients attended an intensive two-day orientation to become familiar with social work in the hospital setting. During the first semester, students spent two months shadowing SMV social workers before earning the opportunity to work under supervision. Students attended case presentations, in-services, staff meetings, treatment team meetings, staff huddles and other learning activities as part of their experience. During the second semester, MSW students rotated for one to two weeks through additional units at SMV. Students also had the opportunity to shadow social workers in various locations throughout the Sharp system. MFT and MSW students working specifically with outpatients also attended quarterly two-hour trainings. In addition, SMV continued to participate in the Health Sciences High and Middle College (HSHMC) program in FY 2019. The program provided 19 students in grades 11 and 12 with professional development opportunities within SMV's nursing units (Intensive Treatment Program, Mood Disorders, Senior Behavioral Health, SIOP and Chemical Dependency Recovery) as well as nutrition services. In addition, students received instruction on educational and job requirements as well as career ladder development. During FY 2019, HSHMC students spent more than 4,100 hours at SMV. In FY 2019, SMV provided behavioral health resources to more than 175 students at the Mesa College Mental Health Fair and the San Diego City College Health and Wellness Expo. SMV also provided behavioral health resources to more than 100 students at Mesa College and HSHMC in recognition of Suicide Prevention Week in September. At the 2019 Agency Internship Fair hosted by SDSU, University of Southern California and CSUSM, SMV provided more than 350 behavioral health students, graduate students and clinicians with behavioral health resources and information about student internships. SMV and SMC provided continuing education classes, conferences and trainings for behavioral health care professionals in FY 2019, including psychologists, psychiatrists, community physicians, social workers, nurses and other health and human service providers. In November, an SMV clinician provided behavioral health resources to 500 attendees at the San Diego In-Home Supportive Services Public Authority's Provider Appreciation Day event at the Balboa Park Club. Behavioral health resources were also provided to more than 400 attendees of the annual Early Childhood Mental Health We Can't Wait Conference in September, which was held at the Crowne Plaza San Diego. SMV clinicians shared knowledge and best practices with the larger professional health care community through the development of educational materials on behavioral health and patient care as well as participation in student research. In FY 2019, SMV continued to assist with the development of geriatric behavioral health and dementia care curricula for SDSU's Responsive Integrated Health Solutions, a County of San Diego Behavioral Health contracted program within SDSU's Academy for Professional Excellence. In addition, clinicians and patients from SMV's SIOP continued to participate in research to help graduate psychology students from SDSU better understand the needs of people with serious mental illness, as well as barriers preventing this population from accessing cancer screenings. Throughout FY 2019, 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, 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”

“* Angels Foster Family Network * ArtWalk * Asian Business Association of San Diego * Association for Ambulatory Behavioral Healthcare * Association for Clinical Pastoral Education * Association for Community Health Improvement * Association for Contextual Behavioral Science - Aging Special Interest Group * Association of Black Psychologists * Association of California Nurse Leaders * Association of Fundraising Professionals - San Diego Chapter * Association of Women's Health, Obstetric and Neonatal Nurses * Azusa Pacific University * Balboa Institute of Transplantation * Barney & Barney Foundation * Bayside Community Center * Beacon Council's Patient Safety Collaborative * Behavioral Health Recognition Dinner Planning Team * Borrego Health * Boys and Girls Club of South County * Cabrillo Credit Union Sharp Division Board * Cabrillo Credit Union Supervisory Committee * Cal Hospital Compare Board of Directors * Cal Hospital Compare Safe Opioid Hospital Work Group * California Academy of Nutrition and Dietetics - San Diego District * California Association of Health Plans * California Association of Hospitals and Health Systems (CAHHS) * CAHHS Committee on Volunteer Services and Directors' Coordinating Council * California Association of Marriage and Family Therapists San Diego Chapter * California Association of Physician Groups * California Board of Behavioral Health Sciences * California Department of Public Health (CDPH) * CDPH Clinical Laboratory Technology Advisory Committee * CDPH Healthcare Associated Infections/Antimicrobial Stewardship Program subcommittee * CDPH Healthcare Associated Infection Advisory Committee * CDPH Joint Advisory Committee * California Emergency Medical Services Authority * California Health Care Foundation (CHCF) California Health Information Association * CHCF California POLST eRegistry Evaluation Team * California Hospice and Palliative Care Association * California Hospital Association (CHA) * CHA Emergency Management Advisory Committee * CHA Hospital Quality Institute Regional Quality Leaders Network * CHA Managed Care Committee * CHA San Diego Association of Directors of Volunteer Services * CHA Workforce Committee * California Immunization Coalition * California Library Association * California Maternal Quality Care Collaborative * California Nursing Students' Association * California Perinatal Quality Care Collaborative * California School-Age Families Education * California Society of Health-System Pharmacists * California Society for Clinical Social Work Professionals * California State University San Marcos * California Teratogen Information Service * Cameron Family YMCA * Caregiver Coalition of San Diego * Case Management Society of America * Celebrando Latinas * Center for Community Solutions * Central San Diego Black Chamber of Commerce * Champions for Health * Chicano Federation of San Diego County * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Police Foundation * City of Chula Vista * City of San Diego * City of San Diego Park & Recreation * Clairemont Lutheran Church * Coalition for Compassionate Care of California * Commission on Collegiate Nursing Education * Community Center for the Blind and Visually Impaired * Community Health Improvement Partners (CHIP) Behavioral Health Work Team * CHIP ILA Work Team * CHIP Suicide Prevention Council * Consortium for Nursing Excellence, San Diego * Coronado Chamber of Commerce * Coronado Public Library * Coronado SAFE (Student and Family Enrichment) * Coronado Senior Center Planning Committee * Council of Women's and Infants' Specialty Hospitals * County of San Diego Aging and Independence Services * County Service Area - 69 Advisory Board * Downtown San Diego Partnership * Downtown San Diego Silvercrest Residence * East County Action Network * East County Elder Abuse Council * East County Senior Service Providers * Emergency Nurses Association - San Diego Chapter * Employee Assistance Professionals Ass”

“* San Diego Blood Bank Board of Directors * San Diego Brain Injury Foundation Board of Directors * San Diego Coalition for Compassionate Care/San Diego Physician Orders for Life-Sustaining Treatment (POLST) Coalition * San Diego Coalition for Mental Health * San Diego Committee on Employment for People with disABILITIES * San Diego Community Action Network * San Diego Community College District * San Diego Council on Literacy * San Diego County * San Diego County Breastfeeding Coalition * San Diego County Civilian/Military Liaison Work Group * San Diego County Coalition for Improving End-of-Life Care * San Diego County Community Emergency Response Team * San Diego County Council on Aging (SDCCOA) * San Diego County Emergency Medical Care Committee * San Diego County Hospice Veteran Partnership * San Diego County Medical Society Bioethics Commission * San Diego County Older Adult Behavioral Health System of Care Council * San Diego County Public Health Nursing Advisory Board * San Diego County Regional Human Trafficking And Commercial Sexual Exploitation of Children Advisory Council * San Diego County Stroke Consortium * San Diego Dementia Consortium * San Diego East County Chamber of Commerce * San Diego Eye Bank Nurses' Advisory Board * San Diego Family Care * San Diego Fire-Rescue Department * San Diego Food System Alliance * San Diego Freedom Ranch * San Diego Habitat for Humanity * San Diego Health Connect * San Diego Health Connect POLST e-registry workgroup * San Diego Health Information Association * San Diego Housing Commission * San Diego Human Dignity Foundation * San Diego Humane Society * San Diego Hunger Coalition * San Diego Imaging - Chula Vista * San Diego Immunization Coalition * San Diego-Imperial County Council of Hospital Volunteers * San Diego-Imperial County Firefighters Advisory Council * San Diego LGBT Pride * San Diego Magazine * San Diego Mental Health Coalition * San Diego Military Family Collaborative (SDMFC) * San Diego National Association of Hispanic Nurses * San Diego North Chamber of Commerce * San Diego Organization of Healthcare Leaders * San Diego Psychological Association Supervision Committee * San Diego Regional Chamber of Commerce * San Diego Regional Home Care Council * San Diego Regional Human Trafficking and Commercial Sexual Exploitation of Children Advisory Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego Second Chance * San Diego Silvercrest Residence * San Diego Square * San Diego State University * San Diego Unified School District * San Diego Workforce Partnership (SDWP) * San Ysidro Health * Santee-Lakeside Rotary Club * SAY San Diego * Sepsis Alliance * Serra Mesa Planning Group Board * Serving Seniors * Sharp and Children's MRI Board * Sharp and UC San Diego Health's Joint Venture * Soroptimist International of Coronado * South Bay Community Services * Southern Caregiver Resource Center * Southwestern College * Special Needs Trust Foundation * Special Olympics * Ssubi is Hope * St. Paul's PACE * St. Paul's Retirement Home Foundation * St. Peter's by the Sea Lutheran Church * Statewide Medical Health Exercise Program * Suicide Prevention Council Media Subcommittee * Susan G. Komen(r) San Diego * Surfrider Foundation * Survivors of Suicide Loss * The Academy * The Arc of San Diego * The Salvation Army Ray & Joan Kroc Corps Community Center Advisory Council * Transitional Age Youth Behavioral Health Services Council * Trauma Center Association of America Board of Directors * UC San Diego * Union of Pan Asian Communities * University of San Diego * University of Southern California * University of St. Augustine for Health Sciences * USS Midway Museum * VA San Diego Healthcare System * VA San Diego Mental Health Council * Veterans Home of California - Chula Vista * Veterans Village of San Diego * Vista Hill Foundation * Vista Hill ParentCare * We Honor Veterans * Westminster Manor * Women, Infants and Children Program * Wreaths Across America - San”

“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 - -20854249; Prior period restatement of Medi-Cal Hospital Fee Program due to adoption of ASC 606 - 44017430;”