SCRIPPS HEALTH: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: SCRIPPS HEALTH (EIN 95-1684089)
Tax period: 2020-10-01 to 2021-09-30
Filed: 2022-08-10
IRS object ID: 202202229349300245
Schema version: 2020v4.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-10T14:47:12-05:00	ReturnTs
Tax Period End	2021-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	ERNST & YOUNG US LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	101 E WASHINGTON ST STE 910	AddressLine1Txt
City	PHOENIX	CityNm
State Abbreviation	AZ	StateAbbreviationCd
ZIP	85004	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	951684089	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Scripps Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% Brett Tande	InCareOfNm
Business Name Control	SCRI	BusinessNameControlTxt
Phone	8586787901	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10140 CAMPUS POINT DRIVE	AddressLine1Txt
City	SAN DIEGO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	92121	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	BRETT TANDE	PersonNm
Person Title	CORP SR VP/CFO	PersonTitleTxt
Phone	8586797901	PhoneNum
Signature	2022-08-08	SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	BRETT	PersonFirstNm
Person Last	TANDE	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	STEVEN T RUTTI	PreparerPersonNm
PTIN	P00775456	PTIN
Phone	6023223051	PhoneNum
Preparation	2022-07-29	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Christopher Van Gorder	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10140 Campus Point Drive	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	92121	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$3,759,567,825	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SCRIPPS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1924	FormationYr
Legal Domicile State	CA	LegalDomicileStateCd
Activity Or Mission	Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $3.8 billion, private not-for-profit integrated health system in San Diego, Ca. (see Sch O)	ActivityOrMissionDesc
Voting Members Governing Body	14	VotingMembersGoverningBodyCnt
Voting Members Independent	13	VotingMembersIndependentCnt
Total Employee	18645	TotalEmployeeCnt
Total Volunteers	264	TotalVolunteersCnt
Total Gross UBI	$4,307,079	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$275,995	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$145,322,851	PYContributionsGrantsAmt
CY Contributions Grants	$198,167,041	CYContributionsGrantsAmt
PY Program Service Revenue	$3,136,723,551	PYProgramServiceRevenueAmt
CY Program Service Revenue	$3,302,028,743	CYProgramServiceRevenueAmt
PY Investment Income	$89,688,123	PYInvestmentIncomeAmt
CY Investment Income	$131,452,621	CYInvestmentIncomeAmt
PY Other Revenue	$115,371,998	PYOtherRevenueAmt
CY Other Revenue	$129,298,395	CYOtherRevenueAmt
PY Total Revenue	$3,487,106,523	PYTotalRevenueAmt
CY Total Revenue	$3,760,946,800	CYTotalRevenueAmt
PY Grants And Similar Paid	$1,203,950	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$840,000	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,419,930,850	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,552,725,968	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$6,711,261	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,822,252,952	PYOtherExpensesAmt
CY Other Expenses	$1,962,226,886	CYOtherExpensesAmt
PY Total Expenses	$3,243,387,752	PYTotalExpensesAmt
CY Total Expenses	$3,515,792,854	CYTotalExpensesAmt
PY Revenues Less Expenses	$243,718,771	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$245,153,946	CYRevenuesLessExpensesAmt
Total Assets BOY	$6,720,360,494	TotalAssetsBOYAmt
Total Assets EOY	$7,649,635,938	TotalAssetsEOYAmt
Total Liabilities BOY	$2,098,076,504	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$2,365,563,136	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$4,622,283,990	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$5,284,072,802	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	SEE SCHEDULE O.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$3,107,426,728	ExpenseAmt
Grant	$840,000	GrantAmt
Revenue	$3,425,444,408	RevenueAmt
Desc	SEE SCHEDULE O.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$1,454,855	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$1,979,308	RevenueAmt
Desc	The Maxwell H. and Muriel Gluck Child Care center provides child care and pre-school education for the benefit of individuals in the community of San Diego, including employees and patients of the nonprofit 501(C)(3) entities of Scripps Health and Scripps Research Institute. Special emphasis is placed on a variety of learning and play activities in the musical and visual arts field.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$3,108,881,583	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	Yes (true)	ConservationEasementsInd
Collections Of Art	Yes (true)	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (true)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (true)	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	Yes (true)	ForeignOfficeInd
Foreign Activities	Yes (true)	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	Yes (true)	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	Yes (true)	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	Yes (true)	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	Yes (true)	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	Yes (true)	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	799	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	18645	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	Yes (true)	ForeignFinancialAccountInd
Foreign Country	MX	ForeignCountryCd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (true)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (true)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	Yes (true)	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	14	GoverningBodyVotingMembersCnt
Independent Voting Member	13	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	false	MembersOrStockholdersInd
Election Of Board Members	false	ElectionOfBoardMembersInd
Decisions Subject To Approva	false	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (true)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Brett Tande	PersonNm
Phone	8586786828	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10140 Campus Point Drive	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	92121	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (39 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CHRISTOPHER VAN GORDER
PRESIDENT & CEO/TRUSTEE	58.0	2.0	Yes (X)	Yes (X)	$2,442,197	$0	$341,024
SHIRAZ FAGAN
CHIEF EXEC, SR VP (PART-YEAR)	50.0	0.0			$1,704,623	$0	$5,603	Yes (X)
RICHARD ROTHBERGER
TREASURER / EXEC VP, CFO	54.0	1.0		Yes (X)	$1,604,419	$0	$72,447
JAMES LA BELLE MD
CORP SR VP, CMO (PART-YEAR)	50.0	0.0			$1,520,434	$0	$2,857	Yes (X)
RICHARD SHERIDAN
FORMER OFFICER	0.0	0.0			$1,203,364	$0	$275,162		Yes (X)
THOMAS BUCHHOLZ
CORP SR. VP, MD ANDERSON	50.0	0.0			$1,213,918	$0	$225,739	Yes (X)
CARL ETTER
CHIEF EXECUTIVE, SR VP	50.0	0.0			$1,065,764	$0	$179,208	Yes (X)
RICHARD NEALE
CORP EXEC VP, CHIEF GROWTH OFF	50.0	0.0			$1,076,208	$0	$152,530	Yes (X)
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	50.0	0.0			$1,019,526	$0	$202,041	Yes (X)
BARBARA PRICE
CORP SR VP, BUS&SERV LINE DEV	50.0	0.0			$1,001,510	$0	$191,070	Yes (X)
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	50.0	0.0			$943,802	$0	$60,831	Yes (X)
JOHN ENGLE
CORP SR. VP, CHIEF DEVELOPMENT	50.0	0.0			$792,499	$0	$148,999	Yes (X)
GHAZALA SHARIEFF
CORP SR. VP, ACUTE CARE/CLIN E	50.0	0.0			$698,437	$0	$88,139	Yes (X)
ERIC COLE
CORP SVP, HUMAN RESOURCES	50.0	0.0			$745,843	$0	$35,655	Yes (X)
JOHN POOLE
CORP VP, SYSTEM IMPROVEMENT	50.0	0.0			$649,027	$0	$122,408			Yes (X)
LISA RISSER-THAKUR
CORP SR. VP, ANCILLARY OPS	50.0	0.0			$630,761	$0	$129,513	Yes (X)
BRAD ELLIS
CORP VP, ASST GEN COUNSEL, SEC	49.0	1.0		Yes (X)	$645,107	$0	$106,282
SHAWN FORRESTER
CORP VP, PAYER RELATIONS	20.0	20.0			$615,950	$0	$121,244	Yes (X)
CHRISTEE THOMAS
CORP VP, REV CYCLE/CNT BUS OFC	50.0	0.0			$620,030	$0	$99,957			Yes (X)
SHANE THIELMAN
CORP SR. VP, CIO	50.0	0.0			$572,118	$0	$138,153	Yes (X)
GERALD L SODERSTROM
CORP VP, AUDIT / COMPLIANCE	50.0	0.0			$583,823	$0	$103,882			Yes (X)
TRACY CHU
CORP VP, POP HLTH CHF EXEC/ACO	50.0	0.0			$553,705	$0	$95,224			Yes (X)
MARY ELLEN DOYLE
CORP VP, NURSING OPS	50.0	0.0			$590,102	$0	$52,126	Yes (X)
LAURANCE CRACROFT
VP, PHYSICIAN NETWORK DEVT	50.0	0.0			$529,395	$0	$49,568			Yes (X)
MONIQUE GONZALEZ
ASSISTANT SECRETARY	50.0	0.0		Yes (X)	$86,181	$0	$28,128
MIELLE SCHWARTZ
EXECUTIVE ASSISTANT SECRETARY	39.0	1.0		Yes (X)	$73,493	$0	$26,761
GENE H BARDUSON
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
RICHARD C BIGELOW
TRUSTEE, VICE CHAIR	13.0	1.0	Yes (X)	Yes (X)	$0	$0	$0
JEFF BOWMAN
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
JOHN BOYER PHD
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
JAN CALDWELL
TRUSTEE, CHAIR	13.0	1.0	Yes (X)	Yes (X)	$0	$0	$0
JUDY CHURCHILL PHD
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
NICOLE A CLAY
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
DON GOLDMAN
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
KEVIN T HAMILTON
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
KATHERINE A LAUER
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
MARTY J LEVIN
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
ELLIOT A SCOTT
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0
RICHARD VORTMANN
TRUSTEE	13.0	1.0	Yes (X)		$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$23,108,743	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$3,027,790	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	3013	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Scripps Clinic Medical Group Inc
10666 N Torrey Pines Rd	La Jolla	CA	92037	Physician Services	$320,446,207
Scripps Coastal Medical Group
501 Washington Ave	San Diego	CA	92103	Physician Services	$58,533,190
Scripps Health Inpatient Providers
10010 Campus Point Dr	San Diego	CA	92121	Physician Services	$34,372,454
Medimpact Healthcare Systems
10181 Scripps Gateway Ct	San Diego	CA	92131	Pharmaceutical Svcs	$33,422,824
Emergency Acute Care Medical Group
440 Stevens Ave Ste 100	San Diego	CA	92075	Physician Services	$13,891,394

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	147	CntrctRcvdGreaterThan100KCnt
Fundraising	$226,845	FundraisingAmt
Government Grants	$50,434,718	GovernmentGrantsAmt
All Other Contributions	$147,505,478	AllOtherContributionsAmt
Noncash Contributions	$83,699,812	NoncashContributionsAmt
Total Contributions	$198,167,041	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
HEALTHCARE DELIVERY REV	622110	$2,958,966,418	$2,957,653,428	$1,312,990	$0
PROVIDER FEE REVENUE	622110	$152,003,067	$152,003,067	$0	$0
Capitation Premium	622110	$144,496,050	$144,496,050	$0	$0
Joint Venture Revenue	900099	$13,554,762	$13,554,762	$0	$0
RENTAL INCOME - MOB	531120	$13,084,640	$13,084,640	$0	$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,923,806	TotalRevenueColumnAmt
Related Or Exempt Func Income	$19,857,084	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$66,722	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$3,302,028,743	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$48,325,536	TotalRevenueColumnAmt
Related Or Exempt Func Income	$637,541	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$403,025	UnrelatedBusinessRevenueAmt
Exclusion	$47,284,970	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$81,596,005	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	-$1,531,080	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$83,127,085	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$83,127,085	TotalRevenueColumnAmt
Exclusion	$83,127,085	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$69,030	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$226,845	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$152,105	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$83,075	TotalRevenueColumnAmt
Exclusion	-$83,075	ExclusionAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$0	GamingGrossIncomeAmt
Gaming Direct Expenses	$0	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$0	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$0	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
MANAGEMENT SERVICES	561110	$46,181,614	$44,315,009	$1,866,605	$0
PHARMACEUTICAL REVENUE	446110	$33,474,606	$33,474,606		$0
All other revenue	900099	$49,725,250	$46,967,817	$657,737	$2,099,696

Field	Value	IRS element (for citing)
Other Revenue Total	$129,381,470	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,760,946,800	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,426,044,004	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$4,307,079	UnrelatedBusinessRevenueAmt
Exclusion	$132,428,676	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$840,000	TotalAmt
Program Services	$840,000	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$19,476,774	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$19,476,774	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$202,408	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$202,408	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$1,274,640,907	TotalAmt
Program Services	$1,091,064,871	ProgramServicesAmt
Management And General	$179,334,596	ManagementAndGeneralAmt
Fundraising	$4,241,440	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$46,934,283	TotalAmt
Program Services	$38,688,052	ProgramServicesAmt
Management And General	$8,150,301	ManagementAndGeneralAmt
Fundraising	$95,930	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$112,959,269	TotalAmt
Program Services	$112,556,050	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$403,219	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$98,512,327	TotalAmt
Program Services	$81,012,946	ProgramServicesAmt
Management And General	$17,230,432	ManagementAndGeneralAmt
Fundraising	$268,949	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$11,327,899	TotalAmt
Program Services	$1,498,774	ProgramServicesAmt
Management And General	$9,824,733	ManagementAndGeneralAmt
Fundraising	$4,392	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,163,291	TotalAmt
Program Services	$25,451	ProgramServicesAmt
Management And General	$1,137,840	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$298,605	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$298,605	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Fundraising	$0	FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$6,380,713	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$6,380,713	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$754,501,471	TotalAmt
Program Services	$685,582,290	ProgramServicesAmt
Management And General	$68,465,426	ManagementAndGeneralAmt
Fundraising	$453,755	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$3,682,292	TotalAmt
Program Services	$66,167	ProgramServicesAmt
Management And General	$3,615,631	ManagementAndGeneralAmt
Fundraising	$494	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$64,129,061	TotalAmt
Program Services	$53,602,978	ProgramServicesAmt
Management And General	$9,976,771	ManagementAndGeneralAmt
Fundraising	$549,312	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$58,084,628	TotalAmt
Program Services	$29,277,161	ProgramServicesAmt
Management And General	$28,807,467	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$85,967,165	TotalAmt
Program Services	$78,060,563	ProgramServicesAmt
Management And General	$7,693,908	ManagementAndGeneralAmt
Fundraising	$212,694	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$22,890,117	TotalAmt
Program Services	$19,614,272	ProgramServicesAmt
Management And General	$3,275,845	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$191,211,264	TotalAmt
Program Services	$174,438,078	ProgramServicesAmt
Management And General	$16,773,186	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$7,317,387	TotalAmt
Program Services	$7,310,533	ProgramServicesAmt
Management And General	$6,854	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$616,252,082	$616,252,082	$0	$0
HOSPITAL FEE PROGRAM	$103,494,413	$103,494,413
Repairs & Maintenance	$31,970,112	$12,420,899	$19,548,520	$693
ALL OTHER EXPENSES	$3,556,386	$3,076,003	$0	$480,383

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,515,792,854	TotalAmt
Program Services	$3,108,881,583	ProgramServicesAmt
Management And General	$400,200,010	ManagementAndGeneralAmt
Fundraising	$6,711,261	FundraisingAmt

Total Joint Costs TotalJointCostsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$852,352,866	BOYAmt
EOY	$656,798,524	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$6,746,587	BOYAmt
EOY	$12,950,578	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$610,810,894	BOYAmt
EOY	$751,613,657	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$20,843,020	BOYAmt
EOY	$21,534,529	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$61,624,818	BOYAmt
EOY	$79,843,600	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$29,813,638	BOYAmt
EOY	$40,345,860	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$4,400,286,093	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$2,193,361,519	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$2,039,528,311	BOYAmt
EOY	$2,206,924,574	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,219,922,119	BOYAmt
EOY	$2,819,854,076	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$367,416,000	BOYAmt
EOY	$547,462,000	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$73,538,809	BOYAmt
EOY	$77,238,578	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$45,109,895	BOYAmt
EOY	$45,109,895	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$392,653,537	BOYAmt
EOY	$389,960,067	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,720,360,494	BOYAmt
EOY	$7,649,635,938	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$818,637,337	BOYAmt
EOY	$774,230,142	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$792,432,964	BOYAmt
EOY	$1,068,134,200	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$102,260,000	BOYAmt
EOY	$120,938,623	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$384,746,203	BOYAmt
EOY	$402,260,171	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,098,076,504	BOYAmt
EOY	$2,365,563,136	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,351,904,421	BOYAmt
EOY	$4,971,037,007	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$270,379,569	BOYAmt
EOY	$313,035,795	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$4,622,283,990	BOYAmt
EOY	$5,284,072,802	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$6,720,360,494	BOYAmt
EOY	$7,649,635,938	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$245,153,946	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$416,068,128	NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts	$0	DonatedServicesAndUseFcltsAmt
Investment Expense	$0	InvestmentExpenseAmt
Prior Period Adjustments	$0	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	$566,738	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	Yes (true)	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Media Advertisements	$0	MediaAdvertisementsAmt
Mailings Members	Yes (true)	MailingsMembersInd
Mailings Members	$150	MailingsMembersAmt
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Publications Or Broadcast	$0	PublicationsOrBroadcastAmt
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Grants Other Organizations	$0	GrantsOtherOrganizationsAmt
Direct Contact Legislators	Yes (true)	DirectContactLegislatorsInd
Direct Contact Legislators	$261,125	DirectContactLegislatorsAmt
Rallies Demonstrations	false	RalliesDemonstrationsInd
Rallies Demonstrations	$0	RalliesDemonstrationsAmt
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$229,980	OtherActivitiesAmt
Total Lobbying Expenditures	$491,255	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE C, PART II-B	PUBLIC AFFAIRS INFORMATION AND EDUCATION SCRIPPS HEALTH ON ITS OWN BEHALF AND AS A MEMBER OF SEVERAL HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS PARTICIPATES IN PUBLIC AFFAIRS AND ADVOCACY ACTIVITIES. SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY AND SPECIFICALLY ON BEHALF OF SCRIPPS HEALTH. OTHER ACTIVITY IS ORGANIZED BY THESE INVOLVED ORGANIZATIONS SUPPORTED BY SCRIPPS HEALTH PARTICIPATION. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: ACCOUNTABLE CARE ACT (HEALTH REFORM); BUDGET AND FISCAL POLICY IMPACTS; REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY AND THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; UNINSURED, COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING, VALUE-BASED PURCHASING; BUNDLED PAYMENTS; ACCOUNTABLE CARE ORGANIZATIONS, MEDICARE, MEDICAID. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. DIRECT COMMUNICATION (MEETINGS, EMAIL, CALLS, LETTERS) WITH SAN DIEGO LEGISLATIVE DELEGATIONS - FEDERAL AND STATE. ON SAN DIEGO LOCAL LEVEL EMPLOYED SD LAND LAWYERS TO REPRESENT INTERESTS ON LAND DEVELOPMENT NEEDS. ON CALIFORNIA STATE LEVEL EMPLOYED LOBBY FIRM JGC GOVERNMENT RELATIONS TO REPRESENT INTERESTS ON CERTAIN MEASURES. LOBBY FIRM ALSO WORKED WITH OTHER HEALTH SYSTEM CONTRACT LOBBYISTS AND CALIFORNIA HOSPITAL ASSOCIATION LOBBY TEAM ON SELECTED LEGISLATION. WORKED IN CONCERT WITH STATE AND NATIONAL HEALTH CARE ORGANIZATIONS THAT CONDUCTED LOBBY PROGRAMS, INCLUDING: AMERICAN HOSPITAL ASSOCIATION, CALIFORNIA HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES, PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, ALLIANCE OF CATHOLIC HEALTH CARE. SCRIPPS HEALTH DID NOT FILE FORM 5768 UNDER SECTION 501(H). THERE ARE TESTS FOR TAX EXEMPTION - A "SUBSTANTIAL PART TESTAN "EXPENDITURE TEST." AS A 501(C)(3) ORGANIZATION, WE CAN OPT TO FOLLOW THE GUIDELINE THAT "NO SUBSTANTIAL PART" OF OUR ACTIVITIES ARE CARRIED ON TO INFLUENCE LEGISLATION. UNDER SECTION 501(H), ELIGIBLE 501(C)(3) ORGANIZATIONS CAN ELECT TO MAKE LIMITED EXPENDITURES TO INFLUENCE LEGISLATION. THE "EXPENDITURE TEST" IS SUBJECT TO AMOUNTS PERMITTED BY THAT SECTION. WHILE OUR EXPENDITURES FALL WELL BELOW THE LIMITS, WE ALSO EXPEND WHAT IS GENERALLY CONSIDERED AS NO SUBSTANTIAL PART ON SUCH EXPENDITURES. THEREFORE, WE OPT NOT TO FILE FORM 5768, THE FORM REQUIRED UNDER SECTION 501(H). NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE
SCHEDULE C, PART II - B, LINE 1B	PERSONS AT SCRIPPS HEALTH EXCEEDED 5% OF TOTAL TIME SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES.
SCHEDULE C, PART II - B, LINE 1D	POSTAGE FOR COMMUNITY LETTER SENT TO NEIGHBORS ADJACENT TO SCRIPPS MEMORIAL HOSPITAL ENCINITAS IN THE CITY OF ENCINITAS AS PART OF ENTITLEMENT REQUIREMENTS FOR THE CITY REQUIRED COMMUNITY PARTICIPATION PLAN FOR THE ENTITLEMENT OF AN ACUTE CARE BUILDING ON THE HOSPITAL CAMPUS.
SCHEDULE C, PART II - B, LINE 1G	VALUE DETERMINED UTILIZING GROSS-UP METHOD FOR DIRECT LOBBYING COSTS. LOBBYING LABOR COSTS OF (2) PERSONS AT SCRIPPS HEALTH X 175% + ALLOCABLE THIRD-PARTY COSTS (JGC CONSULTING, SD LAND LAWYERS) SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES ARE REFERENCED HERE.
SCHEDULE C, PART II - B, LINE 1I	OTHER ACTIVITIES APPROXIMATE VALUE CONSIDERS A PORTION OF THE DUES OF MEMBER ORGANIZATIONS SPENT ON LOBBYING IN ADDITION TO ANY TRAVEL EXPENSES OCCURRED FOR GOVERNMENT RELATIONS: SENIOR DIRECTOR, GOVERNMENT RELATIONS; DIRECTOR, COMMUNITY RELATIONS RELATED TO LOBBYING ACTIVITIES.

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Historic Structure	Yes (X)	HistoricStructureInd
Total Easements	1	TotalEasementsCnt
Total Acreage	16.00	TotalAcreageCnt
Historic Structure Easements	1	HistoricStructureEasementsCnt
States Easements Held	1	StatesEasementsHeldCnt
Written Policy Monitoring	Yes (true)	WrittenPolicyMonitoringInd
Expenses Incurred Enforcement	$0	ExpensesIncurredEnforcementAmt
Section170h Rqr Stsfd	Yes (true)	Section170hRqrStsfdInd

Art Public Exhibition Amounts ArtPublicExhibitionAmountsGrp

Field	Value	IRS element (for citing)
Revenues Included	$0	RevenuesIncludedAmt
Assets Included	$742,881	AssetsIncludedAmt

Field	Value	IRS element (for citing)
Held Works Art		HeldWorksArtGrp
Collection Used Pub Exhibition	Yes (X)	CollectionUsedPubExhibitionInd
Solicited Assets Sale	false	SolicitedAssetsSaleInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$129,880,000	BeginningYearBalanceAmt
Contributions	$540,474	ContributionsAmt
Investment Earnings Or Losses	$15,126,128	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$897,549	GrantsOrScholarshipsAmt
Other Expenditures	$2,574,215	OtherExpendituresAmt
Administrative Expenses	$1,188,838	AdministrativeExpensesAmt
End Year Balance	$140,886,000	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$121,490,000	BeginningYearBalanceAmt
Contributions	-$141,903	ContributionsAmt
Investment Earnings Or Losses	$12,705,109	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$874,375	GrantsOrScholarshipsAmt
Other Expenditures	$2,148,726	OtherExpendituresAmt
Administrative Expenses	$1,150,105	AdministrativeExpensesAmt
End Year Balance	$129,880,000	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$119,389,000	BeginningYearBalanceAmt
Contributions	$956,581	ContributionsAmt
Investment Earnings Or Losses	$4,884,528	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$844,412	GrantsOrScholarshipsAmt
Other Expenditures	$1,820,256	OtherExpendituresAmt
Administrative Expenses	$1,075,441	AdministrativeExpensesAmt
End Year Balance	$121,490,000	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$124,841,000	BeginningYearBalanceAmt
Contributions	$1,966,841	ContributionsAmt
Investment Earnings Or Losses	$6,490,061	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$810,928	GrantsOrScholarshipsAmt
Other Expenditures	$11,995,794	OtherExpendituresAmt
Administrative Expenses	$1,102,180	AdministrativeExpensesAmt
End Year Balance	$119,389,000	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$116,324,000	BeginningYearBalanceAmt
Contributions	$317,621	ContributionsAmt
Investment Earnings Or Losses	$13,011,507	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$925,456	GrantsOrScholarshipsAmt
Other Expenditures	$2,761,983	OtherExpendituresAmt
Administrative Expenses	$1,124,689	AdministrativeExpensesAmt
End Year Balance	$124,841,000	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	false	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$42,937,333	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$129,693,143	OtherCostOrOtherBasisAmt
Book Value	$172,630,476	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,019,994,062	OtherCostOrOtherBasisAmt
Depreciation	$869,995,049	DepreciationAmt
Book Value	$1,149,999,013	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$102,817,914	OtherCostOrOtherBasisAmt
Depreciation	$83,367,067	DepreciationAmt
Book Value	$19,450,847	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,802,914,772	OtherCostOrOtherBasisAmt
Depreciation	$1,238,128,905	DepreciationAmt
Book Value	$564,785,867	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$301,928,869	OtherCostOrOtherBasisAmt
Depreciation	$1,870,498	DepreciationAmt
Book Value	$300,058,371	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$2,206,924,574	TotalBookValueLandBuildingsAmt
Financial Derivatives		FinancialDerivativesGrp
Closely Held Equity Interests		CloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (3 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Multi-Strategy Funds	$340,204,000	F
Private Equity Funds	$159,258,000	F
Limited Partnership	$48,000,000	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$547,462,000	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDesc	Book ValueBookValueAmt
RIGHT OF USE - OPERATING	$264,302,904
PROVIDER FEE RECEIVABLE	$89,426,290
DEFERRED INVESTMENTS	$10,575,864
CONTRACT RECEIVABLES	$4,354,090
DEFERRED RENT RECEIVABLE	$1,926,087
Art Investments	$742,881
OTHER LONG TERM ASSETS	$18,631,951

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$389,960,067	TotalBookValueOtherAssetsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (9 entries)

DescDesc	AmtAmt
DEFERRED RETIREMENT	$250,513,163
PROVIDER FEE LIABILITY	$62,010,653
SELF-INSURED MALPRACTICE LIABILITY	$31,667,224
Self-Insured Worker's Compensation Liability	$29,539,000
ANNUITY AND UNITRUSTS	$28,384,036
DEFERRED FICA - CARES ACT	$18,986,786
Asset Retirement Obligation	$17,005,636
Deposits and Contingencies	$263,226
Intercompany Liabilities	-$36,109,553

Field	Value	IRS element (for citing)
Total Liability	$402,260,171	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART II, LINE 9	CONSERVATION EASEMENT The historical structure that is considered to be a conservative easement is reported in the Mercy Hospital entity of the consolidated financial statements.
SCHEDULE D, PART III, LINE 4	Scripps Health accepts and maintains gifts-in-kind contributions for art and sculptures ("Collections"). Collections donated with an appraised value greater than $10,000 are recorded in the general ledger and classified as Other Assets and Donor without Restriction Contributions. The Collections are maintained by Scripps Health and are publicly displayed. An annual inventory to assess condition of the Collections is performed. Scripps does not intend to sell the collections for any financial benefit. Scripps Health's Collections provides a clear contribution to make and offer opportunities in delivery of better health, wellbeing and improved experience for patients, service users and staff across the system.
SCHEDULE D, PART V, LINE 4	CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES: $636,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES: $16,826,514 CONTRIBUTIONS RECEIVED FOR USE IN THE SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS: $39,852,692 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE: $12,785,414 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS: $13,520,450
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITION UNDER ASC 740 (AKA FIN 48) SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OF BUSINESS, REGULARLY CARRIED ON, AND NOT IN THE FURTHERANCE OF THE PURPOSED FOR WHICH IT WAS GRANTED EXEMPTION. UNDER FASB ASC 740, INCOME TAXES, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE ORGANIZATION RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE LIKELY THAN NOT THRESHOLD IS MET. THE ORGANIZATION RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS ONLY FOR TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAXES, INTEREST OR PENALTIES AND NO SIGNIFICANT TAX ASSETS FOR TAX BENEFITS WAS ACCRUED AT SEPTEMBER 30, 2021 OR 2020. SCRIPPS HEALTH CURRENTLY FILES FORM 990 (INFORMATIONAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAXES) AND Form 990T (BUSINESS INCOME TAX RETURN FOR AN EXEMPT ORGANIZATION) IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. SCRIPPS HEALTH IS NOT SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2016 IN MAJOR TAX JURISDICTIONS.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (3 entries)

RegionRegionTxt	OfficesOfficesCnt	EmployeeEmployeeCnt	Type Of Activities ConductedTypeOfActivitiesConductedTxt	Specific Services ProvidedSpecificServicesProvidedTxt	Region Total ExpendituresRegionTotalExpendituresAmt
North America	0	13	Program Services	Reconstructive surgery	$91,307
Central America and the Caribbean			Investments		$344,513,032
Europe (Including Iceland and Greenland)			Investments		$105,703,086

Field	Value	IRS element (for citing)
Subtotal Offices	0	SubtotalOfficesCnt
Subtotal Employees	13	SubtotalEmployeesCnt
Total Office	0	TotalOfficeCnt
Total Employee	13	TotalEmployeeCnt
Subtotal Spent	$450,307,425	SubtotalSpentAmt
Total Spent	$450,307,425	TotalSpentAmt
Transfer To Foreign Corp	Yes (true)	TransferToForeignCorpInd
Interest In Foreign Trust	false	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (true)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	Yes (true)	PassiveForeignInvestmestCoInd
Foreign Partnership	Yes (true)	ForeignPartnershipInd
Boycott Countries	false	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Procedures for Monitoring Use of Grants	FormAndLineReferenceDesc
Explanation	The accrual method of accounting was used to determine the amounts in Column F.	ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Scripps Clinic	Event1Nm
Gross Receipts Event1	$295,875	GrossReceiptsEvent1Amt
Charitable Contri Event1	$226,845	CharitableContriEvent1Amt
Gross Revenue Event1	$69,030	GrossRevenueEvent1Amt
Rent Facility Costs Event1	$114,456	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$415	FoodAndBeverageEvent1Amt
Entertainment Event1	$2,000	EntertainmentEvent1Amt
Other Direct Expenses Event1	$35,234	OtherDirectExpensesEvent1Amt
Other Events Total	0	OtherEventsTotalCnt
Gross Receipts Total	$295,875	GrossReceiptsTotalAmt
Charitable Contributions Tot	$226,845	CharitableContributionsTotAmt
Gross Revenue Total Events	$69,030	GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events	$114,456	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$415	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$2,000	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$35,234	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$152,105	DirectExpenseSummaryEventsAmt
Net Income Summary	-$83,075	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,572,864	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$17,572,864	NetCommunityBenefitExpnsAmt
Total Expense	0.00500	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$420,896,844	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$294,882,772	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$126,014,072	NetCommunityBenefitExpnsAmt
Total Expense	0.03580	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$438,469,708	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$294,882,772	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$143,586,936	NetCommunityBenefitExpnsAmt
Total Expense	0.04080	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$8,826,310	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,539,757	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,286,553	NetCommunityBenefitExpnsAmt
Total Expense	0.00210	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$40,211,103	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,752,036	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$31,459,067	NetCommunityBenefitExpnsAmt
Total Expense	0.00890	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,043,195	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,859,692	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,183,503	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,100,081	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,330,254	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,769,827	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$763,819	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$763,819	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$75,944,508	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,481,739	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$43,462,769	NetCommunityBenefitExpnsAmt
Total Expense	0.01230	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$514,414,216	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$327,364,511	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$187,049,705	NetCommunityBenefitExpnsAmt
Total Expense	0.05310	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$31,477	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$31,477	NetCommunityBenefitExpnsAmt

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,750	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,750	NetCommunityBenefitExpnsAmt

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$35,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$35,000	NetCommunityBenefitExpnsAmt

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,197	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$14,197	NetCommunityBenefitExpnsAmt

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$364,190	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$74,822	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$289,368	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$451,614	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$74,822	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$376,792	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$60,943,680	BadDebtExpenseAmt
Reimbursed By Medicare	$412,591,964	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$513,009,301	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$100,417,337	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (7 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
Scripps Encinitas
Ambulatory Surgery Center	0.5538	0.2525
SURGERY CENTER

Scripps Memorial
Medical Office Building	0.153	0.772
XIMED MEDICAL

Scripps Mercy ASC
Ambulatory Surgery Center	0.735	0.265
ScrippsUSP Surgery
Ambulatory Surgery Center	0.5	0.39
CENTERS

Field	Value	IRS element (for citing)
Hospital Facilities	5	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (5 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Teaching HospitalTeachingHospitalInd	Research FacilityResearchFacilityInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Facility Reporting GroupFacilityReportingGroupCd
SCRIPPS MERCY HOSPITAL
1	4077 5TH AVENUE	SAN DIEGO	CA	92103	WWW.SCRIPPS.ORG	090000074	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
SCRIPPS MEMORIAL HOSPITAL LA JOLLA
2	9888 GENESEE AVENUE	La Jolla	CA	92037	WWW.SCRIPPS.ORG	080000050	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
SCRIPPS GREEN HOSPITAL
3	10666 NORTH TORREY PINES RD	San Diego	CA	92024	WWW.SCRIPPS.ORG	080000139	Yes (X)	Yes (X)	Yes (X)	Yes (X)		A
SCRIPPS MEMORIAL HOSPITAL ENCINITAS
4	354 SANTA FE DRIVE	San Diego	CA	92103	WWW.SCRIPPS.ORG	080000148	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
SELECT SPECIALTY HOSPITAL - SAN DIEGO
5	555 WASHINGTON ST	SAN DIEGO	CA	92103	www.selectspecialtyhospitals.com	090000404	Yes (X)					B

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Prior CHNA ImpactPriorCHNAImpactInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Other CriteriaOtherCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Provided Nonprofit ContactProvidedNonprofitContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd	Communtity Notified FAPCommuntityNotifiedFAPInd	FAP TranslatedFAPTranslatedInd	Other PublicityOtherPublicityInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	Provided Written NoticeProvidedWrittenNoticeInd	Made Effort Orally NotifyMadeEffortOrallyNotifyInd	Processed FAP ApplicationProcessedFAPApplicationInd	Made Presumptive Elig DetermMadePresumptiveEligDetermInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Prospective Medicare MedicaidProspectiveMedicareMedicaidInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd
A
14	false	false	Yes (true)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (true)	Yes (true)	Yes (true)	Yes (true)	Yes (X)	SEE PART V, SECTION C	Yes (X)	Yes (true)	19	Yes (true)	SEE PART V, SECTION C	false	Yes (true)	Yes (X)	200.	400.	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (true)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	SEE PART V, SECTION C	Yes (X)	SEE PART V, SECTION C	Yes (X)	SEE SECTION C	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	false	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	false	false
B
5	false	Yes (true)	false																						false	Yes (true)	Yes (X)	200.	400.	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (true)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	SEE PART V, SECTION C	Yes (X)	SEE PART V, SECTION C	Yes (X)	SEE SECTION C	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	false	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (true)	Yes (X)	false	false

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART V, LINE 2	REPORTING GROUP B SCRIPPS HEALTH ENTERED INTO A JOINT VENTURE RELATIONSHIP WITH UCSD AND SELECT MEDICAL. SCRIPPS AND UCSD WOULD EACH OWN 24.5% OF THE VENTURE AND SELECT WOULD OWN 51%. SECTION 1.5 OF THE AGREEMENT NOTES THAT THE PURPOSE OF THE COMPANY IS TO OWN, OPERATE, AND MANAGE A LONG TERM ACUTE CARE HOSPITAL AND THAT THE COMPANY AND BUSINESS SHALL AT ALL TIMES BE OPERATED AND MANAGED IN A MANNER THAT FURTHERS THE CHARITABLE AND COMMUNITY-BASED HEALTHCARE PURPOSES, MISSION, VISION AND VALUES OF THE TAX EXEMPT MEMBERS INCLUDING: - PROVIDING ACCESS TO PATIENT CARE SERVICES BASED ON MEDICAL NECESSITY. - PROVIDING CARE TO THOSE COVERED BY MEDICARE, MEDICAID/MEDI-CAL AND OTHER FEDERAL AND STATE GOVERNMENTAL PROGRAMS. - ESTABLISHING A FINANCIAL ASSISTANCE POLICY AND CHARITY CARE POLICY. - COOPERATING WITH THE LLC MEMBERS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. SCHEDULE H, PART V, LINE 3E REPORTING GROUP A THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. WITH THE HEALTH AND SOCIAL PRIORITY AREAS IDENTIFIED, SCRIPPS HAS DEVELOPED VARIOUS INITIATIVES, STRATEGIES AND METRICS TO MEASURE AND EVALUATE THE EFFECTIVNESS OF THE NEEDS IDENTIFIED IN THE CHNA. SCHEDULE H, PART V, LINE 5 REPORTING GROUP A HEALTH EXPERTS, COMMUNITY LEADERS AND RESIDENTS FEEDBACK COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED IN THE 2019 CHNA WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN-DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH AND SOCIAL NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY ENGAGEMENT ACTIVITIES INCLUDED FOCUS GROUPS, KEY INFORMANT INTERVIEWS, AND AN ONLINE SURVEY WHICH TARGETED STAKEHOLDERS FROM EVERY REGION OF SAN DIEGO COUNTY, 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 COMMUNITY HEALTH NEEDS ASSESSMENT: 138 COMMUNITY RESIDENTS AND 441 LEADERS AND EXPERTS. KEY INFORMANT INTERVIEWS AND FOCUS GROUPS WERE UTILIZED TO IDENTIFY AND EXPLORE PRIORITY HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO CARE, AND COMMUNITY ASSETS AND RESOURCES. FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED IN A SEMI-STRUCTURED MANNER. EXPERT INTERVIEWERS AND FACILITATORS FROM THE IPH EMPLOYED THE QUESTIONS DEVELOPED AND APPROVED BY THE CHNA COMMITTEE TO GENERATE DISCUSSION ABOUT SPECIFIC COMMUNITY HEALTH NEEDS AS WELL AS OPEN ENDED QUESTIONS FOR BROADER DISCUSSIONS. BROAD QUESTIONS ABOUT HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH WERE ASKED AT THE BEGINNING OF EACH DISCUSSION AND WERE FOLLOWED BY MORE SPECIFIC QUESTIONS TARGETED FOR THE PARTICIPANTS. QUESTIONS VARIED DEPENDING FOR EACH INTERVIEW AND FOCUS GROUP, DEPENDING ON THE EXPERTISE AND/OR SPECIFIC INTERESTS OF THE PERSON OR GROUP PARTICIPATING. IN ADDITION, WHEN APPROPRIATE GIVEN THE COMPOSITION OF THE FOCUS GROUP, DISCUSSIONS WERE ALLOWED TO FLOW IN A CONVERSATIONAL MANNER TO ENSURE THAT COMMUNITY RESIDENTS HAD THE OPPORTUNITY TO DISCUSS ISSUES OF IMPORTANCE TO THEM. ONE FOCUS GROUP WAS CONDUCTED VIA A VIDEO CONFERENCE CALL; ALL OTHERS WERE CONDUCTED IN-PERSON. FOR IN-PERSON GROUP EVENTS, FOOD WAS PROVIDED FOR THE PARTICIPANTS. INCENTIVES, IN THE FORM OF GIFT CARDS, WERE ALSO PROVIDED WHEN THE GROUPS WERE COMPRISED OF COMMUNITY RESIDENTS. THE CONTACT PERSON FOR THAT COMMUNITY RESIDENT FOCUS GROUPS PROVIDED SUGGESTIONS ON THE TYPE OF INCENTIVES TO PROVIDE. EACH INTERVIEW AND FOCUS GROUP BEGAN WITH A DISCUSSION ABOUT THE PURPOSE AND PROCESS OF THE CHNA. THE IPH FACILITATOR THEN RECEIVED CONSENT TO PROCEED AND REASSURED PARTICIPANTS THAT THEIR PARTICIPATION WAS VOLUNTARY, AND THEIR FEEDBACK WOULD BE ANONYMOUS. INTERPRETATIVE AND TRANSLATION SERVICES WERE ARRANGED FOR ANY GROUP THAT REQUESTED THEM. TWO FOCUS GROUPS WERE CONDUCTED IN SPANISH, AND ONE HAD SIMULTANEOUS ENGLISH AND SPANISH INTERPRETATIONS VIA HEADSETS FOR ALL PARTICIPANTS. FOR EACH FOCUS GROUP AND KEY INFORMANT INTERVIEW, IPH STAFF IN ADDITION TO THE FACILITATOR OR INTERVIEWER TOOK DETAILED NOTES AND THEN SHARED SUMMARIES WITH FULL IPH RESEARCH TEAM. THESE SUMMARIES WERE THEN ENTERED INTO THE QUALITATIVE RESEARCH SOFTWARE (NVIVO) AS STAND-ALONE SETS OF DATA. AFTER ALL THE FOCUS GROUPS AND INTERVIEW SUMMARIES WERE COMPLETED, THE TEAM USED SOFTWARE TOOLS TO ANALYZE THE QUALITATIVE DATA. ALL HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH THAT WERE MENTIONED WERE TABULATED. THE IPH THEN MADE A COMPLETE LIST OF ALL THE CONDITIONS MENTIONED IN FOCUS GROUPS OR INTERVIEWS, COUNTED HOW MANY GROUPS OR INFORMANTS LISTED THOSE CONDITIONS, AND NOTED HOW MANY TIMES THEY HAD BEEN PRIORITIZED BY A FOCUS GROUP. THIS QUALITATIVE DATA ANALYSIS WAS DESIGNED TO IDENTIFY EMERGENT THEMES. ONLINE SURVEY THE CHNA ONLINE SURVEY WAS USED TO RANK HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH IN ORDER OF IMPORTANCE WITHIN THE COMMUNITY. THE SURVEY WAS DISTRIBUTED VIA EMAIL TO TARGETED COMMUNITY- BASED ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, RESIDENT LED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, GOVERNMENTAL AGENCIES, AND HOSPITALS AND HEALTH SYSTEMS WHO SERVE A DIVERSE ARRAY OF PEOPLE IN SAN DIEGO COUNTY. WHEN POSSIBLE, THESE ORGANIZATIONS SHARED THE LINK TO THE SURVEY WITH THEIR CLIENTELE. EMAIL RECIPIENTS WERE ALSO ENCOURAGED TO SHARE THE SURVEY WITH THEIR COLLEAGUES. THROUGH THE LEADERSHIP OF THE COUNTY PUBLIC HEALTH OFFICER, DR. WILMA WOOTEN, THERE WAS A COORDINATED EFFORT TO DISTRIBUTE THE SURVEY TO THE COUNTY OF SAN DIEGO PUBLIC HEALTH STAFF (CALIFORNIA CHILDREN SERVICES, EPIDEMIOLOGY AND IMMUNIZATION SERVICES, HIV, STD, & HEPATITIS, MATERNAL, CHILD & FAMILY HEALTH SERVICES, PUBLIC HEALTH PREPAREDNESS & RESPONSE, PUBLIC HEALTH SERVICES ADMINISTRATION, TUBERCULOSIS CONTROL AND REFUGEE HEALTH). RESOURCES THE 2019 CHNA IDENTIFIED MANY HEALTH RESOURCES IN SAN DIEGO COUNTY, INCLUDING THOSE PROVIDED BY COMMUNITY-BASED ORGANIZATIONS, GOVERNMENT DEPARTMENTS AND AGENCIES, HOSPITAL AND CLINIC PARTNERS, AND OTHER COMMUNITY MEMBERS AND ORGANIZATIONS ENGAGED IN ADDRESSING MANY OF THE HEALTH NEEDS IDENTIFIED BY THIS ASSESSMENT. IN ADDITION, 2-1-1 SAN DIEGO IS AN IMPORTANT COMMUNITY RESOURCE AND INFORMATION HUB THAT FACILITATES ACCESS TO SERVICES. THROUGH ITS 24/7 PHONE SERVICE AND ONLINE DATABASE, 2-1-1 SAN DIEGO HELPS CONNECT INDIVIDUALS WITH COMMUNITY, HEALTH, AND DISASTER SERVICES. IN ADDITION TO COMMUNITY INPUT ON HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH, A WEALTH OF IDEAS EMERGED FROM COMMUNITY ENGAGEMENT PARTICIPANTS ABOUT HOW HOSPITALS AND HEALTH SYSTEMS COULD SUPPORT, EXPAND, OR CREATE ADDITIONAL RESOURCES AND PARTNER WITH ORGANIZATIONS TO BETTER MEET SAN DIEGO'S COMMUNITY HEALTH NEEDS.
SCHEDULE H, PART V, LINE 6A	REPORTING GROUP A THE CHNA INCLUDED THE FOLLOWING OTHER HOSPITALS: - KAISER FOUNDATION HOSPITAL - SAN DIEGO AND ZION - PALOMAR HEALTH - RADY CHILDREN'S HOSPITAL - SAN DIEGO - SHARP HEALTHCARE - TRI-CITY MEDICAL CENTER - UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM
SCHEDULE H, PART V, LINE 6B	REPORTING GROUP A THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC SAN DIEGO 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. SCRIPPS HEALTH ACTIVELY PARTICIPATED IN THE COLLABORATIVE CHNA PROCESS LED BY THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES AND DEVELOPED A SCRIPPS CONSOLIDATED CHNA REPORT FOR THE SYSTEM. SCHEDULE H, PART V, LINE 7A REPORTING GROUP A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ADDRESSING-COMMU NITY-NEEDS
SCHEDULE H, PART V, LINE 10A	REPORTING GROUP A THE IMPLEMENTATION STARTEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ADDRESSING-COMMU NITY-NEEDS
SCHEDULE H, PART V, LINE 11	REPORTING GROUP A WITH THE 2019 CHNA COMPLETE AND HEALTH AND SOCIAL PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY - A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. PLANS TO MONITOR THE IMPLEMENTATION PLAN ARE ALSO TAILORED TO EACH STRATEGY AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION PLAN IS FILED WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H ON AN ANNUAL BASIS. HEALTH AND SOCIAL NEEDS SCRIPPS IS ADDRESSING THE HEALTH FOCUS AREAS IDENTIFIED ABOVE WERE DETERMINED THROUGH DATA COLLECTION, ANALYSIS AND A PRIORITIZATION PROCESS THAT INCORPORATED COMMUNITY INPUT. SCRIPPS IS ADDRESSING AGING CONCERNS, BEHAVIORAL HEALTH, CANCER, AND CHRONIC DISEASES WHICH INCLUDES CARDIOVASCULAR DISEASE, DIABETES AND OBESITY IN THIS IMPLEMENTATION PLAN. SCRIPPS ADDRESSES MANY OF THE SOCIAL DETERMINANTS OF HEALTH WITHIN THE HEALTH CONDITIONS IDENTIFIED IN THIS REPORT SUCH AS ACCESS TO CARE, COMMUNITY AND SOCIAL SUPPORT, ECONOMIC SECURITY, EDUCATION, UNINTENTIONAL INJURY AND VIOLENCE AND HOMELESSNESS AND HOUSING INSTABILITY. IN ADDITION, SCRIPPS IDENTIFIES SPECIFIC PROGRAMS IN ITS IMPLEMENTATION PLAN THAT ADDRESS COMMUNITY AND SOCIAL SUPPORT, ECONOMIC SECURITY, EDUCATION AND UNINTENTIONAL INJURY AND VIOLENCE. HEALTH AND SOCIAL NEEDS SCRIPPS IS NOT DIRECTLY ADDRESSING HOMELESSNESS AND HOUSING INSTABILITY ARE IDENTIFIED AS IMPORTANT FACTORS WITHIN A FEW OF OUR PROGRAMS BUT ARE NOT ADDRESSED IN DETAIL IN THE SCRIPPS IMPLEMENTATION PLAN, WITH SCRIPPS FOCUSING OUR RESOURCES ON MORE DIRECT HEALTH ISSUES AND CONDITIONS, IN ACCORDANCE WITH OUR EXPERTISE AND MISSION. ALTHOUGH SCRIPPS IS NOT A PROVIDER OF HOUSING, OUR SOCIAL WORK AND CASE MANAGEMENT DEPARTMENTS PARTNER WITH SOCIAL SERVICE ORGANIZATIONS AND HOUSING PROVIDERS TO ADDRESS THIS UNMET NEED BY CONNECTING PATIENTS TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO CONTINUE THE EXPLORATIONS OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE NEEDS AND FUTURE NEEDS IDENTIFIED. SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL SUITED TO DEVELOPING A RESPONSE TO THE SCRIPPS CHNA. THE ANNUAL EVALUATION OF THE IMPLEMENTATION PLAN ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. SCRIPPS HEALTH HAS A CONSISTENT FOCUS ON THE STRATEGIES AND INITIATIVES, THEIR MEASURES OF IMPLEMENTATION AND THE METRICS USED TO EVALUATE THEIR EFFECTIVENESS. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS
SCHEDULE H, PART V, LINE 13H	REPORTING GROUP A & B OTHER CRITERIA TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 40% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS.
SCHEDULE H, PART V, LINES 16A, 16B, & 16C	REPORTING GROUP A & B THE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY IS WIDELY AVAILABLE ON THE SCRIPPS HEALTH WEBSITE AT: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE
SCHEDULE H, PART V, LINE 16J	REPORTING GROUP A & B THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO; - POSTERS IN CONSPICUOUS REGISTRATION AREAS I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS. - PAPER COPIES OF SCRIPPS FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSION AREAS. PATIENTS MAY ALTERNATIVELY REQUEST COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. - THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE CONSPICUOUSLY POSTED ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CONTAINS THE WEB SITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. - THE FINANCIAL ASSISTANCE SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT OF SERVICES AT A SCRIPPS FACILITY. - ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDES ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. - THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). - A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT COMMUNITY EVENTS AND IS PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. - SCRIPPS PROVIDES A COPY OF ITS POLICY AND RELATED INFORMATION TO THE CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. IN ADDITION, SCRIPPS POLICY IS AVAILABLE TO THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW IS FACILITATED THROUGH THE USE OF INTERPRETERS (LANGUAGE, VISION, AND HEARING) OR WRITTEN MATERIALS AS REQUESTED BY THE INDIVIDUAL.

Field	Value	IRS element (for citing)
Facility	52	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (52 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
Scripps Clinic - Torrey Pines
10666 N TORREY PINES ROAD	LA JOLLA	CA	92037	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Rancho Bernardo
15004 INNOVATION DRIVE	SAN DIEGO	CA	92128	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Carmel Valley
3811 VALLEY CENTER DR	SAN DIEGO	CA	92130	Primary and specialty care services in an ambulatory environment
Scripps Medical Lab
9235 WAPLES ST 150	SAN DIEGO	CA	92121	Laboratory services
SCRIPPS CLINIC ANDERSON MEDICAL PAVILION
9898 GENESEE AVE	LA JOLLA	CA	92037	Primary and specialty care services in an ambulatory environment
Imaging Healthcare Specialists LLC
150 WEST WASHINGTON ST	SAN DIEGO	CA	92103	Medical imaging services
Scripps Clinic - Encinitas
310 SANTA FE DR	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Jefferson
2205 VISTA WAY	OCEANSIDE	CA	92054	Primary and specialty care services in an ambulatory environment
SCMC - Encinitas
477 N EL CAMINO REAL A205 B305	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Rancho San Diego
10862 CALLE VERDE	LA MESA	CA	91941	Primary and specialty care services in ambulatory environment
Scripps Clinic - Mission Valley
7565 MISSION VALLEY RD	SAN DIEGO	CA	92108	Primary and specialty care services in an ambulatory environment
Scripps Clinic-La Jolla Memorial Campus
9850 GENESEE AVE XIMED BLDG 600	SAN DIEGO	CA	92121	Primary and specialty care services in an ambulatory environment
Scripps Hospital Medical Services
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	Primary and specialty care services in an ambulatory environment
SCMC - Carlsbad
2176 SALK AVE	CARLSBAD	CA	92008	Primary and specialty care services in an ambulatory environment
SCMC - Cedar
130 CEDAR RD	VISTA	CA	92083	Primary and specialty care services in an ambulatory environment
SCMC - Oceanside
4318 MISSION AVE	OCEANSIDE	CA	92057	Primary and specialty care services in an ambulatory environment
SCMC Hillcrest
501 WASHINGTON ST 525 600	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
SCMC - Jefferson
2205 VISTA WAY	OCEANSIDE	CA	92054	Primary and specialty care services in an ambulatory environment
SCMC - Encinitas OBGYN
332 SANTA FE DR 115	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
Mercy ASC
550 WASHINGTON ST 1ST FL	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Del Mar
12395 EL CAMINO REAL 317 112 1	DEL MAR	CA	92130	Primary and specialty care services in an ambulatory environment
La Jolla Radiology - La Jolla
9888 GENESEE AVE	LA JOLLA	CA	92037	Primary and specialty care services in an ambulatory environment
Encinitas Surgery Center LLC
320 SANTA FE DR LL1-2	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
SC Radiation Therapy Ctr - Vista
916 SYCAMORE AVE 100	VISTA	CA	92082	Primary and specialty care services in an ambulatory environment
SCMC - Eastlake
971 LANE AVENUE	CHULA VISTA	CA	91914	Primary and specialty care services in an ambulatory environment
La Jolla Radiology - Encinitas
354 SANTA FE DR	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
Scripps Pharmacy - Green
10666 N TORREY PINES RD	LA JOLLA	CA	92037	Medical pharmacy
Scripps Cardio & Thor Surg Ctr La Jolla
9850 GENESEE AVE 560	LA JOLLA	CA	92037	Primary and specialty care services in an ambulatory environment
Scripps Clinic - San Diego OBGYN
2918 FIFTH AVE 100	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Mercy Campus
4020 FIFTH AVE 401	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Santee
278 TOWN CENTER PKWY 105	SANTEE	CA	92071	Primary and specialty care services in an ambulatory environment
SCMC - Solana Beach
380 STEVEN AVE 100	SOLANA BEACH	CA	92075	Primary and specialty care services in an ambulatory environment
La Jolla Radiology - Mercy
4077 FIFTH AVE	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Liberty Station
2445 TRUXTUN RD	SAN DIEGO	CA	92106	Primary and specialty care services in an ambulatory environment
Scripps Pharmacy - Encinitas
354 SANTA FE DR	ENCINITAS	CA	92024	Medical pharmacy
SCMC - Escondido
488 E VALLEY PKWY 411	ESCONDIDO	CA	92025	Primary and specialty care services in an ambulatory environment
SC Radiation Therapy Ctr - Encinitas
477 N EL CAMINO REAL D100	ENCINITAS	CA	92024	Primary and specialty care services in an ambulatory environment
Scripps Clinic - La Jolla OBGYN
9850 GENESEE AVE 170	SAN DIEGO	CA	92121	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Hillcrest Surgery
4060 FOURTH AVE 330	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
SCMC - San Marcos
111 CAMPUS WAY STE 301	SAN MARCOS	CA	92078	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Encinitas OP Rehab
1092 EL CAMINO REAL	ENCINITAS	CA	92024	Rehabilitation services
SCRIPPS CARDIO & THOR SURG CTR-HILLCREST
501 WASHINGTON ST 525	SAN DIEGO	CA	92103	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Eastlake Specialty
971 LANE AVE	CHULA VISTA	CA	91914	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Coronado
1317 A YNES PL	CORONADO	CA	92118	Primary and specialty care services in an ambulatory environment
Scripps Clinic - MD Anderson Cancer Ctr
10670 JOHN JAY HOPKINS DR	LA JOLLA	CA	92121	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Chula Vista
450 FOURTH AVE	CHULA VISTA	CA	91910	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Cedar Specialty
130 CEDAR RD	VISTA	CA	92083	Primary and specialty care services in an ambulatory environment
Scripps Clinic - UTC
9333 GENESEE AVE 170	SAN DIEGO	CA	92121	Primary and specialty care services in an ambulatory environment
Scripps Clinic - Mental Health
15004 INNOVATION DR	SAN DIEGO	CA	92128	Primary and specialty care services in an ambulatory environment
Scripps Pharmacy
10140 CAMPUS POINT DR	SAN DIEGO	CA	92121	Medical pharmacy
Scripps Home Health Services
9619 CHEASPEAKE DR 300	SAN DIEGO	CA	92123	Home Health services
Scripps USP Surgery Centers LLC
15305 DALLAS PKWY STE 1600 LC 28	ADDISON	TX	75001	Primary and specialty care services in an ambulatory environment

Supplemental Information Detail SupplementalInformationDetail (13 entries)

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SCHEDULE H, PART I, LINE 3C	SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS FINANCIAL ASSISTANCE POLICY (FAP) IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS WILL FULLY FORGIVE THE ENTIRE BILL OR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, Scripps WILL FORGIVE A PORTION OF THE BILL. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AMOUNTS GENERALLY BILLED (AGB) AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 40% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. PATIENTS DETERMINED TO BE "HOMELESSNOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100% FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART I, LINE 6A	SCRIPPS HEALTH COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY SCHEDULE H, PART I, LINE 7 FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES, AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA LYON SOFTWARE'S COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CBISA WAS DEVELOPED IN COOPERATION WITH LYON SOFTWARE, THE CATHOLIC HEALTH ASSOCIATION (CHA) AND THE VETERANS HEALTH ADMINISTRATION. THE SOFTWARE SUPPLEMENTED THE ORIGINAL SOCIAL ACCOUNTABILITY BUDGET: A PROCESS FOR PLANNING AND REPORTING COMMUNITY SERVICE IN A TIME FOR FISCAL CONSTRAINT, PUBLISHED IN 1989, AND HAS BEEN REGULARLY UPGRADED AS COMMUNITY BENEFIT ACCOUNTING AND REPORTING METHODS HAVE EVOLVED AND AS COMMUNITY BENEFIT REPORTING HAS BECOME A FEDERAL REPORTING REQUIREMENT. THE CBISA DATABASE HELPS COLLECT, TRACK AND REPORT COMMUNITY BENEFIT EFFORTS AND IS ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN "ACTIVITY". FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. WHERE COST ACCOUNTING IS USED, SCRIPPS HEALTH ADDRESSES ALL PATIENT SEGMENTS FOR HOSPITAL FACILITIES. SCRIPPS UNCOMPENSATED CARE FY2021 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR CHARITY CARE ARE ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. HOSPITAL FEE PROGRAM (REFLECTED IN PART I, LINE 7B & 7I) THIRTY-MONTH HOSPITAL FEE PROGRAM DURING THE YEAR ENDED SEPTEMBER 30, 2021, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $152,003,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $105,914,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECORDED $2,420,000 FOR CHARITABLE CONTRIBUTIONS TO CALIFORNIA HEALTH FOUNDATION & TRUST (CHFT) IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEALTH FROM PROVIDER FEE WAS $48,509,000 IN FISCAL YEAR 2021. A COST-TO-CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL PATIENT SEGMENTS REPORTED AS CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS THAT ARE PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. NEVERTHELESS, THE SERVICE IS PROVIDED BECAUSE IT MEETS AN IDENTIFIED COMMUNITY NEED, WHICH IF NO LONGER OFFERED WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION. SUBSIDIZED SERVICES DO NOT INCLUDE ANCILLARY SERVICES THAT SUPPORT LINES, SUCH AS LAB AND RADIOLOGY (IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE). THE TOTAL EXPENSE FOR SUBSIDIZED HEALTH SERVICES FOR SCRIPPS MERCY FISCAL YEAR 2021 WAS $2,183,502. THIS INCLUDES SCRIPPS INPATIENT BEHAVIORAL HEALTH. SCRIPPS OFFERS INPATIENT ADULT BEHAVIORAL HEALTH SERVICES AT THE SCRIPPS MERCY HOSPITAL, SAN DIEGO CAMPUS. THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM ALSO ACTIVELY SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. SCRIPPS RESIDENT CLINIC AT THE HILLCREST FAMILY HEALTH CENTER IN JANUARY 2019, THE SCRIPPS MERCY HOSPITAL TRANSITIONED THE INTERNAL MEDICINE AMBULATORY TEACHING PROGRAM FROM SCRIPPS MERCY HOSPITAL MERCY CLINIC TO HILLCREST FAMILY HEALTH CENTER. THIS IS A FACILITY WITHIN THE NETWORK OF FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD); THE SCRIPPS RESIDENT CLINIC WAS INCORPORATED INTO THE OPERATION OF THE FHCSD HILLCREST FAMILY HEALTH CENTER. THIS MOVE EXPANDS THE EXISTING AFFILIATION BETWEEN SCRIPPS MERCY HOSPITAL AND FAMILY HEALTH CENTERS OF SAN DIEGO TO INCLUDE THE GME OUTPATIENT CLINICAL ROTATION FOR INTERNAL MEDICINE. THE GME AFFILIATION WITH FHCSD IS A SIGNIFICANT OPPORTUNITY FOR OUR PATIENTS TO HAVE ACCESS TO MUCH MORE COMPREHENSIVE INTERDISCIPLINARY CARE. IT IS ALSO AN OPPORTUNITY FOR OUR RESIDENTS TO LEARN MORE ABOUT FUNCTIONING IN AN INTERDISCIPLINARY SETTING AND COLLABORATING WITH OTHER HEALTHCARE PROVIDERS. THE AFFILIATION WITH FHCSD HAS IMPROVED THE PATIENT'S TRANSITION OF CARE FROM THE HOSPITAL'S INPATIENT SETTING TO OUTPATIENT / FOLLOW-UP CARE WITH THE SUPPORT OF FHCSD CARE COORDINATION PROCESSES. THE NEW SCRIPPS MD ANDERSON PREBYS CANCER CENTER ON THE MERCY HOSPITAL CAMPUS WILL EXPAND LEARNING OPPORTUNITIES FOR OUR RESIDENTS, AND FUTURE CAREERS IN HEMATOLOGY/ONCOLOGY. THE AGREEMENT TO CO-LOCATE THE GME PROGRAM WITH FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) IS AN EXPANSION OF AN ONGOING, SUCCESSFUL RELATIONSHIP WITH THIS FEDERALLY QUALIFIED HEALTH CENTER. SCRIPPS AND FHCSD ALREADY WORK TOGETHER IN A NUMBER OF AREAS THAT BENEFIT THE MEDICALLY UNDERSERVED, INCLUDING A PEDIATRIC RESIDENCY TRAINING PROGRAM, A COLLABORATIVE PRENATAL CARE AND DELIVERY PROGRAM, A COORDINATED BEHAVIORAL HEALTH PROGRAM, AND EMERGENCY ROOM REFERRALS FOR PATIENTS WITHOUT MEDICAL HOMES. THIS PROGRAM HAS GIVEN ITS PATIENTS ACCESS TO INCREASED SERVICES, INCLUDING CASE MANAGEMENT, ONSITE PSYCHIATRIC SERVICES, DENTAL CARE, ONSITE PHLEBOTOMY, ADJACENT HIV/AIDS/HEPATITIS C TREATMENT, PHYSICAL THERAPY, ACUPUNCTURE, SPORTS MEDICINE, AND OTHER SERVICES. FROM A GME PERSPECTIVE, THIS IS AN OPPORTUNITY FOR OUR RESIDENTS TO PRACTICE WITHIN A BROADER INTERDISCIPLINARY SETTING AND REGULARLY COLLABORATE WITH OTHER COMMUNITY HEALTH CARE PROVIDERS. SUBSPECIALTY TEACHING IS PROVIDED TO THE FAMILY MEDICINE RESIDENTS BY SCRIPPS MERCY SUBSPECIALTY FACULTY. IN ADDITION, SINCE 2013, SCRIPPS MERCY MEDICAL EDUCATION HAS SUPPORTED THE TEACHING HEALTH CENTERS FAMILY MEDICINE RESIDENCY AT FAMILY HEALTH CENTERS, WITH ALL INPATIENT TEACHING EXCEPT FOR PEDIATRICS OCCURRING AT SCRIPPS MERCY HOSPITAL SAN DIEGO. BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. SCRIPPS MERCY HOSPITAL'S BEHAVIORAL HEALTH INPATIENT PROGRAM HELPS PATIENTS, AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. BEHAVIORAL HEALTH CHALLENGES . LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. . IN FISCAL YEAR 2021, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM EXPERIENCED A $6.3 MILLION LOSS IN TOTAL OPERATIONS WITH $4.1 MILLION OF THIS LOSS BEING CAPTURED IN MEDI-CAL/CMS AND CHARITY CARE. . IN FISCAL YEAR 2021, 1.9 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. BEHAVIORAL HEALTH OUTPATIENT SERVICES SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE BEHAVIORAL HEALTH OUTPATIENT DAY PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO TO EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE MEDI-CAL POPULATION. COLLABORATION WITH HOSPITAL PARTNERS SUCH AS NAMI (NATIONAL ALLIANCE OF MENTAL ILLNESS), THE FAMILY HEALTH CENTERS OF SAN DIEGO, THE MCALISTER INSTITUTE AND HAZELDEN BETTY FORD HIGHLIGHT SCRIPPS COMMITMENT TO THE COMMUNITY WE SERVE. SCRIPPS HAS ALSO RECEIVED GRANT MONEY AS PART OF THE BEHAVIORAL HEALTH PILOT PROJECT TO EMBED SUBSTANCE USE COUNSELORS IN THE EMERGENCY DEPARTMENT TO FACILITATE LINKAGE TO MEDICATION ASSISTED OUTPATIENT PROGRAMS. FACILITATE LINKAGE TO MEDICATION ASSISTED OUTPATIENT PROGRAMS.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES F2 - ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2 EXECUTIVE LEADERSHIP SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS; SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). NORTH SAN DIEGO BUSINESS CHAMBER HEALTH COMMITTEE MEETING THE CHAMBER STRIVES TO DELIVER UP-TO-DATE, HEALTH-RELATED INFORMATION GO ENHANCE THE QUALITY OF LIFE TO THE BUSINESS COMMUNITY. THE HEALTH COMMITTEE SERVES AS A FRONT LINE TO EDUCATE SAN DIEGO NORTH BUSINESS ABOUT HEALTH CARE ISSUES SPECIFIC TO THE REGION THAT IMPACT BOTTOM LINES AND WORKFORCE PRODUCTIVITY. THE SCRIPPS DIRECTOR OF COMMUNITY BENEFIT ATTENDS THESE MEETINGS. F3 - COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3. SAN DIEGO COUNTY HEALTHCARE DISASTER COALITION SCRIPPS HEALTH PARTICIPATED IN SAN DIEGO COUNTY HEALTHCARE DISASTER COALITION AND STATE OF CALIFORNIA ADVISORY GROUPS TO PLAN, IMPLEMENT AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND EXERCISES. SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE SCRIPPS HEALTH PARTICIPATES IN THE SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE. THIS IS A FUNDING WORKGROUP WHICH PROVIDES LEADERSHIP AND FUNDING THROUGH GRANTS AND COOPERATIVE AGREEMENTS TO STATES, TERRITORIES, AND ELIGIBLE MUNICIPALITIES IN ORDER TO IMPROVE SURGE CAPACITY AND ENHANCE COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES. SCRIPPS BIOMED TEAM - VOLUNTEER SAN DIEGO COUNTY VENTILATOR ASSEMBLY SCRIPPS BIOMED TEAM ASSISTED THE SAN DIEGO COUNTY IN ASSEMBLING ITS WAREHOUSE INVENTORY OF SERVO-U VENTILATORS. THE BIOMED TEAM COMPLETED ASSEMBLY OF 130 VENTILATORS. SAN DIEGO PUBLIC LIBRARY FOUNDATION THE LIBRARY FOUNDATION WILL USE THE SPONSORSHIP FROM SCRIPPS HEALTH AS PART OF ITS MULTI-FACETED APPROACH TO SUPPORTING THE LIBRARY IN MEETING CHANGING AND GROWING COMMUNITY NEEDS AND IN REDUCING DIGITAL INEQUITIES THAT HAVE BEEN SPOTLIGHTED IN RECENT MONTHS. IN A JUNE 2020 MCKINSEY & COMPANY REPORT, RESEARCHERS NOTED THAT THE EFFECTS OF COVID-19-RELATED LEARNING LOSSES WILL HAVE A LIFELONG IMPACT. THIS IMPACT WILL BE DISPROPORTIONATELY FELT BY UNDERSERVED FAMILIES AND THOSE WITHOUT ACCESS TO THE INTERNET FROM HOME. AS THE REPORT NOTED, THESE LEARNING LOSSES ARE NOT JUST AN ECONOMIC ISSUE, BUT ALSO CORRESPOND TO HEALTH AND WELLBEING, CRIME AND INCARCERATION LEVELS, AND PARTICIPATION IN CIVIC LIFE. THE LIBRARY HAS ALWAYS SERVED AS A SUPPORT SYSTEM FOR THE ENTIRE COMMUNITY, AND THE LIBRARY FOUNDATION IS ADOPTING A MULTI-FACETED APPROACH TO HELP THE LIBRARY TO ADAPT AND TO ADDRESS THE COMMUNITY'S NEEDS FOR TECHNOLOGY, RESOURCES, AND SERVICES. ACTIVITIES INCLUDE: - EQUIPPING THE INNOVATION LAB AT THE CENTRAL LIBRARY @ JOAN ^ IRWIN JACOBS COMMON WITH HIGH-CAPACITY 3D PRINTERS AND REQUIRED MATERIALS TO PRODUCE HUNDREDS OF FACE SHIELDS PER WEEK FOR SAN DIEGO'S FRONT-LINE HEALTHCARE WORKERS. - GIVING LAPTOPS TO PROGRAM PARTICIPANTS WHO ARE NOT ABLE TO AFFORD ONE SO THEY CAN CONTINUE WITH THEIR LITERACY TRAINING, CONTINUE TO MAKE PROGRESS IN THE CAREER ONLINE HIGH SCHOOL PROGRAM, GET HIGH-LEVEL STEAM EDUCATION THROUGH LIBRARY NEXT, AND MORE. WE MADE AN INITIAL COMMITMENT OF 240 COMPUTERS, WHICH WE ESTIMATE WILL BE EXHAUSTED AND NEED TO BE REPLENISHED BY DECEMBER. - PROVIDING LAPTOPS FOR PATRON USE IN OUTDOOR LIBRARY SPACES. WE HAVE PROVIDED 110 LAPTOPS FOR THIS PROJECT SO FAR AND EXPECT TO EXPAND SOON. - EXPANDING THE DIGITAL LIBRARY (PARTS OF WHICH HAVE SEEN A 300% INCREASE IN USE) WITH ADDITIONAL DATABASES, EBOOKS, AND RESOURCES. - SUCCESSFULLY ADVOCATING AGAINST AN UNPRECEDENTED $9MM IN PROPOSED CUTS TO THE CITY'S LIBRARY BUDGET WHICH WOULD HAVE GREATLY REDUCED LIBRARY OPERATING HOURS, ELIMINATING 240+ LIBRARY POSITIONS, AND THE PERMANENT CLOSURE OF A BRANCH IN A HIGH-NEEDS NEIGHBORHOOD. - PROVIDING EQUIPMENT FOR EACH BRANCH LIBRARY TO FACILITATE THE TRANSITION OF LIBRARY PROGRAMS TO AN ONLINE FORMAT. F5 - LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. ENLISTED LEADERSHIP FOUNDATION - THE FOUNDRY OK ENLISTED LEADERSHIP FOUNDATION IS A SAN DIEGO BASED NON-PROFIT GROUP 501(C)3 DEDICATED TO LEADERSHIP DEVELOPMENT OF NAVY SECOND CLASS, FIRST CLASS, AND CHIEF PETTY OFFICERS. THIS ORGANIZATION WAS FORMED BY A TEAM OF ACTIVE DUTY AND RETIRED COMMAND / MASTER CHIEF PETTY OFFICERS TO DEVELOP CURRENT AND FUTURE LEADERS THROUGH A PHILOSOPHY OF SHARING AND MENTORING BASED ON COMBINED GENERATIONS OF GROWTH AND GROOMING. LEADERSHIP LECTURE GIVEN BY CHRIS VAN GORDER, PRESIDENT AND CEO. SAN DIEGO SHERRIFF'S SEARCH & RESCUE ACADEMY - EMERGENCY REPONSE MODULE THE AMERICAN RED CROSS EMERGENCY MEDICAL RESPONSE COURSE PROVIDES THE PARTICIPANT WITH THE KNOWLEDGE AND SKILLS NECESSARY TO WORK AS AN EMERGENCY MEDICAL RESPONDER (EMR). THE CLASS INSTRUCTED BY CHRIS VAN GORDER, SCRIPPS PRESIDENT AND CEO. F7 - COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 7. HEALTH CARE PUBLIC AND GOVERNMENT ADVOCACY SCRIPPS PUBLIC AND GOVERNMENT AFFAIRS SUPPORTS RELATIONSHIP BUILDING AMONG INTERESTED AND AFFECTED PARTIES RELATIVE TO THE NATION'S HEALTH CARE REFORM DEBATE AND DECISION MAKING. THE GOAL IS TO EDUCATE AND INFORM RELATIVE TO ALL ASPECTS OF REFORM DISCUSSION, FROM HEALTH INFORMATION TECHNOLOGY TO THE ENACTMENT AND IMPLEMENTATION OF THE PATIENT PROTECTION AND ACCOUNTABLE CARE ACT. THE SAN DIEGO LGBT COMMUNITY CENTER SCRIPPS SPONSORED THE SAN DIEGO LESBIAN, GAY, BISEXUAL, AND TRANSGENDER COMMUNITY CENTER INC., (D.B.A., THE CENTER). THE CENTER IS ONE OF THE LARGEST AND MOST VIBRANT LGBT COMMUNITY CENTERS IN THE NATION. FUNCTIONING AS THE SAN DIEGO LGBT COMMUNITY'S ANCHOR ORGANIZATION, THE CENTER IS LED BY A 10-MEMBER BOARD OF DIRECTORS, EMPLOYS MORE THAN 70 PAID STAFF AND UTILIZES MORE THAN 1,200 COMMUNITY VOLUNTEERS TO ACHIEVE ITS TWIN GOALS OF PROMOTING LGBT HEALTH/WELLNESS AND HUMAN RIGHTS. THE CENTER PROVIDES TARGETED PROGRAMS AND SERVICES TO THE FULL DIVERSITY OF THE SAN DIEGO LGBT COMMUNITY, INCLUDING MEN, WOMEN, YOUTH, SENIORS, TRANSGENDER AND NON-BINARY INDIVIDUALS, FAMILIES, LGBT LATINO COMMUNITY MEMBERS AND THEIR FAMILIES, AND THOSE LIVING WITH HIV. LAST YEAR, THE CENTER PROVIDED MORE THAN 82,000 DIRECT SERVICE VISITS TO SAN DIEGO COMMUNITY MEMBERS, AND THROUGH ITS EVENTS, ACTIVITIES AND ADVOCACY, TOUCHED THE LIVES OF THOUSANDS MORE. F8-WORKFORCE DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 8. SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) SCRIPPS SPONSORED THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS ANNUAL CONFERENCE WHICH FOCUSED ON OPIOID USAGE. FOUNDED IN 2001, THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) IS AN OFFICIAL COMBINED CHAPTER OF THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES (ACHE), AN INTERNATIONAL PROFESSIONAL SOCIETY OF MORE THAN 30,000 HEALTHCARE EXECUTIVES. SOHL OFFERS AN ENVIRONMENT FOR CONTINUAL GROWTH AND PROFESSIONAL DEVELOPMENT, AND BUILDING RELATIONSHIPS AMONG PEERS AND INDUSTRY LEADERS AT THE LOCAL LEVEL. MEMBERS REPRESENT HEALTHCARE LEADERS IN ALL SECTORS OF THE HEALTHCARE INDUSTRY. YOUTH EDUCATIONAL PROGRAMS SCRIPPS IS DEDICATED TO BUILDING THE FUTURE PIPELINE OF HEALTH PROFESSIONALS. SCRIPPS IMPLEMENTS A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES. THROUGH SEVERAL INTERNSHIPS AND OTHER EDUCATIONAL PROGRAMS, SCRIPPS COLLABORATES WITH HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRST-HAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. NURSES AND OTHER CLINICAL AND NON-CLINICAL EMPLOYEES PLAY IMPORTANT ROLES IN THESE EDUCATIONAL EXPERIENCES, AS THE STUDENTS ARE INTERACTING WITH THEM DAILY THROUGH THE PROGRAMS. A TOTAL OF 2,028 YOUTH PARTICIPATED IN THESE PROGRAMS AND MORE THAN 75% OF YOUTH ARE ON A TRACK FOR A HEALTH CAREER. DUE TO COVID-19 AND IN-PERSON RESTRICTIONS ALL YOUTH ACTIVITIES (MENTORING, CLASSROOM PRESENTATIONS, HOSPITAL TOURS, SURGERY VIEWINGS) WERE TRANSITIONED TO VIRTUAL PLATFORMS FOR DISTANCE LEARNING FOR FISCAL YEAR 2021. TOPICS AND ACTIVITIES CONTINUED TO BE REQUESTED BY THE SWEETWATER SCHOOL DISTRICT TO ENHANCE AND SUPPORT CLASSROOM CURRICULUM. SCRIPPS MERCY'S SCHOOL TO HEATH CAREERS FAMILY PRACTICE MEDICAL RESIDENTS PROVIDE INTERACTIVE CLASSROOM PRESENTATIONS ON A VARIETY OF PUBLIC HEALTH CONCERNS, MEDIC
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS DERIVED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMNTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGRDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED.
SCHEDULE H, PART III, LINE 4	FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES.
SCHEDULE H, PART III, LINE 8A	MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT.
SCHEDULE H, PART III, LINE 9B	COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN SAN DIEGO COUNTY, THE LONG HISTORY OF COLLABORATION AMONG HOSPITALS, HEALTHCARE SYSTEMS AND COMMUNITY PARTNERS HAS RESULTED IN SUCCESSFUL PARTNERSHIP ON PAST CHNAS. WHILE PUBLIC INSTITUTIONS AND DISTRICT HOSPITALS DO NOT HAVE TO REPORT UNDER SB 697, THESE INSTITUTIONS HAVE BECOME AN INTEGRAL PART OF THE CHNA IN SAN DIEGO COUNTY. INFORMATION IS GATHERED THROUGH THE CHNA FOR THE PURPOSES OF REPORTING COMMUNITY BENEFIT, DEVELOPING STRATEGIC PLANS, CREATING ANNUAL REPORTS, PROVIDING INPUT ON LEGISLATIVE DECISIONS, AND INFORMING THE GENERAL COMMUNITY OF HEALTH ISSUES AND TRENDS. AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATIONS STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES EVERY THREE YEARS. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS AND CONSUMER GROUPS. THE 2019 SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. THE REPORT HELPS US UNDERSTAND OUR COMMUNITY'S HEALTH NEEDS AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THE REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THIS REPORT COMPLIES WITH FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING HOSPITAL FACILITIES OWNED AND OPERATED BY AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS. FOR MORE DETAILED INFORMATION ON THE CHNA REGULATORY REQUIREMENTS AND IMPLEMENTATION STRATEGY SEE: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: OVERVIEW AND BACKGROUND AS STATED EALIER, EVERY THREE YEARS, THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) CONDUCTS A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO MEET IRS REGULATORY REQUIREMENTS AND TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS, PARTICULARLY THOSE WHO EXPERIENCE HEALTH INEQUITIES. THE CHNA IS IMPLEMENTED AND MANAGED BY A STANDING CHNA COMMITTEE COMPRISED OF REPRESENTATIVES FROM SEVEN HOSPITALS AND HEALTH SYSTEMS. THIS COMMITTEE REPORTS TO THE HASD&IC BOARD OF DIRECTORS WHO PROVIDE POLICY DIRECTION AND ENSURE THAT THE INTERESTS OF ALL MEMBER HOSPITALS AND HEALTH SYSTEMS ARE MET. HASD&IC CONTRACTS WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PERFORM THE NEEDS ASSESSMENT. SCRIPPS HEALTH ACTIVELY PARTICIPATES IN THE COLLABORATIVE CHNA PROCESS LED BY THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES AND DEVELOPS A SCRIPPS CONSOLIDATED CHNA REPORT. THE 2019 CHNA BUILT ON THE RESULTS OF THE 2016 CHNA AND INCLUDED THREE TYPES OF COMMUNITY ENGAGEMENT EFFORTS: FOCUS GROUPS WITH RESIDENTS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, AND HEALTH CARE LEADERS; KEY INFORMANT INTERVIEWS WITH HEALTH CARE EXPERTS; AND AN ONLINE SURVEY FOR RESIDENTS AND STAKEHOLDERS. IN ADDITION, THE CHNA INCLUDED EXTENSIVE QUANTITATIVE ANALYSIS OF NATIONAL AND STATE-WIDE DATA SETS, SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND INPATIENT HOSPITAL DISCHARGE DATA, COMMUNITY CLINIC USAGE DATA, COUNTY MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. THESE TWO DIFFERENT APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY HEALTH NEEDS FROM MULTIPLE PERSPECTIVES. IN ADDITION TO THIS COLLABORATIVE CHNA PROCESS, KAISER FOUNDATION HOSPITAL (KFH)-SAN DIEGO AND ZION CONDUCTED A SEPARATE CHNA PROCESS; DATA WERE SHARED BETWEEN THE TWO GROUPS. THESE SIMULTANEOUS PROCESSES ALLOWED FOR A MORE ROBUST, COMPREHENSIVE CHNA FOR ALL SAN DIEGO COUNTY HOSPITALS AND HEALTH CARE SYSTEMS. METHODOLOGY FOR THE 2019 CHNA QUANTITATIVE ANALYSES OF PUBLICLY AVAILABLE DATA PROVIDED AN OVERVIEW OF CRITICAL HEALTH ISSUES ACROSS SAN DIEGO COUNTY, WHILE QUALITATIVE ANALYSES OF FEEDBACK FROM THE COMMUNITY PROVIDED AN APPRECIATION FOR THE EXPERIENCES AND NEEDS OF SAN DIEGANS. THE CHNA COMMITTEE REVIEWED THESE ANALYSES AND APPLIED A PRE-DETERMINED SET OF CRITERIA TO THEM TO PRIORITIZE THE TOP HEALTH NEEDS IN SAN DIEGO COUNTY. QUANTITATIVE DATA COLLECTION AND ANALYSIS THE PURPOSE OF THE 2019 CHNA WAS TO IDENTIFY, UNDERSTAND, AND PRIORITIZE THE HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS FACING INEQUITIES. THIS WAS ACCOMPLISHED THROUGH TWO TYPES OF DATA COLLECTION: (1) QUALITATIVE DATA WAS COLLECTED THROUGH A COMMUNITY ENGAGEMENT PROCESS DESIGNED TO SOLICIT IN-DEPTH FEEDBACK FROM RESIDENTS IN HIGH-NEED NEIGHBORHOODS AND FROM LOCAL HEALTH EXPERTS AND LEADERS; AND (2) QUANTITATIVE DATA WAS OBTAINED BY EXTRACTING AND ANALYZING DATA FROM SECONDARY DATA SOURCES. SPECIAL EFFORTS WERE MADE TO INCLUDE COMMUNITY RESIDENTS FROM GROUPS THAT EXPERIENCE HEALTH DISPARITIES AND SERVICE PROVIDERS WHO WORK WITH THOSE GROUPS. QUANTITATIVE DATA WERE DRAWN FROM SEVERAL PUBLIC SOURCES. DATA FROM DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEEDS INDEX (CNI) AND THE PUBLIC HEALTH ALLIANCE OF SOUTHERN CALIFORNIA'S HEALTHY PLACES INDEX (HPI) WERE USED TO IDENTIFY GEOGRAPHIC COMMUNITIES IN SAN DIEGO COUNTY THAT WERE MORE LIKELY TO BE EXPERIENCING HEALTH INEQUITIES, WHICH GUIDED THE SELECTION OF COMMUNITIES FOR THE ENGAGEMENT AND THE DEVELOPMENT OF ENGAGEMENT QUESTIONS. HOSPITAL DISCHARGE DATA EXPORTED FROM SPEEDTRACK'S CALIFORNIA UNIVERSAL PATIENT INFORMATION DISCOVERY, OR CUPID APPLICATION WERE USED TO IDENTIFY CURRENT AND THREE-YEAR TRENDS IN PRIMARY DIAGNOSIS DISCHARGE CATEGORIES AND WERE STRATIFIED BY AGE AND RACE. THIS ALLOWED FOR THE IDENTIFICATION OF HEALTH DISPARITIES AND THE CONDITIONS HAVING THE GREATEST IMPACT ON HOSPITALS AND HEALTH SYSTEMS IN SAN DIEGO COUNTY. DATA FROM NATIONAL AND STATE-WIDE DATA SETS WERE ANALYZED INCLUDING SAN DIEGO COUNTY MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. IN ADDITION, KAISER PERMANENTE CONSOLIDATED DATA FROM SEVERAL NATIONAL AND STATE-WIDE DATA SETS RELATED TO A VARIETY OF HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH IN SAN DIEGO COUNTY AND CONDUCTED A COMPREHENSIVE STATISTICAL ANALYSIS TO IDENTIFY WHICH SOCIAL DETERMINANTS OF HEALTH 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. THESE ANALYSES GUIDED THE DESIGN OF THE ONLINE SURVEY, INTERVIEW, AND FOCUS GROUP QUESTIONS. 2019 CHNA PRIORITIZATION OF THE TOP HEALTH NEEDS 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 SAN DIEGO COUNTY. 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 SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. OVER THE COURSE OF SEVERAL MEETINGS, THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. EACH HEALTH CONDITION AND SOCIAL DETERMINANT OF HEALTH FOR WHICH THE COMMITTEE HAD DATA WAS CONSIDERED AND DISCUSSED IN TERMS OF THESE CRITERIA. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH THAT MET THE LARGEST NUMBER OF CRITERIA WERE CHOSEN AS TOP PRIORITIES. THE 2019 CHNA IDENTIFIED TEN COMMUNITY HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) AS THE MOST CRITICAL HEALTH AND SOCIAL NEEDS WITHIN SAN DIEGO COUNTY (LISTED IN ALPHABETICAL ORDER BY SDOH AND HEALTH CONDITION). 1. ACCESS TO HEALTH CARE 2. AGING CONCERNS 3. BEHAVIORAL HEALTH 4. CANCER 5. CHRONIC CONDITIONS 6. COMMUNITY AND SOCIAL SUPPORT 7. ECONOMIC SECURITY 8. EDUCATION 9. HOMELESSNESS AND HOUSING INSTABILITY 10. UNINTENTIONAL INJURY AND VIOLENCE IN ADDITION, AN UNDERLYING THEME OF STIGMA AND THE BARRIERS IT CREATES AROSE ACROSS COMMUNITY ENGAGEMENT. IN TERMS OF SDOH, STIGMA IMPACTS THE WAY IN WHICH PEOPLE ACCESS NEEDED SERVICES AND CAN IMPACT THE COMMUNITY'S ABILITY TO MAINTAIN AND MANAGE THEIR HEALTH AND HEALTH CONDITIONS. ACCESS TO HEALTH CARE. ACCESS TO HEALTH CARE EMERGED AS A HIGH PRIORITY HEALTH NEED IN BOTH THE SECONDARY DATA ANALYSES AND THE COMMUNITY ENGAGEMENT EVENTS. OVERCOMING BARRIERS TO HEALT
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E. EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENT'S UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FORPAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENT'S ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL-OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. FOR THE PURPOSES OF THE 2019 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. BECAUSE OF ITS GEOGRAPHIC SIZE AND LARGE POPULATION, THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ORGANIZES THEIR SERVICE AREAS INTO SIX GEOGRAPHIC REGIONS: CENTRAL, EAST, NORTH CENTRAL, NORTH COASTAL, NORTH INLAND, AND SOUTH. EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE BY ZIP CODE LEVEL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 64 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. SCRIPPS MERCY HOSPITAL SAN DIEGO AND SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUSES ARE DESIGNATED BY THE GOVERNMENT AS A DISPROPORTIONATE SHARE HOSPITAL, IN REFLECTION OF THE DIVERSITY OF THE POPULATION THEY SERVE. BOTH HOSPITAL CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED MEDICARE AND MEDI-CAL. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.3 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,206 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTS THE REGION'S POPULATION WILL GROW BY NEARLY ONE MILLION PEOPLE BY 2050. THIS FORECAST IS CONSISTENT WITH PREVIOUS EXPECTATIONS ALTHOUGH FUTURE GROWTH RATES HAVE BEEN REDUCED DUE TO INCREASED DOMESTIC MIGRATION OUT OF THE REGION. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DEFINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE DISTRIBUTION OF A POPULATION ARE ALL IMPORTANT FACTORS IN UNDERSTANDING COMMUNITIES AND THEIR RESIDENTS. SAN DIEGO IS THE SECOND MOST POPULOUS COUNTY IN CALIFORNIA AND FIFTH MOST POPULOUS IN THE UNITED STATES. SAN DIEGO HAS: - OVER 3.3 MILLION RESIDENTS - MAJORITY MINORITY POPULATION o 45.9% (~1.5 MILLION) NON-HISPANIC WHITE o 34.2% (~1.1 MILLION) HISPANIC o 11% (369,059) ASIAN/PACIFIC ISLANDERS o 4.8% (159,320) BLACKS o 0.5% (15,000) AMERICAN INDIAN/ALASKA NATIVE o 3.6% (120,674) OTHER RACE/ETHNICITY, INCLUDING TWO OR MORE RACES COMPRISED. - BUSIEST LAND BORDER CROSSING IN THE WORLD - 1 OF EVERY 13 PEOPLE WHO ENTER THE US COME THROUGH SAN YSIDRO - 70 MILES OF COASTLINE - 16 NAVAL AND MILITARY INSTALLATIONS - 18 FEDERALLY QUALIFIED RECOGNIZED INDIAN RESERVATIONS - A TOTAL OF 4,526 SQUARE MILES, LARGER THAN RHODE ISLAND AND DELAWARE COMBINED FOLLOWING THE ACA, THE NUMBER OF UNINSURED NONELDERLY AMERICANS DECLINED BY 20 MILLION, DROPPING TO AN HISTORIC LOW IN 2016. HOWEVER, BEGINNING IN 2017, THE NUMBER OF UNINSURED NONELDERLY AMERICANS INCREASED FOR THREE STRAIGHT YEARS, GROWING BY 2.2 MILLION FROM 26.7 MILLION IN 2016 TO 28.9 MILLION IN 2019, AND THE UNINSURED RATE INCREASED FROM 10.3% IN 2016 TO 10.9% IN 2019 FOR CALIFORNIA AND FROM 10.4% IN 2016 TO 11.3% IN 2019 IN SAN DIEGO COUNTY. COVERAGE DURING THE COVID-19 PANDEMIC THE ECONOMIC DOWNTURN CAUSED BY THE CORONAVIRUS PANDEMIC HAS RENEWED ATTENTION ON HEALTH INSURANCE COVERAGE AS MILLIONS HAVE LOST THEIR JOBS AND POTENTIALLY THEIR HEALTH COVERAGE. THE AFFORDABLE CARE ACT (ACA) SOUGHT TO ADDRESS THE GAPS IN OUR HEALTH CARE SYSTEM THAT LEAVE MILLIONS OF PEOPLE WITHOUT HEALTH INSURANCE BY EXTENDING MEDICAID COVERAGE TO MANY LOW-INCOME INDIVIDUALS AND PROVIDING SUBSIDIES FOR MARKETPLACE COVERAGE FOR INDIVIDUALS BELOW 400% OF POVERTY. KEY FINDINGS NATIONAL DATA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) SHOWED THAT THE UNINSURED RATE HELD STEADY DURING 2020 DESPITE THE COVID-19 PANDEMIC. THIS DATA COMES FROM THE NATIONAL HEALTH INTERVIEW SURVEY, CONSIDERED ONE OF THE MOST COMPREHENSIVE SOURCES OF INFORMATION ABOUT HEALTH INSURANCE COVERAGE DUE TO THE LARGE SAMPLE SIZE AND THE FACT THAT DATA IS COLLECTED YEAR-ROUND. THE OVERALL UNINSURED RATE IN 2020 WAS 9.7 PERCENT (ABOUT 31.6 MILLION PEOPLE) COMPARED TO 10.3 PERCENT (ABOUT 33.2 MILLION PEOPLE) IN 2019. INFORMATION ON SOCIOECONOMIC FACTORS, ACCESS TO CARE, HEALTH BEHAVIORS, AND THE PHYSICAL ENVIRONMENT CAN BE FOUND IN THE SCRIPPS 2019 CHNA REPORT AT SCRIPPS HEALTH 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. IDENTIFYING HIGH-NEED AREAS A CRITICAL COMPONENT OF UNDERSTANDING COMMUNITY HEALTH IS TO IDENTIFY GEOGRAPHIC AREAS OF INEQUITIES. THE CHNA COMMITTEE UTILIZED TWO METRICS TO DETERMINE WHICH AREAS OF SAN DIEGO COUNTY LIKELY EXPERIENCE THE GREATEST HEALTH DISPARITIES: (1) THE HEALTHY PEOPLE INDEX (HPI) WHICH ANALYZES HEALTH OPPORTUNITIES BY CENSUS TRACT; AND (2) THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI), WHICH MEASURES BARRIERS TO SOCIO-ECONOMIC SECURITY BY ZIP CODE. DATA FROM THESE TWO SOURCES PROVIDED KEY INFORMATION ABOUT RESOURCES AND DISPARITIES IN DIFFERENT REGIONS OF SAN DIEGO COUNTY AND GUIDED THE SELECTION PROCESS FOR THE COMMUNITY ENGAGEMENT.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH AND OUR PARTNERSHIPS DO NOT STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDE WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS, AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY21 (OCTOBER 2020 TO SEPTEMBER 2021), SCRIPPS INVESTED $33,228,894 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES AND SCRIPPS WHITTIER DIABETES INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES; "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. A LACK OF HEALTH INSURANCE IS A PREDICTOR OF MANY HEALTH CONDITIONS, INCLUDING MORE POOR MENTAL HEALTH DAYS, MORE VISITS TO THE ED FOR HEART ATTACKS, A HIGHER PREVALENCE OF ASTHMA, AND OBESITY, MORE LOW BIRTH WEIGHT BABIES, AND HIGHER PREVALENCE OF SMOKING. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. ACCESS TO HEALTH CARE EMERGED AS A HIGH PRIORITY HEALTH NEED IN BOTH THE SECONDARY DATA ANALYSES AND COMMUNITY ENGAGEMENT EVENTS IN THE 2019 SCRIPPS COMMUNITY HEALTH NEEDS ASSESSMENT. THROUGH THE COMMUNITY ENGAGEMENT CONDUCTED WE HEARD FROM THE COMMUNITY THAT EVEN WHEN INSURANCE IS SECURED, INCLUDED LACK OF TRANSPORTATION - ESPECIALLY FOR SENIORS - AND LACK OF CULTURALLY AND LINGUISTICALLY COMPETENT CARE ARE MAIN BARRIERS. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED A NUMBER OF PROGRAMS AND ACTIVITIES IN FY21. BELOW ARE A FEW EXAMPLES OF ACCESS TO CARE PROGRAMS. MORE INFORMATION CAN BE FOUND IN THE SCRIPPS COMMUNITY BENEFIT PLANS AND REPORT, HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY. MERCY OUTREACH SURGICAL TEAM PROVIDES LIFE-CHANGING CARE TO CHILDREN IN MEXICO FOR THREE DECADES, THE MERCY OUTREACH SURGICAL TEAM (MOST) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. MOST IS AN INDEPENDENT, NONPROFIT ORGANIZATION FOUNDED IN 1987 AT SCRIPPS MERCY HOSPITAL WHOSE MISSION IS TO PROVIDE FREE SURGERIES AND VISION CARE TO UNDERSERVED CHILDREN IN MEXICO. AFTER THE 9/11 TERRORIST ATTACK, MOST'S MISSIONS HAD TO BE SHIFTED EXCLUSIVELY TO TRIPS IN MEXICO, DUE TO DIFFICULTY GETTING CHILDREN ACROSS THE BORDER FROM MEXICO INTO THE U.S. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. IN MEXICO, MOST VOLUNTEERS TYPICALLY PERFORM HUNDREDS OF SURGERIES PER MISSION - AND MORE THAN 14,000 OVERALL SINCE ITS FOUNDING -- FOR ISSUES LIKE CLEFT PALATES, CROSSED EYES, BURN SCARS, HERNIA REPAIRS AND MORE. MOST ALSO ADDED A VISION PROGRAM IN 2004 THAT PROVIDES MORE THAN 100 PAIRS OF EYEGLASSES PER TRIP TO CHILDREN IN NEED. MOST HAS BEEN WORKING WITH AN ORGANIZATION IN MEXICO TO SPONSOR CLEFT PALATE AND LIP SURGERIES AND ALSO PROVIDED MUCH NEEDED PPE AND OTHER MEDICAL SUPPLIES TO TEHUACN, A CITY MOST HAS VISITED FOR MISSION TRIPS SEVERAL TIMES, TO HELP CARE FOR PATIENTS. SINCE MOST HAD TO PAUSE ITS TRAVEL INTO MEXICO DUE TO COVID-19 RESTRICTIONS AND IT HAD BEEN LOOKING FOR WAYS TO SERVE THOSE IN NEED ONCE PUBLIC HEALTH CONDITIONS ALLOWED. MOST SAW AN OPPORTUNITY TO CONTINUE ITS MISSION IN SAN DIEGO WHEN THE EMERGENCY SHELTER WAS OPENED AT THE SAN DIEGO CONVENTION CENTER. DURING FISCAL YEAR 2021, A TEAM OF 35 VOLUNTEERS FROM MOST HOSTED A FREE, FULL DAY VISION CLINIC INSIDE THE SAN DIEGO CONVENTION CENTER EMERGENCY SHELTER, WHERE THEY SERVED 615 CHILDREN, MOSTLY 13-17 WITH A FEW YOUNGER ONES AND PERFORMED VISION SCREENINGS AND PROVIDED PRESCRIPTION EYEGLASSES TO THOSE WHO NEEDED THEM. FOR THOSE WHO REQUIRED GLASSES, THEY WERE ABLE TO TRY ON A VARIETY OF FRAMES AND PICK THE ONES THAT THEY LIKED THE BEST. LENS FITTERS WORKED WITH EACH CHILD TO ENSURE THAT THEY WOULD BE PLEASED WITH THE WAY THEY WOULD LOOK IN THEIR NEW GLASSES - ENSURING THAT THEY WOULD ACTUALLY WEAR THEM. THE JUNE 12 CLINIC WAS THE MOST'S FIRST MISSION IN WELL OVER A YEAR, SINCE COVID-19 RESTRICTIONS BLOCKED ITS TRADITIONAL TRAVEL INTO MEXICO. VOLUNTEERS AT THE JUNE 12 VISION CLINIC INCLUDED OPTOMETRISTS, OPHTHALMIC VOLUNTEERS, NURSES, AND OTHER SUPPORT STAFF WHO PROVIDED INTERPRETATION, TRAFFIC CONTROL ADMINISTRATIVE TASKS. MOVING FORWARD, MOST HOPES TO RESUME ITS MEDICAL MISSIONS INTO MEXICO IN EARLY 2022. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) SCRIPPS HEALTH HAS AN AGREEMENT WITH THE SAN DIEGO CITY REFUGE OF RECUPERATIVE CARE SHELTER (RCS) WHICH PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. LACK OF FUNDING, MENTAL ILLNESS, AS WELL AS ALCOHOL AND/OR SUBSTANCE ABUSE, MAKES POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. DURING THE PANDEMIC ALL SAN DIEGO HOMELESS SHELTERS EXPERIENCED COVID-19 OUTBREAKS, MAKING RCS A TRUE PLACE OF REFUGE FOR 44 OF OUR CHRONICALLY HOMELESS PATIENTS. THE CASE MANAGEMENT AND SOCIAL WORK DEPARTMENTS ASSIST WITH A NEEDED SUPPLY OF MEDICATION, APPOINTMENTS, DURABLE MEDICAL EQUIPMENT (DME), SETTING UP HOME HEALTH SERVICES IF NEEDED, AND CONNECTS PATIENTS TO PSYCH AS PART OF THE HOSPITAL DISCHARGE PLAN TO CITY OF REFUGE. CITY OF REFUGE FURTHER SUPPORTS CLIENTS IN MEETING THESE GOALS USING COMMUNITY RESOURCES TO MEET INDIVIDUAL SOCIAL SERVICE NEEDS. SCRIPPS PAYS THE CITY OF REFUGE A DAILY RATE FOR HOUSING AND SERVICES THEY PROVIDE TO THE PATIENTS. THE CITY OF REFUGE PROVIDES A SAFE, SECURE ENVIRONMENT, WITH 24-HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, CASE MANAGEMENT, ASSISTANCE WITH MEDI-CAL, WITH TRANSITION TO MANAGED MEDI-CAL AND DISABILITY APPLICATIONS, REFERRALS TO REHAB AND OTHER PROGRAMS, AND HELP FINDING PERMANENT OR TRANSITIONAL HOUSING USING COUNTY RESOURCES. DME AND OTHER NEEDED SERVICES ARE PROVIDED BY SCRIPPS WHEN FUNDING IS NOT AVAILABLE. ALL PATIENTS ARE CONNECTED TO A MEDICAL HOME, AND PRIMARY CARE IN THE COMMUNITY. PATIENTS WITH PSYCH DISORDERS ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY IF THEY ARE WILLING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED BY CITY OF REFUGE, BUT MAY INCLUDE INSURANCE FUNDED TRANSPORT SERVICES, AND OCCASIONALLY SCRIPPS SHUTTLE, OR USE OF TAXI VOUCHER. THE CITY OF REFUGE BEGAN TAKING PATIENTS ROUTINELY IN OCTOBER OF 2019. THIS YEAR 44 PATIENTS SO FAR HAVE MET THE NEED
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $3.8 BILLION NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 600,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 3,000 AFFILIATED PHYSICIANS AND MORE THAN 16,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES AND AN AMBULATORY CARE NETWORK OF PHYSICIAN OFFICES AND 31 OUTPATIENT CLINICS, AND 15 SCRIPPS HEALTH EXPRESS SITES. SCRIPPS ALSO OFFERS PAYER PRODUCTS AND POPULATION HEALTH SERVICES THROUGH SCRIPPS ACCOUNTABLE CARE ORGANIZATION, SCRIPPS HEALTH PLAN AND CUSTOMIZED NARROW NETWORK PLANS IN COLLABORATION WITH THIRD-PARTY PAYERS. AS A TAX-EXEMPT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. SCRIPPS HEALTH IS A LEADING PROVIDER OF MEDICAL CARE, IMPROVING COMMUNITY HEALTH AND ADVANCING MEDICINE IN SAN DIEGO COUNTY. THE SYSTEM OPERATES FOUR ACUTE-CARE HOSPITALS ON FIVE CAMPUSES AND NUMEROUS AMBULATORY CLINICS GEOGRAPHICALLY LOCATED ACROSS THE ENTIRE COUNTY, FROM CHULA VISTA TO OCEANSIDE. THE SYSTEM IS RECOGNIZED FOR OUR EXPERTISE IN WOMEN'S HEALTH, CANCER CARE, CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT, AND NEUROCOGNITIVE CARE INCLUDING DEMENTIA AND THERAPY-INDUCED COGNITIVE SEQUELA. SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, AND DIGITAL HEALTH CARE. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONGSTANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. OUR HOSPITALS ARE CONSISTENTLY RANKED BY U.S. NEWS & WORLD REPORT AMONG THE NATION'S BEST AND SCRIPPS IS REGULARLY RECOGNIZED BY FORTUNE MAGAZINE, WORKING MOTHER MAGAZINE, AND THE ADVISORY BOARD AS ONE OF THE BEST PLACES IN THE NATION TO WORK. IMPORTANTLY, SCRIPPS CULTURE IS ONE OF CARING; THE SPIRIT AND CULTURE ESTABLISHED BY TWO PIONEERING FOUNDERS, MOTHER MARY MICHAEL CUMMINGS AND ELLEN BROWNING SCRIPPS STILL DEFINE WHO WE ARE TODAY. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG.
SCHEDULE H, PART VI, LINE 7	CALIFORNIA. SCRIPPS HEALTH COMMUNITY BENEFIT PLAN AND REPORT CAN BE FOUND AT: HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Purpose Of GrantPurposeOfGrantTxt
American Heart Association - Heart Walk
9404 Genesee Ave 240	La Jolla	CA	92037	135613797	501(c)(3)	$10,000	$0	Program support
Consumer Center of Legal Aid Society
1764 San Diego Ave 200	San Diego	CA	92110	951869806	501(c)(3)	$120,000	$0	Program Support
Enlisted Leadership Foundation-The Foundry
2307 Fenton Pkwy	San Diego	CA	92108	465029314	501(c)(3)	$35,000	$0	PROGRAM SUPPORT
Eric Paredes Save a Life Foundation
2514 Jamcha Rd Ste 502	El Cajon	CA	92019	800636157	501(c)(3)	$8,500	$0	PROGRAM SUPPORT
Family Health Centers of San Diego
823 Gateway Center Way	San Diego	CA	92102	952833205	501(c)(3)	$300,000	$0	PROGRAM SUPPORT
La Maestra Health Center
4305 University Ave	San Diego	CA	92105	330473171	501(c)(3)	$40,000	$0	PROGRAM SUPPORT
FHCSD - Spirit of the Barrio
823 Gateway Center Way	San Diego	CA	92102	952833205	501(c)(3)	$7,500	$0	PROGRAM SUPPORT
FHCSD - Int Med OutPaitent Teaching Clinic
823 Gateway Center Way	San Diego	CA	92102	952833205	501(c)(3)	$309,000	$0	PROGRAM SUPPORT
San Diego LGBT Community Center
3909 Centre St	San Diego	CA	92013	237332048	501(c)(3)	$10,000	$0	PROGRAM SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	9	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PART I, LINE 2	FormAndLineReferenceDesc
Explanation	Description of Organization's Procedures for Monitoring the Use of Grants Grantee shall submit to Scripps Health, attention Director of Community Benefit Services at 10140 Campus Point Court, CPA 320, San Diego, CA 92121, the following: A. A semi-annual summary progress report and a line item financial accounting of the grant disbursement is required. Reports shall include, but not be limited to, progress made toward meeting objectives outlined in the grant application. B. Within thirty (30) days following the expiration date of the grant a final progress report shall be submitted to Scripps Health. In addition to the progress made toward meeting the objectives outlined in the grant application, the Final Report should include quantitative and qualitative results of the program against its stated goals and objectives. A line item financial accounting of the grant disbursement against the budget must be included as part of this final report. C. The Grantee shall provide Scripps Health with any additional information or progress updates, relative to grant project, as reasonably requested. D. Scripps Health reserves the right to audit expenditures and supporting documentation.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Discretionary Spending Acct	Yes (X)	DiscretionarySpendingAcctInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (true)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (24 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CHRISTOPHER VAN GORDER
PRESIDENT & CEO/TRUSTEE	$1,519,571	$0	$690,014	$0	$232,612	$0	$328,393	$0	$12,631	$0	$2,783,221	$0	$161,632	$0
SHIRAZ FAGAN
CHIEF EXEC, SR VP (PART-YEAR)	$133,535	$0	$333,044	$0	$1,238,044	$0	$0	$0	$5,603	$0	$1,710,226	$0	$333,557	$0
RICHARD ROTHBERGER
TREASURER / EXEC VP, CFO	$870,552	$0	$307,924	$0	$425,943	$0	$69,944	$0	$2,503	$0	$1,676,866	$0	$348,292	$0
JAMES LA BELLE MD
CORP SR VP, CMO (PART-YEAR)	$39,365	$0	$226,089	$0	$1,254,980	$0	$0	$0	$2,857	$0	$1,523,291	$0	$575,773	$0
RICHARD SHERIDAN
FORMER OFFICER	$0	$0	$238,270	$0	$965,094	$0	$275,162	$0	$0	$0	$1,478,526	$0	$358,359	$0
THOMAS BUCHHOLZ
CORP SR. VP, MD ANDERSON	$749,753	$0	$225,112	$0	$239,053	$0	$200,556	$0	$25,183	$0	$1,439,657	$0	$226,154	$0
CARL ETTER
CHIEF EXECUTIVE, SR VP	$693,754	$0	$198,144	$0	$173,866	$0	$161,809	$0	$17,399	$0	$1,244,972	$0	$120,365	$0
RICHARD NEALE
CORP EXEC VP, CHIEF GROWTH OFF	$554,164	$0	$205,541	$0	$316,503	$0	$102,251	$0	$50,279	$0	$1,228,738	$0	$278,387	$0
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	$632,419	$0	$203,580	$0	$183,527	$0	$168,556	$0	$33,485	$0	$1,221,567	$0	$156,535	$0
BARBARA PRICE
CORP SR VP, BUS&SERV LINE DEV	$606,715	$0	$189,553	$0	$205,242	$0	$165,699	$0	$25,371	$0	$1,192,580	$0	$192,947	$0
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	$655,054	$0	$236,370	$0	$52,378	$0	$47,813	$0	$13,018	$0	$1,004,633	$0	$10,990	$0
JOHN ENGLE
CORP SR. VP, CHIEF DEVELOPMENT	$472,381	$0	$148,444	$0	$171,674	$0	$118,496	$0	$30,503	$0	$941,498	$0	$123,140	$0
GHAZALA SHARIEFF
CORP SR. VP, ACUTE CARE/CLIN E	$567,883	$0	$82,105	$0	$48,449	$0	$56,142	$0	$31,997	$0	$786,576	$0	$34,067	$0
ERIC COLE
CORP SVP, HUMAN RESOURCES	$453,479	$0	$109,023	$0	$183,341	$0	$0	$0	$35,655	$0	$781,498	$0	$157,635	$0
JOHN POOLE
CORP VP, SYSTEM IMPROVEMENT	$438,520	$0	$118,223	$0	$92,284	$0	$102,594	$0	$19,814	$0	$771,435	$0	$80,698	$0
LISA RISSER-THAKUR
CORP SR. VP, ANCILLARY OPS	$438,648	$0	$134,417	$0	$57,696	$0	$106,705	$0	$22,808	$0	$760,274	$0	$45,538	$0
BRAD ELLIS
CORP VP, ASST GEN COUNSEL, SEC	$448,395	$0	$97,877	$0	$98,835	$0	$72,473	$0	$33,809	$0	$751,389	$0	$86,774	$0
SHAWN FORRESTER
CORP VP, PAYER RELATIONS	$445,071	$0	$82,933	$0	$87,946	$0	$97,626	$0	$23,618	$0	$737,194	$0	$77,308	$0
CHRISTEE THOMAS
CORP VP, REV CYCLE/CNT BUS OFC	$372,150	$0	$96,242	$0	$151,638	$0	$86,934	$0	$13,023	$0	$719,987	$0	$119,310	$0
SHANE THIELMAN
CORP SR. VP, CIO	$448,644	$0	$58,482	$0	$64,992	$0	$102,335	$0	$35,818	$0	$710,271	$0	$52,769	$0
GERALD L SODERSTROM
CORP VP, AUDIT / COMPLIANCE	$369,024	$0	$97,605	$0	$117,194	$0	$66,470	$0	$37,412	$0	$687,705	$0	$102,177	$0
TRACY CHU
CORP VP, POP HLTH CHF EXEC/ACO	$386,280	$0	$74,902	$0	$92,523	$0	$82,354	$0	$12,870	$0	$648,929	$0	$68,640	$0
MARY ELLEN DOYLE
CORP VP, NURSING OPS	$404,134	$0	$106,031	$0	$79,937	$0	$25,957	$0	$26,169	$0	$642,228	$0	$61,706	$0
LAURANCE CRACROFT
VP, PHYSICIAN NETWORK DEVT	$413,534	$0	$101,740	$0	$14,121	$0	$14,250	$0	$35,318	$0	$578,963	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1A	SUPPLEMENTAL COMPENSATION INFORMATION SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE COST APPROXIMATELY $2,039 DURING FY21. CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2S.
SCHEDULE J, PART I, LINE 4A	RECEIVE A SEVERANCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY IN CALENDAR YEAR 2020: SHIRAZ FAGAN - $740,379 JAMES LA BELLE, MD - $653,013 RICHARD SHERIDAN - $606,735
SCHEDULE J, PART I, LINE 4B	SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE, AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR THE PARTICIPANTS. EFFECTIVE DECEMBER 31, 2017, SCRIPPS HEALTH TERMINATED THIS 409(A) PLAN AND DISTRIBUTED TO EACH PARTICIPANT AN AMOUNT EQUAL TO THE INCOME TAX WITHHOLDING AND FICA TAXES DUE ON THE VESTED BENEFITS. NO PAYMENTS WERE MADE DURING CY20. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2020: CHRISTOPHER VAN GORDER - $161,632 SHIRAZ FAGAN - $333,557 RICHARD ROTHBERGER - $160,810 JAMES LA BELLE, MD - $575,773 RICHARD SHERIDAN - $358,359 CARL ETTER - $120,365 RICHARD NEALE - $76,233 THOMAS GAMMIERE - $105,612 BARBARA PRICE - $116,639 JUNE KOMAR - $10,990 JOHN ENGLE - $59,294 GHAZALA SHARIEFF - $34,067 ERIC COLE - $41,789 BRAD ELLIS - $37,713 CHRISTEE THOMAS - $51,239 GERALD L. SODERSTROM - $52,983 MARY ELLEN DOYLE - $61,706 SHAWN FORRESTER - $77,308

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTH
A	680164610	1309116Y1	2007-03-02	$49,995,000	SEE PART IV	false	false	Yes (true)
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
B	521643828	13033LFL6	2010-02-04	$100,000,000	SEE PART VI	false	false	false
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
C	521643828	13033LVZ7	2012-02-01	$288,143,095	SEE PART VI	false	false	false
California Health Facilities Financing Authority
D	521643828	000000000	2016-02-29	$150,000,000	SEE PART VI	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$0	$0	$49,995,000	$0	$0	$0	$146,070	$0	$0	$49,848,390	$0	$0	2007	Yes (true)	false	Yes (true)	Yes (true)
B	$0	$0	$100,002,530	$0	$0	$0	$0	$0	$0	$100,002,530	$0	$0	2011	false	false	Yes (true)	Yes (true)
C	$0	$0	$288,160,329	$0	$0	$0	$0	$0	$0	$288,160,329	$0	$0	2013	false	false	Yes (true)	Yes (true)
D	$73,965,000	$0	$150,000,000	$0	$0	$0	$0	$0	$0	$150,000,000	$0	$0	2016	false	false	Yes (true)	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Any Research AgreementsAnyResearchAgreementsInd	Engage Bond Counsel ResearchEngageBondCounselResearchInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Remedial Action TakenRemedialActionTakenInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd	Private Bus Concerning UBIPrivateBusConcerningUBIPct	Total Private Business UseTotalPrivateBusinessUsePct
A	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0	false	false	false	Yes (true)
B	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0.00000	false	false	false	Yes (true)	0.00000	0.00000
C	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0.00000	false	false	false	Yes (true)	0.00000	0.00000
D	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0.00000	false	false	false	Yes (true)	0.00000	0.00000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1Txt	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd
0
A	Yes (true)	Yes (true)	false	false	0	Yes (true)	Yes (true)
0
B	false	Yes (true)	false	false	0	false	Yes (true)	false	false	Yes (true)
0
C	false	Yes (true)	false	false	0	false	Yes (true)	false	false	Yes (true)
0
D	false	false	false	false	0	false	Yes (true)	false	false	Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (true)
B	Yes (true)
C	Yes (true)
D	Yes (true)

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
California Health Facilities Financing Authority
A	521643828	000000000	2017-01-31	$160,000,000	SEE PART VI	false	false	false
California Health Facilities Financing Authority
B	521643828	000000000	2019-11-15	$99,360,000	SEE PART VI	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$0	$0	$160,000,000	$0	$0	$0	$0	$0	$0	$0	$160,000,000	$0	2017	Yes (true)	false	Yes (true)	Yes (true)
B	$3,360,000	$0	$99,360,000	$0	$0	$0	$0	$0	$0	$0	$99,360,000	$0	2019	Yes (true)	false	Yes (true)	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Any Research AgreementsAnyResearchAgreementsInd	Engage Bond Counsel ResearchEngageBondCounselResearchInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Private Bus Concerning UBIPrivateBusConcerningUBIPct	Total Private Business UseTotalPrivateBusinessUsePct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Remedial Action TakenRemedialActionTakenInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0.00000	0.00000	0.00000	false	false	false	Yes (true)
B	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0.00000	0.00000	0.00000	false	false	false	Yes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1Txt	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
A	false	Yes (true)	false	false	false	false	false	0	false	Yes (true)
0
B	false	Yes (true)	false	false	false	false	false	0	false	Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (true)
B	Yes (true)

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K, PART I, COLUMN (E) - ISSUE PRICE	FormAndLineReferenceDesc
Explanation	BOND ISSUE 1-A (2007A): The stated par of $49,995,000 differs from the $149,875,000 reported on Form 8038 as the $49,995,000 amount represents the Scripps Health's portion on in a pool bond loan program. SCHEDULE K, PART I, COLUMN (F) - DESCRIPTION OF PURPOSE BOND ISSUE 1-A (2007A): POOL BOND. PROCEEDS WERE USED TO REFUND COMMERCIAL PAPER REVENUE NOTES, SERIES 2005A, WHICH WERE USED TO PURCHASE EQUIPMENT. BOND ISSUE 1-B (2010B & C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 1-C (2012A-C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 1-D (2016A/B): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-A (2017A): THE $160,000,000 (2017A) REFUNDED THE 2008B-F BONDS. THE ISSUE DATE FOR THE 2008B-F BONDS WAS 8/14/2008. BOND ISSUE 2-B (2019A): THE 2019A ISSUE REFUNDED THE 2010A ISSUE. SCHEDULE K, PART II, LINE 3 BOND ISSUE 1-B (2010B/C) THE AMOUNT SHOWN IN PART II, LINE 3 CONSISTS OF THE ISSUE PRICE OF THE BONDS $100,000,000 PLUS PROJECT FUND INVESTMENT EARNINGS OF $2,530. BOND ISSUE 1-C (2012A-C): THE AMOUNT SHOWN IN PART II, LINE 3 CONSISTS OF THE ISSUE PRICE OF THE BONDS $288,143,095 PLUS INVESTMENT EARNINGS OF $17,234. SCHEDULE K, PART III, LINE 3B THE OBLIGOR'S LEGAL DEPARTMENT REVIEWS CONTRACTS AND AGREEMENTS TO ENSURE COMPLIANCE WITH PRIVATE BUSINESS USE REGULATIONS, ENGAGING OUTSIDE LEGAL COUNSEL, AS NECCESARY. SCHEDULE K, PART IV, LINE 2C BOND ISSUE 1-B (2010B/C): THE 2010B/C REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 4, 2015. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE 1-C (2012A-C): THE 2012A-C REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 1, 2015. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE 1-D (2016A/B): THE 2016A/B REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 28, 2018. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. SCHEDULE K, PART IV, LINE 3 BOND ISSUE 1-C (2012A-C): THE 2012A ISSUE TOTALING $188,143,094 IS A FIXED RATE ISSUE WHEREAS THE 2010B&C TOTALING $100,000,000 IS A VARIABLE RATE ISSUE. SCHEDULE K, PART IV, LINE 6 BOND ISSUE 1-A (2007A): AN AMOUNT IN THE COST OF ISSUANCE FUND NOT EXCEEDING $100,000 WAS NOT DISBURSED UNTIL MAY 2008. SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION THE ORGANIZATION HAS ADOPTED TAX-EXEMPT BOND COMPLIANCE PROCEDURES, INCLUDING PROCEDURES TO MONITOR PRIVATE BUSINESS USE OF FINANCED PROPERTY AND TAKING REMEDIAL ACTIONS, IF NECESSARY. THE ORGANIZATION IS AWARE OF THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS, AND HAS DISCUSSED THAT PROGRAM WITH COUNSEL. THE ORGANIZATION HAS REVISED ITS WRITTEN PROCEDURES TO SPECIFICALLY MAKE REFERENCE TO THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS.	ExplanationTxt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)

Relationship With OrgRelationshipWithOrgTxt	Loan PurposeLoanPurposeTxt	Loan From OrganizationLoanFromOrganizationInd	Original PrincipalOriginalPrincipalAmt	Balance DueBalanceDueAmt	DefaultDefaultInd	Board Or Committee ApprovalBoardOrCommitteeApprovalInd	Written AgreementWrittenAgreementInd
Chris Van Gorder
OFFICER	Def Comp	Yes (X)	$10,023,866	$12,805,710	false	Yes (true)	Yes (true)
June Komar
EXECUTIVE	Def Comp	Yes (X)	$2,769,010	$3,537,472	false	Yes (true)	Yes (true)
Richard Sheridan
OFFICER	Def Comp	Yes (X)	$4,063,606	$5,191,347	false	Yes (true)	Yes (true)

Field	Value	IRS element (for citing)
Total Balance Due	$21,534,529	TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (24 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$139,233,969	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$5,960,608	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$4,789,100	LEGAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$2,738,592	CONSTRUCTION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$1,984,045	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$1,470,828	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$870,917	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$721,698	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$533,750	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$216,322	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$160,715	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$158,075	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$140,484	FINANCIAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$136,214	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$134,945	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$129,157	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$121,390	EMPLOYEE SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$115,120	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$114,612	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$113,599	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$107,844	MEDICAL SERVICES	false
KATIE WOODHEAD
SEE PART V	$46,992	SEE PART V	false
LINDSEY VAN GORDER
SEE PART V	$83,820	SEE PART V	false
DAVID VAN GORDER
SEE PART V	$71,595	SEE PART V	false

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE L, PART II	LOANS TO AND FROM INTERESTED PERSONS EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR FOUR PLAN PARTICIPANTS. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO THOSE FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME.
SCHEDULE L, PART IV	KATIE WOODHEAD, DAUGHTER OF KEY EMPLOYEE JOHN ENGLE, IS EMPLOYED BY SCRIPPS HEALTH. LINDSEY VAN GORDER, DAUGHTER-IN-LAW OF BOARD MEMBER AND OFFICER CHRIS VAN GORDER, IS EMPLOYED BY SCRIPPS HEALTH. DAVID VAN GORDER, SON OF BOARD MEMBER AND OFFICER CHRIS VAN GORDER, IS EMPLOYED BY SCRIPPS HEALTH.

Schedule M IRS990ScheduleM

Field	Value	IRS element (for citing)
Works Of Art		WorksOfArtGrp
Art Historical Treasures		ArtHistoricalTreasuresGrp
Art Fractional Interest		ArtFractionalInterestGrp
Books And Publications		BooksAndPublicationsGrp
Clothing And Household Goods		ClothingAndHouseholdGoodsGrp
Cars And Other Vehicles		CarsAndOtherVehiclesGrp
Boats And Planes		BoatsAndPlanesGrp
Intellectual Property		IntellectualPropertyGrp

Securities Publicly Traded SecuritiesPubliclyTradedGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	35	ContributionCnt
Noncash Contributions Rpt F990	$34,831,361	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Securities Closely Held Stock		SecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust Intrsts		SecurPrtnrshpTrustIntrstsGrp

Securities Miscellaneous SecuritiesMiscellaneousGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$48,000,000	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Qualified Contrib Hist Struct		QualifiedContribHistStructGrp
Qualified Contrib Other		QualifiedContribOtherGrp

Real Estate Residential RealEstateResidentialGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$375,000	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Real Estate Commercial		RealEstateCommercialGrp
Real Estate Other		RealEstateOtherGrp
Collectibles		CollectiblesGrp
Food Inventory		FoodInventoryGrp
Drugs And Medical Supplies		DrugsAndMedicalSuppliesGrp
Taxidermy		TaxidermyGrp
Historical Artifacts		HistoricalArtifactsGrp
Scientific Specimens		ScientificSpecimensGrp
Archaeological Artifacts		ArchaeologicalArtifactsGrp

Other Non Cash Contri Table OtherNonCashContriTableGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Desc	Equipment	Desc
Contribution	3	ContributionCnt
Noncash Contributions Rpt F990	$493,451	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Form8283 Received	1	Form8283ReceivedCnt
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (true)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	Yes (true)	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE M, PART I, COLUMN (B)	CONTRIBUTIONS REPORTED THE NUMBER OF TRANSACTION, WHICH MOST CLOSELY APPROXIMATES THE NUMBER OF ITEMS CONTIRBUTED, IS BEING REPORTED IN COLUMN B.
SCHEDULE M, PART I, LINE 12	Assignment of interest (ownership) in Dr. Seuss Enterprises, L.P, of which the shares/interest are not publicly available as it's a private Limited Partnership.
SCHEDULE M, PART I, LINE 32B	THIRD PARTIES ENGAGED TO SOLICIT, PROCESS, AND SELL NON-CASH CONTRIBUTIONS GIFTS Gifts of securities are liquidated through licensed securities brokers. Gifts of real estate are liquidated through licensed real estate brokers.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (43 entries)

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FORM 990, PART I AND PART III, LINE 1	FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $3.8 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS OVER HALF A MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF 2,600 AFFILIATED PHYSICIANS AND 18,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. RECOGNIZED AS A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, GENOMIC MEDICINE, WIRELESS HEALTH AND GRADUATE MEDICAL EDUCATION. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONG STANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. TODAY, THE HEALTH SYSTEM EXTENDS FROM CHULA VISTA TO OCEANSIDE, WITH 26 PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS WAS NAMED BY TRUVEN IN 2013 AS ONE OF THE TOP 15 LARGE HEALTH SYSTEMS IN THE NATION FOR PROVIDING HIGH-QUALITY, SAFE AND EFFICIENT PATIENT CARE. ON THE FOREFRONT OF GENOMIC MEDICINE AND WIRELESS HEALTH TECHNOLOGY, THE ORGANIZATION IS DEDICATED TO IMPROVING COMMUNITY HEALTH WHILE ADVANCING MEDICINE THROUGH CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. SCRIPPS HAS ALSO EARNED A NATIONAL REPUTATION AS A PREMIER EMPLOYER, NAMED BY FORTUNE MAGAZINE AS ONE OF AMERICA'S "100 BEST COMPANIES TO WORK FOR" EVERY YEAR SINCE 2008. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY.
FORM 990, PART III, LINE 4A	FULFILLING THE SCRIPPS MISSION DURING FISCAL YEAR 2021, SCRIPPS DEVOTED $538,036,955 TO COMMUNITY BENEFIT PROGRAMS AND SERVICES IN THE AREAS OF UNCOMPENSATED CARE, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND HEALTH RESEARCH. UNCOMPENSATED CARE INCLUDES CHARITY CARE, BAD DEBT, AND MEDI-CAL AND MEDICARE SHORTFALLS. OUR PROGRAMS EMPHASIZE COMMUNITY-BASED PREVENTION EFFORTS AND USE INNOVATIVE APPROACHES TO REACH RESIDENTS AT GREATEST RISK FOR HEALTH PROBLEMS. SCRIPPS MAKES COMMITMENTS TO IMPROVE THE HEALTH OF OUR PATIENTS AND OUR SAN DIEGO DIVERSE COMMUNITIES. AS A LONG-STANDING MEMBER OF THESE COMMUNITIES, AND AS A NOT-FOR-PROFIT COMMUNITY RESOURCE, OUR GOAL AND RESPONSIBILITY ARE TO PROVIDE HELP AND ASSISTANCE FOR ALL WHO COME TO US FOR CARE, AND TO REACH OUT ESPECIALLY TO THOSE WHO FIND THEMSELVES VULNERABLE AND WITHOUT SUPPORT. THIS RESPONSIBILITY IS AN INTRINSIC PART OF OUR MISSION. THROUGH OUR CONTINUED ACTIONS AND COMMUNITY PARTNERSHIPS, WE STRIVE TO RAISE THE QUALITY OF LIFE IN THE COMMUNITY AS A WHOLE. SAN DIEGO COUNTY COMMUNITY DEFINED SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ORGANIZES THEIR SERVICE AREAS INTO SIX GEOGRAPHIC REGIONS DUE TO ITS LARGE GEOGRAPHIC SIZE AND POPULATION. CENTRAL, EAST, NORTH CENTRAL, NORTH COASTAL, NORTH INLAND AND SOUTH. THE DEMOGRAPHICS OF SAN DIEGO REFLECT A DIVERSE POPULATION, WITH CONSIDERABLE VARIATION BETWEEN THE DIFFERENT REGIONS. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DEFINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE CHANGE IN RACE, ETHNICITY, AND AGE DISTRIBUTION ARE ALL IMPORTANT FACTORS IN UNDERSTANDING COMMUNITIES AND THEIR HEALTH NEEDS. SAN DIEGO IS THE SECOND MOST POPULOUS COUNTY IN CALIFORNIA AND FIFTH MOST POPULOUS IN THE UNITED STATES. SAN DIEGO HAS: - OVER 3.3 MILLION RESIDENTS - MAJORITY MINORITY POPULATION - BUSIEST LAND BORDER CROSSING IN THE WORLD - 1 OF EVERY 13 PEOPLE WHO ENTER THE US COME THROUGH SAN YSIDRO - 70 MILES OF COASTLINE - 16 NAVAL AND MILITARY INSTALLATIONS - 18 FEDERALLY QUALIFIED RECOGNIZED INDIAN RESERVATIONS - A TOTAL OF 4,526 SQUARE MILES, LARGER THAN RHODE ISLAND AND DELAWARE COMBINED SAN DIEGO'S UNINSURED LOW-INCOME AND UNINSURED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS AND HEALTH OUTCOMES. DATA FROM THE AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. SAN DIEGO RESIDENTS HAVE MORE EDUCATION, HIGHER INCOMES, LOWER POVERTY, AND LOWER UNEMPLOYMENT RATES THAN THE STATEWIDE POPULATION. NONETHELESS, MORE THAN ONE IN FOUR RESIDENTS IN THE REGION LIVES IN A HOUSEHOLD EARNING LESS THAN 200% OF THE FEDERAL POVERTY LEVEL, OR $53,000 FOR A FAMILY OF FOUR IN 2021. UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA), MILLIONS OF CALIFORNIANS HAVE GAINED HEALTH COVERAGE. THESE GAINS HAVE COME EITHER THROUGH THE EXPANSION OF MEDICAID (CALLED MEDI-CAL IN CALIFORNIA) TO LOW INCOME ADULTS EARNING UP TO 138% OF THE FEDERAL POVERTY GUIDELINE (FPG), OR THROUGH COVERED CALIFORNIA, THE STATE'S ACA HEALTH INSURANCE MARKETPLACE, WHERE PEOPLE EARNING UP TO 400% FPL CAN PURCHASE SUBSIDIZED INSURANCE COVERAGE. THE MAJOR COVERAGE EXPANSIONS OF THE ACA WERE IMPLEMENTED STARTING IN 2014 AND BETWEEN 2013 AND 2018, THE UNINSURED RATE FOR CALIFORNIANS UNDER AGE 65 WAS NEARLY HALVED, DROPPING FROM 15.5% TO 8.1% (THIS PERCENTAGE INCLUDES CHILDREN). FOLLOWING THE ACA, THE NUMBER OF UNINSURED NONELDERLY AMERICANS DECLINED BY 20 MILLION, DROPPING TO AN HISTORIC LOW IN 2016. HOWEVER, BEGINNING IN 2017, THE NUMBER OF UNINSURED NONELDERLY AMERICANS INCREASED FOR THREE STRAIGHT YEARS, GROWING BY 2.2 MILLION FROM 26.7 MILLION IN 2016 TO 28.9 MILLION IN 2019. THE UNINSURED RATE FOR CALIFORNIA INCREASED FROM 10.3% IN 2016 TO 10.9% IN 2019 AND FOR SAN DIEGO COUNTY INCREASED FROM 10.4% IN 2016 TO 11.3% IN 2019. COVERAGE DURING THE COVID-19 PANDEMIC THE ECONOMIC DOWNTURN CAUSED BY THE CORONAVIRUS PANDEMIC HAS RENEWED ATTENTION ON HEALTH INSURANCE COVERAGE AS MILLIONS HAVE LOST THEIR JOBS AND POTENTIALLY THEIR HEALTH COVERAGE. THE AFFORDABLE CARE ACT (ACA) SOUGHT TO ADDRESS THE GAPS IN OUR HEALTH CARE SYSTEM THAT LEAVE MILLIONS OF PEOPLE WITHOUT HEALTH INSURANCE BY EXTENDING MEDICAID COVERAGE TO MANY LOW-INCOME INDIVIDUALS AND PROVIDING SUBSIDIES FOR MARKETPLACE COVERAGE FOR INDIVIDUALS BELOW 400% OF POVERTY. KEY FINDINGS NATIONAL DATA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) SHOWED THAT THE UNINSURED RATE HELD STEADY DURING 2020 DESPITE THE COVID-19 PANDEMIC. THIS DATA COMES FROM THE NATIONAL HEALTH INTERVIEW SURVEY, CONSIDERED ONE OF THE MOST COMPREHENSIVE SOURCES OF INFORMATION ABOUT HEALTH INSURANCE COVERAGE DUE TO THE LARGE SAMPLE SIZE AND THE FACT THAT DATA IS COLLECTED YEAR-ROUND. THE OVERALL UNINSURED RATE IN 2020 WAS 9.7 PERCENT (ABOUT 31.6 MILLION PEOPLE) COMPARED TO 10.3 PERCENT (ABOUT 33.2 MILLION PEOPLE) IN 2019. SCRIPPS HEALTH COMMUNITY SERVED HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT, AND PRIMARY CARE. IN FISCAL YEAR 2021, SCRIPPS PROVIDED 2,610,833 OUTPATIENT VISITS. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS, AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. ASSESSING COMMUNITY NEED SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGION'S MOST VULNERABLE POPULATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATEWIDE LEGISLATION IN THE EARLY 1990S. SB 697 TOOK EFFECT IN 1995, WHICH REQUIRED PRIVATE NOT-FOR-PROFIT HOSPITALS TO SUBMIT DETAILED INFORMATION TO THE DEPARTMENT OF HEALTHCARE ACCESS AND INFORMATION (HCAI) ON THEIR COMMUNITY BENEFIT CONTRIBUTIONS. FORMERLY NAMED THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD). ANNUAL HOSPITAL COMMUNITY BENEFIT REPORTS ARE SUMMARIZED BY HCAI IN A REPORT TO THE LEGISLATURE, WHICH PROVIDES VALUABLE INFORMATION FOR GOVERNMENT OFFICIALS TO ASSESS THE CARE AND SERVICES PROVIDED TO THEIR CONSTITUENTS. THE SB 697 REQUIREMENT WAS SUPPLEMENTED IN 2010 BY REQUIREMENTS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OR ACA THAT NOT-FOR-PROFIT HOSPITALS CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS WITH COMMUNITY STAKE HOLDERS TO DETERMINE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY THEY SERVE AND IMPLEMENTATION STRATEGIES TO HELP MEET THOSE NEEDS. ADDITIONAL INFORMATION ON THE ACA REQUIREMENTS FOR NOT-FOR-PROFIT HOSPITALS CAN BE FOUND AT HTTP://WWW.IRS.GOV, KEYWORD: "CHARITABLE ORGANIZATIONS." AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATIONS STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES EVERY THREE YEARS. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS AND CONSUMER GROUPS. THE 2019 SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. THE REPORT HELPS US UNDERSTAND OUR COMMUNITY'S HEALTH NEEDS AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT.
FORM 990, PART III, LINE 4A (CONTINUED)	CHNA EXECUTIVE SUMMARY THE EXECUTIVE SUMMARY PROVIDES A HIGH-LEVEL SUMMARY OF THE 2019 CHNA METHODOLOGY AND FINDINGS. THE FULL CHNA REPORT CONTAINS IN-DEPTH INFORMATION AND EXPLANATIONS OF THE DATA THAT PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WILL USE TO EVALUATE THE HEALTH NEEDS OF THEIR PATIENTS AND DETERMINE, ADAPT, OR CREATE PROGRAMS AT THEIR FACILITIES. SEVEN HOSPITALS AND HEALTH CARE SYSTEMS, INCLUDING SCRIPPS HEALTH CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT THE CURRENT TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. THE COMPLETE HASD&IC 2019 CHNA IS AVAILABLE FOR PUBLIC VIEWING AND DOWNLOAD AT HTTPS://HASDIC.ORG/2019-CHNA/. PARTICIPATING HOSPITALS USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND MEET IRS REGULATORY REQUIREMENTS. PER LEGISLATION HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. THE 2019 CHNA WAS COMPLETED IN SEPTEMBER 2019 AND THE COMPLETE REPORT IS AVAILABLE ONLINE AT SCRIPPS HEALTH 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE 2019 SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY AND BUILD ON THE RESULTS OF THE 2016 CHNA. IT INCLUDES THREE TYPES OF COMMUNITY ENGAGEMENT EFFORTS: FOCUS GROUPS WITH RESIDENTS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, AND HEALTH CARE LEADERS; KEY INFORMANT INTERVIEWS WITH HEALTH CARE EXPERTS; AND AN ONLINE SURVEY FOR RESIDENTS AND STAKEHOLDERS. IN ADDITION, THE CHNA INCLUDES EXTENSIVE QUANTITATIVE ANALYSIS OF NATIONAL AND STATE-WIDE DATA SETS, SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND INPATIENT HOSPITAL DISCHARGE DATA, COUNTY MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. THESE TWO DIFFERENT APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY HEALTH NEEDS FROM MULTIPLE PERSPECTIVES. PARTICIPATING HOSPITALS WILL USE THIS INFORMATION TO INFORM AND GUIDE HOSPITAL PROGRAMS AND STRATEGIES. THIS REPORT INCLUDES AN ANALYSIS OF HEALTH OUTCOMES AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH WHICH CREATE HEALTH INEQUITIES-'THE UNFAIR AND AVOIDABLE DIFFERENCES IN HEALTH STATUS SEEN WITHIN AND BETWEEN COUNTRIES AND COMMUNITIES WITH THE UNDERSTANDING THAT THE BURDEN OF ILLNESS, PREMATURE DEATH, AND DISABILITY DISPROPORTIONALLY AFFECTS RACIAL AND MINORITY POPULATION GROUPS AND OTHER UNDERSERVED POPULATIONS. UNDERSTANDING REGIONAL AND POPULATION-SPECIFIC DIFFERENCES IS AN IMPORTANT STEP TO UNDERSTANDING AND ULTIMATELY STRATEGIZING WAYS TO MAKE COLLECTIVE IMPACT. THESE NEW INSIGHTS WILL ALLOW PARTICIPATING HOSPITALS TO IDENTIFY EFFECTIVE STRATEGIES TO ADDRESS THE MOST PREVALENT AND CHALLENGING HEALTH NEEDS IN THE COMMUNITY. 2019 CHNA OBJECTIVES THE OBJECTIVES OF THE 2019 CHNA WERE TO ACCOMPLISH THE FOLLOWING GOALS: - IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH-RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS WHO FACE INEQUITIES. - PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY, AS WELL AS INFORM AND GUIDE LOCAL HOSPITALS IN THE DEVELOPMENT OF THEIR PROGRAMS AND STRATEGIES THAT ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. - BUILD ON AND STRENGTHEN COMMUNITY PARTNERSHIPS ESTABLISHED THROUGH THE PREVIOUS CHNA PROCESS. OVERVIEW AND BACKGROUND HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (2019 CHNA). THE 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 . SHARP HEALTHCARE . TR-CITY MEDICAL CENTER . UC SAN DIEGO HEALTH THE 2019 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. COMMUNITY PRIORITY PROCESS (CHNA METHODOLOGY) FOR THE 2019 CHNA QUANTITATIVE ANALYSES OF PUBLICLY AVAILABLE DATA PROVIDED AN OVERVIEW OF CRITICAL HEALTH ISSUES ACROSS SAN DIEGO COUNTY, WHILE QUALITATIVE ANALYSES OF FEEDBACK FROM THE COMMUNITY PROVIDED AN APPRECIATION FOR THE EXPERIENCES AND NEEDS OF SAN DIEGANS. THE CHNA COMMITTEE REVIEWED THESE ANALYSES AND APPLIED A PRE-DETERMINED SET OF CRITERIA TO THEM TO PRIORITIZE THE TOP HEALTH NEEDS IN SAN DIEGO COUNTY. FOR A COMPLETE DESCRIPTION OF THE HASD&IC 2019 PROCESS AND FINDINGS, SEE FULL REPORT AVAILABLE AT HTTPS://WWW.HASDIC.ORG/2019-CHNA. QUANTITATIVE QUANTITATIVE DATA WERE DRAWN FROM SEVERAL PUBLIC SOURCES. DATA FROM DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEEDS INDEX (CNI) AND THE PUBLIC HEALTH ALLIANCE OF SOUTHERN CALIFORNIA'S HEALTHY PLACES INDEX (HPI) WERE USED TO IDENTIFY GEOGRAPHIC COMMUNITIES IN SAN DIEGO COUNTY THAT WERE MORE LIKELY TO BE EXPERIENCING HEALTH INEQUITIES, WHICH GUIDED THE SELECTION OF COMMUNITIES FOR THE ENGAGEMENT AND THE DEVELOPMENT OF ENGAGEMENT QUESTIONS. HOSPITAL DISCHARGE DATA EXPORTED FROM SPEEDTRACK'S CALIFORNIA UNIVERSAL PATIENT INFORMATION DISCOVERY, OR CUPID APPLICATION WERE USED TO IDENTIFY CURRENT AND THREE-YEAR TRENDS IN PRIMARY DIAGNOSIS DISCHARGE CATEGORIES AND WERE STRATIFIED BY AGE AND RACE. THIS ALLOWED FOR THE IDENTIFICATION OF HEALTH DISPARITIES AND THE CONDITIONS HAVING THE GREATEST IMPACT ON HOSPITALS AND HEALTH SYSTEMS IN SAN DIEGO COUNTY. DATA FROM NATIONAL AND STATE-WIDE DATA SETS WERE ANALYZED INCLUDING SAN DIEGO COUNTY MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. IN ADDITION, KAISER PERMANENTE CONSOLIDATED DATA FROM SEVERAL NATIONAL AND STATE-WIDE DATA SETS RELATED TO A VARIETY OF HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH IN SAN DIEGO COUNTY AND CONDUCTED A COMPREHENSIVE STATISTICAL ANALYSIS TO IDENTIFY WHICH SOCIAL DETERMINANTS OF HEALTH 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. THESE ANALYSES GUIDED THE DESIGN OF THE ONLINE SURVEY, INTERVIEW, AND FOCUS GROUP QUESTIONS. QUALITATIVE - COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT ACTIVITIES INCLUDED FOCUS GROUPS, KEY INFORMANT INTERVIEWS, AND AN ONLINE SURVEY WHICH TARGETED STAKEHOLDERS FROM EVERY REGION OF SAN DIEGO COUNTY, 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 COMMUNITY HEALTH NEEDS ASSESSMENT: 138 COMMUNITY RESIDENTS AND 441 LEADERS AND EXPERTS. 2019 CHNA PRIORITIZATION OF THE TOP HEALTH NEEDS 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 SAN DIEGO COUNTY. 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 SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. 2019 FINDINGS: TOP 10 COMMUNITY HEALTH NEEDS THE CHNA COMMITTEE IDENTIFIED THE FOLLOWING AS THE HIGHEST PRIORITY COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER BY SDOH OR HEALTH CONDITION). ACCESS TO HEALTH CARE. OVERCOMING BARRIERS TO HEALTH CARE, SUCH AS LACK OF HEALTH INSURANCE AND INSURANCE ISSUES, ECONOMIC INSECURITY, TRANSPORTATION, THE SHORTAGE OF CULTURALLY COMPETENT CARE, FEARS ABOUT IMMIGRATION STATUS, AND THE SHORTAGE OF HEALTH CARE PROVIDERS EMERGED AS A HIGH PRIORITY COMMUNITY NEED. IN ADDITION, SPECIFIC SERVICES WERE IDENTIFIED AS CHALLENGING TO OBTAIN, INCLUDING BEHAVIORAL HEALTH CARE, DENTAL CARE, PRIMARY CARE, AND SPECIALTY CARE. AGING CONCERNS. CONDITIONS THAT PREDOMINANTLY AFFECT PEOPLE WHO ARE 65 AND OLDER SUCH AS ALZHEIMER'S DISEASE, PARKINSON'S, DEMENTIA, FALLS, AND LIMITED MOBILITY WERE IDENTIFIED AS A HIGH PRIORITY HEALTH NEED. COMMUNITY ENGAGEMENT PARTICIPANTS MOST OFTEN DESCRIBED AGING CONCERNS IN RELATION TO THE SOCIAL DETERMINANTS OF HEALTH, INCLUDING: TRANSPORTATION, ACCESS TO FRESH FOOD, SOCIAL ISOLATION AND INADEQUATE FAMILY SUPPORT, AND ECONOMIC INSECURITY.
FORM 990, PART III, LINE 4A (CONTINUED)	BEHAVIORAL HEALTH. GREATER ACCESS TO BEHAVIORAL HEALTH CARE WAS CITED AS A PRIORITY HEALTH NEED. THREE TYPES OF BEHAVIORAL HEALTH CARE WERE IDENTIFIED AS CHALLENGING TO ACCESS: URGENT CARE SERVICES FOR CRISIS SITUATIONS; INPATIENT PSYCHIATRIC BEDS AND SUBSTANCE ABUSE FACILITIES; AND TRANSITIONAL PROGRAMS AND SERVICES FOR POST-ACUTE CARE. IN ADDITION, SEVERAL BARRIERS TO BEHAVIORAL HEALTH CARE WERE NAMED AS PRIORITIES TO ADDRESS, INCLUDING A LACK OF AVAILABILITY OF NEEDED SERVICES AND APPOINTMENTS, INSURANCE ISSUES, LOGISTICAL ISSUES, SUCH AS TRANSPORTATION AND TIME OFF WORK, AND THE INABILITY TO PAY CO-PAYS AND DEDUCTIBLES. CANCER. HEALTH NEEDS RELATED TO CANCER WERE DESCRIBED IN RELATION TO THE EFFECTS ON WELL-BEING BEYOND PHYSICAL HEALTH. THESE INCLUDE FINANCIAL, PRACTICAL, AND EMOTIONAL IMPACTS ON INDIVIDUALS AND FAMILIES; THESE EFFECTS ARE EXACERBATED BY BARRIERS TO CANCER CARE. CHRONIC CONDITIONS. THREE CHRONIC CONDITIONS WERE IDENTIFIED AS PRIORITIES: CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY. KEY FACTORS THAT INDIVIDUALS STRUGGLE WITH TO PREVENT CHRONIC DISEASES INCLUDE ACCESS TO FRESH, HEALTH FOODS AND SAFE PLACES TO EXERCISE AND PLAY. IN ADDITION, ECONOMIC ISSUES, TRANSPORTATION TO MEDICAL CARE, FEARS ABOUT IMMIGRATION STATUS, AND A LACK OF KNOWLEDGE ABOUT CHRONIC CONDITIONS WERE NAMED AS PARTICULAR CHALLENGES RELATED TO THE MANAGEMENT OF CHRONIC CONDITIONS. COMMUNITY AND SOCIAL SUPPORT. A HIGH PRIORITY FOR THE WELL-BEING OF SAN DIEGO RESIDENTS IS ENSURING THAT INDIVIDUALS HAVE ADEQUATE RESOURCES AND SUBSTANTIAL SUPPORT WITHIN THEIR NEIGHBORHOOD. VALUABLE NEIGHBORHOOD RESOURCES INCLUDE FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) AND THOSE THAT ARE CULTURALLY AND LINGUISTICALLY COMPETENT. WITHOUT ADEQUATE SUPPORT FROM OTHERS, COMMUNITY ENGAGEMENT AND COMMUNITY SPIRIT ARE AFFECTED. ECONOMIC SECURITY. ECONOMIC SECURITY WAS NAMED AS VITALLY IMPORTANT TO THE WELL-BEING OF SAN DIEGO RESIDENTS AND WAS DESCRIBED AS IMPACTING EVERY ASPECT OF RESIDENTS' DAILY LIFE. THE HEALTH OF THOSE WHO ARE ECONOMICALLY INSECURE IS NEGATIVELY AFFECTED BY FOOD INSECURITY, CHRONIC STRESS AND ANXIETY, AND THE LACK OF TIME AND MONEY TO TAKE CARE OF HEALTH NEEDS. IN SAN DIEGO COUNTY, 13.3% OF RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL AND 15% EXPERIENCE FOOD INSECURITY. THOSE WHO ARE ECONOMICALLY INSECURE ARE AT GREATER RISK OF POOR MENTAL HEALTH DAYS, AS WELL AS, ASTHMA, OBESITY, DIABETES, STROKE, CANCER, SMOKING, PEDESTRIAN INJURY AND VISITS TO THE EMERGENCY DEPARTMENT FOR HEART ATTACKS. FACTORS IDENTIFIED AS CONTRIBUTING TO ECONOMIC INSECURITY INCLUDE HOUSING AND CHILD CARE COSTS AS WELL AS LOW WAGES. EDUCATION. RECEIVING A HIGH SCHOOL DIPLOMA, HAVING THE OPPORTUNITY TO PURSUE HIGHER OR VOCATIONAL EDUCATION, BEING HEALTH LITERATE, AND HAVING OPPORTUNITIES FOR NON-ACADEMIC CONTINUING EDUCATION WERE IDENTIFIED AS IMPORTANT PRIORITIES FOR THE HEALTH AND WELL-BEING OF SAN DIEGO RESIDENTS. FAMILY STRESS AND A LACK OF SCHOOL AND COMMUNITY RESOURCES WERE IDENTIFIED AS FACTORS UNDERLYING LOW LEVELS OF EDUCATIONAL ATTAINMENT. HOMELESSNESS AND HOUSING INSTABILITY. HOMELESSNESS AND HOUSING INSTABILITY WERE NAMED AS IMPORTANT FACTORS AFFECTING THE HEALTH OF SAN DIEGO COUNTY RESIDENTS. THEY WERE DESCRIBED AS HAVING SERIOUS HEALTH IMPACTS, SUCH AS INCREASING EXPOSURE TO INFECTIOUS DISEASE, CREATING SUBSTANTIAL CHALLENGES IN THE MANAGEMENT OF CHRONIC DISEASES AND WOUND CARE, AND INCREASING STRESS AND ANXIETY. POOR HOUSING CONDITIONS WERE ALSO CITED AS IMPACTFUL OF PHYSICAL AND MENTAL HEALTH; CROWDED HOUSING LEADS TO THE SPREAD OF ILLNESS, AND ENVIRONMENTAL HAZARDS CAN EXACERBATE CONDITIONS LIKE ASTHMA. UNINTENTIONAL INJURY AND VIOLENCE. EXPOSURE TO VIOLENCE AND NEIGHBORHOOD SAFETY WERE CITED AS PRIORITY HEALTH NEEDS FOR SAN DIEGANS. NEIGHBORHOOD SAFETY WAS DISCUSSED AS INFLUENCING RESIDENTS' ABILITY TO MAINTAIN GOOD HEALTH, WHILE EXPOSURE TO VIOLENCE WAS DESCRIBED AS TRAUMATIC AND IMPACTFUL ON MENTAL HEALTH. COMMUNITY RESOURCES THE 2019 CHNA IDENTIFIED MANY HEALTH RESOURCES IN SAN DIEGO COUNTY, INCLUDING THOSE PROVIDED BY COMMUNITY-BASED ORGANIZATIONS, GOVERNMENT DEPARTMENTS AND AGENCIES, HOSPITAL AND CLINIC PARTNERS, AND OTHER COMMUNITY MEMBERS AND ORGANIZATIONS ENGAGED IN ADDRESSING MANY OF THE HEALTH NEEDS IDENTIFIED BY THIS ASSESSMENT. IN ADDITION, 2-1-1 SAN DIEGO IS AN IMPORTANT COMMUNITY RESOURCE AND INFORMATION HUB THAT FACILITATES ACCESS TO SERVICES. THROUGH ITS 24/7 PHONE SERVICE AND ONLINE DATABASE, 2-1-1 SAN DIEGO HELPS CONNECT INDIVIDUALS WITH COMMUNITY, HEALTH, AND DISASTER SERVICES. IN ADDITION TO COMMUNITY INPUT ON HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH, A WEALTH OF IDEAS EMERGED FROM COMMUNITY ENGAGEMENT PARTICIPANTS ABOUT HOW HOSPITALS AND HEALTH SYSTEMS COULD SUPPORT, EXPAND, OR CREATE ADDITIONAL RESOURCES AND PARTNER WITH ORGANIZATIONS TO BETTER MEET SAN DIEGO'S COMMUNITY HEALTH NEEDS. NEXT STEPS THE 2019 CHNA IS UTILIZED BY SCRIPPS HEALTH AND PARTICIPATING HOSPITALS AND HEALTH SYSTEMS TO EVALUATE OPPORTUNITIES FOR NEXT STEPS TO ADDRESS THE TOP IDENTIFIED HEALTH AND SOCIAL NEEDS IN THEIR RESPECTIVE PATIENT COMMUNITIES. IN ADDITION, THE CHNA REPORT IS MADE AVAILABLE TO THE BROADER COMMUNITY AND IS INTENDED TO BE A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTH CARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH ACCESS AND HEALTH IMPROVEMENT EFFORTS. SCRIPPS IS CURRENTLY WORKING WITH THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) AND THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE ON THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). BEGINNING IN 2021, EVERY PRIVATE HOSPITAL, HEALTH SYSTEM, HEALTH DISTRICT AND BEHAVIORAL HEALTH HOSPITAL IN SAN DIEGO IS NOW PART OF OUR COLLECTIVE CHNA EFFORT TO BETTER UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF SAN DIEGO COMMUNITIES. THE COLLABORATIVE CHNA PROVIDES INFORMATION THAT HELPS HOSPITALS AND HEALTH SYSTEMS ADJUST THEIR PROGRAMS AND SERVICES TO BETTER MEET THE SPECIFIC HEALTH NEEDS OF THE COMMUNITIES THEY SERVE. IN ADDITION, THE CHNA COMMITTEE IS RE-ENVISIONING HOW BEST TO WORK COLLABORATIVELY IN A VIRTUAL ENVIRONMENT AND CONTINUING TO LOOK AT HEALTH AND SOCIAL NEEDS FROM A HEALTH EQUITY FRAMEWORK. THE 2022 CHNA IS EXPECTED TO BE FINALIZED IN THE FALL OF 2022. HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES; 2019 COMMUNITY HEALTH NEEDS ASSESSENT PHASE TWO IN JULY 2019, THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) COMPLETED THE TRIENNIAL COLLABORATE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS, PARTICULARLY THOSE WHO EXPERIENCE HEALTH INEQUITIES. THE CHNA IS MANAGED BY A STANDING CHNA COMMITTEE COMPRISED OF REPRESENTATIVES FROM HOSPITALS, AND HEALTH SYSTEMS AND HEALTH DISTRICTS. HASD&IC CONTRACTED WITH THE INSTITUTE OF PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO CONDUCT THE NEEDS ASSESSMENT. THE CHNA COMMITTEE WORKED WITH IPH TO DISTRIBUTE A FOLLOW-UP SURVEY TO GATHER FEEDBACK ON THE 2019 CHNA FINDINGS THROUGH A PHASE 2 SURVEY. THE SURVEY SOUGHT TO FURTHER EXPLORE FREQUENTLY RECURRING THEMES THAT EMERGED DURING COMMUNITY DISCUSSIONS IN THE 2019 CHNA, INCLUDING: ACCESS TO CARE, STIGMA, IMMIGRATION, AND PUBLIC CHARGE. NOTE: THE PHASE 2 SURVEY WAS DEVELOPED AND DISSEMINATED PRIOR TO THE COVID-19 PANDEMIC TAKING HOLD IN THE SAN DIEGO REGION. THE CHNA COMMITTEE RECOGNIZES THAT COMMUNITIES FACING INEQUITIES ARE DEALING WITH UNPRECEDENTED CHALLENGES AND THE DEVASTATING INCREASE IN NEEDS IS NOT CAPTURED IN THESE FINDINGS. NEARLY 92% OF RESPONDENTS (114 OUT OF 124 RESPONDENTS) AGREED OR STRONGLY AGREED THAT THE HEALTH NEEDS IDENTIFIED IN THE 2019 CHNA REPRESENT THE TOP HEALTH NEEDS OF COMMUNITIES FACING INEQUITIES WITHIN SAN DIEGO COUNTY. MOST SURVEY RESPONDENTS WERE FROM COMMUNITY-BASED ORGANIZATIONS (39.5%), FOLLOWED BY HOSPITALS/HEALTH SYSTEMS (16.1%) AND COMMUNITY RESIDENTS (11.3%). A TOTAL OF 105 SURVEY PARTICIPANTS RESPONDED TO THE QUESTION ABOUT WHERE THEY LIVE OR WORK. OVERALL, 37.4% OF SURVEY RESPONDENTS SERVED ALL REGIONS OF SAN DIEGO COUNTY AND 26.8% LIVED IN OR WORK AT NORTH INLAND. FOR ADDITIONAL DETAILS, INCLUDING COMMUNITY SUGGESTIONS AND RECOMMENDATIONS TO ADDRESS IDENTIFIED NEEDS, PLEASE SEE THE FULL REPORT ON THE HASD&IC WEBSITE, HTTPS://HASDIC.ORG/2019-CHNA/.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS HEALTH IMPLEMENTATION PLAN WITH THE 2019 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY - A MULTIFACETED, MULTI-STAKEHOLDER, PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL SUITED TO DEVELOPING A RESPONSE TO THE SCRIPPS CHNA. THE ANNUAL EVALUATION OF THE IMPLEMENTATION PLAN ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION PLAN ARE ALSO TAILORED TO EACH STRATEGY AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION PLAN IS FILED WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H ON AN ANNUAL BASIS. SCRIPPS HEALTH HAS A CONSISTENT FOCUS ON THE STRATEGIES AND INITIATIVES, THEIR MEASURES OF IMPLEMENTATION AND THE METRICS USED TO EVALUATE THEIR EFFECTIVENESS. THE COMPLETE FY20-FY22 IMPLEMENTATION PLAN REPORT IS AVAILABLE ONLINE AT SCRIPPS.ORG. UNCOMPENSATED HEALTH CARE SCRIPPS CONTRIBUTES SIGNIFICANT RESOURCES PROVIDING LOW AND NO-COST HEALTH CARE FOR OUR PATIENTS IN NEED. DURING FISCAL YEAR 2021, SCRIPPS CONTRIBUTED $494,197,396 IN UNCOMPENSATED HEALTH CARE, INCLUDING $17,572,864 IN CHARITY CARE, $469,353,119 IN MEDI-CAL AND MEDICARE SHORTFALL, AND $7,271,413 BAD DEBT. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNDERINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED/UNDERINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 64 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. SCRIPPS MERCY HOSPITAL SAN DIEGO AND SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUSES ARE DESIGNATED BY THE GOVERNMENT AS A DISPROPORTIONATE SHARE HOSPITAL, IN REFLECTION OF THE DIVERSITY OF THE POPULATION THEY SERVE. BOTH HOSPITAL CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED MEDICARE AND MEDI-CAL. FINANCIAL ASSISTANCE - ASSISTING LOW-INCOME, UNINSURED PATIENTS THE SCRIPPS FINANCIAL ASSISTANCE POLICY IS CONSISTENT WITH THE LANGUAGE OF BOTH STATE (AB774) CALIFORNIA HOSPITAL FAIR PRICING LEGISLATION AND THE INTERNAL REVENUE CODE (IRC) 501(R) REGULATIONS. THESE PRACTICES REFLECT OUR COMMITMENT TO ASSISTING LOW-INCOME AND UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE AND FLEXIBLE BILLING AND DEBT COLLECTION PRACTICES. THESE PROGRAMS ARE AVAILABLE TO EVERYONE IN NEED, REGARDLESS OF THEIR RACE, ETHNICITY, GENDER, RELIGION, OR NATIONAL ORIGIN. SCRIPPS MAKES EVERY EFFORT TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION. ADDITIONALLY, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS FORGIVES THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, A PORTION OF THE BILL IS FORGIVEN. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT CHARGED MORE THAN SCRIPPS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. FOR 2022, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DEFINED A FAMILY OF FOUR AT 200 PERCENT FEDERAL POVERTY LEVEL AS $55,500. PUBLIC RESOURCE SPECIALIST TEAM THE PUBLIC RESOURCE SPECIALISTS (PRS) ARE EXPERIENCED STAFF WITH STRONG KNOWLEDGE OF COUNTY PROGRAMS. PRS SCREENS ALL UNINSURED AND UNDERINSURED PATIENTS WHO HAVE RECEIVED SERVICES AT ANY OF THE FIVE SCRIPPS HOSPITAL FACILITIES. THEY OFFER SUPPORT TO PATIENTS AND PROVIDE GUIDANCE ON AVAILABLE FUNDING OPTIONS FOR COUNTY, STATE, AND FEDERAL PROGRAMS. THE PRS TEAM IS RESPONSIBLE FOR SUBMITTING AND MONITORING ALL APPLICATIONS AND FOLLOWING UP WITH APPEALS. IN ADDITION, THEY SERVE AS A TECHNICAL RESOURCE TO CASE MANAGEMENT, SOCIAL WORK, AND OTHER HOSPITAL STAFF WHEN PATIENT FUNDING IMPACTS DISCHARGE PLANNING AND LEVEL OF CARE TRANSFERS. THE PRS TEAM SERVES HOSPITAL PATIENTS BY OFFERING IMMEDIATE TEMPORARY COVERAGE THROUGH THE PRESUMPTIVE ELIGIBILITY PROGRAMS (PE), COVID-19 UNINSURED GROUP AND SUBMITTING INSURANCE AFFORDABILITY APPLICATIONS TO THE COUNTY FOR PROCESSING OF ONGOING BENEFITS. OTHER SERVICES OFFERED ARE ASSISTANCE WITH INITIATING APPLICATIONS WITH DMV, VA, EDD, SOCIAL SECURITY AND MEDI-CAL FOR CAL-FRESH ENROLLMENT. IN FISCAL YEAR 2021, THE PRS TEAM SUCCESSFULLY SCREENED 4,551 FOOD INSECURE PATIENTS. OUT OF THOSE SCREENINGS, PRS SUBMITTED 3,418 MEDI-CAL APPLICATIONS TO THE COUNTY AND 31% OF THE APPLICATIONS SUBMITTED WERE FOR BOTH MEDI-CAL AND CALFRESH. COMMUNITY HEALTH SERVICES COMMUNITY HEALTH SERVICES INCLUDE PREVENTION AND WELLNESS PROGRAMS, SCREENINGS, HEALTH EDUCATION, SUPPORT GROUPS AND HEALTH FAIRS, SUPPORTED BY OPERATIONAL FUNDS, GRANTS, IN-KIND-DONATIONS AND PHILANTHROPY. ACCESS TO CARE ACCESS TO HIGH QUALITY, COMPREHENSIVE CARE IS VITAL FOR PRESERVING GOOD HEALTH, PREVENTING AND MANAGING DISEASE, DECREASING DISABILITY, AVERTING PREMATURE DEATH, AND ACHIEVING HEALTH EQUITY FOR ALL. TO ACCESS CARE, PEOPLE NEED HEALTH INSURANCE COVERAGE AND A CONSISTENT SOURCE OF CARE THAT PROVIDES EVIDENCE-BASED, CULTURALLY COMPETENT PREVENTIVE AND EMERGENCY MEDICAL SERVICES IN A TIMELY MANNER. A LACK OF HEALTH INSURANCE COVERAGE REPRESENTS A MAJOR BARRIER TO HEALTH CARE SERVICES. IN SAN DIEGO COUNTY, 12% OF PEOPLE ARE UNINSURED. CERTAIN GROUPS, INCLUDING THOSE WHO IDENTIFY AS "OTHER", NATIVE AMERICAN/ALASKA NATIVES, HISPANICS, PACIFIC ISLANDERS, AND BLACKS, HAVE HIGHER RATES OF BEING UNINSURED THAN OTHERS. ACCESS TO CARE INCLUDES TWO COMPONENTS-THE SPECIFIC SERVICES THAT INDIVIDUALS ARE UNABLE TO OBTAIN AND THE BARRIERS AND SDOH THAT PREVENT INDIVIDUALS FROM OBTAINING THESE SERVICES. 1. TYPES OF CARE THAT ARE DIFFICULT TO ACCESS - BEHAVIORAL HEALTH CARE - DENTAL CARE - PRIMARY CARE - SPECIALTY CARE 2. BARRIERS TO ACCESSING CARE & ASSOCIATED SDOH - CULTURALLY COMPETENT CARE - ECONOMIC SECURITY - FEAR RELATED TO IMMIGRATION STATUS - LACK OF HEALTH INSURANCE & INSURANCE ISSUES - SHORTAGE OF HEALTH CARE PROVIDERS - TRANSPORTATION A LACK OF HEALTH INSURANCE IS A PREDICTOR OF MANY HEALTH CONDITIONS, INCLUDING MORE POOR MENTAL HEALTH DAYS, MORE VISITS TO THE ED FOR HEART ATTACKS, A HIGHER PREVALENCE OF ASTHMA, AND OBESITY, MORE LOW BIRTH WEIGHT BABIES, AND HIGHER PREVALENCE OF SMOKING. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. ACCESS TO HEALTH CARE EMERGED AS A HIGH PRIORITY HEALTH NEED IN BOTH THE SECONDARY DATA ANALYSES AND COMMUNITY ENGAGEMENT EVENTS IN THE 2019 SCRIPPS COMMUNITY HEALTH NEEDS ASSESSMENT. THROUGH THE COMMUNITY ENGAGEMENT CONDUCTED WE HEARD FROM THE COMMUNITY THAT EVEN WHEN INSURANCE IS SECURED, INCLUDED LACK OF TRANSPORTATION - ESPECIALLY FOR SENIORS - AND LACK OF CULTURALLY AND LINGUISTICALLY COMPETENT CARE ARE MAIN BARRIERS. TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED SEVERAL PROGRAMS AND ACTIVITIES IN FISCAL YEAR 2021.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS RECUPERATIVE CARE PROGRAMS (RCU) SCRIPPS HEALTH HAS AN AGREEMENT WITH THE SAN DIEGO CITY REFUGE OF RECUPERATIVE CARE SHELTER (RCS) WHICH PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. LACK OF FUNDING, MENTAL ILLNESS, AS WELL AS ALCOHOL AND/OR SUBSTANCE ABUSE, MAKES POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. DURING THE PANDEMIC ALL SAN DIEGO HOMELESS SHELTERS EXPERIENCED COVID-19 OUTBREAKS, MAKING RCS A TRUE PLACE OF REFUGE FOR 44 OF OUR CHRONICALLY HOMELESS PATIENTS. THE CASE MANAGEMENT AND SOCIAL WORK DEPARTMENTS ASSIST WITH A NEEDED SUPPLY OF MEDICATION, APPOINTMENTS, DURABLE MEDICAL EQUIPMENT (DME), SETTING UP HOME HEALTH SERVICES IF NEEDED, AND CONNECTS PATIENTS TO PSYCH AS PART OF THE HOSPITAL DISCHARGE PLAN TO CITY OF REFUGE. CITY OF REFUGE FURTHER SUPPORTS CLIENTS IN MEETING THESE GOALS USING COMMUNITY RESOURCES TO MEET INDIVIDUAL SOCIAL SERVICE NEEDS. SCRIPPS PAYS THE CITY OF REFUGE A DAILY RATE FOR HOUSING AND SERVICES THEY PROVIDE TO THE PATIENTS. THE CITY OF REFUGE PROVIDES A SAFE, SECURE ENVIRONMENT, WITH 24-HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, CASE MANAGEMENT, ASSISTANCE WITH MEDI-CAL, WITH TRANSITION TO MANAGED MEDI-CAL AND DISABILITY APPLICATIONS, REFERRALS TO REHAB AND OTHER PROGRAMS, AND HELP FINDING PERMANENT OR TRANSITIONAL HOUSING USING COUNTY RESOURCES. DME AND OTHER NEEDED SERVICES ARE PROVIDED BY SCRIPPS WHEN FUNDING IS NOT AVAILABLE. ALL PATIENTS ARE CONNECTED TO A MEDICAL HOME, AND PRIMARY CARE IN THE COMMUNITY. PATIENTS WITH PSYCH DISORDERS ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY IF THEY ARE WILLING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED BY CITY OF REFUGE, BUT MAY INCLUDE INSURANCE FUNDED TRANSPORT SERVICES, AND OCCASIONALLY SCRIPPS SHUTTLE, OR USE OF TAXI VOUCHER. THE CITY OF REFUGE BEGAN TAKING PATIENTS ROUTINELY IN OCTOBER OF 2019. THIS YEAR 44 PATIENTS SO FAR HAVE MET THE NEED FOR RCS ADMISSION, BUT MANY DID NOT QUALIFY DUE TO BEHAVIOR, UNSTABLE MENTAL ILLNESS, OR UNWILLINGNESS TO ABSTAIN FROM SUBSTANCE ABUSE. AS A GROUP, THE RCS PATIENTS HAD A CUMULATIVE OF 480 HOSPITAL DAYS OF STAY, AN AVERAGE OF 10.9 HOSPITAL DAYS OF STAY, BEFORE GOING TO RCS OCTOBER 2020 TO DATE. THE RCS HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: IV ANTIBIOTICS, WOUND VACS, SKIN GRAFTS, FRACTURES, ABSCESSES, OSTEOMYELITIS, AMPUTATION, DOG BITES, DKA, GI BLEEDS, PANCREATITIS, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, DIABETES, MILD ENCEPHALOPATHY, OSTOMIES, MVA, PEDESTRIAN VERSUS AUTO, PLEURAL EFFUSION, CVA, CANCER (LYMPHOMA, PANCREATIC CANCER), HIV/AIDS, SEPSIS, RESPIRATORY FAILURE, PNEUMONIA, CHF. PATIENTS WERE ASSAULT VICTIMS WITH GUNSHOT AND STAB WOUNDS, FACIAL TRAUMA, AND SURGICAL POST OP PATIENTS AND MANY ARE DIABETIC. PSYCH PROBLEMS ARE COMMON AND OCCASIONALLY THE MAIN ISSUE FOR RCS CLIENTS. OVER 80% OF THIS GROUP WERE EITHER POSITIVE FOR ALCOHOL, DRUGS OR DRUG SCREEN OR HAD A DRUG HISTORY ADDRESSED BY THE PHYSICIAN IN THE H & P. MORE SPECIFICALLY, 30% OF RCS CLIENTS HAD USED OPIATES, HEROIN, OR METH. THE FOLLOWING ARE OUTCOME METRICS TRACKED BY SCRIPPS FOR THE CITY OF REFUGE PROGRAM. - FOR FY21 TOTAL COST SAVINGS FOR SCRIPPS WERE $735,150. - OF RECUPERATIVE CARE SHELTER PATIENTS, 22% HAD STANDARD MEDI-CAL INSURANCE, 11% HPE (HEALTH PRESUMPTIVE ELIGIBILITY) MEDI-CAL, AND 45% MEDI-CAL HMO'S. - APPROXIMATELY 20% OF PATIENTS SOUGHT TO SECURE INCOME FROM GOVERNMENT PROGRAMS, SOCIAL SECURITY, AND CA SHORT TERM DISABILITY; SIX TOTAL CLIENTS APPLIED OR RECEIVED INCOME BENEFITS. FOUR HAVE APPLIED AND RECEIVED MEDI-CAL HMO'S WHILE AT THE RCS WITH THE ASSISTANCE OF THEIR CASE MANAGEMENT DEPARTMENT. - THE PROGRAM ASSISTED SCRIPPS MD ANDERSON CANCER CENTER PATIENTS. - RCS ASSISTED TWO PATIENTS IN MAINTAINING THEIR HEALTH AND TRANSITIONED THEM INTO INDEPENDENT LIVING HOMES FOR ADDITIONAL CARE. THIS YEAR WE HAD SEVERAL SUCCESSES, WITH THE RCS MANAGER ASSISTING WITH THREE FAMILY REUNIFICATIONS OUT OF STATE. THREE PATIENTS TRANSITIONED TO DRUG REHAB CENTERS, AND SEVERAL INTO PATH, INTERFAITH, AND MENTAL HEALTH TREATMENT PROGRAMS. - THE COMPLEX CARE MANAGER ENSURED 90 PERCENT OF RCS PATIENTS WERE SCHEDULED AND CONNECTED TO A PRIMARY CARE PROVIDER OR HAD ESTABLISHED CARE AT ONE OF THE COMMUNITY CLINICS. - ONE OF THE PATIENTS ADMITTED TO RCS WAS ESTABLISHED WITH ONGOING ONCOLOGY CARE AND TREATMENT WITH ASSISTANCE FROM MEDI-CAL AND SCRIPPS MD ANDERSON CANCER CENTER. - FOLLOWING THEIR STAY AT CITY OF REFUGE: 18% OF THE RCS PATIENTS COMPLETED THEIR RECUPERATIVE CARE AND RETURNED TO PREVIOUS LIVING AND 5% WENT BACK TO THE HOSPITAL AS THEY NEEDED FURTHER TREATMENT. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, RESIDENTS AND FELLOWS. GME RESIDENTS AND MANY ATTENDING PHYSICIANS MAINTAIN AN EVENING CLINIC AT ST. LEO'S MISSION COMMUNITY CLINIC IN NORTH COUNTY (DUE TO THE PANDEMIC, THIS INITIATIVE WAS PUT ON HOLD IN MARCH OF 2020 BUT RESUMED IN APRIL 2021). TWO RESIDENTS VOLUNTEER EVERY WEDNESDAY TO PROVIDE MEDICAL CARE TO UNINSURED PATIENTS WITH A VARIETY OF CONDITIONS, INCLUDING DIABETES, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. THEY ALSO IDENTIFY MANY ACUTE CONDITIONS, INCLUDING VIRAL INFECTIONS, SKIN INFECTIONS, EYE PROBLEMS AND MUSCULOSKELETAL ISSUES, AND EDUCATE PATIENTS ABOUT THEIR HEALTH. PATIENTS MAY GET FLU VACCINATIONS AND SOME BASIC LAB TESTS. IF NEEDED, ST. LEO'S PATIENTS ARE REFERRED TO PROVIDERS WHO PROVIDE CARE AT A REDUCED COST. FIJI SOLOMON ISLANDS MEDICAL MISSION THE MEDICAL MISSION CONSISTS OF SCRIPPS HEALTH GENERAL MEDICAL SPECIALISTS AND RESIDENTS SETTING UP CLINICS ON RURAL ISLANDS FOR THE PURPOSE OF PROVIDING MUCH NEEDED MEDICAL CARE, MEDICAL SUPPLIES AND SURGICAL SCREENING FOR AN UNDERSERVED POPULATION THAT HAVE NO ACCESS TO BASIC MEDICAL CARE. THE INTERNATIONAL MEDICAL MISSIONS PROVIDE AN EXCEPTIONAL CLINICAL EDUCATION EXPERIENCE TO OUR SENIOR INTERNAL MEDICINE RESIDENTS AT SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL. THESE RESIDENT MISSIONS TAKE PLACE IN THE SOLOMON ISLANDS IN THE SOUTH PACIFIC, WHERE THE RATIO OF DOCTORS TO POPULATION IS 1:20,000. THE LOLOMA FOUNDATION PROVIDES MEDICAL CARE TO THESE ISLANDERS IN ASSOCIATION WITH SCRIPPS HEALTH. RESIDENTS EXPERIENCED THE CHALLENGES OF PROVIDING CARE IN THIRD WORLD CONDITIONS, WITHOUT TECHNOLOGY, AND USING ONLY THEIR EXCELLENT ACADEMIC AND PRACTICAL TRAINING TO DIAGNOSE AND TREAT PATIENTS. ISLANDERS WITH SERIOUS MEDICAL CONDITIONS ARE REFERRED TO THE NEAREST HOSPITAL, WHICH IS SEVERAL HOURS AWAY BY BOAT AND CAR. DUE TO COVID-19 MISSIONS WERE PAUSED.
FORM 990, PART III, LINE 4A (CONTINUED)	MERCY OUTREACH SURGICAL TEAM PROVIDES LIFE-CHANGING CARE TO CHILDREN IN MEXICO FOR THREE DECADES, THE MERCY OUTREACH SURGICAL TEAM (MOST) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. MOST IS AN INDEPENDENT, NONPROFIT ORGANIZATION FOUNDED IN 1987 AT SCRIPPS MERCY HOSPITAL WHOSE MISSION IS TO PROVIDE FREE SURGERIES AND VISION CARE TO UNDERSERVED CHILDREN IN MEXICO. AFTER THE 9/11 TERRORIST ATTACK, MOST'S MISSIONS HAD TO BE SHIFTED EXCLUSIVELY TO TRIPS IN MEXICO, DUE TO DIFFICULTY GETTING CHILDREN ACROSS THE BORDER FROM MEXICO INTO THE U.S. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. IN MEXICO, MOST VOLUNTEERS TYPICALLY PERFORM HUNDREDS OF SURGERIES PER MISSION-AND MORE THAN 14,000 OVERALL SINCE ITS FOUNDING-FOR ISSUES LIKE CLEFT PALATES, CROSSED EYES, BURN SCARS, HERNIA REPAIRS AND MORE. MOST ALSO ADDED A VISION PROGRAM IN 2004 THAT PROVIDES MORE THAN 100 PAIRS OF EYEGLASSES PER TRIP TO CHILDREN IN NEED. MOST HAS BEEN WORKING WITH AN ORGANIZATION IN MEXICO TO SPONSOR CLEFT PALATE AND LIP SURGERIES AND PROVIDED MUCH NEEDED PPE AND OTHER MEDICAL SUPPLIES TO TEHUACN, A CITY MOST HAS VISITED FOR MISSION TRIPS SEVERAL TIMES, TO HELP CARE FOR PATIENTS. SINCE MOST HAD TO PAUSE ITS TRAVEL INTO MEXICO DUE TO COVID-19 RESTRICTIONS AND IT HAD BEEN LOOKING FOR WAYS TO SERVE THOSE IN NEED ONCE PUBLIC HEALTH CONDITIONS ALLOWED. MOST SAW AN OPPORTUNITY TO CONTINUE ITS MISSION IN SAN DIEGO WHEN THE EMERGENCY SHELTER WAS OPENED AT THE SAN DIEGO CONVENTION CENTER. DURING FISCAL YEAR 2021, A TEAM OF THIRTY-FIVE VOLUNTEERS FROM MOST HOSTED A FREE, FULL DAY VISION CLINIC INSIDE THE SAN DIEGO CONVENTION CENTER EMERGENCY SHELTER, WHERE THEY SERVED 615 CHILDREN, MOSTLY 13-17 WITH A FEW YOUNGER ONES AND PERFORMED VISION SCREENINGS AND PROVIDED PRESCRIPTION EYEGLASSES TO THOSE WHO NEEDED THEM. FOR THOSE WHO REQUIRED GLASSES, THEY WERE ABLE TO TRY ON A VARIETY OF FRAMES AND PICK THE ONES THAT THEY LIKED THE BEST. LENS FITTERS WORKED WITH EACH CHILD TO ENSURE THAT THEY WOULD BE PLEASED WITH THE WAY THEY WOULD LOOK IN THEIR NEW GLASSES - ENSURING THEY WOULD WEAR THEM. THE JUNE 12 CLINIC WAS THE MOST'S FIRST MISSION IN WELL OVER A YEAR, SINCE COVID-19 RESTRICTIONS BLOCKED ITS TRADITIONAL TRAVEL INTO MEXICO. VOLUNTEERS AT THE JUNE 12 VISION CLINIC INCLUDED OPTOMETRISTS, OPHTHALMIC VOLUNTEERS, NURSES, AND OTHER SUPPORT STAFF WHO PROVIDED INTERPRETATION, TRAFFIC CONTROL ADMINISTRATIVE TASKS. MOVING FORWARD, MOST HOPES TO RESUME ITS MEDICAL MISSIONS INTO MEXICO IN 2022. SCRIPPS -SPONSORED AMERICAN RED CROSS BLOOD DRIVES SCRIPPS HEALTH PARTNERED WITH THE AMERICAN RED CROSS IN FISCAL YEAR 2021 TO HOST FOUR BLOOD DRIVES; 84 SCRIPPS EMPLOYEES DONATED BLOOD THROUGHOUT THE YEAR. SCRIPPS HEALTH COLLECTED 90 PINTS OF BLOOD (FOR EVERY PINT DONATED 3 LIVES ARE SAVED), WHICH SAVED APPROXIMATELY 270 LIVES. SCRIPPS PROMOTED THE BLOOD DRIVES THROUGH OUR SYSTEM WIDE COMMUNICATION CHANNELS AND OUR WELLNESS ALL AROUND YOU CAMPAIGN. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2021, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $138,500 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO. THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $4.2 MILLION TO DATE. PROGRAMS FUNDED DURING FISCAL YEAR 2021 INCLUDED: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW INCOME, UNINSURED MERCY CLINIC AND BEHAVIORAL HEALTH PATIENTS HELP OBTAINING HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME INTENSIVE GOVERNMENT BENEFIT CASES. THE CONSUMER CENTER STRESSES THE IMPORTANCE OF ACCESSING COMMUNITY-BASED SERVICES FOR ROUTINE HEALTH CARE INSTEAD OF USING THE ED'S AND HOSPITAL DEPARTMENTS. THEY ALSO EMPHASIZE THE IMPORTANCE OF ESTABLISHING MEDICAL HOMES. CATHOLIC CHARITIES FUNDING PROVIDES SHORT TERM EMERGENCY SHELTER FOR MEDICALLY FRAGILE HOMELESS PATIENTS UPON DISCHARGE FROM SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA. CASE MANAGEMENT AND SHELTER ARE PROVIDED FOR HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL. WHILE THESE PATIENTS NO LONGER REQUIRE HOSPITAL CARE, THEY DO NEED A SHORT-TERM RECUPERATIVE ENVIRONMENT. PATIENTS WHO DEMONSTRATE A WILLINGNESS TO CHANGE RECEIVE ONE WEEK IN A HOTEL, ALONG WITH FOOD AND BUS FARE TO PURSUE A CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. THE PARTNERSHIP SEEKS TO REDUCE EMERGENCY ROOM RECIDIVISM IN THIS POPULATION AND IMPROVE THEIR QUALITY OF LIFE. 2-1-1 COMMUNITY INFORMATION EXCHANGE 2-1-1 SAN DIEGO SERVES ALL OF SAN DIEGO COUNTY, INCLUDING THE POPULATION SERVED BY SCRIPPS, AS THE REGION'S TRUSTED PRIMARY CONNECTION TO MORE THAN 6,000 COMMUNITY, HEALTH AND DISASTER SERVICES IN MORE THAN 200 LANGUAGES, 24 HOURS A DAY. IN ADDITION, 2-1-1 SAN DIEGO OPERATES A 2-1-1 INFORMATION HOTLINE (CALL CENTER) IN THE SAN DIEGO AND IMPERIAL COUNTY. CALL CENTER SERVICES ARE DESIGNED TO HELP MEMBERS OF THE PUBLIC ("CLIENTS") TO CONNECT WITH COMMUNITY RESOURCES TO ASSIST CLIENTS OBTAIN MEDICAL CARE, MENTAL HEALTH SERVICES, HOUSING, FOOD, CLOTHING, GOVERNMENT BENEFITS, AMONG OTHER THINGS. 2-1-1 SAN DIEGO HAS EXPANDED ITS REFERRAL SERVICES TO INCLUDE DIRECT REFERRAL TO CLIENTS TO COMMUNITY RESOURCES AND ACCESS TO THE COMMUNITY INFORMATION EXCHANGE (CIE) DATABASE. THE CIE IS AN ECOSYSTEM COMPRISED OF MULTIDISCIPLINARY NETWORK PARTNERS THAT USE A SHARED LANGUAGE, A RESOURCE DATABASE, AND AN INTEGRATED TECHNOLOGY PLATFORM TO DELIVER ENHANCED COMMUNITY CARE PLANNING. CARE PLANNING TOOLS ENABLE PARTNERS TO INTEGRATE DATA FROM MULTIPLE SOURCES AND MAKE BI-DIRECTIONAL REFERRALS TO CREATE A SHARED LONGITUDINAL RECORD. BY FOCUSING ON THESE CORE COMPONENTS, A CIE ENABLES COMMUNITIES TO SHIFT AWAY FROM A REACTIVE APPROACH TO PROVIDING CARE TOWARD PROACTIVE, HOLISTIC, PERSON-CENTERED CARE. SAN DIEGO'S CIE SUPPORTS APPROACHES TO WHOLE-PERSON HEALTH AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH BY COORDINATING CARE IN THE SOCIAL SERVICES SECTOR AND CONNECTING TO THE HEALTH SECTOR. WHEN RESIDENTS CALL 2-1-1, THE CIE MATCHES THEM TO APPROPRIATE HEALTH AND SOCIAL SERVICES AND ASSISTS PARTICIPATING COMMUNITY PARTNERS WITH CASE MANAGEMENT BY DEVELOPING A SHARED LONGITUDINAL RECORD FOR EACH CLIENT, SENDING CARE COORDINATION ALERTS, AND ENABLING BIDIRECTIONAL REFERRALS. THE COUNTY'S CENTRALIZED HUB OF INFORMATION, CONNECTWELLSD, ALLOWS COUNTY STAFF AND PARTNERS TO SHARE INFORMATION AND COLLABORATE ACROSS COUNTY DEPARTMENTS TO DELIVER PERSON-CENTERED SERVICES. 2-1-1 SAN DIEGO HAS PARTNERED WITH SCRIPPS SINCE 2011 TO PROVIDE CARE COORDINATION SERVICES TO CLIENTS IN NEED OF HEALTH NAVIGATION SUPPORT. A SCRIPPS GRANT WAS NOT GIVEN IN FISCAL YEAR 2021, BUT THE PROJECT CONTINUES TO SERVE SCRIPPS MERCY HOSPITAL PATIENTS, FOCUSING ON HOMELESS AND HOUSING INSECURE INDIVIDUALS AND TO ASSIST IN HOSPITAL DISCHARGE PLANNING. COMMUNITY INFORMATION EXCHANGE CIE 2021 SUMMIT SCRIPPS ATTENDED THE 4TH ANNUAL COMMUNITY INFORMATION EXCHANGE (CIE) 2021 SUMMIT. THE 2021 SUMMIT WAS HELD VIRTUALLY DUE TO THE CONTINUED IMPACT OF COVID-19. THE THREE-DAY VIRTUAL CONFERENCE CENTERED ON THE THEME, LEADING WITH COMMUNITY TO DRIVE SYSTEMS CHANGE, AND EXPLORED HOW COMMUNITY-LED MODEL OF A COMMUNITY INFORMATION EXCHANGE CAN PROMOTE RACIAL HEALTH EQUITY AND INCLUSIVITY IN HEALTH AND SOCIAL SERVICES. CORE TO THE THEME OF THE CIE SUMMIT, THIS YEAR'S VIRTUAL EVENT: - THE SUMMIT INCLUDED TRACKS ON GOVERNANCE AND POWER, DATA OWNERSHIP AND TECHNOLOGY AND SUSTAINABILITY AND POLICY. - EXPLORED COMMUNITY-BASED APPROACHES FOR BUILDING A CIE. - INCORPORATED THOUGHTFUL STRATEGIES FOR ACTIVATING COMMUNITY VOICE. - EMPHASIZED REPRESENTATION OF DIVERSE PERSPECTIVES OF INFORM CIE DESIGN, IMPLEMENTATION AND DATA COLLECTION.
FORM 990, PART III, LINE 4A (CONTINUED)	CANCER/ONCOLOGY CANCER IS A TERM USED TO DESCRIBE A GROUP OF DISEASES THAT CAUSE THE UNCONTROLLED GROWTH, INVASION, AND SPREAD (METASTASIS) OF ABNORMAL CELLS. CANCER IS CAUSED BY EXTERNAL FACTORS SUCH AS ENVIRONMENTAL CONDITIONS, RADIATION, INFECTIOUS ORGANISMS, POOR DIET AND LACK OF EXERCISE, AND TOBACCO USE, AS WELL AS INTERNAL FACTORS SUCH AS GENETIC MUTATIONS, AND HORMONES. CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES. CANCER CAUSES ONE OUT OF EVERY FOUR DEATHS IN THE UNITED STATES. ACCORDING TO THE AMERICAN CANCER SOCIETY, CANCER SURVIVAL IS MORE LIKELY TO BE SUCCESSFUL IF THE CANCER IS DIAGNOSED AT AN EARLY STAGE. SUCH DIAGNOSIS IS AN INDICATION OF SCREENING AND EARLY DETECTION. REGULAR SCREENING THAT ALLOWS FOR THE EARLY DETECTION AND REMOVAL OF PRECANCEROUS GROWTHS IS KNOWN TO REDUCE MORTALITY FOR CANCERS OF THE CERVIX, COLON AND RECTUM. FIVE-YEAR RELATIVE SURVIVAL RATES FOR COMMON CANCERS, SUCH AS BREAST, PROSTATE, COLON AND RECTUM, CERVIX, AND MELANOMA OF THE SKIN, ARE 93 PERCENT TO 100 PERCENT IF THEY ARE DISCOVERED BEFORE HAVING SPREAD BEYOND THE ORGAN WHERE THE CANCER BEGAN. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF CANCER IS DESCRIBED BELOW: - THE HASD&IC 2019 CHNA CONTINUED TO IDENTIFY CANCER DISEASE AS ONE OF THE TOP PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS. - 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. - CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES, BUT MANY KINDS OF CANCER CAN BE PREVENTED OR CAUGHT EARLY. - IN 2019, CANCER WAS THE LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY, RESPONSIBLE FOR 22.9 PERCENT OF ALL UNDERLYING CAUSES OF DEATHS. - IN 2019, THERE WERE 5,018 DEATHS DUE TO CANCER (ALL SITES) IN SAN DIEGO COUNTY IN 2019. THE AGE-ADJUSTED RATE IF DEATH DUE TO CANCER WAS 135.2 DEATHS PER 100,000 POPULATION IN SAN DIEGO COUNTY. - IN 2019, 16.9% OF ALL CANCER DEATHS IN SAN DIEGO COUNTY WERE DUE TO LUNG CANCER, 8.6% TO COLORECTAL CANCER, 7.9% TO PANCREATIC CANCER, 7.6% TO FEMALE BREAST CANCER, 7.1% TO PROSTATE CANCER, 6.4% TO FEMALE REPRODUCTIVE CANCERS, 6.4 % TO LIVER CANCER, AND 3.8% EACH TO BRAIN CANCER AND LEUKEMIA. - IN 2021 THERE WILL BE AN ESTIMATED 187,140 NEW CANCER CASES AND 61,860 CANCER DEATHS, AN INCIDENCE RATE OF 404.6 AVERAGE ANNUAL RATE PER 100,000 AND A DEATH RATE OF 140.3 AVERAGE ANNUAL RATE PER 100,000 IN CALIFORNIA. (ACS, 2021). - ACCORDING TO FINDINGS FROM THE ACS 2021 CANCER FACTS & FIGURES REPORT, SCREENING OFFERS THE ABILITY FOR SECONDARY PREVENTION BY DETECTING CANCER EARLY. IT IS ESTIMATED THAT NEARLY 1.9 MILLION NEW CASES OF CANCER WILL BE DIAGNOSED IN 2021. PROSTATE CANCER IS THE MOST COMMON CANCER AMONG MALES (26%), FOLLOWED BY LUNG (12%) AND COLORECTAL (8%) CANCERS. AMONG FEMALES, BREAST (30%), LUNG (13%), AND COLORECTAL (8%) CANCERS ARE THE MOST COMMON. - ACCORDING TO FINDINGS FROM THE ACS 2021 CANCER FACTS & FIGURES REPORT, CANCER INCIDENCE RATES ARE HIGHER IN MALES THAN IN FEMALES FOR EACH RACIAL/ETHNIC POPULATION, ALTHOUGH RATES ARE VERY SIMILAR IN ASIAN/PACIFIC ISLANDERS. THE HIGHEST INCIDENCE RATES ARE IN BLACKS AMONG MALES AND IN WHITES AMONG FEMALES. ASIAN/PACIFIC ISLANDERS HAVE THE LOWEST RATES IN BOTH SEXES. - ACCORDING TO FINDINGS FROM THE ACS CANCER FACTS & FIGURES 2021 REPORT, OLDER AGE AND BEING FEMALE ARE THE STRONGEST RISK FACTORS FOR BREAST CANCER. POTENTIALLY MODIFIABLE FACTORS ASSOCIATED WITH INCREASED RISK INCLUDE WEIGHT GAIN AFTER THE AGE OF 18 AND/OR BEING OVERWEIGHT OR OBESE, MENOPAUSAL HORMONE THERAPY, ALCOHOL CONSUMPTION AND PHYSICAL INACTIVITY (ACS, 2021). - THE SAME REPORT INDICATES THAT PEOPLE WITH LOWER SOCIOECONOMIC STATUS HAVE HIGHER CANCER DEATH RATES THAN THOSE WITH HIGHER SOCIOECONOMIC STATUS, REGARDLESS OF DEMOGRAPHIC FACTORS SUCH AS RACE/ETHNICITY. RACIAL AND ETHNIC DISPARITIES IN THE CANCER BURDEN LARGELY REFLECT DISPROPORTIONATE POVERTY. SOCIAL INEQUALITIES, INCLUDING COMMUNICATION BARRIERS AND PROVIDER/PATIENT ASSUMPTIONS, CAN AFFECT INTERACTIONS BETWEEN PATIENTS AND PHYSICIANS AND CONTRIBUTE TO MISCOMMUNICATION AND/OR DELIVERY OF SUBSTANDARD CARE (ACS, 2021). - A RECENT STUDY BY THE ACS FOUND THAT AT LEAST 42% OF NEWLY DIAGNOSED CANCER CASES IN THE U.S. - ABOUT 797,000 CASES IN 2021 - ARE POTENTIALLY AVOIDABLE. THIS INCLUDES THE 19% OF ALL CANCERS CAUSED BY TOBACCO USE AS WELL AS THE 18% CAUSED BY A COMBINATION OF EXCESS BODY WEIGHT, ALCOHOL CONSUMPTION, POOR NUTRITION AND PHYSICAL INACTIVITY (ACS, 2021). - THE JOURNAL OF ONCOLOGY NAVIGATION & SPONSORSHIP (JONS) EMPHASIZES THE IMPORTANCE OF PATIENT NAVIGATORS AS PART OF A MULTIDISCIPLINARY ONCOLOGY TEAM WITH THE GOAL OF REDUCING MORTALITY AMONG UNDERSERVED PATIENTS. THE NAVIGATOR WORKS WITH THE PATIENT ACROSS THE CARE CONTINUUM, AND OFTEN MAKES SUGGESTIONS TO HELP MANAGE A PATIENT FROM A HOLISTIC PERSPECTIVE (JONS, 2019). - ACCORDING TO THE NIH, CLINICAL TRIALS, A PART OF CLINICAL RESEARCH, ARE AT THE HEART OF ALL MEDICAL ADVANCES. CLINICAL TRIALS LOOK AT NEW WAYS TO PREVENT, DETECT OR TREAT DISEASE BY DETERMINING THE SAFETY AND EFFICACY OF A NEW TEST OR TREATMENT. GREATER CLINICAL TRIAL ENROLLMENT BENEFITS MEDICAL RESEARCH AND INCREASES THE HEALTH OF FUTURE GENERATIONS AS WELL AS IMPROVES DISEASE OUTCOMES, QUALITY OF LIFE AND HEALTH OF TRIAL PARTICIPANTS (NIH, 2019). SCRIPPS HEALTH CURRENTLY CARES FOR ONE-THIRD OF CANCER PATIENTS IN SAN DIEGO. SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS TO EDUCATE PEOPLE ABOUT THE IMPORTANCE OF EARLY DETECTION AND TREATMENT FOR SOME OF THE MOST COMMON FORMS OF CANCER. SCRIPPS HEALTH IS COMMITTED TO PROVIDING CARE TO ALL THOSE IN NEED. WE SERVE AN ETHNICALLY AND ECONOMICALLY DIVERSE POPULATION INCLUDING CARING FOR TRADITIONALLY MARGINALIZED AND UNDERSERVED WITH RESPECT TO HEALTH CARE. AT SCRIPPS, CANCER CARE IS MORE THAN JUST MEDICAL TREATMENT, AND A WIDE ARRAY OF RESOURCES ARE PROVIDED SUCH AS COUNSELING, SUPPORT GROUPS, COMPLEMENTARY THERAPIES, AND EDUCATIONAL WORKSHOPS. HERE ARE A FEW EXAMPLES OF SCRIPPS CANCER PROGRAMS DURING FISCAL YEAR 2021: SCRIPPS MD ANDERSON CANCER CENTER - REGISTERED NURSE NAVIGATOR PROGRAM SCRIPPS PROVIDES A REGISTERED NURSE, DEDICATED TO ASSISTING CANCER PATIENTS AND THEIR FAMILIES WITH NAVIGATING THROUGH THE JOURNEY FROM DIAGNOSIS, TREATMENT AND SURVIVORSHIP FROM CANCER. THE FOCUS IS ON EDUCATION AND OUTREACH, AS WELL AS SUPPORT SERVICES IN THIS POPULATION. SCRIPPS MD ANDERSON CANCER CENTER - OUPATIENT SOCIAL WORKER & LIAISON PROGRAM SCRIPPS PROVIDES SPECIALLY TRAINED ONCOLOGY SOCIAL WORKERS WHO UNDERSTAND THE COMPLEXITIES OF LIVING WITH CANCER AND ARE DEDICATED TO ASSISTING CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. THE SOCIAL WORKERS HELP TO ACCESS THE MOST APPROPRIATE COMMUNITY AND MEDICAL RESOURCES AND PROVIDE SHORT TERM COUNSELING AS WELL AS ASSIST WITH TRANSPORTATION, LODGING AND FINANCIAL CONCERNS. SCRIPPS MD ANDERSON CANCER CENTER- OUTPATINT HEREDITY AND CANCER GENETIC COUNSELING PROGRAM SCRIPPS MD ANDERSON CANCER CENTER GENETIC COUNSELING TEAM HELPS INDIVIDUALS AND THEIR FAMILIES UNDERSTAND THEIR CANCER RISKS SO THAT INDIVIDUALIZED CANCER SCREENING AND RISK REDUCTION PLANS CAN BE DESIGNED. IN ADDITION TO PROVIDING INFORMATION AND GUIDANCE ABOUT GENETIC TESTING, GENETIC COUNSELORS INTERPRET TEST RESULTS, ADVISE FAMILIES ABOUT THEIR OPTIONS AND PROVIDE EDUCATION AND SUPPORT. SCRIPPS MD ANDERSON CANCER CENTER SUPPORT GROUPS THROUGH GENEROUS COMMUNITY SUPPORT, SCRIPPS MD ANDERSON CANCER CENTER PROVIDES A WIDE RANGE OF SUPPORT SERVICES AND PATIENT ASSISTANCE PROGRAMS. THROUGHOUT THE SYSTEM, ONCOLOGY SOCIAL WORKERS OR ONCOLOGY NURSE NAVIGATORS PROVIDE COUNSELING SERVICES AND GUIDANCE REGARDING TRANSPORTATION, HOUSING, HOMECARE, FINANCIAL, BENEFITS, EMOTIONAL CONCERNS, AND OTHER ISSUES. FREE PROFESSIONALLY FACILITATED SUPPORT GROUPS SPONSORED BY THE CANCER CENTER MEET REGULARLY AT VARIOUS LOCATIONS TO HELP PATIENTS AND LOVED ONES FIND SUPPORT, GUIDANCE, AND ENCOURAGEMENT. FREE EDUCATIONAL WORKSHOPS ARE HELD AT VARIOUS SITES. DUE TO COVID-19, MEETINGS WERE SUSPENDED FOR THE YEAR AS THERE WAS RESTRICTED ACCESS TO THE HOSPITAL.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS MD ANDERSON CANCER SURVIVORS DAY SURVIVORS DAY IS A TIME TO RECOGNIZE THE NATION'S 15.5 MILLION CANCER SURVIVORS, TO FOCUS ATTENTION ON ISSUES OF SURVIVORSHIP, AND TO ACKNOWLEDGE MEDICAL PROFESSIONALS DEDICATED TO CANCER TREATMENT, RESEARCH AND SUPPORT SERVICES. NATIONAL CANCER SURVIVORS DAY EVENTS ARE HELD IN HUNDREDS OF COMMUNITIES NATIONWIDE THROUGHOUT THE MONTH OF JUNE. SCRIPPS HOLDS A CELEBRATORY EVENT AT VARIOUS SCRIPPS HOSPITALS EACH YEAR TO PROVIDE AN OPPORTUNITY FOR THOSE THAT HAVE BATTLED CANCER TO COME TOGETHER AND ENJOY THE COMPANY OF FRIENDS, FAMILY AND THE CAMARADERIE OF FELLOW CANCER SURVIVORS. CANCER SURVIVORS AND OTHER GUESTS SHARE INSPIRATIONAL STORIES, LEARN ABOUT ADVANCES IN CANCER TREATMENT AND RESEARCH AND ENJOY THE OPPORTUNITY TO CONNECT WITH CAREGIVERS AND FELLOW SURVIVORS. EACH YEAR THE CANCER SURVIVOR EVENTS HELP CELEBRATE LIFE, INSPIRE THOSE RECENTLY DIAGNOSED, OFFER SUPPORT TO FAMILY AND LOVED ONES AND RECOGNIZE ALL WHO PROVIDED SUPPORT ALONG THE WAY. THEY ALSO PROVIDE A FORUM FOR DISCUSSING THE PHYSICAL, FINANCIAL AND SOCIAL ISSUES THAT MANY CANCER SURVIVORS FACE FOLLOWING COMPLETION OF TREATMENT. DUE TO COVID-19 THESE EVENTS WERE POSTPONED. SCRIPPS MD ANDERSON CANCER CENTER - POLSTER BREAST CARE THE SCRIPPS POLSTER BREAST CARE PROGRAM SPONSORS THE YOUNG WOMEN'S SUPPORT GROUP WHICH PROVIDE A VENUE FOR WOMEN UNDER THE AGE OF 40 TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES AND RECEIVE SUPPORT. THE GROUPS ARE OFFERED TO WOMEN IN THE SAN DIEGO COMMUNITY. TOPICS RELATED TO BREAST HEALTH ARE ALSO OFFERED TO THE COMMUNITY. DUE TO COVID-19 MEETINGS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SCRIPPS MD ANDERSON CANCER CENTER LIFEGUARD AND FIRST RESPONDERS' CANCER SCREENINGS SCRIPPS HOSTED A FREE SKIN CANCER SCREENING CLINIC FOR ALL STATE AND LOCAL LIFEGUARDS, AND FIRST RESPONDERS AT THE SAN ELIJO STATE BEACH LIFEGUARD HEADQUARTERS. ACCORDING TO THE AMERICAN CANCER SOCIETY, SKIN CANCER IS BY FAR THE MOST COMMON FORM OF CANCER. MORE SKIN CANCERS ARE DIAGNOSED IN THE U.S. EACH YEAR THAN ALL OTHER CANCERS COMBINED. DERMATOLOGISTS ARE STARTING TO SEE THE INDIRECT EFFECT OF COVID-19 ON PEOPLE'S SKIN WITH MORE ADVANCED CASES. FOR OVER 20 YEARS, SCRIPPS HEALTH HAS OFFERED FREE SCREENINGS TO LIFEGUARDS AND OTHER FIRST RESPONDERS AS PART OF ITS COMMUNITY BENEFIT PROGRAM. AFTER THE LIFEGUARD COMPLETES A FORM FROM THE AMERICAN ACADEMY OF DERMATOLOGY, THEY STEP INTO A SCREENING ROOM AND A BOARD-CERTIFIED DERMATOLOGIST AND NURSE CONDUCT THE SCREENING. SCRIPPS SHILEY FITNESS CENTER - LYMPHEDEMA STRETCH THE SCRIPPS SHILEY FITNESS CENTER PROVIDES THERAPEUTIC EXERCISES KNOWN TO HELP RELIEVE SWELLING AND PAIN CAUSED BY LYMPHEDEMA. EXPERTS FROM SCRIPPS SHILEY FITNESS CENTER PROVIDE PROPER EXERCISE TECHNIQUES TO ALLEVIATE SWELLING AND REDUCE DISCOMFORT. THE 45-MINUTE CLASS UTILIZES A COMBINATION OF SEATED, STANDING AND FLOOR EXERCISES THAT INCLUDES CARDIOVASCULAR EXERCISE, STRENGTH TRAINING, FUNCTIONAL FITNESS, FLEXIBILITY AND MOBILITY AND CORE CONTROL. SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CANCER SUPORT SERVICES: BREAST HEALTH OUTREACH AND EDUCATION PROGRAM A LAY HEALTH PROFESSIONAL LED HEALTH AND WELLNESS PROGRAM THAT AIMS TO IMPROVE THE LIVES OF WOMEN IN SAN DIEGO'S SOUTH BAY WITH BREAST CANCER EDUCATION, PREVENTION AND TREATMENT SUPPORT. LAY HEALTH PROFESSIONALS TEACH WOMEN IN THEIR NATIVE LANGUAGE WITH SENSITIVITY TO A WOMAN'S ETHNIC AND CULTURAL NORMS. THE PROGRAM MODEL INCLUDES A LOCAL COMMUNITY LAY HEALTH EXPERT, A CANCER SURVIVOR AND A NURSE NAVIGATOR. THE COMMUNITY LAY HEALTH EXPERT HAS KNOWLEDGE OF BREAST CANCER, OFFERS EDUCATION AND EMOTIONAL SUPPORT AND PROVIDES REFERRALS IN A CULTURALLY APPROPRIATE AND LANGUAGE SENSITIVE WAY. WORKING TOGETHER, THE LAY HEALTH EXPERT AND VOLUNTEER PRESENT A VERY STRONG FRONT FOR BREAST CANCER AWARENESS AND FULL SUPPORT SYSTEM FOR THOSE ALREADY DIAGNOSED. MOREOVER, THE FACT THEY ARE BILINGUAL LENDS AN AIR OF AUTOMATIC TRUST AMONG THE COMMUNITY AS THEY CAN CONNECT WITH THE RESIDENTS ON A CULTURAL LEVEL. IN FISCAL YEAR 2021, A TOTAL OF 267 WOMEN WERE REFERRED TO CLINICAL BREAST HEALTH SERVICES IN THE COMMUNITY AND TO SCRIPPS MERCY HOSPITAL CHULA VISTA RADIOLOGY SERVICES. EDUCATIONAL SERVICES: FLYERS DISTRIBUTED, EDUCATION, PHONE CALLS, SOCIAL/EMOTIONAL SUPPORT, CASE MANAGEMENT, HOSPITAL VISITS, HOME VISITS, LETTERS SENT TO PATIENTS/PROVIDERS, MAILED EDUCATIONAL MATERIAL, BREAST CANCER SUPPLIES (I.E., MEDICAL RECORD BINDER, CAPS, WIGS, BRAS, HATS, MASTECTOMY PILLOW, ETC.), TO SUPPORT GROUP PARTICIPANTS. OUTREACH SERVICES: OUTREACH TO THOSE OVERDUE FOR SCREENING AND COMMUNITY REFERRALS, BREAST CANCER HOSPITAL REFERRALS, COMMUNITY BREAST CANCER REFERRALS, FOLLOW UP REFERRALS FROM RADIOLOGY ARE SENT TO OUTREACH SERVICES, COMMUNITY OUTREACH/EDUCATIONAL PRESENTATION ATTENDANCE. DUE TO COVID-19 MANY OF THE OUTREACH AND EDUCATION PROGRAMS CEASED DUE TO LARGE GROUP GATHERING RESTRICTIONS; SOME SERVICES WERE ABLE TO TRANSITION TO A VIRTUAL PLATFORM. SCRIPPS MERCY HOSPITAL CHULA VISTA BREAST CANCER SUPPORT GROUP SCRIPPS WELL-BEING CENTER HOLDS A BI-MONTHLY SUPPORT GROUP THAT HELPS INDIVIDUALS COPE WITH CANCER. GROUP SUPPORT INCLUDES NAVIGATING THE CANCER SYSTEM AND EDUCATIONAL PRESENTATIONS BY LOCAL PROVIDERS ARE OFFERED. A TOTAL OF 102 WOMEN PARTICIPATED IN THE BREAST CANCER SUPPORT GROUP. DUE TO COVID-19 THIS SUPPORT GROUP TRANSITIONED TO CONFERENCE CALLS AND VIRTUAL OFFERINGS AND AS OF AUGUST 2021 THIS GROUP IS CURRENTLY MEETING OUTSIDE A LOCAL PARK. LEUKEMIA & LYMPHOMA SOCIETY THIS BLOOD CANCER CONFERENCE (BCC) IS ONE OF MANY PROGRAMS DEVELOPED BY THE LEUKEMIA & LYMPHOMA SOCIETY (LLS) TO MEET THE NEEDS OF PATIENTS, SURVIVORS, FAMILIES AND ONCOLOGY PROFESSIONALS, THE PEOPLE WHO DEAL WITH BLOOD CANCER EVERY DAY AND THE PEOPLE WHO CARE FOR THEM. BCC ATTENDEES RECEIVE THE MOST CURRENT INFORMATION AND ACCESS TO LOCAL RESOURCES TO HELP NAVIGATE AND MAKE INFORMED DECISIONS ABOUT THEIR TREATMENT AND SURVIVAL. SCRIPPS WAS A PARTICIPANT AT THE VIRTUAL CONFERENCE IN FISCAL YEAR 2021. CARDIOVASCULAR DISEASE 'DISEASES OF THE HEART' WERE THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY IN 2019. IN ADDITION, 'CEREBROVASCULAR DISEASES' WERE THE FOURTH LEADING CAUSE OF DEATH, AND ESSENTIAL (HYPERTENSION AND HYPERTENSIVE RENAL DISEASE' WAS THE TENTH. CORONARY HEART DISEASE IS THE MOST COMMON FORM OF HEART DISEASE. HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CVD AND STROKE. ABOUT HALF OF AMERICANS (49%) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS.
FORM 990, PART III, LINE 4A (CONTINUED)	RISK FACTORS FOR CARDIOVASCULAR DISEASE: BEHAVIORS: TOBACCO USE, OBESITY, POOR DIET THAT IS HIGH IN SATURATED FATS, AND EXCESSIVE ALCOHOL USE. CONDITIONS: HIGH CHOLESTEROL LEVELS, HIGH BLOOD PRESSURE AND DIABETES. HEREDITY: GENETIC FACTORS LIKELY PLAY A ROLE IN HEART DISEASE AND CAN INCREASE RISK. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF CARDIOVASCULAR DISEASE IS DESCRIBED BELOW: - THE HASD&IC AND SCRIPPS 2019 CHNA CONTINUED TO IDENTIFY CARDIOVASCULAR DISEASE (INCLUDING CEREBROVASCULAR DISEASE/STROKE) AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - ACCORDING TO DATA PRESENTED IN THE HASD&IC AND SCRIPPS 2019 CHNA, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CARDIOVASCULAR DISEASE AND STROKE. ABOUT HALF OF ALL AMERICANS (47 PERCENT) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS. ADDITIONAL RISK FACTORS INCLUDE ALCOHOL USE, OBESITY, PHYSICAL INACTIVITY, POOR DIET, DIABETES AND GENETIC FACTORS. - FOCUS GROUPS AND KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE HASD&IC AND SCRIPPS HEALTH 2019 CHNAS IDENTIFIED NUMEROUS BARRIERS TO CARE FOR CHRONIC CONDITIONS SUCH AS CVD, INCLUDING: LACK OF ACCESS TO HEALTHY FOOD; TRANSPORTATION; PHYSICAL LIMITATIONS OR LIMITED MOBILITY; HIGH HEALTH CARE COSTS; ECONOMIC INSECURITY; LOW HEALTH LITERACY; POOR HEALTH BEHAVIORS, SUCH AS UNHEALTHY DIET OR MINIMAL PHYSICAL ACTIVITY; POOR MEDICATION MANAGEMENT; UNSAFE NEIGHBORHOODS; AND UNSTABLE OR COMPLETE LACK OF HOUSING. - ACCORDING TO DATA PRESENTED IN THE HASD&IC AND SCRIPPS 2019 CHNA, RATES OF ED VISITS FOR CORONARY HEART DISEASE (CHD) IN SAN DIEGO COUNTY INCREASED 35.3% FROM 2014 TO 2016, WITH THE MOST SIGNIFICANT INCREASES IN INDIVIDUALS AGES 45 TO 64 (41.9%) AND THOSE IDENTIFIED AS ASIAN/PACIFIC ISLANDER (55.1%). - IN 2019 THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY WAS DISEASES OF THE HEART AND CEREBROVASCULAR DISEASES INCLUDING STROKE WERE THE THIRD LEADING CAUSE OF DEATH FOR SAN DIEGO COUNTY OVERALL. - IN 2019, THERE WERE 1,620 DEATHS DUE TO STROKE IN SAN DIEGO COUNTY. THE AGE-ADJUSTED DEATH RATE DUE TO STROKE WAS 42.4 PER 100,000 POPULATION, WHICH WAS HIGHER THAN THE HP2030 TARGET OF 33.4 DEATHS PER 100,000. - IN 2019, THERE WERE 6,500 HOSPITALIZATIONS FOR STROKE IN SAN DIEGO COUNTY, WITH AN AGE-ADJUSTED RATE OF 177.5 PER 100,000 POPULATION. - IN 2019, THERE WERE 2,828 STROKE-RELATED ED VISITS IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF ED VISITS WAS 76.7 PER 100,000 POPULATION. - ACCORDING TO 2020 CHIS DATA, 23.2% OF SAN DIEGO COUNTY RESIDENTS HAD EVER BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE, WHILE 7.8% HAD BORDERLINE HIGH BLOOD PRESSURE. IN ADDITION, 24.3% OF SAN DIEGO COUNTY ADULTS REPORTED BEING OBESE. - ACCORDING TO THE CDC, HEART DISEASE (INCLUDING CHD, HYPERTENSION AND STROKE) IS THE LEADING CAUSE OF DEATH FOR BOTH MEN AND WOMEN, AND KILLS APPROXIMATELY 659,000 PEOPLE EACH YEAR (CDC, 2021). - HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST RACIAL/ETHNIC GROUPS IN THE U.S. INCLUDING BLACK/AFRICAN AMERICAN, AMERICAN INDIAN, ALASKA NATIVE, HISPANIC, AND WHITE MEN. FOR WOMEN FROM THE PACIFIC ISLANDS, AND ASIAN AMERICAN, AMERICAN INDIAN, ALASKA NATIVE, AND HISPANIC WOMEN, HEART DISEASE IS SECOND ONLY TO CANCER (CDC, 2021). - IN ITS 2021 HEART DISEASE AND STROKE STATISTICAL UPDATE, THE AHA REPORTED THAT CHD WAS RESPONSIBLE FOR 13% OF ALL DEATHS IN THE U.S. IN 2018, KILLING NEARLY 366,000 PEOPLE. DEATH RATES AND ACTUAL NUMBERS OF DEATHS FROM CHD DECREASED SIGNIFICANTLY BETWEEN 2008 AND 2018, BUT DISEASE BURDEN AND RISK FACTORS REMAIN HIGH. ACCORDING TO BLOOD PRESSURE GUIDELINES CHAMPIONED BY THE AHA AND THE AMERICAN COLLEGE OF CARDIOLOGY, 47.3% OF U.S. ADULTS HAVE HYPERTENSION (AHA, 2021). - ACCORDING TO THE AHA, IT MAY BE POSSIBLE TO PREVENT HEART DISEASE, STROKE, AND CVD BY NOT SMOKING, ENGAGING IN DAILY PHYSICAL ACTIVITY, MAINTAINING A HEALTHY DIET AND BODY WEIGHT, AND CONTROLLING CHOLESTEROL, BLOOD PRESSURE, AND BLOOD SUGAR (AHA, 2021). - THE CDC ASSERTS THAT SEVERAL HEALTH CONDITIONS, ALONG WITH LIFESTYLE, AGE AND FAMILY HISTORY ARE RISK FACTORS THAT CAN INCREASE AN INDIVIDUAL'S RISK FOR HEART DISEASE. ABOUT HALF OF ALL AMERICANS (47%) HAVE AT LEAST 1 OF 3 KEY RISK FACTORS FOR HEART DISEASE: HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND SMOKING (CDC, 2019). NOT ONLY IS SCRIPPS A NATIONALLY RECOGNIZED HEART CARE LEADER, CONSISTENTLY RANKED BY U.S. NEWS & WORLD REPORT AS ONE OF AMERICA'S BEST HOSPITALS FOR CARDIOLOGY AND HEART SURGERY, BUT WE TREAT MORE HEART PATIENTS THAN ANY OTHER HEALTH CARE PROVIDER IN SAN DIEGO. WE HAVE STATE-OF-THE-ART TECHNOLOGY AND HIGHLY TRAINED HEART CARE SPECIALISTS, PROVIDING AN INNOVATIVE AND EXPANSIVE SCOPE OF SERVICES AND HIGH-QUALITY OUTCOMES. ALONG WITH THE TREMENDOUS CARE SCRIPPS PROVIDES WITHIN OUR HOSPITALS AND OUTPATIENT CLINICS, SCRIPPS ALSO SUPPORTS OUR SURROUNDING COMMUNITIES WITH RESOURCES, OUTREACH PROGRAMS AND PARTNERSHIPS TO ENSURE THE HEARTBEAT OF OUR COMMUNITY CONTINUES. DURING FISCAL YEAR 2021, SCRIPPS ENGAGED IN THE FOLLOWING HEART HEALTH, STROKE, AND CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT ACTIVITIES. CPR CLASSES FOR PATIENTS AND FAMILIES OF THE CARDIAC TREATMENT CENTER CPR CLASSES ARE OFFERED FOUR TIMES A YEAR TO CARDIAC TREATMENT CENTER PATIENTS AND THEIR FAMILIES. THE PROGRAM IMPROVES COMMUNITY HEALTH BY INCREASING KNOWLEDGE OF CARDIOPULMONARY RESUSCITATION PRACTICES. DUE TO COVID-19 THESE CLASSES WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS ARE DESIGNED FOR CARDIOVASCULAR HEALTH IMPROVEMENT. CLASSES INCLUDE TRAINING IN BALANCE, SLOW FLOW YOGA, TAI CHI, FIT BALL, CHAIR YOGA AND MEDITATION, MINDFULNESS, ACUPRESSURE AND BREATH WORK FOR STRESS, MEDITATION AND ARM EXERCISE. THE CARDIAC TREATMENT CENTER ALSO PROVIDES EXERCISE PROGRAMS THAT INCLUDE NUTRITIONAL EDUCATION THROUGH THE PULMONARY CLASS, DIETARY ONE-ON-ONE COUNSELING, NUTRITION CLASS, BREATHING FOR BETTER HEALTH DURING COVID-19 AND THE CARDIAC LIFE PROJECT. THE BETTER BREATHERS PROVIDE ADDITIONAL EDUCATION IN CARDIOVASCULAR HEALTH. THESE CLASSES WERE OFFERED VIRTUALLY STARTING IN MARCH 2020 EXCEPT FOR LIFE PROJECT AND BETTER BREATHERS. CARDIAC TREATMENT CENTER'S LIFE PROJECT THE CARDIAC TREATMENT CENTER'S LIFE PROJECT IS A SUPPORT GROUP FOR PEOPLE WITH HEART DISEASE AND THEIR FAMILY MEMBERS. THE GOAL IS TO PROVIDE EDUCATION AND RESOURCES ON COPING WITH HEART DISEASE IN A FRIENDLY AND SUPPORTIVE ENVIRONMENT. DUE TO COVID-19 THESE CLASSES WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. PULMONARY CARDIAC CLASS THIS EDUCATIONAL CLASS PROVIDED BY THE SCRIPPS CARDIAC TREATMENT CENTER IS A COMPREHENSIVE SIX-WEEK EDUCATION PROGRAM FOR PULMONARY PATIENTS TO HELP THEM TO MANAGE THEIR DISEASE. THEY WILL LEARN LIFESTYLE MANAGEMENT FOR A HEALTHY LIFE, NUTRITION AND EXERCISE ARE PART OF THE SERIES. THIS CLASS WAS OFFERED VIRTUALLY STARTING IN MARCH 2020 DUE TO COVID-19. STUDENT PRECEPTORSHIP AT CARDIAC TREATMENT CENTER SCRIPPS PROVIDES PRECEPTORSHIPS FOR STUDENT RNS, EXERCISE PHYSIOLOGISTS AND CARDIAC SONOGRAPHERS. THE SCRIPPS CARDIAC TREATMENT CENTER NURSES' MENTOR THE STUDENTS THROUGH EDUCATION AND MODELING. THE STUDENTS LEARN THE ROLES AND RESPONSIBILITIES REQUIRED OF THE POSITIONS. DUE TO COVID-19 THE PRECEPTORSHIPS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. COUNTY OF SAN DIEGO LOVE YOUR HEART BLOOD PRESSURE SCREENINGS IN SAN DIEGO REGION, THE PERCENTAGE OF ADULTS WITH HIGH BLOOD PRESSURE NOT TAKING BLOOD PRESSURE MEDICATION IS 35%, HIGHER THAN CALIFORNIA (29%) AND THE UNITED STATES (21.7%). HIGH BLOOD PRESSURE IS KNOWN AS THE "SILENT KILLER" BECAUSE IT MAY SHOW NO SYMPTOMS. HOWEVER, HYPERTENSION PUTS PEOPLE AT AN INCREASED RISK FOR HEART DISEASE AND STROKE, TWO OF THE TOP CAUSES OF DEATH IN THE REGION. FIFTY-NINE PERCENT OF SAN DIEGANS HAD HYPERTENSION. TEN YEARS AGO, THE COUNTY LAUNCHED THE "LOVE YOUR HEART" CAMPAIGN, AN ANNUAL EVENT WITH A SIMPLE MISSION-HELP PREVENT HEART DISEASE AND STOKE TO REDUCE THE PERCENTAGE OF DEATHS IN SAN DIEGO COUNTY DUE TO CHRONIC DISEASE. ORGANIZATIONS FROM ACROSS THE U.S. AND MEXICO JOIN TO PROVIDE FREE BLOOD PRESSURE SCREENINGS TO THE PUBLIC ON VALENTINE'S DAY. THE LOVE YOUR HEART ANNUAL CAMPAIGN WAS LAUNCHED ON VALENTINE'S DAY 2012 TO ADDRESS THE NEGATIVE IMPACTS OF HEART DISEASE IN THE REGION. IN 2021, COUNTY LEADERS, REGIONAL OFFICIALS AND COMMUNITY PARTNERS HAD A VIRTUAL NEWS CONFERENCE TO ENCOURAGE PEOPLE TO GET A BLOOD PRESSURE SCREENING. THIS YEAR, DUE TO THE ONGOING COVID-19 PANDEMIC, THE NUMBER OF SITES OFFERING BLOOD PRESSURE SCREENINGS WAS LIMITED BUT THE CAMPAIGN LASTED AN ENTIRE WEEK, FROM FEB. 8 THROUGH FEB. 14. WHILE SOME LOCAL BUSINESSES HAD BLOOD PRESSURE SCREENINGS ON SITE, SAN DIEGANS WERE ENCOURAGED TO ONLY GET THEIR BLOOD PRESSURE CHECKED IF THEY WERE CONDUCTING ESSENTIAL ACTIVITIES.
FORM 990, PART III, LINE 4A (CONTINUED)	LEFT VENTRICULAR ASSIST DEVICE (LVAD) SUPPORT GROUP SCRIPPS OFFERS A SUPPORT GROUP FOR PATIENTS WITH A LEFT VENTRICULAR ASSIST DEVICE. THIS GROUP PROVIDES EDUCATION AND SUPPORT TO THOSE PATIENTS AND THEIR CAREGIVERS/PARTNERS. TOPICS INCLUDE SAFETY AND PROPER MECHANICS REQUIRED FOR THE DEVICE. THE GROUP MET VIRTUALLY IN FY 2021. JOE NIEKRO FOUNDATION SCRIPPS HEALTH PROVIDES MEETING SPACE FOR THE JOE NIEKRO FOUNDATION SUPPORT GROUPS OF PATIENTS, FAMILIES AND FRIENDS WHO HAVE BEEN AFFECTED WITH BRAIN ANEURYSMS OR HEMORRHAGIC STROKE. THE PROGRAM IS OPENED TO THE PUBLIC. DUE TO COVID-19 THE SUPPORT GROUPS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. EDUCATING WOMEN ABOUT HEART HEALTH SCRIPPS WOMEN'S HEART CENTER IS DEVOTED TO CARING FOR WOMEN AND EDUCATING PATIENTS ABOUT HEART DISEASE PREVENTION. HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR WOMEN CARDIOVASCULAR DISEASE IS THE NUMBER 1 KILLER OF WOMEN, CAUSING 1 IN 3 DEATHS EACH YEAR. THAT IS APPROXIMATELY ONE WOMAN EVERY MINUTE. OUR FEMALE CARDIOLOGISTS FOCUS ON EMPOWERING THEIR PATIENTS AND THE COMMUNITY TO TAKE CARE OF THEIR HEARTS THROUGH EDUCATION, HEALTHY LIFESTYLES AND EXPERT MEDICAL CARE WHEN NEEDED. THE ERIC PAREDES SAVE A LIFE FOUNDATION- SUDDEN CARDIAC ARREST SCREENINGS ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), ABOUT 2,000 YOUNG, SEEMINGLY HEALTHY PEOPLE UNDER AGE 25 IN THE UNITED STATES DIE EACH YEAR OF SUDDEN CARDIAC ARREST. SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEART'S ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE ELECTROCARDIOGRAM (EKG). UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. ACCORDING TO THE SAN DIEGO MEDICAL EXAMINER RECORDS, WE LOSE AT LEAST 12 YOUTH ANNUALLY TO SCA. SCRIPPS EFFORTS BEGAN WHEN A REGISTERED NURSE AT SCRIPPS CREATED THE FOUNDATION AFTER HER 15-YEAR-OLD SON, ERIC PASSED AWAY FROM SUDDEN CARDIAC ARREST IN 2009. TURNING TRAGEDY INTO AN OPPORTUNITY, THE PAREDES' ESTABLISHED THE ORGANIZATION TO PREVENT SUDDEN CARDIAC ARREST IN SCHOOL-AGE CHILDREN AND ADOLESCENTS. AS A SPONSOR FOR THE ERIC PAREDES SAVE A LIFE FOUNDATION, SCRIPPS HAS SUPPORTED MORE THAN 34,000 FREE CARDIAC SCREENINGS TO LOCAL TEENS, INCLUDING THE HOMELESS, UNINSURED, AND UNDERINSURED THROUGH MORE THAN $120,000 IN ANNUAL CONTRIBUTION SINCE 2012. IN FISCAL YEAR 2021, SCRIPPS MADE AN $8,500 CONTRIBUTION TO HELP PAY FOR SCREENINGS. THE SUPPORT HAS FUNDED FREE YOUTH HEART SCREENINGS, WHICH HAVE IDENTIFIED A TOTAL OF 534 WITH CARDIAC ABNORMALITIES - 239 SERIOUS ENOUGH TO CAUSE SUDDEN CARDIAC ARREST. TYPICALLY, SIX YOUTH HEART SCREENINGS SERVING UP TO 1,000 INDIVIDUALS ARE HOSTED ANNUALLY, HOWEVER, AFTER AN 18-MONTH PAUSE THE ERIC PAREDES FOUNDATION HOSTED A SMALL SCREENING EVENT IN PARTNERSHIP WITH THE CALIFORNIA HIGHWAY PATROL AT ITS KEARNY MESA HEADQUARTERS WHERE 191 YOUTH WERE SCREENED WITH SEVEN CARDIAC ABNORMALITIES DISCOVERED - THREE SERIOUS ENOUGH TO CAUSE SCA. CUMULATIVE DATA SHOWS THAT AN AVERAGE OF 57% OF PARENTS WERE NOT AWARE OF THE NEED TO ACTIVELY PREVENT SCA, WITH 68% UNFAMILIAR WITH WARNING SIGNS AND RISK FACTORS. THE FOLLOWING ADDITIONAL METRICS WERE TRACKED: - TEENS WITHOUT A PEDIATRICIAN/FAMILY DOC: 29 - TEENS WHO USE COMMUNITY CLINIC: 20 - SCRIPPS VOLUNTEERS: 7 - SCRIPPS VOLUNTEER HOURS: 54 - LOW TO MODERATE INCOME HOUSEHOLDS: 51% - REPRESENTATION OF DIVERSE COMMUNITIES: 52% THE ERIC PAREDES SAVE A LIFE FOUNDATION - PRESCRIPTION FOR PREVENTION WHEN SCREENINGS WERE PAUSED DUE TO THE COVID-19 PANDEMIC, SCRIPPS SUPPORT ALSO HELPED THE ERIC PAREDES FOUNDATION PIVOT TO DEVELOP PRESCRIPTION FOR PREVENTION - A FREE, ACCREDITED TRAINING FOR PRIMARY CARE PRACTITIONERS ON INCORPORATING A ROBUST CARDIAC RISK ASSESSMENT IN YOUTH INTO THEIR PRACTICE. IN PARTNERSHIP WITH SDSU'S INSTITUTE FOR PUBLIC HEALTH AND UC IRVINE, THE ERIC PAREDES SAVE A LIFE FOUNDATION PRODUCED THE FIRST CME/CNE ON INCORPORATING SUDDEN CARDIAC ARREST PREVENTION INTO PRIMARY CARE PRACTICES. STUDIES SHOW CARDIAC CONSIDERATION IS AN OFTEN-OVERLOOKED AREA OF ASSESSMENT. THE TRAINING MODULE REVIEWS SCA WARNING SIGNS, RISK FACTORS AND RECOMMENDED DIAGNOSTIC TESTING PROTOCOL. THE CME DEVELOPMENT WAS DIRECTED AND NARRATED BY DR. JOHN ROGERS, SCRIPPS CARDIOLOGIST AND EP SAVE A LIFE MEDICAL DIRECTOR, AND SCRIPPS HEALTH WAS INSTRUMENTAL IN FACILITATING ENGAGEMENT IN BOTH A FRONT-END NEEDS ASSESSMENT AND IN PARTICIPATION IN THE TRAINING MODULE THROUGH DIRECT COMMUNICATION WITH PRIMARY CARE PHYSICIANS (PCPS). FUNDING SUPPORTED DEVELOPMENT AND PROMOTION OF THE TRAINING MODULE ON A LOCAL, STATE, AND NATIONAL LEVEL, AND WITH THE SAN DIEGO CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS. PRELIMINARY DATA SUGGESTS THAT COVID-19 CAN LEAD TO HEART DAMAGE AND PROFESSIONAL MEDICAL ASSOCIATIONS HAVE RELEASED RECOMMENDATIONS FOR CARDIAC ASSESSMENT OF STUDENT ATHLETES WHO HAVE BEEN EXPOSED BEFORE RETURNING TO PLAY. THIS TRAINING SUPPORTS A CRITICAL SKILL SET FOR PCPS. THE SCRIPPS PARTICIPATION IN LIVE CME EVENTS/EARLY NEEDS ASSESSMENT OF TOTAL PARTICIPANTS WAS 45%. TO DATE, MORE THAN 400 PCPS HAVE REGISTERED FOR THE COURSE WITH A HUNDRED MORE EXPOSED TO THE PROGRAM THROUGH LIVE/ONLINE LECTURES AND THE CME NOW BEING HOSTED IN THEIR CONTINUING EDUCATION PORTAL. DR. JOHN ROGERS ALSO MADE PRESENTATIONS TO PROFESSIONAL MEDICAL ASSOCIATION CONFERENCES, INCLUDING THE NATIONAL ASSOCIATION OF PEDIATRIC NURSE PRACTITIONERS, GEORGIA NURSE ASSOCIATION, SOCIETY FOR PHYSICIAN ASSISTANTS IN PEDIATRICS AND THE 24TH ANNUAL SAN DIEGO SCHOOL HEALTH CONFERENCE. PRE/POST TEST PERFORMANCE AVERAGE KNOWLEDGE IMPROVEMENT WAS 40%-95%. THE ERIC PAREDES SAVE A LIFE FOUNDATION - SMART HEARTS DO NOT MISS A BEAT SUDDEN CARDIAC ARREST (SCA) IS THE LEADING CAUSE OF DEATH ON SCHOOL CAMPUSES AND THE NUMBER ONE KILLER OF STUDENT ATHLETES. ONE IN 300 YOUTH HAS AN UNDETECTED HEART CONDITION THAT PUTS THEM AT RISK. SMART HEARTS DO NOT MISS A BEAT IS A NEW PROGRAM THAT EMPOWERS YOUNG PEOPLE TO PREVENT SUDDEN DEATH AT HOME, IN SCHOOL, ON THE FIELD, AT THE DOCTOR'S OFFICE AND UN THEIR FUTURE FAMILIES, AND WORKPLACES. THE PROGRAM OFFERS SCA PREVENTION LEARNING FOR SCHOOL AGED STUDENTS TO EMPOWER THE NEXT GENERATION OF LIFE SAVERS. THIS PROGRAM SERVED 1,200 YOUTH, INCLUDING DOZENS THOUGH SCRIPPS SD BORDER AHEC COMMUNITY BENEFIT PROGRAM THAT SERVES HEALTH PATHWAY STUDENTS IN SWEETWATER UNIFIED HIGH SCHOOL DISTRICT AND ITS HEALTH CAREER OCCUPATION PROGRAM (HCOP) SUMMER CAMP. THE DEVELOPMENT OF A CLASSROOM OR INDEPENDENT LEARNING MODULE INCLUDED A SERIES OF VIDEOS, ACTIVITIES, AND QUIZZES FOR MIDDLE AND HIGH SCHOOL STUDENTS. THROUGH A PRE AND POSTTEST, STUDENTS ON AVERAGE IMPROVED THEIR KNOWLEDGE FROM 50% TO OVER 85%. THE PROGRAM GOALS ARE: - EDUCATE YOUTH TO RECOGNIZE WARNING SIGNS AND FAMILY RISK FACTORS SO THEY CAN BE THEIR OWN HEART HEALTH ADVOCATE. - EMPOWER YOUTH TO USE CPR AND AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED) AND TEACH OTHERS THE CARDIAC CHAIN OF SURVIVAL. - EQUIP YOUTH WITH LEADERSHIP SKILLS THAT PREPARE THEM TO ADVOCATE FOR PREVENTION IN THEIR COMMUNITIES. SWEETWATER UNION HIGH SCHOOL DISTRICT - SPORTS SCREENINGS EVERY YEAR, THREE TO FIVE STUDENT ATHLETES IN SAN DIEGO COUNTY DIE SUDDENLY AND UNEXPECTEDLY FROM SUDDEN CARDIAC ARREST/DEATH (SCA/D). SCA IS AN ABNORMALITY IN THE HEART'S ELECTRICAL SYSTEM THAT CAN HAPPEN WITHOUT SYMPTOMS OR WARNING SIGNS. HOWEVER, THIS LIFE-THREATENING CONDITION CAN BE DETECTED WITH A CARDIAC SCREENING EXAM. SCRIPPS MERCY HOSPITAL CHULA VISTA FAMILY MEDICINE RESIDENCY, SOUTHWEST SPORTS WELLNESS FOUNDATION, AND THE SWEETWATER UNION HIGH SCHOOL DISTRICT PARTNER TO PREVENT SUDDEN CARDIAC ARREST AND DEATH AMONG HIGH SCHOOL STUDENTS BY INCREASING AWARENESS OF THE IMPORTANCE OF HEALTHY LIFESTYLES AND CARDIOVASCULAR SCREENINGS AMONG ACTIVE STUDENTS. FAMILY MEDICINE RESIDENTS OFFER YEARLY CARDIAC SCREENING AND SPORTS PHYSICALS BEFORE STUDENTS PARTICIPATE IN ORGANIZED SPORTS AND OPERATE AN INJURY CLINIC DURING FOOTBALL SEASON TO EVALUATE AND TREAT POSSIBLE CONCUSSIONS AND OTHER INJURIES. DUE TO COVID-19 THE SCREENING EVENTS AND INJURY CLINICS WE NOT HELD. THE INJURY CLINIC WILL RESUME OCTOBER 2021.
FORM 990, PART III, LINE 4A (CONTINUED)	SU CORAZON, SU VIDA / YOUR HEART, YOUR LIFE COMMUNITY INTERVENTION TO IMPROVE EDUCATION AND AWARENESS OF HEART DISEASE THE YOUR HEART, YOUR LIFE (SU CORAZON, SU VIDA) PROGRAM IS DESIGNED TO HELP PREVENT HEART DISEASE THROUGH EDUCATION AND PROVIDE SUPPORT AND OUTREACH TO THOSE ALREADY LIVING WITH HEART DISEASE AND OTHER RELATED CHRONIC DISEASES SUCH AS DIABETES AND HIGH BLOOD PRESSURE. TOPICS COVERED IN THE CLASSES INCLUDE HEART DISEASE RISK FACTORS, SIGNS OF A HEART ATTACK AND STROKE, LIFESTYLE CHANGES, DIABETES, CHOLESTEROL AND NUTRITION EDUCATION. HEIGHT, WEIGHT, AND BLOOD PRESSURES ARE RECORDED IN THE FIRST AND LAST CLASS TO MEASURE A DIFFERENCE AND IMPACT OF THE LIFESTYLE CHANGES IMPLEMENTED FROM PARTICIPATING IN THE SESSIONS. OVERALL, PARTICIPANTS HAVE MADE A POSITIVE IMPACT FROM THE COURSE BASED ON THE HEALTH ASSESSMENTS. CLASSES WERE CANCELLED THIS FISCAL YEAR DUE TO COVID-19. STROKE CARE PROGRAMS ON AVERAGE, A STROKE OCCURS EVERY 40 SECONDS IN THE UNITED STATES. MORE THAN 1,500 STOKE DEATHS OCCURRED IN SAN DIEGO COUNTY IN 2019, AND ABOUT 15 PEOPLE ARE HOSPITALIZED DUE TO STROKE EVERY DAY. SCRIPPS SPONSORS A WIDE VARIETY OF STROKE RELATED EDUCATION AND AWARENESS PROGRAMS. THESE INCLUDE SUPPORT GROUPS AND EDUCATION FOR STROKE AND BRAIN INJURY SURVIVORS AND THEIR LOVED ONES. INFORMATION AND RESOURCES ARE PROVIDED, ALONG WITH SKILLS TO HELP REINFORCE INNER STRENGTHS AND LEARN SELF-CARE STRATEGIES. SUPPORT GROUPS OFFER THE ABILITY TO DEVELOP ENCOURAGING PEER RELATIONSHIPS ALONG WITH THE GOAL OF RETURNING TO AND CONTINUING A LIFE OF MEANING AND PURPOSE. DUE TO COVID-19 THESE SUPPORT GROUPS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SAN DIEGO COUNTY STROKE CONSORTIUM SCRIPPS STROKE PROGRAM PARTICIPATES IN THE SD COUNTY STROKE CONSORTIUM, A COUNTY-WIDE STROKE GROUP, CONSISTING OF SD COUNTY STROKE RECEIVING CENTER STROKE PROGRAM COORDINATORS, STROKE CHAMPIONS AND STROKE LEADERSHIP. ADDITIONALLY, THE MEETING IS ATTENDED BY STROKE PROGRAM MEDICAL DIRECTORS AND SD COUNTY LEADERSHIP. THE STROKE CONSORTIUM SERVES AS A POINT OF CONTACT FOR CONTINUITY OF STROKE CARE IN SAN DIEGO COUNTY. SCRIPPS STROKE PROGRAM DEDICATES TIME AND RESOURCES TO LEAD EFFORTS TO CREATE AND DISSEMINATE A UNIFIED COMMUNITY MESSAGE URGING SAN DIEGO COUNTY RESIDENTS TO SEEK EMERGENCY TREATMENT WHEN SUFFERING SYMPTOMS OF A STROKE. SCRIPPS STROKE PROGRAM LED A COLLABORATIVE GROUP INCLUDING SAN DIEGO COUNTY EMS, SAN DIEGO REGIONAL AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION, AND THE SAN DIEGO COUNTY STROKE CONSORTIUM IN CREATING A UNITED MARKETING CAMPAIGN. THE SLOGAN "WE ARE HERE FOR YOU. EVERY MINUTE MATTERS" ACCOMPANIED BY A GRAPHIC MESSAGE WAS UTILIZED TO HIGHLIGHT THE IMPORTANCE OF SEEKING EMERGENCY TREATMENT WHEN EXPERIENCING STROKE-LIKE SYMPTOMS. THE COMMUNITY COLLABORATION WAS ALSO SUBMITTED FOR CONSIDERATION AT THE 2021 INTERNATIONAL STROKE CONFERENCE. COLLABORATIVE SAN DIEGO COUNTY STROKE CENTER COMMUNITY MESSAGING CAMPAIGN THE SAN DIEGO COUNTY STROKE CONSORTIUM (CHAIRED BY AND OF WHICH ALL SCRIPPS HEALTH STROKE PROGRAMS PARTICIPATE) PERFORMED A COLLABORATIVE SD COUNTY STROKE CENTER COMMUNITY MESSAGING CAMPAIGN IN MAY/JUNE DURING THE PANDEMIC. THE GENERAL POINT OF THE CONSORTIUM PROJECT WAS TO REASSURE/REMIND COMMUNITY MEMBERS OF THE IMPORTANCE OF ACCESSING 911 FOR STROKE SYMPTOMS, TO PRESENT FOR TIMELY CARE, DESPITE THE ONGOING PANDEMIC. THE COMMUNITY MESSAGING PROJECT WAS SELECTED BY THE INTERNATIONAL STROKE CONFERENCE IN MARCH 2021 AS A FEATURED POSTER PRESENTATION. ADDITIONALLY, THE SAN DIEGO COUNTY STROKE CONSORTIUM WAS CHOSEN TO PRESENT THREE ADDITIONAL POSTER PRESENTATIONS AT THE 2021 INTERNATIONAL STROKE CONFERENCE, ALL OF WHICH CONTRIBUTED TO KNOWLEDGE OF SD COMMUNITY MEMBER'S RESPONSE TO STROKE CARE DURING THE COVID-19 PANDEMIC. IN FISCAL YEAR 2021, SCRIPPS MEDICAL DIRECTOR OF SCRIPPS HEALTH STROKE PROGRAMS PROMOTED A COMMUNITY PODCAST TO DISCUSS WHO IS AT RISK FOR STROKE, HOW TO LOWER YOUR STROKE RISK AND REVIEW THE SIGNS OF STROKE AND IMPORTANCE OF SEEKING IMMEDIATE CARE. SCRIPPS HEALTH STROKE PROGRAM COMMUNITY EVENTS LA COSTA GLEN RETIREMENT COMMUNITY THE SCRIPPS HEALTH STROKE TEAM PARTICIPATED IN AN EDUCATIONAL EVENT AT LA COSTA GLEN IN CARLSBAD, CA ON APRIL 20, 2021. FIFTY COMMUNITY MEMBERS WERE SERVED (20 IN PERSON DUE TO COVID-19 RESTRICTIONS; 30 SERVED VIA LIVE STREAM ON RESIDENT'S TELEVISIONS). STROKE TEAM MEMBERS PROVIDED COMMUNITY OUTREACH AN EDUCATIONAL LECTURE TO THE LA COSTA GLEN COMMUNITY RESIDENTS ABOUT STROKE RISK FACTORS AND BE-FAST-HOW TO RECOGNIZE SYMPTOMS OF STROKE AND CALLING 911 WHEN SOMEONE IS EXHIBITING STROKE SYMPTOMS. CARLSBAD BY THE SEA RETIREMENT COMMUNITY THE SCRIPPS HEALTH STROKE TEAM PARTICIPATED IN AN EDUCATION EVENT AT CARLSBAD BY THE SEA IN CARLSBAD, CA ON JUNE 30,2021. FORTY COMMUNITY MEMBERS WERE SERVED IN PERSON WITH SOCIAL DISTANCING. STROKE TEAM MEMBERS PROVIDED COMMUNITY OUTREACH VIA AN EDUCATION LECTURE TO THE CARLSBAD BY THE SEA COMMUNITY RESIDENTS ABOUT STROKE RISK FACTORS AND BE-FAST-HOW TO RECOGNIZE SYMPTOMS OF STROKE AND CALLING 911 WHEN SOMEONE IS EXHIBITING STROKE SYMPTOMS. STROKE AND BRAIN INJURY SUPPORT GROUP AT SCRIPPS MERCY HOSPITAL CHULA VISTA WELL BEING CENTER THE STROKE SUPPORT GROUP IS FOR STROKE AND BRAIN INJURY SURVIVORS, CAREGIVERS, AND LOVED ONES. THE GROUP'S GOAL IS TO EDUCATE AND EMPOWER SURVIVORS. ATTENDEES RECEIVE INFORMATION AND RESOURCES, REINFORCE INNER STRENGTHS, LEARN SELF-CARE STRATEGIES, AND DEVELOP ENCOURAGING PEER RELATIONSHIPS. A TOTAL OF 30 PEOPLE PARTICIPATED IN THE SUPPORT GROUP. DUE TO COVID-19 THE GROUP HAS TRANSITIONED TO CONFERENCE CALL GROUP WHICH HAS IMPACTED THE OVERALL NUMBER OF PARTICIPANTS FOR THE YEAR. BRAINMASTERS: STROKE AND BRAIN INJURY SURVIVORS SUPPORT GROUP IN 2017, SCRIPPS MEMORIAL HOSPITAL ENCINITAS LAUNCHED A PROGRAM TO ADDRESS THE COMMUNICATION CHALLENGES OF STROKE AND BRAIN INJURY SURVIVORS. BRAINMASTERS IS AN IMPROVISATIONAL SPEAKING GROUP FOR ADULTS COPING WITH ACQUIRED BRAIN INJURY. THIS FUN, SUPPORTIVE AND INTERACTIVE GROUP HELPS BRAIN INJURY PATIENTS IMPROVE COMMUNICATION SKILLS, THINK MORE QUICKLY ON THEIR FEET, AND BUILD SELF-CONFIDENCE IN A FRIENDLY, ENCOURAGING ENVIRONMENT. OFFERED AS A COMMUNITY BENEFIT THROUGH SCRIPPS MEMORIAL HOSPITAL ENCINITAS, BRAINMASTERS IS FREE AND OPEN TO THE COMMUNITY. DUE TO COVID-19 RESTRICTIONS MEETINGS WERE NOT HELD IN FISCAL YEAR 2021. DIABETES DIABETES IS AN IMPORTANT HEALTH NEED BECAUSE OF ITS PREVALENCE, ITS IMPACT ON MORBIDITY AND MORTALITY, AND ITS PREVENTABILITY. AN ANALYSIS OF MORTALITY DATA FOR SAN DIEGO COUNTY FOUND THAT IN 2019 'DIABETES MELLITUS' WAS THE SEVENTH LEADING CAUSE OF DEATH. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF DIABETES IS DESCRIBED BELOW: - THE HASD&IC AND SCRIPPS 2019 CHNA CONTINUED TO IDENTIFY DIABETES AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - ACCORDING TO DATA PRESENTED IN THE HASD&IC 2019 CHNA, RATES OF EMERGENCY DEPARTMENT (ED) VISITS FOR DIABETES IN SAN DIEGO COUNTY 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%). - FOCUS GROUPS AND KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE HASD&IC AND SCRIPPS 2019 CHNAS IDENTIFIED NUMEROUS BARRIERS TO CARE FOR CHRONIC CONDITIONS, SUCH AS DIABETES, INCLUDING LACK OF ACCESS TO HEALTHY FOOD; LACK OF TRANSPORTATION; PHYSICAL LIMITATIONS OR LIMITED MOBILITY; HIGH HEALTH CARE COSTS; ECONOMIC INSECURITY; LOW HEALTH LITERACY; POOR HEALTH BEHAVIORS, SUCH AS UNHEALTHY DIET OR LACK OF PHYSICAL ACTIVITY; POOR MEDICATION MANAGEMENT; UNSAFE NEIGHBORHOODS AND UNSTABLE OR COMPLETE LACK OF HOUSING. - THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) IDENTIFY DIABETES AS THE SEVENTH LEADING CAUSE OF DEATH IN THE U.S., AS WELL AS THE LEADING CAUSE OF KIDNEY FAILURE, NON-TRAUMATIC LOWER LIMB AMPUTATIONS AND NEW CASES OF BLINDNESS AMONG ADULTS. - THERE ARE THREE MAIN TYPES OF DIABETES - TYPE 1, TYPE 2 AND GESTATIONAL DIABETES (DIABETES WHILE PREGNANT). TYPE 2 DIABETES IS THE MOST PREVALENT FROM OF DIABETES WITH ABOUT 90-95% OF THE ESTIMATED 34 MILLION PEOPLE LIVING WITH DIABETES HAVING TYPE 2 DIABETES. THERE ARE ALSO AN ADDITIONAL 88 MILLION AMERICANS WITH PREDIABETES IN THE U.S. - MORE THAN 1 IN 3-HAVE PREDIABETES BUT THE MAJORITY OF PEOPLE DO NOT KNOW THEY HAVE IT. PREDIABETES IS A SERIOUS HEALTH CONDITION WHERE YOUR BLOOD SUGAR LEVELS ARE HIGHER THAN NORMAL, BUT NOT HIGH ENOUGH YET TO BE DIAGNOSED AS TYPE 2 DIABETES.
FORM 990, PART III, LINE 4A (CONTINUED)	- IN THE UNITED STATES, 34.2 MILLION PEOPLE HAVE DIABETES, WHICH IS MORE THAN 10% OF THE POPULATION, ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION. ANOTHER 88 MILLION PEOPLE HAVE PREDIABETES. A 2018 STUDY BY CDC RESEARCHERS ESTIMATED THAT THE NUMBER OF AMERICAN ADULTS DIAGNOSED WITH DIABETES WILL REACH 60.6 MILLION, OR 18% OF THE POPULATION, BY 2060. - DIABETES INCREASES THE RISK OF HEART DISEASE AND STROKE AND CAN LEAD TO OTHER SERIOUS COMPLICATIONS, SUCH AS KIDNEY FAILURE, BLINDNESS, AND AMPUTATION OF A TOE, FOOT, OR LEG. PEOPLE WITH DIABETES SPEND MORE ON HEALTH CARE, HAVE FEWER PRODUCTIVE YEARS, AND MISS MORE WORKDAYS COMPARED TO PEOPLE WHO DO NOT HAVE DIABETES. IN 2017, THE TOTAL ESTIMATED COST OF DIAGNOSED DIABETES WAS $327 BILLION, INCLUDING $237 BILLION IN DIRECT MEDICAL COSTS AND $90 BILLION IN ABSENTEEISM, REDUCED PRODUCTIVITY, AND INABILITY TO WORK. - IN 2019, DIABETES WAS THE SEVENTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. - IN 2019, THERE WERE 760 DEATHS DUE TO DIABETES IN SAN DIEGO COUNTY OVERALL. THE AGE-ADJUSTED DEATH RATE DUE TO DIABETES WAS 20.6 PER 100,000 POPULATION. - IN 2019, THERE WERE 4,854 HOSPITALIZATIONS DUE TO DIABETES IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF HOSPITALIZATION WAS 137.2 PER 100,000 POPULATION. - IN 2019, THERE WERE 5,905 DIABETES-RELATED ED VISITS IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF DIABETES-RELATED ED VISITS WAS 169.1 PER 100,000 POPULATION. - ACCORDING TO 2020 CHIS DATA, 7.3% OF ADULTS LIVING IN SAN DIEGO COUNTY INDICATED THAT THEY HAD EVER BEEN DIAGNOSED WITH DIABETES, WHICH WAS LOWER THAN THE STATE OF CALIFORNIA (10.9%). DIABETES RATES AMONG SENIORS WERE PARTICULARLY HIGH, WITH 19.7% OF SAN DIEGO COUNTY ADULTS OVER 65 REPORTING THAT THEY HAD EVER BEEN DIAGNOSED WITH DIABETES. - ACCORDING TO 2018 CHIS DATA, 17.3% OF SAN DIEGO COUNTY RESIDENTS HAD BEEN TOLD BY THEIR DOCTOR THAT THEY HAVE PRE- OR BORDERLINE DIABETES. - ACCORDING TO A REPORT FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (CDPH) TITLED THE BURDEN OF DIABETES IN CALIFORNIA, THE AGE-ADJUSTED PREVALENCE OF PREDIABETES AMONG CALIFORNIA ADULTS AGES 18 AND OVER WAS 14.9% IN 2017, AND THE AGE-ADJUSTED PREVALENCE OF TYPE 2 DIABETES WAS 8.3% (CDPH, 2019). - DATA PRESENTED BY THE UNITED HEALTH FOUNDATION (UHF) INDICATES THAT, IN 2019, DIABETES PREVALENCE IN CALIFORNIA WAS HIGHEST AMONG INDIVIDUALS OF OTHER RACE (14.8%), FOLLOWED BY NON-HISPANIC BLACK INDIVIDUALS (14.4%), HISPANIC INDIVIDUALS (12.4%) AND MULTIRACIAL INDIVIDUALS (11.0%) (UHF, 2020). - ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), DIABETES IS THE SEVENTH LEADING CAUSE OF DEATH IN THE U.S. IN ADDITION, THE NUMBER OF ADULTS DIAGNOSED WITH DIABETES IN THE U.S. HAS MORE THAN DOUBLED IN THE LAST 20 YEARS AS THE U.S. POPULATION HAS AGED AND BECOME MORE OVERWEIGHT (CDC, 2020). - THE CDC'S 2020 NATIONAL DIABETES STATISTICS REPORT INDICATES THAT 89% OF ADULTS DIAGNOSED WITH DIABETES BETWEEN 2013 AND 2016 WERE OVERWEIGHT OR OBESE, AND 68.4% HAD HIGH BLOOD PRESSURE. FACTORS THAT MAY REDUCE THE RISK OF DIABETES COMPLICATIONS INCLUDE HAVING A USUAL SOURCE FOR DIABETES CARE; MEETING RECOMMENDED PHYSICAL ACTIVITY GOALS; MANAGING OR LOSING WEIGHT; MANAGING A1C LEVELS, BLOOD PRESSURE AND CHOLESTEROL; AND QUITTING SMOKING (CDC, 2020). - THE CDC ESTIMATES THAT 34.2 MILLION PEOPLE IN THE U.S. HAD DIABETES IN 2018. OF THOSE INDIVIDUALS, 21.4% MET LABORATORY CRITERIA FOR DIABETES BUT WERE NOT AWARE THEY HAD THE DISEASE (CDC, 2020). - ACCORDING TO THE CDC, DIABETES INCREASES THE RISK OF HEART DISEASE AND STROKE AND CAN LEAD TO OTHER SERIOUS COMPLICATIONS, SUCH AS KIDNEY FAILURE, BLINDNESS, AND AMPUTATION OF A TOE, FOOT, OR LEG. PEOPLE WITH DIABETES SPEND MORE ON HEALTH CARE, HAVE FEWER PRODUCTIVE YEARS, AND MISS MORE WORKDAYS COMPARED TO PEOPLE WHO DO NOT HAVE DIABETES (CDC, 2020). THERE ARE THREE MAJOR TYPES OF DIABETES: TYPE 1, TYPE 2 AND GESTATIONAL. ALL THREE TYPES SHARE SIMILAR CHARACTERISTICS, THE BODY LOSES THE ABILITY TO EITHER MAKE OR USE INSULIN. WITHOUT ENOUGH INSULIN, GLUCOSE STAYS IN THE BLOOD, CREATING DANGEROUS BLOOD SUGAR LEVELS. OVER TIME, THIS ACCUMULATION DAMAGES KIDNEYS, HEART, NERVES, EYES AND OTHER ORGANS. TYPE 2 DIABETES, ONCE KNOWN AS ADULT ONSET OR NONINSULIN DEPENDENT DIABETES, IS A CHRONIC CONDITION THAT AFFECTS THE WAY YOUR BODY METABOLIZES SUGAR (GLUCOSE), WHICH IS YOUR BODY'S MAIN SOURCE OF FUEL. WITH TYPE 2 DIABETES, YOUR BODY EITHER RESISTS THE EFFECTS OF INSULIN, A HORMONE THAT REGULATES THE MOVEMENT OF SUGAR INTO YOUR CELLS OR DOESN'T PRODUCE ENOUGH INSULIN TO MAINTAIN A NORMAL GLUCOSE LEVEL. IF LEFT UNTREATED, TYPE 2 DIABETES CAN BE LIFE THREATENING. CLINICAL SYMPTOMS CAN INCLUDE FREQUENT URINATION, EXCESSIVE THIRST, EXTREME HUNGER, SUDDEN VISION CHANGES, UNEXPLAINED WEIGHT LOSS, EXTREME FATIGUE, SORES THAT ARE SLOW TO HEAL, AND INCREASED NUMBER OF INFECTIONS. TYPE 2 DIABETES HAS REACHED EPIDEMIC PROPORTIONS, AND PEOPLE OF HISPANIC ORIGIN HAVE DRAMATICALLY HIGHER RATES OF THE DISEASE AND THE COMPLICATIONS THAT GO ALONG WITH ITS POOR MANAGEMENT, INCLUDING CARDIOVASCULAR DISEASE, EYE DISEASE AND LIMB AMPUTATION. IN FACT, IT IS ESTIMATED THAT ONE OUT OF EVERY TWO HISPANIC CHILDREN BORN IN 2000 WILL DEVELOP DIABETES IN ADULTHOOD. THIS IS ESPECIALLY TRUE IN THE SOUTH BAY COMMUNITIES IN SAN DIEGO. SPECIFICALLY, THE CITY OF CHULA VISTA IS HOME TO 26,000 LATINOS WITH DIAGNOSED DIABETES AND TENS OF THOUSANDS MORE WHO ARE UNDIAGNOSED, HAVE PRE- DIABETES AND ARE AT HIGH RISK OF DEVELOPING DIABETES. SOME FACTS ABOUT TYPE 2 DIABETES: - DIABETES IS A MAJOR CAUSE OF HEART DISEASE AND STROKE AND IS THE 7TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND CALIFORNIA. - MORE THAN 1 OUT OF 3 ADULTS HAVE PREDIABETES AND 15 TO 30% OF THOSE WITH PREDIABETES WILL DEVELOP TYPE 2 DIABETES WITHIN 5 YEARS. - NINE OUT OF 10 PEOPLE WITH PREDIABETES DON'T KNOW THEY HAVE IT. SOME RISK FACTORS FOR DEVELOPING DIABETES INCLUDE: - BEING OVERWEIGHT OR OBESE - HAVING A PARENT, BROTHER OR SISTER WITH DIABETES. - SMOKING - HAVING BLOOD PRESSURE MEASURING 140/90 OR HIGHER. - BEING PHYSICALLY INACTIVE, EXERCISING FEWER THAN THREE TIMES A WEEK. - A HISTORY OF GESTATIONAL DIABETES - IF YOU ARE 65 YEARS OF AGE OR OLDER AS INCIDENCES OF NEW DIABETES CASES HAVE BECOME MORE PREVALENT AMONG NON-HISPANIC BLACKS COUPLED WITH EXISTING CASES BEING HIGHEST AMONG AMERICAN INDIAN AND ALASKA NATIVE PEOPLE, IT IS IMPORTANT TO HIGHLIGHT AND ADDRESS HEALTH DISPARITIES IN DIABETES IMPACTING MINORITY POPULATIONS. FACTORS INCLUDING LACK OF ACCESS TO HEALTHCARE, QUALITY OF CARE RECEIVED, AND SOCIOECONOMIC STATUS HAVE DISPROPORTIONATELY AFFECTED RACIAL AND ETHNIC MINORITY POPULATIONS IN BOTH THE PREVALENCE OF THIS DISEASE AND HEALTH OUTCOMES. SCRIPPS HEALTH DIABETES PROGRAMS DIABETES CARE IS DEEPLY EMBEDDED IN THE HISTORY OF SCRIPPS HEALTH. IN 1924, ELLEN BROWNING SCRIPPS FOUNDED THE SCRIPPS METABOLIC CLINIC IN LA JOLLA NEXT DOOR TO THE ORIGINAL SCRIPPS MEMORIAL HOSPITAL. JUST TWO YEARS EARLIER, THE DISCOVERY OF INSULIN HAD SPARKED A REVOLUTION IN THE TREATMENT OF DIABETES, COMMONLY CALLED METABOLIC DISEASE AT THE TIME, WHICH HAD PREVIOUSLY BEEN HOPELESSLY UNTREATABLE AND DEADLY IN MOST CASES. SCRIPPS IS MAKING EVERY EFFORT TO HELP PATIENTS AND OUR COMMUNITIES WITH PREDIABETES REVERSE COURSE AND LEAD HEALTHIER LIVES. SCRIPPS WHITTIER DIABETES INSTITUTE, BY THE NUMBERS IN 2020: - 6,600: PATIENT CONSULTATIONS - 2,839: VISITS MADE BY PROJECT DULCE CARE MANAGERS - 987: VISITS FOR WOMEN ENROLLED IN THE DIABETES IN PREGNANCY PROGRAM - 266: HOSPITALIZED PATIENTS FOLLOWED WITH CONTINUOUS GLUCOSE MONITORING (CGM) INCLUDING 30% WITH COVID-19 - 142: PEOPLE ENROLLED IN THE DIABETES PREVENTION PROGRAM - 17: ACTIVE STUDIES WITH 759 PARTICIPANTS - $4 MILLION: FUNDING AWARDED FOR 6 NEW RESEARCH PROJECTS DURING FISCAL YEAR 2021, SCRIPPS SPONSORED THE FOLLOWING DIABETES MANAGEMENT PROGRAMS AND INITIATIVES: WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA THE WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA SERVES ONE OF SAN DIEGO'S COMMUNITIES HIT HARDEST BY THE DIABETES EPIDEMIC. NEARLY 40 PERCENT OF PATIENTS ADMITTED TO SCRIPPS MEMORIAL HOSPITAL CHULA VISTA, AND NEARLY 32 PERCENT OF PATIENTS IN THE HEART CATHETERIZATION LAB, HAVE DIABETES. COUNTY STATISTICS TELL US THAT THE RATES OF DEATH, HOSPITALIZATIONS AND EMERGENCY ROOM VISITS ARE TWICE AS HIGH IN CHULA VISTA COMPARED TO ALL OF SAN DIEGO COUNTY. THE CENTER HAS ADDED CRITICAL CLASSROOM SPACE TO MEET THE HIGH DEMAND FOR SERVICES AND OFFERS A FULL RANGE OF WELLNESS, PREVENTION, DIABETES EDUCATION, AND NUTRITION SERVICES AND ENDOCRINOLOGY SPECIALTY VISITS IN ENGLISH AND SPANISH. IN RESPONSE TO THE PANDEMIC, VISITS ARE AVAILABLE LIVE OR VIA TELEHEALTH AND ALL GROUP CLASSES WILL CONTINUE BEING OFFERED AS LIVE LONG-DISTANCE VIRTUAL GROUP CLASSES.
FORM 990, PART III, LINE 4A (CONTINUED)	PROJECT DULCE SCRIPPS WHITTIER HAS LED THE WAY IN DEVELOPING COMPREHENSIVE, CULTURALLY SENSITIVE DIABETES CARE MANAGEMENT PROGRAMS TO PROVIDE CARE FOR PEOPLE IN HIGH-RISK, UNDERSERVED COMMUNITIES THROUGH PROJECT DULCE, WHICH USES NURSES, DIETICIANS AND SPECIALLY TRAINED EDUCATORS KNOWN AS "PROMOTORAS" TO COUNSEL DIABETES PATIENTS WHILE EDUCATING THEM TO SUPPORT OTHERS WITH DIABETES WITHIN THEIR OWN CULTURAL GROUPS. DIABETES MANAGEMENT CLASSES HAVE BEEN ADAPTED FOR HISPANIC, AFRICAN AMERICAN, FILIPINO AND VIETNAMESE POPULATIONS, AND ARE TAUGHT IN THE PATIENTS' NATIVE LANGUAGES. THE PROGRAM IS TEAM BASED AND INCORPORATES THE CHRONIC CARE MODEL. RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION ADA AND 1 OF 3 PROGRAMS ENDORSED BY THE CENTERS FOR MEDICAID AND THE AMERICAN DIABETES ASSOCIATION AS A BEST PRACTICE MODEL, PROJECT DULCE HAS BEEN ACTIVE IN COMMUNITIES ACROSS SAN DIEGO FOR THE PAST 26 YEARS. INFORMED BY THE CHRONIC CARE MODEL, PROJECT DULCE'S NURSE-LED MULTI-DISCIPLINARY TEAM PROVIDES CLINICAL MANAGEMENT WHILE PEER EDUCATORS ALSO KNOWN AS PROMOTORAS DELIVER CULTURALLY APPROPRIATE SELF-MANAGEMENT EDUCATION TO ADULTS WITH POORLY CONTROLLED TYPE 2 DIABETES. THIS INNOVATIVE PROGRAM COMBINES STATE OF THE ART CLINICAL DIABETES MANAGEMENT WITH PROVEN EDUCATIONAL AND BEHAVIORAL INTERVENTIONS. ONE OF THE PRIMARY COMPONENTS OF THE PROGRAM IS RECRUITING PEER EDUCATORS FROM THE COMMUNITY TO WORK DIRECTLY WITH PATIENTS. THESE EDUCATORS REFLECT THE DIVERSE POPULATION AFFECTED BY DIABETES AND HELP TEACH OTHERS ABOUT CHANGING EATING HABITS, ADOPTING EXERCISE ROUTINES AND NURTURING THEIR WELLBEING TO MANAGE THIS CHRONIC DISEASE. IN FISCAL YEAR 2021, PROJECT DULCE PROVIDED 2,551 DIABETES CARE AND EDUCATION VISITS FOR LOW INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO. RETINAL SCREENING PROGRAM IT IS ESTIMATED THAT EVERY 24 HOURS, 55 PEOPLE WILL LOSE THEIR VISION BECAUSE OF DIABETIC-RELATED EYE DISEASE (DIABETIC RETINOPATHY) EVEN THOUGH 95 PERCENT OF DIABETIC BLINDNESS COULD BE PREVENTED WITH EARLY DIAGNOSIS AND TREATMENT. FOR MORE THAN A DECADE, SCRIPPS HAS BEEN SCREENING PEOPLE IN UNDERSERVED COMMUNITIES FOR DIABETIC RETINOPATHY USING A MOBILE CAMERA. OUR FREE OR LOW-COST EYE EXAMS DIAGNOSE INDIVIDUALS AT HIGH RISK FOR RETINAL DAMAGE AND HELP PATIENTS GET TREATMENT AND REFERRALS TO SPECIALISTS. DUE TO COVID-19 THE SCREENINGS WERE NOT CONDUCTED DUE TO COVID-19 RESTRICTIONS. DIABETES PREVENTION PROGRAM THE UCLA CENTER FOR HEALTH POLICY AND RESEARCH RECENTLY PUBLISHED DATA THAT REVEALED NEARLY HALF OF CALIFORNIA ADULTS HAVE PREDIABETES OR DIABETES. WHILE THE SCRIPPS WHITTIER DIABETES INSTITUTE HAS BEEN PROVIDING THE BEST CARE FOR PEOPLE WITH DIABETES FOR DECADES, THE INSTITUTE HAS CONTINUED TO EXPAND CARE WITH THE SCRIPPS DIABETES PREVENTION PROGRAM (DPP), WHICH IS A YEAR-LONG INTERVENTION WHERE PEOPLE WITH PREDIABETES MEET WEEKLY FOR 16 WEEKS, THEN MONTHLY THEREAFTER. THE DPP IS AN INTENSIVE LIFESTYLE BEHAVIOR CHANGE INTERVENTION PROGRAM THAT HAS BEEN PROVEN TO PREVENT DIABETES IN LARGE-SCALE NATIONAL STUDIES. SCRIPPS PROGRAM IS PART OF THE NATIONAL DIABETES PREVENTION PROGRAM, LED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE PROGRAM IS CONSIDERED A MEDICARE BENEFIT FOR PREDIABETIC PATIENTS, AND A DOCTOR'S REFERRAL IS NOT REQUIRED. THE DIABETES PREVENTION PROGRAM (DPP) HAS BEEN THOROUGHLY EVALUATED IN NIH SPONSORED RANDOMIZED CONTROLLED TRIALS AND HAS BEEN FOUND TO DECREASE THE NUMBER OF NEW CASES OF DIABETES AMONG THOSE WITH PREDIABETES BY 58%. AMONG PEOPLE OVER AGE 60, THERE WAS A 71% REDUCTION IN NEW CASES. AFTER A BRIEF PAUSE AT THE START OF THE PANDEMIC, SCRIPPS LAUNCHED A VIRTUAL VERSION OF ITS DIABETES PREVENTION PROGRAM IN WHICH SMALL COHORTS MEET ONLINE ONCE A WEEK FOR THE FIRST FOUR MONTHS, THEN TWICE A MONTH. THE STRUCTURED RESEARCH-BASED PROGRAM IS EFFECTIVE AND PROVIDES THE SUPPORT NEEDED TO MAKE HEALTHY HABITS THAT WILL LAST FOR LIFE. SESSIONS FOCUS ON TOPICS SUCH AS DIET AND EXERCISE, MANAGING STRESS AND OVERCOMING BARRIERS. EACH PARTICIPANT IS ALSO PAIRED WITH A LIFESTYLE COACH WHO HELPS THEM SET AND MEET THEIR GOALS. IN FISCAL YEAR 2021, 217 PATIENTS ATTENDED 82 SCRIPPS DPP ORIENTATION SESSIONS. MUCH OF THE EFFORT IS FOCUSED ON THE SOUTH BAY FOR THE LATINO POPULATION, WHICH IS AT HIGHER RISK OF ACQUIRING DIABETES THAN THEIR WHITE COUNTERPARTS. HEALTH RELATED BEHAVIORS HEALTH RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLE'S HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH RELATED BEHAVIORS, SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY, ORAL HEALTH AND INJURY PREVENTION, HAVE BECOME IMPORTANT COMPONENTS OF LONG-TERM LIFE. THE RISK FACTORS FOR MANY CHRONIC DISEASES ARE WELL KNOWN. IN PARTICULAR, AN UNHEALTHY DIET, PHYSICAL INACTIVITY AND SUBSTANCE USE HAVE BEEN CITED BY THE WORLD HEALTH ORGANIZATION (http://www.who.int/chp) AS IMPORTANT HEALTH BEHAVIORS THAT CONTRIBUTE TO ILLNESSES SUCH AS CARDIOVASCULAR DISEASE, CANCER, CHRONIC RESPIRATORY DISEASE, DIABETES, AND OTHERS INCLUDING MENTAL DISORDERS AND ORAL DISEASES. - THE HASD&IC AND SCRIPPS 2019 CHNA IDENTIFIED TEN TOP HEALTH AND SOCIAL NEEDS IN SAN DIEGO COUNTY. THESE TEN SOCIAL DETERMINANTS ARE: ACCESS TO CARE, COMMUNITY AND SOCIAL SUPPORT, ECONOMIC SECURITY, EDUCATION, HOMELESSNESS AND HOUSING INSTABILITY, UNINTENTIONAL INJURY AND VIOLENCE, AGING CONCERNS, BEHAVIORAL HEALTH, CANCER AND CHRONIC CONDITIONS. - KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE HASD&IC 2019 CHNA SUGGESTED SEVERAL HEALTH IMPROVEMENT STRATEGIES TO ADDRESS THE HEALTH ISSUES IDENTIFIED FOR SAN DIEGO COUNTY. THESE STRATEGIES INCLUDE BEHAVIORAL HEALTH PREVENTION AND STIGMA REDUCTION; EDUCATION ON DISEASE MANAGEMENT AND FOOD INSECURITY; INTEGRATING PHYSICAL AND MENTAL HEALTH CARE; BETTER COORDINATION OF CARE; GREATER CULTURAL COMPETENCE AND DIVERSITY; AND ENGAGEMENT OF PATIENT NAVIGATORS AND CASE MANAGERS IN THE COMMUNITY. - ACCORDING TO 2020 CHIS DATA, 23.2% OF SAN DIEGO COUNTY RESIDENTS HAD EVER BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE, WHILE 7.8% HAD BORDERLINE HIGH BLOOD PRESSURE. IN ADDITION, 24.3% OF SAN DIEGO COUNTY ADULTS REPORTED BEING OBESE. - IN 2018, 17.7% OF SAN DIEGO COUNTY ADULTS REPORTED THAT FRESH FRUITS AND VEGETABLES WERE ONLY SOMETIMES AVAILABLE IN THEIR NEIGHBORHOOD (CHIS, 2018). - IN CALIFORNIA, THE SELF-REPORTED OBESITY RATE IN 2020 WAS 30.3%. PREVALENCE OF OBESITY DECREASED AS EDUCATION LEVELS INCREASED, HIGHLIGHTING THE NEED FOR HEALTH EDUCATION AS A TOOL FOR REDUCING OBESITY RATES (CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), 2021). - ACCORDING TO THE CDC, SOME OF THE LEADING CAUSES OF PREVENTABLE DEATH INCLUDE OBESITY-RELATED CONDITIONS, SUCH AS HEART DISEASE, STROKE, TYPE 2 DIABETES AND SOME TYPES OF CANCER (CDC, 2021). - THE HHSA'S LIVE WELL SAN DIEGO (LWSD) 3-4-50 INITIATIVE IDENTIFIED THREE BEHAVIORS (POOR DIET, PHYSICAL INACTIVITY AND TOBACCO USE) THAT CONTRIBUTE TO FOUR CHRONIC CONDITIONS (CANCER, HEART DISEASE/STROKE, TYPE 2 DIABETES AND PULMONARY DISEASES), WHICH RESULT IN MORE THAN 50 PERCENT OF DEATHS WORLDWIDE. IN 2019, 50 PERCENT OF ALL DEATHS IN SAN DIEGO COUNTY WERE ATTRIBUTED TO 3-4-50 CONDITIONS. - ACCORDING TO THE NIH NATIONAL LIBRARY OF MEDICINE (NNLM), NEARLY 9 OUT OF 10 U.S. ADULTS STRUGGLE WITH HEALTH LITERACY, WHICH INVOLVES THE INFORMATION AND SERVICES THAT PEOPLE NEED TO MAKE WELL-INFORMED HEALTH DECISIONS. LIMITED HEALTH LITERACY IS ASSOCIATED WITH POOR HEALTH OUTCOMES, INCLUDING HOSPITAL STAYS AND ED VISITS; MEDICATION ERRORS; DIFFICULTY MANAGING CHRONIC DISEASES; AND SKIPPING PREVENTIVE SERVICES, SUCH AS FLU VACCINES (NNLM, 2021). UNDERSTANDING THAT PERSONAL BEHAVIORS PLAY A SIGNIFICANT ROLE IN AN INDIVIDUAL'S OVERALL HEALTH STATUS, SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS THAT HELP PEOPLE TAKE CHARGE OF THEIR OWN, AND THEIR FAMILIES,' HEALTH. DURING FISCAL YEAR 2021, SCRIPPS SPONSORED SEVERAL HEALTH BEHAVIOR MODIFICATION EFFORTS: COMMUNITY BASED HEALTH IMPROVEMENT ACTIVITIES COMMUNITY MEMBERS PARTICIPATED IN A VARIETY OF CLASSES, PREVENTION LECTURES AND SUPPORT GROUPS. APPROXIMATELY 1,000 ATTENDED THESE PROGRAMS HELD AT THE CHULA VISTA WELL BEING CENTER. THIS YEAR'S NUMBERS CONTINUED TO BE IMPACTED DUE TO THE COVID-19 PANDEMIC. IN PERSON SUPPORT GROUPS, CLASSES, ACTIVITIES CEASED MID-MARCH 2020. MANY IN-PERSON ACTIVITIES HAVE NOT BEEN ABLE TO RECONVENE DUE TO THE LARGE GROUP RESTRICTIONS AND/OR BEING A VULNERABLE POPULATION DUE TO AGE AND/OR HEALTH CONDITION. A FEW GROUPS HAVE BEEN ABLE TO TRANSITION TO A CONFERENCE CALL OR VIRTUAL PLATFORM TO CONTINUE MEETING.
FORM 990, PART III, LINE 4A (CONTINUED)	HELPING PATIENTS NAVIGATE POST DISCHARGE SERVICES HELPING PATIENTS NAVIGATE POST DISCHARGE SERVICES ARE OFFERED BY SCRIPPS MERCY HOSPITAL WELL BEING CENTER TO PATIENTS AND THEIR FAMILY TO DECREASE THE RISKS OF READMISSION, KEEP PATIENTS ON A HEALTHY PATHWAY AND TO INCREASE PATIENT CONTINUITY. SERVICES AND ASSISTANCE ARE PROVIDED FOR 30 DAYS POST DISCHARGE AND UP TO ONE YEAR FOR ANY SOCIAL WORK OR NURSE CASE MANAGER REFERRAL AND/OR PATIENTS WITH THE FOLLOWING CONDITIONS: ACUTE MYOCARDIAL INFARCTION (AMI), CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), CHRONIC HEART FAILURE (CHF), PNEUMONIA, CORONARY ARTERY BYPASS GRAFTING (CABG), TOTAL KNEE OR HIP REPLACEMENT, AND COVID-19. COMMUNITY PATIENT POST DISCHARGE SERVICES INCLUDE HOME VISITS, ASSISTANCE WITH FOLLOW UP PHYSICIAN VISITS, PHONE CALLS, PROVIDING COMMUNITY AND SOCIAL SERVICE RESOURCES, AND APPLICATION ASSISTANCE (MEDICAL INSURANCE, SDI, HOUSING, SNAP, MAMA'S KITCHEN), AND A REFERRAL AND/OR APPOINTMENT TO A LOCAL COMMUNITY CLINIC OR THE SCRIPPS ADVANCED CARE CLINIC. THESE SERVICES ARE CURRENTLY ONLY AVAILABLE AT SCRIPPS MERCY HOSPITAL CHULA VISTA AND SAN DIEGO. THE FOLLOWING ARE METRICS TRACKED BY THE PROGRAM: - 813 PATIENT REFERRALS WERE RECEIVED (30 DAY AND SOCIAL WORK) - 716 PATIENTS WERE CONTACTED/REACHED (THIS INCLUDES 30-DAY FOLLOW UP AND SOCIAL WORK REFERRAL PATIENTS) - 97 PATIENTS - UNABLE TO REACH, DECEASED, DECLINED FOLLOW-UP SERVICES, LANGUAGE BARRIER - 70 PATIENTS WERE READMITTED (SOURCE: CAREGIVER, EPIC) COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) SCRIPPS IS A PARTNER WITH CHIP AND COLLABORATIVELY WORKS ON A RESIDENT LEADERSHIP MODEL THAT HAS EMPOWERED 700+ CITIZENS ACROSS THE COUNTY (AND BEYOND) TO AFFECT CHANGE IN A WIDE RANGE OF COMMUNITY HEALTH AREAS SUCH AS PUBLIC SAFETY, ACCESS TO HEALTHY FOODS, AND INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. IN ADDITION, SCRIPPS IS A MEMBER OF THE CHIP PUBLIC POLICY COMMITTEE. THE AIM OF THE PUBLIC POLICY COMMITTEE IS TO OUT ACTION TO FIVE PRIORITY ISSUES: ACCESS TO HEALTHCARE, SOCIAL DETERMINANTS OF HEALTH, OBESITY, MENTAL/BEHAVIORAL HEALTH AND VIOLENCE AND INJURY PREVENTION. OVERARCHING POLICY STATEMENTS ON ACCESS TO HEALTHCARE AND SOCIAL DETERMINANTS OF HEALTH GUIDE CHIP EFFORTS OVERALL, AS WELL AS CHIP ACTIVITIES ADDRESSING OBESITY, MENTAL/BEHAVIORAL HEALTH AND VIOLENCE AND INJURY PREVENTION. HEALTH EDUCATION AND SUPPORT GROUPS SCRIPPS EDUCATION AND SUPPORT GROUPS ARE PROVIDED TO SAN DIEGO COUNTY RESIDENTS FOR A WIDE VARIETY OF HEALTH CONCERNS. TOPICS INCLUDE, FALL PREVENTION, STROKE AWARENESS, BLADDER AND PELVIC FLOOR WELLNESS, POSTPARTUM ISSUES, AND GYNECOLOGICAL CANCER. DUE TO COVID-19 ALL EDUCATION AND SUPPORT GROUPS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. OPIOID STEWARDSHIP PROGRAM (OSP) AND BRIDGE PROGRAM OPIOIDS ARE NOT BENIGN THERAPY AND OPIOID DEPENDENCE IS OFTEN A HEALTH CARE-ACQUIRED CONDITION. A RECENT JAMA STUDY CONCLUDED THAT 6% OF OPIOID-NAVE PATIENTS WHO RECEIVE OPIOIDS FOLLOWING SURGERY, EVEN MINOR SURGERIES, ARE STILL USING OPIOIDS 90 DAYS LATER. ALTHOUGH OPIOIDS REMAIN AN INTEGRAL PART OF ACUTE POST-OPERATIVE PAIN MANAGEMENT, THE DATA DEMONSTRATES RISK FOR CREATING LONG-TERM DEPENDENCE. - THE U.S. USES 80% OF THE WORLD'S OPIOID SUPPLY DESPITE HAVING ONLY 5% OF THE POPULATION. - THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) ATTRIBUTES 90 DEATHS PER DAY TO OPIOID OVERDOSES. - THE ECONOMIC COST TO U.S. SOCIETY OF NONMEDICAL USE OF PRESCRIPTION OPIOIDS HAS BEEN ESTIMATED TO EXCEED $70 BILLION ANNUALLY, INCLUDING HEALTH CARE, WORKPLACE, AND CRIMINAL JUSTICE COSTS. IN 2019, THERE WERE 927 ED VISITS (27.7 PER 100,000 POPULATION) AND 483 HOSPITALIZATIONS (14.4 PER 100,000) RELATED TO OPIOID MISUSE IN SAN DIEGO COUNTY. PERCENT CHANGE FROM 2017 TO 2019 IS 22.1% FOR ED VISITS AND -21.3% FOR HOSPITALIZATION. MALES ARE 1.8 TIMES MORE LIKELY TO VISIT THE ED FOR OPIOID MISUSE THAN FEMALES AND 2.0 TIMES MORE LIKELY TO BE HOSPITALIZED FOR OPIOID MISUSE THAN FEMALES IN 2019. FOR RACE/ETHNICITY, NON-HISPANIC BLACK HAS THE HIGHEST RATE FOR ED VISITS (43.0 PER 100,000), FOLLOWED BY NON-HISPANIC WHITE (35.9 PER 100,000). FOR AGE GROUPS, 27-44 HAD THE HIGHEST ED VISITS FOR OPIOID MISUSE (57.2 PER 100,000), FOLLOWED BY 18-26 YEARS OLD (41.9 PER 100,000). CALIFORNIA HOSPITAL COMPARE (CHC), A NONPROFIT ORGANIZATION THAT PROVIDES CALIFORNIANS WITH HOSPITAL PERFORMANCE RATINGS, NAMED ALL FOUR OF SCRIPPS HEALTH'S HOSPITALS TO ITS 2020 OPIOID CARE HONOR ROLL. SCRIPPS IS THE ONLY HEALTH CARE ORGANIZATION IN SAN DIEGO COUNTY TO BE RECOGNIZED ON THE INAUGURAL STATEWIDE LIST. THE 2020 OPIOID CARE HONOR ROLL RECOGNIZES 53 CALIFORNIA HOSPITALS FOR THEIR PROGRESS AND PERFORMANCE IN PROMOTING SAFE AND EFFECTIVE OPIOID USE, PROVIDING TREATMENT FOR PATIENTS WITH OPIOID USE DISORDER AND PROVIDING ACCESS TO NALOXONE TO PREVENT OPIOID OVERDOSES. ACCORDING TO PRELIMINARY STATE DATA, 5,363 CALIFORNIANS HAVE DIED OF AN OPIOID-RELATED OVERDOSE IN 2020. CHC RECOGNIZED SCRIPPS FOR TAKING A VARIETY OF APPROACHES TO ADDRESS OVERUSE OF OPIOIDS AMONG ITS PATIENTS. FOR PATIENTS BEING DISCHARGED FROM AN EMERGENCY DEPARTMENT VISIT OR HOSPITAL STAY, SCRIPPS HAS CREATED EDUCATIONAL VIDEOS THAT IT MAKES AVAILABLE FOR VIEWING AND HAS ALSO SET OPIOID PRESCRIPTION QUANTITY LIMITS AT DISCHARGE. IN ADDITION, SOME SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS HAVE IMPLEMENTED MEDICATION-ASSISTED THERAPY, IN WHICH SPECIALLY LICENSED ER PHYSICIANS CAN ADMINISTER MEDICATIONS AS A BRIDGE FOR PATIENTS WITH OPIOID USE DISORDER UNTIL THEY CAN RECEIVE FURTHER CARE. THE OPIOID STEWARDSHIP PROGRAM (OSP) AT SCRIPPS IS COMBATTING THIS NATIONAL EPIDEMIC BY WORKING WITH PHYSICIANS TO DECREASE THE NUMBER OF OPIOIDS PRESCRIBED TO PATIENTS AND EDUCATING PATIENTS ON PAIN MANAGEMENT. THE PROGRAM HAS ESTABLISHED PRESCRIBING STANDARDS FOR OPIOIDS, RESULTING IN A REDUCTION IN THE NUMBER OF OPIOID PILLS PER PRESCRIPTION AT SCRIPPS HOSPITALS AND OUTPATIENT CENTERS. IN ADDITION, SCRIPPS ALSO HAS OPENED THREE DRUG TAKE-BACK KIOSKS AT ITS ON-SITE PHARMACIES, OFFERING PATIENTS YEAR-ROUND ACCESS TO DISPOSE OF UNUSED, UNNEEDED, OR OUTDATED MEDICATIONS. THE DATA BELOW SHOWS NATIONAL AND STATE TRENDS AND HOW THEY COMPARE TO SCRIPPS. THE METRICS ALSO SHOW DATA FOR CO-PRESCRIBING OPIOIDS WITH BENZODIAZEPINES. ACCORDING TO THE CDC'S CHRONIC PAIN GUIDELINES, CLINICIANS SHOULD AVOID PRESCRIBING OPIOID PAIN MEDICATION AND BENZODIAZEPINES CONCURRENTLY WHENEVER POSSIBLE, AS BOTH CAUSE CENTRAL NERVOUS SYSTEM DEPRESSION AND CAN DECREASE RESPIRATORY DRIVE. CONCURRENT USE HAS ALSO SHOWN SIGNIFICANTLY INCREASED (UP TO FOUR TIMES) RISKS FOR OVERDOSE DEATH COMPARED WITH OPIOID PRESCRIPTION ALONE. SCRIPPS IS MONITORING THIS METRIC TO DECREASE OPIOID-BENZO CO-PRESCRIBING. OPIOID PRESCRIBING, COMPARING 2018 TO 2019 (LAST YEAR OF AVAILABLE NATIONAL DATA): - NATIONAL - 10% REDUCTION - CALIFORNIA - NO REDUCTION - SCRIPPS CLINIC - 10.4% REDUCTION (DATA INCLUDES ONCOLOGY AND HIGH-RISK SURGERIES) - SCRIPPS COASTAL - 26.5% REDUCTION OPIOID PRESCRIBING AT SCRIPPS CLINIC, COMPARING 2018 TO 2020: - 25% REDUCTION IN OPIOID PRESCRIBING - 25% REDUCTION IN OPIOID CO-PRESCRIBING WITH BENZODIAZEPINES OPIOID PRESCRIBING AT SCRIPPS COASTAL, COMPARING 2018 TO 2020: - 39% REDUCTION IN OPIOID PRESCRIBING - 42% REDUCTION ON OPIOID CO-PRESCRIBING WITH BENZODIAZEPINES CALIFORNIA BRIDGE PROGRAM SCRIPPS HAS RECEIVED STATE GRANTS AT EACH OF ITS SCRIPPS HOSPITALS FROM THE CALIFORNIA BRIDGE PROGRAM AND THE CENTER AT SIERRA HEALTH FOUNDATION TO REMOVE BARRIERS TO IDENTIFYING AND TREATING PATIENTS WITH OPIOID USE DISORDER AND PROVIDE MEDICATION-ASSISTED TREATMENT (MAT). COMBINED WITH OTHER RECENT GRANTS FOR SCRIPPS OPIOID STEWARDSHIP PROGRAM, SCRIPPS HAS BEEN AWARDED ALMOST $1 MILLION TO HELP PREVENT AND TREAT OPIOID ADDICTION. SCRIPPS ACTIVELY PROMOTES MAT ACCESS FOR PATIENTS IN THE FORM OF BUPRENORPHINE. THE BRIDGE PROGRAM AIMS TO HELP HOSPITALS AND HEALTH CENTERS EXPAND PATIENT ACCESS TO TREATMENT FOR OPIOID USE DISORDER, INCLUDING ON-THE-SPOT MEDICAL TREATMENT AND COORDINATED OUTPATIENT CARE, WHILE MAT AIMS TO REDUCE THE STIGMA OF OPIOID ADDICTION AND INCREASE PROVIDER SUPPORT FOR MEDICATION ASSISTANCE IN TREATING ADDICTION. ALL TOGETHER, THESE STATE PROGRAMS HAVE AWARDED SCRIPPS $935,000.
FORM 990, PART III, LINE 4A (CONTINUED)	AS PART OF THE GRANT, SCRIPPS NOW HAS BRIDGE COUNSELORS TO HELP PATIENTS WITH OPIOID ADDICTION. BRIDGE COUNSELORS ARE CERTIFIED THROUGH THE CALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS (CAPP) OR THE CALIFORNIA ASSOCIATION FOR DRUG/ALCOHOL EDUCATORS. THEY MEET PATIENTS IN THE EMERGENCY DEPARTMENT AND OTHER INPATIENT AREAS OF BOTH SCRIPPS MERCY CAMPUSES TO PROVIDE RAPID EVIDENCE-BASED MEDICATION-ASSISTED TREATMENT. THEY ALSO CONNECT PATIENTS DIRECTLY TO CONTINUED TREATMENT IN THE COMMUNITY. THE CALIFORNIA BRIDGE GRANT ALSO ENABLED SCRIPPS TO HIRE SUBSTANCE USE DISORDER SERVICE NURSES (SUDS) TO FACILITATE TREATMENT AND ENTRY INTO A COMMUNITY-BASED MAT PROGRAM. SCRIPPS DEPLOYS SPECIALIZED NURSES CERTIFIED IN ADDICTION TO SEE PATIENTS AT THEIR BEDSIDE AND WORK CLOSELY WITH THE PATIENT'S ENTIRE HEALTH CARE TEAM IN FACILITATING SAFE DETOX TREATMENT WHILE HOSPITALIZED. THEY IDENTIFY PATIENTS WHO ARE AT RISK OR ARE CURRENTLY EXPERIENCING WITHDRAWAL FROM ALCOHOL AND OTHER ADDICTIVE SUBSTANCES. SUDS NURSES EVALUATE PATIENTS WHO MEET CERTAIN CRITERIA AND WORK DIRECTLY WITH THE NURSE AND PHYSICIAN TO ENSURE THE PATIENT IS ADEQUATELY MEDICATED TO CONTROL SYMPTOMS OF WITHDRAWAL. SUDS NURSES AT SCRIPPS FUNCTION IN A PROACTIVE AND REACTIVE ROLE AT ALL SCRIPPS HOSPITALS AND COLLABORATE WITH COMMUNITY RESOURCES, INCLUDING FAMILY HEALTH CENTERS OF SAN DIEGO TO PROVIDE MAT, MCALISTER INSTITUTE FOR DETOX BEDS AND THE BETTY FORD CENTER FOR OUTPATIENT CARE. SPONDYLITIS ASSOCIATION SCRIPPS HEALTH PROVIDES MEETING SPACE TO THE SPONDYLITIS ASSOCIATION OF AMERICA (SAA). THIS IS A NON-PROFIT ORGANIZATION FOUNDED IN 1983 TO ADDRESS THE NEEDS OF PEOPLE AFFECTED BY SPONDYLARTHRITIS. SINCE THAT TIME, SAA HAS BEEN AT THE FOREFRONT OF THE FIGHT TO PROMOTE MEDICAL RESEARCH, EDUCATE BOTH THE MEDICAL COMMUNITY AND GENERAL PUBLIC AND ADVOCATE ON BEHALF OF THE PEOPLE THEY SERVE. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. LIVE WELL SAN DIEGO VIRTUAL 5K AND FITNESS CHALLENGE SCRIPPS HEALTH JOINED LIVE WELL SAN DIEGO AS A RECOGNIZED PARTNER ON DECEMBER 13, 2016. LIVE WELL SAN DIEGO IS A VISION FOR A REGION THAT IS BUILDING BETTER HEALTH, LIVING SAFELY AND THRIVING. IT ALIGNS THE EFFORTS OF INDIVIDUALS, ORGANIZATIONS, AND GOVERNMENT TO HELP ALL 3.3 MILLION SAN DIEGO COUNTY RESIDENTS LIVE WELL. THE LIVE WELL SAN DIEGO 5K WAS NOT HELD IN 2021. EXERCISE PROGRAMS AT SCRIPPS SHILEY PAVILION SCRIPPS PROVIDES VIRTUAL COMMUNITY EXERCISE CLASSES TO HELP MOTIVATE AND IMPROVE THE OVERALL WELL-BEING OF OUR COMMUNITY. CLASSES ARE DESIGNED TO ENHANCE THE PHYSICAL WELL-BEING OF THE PARTICIPANTS FROM THE COMFORT OF THEIR HOME WHILE KEEPING THE SENSE OF COMMUNITY BY EXERCISING TOGETHER WITHIN ITS VIRTUAL PLATFORM. AGING CONCERNS ACROSS THE UNITED STATES AND LOCALLY IN SAN DIEGO COUNTY, THE GROWTH IN THE NUMBER AND PROPORTION OF AGING ADULTS OVER THE AGE OF 65 HAS HIT NEW AND UNPRECEDENTED LEVELS IN OUT HISTORY. ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), TWO MAIN FACTORS - LONGER LIFE SPANS AND AGING BOOMERS - WILL "COMBINE TO DOUBLE THE POPULATION OF AMERICANS AGED 65 OR OLDER DURING THE NEXT 25 YEARS TO ABOUT 72 MILLION. BY 2030, OLDER ADULTS WILL ACCOUNT FOR ROUGHLY 20% OF THE U.S. POPULATION." SAN DIEGO IS NOW HOME TO HALF A MILLION PEOPLE OVER AGE 65. THAT NUMBER IS EXPECTED TO REACH 1 MILLION BY 2030, IN ALIGNMENT WITH STATE TRENDS SHOWING AN AGING POPULATION DOUBLING WITHIN THAT TIME. IN 2019, THERE WERE 504,267 RESIDENTS AGES 65 AND OLDER IN SAN DIEGO COUNTY REPRESENTING 14.5% OF THE POPULATION. BETWEEN 2019 AND 2024, IT IS ANTICIPATED THAT SAN DIEGO COUNTY SENIOR POPULATION WILL GROW BY 22.4%. AGING CONCERNS ARE DEFINED AS THOSE CONDITIONS THAT PREDOMINANTLY AFFECT SENIOR PEOPLE WHO ARE 65 AND OLDER SUCH AS ALZHEIMER'S DISEASE, PARKINSON'S, DEMENTIA, FALLS AND LIMITED MOBILITY. ACCORDING TO THE NATIONAL COUNCIL ON AGING (WWW.NCOA.ORG), FALLS ARE THE LEADING CAUSE OF FATAL AND NONFATAL INJURIES FOR OLDER AMERICANS. THIRTY PERCENT OF US ADULTS AGED SIXTY-FIVE AND OLDER HAVE FALLEN AT LEAST ONCE IN THE PAST YEAR, INCLUDING 4.2% WHO FELL THREE OR MORE TIMES. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF AGING CONDITIONS ARE DESCRIBED BELOW: - THE 2019 HASD&IC AND SCRIPPS CHNA IDENTIFIED AGING CONCERNS AS ONE OF THE TOP HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS. - THE 2019 HASD&IC AND SCRIPPS CHNA IDENTIFIED PHYSICAL AND NON-PHYSICAL BARRIERS TO CARE. SENIORS ACCESSING HEALTH CARE CAN BE PARTICULARLY DIFFICULT. WHEN SENIORS CAN NO LONGER DRIVE, FINDING RELIABLE, AFFORDABLE TRANSPORTATION CAN BE CHALLENGING. SENIORS MOST OFTEN HAVE LIMITED INCOME AND ARE CONSTANTLY SHIFTING THEIR FINANCIAL PRIORITIES BETWEEN PAYING FOR HOUSING, FOOD, OR COSTS ASSOCIATED WITH SEEKING HEALTH CARE. HIGH COST OF MEDICATIONS, CO-PAYS AND DEDUCTIBLES WERE CITED AS CREATING FINANCIAL BARRIERS TO ACCESSING HEALTH CARE. PHYSICAL BARRIERS TO CARE, SUCH AS LIMITED MOBILITY, HEARING OR VISION ISSUES MAY ALSO CREATE CHALLENGES FOR SENIORS NEEDING ADDITIONAL ASSISTANCE. FOR THOSE WHO DO NOT SPEAK ENGLISH AS A FIRST LANGUAGE, LANGUAGE CAN ALSO BE A BARRIER TO ACCESSING CARE. AFTER DISCHARGE FROM A HOSPITAL STAY, SENIORS MAY HAVE INADEQUATE SUPPORT AT HOME TO RECOVER WELL AND FOLLOW-UP CARE IS HARD FOR SENIORS TO LOCATE AND SECURE. THESE NEEDS IDENTIFIED BY THE COMMUNITY OVERALL SPOKE TO THE OVERWHELMING NEED TO INCREASE AWARENESS OF COMMUNITY AND SOCIAL SUPPORT PROGRAMS AND SERVICES FOR THIS PARTICULARLY VULNERABLE GROUP. - PER THE 2019 CHNA, CONDITIONS THAT DISPROPORTIONALLY AFFECT OLDER ADULTS WERE IDENTIFIED AS A HIGH PRIORITY HEALTH NEED THROUGH BOTH COMMUNITY ENGAGEMENT EVENTS AND THE SECONDARY ANALYSES. COMMUNITY ENGAGEMENT PARTICIPANTS MOST OFTEN DESCRIBED AGING CONCERNS IN RELATION TO THE SDOH THAT AFFECT SENIORS SUCH AS: - ACCESS TO FRESH FOOD - ECONOMIC INSECURITY (ESPECIALLY FOOD INSECURITY AND HOUSING UNAFFORDABILITY) - SOCIAL ISOLATION AND INADEQUATE FAMILY SUPPORT (LACK OF COMPANIONSHIP, ANXIETY, DEPRESSION, HOPELESSNESS. INADEQUATE FAMILY SUPPORT OR SUPPORT AT HOME TO RECOVER, MAINTAIN ONE'S HEALTH, OR MANAGE THEIR MEDICATIONS INCLUDING ORDERING REFILLS, PICKING UP PRESCRIPTIONS, AND TAKING THE RIGHT DOSE OF MEDICATIONS AT THE RIGHT TIME, CAN BE CHALLENGING FOR OLDER ADULTS WHO DO NOT HAVE ADEQUATE SUPPORT). - TRANSPORTATION (LACK OF ACCESSIBLE OR RELIABLE TRANSPORTATION OPTIONS TO AND FROM APPOINTMENTS, TO GO GROCERY SHOPPING, OR JUST SOCIALIZE WITH OTHERS) - IN 2019, ALZHEIMER'S DISEASE WAS THE FOURTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY FOR ALL AGE GROUPS. DEMENTIA IS A CLINICAL SYNDROME OF THE DECLINE IN MEMORY AND OTHER THINKING ABILITIES. IT IS CAUSED BY VARIOUS DISEASES AND CONDITIONS THAT RESULT IN DAMAGE TO BRAIN CELLS AND LEAD TO DISTINCT SYMPTOM PATTERNS AND DISTINGUISHING BRAIN ABNORMALITIES. ALZHEIMER'S DISEASE (AD) IS A PROGRESSIVE BRAIN DISORDER THAT GRADUALLY DESTROYS A PERSON'S MEMORY AND ABILITY TO LEARN, REASON, MAKE JUDGEMENTS, COMMUNICATE, AND CARRY OUT DAILY ACTIVITIES SUCH AS BATHING AND EATING. AN ESTIMATED 84,405 ADULTS AGED FIFTY-FIVE AND OLDER ARE LIVING WITH SOME FORM OF DEMENTIA AND THIS NUMBER IS PROJECTED TO INCREASE TO MORE THAN 115,000 BY 2030. ALZHEIMER'S DISEASE IS THE MOST EXPENSIVE DISEASE IN THE NATION, WITH ASSOCIATED COSTS HIGHER THAN THOSE OF BOTH CANCER AND HEART DISEASE. RESEARCHERS ESTIMATE THAT BETWEEN INFORMAL CAREGIVING, OUT-OF-POCKET COSTS, AND MEDICAID AND MEDICARE EXPENDITURES, THE LIFETIME COST FOR A PERSON LIVING WITH DEMENTIA IS OVER $320,000. - IN 2019, THE TOP LEADING CAUSES OF DEATH AMONG ADULTS AGES 65 AND OLDER IN SAN DIEGO COUNTY WERE (IN RANK ORDER): DISEASES OF THE HEART, CANCER, ALZHEIMER'S DISEASE, CEREBROVASCULAR DISEASES (INCLUDING STROKE), CHRONIC LOWER RESPIRATORY DISEASES, DIABETES, ACCIDENTS/UNINTENTIONAL INJURIES, ESSENTIAL HYPERTENSION AND HYPERTENSIVE RENAL DISEASE, PARKINSON'S DISEASE, AND INFLUENZA OR PNEUMONIA. - IN 2019, HOSPITALIZATION RATES AMONG SENIORS WERE HIGHER THAN THE GENERAL POPULATION DUE TO CORONARY HEART DISEASE, STROKE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, NONFATAL UNINTENTIONAL INJURIES (INCLUDING FALLS), CANCER AND ARTHRITIS. - THE TOP THREE CAUSES OF ED UTILIZATION AMONG SAN DIEGO COUNTY RESIDENTS AGES 65 AND OLDER IN 2019 WERE UNINTENTIONAL INJURIES, FALLS AND OVERALL HEART DISEASE. - ACCORDING TO THE CDC, THREE 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. IN 2015, THE DIRECT MEDICAL COSTS ASSOCIATED WITH FALL INJURIES TOTALED MORE THAN $50 BILLION (CDC, 2019).
FORM 990, PART III, LINE 4A (CONTINUED)	OLDER ADULTS EXPERIENCING HOMELESSNESS THE PREVALENCE OF OLDER ADULTS EXPERIENCING HOMELESSNESS REPRESENTS AN ONGOING SIGNIFICANT CONCERN. SAN DIEGO IS NOW THE NINTH MOST EXPENSIVE CITY IN THE U.S. (2019). THE ELDER INDEX, DEVELOPED BY UCLA'S CENTER FOR HEALTH POLICY RESEARCH, REPORTS 41% OF SAN DIEGO'S SENIORS DO NOT HAVE ENOUGH INCOME TO PAY FOR BASIC HOUSING, FOOD, HEALTHCARE, AND TRANSPORTATION. MEANWHILE, GOVERNMENT HOUSING PROGRAMS ARE EXPERIENCING EXTREME WAITING LISTS AND INTAKE TOOLS FAIL TO PRIORITIZE THE ELDERLY. THESE FACTORS, COMBINED WITH SAN DIEGO'S HOUSING CRISIS, ARE INTENSIFYING SENIOR HOMELESSNESS, AS EVIDENCED BY SAN DIEGO'S MOST RECENT 2020 POINT IN TIME COUNT. NATIONAL REPORTS CONFIRM THE NUMBER OF HOMELESS OLDER ADULTS (55 AND OVER) IS PROJECTED TO GROW FROM 170,000 IN 2017 TO 225,000 BY 2026, WITH THE FASTEST GROWTH AMONG THOSE 65 AND OVER. THE NUMBER OF NEWLY HOMELESS IN SAN DIEGO DOUBLED IN 2020. ACCORDING TO SAN DIEGO'S 2020 POINT IN TIME COUNT, ONE OUT OF FOUR OF SAN DIEGO'S HOMELESS ADULTS IS OVER THE AGE OF 55. AMONG THIS GROUP OF UNSHELTERED SENIORS, 88% BECAME HOMELESS IN SAN DIEGO COUNTY AND 43% ARE EXPERIENCING HOMELESSNESS FOR THE FIRST TIME IN THEIR LIVES. ADDITIONALLY, 12% OF THOSE 55 OR OLDER ARE CHRONOLOGICALLY HOMELESS AND UNSHELTERED, AND NEARLY 1 IN 4 WERE FEMALE, WITHIN THIS GROUP OF OLDER ADULTS: - 88% OF SENIORS BECAME HOMELESS IN SAN DIEGO - 43% ARE EXPERIENCING HOMELESSNESS FOR THE FIRST TIME - 54% ARE SLEEPING ON THE STREET OR SIDEWALK - 50% ARE MANAGING A CHRONIC CONDITION - 55% REPORTED A PHYSICAL DISABILITY DURING FISCAL YEAR 2021, SCRIPPS ENGAGED IN THE FOLLOWING PROGRAMS AND SERVICES TO MEET THE NEEDS OF THE AGING POPULATION. SCRIPPS ADVANCED CARE CLINIC THE PROGRAM PROVIDES INTENSIVE, PROACTIVE, MEDICAL, AND SOCIAL SERVICES TO ADULTS LIVING WITH MULTIPLE CHRONIC DISEASES. UNDERSTANDING THAT DISEASES CAN IMPACT ALL ASPECTS OF A PERSON'S LIFE, THE PROGRAM TREATS NOT JUST MEDICAL ISSUES, BUT ALSO THE PSYCHOSOCIAL, ECONOMIC, AND SPIRITUAL ASPECTS OF CARE. THE ADVANCED CARE CLINIC INTERDISCIPLINARY, PATIENT CENTERED TEAM HELPS OPTIMIZE PATIENT HEALTH THROUGH AN EVIDENCE-BASED EXTENSIVIST CLINIC MODEL THAT ASSISTS WITH CARE COORDINATION AND PATIENT ADVOCACY ACROSS HEALTH CARE AND HOME SETTINGS. TO DATE 245 PATIENTS HAVE BEEN SERVED, 45% REDUCTION IN HOSPITALIZATIONS, 49% REDUCTION IN 30-DAY READMISSIONS AND 49% REDUCTION IN ED VISIT RATE. IN ADDITION, THE PROGRAM COORDINATES NON-CLINICAL ISSUES. THE ALZHEIMER'S PROJECT - SAN DIEGO UNITES FOR A CURE AND CARE THE ALZHEIMER'S PROJECT IS A COUNTYWIDE INITIATIVE AIMED AT ACCELERATING THE SEARCH FOR A CURE AND HELPING THE ESTIMATED 60,000 SAN DIEGANS WITH THE DISEASE, ALONG WITH THEIR CAREGIVERS. THE BOARD OF SUPERVISORS APPROVED THE AGING ROADMAP INITIATIVE IN DECEMBER 2014 AND LATER VOTED IN SUPPORT OF AN IMPLEMENTATION TIMETABLE. PARTICIPANTS BEGAN MEETING IN EARLY 2016 TO CRAFT A REGIONAL ROADMAP TO ADDRESS THE DISEASE, FOCUSING ON CURE, CARE, CLINICAL, AND PUBLIC AWARENESS, AND EDUCATION INITIATIVES. DR. MICHAEL LOBATZ FROM SCRIPPS HEALTH IS A LEADING PARTICIPANT OF THIS INITIATIVE AS CHAIRPERSON OF THE CLINICAL ROUND TABLE AND IS A MEMBER OF THE STEERING COMMITTEE. ALZHEIMER'S PROJECT PARTNERS HAVE COLLABORATED TO DEVELOP THE PHYSICIAN GUIDELINES FOR SCREENING, EVALUATION, AND MANAGEMENT OF ADRD IN 2016 TO ASSIST PRIMARY CARE PHYSICIANS IN SUPPORTING THOSE IMPACTED BY DEMENTIA. IN 2019, KAISER PERMANENTE, SCRIPPS CLINIC, SHARP HEALTHCARE AND UCSD GERIATRIC EMERGENCY DEPARTMENT BEGAN INCORPORATING THE RECOMMENDED ACTIONS DESCRIBED IN THE PHYSICIAN GUIDELINES FOR SCREENING, EVALUATION, AND MANAGEMENT OF ADRD INTO THEIR DAILY OPERATIONS. THIS TYPE OF SYSTEMIC ADOPTION OF BEST PRACTICES ENSURES SUSTAINABLE QUALITY CARE. VIRTUAL STANDING STRONG FALL PREVENTION WEBINAR AS PART OF NATIONAL FALL PREVENTION AWARENESS WEEK IN SEPTEMBER 2021, SCRIPPS PARTNERED WITH THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AND THE SAN DIEGO FALL PREVENTION TASK FORCE ON FREE, VIRTUAL EVENTS TO LEARN MORE ABOUT WHAT INDIVIDUALS CAN DO TO PREVENT FALLS. FALLS ARE THE LEADING CAUSE OF INJURY RELATED EMERGENCY DEPARTMENT VISITS FOR OLDER ADULTS. SCRIPPS INSTRUCTED FIVE ONE-HOUR CLASSES AND THE TOPICS ARE LISTED BELOW. THE SCRIPPS EVENT SERVED AS THE OFFICIAL KICK-OFF EVENT FOR FALL PREVENTION AWARENESS WEEK WITH NINE PRESENTATIONS DELIVERED VIRTUALLY. HTTP://WWW.SANDIEGOFALLPREVENTION.ORG/. THE FOLLOWING WERE SOME OF THE TOPICS PROVIDED: - FALL PREVENTION: REDUCING YOUR RISK AND FEARS - A MATTER OF BALANCE SAMPLE CLASS - HEAD TO TOE WORK OUT - GENTLE CHAIR YOGA - HEALTHY BONES FOR BETTER BALANCE FALL PREVENTION AND HOME SAFETY WORKSHOPS MANY OLDER ADULTS EXPERIENCE CONCERNS ABOUT FALLING AND RESTRICT THEIR ACTIVITIES. SCRIPPS SOCIAL WORKERS AND NURSES LECTURE ON WAYS TO REDUCE FALL RISK, IMPROVE SAFETY AWARENESS AND UTILIZE AVAILABLE RESOURCES TO PROMOTE INDEPENDENCE AND OVERALL SAFETY. BALANCE CLASSES ARE DESIGNED TO HELP BUILD BALANCE, POSTURE AND COORDINATION THROUGH STRENGTHENING AND BALANCE EXERCISES. THIS IMPORTANT ASPECT TO HEALTHY LIVING FOR SENIORS PROVIDES EDUCATION ON PREVENTING FALLS THROUGH EXERCISE AND BEING PROACTIVE THROUGH SAFETY MEASURES IN THE HOME. SCRIPPS PHYSICAL THERAPY DEPARTMENT AND PHYSICAL THERAPY SCHOOL VOLUNTEERS PROVIDE FALL RISK ASSESSMENTS. SENIORS MAY ATTEND FROM ALL OVER THE SAN DIEGO COUNTY REGION. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. A MATTER OF BALANCE: MANAGING CONCERNS ABOUT FALLS SCRIPPS EDUCATES OLDER ADULTS ON PREVENTING FALLS THROUGH EXERCISE AND BEING PROACTIVE THROUGH SAFETY MEASURES IN THE HOME. AN 8-WEEK PROGRAM AND LECTURE SERIES PROVIDE PRACTICAL STRATEGIES TO MANAGE FALLS, IMPROVE SAFETY AWARENESS AND UTILIZE AVAILABLE RESOURCES TO PROMOTE INDEPENDENCE AND OVERALL SAFETY. SCRIPPS WAS CHOSEN AS A PILOT SITE TO TEST A NEW VIRTUAL EDITION OF THE A MATTER OF BALANCE PROGRAM WITH RESULTS BEING USED TO LAUNCH THE NEW VIRTUAL EVIDENCE-BASED VERSION IN JANUARY 2021. NINETEEN VIRTUAL CLASSES WERE CONDUCTED IN FISCAL YEAR 2021. SENIOR HEALTH AND WELLBEING PROGRAMS EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD IN PARTNERSHIP WITH LOCAL SENIOR CENTERS, CHURCHES, AND SENIOR HOUSING. THE FOLLOWING PROGRAMS ARE CONDUCTED AS PART OF SCRIPPS MERCY HOSPITAL CHULA VISTA SAN DIEGO BORDER AREA HEALTH EDUCATION CENTER AND SCRIPPS FAMILY MEDICINE RESIDENCY PROGRAM. THESE SENIOR HEALTH CHATS ARE DESIGNED TO PROVIDE HEALTH EDUCATION TO THE OLDER ADULT COMMUNITY. A TOTAL OF 69 SENIORS HAVE PARTICIPATED IN THESE MONTHLY SESSIONS. THESE PRESENTATIONS INCLUDE A VARIETY OF HEALTH AND AGE-RELATED TOPICS THAT INCLUDE HEART HEALTH, UNDERSTANDING OSTEOPOROSIS, PARKINSON'S, COLD VS. FLU, DEPRESSION: SENIOR CONNECTIONS, FALL PREVENTION AND BALANCE, FOOD AND NUTRITION, VITAMINS AND MINERALS, CANCER HEALTH TALK AND A VARIETY OF PREVENTION AND HEALTHY LIFESTYLE TOPICS. THESE PRESENTATIONS ARE FACILITATED BY VARIOUS HEALTH CARE PROFESSIONS AND RESIDENTS. PRESENTATIONS ARE OFFERED IN ENGLISH AND SPANISH. TOPICS ARE ALL CHOSEN BY THE SENIORS THEMSELVES TO MEET THEIR LOCAL NEEDS. ALSO, THE HEALTH CHATS PROVIDE AN INTERCHANGE BETWEEN THE COMMUNITY MEMBERS AND OUR MEDICAL RESIDENTS AND OTHER HEALTH CARE PROFESSIONALS TO FOSTER HEALTHY LIFESTYLES AND HEALTH PREVENTION. THE PROGRAM IS CONDUCTED IN COLLABORATION WITH NORMAN PARK CENTER, CONGREGATIONAL TOWERS SENIOR LIVING. ST. CHARLES NUTRITION CENTER SERVING SENIORS AND KIMBALL AND MORGAN TOWERS SENIOR LIVING. FAMILY MEDICINE RESIDENTS ROTATE THROUGH THESE PROGRAMS TO LEARN MORE ABOUT GERIATRIC MEDICINE, HEALTH AND WELLNESS AND OVERALL PUBLIC HEALTH AND COMMUNITY TRAINING. DUE TO COVID-19 THE GROUP HAS TRANSITIONED TO A CONFERENCE CALL GROUP WHICH HAS IMPACTED THE OVERALL NUMBER OF PARTICIPANTS FOR THE YEAR. PARKINSON'S LSVT (LEE SILVERMAN TRAINING) BIG EXERCISE: SCRIPPS PROVIDES A MAINTENANCE CLASS FOR THOSE WHO HAVE COMPLETED THE LSVT BIG EXERCISE PROTOCOL. THIS CLASS IS TAUGHT BY A PHYSICAL THERAPIST AND IS DESIGNED FOR PARKINSON'S PATIENTS TO IMPROVE STRENGTH AND MOBILITY FOR A HEALTHIER LIFE. DUE TO COVID-19 MEETINGS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS HEALTH GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION BY THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP) ACROSS THE COUNTRY, SENIORS ACCOUNT FOR NEARLY 18% OF EMERGENCY DEPARTMENT VISITS, AND THAT NUMBER IS EXPECTED TO RISE. ALL FOUR SCRIPPS HEALTH EMERGENCY DEPARTMENTS HAVE BEEN ACCREDITED BY THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP) AS GERIATRIC EMERGENCY DEPARTMENTS, A DISTINCTION THAT RECOGNIZES EXCELLENCE IN PROVIDING SPECIALIZED CARE TO ELDERLY PATIENTS. THE SAN DIEGO SENIOR EMERGENCY CARE INITIATIVE (INITIATIVE) AIMS TO IMPROVE OLDER ADULTS' EXPERIENCE AND OUTCOMES IN EDS BY SUPPORTING GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION FOR EDS ACROSS THE SAN DIEGO REGION BY 2021. THESE EDS WILL PROVIDE CARE THAT IS TAILORED TO THE UNIQUE NEEDS OF THE OVER-60 POPULATION BY MODIFYING THE PHYSICAL ENVIRONMENT, ADDING SENIOR-SPECIFIC PROTOCOLS, AND PROVIDING STAFF WITH SPECIAL TRAINING. THE INITIATIVE IS A PUBLIC-PRIVATE PARTNERSHIP INVOLVING THE COUNTY, THE WEST HEALTH INSTITUTE, AND THE REGION'S MAJOR HEALTH SYSTEMS. OBESITY, WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS OBESITY IS AN IMPORTANT HEALTH NEED DUE TO ITS HIGH PREVALENCE IN THE U.S. AND SAN DIEGO. ALTHOUGH IT IS NOT A LEADING CAUSE OF DEATH, IT IS A SIGNIFICANT CONTRIBUTOR TO THE DEVELOPMENT OF OTHER CHRONIC CONDITIONS. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF OBESITY, WEIGHT STATUS, NUTRITION AND ACTIVITY & FITNESS IS DESCRIBED BELOW: - THE HASD&IC AND SCRIPPS 2019 CHNA CONTINUED TO IDENTIFY OBESITY AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - ACCORDING TO 2020 CHIS DATA, 23.2% OF SAN DIEGO COUNTY RESIDENTS HAD EVER BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE, WHILE 7.8% HAD BORDERLINE HIGH BLOOD PRESSURE. IN ADDITION, 24.3% OF SAN DIEGO COUNTY ADULTS REPORTED BEING OBESE. - ACCORDING TO A REPORT RELEASED IN 2019 BY THE SAN DIEGO CHILDHOOD OBESITY INITIATIVE, 34%, OR NEARLY 1 OUT OF EVERY 3 CHILDREN IN SAN DIEGO COUNTY'S SCHOOLS WERE OVERWEIGHT OR OBESE. THESE RATES THESE RATES VARY BY GRADE, WITH 5TH GRADERS HAVING THE HIGHEST RATES OF OVERWEIGHT AND OBESE CHILDREN - 36% - COMPARED TO 7TH GRADERS (34%) AND 9TH GRADERS (33%). IN EXAMINING TRENDS ACROSS LONGER PERIODS OF TIME, OVERWEIGHT AND OBESITY PREVALENCE AMONG CHILDREN IN SAN DIEGO COUNTY APPEARS TO BE LEVELING OFF AND EVEN DECLINING SLIGHTLY. FOR EXAMPLE, A 2005 UCLA STUDY ESTIMATED 36% OF CHILDREN IN SAN DIEGO COUNTY WERE OVERWEIGHT OR OBESE, WITH THAT NUMBER DECREASING TO 35% IN 2010. BASED ON THESE DATA, CHILDHOOD OVERWEIGHT AND OBESITY PREVALENCE IN 2018 HAS DECREASED BY TWO PERCENTAGE POINTS SINCE 2005. THIS SMALL DECREASE FROM 36% TO 34%, HOWEVER, WOULD REPRESENT APPROXIMATELY 8,600 FEWER STUDENTS ACROSS PUBLIC SCHOOL DISTRICTS WHO WERE OVERWEIGHT AND OBESE IN 2017-2018. MORE INFORMATION CAN BE FOUND AT, WWW.SDCOI.ORG. - IN CALIFORNIA, THE SELF-REPORTED OBESITY RATE IN 2020 WAS 30.3%. PREVALENCE OF OBESITY DECREASED AS EDUCATION LEVELS INCREASED, HIGHLIGHTING THE NEED FOR HEALTH EDUCATION AS A TOOL FOR REDUCING OBESITY RATES (CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), 2021). - ACCORDING TO THE CDC, SOME OF THE LEADING CAUSES OF PREVENTABLE DEATH INCLUDE OBESITY-RELATED CONDITIONS, SUCH AS HEART DISEASE, STROKE, TYPE 2 DIABETES AND SOME TYPES OF CANCER (CDC, 2021). - ACCORDING TO THE ARTICLE SOCIAL AND ENVIRONMENTAL FACTORS INFLUENCING OBESITY, OBESITY PREVALENCE IS SIGNIFICANTLY ASSOCIATED WITH SEX, RACIAL OR ETHNIC IDENTITY, AND SOCIOECONOMIC STATUS. HIGHER ODDS OF OBESITY ARE ATTRIBUTED TO MULTIPLE FACTORS, INCLUDING ENVIRONMENTS EXPERIENCING DEPRIVATION, DISORDER, OR HIGH CRIME; PROLIFERATION OF HIGH CALORIE, ENERGY DENSE FOOD OPTIONS THAT ARE PERCEIVED AS MORE AFFORDABLE; AND REDUCTIONS IN OCCUPATIONAL AND TRANSPORTATION-RELATED PHYSICAL ACTIVITY (LEE, CARDEL & DONAHOO, 2019). - ACCORDING TO THE CDC, SOME OF THE LEADING CAUSES OF PREVENTABLE DEATH INCLUDE OBESITY-RELATED CONDITIONS, SUCH AS HEART DISEASE, STROKE, TYPE 2 DIABETES, AND CERTAIN TYPES OF CANCER. - OBESITY IS LARGELY CATEGORIZED AS A SECONDARY DIAGNOSIS IN HOSPITAL DISCHARGE DATA. WHEN EXAMINING INPATIENT HOSPITAL DISCHARGE DATA WITH OBESITY AS A SECONDARY DIAGNOSIS, IT WAS FOUND THAT THE MOST COMMON PRIMARY DIAGNOSIS OF THOSE PATIENTS WAS NONSPECIFIC CHEST PAIN IN AGES 25-64, ABNORMAL PAIN FOR THOSE AGES 15-24, AND THOSE OVER 65 YEARS THEIR PRIMARY DIAGNOSIS WAS OSTEOARTHRITIS, SEPTICEMIA FOLLOWED BY CONGESTIVE HEART FAILURE. - RESEARCH HAS SHOWN THAT AS WEIGHT INCREASES TO REACH THE LEVELS OF "OVERWEIGHT"OBESITY" THE RISKS FOR THE FOLLOWING CONDITIONS ALSO INCREASES: - CORONARY HEART DISEASE - TYPE 2 DIABETES - CANCERS (ENDOMETRIAL, BREAST AND COLON) - HYPERTENSION (HIGH BLOOD PRESSURE) - STROKE - LIVER AND GALLBLADDER DISEASE - SLEEP APNEA AND RESPIRATORY PROBLEMS - OSTEOARTHRITIS EVEN BEFORE THE COVID-19 PANDEMIC, 30% OF LOCAL CHILDREN WERE CONSIDERED OBESE. ACCORDING TO A RECENT STUDY IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, CHILD AND TEEN OBESITY RATES FURTHER INCREASED OVER THE PAST 18 MONTHS OF THE PANDEMIC. OBESITY IS ADDRESSED THROUGH GENERAL NUTRITION AND EXERCISE EDUCATION AND RESOURCES PROVIDED AT SCRIPPS 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. DURING FISCAL YEAR 2021, SCRIPPS ENGAGED IN THE FOLLOWING OBESITY PREVENTION AND TREATMENT ACTIVITIES: SAN DIEGO CHILDHOOD OBESITY INITIATIVE THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (COI) WAS ESTABLISHED IN 2006 AND IS A PRIVATE PUBLIC PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS, AND ENVIRONMENT CHANGE. THE COI IS FACILITATED BY UC SAN DIEGO CENTER FOR COMMUNITY HEALTH AND FUNDED BY THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA). THE INITIATIVE HAS A HEALTH DOMAIN WHICH ENGAGES HEALTHCARE STAKEHOLDERS TO SUPPORT AND ADVOCATE FOR HEALTHY SYSTEMS, POLICIES, AND ENVIRONMENTAL CHANGES. DIABETES PREVENTION PROGRAM (DPP) A LARGE CLINICAL TRIAL CONCLUDED THAT PEOPLE WITH PREDIABETES COULD REDUCE THEIR LIKELIHOOD OF DEVELOPING DIABETES BY 58-70 PERCENT IF THEY LOST JUST 5-7 PERCENT OF THEIR BODY WEIGHT. THE DIABETES PREVENTION PROGRAM IS A SCIENTIFICALLY VALIDATED LIFESTYLE INTERVENTION-BASED MODEL. THE CENTERS FOR DISEASE CONTROL (CDC) AND THE NATIONAL INSTITUTES OF HEALTH (NIH) PROMOTE WIDESPREAD ADOPTION OF THE DPP DUE TO ITS DEMONSTRATED EFFECTIVENESS. SCRIPPS IS RECOGNIZED BY THE CENTERS FOR DISEASE CONTROL AS A NATIONAL DPP PROVIDER AND ROLLED OUT THE PROGRAM TO PATIENTS AND COMMUNITY MEMBERS IN 2016. SCRIPPS AIMS TO DECREASE THE INCIDENCE OF TYPE 2 DIABETES BY MANAGING A MAJOR DIABETES RISK FACTOR, OBESITY IN THE UNDERSERVED, ETHNICALLY DIVERSE POPULATIONS BY TESTING THE EFFECTIVENESS OF LIFESTYLE CURRICULUM. THE PROGRAM USES TRAINED LIFESTYLE COACHES AND A STANDARDIZED CURRICULUM; PARTICIPANTS MEET IN GROUPS WITH A COACH FOR 16 WEEKLY SESSIONS AND SIX TO EIGHT BIMONTHLY FOLLOW-UP SESSIONS. PARTICIPANTS MUST HAVE PREDIABETES AND BE OVERWEIGHT TO ENROLL. NO PHYSICIAN REFERRAL IS REQUIRED, ALTHOUGH MANY PHYSICIANS DO REFER THEIR PATIENTS TO THIS VALUABLE RESOURCE. ORIENTATION SESSIONS ARE HELD IN SPANISH AND ENGLISH THROUGHOUT THE COUNTY. REDUCING CHILDHOOD OBESITY IN SOUTH BAY 5210 PROGRAM SCRIPPS ALSO ADDRESSES CHILDHOOD OBESITY AT THE HIGH SCHOOL LEVEL IN SAN DIEGO'S SOUTH BAY COMMUNITIES THROUGH ITS PARTNERSHIP WITH THE PROMISE NEIGHBORHOOD INITIATIVE, WHICH IMPLEMENTS ACTIVITIES RELATED TO THE NATIONAL 5210 CAMPAIGN. THE MESSAGE IS TO PROMOTE A HEALTHY LIFESTYLE (5 SERVINGS OF FRUITS AND VEGETABLES, 2 HOUR SCREEN TIME LIMIT, 1 HOUR OF PHYSICAL ACTIVITY AND 0 SUGARY DRINKS) PER DAY. THIS FOUR-SESSION SERIES IS DESIGNED TO INCREASE KNOWLEDGE AND BEHAVIORS REGARDING A HEALTHY LIFESTYLE. THE SERIES INCLUDES HANDS-ON ACTIVITIES AND DEMONSTRATIONS. THE FOUNDATION OF THIS PROJECT BEGAN IN 2013 WITH A PARTNERSHIP WITH THE PROMISE NEIGHBORHOOD INITIATIVE AND CASTLE PARK ELEMENTARY SCHOOL TO INCREASE EDUCATION AND AWARENESS ABOUT HEALTHY LIFESTYLES AND TO HELP THE STUDENTS PASS THEIR YEARLY PHYSICAL EDUCATION REQUIREMENTS. SCRIPPS HAS CONTINUED TO ENHANCE AND DEVELOP THE SERIES. DURING FY21 THERE WAS A TOTAL OF 36 PARTICIPANTS FROM CHULA VISTA HIGH SCHOOLS AND STUDENTS FROM HEALTH CAREERS OCCUPATIONAL PROGRAM (HCOP) CAMP SCRIPPS. AS A RESULT OF ACTIVITIES, LESSON PLANS AND ADVOCACY FOR HEALTHY LIVING, THE AMOUNT OF PHYSICAL ACTIVITY AND CONSUMPTION OF FRUITS AND VEGETABLES BY THE YOUTH HAS INCREASED. STUDENT RESPONSES VIA THE 5210-ASSESSMENT SURVEY SHOWED PRE-TEST KNOWLEDGE WAS 63% AND POST-TEST KNOWLEDGE IMPROVEMENT RATE OF 89% AFTER PARTICIPATING IN THE 5210 SESSIONS. DUE TO COVID-19 THESE SESSIONS WERE HELD VIRTUALLY.
FORM 990, PART III, LINE 4A (CONTINUED)	LA MAESTRA FAMILY CLINIC, INC LA MAESTRA FAMILY CLINIC, INC. JOINED THE CITY HEIGHTS WELLNESS CENTER (CHWC) COLLABORATIVE PARTNERSHIP WITH SCRIPPS MERCY HOSPITAL AND RADY CHILDREN'S HOSPITAL AS THE LEASE HOLDER OF THE WELLNESS CENTER STARTING SEPTEMBER 1, 2016. SINCE ITS INCEPTION IN 2002, THE CITY HEIGHTS WELLNESS CENTER HAS BEEN A DYNAMIC, COMMUNITY-BASED PROGRAM DEVELOPED BY SCRIPPS MERCY HOSPITAL AND RADY CHILDREN'S HOSPITAL, WORKING WITH RESIDENTS TO IMPROVE THEIR LIFESTYLE BEHAVIORS AND SELF-SUFFICIENCY SKILLS. MULTIPLE NOT-FOR-PROFIT AND GOVERNMENTAL ORGANIZATIONS, PHILANTHROPIC FOUNDATIONS AND GRASSROOTS GROUPS HAVE JOINED THE EFFORT CONDUCTING HEALTH PROMOTION AND EDUCATIONAL ACTIVITIES FOR COMMUNITY RESIDENTS. A UNIQUE ASPECT OF THE CITY HEIGHTS WELLNESS CENTER IS THE TEACHING KITCHEN THAT IS KNOWN THROUGHOUT THE COMMUNITY AS A PLACE WHERE RESIDENTS AND PROVIDERS COME TOGETHER TO COOK, DISCOVER, AND COMMUNICATE IN A SAFE AND TRUSTED ENVIRONMENT. LA MAESTRA FAMILY CLINIC BRINGS A NEW PERSPECTIVE TO THE PARTNERSHIP AS A COMMUNITY HEALTH CENTER AND PRIMARY CARE PROVIDER SERVING THE CULTURALLY DIVERSE POPULATIONS WITHIN THE CITY HEIGHTS COMMUNITY. LA MAESTRA IS COMMITTED TO MAINTAINING THE COLLABORATIVE NATURE OF THE PARTNERSHIP AND CONTINUES TO WORK WITH CURRENT CHWC AGENCIES AS WELL AS LOOK FOR OPPORTUNITIES TO EXPAND HEALTH PROMOTION SERVICES. THE SCRIPPS MERCY SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS COLLOCATED IN THE WELLNESS CENTER BUT HAS RECENTLY MOVED SERVICES TO A SUITE AT THE PRICE ENTITIES BUILDING. FOOD ADDICTS ANONYMOUS SCRIPPS HEALTH PROVIDES FOOD ADDICTS ANONYMOUS MEETING SPACE TO MEET. FOOD ADDICTS ANONYMOUS IS AN INTERNATIONAL FELLOWSHIP OF MEN AND WOMEN WHO HAVE EXPERIENCED DIFFICULTIES IN LIFE AS A RESULT OF THE WAY THEY EAT. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. TAKE OFF POUNDS SENSIBLY (TOPS) MEETING SCRIPPS HEALTH PROVIDES MEETING SPACE TO TAKE OFF POUNDS SENSIBLY (TOPS). TOPS (TAKE OFF POUNDS SENSIBLY) IS THE SHORT NAME FOR TOPS CLUB, INC., THE ORIGINAL NON-PROFIT, NON-COMMERCIAL NETWORK OF WEIGHT-LOSS SUPPORT GROUPS AND WELLNESS EDUCATION ORGANIZATION. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. A TOTAL OF 249 PEOPLE PARTICIPATED IN TOPS PRIOR TO THE PANDEMIC. GREATER LA JOLLA MEALS ON WHEELS GREATER LA JOLLA MEALS ON WHEELS IS A NON-PROFIT SENIOR SERVICE ORGANIZATION. IT PROVIDES NUTRITIOUS MEALS TO SENIORS, THE HOMEBOUND AND THE DISABLED RESIDING IN THE COMMUNITIES OF LA JOLLA AND UNIVERSITY CITY. SCRIPPS LA JOLLA HOSPITAL PROVIDES OFFICE SPACE TO THE LA JOLLA CHAPTER OF MEALS ON WHEELS. THIS ALLOWS MEALS ON WHEELS TO CONDUCT BUSINESS AND INTERACT WITH VOLUNTEERS FROM A CENTRAL, ESTABLISHED LOCATION. MATERNAL CHILD HEALTH & HIGH-RISK PREGNANCY MOTHERS, INFANTS AND CHILDREN MAKEUP A LARGE SEGMENT OF THE U.S. POPULATION AND THEIR WELL-BEING IS A HEALTH PREDICTOR FOR THE NEXT GENERATION. THERE IS TREMENDOUS FOCUS ON MATERNAL ILLNESS AND DEATH, AND INFANT HEALTH AND SURVIVAL, INCLUDING INFANT MORTALITY RATES, PERINATAL AND OTHER INFANT DEATHS. ACCORDING TO A NEW YORK TIMES ARTICLE, "HUGE RACIAL DISPARITIES FOUND IN DEATHS LINKED TO PREGNANCY, MAY 2019, AFRICAN AMERICAN, NATIVE AMERICAN AND ALASKA NATIVE WOMEN ARE ABOUT THREE TIMES MORE LIKELY TO DIE FROM CAUSES RELATED TO PREGNANCY, COMPARED TO WHITE WOMEN IN THE UNITED STATES. MATERNAL AND INFANT HEALTH ISSUES INCLUDE: - ALCOHOL, TOBACCO AND ILLEGAL SUBSTANCES DURING PREGNANCY, WHICH ARE MAJOR RISK FACTORS FOR LOW BIRTH WEIGHT AND OTHER POOR OUTCOMES. - VERY LOW BIRTH WEIGHT ASSOCIATED WITH PRETERM BIRTH, SPONTANEOUS ABORTION, LOW PRE-PREGNANCY WEIGHT AND SMOKING. - INFANT DEATH RATES ARE HIGHEST AMONG INFANTS BORN TO YOUNG TEENAGERS AND MOTHERS 44 YEARS AND OLDER. BEING PREGNANT, OR TRYING TO BECOME PREGNANT, IS ONLY A SMALL PORTION OF A WOMAN'S LIFE. UNINTENDED PREGNANCY, EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION, ACCOUNTS FOR AN ESTIMATED 49 PERCENT OF PREGNANCIES IN THE U.S. THESE PREGNANCIES ARE ASSOCIATED WITH INCREASED MORBIDITY, AS WELL AS BEHAVIORS LINKED TO ADVERSE HEALTH. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THEIR CHILDREN EXPERIENCE IMPROVED HEALTH, FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND LOWER ABORTION RATES. HIGH RISK PREGNANCY HIGH RISK PREGNANCY CAN BE THE RESULT OF A MEDICAL CONDITION PRESENT BEFORE PREGNANCY OR A MEDICAL CONDITION THAT DEVELOPS DURING PREGNANCY FOR EITHER MOM OR BABY AND CAUSES THE PREGNANCY TO BECOME HIGH RISK. A HIGH-RISK PREGNANCY CAN POSE PROBLEMS BEFORE, DURING OR AFTER DELIVERY AND MIGHT REQUIRE SPECIAL MONITORING THROUGHOUT THE PREGNANCY. RISK FACTORS: - ADVANCED MATERNAL AGE: INCREASED RISK FOR MOTHER'S 35 YEARS AND OLDER. - LIFESTYLE CHOICES: SMOKING, ALCOHOL CONSUMPTION, USE OF ILLEGAL DRUGS. - MEDICAL HISTORY: PRIOR HIGH-RISK PREGNANCIES OR DELIVERIES, FETAL GENETIC CONDITIONS, FAMILY HISTORY OF GENETIC CONDITIONS. - UNDERLYING CONDITIONS: DIABETES, HIGH BLOOD PRESSURE AND EPILEPSY. - MULTIPLE PREGNANCY. - OBESITY DURING PREGNANCY. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF MATERNAL AND CHILD HEALTH & HIGH-RISK PREGNANCIES ARE DESCRIBED BELOW: - IN 2019, 33,880 LIVE BIRTHS RECEIVED EARLY PRENATAL CARE IN SAN DIEGO COUNTY, WHICH TRANSLATES TO 88.2% OF ALL LIVE BIRTHS IN THE REGION. - IN 2019, 141 INFANTS IN SAN DIEGO COUNTY DIED BEFORE THEIR FIRST BIRTHDAY. THE INFANT MORTALITY RATE WAS 3.7 INFANT DEATHS PER 1,000 LIVE BIRTHS. - THERE WERE 3,336 PRETERM BIRTHS IN SAN DIEGO COUNTY IN 2019, REPRESENTING 8.7% OF ALL BIRTHS COUNTYWIDE. - ACCORDING TO THE NATIONAL CENTER FOR HEALTH STATISTICS (NCHS), PRENATAL CARE IMPROVES PREGNANCY OUTCOMES, AND IS AMONG THE MOST FREQUENTLY USED HEALTH CARE SERVICES IN THE U.S. EXPERTS RECOMMEND PRENATAL CARE WITH EARLY, ONGOING RISK ASSESSMENT, AND TYING CONTENT AND TIMING TO INDIVIDUAL NEEDS AND RISK STATUS (NCHS, 2018). - LIVE WELL SAN DIEGO'S (LWSD) REPORT CARD ON CHILDREN AND FAMILIES, 2019 IDENTIFIED THE FOLLOWING BARRIERS TO USE OF PRENATAL CARE: FINANCIAL BARRIERS, SUCH AS LACK OF HEALTH INSURANCE; CONTEXT OF CARE, SUCH AS BIASED TREATMENT FROM PROVIDERS OR LOW CULTURAL COMPETENCE; AND ACCESS ISSUES, SUCH AS TRANSPORTATION, DIFFICULTY OBTAINING AN APPOINTMENT OR INCONVENIENT HOURS (LWSD, 2020). - ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), HEALTH-RELATED FACTORS KNOWN TO CAUSE ADVERSE PREGNANCY OUTCOMES INCLUDE TOBACCO OR SUBSTANCE USE, INFECTIOUS DISEASES, DIABETES, HIGH BLOOD PRESSURE, CERTAIN MEDICATIONS, DEPRESSION, UNSAFE ENVIRONMENTAL OR WORKPLACE CONDITIONS, RADIATION, AND WEIGHT GAIN DURING PREGNANCY (CDC, 2021). - 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, 2021). - ACCORDING TO MARCH OF DIMES DATA, THE RATE OF PRETERM BIRTHS IN THE STATE OF CALIFORNIA WAS 8.8% IN 2020 - LOWER THAN THE NATIONAL AVERAGE. HOWEVER, RACIAL DISPARITIES HAVE WORSENED IN CALIFORNIA, WHERE THE RATE OF PRETERM BIRTH AMONG BLACK WOMEN IS 44% HIGHER THAN THE RATE AMONG ALL OTHER WOMEN (MARCH OF DIMES, 2021). SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION FOR LOW INCOME WOMEN IN SAN DIEGO COUNTY IN FISCAL YEAR 2021. THE FOLLOWING ARE SOME EXAMPLES: COMMUNITY BENEFIT SERVICES - OFFERED MORE THAN 120 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY TO ENHANCE PARENTING SKILLS. LOW-INCOME WOMEN IN SAN DIEGO WHO WERE ELIGIBLE ATTENDED CLASSES AT NO CHARGE OR ON A SLIDING FEE SCHEDULE. DUE TO COVID-19 THESE CLASSES WERE HELD VIRTUALLY. - MAINTAINED EXISTING PRENATAL EDUCATION SERVICES IN ALL REGIONS OF THE COUNTY, ENSURING THAT PROGRAMS CONTINUED TO DEMONSTRATE A SATISFACTION RATING ABOVE 90 PERCENT. - PROVIDED AND SUPPORTED WEEKLY BREASTFEEDING SUPPORT GROUPS AT SIX LOCATIONS THROUGHOUT SAN DIEGO COUNTY, INCLUDING THREE WITH BILINGUAL SERVICES. DURING COVID-19 TWO GROUPS MET VIRTUALLY. - OFFERED 40 MATERNAL CHILD HEALTH CLASSES THROUGHOUT THE COMMUNITY, SUCH AS GETTING READY FOR THE BABY AND GRAND PARENTING TODAY. DUE TO COVID-19 THESE CLASSES WERE HELD VIRTUALLY. - OFFERED 24 CLASSES IN PELVIC FLOOR AND POSTPARTUM CHANGES FOR NEW MOTHERS THROUGHOUT THE COMMUNITY. THESE CLASSES WERE HELD VIRTUALLY DUE TO COVID-19. - THE SCRIPPS CHULA VISTA WELLNESS CENTER OFFERED A VARIETY OF PROGRAMS SUCH AS PARENTING EDUCATION SERIES: FOSTER & KINSHIP CARE PROGRAM AT GROSSMONT COLLEGE, NEWBORN FIRST TIME MOM, HOME VISITING, MATERNAL AND CHILD HEALTH, CLASSES AND SUPPORT GROUPS, BREAST FEEDING SUPPORT, AND CENTERING PREGNANCY GROUPS.
FORM 990, PART III, LINE 4A (CONTINUED)	FIRST 5 PARENTING EDUCATION PARENTING CLASSES ARE OFFERED BY SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER FOR PARENTS WITH CHILDREN OF ALL AGES. A WIDE VARIETY OF TOPICS ARE COVERED INCLUDING ISSUES RELATED TO HEALTH, LEARNING/DEVELOPMENT, FAMILY/SAFETY, ADVOCACY AS WELL AS PARENTING TIPS. THESE SESSIONS ARE CURRENTLY BEING OFFERED TO THE FOSTER, ADOPTIVE AND KINSHIP CARE EDUCATION PROGRAM AT GROSSMONT COLLEGE. SESSIONS ARE FACILITATED BY SCRIPPS FAMILY MEDICINE RESIDENTS AND BEING OFFERED IN ENGLISH AND SPANISH. A TOTAL OF 208 HAVE ATTENDED A PARENT EDUCATION SESSION. THESE SESSIONS ARE BEING HELD VIRTUALLY. FIRST FIVE HOME VISITS IN COLLABORATION WITH THE MEDICAL RESIDENTS, NEWBORN HOME VISITS ARE PROVIDED TO FIRST-TIME MOMS WHO HAVE DELIVERED AT SCRIPPS MERCY HOSPITAL CHULA VISTA. THE VISIT INCLUDES A COMPREHENSIVE ASSESSMENT COVERING SOCIAL, HEALTH, AND ENVIRONMENTAL ISSUES. FURTHER FOLLOW UP IS PROVIDED TO ASSESS CRITICAL HEALTH BEHAVIORS IDENTIFIED. FOLLOW UP AND SUPPORT SERVICES ARE PROVIDED FOR SIX MONTHS. A TOTAL OF 56 SERVICES WERE PROVIDED. HOME VISITS CEASED AS OF MARCH 2020 DUE TO COVID-19. BREAST FEEDING SUPPORT GROUP AN EXPERIENCED BREASTFEEDING INSTRUCTOR LEADS THE BREASTFEEDING SUPPORT GROUP AT THE WELL BEING CENTER WITH MOTHERS WHO WOULD LIKE BREASTFEEDING SUPPORT. THEY INTERACT WITH OTHER MOTHERS AND ARE LED BY THE INSTRUCTOR. BABIES ARE WEIGHED AT THE BEGINNING AND END OF GROUP TO ASSESS HOW MUCH MILK THEY ARE GETTING. DUE TO COVID-19 THIS GROUP CONTINUED TO MEET VIRTUALLY AS OF MARCH 2020. DUE TO THIS TRANSITION THE PARTICIPATION OF THIS GROUP WAS GREATLY IMPACTED. CENTERING PREGNANCY, SCRIPPS FAMILY MEDICINE RESIDENCY RAISING HEALTHY FAMILIES AND CARING FOR THE NEXT GENERATION OF SAN DIEGANS BEFORE THEY'RE BORN HELP CREATE A HEALTHIER COMMUNITY FOR YEARS TO COME. THE SCRIPPS FAMILY MEDICINE PROGRAM AT SCRIPPS MERCY HOSPITAL CHULA VISTA IS PROVIDING ACCESS, EDUCATION AND CLINICAL SERVICES TO NEARLY 75 PREGNANT WOMEN IN SOUTH SAN DIEGO COUNTY. THE GOAL OF THE PROGRAM, "IMPROVING PERINATAL CARE FOR UNDERSERVED LATINA WOMEN - HEALTHY WOMEN, HEALTHY BABIES", IS TO PROVIDE ACCESS TO PERINATAL CARE FOR UNDERSERVED LATINA WOMEN TO IMPROVE BIRTH OUTCOMES. THE PROGRAM APPLIES THE PRINCIPLES OF THE CENTER HEALTH CARE INSTITUTE AND FOCUSES ON CHANGING THE WAY PATIENTS EXPERIENCE THEIR CARE THROUGH ASSESSMENT, EDUCATION AND GROUP SUPPORT. CENTERING PREGNANCY IS THE INSTITUTE'S MODEL DEVOTED SPECIFICALLY TO IMPROVING MATERNAL AND CHILD HEALTH AND HAS BEEN SHOWN TO RESULT IN INCREASED PRENATAL VISITS, GREATER LEVELS OF BREASTFEEDING AND STRONGER RELATIONSHIPS BETWEEN MOTHERS AND THEIR HEALTHCARE PROVIDERS BEFORE, DURING AND AFTER PREGNANCY. WOMEN WHO GAVE BIRTH REPORTED AN ENHANCED PRENATAL EXPERIENCE, GAINED LESS WEIGHT THROUGHOUT THEIR PREGNANCY AND SHOWED IMPROVED HEALTHCARE KNOWLEDGE. SERVICES INCLUDE HOME VISITS, REFERRALS, DATA ENTRY, FOLLOW UP PHONE CALLS, AND OTHER SUPPORT SERVICES. HOME VISITING IS OFFERED TOGETHER WITH FAMILY MEDICINE RESIDENCY AND PARENTING EDUCATION. SINCE COVID-19, THIS PROGRAM HAS BEEN OFFERED VIA TELEMEDICINE. MATERNAL CHILD HEALTH NURSING STUDENTS SCRIPPS PERINATAL EDUCATION PROGRAM SUPPORTS LOCAL NURSING STUDENTS WITH THE OPPORTUNITY TO OBSERVE PRENATAL EDUCATIONAL CLASSES. THIS CRITICAL ASPECT OF THE NURSING EDUCATION ALLOWS THE HOURS AND INFORMATION TO MEET THEIR CLINICAL ROTATION REQUIREMENTS IN MATERNAL CHILD HEALTH. DUE TO COVID-19 THE CLINICAL ROTATIONS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SCRIPPS MERCY'S SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) THE SPECIAL SUPPLEMENT NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS ESTABLISHED AS A PERMANENT PROGRAM IN 1974 TO SAFEGUARD THE HEALTH OF LOW-INCOME WOMEN, INFANTS AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES APPROXIMATELY 6,500 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FY20 THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 65,655 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW-INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS BREAST PUMPS, PADS, AND OTHER SUPPLIES DURING THE POSTPARTUM PERIOD. IN APRIL 2020, IN RESPONSE TO THE STATE-WIDE PUBLIC HEALTH RESTRICTIONS, ALL WIC APPOINTMENTS WENT VIRTUAL INCLUDING THE EDUCATION AND COUNSELING SESSIONS. ONCE WIC ELIGIBILITY REQUIREMENTS WERE MET, FOOD VOUCHERS WERE ISSUED AUTOMATICALLY TO THE WIC EBT CARD. AS A RESULT, THE WIC PROGRAM EXPERIENCED A HIGHER RATE OF PARTICIPANT ENGAGEMENT AND SATISFACTION WITH ON-LINE SERVICES; BARRIERS TO CHILDCARE AND TRANSPORTATION WERE NO LONGER ISSUES FOR CLIENT PARTICIPATION. MIRACLE BABIES SCRIPPS HEALTH PARTNERED WITH MIRACLE BABIES ON THEIR VIRTUAL 5K WALK/RUN. THE MISSION OF MIRACLE BABIES IS TO UNIFY FAMILIES WITH THEIR SICK NEWBORNS THROUGH FINANCIAL ASSISTANCE AND SUPPORTIVE SERVICES TO REDUCE PREGNANCY COMPLICATIONS THROUGH PREVENTION, EDUCATION AND RESEARCH. UNINTENTIONAL INJURY AND VIOLENCE ACCORDING TO HEALTHY PEOPLE 2030, "UNINTENTIONAL INJURIES AND VIOLENCE-RELATED INJURIES CAN BE CAUSED BY A NUMBER OF EVENTS, SUCH AS MOTOR VEHICLE CRASHES AND PHYSICAL ASSAULT CAN OCCUR VIRTUALLY ANYWHERE." UNINTENTIONAL INJURY AND VIOLENCE WERE IDENTIFIED AS A PRIORITY HEALTH NEED IN THE COMMUNITY ENGAGEMENT PROCESS OF THE 2019 CHNA. EXPOSURE TO VIOLENCE AND NEIGHBORHOOD SAFETY WERE CITED AS PRIORITY HEALTH NEEDS FOR SAN DIEGANS. NEIGHBORHOOD SAFETY WAS DISCUSSED AS INFLUENCING RESIDENTS' ABILITY TO MAINTAIN GOOD HEALTH, WHILE EXPOSURE TO VIOLENCE WAS DESCRIBED AS TRAUMATIC AND IMPACTFUL ON MENTAL HEALTH. IN 2019, ACCIDENTS (UNINTENTIONAL INJURIES) WERE THE FIFTH LEADING CAUSE OF DEATH FOR SAN DIEGO COUNTY OVERALL. THE DEATHS ASSOCIATED WITH UNINTENTIONAL INJURIES ARE SIGNIFICANT; YET REPRESENT ONLY A SMALL PART OF A MUCH LARGER PUBLIC HEALTH PROBLEM. HOSPITALIZATION DATA IS A BETTER MEASURE OF THE INJURY PROBLEM THAN THE DEATH DATA ALONE. UNINTENTIONAL INJURIES, MOTOR VEHICLE ACCIDENTS, FALLS, PEDESTRIAN RELATED, FIREARMS, FIRE/BURNS, DROWNING, EXPLOSION, POISONING (INCLUDING DRUGS AND ALCOHOL, GAS, CLEANERS AND CAUSTIC SUBSTANCES) CHOKING/SUFFOCATION, CUT/PIERCE, EXPOSURE TO ELECTRIC CURRENT/RADIATION/FIRE/SMOKE, NATURAL DISASTERS AND INJURIES AT WORK, ARE ONE OF THE LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. MOST EVENTS RESULTING IN INJURY, DISABILITY OR DEATH ARE PREDICTABLE AND PREVENTABLE. THERE ARE MANY RISK FACTORS FOR UNINTENTIONAL INJURY AND VIOLENCE, INCLUDING INDIVIDUAL BEHAVIORS AND CHOICES, SUCH AS ALCOHOL USE OR RISK TAKING; THE PHYSICAL ENVIRONMENT BOTH AT HOME AND IN THE COMMUNITY; ACCESS TO HEALTH SERVICES AND SYSTEMS CREATED FOR INJURY RELATED CARE; THE SOCIAL ENVIRONMENT, INCLUDING INDIVIDUAL SOCIAL EXPERIENCES. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF UNINTENTIONAL INJURY AND VIOLENCE IS DESCRIBED BELOW: - THE HASD&IC AND SCRIPPS 2019 CHNA CONTINUED TO IDENTIFY UNINTENTIONAL INJURY AND VIOLENCE AS ONE OF THE TOP PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS. - ACCORDING TO DATA PRESENTED IN THE HASD&IC AND SCRIPPS 2019 CHNA, RATES OF ED VISITS FOR MOTOR VEHICLE INJURIES IN SAN DIEGO COUNTY INCREASED 9.3% FROM 2014 TO 2016, WHILE DEATHS DUE TO MOTOR VEHICLE INJURIES INCREASED 1.1%. - FOCUS GROUPS CONDUCTED AS PART OF THE HASD&IC AND SCRIPPS 2019 CHNA EMPHASIZED THE IMPORTANCE OF A SAFE ENVIRONMENT AS A CONTRIBUTOR TO GOOD HEALTH. LACK OF A SAFE ENVIRONMENT MAY ENCOURAGE PHYSICAL INACTIVITY, WHICH CONTRIBUTES TO CHRONIC HEALTH CONDITIONS. - IN 2019, ACCIDENTS (UNINTENTIONAL INJURIES) WERE THE FIFTH LEADING CAUSE OF DEATH FOR SAN DIEGO COUNTY OVERALL. - BETWEEN 2015 AND 2019, MORE THAN 5,800 SAN DIEGANS DIED FROM INJURIES THAT WERE NOT SELF-INFLICTED.
FORM 990, PART III, LINE 4A (CONTINUED)	- IN 2019, THERE WERE 927 ED VISITS (27.7 PER 100,000 POPULATION) AND 483 HOSPITALIZATIONS (14.4 PER 100,000) RELATED TO OPIOID MISUSE IN SAN DIEGO COUNTY. PERCENT CHANGE FROM 2017 TO 2019 IS 22.1% FOR ED VISITS AND -21.3% FOR HOSPITALIZATION. MALES ARE 1.8 TIMES MORE LIKELY TO VISIT THE ED FOR OPIOID MISUSE THAN FEMALES AND 2.0 TIMES MORE LIKELY TO BE HOSPITALIZED FOR OPIOID MISUSE THAN FEMALES IN 2019. FOR RACE/ETHNICITY, NON-HISPANIC BLACK HAS THE HIGHEST RATE FOR ED VISITS (43.0 PER 100,000), FOLLOWED BY NON-HISPANIC WHITE (35.9 PER 100,000). FOR AGE GROUPS, 27-44 HAD THE HIGHEST ED VISITS FOR OPIOID MISUSE (57.2 PER 100,000), FOLLOWED BY 18-26 YEARS OLD (41.9 PER 100,000). - UNINTENTIONAL INJURIES ARE ONE OF THE LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. DRUGS, ALCOHOL, VEHICLES, FALLS, GUNS AND SUICIDE CONTINUE TO BE LEADING CAUSES OF DEATHS INVESTIGATED BY THE SAN DIEGO COUNTY MEDICAL EXAMINER'S OFFICE. UNDER LAW, THE COUNTY MEDICAL EXAMINER'S OFFICE INVESTIGATES ALL "UNNATURAL" DEATHS THAT OCCUR BY ACCIDENT, HOMICIDE, OR SUICIDE DUE TO TRAUMAS OR OVERDOSE, OR UNDIAGNOSED OR SUDDEN UNEXPECTED NATURAL CAUSES. - SAN DIEGO COUNTY'S MEDICAL EXAMINER'S OFFICE RELEASE BOTH MID-YEAR STATISTICS COMPARING THE FIRST SIX MONTHS OF 2020 TO 2019 IN ITS 2019 ANNUAL REPORT. LOOKING AT MID-YEAR FIGURES, THE DEPARTMENT INVESTIGATED 1,751 DEATHS THROUGH JUNE THIS YEAR COMPARED TO 1,674 IN THE SAME MONTHS LAST YEAR, A 5% INCREASE. THE MEDICAL EXAMINER'S OFFICE INVESTIGATES DEATHS THAT OCCUR BY ACCIDENT, HOMICIDE, OR SUICIDE DUE TO TRAUMA OR OVERDOSE, OR UNDIAGNOSED OR SUDDEN, UNEXPECTED NATURAL CAUSES. IN CASES WHERE A PERSON DIES A NATURAL DEATH AND IS UNDER A PHYSICIAN'S CARE, THAT PHYSICIAN WILL CERTIFY THE DEATH AND THE PERSON DOES NOT THEN GO TO THE MEDICAL EXAMINER FOR FURTHER INVESTIGATION. - WITHIN THE ACCIDENTAL DEATH CATEGORY, UNINTENTIONAL OVERDOSE DEATHS DUE TO ILLICIT DRUGS, PRESCRIPTION MEDICATION AND ALCOHOL TOXICITY INCREASED BY 21% FROM 320 DEATHS IN THE FIRST HALF OF 2019 TO 387 THE FIRST SIX MONTHS OF THIS YEAR. OF THOSE ACCIDENTAL OVERDOSES, FENTANYL-CAUSED DEATHS INCREASED BY 126% COMPARING THOSE SAME SIX MONTHS WHERE THERE WERE 69 DEATHS IN 2019 AND 156 CASES FOR THE FIRST SIX MONTHS OF THIS YEAR. MOST OFTEN, OVERDOSE DEATHS FROM FENTANYL ARE TRACED TO COUNTERFEIT PILLS THAT RESEMBLE OXYCODONE OR ALPRAZOLAM, 2020 SAN DIEGO COUNTY PRESCRIPTION DRUG ABUSE TASK FORCE. - THERE WAS ALSO A DECREASE OF 5% IN NUMBER OF SUICIDES, 198 THIS YEAR COMPARED TO 209 IN THE SAME SIX MONTHS LAST YEAR. FIREARMS WERE THE LEADING METHOD OF DEATH IN 76 OF THE 198 DEATHS BY SUICIDE THIS YEAR. - HOMICIDES INCREASED BY 14% FOR THE FIRST HALF OF THE YEAR, 59 COMPARED TO LAST YEAR'S 52. IN THIS CATEGORY, FIREARMS WERE AGAIN THE LEADING METHOD OF DEATHS, 32 OF THE 59 DEATHS. - FOR ALL OF 2019, ACCIDENTAL DEATHS OVERALL COMPRISED 50% OF ALL DEPARTMENT INVESTIGATIONS. WITHIN THAT CATEGORY, UNINTENTIONAL OVERDOSES FROM DRUGS-BOTH PRESCRIPTION OR ILLEGAL-AND ALCOHOL WERE, AT 39%, THE LEADING CAUSE OF DEATH. ACCIDENTAL FALLS FOLLOWED AT 33% AND THEN TRAFFIC-RELATED FATALITIES AT 19% WERE NEXT AS OUTLINED IN THE DEPARTMENT'S ANNUAL 2019 YEAR-END REPORT. - DEATHS FROM FALLS INCREASED BY 12% WITH 545 CASES IN 2019 COMPARED TO 488 IN 2018. BLUNT HEAD TRAUMA AND HIP/FEMUR FRACTURE WERE THE LEADING CAUSE OF DEATH IN FALLS. TRAFFIC-RELATED DEATHS DECREASED BY 5% FROM 2018 WHICH HAD 316 DEATHS WHILE 2019 SAW 301 DEATHS. - CDPH AND DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION INJURY DATA INDICATES THAT, IN 2020, UNINTENTIONAL INJURIES CAUSED MORE THAN 1,500 DEATHS, NEARLY 130,000 MILLION ED VISITS, AND MORE THAN 27,500 HOSPITALIZATIONS IN SAN DIEGO COUNTY (CDPH, 2020; SPEEDTRACK, INC., 2020). - IN 2019, UNINTENTIONAL INJURY WAS THE THIRD LEADING CAUSE OF DEATH ACROSS ALL AGE GROUPS IN THE U.S., ACCOUNTING FOR MORE THAN 173,000 DEATHS. UNINTENTIONAL INJURY WAS THE LEADING CAUSE OF DEATH IN THE U.S. FOR PEOPLE AGES 1 TO 44, THE THIRD LEADING CAUSE OF DEATH FOR AGES 45 TO 64, AND THE SEVENTH LEADING CAUSE OF DEATH FOR THOSE OVER THE AGE OF 65 (CDC WONDER ONLINE DATABASE, 2021). THE STATUS OF METHAMPHETAMINE USE IN SAN DIEGO COUNTY THE METHAMPHETAMINE STRIKE FORCE, KNOWN AS THE STRIKE FORCE, WAS ESTABLISHED BY THE SAN DIEGO COUNTY BOARD OF SUPERVISORS IN 1996. TODAY THE STRIKE FORCE IS A COLLABORATION AT FEDERAL, STATE AND LOCAL LEVELS, WITH CONTRIBUTIONS FROM MORE THAN 70 PARTICIPATING AGENCIES. THE ANNUAL MSF REPORT CARD PROVIDES DATA FROM 2020 ON LEADING INDICATORS OF METH PROBLEMS. ACCORDING TO THE METHAMPHETAMINE STRIKE FORCE 2021 REPORT CARD, A TOTAL OF 722 SAN DIEGANS DIED WITH METHAMPHETAMINE IN THEIR SYSTEM AND ANOTHER 576 PEOPLE DIED DUE TO PRESCRIPTION DRUGS IN THE REGION LAST YEAR. THE NEW FIGURE FAR EXCEEDS THE PREVIOUS RECORD SET IN 2019 WHEN 546 DEATHS WERE REPORTED. THE 2021 METH REPORT CARD HIGHLIGHTS THE FOLLOWING DATA POINTS: - 566 MEN AND 156 WOMEN DIED WITH METH IN THEIR SYSTEM. - THERE WERE 16,309 EMERGENCY ROOM VISITS DUE TO METHAMPHETAMINES IN 2019 COMPARED TO 13,020 IN 2018. DATA FROM 2020 WILL BE AVAILABLE IN 2022. - A TOTAL OF 4,740 PEOPLE WERE ADMITTED TO COUNTY-FUNDED TREATMENT PROGRAMS DUE TO METH ABUSE LAST YEAR, VS. 6,591 IN 2019. - 56% OF ADULT ARRESTEES TESTED POSITIVE FOR METH IN 2020, COMPARED TO 59% THE PREVIOUS YEAR. - 8% OF JUVENILE ARRESTEES TESTED POSITIVE FOR METH IN 2020, COMPARED TO 11% IN 2019. - ARRESTS FOR SELLING AND POSSESSION OF METH DECREASED TO 7,211 COMPARED TO 11,313 IN 2019. SAN DIEGO PRESCRIPTION DRUG ABUSE TASK FORCE THE SAN DIEGO PRESCRIPTION DRUG ABUSE TASK FORCE (PDATF) IS A COUNTYWIDE INITIATIVE COMPRISED OF KEY STAKEHOLDERS, COMMUNITY MEMBERS AND LOCAL EXPERTS WORKING TOGETHER TO DECREASE THE HARMS ASSOCIATED WITH THE MISUSE OF PRESCRIPTION DRUGS IN SAN DIEGO COUNTY. MISUSE OF PRESCRIPTION DRUGS IN SAN DIEGO COUNTY CONTINUES TO BE A GROWING PROBLEM. MANY PRESCRIPTIONS RELATED OVERDOSE DEATHS ARE UNINTENTIONAL. THE 2021 PRESCRIPTION DRUG REPORT CARD ALSO INCLUDES STATISTICS ON FENTANYL. IT SHOWS THAT A RECORD 462 PEOPLE DIED FROM FENTANYL IN 2020, COMPARED TO THE 151 THE YEAR BEFORE THAT. THE PRESCRIPTION DRUG AND OPIOID DEATHS REPORTED IN 2020 MORE THAN DOUBLE THE 275 FATALITIES IN 2019. IN ADDITION TO DEATHS, THE PRESCRIPTION DRUG REPORT CARD TRACKS ADDITIONAL KEY INDICATORS OF OPIOID MISUSE IN THE REGION. IT ALSO SHOWS THE FOLLOWING (MOST RECENT YEARS FOR WHICH NUMBERS ARE AVAILABLE VARY BY STATISTIC): - 430 MEN AND 146 WOMEN DIED FROM PRESCRIPTION DRUGS. - 7,723 VISITS TO LOCAL EMERGENCY ROOMS IN 2019, COMPARED TO 6,162 IN 2018. DATA FOR LAST YEAR IS NOT YET AVAILABLE. - TEN PERCENT OF 11TH GRADERS REPORTED PRESCRIPTION DRUG USE IN 2019, THE SAME PERCENT AS IN 2017. THE SURVEY IS DONE EVERY TWO YEARS. - FORTY-SIX PERCENT OF ADULTS ARRESTED REPORTED MISUSING PRESCRIPTION DRUGS IN 2020, THE SAME AS THE YEAR BEFORE. SCRIPPS HEALTH CONTINUED TO ADDRESS UNINTENTIONAL INJURY AND VIOLENCE AND THE FOLLOWING ARE SOME EXAMPLES: OPIOID STEWARDSHIP PROGRAM (OSP) CAL HOSPITAL COMPARE (CHC), A NONPROFIT ORGANIZATION THAT PROVIDES CALIFORNIANS WITH HOSPITAL PERFORMANCE RATINGS, HAS NAMED ALL FOUR OF SCRIPPS HEALTH'S HOSPITALS TO ITS 2020 OPIOID CARE HONOR ROLL. SCRIPPS IS THE ONLY HEALTH CARE ORGANIZATION IN SAN DIEGO COUNTY TO BE RECOGNIZED ON THE INAUGURAL STATEWIDE LIST. THE 2020 OPIOID CARE HONOR ROLL RECOGNIZED 53 CALIFORNIA HOSPITALS FOR THEIR PROGRESS AND PERFORMANCE IN PROMOTING SAFE AND EFFECTIVE OPIOID USE, PROVIDING TREATMENT FOR PATIENTS WITH OPIOID USE DISORDER AND PROVIDING ACCESS TO NALOXONE TO PREVENT OPIOID OVERDOSES. ACCORDING TO PRELIMINARY STATE DATA, 5,363 CALIFORNIANS DIED OF AN OPIOID-RELATED OVERDOSE IN 2020. CHC RECOGNIZED SCRIPPS FOR TAKING A VARIETY OF APPROACHES TO ADDRESS OVERUSE OF OPIOIDS AMONG ITS PATIENTS. FOR PATIENTS BEING DISCHARGED FROM AN EMERGENCY DEPARTMENT VISIT OR HOSPITAL STAY, SCRIPPS HAS CREATED EDUCATIONAL VIDEOS THAT IT MAKES AVAILABLE FOR VIEWING AND HAS ALSO SET OPIOID PRESCRIPTION QUANTITY LIMITS AT DISCHARGE. IN ADDITION, SOME SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS HAVE IMPLEMENTED MEDICATION-ASSISTED THERAPY, IN WHICH SPECIALLY LICENSED ER PHYSICIANS CAN ADMINISTER MEDICATIONS AS A BRIDGE FOR PATIENTS WITH OPIOID USE DISORDER UNTIL THEY CAN RECEIVE FURTHER CARE.
FORM 990, PART III, LINE 4A (CONTINUED)	THE OPIOID STEWARDSHIP PROGRAM HAS SPEARHEADED MULTIPLE PROJECTS AT SCRIPPS TO EDUCATE PATIENTS AND PROVIDERS ABOUT THE RISKS OF OPIOIDS AND THE BENEFITS OF ALTERNATIVE MULTI-MODAL PAIN MANAGEMENT OPTIONS TO REDUCE OPIOID USE. THE PROGRAM HAS ESTABLISHED PRESCRIBING STANDARDS FOR OPIOIDS, RESULTING IN A REDUCTION IN THE NUMBER OF OPIOID PILLS PER PRESCRIPTION AT SCRIPPS HOSPITALS AND OUTPATIENT CENTERS. SCRIPPS HAS DRUG TAKE-BACK KIOSKS AT ITS ON-SITE PHARMACIES, OFFERING PATIENTS YEAR-ROUND ACCESS TO DISPOSE OF UNUSED, UNNEEDED OR OUTDATED MEDICATIONS. ADDITIONALLY, SCRIPPS PROVIDES A RANGE OF NON-PHARMACEUTICAL PAIN MANAGEMENT THERAPIES, INCLUDING MUSIC AND PET THERAPY, ICE AND HEAT TREATMENT, SPIRITUAL CARE AND MORE. CAR SEAT PROGRAM SCRIPPS MEMORIAL HOSPITAL LA JOLLA EMERGENCY DEPARTMENT PROVIDES CAR SEATS TO PATIENTS WHO HAVE BEEN IN AN AUTOMOBILE ACCIDENT AND THEIR CHILD'S CAR SEAT HAS BEEN RENDERED UNSAFE TO USE. THE SERVICE PROVIDES THE EASE OF MIND FOR THE PATIENT IN THEIR ABILITY TO TRANSPORT THEIR CHILD HOME SAFELY. DUE TO COVID-19 THIS PROGRAM WAS PUT ON HOLD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SAN DIEGO BRAIN INJURY FOUNDATION SCRIPPS HEALTH PROVIDES MEETING SPACE TO THE SAN DIEGO BRAIN INJURY FOUNDATION. THE ORGANIZATION PROVIDES QUALITY OF LIFE IMPROVEMENTS FOR BRAIN INJURY SURVIVORS AND SUPPORT TO FAMILY MEMBERS. DUE TO COVID-19 MEETINGS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. EVERY 15 MINUTES ALCOHOL CAN BE ATTRIBUTED TO MORE THAN 100,000 DEATHS IN THE U.S. ANNUALLY, INCLUDING 41% OF ALL TRAFFIC FATALITIES. EVERY 15 MINUTES PROGRAM IS A TWO-DAY IMMERSION EXPERIENCE FOR TEENS ON THE REALISTIC CONSEQUENCES OF DRINKING AND DRIVING, WHICH INVOLVES THE SCHOOLS, LAW ENFORCEMENT, COURTS, EMERGENCY SERVICE PROVIDERS, AND THE MORTUARY. THE "INJURED" STUDENTS ARE TAKEN TO SCRIPPS MERCY TRAUMA CENTER. THIS PROGRAM IS SPONSORED JOINTLY BY LOCAL HIGH SCHOOLS, COUNTY POLICE AND SHERIFF'S DEPARTMENTS, AMBULANCE SERVICES, AND EMERGENCY DEPARTMENTS. DUE TO COVID-19 CLASSES WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. BEACH AREA COMMUNITY COURT PROGRAM THE PROGRAM IS AN EDUCATIONAL PROGRAM FOR FIRST TIME OFFENDERS FOR QUALITY OF LIFE CRIMES. THIS IS A COLLABORATION WITH THE SAN DIEGO POLICE DEPARTMENT, PARKS AND RECREATION, DISTRICT ATTORNEY'S OFFICE AND DISCOVER PACIFIC BEACH. EDUCATION IS PROVIDED TO THE PARTICIPANTS REGARDING THESE QUALITY OF LIFE CRIMES AND THEIR EFFECTS ON THE COMMUNITY, THE EFFECTS OF SMOKING AND ALCOHOL CONSUMPTION AND THE RULES AND REGULATIONS FOR THE BEACH COMMUNITY. DUE TO COVID-19 MEETINGS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SAN DIEGO COUNTY LIFEGUARD EDUCATION CONFERENCE IN FISCAL YEAR 2021 SCRIPPS MEMORIAL HOSPITAL LA JOLLA TRAUMA DEPARTMENT HOSTED A VIRTUAL SAN DIEGO COUNTY LIFEGUARD EDUCATION CONFERENCE. SCRIPPS PARTNERED WITH CALIFORNIA STATE PARKS TO HOST AND MODERATE THE VIRTUAL WEBINAR. MORE THAN 100 INDIVIDUALS LOGGED IN FOR THE WEBINAR. INFORMATION WAS SHARED ON SEVERAL TOPICS CRITICAL FOR LIFEGUARDS, INCLUDING DOWNING RESUSCITATION: THOUGHTS FROM A TRAUMA SURGEON - THE CRITICAL ROLE LIFEGUARDS PLAY IN SURVIVAL AND RECOVERY, BUOYANT OR SINKING, MENTAL STATUS CHECK-IN, THE EFFECTS OF COVID-19 ON LIFEGUARD OPERATIONS AND PERSONNEL, AND DE-ESCALATION. THE VIRTUAL LIFEGUARD EDUCATION CONFERENCE HAS NOW BEEN VIEWED OVER 1,000 TIMES. THE TRAUMA DEPARTMENT PLANS TO CONTINUE THIS PARTNERSHIP WITH THE COUNTY LIFEGUARDS TO PROVIDE EDUCATION AND HELP THEM FURTHER IDENTIFY OPPORTUNITIES FOR COMMUNITY OUTREACH AND INJURY PREVENTION. SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE SCRIPPS HAS PARTNERED WITH THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE TO OFFER "SOFT ROOMS" AT ALL SCRIPPS HOSPITAL FACILITIES EXCEPT SCRIPPS GREEN HOSPITAL. THESE SOFT ROOMS WILL BE AVAILABLE TO PROJECT LIFE ON A MOMENT'S NOTICE TO SERVE AS A SAFE, CONFIDENTIAL ENVIRONMENT FOR LAW ENFORCEMENT TO INTERVIEW VICTIMS OF HUMAN TRAFFICKING AND FOR SERVICE PROVIDERS TO CONNECT WITH THE VICTIMS WITH EMERGENCY SHELTER AND COMMUNITY RESOURCES. THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE RECEIVES 3,000 TO 8,000 HUMAN TRAFFICKING VICTIMS EVERY YEAR IN SAN DIEGO COUNTY. APPROXIMATELY 80 PERCENT ARE BORN IN THE UNITED STATES. SAVING LIVES THROUGH STOP THE BLEED CAMPAIGN WHETHER FROM A BULLET WOUND OR OTHER TRAUMATIC INJURY, SEVERE BLOOD LOSS CAN KILL IN JUST FIVE MINUTES. HOWEVER, ONE-FIFTH OF TRAUMA DEATHS, THE LEADING CAUSE OF DEATH FOR AMERICANS UNDER AGE 46, COULD BE PREVENTED BY STAUNCHING THE BLEEDING. SCRIPPS DOCTORS ARE GETTING BEHIND THE NATIONAL STOP THE BLEED CAMPAIGN. SUPPORTED BY THE AMERICAN COLLEGE OF SURGEONS, THE DEPARTMENT OF HOMELAND SECURITY AND NUMEROUS POLICE DEPARTMENTS, IT AIMS TO TEACH BYSTANDERS HOW TO PROPERLY PLACE PRESSURE ON A WOUND OR APPLY A TOURNIQUET IN AN EMERGENCY. SCRIPPS PROVIDERS PARTICIPATE IN THIS PROGRAM BY TEACHING NONMEDICAL AUDIENCES TO CONTROL LIFE-THREATENING BLEEDING UNTIL PROFESSIONAL MEDICAL HELP ARRIVES. THE 90-MINUTE COURSE INCLUDES A PRESENTATION AND PRACTICE ON APPLYING DIRECT PRESSURE, WOUND PACKING AND USING A TOURNIQUET. DUE TO COVID-19 MEETINGS WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SAN DIEGO DAY OF TRAUMA AWARENESS CONFERENCE THE SAN DIEGO DAY OF TRAUMA IS AN ANNUAL MEETING AIMED AT ALL HEALTHCARE PROVIDERS. IN ATTENDANCE ARE TRAUMA SURGEONS, NURSES, MEDICAL STUDENTS, EMT SERVICE PROVIDERS AND LAW ENFORCEMENT. SCRIPPS PARTICIPATES ANNUALLY WITH LOCAL AGENCIES, GIVING ATTENDEES THE OPPORTUNITY TO LEARN MORE ABOUT TRAUMA SERVICES. DUE TO COVID-19 THIS EVENT WAS POSTPONED FOR THE 2020 AND 2021 ACADEMIC YEAR. THE EVENT WILL BE HOSTED AGAIN IN THE FUTURE. DISASTER PREPAREDNESS EXPO SCRIPPS MERCY HOSPITAL HELD A DISASTER PREPAREDNESS EXPO ON MARCH 23, 2019. THE EVENT INCLUDED A SIDEWALK CPR, STOP THE BLEED WHICH INCLUDE LEARNING BASIC TECHNIQUES OF BLEEDING CONTROL, LEARNING THE SIGNS AND SYMPTOMS OF STROKE AND MEETING THE MEMBERS OF THE TRAUMA TEAM AT SCRIPPS MERCY HOSPITAL. DUE TO COVID-19 THIS EVENT WAS CANCELLED DUE TO RESTRICTED ACCESS TO THE HOSPITAL. BEHAVIORAL HEALTH BEHAVIORAL HEALTH ENCOMPASSES MANY DIFFERENT AREAS INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE. BECAUSE OF THE BROADNESS OF THIS HEALTH ISSUE, IT IS OFTEN DIFFICULT TO CAPTURE THE NEED FOR BEHAVIORAL HEALTH SERVICES WITH A SINGLE MEASURE. MENTAL HEALTH CAN BE DEFINED AS "A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE". MENTAL ILLNESS IS DEFINED AS "COLLECTIVELY ALL DIAGNOSABLE MENTAL DISORDERS"HEALTH CONDITIONS THAT ARE CHARACTERIZED BY ALTERATIONS IN THINKING, MOOD, OR BEHAVIOR (OR SOME COMBINATION THEREOF) ASSOCIATED WITH DISTRESS AND/OR IMPAIRED FUNCTIONING". BEHAVIORAL HEALTH IS AN IMPORTANT HEALTH NEED BECAUSE IT IMPACTS AN INDIVIDUAL'S OVERALL HEALTH STATUS AND IS A COMORBIDITY OFTEN ASSOCIATED WITH MULTIPLE CHRONIC CONDITIONS, SUCH AS DIABETES, OBESITY AND ASTHMA. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF BEHAVIORAL HEALTH IS DESCRIBED BELOW: - THE HASD&IC AND SCRIPPS 2019 CHNA CONTINUED TO IDENTIFY BEHAVIORAL HEALTH AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - THE HASD&IC 2019 CHNA IDENTIFIED BEHAVIORAL HEALTH A TOP PRIORITY HEALTH ISSUE BOTH IN THE SECONDARY DATA ANALYSES AND IN THE COMMUNITY ENGAGEMENT EVENTS. - THE COMMUNITY ENGAGEMENT EVENTS CONDUCTED IN THE 2019 CHNA, IDENTIFIED THAT WHILE SAN DIEGO HAS INNOVATIVE PROGRAMS TO ADDRESS MENTAL HEALTH, RESIDENTS FACE CHALLENGES IN ACCESSING TIMELY, CONSISTENT MENTAL HEALTH CARE. CARE WAS DESCRIBED AS ESPECIALLY DIFFICULT TO OBTAIN WHEN THE MENTAL HEALTH ISSUE WAS NOT CONSIDERED AN EMERGENCY. - HASD&IC 2019 CHNA CONDUCTED A COMMUNITY ENGAGEMENT ANALYSIS AND ACROSS ALL TYPES OF COMMUNITY ENGAGEMENT-FOCUS GROUPS, KEY INFORMANT INTERVIEWS, AND THE ONLINE SURVEY. BEHAVIORAL HEALTH ISSUES WERE IDENTIFIED AS BOTH PREVALENT AND DEBILITATING IN THE COMMUNITY. IN THE ONLINE SURVEY, BEHAVIORAL HEALTH WAS RANKED AS THE HEALTH CONDITION HAVING THE GREATEST IMPACT ON THE HEALTH AND WELL-BEING OF SAN DIEGO COUNTY RESIDENTS AND AS THE SECOND MOST IMPACTFUL CONDITION WHEN HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH WERE COMBINED (ONLY ACCESS TO CARE RANKED HIGHER). IN ADDITION, 63% OF SURVEY RESPONDENTS INDICATED THAT THEY BELIEVE BEHAVIORAL HEALTH IS WORSENING IN SAN DIEGO COUNTY. RESPONDENTS WERE ALSO ASKED TO RANK SPECIFIC BEHAVIORAL HEALTH CONDITIONS HAVING THE GREATEST IMPACT IN SAN DIEGO. THE TOP SEVEN CONDITIONS IDENTIFIED WERE AS FOLLOWS: 1. ALCOHOL USE DISORDER 2. MOOD DISORDERS 3. SUBSTANCE USE DISORDER 4. ANXIETY 5. OPIOID USE 6. SUICIDE AND SUICIDE THOUGHTS/IDEATION 7. SELF-HARM OR SELF-INJURY - AN ANALYSIS OF MORTALITY DATA IN SAN DIEGO COUNTY FOUND THAT IN 2019, INTENTIONAL SELF-HARM (SUICIDE) WAS THE NINTH LEADING CAUSE OF DEATH.
FORM 990, PART III, LINE 4A (CONTINUED)	- IN 2019, THERE WERE 4945 ED VISITS (147.7 PER 100,000 POPULATION) AND 7861 HOSPITALIZATIONS (234.9 PER 100,000) RELATED TO MOOD DISORDERS IN SAN DIEGO COUNTY. PERCENT CHANGE FROM 2017 TO 2019 FOR ED IS -16.7% AND FOR HOSPITALIZATION IS -8.7% - IN 2019, THERE WERE 865 ED VISITS (25.8 PER 100,000 POPULATION) AND 171 HOSPITALIZATIONS (5.1 PER 100,000) RELATED TO CANNABIS USE IN SAN DIEGO COUNTY. PERCENT CHANGE FROM 2017 TO 2019 FOR ED IS 29.2% AND FOR HOSPITALIZATION IS 54.0%. THE AGE MOST IMPACTED IS 18-26 WITH 62.5 PER 100,000 POPULATION FOR ED VISITS AND 15.1 PER 100,000 FOR HOSPITALIZATIONS IN 2019. - IN 2019, THERE WERE 861 ED VISITS (25.7 PER 100,000 POPULATION) AND 379 HOSPITALIZATIONS (11.3 PER 100,000) RELATED TO OPIOID OVERDOSE IN SAN DIEGO COUNTY. PERCENT CHANGE FROM 2017 TO 2019 IS 16.8% FOR ED VISITS AND 19.6% FOR HOSPITALIZATIONS. FOR SEX, MALES (34.6 PER 100,000 POPULATION) ARE 2 TIMES MORE LIKELY TO GO TO THE ED FOR AN OPIOID OVERDOSE THAN FEMALES. FOR RACE/ETHNICITY, NON-HISPANIC BLACK HAVE THE HIGHEST RATE FOR ED VISIT (39.8 PER 100,000) FOLLOWED BY NON-HISPANIC WHITE (31.2 PER 100,000). FOR AGE GROUPS, 27-44 HAVE THE HIGHEST RATE FOR ED VISITS (49.1 PER 100,000), FOLLOWED BY 18-26 FOR ED VISITS (45.1 PER 100,000). SUICIDE AND SUICIDE ATTEMPTS SUICIDE IS A MAJOR COMPLICATION OF DEPRESSION AND A LEADING CAUSE OF NON-NATURAL DEATH FOR ALL AGES IN SAN DIEGO COUNTY, SECOND ONLY TO MOTOR VEHICLE ACCIDENTS. ACCORDING TO THE COUNTY OF SAN DIEGO, HEALTH AND HUMAN SERVICES AGENCY THE NUMBER AND RATE OF PEOPLE WHO DIED BY SUICIDE IN SAN DIEGO COUNTY DECLINED SLIGHTLY IN 2020. IN 2020, WHICH INCLUDED THE FIRST 10 MONTHS OF COVID-19, 419 DIED FROM SUICIDE, 10 FEWER THAN THE PREVIOUS YEAR'S TOTAL OF 429. HOWEVER, THE CONSEQUENCES OF THE PANDEMIC HAVE BOOSTED DEMAND FOR MENTAL HEALTH SERVICES. TO VIEW THE COMPLETE REPORT, VISIT WWW.SPCSANDIEGO.ORG. AMONG THE 2020 REPORT'S FINDINGS: 1. AFTER A PERIOD IN WHICH THE ANNUAL SUICIDE RATE REMAINED STEADY FROM 2013 TO 2018, THE SUICIDE RATE DROPPED BY 10% SINCE 2018. 2. THE 2020 SUICIDE RATE IS THE LOWEST SINCE 2010. 3. WHILE THE SUICIDE NUMBERS DECREASED IN 2020, THE COVID-19 PANDEMIC WAS LIKELY A CONTRIBUTOR FACTOR. 4. SUICIDES CONTINUE TO OUTNUMBER HOMICIDES BY A LARGE MARGIN. 5. THERE WERE ABOUT THREE AND A HALF TIMES AS MANY MALE SUICIDES AS THERE WERE FEMALE SUICIDES. 6. 53% OF ALL SUICIDES ARE WHITE MALES. 7. WHITE MIDDLE-AGED MALES, WHO ARE DIVORCED OR WIDOWED, HAVE THE HIGHEST RATES OF SUICIDE. 8. MALES ARE MORE LIKELY TO USE FIREARMS WHILE FEMALES ARE MORE LIKELY TO USE DRUGS. 9. THE SAN DIEGO COUNTY SUICIDE CONTINUES TO DECREASE BELOW THE NATIONAL RATE AS IS NOW APPROACHING THE CALIFORNIA STATE RATE. IN 2010, THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA) LAUNCHED A SUICIDE PREVENTION PLANNING PROCESS, WHICH WAS FORMED BY THE NATIONAL STRATEGY FOR SUICIDE PREVENTION AND THE CALIFORNIA STRATEGIC PLAN ON SUICIDE PREVENTION. SCRIPPS IS A MEMBER OF THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP), WHICH COLLABORATES WITH THE COUNTY ON THIS INITIATIVE. FOR MORE INFORMATION ON THE STATUS OF SUICIDE AND SUICIDE PREVENTION IN SAN DIEGO COUNTY: 2020 REPORT CARD. HTTPS://WWW.SDCHIP.ORG/INITIATIVES/SUICIDE-PREVENTION-COUNCIL/REPORTS-RESO URCES/ THE REPORT CARD BRINGS TOGETHER THE MOST RECENT DATA AVAILABLE FROM MULTIPLE SOURCES (FOR THE YEARS 2015 THROUGH 2020) TO PRESENT A PROFILE OF SUICIDES FOR ALL AGES IN SAN DIEGO COUNTY. INFORMATION FROM THE COUNTY MEDICAL EXAMINER, THE ACCESS & CRISIS LINE, HOSPITAL EMERGENCY DEPARTMENTS, STUDENT SELF-REPORTS, SUICIDE PREVENTION AWARENESS CAMPAIGNS AND SUICIDE PREVENTION TRAINING PROGRAMS ARE PRESENTED TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE STATUS OF SUICIDE AND EFFORTS TO PREVENT THEM IN SAN DIEGO COUNTY. IN 2019 THERE WERE 3,029 EMERGENCY DEPARTMENT DISCHARGES FOR SELF-INFLICTED CAUSES IN SAN DIEGO COUNTY WHICH IS A RATE OF 90.4 PER 100,000 PEOPLE. THE PERCENT OF STUDENTS WHO SERIOUSLY CONSIDERED SUICIDE IN IN 2020 WAS 14.5%. THE BEHAVIORAL HEALTH PROGRAM AT SCRIPPS MERCY ALSO SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. SCRIPPS HEALTH BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. THE BEHAVIORAL HEALTH INPATIENT PROGRAM AT SCRIPPS MERCY HOSPITAL HELPS PATIENTS AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. BEHAVIORAL HEALTH CHALLENGES - LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. - IN FISCAL YEAR 2021, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM EXPERIENCED A $6.3 MILLION LOSS IN TOTAL OPERATIONS, WITH $4.1 MILLION OF THIS LOSS BEING CAPTURED IN MEDI-CAL/CMS AND CHARITY CARE. - IN FISCAL YEAR 2021, 1.9 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE INTENSIVE BEHAVIORAL HEALTH OUTPATIENT PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) AND EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE POPULATION SERVED. COLLABORATION WITH HOSPITAL PARTNERS SUCH AS NAMI, THE FAMILY HEALTH CENTERS OF SAN DIEGO, THE MCALISTER INSTITUTE AND HAZELDEN BETTY FORD HIGHLIGHT SCRIPPS COMMITMENT TO THE COMMUNITY WE SERVE. SCRIPPS HAS ALSO RECEIVED GRANT MONEY AS PART OF THE BEHAVIORAL HEALTH PILOT PROJECT TO EMBED SUBSTANCE USE COUNSELORS IN THE EMERGENCY DEPARTMENT TO FACILITATE LINKAGE TO MEDICATION ASSISTED OUTPATIENT PROGRAMS. SCRIPPS MERCY AND FAMILY HEALTH CENTERS BEHAVIORAL HEALTH PARTNERSHIP SCRIPPS MERCY HAS ESTABLISHED AN INITIATIVE WITH FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) TO CREATE A MORE ROBUST BEHAVIORAL HEALTH CARE SYSTEM FOR MEDI-CAL PATIENTS THAT RECEIVE CARE AT SCRIPPS MERCY HOSPITAL. THE GOAL IS TO STRENGTHEN THE CONTINUUM OF INTEGRATED PRIMARY AND MENTAL HEALTH SERVICES FOR PATIENTS DISCHARGED FROM VARIOUS HOSPITAL SETTINGS (MEDICAL AND BEHAVIORAL HEALTH INPATIENT AND EMERGENCY CARE) THROUGH A VARIETY OF TIMELY PATIENT ENGAGEMENT STRATEGIES INCLUDING THE EXPANSION OF COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES ADJACENT TO THE HOSPITAL. THE PARTNERSHIP INVOLVES PLACING SOCIAL WORKERS AND SUBSTANCE USE DISORDER (SUD) COUNSELORS IN EMERGENCY DEPARTMENTS TO ASSIST WITH DIVERSIONS TO COMMUNITY RESOURCES OR TO MENTAL HEALTH CARE AS APPROPRIATE. IT IS IMPORTANT TO INVOLVE PATIENTS IN APPROPRIATE OUTPATIENT CARE BEFORE THEIR BEHAVIORAL HEALTH ISSUES BECOME ACUTE, PREVENTING RETURNS TO THE EMERGENCY DEPARTMENT. MENTAL HEALTH OUTREACH SERVICES, A-VISONS VOCATIONAL TRAINING PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, IN PARTNERSHIP WITH THE SAN DIEGO CHAPTER OF MENTAL HEALTH OF AMERICA ESTABLISHED THE A-VISONS VOCATIONAL TRAINING PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS) TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS AND OFFER VOLUNTEER AND EMPLOYMENT OPPORTUNITIES TO PERSONS WITH MENTAL ILLNESS. THIS SUPPORTIVE EMPLOYMENT PROGRAM PROVIDES VOCATIONAL TRAINING FOR PEOPLE RECEIVING MENTAL HEALTH TREATMENT, POTENTIALLY LEADING TO GREATER INDEPENDENCE. THIS YEAR, BEHAVIORAL HEALTH SERVICES CONTINUED PARTICIPATING IN THE A-VISIONS PROGRAM.
FORM 990, PART III, LINE 4A (CONTINUED)	SINCE ITS INCEPTION, 636 INQUIRIES HAVE COME IN, 165 OF THESE RESULTED IN QUALIFIED CANDIDATES WITH 101 VOLUNTEERS AND 54 EMPLOYEES THUS FAR. CURRENTLY, THERE ARE A TOTAL OF 20 ACTIVE CANDIDATES: 19 EMPLOYEES AND ONE VOLUNTEER WHO PARTICIPATE IN THIS SUPPORTIVE EMPLOYMENT PROGRAM. THE AVERAGE LENGTH OF EMPLOYMENT FOR THE 54 EMPLOYEES IS 8.6 YEARS, WITH A RANGE OF 2 MONTHS TO 14.7 YEARS. THE CURRENT PAID EMPLOYEES HAVE BEEN EMPLOYED BETWEEN 2.2 YEARS TO 14.3 YEARS, WITH THE AVERAGE LENGTH OF EMPLOYMENT BEING 8.5 YEARS. A-VISIONS PARTICIPANTS HAVE BEEN EMPLOYED ON A CASUAL/PER DIEM BASIS BY SCRIPPS ENVIRONMENTAL SERVICES, FOOD SERVICES AND CLERICAL SUPPORT FOR HEALTH AND INFORMATION SERVICES, EMERGENCY SERVICES, NURSING RESEARCH, HUMAN RESOURCES, ACCESS, BEHAVIORAL HEALTH, CREDENTIALING, LABOR AND DELIVERY, LABORATORY, MEDICAL STAFFING, PERFORMANCE IMPROVEMENT, SPIRITUAL CARE AND PALLIATIVE CARE SERVICES. PAID A-VISION'S CANDIDATES TYPICALLY LIMIT THEIR WORK TO EIGHT HOURS PER WEEK, WHICH ALLOWS THEM TO MAINTAIN ELIGIBILITY FOR THE DISABILITY BENEFITS, MEDICATIONS AND ONGOING BEHAVIORAL HEALTHCARE THAT SUPPORTS THEIR WORK. COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND THE SUICIDE PREVENTION COUNCIL THE SAN DIEGO COUNTY SUICIDE PREVENTION COUNCIL (SPC) IS A COLLABORATIVE COMMUNITY-WIDE EFFORT FOCUSED ON REALIZING A VISION OF ZERO SUICIDES IN SAN DIEGO COUNTY. ITS GOAL IS TO PREVENT SUICIDE AND ITS DEVASTATING CONSEQUENCES IN SAN DIEGO COUNTY. SINCE 2010, WITH SUPPORT FROM THE COUNTY OF SAN DIEGO BEHAVIORAL HEALTH SERVICES, CHIP PROVIDES DIRECT OVERSIGHT AND GUIDANCE TOWARD THE IMPLEMENTATION OF THE SUICIDE PREVENTION ACTION PLAN. THE CORE STRATEGIES OF THE SUICIDE PREVENTION COUNCIL ARE: - ENHANCING COLLABORATIONS TO PROMOTE A SUICIDE-FREE COMMUNITY - CONDUCTING NEEDS ASSESSMENTS TO IDENTIFY GAPS IN SUICIDE PREVENTION SERVICES AND SUPPORTS - DISSEMINATING VITAL INFORMATION ON THE SIGNS OF SUICIDE AND EFFECTIVE HELP-SEEKING - PROVIDING RESOURCES TO THOSE AFFECTED BY SUICIDE AND SUICIDAL BEHAVIOR - ADVANCING POLICIES AND PRACTICES THAT CONTRIBUTE TO THE PREVENTION OF SUICIDE PSYCHIATRIC LIAISON TEAM (PLT) THE PSYCHIATRIC LIAISON TEAM IS A MOBILE PSYCHIATRIC ASSESSMENT TEAM. CLINICIANS PROVIDE MENTAL HEALTH EVALUATION AND TRIAGE SERVICES TO ACCURATELY ASSESS PATIENTS AND PROVIDE THEM WITH THE BEST AND SAFEST COMMUNITY RESOURCES TO PROMOTE ONGOING CARE. THE TEAM AIMS TO HELP PEOPLE ADHERE TO TREATMENT PLANS, REDUCE HOSPITAL READMISSION RATES, RELIEVE SYMPTOMS AND ULTIMATELY ENSURE THE LONG-TERM STABILIZATION OF THE PATIENT'S MENTAL HEALTH. SCRIPPS WILL CONTINUE TO PROVIDE A DEDICATED PSYCHIATRIC LIAISON TEAM AT ALL SCRIPPS HOSPITALS EMERGENCY DEPARTMENTS AND URGENT CARE SETTINGS (RANCHO BERNARDO AND TORREY PINES). MI PUENTE: "MY BRIDGE" TO BETTER CARDIOMETABOLIC HEALTH AND WELL BEING SCRIPPS WHITTIER DIABETES INSTITUTE RECEIVED A $2.4 MILLION STUDY GRANT FROM THE NIH'S NATIONAL INSTITUTE OF NURSING RESEARCH IN 2015 TO EVALUATE MI PUENTE, A PROGRAM AT SCRIPPS MERCY CHULA VISTA HOSPITAL THAT USES A "NURSE + VOLUNTEER" TEAM APPROACH TO HELP HOSPITALIZED HISPANIC PATIENTS WITH MULTIPLE CHRONIC DISEASES REDUCE THEIR HOSPITALIZATIONS AND IMPROVE THEIR DAY-TO-DAY HEALTH AND QUALITY OF LIFE. INDIVIDUALS OF LOW SOCIOECONOMIC (SES) AND ETHNIC MINORITY STATUS, INCLUDING HISPANICS, THE LARGEST U.S. ETHNIC MINORITY GROUP ARE DISPROPORTIONATELY BURDENED BY CHRONIC CARDIOVASCULAR AND METABOLIC CONDITIONS ("CARDIOMETABOLIC" E.G. OBESITY, DIABETES, HYPERTENSION, HEART DISEASE). HIGH LEVELS OF UNMET BEHAVIORAL HEALTH IN THIS POPULATION CONTRIBUTE TO STRIKING DISPARITIES IN DISEASE PREVALENCE AND OUTCOMES. A BEHAVIORAL HEALTH NURSE PROVIDES IN-HOSPITAL COACHING TO PATIENTS, WHO ARE THEN FOLLOWED POST DISCHARGE BY A VOLUNTEER COMMUNITY PEER MENTOR TO ASSIST THEM IN OVERCOMING BARRIERS THAT MAY INTERFERE WITH ACHIEVING AND MAINTAINING GOOD HEALTH. MI PUENTE AIMS TO IMPROVE CONTINUITY OF CARE AND ADDRESS THE (PHYSICAL AND BEHAVIORAL) HEALTH NEEDS OF THE AT-RISK HISPANIC POPULATION. THIS PROGRAM HOLDS PROMISE FOR IMPACTFUL EXPANSION TO OTHER CONDITIONS AND UNDERSERVED POPULATIONS. BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES MANY PEOPLE FIND THAT THE DAY-TO-DAY TASKS ASSOCIATED WITH HAVING DIABETES TESTING ONE'S BLOOD SUGAR, PLANNING MEALS, GETTING ENOUGH PHYSICAL ACTIVITY AND REMEMBERING TO TAKE MEDICATIONS CAN BE STRESSFUL. A COMMON CONDITION KNOWN AS "DIABETES DISTRESS" CAN BE THE RESULT OF FEELING LIKE IT'S ALL TOO MUCH. SCRIPPS DIABETES CARE AND PREVENTION HAS A DIABETES BEHAVIORAL SPECIALIST ON STAFF TO HELP PEOPLE MANAGE THEIR DIABETES WITHOUT BEING OVERWHELMED OR UNDULY DISTRESSED. THE BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES IS AN INTEGRATED, INTERDISCIPLINARY APPROACH TO MANAGING THE EMOTIONAL AND BEHAVIORAL NEEDS THAT OFTEN LEADS TO BURNOUT OF INDIVIDUALS WITH TYPE 1 AND TYPE 2 DIABETES. THE COLLOCATION OF MEDICAL AND BEHAVIORAL HEALTH SERVICES IN THE SAME FACILITY ALLOW FOR A CONVENIENT, WARM HAND-OFF FROM PHYSICIAN TO BEHAVIORAL HEALTH SPECIALIST. IT ALSO AFFORDS OPPORTUNITIES FOR PHYSICIANS, DIABETES EDUCATORS AND OTHERS TO RECEIVE CONSULTATION ON BEHAVIORAL HEALTH CONCERNS, AND IN TURN, MORE COMPREHENSIVELY ADDRESS THE MULTI-FACETED NEEDS OF THEIR PATIENTS WITH DIABETES. MENTAL HEALTH SUPPORT SERVICES AT LOCAL SCHOOL-BASED CLINICS SCRIPPS FAMILY MEDICINE RESIDENCY AND SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER HAVE PARTNERED TO OFFER CLINICAL TRAINING OPPORTUNITIES FOR MASTER SOCIAL WORK STUDENTS IN TRAINING FROM SAN DIEGO STATE UNIVERSITY AT SOUTHWEST AND PALOMAR HIGH SCHOOLS. THESE STUDENTS WORK WITH LOCAL PROVIDERS THAT ADDRESS THE MENTAL HEALTH NEEDS OF VULNERABLE ADOLESCENTS. A VARIETY OF MENTAL HEALTH ISSUES ARE PRESENT FOR LOCAL HIGH SCHOOL STUDENTS. MANY OF THESE ISSUES INCLUDE DEPRESSION, ANXIETY AND SUICIDE RELATED CONCERNS. THE PROGRAM WORKS TO IMPROVE OVERALL MENTAL HEALTH CARE FOR LOCAL STUDENTS THROUGH A SCHOOL-BASED CLINIC. DUE TO COVID-19 THE SCHOOLS WERE CLOSED FOR SEVERAL WEEKS AND THEN TRANSITIONED TO A VIRTUAL SETTING. THIS PROGRAM WILL BEGIN IN THE NEW SCHOOL YEAR 2022. PATIENT COMMUNITY SERVICES: BEHAVIORAL HEALTH PATIENTS ARE REFERRED FROM SCRIPPS MERCY HOSPITAL CHULA VISTA, FOR ASSISTANCE WITH A WIDE VARIETY OF BEHAVIORAL HEALTH NEEDS INCLUDING ADDICTION, LOSS, ANXIETY AND OTHER MENTAL HEALTH ISSUES. THE WELL-BEING CENTER OFFERS WEEKLY COUNSELING AND/OR REFER PATIENTS TO LOCAL MENTAL HEALTH COUNSELING SERVICES. THESE SERVICES ARE OFFERED REMOTELY DUE TO COVID-19. ALCOHOLIC ANONYMOUS SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF ALCOHOLIC ANONYMOUS. A FELLOWSHIP OF MEN AND WOMEN WHO SHARE THEIR EXPERIENCE, STRENGTH AND SUPPORT OF EACH OTHER. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. GRIEF RECOVERY AFTER A SUBSTANCE PASSING (GRASP) SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF GRASP. GRASP WAS FOUNDED TO HELP PROVIDE SOURCES OF HELP, COMPASSION AND MOST OF ALL, UNDERSTANDING, FOR FAMILIES OR INDIVIDUALS WHO HAVE HAD A LOVED ONE DIE AS A RESULT OF SUBSTANCE USE OR ADDICTION. DUE TO COVID-19 MEETINGS WERE NOT HELD MOST OF THE YEAR DUE TO RESTRICTED ACCESS TO THE HOSPITAL. NATIONAL ALLIANCE OF MENTAL ILLNESS (NAMI) SIBLINGS SUPPORT SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF NAMI SIBLING SUPPORT. THIS IS A CONFIDENTIAL SUPPORT GROUP FOR SIBLINGS OF PERSON WITH MENTAL ILLNESS AND ADULT CHILDREN OF PARENTS WITH MENTAL ILLNESS. THESE MEETINGS WERE CANCELLED DUE TO COVID-19 AND RESTRICTED ACCESS TO THE HOSPITAL. SURVIVORS OF SUICIDE LOSS - SAN DIEGO CHAPTER SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF THE SURVIVORS OF SUICIDE LOSS - SAN DIEGO CHAPTER. THE ORGANIZATION REACHES OUT TO AND SUPPORTS PEOPLE WHO HAVE LOST A LOVED ONE TO SUICIDE. THE GOAL IS TO GIVE SURVIVORS A PLACE WHERE THEY CAN BE COMFORTABLE EXPRESSING THEMSELVES, A PLACE TO FIND SUPPORT, COMFORT, RESOURCES AND HOPE IN A JUDGMENT-FREE ENVIRONMENT. THESE MEETINGS WERE CANCELLED DUE TO COVID-19 AND RESTRICTED ACCESS TO THE HOSPITAL. SCRIPPS DRUG AND ALCOHOL RESOURCES THERE ARE MORE THAN 25 MILLION ILLICIT DRUG USERS IN THE US. THERE ARE AN ESTIMATED 136.9 MILLION CURRENT DRINKERS OF ALCOHOLIC BEVERAGES AND OF THOSE, APPROXIMATELY 23 PERCENT BINGE DRANK IN THE LAST 30 DAYS AND 6.3 PERCENT ARE CONSIDERED HEAVY DRINKERS. IT IS ESTIMATED THERE ARE 8.7 MILLION UNDER-AGE DRINKERS. SUBSTANCE USE, PARTICULARLY OPIOID MISUSE, IS A HEALTH CRISIS THAT HAS REACHED EPIDEMIC PROPORTIONS BOTH NATIONALLY AND LOCALLY. ACCORDING TO THE CDC DRUG USE WAS ALREADY A BIG PROBLEM BEFORE THE CORONAVIRUS PANDEMIC. OVERDOSE DEATHS INCREASED BY 30% NATIONALLY DURING THE PANDEMIC.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS SUBSTANCE USE DISORDER SERVICE (SUDS) NURSES AWARE OF THE IMPACT DRUGS AND ALCOHOL CAN HAVE ON OUR COMMUNITY, SCRIPPS HAS DEVELOPED INNOVATIVE WAYS TO TREATING THIS DESTRUCTIVE DISEASE. SCRIPPS HAS DEPLOYED SPECIALIZED NURSES CERTIFIED IN ADDICTION; THEY SEE PATIENTS AT THEIR BEDSIDE AND WORK CLOSELY WITH THE PATIENT'S ENTIRE HEALTH CARE TEAM TO HELP FACILITATE A SAFE DETOX WHILE HOSPITALIZED. THE SUBSTANCE USE DISORDER SERVICE (SUDS) NURSES ACT IN A PROACTIVE AND REACTIVE ROLE IN ALL SCRIPPS HOSPITALS, HELPING TO IDENTIFY PATIENTS WHO ARE AT RISK, OR ARE CURRENTLY EXPERIENCING WITHDRAWAL FROM ADDICTIVE SUBSTANCES. THIS MOBILE GROUP OF SPECIALLY TRAINED DRUG AND ALCOHOL RESOURCE NURSES PROVIDE EDUCATION, INTERVENTIONS AND DISCHARGE PLACEMENT ASSISTANCE TO PATIENTS IN THE SCRIPPS HOSPITALS. THE RESOURCE NURSES WORK DIRECTLY WITH THE NURSING STAFF AT EACH OF THE HOSPITALS IN SEARCH OF PATIENTS WHO MAY BE AT RISK FOR ALCOHOL/DRUG WITHDRAWAL AND ASSIST WITH IMPLEMENTING A STANDARDIZED PROTOCOL WITHDRAWAL PROCESS. SCRIPPS HAS CHANGED THE WAY WE DELIVER DRUG AND ALCOHOL TREATMENT BY COLLABORATING WITH OTHERS TO DELIVER A CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. WHEN PATIENTS NEED ADDITIONAL CARE, SCRIPPS HAS LINKED ITSELF TO TWO SEPARATE TREATMENT PROGRAMS DESIGNED TO MEET THE COMMUNITY NEEDS. BETTY FORD CENTER IN 2016, SCRIPPS PARTNERED WITH THE BETTY FORD CENTER, WHICH EXPANDED ITS DRUG AND ALCOHOL TREATMENT PROGRAMMING INTO SAN DIEGO. THIS TREATMENT CENTER BRINGS WORLD-RENOWNED ALCOHOL AND DRUG REHAB TO MORE PEOPLE THROUGH WEEKDAY AND WEEKNIGHT OUTPATIENT SERVICES. FAMILY HEALTH CENTERS OF SAN DIEGO FAMILY HEALTH CENTERS OF SAN DIEGO PROVIDES AN ARRAY OF SERVICES, INCLUDING OUTPATIENT DRUG AND ALCOHOL TREATMENT ALONG WITH MEDICATION-ASSISTED TREATMENT AND HARM REDUCTION PROGRAMS. THEIR SERVICES ALSO INCLUDE INDIVIDUAL COUNSELING AND ONE-ON-ONE SUPPORT, EDUCATIONAL SESSIONS, HIV RESTING, HEPATITIS B & C TESTING AND TREATMENT. SOCIAL DETERMINANTS OF HEALTH IN ADDITION TO THE HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA, SOCIAL DETERMINANTS OF HEALTH (SDOH) WERE ALSO IDENTIFIED IN ALL THE COMMUNITY ENGAGEMENT ACTIVITIES. APPROXIMATELY 80 PERCENT OF MODIFIABLE RISKS FOR DISEASES ARE ATTRIBUTABLE TO NON-MEDICAL (UPSTREAM) DETERMINANTS OF HEALTH, SUCH AS HEALTH BEHAVIORS, SOCIOECONOMIC STATUS, AND ENVIRONMENTAL CONDITIONS. TO PREVENT CHRONIC CONDITIONS AND PROMOTE HEALTH, GREATER EMPHASIS SHOULD BE PLACED ON POPULATION HEALTH, WHICH HAS BEEN DEFINED TO FOCUS ON OUTCOMES AS WELL AS ON THE BROADER FACTORS THAT INFLUENCE HEALTH AT A POPULATION LEVEL, INCLUDING MEDICAL CARE SYSTEMS, THE SOCIAL ENVIRONMENT, AND THE PHYSICAL ENVIRONMENT. THE CHNA IDENTIFIED ECONOMIC SECURITY AS A PRIORITY SDOH NEED IN THE SECONDARY DATA ANALYSES AND IN THE COMMUNITY ENGAGEMENT PROCESS. ECONOMIC SECURITY REFERS TO THE ABILITY TO MEET ESSENTIAL FINANCIAL NEEDS SUSTAINABLY, INCLUDING THOSE FOR FOOD, SHELTER, CLOTHING, HYGIENE, HEALTH CARE, AND EDUCATION. ECONOMIC INSECURITY IS ASSOCIATED WITH: - POOR MENTAL HEALTH DAYS - VISITS TO THE ED FOR HEART ATTACKS - ASTHMA - OBESITY - DIABETES - STROKE - CANCER - SMOKING - PEDESTRIAN INJURY ECONOMIC INSECURITY MAY ALSO LEAD TO FOOD INSECURITY, WHICH IS LINKED TO: - FAIR OR POOR HEALTH, ANEMIA, AND ASTHMA IN CHILDREN - MENTAL HEALTH PROBLEMS, DIABETES, HYPERTENSION, HYPERLIPIDEMIA, AND ORAL HEALTH PROBLEMS IN ADULTS - FAIR OR POOR HEALTH, DEPRESSION, AND LIMITATIONS IN ACTIVITIES OF DAILY LIVING IN SENIORS ECONOMIC SECURITY IS ALSO LINKED TO WAGES. - EDUCATIONAL ATTAINMENT IS DIRECTLY RELATED TO ECONOMIC INSECURITY BY WAY OF LOW WAGES AND/OR LIMITED ACCESS TO EMPLOYMENT - IN SAN DIEGO, ADULTS WHO HAD LESS THAN A HIGH SCHOOL DIPLOMA WAS HIGHEST IN SOUTH (21.9%) AND CENTRAL (19.9%) REGIONS. FOOD INSECURITY FOOD INSECURITY IS THE INABILITY TO AFFORD ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. THE HASD&IC 2019 CHNA IDENTIFIED FOOD INSECURITY AND ACCESS TO HEALTHY FOOD AS A SOCIAL DETERMINANT IMPACTING SAN DIEGO'S PRIORITY HEALTH NEEDS. STUDIES DEMONSTRATE THAT HUNGER SIGNIFICANTLY IMPACTS HEALTH. LACK OF ACCESS TO HEALTHY FOOD, OFTEN DUE TO AVAILABILITY AND COST, ARE STRESSORS THAT CONTRIBUTE TO DIABETES, HEART DISEASE, OBESITY, AND OTHER BEHAVIORAL HEALTH ISSUES IN A MYRIAD OF WAYS: - FOOD INSECURE ADULTS WITH DIABETES HAVE HIGHER AVERAGE BLOOD SUGAR. - FOOD-INSECURE ADULTS ARE MORE LIKELY TO BE OBESE. - FOOD INSECURITY IS SIGNIFICANTLY MORE PREVALENT IN ADULTS WITH MOOD DISORDERS. - FOOD INSECURITY IS ASSOCIATED WITH INCREASED RISK OF SUICIDAL THOUGHTS AND SUBSTANCE USE IN ADOLESCENTS. - FOOD INSECURE SENIORS HAVE A SIGNIFICANTLY HIGHER LIKELIHOOD OF HEART DISEASE, DEPRESSION, AND LIMITED ACTIVITIES OF DAILY LIVING. - FOOD-INSECURE ADULTS DELAY THE PURCHASE OF FOOD TO BUY MEDICINES. ACCORDING TO AN ISSUE BRIEF FROM THE SAN DIEGO HUNGER COALITION , THE COVID-19 PANDEMIC AND ECONOMIC CRISIS BOTH INCREASED THE STRAIN ON EXISTING NUTRITION INSECURE POPULATIONS AND INCREASED THE NUMBER OF INDIVIDUALS EXPERIENCING NUTRITION INSECURITY, MANY OF WHOM EXPERIENCED NUTRITION INSECURITY FOR THE FIRST TIME AND HAD LITTLE KNOWLEDGE OF AVAILABLE RESOURCES. IN ADDITION, THE SAN DIEGO HUNGER COALITION REPORT HIGHLIGHTS APPROXIMATELY ONE IN THREE SAN DIEGANS EXPERIENCE NUTRITION INSECURITY OR ARE UNABLE TO PROVIDE THREE NUTRITIOUS MEALS PER DAY FOR THEMSELVES AND/OR THEIR FAMILIES. THIS IS UP FROM AN ESTIMATED ONE IN FOUR SAN DIEGANS IN 2019, WHICH WAS THE LOWEST RATE SINCE THE GREAT RECESSION AND A 10-YEAR LOW FOR THE COUNTY. OF THOSE EXPERIENCING NUTRITION INSECURITY, 28% WERE NEWLY NUTRITION INSECURE IN 2020, WHILE 73% WERE ALREADY STRUGGLING TO MEET THEIR NEEDS BEFORE THE COVID-19 PANDEMIC. NUTRITION INSECURITY DISPROPORTIONATELY IMPACTS THOSE WHO ARE BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC). THE MOST RECENT US CENSUS AMERICAN COMMUNITY SURVEY DATA INDICATES THAT, WHILE AN ESTIMATED 25% OF THE POPULATION IN SAN DIEGO WAS NUTRITION INSECURE IN 2019, 44% OF THE BLACK POPULATION AND 37% OF THE INDIGENOUS POPULATION WERE NUTRITION INSECURE. SIMILARLY, 44% OF HISPANIC OR LATINX PEOPLE ACROSS RACES WERE NUTRITION INSECURE. NUTRITION INSECURITY ALSO DISPROPORTIONATELY IMPACTS PEOPLE WITH DISABILITIES. IN 2019, 40% OF PEOPLE WITH DISABILITIES WERE NUTRITION INSECURE. IT IS ANTICIPATED THESE DISPARITIES HAVE WORSENED DURING THE PANDEMIC. IN 2020, DUE TO THE PANDEMIC, THE PERCENT OF THE POPULATION EXPERIENCING NUTRITION INSECURITY IN SAN DIEGO COUNTY INCREASED FROM 25% IN 2019 TO A PEAK OF 39% (1,291,000 PEOPLE) IN APRIL 2020, THEN LEVELED OFF TO 30% (1,015,000 PEOPLE) IN NOVEMBER 2020. AS OF JUNE 2021, NUTRITION INSECURITY CONTINUES TO AFFECT ONE IN THREE PEOPLE IN SAN DIEGO COUNTY. NUTRITION INSECURITY IS EVEN WORSE AMONG CHILDREN. AS OF MARCH 2021, 284,500 CHILDREN, OR 40% OF CHILDREN IN SAN DIEGO COUNTY WERE NUTRITION INSECURE. NUTRITION INSECURITY IS ALSO PERVASIVE AMONG SENIORS, WITH 146,000, OR 30% OF SENIORS IN SAN DIEGO COUNTY FACING NUTRITION INSECURITY. SAN DIEGO COUNTY MARCH 2021 NUTRITION INSECURITY RATES - TOTAL NUTRITION INSECURE POPULATION: 1,035,000 - THIS REPRESENTS 31% OF TOTAL POPULATION (3,347,270), OR 1 IN 3 PEOPLE - NUTRITION INSECURE CHILDREN: 284,500 - THIS REPRESENTS 40% IF THE TOTAL CHILD POPULATION IN SAN DIEGO COUNTY (717,000) OR MORE THAN 2 IN 5 CHILDREN - NUTRITION INSECURE SENIORS: 146,000 - THIS REPRESENTS 30% OF TOTAL SENIOR POPULATIONS IN SAN DIEGO COUNTY (487,000) FEDERAL CAL-FRESH PROGRAM THE CAL-FRESH PROGRAM, FEDERALLY KNOWN AS THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) IS THE NATION'S LARGEST NUTRITION ASSISTANCE PROGRAM AND HELPS FEED 40 MILLION AMERICANS EACH YEAR. THE FEDERAL GOVERNMENT FUNDS SNAP BENEFITS AND SHARES THE COST WITH THE STATES. SNAP RECIPIENTS RECEIVE FUNDS MONTHLY, WHICH ARE LOADED ONTO AN ELECTRONIC BENEFIT TRANSFER CARD THAT THEY CAN USE TO PURCHASE FOOD FROM PARTICIPATING RETAILERS. SNAP SERVES AS A CRITICAL PIECE OF THE SOCIAL SAFETY NET AND HAS HELPED ENSURE THAT MILLIONS OF AMERICANS HAVE FOOD TO EAT DURING THE PANDEMIC. THE LARGEST SOURCE OF FOOD ASSISTANCE IN SAN DIEGO COUNTY CONTINUES TO BE THE CAL-FRESH (SNAP) PROGRAM. THE TOTAL AMOUNT OF FOOD ASSISTANCE FROM THE CAL-FRESH PROGRAM IN 2020 INCREASED BY AN ESTIMATED 8 MILLION MEALS BETWEEN JANUARY AND NOVEMBER 2020. INCREASES IN CAL-FRESH BENEFITS AND UNEMPLOYMENT LAST YEAR KEPT FOOD INSECURITY FROM GROWING EXPONENTIALLY DUE TO THE PANDEMIC AND THE ECONOMIC SHUTDOWN, BUT THE CHALLENGE PERSISTS FOR MILLIONS OF PEOPLE AND COULD GROW AS SOME OF THE TEMPORARY BENEFITS ASSOCIATED WITH THE PANDEMIC EXPIRE.
FORM 990, PART III, LINE 4A (CONTINUED)	FEDERAL REDUCED-PRICE MEALS PROGRAM (FRPM) ACCORDING TO A REPORT RELEASED BY THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE, WWW.SAN DIEGO COUNTYOI.ORG, THE EFFECT OF POVERTY AND FOOD INSECURITY ON STUDENTS' OVERWEIGHT AND OBESITY RATES CAN MOST PROFOUNDLY BE OBSERVED WHEN LOOKING AT DISTRICTS WITH HIGH CONCENTRATIONS OF STUDENTS ENROLLED IN THE FEDERAL REDUCED-PRICE MEALS PROGRAM (FRPM). ALL STUDENTS CAN PARTICIPATE IN SCHOOL NUTRITION PROGRAMS; HOWEVER, STUDENTS WITH FAMILY INCOMES UNDER 130% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE MEALS, AND THOSE WITH INCOMES BETWEEN 130% AND 185% OF THE POVERTY LEVEL ARE ELIGIBLE FOR LOW-COST (OR "REDUCED PRICE") MEALS. STUDENTS ENROLLED IN THIS PROGRAM NOT ONLY COME FROM LOWER INCOME HOUSEHOLDS BUT ARE ALSO LIKELY TO BE FOOD INSECURE (CALIFORNIA DEPARTMENT OF EDUCATION, STUDENT POVERTY FRPM DATA). PRE-COVID, HALF OF ALL PUBLIC-SCHOOL STUDENTS - OVER 250,000 CHILDREN WERE ENROLLED IN THE FREE & REDUCED-PRICE MEAL PROGRAM. WHEN SCHOOLS CLOSE, WHETHER FOR A SCHEDULED SCHOOL CLOSURE LIKE SUMMER OR AN UNSCHEDULED SCHOOL CLOSURE LIKE A PANDEMIC OR WILDFIRE, FAMILIES OFTEN STRUGGLE TO ENSURE THEIR CHILDREN HAVE THE NUTRITIOUS FOOD THEY NEED TO LEARN, GROW, AND THRIVE. FOR KIDS WHO DEPEND ON SCHOOL MEALS FOR CONSISTENT NUTRITION, MISSED MEALS MEAN SETBACKS IN PHYSICAL HEALTH, EMOTIONAL HEALTH, AND ACADEMIC FULFILLMENT. COVID-19 FORCED SCHOOLS INTO DISTANCED LEARNING, CAUSING MILLIONS OF CHILDREN NATIONWIDE TO LOSE ACCESS TO FREE AND REDUCED-PRICE SCHOOL MEALS. AS A RESULT, FOOD INSECURITY INCREASED MOST DRAMATICALLY AMONG FAMILIES WITH SCHOOL-AGE KIDS. IN SAN DIEGO COUNTY ALONE, FOOD INSECURITY ROSE FROM 1 IN 5 CHILDREN TO 2 IN 5 CHILDREN SINCE THE START OF THE PANDEMIC. THE PANDEMIC-EBT (P-EBT) PROGRAM, INTRODUCED IN 2020, WAS QUICKLY RECOGNIZED BY FAMILIES AND ANTI-HUNGER ADVOCATES AS THE MOST DIRECT AND EFFECTIVE WAY TO CLOSE THE CHILD MEAL GAP DURING TIMES OF SCHOOL CLOSURES (SAN DIEGO HUNGER COALITION). THE PROGRAMS HIGHLIGHTED BELOW ARE WAYS THAT SCRIPPS HEALTH IS ADDRESSING FOOD INSECURITY, SCREENINGS AND ELIGIBILITY BENEFITS. SCRIPPS HEALTH CALFRESH SCREENINGS AS HEALTH CARE DELIVERY SYSTEMS MOVES TOWARDS A POPULATION HEALTH PARADIGM THAT INCENTIVIZES KEEPING PATIENT'S HEALTHY, HOSPITALS AND CLINICS ARE RECOGNIZING THE SIGNIFICANCE OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH, SUCH AS FOOD INSECURITY (FI). HOSPITALS HAVE BEEN MORE PROACTIVE IN INTERVENING AT SOME LEVEL OF CARE TO AID THE INDIVIDUALS SUFFERING FROM FI AND THEIR ABILITY TO GAIN CONTROL OVER THEIR HEALTH. ACCORDINGLY, FOOD ASSISTANCE PROVIDED BY THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)-KNOWN AS CALFRESH IN CALIFORNIA, SIGNIFICANTLY REDUCES THE RATE AND SEVERITY OF POVERTY THROUGHOUT THE STATE (CALIFORNIA BUDGET & POLICY CENTER, 2018). WHILE SNAP AND WOMEN'S, INFANTS, CHILDREN (WIC) HAVE BEEN SUCCESSFUL IN ASSISTING LOW-INCOME CHILDREN AND THEIR FAMILIES WITH ADDITIONAL FUNDING FOR PURCHASING HEALTHY FOODS, THERE IS EVIDENCE THAT SUGGESTS SCREENING FOR FI IN HEALTHCARE SETTINGS IS THE BEST INDICATOR FOR PATIENTS TO ACCESS FOOD-RELATED ASSISTANCE. THE PUBLIC RESOURCE SPECIALIST (PRS) TEAM SCREEN ALL UNINSURED PATIENTS WHO HAVE RECEIVED SERVICES AT ANY OF THE FIVE SCRIPPS HOSPITAL FACILITIES. SCRIPPS HEALTH BEGAN SCREENING FOR CALFRESH IN JUNE 2017 THROUGH THE SUPPORT OF THE PRS TEAM. THE TEAM HAS BEEN SUCCESSFUL IN HAVING AN IMPORTANT CONVERSATION ABOUT FOOD INSECURITY WITH PATIENTS AND IN FISCAL YEAR 2021, THE PRS TEAM SUCCESSFULLY SCREENED 4,551 FOOD INSECURE PATIENTS. OUT OF THOSE SCREENINGS, PRS SUBMITTED 3,418 MEDI-CAL APPLICATIONS TO THE COUNTY AND 31% OF THE APPLICATIONS SUBMITTED WERE FOR BOTH MEDI-CAL AND CALFRESH. SCRIPPS MERCY WIC PROGRAM THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) PROVIDES NUTRITIOUS FOOD, EDUCATION, AND OTHER SUPPORT TO LOW-INCOME PREGNANT, POSTPARTUM, AND BREASTFEEDING WOMEN AND THEIR CHILDREN UP TO AGE 5. THE $6 BILLION PROGRAM IS FEDERALLY FUNDED AND ADMINISTERED BY USDA'S FOOD AND NUTRITION SERVICES AND LOCAL AGENCIES. WIC HELPS ADDRESS SOME SDOH BY PROVIDING ITS PARTICIPANTS WITH GREATER FOOD SECURITY, EDUCATING THEM ABOUT NUTRITION, ASSISTING THEM WITH BREASTFEEDING, AND REFERRING PARTICIPANTS TO SOCIAL SERVICE AGENCIES THAT MAY HELP THEM WITH HOUSING AND OTHER NEEDS. SCRIPPS MERCY WILL CONTINUE TO OFFER WIC SERVICES THROUGH ITS LARGEST DISTRIBUTION LOCATION BASED IN THE CITY HEIGHTS COMMUNITY. THE SCRIPPS MERCY WIC PROGRAM, A FEDERALLY FUNDED NUTRITION PROGRAM TARGETING PREGNANT AND PARENTING WOMEN AND THEIR CHILDREN (AGES 0 TO 5), IS ONE OF FIVE WIC PROGRAMS OPERATING IN SAN DIEGO COUNTY. WIC SERVICES PROVIDE NUTRITION EDUCATION, COUNSELING SERVICES AND FOOD VOUCHERS FOR AN AVERAGE OF 6,200 LOW-INCOME WOMEN, INFANTS AND CHILDREN MONTHLY. IN FISCAL YEAR 2021, THE WIC PROGRAM SERVED 70,450 CLIENTS. LACTATION EDUCATION AND SUPPORT SERVICES ARE OFFERED TO IMPROVE BREASTFEEDING AMONG POSTPARTUM AND PARENTING WOMEN. THE SCRIPPS MERCY SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) HAS DISTRIBUTION SITES AT LA MAESTRA FAMILY CLINIC/CITY HEIGHTS WELLNESS CENTER, AS WELL AS LINDA VISTA HEALTH CENTER AND OTHER STOREFRONT FACILITIES IN CENTRAL AND SOUTH SAN DIEGO COUNTY. IN NOVEMBER 2021, SCRIPPS WIC SERVICES MOVED TO A SUITE AT THE PRICE ENTITIES BUILDING. FOOD FINDERS - RESCUING FOOD, REDUCING HUNGER SCRIPPS CORPORATE FOOD SERVICE PARTNERED WITH FOOD FINDERS, A MULTI-REGIONAL FOOD BANK AND FOOD RESCUE PROGRAM THAT CONNECTS BUSINESSES TO CHARITABLE INSTITUTIONS IN NEED OF DONATIONS. FOOD FINDERS CONNECTED SCRIPPS WITH INTERFAITH COMMUNITY SERVICES IN ESCONDIDO, WHICH DISTRIBUTES FOOD TO PEOPLE IN NEED. ALL LEFTOVER FOOD FROM SCRIPPS CORPORATE FACILITIES IS PACKAGED, PICKED UP EACH DAY AND TRANSFERRED TO THE SCRIPPS 4S RANCH FOOD AND NUTRITION SERVICES FREEZER FOR STORAGE. THE COST IS MINIMAL, AS SCRIPPS USES THE SAME AMOUNT OF LABOR TO PACKAGE THE FOOD AS IT WOULD TO DISPOSE OF IT, AND UNSOLD "GRAB AND GO" ITEMS ARE ALREADY PACKAGED. INTERFAITH COMMUNITY SERVICES PICKS UP THE PACKAGED FROZEN FOOD TWICE PER WEEK AND TRANSPORTS IT TO ONE OF THEIR FACILITIES TO HELP FEED THE COMMUNITY. THIS PROGRAM IS CURRENTLY ON HOLD DUE TO THE COVID-19 PANDEMIC. COOKING FOR HEALTH SCRIPPS CENTER FOR INTEGRATIVE MEDICINE AND BASTYR UNIVERSITY'S MASTER OF SCIENCE IN NUTRITION FOR WELLNESS PROGRAM COLLABORATE ON OFFERING FREE CLASSES THAT TEACH INDIVIDUALS HOW TO MAKE VEGETARIAN AND VEGAN MEALS THAT ARE DELICIOUS AND EASY TO PREPARE. PARTICIPANTS LEARN HOW TO COOK HEALTHY MEALS AND ARE EDUCATED ON WHY INGREDIENTS ARE CHOSEN AND THE HEALTH BENEFITS. THESE COOKING CLASSES FOCUS ON DISEASE PREVENTION, REDUCING OBESITY AND IMPROVING CHRONIC HEALTH ISSUES. DUE TO COVID-19 CLASSES WERE NOT HELD DUE TO RESTRICTED ACCESS TO THE HOSPITAL. SCRIPPS EMPLOYEE FOOD SHARING PROGRAM EMPLOYEES FROM ACROSS THE SYSTEM BEGAN REACHING OUT ABOUT FOOD RESOURCES FOR COLLEAGUES AT SCRIPPS. AS A RESULT OF THESE MUTUAL CONCERNS THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM WAS ESTABLISHED TO ASSIST SCRIPPS FAMILIES EXPERIENCING FOOD INSECURITY AS THE COVID-19 CRISIS CONTINUED. A FOOD DISTRIBUTION EVENT WAS HELD ON MARCH 27, 2021. THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM SUCCESSFULLY DISTRIBUTED FOOD TO 127 COLLEAGUES AND 499 FAMILIES WHO FOUND THEMSELVES IN NEED OF ASSISTANCE DURING THIS COVID-19 CRISIS. FOOD DISTRIBUTED: 8,316 POUNDS OF GROCERIES AND EACH STAFF MEMBER RECEIVED MILK, EGGS, BREAD, FRUIT, VEGETABLES, A BOX OF NON-PERISHABLE FOOD AND A FRESHLY PREPARED MEAL FROM COLORS CAF. IN ADDITION, 105 GIFT CARDS TOTALING $2,320 WERE DISTRIBUTED AND DONATIONS BY PAYROLL DEDUCTION OF 253 EMPLOYEES DONATED $15,845. MANY OF THE RECIPIENTS SHARED WORDS OF THANKS AND GRATITUDE TO THEIR SCRIPPS FAMILY. ONE EVEN NOTED HOW THEY WERE APPRECIATIVE TO WORK FOR "SUCH AN AWESOME ORGANIZATION THAT IS THERE FOR ME WHEN TIMES ARE TOUGH." MANY DEPARTMENTS WORKED COLLABORATIVELY TO MAKE THIS INITIATIVE A SUCCESS SUCH AS HUMAN RESOURCES, FOOD AND NUTRITION SERVICES, AND SECURITY AND FACILITIES TO NAME A FEW. THE SCRIPPS LEADERSHIP ACADEMY ALUMNI ALSO VOLUNTEERED TO HELP PACKAGE AND DISTRIBUTE THE FOOD. MUCH APPRECIATION TO THE EMPLOYEES, PHYSICIANS AND VENDORS WHO DONATED TO THE PROGRAM AS THEIR GENEROSITY HELPED TO MAKE A DIFFERENCE FOR MANY DURING A DIFFICULT TIME. FULL ACCESS AND COORINDATED TRANSPORTATION (FACT) INC. IN 2019, SCRIPPS ENTERED A PARTNERSHIP WITH A LOCAL NONPROFIT- FACILITATING ACCESS TO COORDINATED TRANSPORTATION (FACT) INC., FOR ON-DEMAND RIDES FOR PATIENTS. SCRIPPS STAFF RELIES ON FACT TO ARRANGE FOR PATIENTS GET TO APPOINTMENTS AND FOR DISCHARGED PATIENTS TO RETURN HOME OR GET TO OTHER FACILITIES. THIS COLLABORATIVE SERVICE HAS QUICKLY PROVED TO BE A RELIABLE, CONVENIENT, AND COST-EFFECTIVE SOLUTION TO ONE OF THE DIFFICULT AND EXPENSIVE CHALLENGES IN ACCESSING MEDICAL CARE TRANSPORTATION.
FORM 990, PART III, LINE 4A (CONTINUED)	THE PROGRAM STREAMLINES A VARIETY OF MEDICAL TRANSPORTATION OPTIONS THROUGH A SINGLE POINT OF CONTACT AT FACT. FACT PROVIDED RIDES FOR PATIENTS INCLUDING THOSE WHO NEED SPECIALIZED VEHICLES OR PERSONAL ASSISTANCE TO COMPLETE THE TRIP. SCRIPPS STAFF USE A SINGLE TELEPHONE NUMBER TO CONTACT STAFF AT FACT, WHO THEN HANDLE THE SELECTION OF THE APPROPRIATE VEHICLE, EQUIPMENT, AND PERSONNEL, AND DISPATCH THE RIDE. THE PROGRAM PROVIDES SAVINGS IN PROCESSING TIME, COST OF TRANSPORTATION AND IT OFFERS THE RIDER A MORE RELIABLE AND CONVENIENT TRANSPORTATION SERVICE. THE INITIAL PILOT PROJECT WAS PARTLY FUNDED BY A COMMUNITY ENHANCEMENT GRANT AWARDED TO FACT BY THE COUNTY OF SAN DIEGO. SCRIPPS REALIZED A BENEFIT USING FACT TRANSPORT AS A COST SAVINGS; RATHER THAN USING TAXI VOUCHERS, AS WELL AS TRIPS THAT COULD TAKE SCRIPPS STAFF A GREAT DEAL OF TIME TO FIND A VENDOR TO DO AS OTHER VENDORS MAY NOT BE ABLE TO DO TRIPS TO THE BORDER OR IMPERIAL COUNTY AS READILY. FACT IS A CLEARINGHOUSE OF SORTS WITH MULTIPLE VENDORS AND THEREFORE SAVES THE STAFF TIME IN FINDING THE APPROPRIATE TRANSPORT AT THE RIGHT TIME. SCRIPPS AND FACT RENEWED THEIR AGREEMENT IN 2021 THAT WILL PHASE THIS SERVICE TO ALL SCRIPPS HOSPITALS AND ENABLE STAFF TO SCHEDULE RIDES VIA FACT'S CALL CENTER. TRANSPORTATION IS AVAILABLE 7 DAYS A WEEK FOR SCRIPPS DISCHARGED PATIENTS TO ANY LOCATION WITHIN SAN DIEGO AND BEYOND. MOST RIDES BEGIN AND END AT THE CURBSIDE, HOWEVER DOOR THROUGH DOOR RIDES, WHEELCHAIR ACCESSIBLE RIDES AND GURNEY RIDES ARE AVAILABLE ON DEMAND. FACT HAS PROVIDED 882 RIDES THROUGH AUGUST 2021 FOR SCRIPPS PATIENTS THROUGHOUT SAN DIEGO AND AS FAR AWAY AS IMPERIAL COUNTY. IN ADDITION, FACT HAS DELIVERED OVER 3,200 FOOD BOXES TO SAN DIEGO HOUSEHOLDS DURING APRIL 2020-MARCH 2021. THIS SERVICE WAS FUNDED BY SANDAG GRANTS AND PROVIDED IN COLLABORATION WITH THE COUNTY OF SAN DIEGO AND 2-1-1. FACT TRANSPORTED APPROXIMATELY 300 HOMELESS INDIVIDUALS TO AND FROM SHELTERS/HOTELS AND OTHER LOCATIONS FOR QUARANTINING AND TESTING DURING MARCH 2020-JANUARY 2021. THIS SERVICE WAS MADE POSSIBLE THROUGH A PARTNERSHIP WITH THE SAN DIEGO COUNTY HEALTH & HUMAN SERVICES AGENCY (HSSA). OVER 32,000 FREE TRIPS ON RIDEFACT ALSO FUNDED BY SANDAG, WERE PROVIDED FOR ESSENTIAL NEEDS AS WELL AS FOR ESSENTIAL WORKERS DURING THE PANDEMIC (MARCH 2020-FEBRUARY 2021). OVER 4,000 NEW RIDERS WERE ADDED TO FACT'S CLIENT BASE. THE FOLLOWING ARE THE DIFFERENT TRANSPORTATION MODALITIES THAT FACT-SD PROVIDES: - AMBULATORY - THE RIDER CAN WALK ALONE TO AND FROM THE VEHICLE - CURB-TO-CURB - THE RIDER WILL BE PICKED UP AND DROPPED OFF AT THE CURB OF THE FACILITY/RESIDENCE - DOOR-TO-DOOR - THE RIDER REQUIRES THE DRIVER TO WALK THEM FROM THE DOOR OF THE FACILITY/RESIDENCE TO THE VEHICLE AND FROM THE VEHICLE TO THE DOOR OF THE FACILITY/RESIDENCE - DOOR-THROUGH-DOOR - THE RIDER REQUIRES THE DRIVER TO COME INSIDE THE FACILITY AND TRANSPORT THEM TO THE VEHICLE, THE DRIVER WILL DROP THEM OFF AT THE DOOR OF THE FACILITY OR RESIDENCE - ACCESSIBLE VEHICLES AND MOBILITY DEVICES - WALKER, CANE, FOLDING WHEELCHAIR, WHEELCHAIR, SCOOTER, AND VEHICLES EQUIPPED WITH RAMP OR LIFT - GURNEY TRANSPORTATION SCRIPPS EMPLOYEE SPONSORED HOLIDAY DRIVES THE HOLIDAYS INSPIRE MANY WITH THE SPIRIT OF GIVING, AND IN A YEAR LIKE NO OTHER, GENEROSITY WAS IN FULL FORCE AT SCRIPPS THROUGHOUT THE HOLIDAY SEASON. EACH YEAR SCRIPPS STAFF PUT IN TIME AND ENERGY INTO VARIOUS DONATION DRIVES TO HELP THOSE IN OUR COMMUNITY WHO NEED ASSISTANCE. SCRIPPS TEAMS DONATED CLOTHING, HOUSEHOLD NECESSITIES AND MORE, INCLUDING: - BOYS AND GIRLS CLUB - ADOPTED THREE FAMILIES WHO HAD BEEN DIRECTLY AFFECTED WITH JOB LOSS AND/OR ILLNESS - STANDUP FOR KIDS - HYGIENE AND SNACK PACKS - POLINSKY CHILDREN'S CENTER PROMISE2KIDS CAMPAIGN (ORGANIZATION PROMOTES FOSTER CARE IN CHILDREN) - 38 TOY ITEMS AND 14 MONETARY GIFTS - SOUTH BAY COMMUNITY SERVICES - TOYS AND GIFT CARDS IN ADDITION, SCRIPPS EMPLOYEES "ADOPTED" SEVERAL FAMILIES IN SAN DIEGO WHO WERE EXPERIENCING A TOUGH YEAR. SCRIPPS MERCY HOSPITAL HELD ITS ANNUAL HOLIDAY TOY DRIVE IN EARLY DECEMBER TO BENEFIT THE PEDIATRIC PATIENTS OF LA MAESTRA COMMUNITY HEALTH CENTER IN CITY HEIGHTS. LA MAESTRA'S MISSION GOES BEYOND PROVIDING QUALITY HEALTH CARE TO THE COMMUNITIES IT SERVES. THE LA MAESTRA CIRCLE OF CARE BEGINS WITH THE HEALTH OF THE INDIVIDUAL AT ITS CORE AND EXTENDS OUT INTO THE "WELL-BEING OF THE INDIVIDUAL", WHICH CAPTURES ALL NON-MEDICAL NEEDS. DAILY, INDIVIDUALS COME TO LA MAESTRA FOR ONE TYPE OF SERVICE AND END UP IDENTIFYING SEVERAL OTHER SERVICES AVAILABLE TO MEET THEIR GREATER, AND UNRECOGNIZED NEEDS. FOSTERING VOLUNTEERISM SCRIPPS BELIEVES THAT HEALTH IMPROVEMENT BEGINS WHEN PEOPLE TAKE AN ACTIVE ROLE IN MAKING A POSITIVE IMPACT ON THEIR COMMUNITY. FOR THIS REASON, SCRIPPS SUPPORTS VOLUNTEER PROGRAMS FOR SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS WHO WANT TO MAKE AN EVEN LARGER IMPACT ON THEIR COMMUNITY. SCRIPPS MATCHES THE TALENTS AND INTERESTS OF EMPLOYEES AND PHYSICIANS WITH COMMUNITY NEEDS, SUCH AS MENTORING PARTNERSHIPS WITH LOCAL SCHOOLS AND PROVIDING FREE MEDICAL AND SURGICAL CARE FOR PATIENTS IN NEED. IN ADDITION TO THE FINANCIAL COMMUNITY BENEFIT CONTRIBUTIONS MADE DURING FISCAL YEAR 2021, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS DONATED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS SPONSORED COMMUNITY BENEFIT PROGRAMS. WITH CLOSE TO 11,231 HOURS, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $617,573, WHICH IS NOT INCLUDED IN THE SCRIPPS FISCAL YEAR 2020 COMMUNITY BENEFIT PROGRAMS AND SERVICES TOTALS. (CALCULATION BASED UPON AN AVERAGE HOURLY WAGE FOR THE SCRIPPS HEALTH SYSTEM PLUS BENEFITS). PROFESSIONAL EDUCATION & HEALTH RESEARCH QUALITY HEALTH CARE IS HIGHLY DEPENDENT UPON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS, OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WILL BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH BY DEVELOPING NEW AND INNOVATIVE TREATMENTS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH, MEDICAL EDUCATION AND HEALTH PROFESSIONAL EDUCATION. DURING FISCAL YEAR 2020 (OCTOBER 2020 TO SEPTEMBER 2021), SCRIPPS INVESTED $33,228,893 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES IN SAN DIEGO COUNTY. THIS SECTION HIGHLIGHTS SOME OF OUR PROFESSIONAL EDUCATION AND HEALTH RESEARCH ACTIVITIES. HEALTH PROFESSIONS TRAINING SCRIPPS HEALTH GRADUATE MEDICAL EDUCATION A KEY COMPONENT OF SCRIPPS MISSION IS TO ADVANCE THE EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS AND SPONSOR GRADUATE MEDICAL EDUCATION. BY INVESTING IN THESE AREAS, WE HELP SECURE QUALITY CARE FOR OUR COMMUNITY. SCRIPPS HAS BEEN TRAINING FUTURE PHYSICIANS LONGER THAN ANY OTHER INSTITUTION IN SAN DIEGO. FOR MORE THAN 70 YEARS PHYSICIANS IN SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS HAVE HELPED CARE FOR UNDERSERVED POPULATIONS THROUGHOUT THE REGION. SCRIPPS HAS A COMPREHENSIVE RANGE OF GRADUATE MEDICAL EDUCATION PROGRAMS AT SCRIPPS MERCY HOSPITAL, SCRIPPS FAMILY PRACTICE RESIDENCY PROGRAM AND SCRIPPS GREEN HOSPITAL. SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS ARE WELL-KNOWN FOR EXCELLENCE, PROVIDE A HANDS-ON CURRICULUM THAT FOCUSES ON PATIENT-CENTERED CARE AND OFFER RESIDENCIES IN A VARIETY OF PRACTICES, INCLUDING INTERNAL MEDICINE, FAMILY MEDICINE, PODIATRY, PHARMACY AND PALLIATIVE CARE. IN FISCAL YEAR 2021, SCRIPPS ENROLLED A TOTAL OF 157 RESIDENTS AND 51 FELLOWS THROUGHOUT THE SCRIPPS HEALTH SYSTEM. MORE DETAILS ON THESE PROGRAMS ARE INCLUDED IN SECTION EIGHT AND NINE OF THE COMMUNITY BENEFIT REPORT. IN ADDITION, SCRIPPS HAS A PHARMACY RESIDENCY PROGRAM WHICH TRAIN RESIDENTS WITH DOCTOR OF PHARMACY DEGREES. UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWHIPS PROGRAM THE UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP PROGRAM IS A ONE-YEAR PROGRAM DESIGNED FOR PHYSICIANS WHO WISH TO BECOME SUB-SPECIALISTS AND HAVE A LONG-TERM CAREER IN HOSPICE AND PALLIATIVE MEDICINE. THIS IS A UNIQUE PARTNERSHIP IN WHICH UCSD AND SCRIPPS HEALTH SHARE RESPONSIBILITY FOR THE FELLOWS, WITH TRAINEES SPENDING EQUAL TIME IN BOTH INSTITUTIONS WITH ALL THE BENEFITS OF BOTH INSTITUTIONS. THE FELLOWSHIP PREPARES TRAINEES TO WORK IN A VARIETY OF ROLES, INCLUDING LEADERSHIP POSITIONS IN THE FIELD. GRADUATES HAVE SUCCESSFULLY BECOME HOSPICE MEDICAL DIRECTORS AND PALLIATIVE MEDICINE CONSULTANTS IN OUTPATIENT AND INPATIENT SETTINGS ACROSS THE UNITED STATES. FELLOWS WHO COMPLETE THE UCSD/SCRIPPS HEALTH PROGRAM ARE WELL EQUIPPED TO PRACTICE IN DIVERSE SETTINGS, INCLUDING ACUTE PALLIATIVE CARE UNITS, INPATIENT CONSULTATION, OUTPATIENT CONSULTATION, PATIENTS' HOMES, AND LONG-TERM CARE FACILITIES.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS CONFERENCE SERVICES AND CONTINUING MEDICAL EDUCATION (CME) SCRIPPS CONFERENCE SERVICES AND CONTINUING MEDICAL EDUCATION (CME) IS COMMITTED TO IMPROVING THE QUALITY OF HEALTH CARE AND ADVANCING THE PRACTICE OF MEDICINE BY PROVIDING EVIDENCE-BASED, UP-TO-DATE AND CLINICALLY RELEVANT CONTINUING MEDICAL EDUCATION COURSES. CME IS REQUIRED FOR MEDICAL CREDENTIALING AND MADE AVAILABLE TO PRACTITIONERS ON A COMMUNITY-WIDE BASIS. SCRIPPS HEALTH IS ACCREDITED BY THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (ACCME) TO PROVIDE AMA PRA CATEGORY 1 CREDIT(S) FOR PHYSICIANS. CREDITS FOR OTHER HEALTH PROFESSIONALS ARE ALSO AVAILABLE. IN FISCAL YEAR 2020 SCRIPPS CONTINUING MEDICAL EDUCATION DEPARTMENT PROVIDED A VARIETY OF COURSES AND CONFERENCES WHICH INCLUDED THE FOLLOWING: MELANOMA 2021 31ST ANNUAL CUTANEOUS MALIGNANCY UPDATE DURING THIS COURSE, NATIONALLY RECOGNIZED EXPERTS PRESENTED INFORMATION ON PREVENTION, RISK ASSESSMENT, EARLY DETECTION, GENETIC FACTORS, AND CURRENT AND FUTURE TREATMENT CHOICES FOR MELANOMA PATIENTS. ISSUES CONCERNING SURGICAL MANAGEMENT, ADJUVANT THERAPY, ADVANCED DISEASE THERAPY, AND PERSONALIZING THE COURSE OF TREATMENT FOR INDIVIDUAL PATIENTS WERE ALSO DISCUSSED. THIS COURSE WAS DESIGNED TO PROVIDE INFORMATION THAT WILL HELP CLINICIANS IN THEIR DECISION MAKING WHEN CARING FOR MELANOMA PATIENTS. SCRIPPS MD ANDERSON CANCER CENTER CLINICAL HEMATOLOGY & ONCOLOGY CONFERENCE THE CLINICAL HEMATOLOGY AND ONCOLOGY CONFERENCE WAS DESIGNED FOR HEMATOLOGISTS, ONCOLOGISTS, SURGEONS, RADIATION ONCOLOGISTS, INTERNISTS, AND OTHERS DESIRING AN UPDATE IN THESE SPECIALTY AREAS. THE PRIMARY OBJECTIVE OF THIS COURSE WAS TO BRING TOGETHER CLINICIANS AND LEADING EXPERTS AFFORDING THEM AN INTIMATE LEARNING ENVIRONMENT IN WHICH TO DISCUSS NEW CLINICAL DEVELOPMENTS AND SIGNIFICANT ADVANCES IN DIVERSE AREAS OF HEMATOLOGY AND ONCOLOGY. VENTRICULAR ASSIST DEVICE (VAD) SYMPOSIUM FOR COMMUNITY PARTNERS THIS COMMUNITY SYMPOSIUM WAS PLANNED BY CARDIOLOGY PROVIDERS FROM SCRIPPS HEALTH IN PARTNERSHIP WITH SHARP HEALTHCARE AND UC SAN DIEGO. THE SYMPOSIUM WAS DESIGNED TO EDUCATE HEALTH CARE WORKERS WHO DO NOT SPECIALIZE IN CARDIOLOGY BUT STILL NEED TO TREAT PATIENTS WITH VENTRICULAR ASSIST DEVICES (VAD). CLINICAL ADVANCES IN THE DIAGNOSIS AND MANAGEMENT OF PULMONARY HYPERTENSION THIS CONFERENCE IS UNIQUE IN THAT IT COVERS ALL FORMS OF PULMONARY HYPERTENSION. EXPERT FACULTY REVIEWED THE EPIDEMIOLOGY OF PULMONARY HYPERTENSION (PH), HOW PH IS DIAGNOSED, AND THE POOR OUTCOMES ASSOCIATED WITH PH WHEN LEFT UNTREATED. THE CONFERENCE IS DESIGNED TO PROVIDE A BETTER UNDERSTANDING OF THE DIFFERENCE BETWEEN PULMONARY ARTERIAL HYPERTENSION (PAH) AND PULMONARY VASCULAR HYPERTENSION (PVH) AND WHY THE DIFFERENCE MATTERS. THERAPIES FOR PAH AND PVH WERE ALSO DISCUSSED WITH REFERENCE TO CURRENT CLINICAL GUIDELINES. INAUGURAL SCRIPPS ARRHYTHMIA AND CARDIOMYOPATHY IN WOMEN SYMPOSIUM THE ARRHYTHMIAS AND CARDIOMYOPATHY IN WOMEN SYMPOSIUM WAS DESIGNED TO INCREASE COMPETENCE REGARDING THE RECOGNITION AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN WOMEN. THE SYMPOSIUM EXPLORED NEW AND EMERGING RISK FACTORS FOR WOMEN'S HEART DISEASE WHILE HIGHLIGHTING AREAS OF DISCREPANCY IN CARE MANAGEMENT RELATED TO GENDER. THE GOAL OF THIS ACTIVITY WAS TO IMPROVE OUTCOMES FOR WOMEN WITH CARDIOVASCULAR DISEASE AND ARRHYTHMIAS AS WELL AS PROVIDE EDUCATIONAL INTERVENTIONS FOR BOTH PRIMARY AND SECONDARY PREVENTION. CLINICAL ADVANCES IN HEART FAILURE AND ARRHYTHMIAS EXPERT FACULTY COVERED A WIDE RANGE OF TOPICS INCLUDING THE DIAGNOSIS, MANAGEMENT, AND STATE-OF-THE-ART TREATMENT OF HEART FAILURE, CARDIAC ARRHYTHMIAS, AND HYPERTENSION. FACULTY ALSO REVIEWED A VARIETY OF CO-MORBID AND CHRONIC CONDITIONS PATIENTS WITH HEART DISEASE MAY FACE. THE GOAL OF THE CONFERENCE WAS FOR PARTICIPANTS TO RETURN TO THEIR PRACTICE EQUIPPED WITH THE LATEST EVIDENCE BASE AND PRACTICAL INFORMATION TO IMPROVE PATIENT OUTCOMES. BRAIN INJURY REHABILITATION CONFERENCE THE ANNUAL BRAIN INJURY REHABILITATION CONFERENCE WAS DESIGNED TO PROVIDE A CLEAR UNDERSTANDING OF THE NEED FOR MULTIDISCIPLINARY STRATEGIES IN THE MANAGEMENT OF PATIENTS WITH TRAUMATIC BRAIN INJURIES. A RENOWNED FACULTY OF INTERDISCIPLINARY SPECIALIST PRESENTED THE LATEST RESEARCH AND OUTCOMES FROM A VARIETY OF MEDICAL PERSPECTIVES. CARDIOVASCULAR ATHEROSCLEROSIS: PREDICTION, PREVENTION AND MANAGEMENT SCRIPPS HEALTH'S CARDIOVASCULAR ATHEROSCLEROSIS CONFERENCE WAS DESIGNED TO OFFER A COMPREHENSIVE SUMMARY OF NEW INDICATIONS FOR MEDICAL THERAPIES RESULTING FROM NUMEROUS CLINICAL RIALS CONDUCTED IN THE PAST SEVERAL YEARS DEDICATED TO THE MANAGEMENT AND TREATMENT OF ATHEROSCLEROSIS AND UNDERLYING RISK FACTORS. THE CONFERENCE ALSO AIMED TO PROMOTE CLINICAL AWARENESS REGARDING PRUDENT LIFESTYLE AND DIETARY CHOICES TO IMPROVE PATIENT OUTCOMES. SCRIPPS MD ANDERSON'S CANCER CENTERS 2021 ONCOLOGY UPDATE SCRIPPS MD ANDERSON CANCER CENTER'S 2021 ONCOLOGY UPDATE WAS A ONE-DAY CONFERENCE DESIGNED TO OFFER CLINICIANS AND ADVANCED PRACTICE PROVIDERS A COMPREHENSIVE OVERVIEW OF THE MOST RECENT ADVANCES IN THE TREATMENT OF VARIOUS ONCOLOGIC MALIGNANCIES. DURING THIS COMPREHENSIVE EDUCATIONAL COURSE, ESTEEMED FACULTY REVIEWED EXCITING AND IMPORTANT ABSTRACTS PRESENTED AT THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO) ANNUAL MEETING AND DISCUSSED THEIR RELEVANCE TO THE CLINICAL ONCOLOGY PRACTICE. CARDIOMYOPATHY & CARDIO-ONCOLOGY SYMPOSIUM 2021 THE SCRIPPS CARDIOMYOPATHY AND CARDIO-ONCOLOGY SYMPOSIUM WAS DESIGNED TO PROVIDE A COMPREHENSIVE, CASE-BASED CURRICULUM THAT ADDRESSED IMPORTANT CLINICAL TOPICS RELEVANT TO CARDIOMYOPATHY AND CARDIOVASCULAR HEALTH OF CANCER SURVIVORS. CARDIO-ONCOLOGY IS A GROWING FIELD THAT HAS SIGNIFICANT IMPORTANCE AS NEWLY DEVELOPED CANCER TREATMENTS IMPROVE CANCER SURVIVAL RATES BUT CAN BE ASSOCIATED WITH CARDIOVASCULAR TOXICITIES. THE GOAL OF THE CONFERENCE WAS FOR PARTICIPANTS TO RETURN TO THEIR PRACTICE EQUIPPED WITH THE LATEST EVIDENCE BASE AND PRACTICAL INFORMATION TO IMPROVE PATIENT CARE. NEW TREATMENTS IN CHRONIC LIVER DISEASE THE CONFERENCE REVIEWED NEW MEDICATIONS AND THERAPIES THAT ARE NOW AVAILABLE, OR WILL SOON BE AVAILABLE, AND DISCUSS THEIR COMPARATIVE VALUES. THE RESULTS OF TRIALS AND REAL-WORLD DATA USING ORAL DRUGS TO TREAT CHRONIC VIRAL HEPATITIS B AND C, NON-ALCOHOLIC FATTY LIVER DISEASES, PRIMARY BILIARY CIRRHOSIS, PRIMARY SCLEROSING CHOLANGITIS, HEPATOCELLULAR CARCINOMA AND COMPLICATIONS OF END-STAGE LIVER DISEASE INCLUDING THROMBOCYTOPENIA WERE REVIEWED IN DETAIL. NEW TREATMENTS IN CHRONIC LIVER DISEASE IS A COMPREHENSIVE YET CONCISE PROGRAM FOR UPDATING PHYSICIANS ON THESE AND OTHER COMMONLY ENCOUNTERED PROBLEMS IN THE TREATMENT OF LIVER DISEASES. NEW ADVANCES IN INFLAMMATORY BOWEL DISEASE (IBD) THE NEW ADVANCES IN INFLAMMATORY BOWEL DISEASE CONFERENCE HIGHLIGHTED THE LATEST CONCEPTS IN THE DIAGNOSIS AND TREATMENT OF IBD. DISEASE COMPLICATIONS, SPECIAL POPULATION CONSIDERATIONS, AND SURGICAL OPTIONS WERE DISCUSSED. THE COURSE WAS TAUGHT BY NATIONALLY KNOWN EXPERTS WHO ARE ACTIVELY INVOLVED IN CLINICAL TRIALS AND STUDIES RELATED TO THE MANAGEMENT OF CROHN'S AND COLITIS. PHYSICIANS WERE PROVIDED WITH THE NECESSARY CONTEXT TO INTEGRATE THE RELEVANT INFORMATION INTO THEIR PRACTICES TO IMPROVE THE QUALITY OF LIFE FOR THEIR AFFLICTED PATIENTS. PRIMARY CARE SUMMER CONFERENCE SCRIPPS HEALTH'S PRIMARY CARE SUMMER CONFERENCE WAS DESIGNED BY PRIMARY CARE PHYSICIANS FOR PRIMARY CARE PHYSICIANS AND THEIR INTERDISCIPLINARY CARE TEAM AND PRESENTED CONTENT FROM THEIR UNIQUE PERSPECTIVE. THE 2021 COURSE FEATURED IMPORTANT UPDATES IN INFECTIOUS DISEASE, DERMATOLOGY, AND SLEEP DISORDERS. CURRENT TREATMENTS FOR MIGRAINE AND HEART FAILURE WERE ALSO DISCUSSED AS WELL AS TOOLS FOR REDUCING BIAS AND CREATING AN LGBTQ INCLUSIVE PRACTICE. IN ADDITION TO AN OVERVIEW OF THE HISTORY AND CURRENT SCIENCE OF A VARIETY OF SPECIALTY AREAS, CONTENT WAS PRESENTED IN A VERY PRACTICAL, PATIENT-FOCUSED MANNER RELEVANT TO THE SPECIFIC PRIMARY CARE SETTING AND CHALLENGES. SOLID ORGAN TRANSPLANT LECTURE SERIES THE SCRIPPS SOLID ORGAN TRANSPLANT LECTURE SERIES IS A YEARLONG EVENT FOCUSED ON CURRENT ISSUES IN THE FIELD THAT ARE IN VARIED STATES OF TRANSITION, INCLUDING FACTORS INFLUENCING ORGAN ALLOCATION, THE IMPACT OF INCREASED OVERSIGHT OF REGULATORY AGENCIES ON QUALITY-OF-CARE MEASURES, AND AREAS THAT HAVE AN IMPACT ON SPECIAL POPULATIONS. AN ADDITIONAL KEY OBJECTIVE OF THE SERIES IS TO PROVIDE STIMULUS FOR SUBSEQUENT INTERACTIONS BETWEEN REGULATORY AGENCIES, LEADERS IN THE TRANSPLANT COMMUNITY, PATIENT ADVOCATES, AND CLINICIANS TO FOSTER CONTINUED EVOLUTION OF THESE DISCUSSIONS.
FORM 990, PART III, LINE 4A (CONTINUED)	REGULARLY SCHEDULED SERIES (RSS) SCRIPPS CME OFFERS A WIDE RANGE OF REGULARLY SCHEDULED SERIES (RSS) ON ASSORTED TOPICS INCLUDING WEEKLY GRAND ROUNDS FROM OUR HOSPITALS IN LA JOLLA AND HILLCREST-SAN DIEGO. AN IMPORTANT ADDITION TO THE FY21 GRAND ROUNDS SCHEDULE WAS THE INCLUSION OF A NEW SERIES OF LECTURES DESIGNED TO BRING AWARENESS TO CLINICIANS ON THE ROLE OF GENDER DISPARITIES, CULTURAL AND IMPLICIT BIASES, AND RACISM IN CONTRIBUTING TO HEALTHCARE DISPARITIES WITHIN OUR SOCIETY. THESE LECTURES WILL CONTINUE TO BE INCORPORATED INTO THE GRAND ROUNDS SCHEDULE TO ENCOURAGE ONGOING CONVERSATIONS AROUND THESE PROMINENT ISSUES WITH THE GOAL OF IGNITING LASTING CHANGE, NOT ONLY WITHIN THE SCRIPPS SYSTEM, BUT ALSO SOCIETY. ENDURING MATERIALS/ON DEMAND CME LECTURES A VARIETY OF ON-DEMAND LECTURES AND ENDURING MATERIALS WERE ALSO AVAILABLE IN FY21 TO HEALTH CARE PROVIDERS. TOPICS INCLUDED: TALKING WITH OLDER PATIENTS ABOUT SENSITIVE TOPICS, DIETARY SUPPLEMENTS: A FOUNDATION FOR CLINICAL PRACTICE, UPDATES IN DIABETES MANAGEMENT, AND IMPROVE PRACTICE EFFICIENCIES AND PATIENT/PROVIDER JOY BY ASKING, "WHAT MATTERS TO YOU?" AMONG OTHERS. STUDENT EXPERIENCES WITHIN SCRIPPS SCRIPPS COMMITMENT TO ONGOING LEARNING AND HEALTH CARE EXCELLENCE EXTENDS BEYOND OUR ORGANIZATION. OUR STUDENT PROGRAMS HELP PROMOTE HEALTH CARE CAREERS TO A NEW GENERATION, SHAPE THE FUTURE WORKFORCE AND DEVELOP FUTURE LEADERS IN OUR COMMUNITY. INTERACTING WITH HEALTH CARE PROFESSIONALS IN THE FIELD EXPANDS EDUCATION OUTSIDE THE CLASSROOM. SCRIPPS EMPLOYEES PLAY AN IMPORTANT ROLE AS PRECEPTORS BY INVESTING THEIR TIME TO CREATE A VALUABLE EXPERIENCE FOR THE COMMUNITY. IN FISCAL YEAR 2021, SCRIPPS HOSTED 1,086 STUDENTS WITHIN OUR SYSTEM AND PROVIDED 177,079 DEVELOPMENT HOURS SPANNING NURSING AND ALLIED HEALTH SETTINGS. COLLEGE AND UNIVERSITY AFFILIATIONS SCRIPPS COLLABORATES WITH LOCAL HIGH SCHOOLS, COLLEGES AND UNIVERSITIES TO HELP STUDENTS EXPLORE HEALTH CARE ROLES AND GAIN FIRSTHAND EXPERIENCE AS THEY WORK WITH SCRIPPS PROFESSIONALS. SCRIPPS IS AFFILIATED WITH MORE THAN 110 SCHOOLS AND PROGRAMS, INCLUDING CLINICAL AND NONCLINICAL PARTNERSHIPS. LOCAL SCHOOLS INCLUDE, BUT ARE NOT LIMITED TO, POINT LOMA NAZARENE UNIVERSITY (PLNU), UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD), CALIFORNIA STATE UNIVERSITY SAN MARCOS (CSUSM), SAN DIEGO STATE UNIVERSITY (SDSU), UNIVERSITY OF SAN DIEGO (USD), MESA COLLEGE, SAN DIEGO CITY COLLEGE, GROSSMONT COLLEGE, PALOMAR COLLEGE AND MIRA COSTA COLLEGE. SCRIPPS CONSIDERS NEW PARTNERSHIPS, BASED ON COMMUNITY AND WORKFORCE NEEDS, AND MAINTAINS AN AFFILIATION AGREEMENT COMMITTEE TO REVIEW ALL REQUESTS AND PROVIDE A SYSTEMWIDE APPROACH TO SECURING NEW STUDENTS PLACEMENTS. THIS INTERDISCIPLINARY COMMITTEE REPRESENTS EDUCATION AND DEPARTMENT LEADERSHIP ACROSS THE SCRIPPS SYSTEM ENSURING A PROACTIVE APPROACH TO BUILDING A CAREER PIPELINE FOR TOP TALENT. TO ENSURE STUDENTS FROM HEALTH CARE PROFESSIONS PROGRAMS HAVE ACCESS TO APPROPRIATE EDUCATIONAL EXPERIENCES AT SCRIPPS AND FOSTER A SMOOTH, EFFICIENT PROCESS FOR STUDENT PLACEMENT REQUESTS RECEIPT AND MANAGEMENT, SCRIPPS IS A MEMBER OF THE SAN DIEGO NURSING AND ALLIED HEALTH SERVICE EDUCATION CONSORTIUM AND AMERICAN DATABANK'S COMPLIO ONLINE COMPLIANCE TRACKING SYSTEM. RESEARCH STUDENTS SCRIPPS SUPPORTS GRADUATE RESEARCH FOR MASTER'S AND DOCTORAL STUDENTS AT UNIVERSITIES WITH AFFILIATION AGREEMENTS. NON-PHYSICIAN STUDENTS WHO CONDUCT RESEARCH AT SCRIPPS REPRESENT A VARIETY OF HEALTH CARE DISCIPLINES, INCLUDING PUBLIC HEALTH, PHYSICAL THERAPY, PHARMACY, AND NURSING. IN FISCAL YEAR 2021, SCRIPPS HEALTH RESEARCH EFFORTS INCLUDED STUDENTS FROM A VARIETY OF SCHOOLS SUCH AS; UNIVERSITY OF SAN DIEGO, WESTERN GOVERNORS UNIVERSITY, SAN DIEGO STATE UNIVERSITY, UNIVERSITY OF CALIFORNIA SAN DIEGO, LOMA LINDA UNIVERSITY, UNIVERSITY OF WISCONSIN-MADISON, STANFORD UNIVERSITY SCHOOL OF MEDICINE, SOUTHERN METHODIST UNIVERSITY, RICE UNIVERSITY, WHEATON COLLEGE, UNIVERSITY OF CALIFORNIA BERKELEY, PRINCETON UNIVERSITY, MIRA COSTA COLLEGE, UNION COLLEGE, NORTH SEATTLE COLLEGE, TULANE UNIVERSITY SCHOOL OF MEDICINE, KECK GRADUATE INSTITUTE, PONCE HEALTH SCIENCES UNIVERSITY, ROYAL COLLEGE OF SURGEONS IRELAND, UNIVERSITY OF PUERTO RICO AND POSTDOCTORAL PHARMACY RESIDENCY PROGRAMS, INCLUDING THE PGY1 PHARMACY RESIDENCY PROGRAM. SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) SCRIPPS SPONSORED THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL). THIS ANNUAL SUPPORT MAKES IT POSSIBLE TO OFFER MANY QUALITY, COST-EFFECTIVE EDUCATION, PROFESSIONAL DEVELOPMENT AND NETWORKING OPPORTUNITIES TO HEALTHCARE LEADERS AND ASPIRING LEADERS IN SAN DIEGO AND IMPERIAL COUNTIES. SCRIPPS MERCY EMERGENCY MEDICAL SERVICES (EMS) THROUGH THE SCRIPPS MERCY EMERGENCY MEDICAL SERVICES (EMS) BASE HOSPITAL PROGRAM, A VARIETY OF HEALTH PROFESSIONALS PARTICIPATE IN HOSPITAL-BASED CLINICAL INTERNSHIPS AND CONTINUING EDUCATION OPPORTUNITIES. THE PROGRAM COLLABORATES WITH LOCAL AND REGIONAL EDUCATIONAL INSTITUTIONS TO PROVIDE HANDS-ON TRAINING TO MULTIPLE LEVELS OF HEALTHCARE PROFESSIONALS SUCH AS: FIRST RESPONDERS, EMTS, PARAMEDICS, LAW ENFORCEMENT, MILITARY, MOBILE INTENSIVE CARE NURSES, AND RESIDENT PHYSICIANS. DURING THEIR CLINICAL ROTATIONS AND CONTINUED EDUCATION OFFERINGS, STUDENTS ARE INTRODUCED TO A VARIETY OF EMERGENCY MEDICAL PATIENT CARE TOPICS THAT ARE APPLICABLE THROUGH THE PREHOSPITAL AND HOSPITAL CARE CONTINUUM. THESE EDUCATIONAL OPPORTUNITIES ARE DESIGNED TO ENHANCE THE STUDENTS' LEARNING EXPERIENCE, ALLOWING THEM TO BETTER SERVE THEIR PATIENTS AND OUR LOCAL COMMUNITIES. HIGH SCHOOL PROGRAMS SCRIPPS IS DEDICATED TO PROMOTING HEALTH CARE AS A REWARDING CAREER, COLLABORATING WITH SEVERAL HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRSTHAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. BELOW IS A SUMMARY OF THE HIGH SCHOOL PROGRAMS SCRIPPS MADE AVAILABLE TO THE COMMUNITY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM-HEALTH AND SCIENCE PIPELINE INITIATIVE (HASPI) THIS PROGRAM REACHES OUT TO SAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING A CAREER IN HEALTH CARE. DURING THEIR FIVE-WEEK ROTATION, THE STUDENTS VISIT SCRIPPS MERCY CHULA VISTA, SCRIPPS MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITAL LA JOLLA, ENCINITAS, AND GREEN HOSPITAL. THE STUDENTS VIEW SURGERIES AND SHADOW HEALTHCARE PROFESSIONALS IN THE EMERGENCY DEPARTMENT, ICU, PHARMACY, URGENT CARE, INTERNAL MEDICINE, PHARMACY, AMBULATORY SERVICES, REHAB THERAPY, PATIENT PLANNING, LAB, AND TRAUMA. THIS PROGRAM IS FUNDED THROUGH THE GROSSMONT CUYAMACA COLLEGE DISTRICT AUXILIARY. DUE TO COVID-19, THE HIGH SCHOOL EXPLORATION INTERNSHIP PROGRAM WAS PAUSED. UNIVERSITY CITY HIGH SCHOOL COLLABORATION UNIVERSITY CITY HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOL'S HEALTH CARE ESSENTIALS COURSE. UNIVERSITY CITY HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOL'S HEALTH CARE ESSENTIALS COURSE. STUDENTS ARE SELECTED TO ROTATE THROUGH FIVE DIFFERENT SCRIPPS LOCATIONS, DURING THE SPRING SEMESTER, TO INCREASE THEIR AWARENESS OF HEALTH CARE CAREERS. UC HIGH STUDENTS ARE EXPOSED TO DIFFERENT DEPARTMENTS, EXPLORING CAREER OPTIONS, AND LEARNING VALUABLE LIFE LESSONS ABOUT HEALTH AND HEALING. THIS INTERNSHIP PROGRAM WAS CANCELLED FOR FISCAL YEAR 2021, DUE TO THE PANDEMIC. YOUNG LEADERS IN HEALTH CARE AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOLS' STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENTS IN GRADES 9-12 PARTICIPATE IN THE PROGRAM, WHICH PROVIDES A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS CAREER OPPORTUNITIES. THE MISSION OF THE YOUNG LEADERS IN HEALTH CARE IS: - TO PROVIDE A FORUM FOR HIGH SCHOOL'S STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS BREADTH OF CAREER OPPORTUNITIES. - MENTOR STUDENTS IN THE ACT OF LEADERSHIP GIVING THEM TOOLS TO USE IN THEIR DAILY LIFE CHALLENGES. - PROVIDE A SERVICE PROJECT TO SATISFY HIGH SCHOOL REQUIREMENTS AND MAKE A POSITIVE IMPACT ON THE COMMUNITY. - PROVIDE A VENUE FOR A STUDENT-RUN COMPETITION WHERE EACH SCHOOL PRESENTS A TOPIC IN LINE WITH THE YEAR'S GOAL. THIS COMBINED EXPERIENCE INCLUDES WEEKLY MEETINGS AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE PROGRAM MENTORS' STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY CHALLENGES. EACH YEAR THE STUDENTS WORK TOWARD A FINAL PRESENTATION BASED ON THEIR COMMUNITY SERVICE PROJECTS RELATED TO HEALTH CARE AND WELLNESS.
FORM 990, PART III, LINE 4A (CONTINUED)	THE 2021 CLASS TOUCHED A VARIETY OF TOPICS FROM MENTAL ILLNESS TO THE OPIOID CRISIS. MORE THAN 150 STUDENTS, COMMUNITY MEMBERS AND HEALTH CARE SPECIALISTS ATTENDED THE YOUNG LEADER IN HEALTH CARE FINAL MEETING, CULMINATING WITH STUDENT PRESENTATIONS ON TYPES OF CANCER AND TREATMENTS. STUDENTS THAT PARTICIPATE IN THE PROGRAM ARE ELIGIBLE TO APPLY TO THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM. MEETINGS WERE CONDUCTED AS VIRTUAL TEAMS MEETINGS FOR THE 2020-2021 SCHOOL YEAR. YOUTH EDUCATIONAL PROGRAM ACTIVITIES SCRIPPS IS DEDICATED TO BUILDING THE FUTURE PIPELINE OF HEALTH PROFESSIONALS. SCRIPPS IMPLEMENTS A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES. THROUGH SEVERAL INTERNSHIPS AND OTHER EDUCATIONAL PROGRAMS, SCRIPPS COLLABORATES WITH HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRST-HAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. NURSES AND OTHER CLINICAL AND NON-CLINICAL EMPLOYEES PLAY IMPORTANT ROLES IN THESE EDUCATIONAL EXPERIENCES, AS THE STUDENTS ARE INTERACTING WITH THEM DAILY THROUGH THE PROGRAMS. A TOTAL OF 2,028 YOUTH PARTICIPATED IN THESE PROGRAMS AND MORE THAN 75% OF YOUTH ARE ON A TRACK FOR A HEALTH CAREER. DUE TO COVID-19 AND IN-PERSON RESTRICTIONS ALL YOUTH ACTIVITIES (MENTORING, CLASSROOM PRESENTATIONS, HOSPITAL TOURS, SURGERY VIEWINGS) WERE TRANSITIONED TO VIRTUAL PLATFORMS FOR DISTANCE LEARNING FOR FISCAL YEAR 2021. TOPICS AND ACTIVITIES CONTINUED TO BE REQUESTED BY THE SWEETWATER SCHOOL DISTRICT TO ENHANCE AND SUPPORT CLASSROOM CURRICULUM. CAMP SCRIPPS SUMMER ENRICHMENT PROGRAM DESIGNED TO INTRODUCE YOUTH TO HEALTH CAREERS, THIS PROGRAM DEVELOPED A SIX-WEEK VIRTUAL CAMP EXPERIENCE PROGRAM (JUNE 7, 2021 - JULY 16, 2021) TO EDUCATE YOUTH PARTICIPANTS ON THE DUTIES PERFORMED BY HEALTH CARE PROFESSIONALS IN VARIOUS MEDICAL FIELDS AS WELL AS OTHER PUBLIC HEALTH AND SOCIAL SERVICE TOPICS. PARTICIPANTS PARTICIPATED IN LIVE VIRTUAL CALLS WITH SCRIPPS FAMILY MEDICINE RESIDENTS AND OTHER HOSPITAL AND CLINICAL STAFF AS PART OF THE MENTORING COMPONENT. HANDS-ON LEARNING ACTIVITIES WERE ALSO IMPLEMENTED THIS YEAR. MENTORING PROGRAM DESIGNED TO HELP HIGH SCHOOL STUDENTS SET A COURSE FOR A SUCCESSFUL CAREER IN HEALTH CARE, PARTICIPANTS ARE PAIRED WITH VARIOUS HEALTH AND SOCIAL SERVICE PROFESSIONALS FOR HOURLY SESSIONS TWICE A WEEK FOR FIVE WEEKS IN THE HOSPITAL SETTING. STUDENTS ARE EXPOSED TO A VARIETY OF DUTIES AND ROLES AND VARIOUS DEPARTMENTS. STUDENTS LEARN FIRST-HAND FROM THEIR MENTORS ABOUT THE PARTICULARS OF THAT DEPARTMENT AND POSITION INCLUDING THE PATH THEY NEED TO TAKE IN ORDER TO ACHIEVE A CAREER GOAL. STUDENTS ALSO RECEIVE PRESENTATIONS ON VARIOUS HEALTH CAREERS AND JOB READINESS. FAMILY MEDICINE RESIDENTS ARE MENTORS FOR THIS PROGRAM AND MEET WITH THE STUDENTS EACH WEEK. STUDENTS WILL SHADOW RESIDENTS DURING ROUNDS AND THROUGHOUT THE EXPERIENCE. DUE TO COVID-19 RESTRICTIONS MENTORING TRANSITIONED TO A VIRTUAL PLATFORM AS OF MARCH 2020. HEALTH PROFESSIONALS IN THE CLASSROOM HEALTH CARE PROFESSIONALS, SUCH AS MEDICAL RESIDENTS, DIETICIANS, NURSES AND DOCTORS, ENLIGHTEN STUDENTS ON HEALTH CARE CAREERS AND HEALTH RELATED TOPICS. THESE ARE INTERACTIVE VIRTUAL SESSIONS ON NURSING 101, DOC 101, HEALTH AND NUTRITION, STROKE PREVENTION, BREAST HEALTH, TEEN PREGNANCY, SUBSTANCE USE, STDS, HEALTH PROFESSIONS 101 AND MENTAL HEALTH ISSUES THAT IMPACT HIGH SCHOOL STUDENTS. STUDENTS RECEIVE HEALTH CAREER TOOLS/BROCHURES THAT INCLUDE INFORMATION ON EDUCATION REQUIREMENTS, SCHOLARSHIPS AND WAY TO PAY FOR COLLEGE. DUE TO COVID-19 RESTRICTIONS THE PROGRAM TRANSITIONED TO A VIRTUAL PLATFORM AS OF MARCH 2020. SURGERY VIEWING INTERESTED STUDENTS HAVE AN OPPORTUNITY TO OBSERVE ELECTIVE SURGERIES SUCH AS TOTAL KNEE AND HIP REPLACEMENTS. STUDENTS CAN INTERACT AND ASK ON THE SPOT QUESTIONS OF SURGEONS. THIS PROGRAM HAS BEEN PLACED ON HOLD DUE TO COVID-19. SCHOOL BASED CLINICS THREE HEALTH CLINICS AT PALOMAR, SOUTHWEST HIGH SCHOOL AND HOOVER HIGH SCHOOL ARE ESTABLISHED FOR MEDICAL RESIDENTS TO GAIN ADDITIONAL SKILLS IN ADOLESCENT MEDICINE AND FOR YOUTH TO GAIN THE KNOWLEDGE, ATTITUDES, AND SKILLS NECESSARY TO PURSUE HEALTH CAREERS. DESIGNED BY STUDENTS, FAMILY MEDICINE RESIDENTS AND FACULTY BASED ON YOUTH NEEDS ASSESSMENT SURVEYS, RESIDENTS AND STUDENTS INTERACT TWICE PER WEEK AT THE CLINIC PROVIDING ADOLESCENT MEDICINE. DUE TO COVID-19, THIS PROGRAM WAS PUT ON PAUSE. HEALTH PROFESSIONS EDUCATION, RESIDENT AND STUDENT TRAINING SCRIPPS MERCY CHULA VISTA WELL BEING CENTER WORKS CLOSELY WITH SCRIPPS FAMILY MEDICINE RESIDENCY PROGRAM TO PROVIDE AND EXPAND COMMUNITY MEDICINE OPPORTUNITIES FOR RESIDENTS TO DELIVER SERVICES, TO PLACE MEDICAL STUDENTS IN COMMUNITY HEALTH ACTIVITIES AND TO COORDINATE COMMUNITY EXPERIENCES FOR VISITING/ROTATING RESIDENTS AND MEDICAL STUDENTS. THE WELL BEING CENTER ALSO COORDINATES AND PROVIDES OPPORTUNITIES FOR INDIVIDUALS TO PARTICIPATE IN HEALTH CAREER TALKS, HEALTH TRAINING COMMUNITY ACTIVITIES AND BALINT SUPPORT GROUPS. A TOTAL OF 1,028 HEALTH PROFESSIONALS HAVE BEEN TRAINED. THE COVID-19 PANDEMIC BROUGHT SIGNIFICANT CHANGES TO RESIDENT EDUCATION AND PATIENT CARE IN THE SCRIPPS FAMILY MEDICINE RESIDENCY PROGRAM AT SCRIPPS MERCY CHULA VISTA. THE PROGRAM QUICKLY ADAPTED TO MEET THE NEEDS OF SOUTH BAY WITH HIGH RATES OF COVID-19 INFECTION. ALL EDUCATIONAL AND TRAINING CONFERENCES SHIFTED TO VIRTUAL MODALITIES. SOME OF THE RESIDENT EDUCATION INCLUDED PRESENTATIONS AND TOWN HALL STYLE WORKSHOPS THAT ADDRESS PATHOPHYSIOLOGY OF CORONAVIRUS INFECTION IN ADULTS, CHILDREN AND PREGNANT WOMEN, APPROPRIATE PPE USE, TESTING ALGORITHMS, AND HEALTH DISPARITIES IN RELATION TO COVID-19 INFECTIONS. THE RESIDENTS HAVE CONTINUED TO MEET THE NEEDS OF PATIENTS AT THE CLINIC BOTH IN-PERSON AND VIA TELEHEALTH. FAMILY MEDICINE RESIDENTS HAVE PLAYED A SUPPORTING ROLE IN THE CARE OF HOSPITALIZED PATIENTS WITH COVID-19, INCLUDING IN THE ICU AND LABOR AND DELIVERY. INTERNS AND AREA HEALTH EDUCATION SCHOLARS PROGRAM (AHEC) SCRIPPS MERCY HOSPITAL CHULA VISTA WELL BEING CENTER SERVES AS AN INTERNSHIP PLACEMENT SITE FOR BOTH UNDERGRADUATE AND GRADUATE STUDENTS. THIS EDUCATION TRAINING PROGRAM IS DESIGNED TO RAISE THE NUMBERS, TYPES, DIVERSITY AND RETENTION OF PRIMARY HEALTH AND SOCIAL SERVICE CARE PROFESSIONALS WORKING IN UNDERSERVED AREAS. A TOTAL OF NINE STUDENTS COMPLETED THEIR INTERNSHIP. FIELDS OF STUDY INCLUDE UNDERGRAD SOCIAL WORK, UNDERGRAD PUBLIC HEALTH, MASTER'S IN SOCIAL WORK AND MASTER'S IN PUBLIC HEALTH FROM SAN DIEGO STATE UNIVERSITY; FOUR INTERNS ALSO COMPLETED THE AREA HEALTH EDUCATION CENTER SCHOLAR PROGRAM WHICH IS A COMBINATION OF CLINIC AND DIDACTIC ONLINE TRAINING. ENHANCING FAMILY PRACTICE RESIDENCY TRAINING IN OBSTETRICS AND MATERNAL AND CHILD HEALTH AT THE US/MEXICO BORDER OF SAN DIEGO AND IMPERIAL COUNTY SCRIPPS MERCY FAMILY MEDICINE RESIDENCY PROGRAM RECEIVED A $2.85 MILLION IN GRANT FUNDING FROM THE HEALTH SERVICES AND RESOURCES ADMINISTRATION (HRSA). THE RESIDENCY PROGRAM WILL USE THE FUNDS OVER THE NEXT FIVE YEARS TO DEVELOP AND IMPLEMENT INITIATIVES TO ENHANCE PHYSICIAN TRAINING IN FAMILY MEDICINE OBSTETRICS AND MATERNAL AND CHILD HEALTH ALONG THE U.S/MEXICO BORDER OF SAN DIEGO AND IMPERIAL COUNTIES. THE SCRIPPS TRAINING PROGRAM IS ONE OF 31 MEDICAL RESIDENCY PROGRAMS IN THE U.S RECENTLY SELECTED AS AN AWARD RECIPIENT IN HRSA'S HIGHLY COMPETITIVE GRANT FUNDING OPPORTUNITY, WHICH WAS OPEN TO PRIMARY CARE RESIDENCY PROGRAMS NATIONWIDE. WITH THE GRANT FUNDING, SCRIPPS AIMS TO INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS TRAINED IN PUBLIC HEALTH, ENHANCED OBSTETRICAL CARE AND GENERAL PREVENTIVE MEDICINE WITH MATERNAL HEALTH CARE EXPERTISE. SEVERAL EXPANDED PHYSICIAN TRAINING OPPORTUNITIES ARE PLANNED, INCLUDING NEW EDUCATIONAL TRACKS AND CLINICAL ROTATIONS. THE GOAL OF SCRIPPS' EXPANDED RESIDENT AND FELLOW TRAINING IS TO INCREASE THE NUMBER OF RESIDENCY PROGRAM GRADUATES ABLE TO CARE FOR WOMEN AND CHILDREN TO IMPROVE MATERNAL HEALTH OUTCOMES. THE RESIDENCY PROGRAM WILL ALSO USE THESE FUNDS TO HELP GIVE UNDERSERVED PATIENTS GREATER ACCESS TO HEALTH EDUCATION AND CARE, INCLUDING EXPANDED PATIENT ACCESS TO PRENATAL CLINICS AND LABOR-AND-DELIVERY CARE. THE FAMILY MEDICINE RESIDENCY PROGRAM IS BASED AT SCRIPPS MERCY HOSPITAL CHULA VISTA. FOR MORE THAN 20 YEARS, IT HAS TRAINED PHYSICIAN RESIDENTS TO PROVIDE COMPREHENSIVE AND CULTURALLY SENSITIVE MEDICAL CARE, WITH A FOCUS ON UNDERSERVED POPULATIONS OF THE SOUTH SAN DIEGO BORDER REGION. RESIDENTS IN THE THREE-YEAR GRADUATE MEDICAL EDUCATION PROGRAM COMPLETE INPATIENT ROTATIONS AT SCRIPPS MERCY HOSPITAL CHULA VISTA AND OUTPATIENT ROTATIONS AT SAN YSIDRO HEALTH CENTER, ALONG WITH PROVIDING CARE AT OTHER COMMUNITY CLINICS.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION TEAMS PROVIDE STATE OF THE ART EDUCATION AND TRAINING FOR PEOPLE WHO WISH TO INCREASE THEIR DIABETES MANAGEMENT KNOWLEDGE AND SKILLS. WITH THE RISE IN DIABETES RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP CLINICIANS WITH THE LATEST INFORMATION AND CLINICAL SKILLS. THE WHITTIER'S PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS, INCLUDING ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS, AND OTHER DIABETES SPECIALISTS. THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST POSSIBLE CARE FOR THEIR DIABETES PATIENTS. COURSES ARE TAILORED TO THE NEEDS OF ALLIED HEALTH PROFESSIONALS SEEKING TO UNDERSTAND NEW AND COMPLEX CLINICAL TREATMENT OPTIONS FOR TYPE 1, TYPE 2 AND GESTATIONAL DIABETES. PROFESSIONAL EDUCATION WAS PROVIDED FOR 119 PEOPLE ON INSULIN MANAGEMENT, INCRETIN THERAPY, AND DIABETES DIET AND DIABETES BASICS DURING THE 2020 UPDATES IN DIABETES MANAGEMENT CONFERENCE. PARTICIPANTS CAME FROM LOCAL HEALTH INSTITUTIONS AND THROUGHOUT THE UNITED STATES TO LEARN FROM THE WHITTIER INSTITUTE'S MOST EXPERIENCED DIABETES EXPERTS. OVER THE LAST FISCAL YEAR, THE WHITTIER INSTITUTE'S PROFESSIONAL EDUCATION DEPARTMENT PROVIDED FOUR CME PROGRAMS FOR OVER 200 PHYSICIANS, NURSES, PHARMACISTS, DIETITIANS, MIDLEVEL PROVIDERS, AND SOCIAL WORKERS AND MADE NUMEROUS ACADEMIC AND RESEARCH PRESENTATIONS AT PROFESSIONAL ASSOCIATION MEETINGS. TWO PROJECT DULCE TRAINING SESSIONS WERE HELD DURING THE 2021 FISCAL YEAR AND PROVIDED 43 PARTICIPANTS WITH THE CURRICULUM FOR SUCCESSFUL PROJECT DULCE INTERVENTION. HEALTH RESEARCH TRAUMA RESEARCH GRADUTE STUDENT INTERNSHIP THE TRAUMA RESEARCH GRADUATE STUDENT INTERNSHIP IS DESIGNED FOR ACTIVE STUDENTS WITH AN INTEREST IN PUBLIC HEALTH, EPIDEMIOLOGY, TRAUMA AND INJURY PREVENTION, BIOMEDICAL STATISTICS, AND HEALTH POLICY. THIS INTERNSHIP, IN AN EARLIER FORM, BEGAN IN 2005 AS A POST-BACCALAUREATE RESEARCH INTERNSHIP IN COLLABORATION WITH THE JOHNS-HOPKINS POST-BACCALAUREATE PREMEDICAL PROGRAM. IN 2016, THE TRAUMA RESEARCH PROGRAM BEGAN ACCEPTING MASTER OF PUBLIC HEALTH STUDENTS FROM SAN DIEGO STATE UNIVERSITY'S GRADUATE SCHOOL OF PUBLIC HEALTH TO PROVIDE PRACTICAL EXPERIENCE IN A RESEARCH SETTING. IN 2018, THIS PROGRAM WAS EXPANDED TO INCLUDE STUDENTS IN THE UNIVERSITY OF CALIFORNIA, SAN DIEGO MASTER'S IN CLINICAL RESEARCH PROGRAM. STUDENTS LEARN TO CONSTRUCT STUDY SAMPLES, CLEAN DATA, ANALYZE DATA, AND WRITE MANUSCRIPTS FOR SUBMISSION TO MEDICAL JOURNALS. THE ROTATION IS CONDUCTED AT SCRIPPS MERCY HOSPITAL SAN DIEGO. ALL RESEARCHERS HAVE SUBSEQUENTLY RECEIVED AUTHORSHIP FOR PUBLICATION IN LEADING ACADEMIC JOURNALS. CONTINUOUS GLUCOSE MONITORING STUDY THE NATIONAL INSTITUTES OF HEALTH AWARDED SCRIPPS WHITTIER DIABETES INSTITUTE (SWDI) $3.1 MILLION GRANT TO STUDY THE USE OF WIRELESS CONTINUOUS GLUCOSE MONITORING (CGM) DEVICES AMONG HOSPITALIZED PATIENTS WITH TYPE 2 DIABETES IN HOPE OF BETTER CONTROLLING THEIR BLOOD SUGAR DURING THEIR ADMISSION. THE NEW STUDY WILL BUILD ON EARLIER RESEARCH CONDUCTED BY SCRIPPS WHITTIER AND ON THE SUBSEQUENT USE OF CGM DEVICES AMONG PATIENTS WITH DIABETES IN SCRIPPS HEALTH HOSPITALS DURING THE COVID-19 PANDEMIC. EARLY IN THE PUBLIC HEALTH CRISIS, THE FOOD AND DRUG ADMINISTRATION CLEARED THE WAY FOR HOSPITALS TO USE THE DEVICES TO REDUCE THE NUMBER OF TIMES A NURSE MUST GO INTO A PATIENT'S ROOM FOR MORE CONVENTIONAL FINGER PRICKS. WITHOUT CGM, NURSES TYPICALLY ENTER A PATIENT'S ROOM FOUR TO SIX TIMES A DAY TO CHECK BLOOD GLUCOSE LEVELS. THE 5-YEAR STUDY WILL COMPARE THE USE OF REAL-TIME, CONTINUOUS GLUCOSE MONITORING (CGM) VERSUS STANDARD POINT-OF-CARE (POC) TESTING PROTOCOLS AT SCRIPPS MERCY CHULA VISTA HOSPITAL. THIS LARGE, N=554 RANDOMIZED CONTROLLED TRIAL WILL BUILD ON THE LESSONS LEARNED FROM SWDI'S EARLIER HOSPITAL CGM PILOT STUDY THAT WAS PUBLISHED IN DIABETES CARE IN 2020, AND THE MORE RECENT "CGM AS STANDARD OF CARE" INITIATIVE THAT HAS REACHED MORE THAN 500 PATIENTS AT MERCY SAN DIEGO DURING THE COVID-19 PANDEMIC. THE PRIMARY OUTCOME IS THE PERCENTAGE OF TIME PATIENTS ARE IN THE TARGET GLUCOSE RANGE DURING THEIR HOSPITALIZATION. ADDITIONAL ANALYSES WILL COMPARE RATES OF HOSPITAL-ACQUIRED INFECTION BETWEEN THE GROUPS, AS WELL AS COST EFFECTIVENESS, FEASIBILITY, AND SATISFACTION FROM PATIENT, NURSING, PHYSICIAN, AND HEALTH SYSTEM LEADERSHIP PERSPECTIVES. THE TRIAL IS SLATED TO BEGIN ENROLLMENT IN EARLY 2022. MEDICAL ASSISTANT HEALTH COACHING (MAC) FOR DIABETES IN DIVERSE PRIMARY CARE SETTINGS DIABETES AFFECTS NEARLY 30 MILLION INDIVIDUALS IN THE U.S, AND IF CURRENT TRENDS CONTINUE, 1 OF 3 ADULTS WILL HAVE DIABETES BY 2050. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSME) IS A CORNERSTONE OF EFFECTIVE CARE THAT IMPROVES CLINICAL CONTROL AND HEALTH OUTCOMES; HOWEVER, DSME PARTICIPATION IS LOW, PARTICULARLY AMONG UNDERSERVED POPULATIONS, AND ONGOING SUPPORT IS OFTEN NEEDED TO MAINTAIN DSME GAINS. IN 2015, THE NATIONAL INSTITUTE OF DIABETES AND DIGESTI VE AND KIDNEY DISEASES (NIH/NIDDK) GRANTED SCRIPPS WHITTIER DIABETES INSTITUTE $2.1 MILLION TO FUND THE MAC TRIAL, WHICH IS STUDYING AN INNOVATIVE TEAM CARE APPROACH THAT TRAINS MEDICAL ASSISTANTS (MAS) TO PROVIDE HEALTH COACHING IN THE PRIMARY CARE SETTING TO PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES, HELP THEM PROBLEM SOLVE, AND IMPROVE THEIR DIABETES-RELATED HEALTH OUTCOMES. THE GOALS INCLUDE IMPROVING DIABETES SELF-MANAGEMENT AND CLINICAL OUTCOMES, SUCH AS BLOOD GLUCOSE LEVELS, CHOLESTEROL, AND BLOOD PRESSURE. THE STUDY IS BEING CONDUCTED IN TWO DIVERSE SETTINGS: A SCRIPPS HEALTH PRIMARY CARE PRACTICE, AND A COMMUNITY HEALTH CENTER, NEIGHBORHOOD HEALTHCARE. THE INTERVENTIONS FOR THIS STUDY WERE COMPLETED IN FISCAL YEAR 2019 AND THE DATA IS NOW BEING ANALYZED FOR PUBLICATION. FINAL ANALYSIS OF ALL THE RESULTS WILL BE COMPLETED IN 2022. DIGITAL ME: AN ADAPTIVE MHEALTH INTERVENTION FOR UNDERSERVED HISPANICS WITH DIABETES DIABETES IS A FAST-GROWING EPIDEMIC. IN THE U.S., NEARLY 13.6% OF ADULTS WERE LIVING WITH DIAGNOSED DIABETES IN 2021, WHICH REPRESENTED AN ANNUAL ECONOMIC BURDEN OF $414.5 BILLION, WITH AN AVERAGE ANNUAL COST OF $11,779 PER CASE. HISPANICS FACE A HIGHER RISK OF DEVELOPING THE DISEASE-13.9 PERCENT COMPARED WITH 7.6 PERCENT FOR NON-HISPANIC WHITES. THE NIH'S NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES AWARDED $2.9 MILLION, THE LARGEST NIH AWARD TO SCRIPPS WHITTIER DIABETES INSTITUTE TO DATE, TO STUDY AN INNOVATIVE APPROACH TO HELPING HISPANICS WITH DIABETES BETTER MANAGE THEIR DISEASE. SCRIPPS WHITTIER HAS SHOWN THAT HEALTH-RELATED TEXT MESSAGES SENT EVERY DAY FOR SIX MONTHS TO LOW-INCOME HISPANICS WITH TYPE 2 DIABETES HELPED PRODUCE BLOOD SUGAR LEVEL IMPROVEMENTS THAT EQUALED THOSE RESULTING FROM SOME GLUCOSE-LOWERING MEDICATIONS. THE DULCE DIGITAL CLINICAL TRIAL WAS THE FIRST RANDOMIZED CONTROLLED STUDY TO LOOK AT THE USE OF TEXT MESSAGES TO HELP UNDERSERVED HISPANICS BETTER SELF-MANAGE THEIR DIABETES THROUGH GLYCEMIC CONTROL. DIGITAL-ME PROVIDED PATIENTS WITH TOOLS TO HELP THEM MANAGE THEIR DIABETES DAY TO DAY AND IMPROVE THEIR HEALTH, INCLUDING TEXT MESSAGING, WIRELESS BLOOD GLUCOSE AND MEDICATION MONITORING, DIET AND EXERCISE ASSESSMENTS, AND PERSONALIZED FEEDBACK AND GOAL SETTING. THIS STUDY WAS CONDUCTED IN COLLABORATION WITH NEIGHBORHOOD HEALTHCARE, SAN DIEGO STATE UNIVERSITY, AND THE UNIVERSITY OF CALIFORNIA SAN DIEGO. THE PARTICIPANTS RECEIVED HEALTH-RELATED TEXT MESSAGES EVERY DAY FOR SIX MONTHS AND THEY SAW IMPROVEMENTS IN THEIR BLOOD SUGAR LEVELS THAT EQUALED THOSE RESULTING FROM SOME GLUCOSE-LOWERING MEDICATIONS. THE DIGITAL-ME CLINICAL TRIAL REPRESENTS THE FIRST RANDOMIZED CONTROLLED STUDY TO LOOK AT THE USE OF TEXT MESSAGES TO HELP UNDERSERVED HISPANICS BETTER SELF-MANAGE THEIR DIABETES THROUGH GLYCEMIC CONTROL. THE STUDY FINALIZED ITS ENROLLMENT OF PARTICIPANTS AS OF 2020 DUE TO COVID-19. THE STUDY IS NOW IN THE PROCESS OF FINALIZING THE RESULTS FOR PUBLICATION TO COME OUT IN 2022. SCRIPPS WHITTIER DIABETES DISTRESS STUDY THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES AWARDED A FIVE-YEAR, $3.3 MILLION GRANT IN 2020 TO SCRIPPS WHITTIER DIABETES INSTITUTE TO STUDY THE INTEGRATION OF MENTAL HEALTH SERVICES IN THE CARE OF PATIENTS WITH TYPE 1 DIABETES TO BETTER ADDRESS THE EMOTIONAL DISTRESS THAN OFTEN ACCOMPANIES THE CHRONIC DISEASE. RESEARCHERS AT SCRIPPS WHITTIER WILL USE THE FEDERAL FUNDING TO LAUNCH A LARGE-SCALE, RANDOMIZED, CONTROLLED CLINICAL TRIAL THAT WILL EVALUATE WHETHER THE INTEGRATION OF DIABETES DISTRESS CARE WITH ROUTINE MEDICAL CARE RESULTS IN BETTER MANAGEMENT OF DIABETES AND BETTER HEALTH-RELATED QUALITY OF LIFE. THE STUDY IS A COLLABORATIVE EFFORT THAT CAPITALIZES ON THE COMPLIMENTARY EXPERTISE OF A CLINICAL PSYCHOLOGIST/ENDOCRINOLOGIST PARTNERSHIP. THE PROGRAM WILL BEGIN ENROLLMENT OF PARTICIPANTS IN NOVEMBER 2021.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS HUB ACADEMIC RESEARCH CORE (SHARC) THE SCRIPPS HUB ACADEMIC RESEARCH CORE (SHARC) TEAM IS A PARTNERSHIP BETWEEN THE SCRIPPS RESEARCH TRANSLATIONAL INSTITUTE AND SCRIPPS HEALTH (HOUSED IN THE SCRIPPS WHITTER DIABETES INSTITUTE). THE SCRIPPS HUB IS ONE OF 60 SITES AROUND THE COUNTRY THAT ARE SUPPORTED BY THE NIH'S CLINICAL AND TRANSLATIONAL SCIENCE AWARD (CTSA), WITH A FOCUS ON IMPROVING THE PROCESS OF TRANSLATING RESEARCH FROM BENCH-SIDE TO PRACTICE. WITHIN THIS HUB, THE SHARC TEAM AIMS TO SUPPORT TRANSLATIONAL RESEARCH AT SCRIPPS HEALTH AND THE SCRIPPS RESEARCH TRANSLATIONAL INSTITUTE IN THE FOLLOWING WAYS: RESEARCH NAVIGATION - PROVIDE ASSISTANCE THROUGH THE GRANT PROCESS (FROM PRE- TO POST-AWARD) AND WITH RESEARCH IMPLEMENTATION, ESPECIALLY FOR JUNIOR OR NEW INVESTIGATORS. STATISTICAL SUPPORT - PROVIDE STATISTICAL SUPPORT FOR DESIGNING THE STUDY, FROM SAMPLE SIZE AND POWER CALCULATIONS THROUGH DATA ANALYSIS AND PRESENTATION. COMMUNITY ENGAGEMENT - ENCOURAGE BIDIRECTIONAL COMMUNICATION BETWEEN COMMUNITIES AND RESEARCHERS TO FOSTER PARTICIPATION IN RESEARCH, SHARING AND DISCUSSION OF RESEARCH QUESTIONS AND FINDINGS, AND IMPROVE COMMUNITY HEALTH. COVID-19 RESEARCH & EDUCATION THE FOLLOWING ARE COVID-19 RESEARCH EFFORTS THAT GENERATED GENERALIZABLE KNOWLEDGE AND WERE MADE AVAILABLE TO THE PUBLIC. FROM EDUCATION AND PREVENTION TO RESEARCH NEWS, SCRIPPS IS COMMITTED TO KEEPING THE COMMUNITY UP TO DATE ON THE BATTLE AGAINST COVID-19. PROJECTS ARE BEING LED BY SCRIPPS HEALTH OR CO-LED BY SCRIPPS CLINICAL AND TRANSLATIONAL SCIENCE AWARD (CTSA) SUPPORTED INVESTIGATORS.SCRIPPS WHITTIER DIABETES INSTITUTE - DULCE DIGITAL-COVID AWARE. THE SCRIPPS WHITTIER DIABETES INSTITUTE RECEIVED GRANT APPROVAL IN 2020 BY THE NATIONAL INSTITUTES FOR HEALTH AND NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES (NIH/NIDDK) FOR A 1-YEAR COVID-19 SPECIFIC EXPANSION TO THE 5-YEAR "DULCE DIGITAL-ME (DD-ME): AN ADAPTIVE MHEALTH INTERVENTION FOR UNDERSERVED HISPANICS WITH DIABETES" STUDY. THIS EXPANSION WAS NAMED "DULCE DIGITAL-COVID AWARE (DD-CA)" DISCHARGE TEXTING PLATFORM FOR US/MEXICO BORDER HISPANICS WITH DIABETES + COVID-19." THE PRIMARY GOAL OF DD-CA IS TO USE A TEXTING PLATFORM TO IMPROVE COMMUNICATIONS TO GUIDE RECENTLY DISCHARGED PATIENTS WITH DIABETES. THE DULCE DIGITAL-COVID AWARE (DD-CA) PROGRAM AIMS TO IMPROVE GLUCOSE CONTROL AND REDUCE READMISSION RATES AND COVID-19 TRANSMISSION AFTER PATIENTS LEAVE THE HOSPITAL. THE PARTICIPANTS RECEIVE HEALTH-RELATED TEXT MESSAGES EVERY DAY FOR SIX MONTHS AND WIRELESS BLOOD GLUCOSE MONITORS TO TEXT RANGE VALUES IN WHEN PROMPTED. DD-CA COMBINES CULTURALLY AND LINGUISTICALLY RELEVANT DIABETES AND COVID-19 EDUCATIONAL MESSAGING WITH GLUCOSE MANAGEMENT SUPPORT IN A LOW-COST, EASILY ADOPTABLE PLATFORM TO ADDRESS SPECIFIC BARRIERS IN DIVERSE UNDERSERVED COMMUNITIES. NATIONAL INSTITUTE OF HEALTH (NIH) COMMUNITY ENGAGEMENT ALLIANCE (CEAL) CEAL AWARDS WERE GIVEN TO ELEVEN DIFFERENT STATEWIDE TEAMS, INCLUDING CALIFORNIA. SCRIPPS HEALTH, REPRESENTED BY THE SCRIPPS HUB ACADEMIC RESEARCH CORE (SHARC) TEAM, HAS PARTNERED WITH THE SAN DIEGO COUNTY COVID-19 EQUITY TASK FORCE TO REACH SAN DIEGO COMMUNITIES AS PART OF THE CALIFORNIA CEAL TEAM AWARD. THE SHARC TEAM HAS PREVIOUSLY PARTNERED WITH THE TASK FORCE TO DELIVER VIRTUAL COMMUNITY TOWN HALLS ON COVID-19 AND WILL CONTINUE TO PROVIDE OUTREACH THROUGH VIRTUAL EVENTS AND SAFELY REDESIGNED HEALTH AND RESOURCE FAIRS TO ASSESS COVID-19 KNOWLEDGE AND PERCEPTIONS ABOUT CLINICAL TRIALS. SUPPORTING THIS NIH-WIDE EFFORT ARE THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD) AND THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI). COVID RELATED TRAININGS IN RESPONSE TO THE COVID-19 PANDEMIC AND ITS EFFECT IT HAS HAD ON THE MEDICAL RESIDENTS, SCRIPPS MERCY CHULA VISTA WELL BEING CENTER OBTAINED FUNDING WITH THE PURPOSE OF PROVIDING SUPPORT AND HELPING BUILD THE MEDICAL RESIDENTS CAPACITY IN TREATMENT AND CARE OF COVID-19 POSITIVE PATIENTS. THREE RESIDENCY TRAININGS WERE IMPLEMENTED TO INCLUDE VARIOUS COVID-19 RELATED TOPICS, UPDATES ON CURRENT CARE FOR COVID-19 POSITIVE PATIENTS, PERSONAL PROTECTIVE EQUIPMENT (PPE) GUIDELINES AND DEMONSTRATION WITH THE SCRIPPS PPE COACHES, AND CURRENT TESTING OPTIONS AND GUIDELINES. TRAINING TOPICS INCLUDED: COVID-19 AND PUBLIC HEALTH, COVID-19: PATIENT CARE AND COVID-19 AND OUR CURRENT STATE. A TOTAL OF 29 MEDICAL RESIDENTS AND FACULTY WERE TRAINED. ADDITIONAL COVID-19 RELATED WEBINARS WERE DEVELOPED FOR THE CALIFORNIA STATEWIDE AREA HEALTH EDUCATION CENTER, AND THESE REACHED MORE THAN 1,000 INDIVIDUALS ACROSS THE STATE. A COLLABORATIVE EFFORT WITH SOUTH BAY COMMUNITY SERVICES IS ESTABLISHED TO OFFER COVID-19 RELATED EDUCATION FOR PROMOTORA'S AND PEER EDUCATORS.
FORM 990, PART VI, LINE 11B	990 REVIEW PROCESS WITH GOVERNING BODY THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT & COMPLIANCE COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS.
FORM 990, PART VI, LINE 12C	COMPLIANCE POLICY MONITORING WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT IS REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING.
FORM 990, PART VI, LINES 15A & 15B	OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS +4.0% GEOGRAPHIC DIFFERENTIAL AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: - FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. - SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE +4.0% GEROGRAPHIC DIFFERENTIAL OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. - TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE +4.0% GEOGRAPHIC DIFFERENTIAL OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. - THE BOARD SELECTS THE 65TH PERCENTILE +4.0% GEOGRAPHIC DIFFERENTIAL FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E. THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE +4.0% GEOGRAPHIC DIFFERENTIAL OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). - ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON DECEMBER 09, 2020, JANUARY 27, 2021, AND MARCH 31, 2021. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES.
FORM 990, PART VI, LINE 16	JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS.
FORM 990, PART VI, LINE 19	AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS CHANGE IN VALUE OF DEFERRED GIFTS (1,129,067) JOINT VENTURE DISTRIBUTION 1,644,400 ROUNDING 4,594 OTHER CHANGES IN NET ASSETS 46,811 -------------- TOTAL 566,738
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYS FEES-PROVIDER SVS AGRMENT TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SVS - NON MED TOTAL FEES:87324608
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:68738353
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:30825031
FORM 990 PART IX LINE 11G	DESCRIPTION:ALL OTHER FEES FOR SERVICES TOTAL FEES:54598919

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (11 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Scripps Clinic Billing LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	870797749	HLTHCR ADMIN	CA	$450,576,316	$0	Scripps HLTH
Scripps Mercy Billing LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	870737748	HLTHCR ADMIN	CA	$59,203,471	$0	SCRIPPS HLTH
Imaging Healthcare Specialists LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	203872122	Med Imaging	CA	$51,147,723	$45,101,306	Scripps HLTH
Scripps Hospital Billing Services LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	611677183	HLTHCR ADMIN	CA	$8,480,141	$0	Scripps HLTH
Scripps Cardio&Thoractic Surgery Billing
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	270620996	HLTHCR ADMIN	CA	$4,875,999	$0	Scripps HLTH
Maxwell H & Muriel Gluck Child Care Ctr
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	831953045	Childcare	CA	$1,896,101	$1,682,746	Scripps HLTH
Scripps Accountable Care Organization
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	364837442	HLTHCR ADMIN	CA	$9,665,720	$15,435,077	Scripps HLTH
Scripps ASC Management LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	831187975	HLTHCR ADMIN	CA	$0	$0	IHS Holding
IHS Holding Company LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	473437677	HLTHCR ADMIN	CA	$0	$35,779,242	Scripps HLTH
Scripps Behaviorial Health LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	834326624	HLTHCR ADMIN	CA	$0	$0	Scripps HLTH
Scripps Home Health & Hospice Venture
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	841894278	Scripps HLTH	CA	$0	$0	IHS Holding

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
Horizon Hospice
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330220777	Hospice Care	CA	501(c)(3)	10	Scripps hlth	Yes (true)
Mercy Hospital Foundation
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	942958094	Fundraising	CA	501(c)(3)	12a type I	Scripps hlth	Yes (true)
Scripps Health Plan Services Inc
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330782099	Hlthcr svcs	CA	501(c)(3)	12a type I	Scripps hlth	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
Scripps Encinitas Surgery Center
15305 DALLAS PKWY STE 1600 LB 28	ADDISON	TX	75001	205942958	Ambul surgery	CA	Scripps Health	Related	$4,543,687	$2,715,054	false	$0	false	0.57400
Scripps Memorial Ximed Med Center
15305 DALLAS PKWY STE 1600 LB 28	ADDISON	TX	75001	330475481	Real Estate	CA	Scripps Health	Related	$1,145,154	$6,225,435	false	$0	Yes (true)	0.15300
Scripps Mercy Ambulatory Surgery Center
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	450503246	Ambul surgery	CA	Scripps Health	Related	$6,537,728	$3,423,879	false	$0	Yes (true)	0.73500
ScrippsUSP Surgery Center
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	204952911	Ambul surgery	CA	NA	Related	$369,616	$1,464,857	false	$0	false	0.50000
Select Medical
9850 GENESEE AVE STE 900	LA JOLLA	CA	92037	261466122	LT ACUTE CARE	CA	NA	Related	$0	$0	false	$0	Yes (true)	0.24500

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt
Charitable Lead Trust (1)
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330796247	Hospital Support	CA	NA	Trust
Charitable Remainder Trust (35)
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	205156965	Hospital Support	CA	NA	Trust

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	Yes (true)	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	false	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	false	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Scripps Health Plan Services (SHPS)
m	$219,908,803	Accrual
Scripps Health Plan Services (SHPS)
q	$32,650,499	Accrual
Scripps Encinitas Surgery Center
a(IV)	$401,517	Accrual
Scripps Mercy Ambulatory Surgery Center
a(IV)	$328,112	Accrual
Scripps Health Plan Services (SHPS)
j	$163,305	Accrual
Scripps Health Plan Services (SHPS)
l	$332,274,322	Accrual

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PART III	FormAndLineReferenceDesc
Explanation	RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS SCRIPPS ENCINITAS SURGERY CENTER, LLC EIN: 20-5942958 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS MEMORIAL - XIMED MEDICAL CENTER, LP EIN: 33-0475481 ADDRESS: 9850 GENESEE AVE, STE 900, LA JOLLA, CA 92037 SCRIPPS MERCY AMBULATORY SURGERY CENTER, LLC EIN: 45-0503246 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS/USP SURGERY CENTERS, LLC EIN: 20-5942911 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SELECT MEDICAL EIN: 26-1466122 ADDRESS: 555 WASHINGTON ST., SAN DIEGO , CA 92103	ExplanationTxt