Sharp Healthcare

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

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

“The Compensation Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November 2017.”

“The Compensation Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November 2017.”

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

“Case Management - Total Revenue: 659183, Related or Exempt Function Revenue: , Unrelated Business Revenue: 659183, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; All other program service revenue - Total Revenue: 2652635, Related or Exempt Function Revenue: 2652635, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“All other revenue - Total Revenue: 182955, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 182955;”

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

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

“From 2013 to 2018, the Press Ganey organization recognized multiple Sharp entities with Guardian of Excellence Awards. Based on one year of data, this designation recognizes recipients that reach the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality. Awarded Sharp entities in the employee engagement category included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health, while SMH, SMH OPP and SMBHWN have been awarded for Patient Experience and SCHHC, SMBHWN and SMV have received awards for Physician Engagement. Press Ganey also recognized multiple Sharp entities with the Pinnacle of Excellence Award (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 as well as 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, Sharp was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP has maintained a National Committee for Quality Assurance's (NCQA) Private Health Insurance Plan Rating of 4.5 out of 5 each year since 2016, making it one of the highest-rated health plans in the nation. SHP has also maintained the NCQA's highest level "Excellent" Accreditation status for service and clinical quality each year from 2013 to 2018. The NCQA awards accreditation status based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems measures. Covered California is California's official health insurance marketplace, offering individuals and small businesses the ability to purchase health coverage at federally subsidized rates. SHP earned a five-star rating - the highest possible - in Covered California's 2018 Coverage Year Quality Ratings in the categories of "Summary Quality Rating," "Getting the Right Care" and "Plan Services for Members." America's Physician Groups (APG) is a professional association, representing over 300 medical groups, independent practice associations, and integrated health care systems across the nation. APG has awarded its highest level of distinction - "Elite Status" - to SCMG and SRSMG each year from 2010 to 2018. The Women's Choice Award is a symbol of excellence in customer experience awarded by the collective voice of women. In 2018, SGH received the Women's Choice Award as one of America's Best Breast Centers, Best Stroke Centers and Best Hospitals for Heart Care. The Women's Choice Award also recognized SMH and SMBHWN in 2018 among America's Best Hospitals for Bariatric Surgery, Cancer Care, Obstetrics and Patient Experience, as well as among America's Best Breast and Stroke Centers. SCVMC was also recognized as one of America's Best Breast Centers in 2018. In addition, SCHHC has maintained its ranking as one of America's Best 100 Hospitals for Patient Experience from 2012 to 2018. Powered by the San Diego Association of Governments (SANDAG) in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Sharp received iCommute Diamond Awards - which recognize employers in the San Diego region who have made strides to promote alternative commute choices - in the platinum tier in 2016 and the gold tier in 2017 and 2018. For the fourth year in a row, and the fifth time in six years, Sharp won the top spot in the Mega Employer category in SANDAG's 2016 iCommute Rideshare Corporate Challenge. The annual monthlong challenge encourages”

“SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh - California's Supplemental Nutrition Assistance Program - prior to hospital discharge, which dramatically increased the likelihood that patients will complete CalFresh applications and receive benefits. In February 2017, Sharp's PFS team expanded CalFresh consults to the remainder of Sharp's acute care hospitals. Since 2016, more than 600 Sharp patients have been granted CalFresh benefits. In summer 2015, a pilot program was launched to evaluate eligibility for financial assistance among both insured and unfunded families with babies in the Neonatal Intensive Care Unit (NICU) at SMBHWN. This process included helping families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight apply for Supplemental Security Income (SSI) to help with the cost of care for their baby both within and outside of the hospital. The program was expanded to SCVMC and SGH in 2017, and since its inception, Public Resource Specialists have assisted more than 260 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients who lack a safe home environment. Patients may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. Sharp social workers provide referrals for permanent housing and collaborate with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. In addition, Sharp provides support to SSI claims by providing medical records as needed. SCHHC, SCVMC, SGH and SMH continued to collaborate with the San Diego Rescue Mission (SDRM) to provide services to chronically homeless patients. Through the partnership, Sharp discharges homeless patients to the SDRM's Recuperative Care Unit (RCU), a temporary shelter program that addresses the needs of homeless men and women who are newly released from the hospital but require further supervision. Through the RCU, patients receive case management, social work and counseling services as well as referrals for community-based medical and psychiatric services, long-term housing, and other community support programs. This collaboration between Sharp and SDRM provides a safe discharge plan for homeless individuals who require a stable living environment for their continued recovery. Sharp also continued to collaborate with Father Joe's Villages in support of the County of San Diego Aging and Independence Services' Project SOAR (Senior Options, Advocacy and Referrals). This program provides care management services to frail and disabled adults ages 60 years and older who are at risk for nursing home placement, and do not have access to nor qualify for supportive services through other programs. Sharp determines Project SOAR eligibility during its standard eligibility review process for all patients and refers qualified individuals directly to the program. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships and career pipeline programs. In FY 2018, more than 3,700 student interns dedicated over 585,700 hours within the Sharp system. Sharp provided education and training for students in a variety of disciplines, including multiple areas of nursing (e.g., critical care, medical/surgical, behavioral health, women's services, cardiac services and hospice) and allied health professions such as rehabilitation therapies (speech, physical and occupational therapy), lactation care, pharm”

“Students begin their internship experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of the HSHMC program is the entry level for all students and is conducted over an eight-week period. Through Level I, ninth-grade students shadow primarily non-nursing areas of the hospital as well as complete additional coursework in Infection Control, Medical Ethics, and Introduction to Health Professions. Level II is designed for students in grades 10 through 12 and includes enhanced patient interaction, college-level clinical rotations, and hands-on experience. Level II students are placed in a new assignment each semester for a variety of patient care experiences, and take additional health-related coursework at a community college, including Health 101, Public Health, Psychology and Abnormal Psychology, Realities of Nutrition, Intro to Health Professions and Organizations, and Health and Social Injustice, among other courses. In FY 2018, 342 HSHMC students - including 100 Level I students and 242 Level II students - were supervised for more than 61,500 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology; occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; respiratory care; cardiovascular care; spiritual care; wound care; long-term care; endoscopy; engineering; nutrition; infection control; pulmonary services; maternal infant services; NICU; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2018, the HSHMC program graduated 151 students in its eighth full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Sixty-seven percent of HSHMC students are economically disadvantaged, and the school's free and reduced-price meal eligibility rate is higher than the average for both SDC and California. Despite these challenges, HSHMC maintains a 95 percent attendance rate and excels in preparing students for high school graduation, college entrance and a future career. In 2018, 91 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 83 percent of students said they wanted to pursue a career in health care. In addition, HSHMC has a 98.7 percent graduation rate, which is higher than the state of California's average of 82.7 percent. HSHMC has received numerous awards for its innovation, vision and impact. In 2017, HSHMC received the Schools of Opportunity Gold Recognition - the highest level that can be awarded - by Schools of Opportunity, a project of the National Education Policy Center at the University of Colorado Boulder. This project recognizes public high schools around the nation that engage in research-based practices focused on closing opportunity gaps for student learning. Previously, HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. HSHMC was also recognized as a U.S. News & World Report Best High Schools bronze award winner in 2014, 2016 and 2017. In addition, the California Department of Education recognized HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and as a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high- and low-performing students. Further, HSHMC was recognized with a 2015 Model Professional Learning Community at Work Award by Solution Tree for its sustained success in raising student achievement. In addition, HSHM”

“Research Sharp Center for Research Innovation is critical to the future of health care. The Sharp Center for Research supports innovation through its commitment to protecting research participants and promoting high quality research initiatives that provide valuable knowledge to the San Diego health care community and positively impact patients and community members. The Sharp Center for Research includes the Human Research Protection Program (HRPP), which includes the Institutional Review Board (IRB) and the Outcomes Research Institute (ORI). Human Research Protection Program and Institutional Review Board The Sharp Center for Research is accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This accreditation acts as a public affirmation of the HRPP's commitment to following rigorous standards for ethics, quality and protection for human research. To date, Sharp is the only health system in SDC to receive accreditation from the AAHRPP. The Center for Research's HRPP is responsible for the ethical and regulatory compliant oversight of research conducted at Sharp and includes three components: the Sharp organization, the researchers and the IRB. As one of the key components of the HRPP, the IRB seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants must be reviewed by the IRB in order to protect participant safety and maintain responsible research conduct. In FY 2018, a dedicated IRB committee of 18 - including physicians, nurses, pharmacists and non-scientists - devoted hundreds of hours to the review and analysis of both new and ongoing research studies. Research at Sharp is conducted on all clinical phases of drug and device development, and the populations studied span the life cycle - from newborns to older adults. These clinical trials increase scientific knowledge and enable health care providers to assess the safety and effectiveness of new treatments. At any given time, Sharp participates in approximately 250 clinical trials covering many therapeutic areas, including behavioral health, emergency care, infectious disease, neonatal, heart and vascular, kidney, liver, neurology, orthopedics and oncology - the latter of which comprises the largest share of Sharp's clinical trials. The HRPP educates and supports researchers across Sharp as well as the broader San Diego health and research communities regarding the protection of human research participants. As part of its mission, the Center for Research hosts quarterly meetings on relevant educational topics for community physicians, psychologists, research nurses, study coordinators and students throughout San Diego. The FY 2018 quarterly meetings included the following presentations: Research Community Outreach; Completing Subject Enrollment Logs and Attestation Reports; Reporting Deviations in Research Protocol; Clinical Trials Coverage Analysis; Compliance and Education Requirements; Creating Research Study Budgets; Who is a Sub-Investigator; and Utilizing IRB Software. Education was also provided on the Stark Law, Medicare Secondary Payer Rule, Common Rule, and AAHRPP guidelines for reaccreditation. Outcomes Research Institute Since its inception in 2010, Sharp's ORI has sought to measure the long-term results of care to continue to develop and promote best practices in health care delivery. The ORI enables Sharp to develop and disseminate new knowledge to the larger health care community, and help improve the quality of care delivery across SDC. The ORI collaborates with Sharp team members to aid in the design of patient-centered outcomes research projects; assist with study protocol development, data collection and analysis; explore funding mechanisms for research projects; and facilitate IRB application submissions. The ORI seeks guidance and expertise from the local and national academic com”

“Volunteer Service Sharp Lends a Hand In FY 2018, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely solely on Sharp for volunteer labor; and support existing nonprofit initiatives, community activities or other programs that serve SDC. SLAH selected 23 volunteer projects for FY 2018: Food Bank; FSD; Mama's Kitchen; San Diego Wreaths Across America; USS Midway Foreign Object Damage (FOD) Walk-down; American Diabetes Association (ADA) Tour de Cure; Promises2Kids; Partnerships with Industry; Ssubi is Hope Greening for Good Project; Special Olympics Regional Fall Games, Bowling Tournament and Annual Spring Games; Habitat for Humanity ReStore; Stand Down for Homeless Veterans; Life Rolls On - They Will Surf Again; I Love a Clean San Diego's Beautify Chula Vista Day, Creek to Bay Cleanup, Clean Cities Initiative Cleanup and Coastal Cleanup Day; the San Diego River Park Foundation's Point Loma Native Plant Garden, San Diego River Garden, and Coastal Habitat Restoration; and River Kids Discovery Days - a joint effort between I Love a Clean San Diego and the San Diego River Park Foundation. More than 3,000 Sharp employees, family members and friends volunteered over 6,700 hours in support of these projects. The Food Bank feeds San Diegans in need, advocates for the hungry, and educates the public about hunger-related issues. Each month, the Food Bank serves 370,000 San Diegans. Backpacks filled with a weekend's supply of food are provided to chronically hungry elementary school children throughout SDC, while Food Bank distribution sites provide boxes of groceries and staple food items to low-income seniors. The Food Bank distributed a total of 28 million pounds of food - the equivalent of 23.3 million meals - during its most recent FY. Over 120 SLAH volunteers gathered at the Food Bank warehouse to help inspect, clean, sort and package donated food as well as assist with assembling boxes and cleaning the facility at more than 15 events between December 2017 and September 2018. FSD, part of the Feeding America network, provides food and resources to a network of neighborhood partners in SDC serving healthy food to more than 63,000 local children, families and seniors every week. FSD relies on the generous support of individuals, corporations, foundations and community groups to sustain critical hunger-relief and nutrition programs throughout the region. Ninety SLAH volunteers helped sort food, prepare bags for distribution, and clean produce for FSD at more than 10 events during FY 2018. Established in 1990, Mama's Kitchen is a community-driven organization that enlists volunteers to help prepare and deliver nutritious meals to community members affected by acquired immunodeficiency syndrome (AIDS) or cancer who are unable to shop or cook for themselves. Mama's Kitchen strives to help its clients stay healthy, preserve their dignity, and keep their families together by providing free culturally appropriate home-delivered meals, pantry services and nutrition education. In December and February, 25 SLAH volunteers helped Mama's Kitchen serve meals to the community by preparing and packaging snack and vegetable items for delivery. In December 2017, SLAH participated in Wreaths Across America, a national event dedicated to honoring veterans, remembering fallen heroes, and teaching children about the sacrifices made by veterans and their families. At three local cemeteries - Fort Rosecrans National Cemetery, Miramar National Cemetery and Greenwood Memorial Park - 205 SLAH volunteers honored veterans by placing donated wreaths on their gravesites. The USS Midway is a retired aircraft carrier that serves as a museum and memorial to the 225,000 Navy sailors who served on board between 1943 and 1992. To help keep the deck of the Midway museum clean, SLAH volunteers participated in a”

“In October 2017, 10 SLAH volunteers joined I Love a Clean San Diego and the City of Chula Vista for the 15th annual Beautify Chula Vista Day. Volunteers met at Rice Canyon in Discovery Park and assisted with watering and care of recent plantings, litter removal and additional projects to make the canyon shine. SLAH also partnered with I Love a Clean San Diego for the 16th annual Creek to Bay Cleanup in April, in celebration of Earth Day. Approximately 20 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In August, seven volunteers participated in I Love a Clean San Diego's Clean Cities Initiative Cleanup by sweeping streets along sidewalks in an Imperial Beach neighborhood. In September, 12 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including Ocean Beach Dog Beach, Chula Vista Marina View Park, Mission Trails Regional Park, Mission Bay, Lake Miramar, Cardiff Seaside Beach,Coronado City Beach and Scripps Pier in La Jolla. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. Approximately 30 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in October, November, June and August, as well as at the San Diego River Garden in Mission Valley in December, July and September. Activities included trail maintenance, watering, pruning and other light gardening projects. In May, eight SLAH volunteers joined the San Diego River Park Foundation's Coastal Habitat Restoration event in Ocean Beach. The team worked to save and restore one of the last remaining coastal dune and wetland habitats in San Diego by removing invasive plants and litter, watering and caring for recent plantings and native plants, and providing trail maintenance. In March, I Love a Clean San Diego and the San Diego River Park Foundation partnered to provide the fourth annual River Kids Discovery Days. Five SLAH volunteers participated in the free event, which provides river education and service events to teach more than 600 children and families about protecting the Earth's natural resources. In addition to these projects, Sharp expanded the SLAH program to include the coordination and promotion of a year-round blood donation effort to provide needed blood to local organizations serving the community. In FY 2018, Sharp committed to collecting at least 1,000 units of blood from Sharp employees, family and friends. Throughout the year, Sharp hosted 42 blood drives at 11 locations systemwide to benefit the San Diego Blood Bank. In addition, SLAH encouraged Sharp employees to donate blood at local Red Cross locations. Through these efforts, SLAH helped Sharp collect 1,288 units of blood, surpassing its goal by nearly 300 units. Sharp Humanitarian Service Program The Sharp Humanitarian Service Program provides paid leave time for Sharp employees to volunteer for programs that provide health care or other supportive services to underserved or adversely affected populations. In FY 2018, the program funded nearly 50 employees on humanitarian trips to Mexico, Fiji, the Philippines, Tanzania, Kenya and other locations throughout the world. Poured Out is a nonprofit organization that connects people and resources to those in need following a natural disaster through its U.S. Disaster Response team. World Hope International works with vulnerable and exploited communities to alleviate poverty, suffering, and injustice. In October, two Sharp team members joined these organizations to help respond to more than 100 people devastated by Hurricane Harvey in Port Arthur, Texas. Working as quickly as possible, the team helped restore damaged homes by mucking”

“For three weeks in July and August, a Sharp team member helped lead a team of six PLNU students on a mission trip to Azores, Portugal, with LoveWorks, a short-term mission program committed to sending well-trained, culturally sensitive and flexible teams of student missionaries to serve in challenging and remote areas of the world. The team provided numerous services to the Azorean community, including renovating a local church's thrift store that provides free clothing and supplies to those in need; assisting at health fairs; performing blood pressure checks; answering health-related questions; and referring individuals to local health clinics. Living Room Ministries International is a nonprofit organization dedicated to offering hope and help to rural villages in Kenya through physical, psychological and spiritual care. The organization provides hospice and community-based palliative care services to people with terminal illness, supports families with dying loved ones, and cares for those who lack love and support at the end of life. In September, a Sharp physical therapist traveled with Living Room Ministries International to provide patient care, physical therapy services, staff training and student supervision to approximately 100 Kenyans. Community Walks Heart disease is the leading cause of death in the U.S. Sharp proudly supports the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In FY 2018, more than 120 teams from entities across the Sharp system raised funds for the walk through activities such as auctions, prize drawings and a karaoke competition. In September, nearly 1,000 employees, family members and friends represented Sharp during the walk at Balboa Park. For the past 22 years, Sharp has maintained its position as the No. 1 team in San Diego. In 2018, Sharp was the No. 3 team in the AHA Western States Affiliate, raising more than $200,000. To date, Sharp's fundraising efforts have raised more than $3 million in support of the San Diego Heart & Stroke Walk. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community and help make a difference in the lives of others. Sharp provides many volunteer opportunities for individuals of all ages and skill levels to assist with a wide variety of programs, events and initiatives across the Sharp system. This includes devoting time and compassion to patients within Sharp's hospitals; assisting with community events for the general public; and support for annual golf tournaments, galas and other events to benefit Sharp's various foundations, including the Sharp HealthCare Foundation, Grossmont Hospital Foundation and Coronado Hospital Foundation. On average, more than 1,700 individuals actively volunteered at Sharp each month in FY 2018. This included more than 1,800 auxiliary members, thousands of individual volunteers from the San Diego community, and volunteers for Sharp's foundations. Throughout the year, volunteers contributed more than 253,700 hours of service to Sharp and its initiatives.5 More than 16,500 of these hours were dedicated to activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the average number of active volunteers per month as well as the total number of volunteer service hours provided to each Sharp entity, specifically for patient and community support. Table 2: Sharp HealthCare Volunteers and Volunteer Hours - FY 2018 Sharp Chula Vista Medical Center: Average Active Volunteers per Month - 357 Total Volunteer Hours - 49,840 Sharp Coronado Hospital and Healthcare Center: Average Active Volunteers per Month - 65 Total Volunteer Hours - 10,263 Sharp Grossmont Hospital: Average Active Volunteers per Month - 631 Total Volunteer Hours - 100,173 Sharp HospiceCare: Average Active Volunteers per Month - 70 Total Volunteer Hours - 9,477 Sharp Metropolitan”

“Sharp HospiceCare continued to provide the 11th Hour program to ensure that no patient died alone. Through the program, volunteers accompanied patients who were in their final moments of life but did not have family members present. This included holding the patient's hand, reading softly to them and simply remaining by their side. Families who were present with their dying loved one could also receive comfort from a volunteer while their loved one passed away. Twelve volunteers were trained through the 11th Hour program in FY 2018. In FY 2018, Sharp HospiceCare trained six volunteers in integrative therapies to promote relaxation and restful sleep and enhance the quality of life for Sharp HospiceCare patients and their caregivers. Integrative therapies included Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain; Reiki, a Japanese energy healing therapy in which practitioners use their hands on or above the patient's body to facilitate the healing process; aromatherapy; and hand massage. Volunteers also support Sharp HospiceCare's partnership with We Honor Veterans (WHV). WHV is a national program developed by the National Hospice and Palliative Care Organization in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide education and training that qualifies their volunteers to identify and support veteran patients and their caregivers. This includes the Vet-to-Vet Volunteer program, which pairs volunteers who have military experience with veteran patients. The program also honors veteran patients through special pinning ceremonies during which volunteers present them with a WHV pin and a certificate of appreciation for their service. In FY 2018, Sharp HospiceCare held pinning ceremonies for more than 90 Sharp HospiceCare veteran patients as well as pinned nearly 80 veteran community members during community events. Sharp HospiceCare continued to offer the Memory Bear program to support community members who have lost a loved one. Volunteers created teddy bears out of the garments of those who have passed on, which served as special keepsakes and permanent reminders of the grieving individual's loved one. In FY 2018, volunteers dedicated approximately 3,400 hours to sewing more than 850 bears for over 240 families. Sharp HospiceCare recognizes the valuable impact that volunteers have on the experience of its patients, family and caregivers. In light of this recognition, Sharp HospiceCare offered a monthly continuing education support group to enhance volunteers' skills. In addition, Sharp HospiceCare honored its volunteers during National Volunteer Week in April and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV, SMC) Volunteer Programs Through the Community Care Partner (CCP) program at SMH, hospital volunteers are hand-selected and trained to serve and comfort patients without family or friends present during their hospital stay. Activities may include reading, writing letters, taking walks, playing games, or simply comforting patients through conversation. In addition, CCP volunteers help keep patients safe by notifying medical staff when needs arise - a task that is usually performed by a family member or friend but often overlooked for patients who lack a companion. In FY 2018, 14 CCP volunteers devoted nearly 430 hours to approximately 440 patient visits. The Cushman Wellness Center Community Health Library and SMH Volunteer Department continued to offer the Health Information Ambassador program in FY 2018. 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 and empowers them to become involved in their own health care. Through the program, hospital volunteers”

“According to the January 2018 WeAllCount Annual Report, there are nearly 8,600 individuals experiencing homelessness in SDC, nearly 5,000 of whom are unsheltered. This represents a decrease of six percent region-wide from 2017. Since 2011, Sharp has sponsored the Downtown San Diego Partnership's Family Reunification Program, which serves to reduce the number of homeless individuals on the streets of downtown San Diego. Through the program, homeless outreach coordinators from the Downtown San Diego Partnership's Clean & Safe Program identify homeless individuals who will be best served by traveling back home to loved ones. Family and friends are contacted to ensure that the individuals have a place to stay and the support they need to get back on their feet. Once confirmed, the outreach team provides the transportation needed to reconnect with their support system. With Sharp's help, the Family Reunification Program has reunited nearly 2,200 homeless individuals in Downtown San Diego with friends and family across the nation. The University of California, Los Angeles Center for Health Policy and Research's Elder Index states that two in five (41 percent) San Diego seniors will have to choose between buying food and paying rent. Through the Giving Tree program at the Downtown Sharp Senior Health Center, community members and staff donate gift cards to make the holidays brighter for seniors in need. In December 2017, each patient who visited the Downtown Sharp Senior Health Center left with a gift bag and a gift card to a local drug store, grocery store or restaurant. The SGH Engineering Department led a variety of volunteer initiatives in FY 2018. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting visitors, patients and staff. Through the program, the SGH landscape 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. In FY 2018, the team delivered two to four vases of flowers with an inspirational quote each week, with as many as six vases or more 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 East County seniors, as well as offers roses for SGH's annual patient remembrance service. Now in its eighth 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 a bouquet of balloons, ribbon, a Sodexo care bear or football, and a chocolate pastry created by SGH and Sodexo chefs, and deliver it to the individual. In FY 2018, the team assembled up to eight Cheers Bouquets per month, including bouquets for more than 40 new fathers on Father's Day weekend. For the past eight years, the SGH Engineering Department, landscape team and Auxiliary have collaborated with local businesses to bring The Shirt Off Our Backs Program to community members in need during the holidays. Through the program, volunteers collect and donate a variety of items to help meet the basic needs of homeless or low-income children and adults. In FY 2018, volunteers filled two trucks with donated food and other essential items, including 50 hygiene kits (shampoo, soap, wipes, toothbrushes, etc.), 250 handmade sandwiches and 100 water bottles as well as clothing, socks, shoes, toys,”

“Commuter Solutions Subcommittee Commuter solutions To monitor progress and measure tangible results, All Ways Green utilizes a Sharp-developed report card, which trends each domain's annual performance against a baseline. The report card shows where the desired results have been achieved as well as identifies opportunities for improvement. These opportunities for improvement are used to strategically plan initiatives that engage Sharp's workforce in reducing the organization's carbon footprint. Sharp continues to invest in technology and programs that reduce carbon emissions and minimize waste. Through these efforts, in FY 2018, Sharp hospitals prevented nearly 210,000 pounds of cardboard and plastic from entering landfills, and reduced carbon dioxide emissions by more than 115,000 pounds. Sharp's goals and accomplishments within each All Ways Green committee/subcommittee and domain are described below. Natural Resource Conservation According to the EPA, health care ranks as the country's second most energy intensive industry, emitting roughly eight percent of the nation's greenhouse gas emissions. In the U.S., hospital water use constitutes seven percent of the total water used in commercial and institutional buildings. Sharp's goal is to optimize the use of electricity, gas and water across its facilities, identify and evaluate opportunities for improvement, implement initiatives in the most cost-effective manner, and track progress. A World Health Organization report published in 2017 encouraged hospitals to proactively address the environmental footprint of the health care sector by reducing power consumption, utilizing alternative energy generation, recycling and conserving resources. Sharp's Natural Resource Subcommittee is addressing this call by implementing numerous energy and water conservation initiatives, including infrastructure changes and adopting best practices to ensure its facilities are optimally operated while monitoring and measuring energy and water consumption. The Natural Resource Subcommittee is responsible for communications to employees about the energy-conscious behaviors that can be practiced in the workplace and at home to promote continuous energy and water savings. Sharp was one of the first health care organizations in the county to commit to environmental best practices in information technology. In 2013, Sharp became the first health care system in San Diego to implement a computer management program that places computers and monitors into a low-power sleep mode after a one-hour period of inactivity. Since its implementation, the program has been installed on all computers at the organization and has resulted in annual energy savings in excess of 1.6 million kilowatt-hours (kWh). The initiative earned Sharp a Certificate of Recognition from the EPA, which recognizes organizations' achievements in energy conservation and efficiency. Since April 2016, the SGH campus has been essentially off the electrical grid due to the completion of a new state-of-the-art Central Energy Plant (CEP), named the Brady Family Cogen. The CEP includes a 52-ton, 4.4-megawatt combustion turbine generator that generates enough electricity to meet up to 95 percent of the hospital's needs while reducing greenhouse gases by up to 90 percent. In addition to providing electrical power, the CEP converts heat to steam to operate medical equipment, space heating and air conditioning as well as provides hot and cold water to the hospital. The new CEP fully complies with state and local standards for air emissions. In 2017, new software was installed on ten data center air conditioner units, resulting in more efficient cooling of the data center and a 16 percent decrease in power usage for these devices. New virtual environments replaced more than 150 devices in the data center, further reducing power and cooling needs for the building. In addition, after implementing TSO Logic software in 2015, Sharp can conservatively reduce”

“Electric Vehicle Charging Stations: SCVMC, System Offices, SMH/SMBHWN, SRSMG. Electronic/Low-flow Faucets: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Energy-efficient Kitchen/Cafe Appliances: SCHHC, SCVMC, SGH, SMH/SMBHWN. Energy-efficient Chillers/ Motors: SCHHC, SCVMC, SGH, SMH/SMBHWN. Faucets and Toilet Retrofits: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. HVAC projects: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Lighting Retrofits to LEDs: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Occupancy Sensors SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Mist Eliminators SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Moisture-sensitive Sprinkler Controls: SCHHC,SGH, SMH/SMBHWN. Plumbing Projects to Address Water Leaks SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Thermostat Control Software & Temperature Setback Projects: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Filtered Water Dispensers to Replace Water Bottles: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Water-efficient Dishwashing/ Equipment Washing/ Chemical Dispensing System: SCHHC, SCVMC, SGH, SMH/SMBHWN. Waste Minimization U.S. hospitals generate an average of 26 pounds of waste per staffed bed each day, approximately 15 percent of which is considered hazardous material. Sharp is committed to significantly reducing waste at each entity and extending the lifespan of local landfills. Sharp's Waste Minimization Committee provides oversight of systemwide waste minimization initiatives, including proper waste segregation and enhanced recycling efforts. Sharp made the following achievements in waste minimization in FY 2018: * Sharp proactively recycled more than 1,700 tons of construction debris from its major building project at SCVMC. * Sharp's single-waste stream recycling program diverted more than 2.5 million pounds of trash from the landfill, including nonconfidential paper, cardboard, exam table paper, plastic, aluminum cans and glass containers. * Sharp collected, reprocessed and sterilized 136,000 pounds of surgical instruments for further use. * Sharp donated over 64,000 pounds of computer equipment in place of utilizing e-waste disposal. * Sharp diverted nearly 120,000 pounds of plastic and cardboard from the landfill through the use of reusable sharps containers. Sharp was named the 2017 Outstanding Recycling Program by the 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. Sharp was an early adopter in its commitment to waste diversion and consistently diverts over 37 percent of waste through recycling, donating, composting, reprocessing and reusing programs. Sharp's waste minimization efforts have resulted in more than 4,500 tons of waste diverted from the landfill. See Table 5 for waste diversion rates and Table 6 for specific waste minimization efforts at Sharp in FY 2018. Table 5: Sharp HealthCare Waste Diversion - FY 2018 Sharp Chula Vista Medical Center: Recycled Waste Per Year (pounds)- 4,264,722 Total Waste Per Year (pounds)- 7,174,063 Percent Recycled - 59% Sharp Coronado Hospital and Healthcare Center: Recycled Waste Per Year (pounds)- 551,442 Total Waste Per Year (pounds)- 2,062,355 Percent Recycled - 27% Sharp Grossmont Hospital: Recycled Waste Per Year (pounds)- 1,558,396 Total Waste Per Year (pounds)- 4,940,651 Percent Recycled - 32% Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns: Recycled Waste Per Year (pounds)- 1,592,405 Recycled Waste Per Year (pounds)- 6,408,972 Percent Recycled - 25% Sharp Mesa Vista Hospital: Recycled Waste Per Year (pounds)- 196,420 Total Waste Per Year (pounds)- 494,786 Percent Recycled - 40% Sharp Rees-Stealy M”

“Since August 2016, SMH, SMV, and SGH have collaborated with the SDRM and the Food Bank in an innovative food recovery program that donates food items that can no longer be used in Sharp's kitchens but are perfectly healthy and nutritious to more than 45 hunger-relief organizations in SDC. In addition, SCVMC's partnership with FSD and SCHHC's partnership with the Food Bank makes Sharp the first health care system in the county to donate food to San Diego's needy at such a wide-scale level. Food recovery efforts benefit the local community by ensuring access to nutritious meals for the food insecure, while also enabling Sharp to save on waste disposal costs and keep food out of landfills. In 2018, Sharp donated almost nine tons of food to these safety-net organizations. Also in 2018, Sharp's imperfect produce program purchased more than 6,500 pounds of less-than-perfect fruits and vegetables per month that are nutrient-rich and full of flavor but would have been thrown away by Sharp's food vendors. Four Sharp hospitals are now participating in composting efforts. SMMC was the first hospital in SDC to participate in the City of San Diego's food scraps composting program in 2012. In 2017, the program expanded to SCVMC in partnership with the City of Chula Vista. Also in 2017, SGH collaborated with Resource Management Group recycling center to begin a composting program, which was expanded to SCHHC in September 2018. Through these programs, food waste at these Sharp sites is processed into a rich compost product and is provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water and helping the environment by recycling valuable organic materials. In FY 2018, Sharp's composting programs diverted approximately 480,000 pounds of waste from landfills. Sharp's waste-mindful operations, including self-audit checklists, continue to help kitchen teams reduce their carbon footprint between food preparation and cleanup. Sharp is also in the process of eliminating oil fryers in its kitchens. SCHHC and SMMC have already switched to healthier methods of food preparation. SGH and SCVMC are participating in the cooking oil recycling program, which, in 2018, collected more than 8,000 pounds of oil, which is converted into safe biodiesel oil. Further, SCHHC, SMH and SMV continued to operate the first county-approved hospital-based organic gardens. Produce from the gardens is used in meals served at the hospital cafes. Sharp is an active member of San Diego's Nutrition in Healthcare Leadership Team, a subcommittee of the San Diego County Childhood Obesity Initiative's health care domain. Sharp is also a participant in Practice Greenhealth's Healthier Food Challenge. As a participant, Sharp commits to reducing its purchase of meats, increasing its purchase of locally-grown food, and increasing its percentage of sustainable animal proteins. In FY 2018, Sharp reduced animal protein purchases by more than 550,000 pounds. This represents a 31 percent reduction in animal protein purchases since FY 2014. In FY 2018, approximately 329,000 pounds of locally sourced produce were used in Sharp's kitchens, representing an increase of 57,000 pounds (more than 20 percent) of locally sourced produce since FY 2014. This is an area of great focus at Sharp and is expected to significantly increase in the next five years as more farmers are identified and certified to provide this safe, reliable source of naturally healthy produce. In FY 2018, Sharp purchased more than 13,000 pounds of sustainable animal protein, representing a 50 percent increase from FY 2014. Sustainable animal protein includes beef and cage-free chicken that is grass-fed and antibiotic- and hormone-free. Sharp was a recipient of the 2018 EMIES UnWasted Food award from the San Diego Food System Allian”

“Community Education and Outreach Sharp actively educates the community about its sustainability programs. In FY 2018, Sharp participated in the following outreach activities: * Sharp published e-newsletters for employees highlighting its recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling and energy and water conservation. * Sharp held its sixth annual systemwide All Ways Green Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how to decrease water, energy and resource consumption, divert waste through recycling, and reduce their carbon footprint by using alternative transportation at work and home. Many of Sharp's key vendors participated in these fairs to help raise awareness of green initiatives and how Sharp is involved in those programs. * Sharp held a community recycling event that included free e-waste recycling and confidential document destruction. The event also included the U.S. Drug Enforcement Agency's Drug Take Back Program, which provides a safe, convenient, and responsible method of drug disposal and educates the general public about the potential for prescription medication abuse. * Sharp participates in San Diego County's Hazmat Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC. Additional community environmental education and outreach initiatives at Sharp are highlighted in Table 8. Table 8: Environmental Community Education and Outreach America Recycles Day: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Bike to Work Day: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Earth Week Activities: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Environmental Policy: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Green Team: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. No Smoking Policy: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Organic Farmer's Market: SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SMV/SMC. Organic Gardens: SCHHC, SMH/SMBHWN. Recycling Education: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Ride Share Promotion: SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG. Emergency and Disaster Preparedness Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. In FY 2018, 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 education courses to first responders and community health care providers throughout SDC. This included a standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System (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. In addition, a course was offered to train participants to use the WebEOC crisis information management system, which provides real-time information sharing between health care systems and outside agencies during a disaster. In September, Sharp hosted its seventh annual Disaster Preparedness Expo to educate San Diego community members about effective disaster preparedness and response in the event of an earthquake, fire, power outage or other emergency. Held at Balboa Park, the free event provided more than 800 community members with a variety of disaster exhibitors, demonstrations and displays, as well as education on personal and family disaster planning. In”

“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 2018, nearly 10,000 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, including 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, Sharp Best Health encourages team members to use Fitbit wireless activity monitors to track their steps, distance, calories burned, sleep patterns and more. By syncing statistics to computers or smartphones, these devices inspire team members to achieve their personal fitness goals one step at a time. Throughout the year, Sharp Best Health held both entity-specific and systemwide Fitbit Step Challenges to encourage team members to set personal goals and compete for prizes. During FY 2018, more than 1,500 participants across the Sharp system walked an average of 8,700 steps per day. Since the Fitbit program's inception in 2014, participating employees have increased their average total steps by 24 percent. In addition, Sharp's acceptable footwear policy permits employees to wear walking shoes each day of the week at Sharp corporate offices to promote safety along with increased physical activity. Sharp Best Health hosted a variety of wellness programs and events for employees and their family and friends. This included systemwide walking and hiking clubs through which more than 90 participants completed six hikes during FY 2018. Sharp Best Health participated in community health events throughout the year, including the American Cancer Society Great American Smoke Out, American Heart Month, National Nutrition Month, National Health and Fitness Month, National Fresh Fruits & Vegetables Month, Stress Management Month and National Walking Month. Sharp Best Health also supported the San Diego Heart & Stroke Walk by hosting donation-based indoor cycling classes at Toby Wells YMCA. In addition, Sharp Best Health partnered with the AHA to promote walking meetings as a heart-healthy alternative to standard meetings. At Sharp System Offices, Sharp Best Health partnered with the Humane Society to provide free "Animal-Based Stress Relief" events where employees were given the opportunity to relieve stress and get some exercise while providing highly valuable human interaction for sheltered dogs and puppies. Sharp Best Health provided on-site health and fitness classes and workshops for employees throughout FY 2018. 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, the truth about counting calories, and the impact of sleep, stress and aging on health. Classes were also offered on stress management techniques and the importance of taking micro-breaks. Fitness offerings included yoga, Zumba, weight training and aquatics classes. Sharp Best Health also offered recipe demonstrations to encourage healthy meal preparation at home. Sharp Best Health offered employees a new wellness initiative in FY 2018 called the Better Balance Project, which is intended to help attendees achieve a better sense of balance and well-being. Instead of making radical, time-consuming changes, participants were encouraged to make small but powerful health adjustments that are frequently overlooked. Each week throughout the four-week progra”

“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 $248.5 million and quality assurance fees and pledges totaling $161.1 million in FY 2018. The net FY 2018 impact of the program totaling $87.4 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 2018 understate the true unreimbursed medical care services performed for the past fiscal year. Table 10 illustrates the impact of the Medi-Cal Hospital Fee Program on Sharp's unreimbursed medical care services in FY 2018. Table 10: Sharp HealthCare Unreimbursed Medical Care Services: Medi-Cal Hospital Fee Program Impact - FY 2018 Medicare & Medicare HMO - $125,364,745 Medicare Capitated - $123,297,615 Medi-Cal, Medi-Cal HMO & CMS Before Provider Fee - $187,303,059 Provider Fee - $(48,792,687) Medi-Cal, Medi-Cal HMO & CMS After Provider Fee - $138,510,372 CHAMPVA & Workers' Comp. - $7,642,323 Bad Debt - $6,511,004 Charity Care - $24,969,673 Total Before Provider Fee - $475,088,419 Provider Fee - $(48,792,687) Total Before Provider Fee - $426,295,732 Table 11 lists community benefit costs provided by each Sharp entity. Table 11: Total Economic Value of Community Benefit Provided By Sharp HealthCare Entities - Estimated FY 2018 Unreimbursed Costs Sharp Chula Vista Medical Center - $90,298,683 Sharp Coronado Hospital and Healthcare Center - $21,258,431 Sharp Grossmont Hospital - $128,924,916 Sharp Mary Birch Hospital for Women & Newborn - $9,761,499 Sharp Memorial Hospital - $167,314,062 Sharp Mesa Vista Hospital and Sharp McDonald Center - $19,779,122 Sharp Health Plan - $69,903 TOTAL FOR ALL ENTITIES - $437,406,616 Table 12 includes a summary of unreimbursed costs for each Sharp hospital entity based on the categories specifically identified in SB 697. For a detailed summary of unreimbursed costs of community benefit provided by each Sharp entity in FY 2018, see tables presented in individual entity sections. Table 12: Detailed Economic Value of SB 697 Categories - Estimated FY 2018 Unreimbursed Costs Sharp Chula Vista Medical Center: Medical Care Services - $87,878,861 Other Benefits for Vulnerable Populations - $571,854 Other Benefits for the Broader Community - $364,393 Health Research, Education and Training Programs - $1,483,575 Total - $90,298,683 Sharp Coronado Hospital and Healthcare Center: Medical Care Services - $20,564,090 Other Benefits for Vulnerable Populations - $84,351 Other Benefits for the Broader Community - $89,574 Health Research, Education and Training Programs - $520,416 Total - 21,258,431 Sharp Grossmont Hospital: Medical Care Services - $125,643,033 Other Benefits for Vulnerable Populations - $1,157,648 Other Benefits for the Broader Community - $559,470 Health Research, Education and Training Programs - $1,564,765 Total - $128,924,916 Sharp Mary Birch Hospital for Women & Newborns: Medical Care Services - $9,316,725 Other Benefits for Vulnerable Populations - $87,059 Other Benefits for the Broader Community - $119,237 Health Research, Education and Training Programs - $238,478 Total - $9,761,499 Sharp Memorial Hospital: Medical Care Services - $163,867,752 Other Benefits for Vulnerable Populations - $1,323,591 Other Benefits for the Broader Community - $561,771 Health Research, Education and Training Programs - $1,560,948 Total - $167,314,062 Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $19,025,271 Other Benefits for Vulnerable Populations - $448,871 Other Benefits for the Broader Community - $127,420 Health Research, Education and Training Programs - $177,560 Total - $19,779,122 Sharp Health Plan: Medical Care Services - $0 Other Benefits for Vulnerable Population”

“Top 15 Health Needs Based on 2013 Initial Quantitative Analysis were as follows: Acute Respiratory Infections Asthma Back Pain Breast Cancer Cardiovascular Disease Colorectal Cancer Dementia and Alzheimer's Diabetes (Type 2) High Risk Pregnancy Lung Cancer Mental Health/ Mental Illness Obesity Prostate Cancer Skin Cancer Unintentional Injuries Sharp's 2013 CHNA process and findings were significantly informed by the collaborative HASD&IC CHNA model. Consequently, Sharp's 2016 CHNA process sought to gain further insight into the needs identified across its different hospitals in 2013, including (in alphabetical order) behavioral health, cancer, cardiovascular disease, Type 2 diabetes, high-risk pregnancy, obesity and senior health. Specific objectives of Sharp's 2016 CHNA process included: * Gather in-depth feedback to aid in the understanding of the most significant health needs impacting community members in SDC, particularly Sharp patients. * Connect the identified health needs with associated social determinants of health (SDOH) to further understand the challenges that community members and Sharp patients - particularly those in communities of high need - face in their attempts to access health care and maintain health and well-being. * Identify currently available community resources that support identified health conditions and health challenges. * Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community. Study Area Defined For the purposes of the collaborative HASD&IC 2016 CHNA, the study area is the entire County of San Diego due to a broad representation of hospitals in the area. With more than three million residents, SDC is socially and ethnically diverse. Information on key demographics, socioeconomic factors, access to care, health behaviors, and the physical environment can be found in the full HASD&IC 2016 CHNA report at http://hasdic.org. As the study area for both the collaborative HASD&IC 2016 and Sharp 2016 CHNAs cover SDC, the HASD&IC 2016 CHNA process and findings significantly informed Sharp's CHNA process/findings, and as such, are described as applicable throughout Sharp's CHNAs. For complete details on the HASD&IC 2016 CHNA process, please visit the HASD&IC website or contact Lindsey Wade, Vice President, Public Policy at HASD&IC at [email protected]. For the collaborative HASD&IC 2016 CHNA process, the IPH employed a rigorous methodology using both community input and quantitative analysis to provide a deeper understanding of barriers to health improvement in SDC. The 2016 CHNA process began with a comprehensive scan of recent community health statistics in order to validate the regional significance of the top four health needs identified in the HASD&IC 2013 CHNA. Quantitative data for both the HASD&IC 2016 CHNA and Sharp 2016 CHNAs included 2013 OSHPD demographic data for hospital inpatient, emergency department (ED), and ambulatory care encounters to understand the hospital patient population. Clinic data was also gathered from OSHPD and incorporated in order to provide a more holistic view of health care utilization in SDC. Additional variables analyzed in the 2016 CHNA processes are included in Table 13; variables were analyzed at the ZIP code level wherever possible. Table 13: Data Variables in the HASD&IC and Sharp 2016 CHNAs * Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters * Community Clinic Visits * Demographic Data (socioeconomic indicators) * Mortality and Morbidity Data * Regional Program Data (childhood obesity trends and community resource referral patterns) * Social Determinants of Health and Health Behaviors (education, income, insurance, physical environment, physical activity, diet and substance abuse) Based on the results of the community health statistics scan and feedback from community partners received du”

“Steps Completed to Prepare Sharp's Community Benefit Report On an annual basis, each Sharp hospital performs the following steps in the preparation of its Community Benefit Report: * Establishes and/or reviews hospital-specific objectives taking into account results of the entity CHNA and evaluation of the entity's service area and expertise/services provided to the community * Verifies the necessity for an ongoing focus on identified community needs and/or adds newly identified community needs * Reports on activities conducted in the prior fiscal year - FY 2018 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken - FY 2019 Plan * Reports and categorizes the economic value of community benefit provided in FY 2018, according to the framework specifically identified in Senate Bill 697 * Reviews and approves a Community Benefit Plan * Distributes the Community Benefit Plan and Report to members of the Sharp Board of Directors and each of the Sharp hospital boards of directors, highlighting activities provided in the prior fiscal year as well as specific action steps to be undertaken in the upcoming fiscal year * Implement community benefit activities identified for the upcoming fiscal year Ongoing Commitment to Collaboration Underscoring Sharp's ongoing commitment to collaboration in order to address community health priorities and improve the health of San Diegans, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, Association for Community Health Improvement, statewide California Hospital Association, HASD&IC, and a variety of local collaboratives including but not limited to the San Diego Hunger Coalition, the San Diego Regional Chamber of Commerce and 2-1-1 San Diego. Appendix A Sharp HealthCare Involvement in Community OrganizationsThe list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2018. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Adult Protective Services * Alliance for African Assistance * Altrusa International Club of San Diego * Alzheimer's Project Safety Workgroup * Alzheimer's San Diego * Alzheimer's San Diego Client Advisory Board * American Academy of Nursing * American Association of Colleges of Nursing * American Association of Critical-Care Nurses * American Cancer Society * American College of Healthcare Executives * American Congress of Obstetricians and Gynecologists * American Diabetes Association * American Foundation for Suicide Prevention * American Heart Association * American Hospital Association * American Hospital Association Regional Policy Board * American Lung Association * American Nurses Association * American Psychiatric Nurses Association * American Red Cross of San Diego * Angels Foster Family Network * The Arc of San Diego * 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 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 * BAME Renaissance, Inc. (BAME CDC) * 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 * California Academy of Nutrition and Dietetics - San Diego District * California Association of Health Plans * California Association of Hospitals and Health Systems”

“Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, all tax exempt bond balances, including those allocated to other members of the Obligated Group, are reported on the Sharp HealthCare return (EIN 95-6077327). The Sharp HealthCare Obligated Group is comprised of Sharp HealthCare (EIN 95-6077327), Sharp Memorial Hospital (EIN 95-3782169), Grossmont Hospital Corporation (EIN 33-0449527), and Sharp Chula Vista Medical Center (EIN 95-2367304).”

“Med fees - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 52195, Fundraising Expenses: ; Purchased Services - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 22754510, Fundraising Expenses: ; Registry - Total Expense: 2953078, Program Service Expense: 435638, Management and General Expenses: 2517440, Fundraising Expenses: ;”

“Current year other comprehensive income - 5644758; beneficial interest in sharp healthcare foundation - 12820606; book/tax differences on partnership interest - mri - 87234; book/tax diff on partnership interest - ucsd/sharp transplant program - 588444; book/tax diff on partnership interest - shc aco, llc - 4836025;”

“Participate in International Travel & Health Insurance conference. Sharp HealthCare employees volunteered for humanitarian missions.”

“The management team evaluates requests for contributions from outside organizations taking into account how they align with the organization's mission. No monitoring is done after grants are made.”

“* Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Point Loma/Hervey Library * Point Loma Nazarene University * Postpartum Health Alliance * Practice Greenhealth * Promises2Kids * Psychiatric Emergency Response Team * Public Health Emergency Hospital Preparedness Program * Regional Perinatal System * Residential Care Committee * Ronald McDonald House Operations Committee * Rotary Club of Chula Vista * Rotary Club of Coronado * San Diego Association of Diabetes Educators * San Diego Association of Governments * San Diego Blood Bank * San Diego Community Action Network * San Diego Community College District * San Diego County * San Diego County Aging and Independence Services * San Diego Dietetic Association * San Diego East County Chamber of Commerce * San Diego Eye Bank Nurses' Advisory Board * San Diego Fire-Rescue Department * San Diego Food System Alliance * San Diego Freedom Ranch * San Diego Habitat for Humanity * 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 North Chamber of Commerce * San Diego Organization of Healthcare Leaders * San Diego Physician Orders for Life-Sustaining Treatment Coalition/San Diego Coalition for Compassionate Care * San Diego Psych-Law Society * San Diego Psychological Association Supervision Committee * San Diego Regional Chamber of Commerce * San Diego Regional Healthcare Sustainability Collaborative * San Diego Regional Home Care Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego Square * San Diego State University * San Diego Unified School District * San Diego Workforce Partnership (SDWP) * Santee-Lakeside Rotary Club * SAY San Diego * Serving Seniors * Sharp and Children's MRI Board * Sharp and UC San Diego Health's Joint Venture * Smart Kitchens San Diego * South Bay Community Services * South Bay Senior Providers * South County Action Network * South County Economic Development Council * 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 * Statewide Medical Health Exercise Program * SuperFood Drive * The Meeting Place * Transitional Age Youth Behavioral Health Services Council * Trauma Center Association of America * Union of Pan Asian Communities * University of California, San Diego * University of San Diego * University of Southern California * USS Midway Museum * VA San Diego Healthcare System * VA San Diego Mental Health Council * Veterans Village of San Diego * Vista Hill ParentCare * We Honor Veterans * Westminster Tower * Women, Infants and Children Program * Wreaths Across America - San Diego * YMCA * YWCA Becky's House * YWCA Board of Directors * YWCA In the Company of Women Event”