GROSSMONT HOSPITAL CORPORATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: GROSSMONT HOSPITAL CORPORATION (EIN 33-0449527)
Tax period: 2016-10-01 to 2017-09-30
Filed: 2018-08-09
IRS object ID: 201812219349301281
Schema version: 2016v3.0
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 H
Schedule I
Schedule J
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-08-09T17:00:12-05:00	ReturnTs
Tax Period End	2017-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	346565596	PreparerFirmEIN

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	4365 Executive Drive Suite 1600	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	921212101	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	330449527	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Grossmont Hospital Corporation	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	GROS	BusinessNameControlTxt
Phone	8584995150	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8695 Spectrum Center Blvd	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	921231489	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Daniel J Kindron	PersonNm
Person Title	CFO	PersonTitleTxt
Signature	2018-08-09	SignatureDt
Discuss With Paid Preparer	false	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
PTIN	P00634378	PTIN
Phone	8585357200	PhoneNum

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Sharp Grossmont Hospital	BusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	William S Evans	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8695 Spectrum Center Blvd	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	921231489	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$853,140,980	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.sharp.com	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1991	FormationYr
Legal Domicile State	CA	LegalDomicileStateCd
Activity Or Mission	Grossmont Hospital provides inpatient and outpatient medical services to the community.	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	4303	TotalEmployeeCnt
Total Volunteers	617	TotalVolunteersCnt
Total Gross UBI	$535,241	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$162,757	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$31,077,320	PYContributionsGrantsAmt
CY Contributions Grants	$17,344,001	CYContributionsGrantsAmt
PY Program Service Revenue	$698,977,890	PYProgramServiceRevenueAmt
CY Program Service Revenue	$671,380,675	CYProgramServiceRevenueAmt
PY Investment Income	$5,373,551	PYInvestmentIncomeAmt
CY Investment Income	$46,933,130	CYInvestmentIncomeAmt
PY Other Revenue	$2,570,158	PYOtherRevenueAmt
CY Other Revenue	$3,310,038	CYOtherRevenueAmt
PY Total Revenue	$737,998,919	PYTotalRevenueAmt
CY Total Revenue	$738,967,844	CYTotalRevenueAmt
PY Grants And Similar Paid	$359,874	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$375,025	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$333,410,475	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$344,991,565	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$1,134,990	CYTotalFundraisingExpenseAmt
PY Other Expenses	$338,484,245	PYOtherExpensesAmt
CY Other Expenses	$325,590,292	CYOtherExpensesAmt
PY Total Expenses	$672,254,594	PYTotalExpensesAmt
CY Total Expenses	$670,956,882	CYTotalExpensesAmt
PY Revenues Less Expenses	$65,744,325	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$68,010,962	CYRevenuesLessExpensesAmt
Total Assets BOY	$951,211,185	TotalAssetsBOYAmt
Total Assets EOY	$1,007,344,215	TotalAssetsEOYAmt
Total Liabilities BOY	$177,765,716	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$173,156,774	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$773,445,469	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$834,187,441	NetAssetsOrFundBalancesEOYAmt
Mission	See Schedule O.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$621,160,056	ExpenseAmt
Grant	$375,025	GrantAmt
Revenue	$671,380,675	RevenueAmt
Desc	Grossmont Hospital provides inpatient and outpatient services to the community. Patient days were 130,123 and outpatient visits were 292,312 for the twelve months ended 9/30/17. See Community Benefit Report on Schedule O.	Desc
Total Program Service Expenses	$621,160,056	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	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	Yes (true)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	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	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	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	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (true)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (true)	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	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	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	4303	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	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	Yes (true)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	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

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Tim Handgis	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	8584995150	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8695 Spectrum Center Blvd	AddressLine1Txt
City	San Diego	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	92123	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (37 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	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Michael W Murphy
PRESIDENT & CEO SHC	6.0	58.0	Yes (X)	Yes (X)	$0	$1,840,078	$108,207
William S Evans
CEO GHC	60.0	0.0	Yes (X)	Yes (X)	$0	$768,699	$20,042
Tom Cantor
SECRETARY	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
Jerry Fazio
VICE CHAIR	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
David Grundstrom
CHAIR	2.0	2.0	Yes (X)	Yes (X)	$0	$0	$0
Randolph Lenac
TREASURER	4.0	0	Yes (X)	Yes (X)	$0	$0	$0
Michael Emerson
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Allan Goetz
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Peter Hanson MD
DIRECTOR	2.0	2.0	Yes (X)		$27,563	$0	$0
Tom Karlo
DIRECTOR	2.0	2.0	Yes (X)		$0	$0	$0
Shakeel Kazi
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Diane Keltner
DIRECTOR	1.0	0	Yes (X)		$0	$0	$0
Jay La Suer
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Brian Moore MD
DIRECTOR	2.0	0	Yes (X)		$30,558	$0	$0
Ron Oberndorfer
DIRECTOR	1.5	0	Yes (X)		$0	$0	$0
Eric Orr MD
DIRECTOR	2.0	0	Yes (X)		$60,000	$0	$0
Jim Parker
DIRECTOR	5.0	0	Yes (X)		$0	$0	$0
K Michael Peddecord
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Bettie Wells
DIRECTOR	2.0	0	Yes (X)		$0	$0	$0
Ann Pumpian
SVP & CFO SHC	1.0	28.0		Yes (X)	$0	$983,486	$52,605
Staci L Dickerson
SVP & CFO SHC	2.0	58.0		Yes (X)	$0	$405,894	$32,567
Carlisle C Lewis III
SVP LEGAL/HR	6.0	54.0		Yes (X)	$0	$909,224	$61,909
Daniel J Kindron
CFO GHC	50.0	0.0		Yes (X)	$0	$236,040	$9,211
Anthony Damico
COO GHC	55.0	0.0			$0	$334,442	$23,265	Yes (X)
Louise White
VP PATIENT CARE GHC	50.0	0.0			$0	$299,845	$26,191	Yes (X)
Suzanne Johnson
VP HOSPICE	50.0	0.0			$0	$254,606	$31,062	Yes (X)
Kenneth Schell
DIR PHARMACY GHC	50.0	0			$234,917	$0	$20,510	Yes (X)
Jason Broad
VP PERFORMANCE EXCELLENCE	50.0	0.0			$0	$200,475	$19,921	Yes (X)
Hoangmy Nguyen
DIR PHARMACY GHC	50.0	0			$270,574	$0	$20,884	Yes (X)
Nancy Greengold
CMO GHC	50.0	0.0			$0	$398,494	$20,648		Yes (X)
Glicerio Cid Jr
ADVANCED CLINICIAN	76.0	0			$293,985	$0	$17,818		Yes (X)
Patrick Guo
LEAD MED RAD PHYSICIST	45.0	0			$242,344	$0	$14,681		Yes (X)
Maria McCane
CN WEEKEND	61.0	0			$237,416	$0	$19,158		Yes (X)
Barbara Hazer
PHARMACIST	40.0	0			$222,080	$0	$30,680		Yes (X)
Maryann Cone
FORMER KEY EMPLOYEE	0.0	0.0			$0	$327,802	$16,229			Yes (X)
Janet Hanley
FORMER KEY EMPLOYEE	0.0	40.0			$0	$240,424	$28,431			Yes (X)
Kari Cornicelli
FORMER OFFICER	0.0	50.0			$0	$304,424	$38,685			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,619,437	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$7,503,933	TotReportableCompRltdOrgAmt
Total Other Compensation	$612,704	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	820	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIII	Yes (X)	InfoInScheduleOPartVIIIInd
Related Organizations	$4,446,406	RelatedOrganizationsAmt
Government Grants	$12,812,595	GovernmentGrantsAmt
All Other Contributions	$85,000	AllOtherContributionsAmt
Noncash Contributions	$12,544,069	NoncashContributionsAmt
Total Contributions	$17,344,001	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
MEDICARE/MEDICAID	900099	$381,735,630	$381,735,630
PATIENT SERVICES	900099	$284,611,676	$284,611,676
MEDICAL OFFICE LEASE	531120	$3,429,726	$3,429,726
REFERENCE LAB	621500	$535,241		$535,241
CONTRACT PHARMACY	900099	$481,749	$481,749

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$586,653	TotalRevenueColumnAmt
Related Or Exempt Func Income	$586,653	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$671,380,675	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$8,963,048	TotalRevenueColumnAmt
Exclusion	$8,963,048	ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$152,003,044	SecuritiesAmt
Other	$140,174	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$114,132,992	SecuritiesAmt
Other	$40,144	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$37,870,052	SecuritiesAmt
Other	$100,030	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$37,970,082	TotalRevenueColumnAmt
Exclusion	$37,970,082	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
PARKING	812930	$1,236,473	$1,236,473
AUXILIARY	453220	$880,888	$880,888
HEALTH PLAN IT ACCESS FEES	900099	$999,615	$999,615

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$193,062	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$193,062	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$3,310,038	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$738,967,844	TotalRevenueColumnAmt
Related Or Exempt Func Income	$670,845,434	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$535,241	UnrelatedBusinessRevenueAmt
Exclusion	$50,243,168	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$375,025	TotalAmt
Program Services	$375,025	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	$3,140,123	TotalAmt
Program Services	$1,857,173	ProgramServicesAmt
Management And General	$1,282,950	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$169,164	TotalAmt
Program Services	$169,164	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$275,179,163	TotalAmt
Program Services	$271,339,919	ProgramServicesAmt
Management And General	$3,839,244	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$9,174,723	TotalAmt
Program Services	$9,026,192	ProgramServicesAmt
Management And General	$148,531	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$37,021,537	TotalAmt
Program Services	$36,077,925	ProgramServicesAmt
Management And General	$943,612	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$20,306,855	TotalAmt
Program Services	$20,003,268	ProgramServicesAmt
Management And General	$303,587	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$23,015,705	TotalAmt
Program Services	$21,597,633	ProgramServicesAmt
Management And General	$1,418,072	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$969,208	TotalAmt
Program Services	$27,593	ProgramServicesAmt
Management And General	$941,615	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$7,537,876	TotalAmt
Management And General	$7,537,876	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$42,267	TotalAmt
Management And General	$42,267	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$304,281	TotalAmt
Management And General	$304,281	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$45,279,409	TotalAmt
Program Services	$43,562,271	ProgramServicesAmt
Management And General	$1,717,138	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$5,527,133	TotalAmt
Program Services	$116,009	ProgramServicesAmt
Management And General	$5,411,124	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$19,420,133	TotalAmt
Program Services	$17,363,806	ProgramServicesAmt
Management And General	$2,056,327	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$26,528,319	TotalAmt
Program Services	$25,732,469	ProgramServicesAmt
Management And General	$795,850	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$9,912,844	TotalAmt
Program Services	$7,691,511	ProgramServicesAmt
Management And General	$2,221,333	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$468,169	TotalAmt
Program Services	$455,341	ProgramServicesAmt
Management And General	$12,828	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$690,615	TotalAmt
Program Services	$258,231	ProgramServicesAmt
Management And General	$432,384	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$3,323,976	TotalAmt
Program Services	$2,900,433	ProgramServicesAmt
Management And General	$423,543	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$30,895,763	TotalAmt
Program Services	$24,465,226	ProgramServicesAmt
Management And General	$6,430,537	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$3,537,565	TotalAmt
Program Services	$3,058,212	ProgramServicesAmt
Management And General	$479,353	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$83,679,054	$83,679,054
MEDI-CAL PROVIDER TAX	$21,461,254	$21,461,254
SYSTEM ALLOCATION	$31,169,490	$20,827,851	$10,341,639
REPAIRS AND MAINTENANCE	$7,913,664	$7,453,625	$460,039

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,913,567	TotalAmt
Program Services	$1,660,871	ProgramServicesAmt
Management And General	$1,117,706	ManagementAndGeneralAmt
Fundraising	$1,134,990	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$670,956,882	TotalAmt
Program Services	$621,160,056	ProgramServicesAmt
Management And General	$48,661,836	ManagementAndGeneralAmt
Fundraising	$1,134,990	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$32,776,077	BOYAmt
EOY	$34,517,292	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$10,404,519	BOYAmt
EOY	$11,301,361	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$94,854,113	BOYAmt
EOY	$87,348,312	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$12,926,507	BOYAmt
EOY	$12,662,115	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$4,153,282	BOYAmt
EOY	$14,251,606	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$652,845,815	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$261,117,947	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$364,661,087	BOYAmt
EOY	$391,727,868	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$399,922,689	BOYAmt
EOY	$429,661,760	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$1,243,415	BOYAmt
EOY	$1,179,789	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$23,753,147	BOYAmt
EOY	$24,203,648	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$6,516,349	BOYAmt
EOY	$490,464	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$951,211,185	BOYAmt
EOY	$1,007,344,215	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$55,991,262	BOYAmt
EOY	$54,006,342	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$8,552,104	BOYAmt
EOY	$13,373,870	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$15,500,000	BOYAmt
EOY	$15,500,000	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$97,722,350	BOYAmt
EOY	$90,276,562	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$177,765,716	BOYAmt
EOY	$173,156,774	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$756,715,743	BOYAmt
EOY	$816,631,667	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$15,612,323	BOYAmt
EOY	$16,437,371	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,117,403	BOYAmt
EOY	$1,118,403	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$773,445,469	BOYAmt
EOY	$834,187,441	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$951,211,185	BOYAmt
EOY	$1,007,344,215	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$68,010,962	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$11,245,275	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$3,976,285	OtherChangesInNetAssetsAmt
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	false	FederalGrantAuditRequiredInd

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)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$42,267	OtherActivitiesAmt
Total Lobbying Expenditures	$42,267	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

Grossmont Hospital Corporation (GHC) pays annual dues to the California Hospital Association (CHA), the Healthcare Association of San Diego and Imperial Counties (HASD&IC), the California Association of Hospitals and Health Systems (CAHHS), the American Hospital Association (AHA) and the California Hospice and Palliative Care Association (CHAPCA). CHA, HASDIC, CAHHS, AHA, and CHAPCA have determined that a portion of their membership dues are used for lobbying purposes. GHC's FY 2017 portion of annual dues calculated to have been used for lobbying was $42,267.

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,144,772	BeginningYearBalanceAmt
Contributions	$1,000	ContributionsAmt
Investment Earnings Or Losses	$500,089	InvestmentEarningsOrLossesAmt
Other Expenditures	$324,028	OtherExpendituresAmt
End Year Balance	$5,321,833	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,759,731	BeginningYearBalanceAmt
Contributions	$21,000	ContributionsAmt
Investment Earnings Or Losses	$367,800	InvestmentEarningsOrLossesAmt
Other Expenditures	$3,759	OtherExpendituresAmt
End Year Balance	$5,144,772	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,948,052	BeginningYearBalanceAmt
Contributions	$25,917	ContributionsAmt
Investment Earnings Or Losses	-$87,824	InvestmentEarningsOrLossesAmt
Other Expenditures	$126,414	OtherExpendituresAmt
End Year Balance	$4,759,731	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,952,926	BeginningYearBalanceAmt
Contributions	$695,673	ContributionsAmt
Investment Earnings Or Losses	$307,715	InvestmentEarningsOrLossesAmt
Other Expenditures	$8,262	OtherExpendituresAmt
End Year Balance	$4,948,052	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,791,203	BeginningYearBalanceAmt
Contributions	$1,000	ContributionsAmt
Investment Earnings Or Losses	$160,723	InvestmentEarningsOrLossesAmt
End Year Balance	$3,952,926	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.69	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.31	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.0	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$581,843	OtherCostOrOtherBasisAmt
Book Value	$581,843	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$483,622,121	OtherCostOrOtherBasisAmt
Depreciation	$182,890,761	DepreciationAmt
Book Value	$300,731,360	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,824,444	OtherCostOrOtherBasisAmt
Depreciation	$2,253,874	DepreciationAmt
Book Value	$2,570,570	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$102,662,150	OtherCostOrOtherBasisAmt
Depreciation	$66,403,089	DepreciationAmt
Book Value	$36,259,061	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$61,155,257	OtherCostOrOtherBasisAmt
Depreciation	$9,570,223	DepreciationAmt
Book Value	$51,585,034	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$391,727,868	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)

DescDesc	AmtAmt
MARK TO MARKET SWAP
LONG TERM PENSION LIABILITY	$3,989,807
LONG TERM WORKERS' COMPENSATION LIABILITY	$380,108
OTHER LIABILITIES	$85,000
INTERCOMPANY PAYABLE	$11,363,909
ALLOCATED TAX EXEMPT BONDS	$68,100,766
CAPITAL LEASES	$5,335,697
PROGRAM RESERVES	$1,021,275

Field	Value	IRS element (for citing)
Total Liability	$90,276,562	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$712,581,234	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	-$11,245,275	NetUnrealizedGainsInvstAmt
Other Revenue	-$234,776	OtherRevenueAmt
Revenue Not Reported	-$11,480,051	RevenueNotReportedAmt
Revenue Subtotal	$724,061,285	RevenueSubtotalAmt
Investment Expenses Not Incld	$304,281	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$14,602,278	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$14,906,559	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$738,967,844	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$669,349,414	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$107,598	OtherExpensesIncludedAmt
Expenses Not Reported	$107,598	ExpensesNotReportedAmt
Expenses Subtotal	$669,241,816	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$304,281	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$1,410,785	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$1,715,066	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$670,956,882	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule D, Part V, Line 4 Intended uses of endowment funds	Grossmont Hospital Foundation holds 24 board designated and permanent endowments for Grossmont Hospital Corporation that are restricted for a variety of purposes, such as hospice and hospice homes, diabetes, nursing education, cancer treatment, hospital equipment and technology, and more.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	Sharp recognizes tax benefits from any uncertain tax positions 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. Sharp 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 not met. Sharp 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. At September 30, 2017 and 2016, no such assets or liabilities were recorded.
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	Foundation Donations to Individuals - 107598 Loss on Disposal of Assets - -342374
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements	Donations of Capital / Donation for Capital Purchased - 13477728 Medical Staff / Auxiliary Revenue - 1124550
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	Foundation Donations to Individuals - 107598
Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements	Medical Staff / Auxiliary Expenses - 1068411 Loss on Disposal of Assets - 342374

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	false	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	$6,873,840	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,873,840	NetCommunityBenefitExpnsAmt
Total Expense	0.0102	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$230,425,848	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$188,434,597	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$41,991,251	NetCommunityBenefitExpnsAmt
Total Expense	0.0624	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,306,104	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,324,860	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$238,605,792	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$189,759,457	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$48,865,091	NetCommunityBenefitExpnsAmt
Total Expense	0.0726	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$796,272	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$796,272	NetCommunityBenefitExpnsAmt
Total Expense	0.0012	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$466,334	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$466,334	NetCommunityBenefitExpnsAmt
Total Expense	0.0007	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$86,219,728	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$71,562,029	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$14,657,699	NetCommunityBenefitExpnsAmt
Total Expense	0.0218	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$324,865	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$324,865	NetCommunityBenefitExpnsAmt
Total Expense	0.0005	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$87,807,199	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$71,562,029	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$16,245,170	NetCommunityBenefitExpnsAmt
Total Expense	0.0241	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$326,412,991	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$261,321,486	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$65,110,261	NetCommunityBenefitExpnsAmt
Total Expense	0.0967	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,160	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,160	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$30,695	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$30,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$47,855	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$30,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,160	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReportedInd
Bad Debt Expense	$9,088,014	BadDebtExpenseAmt
Reimbursed By Medicare	$93,435,985	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$124,756,435	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$31,320,450	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

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	GROSSMONT IMAGING LLC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	JOINT VENTURE-DIAGNOSTIC IMAGING	PrimaryActivitiesTxt
Org Profit Or Ownership	0.5	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0.0	OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership	0.5	PhysiciansProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GROSSMONT HOSPITAL CORPORATION	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	5555 GROSSMONT CENTER DRIVE	AddressLine1Txt
City	LA MESA	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	91942	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.SHARP.COM/GROSSMONT	WebsiteAddressTxt
State License	080000006	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	GROSSMONT HOSPITAL CORPORATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	http://www.sharp.com/about/community/health-needs-assessments.cfm	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	http://www.sharp.com/about/community/health-needs-assessments.cfm	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.0	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://www.sharp.com/patient/billing/financial-assistance.cfm	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://www.sharp.com/patient/billing/financial-assistance.cfm	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://www.sharp.com/patient/billing/financial-assistance.cfm	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Prospective Medicare Medicaid	Yes (X)	ProspectiveMedicareMedicaidInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - GROSSMONT HOSPITAL CORPORATION. Based on the results of the community health statistics scan and feedback from community partners received during the 2016 CHNA planning process, a number of community engagement activities were conducted across SDC, as well as specific to SGH, in order to provide a more comprehensive understanding of the identified health needs, including their associated social determinants of health and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. Community engagement activities of the collaborative 2016 CHNA included: 19 key informant interviews, facilitated discussions with 87 care coordinators (community partnership discussions), and input from more than 230 community residents through a Health Access and Navigation ("Roadmap") Survey. Key informants included county public health officers, health care and social service providers, and members of community-based organizations, including advocacy groups representing communities facing inequities. Further, SGH-specific community and patient engagement efforts included additional key informant interviews, facilitated discussions with nearly 40 health care professionals and the collection of nearly 100 more Health Access and Navigation Surveys from patients and community members. These community engagement activities were conducted from July, 2015 through March, 2016.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - GROSSMONT HOSPITAL CORPORATION. The HASD&IC Board of Directors convened a CHNA Committee to plan and implement the collaborative 2016 CHNA process. The CHNA Committee is comprised of representatives from all seven participating hospitals and health care systems: * Kaiser Foundation Hospital - San Diego * Palomar Health * Rady Children's Hospital - San Diego * Scripps Health (Chair) * Sharp HealthCare (Vice Chair) * Tri-City Medical Center * University of California San Diego Health
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - GROSSMONT HOSPITAL CORPORATION. The SGH 2016 CHNA examines the health needs of the community members it serves in San Diego County (SDC). SGH's 2016 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 Community Health Needs Assessment process and findings for SDC. This collaborative process was conducted under the auspices of HASD&IC, and in contract with the Institute for Public Health (IPH) at San Diego State University (SDSU).
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - GROSSMONT HOSPITAL CORPORATION. The findings of SGH's 2016 Community Health Needs Assessment (CHNA) further dove into priority health needs impacting the communities served by SGH, particularly those community members facing inequities, as well as provided insight gathered from direct conversations with the community. SGH's 2016 CHNA continued to identify the following health needs for its community: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * Obesity * Senior Health Further, in recognition of the significance of various forms of cancer prioritized in the 2013 CHNA process, as well as discussion with SGH team members and the priorities they observe in their patient population, SGH's 2016 CHNA also identified cancer as a priority health need to address in its community. SGH reviewed its 2016 CHNA to assist in the design and implementation of programs and services provided at SGH for its community members. In identifying these priorities, SGH also considered the expertise and mission of its programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise SGH's service area and region. SGH provides programming and services that address the following identified community health needs: cancer, cardiovascular disease, type 2 diabetes, senior health, obesity and behavioral health (clinical services only for the latter - please see details below). SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. However, beyond these clinical services, SGH does not have the resources to comprehensively meet the need for community education and support around the identified health need of behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. The identified health need of obesity is not specifically targeted in education, however is addressed through general nutrition and exercise education and resources provided at SGH, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC - including the region served by SGH - provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. SGH's most recent implementation strategy (FY 2018 - FY 2021), available online at https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm details specific programs that SGH provides to address needs identified in its 2016 CHNA, as well information on identified health needs that SGH lacks resources to comprehensively address. Additionally, through further analysis of SGH's community programs and in consultation with SGH's community relations team, SGH also addresses the following priority health needs for community members served by SGH: * Women's and prenatal health services and education * Prevention of unintentional injuries * Support during the transition of care process for high-risk, underserved and underfunded patients * Collaboration with local schools to promote interest in health care careers These programs are detailed further in the SGH section of Sharp HealthCare's FY 2017 Community Benefit Plan and Report, available for public viewing/download at: https://www.sharp.com/about/community/community-benefits/benefit-report.cfm.
Schedule H, Part V, Section B, Line 20 Facility , 1	Facility , 1 - Grossmont Hospital. Grossmont Hospital does not make presumptive FAP-eligibility determinations based on third-party information as defined in section 501(r)-6(c)(2). Instead, Grossmont Hospital makes reasonable efforts based on notification and processing of applications as defined in 501(r)-6(c)(3).

Field	Value	IRS element (for citing)
Facility	0	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt	Address Line2USAddress/AddressLine2Txt
SHARP HOSPICE CARE
8881 FLETCHER PARKWAY SUITE 336	LA MESA	CA	91942	HOSPICE
PMB MEDICAL OFFICE BUILDING
8860 CENTER DRIVE SUITE 100	LA MESA	CA	91942	OUTPATIENT SERVICES
GROSSMONT MEDICAL PLAZA
5525 GROSSMONT CENTER DRIVE SUITE L	LA MESA	CA	91942	OUTPATIENT SERVICES	L
BRIAR PATCH
9000 WAKARUSA ROAD	LA MESA	CA	91942	OUTPATIENT SERVICES
GROSSMONT IMAGING LLC
8881 FLETHCER PARKWAY SUITE 102	LA MESA	CA	91942	JOINT VENTURE - DIAGNOSTIC IMAGING
PMB MEDICAL OFFICE BUILDING
8860 CENTER DRIVE SUITE 200	LA MESA	CA	91942	OUTPATIENT SERVICES - INFUSION
LAKEVIEW HOSPICE HOME
9472 LOREN DRIVE	LA MESA	CA	91942	HOSPICE HOME
PARKVIEW HOSPICE HOME
5788 LYDEN WAY	SAN DIEGO	CA	92120	HOSPICE HOME
GROSSMONT IMAGING LLC
9640 MISSION GORGE ROAD SUITE H	SANTEE	CA	92071	JOINT VENTURE - DIAGNOSTIC IMAGING

Supplemental Information Detail SupplementalInformationDetail (19 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 7f PART I, LINE 7 COL F	Bad debt expense is netted against revenue. As such, $0.00 was backed out of total expenses for column (f) calculation.
Schedule H, Part VI, Line 7 PART VI, LINE 7	Sharp HealthCare prepares an annual Community Benefit Report in accordance with the requirements of California Senate Bill (SB) 697, community benefit legislation (According to SB 697, hospitals under the common control of a single corporation or another entity may file a consolidated report with the Calif. Office of Statewide Health Planning and Development (OSHPD)). Sharp HealthCare submits an annual Community Benefit Report to the California OSHPD. The Sharp HealthCare Community Benefit Plan and Report, Fiscal Year 2017 is available online at https://www.sharp.com/about/community/community-benefits/benefit-report.cfm .
Schedule H, Part III, Line 3 PART III, LINE 3	No figure is reported on Part III, line 3 (estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy) due to all amounts attributable to patients eligible under the charity care policy being reported as charity.
Schedule H, Part III, Line 7 PART III, LINE 7	The organization incurred additional Medicare shortfall that is not allowed to be reported on Parts I and III, due to the definition of Medicare shortfall as prescribed by the IRS. This additional shortfall arises from the use of the Medicare cost report data which excludes fee based services, non-billable services, and disallowed operating expenses which the organization has determined to be revenues and expenses of the Medicare program and should be included in the total shortfall. A reconciliation of what the organization classifies as Medicare shortfall is as follows: Medicare revenue received reported on Parts I and III - $164,998,014 Medicare allowable costs reported on Parts I and III - $190,732.979 Shortfall included on Parts I and III - $(25,734,965) Actual Medicare revenue received - $167,382,628 Actual Medicare cost - $206,880,174 Actual Medicare shortfall - $(39,497,546) Additional Medicare shortfall not on Parts I and III - $(13,762,582)
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Sharp HealthCare
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Historical charity care percentages are applied to current revenues to estimate charity on a monthly basis. Actual charity transactions are applied against the estimate and any increase or decrease over estimated amounts is accounted for. Other Cost includes State/County programs included in the S-10 for Medicare Cost Reporting primarily for prison/in custody patient care. Ratios of Cost to Charges (RCC) were calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, so worksheet C represents direct revenue and expense plus stepdown from Overhead departments. The Ratio of Cost to Charges (RCC) by CMS line was then applied to the applicable revenue departments broken down by payer to obtain the fully weighted cost by payer.
Schedule H, Part II Community Building Activities	Grossmont Hospital Corporation at times provides a provision for housing for vulnerable patients upon discharge from the hospital. Grossmont Hospital Corporation incurred expenses for disaster preparedness training and capital expenditures. Grossmont Hospital Corporation incurred expenses for coalition building.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	Bad Debt represents amounts that go unpaid where the patient was determined to have the ability to pay. If an inability to pay is demonstrated, then full or partial Charity is granted and not considered Bad Debt. Bad Debt at Cost should be included as a Community Benefit because, like other shortfall programs, we are required to accept these patients through the Emergency Room or as a referral with "good faith" in collecting. Grossmont Hospital Corporation consolidates into Sharp HealthCare's audited financial statements. The audited financial statements of Sharp HealthCare include a footnote discussing accounts receivable and allowance for doubtful accounts which is included below. *Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, Sharp analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, Sharp analyzes contractually due amounts and provides an allowance for doubtful accounts, if necessary. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), Sharp records a provision for doubtful accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Sharp HealthCare's audited financial statements include a deduction from revenue line on the Combined Statement of Operations titled Provision for Doubtful Accounts. Additionally, the accounts receivable line on the Combined Balance Sheet details the amount of allowance for doubtful accounts that is netted against the receivable balance.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	Medicare should be included as a community benefit because participation in the Medicare program requires all patients be accepted whether through the Emergency Room or as a referral and Grossmont Hospital Corporation must accept the Medicare established rates whether they cover the cost or not. Ratios of Cost to Charges (RCC) were calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, representing direct revenue and expense plus stepdown from Overhead departments. The RCC by CMS line was then applied to the applicable revenue departments broken down by payor to obtain the fully weighted cost by payer.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Sharp does not initiate collection activities on accounts known to be eligible for Financial Assistance or Charity care. It is also Sharp's policy to recall/cancel accounts assigned to a collection agency if it is determined, at any time, a patient account is eligible for Financial Assistance or Charity care.
Schedule H, Part V, Section B, Line 16a FAP website	- GROSSMONT HOSPITAL CORPORATION: Line 16a URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;
Schedule H, Part V, Section B, Line 16b FAP Application website	- GROSSMONT HOSPITAL CORPORATION: Line 16b URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- GROSSMONT HOSPITAL CORPORATION: Line 16c URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;
Schedule H, Part VI, Line 2 Needs assessment	Sharp HealthCare (Sharp) has been a long-time partner in the process of identifying and responding to the health needs of the San Diego community. This partnership has included a broad range of hospitals, health care organizations, and community agencies in order to conduct triennial Community Health Needs Assessments (CHNAs) more than 20 years. Sharp hospitals, including Sharp Grossmont Hospital (SGH), base their community benefit and community health programs on both the findings of these needs assessments and the combination of expertise in programs and services offered and the knowledge of the populations and communities served by each Sharp hospital. SGH reviewed its CHNA and used the assessment to help inform priority needs for members of the communities it serves. In identifying these priorities, SGH also considered the expertise and mission of its programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise SGH's service area and region. SGH is committed to the health and well-being of its community, and the findings of SGH's most recent (2016) CHNA help inform the activities and services provided by SCHHC to improve the health of its community members. These programs are detailed in SGH's FY18-FY 21 implementation strategy, which are available online to the community at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH does not have the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. Additionally, through further analysis of SGH's community programs and in consultation with SGH's community relations team, SGH also addresses the following priority health needs for community members served by SGH: Women's and prenatal health services and education Prevention of unintentional injuries Support during the transition of care process for high-risk, underserved and underfunded patients Collaboration with local schools to promote interest in health care careers These programs are detailed further in the SGH section of Sharp HealthCare's FY 2015 Community Benefit Plan and Report, available for public viewing/download at: https://www.sharp.com/about/community/community-benefits/benefit-report.cfm . In addition, SGH: Incorporates community priorities and community input into its strategic plan and develops service line-specific goals Estimates an annual budget for community programs and services based on community needs, the prior year's experience and current funding levels Prepares and distributes information on community benefits programs and services through its foundation and community newsletters Consults with representatives from a variety of departments, to discuss, plan and implement community activities
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Sharp HealthCare's financial assistance policy is in furtherance of its charitable mission. The policy identifies eligibility for, and circumstances under which, financial assistance will be extended to Sharp HealthCare's hospital patients for medically necessary services. "Charity Care" is that portion of Sharp HealthCare's charges for medically necessary patient care services provided by a hospital that a patient (either individually or through a third party payer) is unable to pay. Charity Care does not include bad debt, contractual adjustments, or un-reimbursed costs of providing care to patients eligible under government programs for health care services to low-income and medically indigent patients. "Financial Assistance," means any reduction of charges for medically necessary services as defined herein that may be made by Sharp HealthCare either for, or on behalf of, a patient who applies to Sharp HealthCare for Financial Assistance and meets Sharp HealthCare's financial eligibility requirements or criteria as described in this policy. For purposes of the policy Financial Assistance includes "charity care" which means a 100% reduction in charges for medically necessary services and "partial charity care" which means a reduction in a portion of charges for such services. All patients should be screened at the time of admission or at registration for ability to pay for services, including whether or not they are candidates for Financial Assistance. Care for patients presenting with a known or possible emergency medical condition or in active labor shall not be delayed in order to assess financial status. In order to both inform patients of the various programs they may be entitled to, and assist them in the application process, Uncompensated Care Specialists provide patient(s) with a Financial Assistance Form. The Uncompensated Care Specialists direct the patient (or their guarantor) to complete a Patient Financial Statement, include specified financial items for both the patient and spouse (if any), direct the patient to return all information within ten days and document in patient's account history notes the substance of any patient discussions and that the Patient Financial Statement was provided. Following internal processing of the Financial Assistance Form, Sharp Uncompensated Care Specialists and/or Private Pay Representatives notify patient of Financial Assistance Application results, document the decision in all approved and denied Financial Assistance Accounts and secure payment arrangements for remaining balance of partial Financial Assistance or denied Financial Assistance accounts. All follow-up and patient interaction is documented in the patient's account history notes.
Schedule H, Part VI, Line 4 Community information	The community served by Sharp Grossmont Hospital includes the entire east region of San Diego County, including the sub-regional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. For SGH's 2016 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by SGH with especially high need include, but are not limited to, Lemon Grove, Spring Valley and El Cajon. In SDC's east region in 2016, 100 percent of surveyed children ages zero to 11 and 100 percent of surveyed children ages 12 to 17 had health insurance coverage, which meet the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. 96.5 percent of surveyed adults ages 18 to 64 had health insurance, which falls short of the HP2020 target. In the east region in 2016, 11.3 percent of adults ages 18 to 64 did not have a usual source of care and 8.9 percent of these adults had health insurance. In addition, 8.7 percent of adults without a usual source of care reported fair health outcomes. In 2015, the unemployment rate in SDC's east region was 11.3 percent, which was higher than the rate for SDC overall (10.3 percent). During 2015-2016, 16.9 percent of adults ages 18 to 64 in SDC's east region reported living below the federal poverty level (FPL). Among east region adults with a household income below 200 percent FPL, 44.8 percent of those surveyed in in 2015-2016 reported experiencing food insecurity (lack of access to healthy food). In addition, 17.8 percent of east region adults with a household income below 300 percent FPL reported participation in CalFresh, the Supplemental Nutrition Assistance Program in California. East region figures for food insecurity and CalFresh participation during in 2015-2016 were higher than the rates for the county overall (42.4 percent and 17.5 percent, respectively). Further, 10.5 percent of east region adults with a household income below 300 percent FPL received Supplemental Security Income, higher than SDC overall (8.6 percent). In 2015, there were 63,901 residents ages 65 and older in SDC's east region, representing 14.4 percent of the total regional population and a higher proportion than any other region in the county. Between 2015 and 2020, it is anticipated that the east region's senior population will grow by 20.7 percent, slower than the growth rate for seniors in SDC overall (22 percent).
Schedule H, Part VI, Line 5 Promotion of community health	Sharp Grossmont Hospital has an open medical staff and a community board. Surplus funds generated by hospital operations are re-invested by the organization to fund capital improvements and acquire state of the art medical equipment with the intent of continually improving patient care. Further, as San Diego's largest private employer, Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego earth-friendly businesses to help identify best practices reduce the costs of green practices and facilitate implementation of sustainable initiatives. Sharp believes the promotion of healthy food choices is necessary to improve the health of patients, employees and the community. Sharp's recommitment to healthy food and sustainable nutrition practices began more than five years ago with a strategy to increase the availability of healthy food options at Sharp facilities. Since that time, Sharp, in collaboration with Sodexo - Sharp's food service partner - has been an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers to adopt healthier eating habits, combat obesity and minimize waste. These programs include but are not limited to regular donations of surplus food to San Diego Rescue Mission and the San Diego Food Bank, a cooking oil recycling program, composting, and active membership in San Diego's Nutrition in Healthcare Leadership Team, a subcommittee of the San Diego County Childhood Obesity Initiative. In addition, Sharp protects the San Diego community through essential emergency and disaster planning activities and services. In FY 2017, Sharp provided education to staff, community members and community health professionals, and partnered with numerous state and local organizations, to prepare for an emergency or disaster. Sharp's emergency preparedness team offered educational courses to first responders and health care providers throughout SDC. This included a standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System (HICS) as well as a training focused specifically on HICS, an incident management system that can be used by hospitals to manage threats, planned events or emergencies. In addition, a course was offered to train participants to use the WebEOC crisis information management system, which provides real-time information sharing between health care systems and outside agencies during a disaster. Through participation in the U.S. Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes Sharp's acute-care hospitals, Sharp Rees-Stealy Medical Group Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, other San Diego hospitals and health systems, community clinics, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriff's Department and the Marine Corps Air Station Miramar Fire Department. The partnership continually identifies and develops relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve San Diego County and are located near partner health care facilities. Through networking, planning, and the sharing of resources, trainings and information, members of the partnership are better prepared for a coordinated response to an emergency or disaster affecting San Diego. In recent years, endemic events occurring across the globe have had the potential to impact public health in the local San Diego community. Sharp has continued to partner with community agencies, County of San Diego Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This preparation has allowed for the continued delivery of uninterrupted care to the community in the face of public health threats.
Schedule H, Part VI, Line 6 Affiliated health care system	Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 24 medical centers; five urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp also offers individual and group Health Maintenance Organization (HMO) coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2017, Sharp is licensed to operate 2,084 beds and has more than 2,600 Sharp-affiliated physicians and 18,000 employees. It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patient expectations and are provided in a caring, convenient, cost-effective and accessible manner. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen, embodying an organization of people working together to do the right thing every day to improve the health and wellbeing of those it serves. With 524 licensed beds, Sharp Grossmont Hospital is the largest provider of health care services in San Diego's East County, and operates one of the busiest emergency rooms in San Diego County. SGH is known for outstanding programs in heart care, orthopedics, rehabilitation, robotic surgery, stroke care and women's health. Sharp Grossmont Hospital received Magnet Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor awarded by the ANCC and is accepted nationally as the gold standard in nursing excellence.
Schedule H, Part VI, Line 7 State filing of community benefit report	CA

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
California Health Foundation & Trust
1215 K Street Suite 800	Sacramento	CA	95814	941498697	501 (c) (3)	$219,921	Medi-Cal Program
Grossmont Hospital Foundation
8695 Spectrum Center Blvd	San Diego	CA	921231489	330124488	501 (c) (3)	$123,554	Sponsorship - Continuing Medical Education, Gala, Golf Tournament, Regatta	$35	FMV	Snacks for Regatta

Field	Value	IRS element (for citing)
Total501c3 Org	2	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 Procedures for monitoring use of grant funds.	FormAndLineReferenceDesc
Explanation	The Management team evaluates requests for contributions from outside organizations taking into account how they align with the organization's mission. No monitoring is done after grants are made.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	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 (20 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
Michael W Murphy
PRESIDENT & CEO SHC	$0	$1,383,503	$0	$382,168	$0	$74,407	$0	$87,784	$0	$20,423	$0	$1,948,285	$0	$0
William S Evans
CEO GHC	$0	$633,443	$0	$100,462	$0	$34,794	$0	$0	$0	$20,042	$0	$788,741	$0	$0
Kari Cornicelli
FORMER OFFICER	$0	$235,620	$0	$49,518	$0	$19,286	$0	$19,665	$0	$19,020	$0	$343,109	$0	$0
Ann Pumpian
SVP & CFO SHC	$0	$788,611	$0	$161,431	$0	$33,444	$0	$37,083	$0	$15,522	$0	$1,036,091	$0	$0
Staci L Dickerson
SVP & CFO SHC	$0	$316,011	$0	$64,652	$0	$25,231	$0	$18,709	$0	$13,858	$0	$438,461	$0	$0
Carlisle C Lewis III
SVP LEGAL/HR	$0	$740,698	$0	$136,010	$0	$32,516	$0	$42,354	$0	$19,555	$0	$971,133	$0	$0
Daniel J Kindron
CFO GHC	$0	$195,277	$0	$32,699	$0	$8,064	$0	$7,919	$0	$1,292	$0	$245,251	$0	$0
Maryann Cone
FORMER KEY EMPLOYEE	$0	$129	$0	$0	$0	$327,673	$0	$16,229	$0	$0	$0	$344,031	$0	$0
Janet Hanley
FORMER KEY EMPLOYEE	$0	$198,488	$0	$40,197	$0	$1,739	$0	$15,050	$0	$13,381	$0	$268,855	$0	$0
Anthony Damico
COO GHC	$0	$273,707	$0	$39,984	$0	$20,751	$0	$14,821	$0	$8,444	$0	$357,707	$0	$0
Louise White
VP PATIENT CARE GHC	$0	$254,656	$0	$42,805	$0	$2,384	$0	$12,079	$0	$14,112	$0	$326,036	$0	$0
Suzanne Johnson
VP HOSPICE	$0	$198,490	$0	$45,424	$0	$10,692	$0	$13,012	$0	$18,050	$0	$285,668	$0	$0
Kenneth Schell
DIR PHARMACY GHC	$205,225	$0	$27,597	$0	$2,095	$0	$6,687	$0	$13,823	$0	$255,427	$0	$0	$0
Jason Broad
VP PERFORMANCE EXCELLENCE	$0	$171,284	$0	$28,661	$0	$530	$0	$11,959	$0	$7,962	$0	$220,396	$0	$0
Hoangmy Nguyen
DIR PHARMACY GHC	$233,653	$0	$36,376	$0	$545	$0	$7,555	$0	$13,329	$0	$291,458	$0	$0	$0
Nancy Greengold
CMO GHC	$0	$362,072	$0	$10,000	$0	$26,422	$0	$11,843	$0	$8,805	$0	$419,142	$0	$0
Glicerio Cid Jr
ADVANCED CLINICIAN	$289,135	$0	$0	$0	$4,850	$0	$10,205	$0	$7,613	$0	$311,803	$0	$0	$0
Patrick Guo
LEAD MED RAD PHYSICIST	$233,051	$0	$0	$0	$9,293	$0	$13,052	$0	$1,629	$0	$257,025	$0	$0	$0
Maria McCane
CN WEEKEND	$232,862	$0	$0	$0	$4,554	$0	$11,610	$0	$7,548	$0	$256,574	$0	$0	$0
Barbara Hazer
PHARMACIST	$210,576	$0	$0	$0	$11,504	$0	$22,843	$0	$7,837	$0	$252,760	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part II, Column (B)(i) PART II, LINE 3 ,COL B(I)	Compensation was paid to Dr. Peter Hanson through Peter B. Hanson MD Inc. by Grossmont Hospital Corporation for medical director services.
Schedule J, Part II, Column (B)(i) PART II, LINE 4, COL B(I)	Compensation was paid to Dr. Brian Moore through X-Ray Medical Group by Grossmont Hospital Corporation for past Chief of Staff services.
Schedule J, Part II, Column (B)(i) PART II, LINE 5, COL B(I)	Compensation was paid to Dr. Eric Orr through Carl Eric Orr MD Inc. by Grossmont Hospital Corporation for chief of staff services.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	THE COMPENSATION COMMITTEE OF SHARP HEALTHCARE, THE PARENT ORGANIZATION, ESTABLISHES THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE COMPENSATION COMMITTEE ENGAGES INDEPENDENT COMPENSATION CONSULTANTS AND THE AMOUNT IS APPROVED BY BOTH THE COMPENSATION COMMITTEE AND BOARD OF DIRECTORS.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	Sharp HealthCare ("Company") sponsors an Executive Flexible Benefit Plan ("Plan") to provide designated executives with a reasonable level of benefits in return for their continued employment with the Company. The Plan is administered on a Plan Year basis of January 1 to December 31. Changes in Flexible Benefit Options are permitted annually, effective January 1 of the new Plan Year. The provisions of the Plan, which were restated effective as of December 31, 2008, are described below as restated. The Plan is available to the Chief Executive Officer, Executive Vice President of Hospital Operations, and Senior Vice Presidents. The Flexible Benefit Allowance available to each participant each plan year shall equal the sum of the following: - A company provided base allowance equal to 18% of the participant's base salary - A participant deferral up to 6% of the participant's pre-tax base salary for such plan year as elected by the participant - A company match should the participant make an elective deferral for a plan year. The company match begins at 2% for the first 1% elective deferral and increases 0.5% for each additional 1% elective deferral, to a maximum match of 4.5% on a 6% elective deferral. The Plan allows participants to use the Flexible Benefit Allowance to purchase additional long-term disability coverage, long-term care coverage, and flexible survivor coverage/accumulation benefits (life insurance). Participants in the flexible survivor coverage/accumulation benefits plan previously could elect to apply Flexible Benefit Allowance to acquire additional survivor coverage, or toward deposits to the Supplemental Survivor Accumulation Benefit Plan ("SSAB") to fund post-retirement survivor benefits, subject to the ERISA limit provided their policies were issued prior to September 18, 2003. The Company shall automatically continue whatever elective coverage and additional deposit elections that were in place for the SSAB during the 2008 plan year. No elective coverage or additional deposits were available to participants whose policies were issued on or after September 18, 2003. Any Flexible Benefit Allowance that remains after purchasing these additional coverages shall be paid to the participant in cash in equal installments throughout the Plan Year, not less frequently than quarterly. If the participant separates from service during the Plan Year, the participant forfeits any unpaid Allowance.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
STEPHEN HANLEY
Stephen Hanley, an employee of GHC, is the son of Janet Hanley, a former key employee of GHC.	$64,849	EMPLOYMENT	false
MARY ANN PEDDECORD
May Ann Peddecord is employee of GHC and spouse of Kenneth Peddecord, Director.	$104,315	EMPLOYMENT	false
CONTRIBUTOR #3 FROM SCHEDULE B
GHC purchased equipment and service from contributor #3 on Schedule B	$367,225	Grossmont Hospital Corporation purchased equipment and service agreements from contributor #3 from Schedule B, a substantial contributor of Grossmont Hospital Corporation.	false

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (6 entries)

Non Cash CheckboxNonCashCheckboxInd	DescDesc	ContributionContributionCnt	Noncash Contributions Rpt F990NoncashContributionsRptF990Amt	Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)	Heart & Vascular	12	$9,141,814	Cost
Yes (X)	Central Power Plant	12	$3,243,065	Cost
Yes (X)	EAST TOWER	7	$54,844	Cost
Yes (X)	Co-Gen	1	$16,950	Cost
Yes (X)	Supplies	3	$2,396	Cost
Yes (X)	Equipment	1	$85,000	Cost

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (true)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	false	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule M, Part I Explanations of reporting method for number of contributions	FormAndLineReferenceDesc
Explanation	Other - Heart & Vascular Number of Contributions Other - Co-Gen Number of Contributions Other - Supplies Number of Contributions	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (65 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, Line 1 PART III, LINE 1	To establish, maintain, conduct, and operate a hospital or hospitals related, associated and complimentary facilities and services, such as, but not limited to, skilled nursing, extended care, outpatient care, home care, and other health care programs, activities, services and facilities. To carry on any educational activities related to rendering care to the sick and injured, or to the promotion of health. To promote and carry on scientific research related to the care of the sick and injured, or to the promotion of health. To participate in any activity designed and carried on to promote the general health of the community. To operate and maintain this corporation and its assets for the benefit of the communities served by Grossmont Healthcare District, a political subdivision of the State of California, organized pursuant to Local Hospital District Law (Division 23 of the California Health & Safety Code), and which is located in San Diego County, California. Generally do anything and everything necessary, expedient or incidental to the foregoing.
Form 990, Part III, Line 4a Community Benefit Report	Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2017 Section 1 An Overview of Sharp HealthCare We're an organization filled with passionate, determined and caring people, who have grown our health care system into the remarkable place that it is. Each day, these professionals recognize and celebrate the purpose of their work and the impact it has on our neighbors, friends and family in the community. - Michael W. Murphy, President and Chief Executive Officer, Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 24 medical centers; five urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp also offers individual and group Health Maintenance Organization (HMO) coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2017, Sharp is licensed to operate 2,084 beds and has more than 2,600 Sharp-affiliated physicians and 18,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in SDC's fast-growing South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women's and infant's services, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, sub-acute and long-term care, liver care, rehabilitation therapies, orthopedics, and hospice and emergency services. Sharp Grossmont Hospital (524 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, oncology, orthopedics, rehabilitation, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in cancer treatment, orthopedics, organ transplantation, bariatric surgery, heart care and rehabilitation. SMH also houses the county's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 licensed beds) A freestanding women's hospital specializing in labor and delivery services, high-risk pregnancy, obstetrics, gynecology, gynecologic oncology and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other hospital in California. Sharp Mesa Vista Hospital (158 licensed beds) As the most comprehensive mental health hospital in San Diego, Sharp Mesa Vista Hospital (SMV) provides behavioral health services to treat anxiety, depression, substance abuse, eating disorders, bipolar disorder and more for patients of all ages. Sharp McDonald Center (16 licensed beds) Sharp McDonald Center (SMC) is the only medically supervised substance abuse recovery center in SDC. Offering the most comprehensive hospital-based treatment program in San Diego, SMC provides services such as addiction treatment, medically supervised detoxification and rehabilitation, day treatment, outpatient and inpatient programs, and aftercare. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH and are referred to herein as the Sharp Metropolitan Medical Campus (SMMC). The operations of Sharp Rees-Stealy Medical Group (SRSMG) are included within the not-for-profit public benefit corporation of Sharp, the parent organization. The operations of SGH are reported under the not-for-profit public benefit corporation of Grossmont Hospital Corporation. The operations of Sharp HospiceCare are reported within SGH. Mission Statement It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patients' expectations and are provided in a caring, convenient, cost-effective and accessible manner. Vision Sharp's vision is to become the best health system in the universe. Sharp will attain this position by transforming the health care experience through a culture of caring, quality, safety, service, innovation and excellence. Sharp will be recognized by employees, physicians, patients and families, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen embodying an organization of people working together to do the right thing every day to improve the health of those it serves. Values * Integrity - Trustworthy, Respectful, Sincere, Authentic, Committed to Organizational Mission and Values * Caring - Compassionate, Communicative, Service-Oriented, Dedicated to Teamwork and Collaboration, Serves Others Above Self, Celebrates Wins, Embraces Diversity * Safety - Reliable, Competent, Inquiring, Unwavering, Resilient, Transparent, Sound Decision Maker * Innovation - Creative, Drives for Continuous Improvement, Initiates Breakthroughs, Develops Self, Willing to Accept New Ideas and Change * Excellence - Quality-Focused, Compelled by Operational and Service Excellence, Cost Effective, Accountable Culture: The Sharp Experience For more than 18 years, Sharp has been on a journey to transform the health care experience for patients and their families, physicians and staff. Through a sweeping organization-wide performance-and-experience-improvement initiative called The Sharp Experience, the entire Sharp team has recommitted to purposeful, worthwhile work and creating the kind of health care people want and deserve. This work has added discipline and focus to every part of the organization, helping to make Sharp one of the nation's top-ranked health care systems. Sharp is San Diego's health care leader because it remains focused on the most important element of the health care equation: the people. Through this extraordinary initiative, Sharp is transforming the health care experience in San Diego by striving to be: * The best place to work: Attracting and retaining highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration, and professional and personal growth. This commitment to serving patients and supporting one another will make Sharp "the best health system in the universe." * The best place to practice medicine: Creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers; experience unsurpassed service as valued customers; have access to state-of-the-art equipment and cutting-edge technology; and enjoy the camaraderie of the highest-caliber medical staff at San Diego's health care leader. * The best place to receive care: Providing a new standard of service in the health care industry, much like that of a five-star hotel; employing service-oriented individuals who see it as their privilege to exceed the expectations of every patient-treating them with the utmost care, compassion and respect; and creating healing environments that are pleasant, soothing, safe, immaculate, and easy to access and navigate. Through this transformation, Sharp continues to live its mission to care for all people, with special concern for the underserved and San Diego's diverse population. This is something Sharp has been doing for more than half a century. Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp made an important decision regarding these pillars as part of its continued journey toward excellence.
Form 990, Part III, Line 4a Community Benefit Report	Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * Sensitivity to operations * A reluctance to simplify * Preoccupation with failure * Deference to expertise * Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could improve. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization - Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. The seven pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: 1. Demonstrate and improve clinical excellence and exceed customer expectations. 2. Keep patients, employees and physicians safe and free from harm. 3. Create exceptional experiences at every touch point for patients and families, enrollees, physicians, partners and team members. 4. Create a values-driven culture that attracts, retains and promotes the best people who are committed to Sharp's mission and vision. 5. Achieve financial results to ensure Sharp's ability to deliver on its mission and vision. 6. Achieve net revenue growth to enhance market position, sustain infrastructure improvements and support innovative development. 7. Be an exemplary public citizen by improving the health of our community and environment. Awards Below please find a selection of recognitions Sharp has received in recent years: In 2013, 2014, 2016 and 2017, Sharp was recognized as one of the "World's Most Ethical (WME) Companies" by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was ranked No. 45 out of 500 large employers on Forbes' 2017 America's Best Employers listing. In 2016, Sharp ranked No. 16 and received the No. 2 spot on the newcomer's list. Sharp was also ranked No. 52 out of 250 organizations on Forbes' 2017 America's Best Employers for Diversity and was the only hospital system listed in San Diego. In 2017, Sharp was recognized as one of "150 Top Places to Work in Healthcare" by Becker's Hospital Review. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees. In 2015 and 2017, Sharp ranked first for "San Diego's Best Hospital Group" in the annual San Diego Union-Tribune Readers Poll. Sharp ranked second in this category in 2016. SMH ranked first for "San Diego's Best Hospital" in 2017 while ranking second in this category in 2016. Also in 2016, SMBHWN and SGH ranked third and fourth, respectively, for "San Diego's Best Hospital." From 2015 to 2017, Sharp Community Medical Group (SCMG) ranked first as "San Diego's Best Medical Group." In 2016, SRSMG ranked third for "San Diego's Best Medical Group" and was recognized as "San Diego's Best Hearing Aid Store" in 2017. In 2016 and 2017, SMBHWN was named to The Leapfrog Group's Top Hospitals list, which recognizes facilities that meet the highest standards of patient safety, care quality and efficiency. In 2016, SMH was also recognized as a Top Hospital. SGH, SMH and SMBHWN received MAGNET(r) recognition by the American Nurses Credentialing Center (ANCC). The MAGNET Recognition Program(r) is the highest level of honor bestowed by the ANCC and is recognized nationally as the gold standard in nursing excellence. Sharp was named one of the nation's "Most Wired" health care systems from 2012 to 2017 by Hospitals & Health Networks magazine's annual Most Wired Survey and Benchmark Study. "Most Wired" hospitals are committed to using technology to enhance quality of care for both patients and staff. Planetree is a coalition of more than 80 hospitals worldwide that are committed to improving medical care from the patient's perspective. In 2007, SCHHC became a Designated Planetree Person-Centered Hospital and was re-designated in 2017 for the fourth consecutive time. Additionally, SCHHC achieved Planetree Designation with Distinction for its leadership and innovation in patient-centered care. SMH became a Planetree Person-Centered Hospital in 2012 and achieved Planetree Designation with Distinction in 2014. In 2015, SMH was re-designated as a Planetree Person-Centered Hospital. In 2014, SCVMC joined SCHHC and SMH as a Designated Planetree Person-Centered Hospital. SCHHC and SCVMC received Energy Star (ES) designation from the U.S. Environmental Protection Agency (EPA) for outstanding energy efficiency. Buildings that are awarded ES certification use an average of 40 percent less energy than other buildings and release 35 percent less carbon dioxide (CO2) into the atmosphere. SCHHC first earned the ES certification in 2007, then again each year from 2010 through 2013, and most recently in 2017. SCVMC received ES certification from 2009 to 2011 as well as in 2013, 2015 and 2017. San Diego Gas & Electric (SDG&E) named Sharp the 2017 Grand Energy Champion at its annual Energy Showcase Awards. Sharp was recognized for making tremendous strides in reducing its consumption of electricity and natural gas, and in promoting energy-saving techniques to the community. SDG&E also named Sharp as San Diego's "Healthcare 2014 Energy Champion" for its successes in energy conservation. In 2013 and 2015, Sharp was named a "Recycler of the Year" at the City of San Diego Environmental Services Department's annual Waste Reduction and Recycling Awards Program for a successful and extensive recycling program. SMH and SMBHWN were honored for their comprehensive waste-reduction programs in 2013. Sharp was named the 2017 Outstanding Recycling Program by California Resource Recovery Association (CRRA) - California's statewide recycling association - for its innovative waste-minimization initiatives. As the oldest and one of the largest nonprofit recycling organizations in the country, CRRA is dedicated to achieving environmental sustainability in and beyond California through zero waste strategies, including product stewardship, waste prevention, reuse, recycling and composting. Sharp was one of five awardees in San Diego to receive a 2016 EMIES UnWasted Food Award by the San Diego Food System Alliance for developing best practices in waste prevention, composting, recycling, food donation and source reduction efforts in partnership with the Sodexo Food and Nutrition team. In 2016, Sharp ranked third on San Diego Business Journal's list of Healthiest Companies. The Healthiest Companies list honors those organizations that have created a supportive environment for their employees and fostered a work/life balance for their families. In 2015, Sharp Best Health received the American Heart Association(r) (AHA) Fit-Friendly Worksites Honor Roll award (Gold Category) for the third consecutive year, which recognizes employers that promote a culture of health and physical activity in the workplace or community. SRSMG was recognized by the Centers for Disease Control and Prevention (CDC) as a 2017 Million Hearts Hypertension Control Champion for achieving blood pressure control for at least 70 percent of its adult patients with hypertension.
Form 990, Part III, Line 4a Community Benefit Report	From 2013 to 2017, the Press Ganey organization recognized multiple SHC entities with Guardian of Excellence Awards(r). Based on one year of data, this designation recognizes recipients that reach the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality. Awarded SHC entities included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, SHC, Sharp HospiceCare, SRSMG, SCMG and Sharp Home Health for Employee Engagement; SMH and SMBHWN for Patient Experience; and SCHHC, SMBHWN and SMV for Physician Engagement. Press Ganey also recognized multiple SHC entities with the Pinnacle of Excellence Award(r) (formerly named the Beacon of Excellence Award). This award recognizes the top three performing health care organizations that have maintained consistently high levels of excellence over three years in the Press Ganey categories of Patient Experience, Employee Engagement, Physician Engagement and Clinical Quality Performance. In 2013 and 2015 through 2017, Press Ganey recognized SMH for patient experience. From 2013 to 2015, SHC was recognized for Employee Engagement. In 2013, SCHHC and SMV were recognized for Physician Engagement. SHP's 2016-2017 National Committee for Quality Assurance's (NCQA) Private Health Insurance Rankings rating increased from a 4 to 4.5 out of 5, making it one of the highest-rated health plans in the nation. SHP was also ranked a top 100 U.S. health plan and a top three California health plan from 2014 to 2015, which rated health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. SHP also received the highest level "Excellent" Accreditation status from the NCQA each year from 2013 to 2015. The NCQA awards accreditation status is based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. In addition, SHP was rated highest in California among reporting California health plans in the rating categories of Rating of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating of Health Promotion and Education in NCQA's 2015 Quality Compass/CAHPS survey, which provides state, regional and national benchmarks as well as individual plan performance. From 2013 to 2017, Sharp ranked in the top 10 of the large employers category as one of the "Best Places to Work" for information technology professionals by the International Data Group's Computerworld survey. The list is compiled by evaluating a company's benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. The Women's Choice Award(r) is a symbol of excellence in customer experience awarded by the collective voice of women. SGH received a Women's Choice Award(r) as one of America's Best Hospitals for Cancer Care in 2015, Obstetrics in 2016 and Heart Care in 2017. SMH and SGH received a Women's Choice Award(r) as one of America's Best Stroke Centers in 2017. In 2015, SMBHWN received the award as one of America's Best Hospitals for Obstetrics. The Women's Choice Award(r) also ranked SCHHC, SCVMC and SMH amongst America's 100 Best Hospitals for Patient Experience in 2017. In addition, SMH received the award as one of America's Best Hospitals for Bariatric Surgery in 2017. For the fourth year in a row, and the fifth time in six years, Sharp won the top spot in the Mega Employer category in the San Diego Association of Governments' (SANDAG) iCommute 2016 Rideshare Corporate Challenge. The annual month-long challenge encourages the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or transit commutes. Powered by SANDAG and in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. Sharp was named the 2015 Medical Provider of the Year at the International Travel & Health Insurance Journal (ITIJ) Awards. The ITIJ honors companies that have made an outstanding contribution to the global travel and health insurance industry over the past year. Sharp's Global Patient Services program coordinates patient transfers and evacuations for medical emergencies from around the world to a Sharp hospital. Global Healthcare Exchange (GHX) recognized Sharp as one of the 2016 GHX "Best 50" Supply Chains in North America. Organizations receiving this distinction are recognized for their work in improving operational performance and driving down costs through supply chain automation. Patient Access to Care Programs Sharp provides financial assistance and a variety of support services to improve access to care for uninsured, underinsured and high-risk patients without the ability to pay and insured patients with inadequate coverage. Sharp does not refuse any patient requiring emergency medical care. Sharp provides services to help every uninsured patient receiving care in the ED find opportunities for health coverage through PointCare - a team of health coverage experts whose principal product is a quick, web-based screening, enrollment and reporting technology designed to provide community members with health coverage and financial assistance options. At Sharp, patients use a simple online questionnaire through PointCare to generate personalized coverage options that are filed in their account for future reference and accessibility. The results of the questionnaire allow Sharp staff to have an informed and supportive discussion with the patient about health care coverage, and empower them with options. From October 2015 to July 2017, Sharp helped nearly 22,800 self-pay patients through PointCare, while ensuring that each patient's dignity was maintained throughout the process. In 2014, Sharp hospitals implemented an on-site process for real-time Medi-Cal eligibility determinations (Presumptive Eligibility), making Sharp the first hospital system in SDC to provide this service. In Fiscal Year (FY) 2017, Sharp secured this benefit for approximately 3,800 unfunded patients in the ED. In support of Covered California's annual open enrollment period, 25 members of Sharp's registration staff have become Certified Application Counselors in order to better assist both patients and the general community with navigating the Covered California website and plan enrollment. In collaboration with San Diego-based CSI Financial Services, Sharp offers a more affordable alternative for patients struggling to resolve their hospital bills through ClearBalance - a specialized loan program for patients facing high medical bills. Through the program, both insured and uninsured patients have the opportunity to secure small bank loans in order to pay off their medical bills in low monthly installments, preventing unpaid accounts from going to collections. In addition, three Sharp hospitals - SCVMC, SGH and SMH - qualify as covered entities for the 340B Drug Pricing Program administered by the Health Resources and Services Administration. Hospital participation in the 340B Drug Pricing Program permits the purchase of outpatient drugs at reduced prices. The savings from this program are used to offset patient care costs for Sharp's most vulnerable patient populations, as well as to assist with patient access to medications through the Patient Assistance Team. The Patient Assistance Team helps those in need of assistance gain access to free or low-cost medications. Patients are referred for medication assistance through population health teams, physicians, pharmacists, case managers, social workers, nurses or even other patients, as well as identified through usage reports. Eligible patients receive assistance that may help reduce readmissions and the need for frequent medical services resulting from the lack of access to medication. Team members research all available options, including programs offered by drug manufacturers, grant-based programs offered by foundations, copay assistance and other low-cost alternatives. In FY 2017, the Patient Assistance Team helped uninsured and underinsured patients access prescriptions worth a total of $3.9 million.
Form 990, Part III, Line 4a Community Benefit Report	Also in 2017, Sharp supported and provided payment options to high-risk, uninsured and underinsured patients at all Sharp hospitals who were unable to meet their financial responsibility after health insurance. Through the Maximum Out of Pocket Program, team members met with patients to help them better understand their health insurance benefits and how to access care during their hospital stay, as well as provided payment options. In addition, Public Resource Specialists, from Sharp's Patient Financial Services (PFS) team offered support to uninsured and underinsured patients at all Sharp hospitals in need of extra guidance on available funding options. The Public Resource Specialists performed field calls (home visits) to patients who left the hospital and required assistance with completing the coverage application process. SGH's PFS team worked closely with the hospital's Care Transitions Intervention program to evaluate patients for CalFresh, the Supplemental Nutrition Assistance Program in California, prior to hospital discharge, dramatically increasing the likelihood that patients complete CalFresh applications and receive benefits. In FY 2017, SGH's PFS team completed 687 CalFresh applications and 405 patients were granted CalFresh benefits. In February 2017, Sharp's PFS team expanded this program to the remainder of Sharp's acute care hospitals. In summer 2015, a pilot program was launched at SMBHWN to evaluate both insured and unfunded families with Neonatal Intensive Care Unit (NICU) babies for financial assistance. This process included helping families whose newborn had been diagnosed with a devastating medical condition or extremely low birth weight apply for Supplemental Security Income (SSI) to help with the cost of care for their newborn both within and outside of the hospital. Public Resource Specialists have assisted more than 150 families through the SSI application process. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. SCHHC, SGH and SMH work with the San Diego Rescue Mission (SDRM) to identify homeless patients, or patients who have exhausted other community housing resources, who have a continuing medical need after hospital discharge. Once referred to the SDRM's Recuperative Care Unit, patients receive follow-up medical care through Sharp in a safe environment, and may also receive psychiatric care, assistance scheduling specialty appointments, support with CalFresh applications, and connections to community resources, including programs that support continued sobriety and residential treatment. In addition, a social worker provides referrals for permanent housing and collaborates with St. Vincent de Paul Village to assist with the SSI application process through HOPE (Homeless Outreach Programs for Entitlement) San Diego - an effort to increase access to SSI for people who are homeless or at risk of homelessness. Sharp is committed to providing medical records to support an SSI claim free of charge. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships and career pipeline programs. In FY 2017, nearly 4,600 student interns dedicated more than 650,000 hours within the Sharp system. Sharp provided education and training for students in a variety of disciplines, including nursing students (e.g., critical care, medical/surgical, behavioral health, women's services, cardiac services and hospice) and allied health professions such as rehabilitation therapies (speech, physical and occupational therapy), pharmacy, respiratory therapy, imaging, cardiovascular, dietetics, lab, radiation therapy, surgical technology, paramedic, social work, psychology, business, health information management and public health. Students came from local community colleges, such as Grossmont College, San Diego City College, San Diego Mesa College and Southwestern College (SWC); local and national universities such as Point Loma Nazarene University (PLNU), San Diego State University (SDSU), University of California (UC), San Diego, and University of San Diego (USD); and vocational schools such as Concorde Career College. Table 1 presents the total number of students and student hours at each Sharp entity in FY 2017. Table 1: Sharp HealthCare Internships - FY 2017 Sharp Chula Vista Medical Center: Students - 804, Hours - 135,872 Sharp Coronado Hospital and Healthcare Center: Students - 663, Hours - 104,697 Sharp Grossmont Hospital: Students - 1,007, Hours - 144,056 Sharp Mary Birch Hospital for Women & Newborns: Students - 202, Hours - 22,076 Sharp Memorial Hospital: Students - 777, Hours - 116,662 Sharp Mesa Vista Hospital: Students - 442, Hours - 59,668 Sharp HospiceCare : Students - 56, Hours - 1,356 Sharp HealthCare: Students - 645, Hours - 68,383 Total: Students - 4,596, Hours - 652,770 In addition, Sharp offers a graduate level Clinical Pastoral Education program, which teaches students clinical theories and skills to provide spiritual care to patients and their families. In FY 2017, the program supervised six chaplain residents and eight chaplain interns on the campuses of SGH, SMBHWN, SMH, SMV and Sharp Home Health services. International Rescue Committee Sharp hosts more than 4,000 students annually for clinical rotations, internships and other educational experiences. Further underscoring how both workforce and community partnership development are critical to the fulfillment of Sharp's mission, the Staffing Resource Network (SRN) within Sharp's Workforce Support Services division of Human Resources facilitates the placement of students across the Sharp system. New in FY 2017, the Sharp SRN collaborated with SWC and the International Rescue Committee (IRC) on a workforce development partnership specifically serving San Diego's refugee community. IRC is a global humanitarian aid organization that focuses on helping refugees survive, recover, and resettle their lives. As part of its mission, IRC works to educate and find employment for refugees once they are settled. One such program trains refugees to work as Certified Nursing Assistants (CNAs). Traditional CNA training programs prepare participants for work in skilled nursing facilities, which do not require the training necessary for work in acute care settings and provide little opportunity for advancement. Sharp SRN's collaboration with IRC and SWC enhances the SWC CNA training program by providing acute care clinical training and experience. Program participants take an acute care nursing assistant course at SWC, and Sharp provides staff preceptors, medical supplies and learning experiences within Sharp hospitals that prepare participants for jobs in hospital environments. Following completion of the program, CNAs are qualified to work in any acute care setting. The partnership began in spring 2017, with five students enrolling in and completing the program, and two graduates securing positions within SRN's inter-facility acute care nursing assistant float pool. Thus far, the new team members from the IRC training program are on their way to successful careers at Sharp. Health Sciences High and Middle College Sharp partners with charter school Health Sciences High and Middle College (HSHMC) to provide high school students with broad exposure to health care careers. Through this partnership, HSHMC students connect with Sharp team members through job shadowing to explore real-world applications of their school-based knowledge and skills. This collaboration prepares students to enter health, science and medical technology careers in the following five pathways: biotechnology research and development, diagnostic services, health informatics, support services and therapeutic services. The high school curriculum provides students with a variety of service-learning projects and internships focused on careers in health care. Students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. The HSHMC program began in 2007 with students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. Students also devote time to various SRSMG sites.
Form 990, Part III, Line 4a Community Benefit Report	Students begin their internship experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of the HSHMC program is the entry level for all students and is conducted over an eight-week period. Through Level I, ninth-grade students shadow primarily non-nursing areas of the hospital as well as complete additional coursework in Infection Control, Medical Ethics, and Introduction to Health Professions. Level II is designed for students in grades 10 through 12 and includes enhanced patient interaction, college-level clinical rotations, and hands-on experience. Level II students are placed in a new assignment each semester for a variety of patient care experiences, and take additional health-related coursework at a community college, including Health 101, Public Health, Psychology and Abnormal Psychology, Realities of Nutrition, Intro to Health Professions and Organizations, and Health and Social Injustice. In FY 2017, 432 HSHMC students - including 162 Level I students and 270 Level II students - were supervised for more than 97,700 hours on Sharp campuses. Students rotated through instructional pods in specialty areas, including but not limited to: nursing; emergency services; obstetrics and gynecology; occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; rehabilitation; laboratory services; pharmacy; pathology; radiation oncology; radiology; endoscopy; engineering; nutrition; infection control; pulmonary services; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2017, the HSHMC program graduated 161 students in its seventh full class. Each year, Sharp reviews and evaluates its collaboration with HSHMC, including the outcomes of students and graduates, to promote long-term sustainability. Although many HSHMC students face financial hardship - the free and reduced-price meal eligibility rate is higher than the averages for SDC and California - the school excels in preparing students for high school graduation, college entrance and a future career. In 2017, 90 percent of the HSHMC graduating class went on to attend two- or four-year college, while 80 percent of students said they wanted to pursue a career in health care. In addition, HSHMC has a 98.7 percent graduation rate, which is higher than California's 83.2 percent state average. HSHMC received the 2016 Impact Award from the Classroom for the Future Foundation as the most innovative education program in SDC. Each year, the Classroom for the Future Foundation awards education programs across SDC in four categories: innovate, inspire, achieve and impact. HSHMC was also recognized as a U.S. News & World Report Best High Schools bronze award winner in 2014, 2016 and 2017. The California Department of Education recognized HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and as a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high- and low-performing students. HSHMC was also recognized with a 2015 Model Professional Learning Community at Work(tm) Award by Solution Tree for its sustained success in raising student achievement. Professional Learning Communities are schools and districts in which educators recognize the key to improved learning for students is ongoing, job-embedded education for the adults who serve those students. HSHMC was one in approximately 200 schools and districts in the U.S. and Canada - and the first school in SDC - to receive this honor. In addition, HSHMC was a 2014 National School Safety Advocacy Council award winner. Lectures and Continuing Education Sharp contributes to the academic development of students at colleges and universities throughout San Diego. In FY 2017, Sharp staff provided hundreds of hours in guest lectures and presentations on numerous health care topics. Lecture topics included stroke treatment techniques; health information technology (HIT); diabetes; spiritual care in the health care setting; a variety of health administration topics; electronic medical records, clinical informatics and change management; spinal cord injury (SCI); and topics related to end-of-life care, including advance care planning, Physician Orders for Life-Sustaining Treatment, hospice, palliative care, bereavement, bioethics and goals of care. Lectures were delivered to students at San Diego Mesa College, SDSU, USD, Azusa Pacific University (APU), California State University San Marcos (CSUSM) and the University of St. Augustine. These students were enrolled in a variety of programs, including nursing, nurse practitioner, physical therapy, medical assisting, HIT, health care informatics and public health. Sharp's Continuing Medical Education (CME) Department is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education, as well as by the Accreditation Council for Pharmacy Education to provide continuing pharmacy education. Sharp's CME Department provides evidence-based and clinically relevant professional development opportunities to help practicing physicians and pharmacists improve patient safety and enhance clinical outcomes. In FY 2017, Sharp's CME Department invested more than 546 hours in live and online CME activities for San Diego health care providers. This included conferences on advanced illness management, patient safety, cardiology, oncology, urgent care, kidney transplant and osteopathic medicine, as well as presentations on HROs, telehealth, physician leadership, sepsis, infection prevention and opioid usage. Research Sharp Center for Research Innovation is critical to the future of health care. The Sharp Center for Research supports innovation through its commitment to protecting research participants and promoting high quality research initiatives that provide valuable knowledge to the San Diego health care community and positively impact patients and community members. The Center for Research includes the Human Research Protection Program (HRPP), which includes the Institutional Review Board (IRB) and the Outcomes Research Institute (ORI). Human Research Protection Program and Institutional Review Board In March 2016, The Sharp Center for Research received accreditation by the Association for the Accreditation of Human Research Protection Programs. The accreditation acts as a public affirmation of the HRPP's commitment to following rigorous standards for ethics, quality and protection for human research. To date, Sharp is the only health system in SDC to receive this accreditation. The Center for Research's HRPP is responsible for the ethical and regulatory compliant oversight of research conducted at Sharp and includes three components: the organization, the researchers and the IRB. As one of the key components of the HRPP, the IRB seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants must be reviewed by the IRB in order to protect participant safety and maintain responsible research conduct. In FY 2017, a dedicated IRB committee of 16 - including physicians, nurses, pharmacists and non-scientists - devoted hundreds of hours to the review and analysis of both new and ongoing research studies. Research at Sharp is conducted on all clinical phases of drug and device development, and the populations studied span the life cycle - from neonates to older adults. These clinical trials increase scientific knowledge and enable health care providers to assess the safety and effectiveness of new treatments. Sharp participates in approximately 210 clinical trials at any given time covering many therapeutic areas, including behavioral health, emergency care, infectious disease, neonatal, heart and vascular, kidney, liver, neurology, orthopedics and oncology - the latter of which comprises the largest share of Sharp's clinical trials. The HRPP provides education and support for researchers across Sharp as well as the broader San Diego health and research communities regarding the protection of human research participants. As part of its mission, the Center for Research hosts quarterly meetings on relevant educational topics for community physicians, psychologists, research nurses, study coordinators and students throughout San Diego. Presentations at the quarterly meetings in FY 2017 included Research Community Outreach; Completing Subject Enrollment Logs and Attestation Reports; Reporting Deviations in Research Protocol; Clinical Trials Coverage Analysis; Compliance and Education Requirements; Creating Research Study Budgets; Who is a Sub-Investigator; and Utilizing IRB Software.
Form 990, Part III, Line 4a Community Benefit Report	Outcomes Research Institute Since its inception in 2010, Sharp's ORI seeks to measure the long-term results of care to continue to develop and promote best practices in health care delivery. The ORI enables Sharp to develop and disseminate new knowledge to the larger health care community, and help improve the quality of care delivery across SDC. The ORI collaborates with Sharp team members to facilitate the design of patient-centered outcomes research projects; assist with study protocol development, data collection and analysis; explore funding mechanisms for research projects; and facilitate IRB application submissions. The ORI seeks guidance and expertise from the local and national academic community on how to effectively conduct outcomes research to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University. In addition, in FY 2017, ORI research studies were presented at various professional conferences, including the Health Care Systems Research Network Conference in San Diego, the Cardiovascular Disease and Stroke Scientific Sessions in Arlington, Virginia, and the Academy Health Annual Research Meeting in New Orleans, Louisiana. Presentations included Utilizing Data Analytics and Innovation Partnerships to Reduce Hospital Readmissions; Influence of Ethnic and Gender Diversity in Quality of Care for Patients Receiving Treatment for Acute Myocardial Infarction; and Impact of Behavioral Health Data in Improving Prediction of Hospital Patient Readmissions. Beginning in September 2016, the ORI expanded its capabilities by adding a full-time postdoctoral clinical psychology fellowship position and a half-time practicum placement for a predoctoral graduate student. Based on the successful contributions of these programs, the ORI has hired a full-time clinical psychologist, renewed the graduate student practicum placement, and will offer new research training experiences for three psychology undergraduate students in FY 2018. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows and mentors to change and improve clinical practice and patient care through identifying a care problem, developing a plan to solve it and incorporating this new knowledge into practice. The EBPI is part of the Consortium for Nursing Excellence, San Diego, which promotes evidence-based practices in the nursing community. The consortium is a partnership between Sharp, Scripps Health, Palomar Health, Rady Children's Hospital - San Diego, UC San Diego Health, U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, Elizabeth Hospice, PLNU, SDSU, APU and USD. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom, and structured mentorship throughout the program. EBPI fellows and mentors partner with one another through a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellows through the process of evidence-based practice. Mentors also assist fellows in working collaboratively with other key hospital leadership personnel. In FY 2017, the nine-month program culminated with a community conference and graduation ceremony in November, during which the EBPI fellows and mentors shared project results. Forty-six attendees, including 23 fellows and 23 mentors, graduated from the program. Projects addressed the following issues in clinical practice and patient care: post-operative spine mobilization; reduction of anxiety for hospitalized patients undergoing caesarean section; nurse-physician rounding; the impact of wall art in the psychiatric intensive care unit; early mobilization in the adult trauma population; the impact of education on cell phone cleaning among NICU visitors and staff; and improving discharge timeliness. Volunteer Service Sharp Lends a Hand In FY 2017, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely solely on Sharp for volunteer labor; and support existing nonprofit initiatives, community activities or other programs that serve SDC. Nineteen projects were selected for FY 2017: San Diego Food Bank (Food Bank); Feeding San Diego (FSD); Mama's Kitchen; Kitchens for Good; San Diego Wreaths Across America; American Diabetes Association (ADA) Tour de Cure; Doors of Change; Promises2Kids; Ssubi is Hope Greening for Good Project; Special Olympics; Habitat for Humanity; Stand Down for Homeless Veterans; Life Rolls On - They Will Surf Again; I Love a Clean San Diego's Creek to Bay Cleanup and Coastal Cleanup Day; the San Diego River Park Foundation's Point Loma Native Plant Garden, Coastal Habitat Restoration, and Clean and Green River Cleanup; and River Kids Discovery Days - a joint effort between I Love a Clean San Diego and the San Diego River Park Foundation. More than 2,300 Sharp employees, family members and friends volunteered over 6,500 hours in support of these projects. The Food Bank feeds San Diegans in need, advocates for the hungry, and educates the public about hunger-related issues. The Food Bank distributes an average of 26 million pounds of food - equivalent to 21.6 million meals - throughout the year and serves nearly 400,000 San Diegans each month. Throughout SDC, weekend backpacks full of food are provided to chronically hungry children at elementary schools, while distribution sites provide boxes of groceries and staple food items to low-income seniors. On nine days between November 2016 and June 2017, more than 325 SLAH volunteers inspected, cleaned, sorted and packaged donated food. SLAH volunteers also assembled boxes and cleaned the Food Bank warehouse. FSD, part of the Feeding America network, is the leading hunger-relief organization in SDC, serving healthy food to more than 63,000 local children, families and seniors every week. FSD relies on the generous support of individuals, corporations, foundations and community groups to sustain critical hunger-relief and nutrition programs throughout the region. On eight days in February, March, July and September, 145 SLAH volunteers helped sort food, prepare bags for distribution, and clean produce for FSD. Established in 1990, Mama's Kitchen is a community-driven organization that enlists volunteers to help prepare and deliver nutritious meals to community members affected by acquired immunodeficiency syndrome (AIDS) or cancer who are unable to shop or cook for themselves. Mama's Kitchen strives to help its clients stay healthy, preserve their dignity, and keep their families together by providing free, culturally appropriate home-delivered meals, pantry services and nutrition education. In February, April, August and September, 75 SLAH volunteers helped Mama's Kitchen serve meals to the community by preparing and packaging snack and vegetable items for delivery. Kitchens for Good breaks the cycle of food waste, poverty and hunger through innovative programs in workforce training, healthy food production and social enterprise. Through its Community Cooking Days program, volunteers help transform reclaimed produce into hundreds of hunger relief meals. In April, May and August, 40 SLAH volunteers helped with food preparation, cooking, meal assembly, packaging and cleaning to support the distribution of hunger relief meals by Kitchens for Good's community partners. In December 2016, SLAH participated in Wreaths Across America, a national event dedicated to honoring veterans, remembering fallen heroes, and teaching children about the sacrifices made by veterans and their families. At three local cemeteries - Fort Rosecrans National Cemetery, Miramar National Cemetery, and Greenwood Memorial Park - 235 SLAH volunteers honored veterans by placing donated wreaths on their gravesites.
Form 990, Part III, Line 4a Community Benefit Report	SLAH volunteers participated in the ADA Tour de Cure 2017 to support the one million (or one in three) San Diegans with diabetes or prediabetes and raise critical funds for diabetes research, education and advocacy in support of the ADA. For two days in April, approximately 30 SLAH volunteers assisted with support and first aid. Doors of Change is a nonprofit organization dedicated to solving youth homelessness through empowerment and self-sufficiency. Through its Taking Music & Art to the Streets program, Doors of Change provides homeless youth with free music and art lessons, haircuts, hot meals, clothing, chiropractic care and social services. On eight days in February, June, and August, 35 SLAH volunteers served homeless youth at the Episcopal Church Center in Ocean Beach by sorting clothing and hygiene products, making sandwiches, and cleaning up after the program. Promises2Kids provides current and former foster youth in SDC with the tools, opportunities and guidance they need to grow into healthy, happy and successful adults. In June and July, 20 SLAH volunteers supported the Guardian Scholars and Camp Connect programs by assembling goody bags, packing boxes, and assisting with inventory, as well as assembling care packages for college students raised in the foster care system. The Ssubi is Hope Greening for Good project collects discarded but safe and usable supplies from U.S. hospitals and distributes them to clinics around the world that have little or no medical resources. In addition to providing life-changing and life-saving services to people in underserved countries, the project has protected the environment by keeping more than one million pounds of medical surplus out of local landfills. On 20 days between October 2016 and September 2017, 265 SLAH volunteers joined the Greening for Good project to evaluate, sort, label and prepare medical materials for shipment. The Special Olympics Southern California - San Diego County program offers free, year-round sports training and competition for children and adults with intellectual disabilities. In May 2017, 25 SLAH volunteers supported the program's basketball competition during the Regional Spring Games at Carlsbad High School. Volunteers served as athlete escorts as well as assisted with score-keeping, time-keeping and the awards ceremony. In addition to building homes in partnership with local people in need, San Diego Habitat for Humanity operates two ReStore retail centers with a wide variety of new or gently used building materials and home furnishings for public purchase. The ReStore centers provide affordable merchandise to customers while helping fund the construction of Habitat homes throughout SDC. On two days in August and September, 20 volunteers organized donated items and took inventory of stock for the Mission Valley ReStore retail center. SLAH participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego, to provide community-based social services to veterans without a permanent residence. Over 10 days in June and July, approximately 120 volunteers sorted and organized clothing donations as well as set up and worked in the event's clothing tent. In addition, approximately 60 clinical volunteers - including Sharp-affiliated physicians and Sharp nurses, podiatry technicians, pharmacists and licensed pharmacy technicians - provided medical and pharmaceutical services. More than 900 veterans were served through the 2017 Stand Down for Homeless Veterans events. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by SCI. Through the organization's award-winning program, They Will Surf Again, paraplegic and quadriplegic community members can experience mobility through surfing with support from adaptive equipment and volunteers. In September, an estimated 60 SLAH volunteers assisted They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. In celebration of Earth Day, in April, SLAH partnered with I Love a Clean San Diego for the 15th annual Creek to Bay Cleanup. Approximately 35 SLAH volunteers participated in this countywide effort to beautify San Diego's beaches, bays, trails, canyons and parks. In September, 11 volunteers supported I Love a Clean San Diego's California Coastal Cleanup Day to ensure a clean, safe and healthy community by removing litter from open spaces throughout SDC, including Ocean Beach Dog Beach, Chula Vista Marina View Park, Mission Trails Regional Park, Pacific Beach, San Dieguito Lagoon, Los Penasquitos Canyon, San Diego River and Coronado City Beach. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. Approximately 10 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in August. Activities included trail maintenance, watering, pruning and other light gardening projects. In January, March, May, July and September, 80 SLAH volunteers joined the San Diego River Park Foundation's Coastal Habitat Restoration events in Ocean Beach. The team worked to save and restore one of the last remaining coastal dune and wetland habitats in San Diego by removing invasive plants and litter, watering and caring for recent plantings and native plants, and providing trail maintenance. SLAH joined the San Diego River Park Foundation once again in May and June during the Clean and Green River Clean Up days. Approximately 35 SLAH volunteers gathered to help create a healthier, cleaner and safer San Diego River Park system by removing garbage and debris from identified sites along the San Diego River. In March, I Love a Clean San Diego and the San Diego River Park Foundation partnered to provide the third annual River Kids Discovery Days. Six SLAH volunteers participated in the free event, which provides river education and service events to teach more than 600 children and families about protecting the Earth's natural resources. Sharp Humanitarian Service Program In FY 2017, the Sharp Humanitarian Service Program funded more than 60 Sharp employees in programs that provided health care or other supportive services to underserved or adversely affected populations in Mexico, Guatemala, the Philippines, Vietnam, Peru, Armenia and other countries throughout the world. In April, Sharp team members traveled to San Quintin, Baja California, as part of the VIIDAI (Viajes Interinstitucional de Integracion Docente, Asistencial y de Investigacion) program. VIIDAI is an international public health field experience that integrates students and faculty from three participating universities - SDSU, UC San Diego and the Universidad Autonoma de Baja California - to promote health and provide services to underserved populations while increasing cultural awareness. Held at a local elementary school, the weeklong program provided more than 100 community members with clinical, dental and psychological services. In addition, participants trained 12 teachers to deliver a hygiene curriculum that encourages proper handwashing behaviors among the school's nearly 300 students, who frequently contract parasitic infections due to poor hygiene practices. Sharp team members also volunteered in Guatemala in May as part of a medical mission trip with Friends with Purpose, a nonprofit organization dedicated to providing medical care and community development in underserved communities around the world. The team of surgeons, registered nurses, anesthesia providers and other volunteers traveled to the city of Patzun, where they performed 43 surgeries on local patients, including gallbladder removals, hernia repairs and the removal of cysts.
Form 990, Part III, Line 4a Community Benefit Report	CHOICE Humanitarian and the doTERRA Healing Hands Foundation are dedicated to eliminating poverty and empowering impoverished communities with the tools they need to become self-reliant. For one week in February, a Sharp team member joined these organizations on a mission to the Alta Verapaz region of Guatemala. The mission team of 20, including a dietitian, an emergency medical technician, and a research scientist, built vented stoves for more than 40 families to help prevent respiratory problems associated with open-fire cooking techniques as well as dug post holes for fencing to surround sustainable farm land. The team also partnered with Days for Girls - a nonprofit organization committed to feminine hygiene access and education for females throughout the world - to provide personal hygiene training and education for local women and girls, including the provision of reusable feminine hygiene kits. The Alegado Foundation is a San Diego-based medical mission organization determined to help children, the sick and the aged through the provision of medical services, and donations of medical supplies, children's books, toys and sports equipment. In March, a Sharp team member joined the Alegado Foundation on a medical mission to the southern Philippines. Alongside local doctors, nurses, dentists, elementary school teachers and Philippine military personnel, the team provided free medicine, medical consultations, dental services and minor surgical procedures to approximately 275 patients over a two-day period. The team also fed and read to local children and provided free haircuts for youth and senior citizens. Random Acts of Kindness Life (RAKlife) is a nonprofit organization dedicated to developing a global culture that incorporates random acts of kindness into daily life to help those less fortunate around the world. For 10 days in April, a Sharp team member participated in a RAKlife trip to the Mai Chau District in Northwestern Vietnam, where the team built a small house and a clean water basin for a local family. In February, another Sharp team member visited Vietnam for two weeks through Prisoners of Hope, a ministry offered through the Rock Church Global Outreach program. The mission team provided a variety of medical and optometry services for approximately 1,190 medical patients and 800 optometry patients, including prisoners, orphans, the disabled, and those living in poverty. Since 1934, Liga International (The Flying Doctors of Mercy) has provided free health care and education to the people of the Mexican state of Sinaloa. In March and April, a Sharp nurse traveled to the city of El Fuerte, Sinaloa, to assist with admitting, operating and recovery for approximately 30 local patient surgeries. In May, a Sharp nurse participated in a 10-day mission trip to Lima, Peru, through CardioStart International - a global volunteer organization that brings specialized cardiac care teams to underserved regions. The team, which included a cardiac surgeon, anesthesiologist, cardiologist, respiratory therapist, nurses and support staff, performed surgery for eight children with congenital heart defects as well as provided advanced cardiac education to help local medical teams improve surgical outcomes and patient care. Also in May, a Sharp team member helped co-lead a team of eight PLNU students on a mission trip to Armenia with LoveWorks, a short-term mission program committed to sending well-trained, culturally sensitive and flexible teams of student missionaries to serve in challenging and remote areas of the world. The team provided numerous services to Armenian families, including: donating clothing to the impoverished; repainting local schools; helping a local church move to a larger facility; and encouraging local churches in their ministry to women, children and teens. Community Walks Heart disease is the leading cause of death in the U.S. For the past 21 years, Sharp has proudly supported the AHA's annual San Diego Heart & Stroke Walk, which promotes physical activity to build healthier lives, free of cardiovascular diseases and stroke. In September 2017, approximately 960 walkers represented Sharp at the 2017 San Diego Heart & Stroke Walk held at Balboa Park. More than 120 teams, representing entities across the Sharp system, raised funds for the walk through numerous activities, such as auctions, drawings for prizes and a karaoke competition. Sharp has maintained its position as the No. 1 team in San Diego for the past 21 years and was the No. 2 team in the AHA Western States Affiliate for the third year in a row, raising more than $217,700 and setting a SHC fundraising record. To date, Sharp has raised more than $3 million through its San Diego Heart & Stroke Walk fundraising efforts. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community and help make a difference in the lives of others. Sharp provides many volunteer opportunities for individuals to assist with a wide variety of programs, events and initiatives across the Sharp system. Volunteers of all ages and skill level devote their time and compassion to patients within Sharp's hospitals, community events for the general public, and activities supporting Sharp's various foundations. On average, more than 1,780 individuals actively volunteered at Sharp each month in FY 2017, contributing a total of nearly 253,900 hours of service to Sharp and its initiatives. This included more than 1,900 auxiliary members and thousands of individual volunteers from the San Diego community, including volunteers for Sharp's foundations. Nearly 13,800 volunteer hours were dedicated to activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the average number of active volunteers per month as well as the total number of volunteer service hours provided to each Sharp entity, specifically for patient and community support. Table 2: Sharp HealthCare Volunteers and Volunteer Hours - FY 2017 Sharp Chula Vista Medical Center: Average Active Volunteers per Month - 373, Total Volunteer Hours - 47,967 Sharp Coronado Hospital and Healthcare Center: Average Active Volunteers per Month - 67, Total Volunteer Hours - 9,679 Sharp Grossmont Hospital: Average Active Volunteers per Month - 617, Total Volunteer Hours - 101,261 Sharp HospiceCare: Average Active Volunteers per Month - 70, Total Volunteer Hours - 7,446 Sharp Metropolitan Medical Campus: Average Active Volunteers per Month - 628, Total Volunteer Hours - 82,893 TOTAL: Average Active Volunteers per Month - 1,755, Total Volunteer Hours - 249,246 Volunteers supported Sharp's foundations - including the Sharp HealthCare Foundation, Grossmont Hospital Foundation and Coronado Hospital Foundation - through assistance with various events, such as annual golf tournaments and galas. In addition, Sharp offers a systemwide Junior Volunteer Program for high school students interested in giving back to their communities and exploring future health care careers. Program requirements vary, however all require a high grade point average and a long-term commitment of at least 100 hours. The Junior Volunteer Program supports workforce development by introducing the students to careers in health care, including clinical and ancillary support services. The junior volunteers enhance patient-centered care through hospitality, such as greeting and escorting patients and families, answering questions, and creating a welcoming and relaxing environment for guests. Through volunteering in the gift shops and thrift store, they learn about merchandising, fundraising and retail sales. On the inpatient units, they are exposed to clinical experiences that provide a glimpse into future careers. Junior volunteers also have the opportunity to help raise funds for hospital programs and provide clerical support to hospital departments. In FY 2017, nearly 510 high school students contributed more than 53,600 hours to the Junior Volunteer Program. This included 74 junior volunteers who provided approximately 4,400 hours of service at SMH and SMBHWN; 160 junior volunteers who dedicated more than 17,500 hours of service at SCVMC; and 275 junior volunteers who contributed more than 31,700 hours of service at SGH.
Form 990, Part III, Line 4a Community Benefit Report	Volunteers on Sharp's various entity boards provide program oversight, administration and decision-making regarding financial resources. In FY 2017, nearly 130 volunteers contributed their time to Sharp's boards. Sharp employees also donate time as volunteers for the Sharp organization, including service on the Cabrillo Credit Union Sharp Division Board, Sharp and Children's MRI Board, Grossmont Imaging LLC Board, and Sharp and UC San Diego Health's Joint Venture Board, which oversees the operations of their joint Liver Transplantation and Bone Marrow Transplant Programs. This section describes the achievements of various Sharp volunteer programs in FY 2017. Sharp HospiceCare Volunteer Programs Sharp HospiceCare offered various volunteer training opportunities in FY 2017, providing valuable knowledge and experience to volunteers who are often working towards a career in the medical field. Volunteers supported Sharp HospiceCare and those it serves by providing companionship to those near the end of life, support for families and caregivers, and help with community outreach. Approximately 50 new hospice volunteers were trained in FY 2017. Volunteers completed an extensive 24-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their volunteer activities. In addition, seven teenagers participated in Sharp HospiceCare's Teen Volunteer program. In this program, teens completed special projects in Sharp HospiceCare administration, as well as assisted with patients at Sharp HospiceCare's LakeView, ParkView and BonitaView hospice homes. Tasks included grooming and hygiene activities, and simple acts of kindness such as sitting with patients, listening to their stories and holding their hand. Further, seven premedical students from SDSU, UC San Diego and CSUSM volunteered time by supporting family caregivers in private homes. Sharp HospiceCare continued to provide the 11th Hour program to ensure that no patient died alone. Through the program, volunteers accompanied patients who were in their final moments of life but did not have family members present. This included holding the patient's hand, reading softly to them and simply remaining by their side. Families who were present with their dying loved one could also receive comfort from a volunteer as their loved one passed away. Ten volunteers were trained through the 11th Hour program in FY 2017. In FY 2017, Sharp HospiceCare trained 12 volunteers in integrative therapies to promote relaxation and restful sleep and enhance the quality of life for Sharp HospiceCare patients and their caregivers. Integrative therapies included Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain; Reiki, a Japanese energy healing therapy in which practitioners use their hands on or above the patient's body to facilitate the healing process; aromatherapy; and hand massage. Volunteers help support Sharp HospiceCare's partnership with We Honor Veterans (WHV). WHV is a national program developed by the National Hospice and Palliative Care Organization in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare is equipped to provide education and training that qualifies their volunteers to identify and support veteran patients and their caregivers. This includes the Vet-to-Vet Volunteer program, which aims to pair volunteers who have military experience with veteran patients, as well as honors veteran patients through special pinning ceremonies. In FY 2017, Sharp HospiceCare held two pinning ceremonies during which volunteers presented a WHV pin and a certificate of appreciation to approximately 90 Sharp HospiceCare veteran patients as well as more than 50 veteran community members. Sharp HospiceCare continued to offer the Memory Bear program to support community members who have lost a loved one. Through the program, volunteers created teddy bears out of the garments of those who have passed on, which served as special keepsakes and permanent reminders of the grieving individual's loved one. In FY 2017, volunteers dedicated nearly 2,700 hours to sewing more than 670 bears for approximately 240 families. Sharp HospiceCare recognizes the valuable impact that volunteers have on the experience of its patients, family and caregivers. In light of this recognition, Sharp HospiceCare offered a monthly continuing education support group to enhance the skills of its volunteers. In addition, Sharp HospiceCare honored its volunteers during National Volunteer Week in April, and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV, SMC) Volunteer Programs Through the Community Care Partner (CCP) program at SMH, hospital volunteers are hand-selected and trained to serve and comfort patients without family or friends present during their hospital stay. Activities may include reading, writing letters, taking walks, playing games, or simply comforting patients through conversation. In addition, CCP volunteers help keep patients safe by notifying medical staff when needs arise - a task that is usually performed by a family member or friend but often overlooked for patients who lack a companion. In FY 2017, 9 CCP volunteers devoted nearly 600 hours to approximately 460 patient visits. The Cushman Wellness Center Community Health Library and SMH Volunteer Department continued to offer the Health Information Ambassador program in FY 2017. Serving SMH, the SMH Rehabilitation Center and SMBHWN's perinatal special care unit, the program brings the library's services directly to patients and family members and empowers them to become involved in their own health care. Through the program, hospital volunteers receive specialized training to become Health Information Ambassadors, who offer to bring patients and family members additional resources on their diagnosis during their hospital stay. Information requests are brought to the consumer health librarian who then prints consumer-oriented information from high-quality websites, and returns the information back to the patients and families through the Health Information Ambassadors. Patients and family members are also provided with access to an online database of reliable health information as well as the opportunity to keep in touch with the library to ensure they continue to receive quality health information at home. In FY 2017, the Health Information Ambassadors visited more than 2,400 patient rooms and filled over 500 information requests. Established in 2007, the Arts for Healing program at SMMC uses art and music to reduce feelings of fear, stress, pain and isolation among patients facing significant medical challenges and their loved ones. The program brings a variety of activities to patients at their bedside - including painting, beading, creative writing, card-making, seasonal crafts, scrapbooking, quilting, music and drumming - to help improve emotional and spiritual health, and promote a faster recovery. The program also engages visitors and members of the community during hospital and community events. Funded completely by donations, Arts for Healing is led by Sharp's Spiritual Care Department and is implemented with help from licensed music and art therapists as well as a team of trained volunteers. At SMH, Arts for Healing typically serves patients who are receiving cancer treatment, recovering from surgery or stroke, awaiting organ transplantation, receiving palliative care, or facing life with newly acquired disabilities following catastrophic events. At SMBHWN, Arts for Healing supports mothers with high-risk pregnancies who are susceptible to stress and loneliness during extended hospital stays prior to childbirth. Music therapy is also provided in the NICU to promote development in premature babies. At SMV and SMC, Arts for Healing offers several art and music therapy groups, including groups for patients recovering from drug addiction, adolescents and adults receiving treatment for mood and anxiety disorders, and older adults receiving treatment for dementia and depression. In collaboration with SMMC's social workers and palliative care nurses, in FY 2017 Arts for Healing facilitated the donation of more than 300 blankets and quilts to patients receiving end-of-life care at SMH. Twelve of the blankets were knitted and crocheted by patients at the SMV East County Outpatient Programs site, an activity that was also designed to reduce anxiety and depression among the patients crafting the blankets.
Form 990, Part III, Line 4a Community Benefit Report	Throughout the year, Arts for Healing led art and music activities for hundreds of patients and community members in recognition of various holidays and Sharp events, including Saturday with Santa, a public event hosted each December by the SMH Auxiliary; Valentine's Day; National Hospital Week in May; Cancer Awareness Week in June; Sharp's annual Women's Health Conference; and Sharp's annual Disaster Preparedness Expo. In FY 2017, 44 volunteers, including students from various colleges and universities, facilitated art activities for patients and their loved ones through Arts for Healing. Since its launch, the program has provided more than 6,300 one-on-one music therapy sessions and over 2,100 group music and art therapy sessions. In addition, Arts for Healing volunteers have knit 530 baby items for expectant mothers, created approximately 50,000 pieces of art, and enriched more than 55,700 patients, guests and staff through musical performances. In total, more than 117,600 patients, guests and staff have benefitted from the time and talent provided by the Arts for Healing program. Other Sharp Community Efforts In FY 2017, Sharp engaged in a variety of community service projects to improve the well-being of community members throughout San Diego. Below are just a few examples of these efforts. According to the January 2017 WeAllCount Annual Report, there were 9,116 individuals experiencing homelessness in SDC, which represents an increase of 5 percent region-wide from 2016. Since 2011, Sharp has sponsored the Downtown San Diego Partnership's Family Reunification Program, which serves to reduce the number of homeless individuals on the streets of Downtown. Through the program, homeless outreach coordinators from the Downtown San Diego Partnership's Clean & Safe Program identify homeless individuals who will be best served by traveling back home to loved ones. Family and friends are contacted to ensure that the individuals have a place to stay and the support they need to get back on their feet. Once confirmed, the outreach team provides the transportation needed to reconnect with their support system. With Sharp's help, the Family Reunification Program has reunited more than 1,000 homeless individuals in Downtown San Diego with friends and family across the nation. Diapers are expensive - a month's supply can cost up to $100 per child - and cannot be purchased with CalFresh or Women, Infants, and Children (WIC) benefits. As a result, parents with limited economic resources may change diapers less frequently than recommended and unintentionally place their infant at risk. In FY 2017, Sharp worked with Assemblywoman Lorena Gonzalez, SDG&E and hundreds of organizations and citizens across San Diego to help struggling families cope with a serious challenge - the cost of diapers - by donating diapers to the Food Bank's new Diaper Bank Program. The Diaper Drive, hosted by SDG&E, netted more than 27,000 diapers for families in need, nearly tripling the goal of 10,000 diapers. Sharp employees showed their support for this cause by donating more than 6,500 diapers. The SGH Engineering Department led a variety of volunteer initiatives in FY 2017. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting visitors, patients and staff. Through the program, the SGH landscape team grows, cuts, bundles and delivers colorful bouquets to patient rooms as well as offers single-stem roses in a small bud vase to passers-by. In FY 2017, the team delivered three to four vases of flowers with an inspirational quote each week, with as many as eight vases or more during peak flower season and upon additional requests. In addition, nearly 40 vases of flowers were delivered to new mothers in the hospital on Mother's Day. This Bud's for You also supports the SGH Senior Resource Center and Meals on Wheels partnership by providing floral centerpieces for their fundraising events to benefit East County seniors, as well as offers roses for SGH's annual patient remembrance service. Now in its seventh year, the program has become a natural part of the landscape team's day - an act that is simply part of what they do to enhance the experience of hospital visitors. The SGH Engineering Department further extends the spirit of caring through the creation of Cheers Bouquets for patients or visitors that appear to need encouragement or cheer, as well as to recognize patient birthdays, anniversaries and other special moments. With help from Sodexo - the hospital's food service, housekeeping and engineering vendor - a bouquet is quickly assembled (with balloons, ribbon, a Sodexo Care Bear and/or football) and delivered to the individual. In FY 2017, the team assembled up to 10 Cheers Bouquets per month, including bouquets for more than 40 new fathers on Father's Day weekend. For the past seven years, the SGH Engineering Department, landscape team and Auxiliary have collaborated with local businesses to bring The Shirt Off Our Backs Program to community members in need during the holidays. Through the program, volunteers collect and donate a variety of items to help meet the basic needs of homeless or low-income children and adults. In FY 2017, volunteers filled two trucks with donated food and other essential items, including 200 handmade sandwiches and 100 water bottles as well as clothing, socks, shoes, hygiene kits, toys, towels, blankets, pet food and other household items. The SGH landscape team created the award-winning Heart 2 Heart project through which the team places heart-shaped stones etched with reflections around the hospital campus for patients, visitors and staff to search for and reflect upon. The team also installed other various heart shapes made out of flagstone or cobble on planters and stone areas of the campus to encourage walking and engage campus walkers in its scenery. The Heart 2 Heart project earned the team the 2016 Spirit of Sodexo Award for North America after competing against 1,100 nominations from across all Sodexo business units in the U.S. and Canada. As a Gold Level finalist - the company's highest honor - the SGH landscape team demonstrates Sodexo's commitment to clients and customers as the heart of business. The SGH Engineering Department also participated in the Food Bank's Food 4 Kids Backpack program in FY 2017. The program provides weekend food packages to chronically hungry elementary school students from low-income households who are at risk of hunger over the weekend when free school meals are unavailable. Food 4 Kids strives to improve school performance and health by alleviating hunger. The program also provides information to parents about available local community services. Each week between January and April 2017, the SGH Engineering Department filled approximately 20 backpacks with roughly 250 pounds of food to ensure hungry students had access to food through the weekend. Since 2014, SGH nurses have organized an annual backpack drive in collaboration with Christie's Place - a nonprofit organization that supports women, children and families affected by human immunodeficiency virus/AIDS - to prepare children and teens for academic success. Team members from a variety of departments help provide a backpack with school supplies, including personal notes wishing the students all the best for the coming school year. Each year, the team distributes more than 250 backpacks to youth during a back-to-school party in Balboa Park. Similarly, the Labor and Delivery Department at SMBHWN is committed to the fight against hunger through participation in the International Relief Team's (IRT) Feeding San Diego's Kids project. Based in San Diego, IRT is a relief organization providing worldwide support that combines both short-term relief efforts and long-term programs to save and change lives. Through Feeding San Diego's Kids, nutritious food is provided to children in the Linda Vista Elementary School nutrition club, a group specifically for children who have been identified as homeless by the school nurse. Every week during the school year, labor and delivery team members fill backpacks with nonperishable, nutritious food that can feed a family of four over the weekend. The backpacks are also filled with nutrition-related prizes to encourage students and families to learn and participate in their own nutrition as well as with occasional holiday-related gifts. Approximately 25 elementary school children and their families are helped through the program each year. Since the start of the program in May 2013, the team has filled 5,500 backpacks with approximately 132,000 meals.
Form 990, Part III, Line 4a Community Benefit Report	For more than 30 years, SGH has provided its annual Santa's Korner giving event to provide for those in need during the holidays. Through this effort, various hospital departments adopt a family - who has been vetted and referred by local service agencies - and dedicate personal time to making the holidays the best they can be for each family. Special holiday gifts, including grocery gift cards, clothing, toiletries, household items, movie tickets, bicycles, children's toys and a holiday meal, are purchased for the families by hospital staff using primarily their personal resources and through occasional fundraisers. Santa's Korner served 33 families - equivalent to 118 individuals - during the 2016 holiday season. For the past three years, SCVMC has supported Operation Gobble Thanksgiving Turkey Distribution, an event started by Assemblywoman Lorena Gonzalez. In 2016, Operation Gobble provided Thanksgiving turkeys to 30 patients from the Barnhart Cancer Center's Medical and Radiation oncology departments. In addition, in December, SCVMC partnered with a Chula Vista chapter of Optimist International for a Holiday Bike Giveaway. Optimist International is a worldwide volunteer organization that helps develop children to their full potential. The Holiday Bike Giveaway program helped provide bicycles to nine children of cancer patients as Christmas gifts. All Ways Green Initiative As San Diego's largest private employer and leading health care provider, Sharp has long been committed to improving the health of the environment and therefore the communities it serves. Sharp recognizes the connection between a healthy environment and individual health and well-being, and is dedicated to minimizing adverse environmental impacts by creating healthy green practices for employees, physicians and patients. Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego's Earth-friendly businesses to help identify best practices, reduce the costs of green practices, and facilitate the implementation of sustainable initiatives. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Through the All Ways Green(tm) initiative, Sharp maintains an environmentally conscious footprint and communicates sustainability throughout the organization and the San Diego community. Sharp's systemwide All Ways Green Committee is responsible for spearheading the organization's green efforts. Sharp's active environmental initiatives are concentrated in five domains: (1) energy efficiency, (2) water conservation,(3) waste minimization, (4), commuter solutions, and (5) sustainable food practices. Specialized committees/subcommittees are responsible for each of these domains (see Table 3), while established Green Teams at each Sharp entity are responsiblefor developing new programs that educate and motivate Sharp employees to conserve natural resources and reduce, reuse and recycle. Table 3: All Ways Green(tm) Committees/Subcommittees and Domains Natural Resource Subcommittee- Energy efficiency and water conservation Waste Minimization Committee - Waste minimization Food and Nutrition Best Health Committee - Sustainable food practices Commuter Solutions Subcommittee - Commuter solutions To monitor progress and measure tangible results, All Ways Green(tm) utilizes a customized report card, which evaluates each domain's annual performance against a baseline. The report card is designed to show where the desired results have been achieved and where improvements are still needed. Entity Green Teams utilize the report card to communicate the initiative results to all staff and to establish more effective sustainability practices. Sharp's goals and accomplishments within each All Ways Green committee/subcommittee and domain are described below. Natural Resource Conservation According to the EPA, health care ranks as the country's second most energy intensive industry, and hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the U.S. Sharp's goal is to optimize the use of electricity, gas and water across its facilities, identify and evaluate opportunities for improvement, implement initiatives in the most cost-effective manner, and track progress. The EPA states that 30 percent of the health care sector's current energy use could be reduced without sacrificing quality of care through a shift toward energy efficiency and use of renewable energy sources. Sharp's Natural Resource Subcommittee has responded to this challenge by implementing numerous energy and water conservation initiatives, including infrastructure changes and adopting best practices to ensure its facilities are optimally operated while monitoring and measuring energy and water consumption. The Natural Resource Subcommittee also educates employees about the energy-conscious behaviors that can be practiced in the workplace and at home to promote continuous energy and water savings. In FY 2017, Sharp extended its commitment to environmental best practices in information technology. New software was installed on 10 data center air conditioner units, resulting in more efficient cooling of the data center and a 16 percent decrease in power usage for these devices. New virtual environments replaced more than 150 devices in the data center, further reducing power and cooling needs for the building. In 2015, Sharp implemented TSO Logic software, which identifies opportunities for replacing inefficient, energy-consuming hardware with energy-efficient hardware in Sharp's centralized data center. This innovative system also identifies underutilized hardware, which can be permanently shut down or be acquiesced during periods of non-utilization. With this software, Sharp could conservatively reduce hardware electrical consumption by more than five percent each year. In 2013, Sharp became the first health care system in San Diego to implement a computer management program, which enables computers and monitors to go into a low-power sleep mode after a period of inactivity. Since its implementation, the program has been installed on over 17,000 computers and has resulted in annual energy savings in excess of 1.6 million kilowatt-hours (kWh). The initiative earned Sharp a Certificate of Recognition from the EPA, which recognizes organizations' achievements in energy conservation and efficiency. Since April 2016, the SGH campus has been virtually removed from the electrical grid due to the completion of the new state-of-the-art Central Energy Plant (CEP), which now supplies the campus with its own generated energy. Named the Brady Family Cogen, the focus of the CEP is a new 52-ton, 4.4 megawatt combustion turbine generator, which generates enough electricity to meet up to 95 percent of the hospital's needs and reduces greenhouse gases by up to 90 percent. In addition to providing electrical power, the CEP converts heat to steam to operate medical equipment, space heating and air conditioning. It also provides hot and cold water to the hospital. The new CEP fully complies with state and local standards for air emissions. During California's five-year drought, Sharp adopted a focused water conservation program at all sites. Although the drought restrictions were officially lifted in 2017, Sharp remains dedicated to being water-wise. In alignment with this commitment, Sharp partners with Emerald Textiles for its laundry and linen services. The company operates a state-of-the-art plant that is efficiently designed to reduce utility consumption and preserve natural resources. Each year, Emerald Textiles saves an estimated 40 million gallons of water (50 percent of total usage) through its water filtration system, more than 71,000 kWh of electricity through the use of energy-efficient lighting, and over 700,000 therms of gas due to the use of energy-efficient laundry equipment. Additional water conservation initiatives at Sharp are outlined in Table 4. In May 2017, Sharp was named San Diego's Grand Energy Champion by SDG&E in recognition of its continuous commitment to implementing energy efficiency measures. The award specifically noted the particular challenges faced by a health care organization trying to save energy, given the need to maintain a comfortable, clean and safe environment for patients, visitors and staff 24 hours a day, seven days a week.
Form 990, Part III, Line 4a Community Benefit Report	Promoting its partnership with SDG&E, since 2016, Sharp has participated in the San Diego Regional Healthcare Sustainability Collaborative. Led by SDG&E and Cleantech San Diego, this initiative presents a platform for San Diego health care providers to advance energy conservation practices through best practice sharing and new technology validation as they pursue the next wave of sustainability initiatives. This collaborative enables sustainability, energy, facilities and operations health care leaders across SDC to share recent project successes, best practices and findings from new technology pilot evaluations. In addition, SDG&E's staff participates in Sharp's Natural Resource Subcommittee to help Sharp identify energy savings initiatives and associated rebates and incentives to reduce the overall costs of energy savings projects. To demonstrate its ongoing commitment to reducing energy consumption on a national level, in FY 2017 Sharp joined Practice Greenhealth's Healthier Hospitals Lean Energy Challenge - an initiative that provides support and guidance for hospitals that aspire to reduce energy consumption, increase energy efficiency, and save significantly on energy costs. All Sharp hospitals engage in the EPA's ES database and monitor their ES scores on a monthly basis, thus following an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC and SCVMC received the ES certification in 2017 (SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification from 2009 to 2011, 2013 and 2015). In addition, Sharp's SRSMG Downtown medical office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, one of the first medical office buildings in San Diego of its kind. Additional energy conservation initiatives at Sharp are outlined in Table 4. Table 4: Natural Resource Projects by Sharp HealthCare Entity Establish Energy and Water Use Baseline - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG ES Participation - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC Air Handler Projects - SCHHC, SMH/SMBHWN Cogeneration Plant - SGH Drip Irrigation/ Landscape Water Reduction Systems - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Drought-tolerant Landscaping - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Electric Vehicle Charging Stations - SCVMC, System Offices, SMH/SMBHWN, SRSMG Electronic/Low-flow Faucets - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Energy-efficient Kitchen/Cafe Appliances - SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN Energy-efficient Chillers/ Motors - SCHHC, SCVMC, System Offices, SMH/SMBHWN Faucets and Toilet Retrofits - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Heating, Ventilation and Air Conditioning projects- SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Natural Resource Project - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Light-emitting Diode (LED) - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Occupancy Sensors - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Lighting Retrofits - SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Mist Eliminators - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Moisture-sensitive Sprinkler Controls - SCHHC, SGH, SMH/SMBHWN Plumbing Projects to Address Water Leaks - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Thermostat Control Software - System Services Water Dispensers to Replace Water Bottles - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Water-efficient Dishwashing/ Equipment Washing/ Chemical Dispensing System - SCHHC, SCVMC, SGH, SMH/SMBHWN Waste Minimization U.S. hospitals generate an average of 26 pounds of waste per staffed bed each day, approximately 15 percent of which is considered hazardous material. Sharp is committed to significantly reducing waste at each entity and extending the lifespan of local landfills. Sharp's Waste Minimization Committee provides oversight of systemwide waste minimization initiatives including proper waste segregation and enhancing recycling efforts. Sharp made the following achievements in waste minimization in FY 2017: * Sharp increased purchases of 100 percent recycled goods at all sites. * Sharp proactively recycled more than 350 tons of construction debris from its two major building projects at SCVMC and SRSMG Rancho Bernardo. * SGH and SCVMC implemented green waste recycling through which they generated more than 125,000 pounds of green waste that is essential to prolonging the life of the landfill. * Sharp's single-waste stream recycling program diverted more than 2.5 million pounds of trash from the landfill, including non-confidential paper, cardboard, exam table paper, plastic, aluminum cans and glass containers. * Sharp collected, reprocessed and sterilized 127,000 pounds of surgical instruments for further use. * Sharp donated nearly 14,000 pounds of old computer equipment through the Technology Training Foundation of America. * Sharp diverted nearly 153,000 pounds of plastic and cardboard from the landfill through the use of reusable sharps containers. * Sharp recycled more than 14,000 pounds of blue wrap and disposable privacy curtains (surgical blue wrap is recycled at all hospital sites while SCVMC recycles disposable privacy curtains). Sharp was named the 2017 Outstanding Recycling Program by CRRA - California's statewide recycling association - for its innovative waste minimization initiatives. In addition, the City of San Diego's Environmental Services Department named Sharp as one of the Recyclers of the Year in its 2016 Waste Reduction and Recycling Awards Program. Sharp was an early adopter in its commitment to waste diversion, and now diverts more than 40 percent of waste through recycling, donating, composting, reprocessing, and reusing programs. Sharp's waste minimization efforts have resulted in more than 5,000 tons of waste diverted from the landfill. See Table 5 for waste diversion rates and Table 6 for specific waste minimization efforts at Sharp in FY 2017. Table 5: Sharp HealthCare Waste Diversion - FY 2017- Percent Recycled Sharp Chula Vista Medical Center - 43% Sharp Coronado Hospital and Healthcare Center - 22% Sharp Grossmont Hospital - 37% Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns - 36% Sharp Mesa Vista Hospital- 52% Sharp Rees-Stealy Medical Group - 69% System Offices - 59% Total Sharp HealthCare - 43% Table 6: Waste Minimization Efforts by Sharp HealthCare Entity Establish Waste Diversion baseline - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Single-stream Recycling - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Recycled Paper - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Blue Wrap Recycling - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC, SRSMG Composting - SCVMC, SGH, SMH/SMBHWN, SMV/SMC Construction Debris Recycling - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Electronic Cafe Menus - SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SMV/SMC Electronic Patient Bills and Paperless Payroll - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Electronic and Pharmaceutical Waste Recycling Events - System Services Organic Waste Recycling (Green Waste)- SCVMC, SGH Recycle Bins Distribution - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Repurposing of Unused Medical Supplies and Equipment - SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SRSMG Reusable Sharps Containers - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC Single Serve Paper Napkins and Plastic Cutlery Dispensers - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Surgical Instrument Reprocessing - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMG Replacement of Bottled Water with Spa Water - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG
Form 990, Part III, Line 4a Community Benefit Report	Sustainable Food Practices Sharp believes that food is medicine and the promotion of healthy food choices is necessary to improve the health of patients, employees, and the community. Sharp's commitment to healthy food and nutrition sustainability practices began over six years ago with a strategy to increase the selection of healthy food options to improve engagement. In collaboration with its food service partner Sodexo, Sharp continues to be an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers and reduce its carbon footprint. The goal of Sharp's Food and Nutrition Best Health Committee is to promote food sustainability efforts throughout the health care system and within the greater San Diego community. This includes a focus on Sharp's sustainable Mindful Food program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. Sharp's Mindful Food program includes the promotion of Meatless Mondays to reduce meat consumption; increased purchases of beef and poultry raised without the routine use of antibiotics; menus that highlight wellness options; participation in Community Supported Agriculture (CSA), a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm; increased use of locally sourced fresh, organic and sustainable food; food composting; increased recycling activities; the promotion of sugarless beverages; and the use of post-consumer recycled packaging solutions. Additional sustainability initiatives implemented by Sharp are described below. * Since August 2016, SMH, SMV, and SGH have collaborated with the SDRM and the Food Bank in an innovative food recovery program that donates food items that can no longer be used in Sharp's kitchens but are perfectly healthy and nutritious to more than 45 hunger relief organizations in SDC. In addition, SCVMC and SCHHC recently partnered with FSD, making Sharp the first health care system in the county to donate food to San Diego's needy at such a wide-scale level. Food recovery efforts benefit the local community by ensuring access to nutritious meals for the food insecure, while also enabling Sharp to save on waste disposal costs and keep food out of landfills. In 2017, Sharp donated 18,300 pounds of food to these safety-net organizations. * In FY 2017, Sharp's composting programs diverted approximately 442,000 pounds of waste from landfills. SMMC was the first group of hospitals in SDC to participate in the city's food scraps composting program in 2012. In 2017, the program expanded to SCVMC with its engagement of the City of Chula Vista. Also in 2017, SGH collaborated with Resource Management Group recycling center to begin a composting program. Through these programs, food waste at these three Sharp sites is processed into a rich compost product and provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water and helping the environment by recycling valuable organic materials. According to the City of San Diego, such waste diversion programs contribute to the extension of the landfill's lifespan from 2012 to at least 2022. * Launched in 2016, a soup stock program at SMH turns previously unused vegetable scraps into soup stock and saves, on average, 174 pounds of food each week. In addition, SCHHC saves an average of 45 pounds of food through its soup stock program. * In 2017, Sharp's imperfect produce program purchased more than 20,000 pounds of less-than-perfect fruits and vegetables per month that are nutrient-rich and full of flavor but would have been thrown away by Sharp's food vendors. The imperfect produce program is currently in effect at SCVMC with plans to expand across the system. * In 2017, Sharp's cooking oil recycling program collected more than 6,000 pounds of oil, which is converted into safe biodiesel oil. * SCHHC, SMH and SMV continued to operate the first county-approved hospital-based organic gardens. Produce from the gardens is used in meals served at the hospital cafes. * Sharp's waste-mindful operations, including self-audit checklists, continue to help kitchen teams reduce their carbon footprint between food preparation and cleanup. In recognition of these initiatives, the San Diego Food System Alliance awarded Sharp and Sodexo an EMIES UnWasted Food Award in 2016. Named after the Bill Emerson Good Samaritan Food Donation Act, which provides protection to good faith donors, this award was created to encourage food donation to nonprofit organizations. Sharp earned the award for instituting exemplary practices around prevention/source reduction, food donation, and composting/recycling. Sharp is an active member of San Diego's Nutrition in Healthcare Leadership Team, a subcommittee of the San Diego County Childhood Obesity Initiative's health care domain. Sharp is also a participant in Practice Greenhealth's Healthier Food Challenge. As a participant, Sharp commits to reducing its purchase of meats, increasing its purchase of locally-grown food, and increasing its percentage of sustainable animal proteins. Sharp measures the impact of its food initiatives using these three indicators, the results of which are described below. 1. Decrease in Animal Protein Purchases - In FY 2017, Sharp reduced animal protein purchases by more than 550,000 pounds. This represents a 31 percent reduction in animal protein purchases since FY 2014. 2. Increase in Locally Grown Produce - Sharp and Sodexo have made a concerted effort to increase the amount of locally grown produce to support community-based farmers and reduce the time and miles needed to receive the produce in Sharp's kitchens. In FY 2017, approximately 329,000 pounds of locally sourced produce were used in Sharp's kitchens, representing an increase of 57,000 pounds (more than 20 percent) of locally sourced produce since FY 2014. This is an area of great focus at Sharp and is expected to significantly increase in the next five years as more farmers are identified and certified to provide this safe, reliable source of naturally healthy produce. 3. Sustainable Animal Protein - In FY 2017, Sharp purchased more than 13,000 pounds of sustainable animal protein, representing a 50 percent increase from FY 2014. Sustainable animal protein includes beef and cage-free chicken that is grass-fed and antibiotic and hormone free. Sharp and Sodexo remain committed to increasing healthy food offerings in an effort to combat obesity, improve sustainability, and ultimately change the eating habits of patients, staff and community members for the better. Sharp's sustainable food initiatives are outlined in Table 7. Table 7: Sustainable Food Projects by Sharp HealthCare Entity Report Card and Indicators Tracking - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Food Recovery - SCHHC, SCVMC, SGH, SMH/SMBHWN, SMV/SMC, SRSMG Soup Stock - SMH/SMBHWN Imperfect Produce - SCVMC Composting - SCVMC, SGH, SMH/SMBHWN, SMV/SMC Oil Recycling - SCVMC, SGH, SMV/SMC Commuter Solutions Sharp supports ride sharing, public transit programs and other transportation efforts to reduce transportation emissions generated by Sharp and its employees. Sharp's Commuter Solutions Subcommittee continuously works to develop innovative and accessible programs and marketing campaigns to educate employees on the benefits of ride sharing and other alternative modes of transportation. Sharp replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, which save approximately five miles per gallon. In addition, Sharp's employee parking lots offer carpool and motorcycle parking spaces. Employees can also purchase discounted monthly bus passes. As part of the nationwide Electric Vehicle Project, Sharp installed electric vehicle chargers (EVCs) at its corporate office location, SCVMC, SMMC, and some SRSMG sites. Sharp was the first health care system in San Diego to offer EVCs, supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on petroleum. Sharp will continue efforts to expand EVCs at its other entities. The use of the EVCs has resulted in a reduction of approximately 33 tons of CO2 and 3,800 gallons of fuel in FY 2017.
Form 990, Part III, Line 4a Community Benefit Report	Sharp offers bike racks as well as a Bicycle Commuter Benefit, which gives employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. In addition, Sharp participates in the SANDAG Bike to Work Day event every year in May. During the 2017 challenge, Sharp employees were among almost 10,000 San Diegans who opted to ride their bike to work. Sharp supported community cyclists by hosting food and beverage pit stops at various sites throughout SDC. Sharp also encourages employees to participate in the SANDAG iCommute RideMatcher vanpool and carpool program, which can help employees find convenient ride share partners and promote sustainable commuting. Using iCommute's TripTracker, employees can monitor the cost and carbon savings resulting from their alternate commuting methods. In addition, Sharp is enrolled in SANDAG's Guaranteed Ride Home program, which provides commuters who carpool, vanpool, take an express bus, ride the Coaster, or bike to work three or more times a week with a taxi or a rental car in case of an emergency or being stranded at work. In recognition of Rideshare Month every October, Sharp participates in SANDAG's iCommute Rideshare Corporate Challenge where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling and public transit. In FY 2017, 84 organizations in SDC - representing more than 200,000 employees - competed in the challenge. Sharp won the top spot in the Mega Employer category for the fourth year in a row and for the fifth time in six years. The annual challenge is instrumental in helping reduce traffic congestion and greenhouse gas emissions throughout the region. Furthering the commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for almost 500 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription, and human resources. Sharp also provides compressed work schedule options to eligible full-time employees, which enables them to complete the basic eighty-hour biweekly work requirement in less than 10 workdays and thus reduces commute costs, lowers parking demand, and helps the environment. Sharp's ongoing efforts to promote alternative commute choices in the workplace has led to recognition as a SANDAG iCommute Diamond Award recipient consistently between 2001 and 2010, and again from 2013 through 2017. Community Education and Outreach Sharp actively educates the community about its sustainability programs. In FY 2017, Sharp participated in the following outreach activities: * Sharp published e-newsletters for employees highlighting its recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling, and energy and water conservation. * Sharp held its sixth annual systemwide All Ways Green(tm) Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how they can decrease water, energy and resource consumption, divert waste through recycling, and reduce their carbon footprint by using alternative transportation at work and home. Many of Sharp's key vendors participated in the fairs to help raise awareness of green initiatives and how Sharp is involved in those programs. * Sharp held a community recycling event that included free e-waste recycling and confidential document destruction. The event also included the U.S. Drug Enforcement Agency's Drug Take Back Program, which provides a safe, convenient, and responsible method of drug disposal and educates the general public about the potential for prescription medication abuse. * In recognition of America Recycles Day, Sharp created a video for all Sharp employees to view on the intranet. The video highlights that every employee can make a difference by recycling as well as shows how recyclables are sorted at the local processing facility instead of being disposed of in the landfill. * Sharp participates in San Diego County's Hazmat Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC. Additional community environmental education and outreach initiatives at Sharp are highlighted in Table 8. Table 8: Environmental Community Education and Outreach by Sharp HealthCare Entity - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG America Recycles Day - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Bike to Work Day - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Earth Week Activities - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Environmental Policy - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Green Team - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG No Smoking Policy - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Organic Farmer's Market - SCHHC, SCVMC, SGH, System Offices, SMH/SMBHWN, SMV/SMC Organic Gardens - SCHHC, SMH/SMBHWN Recycling Education - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Ride Share Promotion - SCHHC, SCVMC, SGH, System Offices, SHP, SMH/SMBHWN, SMV/SMC, SRSMG Emergency and Disaster Preparedness Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. In FY 2017, Sharp provided education to staff, community members and community health professionals, and partnered with numerous state and local organizations, to prepare for an emergency or disaster. Sharp's emergency preparedness team offered educational courses to first responders and health care providers throughout SDC. This included a standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System (HICS) as well as a training focused specifically on HICS, an incident management system that can be used by hospitals to manage threats, planned events or emergencies. In addition, a course was offered to train participants to use the WebEOC crisis information management system, which provides real-time information sharing between health care systems and outside agencies during a disaster. In September, Sharp's emergency preparedness leadership shared its expertise with other hospitals, health care providers, community partners and government agencies at the annual Disaster Planning for California Hospitals conference. Education provided by Sharp included strategies for building and maintaining sustainable and resilient health care coalitions, and improving emergency communications through the use of plain language. In FY 2017, Sharp's emergency preparedness leadership donated their time to state and local organizations and committees, including County of San Diego Emergency Medical Care Committee, California Hospital Association Emergency Management Advisory Committee, California Department of Public Health Joint Advisory Committee, Ronald McDonald House Operations Committee and San Diego County Civilian/Military Liaison Work Group. Sharp was also a member of the San Diego Healthcare Disaster Coalition - a group of representatives from SDC hospitals, health care delivery agencies, county officials, fire agencies, law enforcement and the American Red Cross, through which Sharp's emergency preparedness leadership heads an evacuation subcommittee to review hospital evacuation planning and identify best practices and tools. Sharp's emergency preparedness leadership continued to participate in the Statewide Medical Health Exercise Program - a work group of representatives from local, regional and state agencies including, health departments, emergency medical services, environmental health departments, hospitals, law enforcement, fire services and more - which is designed to guide local emergency planners in developing, planning and conducting emergency responses.
Form 990, Part III, Line 4a Community Benefit Report	Through participation in the U.S. Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes SCVMC, SCHHC, SGH, SMH, SRSMG Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital Chula Vista, Kaiser Permanente San Diego and Zion Medical Centers, Alvarado Hospital Medical Center, Paradise Valley Hospital, UC San Diego Health, Palomar Health, Health Center Partners of Southern California, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriff's Department and Marine Corps Air Station Miramar Fire Department. The partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. Through networking, planning, and the sharing of resources, trainings and information, members of the partnership are better prepared for a coordinated response to an emergency or disaster affecting SDC. Sharp supports safety efforts of the state and the city of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to a mass decontamination event. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event of an interruption to the system's normal water supply. In September, Sharp hosted its sixth annual Disaster Preparedness Expo to educate San Diego residents on effective disaster preparedness and response in the event of an earthquake, fire, power outage or other emergency. Held at Liberty Station, the free event provided more than 700 community members with a variety of disaster exhibitors, demonstrations and displays as well as education on personal and family disaster planning. In recent years, endemic events occurring across the globe have had the potential to impact public health in the local San Diego community. Sharp has continued to partner with community agencies, County of San Diego Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This preparation has allowed for the continued delivery of uninterrupted care to the community in the face of public health threats. Employee Wellness: Sharp Best Health Sharp recognizes that improving the health of its team members benefits the health of the broader community. Since 2010, the Sharp Best Health employee wellness program has created wellness initiatives to improve the overall health, safety, happiness and productivity of Sharp's workforce. Each Sharp hospital, SRSMG and corporate location has a dedicated Best Health committee that works to motivate team members to incorporate healthy habits into their lifestyles and support them on their journey to attain their personal health goals. Team members are encouraged to participate in a variety of workplace health initiatives ranging from fitness challenges and weight management programs to health education and events. Sharp Best Health also offers an interactive web-based health portal where employees can create a wellness plan and track their progress. Since 2013, Sharp Best Health has offered annual employee health screenings to raise individual awareness of important biometric health measures, educate team members on reducing the risk of related health issues, and encourage employees to track changes in their metrics over time. In FY 2017, nearly 10,000 employees received health screenings for blood pressure, cholesterol, body mass index, blood sugar and tobacco use. Post-screening resources and tools are available for Sharp employees and their family members, including free access to a health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management, and managing the challenges of living with a chronic condition such as diabetes, high blood pressure, asthma or arthritis. The AHA recommends walking 10,000 steps a day to help improve or maintain a healthy lifestyle. To align with this goal, Sharp Best Health encourages team members to use a Fitbit Zip(tm) wireless pedometer to track their steps, distance, calories burned, sleep patterns and more. By syncing these statistics to computers or smartphones, the Fitbit Zips(tm) can inspire team members to achieve their personal fitness goals one step at a time. Throughout the year, Sharp Best Health held both entity-specific and systemwide Fitbit Step Challenges to encourage team members to set personal goals and compete for prizes. During FY 2017, more than 700 participants across the Sharp system walked the equivalent of 57,080 miles. Since the Fitbit Zip(tm) program's inception in 2014, participating employees have increased their average total steps by 22 percent. Additionally, to promote safety along with increased physical activity, Sharp Best Health updated Sharp's acceptable footwear policy to permit walking shoes each day of the week at Sharp corporate offices. Sharp Best Health hosted a variety of wellness programs and events for employees and their family and friends. This included systemwide walking and hiking clubs through which more than 500 participants completed more than 50 hikes during FY 2017. In addition, in February, Sharp's Best Health committees collaborated to host the third annual 5K the Sharp Way Walk/Run Event at Tidelands Park in Coronado, which engaged 300 employees and family members. Sharp Best Health participated in community health events throughout the year, including the American Cancer Society Great American Smoke Out, National Nutrition Month, National Fresh Fruits & Vegetables Month, Stress Awareness Month and National Walking Day. Sharp Best Health also aligned its summer Fitbit challenges with the San Diego Heart & Stroke Walk by making a contribution to the AHA on behalf of each of the challenge winners. In addition, Sharp Best Health partnered with the AHA to promote walking meetings as a heart healthy alternative to standard meetings. At Sharp System Offices, Sharp Best Health partnered with the Humane Society to provide free "Walk a Dog, Boost Your Health Events" where employees were given the opportunity to relieve stress and get some exercise while providing highly valuable human interaction for sheltered dogs and puppies. Sharp Best Health provided on-site health and fitness classes for employees throughout FY 2017. This included an educational session on the importance of taking micro-breaks, the health impact of extended periods of sitting, and simple stretches to incorporate into the workday. Workshops were also offered on managing chronic pain as well as on the MELT technique, which uses soft body rollers and hand and foot balls to self-treat joint pain and tension. Fitness offerings included yoga, Zumba and aquatics classes. Sharp Best Health also offered recipe demonstrations to encourage healthy meal preparation at home. In FY 2017, Sharp Best Health went beyond nutrition and physical fitness to support the overall health and happiness of employees by working with the vendor Whil, to launch their digital mindfulness and yoga training platform designed to help employees manage stress and improve their well-being. Offering more than 1,200 mindfulness and yoga sessions of various lengths and skill levels, Whil gives employees the flexibility to move at their own pace and set their own goals. Whil has also been used throughout the system as a tool during staff meetings, department huddles and shift changes. Since Whil's launch, more than 2,100 employees have become active users. Sharp Best Health also collaborated with certified mindfulness facilitators to provide on-site mindfulness programming at six Sharp locations, including both series and drop-in classes. New in 2017, Sharp Best Health introduced Wellness on Wheels, a monthly educational event offered to Sharp employees to address the challenge of accessing online health resources and programs during work hours. Wellness on Wheels involves "rounding" in staff lounges, hospital units, and nursing stations to promote a new and relevant subject each month. Each session includes an educational component, an interactive activity and a call to action. Wellness on Wheels brings wellness education to employees where they work, accommodating their unique schedules and dedication to patient care. Keeping the experience relevant and quick allows staff who were previously unable to receive wellness resources to access these benefits.
Form 990, Part III, Line 4a Community Benefit Report	Sharp has established a systemwide Mindful healthy food initiative in partnership with Sodexo. As part of the Mindful program, Sharp's cafeteria menus were redesigned to include sustainable, nutritious and enticing food options that foster a healthy lifestyle among patients, visitors and staff. In 2017, Sharp partnered with Farm Fresh to You to make customizable boxes of organic, locally-grown produce available for purchase by employees. This CSA service offers a convenient method for employees and their families to incorporate more fruits and vegetables into their diet while supporting local farmers. Weight Watchers(r) offers weight-loss services and products founded on a scientifically based approach to weight management that encourages healthy eating, increased physical activity and healthy weight management behaviors. Sharp Best Health continued its partnership with Weight Watchers(r) to offer Sharp team members a subsidized membership rate to any Weight Watchers(r) program. With program availability at work, in the community and online, this partnership has offered Sharp team members a variety of healthy-eating and physical-activity options that can be tailored to different lifestyles and schedules. At any given time during FY 2017, approximately 720 Sharp employees were actively using Weight Watchers(r). Since the program was deployed in 2016, participating employees have lost an estimated 3,000 pounds. In addition to providing Weight Watchers(r) at work, during FY 2017 Sharp Best Health partnered with the Sharp Rees-Stealy Center for Health Management to offer free in-person and online nutrition classes to Sharp employees through the New Weigh program. New Weigh is an eight-week weight loss program that emphasizes nutrition education and healthy lifestyle development. Program participants create a semi-structured food plan, and have access to a skilled health coach or registered dietitian to ensure continued support and accountability. During FY 2017, 210 Sharp employees completed the New Weigh program. Nearly one in six community members face the threat of hunger every day in SDC. Each month, the Food Bank distributes food to approximately 370,000 children and families, active duty military, and fixed income seniors living in poverty. For more than a decade, Sharp has supported the Food Bank's tremendous efforts through a holiday food drive. During the 2016 holiday season, Sharp Best Health and Sharp Community Benefit collaborated to take this effort a step further. In partnership with SuperFood Drive - a San Diego-based organization committed to educating the community about the health benefits of eating nutrient-dense superfoods and ensuring the accessibility of healthy food to all - Sharp transformed its traditional food drives to "superfood drives," encouraging nonperishable food donations that are also nutritious, sustaining and essential for a healthy life. Through the six-week holiday superfood drive at locations throughout the Sharp system, Sharp doubled its number of food drive sites from earlier holiday seasons, and collected more than 3,000 pounds of nutritious food - an increase of 90 percent compared to previous years. In addition, Sharp team members donated nearly $2,900 through a new Sharp Virtual Food Drive specifically benefiting the Food Bank. Combined, these donations and funds provided nearly 16,000 healthy meals for San Diegans in need of assistance with putting food on the table during the 2016 holiday season. Section 2 Executive Summary It's important to me that Sharp HealthCare promotes policies that improve access to health care, because we all deserve an opportunity to live the healthiest life we can. - Sara Steinhoffer, Vice President of Government Relations, Sharp HealthCare This Executive Summary provides an overview of community benefit planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefit Plan and Report, and a summary of community benefit programs and services provided by Sharp in Fiscal Year 2017 (FY 2017) (October 1, 2016, through September 30, 2017). In addition, the summary reports the economic value of community benefit provided by Sharp, according to the framework specifically identified in Senate Bill 697 (SB 697), for the following entities: * Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefit Planning at Sharp HealthCare Sharp bases its community benefit planning on its triennial community health needs assessments (CHNA) combined with the expertise in programs and services of each Sharp hospital. For details on Sharp's CHNA process, please see Section 3: Community Benefit Planning Process. Listing of Community Needs Addressed in the Sharp HealthCare Community Benefit Plan and Report, FY 2017 The following community needs are addressed by one or more Sharp hospitals in this Community Benefit Report: * Access to care for individuals without a medical provider and support for high-risk, underserved and underfunded patients * Education and screening programs on health conditions, such as heart and vascular disease, stroke, cancer, diabetes, preterm delivery, unintentional injuries and behavioral health * Health education, support and screening activities for seniors * Welfare of seniors and disabled people * Special support services for hospice patients and their loved ones, and for the community * Support of community nonprofit health organizations * Education and training of community health care professionals * Student and intern supervision and support * Collaboration with local schools to promote interest in health care careers * Cancer education, patient navigation services and participation in clinical trials * Women's and prenatal health services and education * Meeting the needs of new mothers and their loved ones * Mental health and substance abuse education and support for the community Highlights of Community Benefit Provided by Sharp in FY 2017 The following are examples of community benefit programs and services provided by Sharp hospitals and entities in FY 2017. * Medical Care Services included uncompensated care for patients who are unable to pay for services, and the unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services, Civilian Health and Medical Program of the United States of America Department of Veterans Affairs (CHAMPVA), and TRICARE - the regionally managed health care program for active-duty, National Guard and Reserve members, retirees, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; flu vaccinations and services for seniors; financial and other support to community clinics to assist in providing and improving access to health services; Project HELP; Meals on Wheels; contribution of time to Stand Down for Homeless Veterans, the San Diego Food Bank, and Feeding San Diego; financial and other support to the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers and made its facilities available for use by community groups at no charge. Sharp executive leadership and staff also actively participated in numerous community organizations, committees and coalitions to improve the health of the community. See Appendix A for a listing of Sharp's involvement in community organizations. In addition, the category included costs associated with planning and operating community benefit programs, such as CHNA development and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care students and professionals, as well as supervision and support for students and interns. Time was also devoted to generalizable health-related research projects that were made available to the broader health care community.
Form 990, Part III, Line 4a Community Benefit Report	Economic Value of Community Benefit Provided in FY 2017 In FY 2017, Sharp provided a total of $415,307,122 in community benefit programs and services that were unreimbursed. Table 9 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 9: Sharp HealthCare Total Community Benefit - FY 2017 (Economic value is based on unreimbursed costs) Medical Care Services: Shortfall in Medi-Cal - $140,198,987 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $222,539,275 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $7,999,688 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in CHAMPVA/TRICARE - $6,179,147 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Workers' Compensation - $53,553 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Charity Care - $22,033,461 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Bad Debt - $7,489,410 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Other Benefits for Vulnerable Populations, Broader Community, and Health Research, Education and Training Programs: Patient transportation and other assistance for the needy - $2,803,035 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events - $1,680,320 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Education and training programs for students, interns and health care professionals - $4,330,246 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. In FY 2015, the State of California and the Centers for Medicare and Medicaid Services approved a Medi-Cal Hospital Fee Program for the time period of January 1, 2014 through December 31, 2016. This resulted in an increased reimbursement of $89.7 million and an assessment of a quality assurance fee and pledge totaling $56.3 million in FY 2017. The net impact of the program totaling $33.4 million reduced the amount of unreimbursed medical care service for the Medi-Cal population. This reimbursement helped offset prior years' unreimbursed medical care services, however the additional funds recorded in FY 2017 understate the true unreimbursed medical care services performed for the past fiscal year. Table 10 illustrates the impact of the Medi-Cal Hospital Fee Program on Sharp's medical care services in FY 2017. Table 10: Sharp HealthCare Medical Care Services: Medical Care Services before Provider Fee - $436,492,747 Provider Fee - $(29,999,226) Net Medical Care Services after Provider Fee - $406,493,521 Table 11 lists community benefit costs provided by each Sharp entity and Table 11: Total Economic Value of Community Benefit Provided by Sharp HealthCare Entities - Estimated FY 2017 Unreimbursed Costs Sharp Chula Vista Medical Center - $80,231,642 Sharp Coronado Hospital and Healthcare Center- $17,045,590 Sharp Grossmont Hospital - $118,063,679 Sharp Mary Birch Hospital for Women & Newborns - $11,206,475 Sharp Memorial Hospital - $170,666,302 Sharp Mesa Vista Hospital and Sharp McDonald Center - $18,024,214 Sharp Health Plan - $69,220 TOTAL FOR ALL ENTITIES - $415,307,122 Table 12 includes a summary of unreimbursed costs for each Sharp hospital entity based on the categories specifically identified in SB 697. For a detailed summary of unreimbursed costs of community benefit provided by Sharp Grossmont Hospital in FY 2017, see tables presented in Sections 4 and 5. Table 12: Detailed Economic Value of SB 697 Categories - Estimated FY 2017 Unreimbursed Costs Sharp Chula Vista Medical Center: Medical Care Services - $78,695,427 Other Benefits for Vulnerable Populations- $322,813 Other Benefits for the Broader Community - $218,217 Health Research, Education and Training Programs - $995,185 Total - $80,231,642 Sharp Coronado Hospital and Healthcare Center: Medical Care Services - $16,678,892 Other Benefits for Vulnerable Populations- $37,305 Other Benefits for the Broader Community - $55,596 Health Research, Education and Training Programs - $273,797 Total - $17,045,590 Sharp Grossmont Hospital: Medical Care Services - $115,474,253 Other Benefits for Vulnerable Populations- $834,124 Other Benefits for the Broader Community - $551,723 Health Research, Education and Training Programs - $1,203,579 Total - $118,063,679 Sharp Mary Birch Hospital for Women & Newborns: Medical Care Services - $10,872,953 Other Benefits for Vulnerable Populations- $45,688 Other Benefits for the Broader Community - $90,276 Health Research, Education and Training Programs - $197,558 Total - $11,206,475 Sharp Memorial Hospital: Medical Care Services - $167,900,539 Other Benefits for Vulnerable Populations- $1,018,661 Other Benefits for the Broader Community - $443,956 Health Research, Education and Training Programs - $1,303,146 Total - $170,666,302 Sharp Mesa Vista Hospital and Sharp McDonald Center: Medical Care Services - $16,871,457 Other Benefits for Vulnerable Populations- $522,956 Other Benefits for the Broader Community - $278,986 Health Research, Education and Training Programs - $350,815 Total - $18,024,214 Sharp Health Plan: Other Benefits for Vulnerable Populations- $21,488 Other Benefits for the Broader Community - $41,566 Health Research, Education and Training Programs - $6,166 Total - $69,220 Section 3 Community Benefit Planning Process "An exceptional community citizen is practical as well as visionary; a great leader. Someone who can collaborate at multiple levels during a difficult time for the greater good." - Stacey Hrountas, Chief Executive Officer, Sharp Rees-Stealy Medical Group.
Form 990, Part III, Line 4a Community Benefit Report	For more than 20 years, Sharp HealthCare (Sharp) has based its community benefit planning on findings from its triennial Community Health Needs Assessment (CHNA) process. CHNA findings are used in combination with the expertise in programs and services of each Sharp hospital, as well as knowledge of the populations and communities served by those hospitals, to provide a foundation for community benefit program planning and implementation. Methodology to Conduct the 2016 Sharp HealthCare Community Health Needs Assessments Sharp has been a longtime partner in the process of identifying and responding to the health needs of the San Diego community. Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations and community agencies to conduct a triennial CHNA that identifies and prioritizes health needs for San Diego County (SDC). In addition, to address the requirements for not-for-profit hospitals under the Patient Protection and Affordable Care Act, Sharp has developed CHNAs for each of its individually licensed hospitals since 2013. This process gathers both salient hospital data and the perspectives of health leaders and residents in order to identify and prioritize health needs for community members across the county, with a special focus on vulnerable populations. Further, the process seeks to highlight health needs that hospitals could impact through programs, services and collaboration. For the 2016 CHNA process, Sharp actively participated in a collaborative CHNA effort led by the Hospital Association of San Diego and Imperial Counties (HASD&IC) and in contract with the Institute for Public Health (IPH) at San Diego State University. The process and findings of the collaborative HASD&IC 2016 CHNA significantly informed the process and findings of Sharp's individual hospital CHNAs. The complete HASD&IC 2016 CHNA is available for public viewing and download at http://www.hasdic.org. To develop its individual hospital CHNAs, Sharp analyzed hospital-specific data and contracted separately with IPH to conduct community engagement activities expressly for the patients and community members it serves. In accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2016 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns, as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2016 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2016 CHNAs for each Sharp hospital help inform current and future community benefit programs and services, especially for community members facing inequities. This section describes the general methodology employed for Sharp HealthCare's 2016 CHNAs. CHNA Committee The HASD&IC Board of Directors convened a CHNA Committee to plan and implement the collaborative 2016 CHNA process. The CHNA Committee includes representatives from all seven participating hospitals and health care systems: * Kaiser Foundation Hospitals - San Diego * Palomar Health * Rady Children's Hospital - San Diego * Scripps Health (Chair) * Sharp HealthCare (Vice Chair) * Tri-City Medical Center * University of California (UC), San Diego Health CHNA Objectives In response to community feedback on the 2013 CHNA process and findings, and in recognition of the challenges that health providers, community organizations and residents face in their efforts to prevent, diagnose and manage chronic conditions, the HASD&IC 2016 CHNA process focused on gaining deeper insight into the top health needs identified for SDC through the 2013 CHNA process. Sharp's 2013 CHNA process and findings were significantly informed by the collaborative HASD&IC CHNA model. Consequently, Sharp's 2016 CHNA process sought to gain further insight into the needs identified across its different hospitals in 2013, including (in alphabetical order) behavioral health, cancer, cardiovascular disease, Type 2 diabetes, high-risk pregnancy, obesity and senior health. Specific objectives of Sharp's 2016 CHNA process included: * Gather in-depth feedback to aid in the understanding of the most significant health needs impacting community members in SDC, particularly Sharp patients. * Connect the identified health needs with associated social determinants of health (SDOH) to further understand the challenges that community members and Sharp patients - particularly those in communities of high need - face in their attempts to access health care and maintain health and well-being. * Identify currently available community resources that support identified health conditions and health challenges. * Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community. Study Area Defined For the purposes of the collaborative HASD&IC 2016 CHNA, the study area is the entire County of San Diego due to a broad representation of hospitals in the area. With more than three million residents, SDC is socially and ethnically diverse. Information on key demographics, socioeconomic factors, access to care, health behaviors, and the physical environment can be found in the full HASD&IC 2016 CHNA report at: http://hasdic.org. As the study area for both the collaborative HASD&IC 2016 and Sharp 2016 CHNAs cover SDC, the HASD&IC 2016 CHNA process and findings significantly informed Sharp's CHNA process/findings, and as such, are described as applicable throughout Sharp's CHNAs. For complete details on the HASD&IC 2016 CHNA process, please visit the HASD&IC website or contact Lindsey Wade, Vice President, Public Policy at HASD&IC at lwade@hasdic.org. For the collaborative HASD&IC 2016 CHNA process, the IPH employed a rigorous methodology using both community input and quantitative analysis to provide a deeper understanding of barriers to health improvement in SDC. The 2016 CHNA process began with a comprehensive scan of recent community health statistics in order to validate the regional significance of the top four health needs identified in the HASD&IC 2013 CHNA. Quantitative data for both the HASD&IC 2016 CHNA and Sharp 2016 CHNAs included 2013 OSHPD demographic data for hospital inpatient, emergency department (ED), and ambulatory care encounters to understand the hospital patient population. Clinic data was also gathered from OSHPD and incorporated in order to provide a more holistic view of health care utilization in SDC. Additional variables analyzed in the 2016 CHNA processes are included in Table 13; variables were analyzed at the ZIP code level wherever possible. Table 13: Data Variables in the HASD&IC and Sharp 2016 CHNAs Secondary Data Variables Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters Community Clinic Visits Demographic Data (socioeconomic indicators) Mortality and Morbidity Data Regional Program Data (childhood obesity trends and community resource referral patterns) Social Determinants of Health and Health Behaviors (education, income, insurance, physical environment, physical activity, diet and substance abuse) Based on the results of the community health statistics scan and feedback from community partners received during the 2016 CHNA planning process, a number of community engagement activities were conducted across SDC, as well as specific to Sharp patents, in order to provide a more comprehensive understanding of identified health needs, including their associated SDOH and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. In addition, Sharp contracted with IPH to collect additional community input through three primary methods: facilitated discussions, key informant interviews, and the Health Access and Navigation Survey with patients and community members. This input focused on behavioral health, cancer, cardiovascular health, diabetes, high-risk pregnancy, senior health and the needs of highly vulnerable patients and community members. In addition, Sharp conducted specific outreach to community promoters, and members of Sharp's Patient Family Advisory Councils - community members who are also current or former Sharp patients. Findings The collaborative HASD&IC 2016 CHNA prioritized the top health needs for SDC through application of the following five criteria: 1. Magnitude or Prevalence 2. Severity 3. Health Disparities 4. Trends 5. Community Concern
Form 990, Part III, Line 4a Community Benefit Report	Using these criteria, IPH created a summary matrix for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, Type 2 diabetes and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. As the HASD&IC 2016 CHNA process included robust representation from the communities served by Sharp, the findings of the prioritization process applied to the same four priority health needs identified for Sharp (behavioral health, cardiovascular, Type 2 diabetes and obesity). In addition, findings from Sharp's 2016 CHNAs continued to prioritize cancer, high-risk pregnancy and senior health among the top health needs for its community. In addition, analysis of feedback from the 2016 CHNA community engagement activities identified SDOH to be a key theme among community health needs. Ten SDOH were consistently referenced across the different community engagement activities conducted in both HASD&IC's and Sharp's CHNAs. The importance of these SDOH was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these SDOH. Ongoing Commitment to Collaboration Underscoring Sharp's ongoing commitment to collaboration in order to address community health priorities and improve the health of San Diegans, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, Association for Community Health Improvement, statewide California Hospital Association, HASD&IC, and a variety of local collaboratives including but not limited to the San Diego Hunger Coalition, the San Diego Regional Chamber of Commerce and Community Health Improvement Partners. Section 4 Sharp Grossmont Hospital Community is really about vibrant connections between people; the people that live near us, the people we serve on a daily basis, and the people that provide our services all working together to shape life moments for each person. - Scott Evans, Chief Executive Officer, Sharp Grossmont Hospital FY 2017 Community Benefit Program Highlights Sharp Grossmont Hospital (SGH) provided $118,063,679 in community benefit in Fiscal Year 2017 (FY 2017). See Table 22 for a summary of unreimbursed costs based on the categories identified in Senate Bill (SB 697), for the distribution of SGH's community benefit among those categories. Table 22: Economic Value of Community Benefit Provided Sharp Grossmont Hospital - Estimated FY 2017 Unreimbursed Costs Medical Care Services: Shortfall in Medi-Cal - $42,806,043 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in Medicare - $62,806,884 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in San Diego County Indigent Medical Services - $162,019 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Shortfall in CHAMPVA/TRICARE - $1,249,303 Note: Methodology for calculating shortfalls in public programs is based on Sharp's payor-specific cost-to-charge ratios, which are derived from the cost accounting system, offset by the actual payments received. Costs for patients paid through the Medicare program on a prospective basis also include payments to third parties related to the specific population. Charity Care - $6,873,840 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Bad Debt - $1,576,164 Note: Charity care and bad debt reflect the unreimbursed costs of providing services to patients without the ability to pay for services at the time the services were rendered. Other Benefits for Vulnerable Populations, Broader Community, and Health Research, Education and Training Programs: Project HELP, patient transportation, and other assistance for the needy - $834,124 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Health education and information, health screenings, flu vaccinations, support groups, meeting room space and donations of time to community organizations - $551,723 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Education and training programs for students, interns and health care professionals - $1,203,579 Note: Unreimbursed costs may include an hourly rate for labor and benefits plus costs for supplies, materials and other purchased services. Any offsetting revenue (such as fees, grants or external donations) is deducted from the costs of providing services. Unreimbursed costs were estimated by each department responsible for providing the program or service. Key highlights: * Medical Care Services included uncompensated care for patients who were unable to pay for services and the unreimbursed costs of public programs such as Medi-Cal, Medicare and CHAMPVA/TRICARE. In FY 2015, the State of California and the Centers for Medicare and Medicaid Services approved a Medi-Cal Hospital Fee Program for the time period of January 1, 2014 through December 31, 2016. This resulted in an increased reimbursement of $9.7 million to SGH. This reimbursement helped offset prior years' unreimbursed medical care services; however, the additional funds recorded in FY 2017 understate the true unreimbursed medical care services performed for the past fiscal year. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits; financial and other support to Neighborhood Healthcare; Project HELP, which provides funding for specific needs (e.g., medications, etc.) to assist lower-income patients; flu vaccination clinics for high-risk adults, including seniors; contribution of time to Stand Down for Homeless Veterans, Doors of Change, Kitchens for Good, Mama's Kitchen, Feeding San Diego (FSD), Ssubi is Hope and the San Diego Food Bank (Food Bank); the Sharp Humanitarian Service Program; support for Meals on Wheels San Diego County; the provision of durable medical equipment (DME); support services for discharged homeless patients in partnership with San Diego Rescue Mission (SDRM); the Care Transitions Intervention program; and other assistance for vulnerable and high-risk community members.
Form 990, Part III, Line 4a Community Benefit Report	* Other Benefits for the Broader Community included health education and information on a variety of topics; support groups; participation in community health fairs and events; health screenings for stroke, blood pressure, diabetes, fall prevention, hand, lung function and carotid artery disease; community education and resources provided by the SGH cancer patient navigator program; and specialized education and flu vaccinations offered through the SGH Senior Resource Center. SGH also collaborated with local schools to promote interest in health care careers and donated meeting room space to community groups. SGH staff actively participated in community boards, committees, and civic organizations, including but not limited to the County of San Diego Aging and Independence Services (AIS), Association of California Nurse Leaders (ACNL), Neighborhood Healthcare, Meals on Wheels San Diego County East County Advisory Board, Caregiver Coalition of San Diego (the Caregiver Education Committee), Partnership for Smoke-Free Families, San Diego County Breastfeeding Coalition Advisory Board, the Beacon Council's Patient Safety Collaborative, East County Action Network (ECAN), East County Senior Service Providers (ECSSP), Hospital Association of San Diego and Imperial Counties (HASD&IC), the local chapter of Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), California Association of Hospitals and Health Systems (CAHHS) Committee on Volunteer Services and Directors' Coordinating Council, San Diego Association of Directors of Volunteer Services, Emergency Nurses Association, California Society for Clinical Social Work Professionals, Santee-Lakeside Rotary Club, Grossmont Healthcare District Community Grants and Sponsorships Committee, John A. Davis Family YMCA Board of Management, Santee Chamber of Commerce, Angels Foster Family Network, La Mesa Parks and Recreation, and Lantern Crest Senior Living Advisory Board. See Appendix A for a listing of Sharp HealthCare's (Sharp's or SHC's) community involvement. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training for health care professionals, student and intern supervision and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Definition of Community SGH is located at 5555 Grossmont Center Drive in La Mesa, ZIP code 91942. The community served by SGH includes the entire east region of San Diego County (SDC), including the subregional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. For SGH's 2016 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by SGH with especially high need include, but are not limited to, Lemon Grove, Spring Valley and El Cajon. Description of Community Health In SDC's east region in 2016, 100 percent of surveyed children ages zero to 11 and 100 percent of surveyed children ages 12 to 17 had health insurance coverage, which meet the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. 96.5 percent of surveyed adults ages 18 to 64 had health insurance, which falls short of the HP2020 target. In the east region in 2016, 11.3 percent of adults ages 18 to 64 did not have a usual source of care and 8.9 percent of these adults had health insurance. In addition, 8.7 percent of adults without a usual source of care reported fair health outcomes. See Table 23 for a summary of key indicators of access to care, and Table 24 for data regarding eligibility for Medi-Cal. In 2015, the unemployment rate in SDC's east region was 11.3 percent, which was higher than the rate for SDC overall (10.3 percent). During 2015-2016, 16.9 percent of adults ages 18 to 64 in SDC's east region reported living below the federal poverty level (FPL). Among east region adults with a household income below 200 percent FPL, 44.8 percent of those surveyed in in 2015-2016 reported experiencing food insecurity (lack of access to healthy food). In addition, 17.8 percent of east region adults with a household income below 300 percent FPL reported participation in CalFresh, the Supplemental Nutrition Assistance Program in California. East region figures for food insecurity and CalFresh participation during in 2015-2016 were higher than the rates for the county overall (42.4 percent and 17.5 percent, respectively). Further, 10.5 percent of east region adults with a household income below 300 percent FPL received Supplemental Security Income, higher than SDC overall (8.6 percent). In 2015, there were 63,901 residents ages 65 and older in SDC's east region, representing 14.4 percent of the total regional population and a higher proportion than any other region in the county. Between 2015 and 2020, it is anticipated that the east region's senior population will grow by 20.7 percent, slower than the growth rate for seniors in SDC overall (22 percent). Table 23: Health Care Access in SDC's East Region, 2016 Current Health Insurance Coverage: Children 0 to 11 Years: Rate - 100%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 100%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 96.5%, HP2020 Target - 100% Regular Source of Medical Care: Children 0 to 11 Years: Rate - 100%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 24.6%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 88.7%, HP2020 Target - 89.4% Not Currently Insured: Adults 18 to 64 Years: Rate - 3.5%, HP2020 Target - N/A Source: 2016 California Health Interview Survey (CHIS) Table 24: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC's East Region (Adults Ages 18 to 64 Years), 2016 Medi-Cal Eligible - 4.9% Not Eligible - 95.1% Source: 2016 CHIS. This information is sourced from the 2016 CHIS Health Profile for SDC, provided by the UCLA Center for Health Policy Research. Starting in 2013, the California state budget required children enrolled in the Healthy Families Program to transition enrollment into Medi-Cal. Formerly, this table included Healthy Family eligibility in San Diego County using pre-ACA data. The Affordable Care Act now determines financial eligibility for Medi-Cal using Modified-Adjusted Gross Income, based on income and number of persons in the household. In 2015, cancer and coronary heart disease (CHD) were the top two leading causes of death in SDC's east region. See Table 25 for a summary of leading causes of death in the east region. For additional demographic and health data for communities served by SGH, please refer to the SGH 2016 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm. Table 25: Leading Causes of Death in SDC's East Region, 2015 Overall Cancer: Number of Deaths - 921, Percent of Total Deaths - 24.1% Coronary Heart Disease: Number of Deaths - 534, Percent of Total Deaths - 13.9% Alzheimer's Disease and Related Dementias: Number of Deaths - 432, Percent of Total Deaths - 11.3% Chronic Obstructive Pulmonary Disease/Chronic Lower Respiratory Diseases: Number of Deaths - 217, Percent of Total Deaths - 5.7% Unintentional Injuries: Number of Deaths - 204, Percent of Total Deaths - 5.3% Stroke: Number of Deaths - 196, Percent of Total Deaths - 5.1% Overall Hypertensive Diseases: Number of Deaths - 153, Percent of Total Deaths - 4.0% Diabetes: Number of Deaths - 135, Percent of Total Deaths - 3.5% Overdose/Poisoning: Number of Deaths - 70, Percent of Total Deaths - 1.8% Suicide: Number of Deaths - 55, Percent of Total Deaths - 1.4% All Other Causes: Number of Deaths - 912, Percent of Total Deaths - 23.8% Total Deaths: Number of Deaths - 3,829, Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology & Immunization Services Branch
Form 990, Part III, Line 4a Community Benefit Report	Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, SGH: * Incorporates community priorities and community input into its strategic plan and develops service line-specific goals * Estimates an annual budget for community programs and services based on community needs, previous years' experience and current funding levels * Prepares and distributes a monthly report of community activities to its board of directors, describing community benefit programs provided, such as education, screenings and flu vaccinations * Prepares and distributes information on community benefit programs and services through its foundation and community newsletters * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SGH 2016 CHNA SGH completed its most recent CHNA in September 2016. SGH's 2016 CHNA was significantly influenced by the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 CHNA process and findings, and details on those processes are available in Section 3: Community Benefit Planning Process of this report. In addition, this year SGH completed its most current implementation strategy - a description of SGH programs designed to address the priority health needs identified in the 2016 CHNA. The most recent CHNA and implementation strategy for SGH are available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through the SGH 2016 CHNA, the following priority health needs were identified for the communities served by SGH: * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type 2 * Obesity * Senior Health In alignment with these identified needs, the following pages detail programs that specifically address cardiovascular disease, diabetes and senior health. SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH lacks the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH. There are also programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy Medical Group (SRSMG) clinics throughout SDC - including SDC's east region - provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. For additional details on SGH programs that specifically address the needs identified in the 2016 CHNA, please refer to SGH's implementation strategy available at http://www.sharp.com/about/community/health-needs-assessments.cfm. Through further analysis of SGH's community programs and in consultation with SGH service line leaders and community relations team members, this section also addresses the following priority health needs for community members served by SGH: * General community health education and wellness * Women's and prenatal health services and education * Prevention of unintentional injuries * Support during the transition of care process for high-risk, underserved and underfunded patients * Collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2017 Report of Activities conducted in support of the objective(s), and Fiscal Year 2018 (FY 2018) Plan. Identified Community Need: Education, Support and Screening for Stroke Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify cardiovascular disease (including cerebrovascular disease/stroke) as one of the top four priority health issues for community members in SDC. * According to data presented in the SGH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. About half of all Americans (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 (Centers for Disease Control and Prevention (CDC), 2015). * In 2015, stroke was the sixth leading cause of death for SDC's east region. * In 2015, there were 196 deaths due to stroke in SDC's east region. The region's age-adjusted death rate due to stroke was 35.3 per 100,000 population. This rate was the second highest among all SDC regions and was higher than the overall SDC age-adjusted death rate of 33.3 per 100,000 population as well as the HP2020 target of 34.8 deaths per 100,000 population. * In 2015, there were 1,095 hospitalizations due to stroke in SDC's east region. The region's age-adjusted rate of hospitalizations for stroke was 200.6 per 100,000 population, which is the third highest among all SDC regions as well as higher than the age-adjusted rate for SDC overall (178.1 per 100,000 population). * In 2015, there were 285 stroke-related ED discharges in SDC's east region. The age-adjusted rate of discharge was 52.0 per 100,000 population, which was lower than the rate in 2014 (59.7 per 100,000 population). * According to the 2012 HHSA report titled Critical Pathways: The Disease Continuum, the most common risk factors associated with stroke include physical inactivity, tobacco use, alcohol or drug use, poor nutrition, poor medical care, stress, depression, high cholesterol and diabetes. * According to 2016 CHIS data, an estimated 36.6 percent of east region adults were obese, 17.9 percent reported eating fast food four or more times in the past week, 9.8 percent smoked cigarettes, and 61.4 percent did not regularly walk for transportation, fun, or exercise, all of which were higher than overall SDC rates. * The CDC estimates that up to 80 percent of strokes are preventable through the recognition of early signs/symptoms and the elimination of stroke risk factors. * The National Institute of Neurological Disorders and Stroke (NINDS) reports that 25 percent of people who recover from their first stroke will have another stroke within 5 years (NINDS, 2016). Objective * Provide stroke education, support and screening services for the east region of SDC FY 2017 Report of Activities SGH is recognized with advanced certification by the Joint Commission as a Primary Stroke Center and was recertified in June 2014. The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SGH is a recipient of the American Heart Association (AHA)/American Stroke Association's (ASA) Get With The Guidelines(r) (GWTG) - Stroke Gold Plus Quality Achievement Award for excellence in stroke care as well as the Target: Stroke Elite Honor Roll designation. The AHA/ASA's GWTG is a national effort focused on ensuring the use of evidence-based therapies to improve outcomes for stroke patients. The AHA/ASA's Target: Stroke Elite Honor Roll designation focuses on improving the timeliness of intravenous tissue plasminogen activator (IV t-PA) administration to eligible patients.
Form 990, Part III, Line 4a Community Benefit Report	In FY 2017, the SGH Stroke Center provided stroke education and screenings at 12 community events in SDC's east region. During the events, the team provided more than 430 community members with information about stroke risk factors, warning signs, and appropriate interventions, including arrival at the hospital within early onset of symptoms. In addition, nearly 150 community members received blood pressure checks or stroke screenings, 20 of whom were referred for a follow-up. During the screenings, the SGH Stroke Center identified risk factors as well as provided education, and advised behavior modification, including smoking cessation, weight loss and stress reduction. Events were held at various community sites, including but not limited to: the Spring into Healthy Living event at the McGrath Family YMCA; Health Fair and Flu Shot event at the Jewish Family Service of San Diego (JFS) College Avenue Center; ECSSP's 18th annual East County Senior Health Fair at the La Mesa Community Center; La Mesa Police Department's fifth annual Safety Fair at the La Mesa Community Center; the Dr. William C. Herrick Community Health Care Library; the San Diego East County Chamber of Commerce's Health Fair Saturday at Grossmont Center; Grossmont Healthcare District Conference Center; and the Lakeside Fire Department Open House at Lakeside Fire Station 2. In September, Sharp's systemwide Stroke Program participated in Strike Out Stroke Night at the Padres, held at Petco Park. This annual event is organized by the San Diego County Stroke Consortium, the HHSA, the San Diego Padres and other key partners to promote stroke awareness and celebrate stroke survivors. During the baseball game, Sharp offered stroke and blood pressure screenings, education about the warning signs of stroke and how to respond using FAST (Face, Arms, Speech, Time) - an easy way to remember the sudden signs of stroke. Free giveaways were provided throughout the evening, while stroke education was displayed on the JumboTron to the entire stadium of more than 39,000 community members. In addition, the SGH Stroke Center provided stroke education and screenings of personal risk factors for stroke with pulse checks to more than 200 attendees at the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina in April. Educational topics included different types of strokes, how to identify risk factors for stroke, strategies for risk reduction and stroke recognition. In collaboration with the SGH Senior Resource Center, the SGH Stroke Center and a Sharp interventional neuroradiologist presented on the recent advances in the treatment of stroke and provided resources to nearly 30 community members at the Dr. William C. Herrick Community Health Care Library in May. The SGH Stroke Center also conducted personal health interviews, blood pressure and pulse checks, and provided education on emergency treatment for stroke, prevention and warning signs, and how to respond using FAST. In addition, from October to January, the SGH Stroke Center provided stroke education to nearly 40 homeless community members. Individuals received education on stroke signs and symptoms and how to respond FAST as well as FAST stroke cards, free inspirational books and food. In FY 2017, the SGH Outpatient Rehabilitation Department offered a Stroke Communication Support Group for stroke survivors and their family members twice a month that focused on brain injury survivors with aphasia or other speech or language difficulties. Topics included games to improve visual skills, language stimulation, listening activities and social interaction. The support group is sponsored by Young Enthusiastic Stroke Survivors. Approximately five community members attended each session. SGH also actively participated in the quarterly San Diego County Stroke Consortium, a collaborative effort to improve stroke care and discuss issues impacting stroke care in SDC. Additionally, SGH continued collaborating with the County of San Diego Emergency Medical Services (EMS) for the 12th year to provide data for the SDC stroke registry. FY 2018 Plan SGH Stroke Center will do the following: * Participate in stroke screening and education events in the east region of SDC * Provide education for individuals with identified stroke risk factors * Offer a stroke support group in conjunction with the hospital's Outpatient Rehabilitation Department * Continue to participate in Strike Out Stroke Night at the Padres * Continue to participate in the San Diego County Stroke Consortium with other SDC hospitals * Continue to provide data to the SDC stroke registry * Provide at least one physician speaking event around stroke care and prevention * Provide stroke education and screenings at the Sharp Women's Health Conference * Participate in Sharp's partnership with the City of San Diego to provide stroke education and resources to employees and residents in the city's nine districts Identified Community Need: Heart and Vascular Disease Education and Screening Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify cardiovascular disease as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify cardiovascular disease as one of the top four priority health issues for community members in SDC. * Data analysis in the 2016 CHNAs revealed a higher rate of hospital discharges due to cardiovascular disease in more vulnerable communities within SDC's east region, such as El Cajon and Jacumba (Dignity Health, San Diego Geographic Information Source (SanGIS), Office of Statewide Health Planning and Development (OSHPD) & SpeedTrack Inc., 2015). * A cardiovascular health key informant interview conducted as part of the SGH 2016 CHNA process identified the following important issues facing cardiology patients: access to care, obtaining medications, understanding diet, understanding symptoms, and communicating their needs to providers. * The key informant interview identified the following as effective strategies for cardiology patients: taking time to teach patients about their disease and self-management; building relationships with patients; providing educational materials; Backline (a text messaging service connecting patients and providers) numbers for providers; education for general practitioners; and including a trained addictions specialist on the care team. * In addition, the cardiovascular health key informant interview identified the following risk factors for heart disease: diabetes, lack of social support, substance use disorders, financial issues, transportation, and lack of health education. Addiction is of particular concern, as nearly all SGH cardiology patients under age 55 have substance use issues. * According to the SGH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. * In 2015, heart disease was the second leading cause of death for SDC's east region. * In 2015, there were 534 deaths due to CHD in SDC's east region. The region's age-adjusted death rate due to heart disease was 95.7 per 100,000 population. This was higher than the SDC overall age-adjusted death rate (83.9 deaths per 100,000 population), but below the HP2020 target (103.4 deaths per 100,000 population). * In 2015, there were 1,053 hospitalizations due to CHD in SDC's east region. The rate of hospitalization for heart disease was 187.3 per 100,000 population, which is higher than SDC's overall age-adjusted rate (165.5 per 100,000 population). * In 2015, there were 232 ED discharges for CHD in SDC's east region. The age-adjusted rate of ED discharges was 41.9 per 100,000 population, which is the highest in the county, and higher than the age-adjusted rate for SDC overall (31.5 per 100,000 population). * According to CHIS, in 2016 5.9 percent of adults living in SDC's east region indicated that they were ever diagnosed with heart disease, which is higher than SDC overall at 4.7 percent. Among those diagnosed with heart disease in the east region, only 70.6 percent were provided a heart disease management plan by their health provider. * The 2016 CHIS results showed that 31.4 percent of adults living in SDC's east region had ever been diagnosed with high blood pressure. This is higher than SDC overall, at 26.4 percent, and California, at 28.4 percent.
Form 990, Part III, Line 4a Community Benefit Report	* According to data presented in the HHSA 2014 Live Well Community Health Assessment, east region residents were more likely to be obese, smoke tobacco, regularly eat fast food and binge drink than residents of other regions, all of which may increase the risk of developing CHD. * According to the CDC, heart disease kills approximately 610,000 people annually, and is the leading cause of death for both men and women (CDC, 2015). * In their 2017 statistical update, the AHA reported that in 2014, cardiovascular disease was listed as the underlying cause of death for 30.8 percent of all deaths in the U.S. * According to new blood pressure guidelines championed by the AHA, an estimated 46 percent of U.S. adults now have hypertension (AHA, 2017). Objectives * Provide heart and vascular education and screening services for the community, with an emphasis on adults, women and seniors * Provide expertise in cardiovascular care to community health care professionals through participation in professional conferences and collaboratives * Participate in programs to improve the care and outcomes of individuals with heart and vascular disease FY 2017 Report of Activities In FY 2017, SGH's Cardiac Rehabilitation Department provided education and support to patients and community members impacted by congestive heart failure (CHF). A free, monthly CHF class and support group provided nearly 120 individuals with a supportive environment to discuss various topics about living well with CHF. A free Heart and Vascular Risk Factors Education class was offered twice a month to individuals who were hospitalized within the last six months due to select heart conditions, reaching more than 200 individuals. SGH's Cardiac Training Center and Cardiac Rehabilitation Departments participated in a variety of community events throughout San Diego in FY 2017. Together, they offered community members free blood pressure screenings, cardiopulmonary resuscitation (CPR) demonstrations, and cardiac health education and resources, including prevention, symptom recognition, evaluation and treatment. Events included the Sharp Disaster Preparedness Expo, Sharp's free Sweetheart Heartsaver CPR course and dinner for couples, Coronado High School health fair, Celebrando Latinas, the AHA Heart & Stroke Walk and the annual Sharp Women's Health Conference. In addition, the Cardiac Rehabilitation team collaborated with the SGH Senior Resource Center to educate nearly 20 seniors at the Herrick Community Health Care Library about the importance of exercise and nutrition to maintain a healthy heart in February. Further, the Cardiac Rehabilitation team provided free flu shots to more than 15 community seniors during a flu clinic held at the hospital in October. In April, SGH held its annual Heart Health Expo to help community members live long, heart-healthy lives through the provision of information on strategies for heart disease prevention as well as the latest treatments for heart disease, weakened arteries, and more. The free community event featured a heart-healthy breakfast and health screenings for blood pressure, cholesterol and glucose. Exhibitor tables highlighted various hospital services including nutrition, cardiac rehabilitation, heart and vascular, stroke, and senior services, as well as local organizations to connect attendees to community resources, including the AHA, Mended Hearts, San Diego Oasis and John A. Davis Family YMCA. In addition, SGH offered education on appropriate treatment options for heart-related conditions - including self-dissolving stents to help open blocked blood vessels and minimally invasive techniques for treating aneurysms - from cardiovascular care experts. A question-and-answer session was also offered to encourage individuals to ask heart health questions. In honor of National CPR and Automated External Defibrillator (AED) Awareness Week in June, the Cardiac Training Center invited children ages 10 and older from the community to a free CPR/AED class and demonstration at Briercrest Park in La Mesa. During the event, the Cardiac Training Center provided free CPR lessons and CPR/AED educational materials to help raise awareness and increase bystander response rates in cardiac emergencies. Throughout FY 2017, SGH-affiliated cardiologists shared heart-related information with local news outlets, including FOX 5 San Diego and The East County Californian. Topics included the differences between heart attack, heart failure and stroke; the symptoms of heart disease; and the six surprising signs of heart disease. Throughout the year, SGH provided expert speakers on heart disease and heart failure at professional conferences and events. This included SGH's eighth annual Heart and Vascular Conference in October, a two-day event where more than 400 health care professionals - including physicians, nurses and allied health workers caring for patients with cardiovascular disease - received education on advances in cardiovascular care at the U.S. Grant Hotel. In November and May, SGH participated in the 11th and 12th semiannual meetings of Southern California VOICe (Vascular Outcomes Improvement Collaborative), which included more than 40 regional vascular physicians, nurses, epidemiologists, scientists and research personnel working together to collect and analyze vascular data in an effort to improve patient care. SGH shared its expertise on the use of data processes to improve outcomes, compliance to standards, and care. SGH continued to participate in programs to improve the care and outcomes of individuals with heart and vascular disease. To help improve care for acutely ill patients in SDC, SGH provided data on STEMI (ST-elevation myocardial infarction or acute heart attack) to the County of San Diego EMS. Sharp also hosted the quarterly County of San Diego EMS Advisory Council for STEMI at Sharp's System Offices. Additionally, SGH provided its Peripheral Vascular Disease Rehabilitation Program to provide education and coaching on exercise, diet and medication to keep patients - particularly low-income patients - at the highest functional level. The program is partially funded by donations to the Grossmont Hospital Foundation to help defray the cost for patients with limited resources. SGH's cardiac team is committed to supporting future health care leaders through active participation in student training and internship programs. In FY 2017, the team spent more than 430 hours mentoring more than 30 students from Azusa Pacific University (APU), San Diego State University (SDSU), University of California (UC), San Diego, Grossmont College, National University and Western University of Health Sciences, including students with an interest in a career as a nurse or cardiovascular technician. FY 2018 Plan SGH will do the following: * Provide a free monthly CHF class and support group * Provide free bimonthly Heart and Vascular Risk Factor Education classes * Provide cardiac and vascular risk factor education and screening at community events * Provide one cardiac health lecture and a Cardiovascular Expo for community members * Pursue additional research opportunities to benefit patients and community members * As invited, offer educational speakers to the professional community on topics such as performance improvements in CHF and acute myocardial infarction, and cardiovascular treatment options * Provide a conference on heart and vascular disease for community physicians andother health care professionals * Continue to provide student learning opportunities * Continue to provide data on STEMI to the County of San Diego EMS * Continue to provide the Peripheral Vascular Disease Rehabilitation Program Identified Community Need: Diabetes Education, Prevention and Support Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify Type 2 diabetes as one of six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA continued to identify Type 2 diabetes as one of the top four priority health issues affecting community members in SDC. * Data analysis in the 2016 CHNAs revealed a higher rate of hospital discharges due to diabetes in more vulnerable communities within SDC's east region, such as El Cajon and Jacumba (Dignity Health, SanGIS, OSHPD & SpeedTrack Inc., 2015). * Sharp diabetes educator discussions conducted as part of the SGH 2016 CHNA process identified several challenges to health improvement among their diabetes patients, including: accessing a physician; finding support programs; getting outpatient needs met (i.e., appointments with psychologists or endocrinologists); and a lack of diabetes education coverage under Medi-Cal.
Form 990, Part III, Line 4a Community Benefit Report	* The Sharp diabetes educator discussions also identified the following barriers to adopting healthy behaviors among diabetes patients: affordability of glucose testing strips; unmet behavioral health needs; food insecurity; and knowledge of benefits. * According to data presented in the SGH 2016 CHNA, diabetes is a major cause of heart disease and stroke. The CDC also identifies diabetes as a leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults in the U.S. (CDC, 2014). * According to diabetes data analyzed in the SGH 2016 CHNA process, among SDC patients with a primary diagnosis of a diabetes-related ICD-9 code in 2013, 'Diabetes...Uncontrolled' was the top inpatient primary diagnosis related to Type 2 diabetes for individuals ages 15 to 24 and ages 45 and older. Among individuals ages 25 to 44, the top inpatient primary diagnosis was 'Abnormal Glucose Tolerance of Mother with Delivery,' followed by 'Diabetes...Uncontrolled.' * In 2015, diabetes was the seventh leading cause of death in SDC's east region. * In 2015, there were 135 deaths due to diabetes in SDC's east region. The region's age-adjusted death rate due to diabetes was 24.2 per 100,000 population, higher than the overall SDC age-adjusted rate (21.0 deaths per 100,000 population). * In 2015, there were 865 hospitalizations due to diabetes in SDC's east region. The age-adjusted rate of hospitalizations for diabetes was 170.3 per 100,000 population. This rate was the second highest among all SDC regions and higher than the age-adjusted rate of hospitalization for SDC overall (123.1 per 100,000 population). * In 2015, there were 918 diabetes-related ED discharges in SDC's east region. The age-adjusted rate of diabetes-related ED discharges was 183.1 per 100,000 population. This was the second highest rate among all SDC regions and was higher than the age-adjusted rate for SDC overall (143.5 per 100,000 population). * According to the 2016 CHIS, 10.2 percent of adults living in SDC's east region indicated that they had ever been diagnosed with diabetes, which was higher than SDC overall (7.8 percent) and the state of California (9.1 percent). Diabetes rates among seniors were particularly high, with 22.3 percent of east region adults over 65 reporting that they had ever been diagnosed with diabetes. * According to 2016 CHIS data, 16.2 percent of residents in the east region had been told by their doctor that they have pre- or borderline diabetes, compared to 11.7 percent of residents in SDC overall. * According to the 2012 report from HHSA titled Critical Pathways: The Disease Continuum, the most common behavioral and social risk factors associated with Type 2 diabetes include substance use, physical inactivity, poor nutrition, poor medical care and irregular health checks (e.g., A1C, dental, eye and foot). * According to the CDC's 2017 National Diabetes Statistics Report, 87.5 percent of adults diagnosed with diabetes were overweight or obese. To prevent or delay the onset of diabetes, the CDC recommends lifestyle changes such as losing weight, eating healthier, and getting regular physical activity. * A study by the University of California, Los Angeles (UCLA) Center for Health Policy Research found that 13 million adults in California (46 percent) are estimated to have prediabetes or undiagnosed diabetes, while another 2.5 million (9 percent) have already been diagnosed with diabetes (UCLA Center for Health Policy Research, 2016). * The CDC estimates that 30.2 million people in the U.S. have diabetes. Of those individuals, 23 million have been diagnosed while 7.2 million are undiagnosed (National Diabetes Statistics Report, 2017). * According to the CDC, prevention efforts such as the Diabetes Prevention Program can cut the risk of developing diabetes by more than half. However California has been slow to devote state money to such programs. A report by the California State Auditor found that in 2012-2013, California's per capita funding for diabetes prevention was the lowest in the nation at just three cents per person (California State Auditor, 2015). * According to the American Diabetes Association (ADA), diabetes treatment costs California approximately $27.6 billion per year, with Medi-Cal and Medicare bearing the majority of the state's burden (ADA, 2015). Objectives * Provide diabetes education, prevention and support in the east region of SDC * Collaborate with community organizations and projects to provide diabetes education to SDC's vulnerable populations * Participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community FY 2017 Report of Activities The SGH Diabetes Education Program is recognized by the ADA for meeting national standards for excellence and quality in diabetes education. The program provides individuals and their support system with the skills needed to successfully self-manage their diabetes. Small group and one-on-one education options are offered in English and Spanish. In FY 2017, the SHC Diabetes Education Program provided diabetes education and support to approximately 1,000 attendees at the Sharp Women's Health Conference. This included diabetes risk assessments using the ADA's Diabetes Risk Test questionnaire as well as resources on prediabetes, diabetes management and nutrition. In addition, a diabetes educator presented on how to control blood sugar levels, diabetes risk factors, behaviors that can reduce the risk of complications, and the long-term investments needed for successful management. Further, in October, the SHC Diabetes Education Program provided fundraising and team participation for the ADA's Step Out Walk to Stop Diabetes held at the Embarcadero Marina Park South. The SHC Diabetes Education Program provided education to various community groups throughout the year. In collaboration with the SGH Senior Resource Center, the program provided a lecture on diabetes and the power of lifestyle change to nearly 15 senior community members at the Dr. William C. Herrick Community Health Care Library. The SHC Diabetes Education program also provided two lectures on prediabetes, risk factors, nutrition, and lifestyle tools for prevention to six community members at the SGH Brier Patch campus. In addition, the program continued to collaborate with Family Health Centers of San Diego (FHCSD) to provide diabetes education to FHCSD diabetic patients at multiple sites throughout SDC, including those in the east region, through FHCSD's Diabetes Management Care Coordination Project (DMCCP). DMCCP provides FHCSD diabetes patients with weekly group health and nutrition education, healthy cooking demonstrations, physical activity classes, and one-on-one support from a nurse practitioner. In addition, project "graduates" offer peer support and education to current project enrollees in both English and Spanish. The project monitors enrollees' A1C and blood glucose levels and physical activity, and has proven successful outcomes in lowering and maintaining these levels. The project monitors enrollees' physical activity, as well as their A1C and blood glucose levels which it has proven to successfully maintain and lower. At FHCSD's Lemon Grove site, SHC diabetes educators provided five lectures to more than 60 community members. Topics included creating an active lifestyle, nutrition, diabetes self-management, goal setting, and diabetes risk factors, symptoms and treatment. In 2017, participants with more severe cases of diabetes (i.e., higher blood glucose levels) compared to the overall group experienced a decrease of 37 percent in blood glucose levels.
Form 990, Part III, Line 4a Community Benefit Report	The SHC Diabetes Education Program is an affiliate of the California Diabetes and Pregnancy Program's Sweet Success Program, which provides comprehensive technical support and education to medical personnel and community liaisons to promote improved outcomes for high-risk pregnant women with diabetes. As an affiliate, the SHC Diabetes Education Program educates underserved pregnant women and breastfeeding mothers with Type 1, Type 2 or gestational diabetes (diabetes developed during pregnancy) on how to manage their blood sugar levels. In collaboration with community clinics, in FY 2017 the team provided these patients with a variety of education and resources, including gestational diabetes statistics; new diagnostic criteria; treatment and management of blood glucose levels; goals for blood sugar levels before and after a meal; insulin requirements; self-care practices; nutrition and meal planning; exercise and weight management; monitoring fetal movement; and the risks and complications of uncontrolled diabetes. Clinic patients also received logbooks to track and manage their blood sugar levels. In addition, the SHC Diabetes Education Program evaluated patients' management of their blood sugar levels and collaborated with community clinics' obstetrician/gynecologists to prevent complications. At SGH, the SHC Diabetes Education Program provided services and education to nearly 220 underserved pregnant women with diabetes. In FY 2017, the SHC Diabetes Education Program continued to provide services and resources to meet the needs of San Diego's newly immigrated Iraqi Chaldean population. The program facilitated translation as well as provided resources to better assist Chaldean cultural needs. Educational resources included How to Live Healthy With Diabetes; What You Need to Know About Diabetes; All About Blood Glucose for People With Type 2 Diabetes; All About Carbohydrate Counting; Getting the Very Best Care for Your Diabetes; All About Insulin Resistance; All About Physical Activity With Diabetes; Gestational Diabetes Mellitus Seven-Day Menu Plan; Food Groups; and Arabic language materials about pregnancy. Handouts were provided in Arabic, Somali, Tagalog, Vietnamese and Spanish, and live interpreter services were available in more than 200 languages via the Stratus Video Interpreting iPad application. The team also distributed food diaries and logbooks for blood sugar level tracking to these community members. Further, Sharp team members received education regarding the different cultural needs of these diverse communities. In FY 2017, the SHC Diabetes Education Program supported the professional health care community through participation in the ADA's 77th Scientific Sessions conference at the San Diego Convention Center. The conference theme was Experience New Horizons in Diabetes, which taught more than 13,000 international attendees about the most significant advances in diabetes care and research. During the conference, the SHC Diabetes Education Program shared an abstract titled Clinical Dashboard to Evaluate and Monitor Institutional Quality and Effectiveness of Diabetes Crisis Management. The abstract was designed to help frontline caregivers decrease variations in care and measure the effectiveness of improving the application of the diabetes crisis algorithm in order to better treat serious metabolic complications of diabetes. The SHC Diabetes Education Program improved the dashboard by adding variables such as the time spent in the emergency room, the time to start insulin infusion, and the transfer time from the intensive care unit. Further, in FY 2017 the SHC Diabetes Education program provided diabetes education to nurse practitioner students at SDSU, while the SGH Diabetes Education Program mentored a dietitian intern from the San Diego Women, Infants and Children (WIC) program. FY 2018 Plan The SGH Diabetes Education Program will do the following: * Provide community members with prediabetes and diabetes information at various community venues in SDC's east region * Explore additional collaborations to assist and educate food insecure community members * Participate in Sharp's partnership with the City of San Diego to provide diabetes education and resources to employees and residents in the city's nine districts * Continue to foster relationships and collaborate with FHCSD to provide education and resources to their diabetic patients * Continue to provide gestational services and resources to underserved pregnant women, both at the hospital and in collaboration with community clinics * Participate in Tour de Cure - the ADA's signature fundraising event to fight diabetes and its burdens * Maintain up-to-date resources to support community members with diabetes treatment and prevention, particularly foreign language and culturally appropriate resources for diverse populations * Continue to participate in local and national professional conferences - including those held by the ADA, American Association of Diabetes Educators and the San Diego Association of Diabetes Educators - to share best practices in diabetes treatment and control with the broader health care community * Conduct educational outpatient and inpatient symposiums for health care professionals Identified Community Need: Health Education, Screening and Support for Seniors Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA continued to identify senior health as one of six top priority health issues for community members served by SGH. * The HASD&IC 2016 CHNA continued to identify dementia and Alzheimer's disease among the top 15 priority health conditions seen in SDC hospitals. * As part of the SGH 2016 CHNA, discussions held with nurses and social workers from Sharp's Senior Health Centers identified the following challenges to improving the health of seniors in SDC: access to care issues due to aging, decreased driving or loss of support system; difficulty purchasing medications due to financial issues, lack of transportation or lack of motivation; difficulty understanding medical instructions; inability to recognize a health problem exists; memory issues; and the perception that health issues and loneliness are a normal part of aging. * Sharp senior health discussions held as part of the SGH 2016 CHNA process identified the most common health-related issues or needs as: anxiety; cardiac disease; cognitive impairment and dementia; depression; diabetes; psychosis and chronic mental illness (specific to the population served by the Downtown Senior Health Center); hypertension; increased need for caregivers; isolation, contributing to poor diet, bad habits, and depression; loss of purpose; and substance abuse, particularly for prescription drugs. * Seniors participating in the SGH 2016 CHNA Health Access and Navigation Survey prioritized the following barriers to accessing health care: understanding health insurance, including confusing terms; knowing where to go for care, especially understanding when to use the ED, urgent care and primary care; using health insurance, including understanding health care costs/bills and knowing what services are covered; getting health insurance; and follow-up care, including understanding next steps and finding available appointments. * In 2015, Alzheimer's disease was the third leading cause of death in SDC's east region. * In 2015, the top 10 leading causes of death among senior adults ages 65 and older in SDC's east region were (in rank order): overall cancer, CHD, Alzheimer's disease and other dementias (ADOD), chronic obstructive pulmonary disease (COPD)/chronic lower respiratory diseases, stroke, overall hypertensive diseases, diabetes, unintentional injuries, Parkinson's disease, and falls. * In 2015, seniors in SDC's east region experienced higher rates of hospitalization for all major causes, when compared to SDC overall. * The top three causes of ED utilization among SDC's east region residents ages 65 years and older in 2015 were falls, COPD and overall hypertensive diseases. * In 2012, 71,655 calls were made to 911 for seniors in need of emergency medical care in SDC, which represents a call for one out of every five seniors. Seniors in SDC use the 911 system at higher rates than any other age group (HHSA, 2015). * A 2016 HHSA report titled Identifying Health Disparities to Achieve Health Equity in San Diego County: Age found that seniors in SDC's east region have disproportionately high death rates for cancer, COPD, CHD, and stroke when compared to other seniors in the county overall.
Form 990, Part III, Line 4a Community Benefit Report	* According to the CDC, 2.8 million older adults are treated in the ED for falls every year. One in five falls causes a serious injury, such as broken bones or a head injury. These injuries may result in serious mobility issues and difficulty with everyday tasks or living independently. The direct medical costs for fall injuries are estimated at $31 billion annually (CDC, 2017). * In 2013, an estimated 62,000 San Diegans 55 and over were living with ADOD. One quarter of these residents were living in the east region. Between 2013 and 2030, the number of east region residents living with ADOD is projected to increase by 39.7 percent (Alzheimer's Disease and Other Dementias in San Diego County, HHSA, 2016). * In 2016, an estimated 54.9 percent of SDC's east region residents ages 65 and older reported that they were vaccinated for influenza in the past 12 months (CHIS, 2016). In 2015, almost two-thirds of the influenza hospitalizations and 13 of the 14 influenza deaths in the east region were experienced by residents ages 65 and older (HHSA, 2015). * Research shows that caregiving can have serious physical and mental health consequences. According to findings from the Stress in America survey, described in a report titled Valuing the Invaluable, caregivers to older relatives report poorer health and higher stress levels than the general population. Fifty-five percent of surveyed caregivers reported feeling overwhelmed by the amount of care their family member needs (American Association of Retired Persons (AARP) Public Policy Institute, updated July 2015). * According to a report from the National Alliance for Caregiving (NAC) and the AARP titled Caregiving in the U.S. 2015, an estimated 34.2 million adults have provided unpaid care to an adult age 50 or older in the past 12 months. In addition, 60 percent of unpaid caregivers are female, and nearly 1 in 10 caregivers are ages 75 or older (AARP and NAC, 2015). * The UCLA Center for Health Policy Research conducted a study highlighting the plight of California's "hidden poor," finding 772,000 seniors who live in the gap between the FPL and the Elder Economic Security Standard. The highest proportion of seniors living in this gap includes renters, Latinos, women, and grandparents raising grandchildren (Padilla-Frausto, & Wallace, 2015). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * Provide daily telephone reassurance/safety check calls to ensure the safety of homebound seniors and disabled adults in SDC's east region * In collaboration with community partners, offer seasonal flu vaccination clinics at convenient locations for seniors and high-risk adults in the community * Serve as a referral resource to additional support services in the community for senior residents in SDC's east region * Provide education and community resources to caregivers * Maintain and grow partnerships with community organizations to expand community outreach and provide community members with updated information on available services and resources FY 2017 Report of Activities Sharp Senior Resource Centers meet the unique needs of seniors and their caregivers by connecting them to a variety of free and low-cost programs and services through email, phone and in-person consultations. The Sharp Senior Resource Centers' compassionate staff and volunteers provide personalized support and clear, accurate information regarding health education and screenings, community referrals and caregiver resources. In FY 2017, the SGH Senior Resource Center developed and mailed quarterly calendars of its programs and services to more than 6,900 households in SDC's east region, as well as distributed approximately 4,000 Vials of Life, which are small vinyl sleeves that can be magnetically placed on a refrigerator to provide emergency personnel with critical medical information for seniors and disabled people. The SGH Senior Resource Center provides a telephone reassurance and safety check program for isolated or homebound seniors and disabled community members living in SDC's east region. Through the program, SGH Senior Resource Center staff and volunteers place daily computerized phone calls to participants at regularly scheduled times. In the event that staff members do not connect with participants, a phone call is placed to family members or friends to ensure the participant's safety. In FY 2017, staff placed more than 4,700 phone calls to approximately 15 seniors and disabled community members, as well as more than 50 follow-up phone calls to family and friends. In FY 2017, the SGH Senior Resource Center reached more than 640 community members through more than 30 free health education programs held on the SGH campus and at the Grossmont HealthCare District Conference Center in SDC's east region. Programs were presented by experts from community organizations as well as Sharp professionals with expertise in physical therapy, diabetes, bereavement, finance, nutrition, nursing, advance care planning (ACP), and rehabilitation. Educational topics included ACP, tools and resources for caregivers, diabetes, Medicare, memory loss, coping with grief and bereavement, tax planning, healthy eating in the new year, heart health, caring for someone with dementia, osteoporosis and preventing fractures, wills and trusts, maintaining a healthy voice, reverse mortgages and gift annuities, home and memory care, finding reliable health information, understanding hospice and how to talk to a doctor. In addition, more than 180 community members were reached through a series of clinical lectures provided by an audiologist, a psychologist, an interventional neuroradiologist, and neurologists covering mental health, neuropathy, recent advances in stroke treatment, restful sleep and digital hearing aids. Further, the SGH Senior Resource Center provided presentations to more than 500 community members on senior services, aging sensitivity and experiencing aging at various locations throughout SDC's east region, including but not limited to Lakeside, El Cajon and Spring Valley, as well as the City of San Diego. Throughout the year, the SGH Senior Resource Center provided seven health screening events at various sites in SDC's east region, reaching approximately 150 members of the senior community. This included four balance and fall prevention screenings, a carotid artery screening, a stroke screening, and a depression screening. In addition, the SGH Senior Resource Center reached nearly 570 community members through more than 40 free blood pressure screenings. As a result of these screenings, 12 seniors were referred to physicians for follow-up care. Screenings were provided at the SGH campus, McGrath Family YMCA in Spring Valley, William C. Herrick Community Health Care Library, La Mesa Adult Enrichment Center, JFS College Avenue Center and Lakeside Community Center, as well as at community health fairs and special events. In FY 2017, the Sharp Senior Resource Centers helped sponsor three conferences for approximately 200 community members who were providing care for a friend or family member. In May, the Sharp Senior Resource Centers collaborated with the Caregiver Coalition of San Diego to provide the Finding the Balance in Caregiving conference at the Chinese Community Center in Tierrasanta. The conference provided education from a social worker, caregiving expert, registered nurse (RN) and attorney on a variety of legal and practical caregiving topics, as well as provided a resource fair for caregivers and their loved ones. In August, the Sharp Senior Resource Centers partnered with the Caregiver Coalition of San Diego and the National Alliance on Mental Illness to provide a conference at First United Methodist Church called A Day for Caregivers: Caring for an Adult Loved One with Mental Health Challenges. This conference provided presentations about self-care, the group wisdom of caregivers, communication skills, legal issues and peer recovery programs, as well as a resource fair. In addition to event coordination at the conferences, the SGH Senior Resource Center provided Vials of Life, senior resources, and information about its services to community members. Further, in collaboration with the Caregiver Coalition of San Diego, the SGH Senior Resource Center sponsored the Fall Prevention and Safety for You and Your Loved One conference at the La Mesa Community Center in September. At the event, the SGH Senior Resource Center provided educational programs and community resources, as well as a presentation that provided strategies for offering help to a loved one. Other topics included balance and fall prevention, exercises, home safety, and medical equipment that can help someone live safely in their home.
Form 990, Part III, Line 4a Community Benefit Report	In April, the SGH Senior Resource Center partnered with Sharp HospiceCare and the City of La Mesa to provide a conference titled Planning for Physical, Mental and Financial Health for community seniors and their families. Held at the La Mesa Community Center, the free conference provided approximately 100 attendees with educational presentations from a physician, attorney, psychologist, registered dietitian (RD), ACP specialist, and other experts on how to plan for a healthier, happier and financially sound future. In July, the SGH Senior Resource Center provided Vials of Life, community resources, and information about its screening events and senior programs at Sharp HospiceCare's Advanced Illness Management (AIM): Referring at the Right Time conference held at Paradise Point Resort & Spa. Nearly 40 physicians, nurses, chaplains, bereavement counselors and other health care providers attended this event, which focused on training health professionals to identify AIM-appropriate patients and provide appropriate palliative care and referrals. The SGH Senior Resource Center also provided blood pressure screenings, Vials of Life, caregiver and community resources and information about its services to more than 110 seniors at the AIS 2017 Vital Aging conference, as well as the SGH Heart Health Expo, a free event offering education and screenings for heart health. Throughout the year, the SGH Senior Resource Center both hosted and participated in health fairs and events throughout SDC's east region. This included the provision of blood pressure screenings and educational resources to more than 1,000 community seniors and caregivers at the Lakeside Community Center, Meadowbrook Mobile Home Estates in Santee, Meadows Mobile Home Park in El Cajon, George L. Stevens Senior Center, La Mesa Community Center, San Diego LGBT Community Center, JFS College Avenue Center, La Vida Real senior community, Grossmont Center, First United Methodist Church, McGrath Family YMCA in Spring Valley and SGH. New in FY 2017, the SGH Senior Resource Center provided four educational sessions on senior services, telephone reassurance calls and Vials of Life to approximately 60 firefighters from the Barona, El Cajon, Santee and Sycuan Fire Departments. The SGH Senior Resource Center coordinated these sessions for the fire departments, which included education from the AIS on elder abuse, mandated reporting requirements and services available through the HHSA. In addition, Alzheimer's San Diego provided education on dementia and information on communication, behaviors and more at the event. Beginning in June, the SGH Senior Resource Center sponsored the Grossmont Mall Walkers, a free fitness program to encourage physical activity among community adults and seniors. Every Saturday, participants gathered at Grossmont Center to walk around the mall and perform gentle exercises led by an instructor from the SGH Senior Resource Center intended to improve balance and strength, and maintain a healthy lifestyle. In FY 2017, more than 470 community members joined the Grossmont Mall Walkers. Throughout FY 2017, the SGH Senior Resource Center continued to coordinate the notification of availability and provision of seasonal flu vaccines in selected community settings. Seniors, caregivers and high-risk adults with limited access to care were alerted through activity calendars, collaborative outreach conducted by the flu clinic site, Sharp.com and paper and electronic newspaper notices. In FY 2017, the SGH Senior Resource Center provided more than 500 seasonal flu vaccinations to high-risk adults with limited access to health care, including seniors without transportation, those with chronic illnesses and caregivers. Vaccinations were offered at 12 community sites, including the Lemon Grove Senior Center, JFS College Avenue Center, La Mesa Community Center, Lakeside Community Center, Journey Community Church, Salvation Army of El Cajon, La Mesa Adult Enrichment Center, food banks in Santee and Spring Valley, and SGH. In addition to providing flu vaccinations at these sites, the SGH Senior Resource Center offered activity calendars detailing upcoming blood pressure and flu clinics, health screenings and community senior programs as well as provided Vials of Life and information regarding telephone reassurance calls. At the food banks, the SGH Senior Resource Center provided vaccines not only to seniors, but also to pregnant women and high-risk community members, many of whom were uninsured or had limited access to transportation. Throughout the year, the SGH Senior Resource Center maintained active relationships with organizations that enhance professional networking and provide quality programming for seniors in SDC's east region. Organizations included the Caregiver Coalition of San Diego (the Caregiver Education Committee), ECAN, ECSSP, AIS Health Promotion Committee and Meals on Wheels Greater San Diego East County Advisory Board. FY 2018 Plan SGH Senior Resource Center will do the following: * Provide resources and support to address relevant concerns of community seniors and caregivers through in-person and phone consultations * Provide community health information and resources through educational programs, monthly blood pressure clinics and a minimum of five health screenings * Collaborate with Sharp experts and community partners to provide approximately 35 seminars that focus on issues of concern to seniors * Provide six additional community presentations on senior services and caregiving * Participate in 12 community health fairs and events targeting seniors * Collaborate with the East County YMCA, AIS and ECAN to provide a healthy living conference for seniors * In collaboration with the Caregiver Coalition of San Diego, coordinate a conference dedicated to family caregiver issues * In collaboration with Sharp HospiceCare, host an aging conference for seniors * Provide telephone reassurance calls to seniors and disabled adults in SDC's east region * Provide approximately 4,000 Vials of Life to senior community members * Produce and distribute quarterly calendars highlighting events of interest to seniors and family caregivers * Collaborate with community organizations to provide 13 opportunities for seasonal flu vaccinations to community members facing barriers to accessing care, including homeless persons * Maintain and grow active relationships with organizations that serve seniors in SDC's east region * In partnership with San Diego Oasis and SGH clinical experts and affiliated physicians, provide a monthly educational program on health and wellness topics for seniors (e.g., vascular disease, fall prevention, stroke, etc.) Identified Community Need: Cancer Education and Support, and Participation in Clinical Trials Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA identified cancer as one of six top priority health issues for community members served by SGH. * The HASD&IC 2016 CHNA continued to identify various types of cancer among the top priority health conditions seen in SDC hospitals. * Sharp cancer navigator discussions conducted as part of the SGH 2016 CHNA process identified the following chief concerns for cancer patients in SDC (including patients in the east region): cultural differences and language barriers between patient and provider; health literacy; financial issues; knowing where to go for care; availability of reliable transportation; difficulty with end-of-life conversations; and lack of advance care directives among cancer patients. * According to 2016 Sharp oncology data, 196 (38 percent) of the 517 SGH cancer patients who received the cancer psychosocial distress screening scored at a range of moderate to severe distress, and were referred to internal or external resources such as social workers or community cancer resources. * The most frequently observed cancers at SGH in 2016 were (in rank order): breast cancer, lung cancer, prostate cancer, colorectal cancer, and female (gynecology) genitourinary cancers. In total, there were 1,493 new cases of cancer at SGH in 2016. * The cancer key informant interview conducted as part of the SGH 2016 CHNA process identified access to insurance, access to appropriate care, and language barriers for non-English speakers as major challenges facing oncology patients. Additional issues include financial, legal, and survivorship issues; emotional, sexual and body image issues; lack of a social network leading to increased need for transportation, in-home support and other treatment-related resources; and end-of-life or palliative care issues.
Form 990, Part III, Line 4a Community Benefit Report	* The cancer key informant interview recommended the following strategies to address barriers of care for those with cancer: the provision of lay navigators, including integration of navigators into the care process; community coordinators with knowledge of hospital needs and community resources; greater hospital and community partnerships; resources to educate providers on end-of-life and palliative care issues; personnel within the health care system to identify resources and answer questions; financial assistance for co-pays, prescriptions, child care and other bills; and survivorship clinics. * As part of the SGH 2016 CHNA process, cancer support group patients participating in the Health Access and Navigation Survey suggested the following areas for improvement in cancer care: more time with doctors; more comprehensive educational groups; a navigator staff member or case manager for all oncology patients, not just newly diagnosed; help navigating health insurance options to identify the best coverage for individual needs; and tours specifically for patients who have a serious illness requiring multiple treatments. * In 2015, cancer was the leading cause of death in SDC's east region and was responsible for 24.1 percent of all deaths. * There were 921 deaths due to cancer (all types) in SDC's east region in 2015. The region's age-adjusted death rate due to cancer was 166.9 deaths per 100,000 population, which is higher than the overall SDC age-adjusted rate of 148.3 per 100,000 population and higher than the HP2020 target of 161.4 deaths per 100,000 population. * In 2015, the east region's age-adjusted death rates were higher than the rates for SDC overall for at least 14 different cancers. * In 2015, 20 percent of all cancer deaths in SDC's east region were due to lung cancer, 9 percent to colorectal cancer, 9 percent to female breast cancer, 6 percent to prostate cancer, 6 percent to pancreatic cancer, and 5 percent to female reproductive cancer (Live Well San Diego, 2015). * By 2018, total cancer cases in SDC are expected to grow by 11.7 percent (California Cancer Registry, 2013; Truven Health Analytics Market Discovery Planning). * According to the American Cancer Society (ACS) Cancer Statistics Center, in 2017 there will be an estimated 27,980 new cases of breast cancer and 4,400 breast cancer deaths for females in California. * In 2015, the age-adjusted mortality rate of breast cancer in the east region was 28.0 per 100,000 population. In SDC overall, the rate was 19.4 per 100,000 population. This represented a 24 percent increase from 2014 and exceeded the HP2020 target of 20.7 breast cancer deaths per 100,000 women. * According to the 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile, in SDC there were 46.1 late-stage cases of breast cancer per 100,000 women, exceeding the HP2020 target of 42.1 cases per 100,000 women. The report projects that SDC will meet the HP2020 target within five years. * The 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile also reported that, in 2013, breast cancer mortality rates in SDC were highest among African American women, at 27.7 deaths per 100,000 women. This exceeded the mortality rate for Caucasian (23.9), Latina (17.3), and Asian/Pacific Islander (13.2). * According to the ACS 2017 California Cancer Facts & Figures report, 72.4 percent of breast cancer cases among non-Hispanic white women in SDC were diagnosed at an early stage, compared with 69.3 percent of African American cases, 68.1 percent of Hispanic cases and 70.4 percent of Asian/Pacific Islander breast cancer cases. Data suggests that early detection resources are needed in minority communities. * According to 2015-2016 CHIS data, 85.7 percent of women in SDC's east region ages 50 to 74 reported having a mammogram in the past two years. This exceeds the HP2020 target of 81.1 percent for breast cancer screenings. Approximately 4.9 percent of SDC east region women in this age range reported that they have never had a mammogram. * According to the findings of the ACS 2017 California Cancer Facts & Figures report, screening offers the ability for secondary prevention by detecting cancer early. Regular screenings that allow for the early detection and removal of precancerous growth are known to reduce mortality for cancers of the cervix, colon, and rectum. Five-year relative survival rates for common cancers are 93 to 100 percent if they are discovered before having spread beyond the organ where the cancer began. * Study findings from the 2015 Susan G. Komen for the Cure(r) San Diego Affiliate Community Profile indicate a critical need for culturally competent outreach, especially for Hispanic, Middle Eastern, and African American women (Susan G. Komen, 2015). * The American Society of Clinical Oncology (ASCO) emphasizes the importance of patient navigators as part of a multidisciplinary oncology team with the goal of reducing mortality among underserved patients. Some of the tasks a patient navigator may assist with include: psychosocial support; assistance with treatment decisions; assistance with insurance issues; arrangement of transportation; coordination of additional services (i.e., fertility preservation); and tracking of interventions and outcomes. The navigator works with the patient across the care continuum, ensuring coordination and efficiency of care, and removal of barriers to care (ASCO, 2016). * According to the National Institutes of Health, clinical trials are part of clinical research and are at the heart of all medical advances. Clinical trials look at new ways to prevent, detect or treat disease, with the goal to determine the safety and efficacy of a new test. Clinical trials also examine other aspects of care, such as improving the quality of life for people with chronic illnesses. If clinical trials are to be successful, it is critical that more people are involved. Objectives * Provide cancer education and support to patients and community members * Provide cancer resources and education at community events * Provide cancer patient navigation and support services to the community * Participate in cancer clinical trials, including screening and enrolling patients FY 2017 Report of Activities Note: SGH is accredited by the National Accreditation Program for Breast Centers, indicating the highest standard of care for patients with diseases of the breast. Sharp (including Sharp Memorial Hospital (SMH), SGH, and Sharp Chula Vista Medical Center (SCVMC)) is also accredited by the American College of Surgeons Commission on Cancer as an Integrated Network Cancer Program, demonstrating its commitment to meet rigorous standards and improve the quality of care for patients with cancer. In FY 2017, the SGH Cancer Center provided education on cancer, breast self-examination demonstrations, breast cancer awareness, and resources from the ACS and National Cancer Institute to approximately 500 individuals at community events, including ECAN's annual Spring Into Healthy Living senior health and wellness fair, San Diego International Film Festival event, Women's Fitness World in Chula Vista and San Diego East County Chamber of Commerce's Health Fair Saturday at Grossmont Center. At Sharp's annual Women's Health Conference in April, the SGH Cancer Center offered cancer education, health screening recommendations for various age groups, breast self-exam demonstrations and cards, information about skin checks and melanoma, and literature on cancer care and prevention including risk reduction through lifestyle changes to approximately 1,000 community members. In October, the SGH Cancer Center participated in a seminar titled Breast Cancer: How Diet and Exercise Can Reduce Your Risk at Sharp System Offices. During the seminar, the SGH Cancer Center offered information on early detection of breast cancer, nutrition and support programs as well as provided a geneticist, navigators and dietitians to answer attendees' questions. Further, SGH Cancer Center staff walked alongside cancer patients and families in the ACS Making Strides Against Breast Cancer Walk in October. Throughout the year, the SGH Cancer Center continued to collaborate with Chaldean and Middle-Eastern community leaders in El Cajon to determine the most common barriers to obtaining breast health care among the Middle-Eastern community as well as how to provide appropriate, culturally sensitive educational materials and trainings for this population.
Form 990, Part III, Line 4a Community Benefit Report	In FY 2017, the SGH Cancer Center provided a variety of free support groups for approximately 85 community members impacted by cancer. Offered twice monthly, the breast cancer support group allowed women in all stages of breast cancer - from recent diagnosis, to treatment and survivorship - to share experiences and discover coping strategies. The lung cancer support group was offered monthly to meet the educational and emotional needs of people living with or caring for someone with lung cancer. This group provided encouragement and hope in a safe environment as well as an opportunity to explore important issues that arise when coping with any phase of treatment. The weekly Art and Chat support group offered cancer patients, survivors and their loved ones a combination of conversation and relaxing drawing methods to increase focus, creativity, self-confidence and personal well-being. The SGH Cancer Center also offered a monthly Man Cave support group for men with cancer, which provided a safe and comfortable setting to explore important issues that can arise when coping with any type of cancer, including work, relationships, family and regaining control over life. Furthering its support for those with cancer, the SGH Cancer Center continued to provide the Wall of Hope and Inspiration - a special art installation created in 2015 for patients and visitors to write words of wisdom, advice and encouragement to those with cancer. The SGH Cancer Center continued to host educational classes at no cost for patients and community members facing cancer. Through the monthly Survivorship Lunch and Learn series, community members, patients and families were invited to hear local experts speak about a unique cancer-related topic each month, such as managing Scanxiety (anxiety associated with upcoming cancer tests and results); communicating with loved ones; the importance of exercise in preventing cancer recurrence; energy healing therapies; creating memories and leaving a legacy; and lifestyle tips for cancer prevention. Attendees were also invited to participate in a question-and-answer session while enjoying a complimentary lunch. The series reached an average of 8 to 12 individuals per session in FY 2017. The SGH Cancer Center also provided meeting space for the ACS' Look Good Feel Better classes, which teach women techniques to manage the appearance-related side effects of cancer treatment (e.g., hair loss, etc.) and boost self-confidence. Classes included a complimentary makeup kit and instruction from a licensed beauty professional on makeup application, skin care, and wearing wigs and headwear. Five classes were offered at the SGH Cancer Center in FY 2017, reaching 32 women. Throughout the year, the SGH Cancer Center offered free workshops for patients and community members. This included free monthly ACP workshops provided in collaboration with Sharp's ACP program. Led by a trained ACP facilitator, the workshops provided more than 15 community members with an overview of the ACP process, basic tools to help define their personal health care choices, communication tips to begin the conversation with loved ones, and guidance on completing an advance health care directive. The SGH Cancer Center also offered a workshop focused on relaxation and quieting the mind to help cancer patients and their loved ones manage the stress, anxiety and difficult emotions that may accompany a cancer diagnosis. In addition, a Managing Sleep and Fatigue Workshop offered patients and family members strategies to help relax, improve sleep and manage persistent fatigue, which is a common side effect both during and after cancer treatment. Further, a quarterly Chemo Brain Workshop: Improving Memory and Concentration was offered to patients experiencing memory problems related to chemotherapy and other cancer treatments. The workshops provided more than 40 community members with tips and strategies to help manage and improve memory during and after cancer treatment. To help guide and support patients and their families before, during and after the course of treatment, the SGH Cancer Center team offered a licensed clinical social worker (LCSW), a certified dietitian, genetics counselors and cancer patient navigators for breast and various other cancers. The LCSW offers psychosocial services (assessments, crisis intervention, counseling, bereavement, cognitive behavioral therapy and stress management), support group leadership, and advocacy and resources for transportation, palliative care and hospice, food and financial assistance. In FY 2017, this included improving patient and family connections to community services, such as the ACS, San Diego Brain Tumor Foundation, Leukemia and Lymphoma Society, Lung Cancer Alliance, Mama's Kitchen, 2-1-1 San Diego (2-1-1), JFS, FSD, and the Food Bank's Breast Cancer Case Management program, as well as other food and financial assistance programs. The LCSW served more than 260 patients and family members in FY 2017, while an additional 33 community members contacted the LCSW for consultation regarding support groups and other SGH Cancer Center services and community resources. The breast health navigator is an RN certified in breast health who personally assists breast cancer patients and their families with navigating the health care system. The breast health navigator offers support, guidance, education, financial assistance referrals and recommendations to community resources. Through collaboration with community clinics - including FHCSD, Neighborhood Healthcare and Borrego Health - the breast health navigator identifies patients who may financially benefit from the Breast and Cervical Cancer Treatment Program. Offered through the California Department of Health Care Services, the program provides urgently needed cancer treatment coverage for unfunded or underfunded low-income patients, while local clinics help facilitate the enrollment process. Patients needing psychosocial support are referred to various local or national support groups, JFS's Breast Cancer Case Management program or the SGH Cancer Center Radiation Oncology Department's LCSW. The breast health navigator also plays an active role in community education at health fairs, providing educational literature about early detection of breast cancer and mammography guidelines, at no charge to the community. In FY 2017, the breast health navigator provided navigation assistance to 179 breast cancer patients in need, including many with late-stage cancer diagnoses. Since 2014, a cancer patient navigator has been designated for patients with cancers other than breast, including patients with head and neck cancers, lung cancer, anal and esophageal cancers as well as any cancer patient with complex care needs. The cancer patient navigator supports patients and their family members through care coordination and connection to needed resources, including transportation, translation needs, financial assistance, speech therapy, nutritional support, feeding tube support, social work services and more. In addition, the cancer patient navigator offers psychosocial support and education about the side effects of radiation therapy. Since the inception of SGH's navigator program, the cancer patient navigator has assisted approximately 325 patients and their families. Two genetics counselors assist patients and family members at SGH and SMH through risk assessment, counseling, genetic testing for personal and family history of cancer, and referrals for high-risk patients. The SGH Cancer Center's certified dietitian assists patients receiving radiation therapy or combined radiation and chemotherapy who are at high-risk for malnutrition. This most often includes patients with head and neck, esophageal, lung, pancreatic and pelvic cancers - including some cervical and rectal. The dietitian provided one-on-one nutrition assessments, education and follow-up to 137 patients in FY 2017. Throughout FY 2017, SGH helped raise community awareness of cancer through television interviews on 10News - ABC San Diego and KUSI News as well as through Newsradio 600 KOGO and various printed articles in The San Diego Union-Tribune, La Mesa Courier, and The East County Californian. Through these outlets, information was shared by a medical social worker, SGH Cancer Center staff and hospital physicians from a variety of specialties, including plastic surgery, oncology and gastroenterology. Topics included breast cancer and reconstructive surgery options; smoking cessation; immunotherapy for cancer treatment; answers to common questions about colon cancer; the link between tanning beds and skin cancer prevention and detection; detecting skin cancer under a tattoo; men's breast cancer; and Scanxiety.
Form 990, Part III, Line 4a Community Benefit Report	The SGH Cancer Center conducts oncology clinical trials to support the discovery of new and improved treatments to help individuals overcome cancer and to enhance scientific knowledge for the larger health and research communities. In FY 2017, the SGH Cancer Center approached and evaluated 248 patients for participation in oncology clinical trials. As a result, 12 patients were enrolled in cancer research studies. In FY 2017, clinical trials focused on multiple types of cancer, including but not limited to breast, lung, neurological, prostate, colorectal, melanoma and lymphomas. FY 2018 Plan The SGH Cancer Center will do the following: * Continue to provide cancer education, resources and breast self-exam demonstrations at community health fairs and events * Continue to provide a free biweekly breast cancer support group for women in all stages of breast cancer * Provide free community support groups, including a group for community members with lung cancer and their caregivers, a group for men with cancer, and an art-themed group * Provide a quarterly Managing Scanxiety workshop to support cancer patients who experience anxiety related to follow-up scans * Continue to host a free monthly Lunch and Learn educational series for cancer patients, survivors and their loved ones * Provide four Look Good Feel Better classes to help female cancer patients manage appearance-related side effects of cancer treatment * Continue to provide ongoing personalized education, information, support and guidance to cancer patients and their loved ones as they move through the continuum of care * Provide education and resources to the community with patient navigators for breast, colon, brain and gynecologic cancers as well as cancer patients with complex care needs * Continue to connect individuals to services and community resources to help them manage their illness * In collaboration with the Sharp ACP program, continue to provide an ACP workshop to assist patients and community members with cancer, and their loved ones, in completing an advance health care directive * Provide legacy planning workshops on various topics, including creating memory boxes, scrapbooks, writing a life story and ethical wills * Screen and enroll cancer patients in clinical trials for research studies * Provide educational information on cancers and available treatments through community residents and community physician lectures * Provide internships to National University Radiation Therapy students * Offer a multi-session couples communication workshop Provide support groups and education for the Chaldean and Middle-Eastern communities * Provide a free seminar to educate community members about lifestyle choices for reducing breast cancer risk * Continue to partner with community clinics to share best practices in the care of cancer patients and to help patients establish medical services * Continue to share cancer information, including prevention and awareness with community members through social media Identified Community Need: Women's, Prenatal and Postpartum Health Services and Education Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC 2016 CHNA continued to identify high-risk pregnancy as one of the top 15 priority health conditions seen in SDC hospitals. * In 2013, SDC's east region had 438 low birth weight (LBW) births, which was 6.8 percent of total births for the region. LBW infants were more likely to be female than male. For infants of black mothers, 11 percent of births were LBW, which is the highest percentage when compared to mothers of other races and ethnicities. * In 2013, 36 infants died before their first birthday in SDC's east region. The infant mortality rate was 5.6 infant deaths per 1,000 live births, which is higher than the infant mortality rate for SDC overall (4.5 infant deaths per 1,000 live births). * There were 891 hospitalizations due to maternal complications in SDC's east region in 2015. The east region's age-adjusted rate was 382.4 per 100,000 population, which was higher than the age-adjusted rate for SDC overall (370.0 per 100,000 population). * In 2013, 5,217 live births received early prenatal care in SDC's east region, which translates to 81.1 percent of all live births in the region. This was slightly lower than the percentage of live births receiving early prenatal care in SDC overall (84.8 percent), and the lowest among all SDC regions. * Strategies that have been shown to increase the use of prenatal care include: affordable health coverage; expedited health coverage for uninsured pregnant women; comprehensive insurance packages including health education and risk counseling; accessible and affordable prenatal services; use of safety net providers such as community clinics and Federally Qualified Health Centers; outreach to enroll women in health coverage and connect them with prenatal services; culturally and linguistically appropriate prenatal services; evidence-based home visiting programs for high-risk pregnant women; trained and certified doulas and community health workers to provide health education, coaching and support; evidence-based group care approaches to reduce costs and enhance the content of care; and transportation assistance such as vouchers for taxis or public transit (Children's Initiative, 2015). * Breastfeeding enhances immunity to disease and decreases the rate and severity of infections in children, and is associated with improved development and decreased risk of childhood obesity. Mothers who breastfeed may have a reduced risk of breast, ovarian, and uterine cancers, quicker postpartum recovery time, and less work missed due to child illness (Children's Initiative, 2015). * In California, SDC ranked 20th out of 50 counties for in-hospital exclusive breastfeeding at 79.6 percent (California WIC) Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2016). * According to 2016 CHIS data, 28.7 percent of women ages 18 to 65 years in SDC's east region were obese (Body Mass Index (BMI) > 30), which is higher than SDC overall (25.2 percent). * According to the California Health Care Almanac, being overweight increases the risk of complications during pregnancy. In 2014, about one in four California mothers was obese or morbidly obese prior to pregnancy, and an additional one in four was overweight (California Health Care Foundation (CHCF), 2016). * According to a report from the California Task Force on the Status of Maternal Mental Health Care, 15.5 percent of women experience prenatal depressive symptoms while 14.1 percent of women experience postpartum depressive symptoms. * According to the CDC, maternal health conditions that are not addressed before pregnancy can lead to complications for the mother and the infant. Several health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, maternal obesity, maternal smoking during pregnancy and maternal deficiency of folic acid (CDC, 2015). * Contributing factors associated with preterm birth include maternal age, race, socioeconomic status, tobacco and alcohol use, substance abuse, stress, high blood pressure, prior pre-term births, carrying more than one baby, infection and late prenatal care (CDC, 2015). * According to the National Center on Substance Abuse and Child Welfare, an estimated 15 percent of infants are affected by prenatal alcohol or illicit drug exposure each year. Substance use during pregnancy increases the risk of negative health outcomes such as stillbirth, miscarriage, LBW, preterm birth, birth deformities, behavioral impairments and withdrawal syndrome (Substance Abuse and Mental Health Services Administration, 2017). Objectives * Conduct outreach and education activities for women on a variety of health topics, including prenatal care and parenting skills * Demonstrate best practices in breastfeeding and maternity care, and provide education and support to new mothers on the importance of breastfeeding * Collaborate with community organizations to help raise awareness of women's health issues and services, as well as to provide low-income and underserved women in the San Diego community with critical prenatal services * Participate in professional associations related to women's services and prenatal health and disseminate research
Form 990, Part III, Line 4a Community Benefit Report	FY 2017 Report of Activities In FY 2017, the SGH Women's Health Center provided education, outreach and support to help meet the unique needs of women, mothers and newborns throughout the community. Free support groups assisted women and families with the challenges and adaptations of having a newborn. Offered twice per week, the breastfeeding support group provided a comfortable environment to discuss the joys and challenges of breastfeeding as well as tips to improve breastfeeding success at home. Facilitated by RN lactation consultants, the group served more than 20 attendees per session in FY 2017, including fathers who were welcome to attend. A weekly postpartum support group, led by social workers, supported approximately 20 mothers per session in FY 2017. Through the support group, mothers with babies up to 12 months of age who are suffering from baby blues symptoms, depression and/or anxiety can share their experiences, learn coping strategies and receive professional referrals. Educational classes covered a variety of parenting and newborn care topics. Through the breastfeeding class, moms-to-be learned basic breastfeeding tips, including understanding the advantages of breastfeeding, positioning and the use of breast pumps. Designed for first-time parents, the Baby Care Basics class provided education on infant care, including car-seat safety, infant nutrition and bathing, as well as hands-on practice with diapering, dressing and swaddling. Other offerings by the SGH Women's Health Center in FY 2017 included classes on caesarean delivery preparation, childbirth preparation, infant and child CPR, and preparing new siblings and grandparents. The SGH Women's Health Center also supported the community through participation in the Sharp Women's Health Conference in April. The SGH Women's Health Center offered information on women's health including labor and delivery, prenatal care, obstetrics/gynecology care, neonatal intensive care options and more to 1,000 attendees. In addition, SGH continued to host an annual neonatal intensive care unit (NICU) Reunion event to offer a unique experience for patients and families whose babies have spent time in the NICU, and celebrate their care long after they leave the hospital. The event reached more than 150 former NICU patients and their families, and included a variety of activities such as face painting, a photo booth (including framed pictures for the families), games, and arts and crafts. The SGH Women's Health Center has implemented several critical process improvements to increase breastfeeding rates among new mothers and continues to explore and participate in opportunities to share these best practices with the broader health care community. This began in 2012 with implementation of the 10 Steps to Successful Breastfeeding initiative, and continued through various other quality strategies to promote exclusive breastfeeding and exclusive breast milk in the NICU. In addition, educational resources provided at community clinics and in the hospital's childbirth education classes have been updated to reflect best practices in breastfeeding for mothers and their families. NICU nurses also continued to encourage mothers to use a pump log to document and increase accountability of their 24-hour breast milk volumes. Early intervention strategies were incorporated to promote the establishment of breast milk in the first couple of weeks. The SGH Women's Health Center also continued to track mothers of premature infants 28 to 34 weeks who established breast milk supply at two weeks. As a result of these comprehensive efforts, the SGH Women's Health Center increased the exclusive breastfeeding rate at discharge for newborns from 49 percent in 2011 to 59 percent in 2017. In addition, in 2015, the SGH Prenatal Clinic joined the Breastfeeding-Friendly Community Health Centers project (BFCHC) - an initiative of SDC's LWSD and funded through a grant from the First 5 Commission of San Diego. Through the BFCHC collaboration, the SGH Prenatal Clinic was selected out of six participating clinics as the pilot clinic to help establish Baby-Friendly USA guidelines around breastfeeding during the prenatal period and after discharge, and support other prenatal clinics in achieving Baby-Friendly USA standards. Though the pilot program ended in 2016, SGH continues its collaboration in the BFCHC to ensure sustainability of the model. The SGH Prenatal Clinic offers a variety of prenatal support for high-risk and underserved women in SDC. Throughout FY 2017, SGH Prenatal Clinic midwives provided in-kind help at Neighborhood Health Centers in El Cajon to support the underserved population in SDC's east region. This included more than 1,360 hours of care for pregnant women five days per week. The SGH Prenatal Clinic also continued to participate in the California Department of Public Health Comprehensive Perinatal Services Program to offer comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits. Services included health education, nutritional guidance, and psychological and social issue support as well as translation services for non-English-speaking women. Nutrition classes were offered as part of this effort in order to reduce the number of women who meet the criteria for gestational diabetes. Women with a current diabetes diagnosis were referred to the SGH Diabetes Education Program, while those with nutrition issues were referred to an SGH registered dietician or the SGH Diabetes Education Program as appropriate. At-risk women with elevate body mass indices (BMIs) received education and glucometers in order to measure their blood sugar and prevent the development of gestational diabetes. In addition, education on gestational diabetes was provided to pregnant members of the community. The SGH Women's Health Center continued its partnership with Vista Hill ParentCare to assist chemically dependent (addicted) women with psychological and social issues during pregnancy. These approaches have been shown to reduce both LBW rates and health care costs in women and infants. The SGH Women's Health Center also provided women with referrals to a variety of community resources, including, but not limited to California Teratogen Information Service (CTIS), WIC, and the County of San Diego Public Health Nursing. In FY 2017, the SGH Women's Health Center participated in and partnered with several community organizations and advisory boards for maternal and child health, including WIC; CTIS; Partnership for Smoke-Free Families; San Diego County Breastfeeding Coalition Advisory Board; Beacon Council's Patient Safety Collaborative; ACNL; the regional Perinatal Care Network; the local chapter of AWHONN; California Maternal Quality Care Collaborative; California Perinatal Quality Care Collaborative; American Association of Critical-Care Nurses - Clinical Scene Investigator Academy; and County of San Diego Public Health Nursing Advisory Board. FY 2018 Plan SGH will do the following: * Provide free breastfeeding, postpartum and new parent support groups * Provide parenting education classes * Participate in wellness events for women with a focus on lifestyle tips to enhance overall health * Share evidence-based maternity care practices through presentations at professional conferences * Provide prenatal clinical and social services as well as education to vulnerable, community clinic patients through the SGH Prenatal Clinic * Provide a NICU graduate reunion for former NICU patients and their family members Identified Community Need: Health Education and Wellness Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2016 CHNA identified behavioral health, cardiovascular disease, Type 2 diabetes, obesity, cancer and senior health as six priority health issues affecting members of the communities served by SGH. * The HASD&IC 2016 CHNA process continued to identify the following among the top priority health conditions in SDC hospitals: diabetes, obesity, cardiovascular disease and stroke, mental health and mental disorders, unintentional injury, high-risk pregnancy, asthma, cancer, back pain, infectious disease and respiratory diseases. * The HASD&IC and SGH 2016 CHNA community engagement activities emphasized 10 social determinants of health (SDOH) as having a serious impact on the four priority health issues in SDC (cardiovascular disease, Type 2 diabetes, behavioral health and obesity). These social determinants are: food insecurity and access to healthy food; access to care or services; homeless/housing issues; physical activity; education/knowledge; cultural competency; transportation; insurance issues; stigma; and poverty.
Form 990, Part III, Line 4a Community Benefit Report	* Key informant interviews conducted as part of the HASD&IC 2016 CHNA suggested several health improvement strategies to address the four priority health issues identified for SDC. 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. * Data analysis in the 2016 CHNAs revealed a higher rate of hospital discharges due to cardiovascular disease and Type 2 diabetes in more vulnerable communities within SDC's east region, such as El Cajon and Jacumba (Dignity Health, SanGIS, OSHPD & SpeedTrack Inc., 2015). * According to data presented in the SGH 2016 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. According to the CDC, about half of Americans (47 percent) have at least one of these three risk factors. Additional risk factors include alcohol use, obesity, diabetes and genetic factors (CDC, 2015). * HHSA's LWSD 3-4-50 initiative identified three behaviors (poor diet, physical inactivity, and tobacco use) contributing 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 2015, 54 percent of all deaths in SDC's east region were attributed to 3-4-50 conditions, which was on par with the rate for SDC overall (54 percent). * In 2015, cancer was the leading cause of death and heart disease was the second leading cause of death for SDC's east region. * According to 2016 CHIS data, the self-reported obesity rate for adults ages 18 and older in SDC's east region was 36.6 percent, which is higher than the rate for SDC overall of 25.3 percent. * In 2016, 17.9 percent of adults ages 18 and older in SDC's east region self-reported eating at fast-food restaurants four or more times each week, which is higher than the rate for SDC overall of 16.3 percent (CHIS, 2016). * Obesity increases the risk of many health conditions, including: CHD, stroke, Type 2 diabetes, and various cancers. Obesity is also linked to environmental factors, such as accessibility and affordability of fresh foods, park availability, social cohesion and neighborhood safety (UCLA Center for Health Policy Research, 2015). * According to the CDC, some of the leading causes of preventable death include obesity-related conditions, such as heart disease, stroke, Type 2 diabetes, and certain types of cancer. In In 2015-2016, 39.8 percent of Americans were obese (CDC, 2017). Objectives * Provide a variety of health and wellness education and services at events and sites throughout the community * Offer health and wellness education to the community through various media outlets FY 2017 Report of Activities Throughout FY 2017, SGH participated in community events, offered presentations at neighborhood sites, and partnered with local media sources to educate community members about a variety of health and wellness topics. In April, staff from a range of hospital departments participated in Sharp's annual Women's Health Conference, where they offered wellness education and services to approximately 1,000 attendees. This included nutrition education, recipes, healthy food samples, answering nutrition-related questions, and a presentation titled Revive Your Eating Experience from an SGH RD. At the conference, SGH also provided more than 110 community members with osteoporosis heel screenings, education on calcium and vitamin D requirements, and exercise tips for osteoporosis treatment and prevention. In addition, hand screenings were provided at the conference, which included evaluations and recommendations for hand pain and discomfort. Furthermore, SGH conducted three blood drives where nearly 120 SGH team members donated more than 100 pints of blood. In May, SGH provided education on infection prevention to 200 seniors and their families at the 18th annual ECSSP Senior Health Fair at the La Mesa Community Center. SGH also participated in the Project Homeless Connect event sponsored by the Grossmont Healthcare District and Grossmont Center in June to offer needed services to the homeless. During this one-day event at The Rock Church in El Cajon, SGH provided information about hepatitis A vaccinations as well as information about local food banks to 140 homeless community members. Approximately 20 attendees received hepatitis A vaccines at the event. In addition, at an event in August held at St. John's Church in El Cajon, SGH provided education about the benefits of pursuing a nursing career to 300 Syrian and Afghan refugees. In FY 2017, SGH RDs offered approximately 1,000 community members nutrition handouts and healthy food samples, as well as answered nutrition-related questions at a health fair at Sempra/San Diego Gas & Electric and SGH's Heart Health Expo. In January, an SGH RD presented on eating well in the new year to approximately 50 community members at the SGH Senior Resource Center. An SGH RD also attended Health Fair Saturday at Grossmont Center, providing approximately 50 attendees with nutrition handouts and healthy food samples, as well as answering nutrition-related questions. In October, an SGH security team member presented on active shooter awareness including information and tips on how to respond in the event of an active shooter incident, and provided a question-and-answer session for more than 35 community members at the La Mesa Lions Club. SGH helped increase awareness about current news and trends impacting the health and safety of community members through television interviews on KUSI News, KPBS and CW6 San Diego as well as through various radio stations and printed articles in The San Diego Union-Tribune, and The East County Californian. Information was shared through these outlets by an ACP specialist, infectious disease specialist, social worker, RN, and physician's assistant, as well as hospital physicians from a variety of specialties, including pulmonary medicine, dermatology, pediatrics, cardiology, and oncology. Topics included, but were not limited to: measures intended to reduce ED crowding; intimacy following a heart attack; smoking cessation methods; battlefield medicine; tips for properly storing leftovers; the hospice experience; supporting a loved one battling addiction; the differences between heart attack, heart failure and stroke; "broken heart syndrome"; maintaining a healthy diet to lessen asthma symptoms; information about colon cancer; what to do if you are bitten by a dog; Scanxiety among cancer patients and survivors; sleep apnea's link to heart disease and hypertension; a possible link between coconut oil and cardiovascular events; the signs and symptoms of breast cancer in men; organ donation; cosmetics and allergic reactions; the link between tanning beds and skin cancer; treatments for nerve damage; how to protect yourself from hepatitis A; recognizing the signs and symptoms of hepatitis A; and screening for skin cancer under tattoos. Throughout FY 2017, staff at SGH regularly led or attended various health boards, committees, and advisory and work groups. Community and professional groups included CAHHS Committee on Volunteer Services and Directors' Coordinating Council, Association of Fundraising Professionals - San Diego Chapter, California Society for Clinical Social Work Professionals, California Academy of Nutrition and Dietetics - San Diego District, Emergency Nurses Association, County Service Area - 69 Advisory Board, County of San Diego Prehospital Emergency Medical Care Committee, National Association of Orthopedic Nurses, Grossmont Healthcare District's Independent Citizens' Bond Oversight Committee, San Diego East County Chamber of Commerce, California Hospital Association (CHA) Board of Trustees, CHA Workforce Committee, HASD&IC, San Diego-Imperial County Council of Hospital Volunteers, Santee-Lakeside Rotary Club, Grossmont Healthcare District Community Grants and Sponsorships Committee, John A. Davis Family YMCA Board of Management, Santee Chamber of Commerce, Lantern Crest Senior Living Advisory Board, Grossmont College Occupational Therapy Assistant Advisory Board, Angels Foster Family Network, La Mesa Parks and Recreation, San Diego Freedom Ranch, AHA, Health Sciences High and Middle College (HSHMC) Board, and San Diego Association of Directors of Volunteer Services.
Form 990, Part III, Line 4a Community Benefit Report	FY 2018 Plan SGH will do the following: * Continue to provide health and wellness offerings to community members at a variety of community events and other sites * Continue to provide health and wellness education through local news sources * In partnership with San Diego Oasis and SGH clinical experts and affiliated physicians, provide a monthly educational program on health and wellness topics for seniors (e.g., vascular disease, fall prevention, stroke, etc.) Identified Community Need: Prevention of Unintentional Injuries Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The HASD&IC 2016 CHNA continued to identify unintentional injury as one of the top priority health conditions seen in SDC hospitals. * In 2015, accidents (unintentional injuries) were the fifth leading cause of death for SDC's east region. Unintentional injuries - due to motor vehicle accidents, falls, pedestrian-related incidents, firearms, fire/burns, drowning, explosions, poisoning (including drugs and alcohol, gas, cleaners and caustic substances), choking/suffocation, cut/pierce, exposure to electrical current/radiation/fire/smoke, natural disasters and workplace injuries - are one of the leading causes of death for SDC residents of all ages, regardless of gender, race or region. * In 2015, there were 204 deaths due to unintentional injury in SDC's east region. The region's age-adjusted death rate due to unintentional injury was 39.1 deaths per 100,000 population, the second highest of all regions in SDC and above the SDC age-adjusted rate of 34.3 deaths per 100,000 population. * In 2015, there were 3,893 hospitalizations related to unintentional injury in SDC's east region. The age-adjusted rate of hospitalizations was 738.6 per 100,000 population, which was above the county age-adjusted average of 586.0 per 100,000 population. * In 2015, there were 28,640 ED discharges related to unintentional injury in SDC's east region. The age-adjusted rate for the east region was 6,032.1 per 100,000 population, which was the second highest of all regions and above the SDC age-adjusted rate (5,017.7 ED visits per 100,000 population). * Unintentional injury was the leading cause of death for children ages zero to 14 years in 2015. The effects of safety campaigns, educational strategies, and change in parenting practices have all had a positive impact on the safety and well-being of children in the San Diego community (HHSA, 2012). * Traumatic injury is the leading cause of death among children, with many survivors enduring the consequences of brain and spinal cord injuries. The physical, emotional, psychological and learning problems that affect injured children, along with the associated costs, make reducing traumatic injuries a high priority for health and safety advocates throughout the nation. Educational programs like ThinkFirst increase knowledge and awareness of the causes and risk factors of brain and spinal cord injury, injury prevention measures, and the use of safety habits at an early age (www.thinkfirst.org/kids, 2015). * According to HP2020, most events resulting in injury, disability or death are predictable and preventable. There are many risk factors for unintentional injury and violence, including individual behaviors and choices, such as alcohol use or risk-taking; the physical environment both at home and in the community; access to health services and systems created for injury-related care; and the social environment, including individual social experiences (social norms, education, victimization history), social relationships (parental monitoring and supervision of youth, peer group associations, family interactions), the community environment (cohesion in schools, neighborhoods and communities) and societal-level factors (cultural beliefs, attitudes, incentives and disincentives, laws and regulations). * The California Department of Public Health's Burden of Chronic Disease and Injury Report: California, 2013 indicates that unintentional injuries are the leading cause of death in children and adults ages one to 44 in California. * The same report states that injuries cause more than 16,000 deaths, 75,000 cases of permanent disability, 240,000 hospitalizations, and 2.3 million ED visits annually in California. * In 2014, unintentional injuries accounted for 84 percent of all injury deaths among adults ages 65 and older in the U.S. (National Center for Health Statistics, 2016). * A 2016 National Vital Statistics Report titled Deaths: Final Data for 2014 indicates that 59.4 percent of injury deaths in the U.S. in 2014 were attributed to three causes: poisoning (26 percent), motor-vehicle accidents (16.9 percent), and falls (16.5 percent). In 2014, the age-adjusted rate of death from unintentional injury in the U.S. was 40.5 deaths per 100,000 population (CDC, 2016). Objective * Offer an injury and violence prevention program for children, adolescents and young adults in SDC's east region FY 2017 Report of Activities In FY 2017, ThinkFirst/Sharp on Survival provided injury prevention education to more than 450 Health and Science Pipeline Initiative (HASPI) students from high schools in SDC's east region. Through the partnership and financial support from HASPI, the ThinkFirst/Sharp on Survival program offered east region schools a variety of services related to HASPI's main goals of increasing health and medical career awareness and improving science proficiency in school. These services included classroom presentations, small assemblies, offsite learning expos, and the opportunity to participate in a half-day tour of the SMH Rehabilitation Center designed specifically for students interested in pursuing careers in health care. Reaching more than 130 students, the HASPI school-site programs consisted of one- to two-hour classes that covered topics such as the modes of injury, disability awareness, and the anatomy and physiology of the brain and spinal cord. These programs were enhanced by powerful personal testimonies from individuals with traumatic brain injury (TBI) or spinal cord injury (SCI), known as Voices for Injury Prevention (VIPs). During a career expo at Grossmont College, more than 300 HASPI students heard from a ThinkFirst Community Health Educator and VIP speakers regarding careers in physical rehabilitation. A variety of disability awareness topics were covered and students were given the opportunity to ask direct questions related to the treatment and care of various populations. The VIP speaker also provided these teens with a unique learning experience by allowing them to practice social interactions with a disabled individual and gain a firsthand account of society's treatment of the disabled population. Twenty HASPI students from Calexico High School in Imperial County participated in a half-day interactive tour of the SMH Rehabilitation Center. Students rotated through five stations that provided hands-on experiences in adapted dressing techniques, wheelchair mobility, and various memory and problem solving activities used in therapy. The experience allowed them to gain a better understanding of not just physical rehabilitation, but also of the challenges that patients face following a life-changing event. ThinkFirst/Sharp on Survival provided education to youth and their parents through participation in the annual Kids Care Fest at the Lakeside Rodeo Grounds, which was sponsored by the Grossmont Healthcare District. During the event, ThinkFirst/Sharp on Survival educated more than 200 children and their parents on injury prevention topics including proper helmet-fitting, booster and car seat use, brain and spinal cord injuries and state laws. ThinkFirst/Sharp on Survival also presented on injury prevention, TBI, SCI, and disability awareness to more than 1,000 college students in SDSU's Disability in Society course. An additional presentation on injury prevention was delivered to 80 students enrolled in the public health program at SDSU. After the presentation, students were provided with the opportunity to ask questions relating to the challenges nonprofit organizations face when conducting public health education and outreach.
Form 990, Part III, Line 4a Community Benefit Report	In April, ThinkFirst/Sharp on Survival team members attended the annual ThinkFirst Conference on Injury Prevention in Los Angeles, California. Coinciding with the annual scientific meeting of the American Association of Neurological Surgeons - the founding organization of ThinkFirst - the theme of the 2017 conference was Promoting a Culture of Safety. Directors and VIP speakers from both U.S. and international ThinkFirst chapters were invited to the conference to learn about new ThinkFirst programs, presentation techniques, injury prevention research and grant writing. During the conference, a Sharp Rehab social worker as well as ThinkFirst/Sharp on Survival's community health educator and VIPs presented on the Sharp Rehab VIP Ambassador program, including how organizations can develop and maintain Ambassador-type programs of their own. The Sharp Rehab VIP Ambassador program was developed to assist recently disabled individuals transition into their new life and help them understand that they can live a rewarding life following disability. FY 2018 Plan ThinkFirst/Sharp on Survival will do the following: * With funding support from grants, provide educational programming and presentations for local schools and organizations * With grant funding, increase community awareness of ThinkFirst/Sharp on Survival through attendance and participation at community events and health fairs * As part of the HASPI partnership, continue to evolve program curricula to meet the needs of health career pathway classes * Grow partnership with HASPI through participation in conferences, round table events and collaboration on letters of support for various funding opportunities * Continue to provide booster seat education to elementary school children and their parents with funding support from grants * Continue to provide college students with injury prevention education through SDSU's Disability in Society course and public health classes * Explore further opportunities to provide education to health care professionals and college students interested in health care careers, including public health students at SDSU * As appropriate and with funding, continue to explore opportunities to utilize additional ThinkFirst/Sharp on Survival curricula to serve populations throughout SDC's east region * Explore additional opportunities for educating HASPI students in Imperial County Identified Community Need: Health Professions Education and Training, and Collaboration with Local Schools to Promote Interest in Health Care Careers Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the 2017 San Diego Workforce Partnership (SDWP) Health Care Priority Sector report, the health care industry in SDC experienced a 44 percent increase in employment growth between 2006 and 2016, higher than the 38 percent growth rate seen by the state of California (SDWP, 2017). * The same report indicated that the six fastest-growing health care occupations in SDC between 2013 and 2016 were physician's assistants (22 percent), medical assistants (18 percent), health care social workers (15 percent), home health aides (13 percent), licensed vocational nurses (12 percent), and medical and clinical lab technicians (11 percent). RNs accounted for 1,366 added jobs during this period, which was the largest increase in total jobs among all health care occupations (SDWP, 2017). * The Health Care Priority Sector report also found that health care employers identified RNs, physicians and surgeons, and health technicians as the most difficult positions to fill. The most frequently cited reason for hiring difficulties were lack of experience, small applicant pools, and insufficient non-technical skills (SDWP, 2017). * A 2014 SDWP labor market analysis indicated an increase in the number of health care training providers in SDC, but a shortage of clinical training facilities where applicants can gain necessary experience. The scarcity of clinical facilities offering prerequisite training has made it increasingly difficult for employers to find qualified workers. * The 2017 SDWP Nonprofit Sector Employment Trends and Career Opportunities report recommends that nonprofit sector health care training and education programs in SDC emphasize soft skills such as being a team player, interpersonal and communication skills, big-picture thinking with the ability to plan and forecast, problem solving, and the ability to adapt to a variety of situations. It also recommends incorporating more training on data management and technology into curriculums in order for graduates to meet the needs of this increasingly data-driven sector. * In its Employment Projections - 2016-2026 report, the U.S. Bureau of Labor Statistics (BLS) projects that health care support occupations and health care practitioners/ technical occupations will contribute about one-fifth of all new jobs and account for almost half of the 30 fastest-growing occupations. There are several factors leading to the increased demand for these professions, including: projected population growth in the next decade; aging of the U.S. population; greater numbers of people living with chronic conditions, such as diabetes or obesity; improvements in medicine and technology; and federal health insurance reform, which has increased the total number of Americans with health insurance coverage (BLS, 2016). * Total employment in California is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. The health care and social assistance sector is expected to be the fastest-growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (BLS, 2015). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (OSHPD Healthcare Atlas, 2017). * As of 2015, the California Health Care Almanac reported that 44 percent of the employed RN workforce was over the age of 50. As this age group moves away from patient care and approaches retirement, it will be critical to have younger RNs trained and in place to handle the turnover (CHCF, 2017). * The BLS projects employment of more than 300,000 RNs in California in 2024, which would be an increase of 17 percent from 2014. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2014). * The BLS projects that the demand for home health aides in California will grow 39 percent from 2014 to 2024. Older individuals often have health problems and need help with daily activities. Thus, as the U.S. population ages, the demand for home health aides will continue to increase (BLS, 2014). * According to forecasts performed by the Healthforce Center at University of California, San Francisco (UCSF), the demand for primary care clinicians in California will increase 12 to 17 percent by 2030. These forecasts predict that the southern border region will experience some of the highest levels of clinician shortages in the state (UCSF, 2017). * A 2014 report from the CHA titled Critical Roles: California's Allied Health Workforce Follow-Up Report emphasizes the importance of local hospitals providing clinical training for nurses and allied health professionals, as well as programs to support mentoring and hospital work experience for interns and high school students. In the coming decades, such programs will have a tremendous impact on the lives of individuals, families and the San Diego community at large. Objectives * Collaborate with local schools to provide opportunities for students to explore health care professions * Collaborate with local colleges and universities to provide professional development lectures to students from local colleges and universities * Offer professional development opportunities for community health professionals
Form 990, Part III, Line 4a Community Benefit Report	FY 2017 Report of Activities Throughout the academic year, SGH provided more than 1,000 students from colleges and universities throughout San Diego with various placement and professional development opportunities. More than 760 nursing students spent nearly 83,400 hours at SGH, including time spent both in clinical rotations and individual preceptor training, while more than 240 ancillary students spent nearly 60,600 hours on the SGH campus. Academic partners included APU; Bay Path University; Brightwood College; California State University (CSU) Chico; CSU Long Beach; CSU Northridge; California State University San Marcos (CSUSM); Casa Loma College; Concorde Career College; EMSTA College; Grand Canyon University; Grand Valley State University; Grossmont College; Grossmont Health Occupations Center; Grossmont Union High School District (GUHSD); Johns Hopkins University; Laboure College; Midwestern University; Mount Saint Mary College; National University; Northern Arizona University; Pacific University; Palomar College; Pima Medical Institute; Point Loma Nazarene University; San Diego City College; San Diego Mesa College; SDSU; San Jose State University; Southwestern College; Stanbridge College; Texas State University; Texas Women's University; Touro University; UC San Diego; University of Indianapolis; University of Phoenix; University of Redlands; University of San Diego; University of Southern California; University of St. Augustine; University of the Pacific; Walden University; Western Governors University and Western University. Further, the SGH Cancer Center provided internships to two National University Radiation Therapy students. SGH continued to collaborate with the GUHSD in the Healthcare Exploration Summer Institute (HESI), providing high school students with opportunities for classroom instruction, job shadowing, observations and limited hands-on experiences. In FY 2017,16 students shadowed staff for two weeks in a variety of hospital specialties, including women's health, laboratory, pulmonary, interventional radiology, pre- and post-operative surgery, the progressive care unit, radiology, pharmacy, supply chain/distribution, nutrition, infection control, the surgical waiting area/concierge, occupational and physical therapy, and the catheterization and hyperbaric laboratories. At the conclusion of the program, students presented their experiences as case studies to family members, educators and hospital staff. Those completing the program received high school credits for an elective course. Also in FY 2017, SGH provided a lecture to HESI students on workplace safety and safe mobilization of patients. SGH also continued its participation in the HSHMC program in FY 2017, providing early professional development for 106 students in 9th through 12th grades. Students spent approximately 34,560 hours shadowing staff in various areas throughout the hospital, including but not limited to progressive care units, food and nutritional services, oncology, acute care medical-surgical nursing, sterile processing, supply distribution, engineering, occupational and physical rehabilitation, endoscopy, women's health, cardiology, pharmacy, medical intensive care unit, surgical intensive care unit, and the concierge as well as SRSMG family practice, podiatry, specialty areas, and primary care. In addition, SGH staff provided students instruction on educational requirements, career ladder development and job requirements. At the end of the academic year, SGH staff provided the students, their loved ones, community leaders and hospital mentors with a symposium that showcased the lessons learned throughout the program. In FY 2017, SGH developed and launched its new pilot program, HealthCare Towne, a field trip designed to build the health care workforce of tomorrow through an early outreach program for middle and junior high school students. This event encouraged students to connect what they learn in the classroom to real-life career opportunities in health care. Healthcare Towne has four major components that include: world of work, the puzzle room, scenario tour and in-the-round activity. The first component, world of work, empowered students to develop self-awareness by exploring their strengths, interests and values. Students were divided into three groups, solving three different scenarios. In the puzzle room, students collaborated to diagnose a hypothetical patient before they arrived at the hospital by interpreting clues to find the answer and reveal the next piece. In the scenario room, students learned about and walked through clinical areas where the patient would receive care, including the ambulance bay, ED, operating room, catheterization laboratory, imaging, and intensive care unit. During the final component, students applied clues, lab results, and what they learned throughout the day to help fully diagnose the patient with several conditions. In September 2017, 31 local junior high students participated in HealthCare Towne. During the event, parents of the students were able to observe the diagnoses process and were educated separately by SGH staff on teenage suicide. SGH sponsored Ethics in Business, a program of the San Diego East County Chamber of Commerce and the GUHSD Career Technical Education Department. The program is designed to train high school students to become principled leaders and includes business, education and community leaders. SGH assisted in facilitating the event, which had approximately 200 high school student attendees. SGH and SMH continued to provide one of only two mobile intensive care nurse (MICN) training programs in SDC. Together, the hospitals offered extensive six-week training programs for San Diego base station emergency nurses. Participants received certification through the County EMS upon successful completion of a 48-hour classroom component, a passing score of 85 percent or higher on the County EMS final examination of SDC protocols, and completion of mandatory ride-along hours in a paramedic unit. In addition, as a radio base station, the Sharp Prehospital/EMS department provided two continuing education Joint Base Regional Care Conferences for EMS personnel and MICN trained RNs in SDC. FY 2018 Plan SGH will do the following: * In collaboration with GUHSD, participate in the HESI * Continue to participate in the HSHMC program * Continue to provide internship and professional development opportunities to college and university students throughout San Diego * Continue to collaborate with local universities to provide professional development lectures for students * Develop an elementary school field trip program to promote healthy decision-making as well as to provide a broad understanding of health care career options * Continue to offer HealthCare Towne to middle and junior high school students Identified Community Need: Support During the Transition of Care Process for High-Risk, Underserved and Underfunded Patients Rationale references the findings of the SGH 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * As part of the SGH 2016 CHNA process, discussions with Sharp's Community-based Care Transitions Program/Care Transitions Intervention (CTI) staff identified the following strategies for improving the health of SDC's vulnerable, high-risk, or medically underserved patients: coaching; educating patients about their disease and the health care system; providing education tailored to specific cultural and linguistic groups; providing transportation, support, hope, and love; and providing a personal health record with resources and information about their medications. * A key informant interview conducted as part of the SGH 2016 CHNA process identified the home environment, transportation and medication management as challenges for vulnerable patients. Recommendations included connecting patients to community resources as part of their transition from hospital to home, expediting services for discharged patients with immediate needs, and developing methods to finance hospital/community partnerships for expedited services. * The HASD&IC 2016 CHNA identified 10 social determinants of health that impact the four priority health needs in SDC (behavioral health, cardiovascular disease, obesity and Type 2 diabetes). These social determinants are: food insecurity and access to healthy food; access to care or services; homeless/housing issues; physical activity; education/knowledge; cultural competency; transportation; insurance issues; stigma; and poverty.
Form 990, Part III, Line 4a Community Benefit Report	* Key informant interviews conducted as part of the HASD&IC 2016 CHNA suggested the following strategies for improving health and removing barriers to care: behavioral health prevention and stigma reduction; education on disease management and food insecurity; improving diversity and cultural competency; coordinating services across the continuum; integrating physical and mental health; and engaging case managers and patient navigators in the community and incorporating them as a routine part of the continuum of care. * Participants in the HASD&IC 2016 CHNA community partner discussions recommended strengths-based case management, greater availability of multicultural providers and translators, and better coordination of discharge procedures as strategies for improving and maintaining health in SDC. * Community members participating in the Health Access and Navigation Survey as part of the HASD&IC 2016 CHNA identified the following top barriers to care: understanding health insurance; getting health insurance; using health insurance; knowing where to go for care; and follow-up care or appointments. * In 2015, the unemployment rate in SDC's east region was 11.3 percent, which was higher than SDC overall (10.3 percent). * As of October 2017, the average unemployment rate in the cities of El Cajon, La Mesa, Lakeside, Lemon Grove, Santee, and Spring Valley was 4.6 percent (Labor Market Information, State of California Employment Development Department, 2017). * The Regional Task Force for the Homeless' January 2017 WeAllCount campaign counted 9,116 homeless individuals in SDC, roughly 62 percent of whom were unsheltered. The most commonly cited cause of homelessness was loss of a job (26 percent), followed by "other" (21 percent), money issues (15 percent), and kicked out/ran away (10 percent). * A 2016 report by the HHSA titled Identifying Health Disparities to Achieve Health Equity in San Diego County: Socioeconomic Status found that low-income communities in the county are disproportionately affected by numerous health issues, including injury, chronic and communicable diseases, poor maternal and child health outcomes, and behavioral health outcomes. Four such low-income communities - El Cajon, La Mesa, Lemon Grove and Mountain Empire - are located in SDC's east region. * The Kaiser Family Foundation's 2016 Employer Health Benefits Survey indicated that the average health insurance premium for a single adult in 2016 is $536 per month, or $6,435 annually. The average health insurance premium for a family in 2016 is $1,512 per month, or $18,142 annually. The average family premium in 2016 is now 20 percent higher than the average family premium in 2010 and 58 percent higher than the average family premium in 2006. Objectives * Connect high-risk, underfunded patients and community members to local resources and organizations for low-cost medical equipment, housing options and follow-up care * Assist economically disadvantaged individuals through transportation and financial assistance for pharmaceuticals * Collaborate with community organizations to provide services to chronically homeless individuals * Through the CTI program, provide high-risk, under- and unfunded patients with health coaching, support and resources that address SDOH to ensure a safe transition home and maintained health and safety FY 2017 Report of Activities In FY 2017, SGH continued to provide post-acute care facilitation for high-risk patients, including individuals who were homeless or without a safe home environment. Individuals received referrals to and assistance from a variety of local resources and organizations. These groups provided support with transportation, placement, medical equipment, medications, outpatient dialysis and nursing home stays. SGH referred high-risk patients, families, and community members to churches, shelters and other community resources for food, safe shelter and other resources. For unemployed, uninsured and underinsured patients, or for those who simply cannot afford the expense of a wheelchair, walker or cane due to a fixed income, SGH has committed to improving access to DME for high-risk patients upon discharge. SGH case managers and social workers actively recruited DME donations from the community, providing nearly 200 DME items to patients in need in 2017. To assist economically disadvantaged individuals, SGH provided more than $173,200 in free medications, transportation, lodging and financial assistance through its Project HELP funds. These funds assisted more than 6,860 individuals in FY 2017. In addition, SGH pharmacists assisted more than 460 economically disadvantaged patients with more than 1,420 outpatient prescriptions valued at approximately $340,570. In addition, SGH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the SDRM, SGH discharged chronically homeless patients to the SDRM's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up care through SGH in a safe space, and also provides psychiatric care, substance abuse counseling and guidance from the SDRM's programs in order to help these patients get back on their feet. Beginning in 2014, SGH piloted the CTI program for its high-risk, vulnerable populations, including Medi-Cal, Medi-Cal pending/presumptive, self-pay, no-pay, refugee populations, homeless and Medicare A or B only patients. Modeled after the countywide Community Care Transitions Program established by the Centers for Medicare & Medicaid Services to serve the Medicare fee-for-service patient population at risk for readmission, the CTI program provides 30-day coaching by an RN or medical social worker at no cost to vulnerable patients who are identified through a comprehensive risk assessment tool. The assessment tool evaluates patients for multiple factors including isolation, co-occurring health issues, food insecurity, behavioral health issues, and other conditions that impact their health and safety. The project team is a collaborative effort between various team members across Sharp, including nurses, case managers and disease specialists as well as team members of SHC community benefit, Patient Financial Services (PFS), SGH's Senior Resource Center, and others. The team ensures that vulnerable patients are connected with community resources and support to safely transition home, and keep them safe and healthy in the community. Partnerships with community organizations connect these patients to critical social services upon discharge, and have included FSD, Food Bank, 2-1-1, FHCSD, various churches, and refugee and other social support organizations. This outreach is critical for sustaining vulnerable patients and empowering them to manage their care in the community. Food insecurity, or lack of access to healthy food, is a key factor in the health status of CTI patients. Since its inception, more than 100 CTI patients were identified as food insecure and provided a direct referral to community hunger relief organizations. In FY 2017, these organizations included FSD and 2-1-1, who then conducted proactive phone calls to CTI patients in order to connect them to resources such as federal assistance programs (through the Food Bank), free food distribution sites throughout San Diego, and assistance with CalFresh enrollment. In addition, the CTI program worked closely with SGH's PFS to evaluate patients for CalFresh benefits prior to hospital discharge, dramatically increasing the likelihood that patients complete CalFresh applications and receive benefits. In FY 2017, SGH's PFS team completed 687 CalFresh applications and 405 patients were granted CalFresh benefits. Further, the CTI program provides medically-tailored emergency food bags for CTI patients without food in their homes. The food bags are supported by funding from the Grossmont Hospital Foundation and include nutritious items specifically designed with guidance from an SGH dietitian for the complex health conditions and nutritional needs of CTI patients, in order to sustain their health until they are connected to food assistance. The food bags provide CTI patients with nonperishable, nutritionally dense foods during the first few days of discharge, when proper nutrition is critical. The coaches provide food bags during their home visit and combine this delivery with a review of the patient's hospitalization and a plan for self-management. In FY 2017, the CTI program provided more than 100 food bags to CTI patients in SDC's east region.
Form 990, Part III, Line 4a Community Benefit Report	In addition, a significant number of CTI patients are diabetic and are challenged with adherence to their care plan because they cannot afford diabetes equipment. To address this challenge, a grant application was submitted and approved by the Neighborhood Walmart(r) located closest to SGH. As a result of this funding, in 2017, 28 "diabetes kits"- including a three-month supply of strips, lancets, glucose monitors, etc. - were put together. These kits help to keep CTI patients safe and managed until their insurance is activated. In addition, blood pressure cuffs, batteries (for the blood pressure cuffs), pill boxes and can openers were provided for CTI patients. Since its inception in May 2014, the CTI pilot has demonstrated a powerful impact. To date, the CTI team has approached more than 2,400 patients, and succeeded in enrolling more than 1,900 individuals in the CTI program. The average readmission rate among the enrolled group is 13 percent, compared to an average readmission rate higher than 22 percent for those individuals who refused CTI coaching services. In FY 2017, the average readmission rate for CTI patients from any status was 9.7 percent - an astounding impact. In addition, SGH coaches devoted hundreds of hours of time directly to these vulnerable patients. It has been the focus on care management as well as addressing SDOH that has contributed to the marked success of this program. The CTI program's partnership with 2-1-1's Health Navigation Program has proven to be one of the most innovative and impactful collaborations of the CTI program, and truly a best practice in delivering care to community members facing inequities. 2-1-1's specialty Health Navigation Program provides in-depth care coordination to better connect, empower, educate and advocate for clients with health needs. 2-1-1 Health Navigators work with clients experiencing issues in accessing care, managing chronic conditions, and those who are uninsured or underinsured. Health Navigators assess clients' specific needs, which are unique to their health condition and situation, referring and educating clients about options and community resources, while also advocating on behalf of clients when needed. In addition, Health Navigators ensure access and utilization of the services referred to and follow-up is conducted with clients over time. Through this partnership, CTI patients are referred to the 2-1-1 Health Navigation Program to address health and social needs and leverage 2-1-1's enrollment services, housing coordination and advocacy. At intake and again at completion of care coordination, 2-1-1 uses a risk rating scale to measure and address: changes in vulnerability related to SDOH (access to food, housing, transportation, etc.); hospital readmission risk; patient satisfaction and patient self-efficacy to both demonstrate program impact and identify areas for improvement. Based on the rating scale, patients fall into one of six categories as shown in CTI patients referred to 2-1-1 are assessed on a variety of measures such as housing, nutrition, primary care, health management, social support, activities of daily living, ambulance use, transportation, income and employment. The risk assessment tool has identified the top needs as housing, food assistance and primary care services. Funded by the Grossmont Hospital Foundation, the CTI program's partnership with 2-1-1 continues to successfully demonstrate the value of SDOH support for high-risk patients post hospital discharge. Since the inception of the partnership in March 2016, 111 patients have been referred to 2-1-1 and patients that have completed the CTI program with 2-1-1 Health Navigation experienced a 91 percent decrease in vulnerability related to SDOH. In its second year of implementation, the partnership with 2-1-1 continued to demonstrate dramatic decreases in vulnerability in the domains of nutrition, housing and safety. In addition, the partnership has had a significant impact on readmission rates among participants. The overall readmission rate for CTI patients who completed the 2-1-1 Health Navigation Program was 9.5 percent and, most importantly, survey outcomes revealed that 92 percent of CTI patients expressed confidence in the care plan to manage their health following completion of the 2-1-1 Health Navigation Program. These outcomes support the ultimate goal of the CTI program - to empower patients and community members with resources and skills to maintain their health and well-being. The CTI program has continued to receive local and national recognition. In 2017, the CTI program was highlighted at the Association of Community Health Improvement's (the community health branch of the American Hospital Association (AhA)) National Conference and Healthcare Without Harm's Community Benefit Innovators Workshop (part of the CleanMed 2017 Conference & Exposition). The program also was a featured poster presentation at the AhA Annual Leadership Summit's Journey Ahead. In addition, CTI was selected to be part of the AhA's Health Research and Educational Trust/Robert Wood Johnson Foundation Culture of Health Learning Collaborative, and was featured as a best practice case study in the project's national report titled A Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health. Further, the CTI team continues to receive requests from health systems and health care organizations locally and throughout the country to share the program's structure, lessons learned and best practices for potential replication and implementation. The CTI model of care/partnership with 2-1-1 has also been replicated at locations in SDC, including UC San Diego Health and Rady Children's Hospital. FY 2018 Plan SGH will do the following: * Continue to provide post-acute care facilitation to high-risk patients * Continue and expand the DME donations project to improve access to necessary medical equipment for high-risk patients who cannot afford DME * Continue to administer Project HELP funds to those in need * Continue to collaborate with community organizations to provide medical care, financial assistance, and psychiatric and social services to chronically homeless patients * Continue to provide high-risk, Medi-Cal and unfunded patients with CTI health coaches and connection to resources, including resources to address food insecurity, housing, and other SDOH * Maintain and strengthen partnerships with FSD and 2-1-1 to strengthen the services of the CTI program and support expansion of the program * Explore opportunities to improve communication with community clinics SGH Program and Service Highlights * 24-hour emergency room and critical care center, with heliport and paramedic base station - designated STEMI Center * Acute care * Ambulatory Care Center * Breast Imaging Center, including mammography * Cardiac Training Center * CTI program * David and Donna Long Center for Cancer Treatment, including clinical trials, genetic counseling, radiation therapy and medical oncology * Electrocardiogram * Electroencephalography * Endoscopy * Grossmont Medical Plaza Outpatient Surgery Center * Group and art therapies * Heart and vascular care - recognized by the AHA * Home health * Home infusion services * Hospice, including BonitaView, LakeView and ParkView hospice homes * Intensive Care Unit * Level III Neonatal Intensive Care Unit * Mental Health Inpatient and Outpatient Services * Orthopedics, including total joint replacement surgery * Outpatient diabetes services, recognized by the ADA * Outpatient Infusion Center * Palliative care services * Pathology services * Pediatric services45 * Pharmacy services * Pre-Anesthesia Evaluation Services * Pulmonary services * Radiology and diagnostic imaging, including computed tomography scan, positron emission tomography scan, digital mammography and DEXA bone density scan * Rehabilitation services (inpatient and outpatient) * Senior Resource Center * Skilled Nursing Facility/Transitional Care Unit * Sleep Disorders Center * Spiritual care services * Stroke Center - recognized by the AHA * Surgical Intensive Care Unit * Surgical services, including robotic surgery * Therapy Pet program * Care Clinic (opening 2018) * Van transportation services * Women's Health Center offering a full range of pregnancy, delivery, gynecologic and women's reproductive services * Wound Healing Center, including hyperbaric medicine Section 5 Sharp HospiceCare Communities banding together can effect positive change and provide support, resources and tangible items to help care for others. Depending on the community, collaboration can be small to very large. We experience it all. - Suzi Johnson, Vice President of Hospice, Sharp HospiceCare
Form 990, Part III, Line 4a Community Benefit Report	Sharp HospiceCare provides programs and services to all of Sharp HealthCare's (Sharp's or SHC's) hospital entities. However, Sharp HospiceCare is licensed under Sharp Grossmont Hospital (SGH) and as such, the financial value of its community benefit programs and services are included in Section 4 of this report. The following description highlights various programs and services provided by Sharp HospiceCare to San Diego County (SDC) in Fiscal Year 2017 (FY 2017) in the following Senate Bill 697 community benefit categories: * Other Benefits for Vulnerable Populations included contribution of time to Stand Down for Homeless Veterans, Ssubi is Hope, Mama's Kitchen, Feeding San Diego and the San Diego Food Bank. * Other Benefits for the Broader Community included a variety of end-of-life support for seniors, families, caregivers and veterans in the San Diego community such as education, support groups and outreach at community health fairs and other events. Sharp HospiceCare staff actively participated in community boards, committees and civic organizations, including San Diego County Coalition for Improving End-of-Life Care (SDCCEOLC), Caregiver Coalition of San Diego, San Diego County Hospice-Veteran Partnership (HVP), California Hospice and Palliative Care Association (CHAPCA), National Hospice and Palliative Care Organization (NHPCO), Southern Caregiver Resource Center (SCRC), San Diego Regional Home Care Council (SDRHCC), San Diego Community Action Network (SanDi-CAN), North County Community Action Network (NorCAN), South County Action Network (SoCAN), East County Senior Service Providers (ECSSP), San Diego Chapter of the Hospice and Palliative Nurses Association (HPNA), San Diego Physician Orders for Life-Sustaining Treatment (POLST) Coalition/San Diego Coalition for Compassionate Care (SDCCC), and San Diego County Medical Society Bioethics Commission. See Appendix A for a listing of Sharp's involvement in community organizations in FY 2017. The category also incorporated costs associated with community benefit planning and administration, including community health needs assessment (CHNA) development and participation. * Health Research, Education and Training Programs included time devoted to education and training for health care professionals and student and intern supervision. Definition of Community Sharp HospiceCare is located at 8881 Fletcher Parkway in La Mesa, ZIP code 91942. Sharp HospiceCare provides comprehensive end-of-life hospice care, specialized palliative care and compassionate support to patients and families throughout SDC. For SHC's 2016 CHNA process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access, including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to the CNI, communities served by Sharp HospiceCare with especially high need include, but are not limited to, East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In SDC overall, there were 397,674 residents (12.3 percent of the SDC population) ages 65 years or older in 2015. Of those, about 23.5 percent were living alone. By 2030, this age group is expected to increase to 723,572 in SDC. In SDC in 2016, 99.7 percent of surveyed children ages zero to 11, 99.5 percent of surveyed children ages 12 to 17, and 90.8 percent of surveyed adults ages 18 to 64 had health insurance, which fall short of the Healthy People 2020 (HP2020) national target of 100 percent health insurance coverage for all individuals under age 65. In SDC in 2016, 14.5 percent of adults ages 18 to 64 did not have a usual source of care and 10.6 percent of these adults had health insurance. In addition, 25.3 percent of adults without a usual source of care reported fair or poor health outcomes. See Table 26 for a summary of key indicators of access to care and Table 27 for data regarding Medi-Cal eligibility. Table 26: Health Care Access in SDC, 2016 Current Health Insurance Coverage: Children 0 to 11 Years: Rate - 99.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 99.5%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 90.8%, HP2020 Target - 100% Regular Source of Medical Care: Children 0 to 11 Years: Rate - 96.7%, HP2020 Target - 100% Children 12 to 17 Years: Rate - 74.1%, HP2020 Target - 100% Adults 18 to 64 Years: Rate - 85.5%, HP2020 Target - 89.4% Not Currently Insured: Adults 18 to 64 Years: Rate - 9.2%, HP2020 Target - N/A Source: 2016 California Health Interview Survey (CHIS) Table 27: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2016 Medi-Cal Eligible - 13.9% Not Eligible - 86.1% Source: 2016 CHIS. This information is sourced from the 2016 California Health Interview Survey (CHIS) Health Profile for SDC, provided by the University of California Los Angeles Center for Health Policy Research. Starting in 2013, the California state budget required children enrolled in the Healthy Families Program to transition enrollment into Medi-Cal. Formerly, this table included Healthy Family eligibility in San Diego County using pre-ACA data. The Affordable Care Act now determines financial eligibility for Medi-Cal using Modified-Adjusted Gross Income, based on income and number of persons in the household Cancer and coronary heart disease were the top two leading causes of death in SDC in 2015. See Table 28 for a summary of leading causes of death in SDC. For additional demographic and health data for communities served by Sharp HospiceCare, please refer to the Sharp Memorial Hospital (SMH) 2016 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments.cfm, which includes data for the primary communities served by Sharp HospiceCare. Table 28: Leading Causes of Death in SDC, 2015 Overall Cancer: Number of Deaths - 5,025, Percent of Total Deaths - 24.3% Coronary Heart Disease: Number of Deaths - 2,898, Percent of Total Deaths - 14.0% Alzheimer's Disease and Related Dementias: Number of Deaths - 2,482, Percent of Total Deaths - 12.0% Unintentional Injuries: Number of Deaths - 1,190, Percent of Total Deaths - 5.8% Stroke: Number of Deaths - 1,162, Percent of Total Deaths - 5.6% Chronic Obstructive Pulmonary Disease/Chronic Lower Respiratory Diseases: Number of Deaths - 973, Percent of Total Deaths - 4.7% Overall Hypertensive Diseases: Number of Deaths - 733, Percent of Total Deaths - 3.5% Diabetes: Number of Deaths - 708, Percent of Total Deaths - 3.4% Overdose/Poisoning: Number of Deaths - 360, Percent of Total Deaths - 1.7% Suicide: Number of Deaths - 342, Percent of Total Deaths - 1.7% All Other Causes: Number of Deaths - 4,795, Percent of Total Deaths - 23.2% Total Deaths: Number of Deaths - 20,668, Percent of Total Deaths - 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology & Immunization Services Branch Community Benefit Planning Process In addition to the steps outlined in Section 3: Community Benefit Planning Process regarding community benefit planning, Sharp HospiceCare: * Consults with representatives from a variety of internal departments and other community organizations to discuss, plan and implement community activities * Participates in programs and workgroups to review and implement services that improve palliative and end-of-life care for the San Diego community * Incorporates end-of-life community needs into its goal development Priority Community Needs Addressed by Sharp HospiceCare The 2016 CHNAs for each SHC acute care hospital, including Sharp Chula Vista Medical Center (SCVMC), Sharp Coronado Hospital and Healthcare Center (SCHHC), SGH and SMH, continued to identify senior health as a priority health need for the community. Sharp HospiceCare provides hospice and palliative care services across the SHC care continuum and helps to address senior health issues through the following community programs and services: * End-of-life and chronic illness management education for community members * Advance care planning (ACP) education and outreach for community members, students and health care professionals * Hospice and palliative care education and training programs for health care professionals, students and volunteers * Bereavement counseling and support For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, objective(s), FY 2017 Report of Activities conducted in support of the objective(s), and Fiscal Year 2018 (FY 2018) Plan.
Form 990, Part III, Line 4a Community Benefit Report	Identified Community Need: End-of-Life and Chronic Illness Management Education for Community Members Rationale references the findings of Sharp's 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * In Sharp's 2016 CHNAs, senior health was identified as one of the priority health issues for community members served by Sharp. * As part of Sharp's 2016 CHNAs, discussions with nurses and social workers from Sharp's Senior Health Centers identified the following challenges to improving the health of seniors in SDC: access to care issues due to aging, decreased driving or loss of support system; difficulty purchasing medications due to financial issues, lack of transportation or lack of motivation; difficulty understanding medical instructions; inability to recognize a health problem exists; memory issues; and the perception that health issues and loneliness are a normal part of aging. * Significant health issues for seniors in SDC include obesity, diabetes mellitus, stroke, chronic lower respiratory diseases, influenza and pneumonia, cancer, heart disease, and mental health issues, such as dementia and Alzheimer's disease (San Diego Association of Governments, 2014). * In SDC, 40.7 percent of adults ages 18 to 64 living at 200 percent below the federal poverty level reported as food insecure (California Health Interview Survey (CHIS), 2016). * Information presented by the Institute of Medicine (IOM) indicates that improving the quality and availability of medical and social services for patients may contribute to a more sustainable care system, in addition to improving quality of life through the end of life. The U.S. population is rapidly aging and becoming increasingly culturally diverse, which increases the need for responsive, patient-centered care. Current limitations to effective end-of-life care include barriers in access to care that disadvantage certain groups, and misalignment between the services patients and families need and those they are able to obtain (IOM, 2014). * Over the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious disease and acute illnesses to chronic diseases and degenerative illnesses. More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions (The State of Aging & Health in America, Centers for Disease Control and Prevention (CDC), 2013). * Nearly two-thirds of California seniors on Medicare had two or more chronic conditions in 2012, and more than one-third had four or more. These seniors have an increased need for care and higher risk for mortality as well as poorer day-to-day functioning (2015 California Health Care Almanac Beds for Boomers report). * According to the Family Caregiver Alliance, in 2014, there were an estimated 3.4 million family caregivers in California. Research shows that caregiving can have serious physical and mental health consequences. Findings from the Stress in America survey, described in a report titled Valuing the Invaluable, show that individuals who serve as caregivers to older relatives report poorer health and higher stress levels than the general population. (American Association of Retired Persons (AARP) Public Policy Institute, updated July 2015). * About six in 10 caregivers assist with medical/nursing tasks for their loved one, and 42 percent of these caregivers are performing those tasks without any formal training. According to Caregiving in the U.S. 2015, 84 percent of caregivers report that they could use more information or help on caregiving topics. The top four topics of concern for caregivers are keeping their loved one safe at home; managing their own emotional or physical stress; making end-of-life decisions; and managing their loved ones' challenging behaviors (AARP and National Alliance for Caregiving, 2015). * According to the Institute on Aging, about 14.9 million Americans are caring for someone with dementia. Caregiver interventions that have shown to successfully improve the health and well-being of dementia caregivers include providing education around how to manage dementia-related symptoms, improving social support for caregivers, and providing caregivers with respite care from caregiver duties (Alzheimer's Association, 2016). * In 2013, 140,000 Californians were served by hospice. Nearly 80 percent of hospice patients were ages 71 and older. At the current rate of use, the number of hospice patients is projected to more than double between 2013 and 2040 and it is projected that in 2040, 88 percent of hospice patients will be 71 and older (2015 California Health Care Almanac Beds for Boomers report). Objectives * Provide education and outreach to the San Diego community concerning advanced illness management (AIM) and end-of-life care * Collaborate with community organizations to provide education and outreach to community members, caregivers and loved ones * Support the unique AIM and end-of-life care needs of military veterans and their families FY 2017 Report of Activities Sharp HospiceCare supports the San Diego community in the areas of end-of-life care, aging and caregiving through participation in a variety of local organizations including SDCCEOLC, SDRHCC, San Diego County HVP, San Diego Chapter of the HPNA, San Diego POLST Coalition/SDCCC, San Diego County Medical Society Bioethics Commission, Caregiver Coalition of San Diego, SanDi-CAN, NorCAN, SoCAN and ECSSP. In partnership with these and other community organizations, in FY 2017, Sharp HospiceCare provided more than 2,500 community members with free education and outreach on a variety of end-of-life and AIM topics, including hospice, palliative care and caregiving, at community health fairs, conferences and other events. Locations included churches, senior living centers, and community health agencies and organizations throughout SDC. In October, Sharp HospiceCare participated in a community conference at the Balboa Park Club titled Planning Ahead: Crucial Conversations, hosted by SanDi-CAN, HHSA and San Diego Park and Recreation. The free event provided more than 60 seniors and family members with tools to help them identify their end-of-life values and goals of care, and learn the communication skills necessary to make informed health care planning decisions. Attendees also learned about California's End of Life Option Act, a law enacted in 2016 that permits terminally ill adult patients to request and receive doctor-prescribed medication to end life. In April, Sharp HospiceCare partnered with the Sharp Senior Resource Centers to provide two aging conferences for community seniors, family members and caregivers, tiled Planning for Physical, Mental and Financial Health. Held at All Souls Episcopal Church in Point Loma and the La Mesa Community Center, the free conferences educated approximately 180 attendees about planning for a healthier, happier and financially sound future. Sharp HospiceCare hosted two Live Stronger Longer conferences in FY 2017. Held at SCHHC in October and at the Bonita-Sunnyside Branch Library in September, the free events focused on teaching community seniors and caregivers about caring for themselves and their loved ones. Approximately 250 community members attended the free events, which offered flu shots, a resource fair and education from community health professionals on aging well, fraud awareness, advance directives, cognitive health, fall prevention, and the emotional aspects of caregiving. Sharp HospiceCare partnered with the Caregiver Coalition of San Diego, National Alliance for Mental Illness and other community organizations to provide several conferences throughout SDC, which reached more than 200 community members who were caring for a friend or family member. Conferences included How to Be a Better Caregiver in the New Year, held at San Dieguito United Methodist Church; Caring for an Adult Loved One Living With Mental Health Challenges, held at First United Methodist Church; and Finding the Balance in Caregiving, held at the La Mesa Community Center. The free conferences included resource fairs as well as presentations on various caregiving topics, including but not limited to care options through the continuum of care; New Year's resolutions for taking care of the caregiver; managing difficult conversations; dementia; mindfulness and stress reduction; legal issues; balance and fall prevention; and home safety.
Form 990, Part III, Line 4a Community Benefit Report	Sharp HospiceCare provided end-of-life and AIM education and resources to more than 1,600 community members at a variety of health fairs and other events throughout the year, including the Sharp Senior Resource Center Annual Senior Health & Information Fair, Spring Into Healthy Living at the McGrath Family YMCA, Sharp Women's Health Conference, Healthfair Saturday at Grossmont Center, La Maestra Community Health Centers' City Heights Health Fair, Norman Park Senior Center Health Fair, San Diego LGBT (Lesbian, Gay, Bisexual, Transgendered) Community Center Senior Resource Fair, San Diego Gas & Electric employee health fair, San Diego Regional Center employee health fair, Senior Health Fair at Lakeside Community Center, Mira Mesa Senior Center's Summer Senior Resource Event, SPARC (Services and Programs Assisting Residents in Our Communities) Caregiver Conference, County of San Diego Aging & Independence Services (AIS) 2017 Vital Aging conferences, South County Behavioral Health Resource Fair, Las Damas de San Diego cancer screening event at the Douglas & Nancy Barnhart Cancer Center, SCVMC Heart Health Expo, and community flu shot clinics at the Coronado Public Library, St. Paul's Plaza, Chula Vista Silvercrest senior residence and Point Loma Community Presbyterian Church. Sharp HospiceCare supports the needs of military veterans and their families through collaboration with local and national organizations that advocate for quality end-of-life care for veterans as well as through participation in veteran-oriented community events. Sharp HospiceCare is a partner in We Honor Veterans (WHV), a national program developed by the NHPCO in collaboration with the U.S. Department of Veterans Affairs (VA) to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As WHV partners, hospice organizations can achieve up to four levels of commitment. Sharp HospiceCare has achieved WHV Partner Levels I, II and III and is currently working toward Level IV. As a Level I Partner, Sharp HospiceCare is equipped to provide veteran-centric education to staff, volunteers and community professionals, including training them to identify patients with military experience. As a Level II Partner, Sharp HospiceCare has built the organizational capacity needed to provide quality care for veterans and their families. As a Level III Partner, Sharp HospiceCare has developed and strengthened relationships with VA medical centers and other veteran organizations. In FY 2017, Sharp HospiceCare conducted a variety of veteran recognition activities as part of its WHV commitment. In honor of Veteran's Day, Sharp HospiceCare celebrated patients who served in the U.S. military by holding 22 flag ceremonies throughout the month of November. During the ceremonies, fellow veterans presented patients with a U.S. flag that had been flown on the USS Midway aircraft carrier. In addition, Sharp HospiceCare held two pinning ceremonies in FY 2017 during which volunteers presented a WHV pin and a certificate of appreciation to approximately 90 Sharp HospiceCare veteran patients as well as more than 50 veteran community members. In December, Sharp HospiceCare participated in additional community events to honor the nation's veterans, including the Spirit of '45 Pearl Harbor 75th anniversary commemoration on the USS Midway and the annual Wreaths Across America wreath-laying ceremony at Fort Rosecrans National Cemetery. Sharp HospiceCare furthered its WHV commitment through the provision of veteran-specific community education and outreach in FY 2017. In June, Sharp HospiceCare hosted the Veterans Recognition, Education and Resource Fair at the Balboa Park Club. The free event included education on post-traumatic stress disorder (PTSD), caregiver support and health care as well as a recognition ceremony and community resource tables for approximately 50 community veterans and their family members. In honor of Veteran's Day in November, Sharp HospiceCare provided education and resources to approximately 50 community members at the Honoring Our Veterans event hosted by the El Cajon City Council Veterans Commission. In September, Sharp HospiceCare participated in the WHV Partner Appreciation Event as part of the 2017 NHPCO Interdisciplinary Conference held at the San Diego Marriott Marquis and Marina. Reaching approximately 100 community veterans and professionals, the free event provided a panel discussion and resource tables, including information from Sharp HospiceCare on how organizations can partner to create an HVP (a coalition of VA facilities and community hospices working together to ensure excellent end-of-life care for veterans and their families). Sharp HospiceCare has been a member of the San Diego County HVP since 2010. Through the partnership, the VA San Diego Healthcare System and San Diego's community hospice organizations collaborate to promote quality care for veterans with a life-limiting illness as well as serve as a voice and resource for veterans and their families. In October, Sharp HospiceCare, the San Diego County HVP and the Caregiver Coalition of San Diego hosted the Veterans Resource Fair at the Silverado Encinitas Memory Care Community. The free event provided veterans, family members and caregivers with community resources, presentations on available health care services, and an appreciation ceremony to honor attending veterans for their service. Sharp HospiceCare continued to participate on SCRC's Operation Family Caregiver advisory board. Operation Family Caregiver equips families of returning service members and veterans with the skills they need to adjust to life after military service. This includes free training and mentorship programs for caregivers of pre- and post- 9/11 service members and veterans with a range of service-related conditions, including traumatic brain injury, amputation, anxiety, depression, PTSD and more. Sharp HospiceCare continued to provide a wig donation program in FY 2017. Through the program, Sharp HospiceCare receives new, unused wigs from manufacturers and cleans and styles the wigs for donation to individuals experiencing hair loss as a result of cancer treatment or other illnesses. Sharp HospiceCare team members offer private wig appointments for community members to select their wig and receive personalized wig fitting, styling and maintenance instructions. Surplus wigs are donated to other departments throughout Sharp, including cancer patients at SMH and the Douglas & Nancy Barnhart Cancer Center at SCVMC. Approximately 150 wigs were donated by Sharp HospiceCare in FY 2017, including wigs for 26 community members. FY 2018 Plan Sharp HospiceCare will do the following: * Continue to collaborate with a variety of local networking groups and community agencies to provide end-of-life and AIM education and resources to community members * Collaborate with SCHHC and the Sharp Senior Resource Centers to host three free aging conferences, reaching 100 community members per conference * Continue to support the needs of military veterans and their families through the provision of education and resources at veteran-oriented community events and collaboration with local and national organizations advocating for quality end-of-life care for veterans * Achieve WHV Partner Level IV to improve access to and quality of care for veterans in the community * Continue to provide a wig donation program Identified Community Need: Advance Care Planning Education and Outreach to Community Members and Health Care Professionals Rationale references the findings of Sharp's 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SHC 2016 CHNAs identify care at the end of life as a critical issue for the senior population. * Discussions held with Sharp cancer patient navigators as part of Sharp's 2016 CHNAs indicated the following major challenges to helping oncology patients: difficulty having end-of-life conversations, which may be due to cultural variation, or lack of physician experience with palliative care; and few individuals having an advance directive. * According to the IOM, there is a need for public education and engagement about end-of-life planning at several levels, including: the societal level, to build support for public and institutional policies that ensure high-quality, sustainable care; the community and family levels, to raise awareness and elevate expectations about care options, the needs of caregivers, and the hallmarks of quality care; and the individual level, to motivate and facilitate ACP and meaningful conversations with family and caregivers.
Form 990, Part III, Line 4a Community Benefit Report	* Advance directives should be completed while people are healthy, which gives them time to think about the end-of-life care they would choose if they were unable to communicate their own wishes. It also allows time to discuss these wishes with loved ones (NHPCO, 2015). * The American Hospital Association's (AhA's) 2012 report titled Advanced Illness Management Strategies: Engaging the Community and a Ready, Willing and Able Workforce describes AIM as a four-phase process incorporating advance directives, ACP, palliative care and hospice care. In the first phase, people are healthy and can recover from reversible illness. To stay ahead of the AIM curve, it is important that individuals engage in ACP before an illness progresses and document their care preferences with trusted family and friends, as well as with their health care provider. * The same report suggests numerous strategies to engage and expand patient and community awareness of the importance of advanced illness and end-of-life decision-making, including: strategies to increase patient accessibility to information, such as providing effective language assistance services or addressing low health literacy; strategies that promote community collaborations, such as developing community engagement programs that align with the patient population's demographic and cultural needs; workforce development strategies, such as employing a diverse and skilled workforce that is tailored to the patient population being served; and internal system strategies, such as tracking the performance of patient engagement programs (AhA, 2012). * Seventy percent of Americans do not have an advance care plan (CDC, 2014). * A 2013 report titled Completion of Advance Directives Among U.S. Consumers, published in The American Journal of Preventive Medicine, shows that of more than 7,900 respondents, only 26.3 percent had an advance directive, with lack of awareness cited as the primary barrier for not having one. This study also indicates racial and educational disparities in the completion of an advance directive and highlights the need for education about end-of-life decisions that is tailored to educational level and race/ethnicity. * About twice as many Caucasians as African Americans have completed advance directives. The difference in prevalence of advance directives is attributable to several factors, including cultural differences in family-centered decision-making, distrust of the health care system, and poor communication between health care professionals and patients (Morhaim and Pollack, 2013). * The CDC describes numerous barriers to ACP, including lack of awareness, denial of death and dying, denial of being in a circumstance in which we are unable to make our own decisions and speak for ourselves, confusion between whether to choose palliative care or continue with life-prolonging treatments, and cultural differences (CDC, 2012). * According to the CDC, planning for the end of life is increasingly being viewed as a public health issue, given its potential to prevent unnecessary suffering and to support an individual's decisions and preferences related to the end of life. In addition, the CDC recognizes the public health opportunity to educate Americans, and especially older adults, about ACP and to improve their quality of care at the end of life (CDC, 2012). * A 2014 Consumer Reports survey of 2,015 adults suggests that Americans would prefer to die at home: 86 percent said they would consider receiving end-of-life-care at home, but just 36 percent said the same about getting that care in a hospital. Despite this, about 60 percent of Americans die in acute care hospitals, 20 percent in nursing homes and only 20 percent at home (Stanford School of Medicine, Palliative Care). Objectives * Provide education, engagement and consultation for community members on ACP and POLST * Educate community health care professionals on ACP and POLST * Empower community members to make informed health care decisions FY 2017 Report of Activities SHC offers a free and confidential ACP program to support community members as they consider their future health care options. Facilitated by Sharp HospiceCare, the ACP program empowers adults of any age and health status to explore and document their beliefs, values and goals as they relate to health care. The program consists of three stages. Stage one, community engagement, focuses on bringing awareness to healthy community members about the importance of ACP. This stage includes basic education and resources, identification of an appropriate health care agent, and completion of an advance directive. Stage two, disease-specific outreach, focuses on education for community members with a progressive chronic illness, including decline in functional status, co-morbidities, potential for hospitalization and caregiver issues. With a goal of anticipating future needs as health declines, this stage focuses on developing a written plan that identifies goals of care, and involves the health care agent and loved ones. The third stage, late-life illness outreach, targets those with a disease prognosis of one year or less. Under these circumstances, specific or urgent decisions must be made and converted into medical orders that will guide the health care provider's actions and remain consistent with goals of care. The focus of this stage is to assist the individual or appointed health care agent with navigating complex medical decisions related to immediate life-sustaining or prolonging measures, including completion of the POLST form, a medical order designed for individuals with advanced progressive or terminal illness that identifies the appropriate informed substitute decision maker as well as care and treatment preference when important health care decisions need to be made. Since 2014, SHC has offered the Sharp HealthCare Advance Directive to guide the public in outlining their health care decisions. The document is publicly available on Sharp's website in both English and Spanish, and uses easy-to-read language to describe what an advance directive is and how and why to complete one. The form allows individuals to put their health care wishes into writing and to appropriately sign the advance directive. With this witnessed signature, the advance directive becomes a legal document that identifies the appropriate informed substitute decision maker, and serves as a tool for health care decision-making. Additional contact information is provided for community members who are interested in speaking with a Sharp ACP facilitator. Throughout FY 2017, the Sharp ACP team provided approximately 170 phone and in-person consultations to community members seeking guidance with identifying their personal goals of care and health care preferences, appointing an appropriate health care agent, and completing an advance directive. In addition, the team engaged more than 2,000 community members and caregivers in education on ACP and POLST. Education was provided at senior centers, senior living communities and home care agencies including: Cameron's Mobile Estates; Vista Village Senior Living; La Vida Del Mar senior community; La Vida Real senior living; St. Paul's Plaza assisted living; Mount Miguel Covenant Village retirement community; North County Senior Connections and Interfaith Community Services; San Diego PACE (Program of All-Inclusive Care for the Elderly); and Sharp Senior Health Center Clairemont. Education at various agencies, groups and other community sites included Alpine Community Church; Coronado Public Library; Peninsula Family YMCA, Rotary Club of La Mesa; Grossmont HealthCare District; San Diego LGBT Community Center; Center for Community Solutions; Philanthropic Educational Organization; the Patient and Family Advisory Council at SMH; and the SGH heart failure support group. Further, the team educated attendees of various community health fairs and events including the San Diego Mesa College Health Fair; Sharp HospiceCare Veterans Education and Resource Fair; AIS 2017 Vital Aging conferences; Sharp's Conviva y Aprenda event at the San Diego Country Club; Binational Health Week; SGH 2017 Heart Health Expo; Sharp Women's Health Conference; Sharp Disaster Preparedness Expo; and Sharp HospiceCare's aging conferences, Live Stronger Longer conferences, and annual Healing Through the Holidays event.
Form 990, Part III, Line 4a Community Benefit Report	Sharp's ACP team reached an additional 35 community members through free ACP workshops in FY 2017, including a monthly workshop at the David and Donna Long Center for Cancer Treatment and workshops at the Laurel Amtower Cancer Institute at SMH in February and June. During the workshops, Sharp's ACP facilitators helped community members impacted by cancer identify their health care choices and create a plan of action. In addition, in July a Sharp ACP facilitator provided a TV interview on KUSI News to educate the San Diego community about ACP and the importance of documenting one's health wishes in the event of a serious illness. In April, Sharp HospiceCare honored National Healthcare Decisions Day (NHDD), a nationwide initiative to educate adults of all ages about the importance of ACP. Approximately 50 community members met with Sharp's ACP experts at SCVMC, SCHHC, SGH and SMH to receive assistance with developing their advance health care plan. Further, an additional 70 community members were reached through NHDD presentations at the United Church of Christ in Ramona, Lantern Crest Senior Living, Grossmont Healthcare District and the La Jolla Community Center. In FY 2017, the Sharp ACP team provided presentations to more than 130 community members about the End of Life Option Act, including members of the Summit Unitarian Universalist Fellowship Church, attendees of the Planning Ahead - Crucial Conversations event held at the Balboa Park Club, and community chaplains. In addition, Sharp HospiceCare provided film screenings and post-film panel discussions of Being Mortal - a documentary that addresses the national dialogue around death and what matters most to patients and families - for approximately 185 community members and health care professionals at Good Samaritan Episcopal Church, Sharp's corporate office and Liberty Station. Throughout the year, Sharp's ACP team educated more than 400 local, state and national health care professionals on ACP and POLST including, but not limited to, Stepping Stone of San Diego; Center for Community Solutions; Coalition for Compassionate Care of California (CCCC); CCCC's California End of Life Option Act: Key Concepts and Critical Conversation Skills for Providers conference; NHPCO Interdisciplinary Conference; Annual Hospital Quality Institute Conference; Sharp HealthCare's Advanced Illness Management Conference; California Association of Marriage and Family Therapists; leaders of the California State University (CSU) Institute for Palliative Care; and members of the Hospice and Palliative Nurses Association. Since FY 2016, Sharp's ACP team has partnered with San Diego Health Connect, AIS, Health Services Advisory Group, County of San Diego Emergency Medical Services, and various health care providers in SDC to ensure that community providers have access to POLST forms through the San Diego Healthcare Information Exchange, a countywide program that securely connects health care providers and patients to private health information exchanges. The Sharp HospiceCare ACP team participates in this initiative - funded by the California Health Care Foundation (CHCF) and supported by the CCCC and California Emergency Medical Services Authority (EMSA) - to create an electronic POLST registry (POLST eRegistry). When a paper POLST form is not readily available during an emergency, the patient's care may be hindered or conflict with their wishes. The POLST eRegistry will improve access to critical information through a cloud-based registry for completed POLST forms to be securely submitted and retrieved. FY 2018 Plan Sharp HospiceCare will do the following: * Provide free ACP and POLST education and outreach to community members through phone and in-person consultations * Collaborate with community organizations to provide educational classes and events to raise community awareness of ACP * In collaboration with SDCCC and SDCCEOLC, provide community events to promote the importance of ACP in honor of NHDD * Continue to provide ACP education and outreach to local, state and national health care professionals * Continue to serve as a community resource regarding the End of Life Option Act * Continue to collaborate with community partners to provide community members with access to advance directive and POLST forms through the San Diego Healthcare Information Exchange * Continue to participate in the CHCF's POLST eRegistry initiative with CCCC and EMSA Identified Community Need: Health Professions and Student Education and Training, and Volunteer Training Rationale references the findings of the SHC 2016 CHNA, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * Total employment in California is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. The health care and social assistance sector is expected to be the fastest-growing service industry, increasing its employment share from 12 percent in 2014 to 13.6 percent in 2024. Occupations and industries related to health care are projected to add the most new jobs, with an increase of 2.3 million jobs (U.S. Bureau of Labor Statistics (BLS), 2015). * In its Employment Projections - 2016-2026 report, the BLS projects that health care support occupations and health care practitioners/technical occupations will contribute about one-fifth of all new jobs and account for almost half of the 30 fastest-growing occupations. There are several factors leading to the increased demand for these professions, including: projected population growth in the next decade; aging of the U.S. population; greater numbers of people living with chronic conditions, such as diabetes or obesity; improvements in medicine and technology; and federal health insurance reform, which has increased the total number of Americans with health insurance coverage (BLS, 2016). * As of 2015, SDC was one of 26 counties in California designated as a Registered Nurse Shortage Area by the California Healthcare Workforce Policy Commission (Office of Statewide Health Planning and Development Healthcare Atlas, 2017). * The BLS projects employment of more than 300,000 registered nurses (RNs) in California in 2024, which would be an increase of 17 percent from 2014. Compared to other health care practitioners and technical health care operators, RNs are projected to have the most opportunity for employment in 2020 (BLS, 2014). * According to the HPNA, professional nurses play a leading role as members of the palliative care and hospice teams, and across the continuum of care, as primary team members who assess, direct, evaluate and coordinate patient needs during the illness experience. Economic models project a significant shortage of between 725,000 and 1.1 million professional nurses by 2030, underscoring the importance of preparing nurses for the future (HPNA, 2015). * The BLS projects that the demand for home health aides in California will grow 39 percent from 2014 to 2024. Older individuals often have health problems and need help with daily activities. Thus, as the U.S. population ages, the demand for home health aides will continue to increase (BLS, 2014). * Direct-care workers in California are responsible for providing 70 to 80 percent of the paid hands-on long-term care for older adults or those living with disabilities or other chronic conditions (Eldercare Workforce Alliance, 2014-2015). * The number of people reaching retirement will double by 2030, accounting for an eight percent increase in the U.S. population needing a wide range of professional health, home care, and social services. An estimated 3.5 million additional health care professionals will be needed by 2030 to care for older adults, while current workforce levels are already stretched. Geriatrics health professions training programs are critical to ensuring there is a skilled eldercare workforce and knowledgeable, well-supported family caregivers available to meet the complex and unique needs of older adults (Eldercare Workforce Alliance, 2014-2015). * While the demand for doctors specializing in the medical care of elderly patients is increasing, the interest among medical students for a career in geriatrics is lagging behind. Factors cited for the low interest among these students include the preference for young patients and acute somatic diseases that can be cured, the complexity of the geriatric population, and the lack of status and financial aspects of the career (Why Medical Students Do Not Choose a Career in Geriatrics: A Systematic Review, BMC Medical Education, 2015).
Form 990, Part III, Line 4a Community Benefit Report	* An AhA 2012 report titled Advanced Illness Management Strategies: Engaging the Community and a Ready, Willing and Able Workforce identifies a critical shortage of health care professionals working in hospice. A task force appointed by the American Academy of Hospice and Palliative Medicine estimates that between 2,800 and 7,500 physicians are needed to bring current hospice programs up to appropriate staffing levels. Additionally, only three percent of RNs identify hospice as their clinical specialty. * The same report identifies a strong need for other trained professionals who play an integral role in AIM and end-of-life care, such as social workers, psychologists, case managers, dietitians, pharmacists, complementary therapists, caregivers, and certified nursing assistants (AhA, 2012). * The San Diego Workforce Partnership (SDWP) recommends programs that provide volunteer experiences to high school and post-secondary students, as on-the-job training could provide real world experience for workers. Programs that target underrepresented groups and disadvantaged students could help increase the number of culturally competent health care workers (SDWP, 2011). * A 2014 report from the California Hospital Association titled Critical Roles: California's Allied Health Workforce Follow-Up Report emphasizes the importance of local hospitals providing clinical training for nurses and allied health professionals, as well as programs to support mentoring and hospital work experience for interns and high school students. In the coming decades, such programs will have a tremendous impact on the lives of individuals, families and the San Diego community at large. Objectives * Provide education and training opportunities around end-of-life care and ACP for students and interns * Through education, training and outreach, guide local, state and national health care organizations in the development and implementation of appropriate services for the needs of the aging population, including individuals in need of AIM * Maintain active relationships and leadership roles with local and national organizations * Provide volunteer opportunities for adults and teens in the San Diego community FY 2017 Report of Activities In FY 2017, Sharp HospiceCare provided training opportunities for 55 nursing students and one ancillary student from colleges and universities including California State University San Marcos (CSUSM), San Diego State University (SDSU), Grand Canyon University, Touro University and Chamberlain University. Students spent more than 1,350 hours shadowing and learning from the nursing staff at Sharp HospiceCare's hospice homes. Sharp's ACP team supports San Diego's future health care workforce through classroom-based lectures designed to enhance students' understanding of hospice and palliative care. In FY 2017, the team provided introductory education to approximately 450 students, including nursing students from Azusa Pacific University, University of San Diego and CSUSM; social work students from SDSU; and students from San Diego Mesa College. Topics included ACP, POLST, goals of care, hospice, palliative care, bioethics and bereavement. Sharp HospiceCare leadership provided education, training and outreach to local, state and national health professionals throughout the year. These efforts sought to guide industry professionals in achieving person-centered, coordinated care through the advancement of innovative hospice and palliative care initiatives. Audiences included the Center to Advance Palliative Care; Advances in Palliative Care Conference; Baylor Scott & White Health; Athena Health; American Case Management Association - Southern California Chapter; National Symposium for Palliative Care; California Department of Health Care Services; CCCC Annual Summit; CSU Institute for Palliative Care National Symposium; SDCCC and CSU Institute for Palliative Care Conference; and the 2017 NHPCO Interdisciplinary Conference. Presentation topics included palliative care, AIM, geriatric cognitive and functional decline; prognostication, successful aging, and ACP. In July, Sharp HospiceCare hosted a continuing education conference titled Advanced Illness Management: The Right Care at the Right Time. The free conference educated approximately 100 physicians, nurses, social workers, chaplains, bereavement counselors and other interested health care providers on the importance of having an organized approach to AIM for patients and their families; how to identify patients who are appropriate for AIM; and how to develop practical steps to improve AIM and palliative care in the emergency department. Sharp HospiceCare provided education, resources and support for additional Sharp-sponsored conferences in FY 2017, including the Sharp Rees-Stealy Medical Group and Sharp Community Medical Group annual conferences, Sharp HealthCare Neuro-Oncology Conference, Sharp HealthCare Cardiovascular Conference, Sharp HealthCare Pulmonary Conference and the SGH eighth annual Heart and Vascular Conference. These conferences provided evidence-based continuing education for more than 1,000 community health providers. Further, in FY 2017, Sharp HospiceCare leadership continued to serve on the board and as a state hospice representative for NHPCO and CHAPCA. Sharp HospiceCare continued to offer volunteer training opportunities in FY 2017 in order to provide valuable knowledge and experience to volunteers who are often working towards a career in the medical field. Volunteers supported Sharp HospiceCare and those it serves by providing companionship to those near the end of life, support for families and caregivers, and help with community outreach. Sharp HospiceCare trained approximately 50 new volunteers in FY 2017. In addition, seven teenagers were trained through Sharp HospiceCare's Teen Volunteer Program, which provides teens with opportunities to participate in special projects in Sharp HospiceCare administration or at Sharp HospiceCare's LakeView, ParkView and BonitaView hospice homes. Volunteer opportunities were also extended to seven premedical students from SDSU, University of California, San Diego and CSUSM, who assisted family caregivers in private homes. Ten volunteers participated in Sharp HospiceCare's 11th Hour Program in FY 2017. Through this special program, volunteers accompanied end-of-life patients without family members present during their final moments as well as comforted family members who were present while their loved one passed away. In addition, approximately 12 volunteers were trained to provide integrative therapies, including Healing Touch, Reiki, aromatherapy and hand massage, to promote relaxation, restful sleep and enhanced quality of life for Sharp HospiceCare patients and their caregivers. As WHV partners, Sharp HospiceCare provides veteran-centric education and training that qualifies volunteers to identify and work with patients who have military experience. This includes the Vet-to-Vet Volunteer program, which pairs war veteran volunteers with veteran patients, as well as honors veteran patients for their service through special pinning ceremonies. FY 2018 Plan Sharp HospiceCare will do the following: * Continue to provide education and training opportunities for nursing and other health care students and interns * Provide students with an end-of-life learning environment in community-based hospice homes * Continue to provide education, training and outreach to local, state and national organizations to support the development and implementation of specialized services to meet the needs of the aging population * Maintain active relationships and leadership roles with local and national organizations * Collaborate with San Diego County HVP to provide training to community health care professionals Identified Community Need: Bereavement Counseling and Support Rationale references the findings of Sharp's 2016 CHNAs, HASD&IC 2016 CHNA or the most recent SDC community health statistics unless otherwise indicated. Rationale * The IOM's 2014 report titled Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life indicates that clinical care is not a person's sole priority near the end of life. Patients and families may be deeply concerned with existential or spiritual issues, including bereavement, and with practical matters of coping. Appropriate support in these areas is an essential component of good care. * According to the same report, risk factors for complicated grief among bereaved caregivers include fewer years of education, younger age of the deceased and lower satisfaction with social support. The care provided by hospices may lead to positive health outcomes, including survival, among the bereaved and may help some people avoid long-term depression and other consequences of complicated grief (IOM, 2014).
Form 990, Part III, Line 4a Community Benefit Report	* According to the NHPCO, grief may be experienced in response to physical losses, such as death, or in response to symbolic or social losses, such as divorce or loss of a job. The grief experience can be affected by one's history and support system. Engaging in self-care practices and accessing counseling and support services can be a guide through some of the challenges of grieving as a person adjusts to his or her loss. * According to a study titled Missed Opportunity: Hospice Care and the Family, caregivers agreed that hospice enabled them to be a caregiver and provide an in-home dying experience for their spouse. However, these caregivers also suggested that hospices could make additional strides to identify and respond to their specific needs for support through the dying and bereavement process (Journal of Social Work in End-of-Life & Palliative Care, 2015). * A 2015 study published in the Journal of the American Medical Association (JAMA) surveyed 305 bereaved spouses of decedents who used hospice and 711 bereaved spouses of decedents who did not use hospice. Surviving spouses of individuals who used hospice for at least three days were more likely to have some reduction in depressive symptoms one year after death when compared to those whose spouses did not use hospice at all (JAMA, 2015). * According to a 2013 study published in the Journal of Palliative Medicine (JPM), many caregivers may benefit from bereavement support, as 12 to 40 percent of caregivers experience poor psychological outcomes, including depression and complicated grief, six months to one year following loss. Targeting services to caregivers at risk for poor psychological well-being following loss may facilitate effective use of hospice bereavement services (JPM, 2013). * According to a 2014 study published in the Journal of Hospice and Palliative Nursing (JHPN), family caregiver descriptions of bereavement adaptation revealed significant themes related to social support in bereavement, including support from professional health care providers, both for themselves and their family member during palliative and hospice care. Risk factors for poor bereavement adaptation included length of time in the caregiver role; loss of an adult child; loss of spouse; and history of multiple losses (JHPN, 2014). Objectives * Provide bereavement education, resources, counseling and support to community members who have lost loved ones * Provide individuals and their families with referrals to community services * Provide the Memory Bear program to support community members who have lost loved ones FY 2017 Report of Activities Throughout FY 2017, Sharp HospiceCare offered a variety of bereavement service options to help grieving community members learn effective ways to cope with the loss of a loved one. Services included professional bereavement counseling for individuals and families as well as free community education, support groups and monthly newsletter mailings. In FY 2017, Sharp HospiceCare devoted nearly 2,200 hours to home, office and phone counseling with people who have lost loved ones, providing them with bereavement counseling services from licensed clinical therapists with specific training in grief and loss. Sharp HospiceCare's bereavement counselors also provided referrals to community counselors, mental health services, bereavement support services and other community resources as needed. Sharp HospiceCare continued to offer the Healing After Loss and the Widow's and Widower's bereavement support groups, which reached approximately 260 community members in FY 2017. Offered quarterly, the groups consisted of eight-week sessions facilitated by skilled mental health care professionals with a specialization in the needs of the bereaved. The Healing After Loss support group focused on addressing the concerns of adults who were grieving the loss of a loved one. Weekly themes included Introduction to the Grief Process; Strategies for Coping with Grief; Communicating with Family and Friends; Experiencing Anger in Grief; Guilt, Regret and Forgiveness; Differentiating Natural Grief and Depression; Use of Ceremony and Ritual to Promote Healing; and Who Am I Now?/What Does Healing Look Like?. The Widow's and Widower's support group addressed concerns of men and women who lost their spouse or partner. Participants had the opportunity to share their emotional challenges and learn coping skills from group members facing similar life situations. In May, Sharp HospiceCare offered support to adults who were grieving the loss of a parent through two Remembering Our Parents classes. Held at the Peninsula Family YMCA and the Grossmont Healthcare District, the presentations helped approximately 20 community members recognize the nature of their loss, identify strategies to help them cope with grief, and discover a sense of hope as Mother's Day and Father's Day approached. In October, a workshop titled Nurturing the Mind, Body and Soul provided strategies for self-care, self-compassion and healing following the death of a loved one to approximately 30 community members at Sharp's corporate office location. Additional bereavement support in FY 2017 was offered to residents of Golden Age Garden apartments and staff at BO-beau kitchen & garden and Coaster Bar & Grill restaurants. Sharp HospiceCare supported approximately 120 community members grieving the loss of a loved one during the 2016 holiday season. In November, Sharp HospiceCare held its annual Healing Through the Holidays event at Sharp's system office, which included presentations on understanding grief, improving coping skills, exploring the spiritual meaning of the holidays in the face of grief, and reviving hope. Two similar events titled Coping with Grief During the Holiday Season were held at the Coronado Public Library in November and at the Grossmont Health Care District in December. These events provided practical suggestions for community members to cope with the painful feelings of loss that often arise during the holidays. Additionally, Sharp HospiceCare provided a Support During the Holiday Season bereavement support group on two days in December, which focused on developing coping skills to promote healing, as well as remembering your loved ones, through the holidays. Sharp HospiceCare continued to offer the Memory Bear program. In this unique program, volunteers use garments of loved ones who have passed on to sew teddy bears as keepsakes for surviving friends and family. In FY 2017, volunteers dedicated nearly 2,700 hours to sewing more than 670 bears for approximately 240 families.Sharp HospiceCare also continued to mail its monthly bereavement support newsletter, Healing Through Grief, to community members for 13 months following the loss of their loved one. Approximately 1,400 newsletters were mailed each month during FY 2017. FY 2018 Plan Sharp HospiceCare will do the following: * Continue to offer individual and family bereavement counseling for community members who have lost a loved one * Continue to provide referrals to community services * Continue to provide a variety of free bereavement support groups * Continue to provide events and support services for individuals grieving the loss of a loved one during the holiday season * Support at least 240 families through the Memory Bear program * Continue to provide 13 mailings of bereavement support newsletters Sharp HospiceCare Program and Service Highlights * Advance care planning * Bereavement care services * Caregiver and family support * Homes for Hospice program * Hospice aides * Hospice nursing services * Integrative therapies * Management for various hospice patient conditions, including: * Alzheimer's disease * Cancer * Debility * Dementia * Heart disease * Human Immunodeficiency Virus * Kidney disease * Liver disease * Pulmonary disease * Stroke * Music therapy * Social services support * Spiritual care services * Volunteer program * We Honor Veterans program Appendix A Sharp HealthCare Involvement in Community Organizations The list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2017. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Adult Protective Services * Aging and Disability Resource Connection * Alliance for African Assistance * Altrusa International Club of San Diego * Alzheimer's Project Safety Workgroup * Alzheimer's San Diego * Alzheimer's San Diego Client Advisory Board * American Academy of Nursing * American Association of Colleges of Nursing * American Association of Critical Care Nurses, San Diego Chapter
Form 990, Part III, Line 4a Community Benefit Report	* American Cancer Society * American College of Healthcare Executives * American Diabetes Association * American Foundation for Suicide Prevention * American Heart Association * American Hospital Association * American Lung Association * American Nurses Association * American Psychiatric Nurses Association * American Red Cross of San Diego * Angels Foster Family Network * The Arc of San Diego * Asian Business Association * Association for Ambulatory Behavioral Healthcare * Association for Clinical Pastoral Education * Association of California Nurse Leaders * Association of Fundraising Professionals - San Diego Chapter * Association of Women's Health, Obstetric and Neonatal Nurses * Azusa Pacific University * BAME Renaissance, Inc. (BAME CDC) * Bayside Community Center * Beacon Council's Patient Safety Collaborative * Boys and Girls Club of South County * Cabrillo Credit Union Sharp Division Board * Cabrillo Credit Union Supervisory Committee * California Academy of Nutrition and Dietetics - San Diego District * California Association of Health Plans * California Association of Hospitals and Health Systems Committee on Volunteer Services and Directors' Coordinating Council * California Association of Marriage and Family Therapists San Diego Chapter * California Association of Physician Groups * California Board of Behavioral Health Sciences * California College San Diego * California Department of Public Health (CDPH) * CDPH Healthcare Acquired Infections/Antimicrobial Stewardship Program subcommittee * CDPH Healthcare Associated Infection Advisory Committee * CDPH Joint Advisory Committee * California Dietetic Association * California Emergency Medical Services Authority * California Health Care Foundation * California Health Information Association * California Hospice and Palliative Care Association * California Hospital Association (CHA) * CHA Board of Trustees * CHA Center for Behavioral Health * CHA Emergency Management Advisory Committee * CHA Hospital Quality Institute Regional Quality Leaders Network * CHA Workforce Committee * California Library Association * California Maternal Quality Care Collaborative * California Perinatal Quality Care Collaborative * California Society for Clinical Social Work Professionals * California State University San Marcos * California Teratogen Information Service * Caregiver Coalition of San Diego * Center on Policy Initiatives * Chicano Federation * Community Health Improvement Partners (CHIP) Behavioral Health Work Team * CHIP Health Literacy San Diego Task Force * CHIP Independent Living Association Advisory Board and Peer Review Advisory Team * CHIP Suicide Prevention Council * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Police Foundation * City of Chula Vista Wellness Program * City of San Diego * City of San Diego Park & Recreation - Therapeutic Recreation Services Disabled Services Advisory Council * Community Center for the Blind and Visually Impaired * Community Emergency Response Team * Consortium for Nursing Excellence, San Diego * Coronado Fire Department * Coronado Public Library * Coronado SAFE (Student and Family Enrichment) * Coronado Senior Center Planning Committee * Doors of Change * Downtown San Diego Partnership * East County Action Network * East County Senior Service Providers * Emergency Nurses Association - San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Family Health Centers of San Diego * Feeding San Diego * Friends of Scott Foundation * Gary and Mary West Senior Wellness Center * George G. Glenner Alzheimer's Family Centers, Inc. * Girl Scouts San Diego * Greater San Diego East County Advisory Board * Grossmont College * Grossmont College Occupational Therapy Assistant Advisory Board * Grossmont College Respiratory Advisory Committee * Grossmont Healthcare District Community Grants and Sponsorships Committee * Grossmont Healthcare District Independent Citizens' Bond Oversight Committee * Grossmont Imaging LLC Board * Grossmont Union High School District * Hands United for Children * Health Care Communicators Board * Health Industry Collaboration Effort, Inc. * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Helix Charter High School * Hidden Heroes Campaign Committee * Home Start, Inc. * Hospice and Palliative Nurses Association - San Diego Chapter * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * HSHMC Board * Hunger Advocacy Network * I Love a Clean San Diego * Inner City Action Network * International Association of Eating Disorders Professionals * The Jacobs & Cushman San Diego Food Bank * Jewish Family Service of San Diego (JFS) * JFS Behavioral Health Committee * JFS Public Affairs Committee * John A. Davis Family YMCA Board of Management * Kitchens for Good * Kiwanis Club of Bonita * La Maestra Community Health Centers * La Mesa Lion's Club * La Mesa Parks and Recreation * Lantern Crest Senior Living Advisory Board * Las Damas de San Diego International Nonprofit Organization * Las Patronas * Las Primeras * Life Rolls On Foundation * Live Well San Diego Check Your Mood Committee * Mama's Kitchen * March of Dimes * Meals on Wheels San Diego County * Meals on Wheels San Diego County East County Advisory Board * Mental Health America * Miracle Babies * MRI Joint Venture Board * National Active and Retired Federal Employees Association * National Alliance on Mental Illness * National Association of Hispanic Nurses, San Diego Chapter * National Association of Neonatal Nurses * National Association of Orthopedic Nurses * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National Kidney Foundation * National University * Neighborhood Healthcare * Neighborhood House Association * North County Community Action Network * North San Diego Business Chamber * Pacific Arts Movement * Palomar Community College * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Point Loma Nazarene University * Practice Greenhealth * Promises2Kids * Psychiatric Emergency Response Team * Regional Perinatal System * Residential Care Committee * Ronald McDonald House Operations Committee * Rotary Club of Chula Vista * Rotary Club of Coronado * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Association of Governments * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Community Action Network * San Diego Community College District * San Diego County Breastfeeding Coalition * San Diego County Breastfeeding Coalition Advisory Board * San Diego County Civilian/Military Liaison Work Group * San Diego County Coalition for Improving End-of-Life Care * San Diego County Council on Aging * San Diego County Emergency Medical Care Committee * San Diego County Falls Prevention Taskforce * San Diego County Health and Human Services Agency * San Diego County Hospice-Veteran Partnership * San Diego County Medical Society Bioethics Commission * San Diego County Older Adult Behavioral Health System of Care Council * San Diego County Older Adult Council * San Diego County Perinatal Care Network * San Diego County Social Services Advisory Board * San Diego County Stroke Consortium * San Diego County Taxpayers Association * San Diego County Unified Disaster Council * San Diego Covered California Collaborative * San Diego Dietetic Association * San Diego East County Chamber of Commerce * San Diego Eye Bank Nurses' Advisory Board * San Diego Fire-Rescue Department * San Diego Food System Alliance, Healthy Food Access Committee * San Diego Freedom Ranch * San Diego Habitat for Humanity * San Diego Health Information Association * San Diego Healthcare Disaster Coalition * San Diego Housing Commission * San Diego Human Dignity Foundation * San Diego Humane Society * San Diego Hunger Coalition * San Diego Immunization Coalition * San Diego-Imperial County Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. * San Diego Mental Health Coalition * San Diego Mental Health History Planning Team * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders * San Diego Physician Orders for Life-Sustaining Treatment Coalition/San Diego Coalition for Compassionate Care
Form 990, Part III, Line 4a Community Benefit Report	* San Diego Psych-Law Society * San Diego Regional Chamber of Commerce * San Diego Regional Healthcare Sustainability Collaborative * San Diego Regional Home Care Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego State University * San Diego Workforce Partnership (SDWP) * SDWP Work Well Committee * Santee Chamber of Commerce * Santee-Lakeside Rotary Club * SAY San Diego * Second Chance * Serving Seniors * Sharp and Children's MRI Board * Sharp and UC San Diego Health's Joint Venture Board * Sigma Theta Tau International Honor Society of Nursing * South Bay Community Services * South County Action Network * South County Economic Development Council * Southern California Association of Neonatal Nurses * Southern Caregiver Resource Center * Southwestern College * Special Needs Trust Foundation * Special Olympics * Ssubi * St. Paul's Retirement Home Foundation * SuperFood Drive * The Meeting Place * THE UNBATTLE PROJECT * Trauma Center Association of America * Union of Pan Asian Communities * University of California, San Diego * University of San Diego * University of Southern California * VA San Diego Healthcare System * VA San Diego Mental Health Council * Veterans Home of California, Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * We Honor Veterans * Westminster Tower * Women, Infants and Children Program * Wreaths Across America - San Diego * YMCA * YWCA Becky's House(r) * YWCA Board of Directors * YWCA Executive Committee * YWCA Finance Committee * YWCA In the Company of Women Event
Form 990, Part IV, Line 24a PART IV, LINE 24A	Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327). This organization's allocated portion is included in Part X, Line 25.
Form 990, Part V, Line 1a	Independent contractors are paid under Sharp HealthCare's tax identification number (95-6077327) and are reported on Sharp HealthCare's tax return.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons	WILLIAM S. EVANS, DANIEL KINDRON, AND ANTHONY DAMICO WERE ALL DIRECTORS ON THE GOVERNING BOARD OF THE GROSSMONT IMAGING JOINT VENTURE - Business relationship, GROSSMONT HOSPITAL CORPORATION DIRECTORS, DAVE GRUNDSTROM AND JIM PARKER, - Family relationship, GROSSMONT HOSPITAL CORPORATION DIRECTORS, PETER HANSON AND JIM PARKER - Business relationship
Form 990, Part VI, Line 6 Classes of members or stockholders	Sharp HealthCare (FEIN 95-6077327) is the sole member of Grossmont Hospital Corporation.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members. Sharp HealthCare also retains the approval rights afforded members for certain significant transactions (e.g. dissolution or sale or transfer of all or substantially all of the assets.)
Form 990, Part VI, Line 11b Review of form 990 by governing body	The final Form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the Director of Accounting & Tax, Vice President of Finance, Senior Vice President and Chief Financial Officer, and entity Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990.
Form 990, Part VI, Line 12c Conflict of interest policy	Grossmont Hospital has a written conflict of interest policy which has been reviewed and approved by the Grossmont Hospital governing board. Grossmont Hospital is committed to preventing any Participant of the Corporation from gaining any personal benefit from information received or from any transaction of Sharp. One component of the written conflict of interest policy requires that Board Members, Corporate Officers, Senior Vice Presidents and Chief Executive Officer(s) submit a conflict of interest statement annually to Legal Services/Senior Vice President of Legal Services who will review all statements. In addition, all Vice Presidents and any employees in the Purchasing/Supply Chain, Audit and Compliance, and Case Management/Discharge Planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the Conflict Review Committee comprised of employees from Sharp's Legal, Compliance, and Internal Audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board Members, Corporate Officers, Senior Vice Presidents, and the Chief Executive Officer(s) shall make such disclosures directly to the Chairman of the Board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the Board Member, Corporate Officer, Senior Vice President or the Chief Executive Officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from Sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with Section 5222 of the California Corporations Code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	The Personnel Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Personnel Committee of the Board of Directors by the independent consultant. The Personnel Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Personnel Committee approves the total compensation for the President/Chief Executive Officer and reviews and approves the compensation and compensation salary ranges for the remainder of the executive team. The Personnel Committee presents its decision to the Board of Directors. The Personnel Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November 2016.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	The Compensation Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Compensation Committee of the Board of Directors by the independent consultant. The Compensation Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Compensation Committee creates and approves the organization's Executive Compensation Philosophies and Strategies statement and as part of this approves the total compensation for the President/Chief Executive Officer and reviews and approves the total compensation recommendations for the remaining executive team. The Compensation Committee presents its decision to the Board of Directors. The Compensation Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November 2016.
Form 990, Part VI, Line 19 Required documents available to the public	The organization does not make its governing documents available to the general public. Policies are considered proprietary information, however in Sharp HealthCare's publicly available Code of Conduct, Sharp outlines its Conflict of Interest policies in a user friendly manner. The annual audited financial statements of the consolidated group are published on the dacbond.com website (www.dacbond.com), are attached to the Form 990 filed for each of the Sharp hospitals, and are available upon request. The annual audited financial statements include combining schedules which disclose the financial results (Balance Sheet, Statement of Operations, Statement of Changes in Net Assets) for each entity of the consolidated group. Quarterly financial statements of Sharp's obligated group are published on the dacbond.com website (www.dacbond.com).
Form 990, Part VII, Section A PART VII, SECTION A	Sharp Grossmont Hospital executives' salaries and wages are paid under Sharp HealthCare's tax ID number (EIN 95-6077327), and as such are also reported on Sharp HealthCare's Form 990.
Form 990, Part VII, Section B, Line 1	Independent contractors are paid under Sharp HealthCare's tax identification number (95-6077327) and are reported on Sharp HealthCare's tax return.
Form 990, Part VIII, Line 2f Other Program Service Revenue	OTHER - Total Revenue: 586653, Related or Exempt Function Revenue: 586653, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	OTHER - Total Revenue: 193062, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 193062;
Form 990, Part X, Line 25 PART X, LINE 25	Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327) and this organization has reported zero on Form 990, Part X, Line 20 and has reported the allocated balance on Line 25.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN MINIMUM PENSION LIABILITY - 3525783; BENEFICIAL INTEREST IN GROSSMONT HOSPITAL FOUNDATION - 450502;
Form 5471 Form 5471	Form 5471 has been filed on behalf of Grossmont Hospital Corporation by Sharp HealthCare (FEIN 95-6077327).

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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
SHARP HEALTHCARE (SHC)
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	956077327	HEALTHCARE ORGANIZATION	CA	501(c)(3)	3	NA	false
SHARP MEMORIAL HOSPITAL (SMH)
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	953782169	HOSPITAL	CA	501(c)(3)	3	SHARP HEALTHCARE	Yes (true)
SHARP CHULA VISTA MEDICAL CENTER (SCVMC)
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	952367304	HOSPITAL	CA	501(c)(3)	3	SHARP HEALTHCARE	Yes (true)
SHARP HEALTHCARE FOUNDATION (SHF)
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	953492461	HEALTHCARE FOUNDATION	CA	501(c)(3)	7	SHARP HEALTHCARE	Yes (true)
GROSSMONT HOSPITAL FOUNDATION
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	330124488	HOSPITAL FOUNDATION	CA	501(c)(3)	7	GROSSMONT HOSPITAL CORPORATION	Yes (true)
SHARP HEALTH PLAN (SHP)
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	330519730	HEALTH PLAN	CA	501(c)(4)		SHARP HEALTHCARE	Yes (true)
SHARP CORONADO HOSPITAL AND HEALTHCARE
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	921231489	950651579	HOSPITAL	CA	501(c)(3)	3	SHARP HEALTHCARE	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 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	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
GROSSMONT IMAGING LLC
7777 ALVARADO ROAD SUITE 108	LA MESA	CA	91941	202655131	DIAGNOSTIC IMAGING	CA	NA	Related	$291,763	$1,546,696	false	Yes (true)	0.5
SHARP HEALTHCARE ACO-II LLC
8695 SPECTRUM CENTER BLVD	SAN DIEGO	CA	92123	812645189	Offices of Physicians	CA	NA	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	CONTINUOUS QUALITY INSURANCE SPC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	CAPTIVE INSURANCE COMPANY	PrimaryActivitiesTxt
Legal Domicile Foreign Country	CJ	LegalDomicileForeignCountryCd

Direct Controlling Entity Name DirectControllingEntityName

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

Field	Value	IRS element (for citing)
Entity Type	C Corporation	EntityTypeTxt
Controlled Organization	false	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (true)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	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	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (16 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Sharp Memorial Hospital
L	$4,688,108	Accrual
Sharp Memorial Hospital
M	$6,447,176	Accrual
Sharp Memorial Hospital
P	$152,472	Accrual
Sharp Memorial Hospital
Q	$212,286	Accrual
Sharp Chula Vista Medical Center
L	$3,528,638	Accrual
Sharp Chula Vista Medical Center
M	$732,231	Accrual
Sharp Chula Vista Medical Center
Q	$105,028	Accrual
Sharp Coronado Hospital And Healthcare Center
M	$244,545	Accrual
Sharp Coronado Hospital and Healthcare Center
L	$244,414	Accrual
Sharp Coronado Hospital and Healthcare Center
Q	$337,945	Accrual
Sharp Coronado Hospital and Healthcare Center
S	$146,524	Accrual
Grossmont Hospital Foundation
Q	$937,143	Accrual
Grossmont Hospital Foundation
C	$4,443,709	Accrual
Grossmont Hospital Foundation
B	$1,235,429	Accrual
Grossmont Hospital Foundation
N	$70,273	Accrual
Sharp Health Plan
L	$899,640	Accrual