SCRIPPS HEALTH: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: SCRIPPS HEALTH (EIN 95-1684089)
Tax period: 2016-10-01 to 2017-09-30
Filed: 2018-08-09
IRS object ID: 201832219349301153
Schema version: 2016v3.1
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-08-09T12:54:14-05:00	ReturnTs
Tax Period End	2017-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	560 MISSION ST STE 1600	AddressLine1Txt
City	SAN FRANCISCO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	94105	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	951684089	EIN

Business Name BusinessName

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

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	RICHARD ROTHBERGER	PersonNm
Person Title	EVP/CFO	PersonTitleTxt
Phone	8586797901	PhoneNum
Signature	2018-08-06	SignatureDt

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	EVA NITTA	PreparerPersonNm
PTIN	P01286320	PTIN
Phone	4158948000	PhoneNum

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

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CHRISTOPHER VAN GORDER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	SAME AS C ABOVE	AddressLine1Txt
City	SAN DIEGO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	92121	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$3,721,047,464	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SCRIPPSHEALTH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1924	FormationYr
Legal Domicile State	CA	LegalDomicileStateCd
Activity Or Mission	FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR- PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CA. (SEE SCH O)	ActivityOrMissionDesc
Voting Members Governing Body	16	VotingMembersGoverningBodyCnt
Voting Members Independent	14	VotingMembersIndependentCnt
Total Employee	16816	TotalEmployeeCnt
Total Volunteers	2168	TotalVolunteersCnt
Total Gross UBI	$7,833,014	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$187,760	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$34,089,147	PYContributionsGrantsAmt
CY Contributions Grants	$50,694,014	CYContributionsGrantsAmt
PY Program Service Revenue	$2,622,932,919	PYProgramServiceRevenueAmt
CY Program Service Revenue	$2,634,688,367	CYProgramServiceRevenueAmt
PY Investment Income	$21,688,960	PYInvestmentIncomeAmt
CY Investment Income	$51,577,904	CYInvestmentIncomeAmt
PY Other Revenue	$81,980,854	PYOtherRevenueAmt
CY Other Revenue	$87,712,048	CYOtherRevenueAmt
PY Total Revenue	$2,760,691,880	PYTotalRevenueAmt
CY Total Revenue	$2,824,672,333	CYTotalRevenueAmt
PY Grants And Similar Paid	$637,925	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$468,506	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,168,033,283	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,218,359,741	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$8,124,256	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,426,602,227	PYOtherExpensesAmt
CY Other Expenses	$1,466,079,709	CYOtherExpensesAmt
PY Total Expenses	$2,595,273,435	PYTotalExpensesAmt
CY Total Expenses	$2,684,907,956	CYTotalExpensesAmt
PY Revenues Less Expenses	$165,418,445	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$139,764,377	CYRevenuesLessExpensesAmt
Total Assets BOY	$4,938,384,870	TotalAssetsBOYAmt
Total Assets EOY	$5,265,457,446	TotalAssetsEOYAmt
Total Liabilities BOY	$1,564,728,331	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,518,445,750	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$3,373,656,539	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$3,747,011,696	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. (CONTINUED IN SCHEDULE O).	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$2,361,032,336	ExpenseAmt
Grant	$468,506	GrantAmt
Revenue	$2,714,200,213	RevenueAmt
Desc	SEE SCHEDULE O.	Desc
Total Program Service Expenses	$2,361,032,336	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	Yes (true)	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	Yes (true)	CreditCounselingInd
Temp Or Permanent Endowments	Yes (true)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (true)	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	Yes (true)	ForeignOfficeInd
Foreign Activities	Yes (true)	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	Yes (true)	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	Yes (true)	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln 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	Yes (true)	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	946	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	16816	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	Yes (true)	ForeignFinancialAccountInd
Foreign Country	MX	ForeignCountryCd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (true)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (true)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	16	GoverningBodyVotingMembersCnt
Independent Voting Member	14	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	false	MembersOrStockholdersInd
Election Of Board Members	false	ElectionOfBoardMembersInd
Decisions Subject To Approva	false	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (true)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	RICHARD ROTHBERGER	PersonNm
Phone	8586786828	PhoneNum

US Address USAddress

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

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
MARY JO ANDERSON CHS
VICE CHAIR/TRUSTEE	12.0	3.0	Yes (X)	Yes (X)	$0	$0	$0
GENE H BARDUSON
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
RICHARD C BIGELOW
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
DOUGLAS A BINGHAM ESQ
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
JEFF BOWMAN
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
JAN CALDWELL
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
JUDY CHURCHILL PHD
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
GORDON R CLARK
CHAIRMAN/TRUSTEE	12.0	3.0	Yes (X)	Yes (X)	$0	$0	$0
NICOLE A CLAY
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
DON GOLDMAN
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
ADOLFO GONZALES
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
KATHERINE A LAUER
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
MARTY J LEVIN
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
CHRISTOPHER VAN GORDER
PRESIDENT & CEO/TRUSTEE	57.0	3.0	Yes (X)	Yes (X)	$2,086,882	$0	$1,308,805
RICHARD VORTMANN
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
ABBY SILVERMAN WEISS
TRUSTEE	12.0	3.0	Yes (X)		$0	$0	$0
GALE D KEEL
ASSISTANT SECRETARY	39.0	1.0		Yes (X)	$98,497	$0	$17,682
RICHARD ROTHBERGER
TREASURER/EXECUTIVE VP/CFO	53.0	2.0		Yes (X)	$1,581,679	$0	$83,402
RICHARD R SHERIDAN
SEC/CORP EXEC VP-HR/GEN COUNSL	53.0	2.0		Yes (X)	$752,792	$0	$388,441
ROBIN BROWN
CHIEF EXECUTIVE, SR VP	50.0	0.0			$789,000	$0	$285,765	Yes (X)
VICTOR V BUZACHERO
CORP SR VP INNOVAT/HR/PERF MGT	50.0	0.0			$1,209,406	$0	$272,306	Yes (X)
MARY ELLEN DOYLE
CORP VP, NURSING OPS	50.0	0.0			$500,014	$0	$91,470	Yes (X)
JOHN ENGLE
CORP SR VP, CHIEF DEVELOPMENT	50.0	0.0			$574,520	$0	$106,091	Yes (X)
CARL ETTER
CHIEF EXECUTIVE, SR VP	50.0	0.0			$713,795	$0	$125,229	Yes (X)
SHIRAZ FAGAN
CHIEF EXECUTIVE, SR VP	50.0	0.0			$824,899	$0	$165,467	Yes (X)
GARY FYBEL
CHIEF EXECUTIVE, SR VP	50.0	0.0			$941,899	$0	$67,938	Yes (X)
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	50.0	0.0			$862,562	$0	$179,233	Yes (X)
JAMES LABELLE MD
CORP SR VP, CHIEF MED OFFICER	50.0	0.0			$840,913	$0	$178,080	Yes (X)
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	50.0	0.0			$963,839	$0	$245,340	Yes (X)
RICHARD NEALE
CORP SVP, CORP DEVELOPMENT	50.0	0.0			$560,281	$0	$115,502	Yes (X)
BARBARA PRICE
CORP SRVP BUS & SERV LINE DEV	50.0	0.0			$702,679	$0	$138,514	Yes (X)
MARC A REYNOLDS
CORP SR VP, PAYER RELATIONS	30.0	20.0			$705,402	$0	$55,620	Yes (X)
SUSAN CAMPBELL
EXEC DIR, EXTERNAL AFFAIRS	50.0	0.0			$476,052	$0	$94,263		Yes (X)
DAVID COHN
CORP VP, REVENUE CYCLE	50.0	0.0			$480,555	$0	$102,054		Yes (X)
JAMES CROWDER
CORP SR VP, CIO	50.0	0.0			$507,127	$0	$117,391		Yes (X)
LEI DONG
DIRECTOR, CHIEF OF MED PHYSICS	50.0	0.0			$542,939	$0	$39,921		Yes (X)
ROBERT T HOFF
CORP VP, HORIZONTAL OPS	50.0	0.0			$483,121	$0	$95,001		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$17,198,853	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$4,273,515	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	2704	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
SCRIPPS CLINIC MEDICAL GROUP INC
10666 N TORREY PINES ROAD	LA JOLLA	CA	92037	PHYSICIAN SERVICES	$283,611,876
SCRIPPS COASTAL MEDICAL GROUP
501 WASHINGTON AVENUE	SAN DIEGO	CA	92103	PHYSICIAN SERVICES	$42,968,974
SCRIPPS HOSPITAL INPATIENT PROVIDER
10010 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	PHYSICIAN SERVICES	$16,130,489
EMERGENCY ACUTE CARE MED CORP
440 STEVENS AVE STE 150	SAN DIEGO	CA	92075	PHYSICIAN SERVICES	$14,147,594
EMERALD TEXTILES LLC
1725 DORNOCH CT	SAN DIEGO	CA	92154	LAUNDRY SERVICES	$8,998,564

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	128	CntrctRcvdGreaterThan100KCnt
Fundraising	$2,053,881	FundraisingAmt
All Other Contributions	$48,640,133	AllOtherContributionsAmt
Noncash Contributions	$2,434,091	NoncashContributionsAmt
Total Contributions	$50,694,014	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
Healthcare Delivery Rev	622110	$2,398,044,122	$2,396,845,091	$1,199,031	$0
Capitation Premium	622110	$148,189,669	$148,189,669	$0	$0
Provider Fee Revenue	622110	$41,804,080	$41,804,080	$0	$0
Joint Venture Revenue	900099	$9,725,647	$9,725,647	$0	$0
Rental Income - MOB	531120	$13,294,104	$13,294,104	$0	$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$23,630,745	TotalRevenueColumnAmt
Related Or Exempt Func Income	$22,700,852	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$929,893	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$2,634,688,367	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$38,867,457	TotalRevenueColumnAmt
Related Or Exempt Func Income	$268,771	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$47,934	UnrelatedBusinessRevenueAmt
Exclusion	$38,550,752	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

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

Royalties Revenue RoyaltiesRevenueGrp

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

Rental Income Or Loss RentalIncomeOrLossGrp

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

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$907,782,048	SecuritiesAmt
Other	$319,929	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$895,391,530	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$12,390,518	SecuritiesAmt
Other	$319,929	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12,710,447	TotalRevenueColumnAmt
Exclusion	$12,710,447	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$219,730	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$2,053,881	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$983,601	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$763,871	TotalRevenueColumnAmt
Exclusion	-$763,871	ExclusionAmt

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

Net Income From Gaming NetIncomeFromGamingGrp

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

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

Net Income Or Loss NetIncomeOrLossGrp

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

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
Cafeteria	722310	$7,465,014	$7,465,014	$0	$0
PROTON CENTER REVENUE	446110	$12,380,143	$12,380,143	$0	$0
Management Services	561110	$39,507,266	$32,977,029	$4,917,349	$1,612,888

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$29,123,496	TotalRevenueColumnAmt
Related Or Exempt Func Income	$26,420,889	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$738,807	UnrelatedBusinessRevenueAmt
Exclusion	$1,963,800	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$88,475,919	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,824,672,333	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,712,071,289	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$7,833,014	UnrelatedBusinessRevenueAmt
Exclusion	$54,074,016	ExclusionAmt

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

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$468,506	TotalAmt
Program Services	$468,506	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

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

Foreign Grants ForeignGrantsGrp

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

Benefits To Members BenefitsToMembersGrp

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

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$17,747,187	TotalAmt
Management And General	$17,747,187	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$130,691	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$130,691	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$986,294,749	TotalAmt
Program Services	$857,054,327	ProgramServicesAmt
Management And General	$124,607,976	ManagementAndGeneralAmt
Fundraising	$4,632,446	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$39,561,243	TotalAmt
Program Services	$32,813,474	ProgramServicesAmt
Management And General	$6,586,112	ManagementAndGeneralAmt
Fundraising	$161,657	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$98,614,341	TotalAmt
Program Services	$71,790,623	ProgramServicesAmt
Management And General	$26,264,125	ManagementAndGeneralAmt
Fundraising	$559,593	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$76,011,530	TotalAmt
Program Services	$63,788,491	ProgramServicesAmt
Management And General	$11,912,249	ManagementAndGeneralAmt
Fundraising	$310,790	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

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

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$3,694,378	TotalAmt
Program Services	$1,617,999	ProgramServicesAmt
Management And General	$2,066,102	ManagementAndGeneralAmt
Fundraising	$10,277	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$981,094	TotalAmt
Program Services	$79,247	ProgramServicesAmt
Management And General	$901,847	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$344,761	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$344,761	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$4,043,436	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$4,043,436	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$551,583,411	TotalAmt
Program Services	$509,707,255	ProgramServicesAmt
Management And General	$41,389,155	ManagementAndGeneralAmt
Fundraising	$487,001	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$5,687,737	TotalAmt
Program Services	$3,370,126	ProgramServicesAmt
Management And General	$2,314,047	ManagementAndGeneralAmt
Fundraising	$3,564	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$62,577,101	TotalAmt
Program Services	$48,256,036	ProgramServicesAmt
Management And General	$13,322,971	ManagementAndGeneralAmt
Fundraising	$998,094	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$37,151,034	TotalAmt
Program Services	$21,977,657	ProgramServicesAmt
Management And General	$15,173,377	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Royalties RoyaltiesGrp

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

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$79,014,486	TotalAmt
Program Services	$70,117,253	ProgramServicesAmt
Management And General	$8,702,560	ManagementAndGeneralAmt
Fundraising	$194,673	FundraisingAmt

Travel TravelGrp

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

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

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

Conferences Meetings ConferencesMeetingsGrp

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

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$24,223,052	TotalAmt
Program Services	$20,140,440	ProgramServicesAmt
Management And General	$4,082,612	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

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

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$160,447,579	TotalAmt
Program Services	$145,066,088	ProgramServicesAmt
Management And General	$15,381,491	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$7,675,995	TotalAmt
Program Services	$7,615,779	ProgramServicesAmt
Management And General	$60,216	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$446,531,090	$446,531,090	$0	$0
Repairs and Maintenance	$39,577,168	$19,559,945	$19,980,471	$36,752
Hospital Fee Program	$36,458,424	$36,458,424	$0	$0
OTHER EXPENSE REIMBURSEMENT	$3,075,879	$2,277,808	$739,978	$58,093

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,013,084	TotalAmt
Program Services	$2,341,768	ProgramServicesAmt
Fundraising	$671,316	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,684,907,956	TotalAmt
Program Services	$2,361,032,336	ProgramServicesAmt
Management And General	$315,751,364	ManagementAndGeneralAmt
Fundraising	$8,124,256	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

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

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$392,256,700	BOYAmt
EOY	$414,047,110	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$19,418,259	BOYAmt
EOY	$16,915,196	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$403,013,333	BOYAmt
EOY	$471,092,320	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$17,543,626	BOYAmt
EOY	$19,161,401	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$254,383	BOYAmt
EOY	$168,071	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$39,372,026	BOYAmt
EOY	$44,073,896	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$22,076,316	BOYAmt
EOY	$36,361,957	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$3,450,994,042	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$1,676,381,007	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$1,676,427,618	BOYAmt
EOY	$1,774,613,035	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,783,233,305	BOYAmt
EOY	$1,881,002,655	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$413,366,000	BOYAmt
EOY	$440,320,000	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$62,558,899	BOYAmt
EOY	$64,637,570	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$45,478,622	BOYAmt
EOY	$46,004,678	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$63,385,783	BOYAmt
EOY	$57,059,557	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,938,384,870	BOYAmt
EOY	$5,265,457,446	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$393,651,235	BOYAmt
EOY	$372,241,581	EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$14,778,468	BOYAmt
EOY	$13,828,654	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$966,591,804	BOYAmt
EOY	$933,879,690	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

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

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$98,230,904	BOYAmt
EOY	$95,502,060	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$91,475,920	BOYAmt
EOY	$102,993,765	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,564,728,331	BOYAmt
EOY	$1,518,445,750	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,178,431,443	BOYAmt
EOY	$3,544,828,258	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$108,703,807	BOYAmt
EOY	$115,358,760	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$86,521,289	BOYAmt
EOY	$86,824,678	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,373,656,539	BOYAmt
EOY	$3,747,011,696	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$4,938,384,870	BOYAmt
EOY	$5,265,457,446	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$139,764,377	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$249,004,807	NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts	$0	DonatedServicesAndUseFcltsAmt
Investment Expense	$0	InvestmentExpenseAmt
Prior Period Adjustments	$0	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	-$15,414,027	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

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

Contributor US Address ContributorUSAddress

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

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

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	Yes (true)	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Media Advertisements	$0	MediaAdvertisementsAmt
Mailings Members	Yes (true)	MailingsMembersInd
Mailings Members	$10,078	MailingsMembersAmt
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Publications Or Broadcast	$0	PublicationsOrBroadcastAmt
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Grants Other Organizations	$0	GrantsOtherOrganizationsAmt
Direct Contact Legislators	Yes (true)	DirectContactLegislatorsInd
Direct Contact Legislators	$391,758	DirectContactLegislatorsAmt
Rallies Demonstrations	Yes (true)	RalliesDemonstrationsInd
Rallies Demonstrations	$37,696	RalliesDemonstrationsAmt
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$251,835	OtherActivitiesAmt
Total Lobbying Expenditures	$691,367	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE C, PART II-B	FormAndLineReferenceDesc
Explanation	PUBLIC AFFAIRS INFORMATION AND EDUCATION SCRIPPS HEALTH ON ITS OWN BEHALF AND AS A MEMBER OF SEVERAL HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS PARTICIPATES REGULARLY IN PUBLIC AFFAIRS AND ADVOCACY ACTIVITIES. SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY AND SPECIFICALLY ON BEHALF OF SCRIPPS HEALTH. OTHER ACTIVITY IS ORGANIZED BY THESE INVOLVED ORGANIZATIONS SUPPORTED BY SCRIPPS HEALTH PARTICIPATION. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: ACCOUNTABLE CARE ACT (HEALTH REFORM); BUDGET AND FISCAL POLICY IMPACTS; REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY AND THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; UNINSURED, COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING, VALUE-BASED PURCHASING; BUNDLED PAYMENTS; ACCOUNTABLE CARE ORGANIZATIONS, MEDICARE, MEDICAID. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. LEGISLATIVE MATTERS - FEDERAL - SEN. CON. RES. 3 (BUDGET RESOLUTION WITH INSTRUCTIONS ON RECONCILIATION REGARDING THE AFFORDABLE CARE ACT (ACA) - H.R. 1628 AMERICAN HEALTH CARE ACT - H.R. 1628 BETTER CARE RECONCILIATION ACT OF 2017 (SENATE VERSION OF HOUSES AMERICAN HEALTH CARE ACT) - GRAHAM-CASSIDY AMENDMENT TO H.R. 1628 - OBAMACARE REPEAL RECONCILIATION ACT AMENDMENT TO H.R. 1628 - ALEXANDER-MURRAY MARKET STABILIZATION ACT (LEGISLATIVE PROPOSAL) - H. CON. RES. 71 (115TH CONGRESS FY 2018 BUDGET ACT) - H.R. 1 TAX CUTS AND JOBS ACT - H.R. 4392 340B PAYMENT CUTS - H.R. 4710 340B PROTECTING ACCESS FOR THE UNDERSERVED AND SAFETY NET ENTITIES (PAUSE) ACT - H.R. 3922 CHAMPIONING HEALTHY KIDS ACT CALIFORNIA - SB 687 ATTORNEY GENERAL APPROVAL OF EMERGENCY DEPARTMENT CLOSURE OR REDUCTION IN SERVICES - SB 554 NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS: BUPRENORPHINE - SB 565 MENTAL HEALTH: INVOLUNTARY COMMITMENT - AB 191 MENTAL HEALTH: INVOLUNTARY TREATMENT - AB 651 NONPROFIT HEALTH FACILITIES: SALE OF ASSETS, ATTORNEY GENERAL APPROVAL - AB 1102 HEALTH FACILITIES: WHISTLE BLOWER PROTECTIONS - SB 562 SINGLE-PAYER HEALTH CARE COVERAGE PROGRAM (CALIFORNIANS FOR A HEALTHY CALIFORNIA ACT) - SB 538 HOSPITAL CONTRACTS - SB 647 HEALTH CARE PROVIDERS: CONTRACTS - AB 387 ALLIED HEALTH TRAINING: MINIMUM WAGE - AB 488 MENTAL HEALTH SERVICES ACT - SB 481 MEDICALLY NECESSARY CARE FOR UNREPRESENTED PATIENTS - AB 820 COMMUNITY PARAMEDIC PROGRAM - AB 1136 MENTAL HEALTH: BED REGISTRIES - AB 5 OPPORTUNITY TO WORK ACT - SB 487 PRACTICE OF MEDICINE: HOSPITALS - AB 1650 EMERGENCY MEDICAL SERVICES: COMMUNITY PARAMEDICINE - AB 1612 CERTIFIED NURSE MIDWIVES - AB 263 EMERGENCY MEDICAL SERVICES: WORKERS' RIGHTS AND WORKING CONDITIONS - SB 237 CRIMINAL PROCEDURE: ARREST - AB 937 REQUESTS REGARDING RESUSCITATIVE MEASURES: RESOLUTION OF CONFLICTING ORDERS - SB 349 CHRONIC DIALYSIS: STAFFING REQUIREMENTS & TURNOVER - AB 1250 COUNTIES: CONTRACTS FOR PERSONAL SERVICES - AB 1372 CRISIS STABILIZATION UNITS: PSYCHIATRIC PATIENT - AB 451 HEALTH FACILITIES: EMERGENCY SERVICES AND CARE DIRECT COMMUNICATION (MEETINGS, EMAIL, CALLS, LETTERS) WITH SAN DIEGO LEGISLATIVE DELEGATIONS FEDERAL AND STATE. ON CALIFORNIA STATE LEVEL EMPLOYED LOBBY FIRM JGC GOVERNMENT RELATIONS TO REPRESENT INTERESTS ON CERTAIN MEASURES. LOBBY FIRM ALSO WORKED WITH OTHER HEALTH SYSTEM CONTRACT LOBBYISTS AND CALIFORNIA HOSPITAL ASSOCIATION LOBBY TEAM ON SELECTED LEGISLATION. WORKED FREQUENTLY IN CONCERT WITH STATE AND NATIONAL HEALTH CARE ORGANIZATIONS THAT CONDUCTED LOBBY PROGRAMS, INCLUDING: AMERICAN HOSPITAL ASSOCIATION, CALIFORNIA HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES, PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, ALLIANCE OF CATHOLIC HEALTH CARE. SCRIPPS HEALTH DID NOT FILE FORM 5768 UNDER SECTION 501(H). THERE ARE TESTS FOR TAX EXEMPTION A "SUBSTANTIAL PART TESTAN "EXPENDITURE TEST." AS A 501(C)(3) ORGANIZATION, WE CAN OPT TO FOLLOW THE GUIDELINE THAT "NO SUBSTANTIAL PART" OF OUR ACTIVITIES ARE CARRIED ON TO INFLUENCE LEGISLATION. UNDER SECTION 501(H), ELIGIBLE 501(C)(3) ORGANIZATIONS CAN ELECT TO MAKE LIMITED EXPENDITURES TO INFLUENCE LEGISLATION. THE "EXPENDITURE TEST" IS SUBJECT TO AMOUNTS PERMITTED BY THAT SECTION. WHILE OUR EXPENDITURES FALL WELL BELOW THE LIMITS, WE ALSO EXPEND WHAT IS GENERALLY CONSIDERED AS NO SUBSTANTIAL PART ON SUCH EXPENDITURES. THEREFORE, WE OPT NOT TO FILE FORM 5768, THE FORM REQUIRED UNDER SECTION 501(H). NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES HEALTH MANAGEMENT ACADEMY PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE PROTON THERAPY CONSORTIUM SAN DIEGO REGIONAL CHAMBER OF COMMERCE SAN DIEGO TAXPAYERS ASSOCIATION SAN DIEGO ECONOMIC DEVELOPMENT CORPORATION COMMUNITY HEALTH IMPROVEMENT PARTNERS	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Historic Structure	Yes (X)	HistoricStructureInd
Total Easements	2	TotalEasementsCnt
Total Acreage	16.00	TotalAcreageCnt
Historic Structure Easements	2	HistoricStructureEasementsCnt
States Easements Held	1	StatesEasementsHeldCnt
Written Policy Monitoring	Yes (true)	WrittenPolicyMonitoringInd
Staff Hours Spent Enforcement	70.00	StaffHoursSpentEnforcementCnt
Section170h Rqr Stsfd	Yes (true)	Section170hRqrStsfdInd
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp
Agent Trustee Etc	false	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	false	InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$108,926,000	BeginningYearBalanceAmt
Contributions	$6,315,759	ContributionsAmt
Investment Earnings Or Losses	$7,473,883	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$1,437,223	GrantsOrScholarshipsAmt
Other Expenditures	$3,833,012	OtherExpendituresAmt
Administrative Expenses	$1,121,407	AdministrativeExpensesAmt
End Year Balance	$116,324,000	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$117,167,000	BeginningYearBalanceAmt
Contributions	$1,388,206	ContributionsAmt
Investment Earnings Or Losses	-$3,512,026	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$1,345,734	GrantsOrScholarshipsAmt
Other Expenditures	$3,632,176	OtherExpendituresAmt
Administrative Expenses	$1,139,270	AdministrativeExpensesAmt
End Year Balance	$108,926,000	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$112,290,000	BeginningYearBalanceAmt
Contributions	$1,480,000	ContributionsAmt
Investment Earnings Or Losses	$9,068,000	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$871,000	GrantsOrScholarshipsAmt
Other Expenditures	$3,853,000	OtherExpendituresAmt
Administrative Expenses	$947,000	AdministrativeExpensesAmt
End Year Balance	$117,167,000	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$103,819,000	BeginningYearBalanceAmt
Contributions	-$1,051,000	ContributionsAmt
Investment Earnings Or Losses	$14,066,000	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$874,000	GrantsOrScholarshipsAmt
Other Expenditures	$2,707,000	OtherExpendituresAmt
Administrative Expenses	$963,000	AdministrativeExpensesAmt
End Year Balance	$112,290,000	EndYearBalanceAmt

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

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$24,235,333	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$98,325,540	OtherCostOrOtherBasisAmt
Book Value	$122,560,873	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,704,455,120	OtherCostOrOtherBasisAmt
Depreciation	$656,347,705	DepreciationAmt
Book Value	$1,048,107,415	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$92,650,047	OtherCostOrOtherBasisAmt
Depreciation	$67,422,720	DepreciationAmt
Book Value	$25,227,327	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,440,725,745	OtherCostOrOtherBasisAmt
Depreciation	$950,734,737	DepreciationAmt
Book Value	$489,991,008	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$90,602,257	OtherCostOrOtherBasisAmt
Depreciation	$1,875,845	DepreciationAmt
Book Value	$88,726,412	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$1,774,613,035	TotalBookValueLandBuildingsAmt
Financial Derivatives		FinancialDerivativesGrp
Closely Held Equity Interests		CloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Multi-strategy funds	$391,231,000	F
Private equity funds	$49,089,000	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$440,320,000	TotalBookValueSecuritiesAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
Self Insured Worker's Compensation Liability	$38,705,413
Deferred Retirement Liability	$12,081,360
SELF INSURED MALPRACTICE LIABILITY	$27,418,663
Asset Retirement Obligation	$15,391,893
Annuity and Unitrust	$10,977,451
Deposits and Contingencies	$260,717
INTERCOMPANY LIABILITIES	-$1,841,732

Field	Value	IRS element (for citing)
Total Liability	$102,993,765	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART II, LINE 3	CHANGES TO CONSERVATION EASEMENTS THERE WERE NO MODIFIED, TRANSFERRED, RELEASED, EXTINGUISHED, OR TERMINATED CONSERVATIVE EASEMENTS IN FY17. SCHEDULE D, PART II, LINE 9 CONSERVATION EASEMENT THE HISTORICAL STRUCTURE THAT IS CONSIDERED TO BE A CONSERVATIVE EASEMENT IS REPORTED IN THE MERCY HOSPITAL ENTITY OF THE CONSOLIDATED FINANCIAL STATEMENTS.
SCHEDULE D, PART V, LINE 4	INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES: $636,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES: $16,760,731 CONTRIBUTIONS RECEIVED FOR USE IN SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS: $45,185,981 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE: $12,784,795 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS: $12,225,243
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS UNDER ASC 740 (AKA FIN 48) SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSE FOR WHICH IT WAS GRANTED EXEMPTION. UNDER FASB ASC 740, INCOME TAXES, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE ORGANIZATION RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE ORGANIZATION RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS ONLY FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AT SEPTEMBER 30, 2017 OR 2016. SCRIPPS HEALTH CURRENTLY FILES FORM 990 (INFORMATIONAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAXES) AND FORM 990-T (BUSINESS INCOME TAX RETURN FOR AN EXEMPT ORGANIZATION) IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. SCRIPPS HEALTH IS NOT SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2013 IN MAJOR TAX JURISDICTIONS.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (3 entries)

RegionRegionTxt	EmployeeEmployeeCnt	Type Of Activities ConductedTypeOfActivitiesConductedTxt	Specific Services ProvidedSpecificServicesProvidedTxt	Region Total ExpendituresRegionTotalExpendituresAmt
North America	68	Program services	RECONSTRUCTIVE SURGERY	$284,423
East Asia and the Pacific	6	Program services	MED CARE & TRAINING	$13,975
Central America and the Caribbean	0	Investments		$51,830,967

Field	Value	IRS element (for citing)
Subtotal Employees	74	SubtotalEmployeesCnt
Total Employee	74	TotalEmployeeCnt
Subtotal Spent	$52,129,365	SubtotalSpentAmt
Total Spent	$52,129,365	TotalSpentAmt
Transfer To Foreign Corp	Yes (true)	TransferToForeignCorpInd
Interest In Foreign Trust	false	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (true)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	false	PassiveForeignInvestmestCoInd
Foreign Partnership	Yes (true)	ForeignPartnershipInd
Boycott Countries	false	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE F, PART I, LINE 3, COLUMN F	FormAndLineReferenceDesc
Explanation	ACCOUNTING METHOD THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS IN COLUMN F.	ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	MERCY BALL	Event1Nm
Gross Receipts Event1	$574,526	GrossReceiptsEvent1Amt
Charitable Contri Event1	$519,526	CharitableContriEvent1Amt
Gross Revenue Event1	$55,000	GrossRevenueEvent1Amt
Rent Facility Costs Event1	$169,478	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$6,389	FoodAndBeverageEvent1Amt
Entertainment Event1	$13,820	EntertainmentEvent1Amt
Other Direct Expenses Event1	$35,164	OtherDirectExpensesEvent1Amt
Event2	CANDLELIGHT	Event2Nm
Gross Receipts Event2	$365,615	GrossReceiptsEvent2Amt
Charitable Contri Event2	$339,345	CharitableContriEvent2Amt
Gross Revenue Event2	$26,270	GrossRevenueEvent2Amt
Rent Facility Costs Event2	$180,099	RentFacilityCostsEvent2Amt
Food And Beverage Event2	$0	FoodAndBeverageEvent2Amt
Entertainment Event2	$18,775	EntertainmentEvent2Amt
Other Direct Expenses Event2	$51,167	OtherDirectExpensesEvent2Amt
Other Events Total	6	OtherEventsTotalCnt
Gross Receipts Other Events	$1,333,470	GrossReceiptsOtherEventsAmt
Charitable Contri Other Events	$1,195,010	CharitableContriOtherEventsAmt
Gross Revenue Other Events	$138,460	GrossRevenueOtherEventsAmt
Rent Fclty Costs Other Events	$331,338	RentFcltyCostsOtherEventsAmt
Food And Beverage Other Events	$10,371	FoodAndBeverageOtherEventsAmt
Entertainment Other Events	$40,073	EntertainmentOtherEventsAmt
Oth Direct Expnss Other Events	$126,927	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$2,273,611	GrossReceiptsTotalAmt
Charitable Contributions Tot	$2,053,881	CharitableContributionsTotAmt
Gross Revenue Total Events	$219,730	GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events	$680,915	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$16,760	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$72,668	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$213,258	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$983,601	DirectExpenseSummaryEventsAmt
Net Income Summary	-$763,871	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

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

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$21,191,733	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$21,191,733	NetCommunityBenefitExpnsAmt
Total Expense	0.00790	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$301,151,011	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$216,015,825	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$85,135,186	NetCommunityBenefitExpnsAmt
Total Expense	0.03170	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$347,939	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$172,870	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$175,069	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$322,690,683	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$216,188,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$106,501,988	NetCommunityBenefitExpnsAmt
Total Expense	0.03970	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,284,131	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,919,920	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,364,211	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$34,403,506	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,115,121	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$26,288,385	NetCommunityBenefitExpnsAmt
Total Expense	0.00980	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,057,739	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,309,173	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,748,566	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,996,545	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$15,876,416	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,120,129	NetCommunityBenefitExpnsAmt
Total Expense	0.00120	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$531,211	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$43,092	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$488,119	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$77,273,132	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$41,263,722	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$36,009,410	NetCommunityBenefitExpnsAmt
Total Expense	0.01350	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$399,963,815	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$257,452,417	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$142,511,398	NetCommunityBenefitExpnsAmt
Total Expense	0.05320	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$58,081	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$58,081	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$39,389	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$39,389	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$541,390	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$541,390	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,570	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,570	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$240,315	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$240,315	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$904,745	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$904,745	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$47,631,853	BadDebtExpenseAmt
Reimbursed By Medicare	$403,502,518	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$470,061,667	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$66,559,149	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

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

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (7 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
Scripps Encinitas
Ambulatory Surgery Center	0.555	0.25
SURGERY CENTER

SCRIPPS MEMORIAL
Medical Office Building	0.153	0.772
XIMED MEDICAL

SCRIPPS MERCY ASC
Ambulatory Surgery Center	0.735	0.265
SCRIPPSUSP SURGERY
Ambulatory Surgery Center	0.5	0.27
CENTERS

Field	Value	IRS element (for citing)
Hospital Facilities	4	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (4 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Teaching HospitalTeachingHospitalInd	Research FacilityResearchFacilityInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Facility Reporting GroupFacilityReportingGroupCd
SCRIPPS MERCY HOSPITAL
1	4077 5TH AVENUE	SAN DIEGO	CA	92103	WWW.SCRIPPS.ORG	090000074	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
SCRIPPS MEMORIAL HOSPITAL LA JOLLA
2	9888 GENESEE AVENUE	LA JOLLA	CA	92307	WWW.SCRIPPS.ORG	080000050	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
SCRIPPS GREEN HOSPITAL
3	10666 NORTH TORREY PINES RD	LA JOLLA	CA	92037	WWW.SCRIPPS.ORG	080000139	Yes (X)	Yes (X)	Yes (X)	Yes (X)		A
SCRIPPS MEMORIAL HOSPITAL ENCINITAS
4	354 SANTA FE DRIVE	San Diego	CA	92024	WWW.SCRIPPS.ORG	080000148	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Facility	14	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	SEE PART V, SECTION C	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	SEE PART V, SECTION C	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.	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
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
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE PART V, SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE PART V, SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE SECTION C	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
Other Publicity	Yes (X)	OtherPublicityInd
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
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
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 (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART V, LINE 5	REPORTING GROUP A HEALTH EXPERTS, COMMUNITY LEADERS AND RESIDENTS FEEDBACK COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED IN THE 2016 CHNA WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATIONS SURVEY - SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY - BEHAVIORAL HEALTH DISCUSSIONS THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN-DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY PARTNER DISCUSSIONS COMMUNITY PARTNER DISCUSSIONS WERE CONDUCTED IN ALL REGIONS OF THE COUNTY BETWEEN JULY AND OCTOBER OF 2015, WITH 87 TOTAL PARTICIPANTS. NON-TRADITIONAL STAKEHOLDERS WERE RECRUITED THROUGH EXISTING COMMUNITY PARTNERSHIPS IN ORDER TO SOLICIT INPUT FROM THOSE WHO WORK DIRECTLY WITH MORE VULNERABLE POPULATIONS. A NON-TRADITIONAL STAKEHOLDER IS DEFINED AS AN INDIVIDUAL OR GROUP WHO HAS NOT BEEN CONSISTENTLY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGHOUT PREVIOUS CYCLES OF THE CHNA. THESE STAKEHOLDERS (COMMUNITY PARTNERS) WERE COMPRISED OF INDIVIDUALS FROM A VARIETY OF BACKGROUNDS INCLUDING: CARE COORDINATORS, OUTREACH WORKERS, COMMUNITY EDUCATION SPECIALISTS, WELLNESS COORDINATORS, SCHOOL NURSES, BEHAVIORAL HEALTH MANAGERS AND WORKERS, CALFRESH OUTREACH COORDINATORS, AND CALFRESH CAPACITY COORDINATORS (CAPACITY COORDINATORS HELP TO BUILD CAPACITY AND COMMUNITY SUPPORT, IMPLEMENT NEW PROJECTS AND PROVIDE TECHNICAL SUPPORT TO BETTER ADDRESS POVERTY AND HUNGER). BEHAVIORAL HEALTH DISCUSSIONS THREE BEHAVIORAL HEALTH DISCUSSIONS TOOK PLACE BETWEEN DECEMBER 2015 AND JANUARY 2016. THE COMBINED TOTAL NUMBER OF ATTENDEES WAS ROUGHLY 58 PEOPLE BETWEEN THE TWO MEETINGS. DUE TO THE COMPLEXITY OF BEHAVIORAL HEALTH, ADDITIONAL DISCUSSIONS WERE HELD SPECIFICALLY TO ENSURE THE QUANTITATIVE DATA THAT WAS GATHERED ACCURATELY REFLECTED CURRENT TRENDS AND AREAS OF TRUE NEED. THE PURPOSE OF THE BEHAVIORAL HEALTH DISCUSSIONS WAS TO GATHER FEEDBACK FROM BEHAVIORAL HEALTH EXPERTS TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY AND AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN BEHAVIORAL HEALTH. MEETINGS FOCUSED ON BEHAVIORAL HEALTH WERE TARGETED TO SOLICIT FEEDBACK FROM STAKEHOLDERS INCLUDING PATIENT ADVOCATES AS WELL AS REPRESENTATIVES FROM HOSPITALS, CLINICS, COUNTY HEALTH & HUMAN SERVICES AGENCY (HHSA), SMALLER BEHAVIORAL OR MENTAL HEALTH FACILITIES, AND HEALTH PLANS. THE BEHAVIORAL HEALTH DISCUSSION TEMPLATE WAS DEVELOPED BASED ON HOSPITAL DISCHARGE DATA ANALYSIS AND INCORPORATED A SYNTHESIS OF THE COMMUNITY PARTNER DISCUSSION DATA. A SUMMARY OF DATA AS IT RELATES TO BEHAVIORAL HEALTH NEEDS WAS PROVIDED TO THE BEHAVIORAL HEALTH EXPERTS PRIOR TO GAINING THEIR FEEDBACK. KEY INFORMANT INTERVIEWS IN RESPONSE TO FEEDBACK FROM THE 2013 CHNA, THE NUMBER OF KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE 2016 CHNA WAS EXPANDED TO INCLUDE EXPERTS WORKING WITH A WIDER VARIETY OF PATIENT POPULATIONS. PARTICIPANTS WERE SELECTED BASED ON THEIR EXPERTISE IN A SPECIFIC CONDITION, AGE GROUP, AND/OR POPULATION. MORE SPECIFICALLY, INDIVIDUALS WHO PARTICIPATED IN THE 2016 CHNA HAD KNOWLEDGE IN AT LEAST ONE OF THE FOLLOWING AREAS: CHILDHOOD ISSUES, SENIOR HEALTH, NATIVE AMERICANS, LATINOS, ASIAN AMERICANS, REFUGEE AND FAMILIES, HOMELESS, LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ) POPULATION, VETERANS, ALCOHOL AND DRUG ADDICTION, CARDIOVASCULAR HEALTH, BEHAVIORAL HEALTH, DIABETES, OBESITY, AND FOOD INSECURITY. IN ADDITION, THERE WAS REPRESENTATION ACROSS MULTIPLE AGENCIES AND ORGANIZATIONS INCLUDING THE SAN DIEGO COUNTY HHSA, LOCAL SCHOOLS, YOUTH PROGRAMS, COMMUNITY CLINICS, AND COMMUNITY-BASED ORGANIZATIONS. THE DEVELOPMENT OF THE KEY INFORMANT INTERVIEW TOOL BEGAN WITH THE RESULTS FROM THE HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES (HASD&IC) 2013 CHNA. THE INTERVIEW QUESTIONS WERE DESIGNED TO PROVIDE IN-DEPTH DETAIL ON THE TOP FOUR HEALTH NEEDS. NINETEEN KEY INFORMANT INTERVIEWS TOOK PLACE EITHER IN-PERSON OR VIA PHONE INTERVIEW BETWEEN JULY 2015 AND FEBRUARY 2016. EACH INTERVIEW LASTED NO LONGER THAN ONE HOUR. SIX QUESTIONS WERE ASKED DURING THE INTERVIEWS, WITH A PARTICULAR FOCUS ON THE TOP FOUR HEALTH NEEDS THAT WERE IDENTIFIED IN THE 2013 CHNA. ALTHOUGH THERE WERE SPECIFIC QUESTIONS ASKED, THE FORMAT OF THE INTERVIEWS ALLOWED FOR AMPLE OPPORTUNITY FOR OPEN DISCUSSION ON HEALTH NEEDS THAT THE KEY INFORMANTS FELT WERE MOST IMPORTANT IN SAN DIEGO COUNTY, INCLUDING THOSE NOT DIRECTLY RELATED TO THE TOP FOUR HEALTH NEEDS. SOME IMPORTANT STRATEGIES THAT KEY INFORMANTS SUGGESTED INCLUDED BEHAVIORAL HEALTH PREVENTION AND STIGMA REDUCTION, EDUCATION ON DISEASE MANAGEMENT AND FOOD INSECURITY, IMPROVING CULTURAL COMPETENCY AND DIVERSITY, AND INTEGRATING PHYSICAL AND MENTAL HEALTH, COORDINATING SERVICES ACROSS THE CONTINUUM, AND ENGAGING CASE MANAGERS AND PATIENT NAVIGATORS IN THE COMMUNITY AND INCORPORATING THEM AS A ROUTINE PART OF THE CONTINUUM OF CARE. SURVEYS TWO DIFFERENT SURVEYS WERE DEVELOPED AND DISSEMINATED THROUGH DIFFERENT AVENUES AS PART OF THE 2016 CHNA PROCESS - THE HEALTH ACCESS AND NAVIGATION SURVEY AND THE COLLABORATIVE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY. HEALTH ACCESS AND NAVIGATION SURVEY THE HEALTH ACCESS AND NAVIGATION SURVEY WAS DEVELOPED IN PARTNERSHIP WITH THE SAN DIEGO COUNTY RESIDENT LEADERSHIP ACADEMY (RLA). AFTER COMPARING RESULTS OF THE RLA'S 2014 COMMUNITY NEEDS ASSESSMENT AND WITH THE FINDINGS FROM THE HASD&IC 2013 CHNA, ACCESS AND NAVIGATION OF HEALTH CARE EMERGED AS A COMMON BARRIER IDENTIFIED BY THE SAN DIEGO COMMUNITY. THE CHNA COMMITTEE COLLABORATED WITH THE RLAS TO DESIGN A SURVEY TOOL THAT COULD IDENTIFY SPECIFIC BARRIERS RESIDENTS FACE WHEN THEY TRY TO ACCESS HEALTH CARE SERVICES. RLA LEADERS AGREED TO DISSEMINATE THE HEALTH ACCESS AND NAVIGATION SURVEY TO RESIDENTS IN THEIR NEIGHBORHOODS. THE ROADMAP SURVEY WAS DESIGNED TO IDENTIFY PARTICULAR AREAS IN WHICH RESIDENTS STRUGGLE WHEN THEY ARE USING THE HEALTH SYSTEM. THE SURVEYS WERE FIELDED ON SEPTEMBER 22, 2015 AND CLOSED NOVEMBER 2, 2015. SURVEY RESPONSES WERE COLLECTED BOTH ELECTRONICALLY AND VIA PAPER AND PENCIL FORMAT FROM COMMUNITY RESIDENTS. PAPER AND ELECTRONIC COPIES OF THE SURVEY WERE MADE AVAILABLE TO THE RLA LEADERS IN SPANISH, ENGLISH, AND ARABIC. AN ONLINE SURVEY LINK WAS ALSO EMAILED OUT IN BOTH SPANISH AND ENGLISH. A TOTAL OF 235 SURVEYS WERE COMPLETED WITH THE MAJORITY BEING COMPLETED ON PAPER (181) AND 54 COMPLETED VIA THE ONLINE SURVEY. ONE HUNDRED AND ELEVEN PAPER SURVEYS AND ZERO ONLINE SURVEYS WERE COMPLETED IN SPANISH. SEVENTY PAPER AND 54 ONLINE SURVEYS WERE COMPLETED IN ENGLISH. NO ARABIC SURVEYS WERE COLLECTED OR COMPLETED. SURVEY PARTICIPANTS WERE ASKED TO CHOOSE THE TOP FIVE BARRIERS THE PARTICIPANTS OR THE POPULATION THEY WORK WITH EXPERIENCE, AND TO RANK THE FIVE BARRIERS FROM ONE TO FIVE, WITH ONE BEING THE MOST TROUBLESOME. MOST STRIKING WAS THAT THE TOP FOUR BARRIERS CITED AS MOST TROUBLESOME WERE ALL PRECURSORS TO SEEING A HEALTH CARE PROVIDER, INDICATING THAT COMMUNITY MEMBERS ARE OFTEN STRUGGLING TO MAKE IT PAST THE FIRST STEPS OF ACCESSING HEALTHCARE. BASED ON THE SURVEY RESPONSES, THE TOP FIVE BARRIERS TO ACCESSING HEALTH CARE WERE: - UNDERSTANDING HEALTH INSURANCE - GETTING HEALTH INSURANCE - USING HEALTH INSURANCE - KNOWING WHERE TO GO FOR CARE - FOLLOW UP CARE AND/OR APPOINTMENT AS THE NUMBER OF INDIVIDUALS WHO HAVE HEALTH INSURANCE IN THE NATION AND WITHIN SAN DIEGO COUNTY HAS INCREASED, SO HAS THE IMPORTANCE OF HELPING PEOPLE UNDERSTAND HOW TO OBTAIN HEALTH INSURANCE, USE HEALTH INSURANCE, AND ACCESS CARE THAT IS APPROPRIATE FOR THEIR HEALTH NEEDS. RESIDENTS' ABILITY TO ACCESS HEALTH CARE IS A CRITICAL FIRST STEP TOWARD IMPROVING THE OVERALL HEALTH OF SAN DIEGO COMMUNITY. 'UNDERSTANDING HEALTH INSURANCE' WAS THE TOP CITED BARRIER IN ALL REGIONS WITH THE EXCEPTION OF EAST REGION WHICH FOUND 'FOLLOW-UP CARE A
SCHEDULE H, PART V, LINE 6A	REPORTING GROUP A GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTHCARE SYSTEMS CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND TO MEET IRS REGULATORY REQUIREMENTS. SCRIPPS CONDUCTED ONE CHNA FOR THE SYSTEM. BEGINNING IN MAY 2015 WITH COMPLETION IN APRIL 2016, THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY MANAGED THE DESIGN, IMPLEMENTATION AND INTERPRETATION OF THE CHNA PROCESS. PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WERE ALL REPRESENTED IN THE CHNA ADVISORY WORKGROUP: - KAISER FOUNDATION HOSPITAL - SAN DIEGO - PALOMAR HEALTH - RADY CHILDREN'S HOSPITAL - SAN DIEGO - SCRIPPS HEALTH - SHARP HEALTHCARE - TRI-CITY MEDICAL CENTER - UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM
SCHEDULE H, PART V, LINE 6B	REPORTING GROUP A IN MAY 2015, THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. SCRIPPS CONDUCTED ONE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE SYSTEM. SCHEDULE H, PART V, LINE 7A REPORTING GROUP A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS
SCHEDULE H, PART V, LINE 10A	REPORTING GROUP A THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS
SCHEDULE H, PART V, LINE 11	REPORTING GROUP A IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT SCRIPPS HEALTH IS FOCUSING ON THE FOUR PRIORITIZED HEALTH NEEDS (CARDIOVASCULAR DISEASE AND STROKE, DIABETES TYPE 2, BEHAVIORAL HEALTH, AND OBESITY). SCRIPPS HAS DEVELOPED VARIOUS INITIATIVES, STRATEGIES AND METRICS TO MEASURE AND EVALUATE THE EFFECTIVENESS OF THE PROGRAMS. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO PROVIDE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE HEALTH CARE NEEDS OF THE REGION'S MOST VULNERABLE POPULATIONS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 CHNA IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES (TYPE 2), 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. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMER'S DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATIONS RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMER'S DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY - A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO THE CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES DESCRIBED AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED IN THE 2016 CHNA (BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, DIABETES TYPE 2 AND OBESITY), TEN SOCIAL DETERMINANTS OF HEALTH NEEDS WERE ALSO KEY THEMES AND REFERENCES IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. THESE TEN SOCIAL DETERMINANTS OF HEALTH NEEDS ARE OUTLINED IN ORDER OF PRIORITY: FOOD INSECURITY AND ACCESS TO HEALTHY FOOD, ACCESS TO CARE OR SERVICES, HOMELESSNESS/HOUSING, PHYSICAL ACTIVITY, EDUCATION/KNOWLEDGE, CULTURAL COMPETENCY, TRANSPORTATION, INSURANCE ISSUES, STIGMA, AND POVERTY. SOME OF THESE SOCIAL DETERMINANTS OF HEALTH NEEDS ARE ADDRESSED WITHIN THE FOUR HEALTH CONDITIONS IDENTIFIED IN THE SCRIPPS IMPLEMENTATION PLAN SUCH AS ACCESS TO CARE, PHYSICAL ACTIVITY, AND EDUCATION/KNOWLEDGE THROUGH VARIOUS PROGRAM INTERVENTIONS. THE OTHER NEEDS WERE NOT ADDRESSED IN DETAIL IN THE SCRIPPS IMPLEMENTATION STRATEGY DUE TO LIMITED FINANCIAL AND/OR STAFFING CONSTRAINTS AND A LACK OF EXPERTISE OR COMPETENCY TO EFFECTIVELY ADDRESS THE NEEDS. IN ADDITION, SOME OF THESE ISSUES ARE BEING ADDRESSED BY OTHER PROVIDERS IN THE SAN DIEGO COMMUNITY WHO HAVE MORE EXPERTISE. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO THE EXPLORATION OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE NEEDS AND FUTURE NEEDS IDENTIFIED.
SCHEDULE H, PART V, LINE 13H	REPORTING GROUP A OTHER CRITERIA TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'S DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS.
SCHEDULE H, PART V, LINES 16A, 16B, & 16C	REPORTING GROUP A THE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY IS WIDELY AVAILABLE ON THE SCRIPPS HEALTH WEBSITE AT: https://www.scripps.org/patients-and-visitors/financial-assistance
SCHEDULE H, PART V, LINE 16J	REPORTING GROUP A THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO; - POSTERS IN CONSPICUOUS REGISTRATION AREAS I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS. - PAPER COPIES OF SCRIPPS FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSION AREAS. PATIENTS MAY ALTERNATIVELY REQUEST COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. - THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE CONSPICUOUSLY POSTED ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CONTAINS THE WEB SITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. - THE FINANCIAL ASSISTANCE SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT OF SERVICES AT A SCRIPPS FACILITY. - ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDES ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. - THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). - A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT COMMUNITY EVENTS AND IS PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. - SCRIPPS PROVIDES A COPY OF ITS POLICY AND RELATED INFORMATION TO THE CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. IN ADDITION, SCRIPPS POLICY IS AVAILABLE TO THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW IS FACILITATED THROUGH THE USE OF INTERPRETERS (LANGUAGE, VISION, AND HEARING) OR WRITTEN MATERIALS AS REQUESTED BY THE INDIVIDUAL.

Field	Value	IRS element (for citing)
Facility	41	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (41 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
SCRIPPS CLINIC - TORREY PINES
10666 N TORREY PINES ROAD	LA JOLLA	CA	92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - RANCHO BERNARDO
15004 INNOVATION DRIVE	SAN DIEGO	CA	92128	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS MEDICAL LAB
9235 WAPLES STREET 150	SAN DIEGO	CA	92121	LABORATORY SERVICES
SCRIPPS CLINIC - CARMEL VALLEY
3811 VALLEY CENTER DRIVE	SAN DIEGO	CA	92130	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
IMAGING HEALTHCARE SPECIALISTS LLC
150 WEST WASHINGTON STREET	SAN DIEGO	CA	92103	MEDICAL IMAGING SERVICES
SCRIPPS CLINIC ANDERSON MEDICAL PAVILION
9898 GENESEE AVENUE	LA JOLLA	CA	92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - ENCINITAS
310 SANTA FE DRIVE	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS HOME HEALTH SERVICES
9619 CHEASPEAKE DRIVE 300	SAN DIEGO	CA	92123	HOME HEALTH SERVICES
SCMC - CEDAR
130 CEDAR ROAD	VISTA	CA	92083	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - ENCINITAS
477 N EL CAMINO REAL A208 B305	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - CARLSBAD
2176 SALK AVENUE	CARLSBAD	CA	92008	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - MISSION VALLEY
7565 MISSION VALLEY ROAD	SAN DIEGO	CA	92108	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC-LA JOLLA MEMORIAL CAMPUS
9850 GENESEE AVE XIMED BLDG 600	SAN DIEGO	CA	92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
MERCY ASC
550 WASHINGTON STREET 1ST FLOOR	SAN DIEGO	CA	92103	PRIMARY AND SPECIALITY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - RANCHO SAN DIEGO
10862 CALLE VERDE	LA MESA	CA	91941	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - HILLCREST
501 WASHINGTON STREET 525 600	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
ENCINITAS SURGERY CENTER LLC
320 SANTA FE DRIVE LL1-2	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - ENCINITAS OBGYN
332 SANTA FE DRIVE 115	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - OCEANSIDE
4318 MISSION AVENUE	OCEANSIDE	CA	92057	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CL RADIATION THERAPY CTR - VISTA
916 SYCAMORE AVENUE SUITE 100	VISTA	CA	92082	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
LA JOLLA RADIOLOGY - LA JOLLA
9888 GENESSEE AVENUE	LA JOLLA	CA	92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - DEL MAR
12395 EL CAMINO REAL 317 112 12	DEL MAR	CA	92130	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS HOSPITAL MEDICAL SERVICES
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CARDIO & THORACIC SURGERY CENTER
9850 GENESEE AVENUE 560	LA JOLLA	CA	92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - EASTLAKE
971 LANE AVENUE	CHULA VISTA	CA	91914	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS PHARMACY - GREEN
10666 NORTH TORREY PINES ROAD	LA JOLLA	CA	92037	MEDICAL PHARMACY
LA JOLLA RADIOLOGY - ENCINITAS
354 SANTA FE DRIVE	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - SOLANA BEACH
380 STEVENS AVENUE 100	SOLANA BEACH	CA	92075	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - SANTEE
278 TOWN CENTER PKWY 105	SANTEE	CA	92071	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - SAN DIEGO OBGYN
2918 FIFTH AVENUE SUITE 100	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
LA JOLLA RADIOLOGY - MERCYCV
4077 FIFTH AVENUE	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCMC - ESCONDIDO
488 E VALLEY PKWY 411	ESCONDIDO	CA	92025	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - LA JOLLA OBGYN
9850 GENESEE AVENUE 170	SAN DIEGO	CA	92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CL RADIATION THRPY CTR ENCINITAS
477 N EL CAMINO REAL SUITE D100	ENCINITAS	CA	92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - HILLCREST SURGERY
4060 FOURTH AVENUE 330	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS PHARMACY - ENCINITAS
354 SANTA FE DRIVE	ENCINITAS	CA	92024	MEDICAL PHARMACY
SCRIPPS CLINIC - MERCY CAMPUS
4020 FIFTH AVENUE 401	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CARDIO & THOR SURG CTR HILLCREST
501 WASHINGTON STREET 525 600	SAN DIEGO	CA	92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - CORONADO
1317 A YNES PLACE	CORONADO	CA	92118	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - UTC
9333 GENESEE AVENUE SUITE 170	SAN DIEGO	CA	92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
SCRIPPS CLINIC - MENTAL HEALTH
15004 INNOVATION DRIVE	SAN DIEGO	CA	92128	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3C	SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE, AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS' FINANCIAL ASSISTANCE POLICY (FAP) IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), Scripps WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, Scripps WILL FORGIVE A PORTION OF THE BILL. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AMOUNTS GENERALLY BILLED (AGB) AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. PATIENTS DETERMINED TO BE "HOMELESSNOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100% FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART I, LINE 6A	SCRIPPS HEALTH COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY SCHEDULE H, PART I, LINE 7, COLUMN F A COST-TO-CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL PATIENT SEGMENTS REPORTED AS CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN EVEN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. SCRIPPS PROVIDES SUCH SERVICES BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, THEY WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION TO PROVIDE. SUBSIDIZED SERVICES DO NOT INCLUDE SUCH ANCILLARY SERVICES AS LAB WORK AND RADIOLOGY. IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE. SCRIPPS' TOTAL NET COST FOR SUBSIDIZED HEALTH SERVICES FOR FY17 WAS $3,748,566 THIS INCLUDES SCRIPPS INPATIENT AND BEHAVIORAL HEALTH SERVICES AND MERCY CLINIC. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO - FACILITY A-1 FOUNDED IN 1944 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 1,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY17 WERE $10,245. A FULL TIME CLINIC STAFF OF NURSES AND OTHER PERSONNEL WORK HAND-IN-HAND WITH PHYSICIANS FROM SCRIPPS MERCY HOSPITAL. AS AN INTEGRAL PART OF TREATING ITS PATIENTS, MERCY CLINIC SERVES AS A TRAINING GROUND FOR NEARLY 100 RESIDENTS EACH YEAR FROM THE SCRIPPS MERCY HOSPITAL GRADUATE MEDICAL EDUCATION PROGRAM. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S "WORKING AND DISABLED POOR". EACH YEAR, 90 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 10 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME, MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED NET COST FOR MERCY CLINIC FOR FY17 WAS $1.9 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE). SCHEDULE H, PART I, LINE 7 FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES, AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA LYON SOFTWARE'S COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CBISA WAS DEVELOPED IN COOPERATION WITH LYON SOFTWARE, THE CATHOLIC HEALTH ASSOCIATION (CHA) AND THE VETERANS HEALTH ADMINISTRATION. THE SOFTWARE SUPPLEMENTED THE ORIGINAL SOCIAL ACCOUNTABILITY BUDGET: A PROCESS FOR PLANNING AND REPORTING COMMUNITY SERVICE IN A TIME FOR FISCAL CONSTRAINT, PUBLISHED IN 1989, AND HAS BEEN REGULARLY UPGRADED AS COMMUNITY BENEFIT ACCOUNTING AND REPORTING METHODS HAVE EVOLVED AND AS COMMUNITY BENEFIT REPORTING HAS BECOME A FEDERAL REPORTING REQUIREMENT. THE CBISA DATABASE HELPS COLLECT, TRACK AND REPORT COMMUNITY BENEFIT EFFORTS AND IS ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN "ACTIVITY". FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. WHERE COST ACCOUNTING IS USED, SCRIPPS HEALTH ADDRESSES ALL PATIENT SEGMENTS FOR HOSPITAL FACILITIES. SCRIPPS UNCOMPENSATED CARE FY2017 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR CHARITY CARE ARE ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. HOSPITAL FEE PROGRAM (REFLECTED IN PART I, LINE 7B & 7I) THIRTY-MONTH HOSPITAL FEE PROGRAM DURING THE YEAR ENDED SEPTEMBER 30, 2017, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $41,804,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $36,368,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECORDED $90,000 FOR CHARITABLE CONTRIBUTIONS TO CHFT IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEALTH FROM PROVIDER FEE WAS $5,346,000 IN FISCAL YEAR 2017. CALENDAR YEAR 2014 - CALENDAR YEAR 2016 HOSPITAL FEE PROGRAM IN SEPTEMBER 2013, SB 239 WAS APPROVED AND CREATED A THREE-YEAR HOSPITAL FEE PROGRAM EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2016. ON DECEMBER 10, 2014, CALIFORNIA HOSPITAL ASSOCIATION (CHA) ANNOUNCED THAT CMS APPROVED THE FEE-FOR-SERVICE PAYMENTS FOR THE PERIOD JANUARY 1, 2014 TO DECEMBER 31, 2016. ON JUNE 30, 2015, CMS APPROVED THE NON-EXPANSION MANAGED CARE RATES FOR THE FIRST SIX MONTHS OF THE THIRTY-SIX MONTH HOSPITAL FEE PROGRAM. DURING THE YEAR ENDED SEPTEMBER 30, 2017, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $41,804,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $36,368,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECORDED $90,000 FOR CHARITABLE CONTRIBUTIONS TO CHFT IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEATH FROM PROVIDER FEE WAS $5,346,000 IN FISCAL YEAR 2017.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES PHYSICAL IMPROVEMENTS AND HOUSING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 1: SCRIPPS MERCY HOSPITAL LEADERSHIP RETREAT VOLUNTEER SERVICE DAY FOUR HOURS OF VOLUNTEER SERVICE THAT ENTAILED PAINTING, CLEANING AND ENHANCING NOT-FOR-PROFIT, HOMELESS SERVICE PROVIDER AGENCY BUILDINGS; SPECIFICALLY, PROJECTS OF CATHOLIC CHARITIES AND JOAN KROC CENTER. ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2: EXECUTIVE LEADERSHIP EXECUTIVE LEADERSHIP, SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). NORTH SAN DIEGO BUSINESS CHAMBER HEALTH COMMITTEE MEETING - THE CHAMBER STRIVES TO DELIVER UP-TO-DATE, HEALTH-RELATED INFORMATION GO ENHANCE THE QUALITY OF LIFE TO THE BUSINESS COMMUNITY. THE HEALTH COMMITTEE SERVES AS A FRONT LINE TO EDUCATE SAN DIEGO NORTH BUSINESS ABOUT HEALTH CARE ISSUES SPECIFIC TO THE REGION THAT IMPACT BOTTOM LINES AND WORKFORCE PRODUCTIVITY. THE SCRIPPS DIRECTOR OF COMMUNITY RELATIONS ATTENDS THESE MEETINGS. COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3: NORTH SAN DIEGO BUSINESS CHAMBER HONORING OUR REGIONS HEROES HONORING OUR REGION'S HEROES AWARDS LUNCHEON, PRESENTED BY SCRIPPS HEALTH, HONORS THE DEDICATED OFFICERS, FIRST RESPONDERS, AND PUBLIC SAFETY LEADERS WHO HAVE GONE ABOVE AND BEYOND IN THEIR DUTIES. HOSPITAL PREPAREDNESS PROGRAM DEVELOPMENTAL COMMITTEE THE HOSPITAL PREPAREDNESS PROGRAM (HPP) PROVIDES LEADERSHIP AND FUNDING THROUGH GRANTS AND COOPERATIVE AGREEMENTS TO STATES, TERRITORIES, AND ELIGIBLE MUNICIPALITIES TO IMPROVE SURGE CAPACITY AND ENHANCE COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES. SCRIPPS HEALTH PARTICIPATES IN THE HPP GRANT FUNDING WORKGROUP. DISASTER PREPAREDNESS - COMMUNITY OUTREACH AND EDUCATION HAVING THE ABILITY TO PROVIDE EMERGENCY SERVICES TO THOSE INJURED IN A LOCAL DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS PARTICIPATES IN SAN DIEGO COUNTY AND STATE OF CALIFORNIA ADVISORY GROUPS TO PLAN, IMPLEMENT, AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND FUNDING EFFORTS. IN ADDITION, SCRIPPS MAINTAINS ACTIVE READINESS FOR THE SCRIPPS HOSPITAL MEDICAL RESPONSE TEAM OR THE SCRIPPS HOSPITAL ADMINISTRATION UNIT. BOTH ARE LEAD TEAMS FOR THE STATE OF CALIFORNIA MOBILE FIELD HOSPITAL DEPLOYMENT. THESE EFFORTS ARE LED BY THE DISASTER PREPAREDNESS PROGRAM UNDER THE DIRECTION OF THE CHIEF MEDICAL OFFICER. SAN DIEGO SHERRIFFS SEARCH & RESCUE ACADEMY EMERGENCY RESPONSE MODULE THE AMERICAN RED CROSS EMERGENCY MEDICAL RESPONSE COURSE IS TO PROVIDE THE PARTICIPANT WITH THE KNOWLEDGE AND SKILLS NECESSARY TO WORK AS AN EMERGENCY MEDICAL RESPONDER (EMR). THE CLASS IS INSTRUCTED BY CHRIS VAN GORDER, SCRIPPS PRESIDENT AND CEO. SAN DIEGO COUNTY HEALTHCARE DISASTER COUNCIL THE SAN DIEGO COUNTY DISASTER COUNCIL ADVISES THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY, PUBLIC HEALTH SERVICES, AND DIVISION OF EMERGENCY MEDICAL (EMS) ON THE COMMUNITYS HEALTH AND MEDICAL DISASTER PREPAREDNESS. SAN DIEGO SEAFOOD SATURDAYS THIS PROGRAM IS A COLLABORATIVE EDUCATIONAL CAMPAIGN ENCOURAGING SAN DIEGANS CONSUMPTION OF LOCAL SEAFOOD AT LEAST ONE DAY A WEEK. SCRIPPS CHEF SUPERVISOR GIVES DEMONSTRATIONS AND LECTURES ON PREPARING MEALS WITH LOCALLY CAUGHT SEAFOOD. SCRIPPS IN-LIEU OF FUNDS SCRIPPS IN-LIEU OF FUNDS ARE USED FOR UNFUNDED OR UNDERFUNDED PATIENTS AND THEIR POST-DISCHARGE NEEDS INCLUDING BOARD AND CARE, SKILLED NURSING FACILITIES, LONG-TERM ACUTE CARE AND HOME HEALTH. IN ADDITION, THE FUNDS MAY BE USED FOR MEDICATIONS, EQUIPMENT AND TRANSPORTATION SERVICES. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5: ENLISTED LEADERSHIP FOUNDATION THE FOUNDRY ENLISTED LEADERSHIP FOUNDATION IS A SAN DIEGO BASED NON-PROFIT GROUP 501(C)3 DEDICATED TO LEADERSHIP DEVELOPMENT OF NAVY SECOND CLASS, FIRST CLASS, AND CHIEF PETTY OFFICERS. THIS ORGANIZATION WAS FORMED BY A TEAM OF ACTIVE DUTY AND RETIRED COMMAND / MASTER CHIEF PETTY OFFICERS TO DEVELOP CURRENT AND FUTURE LEADERS THROUGH A PHILOSOPHY OF SHARING AND MENTORING BASED ON COMBINED GENERATIONS OF GROWTH AND GROOMING. THE LEADERSHIP LECTURE IS GIVEN BY CHRIS VAN GORDER, PRESIDENT AND CEO. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6: SAN DIEGO REGIONAL TASK FORCE ON THE HOMELESS THE MISSION OF THE REGIONAL TASK FORCE ON THE HOMELESS IS TO ENGAGE STAKEHOLDERS IN A COMMUNITY-BASED PROCESS THAT WORKS TO: 1) END HOMELESSNESS FOR ALL INDIVIDUALS AND FAMILIES THROUGHOUT THE REGION. 2) ADDRESS THE UNDERLYING CAUSES OF HOMELESSNESS. 3) LESSEN THE NEGATIVE IMPACT OF HOMELESSNESS ON INDIVIDUALS, FAMILIES AND COMMUNITIES. MEMBERS OF THE GOVERNANCE BOARD ARE BEING SELECTED BY A COMMUNITY PROCESS. BOARD SEATS ARE IDENTIFIED BY THE TYPE OF ORGANIZATION OR REPRESENTATIVE THAT IS NEEDED. SCRIPPS MERCY HOSPITAL CHIEF EXECUTIVE WAS DESIGNATED TO PARTICIPATE REPRESENTING THE HEALTH CARE SECTOR; THE DIRECTOR OF COMMUNITY PROGRAMS DEVELOPMENT ATTENDS ON THE CHIEF EXECUTIVES BEHALF. SAN DIEGO HEALTH CONNECT REFERRALS WORK GROUP SAN DIEGO HEALTH CONNECT SECURELY CONNECTS HOSPITALS, HEALTH SYSTEMS, AND PATIENTS, PRIVATE HEALTH INFORMATION EXCHANGES (HIES) AND OTHER HEALTHCARE STAKEHOLDERS SO THEY CAN SHARE IMPORTANT HEALTH INFORMATION, IN ORDER TO SERVE AND IMPROVE HEALTH CARE FOR ALL COMMUNITY MEMBERS. IMPROVING PATIENT CARE WHILE REDUCING COSTS THROUGH HEALTH INFORMATION TECHNOLOGY AMONG COUNTY HEALTH PROVIDERS. COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 7. HEALTH CARE PUBLIC AND GOVERNMENT ADVOCACY SCRIPPS PUBLIC AND GOVERNMENT AFFAIRS SUPPORTS RELATIONSHIP BUILDING AMONG INTERESTED AND AFFECTED PARTIES RELATIVE TO THE NATION'S HEALTH CARE REFORM DEBATE AND DECISION MAKING. THE GOAL IS TO EDUCATE AND INFORM RELATIVE TO ALL ASPECTS OF REFORM DISCUSSION, FROM HEALTH INFORMATION TECHNOLOGY TO THE ENACTMENT AND IMPLEMENTATION OF THE PATIENT PROTECTION AND ACCOUNTABLE CARE ACT.
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD-DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THE AMOUNT ON PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGARDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED.
SCHEDULE H, PART III, LINE 4	FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES.
SCHEDULE H, PART III, LINE 8	MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT.
SCHEDULE H, PART III, LINE 9B	COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN SAN DIEGO COUNTY, THE LONG HISTORY OF COLLABORATION AMONG HOSPITALS, HEALTHCARE SYSTEMS AND COMMUNITY PARTNERS HAS RESULTED IN SUCCESSFUL PARTNERSHIP ON PAST CHNAS. WHILE PUBLIC INSTITUTIONS AND DISTRICT HOSPITALS DO NOT HAVE TO REPORT UNDER SB 697, THESE INSTITUTIONS HAVE BECOME AN INTEGRAL PART OF THE CHNA IN SAN DIEGO COUNTY. INFORMATION IS GATHERED THROUGH THE CHNA FOR THE PURPOSES OF REPORTING COMMUNITY BENEFIT, DEVELOPING STRATEGIC PLANS, CREATING ANNUAL REPORTS, PROVIDING INPUT ON LEGISLATIVE DECISIONS, AND INFORMING THE GENERAL COMMUNITY OF HEALTH ISSUES AND TRENDS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THE REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THIS REPORT COMPLIES WITH FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING HOSPITAL FACILITIES OWNED AND OPERATED BY AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS. FOR MORE DETAILED INFORMATION ON THE CHNA REGULATORY REQUIREMENTS AND IMPLEMENTATION STRATEGY SEE: https://www.scripps.org/about-us/Scripps-in-the-community/assessing-commun ity-needs SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COMMITTEE DESIGNED THE 2016 CHNA PROCESS BASED ON THE FINDINGS FROM THE 2013 CHNA AND RECOMMENDATIONS FROM THE COMMUNITY. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER): - BEHAVIORAL/MENTAL HEALTH - CARDIOVASCULAR DISEASE - DIABETES (TYPE 2) - OBESITY THE CHNA COMMITTEE COMPLETED A COLLABORATIVE FOLLOW-UP PROCESS (PHASE 2) TO ENSURE THE 2013 CHNA FINDINGS ACCURATELY REFLECTED THE HEALTH NEEDS OF THE COMMUNITY. PHASE 2 COLLECTED COMMUNITY FEEDBACK ON BOTH THE PROCESS AND FINDINGS OF THE 2013 CHNA, AS WELL AS RECOMMENDATIONS FOR THE NEXT CHNA PROCESS. 87% OF RESPONDENTS AGREED THE 2013 CHNA IDENTIFIED THE TOP HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. 78% OF RESPONDENTS AGREED THE METHODOLOGY FOR THE NEXT CHNA SHOULD INCLUDE A DEEPER DIVE INTO THE TOP FOUR HEALTH ISSUES MENTIONED ABOVE. BASED ON THE FINDINGS AND FEEDBACK FROM BOTH PHASES OF THE 2013 CHNA, THE CHNA COMMITTEE MADE A DEEPER ANALYSIS OF THE TOP FOUR IDENTIFIED COMMUNITY HEALTH NEEDS (BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, TYPE 2 DIABETES AND OBESITY). PRIOR TO DESIGNING THE 2016 METHODOLOGY, THE CHNA COMMITTEE MET WITH LEADERS FROM COMMUNITY PARTNER ORGANIZATIONS WHO PARTICIPATED IN THE PRIOR ASSESSMENT. THEY ADVISED THE COMMITTEE ON WAYS TO ENGAGE THEIR STAFF WHO WORK WITH LARGE NUMBERS OF RESIDENTS IN HIGH NEED AND VULNERABLE COMMUNITIES. THE 2016 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 2013 CHNA. BASED ON THE RESULTS OF THE SCAN AND FEEDBACK FROM COMMUNITY PARTNERS RECEIVED DURING THE 2016 PLANNING PROCESS, A NUMBER OF COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED 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 FOUR NEEDS IMPACT THE HEALTH OF SAN DIEGO RESIDENTS WAS CONDUCTED. QUANTITATIVE DATA COLLECTION AND ANALYSIS CALIFORNIA'S OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) IS RESPONSIBLE FOR COLLECTING DATA AND DISSEMINATING INFORMATION ABOUT THE UTILIZATION OF HEALTH CARE IN CALIFORNIA. AS PART OF THE 2016 CHNA DATA COLLECTION PROCESS, 2013 OSHPD DEMOGRAPHIC DATA FOR HOSPITAL INPATIENT, EMERGENCY DEPARTMENT, AND AMBULATORY CARE ENCOUNTERS FROM ALL HOSPITALS WITHIN SAN DIEGO COUNTY WERE ANALYZED TO UNDERSTAND THE HOSPITAL PATIENT POPULATION. CLINIC DATA WAS ALSO GATHERED FROM OSHPD'S WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SAN DIEGO, AS HOSPITAL DISCHARGES MAY NOT REPRESENT ALL THE HEALTH CONDITIONS IN THE COMMUNITY. AFTER COMPARING RESULTS OF THE QUANTITATIVE ANALYSES OF THE SAN DIEGO COUNTY MORTALITY DATA, KP COMMUNITY BENEFIT DATA ANALYSIS TOOL, AND HOSPITAL DISCHARGE DATA, THE FINDINGS DEMONSTRATED THAT BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY CONTINUE TO BE AMONG THE TOP PRIORITY HEALTH NEEDS IN SAN DIEGO COUNTY ACROSS DIFFERENT QUANTITATIVE DATA SOURCES. QUALITATIVE AND COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF COMMUNITY MEMBERS, INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. FOR MORE INFORMATION ON THE COMMUNITY ENGAGEMENT ACTIVITIES SEE NARRATIVE FOR QUESTION 5, SCHEDULE H, PART V, SECTION B. 2016 PRIORITIZATION OF THE TOP FOUR IDENTIFIED HEALTH NEEDS THE PURPOSE OF THIS CHNA WAS TO IDENTIFY AND PRIORITIZE HEALTH ISSUES AND NEEDS IN SAN DIEGO COUNTY USING MULTIPLE SOURCES OF INFORMATION. THE ANALYSIS OF SECONDARY DATA INCORPORATED THE FOLLOWING CRITERIA FOR INCLUSION AS AN IDENTIFIED COMMUNITY HEALTH NEED: 1. MAGNITUDE OR PREVALENCE: THE HEALTH NEED AFFECTS A LARGE NUMBER OF PEOPLE IN ALL REGIONS OF SAN DIEGO. 2. SEVERITY: THE HEALTH NEED HAS SERIOUS CONSEQUENCES (MORBIDITY, MORTALITY, AND/OR ECONOMIC BURDEN). 3. HEALTH DISPARITIES: THE HEALTH NEED DISPROPORTIONATELY IMPACTS THE HEALTH STATUS OF ONE OR MORE VULNERABLE POPULATION GROUPS. 4. TRENDS: THE HEALTH NEED IS EITHER STABLE OR CHANGING OVER TIME, E.G., IMPROVING OR GETTING WORSE. 5. COMMUNITY CONCERN: STAKEHOLDERS, COMMUNITY MEMBERS, AND VULNERABLE POPULATIONS WITHIN THE COMMUNITY VIEW THE HEALTH NEED AS A PRIORITY. USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE. TAKING INTO ACCOUNT THE RESULTS OF THE QUANTITATIVE DATA COLLECTION AND THE FINDINGS FROM THE COMMUNITY ENGAGEMENT ACTIVITIES, A RANK FROM 1 TO 4, WITH 1 BEING THE MOST SIGNIFICANT, WAS APPLIED TO EACH CRITERION. AN OVERALL SCORE WAS GIVEN TO EACH HEALTH NEED BY AVERAGING THE RANKINGS ACROSS ALL FIVE CRITERIA. IN ADDITION, THE SOCIAL DETERMINANTS OF HEALTH WERE ANALYZED AND IDENTIFIED ACROSS ALL HEALTH NEEDS. THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, 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. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMER'S DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E., EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENT'S UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FOR PAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENT'S ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION FOR THE PURPOSES OF THE 2016 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE BY ZIP CODE LEVEL. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,205 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTIONS ARE JUST OVER 1 PERCENT PER YEAR, EXTENDING OUT 25 YEARS TO THE YEAR 2030. THE SANDAG 2050 SUB-REGIONAL GROWTH FORECAST PROJECTS POPULATION GROWTH TO 4.4 MILLION BY 2050. THIS IS A 40.0% INCREASE IN POPULATION GROWTH. RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE INSTITUTE FOR PUBLIC HEALTH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. IN ADDITION, GEOGRAPHIC INFORMATION SYSTEMS (GIS) MAPS WERE CREATED, OVERLAYING CNI DATA AND THE HOSPITAL DISCHARGE RATE BY PRIMARY DIAGNOSIS FOR THE HEALTH CONDITIONS: TYPE 2 DIABETES, CARDIOVASCULAR DISEASE, AND BEHAVIORAL HEALTH. GIS MAPS WERE NOT CREATED FOR OBESITY DUE TO THE FACT THAT OBESITY IS NOT A COMMON PRIMARY DIAGNOSIS, BUT RATHER A SECONDARY CONDITION THAT CONTRIBUTES TO THE PRIMARY REASON FOR A HOSPITAL VISIT. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. POPULATION: OVER 3 MILLION PEOPLE (3,138,265) LIVE IN THE 4,205 SQUARE MILE AREA OF SDC ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%. THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES. RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. PER CALENDAR YEAR 2016 OSHPD ANNUAL FINANCIAL DATA THERE ARE 20 OTHER HOSPITAL FACILITIES SERVING THE SAN DIEGO COMMUNITY. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 59 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. AS A DISPROPORTIONATE-SHARE HOSPITAL, SCRIPPS MERCY SAN DIEGO AND CHULA VISTA CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED-MEDICARE AND MEDI-CAL. SCRIPPS HOSPITALS HOUSED 22.0% PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY17, SCRIPPS PROVIDED 2,380,674 OUTPATIENT VISITS. NEARLY HALF (42.5%) OF SAN DIEGO COUNTY'S 75,499 SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF-PAY. OSHPD 2016 DATA (MOST RECENT YEAR AVAILABLE) SCRIPPS HAS A TOTAL OF 1,417 ACUTE CARE LICENSED BEDS. SAN DIEGO HAS A TOTAL OF 6,450 GENERAL ACUTE CARE LICENSED BEDS. % OF SCRIPPS BEDS IS 1,417/6,450 = 22.0% COUNTY SAFETY NET DISCHARGES CY16: SAFETY NET DISCHARGES INCLUDE PAYER CATEGORIES: COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF-PAY. - CENTRAL DISCHARGES 17,389 - SOUTH SUBURBAN DISCHARGES 14,665 SCRIPPS OSHPD SAFETY NET DISCHARGES CY16: - SCRIPPS CENTRAL DISCHARGES - 5,219 - SCRIPPS SOUTH SUBURBAN DISCHARGES 3,933 THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE. SAN DIEGO'S UNINSURED THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. BETWEEN 2010 AND 2013 THE UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3%, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). SOURCE: U.S. CENSUS BUREAU, 2010 TO 2014 1-YEAR AMERICAN COMMUNITY SURVEYS. ACS UNINSURED RATE IS BASED ON WHETHER AN INDIVIDUAL HAD INSURANCE AT THE TIME OF THE SURVEY. NOTE: THE AMERICAN COMMUNITY SURVEY, ESTIMATES ARE FOR THE CIVILIAN NONINSTITUTIONALIZED POPULATION. THERE ARE THREE INDICATORS DETERMINED TO BE THE MOST POWERFUL PREDICTORS OF POPULATION HEALTH: POVERTY RATE, PERCENT OF POPULATION UNINSURED, AND EDUCATIONAL ATTAINMENT. LOW-INCOME, UNINSURED, AND UNDEREDUCATED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. FIVE-YEAR ESTIMATES FROM THE 2009-2013 AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY: WITHIN SDC, 14.5% OR 441,648 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). FOR CHILDREN 0-17, THE PERCENTAGE LIVING 100% BELOW THE FPL INCREASES TO 18.8%. FOR A HOUSEHOLD SIZE OF 3 THE 100% POVERTY LEVEL IS $20,090 PER YEAR. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. UNINSURED: BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SDC. IN 2014, THE UNINSURED RATE SHARPLY DECREASED, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). LACK OF INSURANCE IS A PRIMARY BARRIER TO HEALTH CARE ACCESS INCLUDING REGULAR PRIMARY CARE, SPECIALTY CARE, AND OTHER HEALTH SERVICES THAT CONTRIBUTES TO POOR HEALTH STATUS. EDU
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH AS A TAX-EXEMPT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY17 (OCTOBER 2016 TO SEPTEMBER 2017), SCRIPPS INVESTED $29,408,514 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE 2016 SCHEDULE H FORM 990 IRS GUIDELINES; "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. LACK OF INSURANCE ALSO INCREASES THE BURDEN ON HOSPITALS AND HEALTH PROVIDERS. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY17 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (M.O.S.T.) WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM (M.O.S.T.) PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FISCAL YEAR 2017, THE M.O.S.T. TEAM SERVED IN TWO OUTREACH MISSION TRIPS. THE M.O.S.T. TEAM VOLUNTEERED 5,436 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 700 PEOPLE SERVED. THE M.O.S.T. PROGRAM CELEBRATED ITS 30TH ANNIVERSARY THIS YEAR. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING, AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACK UP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, AND COUNSELING ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDER ARE CONNECTED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. IN 2017, 67 PATIENTS ACCOUNTED FOR 72 RCU ADMISSIONS. AS A GROUP, THE RCU PATIENTS HAS A CUMULATIVE 1,469 HOSPITAL DAYS OF STAY BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH TRACHEOTOMIES, FEEDING TUBES, IV ANTIBIOTICS, WOUND VACS, MULTIPLE FRACTURES, ABSCESS, OSTEOMYELITIS, PARAPLEGIA, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, HEART VALVE REPLACEMENT, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, CRANIOTOMY, COMPLEX TRAUMA, CVA, CANCER, HIV/AIDS, AND A PATIENT WITH AN EXTERNAL DEFIBRILLATOR, THE LIFE VEST. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEOS CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 45+ RESIDENTS AND 38 FELLOWS. WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. LEOS CLINIC. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTYS MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2017. FIJI SOLOMON ISLANDS MEDICAL MISSION THE MEDICAL MISSION CONSISTS OF SCRIPPS HEALTH GENERAL MEDICAL SPECIALISTS AND RESIDENTS SETTING UP CLINICS ON RURAL ISLANDS FOR THE PURPOSE OF PROVIDING MUCH NEEDED MEDICAL CARE, MEDICAL SUPPLIES AND SURGICAL SCREENING FOR AN UNDERSERVED POPULATION THAT HAVE NO ACCESS TO BASIC MEDICAL CARE. THE INTERNATIONAL MEDICAL MISSIONS PROVIDE AN EXCEPTIONAL CLINICAL EDUCATION EXPERIENCE TO OUR SENIOR INTERNAL MEDICINE RESIDENTS AT SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2017, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $212,000 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO (FOUR GRANTS RANGING FROM $10,000 TO $120,000). THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTYS HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $3.5 MILLION. PROGRAMS FUNDED DURING FISCAL YEAR 2017 INCLUDE: - CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW INCOME, UNINSURED MERCY CLINIC AND BEHAVIORAL HEALTH PATIENTS HELP OBTAINING HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME INTENSIVE GOVERNMENT BENEFIT CASES. - CATHOLIC CHARITIES FUNDING PROVIDES SHORT TERM EMERGENCY SHELTER FOR MEDICALLY FRAGILE HOMELESS PATIENTS UPON DISCHARGE FROM SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA. CASE MANAGEMENT AND SHELTER ARE PROVIDED FOR HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL. WHILE THESE PATIENTS NO LONGER REQUIRE HOSPITAL CARE, THEY DO NEED A SHORT TERM RECUPERATIVE ENVIRONMENT. PATIENTS WHO DEMONSTRATE A WILLINGNESS TO CHANGE RECEIVE ONE WEEK IN A HOTEL, ALONG WITH FOOD AND BUS FARE TO PURSUE A CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. THE PARTNERSHIP SEEKS TO REDUCE EMERGENCY ROOM RECIDIVISM IN THIS POPULATION AND IMPROVE THEIR QUALITY OF LIFE. - 2-1-1 HEALTH CARE NAVIGATION PROGRAM LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 700,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF 2,500 AFFILIATED PHYSICIANS AND 15,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE SERVICES, HOSPICE CARE, AND AN AMBULATORY CARE NETWORK OF PHYSICIAN OFFICES AND 28 OUTPATIENT CENTERS AND CLINICS. SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. AND OUR PARTNERSHIPS DON'T STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDES WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS; AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE.
SCHEDULE H, PART VI, LINE 7	CALIFORNIA SCRIPPS HEALTH COMMUNITY BENEFIT REPORT CAN BE FOUND AT: https://www.scripps.org/about-us/Scripps-in-the-community/

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (14 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
211 SAN DIEGO - HEALTHCARE NAVIGATION
3860 CALLE FORTUNADA	SAN DIEGO	CA	92123	331029843	501(c)(3)	$12,000	PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT CA HOSP FEE PROGRAM PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT
ALZHEIMER'S ASSOCIATION
6632 CONVOY COURT	SAN DIEGO	CA	92111	133039601	501(c)(3)	$25,000	Program Support	$0
ACS MAKING STRIDES AGAINST BREAST CANCER
2655 CAMINO DEL RIO N	SAN DIEGO	CA	92108	131788491	501(c)(3)	$15,000	PROGRAM SUPPORT	$0
AMERICAN HEART ASSOCIATION - SPONSORSHIP
9404 GENESEE AVE 240	LA JOLLA	CA	92037	135613797	501(c)(3)	$10,000	PROGRAM SUPPORT
AMERICAN HEART ASSOCIATION IN-KIND DONATION
9404 GENESEE AVE 240	LA JOLLA	CA	92037	135613797	501(c)(3)		PROGRAM SUPPORT	$9,981	FMV	SUPPLIES
AMERICAN HEART ASSOCIATION-GO RED FOR WOMEN
9404 GENESEE AVE 240	LA JOLLA	CA	92037	135613797	501(c)(3)	$10,000	PROGRAM SUPPORT	$0
CALIFORNIA HEALTH FOUNDATION & TRUST (CHFT)
1215 K STREET STE 800	SACRAMENTO	CA	95814	941498697	501(c)(3)	$90,000	PROGRAM SUPPORT	$0
CATHOLIC CHARITIES
349 CEDAR STREET	SAN DIEGO	CA	92101	237334012	501(c)(3)	$70,000	PROGRAM SUPPORT	$0
CONSUMER CENTER OF LEGAL AID SOCIETY
1764 SAN DIEGO AVE 200	SAN DIEGO	CA	92110	951869806	501(c)(3)	$120,000	PROGRAM SUPPORT	$0
ENLISTED LEADERSHIP FOUNDATION-THE FOUNDRY
2307 FENTON PARKWAY 107-208	SAN DIEGO	CA	92108	465029314	501(c)(3)	$20,000	PROGRAM SUPPORT	$0
ERIC PAREDES SAVE A LIFE FOUNDATION
2514 JAMACHA RD STE 502	EL CAJON	CA	92019	800636157	501(c)(3)	$15,000	PROGRAM SUPPORT	$0
FATHER JOE'S VILLAGES
3350 E ST	SAN DIEGO	CA	92102	330492302	501(c)(3)	$6,525	PROGRAM SUPPORT	$0
THE CITY HEIGHTS WELLNESS CTR - LA MAESTRA
4305 UNIVERSITY AVE STE 150	SAN DIEGO	CA	92105	330473171	501(c)(3)	$40,000		$0
MD ANDERSON CANCER CENTER
PO BOX 301438 UNIT 0705	HOUSTON	TX	77230	746001118	501(c)(3)	$25,000		$0

Field	Value	IRS element (for citing)
Total501c3 Org	12	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PART I, LINE 2	FormAndLineReferenceDesc
Explanation	DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS GRANTEE SHALL SUBMIT TO SCRIPPS HEALTH, ATTENTION MANAGER OF COMMUNITY BENEFIT SERVICES AT 10140 CAMPUS POINT COURT, CPA 308, SAN DIEGO, CA 92121, THE FOLLOWING: A. A SEMI-ANNUAL SUMMARY PROGRESS REPORT AND A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT IS REQUIRED. REPORTS SHALL INCLUDE, BUT NOT BE LIMITED TO, PROGRESS MADE TOWARD MEETING OBJECTIVES OUTLINED IN THE GRANT APPLICATION. B. WITHIN THIRTY (30) DAYS FOLLOWING THE EXPIRATION DATE OF THE GRANT A FINAL PROGRESS REPORT SHALL BE SUBMITTED TO SCRIPPS HEALTH. IN ADDITION TO THE PROGRESS MADE TOWARD MEETING THE OBJECTIVES OUTLINED IN THE GRANT APPLICATION, THE FINAL REPORT SHOULD INCLUDE QUANTITATIVE AND QUALITATIVE RESULTS OF THE PROGRAM AGAINST ITS STATED GOALS AND OBJECTIVES. A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT AGAINST THE BUDGET MUST BE INCLUDED AS PART OF THIS FINAL REPORT. C. THE GRANTEE SHALL PROVIDE SCRIPPS HEALTH WITH ANY ADDITIONAL INFORMATION OR PROGRESS UPDATES, RELATIVE TO GRANT PROJECT, AS REASONABLY REQUESTED. D. SCRIPPS HEALTH RESERVES THE RIGHT TO AUDIT EXPENDITURES AND SUPPORTING DOCUMENTATION.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Discretionary Spending Acct	Yes (X)	DiscretionarySpendingAcctInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	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 (21 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
ROBIN BROWN
CHIEF EXECUTIVE, SR VP	$504,688	$0	$155,130	$0	$129,182	$0	$264,621	$0	$21,144	$0	$1,074,765	$0	$112,973	$0
VICTOR V BUZACHERO
CORP SR VP INNOVAT/HR/PERF MGT	$589,218	$0	$206,392	$0	$413,796	$0	$249,348	$0	$22,958	$0	$1,481,712	$0	$163,008	$0
SUSAN CAMPBELL
EXEC DIR, EXTERNAL AFFAIRS	$316,610	$0	$88,306	$0	$71,136	$0	$56,769	$0	$37,494	$0	$570,315	$0	$45,619	$0
DAVID COHN
CORP VP, REVENUE CYCLE	$351,149	$0	$85,661	$0	$43,745	$0	$60,679	$0	$41,375	$0	$582,609	$0	$31,826	$0
JAMES CROWDER
CORP SR VP, CIO	$415,738	$0	$81,553	$0	$9,836	$0	$90,885	$0	$26,506	$0	$624,518	$0	$0	$0
LEI DONG
DIRECTOR, CHIEF OF MED PHYSICS	$398,405	$0	$77,239	$0	$67,295	$0	$10,600	$0	$29,321	$0	$582,860	$0	$0	$0
MARY ELLEN DOYLE
CORP VP, NURSING OPS	$352,770	$0	$86,787	$0	$60,457	$0	$66,985	$0	$24,485	$0	$591,484	$0	$43,011	$0
JOHN ENGLE
CORP SR VP, CHIEF DEVELOPMENT	$392,704	$0	$114,148	$0	$67,668	$0	$79,760	$0	$26,331	$0	$680,611	$0	$41,468	$0
CARL ETTER
CHIEF EXECUTIVE, SR VP	$483,550	$0	$146,002	$0	$84,243	$0	$104,655	$0	$20,574	$0	$839,024	$0	$63,430	$0
SHIRAZ FAGAN
CHIEF EXECUTIVE, SR VP	$552,812	$0	$167,430	$0	$104,657	$0	$133,718	$0	$31,749	$0	$990,366	$0	$92,485	$0
GARY FYBEL
CHIEF EXECUTIVE, SR VP	$562,220	$0	$171,567	$0	$208,112	$0	$43,954	$0	$23,984	$0	$1,009,837	$0	$169,590	$0
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	$573,184	$0	$177,624	$0	$111,754	$0	$149,186	$0	$30,047	$0	$1,041,795	$0	$89,451	$0
ROBERT T HOFF
CORP VP, HORIZONTAL OPS	$343,441	$0	$83,525	$0	$56,155	$0	$61,210	$0	$33,791	$0	$578,122	$0	$42,729	$0
JAMES LABELLE MD
CORP SR VP, CHIEF MED OFFICER	$619,269	$0	$189,068	$0	$32,576	$0	$147,866	$0	$30,214	$0	$1,018,993	$0	$0	$0
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	$574,147	$0	$212,263	$0	$177,429	$0	$233,512	$0	$11,828	$0	$1,209,179	$0	$163,136	$0
RICHARD NEALE
CORP SVP, CORP DEVELOPMENT	$424,968	$0	$121,077	$0	$14,236	$0	$71,000	$0	$44,502	$0	$675,783	$0	$0	$0
BARBARA PRICE
CORP SRVP BUS & SERV LINE DEV	$474,976	$0	$142,050	$0	$85,653	$0	$111,196	$0	$27,318	$0	$841,193	$0	$74,953	$0
MARC A REYNOLDS
CORP SR VP, PAYER RELATIONS	$374,547	$0	$114,593	$0	$216,262	$0	$34,002	$0	$21,618	$0	$761,022	$0	$199,628	$0
RICHARD ROTHBERGER
TREASURER/EXECUTIVE VP/CFO	$738,670	$0	$277,864	$0	$565,145	$0	$51,344	$0	$32,058	$0	$1,665,081	$0	$316,387	$0
RICHARD R SHERIDAN
SEC/CORP EXEC VP-HR/GEN COUNSL	$546,189	$0	$158,342	$0	$48,261	$0	$359,747	$0	$28,694	$0	$1,141,233	$0	$36,330	$0
CHRISTOPHER VAN GORDER
PRESIDENT & CEO/TRUSTEE	$1,243,009	$0	$568,465	$0	$275,408	$0	$1,281,369	$0	$27,436	$0	$3,395,687	$0	$228,248	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE J, PART I, LINE 1A

SUPPLEMENTAL COMPENSATION INFORMATION SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE IS $136 PER MONTH. CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2S.

SCHEDULE J, PART I, LINE 4B

SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. ACCRUAL OF BENEFITS UNDER THIS PLAN HAVE BEEN FROZEN AND NO ADDITIONAL BENEFITS HAVE BEEN ACCRUED AFTER 2014. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2016: ROBIN BROWN - $112,973 VICTOR V. BUZACHERO - $163,008 SUSAN CAMPBELL - $45,619 DAVID COHN - $31,826 MARY ELLEN DOYLE - $43,011 JOHN ENGLE - $41,468 CARL ETTER - $63,430 SHIRAZ FAGAN - $92,485 GARY FYBEL - $169,590 THOMAS GAMMIERE - $89,451 ROBERT HOFF - $42,729 JUNE KOMAR - $163,136 BARBARA PRICE - $74,953 MARC. A REYNOLDS - $199,628 RICHARD ROTHBERGER - $316,387 RICHARD SHERIDAN - $36,330 CHRISTOPHER VAN GORDER - $228,248 SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTH
A	680164610	1309116Y1	2007-03-02	$49,995,000	SEE PART IV	false	false	Yes (true)
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
B	521643828	13033F5A4	2008-08-14	$99,830,304	SEE PART VI	false	false	false
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
C	521643828	000000000	2017-01-31	$160,000,000	SEE PART VI	false	false	false
California Health Facilities Financing Authority
D	521643828	13033FWK2	2005-06-02	$40,975,000	SEE PART VI	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$0	$0	$49,995,000	$0	$0	$0	$146,070	$0	$0	$49,848,930	$0	$0	2005	Yes (true)	false	Yes (true)	Yes (true)
B	$19,100,000	$0	$99,830,304	$9,902,000	$0	$0	$0	$0	$0	$0	$0	$0	2008	Yes (true)	false	Yes (true)	Yes (true)
C	$0	$0	$160,000,000	$0	$0	$0	$0	$0	$0	$0	$0	$0	2017	Yes (true)	false	Yes (true)	Yes (true)
D	$34,075,000	$0	$40,975,000	$0	$0	$0	$280,659	$918,283	$0	$0	$0	$0	2008	false	Yes (true)	Yes (true)	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

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

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1Txt	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd
0
A	Yes (true)	Yes (true)	false	false	0	Yes (true)	Yes (true)
0
B	false	false	false	false	0	false	Yes (true)	false	false	Yes (true)
0
C	false	false	false	false	0	false	Yes (true)	Yes (true)	false	false
WELLS FARGO
D	false	Yes (true)	Yes (true)	false	0	false	Yes (true)	false	false	Yes (true)	14.	false	false

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

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

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K, PART I, COLUMN (C) - CUSIP NUMBER	FormAndLineReferenceDesc
Explanation	BOND ISSUE D (2005A/2008G): The Series 2005A Bonds, CUSIP 13033FWK2, were exchanged for the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2008G, CUSIP 13033F5M8 (Scripps Health), on August 14, 2008. SCHEDULE K, PART I, COLUMN (E) - ISSUE PRICE BOND ISSUE A (2007A): The stated par of $49,995,000 differs from the $149,875,000 reported on the 8038 tax form as the $49,995,000 amount represents only Scripps Health's portion in a pool bond loan program. BOND ISSUE B (2008A): The stated par of $99,020,000 differs from the $99,830,304 listed in form 8038 Part III line 21 (b) because of an $810,304 original issue premium. SCHEDULE K, PART I, COLUMN (F) - DESCRIPTION OF PURPOSE BOND ISSUE A (2007A): POOL BOND. PROCEEDS WERE USED TO REFUND COMMERCIAL PAPER REVENUE NOTES, SERIES 2005A, WHICH WERE USED TO PURCHASE EQUIPMENT. BOND ISSUE B (2008A): REFUNDING OF PRIOR ISSUES 07/07/2005 BOND ISSUE C (2017A): The $160,000,000 (2017A) refunded the 2008B-F bonds. The issue date for the 2008B-F bonds was 8/14/2008. BOND ISSUE D (2005A/2008G): The $40,975,000 (2008G) exchanged the 2005A bond. The issue date for the 2005A was 6/2/2005. The proceeds of the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2005A (Scripps Health), were issued for the purpose, together with other available funds, of advance refunding the Organizations Series 1998C Bonds. The Series 2005A Bonds, were exchanged for the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2008G (Scripps Health), on August 14, 2008. Based on the advice of bond counsel, the Organization is treating the Series 2008G Bonds as the same issue as the Series 2005A Bonds for federal income tax purposes. Further information regarding the Series 2008G Bonds: - Issuer Name: California Health Facilities Financing Authority; - Issuer EIN: 52-1643828; - CUSIP #: 13033F5M8; - Date Exchanged: 8/14/2008; - Issue Price: N/A; - Description of Purpose: Exchange for Series 2005A Bonds (same issue). BOND ISSUE 2-A (2010A): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BoND ISSUE 2-B (2010B & C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-C (2012A-C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-D (2016A/B): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. SCHEDULE K, PART II, LINE 3 BOND ISSUE 2-A (2010A) The amount shown in Part II, Line 3 consists of the issue price of the bonds ($119,458,924) plus Project Fund investment earnings of $122,508. BOND ISSUE 2-B (2010B/C) The amount shown in Part II, Line 3 consists of the issue price of the bonds $100,000,000 plus Project Fund investment earnings of $2,530. BOND ISSUE 2-C (2012A-C): The amount shown in Part II, Line 3 consists of the issue price of the bonds $288,143,095 plus investment earnings of $17,234. SCHEDULE K, PART III - PRIVATE BUSINESS USE BOND ISSUE B (2008A): The Series 2008A bonds refunded prior bonds originally issued before 2003. Accordingly, Part III reporting is not required. BOND ISSUE D (2005A/2008G): The Series 2005A Bonds refunded prior bonds originally issued before 2003. Accordingly, Part III reporting is not required. SCHEDULE K, PART III, LINE 3B THE OBLIGOR'S LEGAL DEPARTMENT REVIEWS CONTRACTS AND AGREEMENTS TO ENSURE COMPLIANCE WITH PRIVATE BUSINESS USE REGULATIONS, ENGAGING OUTSIDE LEGAL COUNSEL, AS NECESSARY. SCHEDULE K, PART IV, LINE 2C BOND ISSUE B (2008A): The 2008A rebate computation was recently performed on August 14, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE D (2005A/2008G): The 2005A/2008G rebate computation was recently performed on June 2, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-A (2010A): The 2010A rebate computation was recently performed on February 4, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-B (2010B/C): The 2010B/C rebate computation was recently performed on February 4, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-C (2012A-C): The 2012A-C rebate computation was recently performed on February 1, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-D (2016A/B): The 2016A/B rebate computation was recently performed on February 28, 2018. No rebate amount has accrued as of the end of the computation period. SCHEDULE K, PART IV, LINE 3 BOND ISSUE 2-C (2012A-C): THE 2012A ISSUE TOTALING $188,143,094 IS A FIXED RATE ISSUE WHEREAS THE 2010B&C TOTALING $100,000,000 IS A VARIABLE RATE ISSUE. BOND ISSUE D (2005A/2008G): ON SEPTEMBER 18, 2012 THE ORGANIZATION ENTERED INTO INTEREST RATE SWAP NOVATIONS WITH WELLS FARGO BANK, N.A., AS COUNTERPARTY, REPLACING THEN-EXISTING INTEREST RATE SWAPS WITH CITIBANK, N.A. SCHEDULE K, PART IV, LINE 6 BOND ISSUE A (2007A): AN AMOUNT IN THE COSTS OF ISSUANCE FUND NOT EXCEEDING $100,000 WAS NOT DISBURSED UNTIL MAY 2008. SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION THE ORGANIZATION HAS ADOPTED TAX-EXEMPT BOND COMPLIANCE PROCEDURES, INCLUDING PROCEDURES TO MONITOR PRIVATE BUSINESS USE OF FINANCED PROPERTY AND TAKING REMEDIAL ACTIONS, IF NECESSARY. THE ORGANIZATION IS AWARE OF THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS, AND HAS DISCUSSED THAT PROGRAM WITH COUNSEL. THE ORGANIZATION HAS REVISED ITS WRITTEN PROCEDURES TO SPECIFICALLY MAKE REFERENCE TO THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
California Health Facilities Financing Authority
A	521643828	13033LFH5	2010-02-04	$119,458,924	SEE PART VI	false	false	false
California Health Facilities Financing Authority
B	521643828	13033LFL6	2010-02-04	$100,000,000	SEE PART VI	false	false	false
California Health Facilities Financing Authority
C	521643828	13033LVZ7	2012-02-01	$288,143,095	SEE PART VI	false	false	false
California Health Facilities Financing Authority
D	521643828	000000000	2016-02-29	$150,000,000	SEE PART VI	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$11,250,000	$0	$119,581,432	$0	$0	$0	$0	$0	$0	$119,581,432	$0	$0	2011	false	false	Yes (true)	Yes (true)
B	$0	$0	$100,002,530	$0	$0	$0	$0	$0	$0	$100,002,530	$0	$0	2011	false	false	Yes (true)	Yes (true)
C	$0	$0	$288,160,329	$0	$0	$0	$0	$0	$0	$288,160,329	$0	$0	2013	false	false	Yes (true)	Yes (true)
D	$12,580,000	$0	$150,000,000	$0	$0	$0	$0	$0	$0	$150,000,000	$0	$0	2016	false	false	Yes (true)	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Any Research AgreementsAnyResearchAgreementsInd	Engage Bond Counsel ResearchEngageBondCounselResearchInd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Remedial Action TakenRemedialActionTakenInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	false	false	false	Yes (true)
B	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	false	false	false	Yes (true)
C	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	false	false	false	Yes (true)
D	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	false	false	false	Yes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

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

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

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

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (4 entries)

Relationship With OrgRelationshipWithOrgTxt	Loan PurposeLoanPurposeTxt	Loan From OrganizationLoanFromOrganizationInd	Original PrincipalOriginalPrincipalAmt	Balance DueBalanceDueAmt	DefaultDefaultInd	Board Or Committee ApprovalBoardOrCommitteeApprovalInd	Written AgreementWrittenAgreementInd
CHRIS VAN GORDER
OFFICER	DEF COMP	Yes (X)	$10,023,866	$11,237,406	false	Yes (true)	Yes (true)
JUNE KOMAR
EXECUTIVE	DEF COMP	Yes (X)	$2,769,010	$3,104,241	false	Yes (true)	Yes (true)
RICHARD SHERIDAN
OFFICER	DEF COMP	Yes (X)	$4,063,606	$4,555,567	false	Yes (true)	Yes (true)
ROBIN BROWN
EXECUTIVE	DEF COMP	Yes (X)	$2,668,899	$2,992,010	false	Yes (true)	Yes (true)

Field	Value	IRS element (for citing)
Total Balance Due	$21,889,224	TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (16 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
MATHEW BALOGH
SEE PART V	$130,691	SEE PART V	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$311,558	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$121,965	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$133,190	COMPENSATION	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$70,547,990	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$9,233,273	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$2,400,776	EQUIPMENT RENTAL	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$2,289,289	CONSTRUCTION SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$1,853,757	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$1,015,858	LEGAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$700,934	LEGAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$588,890	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$132,800	MEDICAL SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$283,611,876	PHYSICIAN SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$42,968,974	PHYSICIAN SERVICES	false
SUBSTANTIAL CONTRIBUTOR
SUBSTANTIAL CONTRIBUTOR	$16,130,489	PHYSICIAN SERVICES	false

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE L, PART II	LOANS TO AND FROM INTERESTED PERSONS EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR FOUR PLAN PARTICIPANTS. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO THOSE FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME.
SCHEDULE L, PART IV	MATHEW BALOGH, SON-IN-LAW OF BOARD MEMBER GORDON R. CLARK, IS EMPLOYED BY SCRIPPS HEALTH.

Schedule M IRS990ScheduleM

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

Securities Publicly Traded SecuritiesPubliclyTradedGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	13	ContributionCnt
Noncash Contributions Rpt F990	$743,534	NoncashContributionsRptF990Amt
Method Of Determining Revenues	COST/SELLING PRICE	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Securities Closely Held Stock		SecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust Intrsts		SecurPrtnrshpTrustIntrstsGrp
Securities Miscellaneous		SecuritiesMiscellaneousGrp
Qualified Contrib Hist Struct		QualifiedContribHistStructGrp
Qualified Contrib Other		QualifiedContribOtherGrp

Real Estate Residential RealEstateResidentialGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	4	ContributionCnt
Noncash Contributions Rpt F990	$1,690,557	NoncashContributionsRptF990Amt
Method Of Determining Revenues	OPINION OF EXPERTS	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Real Estate Commercial		RealEstateCommercialGrp
Real Estate Other		RealEstateOtherGrp
Collectibles		CollectiblesGrp
Food Inventory		FoodInventoryGrp
Drugs And Medical Supplies		DrugsAndMedicalSuppliesGrp
Taxidermy		TaxidermyGrp
Historical Artifacts		HistoricalArtifactsGrp
Scientific Specimens		ScientificSpecimensGrp
Archaeological Artifacts		ArchaeologicalArtifactsGrp
Form8283 Received	4	Form8283ReceivedCnt
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (true)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	Yes (true)	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE M, PART I, COLUMN (B)	CONTRIBUTIONS REPORTED THE NUMBER OF TRANSACTIONS, WHICH MOST CLOSELY APPROXIMATES THE NUMBER OF ITEMS CONTRIBUTED, IS BEING REPORTED IN COLUMN B.
SCHEDULE M, PART I, LINE 32B	THIRD PARTIES ENGAGED TO SOLICIT, PROCESS, AND SELL NON-CASH CONTRIBUTIONS GIFTS GIFTS OF SECURITIES ARE LIQUIDATED THROUGH LICENSED SECURITIES BROKERS. GIFTS OF REAL ESTATE ARE LIQUIDATED THROUGH LICENSED REAL ESTATE BROKERS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (30 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART I AND PART III, LINE 1	MISSION STATEMENT FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS OVER HALF A MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF 2,600 AFFILIATED PHYSICIANS AND 13,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. RECOGNIZED AS A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, GENOMIC MEDICINE, WIRELESS HEALTH AND GRADUATE MEDICAL EDUCATION. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONG STANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. TODAY, THE HEALTH SYSTEM EXTENDS FROM CHULA VISTA TO OCEANSIDE, WITH 26 PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS WAS NAMED BY TRUVEN IN 2013 AS ONE OF THE TOP 15 LARGE HEALTH SYSTEMS IN THE NATION FOR PROVIDING HIGH-QUALITY, SAFE AND EFFICIENT PATIENT CARE. ON THE FOREFRONT OF GENOMIC MEDICINE AND WIRELESS HEALTH TECHNOLOGY, THE ORGANIZATION IS DEDICATED TO IMPROVING COMMUNITY HEALTH WHILE ADVANCING MEDICINE THROUGH CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. SCRIPPS HAS ALSO EARNED A NATIONAL REPUTATION AS A PREMIER EMPLOYER, NAMED BY FORTUNE MAGAZINE AS ONE OF AMERICA'S "100 BEST COMPANIES TO WORK FOR" EVERY YEAR SINCE 2008. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS FULFILLING THE SCRIPPS MISSION DURING THIS FISCAL YEAR, SCRIPPS DEVOTED $398,028,190 TO COMMUNITY BENEFIT PROGRAMS AND SERVICES IN THE AREAS OF UNCOMPENSATED CARE, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND HEALTH RESEARCH. OUR PROGRAMS EMPHASIZE COMMUNITY-BASED PREVENTION EFFORTS AND USE INNOVATIVE APPROACHES TO REACH RESIDENTS AT GREATEST RISK FOR HEALTH PROBLEMS. WE MAKE COMMITMENTS TO IMPROVE THE HEALTH OF OUR PATIENTS AND OUR SAN DIEGO COMMUNITIES. AS A LONG-STANDING MEMBER OF THESE COMMUNITIES, AND AS A NOT-FOR-PROFIT COMMUNITY RESOURCE, OUR GOAL AND RESPONSIBILITY ARE TO PROVIDE HELP AND ASSISTANCE FOR ALL WHO COME TO US FOR CARE, AND TO REACH OUT ESPECIALLY TO THOSE WHO FIND THEMSELVES VULNERABLE AND WITHOUT SUPPORT. THIS RESPONSIBILITY IS AN INTRINSIC PART OF OUR MISSION. THROUGH OUR CONTINUED ACTIONS AND COMMUNITY PARTNERSHIPS, WE STRIVE TO RAISE THE QUALITY OF LIFE IN THE COMMUNITY AS A WHOLE. ASSESSING COMMUNITY NEED SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGIONS MOST VULNERABLE POPULATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATE WIDE LEGISLATION IN THE EARLY 1990'S. SB 697 TOOK EFFECT IN 1995, WHICH REQUIRED PRIVATE NON-PROFIT HOSPITALS TO SUBMIT DETAILED INFORMATION TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) ON THEIR COMMUNITY BENEFIT CONTRIBUTIONS. ANNUAL HOSPITAL COMMUNITY BENEFIT REPORTS ARE SUMMARIZED BY OSHPD IN A REPORT TO THE LEGISLATURE, WHICH PROVIDES VALUABLE INFORMATION FOR GOVERNMENT OFFICIALS TO ASSESS THE CARE AND SERVICES PROVIDED TO THEIR CONSTITUENTS. THE SB 697 REQUIREMENT WAS SUPPLEMENTED IN 2010 BY REQUIREMENTS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OR ACA THAT NOT-FOR-PROFIT HOSPITALS CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS WITH COMMUNITY STAKE HOLDERS TO DETERMINE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY THEY SERVE AND IMPLEMENTATION STRATEGIES TO HELP MEET THOSE NEEDS. AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX-EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATIONS STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES EVERY THREE YEARS. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS AND CONSUMER GROUPS. THE 2016 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. THE REPORT WILL HELP US BETTER UNDERSTAND OUR COMMUNITYS HEALTH NEEDS, AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE COMPLETE REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/about-us/scripps-in-the-community/assessing-commun ity-needs REQUIRED COMPONENTS OF THE ASSESSMENT PER IRS REQUIREMENTS THERE ARE FIVE COMPONENTS THE CHNA MUST INCLUDE: - A DESCRIPTION OF THE COMMUNITY SERVED BY THE HEALTH SYSTEM AND HOW IT WAS DETERMINED. - A DESCRIPTION OF THE PROCESSES AND METHODS USED TO CONDUCT THE ASSESSMENT. - A DESCRIPTION OF HOW THE HOSPITAL ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. - A PRIORITIZED DESCRIPTION OF ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, AS WELL AS A DESCRIPTION OF THE PROCESS AND CRITERIA USED IN PRIORITIZING SUCH HEALTH NEEDS. - A DESCRIPTION OF THE EXISTING HEALTH CARE FACILITIES AND OTHER RESOURCES WITHIN THE COMMUNITY AVAILABLE TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. EXECUTIVE SUMMARY THE FULL CHNA REPORT CONTAINS IN-DEPTH INFORMATION AND EXPLANATIONS OF THE DATA THAT PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WILL USE TO EVALUATE THE HEALTH NEEDS OF THEIR PATIENTS AND DETERMINE, ADAPT, OR CREATE PROGRAMS AT THEIR FACILITIES. GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTH CARE SYSTEMS, INCLUDING SCRIPPS HEALTH, CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND MEET IRS REGULATORY REQUIREMENTS. PER LEGISLATION, HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. BASED ON THE FINDINGS FROM THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND RECOMMENDATIONS FROM THE COMMUNITY, THE 2016 CHNA WAS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. PARTICIPATING HOSPITALS WILL USE THIS INFORMATION TO INFORM AND GUIDE HOSPITAL PROGRAMS AND STRATEGIES. THIS REPORT INCLUDES AN ANALYSIS OF HEALTH OUTCOMES AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH WHICH CREATE HEALTH INEQUITIES--THE UNFAIR AND AVOIDABLE DIFFERENCES IN HEALTH STATUS SEEN WITHIN AND BETWEEN COUNTRIES AND COMMUNITIES--WITH THE UNDERSTANDING THAT THE BURDEN OF ILLNESS, PREMATURE DEATH, AND DISABILITY DISPROPORTIONALLY AFFECTS RACIAL AND MINORITY POPULATION GROUPS AND OTHER UNDERSERVED POPULATIONS. UNDERSTANDING REGIONAL AND POPULATION-SPECIFIC DIFFERENCES IS AN IMPORTANT STEP TO UNDERSTANDING AND ULTIMATELY STRATEGIZING WAYS TO MAKE COLLECTIVE IMPACT. THESE NEW INSIGHTS WILL ALLOW PARTICIPATING HOSPITALS TO IDENTIFY EFFECTIVE STRATEGIES TO ADDRESS THE MOST PREVALENT AND CHALLENGING HEALTH NEEDS IN THE COMMUNITY.
FORM 990, PART III, LINE 4A (CONTINUED)	OVERVIEW AND BACKGROUND IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH-RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. COMMUNITY DEFINED FOR THE PURPOSES OF THIS 2016 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. OVER THREE MILLION PEOPLE LIVE IN THE SOCIALLY AND ETHNICALLY DIVERSE COUNTY OF SAN DIEGO. BELOW ARE SELECTED COMMUNITY STATISTICS: - NEARLY 15% OF SAN DIEGANS LIVE IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL. - ALMOST 15% OF SAN DIEGANS AGED 25 AND OLDER HAVE NO HIGH SCHOOL DIPLOMA. - A GREATER PROPORTION OF LATINOS, AFRICAN AMERICANS, NATIVE AMERICANS, AND INDIVIDUALS OF OTHER RACES LIVE IN POVERTY COMPARED TO THE OVERALL SAN DIEGO POPULATION. - APPROXIMATELY 46% OF HOUSEHOLDS IN SAN DIEGO HAVE HOUSING COSTS THAT EXCEED 30% OF THEIR INCOME. - APPROXIMATELY 1 IN 7 SAN DIEGANS ARE FOOD INSECURE. - APPROXIMATELY 16% OF SAN DIEGANS AGED 5 AND OLDER HAVE LIMITED ENGLISH PROFICIENCY AND 8.5% ARE LINGUISTICALLY ISOLATED. ADDITIONAL INFORMATION ON SOCIOECONOMIC FACTORS, ACCESS TO CARE, HEALTH BEHAVIORS, AND THE PHYSICAL ENVIRONMENT CAN BE FOUND IN THE FULL SCRIPPS 2016 CHNA REPORT AT SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. BECAUSE OF ITS LARGE GEOGRAPHIC SIZE AND POPULATION, THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ORGANIZED THEIR SERVICE AREAS INTO SIX GEOGRAPHIC REGIONS. CENTRAL, EAST, NORTH CENTRAL, NORTH COASTAL, NORTH INLAND AND SOUTH. WHEN POSSIBLE, DATA IS PRESENTED AT A REGIONAL LEVEL TO PROVIDE MORE DETAILED UNDERSTANDING OF THE POPULATION. SCRIPPS HEALTH COMMUNITY SERVED HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGIONS OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. COMMUNITY PRIORITY PROCESS (CHNA METHODOLOGY) THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. SAN DIEGO COUNTY IS A SOCIALLY AND ETHNICALLY DIVERSE COMMUNITY WITH A POPULATION OF 3.2 MILLION PEOPLE. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE AT ZIP CODE LEVEL. HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. FOR A COMPLETE DESCRIPTION OF THE HASD&IC 2016 PROCESS AND FINDINGS, SEE FULL REPORT AVAILABLE AT http://hasdic.org/2016-chna/. WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER). 1. BEHAVIORAL/MENTAL HEALTH 2. CARDIOVASCULAR DISEASE 3. DIABETES (TYPE 2) 4. OBESITY FOR THE COLLABORATIVE HASD&IC CHNA PROCESS, THE IPH IMPLIED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT AND QUANTITATIVE ANALYSIS TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SDC. FOR THE PURPOSES OF THE CHNA, A "HEALTH NEED" IS DEFINED AS A HEALTH OUTCOME AND/OR THE RELATED CONDITIONS THAT CONTRIBUTE TO A DEFINED HEALTH OUTCOME. 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 2013 CHNA. QUANTITATIVE DATA FOR BOTH THE HASD&IC 2016 CHNA AND SMH 2016 CHNA 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 OSHPDS WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SDC. THE VARIABLES ANALYZED WERE ANALYZED AT THE ZIP CODE LEVEL WHEREVER POSSIBLE. IDENTIFY VULNERABLE COMMUNITIES RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE IPH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITHIN SAN DIEGO COUNTY WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. THE CNI SCORE IS AN AVERAGE OF FIVE DIFFERENT BARRIER SCORES THAT MEASURE VARIOUS SOCIOECONOMIC INDICATORS OF EACH COMMUNITY USING THE 2013 SOURCE DATA. COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - BEHAVIORAL HEALTH DISCUSSIONS - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATION SURVEY - SAN DIEGO COUNTY HHSA SURVEY THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. FINDINGS AND PRIORITIZED HEALTH CONDITIONS THE COLLABORATIVE, HASD&IC 2016 CHNA PRIORITIZED THE TOP HEALTH NEEDS FOR SAN DIEGO COUNTY OVERALL THROUGH THE APPLICATION OF THE FOLLOWING FIVE CRITERIA: 1. MAGNITUDE OR PREVALENCE 2. SEVERITY 3. HEALTH DISPARITIES 4. TRENDS 5. COMMUNITY CONCERN USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE.
FORM 990, PART III, LINE 4A (CONTINUED)	AS A RESULT OF THIS REVIEW, THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SDC. IN ADDITION, CARDIOVASCULAR DISEASE, 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 WITH EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMERS DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITH SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATION RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMERS DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. SOCIAL DETERMINANTS OF HEALTH IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED, SOCIAL DETERMINANTS OF HEALTH WERE A KEY THEME IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. ANALYSIS OF RESULTS FROM THE COMMUNITY PARTNER DISCUSSIONS AND KEY INFORMANT INTERVIEWS REVEALED THE MOST COMMONLY ASSOCIATED SOCIAL DETERMINANTS OF HEALTH FOR EACH OF THE TOP HEALTH NEEDS ABOVE. TEN SOCIAL DETERMINANTS WERE CONSISTENTLY REFERENCED ACROSS THE DIFFERENT COMMUNITY ENGAGEMENT ACTIVITIES. THE IMPORTANCE OF THESE SOCIAL DETERMINANTS WAS ALSO CONFIRMED BY QUANTITATIVE DATA. HOSPITAL PROGRAMS AND COMMUNITY COLLABORATIONS HAVE THE POTENTIAL TO IMPACT THESE SOCIAL DETERMINANTS, WHICH ARE OUTLINED BELOW IN ORDER OF PRIORITY. - FOOD INSECURITY AND ACCESS TO HEALTHY FOOD - ACCESS TO CARE OR SERVICES - HOMELESSNESS/HOUSING ISSUES - PHYSICAL ACTIVITY - EDUCATION/KNOWLEDGE - CULTURAL COMPETENCY - TRANSPORTATION - INSURANCE ISSUES - STIGMA - POVERTY 2016 CHNA FOLLOW UP SURVEY, PHASE 2 THE CHNA COMMITTEE COMPLETED PHASE 2 OF THE 2016 CHNA, WHICH INCLUDED GATHERING COMMUNITY FEEDBACK ON THE 2016 CHNA PROCESS AND STRENGTHENING PARTNERSHIPS AROUND THE IDENTIFIED HEALTH NEEDS AND SOCIAL DETERMINANTS. A SURVEY WAS CONDUCTED IN THE FALL OF 2016 AS A FOLLOW-UP TO THE COLLABORATIVE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THAT WAS COMPLETED IN MAY OF 2016. THE PURPOSE WAS TO GATHER FEEDBACK ON THE IDENTIFIED TOP FOUR HEALTH NEEDS AND THE TOP 10 SOCIAL DETERMINANTS OF HEALTH THAT WERE IDENTIFIED IN THE 2016 CHNA. IN ADDITION, ORGANIZATIONS WERE ASKED ABOUT THEIR SCREENING METHODS FOR BEHAVIORAL HEALTH ISSUES AND METHODS FOR IDENTIFYING SOCIAL DETERMINANTS OF HEALTH. AN ELECTRONIC SURVEY WAS CREATED AND A SURVEY LINK WAS EMAILED TO COMMUNITY PARTNERS. DUE TO THE FACT THAT COMMUNITY PARTNERS WERE ABLE TO FORWARD THE EMAIL TO THEIR COLLEAGUES, THE TOTAL RESPONSE RATE WAS UNABLE TO BE CALCULATED. THE SURVEY WAS OPEN FROM OCTOBER 10TH THROUGH NOVEMBER 7TH, APPROXIMATELY FOUR WEEKS. A TOTAL OF 132 RESPONDENTS COMPLETED THE SURVEY. OF THE 132 RESPONDENTS THAT COMPLETED THE SURVEY, 30 WORKED IN HOSPITALS OR HOSPITAL-BASED SETTINGS, WHILE THE REMAINING 102 RESPONDENTS SELF-IDENTIFIED AS WORKING FOR A RANGE OF ENTITIES INCLUDING BUT NOT LIMITED TO COMMUNITY CLINICS, NOT-FOR-PROFITS, COMMUNITY BASED ORGANIZATIONS, LOCAL GOVERNMENT, AND HEALTH INSURANCE PLANS. IN ADDITION TO SOLICITING FEEDBACK ON THE FINDINGS, THE SURVEY ALSO INCLUDED QUESTIONS SEEKING TO DETERMINE WHETHER THE INTEGRATION OF BEHAVIORAL HEALTH AND PHYSICAL HEALTH IS BEING INTEGRATED LOCALLY, AS WELL AS WHETHER ORGANIZATIONS ARE SCREENING FOR AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH. NINETY NINE RESPONDENTS STATED THAT THEIR ORGANIZATION SCREENS PATIENTS AND CLIENTS ABOUT THEIR SOCIAL DETERMINANTS OF HEALTH. ACCESS TO CARE OF SERVICES TOPPED THE LIST, ALONG WITH HOMELESS/HOUSING ISSUES AND INSURANCE ISSUES. NINETY FOUR RESPONDENTS SHARED INFORMATION ABOUT HOW THEY SCREEN PATIENTS AND DOCUMENT THE INFORMATION. FINDINGS CLEARLY INDICATE THAT THESE ORGANIZATIONS ARE SCREENING PATIENTS FOR SOCIAL DETERMINANTS AND MAKING REFERRALS, BUT INDICATIONS ARE THAT FOLLOW-UP IS SOMEWHAT LIMITED. THERE IS STRONG INTEREST ON THE PART OF RESPONDENTS IN LEARNING MORE ABOUT THE WAYS THAT OUR COMMUNITY PARTNERS ARE SCREENING CLIENTS AND PATIENTS. COLLABORATIVE 2016 CHNA FOLLOW-UP SURVEY RESULTS WHAT HAS CHANGED? SUMMER 2017 ANOTHER COMMUNITY FEEDBACK SURVEY WAS CONDUCTED IN THE SUMMER OF 2017 AS A FOLLOW UP TO THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. COMMUNITY PARTNERS FEEDBACK WAS GATHERED IN ORDER TO UNDERSTAND HOW THE HEALTH AND SOCIAL NEEDS OF COMMUNITIES FACING INEQUITY HAVE CHANGED OVER THE PAST YEAR. FEEDBACK WAS COLLECTED IN SEVERAL KEY AREAS, INCLUDING: 1. HOW HAS ACCESS TO CARE CHANGED OVER THE PAST 12 MONTHS. 2. WAYS THAT HOSPITALS CAN WORK MORE EFFECTIVELY WITH COMMUNITY ORGANIZATIONS TO ENSURE THAT PATIENTS ARE TREATED IN THE MOST APPROPRIATE SETTING. 3. HOW ARE PATIENTS/CLIENTS CONCERNS ABOUT THEIR IMMIGRATION STATUS IMPACTING THEIR ACCESS TO NEEDED HEALTH CARE. 4. GIVEN THE FEDERAL POLICIES AND BUDGET CUTS THAT ARE UNDER CONSIDERATION, WHAT ARE THE GREATEST CHALLENGES IN THE COMMUNITYS ABILITY TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. AN ELECTRONIC SURVEY WAS CREATED AND A SURVEY LINK WAS EMAILED TO COMMUNITY PARTNERS. DUE TO THE FACT THAT COMMUNITY PARTNERS WERE ABLE TO FORWARD THE EMAIL TO THEIR COLLEAGUES THE TOTAL RESPONSE RATE WAS UNABLE TO BE CALCULATED. THE SURVEY WAS OPEN FROM JULY 24TH THROUGH AUGUST 16TH, APPROXIMATELY THREE WEEKS. A TOTAL OF 66 RESPONDENTS COMPLETED THE SURVEY. NEXT STEPS THE RESULTS OF THE COMMUNITY SURVEY WILL GUIDE INDIVIDUAL HOSPITAL PROGRAMS AND PLANS, AND WILL ALSO HELP REFINE THE CHNA PROCESS FOR 2019. HOSPITAL AND HEALTHCARE SYSTEMS THAT PARTICIPATED IN THE HASD&IC 2016 CHNA PROCESS HAVE VARYING REQUIREMENTS FOR NEXT STEPS. PRIVATE, NOT-FOR-PROFIT (TAX-EXEMPT) HOSPITALS AND HEALTHCARE SYSTEMS ARE REQUIRED TO DEVELOP HOSPITAL OR HEALTHCARE SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS AND IMPLEMENTATION STRATEGY PLANS TO ADDRESS SELECTED IDENTIFIED HEALTH NEEDS. THE PARTICIPATING PUBLIC HOSPITALS AND HEALTHCARE SYSTEMS DO NOT HAVE FEDERAL OR STATE CHNA REQUIREMENTS, BUT WORK VERY CLOSELY WITH THEIR PATIENT COMMUNITIES TO ADDRESS HEALTH NEEDS BY PROVIDING PROGRAMS, RESOURCES, AND OPPORTUNITIES FOR COLLABORATION WITH PARTNERS. EVERY PARTICIPATING HOSPITAL AND HEALTHCARE SYSTEM WILL REVIEW THE CHNA DATA AND FINDINGS IN ACCORDANCE WITH THEIR OWN PATIENT COMMUNITIES AND PRINCIPAL FUNCTIONS, AND EVALUATE OPPORTUNITIES FOR NEXT STEPS TO ADDRESS THE TOP IDENTIFIED HEALTH NEEDS IN THEIR RESPECTIVE PATIENT COMMUNITIES. THE CHNA REPORT IS MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND MAY SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTHCARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. SCRIPPS HEALTH IMPLEMENTATION PLAN WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY A MULTIFACETED, MULTI-STAKEHOLDER, PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, DURING FY17-FY19 SCRIPPS HEALTH IS FOCUSING ON THE STRATEGIES AND INITIATIVES, THEIR MEASURES OF IMPLEMENTATION AND THE METRICS USED TO EVALUATE THEIR EFFECTIVENESS.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS WILL MONITOR AND EVALUATE THE STRATEGIES LISTED IN THE IMPLEMENTATION PLAN FOR THE PURPOSE OF TRACKING THE IMPLEMENTATION OF THOSE STRATEGIES AS WELL AS DOCUMENT THE ANTICIPATED IMPACT. PLANS TO MONITOR WILL BE TAILORED TO EACH STRATEGY AND WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURE. THE COMPLETE FY17-FY19 IMPLEMENTATION PLAN REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/about-us/scripps-in-the-community/assessing-commun ity-needs. IN SUPPORT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, A DETAILED DESCRIPTION OF SCRIPPS STRATEGIES AND CORRESPONDING MEASURES/METRICS FOR THE FOUR HEALTH PRIORITY AREAS IDENTIFIED IN THE CHNA CAN BE FOUND AT SCRIPPS.ORG/COMMUNITYBENEFIT. METRICS ARE AS CURRENT AS FY17. DURING THIS FISCAL YEAR, SCRIPPS INVESTED $2,852,330 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED/ENGAGED IN THE FOLLOWING PROGRAMS IN FISCAL YEAR 2017. ACCESS TO CARE TWO PRIMARY BARRIERS TO OBTAINING HEALTH CARE, ON BOTH THE LOCAL AND NATIONAL LEVEL, ARE LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. MORE PEOPLE WITHOUT INSURANCE TRANSLATES INTO HIGHER USE OF EMERGENCY DEPARTMENTS, WHICH BY LAW MUST PROVIDE STABILIZING CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. MERCY OUTREACH SURGICAL TEAM WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM (M.O.S.T) PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FISCAL YEAR 2017, THE M.O.S.T TEAM SERVED IN TWO OUTREACH MISSION TRIPS. THE M.O.S.T TEAM VOLUNTEERED 5,436 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 700 PEOPLE SERVED. THE M.O.S.T PROGRAM CELEBRATED ITS 30TH ANNIVERSARY THIS YEAR. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACK UP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, AND COUNSELING ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDER ARE CONNECTED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. IN 2017, 67 PATIENTS ACCOUNTED FOR 72 RCU ADMISSIONS. AS A GROUP, THE RCU PATIENTS HAS A CUMULATIVE 1,469 HOSPITAL DAYS OF STAY BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH TRACHEOTOMIES, FEEDING TUBES, IV ANTIBIOTICS, WOUND VACS, MULTIPLE FRACTURES, ABSCESS, OSTEOMYELITIS, PARAPLEGIA, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, HEART VALVE REPLACEMENT, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, CRANIOTOMY, COMPLEX TRAUMA, CVA, CANCER, HIV/AIDS, AND A PATIENT WITH AN EXTERNAL DEFIBRILLATOR, THE LIFE VEST. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 45+ RESIDENTS AND 38 FELLOWS. WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. LEOS CLINIC. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTYS MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2017. FIJI SOLOMON ISLANDS MEDICAL MISSION THE MEDICAL MISSION CONSISTS OF SCRIPPS HEALTH GENERAL MEDICAL SPECIALISTS AND RESIDENTS SETTING UP CLINICS ON RURAL ISLANDS FOR THE PURPOSE OF PROVIDING MUCH NEEDED MEDICAL CARE, MEDICAL SUPPLIES AND SURGICAL SCREENING FOR AN UNDERSERVED POPULATION THAT HAVE NO ACCESS TO BASIC MEDICAL CARE. THE INTERNATIONAL MEDICAL MISSIONS PROVIDE AN EXCEPTIONAL CLINICAL EDUCATION EXPERIENCE TO OUR SENIOR INTERNAL MEDICINE RESIDENTS AT SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2017, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ESTABLISHMENT OF ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $212,000 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO (FIVE GRANTS RANGING FROM $10,000 TO $120,000). THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTYS HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $3.5 MILLION. PROGRAMS FUNDED DURING FISCAL YEAR 2017 INCLUDE: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW-INCOME, UNINSURED MERCY CLINIC AND BEHAVIORAL HEALTH PATIENTS HELP OBTAINING HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME-INTENSIVE GOVERNMENT BENEFIT CASES. CATHOLIC CHARITIES FUNDING PROVIDES SHORT TERM EMERGENCY SHELTER FOR MEDICALLY FRAGILE HOMELESS PATIENTS BEING DISCHARGED FROM SCRIPPS MERCY HOSPITAL, SAN DIEGO. THE PROGRAM IS BEING EXPANDED TO SCRIPPS MERCY HOSPITAL, CHULA VISTA. CASE MANAGEMENT AND SHELTER ARE PROVIDED FOR HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL. WHILE THESE PATIENTS NO LONGER REQUIRE HOSPITAL CARE, THEY DO NEED A SHORT TERM RECUPERATIVE ENVIRONMENT. PATIENTS WHO DEMONSTRATE A WILLINGNESS TO CHANGE RECEIVE ONE WEEK IN A HOTEL, ALONG WITH FOOD AND BUS FARE TO PURSUE A CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. THE PARTNERSHIP SEEKS TO REDUCE EMERGENCY ROOM RECIDIVISM IN THIS POPULATION AND IMPROVE THEIR QUALITY OF LIFE. 2-1-1 HEALTH CARE NAVIGATION PROGRAM LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005 AS A MULTILINGUAL AND CONFIDENTIAL SERVICE COMMITTED TO PROVIDING 24/7 ACCESS. THERE WAS AN OVERWHELMING NEED FOR A DEPENDABLE SERVICE TO HELP PEOPLE NAVIGATE TODAY'S COMPLEX HEALTH CARE SYSTEM. SCRIPPS HEALTH HAS BEEN A LONGTIME SUPPORTER OF 2-1-1 SAN DIEGO'S HEALTH NAVIGATION PROGRAM WHICH CREATES A RECORD FOR EVERY PERSON WHO CALLS, IN ORDER TO PROVIDE A SERVICE THAT NAVIGATES CLIENTS THROUGH DIFFERENT REFERRALS AND TRACKS THEIR SUCCESS TOWARD ACHIEVING IMPROVED SOCIAL DETERMINANTS OF HEALTH. ALL 2-1-1 STAFF ARE TRAINED TO IDENTIFY INDIVIDUALS WHO ARE IN NEED OF CARE COORDINATION SERVICES, PARTICULARLY INDIVIDUALS WHO ARE HAVING DIFFICULTIES MANAGING THEIR CHRONIC HEALTH CONDITIONS. HEALTH NAVIGATORS ARE TRAINED TO DETERMINE CLIENT RISK USING THE RISK RATING SCALE (RRS). THE RRS DETERMINES A CLIENTS STATUS RANGING FROM "IN CRISIS" TO "THRIVING" USING SOCIAL DETERMINANTS OF HEALTH SUCH AS HOUSING, NUTRITION, PRIMARY CARE AND HEALTH MANAGEMENT. HEALTH NAVIGATORS ASSESS ON THE FOLLOWING TO DETERMINE WHETHER A CLIENT HAS DECREASED IN VULNERABILITY FOR HEALTH MANAGEMENT: - UNDERSTANDING OF PRESCRIPTION MEDICATION: DOES THE CLIENT UNDERSTAND HOW AND WHEN TO TAKE THEIR MEDICINE AND DO THEY UNDERSTAND THE USE/IMPORTANCE OF EACH MEDICATION? - HEALTH CONDITION MANAGEMENT: DOES THE CLIENT UNDERSTAND THE ILLNESS/DISEASE THAT THEY HAVE BEEN DIAGNOSED WITH, WHAT THEIR PROGNOSIS IS, AND WHAT THEY NEED TO DO IN ORDER TO REMAIN HEALTHY? - HEALTH INSURANCE/ MEDICAL HOME: DOES THE CLIENT HAVE HEALTH INSURANCE AND DO THEY KNOW HOW TO UTILIZE IT? DOES THE CLIENT HAVE A PRIMARY CARE DOCTOR AND/OR SPECIALISTS THAT THEY SEE AND DO THEY KNOW HOW TO MAKE APPOINTMENTS WITH EACH? DOES THE CLIENT KNOW IN WHAT SITUATION THEY SHOULD MAKE AN APPOINTMENT WITH THEIR PCP VS GOING TO AN EMERGENCY ROOM FOR AN IMMEDIATE MEDICAL NEED? - TRANSPORTATION: DOES THE CLIENT HAVE THE MEANS TO GET TO THEIR DOCTORS APPOINTMENTS?
FORM 990, PART III, LINE 4A (CONTINUED)	DURING THIS GRANT PERIOD 2-1-1 PROVIDED CARE COORDINATION SERVICES TO 724 CLIENTS. 2-1-1 HEALTH NAVIGATORS PROVIDED INDIVIDUALIZED NEEDS ASSESSMENTS, CASE PLANNING, INFORMATION, EDUCATION AND REFERRALS AND PROVIDED ONGOING CLIENT CONTACT AND PROGRESS CHECKS VIA PHONE OVER A PERIOD OF TIME RELEVANT TO THE CLIENT'S NEEDS TO CHECK ON AND DOCUMENT CLIENT PROGRESS. AMERICAN HEART ASSOCIATION SCRIPPS PROVIDED FUNDING FOR THE 2017 HEART WALK THROUGH CORPORATE SPONSORSHIP. HEART DISEASE AND STROKE ARE THE NUMBER ONE AND THREE CAUSES OF DEATH IN THE NATION. HEART DISEASE CLAIMS MORE THAN 950,000 AMERICANS EACH YEAR. SCRIPPS PARTNERS WITH THE AMERICAN HEART ASSOCIATION ON ITS ANNUAL HEART WALK TO RAISE FUNDS FOR RESEARCH, PROFESSIONAL AND PUBLIC EDUCATION AND ADVOCACY. FOSTERING VOLUNTEERISM SCRIPPS BELIEVES THAT HEALTH IMPROVEMENT BEGINS WHEN PEOPLE TAKE AN ACTIVE ROLE IN MAKING A POSITIVE IMPACT ON THEIR COMMUNITY. FOR THIS REASON, SCRIPPS SUPPORTS VOLUNTEER PROGRAMS FOR SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS WHO WANT TO MAKE AN EVEN LARGER IMPACT ON THEIR COMMUNITY. SCRIPPS MATCHES THE TALENTS AND INTERESTS OF EMPLOYEES AND PHYSICIANS WITH COMMUNITY NEEDS, SUCH AS MENTORING PARTNERSHIPS WITH LOCAL SCHOOLS AND PROVIDING FREE MEDICAL AND SURGICAL CARE FOR PATIENTS IN NEED. IN ADDITION TO THE FINANCIAL COMMUNITY BENEFIT CONTRIBUTIONS MADE DURING FISCAL YEAR 2017, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS DONATED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS SPONSORED COMMUNITY BENEFIT PROGRAMS. WITH CLOSE TO 9,597 HOURS, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $462,095.55, WHICH IS NOT INCLUDED IN THE SCRIPPS FISCAL YEAR 2017 COMMUNITY BENEFIT PROGRAMS AND SERVICES TOTALS. (CALCULATION BASED UPON AN AVERAGE HOURLY WAGE FOR THE SCRIPPS HEALTH SYSTEM PLUS BENEFITS) CANCER/ONCOLOGY CANCER IS A TERM USED TO DESCRIBE A GROUP OF DISEASES THAT CAUSE THE UNCONTROLLED GROWTH, INVASION, AND SPREAD (METASTASIS) OF ABNORMAL CELLS. CANCER IS CAUSED BY EXTERNAL FACTORS SUCH AS ENVIRONMENTAL CONDITIONS, RADIATION, INFECTIOUS ORGANISMS, POOR DIET AND LACK OF EXERCISE, AND TOBACCO USE, AS WELL AS INTERNAL FACTORS SUCH AS GENETIC MUTATIONS, AND HORMONES. CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES. CANCER CAUSES ONE OUT OF EVERY FOUR DEATHS IN THE UNITED STATES. IN 2013 CANCER WAS THE LEADING CAUSE OF DEATH IN SDC, RESPONSIBLE FOR 24.4 PERCENT OF DEATHS. THERE WERE 5,030 DEATHS DUE TO CANCER (ALL SITES), AND AN AGE ADJUSTED DEATH RATE OF 155.6 DEATHS PER 100,000 POPULATION. ACCORDING TO A 2016 REPORT FROM THE AMERICAN CANCER SOCIETY, CALIFORNIA CANCER FACTS & FIGURES, CANCER SURVIVAL IS MORE LIKELY TO BE SUCCESSFUL IF THE CANCER IS DIAGNOSED AT AN EARLY STAGE. SUCH DIAGNOSIS IS AN INDICATION OF SCREENING AND EARLY DETECTION. REGULAR SCREENING THAT ALLOW FOR THE EARLY DETECTION AND REMOVAL OF PRECANCEROUS GROWTHS ARE KNOWN TO REDUCE MORTALITY FOR CANCERS OF THE CERVIX, COLON AND RECTUM. FIVE YEAR RELATIVE SURVIVAL RATES FOR COMMON CANCERS, SUCH AS BREAST, PROSTATE, COLON AND RECTUM, CERVIX, AND MELANOMA OF THE SKIN, ARE 93 PERCENT TO 100 PERCENT IF THEY ARE DISCOVERED BEFORE HAVING SPREAD BEYOND THE ORGAN WHERE THE CANCER BEGAN. IN 2013, THE PERCENTAGE OF CANCER CASES DIAGNOSED AT AN EARLY AGE IS LOWEST AMONG AFRICAN AMERICAN WOMEN FOR BREAST AND HISPANIC MALES FOR PROSTATE IN SDC. MOST COMMONLY DIAGNOSED CANCERS PROSTATE, LUNG, AND COLORECTAL CANCERS ARE THE MOST COMMONLY DIAGNOSED CANCERS AND THE LEADING CAUSES OF CANCER RELATED DEATH AMONG MEN. SIMILARLY, BREAST, LUNG, AND COLORECTAL CANCERS ARE THE MOST COMMONLY DIAGNOSED CANCERS AND THE LEADING CAUSES OF CANCER RELATED DEATH AMONG WOMEN. FOR BOTH SEXES COMBINED, MELANOMA OF THE SKIN IS THE FIFTH MOST COMMONLY DIAGNOSED CANCER AND PANCREATIC CANCER IS THE FOURTH LEADING CAUSE OF CANCER RELATED DEATH. CANCER DISPARITIES THE BURDEN OF CANCER DOES NOT FALL EQUALLY ON ALL CALIFORNIANS, AND RISK OF DEVELOPING CANCER VARIES CONSIDERABLY BY RACE/ETHNICITY. AMONG MEN, AFRICAN AMERICANS HAVE THE HIGHEST INCIDENCE AND MORTALITY FROM CANCER, FOLLOWED BY NON-HISPANIC WHITES. AMONG WOMEN, NON-HISPANIC WHITES HAVE THE HIGHEST INCIDENCE OF CANCER, BUT AFRICAN AMERICANS HAVE THE HIGHEST CANCER MORTALITY. IN GENERAL, PERSONS OF ASIAN/PACIFIC ISLANDER AND HISPANIC ORIGIN HAVE CANCER RATES THAT ARE ABOUT 30 TO 35 PERCENT LOWER THAN NON-HISPANIC WHITES. HOWEVER, ASIAN/PACIFIC ISLANDERS AND HISPANICS ARE TWO TO THREE TIME MORE LIKELY THAN NON-HISPANIC WHITES TO DEVELOP STOMACH AND LIVER CANCER. HISPANIC WOMEN ALSO HAVE TWICE THE RISK OF BEING DIAGNOSED WITH INVASIVE CERVICAL CANCER RELATIVE TO NON-HISPANIC WHITE WOMEN. SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS TO EDUCATE PEOPLE ABOUT THE IMPORTANCE OF EARLY DETECTION AND TREATMENT FOR SOME OF THE MOST COMMON FORMS OF CANCER. AT SCRIPPS, CANCER CARE IS MORE THAN JUST MEDICAL TREATMENT, AND A WIDE ARRAY OF RESOURCES ARE PROVIDED SUCH AS COUNSELING, SUPPORT GROUPS, COMPLEMENTARY THERAPIES AND EDUCATIONAL WORKSHOPS. HERE ARE A FEW EXAMPLES OF SCRIPPS CANCER PROGRAMS DURING FISCAL YEAR 2017: SCRIPPS CANCER CENTER DIRECTORY OF COMMUNITY RESOURCES SCRIPPS COLLABORATES WITH THE COMMUNITY AND DEVELOPS A CANCER DIRECTORY OF A COMPREHENSIVE LIST OF RESOURCES AVAILABLE FOR CANCER SURVIVORS, THEIR FAMILIES, AND THE COMMUNITY. SCRIPPS GREEN CANCER CENTER SUPPORT GROUPS SCRIPPS GREEN HOSPITAL SUPPORT GROUPS OFFER CANCER PATIENTS THE OPPORTUNITY TO EXPRESS THE EMOTIONS THAT COME WITH A CANCER DIAGNOSIS AND HELP THEM COPE MORE EFFECTIVELY WITH THEIR TREATMENT REGIMENS BY SUPPORT GROUPS THAT NURTURE THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING. CLASSES AT SCRIPPS GREEN CANCER CENTER, SUCH AS THE FREE CANCER WRITING WORKSHOP, "WHEN WORDS HEAL," USE EXPRESSIVE WRITING TO HELP PATIENTS NAVIGATE THEIR JOURNEY WITH CANCER. FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS SKIN CANCER SCREENINGS A TOTAL OF 249 FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS WERE SCREENED FOR SKIN CANCER. HEALTHY WOMEN, HEALTHY LIFESTYLES: SCRIPPS MERCY BREAST HEALTH OUTREACH AND EDUCATION PROGRAM A PROMOTORA LED HEALTH AND WELLNESS PROGRAM THAT AIMS TO IMPROVE THE LIVES OF WOMEN IN SAN DIEGOS SOUTH BAY WITH BREAST CANCER EDUCATION, PREVENTION AND TREATMENT SUPPORT. PROMOTORAS TEACH BREAST HEALTH TO WOMEN WHO HAVE LIMITED OR NO ACCESS TO HEALTH CARE. PROMOTORAS TEACH WOMEN IN THEIR NATIVE LANGUAGE WITH SENSITIVITY TO A WOMANS ETHNIC AND CULTURAL NORMS. THE PROGRAM MODEL INCLUDES A PROMOTORA, CANCER SURVIVOR AND A NURSE NAVIGATOR. THE PROMOTORA HAS KNOWLEDGE OF BREAST CANCER, OFFERS EDUCATION AND EMOTIONAL SUPPORT. SHE ALSO PROVIDES REFERRALS IN CULTURALLY APPROPRIATE AND LANGUAGE SENSITIVE WAY. A BREAST CANCER SURVIVOR AND VOLUNTEER STRENGTHENS THE BENEFITS OF BREAST CANCER EDUCATION AND PREVENTION BY TALKING TO SOMEONE WHO HAS BEEN THERE AND CAN PROVIDE INSIGHT AND SUGGESTIONS, AND IS LIVING PROOF THAT THE DISEASE IS NOT FATAL. WORKING HAND-IN-HAND, THE PROMOTORA AND VOLUNTEER PRESENT A VERY STRONG FRONT FOR BREAST CANCER AWARENESS AND FULL SUPPORT SYSTEM FOR THOSE ALREADY DIAGNOSED. MOREOVER, THE FACT THEY ARE BI-LINGUAL LATINAS LEND AN AIR OF AUTOMATIC TRUST AMONG THE HISPANIC COMMUNITY AS THEY CAN CONNECT WITH THE RESIDENTS ON A CULTURAL LEVEL. SCRIPPS MERCY HOSPITAL, CHULA VISTA: BREAST HEALTH CLINICAL SERVICES A TOTAL OF 500 WOMEN ARE REFERRED TO CLINICAL BREAST HEALTH SERVICES AT COMMUNITY AND SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY SERVICES. MORE THAN 2,400 SERVICES WERE PROVIDED, INCLUDING TELEPHONE REMINDERS, OUTREACH AND EDUCATION, CASE MANAGEMENT AND A VARIETY OF PRESENTATIONS. SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY FOLLOW UP SERVICES MORE THAN 100 WOMEN WERE PROVIDED SERVICES. SERVICES - PROVIDED, INCLUDE ENCOURAGEMENT FOR PATIENTS TO REPEAT EXAMS, ASSISTANCE TO GET PATIENTS HEALTH INSURANCE APPROVAL FOR REPEAT EXAMS, SOCIAL/EMOTIONAL SUPPORT AND EDUCATION ABOUT PREVENTING BREAST CANCER. SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY, POSITIVE BREAST CANCER PATIENT SUPPORT MORE THAN 875 SERVICES WERE PROVIDED INCLUDING PHONE CALLS, HOME VISITS, MAILED EDUCATIONAL MATERIALS AND SUPPLIES (WIGS, BRAS, PROSTHESIS AND MEDICAL RECORD ORGANIZER BINDER). A RESOURCE PACKAGE WITH EDUCATIONAL MATERIALS ON NUTRITION, TREATMENT OPTIONS, COMMONLY ASKED QUESTIONS AND LOCAL RESOURCES WERE ALSO PROVIDED. SCRIPPS MERCY HOSPITAL, CHULA VISTA BREAST CANCER SUPPORT GROUP TOGETHER PROMOTORAS AND CANCER SURVIVORS HOLD A BI-MONTHLY SUPPORT GROUP THAT HELPS INDIVIDUALS COPE WITH LIVING WITH CANCER. MORE THAN 20 WOMEN PARTICIPATE AS PART OF THIS GROUP MONTHLY. GROUP SUPPORT INCLUDING NAVIGATING THE CANCER SYSTEM AND EDUCATIONAL PRESENTATIONS BY LOCAL PROVIDERS ARE OFFERED.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SPONSORS THE YOUNG WOMENS SUPPORT GROUP WHICH PROVIDE A VENUE FOR WOMEN UNDER THE AGE OF 40 TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES AND RECEIVE SUPPORT. THE GROUPS ARE OFFERED TO WOMEN IN THE SAN DIEGO COMMUNITY. TOPICS RELATED TO BREAST HEALTH ARE ALSO OFFERED TO THE COMMUNITY. AMERICAN CANCER SOCIETY (ACS) MAKING STRIDES AGAINST BREAST CANCER SCRIPPS HEALTH PARTICIPATES IN THIS FUNDRAISING EVENT TO RAISE MONEY FOR BREAST CANCER RESEARCH. SCRIPPS ALSO PARTICIPATES IN HOSTING "LOOK GOOD FEEL BETTER" CLASSES PUT ON BY THE ACS. SUSAN G. KOMEN RACE FOR THE CURE SCRIPPS HEALTH PARTICIPATES IN THIS FUNDRAISING EVENT TO SUPPORT BREAST CANCER RESEARCH AND LOCAL BREAST HEALTH INITIATIVES. THE KOMEN RACE FOR THE CURE SERIES RAISES SIGNIFICANT FUNDS AND AWARENESS FOR THE FIGHT AGAINST BREAST CANCER, CELEBRATES BREAST CANCER SURVIVORSHIP AND HONORS THOSE WHO HAVE LOST THEIR BATTLE WITH THE DISEASE. SUSAN G. KOMEN 3 DAY BREAST CANCER WALK SCRIPPS HEALTH WAS THE OFFICIAL PHYSICAL THERAPY SPORTS MEDICINE CREW AT THE EVENT. PROVIDED WOUND CARE, ORTHOPEDIC EVALUATIONS AND TREATMENTS, INCLUDING LIMB AND JOINT TAPING, ASSISTANCE WITH STRETCHING AND EDUCATION FOR SELF-CARE. PANCREATIC CANCER ACTION NETWORK - PURPLE STRIDE SAN DIEGO SCRIPPS PARTICIPATED IN THE PANCREATIC CANCER ACTION NETWORK WALK. THIS IS A NATIONWIDE NETWORK OF PEOPLE DEDICATED TO WORKING TOGETHER TO ADVANCE RESEARCH, SUPPORT PATIENTS AND CREATE HOPE FOR THOSE AFFECTED BY PANCREATIC CANCER. LEUKEMIA & LYMPHOMA SOCIETY - LIGHT THE NIGHT WALK SCRIPPS PARTICIPATED AND SPONSORED THE LIGHT THE NIGHT WALK. A FUNDRAISING CAMPAIGN BENEFITING THE LEUKEMIA & LYMPHOMA SOCIETY (LLS) AND THEIR FUNDING OF RESEARCH TO FIND BLOOD CANCER CURES. AMERICAN LUNG ASSOCIATION - LUNG FORCE WALK SCRIPPS PARTICIPATED AND SPONSORED THE LUNG FORCE WALK. THE WALK IS LED BY THE AMERICAN LUNG ASSOCIATION TO RAISE AWARENESS AND FUNDS TO FIGHT AGAINST LUNG CANCER AND FOR LUNG HEALTH. COLON CANCER ALLIANCE - UNDY RUN/WALK SCRIPPS PARTICIPATED IN THE UNDY RUN/WALK TO RAISE AWARENESS FOR COLON CANCER. THE COLON CANCER ALLIANCE'S MISSION IS TO KNOCK COLON CANCER OUT OF THE TOP THREE CANCER KILLERS. THEY ARE DOING THIS BY CHAMPIONING PREVENTION, FUNDING CUTTING-EDGE RESEARCH AND PROVIDING THE HIGHEST QUALITY PATIENT SUPPORT SERVICES. NINE GIRLS ASK (FOR CURE FOR OVARIAN CANCER) SCRIPPS HEALTH PARTICIPATES IN THE FUNDRAISING EVENT TO SUPPORT OVARIAN CANCER RESEARCH AND INITIATIVES. CANCER AWARENESS AND EDUCATIONAL EVENTS A SERIES OF EDUCATIONAL EVENTS ARE COORDINATED WITH THE AMERICAN CANCER SOCIETY AWARENESS MONTHS. THE EVENTS FOCUS ON VARIOUS TYPES OF CANCER, INCLUDING BREAST, LUNG, CERVICAL, COLORECTAL, SKIN, OVARIAN/GYNECOLOGICAL AND PROSTATE. A REGISTERED NURSE CLINICIAN ANSWERS QUESTIONS AND PROVIDES EDUCATIONAL MATERIALS. ALOHA LOCK CANCER WIG PROGRAM THIS PROGRAM PROVIDES WIGS AND HAIR ACCESSORIES TO CANCER PATIENTS SUFFERING FROM ALOPECIA OR EXPECTED TO SUFFER FROM ALOPECIA. CANCER CENTER REGISTERED NURSE NAVIGATOR PROGRAM SCRIPPS PROVIDED A REGISTERED NURSE, DEDICATED TO ASSISTING CANCER PATIENTS AND THEIR FAMILIES WITH NAVIGATING THROUGH THE JOURNEY FROM DIAGNOSIS, TREATMENT AND SURVIVORSHIP FROM CANCER. THE FOCUS IS ON EDUCATION AND OUTREACH, AS WELL AS, SUPPORT SERVICES IN THIS POPULATION. CANCER CENTER OUTPATIENT HEREDITY AND CANCER GENETIC COUNSELING PROGRAM THIS PROGRAM PROVIDES GENETIC TESTING AND COUNSELING TO CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. CANCER CENTER OUTPATIENT SOCIAL WORKER & LIAISON PROGRAM SCRIPPS PROVIDED A SOCIAL WORKER, DEDICATED TO ASSISTING CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. CANCER SURVIVORS DAY SCRIPPS HOLDS A CELEBRATORY EVENT AT EACH SCRIPPS HOSPITAL EACH YEAR TO PROVIDE AN OPPORTUNITY FOR THOSE THAT HAVE BATTLED CANCER TO COME TOGETHER AND ENJOY THE COMPANY OF FRIENDS, FAMILY AND THE CAMARADERIE OF FELLOW CANCER SURVIVORS. THROUGHOUT THE MONTH OF JUNE CANCER SURVIVORS AND OTHER GUESTS SHARE INSPIRATIONAL STORIES, LEARN ABOUT ADVANCES IN CANCER TREATMENT AND RESEARCH, AND ENJOY THE OPPORTUNITY TO CONNECT WITH CAREGIVERS AND FELLOW SURVIVORS. EACH YEAR THE CANCER SURVIVOR EVENT HELPS CELEBRATE LIFE, INSPIRE THOSE RECENTLY DIAGNOSED, OFFER SUPPORT TO FAMILY AND LOVED ONES AND RECOGNIZE ALL WHO PROVIDED SUPPORT ALONG THE WAY. THEY ALSO PROVIDE A FORUM FOR DISCUSSING THE PHYSICAL, FINANCIAL AND SOCIAL ISSUES THAT MANY CANCER SURVIVORS FACE FOLLOWING COMPLETION OF TREATMENT. CARDIOVASCULAR DISEASE 'DISEASES OF THE HEART' WERE THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY IN 2012. IN ADDITION 'CEREBROVASCULAR DISEASES' WERE THE FIFTH LEADING CAUSE OF DEATH, AND 'ESSENTIAL (PRIMARY) HYPERTENSION AND HYPERTENSIVE RENAL DISEASE' WAS THE TENTH. CORONARY HEART DISEASE IS THE MOST COMMON FORM OF HEART DISEASE. HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CVD AND STROKE. ABOUT HALF OF AMERICANS (49%) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS. RISK FACTORS FOR CARDIOVASCULAR DISEASE: BEHAVIORS: TOBACCO USE, OBESITY, POOR DIET THAT IS HIGH IN SATURATED FATS, AND EXCESSIVE ALCOHOL USE. CONDITIONS: HIGH CHOLESTEROL LEVELS, HIGH BLOOD PRESSURE AND DIABETES. HEREDITY: GENETIC FACTORS LIKELY PLAY A ROLE IN HEART DISEASE AND CAN INCREASE RISK. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE UNITED STATES - HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST RACIAL/ETHNIC GROUPS IN THE UNITED STATES, INCLUDING AFRICAN AMERICANS, HISPANICS AND WHITES. PREVALENCE DATA - IN 2012, 11.1% OF ADULTS AGED 18 AND OVER HAD EVER BEEN TOLD BY A DOCTOR OR OTHER HEALTH PROFESSIONAL THAT THEY HAD HEART DISEASE. - IN 2012, 224% OF ADULTS 18 AND OVER HAD BEEN TOLD ON TWO OR MORE VISITS THAT THEY HAD HYPERTENSION. DISPARITIES AND CARDIOVASCULAR DISEASE - IN 2012, THIRTY FIVE PERCENT OF NON-HISPANIC BLACK WOMEN HAD HYPERTENSION COMPARED WITH 22% OF NON-HISPANIC WHITE WOMEN AND 22% OF HISPANIC WOMEN. 30% OF NON-HISPANIC BLACK MEN HAD HYPERTENSION COMPARED WITH 25% OF NON-HISPANIC WHITE MEN AND 19% OF HISPANIC MEN. - MEN ARE MORE LIKELY THAN WOMEN TO HAVE EVER BEEN TOLD THEY HAVE CORONARY HEART DISEASE OR HYPERTENSION. - INDIVIDUALS WITH LOW INCOMES ARE MUCH MORE LIKELY TO SUFFER FROM HIGH BLOOD PRESSURE, HEART ATTACK, AND STROKE. - AMONG ADULTS AGED 65 AND OVER, THOSE COVERED BY MEDICARE AND MEDICAID WERE MORE LIKELY TO HAVE BEEN TOLD THEY HAD HYPERTENSION THAT THOSE WITH EITHER MEDICARE ALONE OR PRIVATE INSURANCE. - DEPRESSION OCCURS IN UP TO 20% OF PEOPLE WITH HEART DISEASE AND HAS ALSO BEEN FOUND TO BE A RISK FACTOR FOR SUBSEQUENT HEART ATTACKS. DURING FISCAL YEAR 2017, SCRIPPS ENGAGED IN THE FOLLOWING HEART HEALTH, CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT ACTIVITIES. AMERICAN HEART ASSOCIATION HEART WALK SCRIPPS PROVIDED FUNDING FOR THE 2017 HEART WALK THROUGH CORPORATE SPONSORSHIP. HEART DISEASE AND STROKE ARE THE NUMBER ONE AND THREE CAUSES OF DEATH IN THE NATION. HEART DISEASE CLAIMS MORE THAN 950,000 AMERICANS EACH YEAR. SCRIPPS PARTNERS WITH THE AMERICAN HEART ASSOCIATION ON ITS ANNUAL HEART WALK TO RAISE FUNDS FOR RESEARCH, PROFESSIONAL AND PUBLIC EDUCATION AND ADVOCACY. SCRIPPS EMPLOYEES VOLUNTEERED THEIR TIME TO COORDINATE WALKER PARTICIPATION AND FUNDRAISING EFFORTS. THE SAN DIEGO HEART WALK RAISED MORE THAN $1.1 MILLION IN 2017, MORE THAN 1,016 SCRIPPS HEART WALK PARTICIPANTS, (EMPLOYEES, FAMILIES, AND FRIENDS) WALKED TO HELP RAISE MORE THAN $60,000. AMERICAN HEART ASSOCIATION HEART BALL SCRIPPS SPONSORS THIS ANNUAL EVENT THAT BRINGS PHILANTHROPISTS, CARDIOLOGISTS, AND SURVIVORS TOGETHER TO CREATE AWARENESS AROUND HEART DISEASE AND STROKE. FUNDS RAISED HELP SUPPORT LOCAL RESEARCH PROJECTS IN SAN DIEGO. COMMUNITY HEALTH EDUCATION PROGRAMS SCRIPPS HEALTH HAS A ROBUST COMMUNITY HEALTH EDUCATION PROGRAM IN WHICH PHYSICIANS AND EXPERTS COVER A WIDE VARIETY OF TOPICS. CARDIOVASCULAR RELATED TALKS INCLUDE HEALTHY HEARTS AT EVERY AGE, BEYOND BLOOD THINNERS, AND LIVING WELL WITH HEART DISEASE. THESE LECTURES ARE DELIVERED PUBLIC EVENTS HOSTED BY THE SCRIPPS MARKETING DEPARTMENT AND THROUGH ONGOING PARTNERSHIPS WITH OASIS SAN DIEGO AND THE LAWRENCE FAMILY JEWISH COMMUNITY CENTER.
FORM 990, PART III, LINE 4A (CONTINUED)	CPR CLASSES FOR PATIENTS AND FAMILIES OF THE CARDIAC TREATMENT CENTER CPR CLASSES ARE OFFERED FOUR TIMES A YEAR TO CARDIAC TREATMENT CENTER PATIENTS AND THEIR FAMILIES. THE PROGRAM IMPROVES COMMUNITY HEALTH BY INCREASING KNOWLEDGE OF CARDIOPULMONARY RESUSCITATION PRACTICES. CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS INCLUDE TAI-CHI, OFFERED TWICE WEEKLY; CLASSES TO DECREASE STRESS AND IMPROVE BALANCE, STRENGTH AND FLEXIBILITY, RESTORATIVE YOGA, OFFERED THREE TIMES A WEEK; FITBALL: CORE CONDITIONING, OFFERED TWICE A WEEK; CLASSES TO IMPROVE STRENGTH, POSTURE AND CORE STABILITY, YOGA FOR CANCER RECOVERY, OFFERED WEEKLY; CLASSES CENTERING ON BALANCE, OFFERED WEEKLY; CLASSES TO BUILD BALANCE, POSTURE AND COORDINATION, POWER YOGA FOR MULTIPLE SCLEROSIS, OFFERED WEEKLY; CLASSES TO PROMOTE HEALING AND IMPROVE STRENGTH AND FLEXIBILITY AND WEEKLY MEDITATION CLASSES. WEEKLY PULMONARY EDUCATION CLASS, ONE-ON-ONE DIETARY COUNSELING PROGRAM AND BETTER BREATHERS CLASSES ARE ALSO OFFERED. STROKE CARE PROGRAMS SCRIPPS SPONSORS A WIDE VARIETY OF STROKE RELATED EDUCATION AND AWARENESS PROGRAMS. THESE INCLUDE SUPPORT GROUPS AND EDUCATION FOR STROKE AND BRAIN INJURY SURVIVORS AND THEIR LOVED ONE. INFORMATION AND RESOURCES ARE PROVIDED, ALONG WITH SKILLS TO HELP REINFORCE INNER STRENGTHS AND LEARN SELF-CARE STRATEGIES. SUPPORT GROUPS OFFER THE ABILITY TO DEVELOP ENCOURAGING PEER RELATIONSHIPS ALONG WITH THE GOAL OF RETURNING TO AND CONTINUING A LIFE OF MEANING AND PURPOSE. EDUCATING WOMEN ABOUT HEART HEALTH TOGETHER WITH WOMEN HEART NATIONAL HOSPITAL ALLIANCE, SCRIPPS CARDIOVASCULAR DEVELOPED A WOMEN AND HEART DISEASE EDUCATION PROGRAM. THE EFFORTS EDUCATE WOMEN ON THE IMPORTANCE OF HEART HEALTH, PROVIDE SUPPORT GROUPS AND ADVOCATE FOR RESEARCH FUNDING AND POLICIES. SENIOR HEALTH CHATS A WIDE VARIETY OF SENIOR CHATS ARE OFFERED AT LOCAL SENIOR CENTERS IN SOUTH BAY TO ADDRESS EDUCATION AND PREVENTION OF HEART DISEASE. SOME TOPICS INCLUDE HEART HEALTH 101, STROKE, AND A VARIETY OF PREVENTION EDUCATION. A TOTAL OF SIX PRESENTATIONS ARE GIVEN YEARLY TO MORE THAN 100 INDIVIDUALS. THE ERIC PAREDES SAVE A LIFE FOUNDATION EACH YEAR, 7,000 TEENS LOSE THEIR LIVES DUE TO SUDDEN CARDIAC ARREST (SCA). SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE EKG. UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. SAN DIEGO ALONE LOSES THREE TO FIVE TEENS FROM SCA ANNUALLY. AS A SPONSOR FOR THE ERIC PAREDES SAVE A LIFE FOUNDATION, SCRIPPS HAS HELD MORE THAN 20,000 FREE CARDIAC SCREENINGS TO LOCAL TEENS, INCLUDING THE HOMELESS, UNINSURED AND UNDERINSURED. IN 2017, SCRIPPS MADE A $15,000 DONATION TO HELP PAY FOR SCREENINGS. IN 2017, SCRIPPS SUPPORTED SCREENING EVENTS AT AREA HIGH SCHOOLS AND SCREENED 3,533 TEENS, IDENTIFYING 62 WITH ABNORMALITIES AND 18 WHO WERE AT RISK. SCREENING ATHLETES FOR SUDDEN CARDIAC ARREST EVERY YEAR, THREE TO FIVE STUDENT ATHLETES IN SAN DIEGO COUNTY DIE SUDDENLY AND UNEXPECTEDLY FROM SUDDEN CARDIAC ARREST/DEATH (SCA/D). SCA IS AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN HAPPEN WITHOUT SYMPTOMS OR WARNING SIGNS. HOWEVER, THIS LIFE-THREATENING CONDITION CAN BE DETECTED WITH A CARDIAC SCREENING EXAM. SCRIPPS MERCY HOSPITAL CHULA VISTA FAMILY MEDICINE RESIDENCY, SOUTHWEST SPORTS WELLNESS FOUNDATION AND THE SWEETWATER UNION HIGH SCHOOL DISTRICT PARTNER TO PREVENT SUDDEN CARDIAC ARREST AND DEATH AMONG HIGH SCHOOL STUDENTS BY INCREASING AWARENESS OF THE IMPORTANCE OF HEALTHY LIFESTYLES AND CARDIOVASCULAR SCREENINGS AMONG ACTIVE STUDENTS. FAMILY MEDICINE RESIDENTS OFFER YEARLY CARDIAC SCREENING AND SPORTS PHYSICALS BEFORE STUDENTS PARTICIPATE IN ORGANIZED SPORTS, AND IMPLEMENT AN INJURY CLINIC DURING FOOTBALL SEASON TO EVALUATE AND TREAT POSSIBLE CONCUSSIONS AND OTHER INJURIES. SU VIDA, SU CORAZON / YOUR LIFE, YOUR HEART COMMUNITY INTERVENTION TO IMPROVE EDUCATION AND AWARENESS OF HEART DISEASE HEART DISEASE IS ONE OF THE MOST WIDESPREAD AND COSTLY HEALTH PROBLEMS FACING OUR NATION, EVEN THOUGH ITS ALSO ONE OF THE MOST PREVENTABLE. HEART FAILURE AND STROKE ACCOUNT FOR MORE THAN $500 BILLION IN HEALTH CARE COSTS PER YEAR. HEART FAILURE IS A PROGRESSIVE DISEASE, PRIMARILY CAUSED BY HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND DAMAGE TO THE HEART MUSCLE FROM CORONARY ARTERY DISEASE. SCRIPPS HEALTH OFFERS A FIVE WEEK EDUCATIONAL BASED COMMUNITY INTERVENTION PROGRAM TO SUPPORT IMPROVED QUALITY OF LIFE FOR PATIENTS DIAGNOSED WITH HEART DISEASE. TOBACCO USE, ALCOHOL ABUSE, LACK OF PHYSICAL ACTIVITY, POOR NUTRITION, STRESS AND DEPRESSION ARE SOME OF THE MAJOR CONTRIBUTING FACTORS LEADING TO HEART DISEASE, HEART FAILURE AND READMISSION. RECENT LITERATURE SUGGEST THAT A LACK OF POST DISCHARGE SOCIAL SUPPORT AND EDUCATION ARE IMPORTANT TO PREVENT READMISSION. GROUP SESSIONS PROVIDE EDUCATION AND SOCIAL SUPPORT. DISCHARGE PLANNING THAT USES TRANSITIONAL COACHES HAS BEEN PROVEN TO REDUCE READMISSION RATES. THE OVERALL GOAL OF YOUR LIFE, YOUR HEART IS TO DECREASE THE READMISSION RATES FOR HEART FAILURE PATIENTS, WHICH REDUCES MEDICAL COSTS FOR THE PATIENT AND IMPROVES THEIR QUALITY OF LIFE. A TOTAL OF 66 COMMUNITY MEMBERS HAVE PARTICIPATED IN THIS EDUCATIONAL SERIES FOR THOSE AFFECTED BY HYPERTENSION, ANGINA, CARDIAC HEART FAILURE OR ANY OTHER HEART HEALTH CONCERNS. TOPICS COVERED INCLUDE THE RISK OF HEART DISEASE, SIGNS OF HEART ATTACK, DIABETES, CHOLESTEROL, PHYSICAL ACTIVITY, HEALTHY EATING AND MUCH MORE. HEALTH ASSESSMENTS ARE REVIEWED INCLUDING WAIST CIRCUMFERENCE, WEIGHT, HEIGHT, BMI AND BLOOD PRESSURE. OVERALL, PARTICIPANTS HAVE MADE A POSITIVE IMPACT FROM THE COURSE. DIABETES DIABETES IS AN IMPORTANT HEALTH NEED BECAUSE OF ITS PREVALENCE, ITS IMPACT ON MORBIDITY AND MORTALITY, AND ITS PREVENTABILITY. AN ANALYSIS OF MORTALITY DATA FOR SAN DIEGO COUNTY FOUND THAT IN 2012 'DIABETES MELLITUS' WAS THE SEVENTH LEADING CAUSE OF DEATH. THE PERCENTAGE OF ADULTS AGED 20 AND OLDER WHO HAVE EVER BEEN DIAGNOSED WITH DIABETES WAS 7.2% IN 2012 IN SAN DIEGO COUNTY AND HAS BEEN STEADILY RISING SINCE 2005 ACCORDING TO THE NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION. TYPE 2 DIABETES IS AN IMPORTANT TARGET FOR INTERVENTION BECAUSE HOSPITALIZATIONS DUE TO DIABETES RELATED COMPLICATIONS ARE POTENTIALLY PREVENTABLE WITH PROPER MANAGEMENT AND A HEALTHY LIFESTYLE. IN SAN DIEGO, APPROXIMATELY 1.5% OF DISCHARGES IN THE BLACK PATIENT POPULATION WERE ATTRIBUTABLE TO DIABETES COMPARED TO 0.7% OF DISCHARGES OF WHITES. THERE ARE THREE MAJOR TYPES OF DIABETES: TYPE 1, TYPE 2 AND GESTATIONAL. ALL THREE TYPES SHARE SIMILAR CHARACTERISTICS, THE BODY LOSES THE ABILITY TO EITHER MAKE OR TO USE INSULIN. WITHOUT ENOUGH INSULIN, GLUCOSE STAYS IN THE BLOOD, CREATING DANGEROUS BLOOD SUGAR LEVELS. OVER TIME, THIS BUILDUP DAMAGES KIDNEYS, HEART, NERVES, EYES AND OTHER ORGANS. TYPE 2 DIABETES, ONCE KNOWN AS ADULT ONSET OR NONINSULIN DEPENDENT DIABETES, IS A CHRONIC CONDITION THAT AFFECTS THE WAY YOUR BODY METABOLIZES SUGAR (GLUCOSE), WHICH IS YOUR BODYS MAIN SOURCE OF FUEL. WITH TYPE 2 DIABETES, YOUR BODY EITHER RESISTS THE EFFECTS OF INSULIN, A HORMONE THAT REGULATES THE MOVEMENT OF SUGAR INTO YOUR CELLS OR DOESNT PRODUCE ENOUGH INSULIN TO MAINTAIN A NORMAL GLUCOSE LEVEL. IF LEFT UNTREATED, TYPE 2 DIABETES CAN BE LIFE THREATENING. CLINICAL SYMPTOMS CAN INCLUDE: FREQUENT URINATION, EXCESSIVE THIRST, EXTREME HUNGER, SUDDEN VISION CHANGES, UNEXPLAINED WEIGHT LOSS, EXTREME FATIGUE, SORES THAT ARE SLOW TO HEAL, AND INCREASED NUMBER OF INFECTIONS. TYPE 2 DIABETES HAS REACHED EPIDEMIC PROPORTIONS, AND PEOPLE OF HISPANIC ORIGIN HAVE DRAMATICALLY HIGHER RATES OF THE DISEASE AND THE COMPLICATIONS THAT GO ALONG WITH ITS POOR MANAGEMENT, INCLUDING CARDIOVASCULAR DISEASE, EYE DISEASE AND LIMB AMPUTATION. IN FACT, IT IS ESTIMATED THAT ONE OUT OF EVERY TWO HISPANIC CHILDREN BORN IN 2000 WILL DEVELOP DIABETES IN ADULTHOOD. THIS IS ESPECIALLY TRUE IN THE SOUTH BAY COMMUNITIES IN SAN DIEGO. SPECIFICALLY, THE CITY OF CHULA VISTA IS HOME TO 26,000 LATINOS WITH DIAGNOSED DIABETES AND TENS OF THOUSANDS MORE WHO ARE UNDIAGNOSED, HAVE PRE- DIABETES AND ARE AT HIGH RISK OF DEVELOPING DIABETES.
FORM 990, PART III, LINE 4A (CONTINUED)	SOME ALARMING FACTS ABOUT TYPE 2 DIABETES: - ABOUT 1.7 MILLION PEOPLE AGED 20 OR OLDER WERE NEWLY DIAGNOSED WITH DIABETES IN 2012 IN THE U.S. - DIABETES IS A MAJOR CAUSE OF HEART DISEASE AND STROKE, AND IS THE 7TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND CALIFORNIA. - MORE THAN 1 OUT OF 3 ADULTS HAVE PREDIABETES AND 15 TO 30% OF THOSE WITH PREDIABETES WILL DEVELOP TYPE 2 DIABETES WITHIN 5 YEARS. SOME RISK FACTORS FOR DEVELOPING DIABETES INCLUDE: - BEING OVERWEIGHT OR OBESE - HAVING A PARENT, BROTHER OR SISTER WITH DIABETES - SMOKING - HAVING BLOOD PRESSURE MEASURING 140/90 OR HIGHER - BEING PHYSICALLY INACTIVE, EXERCISING FEWER THAN THREE TIMES A WEEK DISPARITIES AND DIABETES: - HISPANICS AND AFRICAN AMERICANS HAVE TWO TIMES HIGHER PREVALENCE: 1 IN 20 NON-HISPANIC WHITES HAVE TYPE 2 DIABETES, COMPARED WITH 1 IN 10 HISPANICS AND 1 IN 11 AFRICAN AMERICANS IN 2011 2012. - IN SAN DIEGO, WHITES AND BLACKS HAD THE HIGHEST DEATH RATES DUE TO DIABETES IN 2012. - THE PREVALENCE OF TYPE 2 DIABETES IS 13 PERCENT HIGHER IN MEN THAN WOMEN IN CALIFORNIA. - IN SAN DIEGO, MALES HAD A HIGHER DEATH RATE THAN FEMALES (22.5 PER 100,000 VERSUS 19.0 PER 100,000 IN 2012). - THE PERCENT OF ADULTS IN CALIFORNIA WITH DIABETES IS ALMOST TWO TIMES HIGHER IN THOSE WITH FAMILIES INCOMES BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL COMPARED TO THOSE WHOSE INCOME IS 300 PERCENT ABOVE. - ADULTS WITH DIABETES ARE MORE LIKELY TO HAVE ARTHRITIS, HYPERTENSION AND CARDIOVASCULAR DISEASE THAN ADULTS WITHOUT DIABETES. - DIABETES IS A LEADING CAUSE OF LOWER LIMB AMPUTATION AND KIDNEY FAILURE IN THE UNITED STATES. AN ESTIMATED 30.3 MILLION PEOPLE OF ALL AGES--OR 9.4% OF THE U.S. POPULATION--HAD DIABETES IN 2015. MORE THAN 7 MILLION AMERICANS ARE UNAWARE THAT THEY HAVE DIABETES. THE COMPLICATIONS RELATED TO DIABETES ARE SERIOUS AND CAN BE REDUCED WITH PREVENTIVE PRACTICES. DIABETES IS A SERIOUS COMMUNITY HEALTH PROBLEM, LEADING TO SCHOOL AND WORK ABSENTEEISM, ELEVATED HOSPITALIZATION RATES, FREQUENT EMERGENCY ROOM VISITS, PERMANENT PHYSICAL DISABILITIES AND SOMETIMES DEATH. DURING FISCAL YEAR 2017, SCRIPPS SPONSORED THE FOLLOWING DIABETES MANAGEMENT INITIATIVES: WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA THE WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA SERVES ONE OF SAN DIEGOS COMMUNITIES HIT HARDEST BY THE DIABETES EPIDEMIC. NEARLY 40 PERCENT OF PATIENTS ADMITTED TO SCRIPPS MEMORIAL HOSPITAL CHULA VISTA, AND NEARLY 32 PERCENT OF PATIENTS IN THE HEART CATHETERIZATION LAB, HAVE DIABETES. COUNTY STATISTICS TELL US THAT THE RATES OF DEATH, HOSPITALIZATIONS AND EMERGENCY ROOM VISITS ARE TWICE AS HIGH IN CHULA VISTA COMPARED TO ALL OF SAN DIEGO COUNTY. WITH THE GENEROUS SUPPORT OF PHILANTHROPIST RICHARD WOLTMAN, THE CENTER ADDED CRITICAL CLASSROOM SPACE IN 2017 TO MEET THE HIGH DEMAND FOR SERVICES. THE CENTER OFFERS A FULL RANGE OF WELLNESS, PREVENTION, DIABETES EDUCATION AND NUTRITION SERVICES IN ENGLISH AND SPANISH. PROJECT DULCE PROJECT DULCE IS A COMPREHENSIVE, CULTURALLY SENSITIVE DIABETES MANAGEMENT PROGRAM FOR UNDERSERVED AND UNINSURED PEOPLE IN SAN DIEGO COUNTY. THE PROGRAM IS TEAM BASED AND INCORPORATES THE CHRONIC CARE MODEL. PROJECT DULCE HAS BEEN ACTIVE IN COMMUNITIES ACROSS SAN DIEGO FOR THE PAST 19 YEARS, PROVIDING DIABETES CARE AND SELF-MANAGEMENT EDUCATION. NURSE LED TEAMS STRIVE FOR MEASURABLE IMPROVEMENTS IN THEIR PATIENTS HEALTH, NURSE EDUCATORS LEAD MULTIDISCIPLINARY TEAMS THAT PROVIDE CLINICAL MANAGEMENT; AND PEER EDUCATORS FROM EACH CULTURAL GROUP, KNOWN AS PROMOTORAS, PROVIDE PUBLIC AND PATIENT EDUCATION FOR THEIR COMMUNITIES. THIS INNOVATIVE PROGRAM COMBINES STATE OF THE ART CLINICAL DIABETES MANAGEMENT WITH PROVEN EDUCATIONAL AND BEHAVIORAL INTERVENTIONS. ONE OF THE PRIMARY COMPONENTS OF THE PROGRAM IS RECRUITING PEER EDUCATORS FROM THE COMMUNITY TO WORK DIRECTLY WITH PATIENTS. THESE EDUCATORS REFLECT THE DIVERSE POPULATION AFFECTED BY DIABETES AND HELP TEACH OTHERS ABOUT CHANGING EATING HABITS, ADOPTING EXERCISE ROUTINES AND OTHER WAYS TO HELP MANAGE THIS CHRONIC DISEASE. IN FISCAL YEAR 2017, PROJECT DULCE PROVIDED 7,504 DIABETES CARE, RETINAL SCREENINGS AND EDUCATION VISITS FOR LOW INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO AND ENROLLED 1,039 NEW PROJECT DULCE PATIENTS. MEDICAL ASSISTANT HEALTH COACHING (MAC) DIABETES AFFECTS NEARLY 30 MILLION INDIVIDUALS IN THE U.S., AND IF CURRENT TRENDS CONTINUE, 1 OF 3 ADULTS WILL HAVE DIABETES BY 2050. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSME) IS A CORNERSTONE OF EFFECTIVE CARE THAT IMPROVES CLINICAL CONTROL AND HEALTH OUTCOMES; HOWEVER, DSME PARTICIPATION IS LOW, PARTICULAR AMONG UNDERSERVED POPULATIONS, AND ONGOING SUPPORT IS OFTEN NEEDED TO MAINTAIN DSME GAINS. IN 2015, THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES (NIH/NIDDK) GRANTED SCRIPPS WHITTIER DIABETES INSTITUTE $2.1 MILLION TO FUND THE MAC TRIAL, WHICH IS STUDYING AN INNOVATIVE TEAM CARE APPROACH THAT TRAINS MEDICAL ASSISTANTS (MAS) TO PROVIDE HEALTH COACHING IN THE PRIMARY CARE SETTING TO PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES, HELP THEM PROBLEM-SOLVE, AND IMPROVE THEIR DIABETES-RELATED HEALTH OUTCOMES. THE GOALS INCLUDE IMPROVING DIABETES SELF-MANAGEMENT AND CLINICAL OUTCOMES, SUCH AS BLOOD GLUCOSE LEVELS, CHOLESTEROL AND BLOOD PRESSURE. THE STUDY IS BEING CONDUCTED IN TWO DIVERSE SETTINGS: A SCRIPPS HEALTH PRIMARY CARE PRACTICE, AND A COMMUNITY HEALTH CENTER, NEIGHBORHOOD HEALTHCARE. DIABETES PREVENTION THE UCLA CENTER FOR HEALTH POLICY AND RESEARCH RECENTLY PUBLISHED DATA THAT REVEALED NEARLY HALF OF CALIFORNIA ADULTS HAVE PREDIABETES OR DIABETES. WHILE THE SCRIPPS WHITTIER DIABETES INSTITUTE HAS BEEN PROVIDING THE BEST CARE FOR PEOPLE WITH DIABETES FOR DECADES, THE INSTITUTE CONTINUED WITH THE SCRIPPS DIABETES PREVENTION PROGRAM (DPP), WHICH IS A YEARLONG INTERVENTION WHERE PEOPLE WITH PREDIABETES MEET WEEKLY FOR 16 WEEKS, THEN MONTHLY THEREAFTER. THE DPP IS AN INTENSIVE LIFESTYLE INTERVENTION PROGRAM THAT HAS BEEN PROVEN TO PREVENT DIABETES IN LARGE-SCALE NATIONAL STUDIES. THE PRIMARY OBJECTIVE IS TO LOSE 5 TO 7% OF BODY WEIGHT THROUGH HEALTHY EATING AND PHYSICAL ACTIVITY. THE DIABETES PREVENTION PROGRAM (DPP) HAS BEEN THOROUGHLY EVALUATED IN NIH SPONSORED RANDOMIZED CONTROLLED TRIALS, AND HAS BEEN FOUND TO DECREASE THE NUMBER OF NEW CASES OF DIABETES AMONG THOSE WITH PREDIABETES BY 58%. AMONG PEOPLE OVER AGE 60, THERE WAS A 71% REDUCTION IN NEW CASES. IN 2017, 441 PATIENTS ATTENDED 80 SCRIPPS DPP ORIENTATION SESSIONS. MUCH OF THE EFFORT IS FOCUSED IN THE SOUTH BAY FOR THE LATINO POPULATION, WHICH IS AT HIGHER RISK OF GETTING DIABETES THAN THEIR WHITE COUNTERPARTS. DIGITAL DIABETES-ME: AN ADAPTIVE MHEALTH INTERVENTION FOR UNDERSERVED HISPANICS WITH DIABETES DIABETES IS A FAST-GROWING EPIDEMIC, AFFLICTING 29.1 MILLION AMERICANS AND COSTING MORE THAN $245 BILLION A YEAR, ACCORDING TO THE AMERICAN DIABETES INSTITUTE. HISPANICS FACE A HIGHER RISK OF DEVELOPING THE DISEASE 13.9 PERCENT COMPARED WITH 7.6 PERCENT FOR NON-HISPANIC WHITES. THE NIHS NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES AWARDED $2.9 MILLION, THE LARGEST NIH AWARD TO SCRIPPS WHITTIER DIABETES INSTITUTE TO DATE, TO STUDY AN INNOVATIVE APPROACH TO HELPING HISPANICS WITH DIABETES BETTER MANAGE THEIR DISEASE. DULCE DIGITAL-ME PROVIDED PATIENTS WITH TOOLS TO HELP THEM MANAGE THEIR DIABETES DAY TO DAY AND IMPROVE THEIR HEALTH, INCLUDING TEXT MESSAGING, WIRELESS BLOOD GLUCOSE AND MEDICATION MONITORING, DIET AND EXERCISE ASSESSMENTS, AND PERSONALIZED FEEDBACK AND GOAL-SETTING. THIS STUDY WAS CONDUCTED IN COLLABORATION WITH NEIGHBORHOOD HEALTHCARE, SAN DIEGO STATE UNIVERSITY AND THE UNIVERSITY OF CALIFORNIA SAN DIEGO. THE PARTICIPANTS RECEIVED HEALTH-RELATED TEXT MESSAGES EVERY DAY FOR SIX MONTHS AND THEY SAW IMPROVEMENTS IN THEIR BLOOD SUGAR LEVELS THAT EQUALED THOSE RESULTING FROM SOME GLUCOSE-LOWERING MEDICATIONS. THE DULCE DIGITAL CLINICAL TRIAL REPRESENTS THE FIRST RANDOMIZED CONTROLLED STUDY TO LOOK AT THE USE OF TEXT MESSAGES TO HELP UNDERSERVED HISPANICS BETTER SELF-MANAGE THEIR DIABETES THROUGH GLYCEMIC CONTROL. THE RESULTS WERE PUBLISHED BY DIABETES CARE IN AN ONLINE PRE-PRINT VERSION OF THE STUDY, WHICH IS SCHEDULED TO BE PUBLISHED IN A FUTURE ISSUE OF THE JOURNAL. HEALTHY LIVING IN 2015, SCRIPPS BEGAN HEALTHY LIVING CLASSES WHICH ARE OPEN TO ANYONE INTERESTED IN LEARNING ABOUT THE BENEFITS OF GOOD NUTRITION, PHYSICAL ACTIVITY, AND AVOIDING TOBACCO. THESE BEHAVIORS CAN HELP TO PREVENT THE FOUR CHRONIC DISEASES (LUNG DISEASE, CANCER, TYPE 2 DIABETES AND, CARDIOVASCULAR DISEASE) THAT CONTRIBUTE TO 50 PERCENT OF ALL THE DEATHS IN THE US. THE THREE-CLASS SERIES IS HELD AT LOCATIONS THROUGHOUT THE COMMUNITY. TWO HUNDRED AND EIGHT PEOPLE ATTENDED HEALTHY LIVING CLASSES THAT WERE PROVIDED THROUGHOUT THE COUNTY, AGAIN WITH SPECIAL ATTENTION TO THE LATINO COMMUNITY OF THE SOUTH BAY.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION TEAMS PROVIDE STATE OF THE ART EDUCATION AND TRAINING FOR PEOPLE WHO WISH TO INCREASE THEIR DIABETES MANAGEMENT KNOWLEDGE AND SKILLS. WITH THE RISE IN DIABETES RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP CLINICIANS WITH THE LATEST INFORMATION AND CLINICAL SKILLS. THE WHITTIERS PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS, INCLUDING: ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS AND OTHER DIABETES SPECIALIST. THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST POSSIBLE CARE FOR THEIR DIABETES PATIENTS. COURSES RESPOND TO THE NEEDS OF ALLIED HEALTH PROFESSIONALS SEEKING TO UNDERSTAND NEW AND COMPLEX CLINICAL TREATMENT OPTIONS FOR TYPE 1, TYPE 2 AND GESTATIONAL DIABETES. PROFESSIONAL EDUCATION WAS PROVIDED FOR 374 PEOPLE ON INSULIN MANAGEMENT, INCRETIN THERAPY, AND DIABETES DIET AND DIABETES BASICS. PARTICIPANTS CAME FROM LOCAL HEALTH INSTITUTIONS AND THROUGHOUT THE UNITED STATES TO LEARN FROM THE WHITTIER INSTITUTES MOST EXPERIENCED DIABETES EXPERTS. OVER THE LAST FISCAL YEAR, THE WHITTIER INSTITUTES PROFESSIONAL EDUCATION DEPARTMENT PROVIDED FOUR CME PROGRAMS FOR PHYSICIANS, NURSES, PHARMACISTS, DIETITIANS, MIDLEVEL PROVIDERS AND SOCIAL WORKERS AND MADE NUMEROUS ACADEMIC AND RESEARCH PRESENTATIONS AT PROFESSIONAL ASSOCIATION MEETINGS. RETINAL SCREENING PROGRAM IT IS ESTIMATED THAT EVERY 24 HOURS, 55 PEOPLE WILL LOSE THEIR VISION AS A RESULT OF DIABETIC-RELATED EYE DISEASE (DIABETIC RETINOPATHY) EVEN THOUGH 95 PERCENT OF DIABETIC BLINDNESS COULD BE PREVENTED WITH EARLY DIAGNOSIS AND TREATMENT. FOR MORE THAN A DECADE, SCRIPPS HAS BEEN SCREENING PEOPLE IN UNDERSERVED COMMUNITIES FOR DIABETIC RETINOPATHY USING A MOBILE CAMERA. OUR FREE OR LOW-COST EYE EXAMS DIAGNOSE INDIVIDUALS AT HIGH RISK FOR RETINAL DAMAGE AND HELP PATIENTS GET TREATMENT AND REFERRALS TO SPECIALISTS. IN 2016, 622 PEOPLE WERE SCREENED, AND 30 PERCENT HAD SOME DEGREE OF DIABETES-RELATED EYE DISEASE. THIS PROGRAM REFERRED 89 PEOPLE WHO HAD ADVANCED DISEASE, 14 PERCENT OF ALL SCREENED OR NEARLY 50 PERCENT OF POSITIVES, TO SPECIALISTS FOR FURTHER CARE. HEALTH RELATED BEHAVIORS HEALTH RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLES HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH RELATED BEHAVIORS, SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY, ORAL HEALTH AND INJURY PREVENTION, HAVE BECOME IMPORTANT COMPONENTS OF LONG TERM LIFE. THE RISK FACTORS FOR MANY CHRONIC DISEASES ARE WELL KNOWN. IN PARTICULAR, AN UNHEALTHY DIET, PHYSICAL INACTIVITY AND SUBSTANCE ABUSE HAVE NEED CITED BY THE WORLD HEALTH ORGANIZATION (HTTP://WWW.WHO.INT/CHP) AS IMPORTANT HEALTH BEHAVIORS THAT CONTRIBUTE TO ILLNESSES SUCH AS CARDIOVASCULAR DISEASE, CANCER, CHRONIC RESPIRATORY DISEASE, DIABETES, AND OTHERS INCLUDING MENTAL DISORDERS AND ORAL DISEASES. FRUIT/VEGETABLE CONSUMPTION: ACCORDING TO DATA FROM CALIFORNIA HEALTH INTERVIEW SURVEY, 48.3% OF CHILDREN AGE 2 AND OLDER REPORTED CONSUMING LESS THAN FIVE SERVINGS OF FRUITS AND VEGETABLES A DAY COMPARED TO 47.7% IN CALIFORNIA OVERALL. ADULTS AGE 18 AND OVER REPORTED EVEN LESS FRUIT AND VEGETABLE CONSUMPTION. APPROXIMATELY 70.5% OF ADULTS REPORTED EATING THE RECOMMENDED AMOUNT EACH DAY. UNHEALTHY EATING HABITS ARE A SIGNIFICANT CONTRIBUTING FACTOR TO FUTURE HEALTH ISSUES INCLUDING OBESITY AND DIABETES. PHYSICAL INACTIVITY: ACCORDING TO THE CDCS NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, 14.9% OF ADULTS AGE 20 AND OLDER SELF-REPORTED THAT THEY PERFORM NO LEISURE TIME PHYSICAL ACTIVITY. HIGHER RATES OF LIMITED LEISURE TIME ACTIVITY WERE REPORTED AT THE STATE AND NATIONAL LEVEL (16.6% AND 22.6% RESPECTIVELY). FOR YOUTH RESULTS OF THE FITNESSGRAM PHYSICAL FITNESS TEST SHOW THAT 29.35% OF CHILDREN 5,7 AND 9 RANKED WITHIN THE "HIGH RISK"NEEDS IMPROVEMENT" ZONES FOR AEROBIC CAPACITY FOR THE 2013 2014 YEAR. THE PERCENTAGE OF CHILDREN THAT ARE NOT IN THE HEALTHY FITNESS ZONE VARIES AMONG ETHNIC GROUPS WITH THE LOWEST BEING NON-HISPANIC ASIANS AT 20.6% AND THE HIGHEST BEING HISPANIC OR LATINOS AT 42.1%. ALTHOUGH THIS IS SMALLER THAN THE STATE AVERAGE OF 36.9%, IT IS STILL CAUSE FOR CONCERN AND MAY LEAD TO SIGNIFICANT HEALTH ISSUES, SUCH AS OBESITY, DIABETES, AND POOR CARDIOVASCULAR HEALTH. ALCOHOL CONSUMPTION: THE PERCENTAGE OF ADULTS AGE 18 AND OLDER WHO SELF-REPORT HEAVY ALCOHOL CONSUMPTION (DEFINED AS MORE THAN TWO DRINKS PER DAY ON AVERAGE FOR MEN AND ONE DRINK PER DAY ON AVERAGE FOR WOMEN) IS 17.2% IN SAN DIEGO COUNTY ACCORDING TO THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). BEHAVIORS SUCH AS EXCESSIVE ALCOHOL CONSUMPTION ARE DETRIMENTAL TO FUTURE HEALTH AND MAY ILLUSTRATE OR PRECLUDE SIGNIFICANT HEALTH ISSUES, SUCH AS CIRRHOSIS, CANCER, AND UNTREATED MENTAL AND BEHAVIORAL HEALTH NEEDS. TOBACCO USAGE: THE BRFSS ALSO REPORTS THAT 12.1% OF ADULTS AGE 18 AND OLDER SELF-REPORTED CURRENTLY SMOKING CIGARETTES SOME DAYS OR EVERY DAY COMPARE TO 18.1% IN THE UNITED STATES, ADJUSTED FOR AGE. TOBACCO USE IS LINKED TO LEADING CAUSES OF DEATH INCLUDING CANCER AND CARDIOVASCULAR DISEASE. UNDERSTANDING THAT PERSONAL BEHAVIORS PLAY A SIGNIFICANT ROLE IN AN INDIVIDUAL'S OVERALL HEALTH STATUS, SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS THAT HELP PEOPLE TAKE CHARGE OF THEIR OWN, AND THEIR FAMILIES', HEALTH. DURING FISCAL YEAR 2017, SCRIPPS SPONSORED A NUMBER OF HEALTH BEHAVIOR MODIFICATION EFFORTS: COMMUNITY PROGRAMS AND CLINICAL SERVICES OF SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS AND FAMILY MEDICINE RESIDENCY PROGRAMS HAVE DELIVERED EXTENSIVE VALUE WITH SUPERIOR OUTCOMES. COMMUNITY SERVICES COMBINED REACHED 10,608 PROGRAM PATIENTS AND PARTICIPANTS. THERE WERE MORE THAN 13,500 CLINICAL VISITS PROVIDED BY SCRIPPS FAMILY MEDICINE RESIDENCY. COMMUNITY BASED HEALTH IMPROVEMENT ACTIVITIES EACH MONTH APPROXIMATELY 200 COMMUNITY MEMBERS PARTICIPATE IN CLASSES, PREVENTION LECTURES AND SUPPORT GROUPS HELD AT THE WELL BEING CENTER AND NORMAN PARK SENIOR CENTER. A TOTAL OF 2,400 COMMUNITY MEMBERS HAVE PARTICIPATED IN CLASSES AND SUPPORT GROUPS. YOUTH PROGRAM ACTIVITIES SCRIPPS CHULA VISTA COMMUNITY BENEFITS SERVICES IMPLEMENTED A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES INCLUDING: CAMP SCRIPPS, MENTORING PROGRAMS, HOSPITAL TOURS, IN- CLASSROOM PRESENTATIONS AND SURGERY VIEWINGS. SCRIPPS FAMILY MEDICINE RESIDENTS ALSO PROVIDE FOOTBALL GAME COVERAGE, SPORT INJURY CLINICS AND PHYSICALS. A TOTAL OF 3,060 YOUTH PARTICIPATED IN THESE PROGRAMS. SENIOR PROGRAMS EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD IN PARTNERSHIP WITH LOCAL SENIOR CENTERS, CHURCHES, AND SENIOR HOUSING. SOME OF THESE ACTIVITIES INCLUDE: SENIOR HEALTH CHATS AND WIDOW SUPPORT GROUP. OVER 100 SENIORS PARTICIPATED IN THESE PROGRAMS. PATIENT COMMUNITY SERVICES SERVICES ARE OFFERED DIRECTLY TO PATIENTS AND THEIR FAMILY POST DISCHARGE TO DECREASE THE RISKS OF READMISSION AND TO INCREASE PATIENT CONTINUITY. SUPPORT SERVICES ARE REFERRAL BASED AND PROVIDE ASSISTANCE WITH THE FOLLOWING: HOUSING/HOMELESSNESS, SENIOR ISSUES, CHRONIC DISEASE ISSUES, DRUG/ALCOHOL AND MENTAL HEALTH, CANCER AND MORE. THIS SERVICE IS CURRENTLY ONLY AVAILABLE AT THE SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUS. SINCE THE START OF THE PROJECT IN JULY 2014, 912 REFERRALS HAVE BEEN RECEIVED. COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND RESIDENT LEADERSHIP ACADEMY MODEL SCRIPPS IS A PARTNER WITH CHIP AND COLLABORATIVELY WORKS ON A RESIDENT LEADERSHIP MODEL THAT HAS EMPOWERED 700+ CITIZENS ACROSS THE COUNTY (AND BEYOND) TO AFFECT CHANGE IN A WIDE RANGE OF COMMUNITY HEALTH AREAS SUCH AS PUBLIC SAFETY, ACCESS TO HEALTHY FOODS, AND INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. HEALTH EDUCATION AND SUPPORT GROUPS EDUCATION AND SUPPORT GROUPS ARE PROVIDED TO SAN DIEGO COUNTY RESIDENTS FOR A WIDE VARIETY OF HEALTH CONCERNS. TOPICS INCLUDE, MACULAR DEGENERATION, FALL PREVENTION, STROKE AWARENESS, MENOPAUSE, SLEEP DISORDERS, FOOT HEALTH, BLADDER AND PELVIC FLOOR WELLNESS, MENTAL ILLNESS, POSTPARTUM ISSUES, GYNECOLOGICAL CANCER, AND MULTIPLE SCLEROSIS. BRAIN AND HEAD GEAR PROTECTION EDUCATIONAL PROGRAM FOR HIGH SCHOOL STUDENTS TO STRESS THE IMPORTANCE OF BIKE SAFETY. BRAIN INJURY PROTECTION THROUGH THE PROPER USED OF HEAD GEAR. PRESCRIPTION TAKE BACK DAY SCRIPPS COLLABORATES WITH THE COUNTY OF SD ON THE PRESCRIPTION DRUG TAKE BACK DAY WHICH PROVIDES AN OPPORTUNITY FOR SAFE DISPOSAL OF LEFT OVER MEDICATIONS.
FORM 990, PART III, LINE 4A (CONTINUED)	DEMENTIA AND ALZHEIMERS DISEASE DEMENTIA IS A CLINICAL SYNDROME OF DECLINE IN MEMORY AND OTHER THINKING ABILITIES. IT IS CAUSED BY VARIOUS DISEASES AND CONDITIONS THAT RESULT IN DAMAGE TO BRAIN CELLS AND LEAD TO DISTINCT SYMPTOM PATTERNS AND DISTINGUISHING BRAIN ABNORMALITIES. ALZHEIMERS DISEASE (AD) IS A PROGRESSIVE BRAIN DISORDER THAT GRADUALLY DESTROYS A PERSONS MEMORY AND ABILITY TO LEARN, REASON, MAKE JUDGMENTS, COMMUNICATE AND CARRY OUT DAILY ACTIVITIES SUCH AS BATHING AND EATING. ALZHEIMERS IS THE 6TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND 3RD LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. IN 2013, AN ESTIMATED 62,000 SAN DIEGANS AGE 55 YEARS AND OLDER WERE LIVING WITH ALZHEIMERS DISEASE AND DEMENTIAS (ADOD), ACCOUNTING FOR 8.3% OF THE 55 YEARS AND OLDER POPULATION. THIS POPULATION WILL ROUGHLY DOUBLE IN LESS THAN 20 YEARS. IN 2013, MORE THAN 20,000 SAN DIEGANS AGE 55 AND OLDER WERE DISCHARGED FROM THE EMERGENCY DEPARTMENT (ED) OR HOSPITAL WITH A MENTION OF ADOD. FINANCIAL BURDEN: - IN 2013 NEARLY 141,000 CAREGIVERS PROVIDED UNPAID CARE FOR THE 62,000 PEOPLE LIVING WITH ADOD IN SAN DIEGO COUNTY. THESE CAREGIVERS PROVIDED NEARLY 161 MILLION HOURS OF UNPAID CARE, VALUED AT NEARLY $2 BILLION DOLLARS. DUE TO THE NEGATIVE EFFECTS OF CAREGIVING ON THEIR OWN HEALTH, THE COST OF PROVIDING HEALTH CARE TO THESE RESIDENTS IN 2013 WAS APPROXIMATELY $77.7 MILLION DOLLARS. PREVALENCE - THERE ARE MORE THAN 5.2 MILLION PEOPLE IN THE UNITED STATES LIVING WITH ADOD. AS THE POPULATION AGES THE NUMBER IS EXPECTED TO TRIPLE BY 2015. - IN CALIFORNIA THERE ARE 588,208 PEOPLE 55 YEARS AND OLDER LIVING WITH ADOD. ONE-TENTH OF AD PATIENTS LIVE IN CALIFORNIA. - IN SAN DIEGO COUNTY, THE NUMBER OF THOSE 55 YEARS AND OLDER WITH ADOD IS EXPECTED TO INCREASE BY 51% BETWEEN 2012 AND 2030, FROM 60,000 TO NEARLY 94,000 RESIDENTS. CURRENTLY, THE EAST COUNTY REGION HAS THE GREATEST NUMBER (14,765) AND PROPORTION (12.4%) OF RESIDENTS 55 YEARS AND OLDER WITH ALZHEIMERS DISEASE AND OTHER DEMENTIAS. THE REGION WITH THE LARGEST ANTICIPATED INCREASE IN ADOD IN THE NORTH CENTRAL AREA, WITH A PROJECTED INCREASE OF 76.8% FROM 2012 TO 2030. HOWEVER, IT IS ESTIMATED THAT BY 2030, NEARLY ONE OUT OF FOUR SAN DIEGANS 55 YEARS AND OLDER WITH ADOD WILL LIVE IN EAST COUNTY. DURING FISCAL YEAR 2017, SCRIPPS ENGAGED IN THE FOLLOWING ALZHEIMERS AND DEMENTIA PREVENTION AND TREATMENT ACTIVITIES: SENIOR HEALTH AND WELL BEING PROGRAMS THE GOAL IS TO INCREASE HEALTH CARE INFORMATION AND PREVENTATIVE SERVICES FOR SENIORS/OLDER ADULTS IN THE SOUTH BAY. EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD AT LOCAL SENIOR CENTERS, CHURCHES AND SENIOR HOUSING. SOME OF THESE ACTIVITIES INCLUDED DEMENTIA, ALZHEIMERS AND PAIN MANAGEMENT, NUTRITION AND WELLNESS AND SPONSORSHIP OF THE ALZHEIMERS ASSOCIATION CAREGIVER CONFERENCE. MORE THAN 200 SENIORS PARTICIPATED IN THESE ACTIVITIES. THE ALZHEIMERS PROJECT SAN DIEGO UNITES FOR A CURE AND CARE THE ALZHEIMERS PROJECT IS A COUNTYWIDE INITIATIVE AIMED AT ACCELERATING THE SEARCH FOR A CURE AND HELPING THE ESTIMATED 60,000 SAN DIEGANS WITH THE DISEASE, ALONG WITH THEIR CAREGIVERS. PARTICIPANTS BEGAN MEETING IN EARLY 2014 TO CRAFT A REGIONAL ROADMAP TO ADDRESS THE DISEASE, FOCUSING ON CURE, CARE, CLINICAL, AND PUBLIC AWARENESS AND EDUCATION INITIATIVES. THE BOARD OF SUPERVISORS APPROVED THE ROADMAP IN DECEMBER 2014 AND LATER VOTED IN SUPPORT OF AN IMPLEMENTATION TIMETABLE. DR. MICHAEL LOBATZ FROM SCRIPPS HEALTH IS A LEADING PARTICIPANT OF THIS INITIATIVE AS A CO-CHAIRPERSON OF THE CLINICAL ROUND TABLE AND IS A MEMBER OF THE STEERING COMMITTEE. ALZHEIMERS SAN DIEGO PROGRAM SUPPORT ALZHEIMERS SAN DIEGO OFFERS A FREE HALF DAY EVENT. ATTENDEES LEARN THE BASICS OF ALZHEIMERS DISEASE, HOW TO PARTNER WITH YOUR DOCTOR AND GET A DIAGNOSIS, AND ADDRESSING BEHAVIOR THROUGH COMPASSIONATE COMMUNICATION. SCRIPPS DONATED $25,000 FOR PROGRAM SUPPORT. OBESITY, WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS OBESITY IS AN IMPORTANT HEALTH NEED DUE TO ITS HIGH PREVALENCE IN THE U.S. AND SAN DIEGO. ALTHOUGH IT IS NOT A LEADING CAUSE OF DEATH, IT IS A SIGNIFICANT CONTRIBUTOR TO THE DEVELOPMENT OF OTHER CHRONIC CONDITIONS. ADULTS: 36.3% OF ADULTS AGED 18 AND OLDER SELF-REPORTED THEY HAVE A BMI BETWEEN 25.0 AND 30.0 (OVERWEIGHT) IN SAN DIEGO COUNTY ACCORDING TO 2011 2012 BRFSS DATA. AN ADDITIONAL 20.1% OF ADULTS AGED 20 YEARS AND OLDER SELF-REPORTED THEY HAVE A BMI GREATER THAN 30.0 (OBESE) IN SAN DIEGO COUNTY. THE PERCENTAGE OF RESIDENTS WHO ARE OBESE WAS HIGHER SLIGHTLY AMONG MEN (21.3%) THAN WOMEN (18.8%). EXCESS WEIGHT MAY INDICATE AN UNHEALTHY LIFESTYLE AND PUTS INDIVIDUALS AT RISK FOR FURTHER HEALTH ISSUES INCLUDING OBESITY, HEART DISEASE, DIABETES, AND OTHER HEALTH ISSUES. YOUTH: FITNESSGRAM IS THE REQUIRED PHYSICAL FITNESS TEST THAT SCHOOL DISTRICTS MUST ADMINISTER TO ALL CALIFORNIA STUDENTS IN GRADES 5, 7 AND 9. THE PERCENTAGE OF CHILDREN IN GRADES 5, 7 AND 9 RANKING WITHIN THE "HEALTH RISK" CATEGORY (OVERWEIGHT) FOR BODY COMPOSITION ON THE FITNESSGRAM PHYSICAL FITNESS TEST WAS 17.7% IN SAN DIEGO COUNTY FOR THE YEARS 2013-2014. FURTHERMORE, APPROXIMATELY 15.9% OF CHILDREN IN GRADES 5, 7 AND 9 WERE RANKED WITHIN THE "HIGH RISK" CATEGORY (OBESE). RATES OF OVERWEIGHT AND OBESE YOUTH WERE HIGHEST AMONG HISPANIC/LATINO AND AFRICAN AMERICAN YOUTH. OBESITY IS LARGELY CATEGORIZED AS A SECONDARY DIAGNOSIS IN HOSPITAL DISCHARGE DATA. AN ANALYSIS OF THE PRIMARY DIAGNOSES ASSOCIATED WITH A SECONDARY DIAGNOSIS OF AN OBESITY RELATED ICD-9 CODE IN 2013 WAS USED TO PROVIDE AN OVERVIEW OF THE MAIN REASONS INDIVIDUALS WITH ABNORMAL WEIGHT SEEK CARE BY AGE GROUP. IN ADDITION, LOCAL PROGRAM DATA WERE SUMMARIZED TO PROVIDE ADDITIONAL PERSPECTIVE ON THE IMPACT OF OBESITY ON MORBIDITY IN SDC. A SUMMARY OF THE TRENDS FOUND WERE AS FOLLOWS: - WHEN EXAMINING INPATIENT HOSPITAL DISCHARGE DATA WITH OBESITY AS A SECONDARY DIAGNOSIS, IT WAS FOUND THAT THE MOST COMMON PRIMARY DIAGNOSIS OF THOSE PATIENTS WERE NONSPECIFIC CHEST PAIN IN AGES 25-64, ABNORMAL PAIN FOR THOSE AGES 15-24, AND THOSE OVER 65 YEARS THEIR PRIMARY DIAGNOSIS WAS OSTEOARTHRITIS, SEPTICEMIA FOLLOWED BY CONGESTIVE HEART FAILURE. SOME FACTS ABOUT OBESITY IN THE UNITED STATES: - ACCORDING TO THE 2013 BRFSS AND YRBSS, 28.3% OF THE U.S. ADULTS WERE OBESE, 35.5% OF ADULTS WERE OVERWEIGHT, 13.7% OF ADOLESCENTS WERE CONSIDERED OBESE AND 16.6% OF ADOLESCENTS WERE OVERWEIGHT. - IN 2013, 21.4% OF ADULTS REPORTED IN ENGAGING IN NO LEISURE TIME ACTIVITY AND THE NUMBER OF ADULTS WHO REPORT EATING LESS THAN ONE VEGETABLE OR FRUIT DAILY IS 17.3% AND 30.4%, RESPECTIVELY. HEALTH CONSEQUENCES DUE TO OVERWEIGHT AND OBESITY: RESEARCH HAS SHOWN THAT AS WEIGHT INCREASES TO REACH THE LEVELS OF "OVERWEIGHT"OBESITY" THE RISKS FOR THE FOLLOWING CONDITIONS ALSO INCREASES: - CORONARY HEART DISEASE - TYPE 2 DIABETES - CANCERS (ENDOMETRIAL, BREAST AND COLON) - HYPERTENSION (HIGH BLOOD PRESSURE) - STROKE - LIVER AND GALLBLADDER DISEASE - SLEEP APNEA AND RESPIRATORY PROBLEMS - OSTEOARTHRITIS OVERWEIGHT AND OBESITY ASSOCIATED COSTS: - IN 2008, MEDICAL COSTS ASSOCIATED WITH OBESITY WERE ESTIMATED AT $147 BILLION, THE MEDICAL COSTS FOR PEOPLE WHO ARE OBESE WERE $1,429 HIGHER THAN THOSE OF NORMAL WEIGHT. DISPARITIES AND OBESITY OBESITY & RACE - ACCORDING TO THE BRFSS, FROM 2012 THROUGH 2014, NON-HISPANIC BLACKS HAD THE HIGHEST PREVALENCE OF SELF-REPORTED OBESITY (38.1%), FOLLOWED BY HISPANICS (31.3%) AND NON-HISPANIC WHITES (27.1%) - IN 2011 2012, THE PREVALENCE AMONG CHILDREN AND ADOLESCENTS WAS HIGHER AMONG HISPANICS (22.4%) AND NON-HISPANICS (20.2%) THAN AMONG NON-HISPANIC WHITES (14.1%) OBESITY & GENDER - AMONG MEN, 42% WERE CONSIDERED TO BE OVERWEIGHT COMPARED TO 29% OF WOMEN. THE MEDIAN PERCENTAGE OF OBESITY WAS SIMILAR AMONG MEN (28%) AND WOMEN (27%) IN THE U.S. OBESITY & INCOME - AMONG NON-HISPANIC BLACK AND MEXICAN AMERICAN MEN, THOSE WITH HIGHER INCOMES ARE MORE LIKELY TO HAVE OBESITY THAN THOSE WITH LOW INCOME. - HIGHER INCOME WOMEN AND WOMEN WITH HIGHER EDUCATIONAL ATTAINMENT ARE LESS LIKELY TO BE OBESE THAN LOW INCOME WOMEN. - OBESITY PREVALENCE WAS THE HIGHEST AMONG CHILDREN IN FAMILIES WITH AN INCOME TO POVERTY RATIO OF 100% OF LESS. OBESITY & QUALITY OF LIFE - OBESITY CAN AFFECT THE QUALITY OF LIFE THROUGH LIMITED MOBILITY AND DECREASED PHYSICAL ENDURANCE, IN ADDITION TO SOCIAL, ACADEMIC, AND JOB DISCRIMINATION.
FORM 990, PART III, LINE 4A (CONTINUED)	DURING FISCAL YEAR 2017, SCRIPPS ENGAGED IN THE FOLLOWING OBESITY PREVENTION AND TREATMENT ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP) AND CHILDHOOD OBESITY INITIATIVE THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (THE INITIATIVE) IS A PRIVATE PUBLIC PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS, AND ENVIRONMENT CHANGE. THE INITIATIVE IS FACILITATED BY COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). CORE FUNDING FOR THE INITIATIVE IS PROVIDED BY THE COUNTY OF SAN DIEGO, FIRST 5 COMMISSION OF SAN DIEGO COUNTY, THE CALIFORNIA ENDOWMENT, AND KAISER-PERMANENTE. SCRIPPS IS A STRONG PARTNER WITH CHIP AND THE OUTCOMES OF THE INITIATIVE HAVE SHOWN A DECREASED CHILDHOOD OBESITY FROM 4% FROM 2005-2010, THE LARGEST DROP IN SOUTHERN CALIFORNIA (MANY AREAS HAVE SEEN INCREASES). ACCORDING TO THE 2016 SAN DIEGO COUNTY STATE OF CHILDHOOD OBESITY REPORT, THE RATE OF OBESITY FOR HISPANIC STUDENTS IS MORE THAN TWICE THAT OF WHITE STUDENTS. THE RATE OF OBESITY FOR ECONOMICALLY DISADVANTAGED STUDENTS IS MORE THAN TWICE THAT OF STUDENTS WHO ARE NOT ECONOMICALLY DISADVANTAGED. HISPANIC STUDENTS REPRESENT APPROXIMATELY HALF OF ALL PUBLIC SCHOOL STUDENTS IN SAN DIEGO COUNTY WITH RESPECT TO RACE/ETHNICITY, AND LOW-INCOME STUDENTS ACCOUNT FOR HALF OF ALL PUBLIC SCHOOL STUDENTS. DIABETES PREVENTION PROGRAM (DPP) CONGRESS AUTHORIZED THE CENTER FOR DISEASE TO ESTABLISH THE NATIONAL DIABETES PREVENTION PROGRAM (NATIONAL DPP; WWW.CDC.GOV/DIABETES/PREVENTION) - A PUBLIC-PRIVATE INITIATIVE TO OFFER EVIDENCE-BASED, COST EFFECTIVE INTERVENTIONS IN COMMUNITIES ACROSS THE UNITED STATES TO PREVENT TYPE 2 DIABETES. THE NATIONAL DPP, A CDC-LED LIFESTYLE CHANGE PROGRAM, HAS MORE THAN 1,300 SITES NATIONWIDE, INCLUDING COUNTY PUBLIC HEALTH DEPARTMENTS, YMCAS, COMMUNITY HEALTH CENTERS, HEALTH CARE FACILITIES, ACADEMIC INSTITUTIONS, AND COMMUNITY CENTERS. THERE ARE 86 MILLION PEOPLE WITH DIABETES AND THIS LIFESTYLE CHANGE PROGRAM HAS BEEN SHOWN TO BE COST EFFECTIVE AND CAN BE COST SAVING. THE DIABETES PREVENTION PROGRAM IS A SCIENTIFICALLY VALIDATED LIFESTYLE INTERVENTION BASED MODEL. THE CENTER FOR DISEASE CONTROL AND THE NATIONAL INSTITUTE OF HEALTH PROMOTE WIDESPREAD ADOPTION OF THE DPP DUE TO ITS DEMONSTRATED EFFECTIVENESS. WITHOUT WEIGHT LOSS AND MODERATE PHYSICAL ACTIVITY 15-30% OF PEOPLE WITH PREDIABETES WILL DEVELOP TYPE 2 DIABETES WITHIN FIVE YEARS. RESEARCH SHOWS STRUCTURED LIFESTYLE INTERVENTIONS CAN CUT THE RISK OF TYPE 2 DIABETES IN HALF. WHILE THE SCRIPPS WHITTIER DIABETES INSTITUTE HAS BEEN PROVIDING THE BEST CARE FOR PEOPLE WITH DIABETES FOR DECADES, THE INSTITUTE CONTINUED WITH THE SCRIPPS DIABETES PREVENTION PROGRAM (DPP), WHICH IS A YEARLONG INTERVENTION WHERE PEOPLE WITH PREDIABETES MEET WEEKLY FOR 16 WEEKS, THEN MONTHLY THEREAFTER. THE DIABETES PREVENTION PROGRAM (DPP) IS AN INTENSIVE LIFESTYLE INTERVENTION PROGRAM THAT HAS BEEN PROVEN TO PREVENT DIABETES IN LARGE-SCALE NATIONAL STUDIES. THE PRIMARY OBJECTIVE IS TO LOSE 5 TO 7% OF BODY WEIGHT THROUGH HEALTHY EATING AND PHYSICAL ACTIVITY. THE DIABETES PREVENTION PROGRAM HAS BEEN THOROUGHLY EVALUATED IN NIH SPONSORED RANDOMIZED CONTROLLED TRIALS, AND HAS BEEN FOUND TO DECREASE THE NUMBER OF NEW CASES OF DIABETES AMONG THOSE WITH PREDIABETES BY 58%. HEALTHY LIVING PROGRAM DIABETES, HEART DISEASE, CANCER AND RESPIRATORY DISEASE ARE THE FOUR MOST PREVALENT SERIOUS CHRONIC DISEASES IN CALIFORNIA. THESE DISEASES CAUSE 50 PERCENT OF ALL DEATHS IN SAN DIEGO AND THROUGHOUT THE U.S., AND MANY PEOPLE HAVE MORE THAN ONE OF THESE CONDITIONS. BECAUSE LIFESTYLE CAN PLAY A MAJOR ROLE IN PREVENTING THESE CHRONIC ILLNESSES, SCRIPPS INTRODUCED HEALTHY LIVING, A FREE, INTERACTIVE EDUCATION PROGRAM TO HELP THE SAN DIEGO COMMUNITY LEARN ABOUT AND ADOPT PRACTICAL WAYS TO IMPROVE THREE BEHAVIORS SMOKING, POOR DIET AND PHYSICAL INACTIVITY THAT CONTRIBUTE TO THESE FOUR DISEASES. PARTICIPANTS LEARN HOW TO MAKE HEALTHY FOOD CHOICES USING LOW COST OPTIONS, MAKE PHYSICAL ACTIVITY PART OF THEIR DAILY LIFE AND LEARN HOW TO STAY MOTIVATED AND MAINTAIN HEALTHY HABITS. SCRIPPS IMPLEMENTS A SERIES OF THREE FREE SESSIONS THAT ENCOURAGE PARTICIPANTS TO IDENTIFY AND ADOPT PRACTICAL WAYS TO IMPROVE THEIR HEALTH HABITS. SESSIONS ARE OFFERED THROUGHOUT SAN DIEGO COUNTY IN ENGLISH AND SPANISH, WITH SPECIAL EMPHASIS ON THE LATINO AND UNDERSERVED COMMUNITIES. SESSIONS INCLUDE HEALTH SCREENING, HEALTHY COOKING TIPS, AND MINDFUL EATING AND PRACTICE SESSIONS. PARTICIPANTS ALSO RECEIVE A PREDIABETES SCREENING; THOSE WHO SCORE HIGH ARE THEN REFERRED TO THE SCRIPPS DIABETES PREVENTION PROGRAM. PROMISE NEIGHBORHOOD INITIATIVE SCRIPPS ALSO ADDRESSES CHILDHOOD OBESITY AT THE HIGH SCHOOL LEVEL IN SAN DIEGOS SOUTH BAY COMMUNITIES THROUGH ITS PARTNERSHIP WITH THE PROMISE NEIGHBORHOOD INITIATIVE, WHICH IMPLEMENTS ACTIVITIES RELATED TO THE NATIONAL 5-2-1-0 CAMPAIGN. SCRIPPS PARTNERS WITH THE PROMISE NEIGHBORHOOD INITIATIVE AND CASTLE PARK ELEMENTARY SCHOOL TO INCREASE EDUCATION AND AWARENESS ABOUT HEALTHY LIFESTYLES FOR STUDENTS, THEIR PARENTS AND SCHOOL STAFF. PROMISE NEIGHBORHOOD DEVELOPED A WELLNESS COMMITTEE COMPOSED OF THE SCHOOL PRINCIPAL, TEACHERS, PARENTS AND SCRIPPS STAFF AIMED TO IMPLEMENT ACTIVITIES THAT SUPPORT 5-2-1-0: 5 FRUITS OR MORE A DAY, 2 HOURS OR LESS OF SCREEN TIME, 1 HOUR OF PHYSICAL ACTIVITY AND 0 SUGARY JUICES. SCHOOL ADMINISTRATORS AND STAFF ARE CLOSELY INVOLVED IN THE PROGRAM, WHICH INCLUDES FIVE EDUCATIONAL SESSIONS, A HEALTH ASSESSMENT SURVEY AND HEALTH PLAN, AND SUPPORT TO HELP THE STUDENTS PASS THEIR YEARLY PHYSICAL EDUCATION REQUIREMENTS. SINCE 2013, MORE THAN 400 CHILDREN AND 200 PARENTS HAVE PARTICIPATED IN WELLNESS ACTIVITIES ON CAMPUS. AS A RESULT OF ACTIVITIES, LESSON PLANS AND ADVOCACY FOR HEALTHY LIVING, THE AMOUNT OF PHYSICAL ACTIVITY AND CONSUMPTION OF FRUITS AND VEGETABLES BY CHILDREN, PARENTS AND STAFF HAS INCREASED. STUDENT RESPONSES VIA A 5-2-1-0 POST HEALTH ASSESSMENT SURVEY SHOWED THAT THERE WAS AN 80% IMPROVEMENT RATE FOR KNOWLEDGE AFTER PARTICIPATING IN THE 5-2-1-0 SESSIONS AND A 38% IMPROVEMENT RATE FOR BEHAVIOR AFTER PARTICIPATING IN THE 5-2-1-0 SESSIONS. CITY HEIGHTS WELLNESS CENTER LA MAESTRA FAMILY CLINIC, INC. JOINED THE CITY HEIGHTS WELLNESS CENTER COLLABORATIVE PARTNERSHIP WITH SCRIPPS MERCY HOSPITAL AND RADY CHILDRENS HOSPITAL AS THE LEASE HOLDER OF THE WELLNESS CENTER STARTING SEPTEMBER 1, 2016. SINCE ITS INCEPTION IN 2002, THE CITY HEIGHTS WELLNESS CENTER HAS BEEN A DYNAMIC, COMMUNITY BASED PROGRAM DEVELOPED BY SCRIPPS MERCY HOSPITAL AND RADY CHILDRENS HOSPITAL, WORKING WITH RESIDENTS TO IMPROVE THEIR LIFESTYLE BEHAVIORS AND SELF-SUFFICIENCY SKILLS. MULTIPLE NOT-FOR-PROFIT AND GOVERNMENTAL ORGANIZATIONS, PHILANTHROPIC FOUNDATIONS AND GRASSROOTS GROUPS HAVE JOINED THE EFFORT CONDUCTING HEALTH PROMOTION AND EDUCATIONAL ACTIVITIES FOR COMMUNITY RESIDENTS. A UNIQUE ASPECT OF THE CITY HEIGHTS WELLNESS CENTER IS THE TEACHING KITCHEN THAT IS KNOWN THROUGHOUT THE COMMUNITY AS A PLACE WHERE RESIDENTS AND PROVIDERS COME TOGETHER TO COOK, DISCOVER AND COMMUNICATE IN A SAFE AND TRUSTED ENVIRONMENT. LA MAESTRA FAMILY CLINIC BRINGS A NEW PERSPECTIVE TO THE PARTNERSHIP AS A COMMUNITY HEALTH CENTER AND PRIMARY CARE PROVIDER SERVING THE CULTURALLY DIVERSE POPULATIONS WITHIN THE CITY HEIGHTS COMMUNITY. LA MAESTRA IS COMMITTED TO MAINTAINING THE COLLABORATIVE NATURE OF THE PARTNERSHIP, AND CONTINUES TO WORK WITH CURRENT CHWC AGENCIES AS WELL AS LOOK FOR OPPORTUNITIES TO EXPAND HEALTH PROMOTION SERVICES. THE SCRIPPS MERCY SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC), COLLOCATED IN THE WELLNESS CENTER, WILL CONTINUE TO PROVIDE WIC SERVICES AS ONE PROGRAM WITHIN THE CITY HEIGHTS WELLNESS CENTER. COLLABORATIVE FOR HEALTHY WEIGHT THIS ADVISORY GROUP MEETS MONTHLY. COLLABORATE FOR HEALTHY WEIGHT IS A PROGRAM OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THE NATIONAL INITIATIVE FOR CHILDRENS HEALTHCARE QUALITY (NICHQ). THE SHARED VISION IS TO CREATE PARTNERSHIPS BETWEEN PRIMARY CARE, PUBLIC HEALTH, AND COMMUNITY ORGANIZATIONS TO DISCOVER SUSTAINABLE WAYS TO PROMOTE HEALTHY WEIGHT AND ELIMINATE HEALTH DISPARITIES IN COMMUNITIES ACROSS THE UNITED STATES. ALL THREE SECTOR MUST COLLABORATE, USING EVIDENCE BASED APPROACHES, TO REVERSE THE OBESITY EPIDEMIC AND IMPROVE THE HEALTH OF OUR COMMUNITIES; 120 MEMBERS. SEVERAL MANUSCRIPTS ARE UNDER DEVELOPMENT. MATERNAL CHILD HEALTH & HIGH RISK PREGNANCY MOTHERS, INFANTS AND CHILDREN MAKEUP A LARGE SEGMENT OF THE U.S. POPULATION AND THEIR WELL-BEING IS A HEALTH PREDICTOR FOR THE NEXT GENERATION. THERE IS TREMENDOUS FOCUS ON MATERNAL ILLNESS AND DEATH, AND INFANT HEALTH AND SURVIVAL, INCLUDING INFANT MORTALITY RATES, ACCESS TO PREVENTATIVE CARE, AND FETAL, PERINATAL AND OTHER INFANT DEATHS.
FORM 990, PART III, LINE 4A (CONTINUED)	MATERNAL AND INFANT HEALTH ISSUES INCLUDE: - ALCOHOL, TOBACCO AND ILLEGAL SUBSTANCES DURING PREGNANCY, WHICH ARE MAJOR RISK FACTORS FOR LOW BIRTH WEIGHT AND OTHER POOR OUTCOMES. - VERY LOW BIRTH WEIGHT ASSOCIATED WITH PRETERM BIRTH, SPONTANEOUS ABORTION, LOW PRE-PREGNANCY WEIGHT AND SMOKING. - INFANT DEATH RATES ARE HIGHEST AMONG INFANTS BORN TO YOUNG TEENAGERS AND MOTHERS 44 YEARS AND OLDER. BEING PREGNANT, OR TRYING TO BECOME PREGNANT, IS ONLY A SMALL PORTION OF A WOMANS LIFE. UNINTENDED PREGNANCY, EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION, ACCOUNTS FOR AN ESTIMATED 49 PERCENT OF PREGNANCIES IN THE U.S. THESE PREGNANCIES ARE ASSOCIATED WITH INCREASED MORBIDITY, AS WELL AS BEHAVIORS LINKED TO ADVERSE HEALTH. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THEIR CHILDREN EXPERIENCE IMPROVED HEALTH, FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND LOWER ABORTION RATES. HIGH RISK PREGNANCY HIGH RISK PREGNANCY CAN BE THE RESULT OF A MEDICAL CONDITION PRESENT BEFORE PREGNANCY OR A MEDICAL CONDITION THAT DEVELOPS DURING PREGNANCY FOR EITHER MOM OR BABY AND CAUSES THE PREGNANCY TO BECOME HIGH RISK. A HIGH RISK PREGNANCY CAN POSE PROBLEMS BEFORE, DURING OR AFTER DELIVERY AND MIGHT REQUIRE SPECIAL MONITORING THROUGHOUT THE PREGNANCY. RISK FACTORS: - ADVANCED MATERNAL AGE: INCREASED RISK FOR MOTHERS 35 YEARS AND OLDER. - LIFESTYLE CHOICES: SMOKING, ALCOHOL CONSUMPTION, USE OF ILLEGAL DRUGS. - MEDICAL HISTORY: PRIOR HIGH RISK PREGNANCIES OR DELIVERIES, FETAL GENETIC CONDITIONS, FAMILY HISTORY OF GENETIC CONDITIONS. - UNDERLYING CONDITIONS: DIABETES, HIGH BLOOD PRESSURE AND EPILEPSY. - MULTIPLE PREGNANCY. - OBESITY DURING PREGNANCY THERE WERE 43,627 LIVE BIRTHS IN SDC OVERALL IN 2013 AND THE FETAL MORTALITY IN SDC WAS 4.56 DEATHS, MEETING THE HP 2020 NATIONAL TARGETS FOR ALL MATERNAL AND INFANT HEALTH INDICATORS INCLUDING THE TARGET OF LESS THAN 5.6 FETAL DEATHS PER 1,000 LIVE BIRTHS AND FETAL DEATHS. MATERNAL AND INFANT HEALTH INDICATORS BY SDC REGION, 2013 SDC REGIONS MET ALL HP 2020 NATIONAL TARGETS IN 2013. IN 2013, FETAL MORTALITY WAS 4.5 FETAL DEATHS PER 1,000 LIVE BIRTHS AND FETAL DEATHS IN THE NORTH COASTAL REGION, 4.3 IN THE NORTH CENTRAL REGION, 5.7 IN THE CENTRAL REGION, 3.1 IN THE SOUTH REGION, 5.6 IN THE EAST REGION, AND 4.1 IN THE NORTH INLAND REGION. SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION FOR LOW INCOME WOMEN IN SAN DIEGO COUNTY IN FISCAL YEAR 2017. THE FOLLOWING ARE SOME EXAMPLES: COMMUNITY BENEFIT SERVICES - OFFERED MORE THAN 1,200 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY TO ENHANCE PARENTING SKILLS. LOW INCOME WOMEN IN SAN DIEGO WHO WERE ELIGIBLE ATTENDED CLASSES AT NO CHARGE OR ON A SLIDING FEE SCHEDULE. - MAINTAINED EXISTING PRENATAL EDUCATION SERVICES IN ALL REGIONS OF THE COUNTY, ENSURING THAT PROGRAMS CONTINUED TO DEMONSTRATE A SATISFACTION RATING ABOVE 87 PERCENT. - PROVIDED AND SUPPORTED WEEKLY BREASTFEEDING SUPPORT GROUPS AT SIX LOCATIONS THROUGHOUT SAN DIEGO COUNTY, INCLUDING TWO WITH BILINGUAL SERVICES. - OFFERED MATERNAL CHILD HEALTH CLASSES THROUGHOUT THE COMMUNITY, SUCH AS BASIC TRAINING FOR DADS, GETTING READY FOR THE BABY, GRAND PARENTING TODAY, PARENT CONNECTION PROGRAMS AND REDIRECTING CHILDRENS BEHAVIOR. - OFFERED THE DOGS AND BABIES PROGRAMS QUARTERLY, WITH MORE THAN 40 ATTENDEES. - OFFERED A PRENATAL YOGA PROGRAM FOR EXPECTANT WOMEN IN SAN DIEGO COUNTY. - OFFERED CLASSES IN PELVIC FLOOR AND POSTPARTUM CHANGES FOR NEW MOTHERS THROUGHOUT THE COMMUNITY. FIRST 5 AND PROMISE NEIGHBORHOOD MORE THAN 400 SERVICES WERE RECEIVED FOR FIRST TIME MOTHERS INCLUDING: HOME VISITS, REFERRALS RECEIVED, DATA ENTRY, FOLLOW UP PHONE CALLS, PATENTING CLASSES AND OTHER SUPPORT SERVICES. A TOTAL OF 231 PARENTS PARTICIPATED IN PARENTING CLASSES, 185 SESSIONS PROVIDED. SCRIPPS MERCYS SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) THE SPECIAL SUPPLEMENT NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS ESTABLISHED AS A PERMANENT PROGRAM IN 1974 TO SAFEGUARD THE HEALTH OF LOW-INCOME WOMEN, INFANTS AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES APPROXIMATELY 6,500 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FISCAL YEAR 2017, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 76,707 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS SUPPLIES, PUMPS AND BREAST PADS, DURING THE POSTPARTUM PERIOD. CENTERING PREGNANCY, SCRIPPS FAMILY MEDICINE RESIDENCY RAISING HEALTHY FAMILIES AND CARING FOR THE NEXT GENERATION OF SAN DIEGANS BEFORE THEYRE BORN HELP CREATE A HEALTHIER COMMUNITY FOR YEARS TO COME. THE SCRIPPS FAMILY MEDICINE PROGRAM AT SCRIPPS MERCY HOSPITAL CHULA VISTA, IS PROVIDING ACCESS, EDUCATION AND CLINICAL SERVICES TO NEARLY 200 PREGNANT WOMEN IN SOUTH SAN DIEGO COUNTY. THE GOAL OF THE PROGRAM, "IMPROVING PERINATAL CARE FOR UNDERSERVED LATINA WOMEN - HEALTHY WOMEN, HEALTHY BABIES," IS TO PROVIDE ACCESS TO PERINATAL CARE FOR UNDERSERVED LATINA WOMEN IN ORDER TO IMPROVE BIRTH OUTCOMES. THE PROGRAM APPLIES THE PRINCIPLES OF THE CENTER HEALTH CARE INSTITUTE AND FOCUSES ON CHANGING THE WAY PATIENTS EXPERIENCE THEIR CARE THROUGH ASSESSMENT, EDUCATION AND GROUP SUPPORT. CENTERING PREGNANCY IS THE INSTITUTES MODEL DEVOTED SPECIFICALLY TO IMPROVING MATERNAL AND CHILD HEALTH, AND HAS BEEN SHOWN TO RESULT IN INCREASED PRENATAL VISITS, GREATER LEVELS OF BREASTFEEDING AND STRONGER RELATIONSHIPS BETWEEN MOTHERS AND THEIR HEALTHCARE PROVIDERS BEFORE, DURING AND AFTER PREGNANCY. THE RESULTS ARE PROMISING. WOMEN WHO GAVE BIRTH REPORTED AN ENHANCED PRENATAL EXPERIENCE, GAINED LESS WEIGHT THROUGHOUT THEIR PREGNANCY AND SHOWED IMPROVED HEALTHCARE KNOWLEDGE. AS THE PROGRAM CONTINUES, PATIENT NAVIGATORS WILL FOLLOW-UP WITH PARTICIPANTS TO GAUGE OTHER IMPORTANT FACTORS AND HELP THEM MAINTAIN HEALTHY LIFESTYLES. UNINTENTIONAL INJURY AND VIOLENCE UNINTENTIONAL INJURIES OCCUR AT HOME, AT WORK, WHILE PARTICIPATING IN SPORTS AND RECREATION, ON THE STREETS AND AT SCHOOL AND ARE ASSOCIATED WITH MOTOR VEHICLE ACCIDENTS, FALLS, FIREARMS, FIRE/BURNS, DROWNING, POISONING (INCLUDING DRUGS AND CAUSTIC SUBSTANCES), ALCOHOL, GAS, CLEANERS AND MANY OTHER CAUSES. THE DEATHS ASSOCIATED WITH UNINTENTIONAL INJURIES ARE SIGNIFICANT, YET REPRESENT ONLY A SMALL PART OF A MUCH LARGER PUBLIC HEALTH PROBLEM. HOSPITALIZATION DATA IS A BETTER MEASURE OF THE INJURY PROBLEM THAN THE DEATH DATA ALONE. UNINTENTIONAL INJURIES, MOTOR VEHICLE ACCIDENTS, FALLS, PEDESTRIAN RELATED, FIREARMS, FIRE/BURNS, DROWNING, EXPLOSION, POISONING (INCLUDING DRUGS AND ALCOHOL, GAS, CLEANERS AND CAUSTIC SUBSTANCES) CHOKING/SUFFOCATION, CUT/PIERCE, EXPOSURE TO ELECTRIC CURRENT/RADIATION/FIRE/SMOKE, NATURAL DISASTERS AND INJURIES AT WORK, ARE ONE OF THE LEADING CAUSES OF DEATH FOR SDC RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. MOST EVENTS RESULTING IN INJURY, DISABILITY OR DEATH ARE PREDICTABLE AND PREVENTABLE. THERE ARE MANY RISK FACTORS FOR UNINTENTIONAL INJURY AND VIOLENCE, INCLUDING INDIVIDUAL BEHAVIORS AND CHOICES, SUCH AS ALCOHOL USE OR RISK TAKING; THE PHYSICAL ENVIRONMENT BOTH AT HOME AND IN THE COMMUNITY; ACCESS TO HEALTH SERVICES AND SYSTEMS CREATED FOR INJURY RELATED CARE; THE SOCIAL ENVIRONMENT, INCLUDING INDIVIDUAL SOCIAL EXPERIENCES. ACCORDING TO THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTHS, BURDEN OF CHRONIC DISEASE AND INJURY REPORT: CALIFORNIA, 2013 INJURIES, INCLUDING BOTH INTENTIONAL AND UNINTENTIONAL, IS THE NUMBER ONE KILLER AND DISABLER OF PERSONS AGES 1 TO 44 YEARS IN CALIFORNIA. THE SAME REPORT STATES THAT EVERY YEAR IN CALIFORNIA, INJURIES, CAUSE MORE THAN 16,000 DEATHS, 75,000 CASES OF DISABILITY, 240,000 HOSPITALIZATIONS, AND 2.3 MILLION ED VISITS. BETWEEN 2010 AND 2013, NEARLY 4,000 SAN DIEGANS DIED AS A RESULT OF UNINTENTIONAL INJURIES. THE REGIONS AGE-ADJUSTED DEATH RATE DUE TO UNINTENTIONAL INJURIES WAS 37.4 DEATHS PER 100,000 POPULATION, THE HIGHEST OF ALL REGIONS IN SDC AND ABOVE THE SDC AGE-ADJUSTED RATE OF 30.6 DEATHS PER 100,000 POPULATION. IN 2013, THERE WERE 3,995 HOSPITALIZATIONS RELATED TO UNINTENTIONAL INJURY IN SDCS EAST REGION. THE AGE-ADJUSTED RATE OF HOSPITALIZATIONS WAS 785 PER 100,000 POPULATION, WHICH IS ABOVE THE COUNTY AGE-ADJUSTED AVERAGE OF 691.5 PER 100,000 POPULATION.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS HEALTH CONTINUES TO ADDRESS UNINTENTIONAL INJURY AND VIOLENCE IN FISCAL YEAR 2017. THE FOLLOWING ARE SOME EXAMPLES: AARP DRIVER SAFETY PROGRAM AN EIGHT HOUR DRIVER IMPROVEMENT COURSE ESPECIALLY DESIGNED FOR MOTORISTS AGE 50 AND OLDER. THE COURSE HELPS DRIVERS REFINE EXISTING SKILLS AND DEVELOP SAFE, DEFENSIVE DRIVING TECHNIQUES. OPEN TO AARP MEMBERS AND NON-MEMBERS ALIKE. AGING SUMMIT EXPO SCRIPPS PROVIDED EDUCATION REGARDING HOME SAFETY, FALL PREVENTION AND MEDICATION SAFETY. FALL PREVENTION AND HOME SAFETY SCRIPPS SOCIAL WORKER AND RN LECTURE ON WAYS TO REDUCE FALL RISK, IMPROVE SAFETY AWARENESS AND UTILIZE AVAILABLE RESOURCES TO PROMOTE INDEPENDENCE AND OVERALL SAFETY. SAN DIEGO BRAIN INJURY FOUNDATION PROVIDE QUALITY OF LIFE IMPROVEMENTS FOR BRAIN INJURY SURVIVORS AND SUPPORT TO FAMILY MEMBERS. SCRIPPS MEMORIAL HOSPITAL ENCINITAS DONATES SPACE TO THIS ORGANIZATION FOR MEETINGS. BRAINMASTERS BRAINMASTERS IS A SUPPORTIVE COMMUNICATION GROUP FOR ADULTS COPING WITH ACQUIRED BRAIN INJURY. IT IS OFFERED AS COMMUNITY BENEFIT THROUGH THE REHABILITATION CENTER AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS. THE MAIN GOAL OF BRAINMASTERS IS TO HELP BRAIN INJURY SURVIVORS TO BUILD CONFIDENCE BY PRACTICING THINKING ON THEIR FEET. THIS HELPS TO ALLEVIATE CHALLENGES WITH COMMUNICATION AND SOCIAL ISOLATION THAT SO MANY BRAIN INJURY SURVIVORS EXPERIENCE. EVERY 15 MINUTES ALCOHOL CAN BE ATTRIBUTED TO MORE THAN 100,000 DEATHS IN THE U.S. ANNUALLY, INCLUDING 41% OF ALL TRAFFIC FATALITIES. THE EVERY 15 MINUTES PROGRAM IS A TWO-DAY IMMERSION EXPERIENCE FOR TEENS ON THE REALISTIC CONSEQUENCES OF DRINKING AND DRIVING, WHICH INVOLVES THE SCHOOLS, LAW ENFORCEMENT, COURTS, EMERGENCY SERVICE PROVIDERS, AND THE MORTUARY. THE "INJURED" STUDENTS ARE TAKEN TO SCRIPPS MERCY TRAUMA CENTER. THIS PROGRAM IS SPONSORED JOINTLY BY LOCAL HIGH SCHOOLS, COUNTY POLICE AND SHERIFFS DEPARTMENTS, AMBULANCE SERVICES, AND EMERGENCY DEPARTMENTS. BEACH AREA COMMUNITY COURT PROGRAM THE PROGRAM IS AN EDUCATIONAL PROGRAM FOR FIRST TIME OFFENDERS FOR QUALITY OF LIFE CRIMES. THIS IS A COLLABORATION WITH THE SAN DIEGO POLICE DEPARTMENT, PARKS AND RECREATION, DISTRICT ATTORNEYS OFFICE AND DISCOVER PACIFIC BEACH. EDUCATION IS PROVIDED TO THE PARTICIPANTS REGARDING THESE QUALITY OF LIFE CRIMES AND THEIR EFFECTS ON THE COMMUNITY, THE EFFECTS OF SMOKING AND ALCOHOL CONSUMPTION AND THE RULES AND REGULATIONS FOR THE BEACH COMMUNITY. SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE SCRIPPS HAS PARTNERED WITH THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE TO OFFER "SOFT ROOMS" AT ALL SCRIPPS HOSPITAL FACILITIES EXCEPT SCRIPPS GREEN HOSPITAL. THESE SOFT ROOMS WILL BE AVAILABLE TO PROJECT LIFE ON A MOMENTS NOTICE TO SERVE AS A SAFE, CONFIDENTIAL ENVIRONMENT FOR LAW ENFORCEMENT TO INTERVIEW VICTIMS OF HUMAN TRAFFICKING AND FOR SERVICE PROVIDERS TO CONNECT WITH THE VICTIMS WITH EMERGENCY SHELTER AND COMMUNITY RESOURCES. THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE RECEIVES 3,000 TO 8,000 HUMAN TRAFFICKING VICTIMS EVERY YEAR IN SAN DIEGO COUNTY. APPROXIMATELY 80 PERCENT ARE BORN IN THE UNITED STATES. BEHAVIORAL HEALTH BEHAVIORAL HEALTH IS AN IMPORTANT HEALTH NEED BECAUSE IT IMPACTS AN INDIVIDUALS OVERALL HEALTH STATUS AND IS A COMORBIDITY OFTEN ASSOCIATED WITH MULTIPLE CHRONIC CONDITIONS, SUCH AS DIABETES, OBESITY AND ASTHMA. BEHAVIORAL HEALTH ENCOMPASSES MANY DIFFERENT AREAS INCLUDING MENTAL HEALTH, MENTAL ILLNESS AND SUBSTANCE ABUSE. BECAUSE OF ITS BROADNESS, IT IS OFTEN DIFFICULT TO CAPTURE THE NEED FOR BEHAVIORAL HEALTH SERVICES WITH A SINGLE MEASURE. AN ANALYSIS OF MORTALITY DATA IN SAN DIEGO COUNTY FOUND THAT IN 2012, ALZHEIMERS DISEASE WAS THE THIRD LEADING CAUSE OF DEATH AND INTENTIONAL SELF-HARM (SUICIDE) WAS THE EIGHTH. HOSPITAL EMERGENCY DEPARTMENT ENCOUNTERS AND INPATIENT DISCHARGE DATA FOR PATIENTS WITH A PRIMARY DIAGNOSIS OF BEHAVIORAL HEALTH-ASSOCIATED ICD 9 CODE IN 2013 WAS USED TO PROVIDE AN OVERVIEW OF MAIN REASONS INDIVIDUALS SOUGHT CARE RELATED TO BEHAVIORAL HEALTH BY AGE GROUP. A SUMMARY OF THE TRENDS FOUND WERE AS FOLLOWS: - OSHPD ED DISCHARGE DATA: ANXIETY DISORDERS WERE THE TOP PRIMARY DIAGNOSIS FOR ED DISCHARGE AMONG THOSE AGED 5 THROUGH 44 AND THOSE 65 AND OLDER. FOR THOSE AGED 45-64, THE TOP ED DISCHARGE FOR BEHAVIORAL HEALTH WAS ALCOHOL-RELATED DISORDER FOLLOWED BY ANXIETY AND MOOD DISORDERS. ALCOHOL RELATED DISORDERS WAS THE NUMBER TWO PRIMARY DIAGNOSIS FOR DISCHARGE FOR THOSE AGED 15 THROUGH 44 AND THOSE 65 YEARS AND OLDER. - OSHPD INPATIENT DISCHARGE DATA REVEALED THAT WHEN EXAMINING THE ICD 9 CODES RELATED TO BEHAVIORAL HEALTH, 'MOOD DISORDERS' WAS THE TOP PRIMARY DIAGNOSIS FOR INPATIENT DISCHARGE FOR AGES 5 THROUGH 24 AND 45 AND OVER. FOR THOSE AGED 25 THROUGH 44, THE TOP BEHAVIORAL HEALTH PRIMARY DIAGNOSIS WAS 'SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS' FOLLOWED BY MOOD DISORDERS. - FEEDBACK FROM THE BEHAVIORAL HEALTH DISCUSSIONS IN THE 2016 CHNA FOUND THAT HIGH RATES OF PSYCHOTIC DISCHARGES IN AGES 25 TO 44 WERE LIKELY LINKED TO UNDERLYING SUBSTANCE ABUSE PROBLEMS. ALTHOUGH PARTICIPANTS AGREED WITH THE FINDINGS, IT WAS FOUND THAT HOSPITAL CODING MAY POTENTIALLY UNDERREPRESENT THE PREVALENCE OF UNDERLYING ISSUES AND MISS CERTAIN CONDITIONS. MOST NOTABLY MISSING FROM OSHPD DATA WAS DEVELOPMENTAL DISORDERS. THE GROUPS ALSO POINTED OUT THE IMPORTANCE OF EMERGING DATA TRENDS. IN RECENT YEARS, DISCUSSION PARTICIPANTS CITED A SIGNIFICANT INCREASE IN DRUG-RELATED DISCHARGES, PARTICULARLY METHAMPHETAMINE (~OVER 100%). IN THE 2016 CHNA MENTAL HEALTH ISSUES AND ALCOHOL/DRUG ABUSE ISSUES WERE CONSISTENTLY SELECTED BY THE HIGHEST NUMBER OF HHSA SURVEY PARTICIPANTS IN ALL REGIONS AS HEALTH PROBLEMS THAT HAVE THE GREATEST IMPACT ON OVERALL COMMUNITY HEALTH. IN ADDITION, AGING CONCERNS INCLUDING ALZHEIMERS DISEASE WAS CITED AMONG THE TOP FIVE MOST IMPORTANT HEALTH NEEDS IN ALL REGIONS IN SDC EXCEPT THE CENTRAL REGION. THE FOLLOWING CATEGORIES WERE FOUND TO BE IMPORTANT HEALTH NEEDS WITH BEHAVIORAL HEALTH IN SDC: - ALZHEIMERS DISEASE (SENIORS) - ANXIETY (ALL AGE GROUPS) - DRUG AND ALCOHOL ISSUES (TEENS AND ADULTS) - MOOD DISORDERS (ALL AGE GROUPS) ANXIETY: ANXIETY IS A NORMAL REACTION TO STRESS BUT CAN BECOME EXCESSIVE, DIFFICULT TO CONTROL, AND ULTIMATELY INTERFERE WITH NORMAL DAY-TO-DAY LIVING. THERE ARE WIDE VARIETY OF ANXIETY DISORDERS INCLUDING POST-TRAUMATIC STRESS DISORDER. NATIONAL PREVALENCE DATA ESTIMATES THAT 18% OF THE POPULATION HAD AN ANXIETY DISORDER, WITH PHOBIAS AND GENERALIZED ANXIETY BEING THE MOST COMMON. IN SAN DIEGO COUNTY, THERE HAS BEEN A STEADY INCREASE IN THE RATE OF ED DISCHARGES WITH A PRIMARY DIAGNOSIS OF ANXIETY. IN PARTICULAR, THERE HAS BEEN A 64.2% INCREASE IN CHILDREN UP TO AGE 14 FROM 25 PER 100,000 IN 2010 TO 41 PER 100,000 IN 2013. SUBSTANCE ABUSE: THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) DEFINES SUBSTANCE USE DISORDERS AS THE RECURRENT USE OF ALCOHOL AND/OR DRUGS WHICH CAUSES CLINICALLY AND FUNCTIONALLY SIGNIFICANT IMPAIRMENT, SUCH AS HEALTH PROBLEMS, DISABILITY, AND FAILURE TO MEET MAJOR RESPONSIBILITIES AT WORK, SCHOOL, OR HOME. THE PERCENTAGE OF ADULTS AGED 18 AND OLDER IN SAN DIEGO COUNTY WHO SELF-REPORT HEAVY ALCOHOL CONSUMPTION (DEFINED AS MORE THAN TWO DRINKS PER DAY ON AVERAGE FOR MEN AND ONE DRINK PER DAY ON AVERAGE FOR WOMEN) IS 17.2%, ADDITIONALLY, 12.1% REPORTED CURRENTLY SMOKING CIGARETTES SOME DAYS OR EVERYDAY ACCORDING TO THE BRFSS. ACUTE SUBSTANCE ABUSE HOSPITALIZATION RATES INCREASED 37.4% FROM 2010 TO 2013 AND INCREASED MOST AMONG 15-24 YEAR OLDS (58%). ACUTE ALCOHOL HOSPITALIZATION RATES GREW MOST AMONG 25-44 YEAR OLDS WITH A 45.9% INCREASE BETWEEN 2010 AND 2013. FINALLY, CHRONIC ALCOHOL ED VISITS AMONG SENIORS AGED 65 AND OLDER INCREASED 89.7% DURING THE SAME PERIOD. ALZHEIMERS DISEASE: ALZHEIMERS IS THE MOST COMMON FORM OF DEMENTIA ALTHOUGH ALL DEMENTIAS ARE CHARACTERIZED BY A DECLINE IN MEMORY, THINKING SKILLS, AND ABILITY TO PERFORM EVERYDAY ACTIVITIES. ACCORDING TO THE 2015 SAN DIEGO COUNTY SENIOR HEALTH REPORT, ROUGHLY 60,000 INDIVIDUALS IN SAN DIEGO ARE LIVING WITH ALZHEIMERS DISEASE OR OTHER DEMENTIA (ADOD) IN 2012. IT IS PROJECTED THAT THE NUMBER OF SAN DIEGO ADULTS AGED 55 AND OLDER WITH ADOD WILL INCREASE BY 55.9% BETWEEN 2012 AND 2030. THE LARGEST MAJORITY OF INDIVIDUALS LIVE IN THE EAST REGION THOUGH THE LARGEST PERCENTAGE IS PROJECTED IN THE NORTH CENTRAL REGION. ADOD ALSO AFFECTS CAREGIVERS PHYSICALLY AND EMOTIONALLY SO SIGNIFICANT INCREASES IN THE NUMBER OF PEOPLE LIVING WITH ADOD WILL HAVE AN IMPACT THAT EXTENDS BEYOND THOSE AFFECTED.
FORM 990, PART III, LINE 4A (CONTINUED)	MOOD DISORDERS: MOOD DISORDERS ARE PARTICULARLY PREVALENT IN THE COMMUNITY AND INCREASING. DATA FROM THE CENTERS FOR MEDICARE AND MEDICAID SHOW THAT AMONG THE FEE-FOR-SERVICE POPULATION, 14.5% SUFFER FROM DEPRESSION COMPARED TO 13.4% IN CALIFORNIA IN 2012. IN ADDITION, AN ANALYSIS OF OSHPD DATA SHOWS THAT THE RATE OF ED DISCHARGES PER 100,000 INDIVIDUALS WITH A PRIMARY DIAGNOSIS OF MOOD DISORDERS INCREASED BY 38.7% FROM 2010 TO 2013 FOR CHILDREN UP TO AGE 14, HOSPITALIZATIONS ALSO WENT UP BY 26.8% IN THIS AGE GROUP. MOOD DISORDERS ARE OFTEN ASSOCIATED WITH COMORBIDITIES INCLUDING DIABETES, OBESITY AND ASTHMA. SUICIDE IS ALSO AN INDICATOR OF POOR MENTAL HEALTH AND IS ONE OF THE MAJOR COMPLICATIONS OF DEPRESSION. IN SAN DIEGO COUNTY, THE SUICIDE RATE ACCORDING TO THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH IS 11.3 PER 100,000 POPULATION WHICH IS ABOVE THE STATE SUICIDE RATE OF 9.8 PER 100,000 AND ABOVE THE HP2020 BENCHMARK OF 10.2 PER 100,000 POPULATION. IT IS ALSO THE EIGHTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. WHEN ADJUSTING FOR RACE/ETHNICITY, NON-HISPANIC WHITES ARE MORE LIKELY TO COMMIT SUICIDE FOLLOWED BY NATIVE HAWAIIAN/PACIFIC ISLANDERS. COMPARING SUICIDE RATES BY RACE, NON-HISPANIC, BLACK, ASIAN, NATIVE HAWAIIAN/PACIFIC ISLANDERS, AND THOSE OF MULTIPLE RACES WERE ALL ABOVE STATE LEVELS. MENTAL AND BEHAVIOR HEALTH COVERS A BROAD RANGE OF TOPICS: - SUBSTANCE ABUSE AND MISUSE ARE ONE SET OF BEHAVIORAL HEALTH PROBLEMS. OTHERS INCLUDE (BUT NOT LIMITED TO) SERIOUS PSYCHOLOGICAL DISTRESS, SUICIDE, AND MENTAL ILLNESS. - BARRIERS CAN EXIST FOR PATIENTS ACROSS THE LIFESPAN. THE NATIONAL SURVEY FOR CHILDRENS HEALTH (HRSA, 2010) SHOWED THAT AMONG CHILDREN WITH EMOTIONAL, DEVELOPMENTAL, OR BEHAVIORAL CONDITIONS, 45.6% WERE RECEIVING NEEDED MENTAL HEALTH SERVICES. - IN 2014, AMONG THE 20.2 MILLION ADULTS WITH A PAST YEAR SUBSTANCE USE DISORDER, 7.9 MILLION (39.1%) HAD ANY MENTAL ILLNESS IN THE PAST YEAR. DEPRESSION: - DEPRESSION IS THE LEADING CAUSE OF DISABILITY WORLDWIDE AND IS A MAJOR CONTRIBUTOR OF GLOBAL BURDEN OF DISEASE. - IN 2014, 11.4% OF ADOLESCENTS AGED 12 TO 17 HAD A MAJOR DEPRESSIVE EPISODE. THE PERCENTAGE WHO USED ILLICIT DRUGS IN THE PAST YEAR WAS HIGHER AMONG THOSE WITH A PAST YEAR MAJOR DEPRESSIVE EPISODE (MDE) THAN IT WAS AMONG THOSE WITHOUT A PAST YEAR MDE (33% VS. 15.2%). PREVALENCE: - IN 2014, AN ESTIMATED 43.6 MILLION (ROUGHLY 18%) ADULTS AGED 18 OR OLDER HAD ANY MENTAL ILLNESS IN THE UNITED STATES. - ONE-HALF OF ALL CHRONIC MENTAL ILLNESS BEGINS BY THE AGE OF 14; THREE QUARTERS BY THE AGE OF 24. DISPARITIES AND BEHAVIORAL HEALTH: BEHAVIORAL HEALTH & RACE - COMPARED WITH WHITES, AFRICAN AMERICANS AND HISPANIC AMERICANS USED MENTAL HEALTH SERVICES AT ABOUT ONE-HALF THE RATE IN 2010. - BLACK ADULTS AND ADOLESCENTS WERE LESS LIKELY THAN THEIR WHITE COUNTERPARTS TO RECEIVE TREATMENT FOR DEPRESSION. - AMERICAN INDIAN/ALASKAN NATIVE ADULTS AND THOSE OF TWO OR MORE RACES HAD THE HIGHEST PREVALENCE OF MENTAL ILLNESS WITH 26% AND 28% LIVING WITH A MENTAL HEALTH CONDITION, RESPECTIVELY. BEHAVIORAL HEALTH & HOUSING - AN ESTIMATED 26% OF HOMELESS ADULTS STAYING IN SHELTERS LIVE WITH SERIOUS MENTAL ILLNESS AND AN ESTIMATED 46% LIVE WITH SEVERE MENTAL ILLNESS AND/OR SUBSTANCE USE DISORDERS. BEHAVIORAL HEALTH & GENDER - MALES COMMIT SUICIDE FOUR TIMES MORE THAN FEMALES. - ADULT MALES WERE LESS LIKELY THAN ADULT FEMALES TO RECEIVE TREATMENT FOR DEPRESSION. BEHAVIORAL HEALTH & SEXUALITY - LGBTQ INDIVIDUALS ARE TWO OR MORE TIMES LIKELY AS STRAIGHT INDIVIDUALS TO HAVE A MENTAL HEALTH CONDITION. BEHAVIORAL HEALTH & CHRONIC DISEASE - MENTAL ILLNESS IS ASSOCIATED WITH CHRONIC DISEASES SUCH AS CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY. SUICIDE AND SUICIDE ATTEMPTS SUICIDE IS A MAJOR COMPLICATION OF DEPRESSION AND A LEADING CAUSE OF NON-NATURAL DEATH FOR ALL AGES IN SAN DIEGO COUNTY, SECOND ONLY TO MOTOR VEHICLE ACCIDENTS. WHILE THE U.S. AND CALIFORNIA STRUGGLE WITH RISING SUICIDE RATES, THE 2015 SAN DIEGO COUNTY (SDC) DATA REVEALED THAT SDC IS HOLDING ITS GROUND ON PROGRESS MADE LAST YEAR. COMPARED TO 2014, WHEN THE SUICIDE RATE DECLINED FOR THE FIRST TIME IN RECENT HISTORY, THE SUICIDE RATE IN 2015 HELD STEADY AT 13.2 PER 100,000 POPULATION. GAINS IN HELP-SEEKING AMONG SAN DIEGANS ARE ALSO STAYING THE COURSE. CRISIS CALLS TO THE LOCAL ACCESS & CRISIS HOTLINE ROSE 1% IN 2015 ON TOP OF THE 15% INCREASE IN 2014. FOR MORE INFORMATION ON THE STATUS OF SUICIDE AND SUICIDE PREVENTION IN SAN DIEGO COUNTY SEE 2017 REPORT CARD AT http://www.sdchip.org/initiatives/suicide-prevention-council/reports-resou rces/ IN 2010, THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA) LAUNCHED A SUICIDE PREVENTION PLANNING PROCESS, WHICH WAS FORMED BY THE NATIONAL STRATEGY FOR SUICIDE PREVENTION AND THE CALIFORNIA STRATEGIC PLAN ON SUICIDE PREVENTION. SCRIPPS IS A MEMBER OF THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP), WHICH COLLABORATES WITH THE COUNTY ON THIS INITIATIVE. THE BEHAVIORAL HEALTH PROGRAM AT SCRIPPS MERCY ALSO SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. SCRIPPS HEALTH BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. THE BEHAVIORAL HEALTH INPATIENT PROGRAM AT SCRIPPS MERCY HOSPITAL HELPS PATIENTS AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. CHALLENGES - LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. - IN 2017, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM LOST $1.6 MILLION IN OPERATING EXPENSES. - IN 2017, 2.3 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE INTENSIVE BEHAVIORAL HEALTH OUTPATIENT PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) AND EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE POPULATION SERVED. SCRIPPS MERCY AND FAMILY HEALTH CENTERS BEHAVIORAL HEALTH PARTNERSHIP SCRIPPS MERCY HAS ESTABLISHED AN INITIATIVE WITH FHCSD TO CREATE A MORE ROBUST BEHAVIORAL HEALTH CARE SYSTEM FOR MEDI-CAL PATIENTS THAT RECEIVE CARE AT SMH. THE GOAL IS TO STRENGTHEN THE CONTINUUM OF INTEGRATED PRIMARY AND MENTAL HEALTH SERVICES FOR PATIENTS DISCHARGED FROM VARIOUS HOSPITAL SETTINGS (MEDICAL AND BEHAVIORAL HEALTH INPATIENT AND EMERGENCY CARE) THROUGH A VARIETY OF TIMELY PATIENT ENGAGEMENT STRATEGIES INCLUDING THE EXPANSION OF COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES ADJACENT TO THE HOSPITAL. THE ULTIMATE GOAL IS TO INVOLVE PATIENTS IN APPROPRIATE OUTPATIENT CARE BEFORE THEIR BEHAVIORAL HEALTH ISSUES BECOME ACUTE SO THEY DO NOT RETURN TO THE EMERGENCY DEPARTMENT. MENTAL HEALTH OUTREACH SERVICES, A-VISIONS VOCATIONAL TRAINING PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, IN PARTNERSHIP WITH THE SAN DIEGO CHAPTER OF MENTAL HEALTH OF AMERICA ESTABLISHED THE A-VISIONS VOCATIONAL TRAINING PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS) TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS AND OFFER VOLUNTEER AND EMPLOYMENT OPPORTUNITIES TO PERSONS WITH MENTAL ILLNESS. THIS SUPPORTIVE EMPLOYMENT PROGRAM PROVIDES VOCATIONAL TRAINING FOR PEOPLE RECEIVING MENTAL HEALTH TREATMENT, POTENTIALLY LEADING TO GREATER INDEPENDENCE. THIS YEAR, BEHAVIORAL HEALTH SERVICES CONTINUED PARTICIPATING IN THE A-VISIONS PROGRAM.
FORM 990, PART III, LINE 4A (CONTINUED)	SINCE ITS INCEPTION, 530 CLIENTS HAVE BEEN ENROLLED AND 93 HAVE BEEN SCRIPPS VOLUNTEERS AND 50 HAVE BEEN EMPLOYED AT SCRIPPS HEALTH. CURRENTLY, THERE ARE A TOTAL OF 25 ACTIVE CANDIDATES, 23 EMPLOYEES AND TWO VOLUNTEERS PARTICIPATING IN THIS SUPPORTIVE EMPLOYMENT PROGRAM. A-VISIONS PARTICIPANTS HAVE BEEN EMPLOYED ON A CASUAL/PER DIEM BASIS BY SCRIPPS ENVIRONMENTAL SERVICES, FOOD SERVICES AND CLERICAL SUPPORT FOR HEALTH AND INFORMATION SERVICES, EMERGENCY SERVICES, NURSING RESEARCH, HUMAN RESOURCES, ACCESS, BEHAVIORAL HEALTH, CREDENTIALING, LABOR AND DELIVERY, LABORATORY, MEDICAL STAFFING, PERFORMANCE IMPROVEMENT, SPIRITUAL CARE AND PALLIATIVE CARE SERVICES. PAID A-VISIONS CANDIDATES TYPICALLY LIMIT THEIR WORK TO EIGHT HOURS PER WEEK, WHICH ALLOWS THEM TO MAINTAIN ELIGIBILITY FOR THE DISABILITY BENEFITS, MEDICATIONS AND ONGOING BEHAVIORAL HEALTHCARE THAT SUPPORTS THEIR WORK. INCREASING AWARENESS OF MENTAL HEALTH ISSUES IN FISCAL YEAR 2017, SCRIPPS BEHAVIORAL HEALTH SERVICES IMPROVED AWARENESS OF MENTAL HEALTH ISSUES BY PROVIDING INFORMATION AND SUPPORTIVE SERVICES FOR MORE THAN 1,000 PEOPLE AT COMMUNITY EVENTS. MENTAL HEALTH AWARENESS MONTH THE MONTH OF MAY IS MENTAL HEALTH AWARENESS MONTH. SCRIPPS HOSPITALS PROVIDED IN THEIR LOBBIES, A MENTAL HEALTH PROFESSIONAL WHO SHARED BROCHURES, COMMUNITY RESOURCES RELATED TO MENTAL ILLNESS, TREATMENT OPTIONS AND ANSWERED QUESTIONS FROM THE PUBLIC AND PATIENTS VISITING THE SCRIPPS FACILITY. COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND SUICIDE PREVENTION COUNCIL THE SAN DIEGO COUNTY SUICIDE PREVENTION COUNCIL (SPC) IS A COLLABORATIVE COMMUNITY-WIDE EFFORT FOCUSED ON REALIZING A VISION OF ZERO SUICIDES IN SAN DIEGO COUNTY. ITS GOAL IS TO PREVENT SUICIDE AND ITS DEVASTATING CONSEQUENCES IN SAN DIEGO COUNTY. SINCE 2010, WITH SUPPORT FROM THE COUNTY OF SAN DIEGO BEHAVIORAL HEALTH SERVICES, CHIP PROVIDES DIRECT OVERSIGHT AND GUIDANCE TOWARD THE IMPLEMENTATION OF THE SUICIDE PREVENTION ACTION PLAN. THE CORE STRATEGIES OF THE SPC ARE: - ENHANCING COLLABORATIONS TO PROMOTE A SUICIDE-FREE COMMUNITY - CONDUCTING NEEDS ASSESSMENTS TO IDENTIFY GAPS IN SUICIDE PREVENTION SERVICES AND SUPPORTS - DISSEMINATING VITAL INFORMATION ON THE SIGNS OF SUICIDE AND EFFECTIVE HELP-SEEKING - PROVIDING RESOURCES TO THOSE AFFECTED BY SUICIDE AND SUICIDAL BEHAVIOR - ADVANCING POLICIES AND PRACTICES THAT CONTRIBUTE TO THE PREVENTION OF SUICIDE PSYCHIATRIC LIAISON TEAM (PLT) THE PSYCHIATRIC LIAISON TEAM IS A MOBILE PSYCHIATRIC ASSESSMENT TEAM. CLINICIANS PROVIDE MENTAL HEALTH EVALUATION AND TRIAGE SERVICES TO ACCURATELY ASSESS PATIENTS AND PROVIDE THEM WITH BEST AND SAFEST COMMUNITY RESOURCES TO PROMOTE ONGOING CARE. THE TEAM AIMS TO HELP PEOPLE ADHERE TO TREATMENT PLANS, REDUCE HOSPITAL READMISSION RATES, RELIEVE SYMPTOMS AND ULTIMATELY ENSURE THE LONG-TERM STABILIZATION OF THE PATIENTS MENTAL HEALTH. SCRIPPS WILL CONTINUE TO PROVIDE A DEDICATED PSYCHIATRIC LIAISON TEAM AT ALL SCRIPPS HOSPITALS EMERGENCY DEPARTMENTS AND URGENT CARE SETTINGS (RANCHO BERNARDO AND TORREY PINES). SCRIPPS DRUG AND ALCOHOL RESOURCES NURSES SCRIPPS HAS IMPLEMENTED THE ROLE OF A MOBILE GROUP OF SPECIALLY TRAINED DRUG AND ALCOHOL RESOURCE NURSES THAT PROVIDE EDUCATION, INTERVENTIONS AND DISCHARGE PLACEMENT ASSISTANCE TO PATIENTS IN THE SCRIPPS HOSPITALS. THE RESOURCE NURSES WORK DIRECTLY WITH THE NURSING STAFF AT EACH OF THE HOSPITALS IN SEARCH OF PATIENTS WHO MAY BE AT RISK FOR ALCOHOL/DRUG WITHDRAWAL AND ASSIST WITH IMPLEMENTING A STANDARDIZED PROTOCOL WITHDRAWAL PROCESS. THROUGH A CONTRACT WITH VOLUNTEERS OF AMERICA (VOA), THE SCRIPPS RESOURCE NURSE IN COLLABORATION WITH CASE MANAGEMENT IS ABLE TO OFFER A LIMITED NUMBER PATIENTS IN NEED OF DETOX RESIDENTIAL PLACEMENT AT THE VOA FACILITY IN NATIONAL CITY. MI PUENTE/MY BRIDGE-SCRIPPS MERCY HOSPITAL CHULA VISTA SCRIPPS WHITTIER DIABETES INSTITUTE ALSO RECEIVED A $2.4 MILLION STUDY GRANT FROM THE NIHS NATIONAL INSTITUTE OF NURSING RESEARCH IN 2015 TO EVALUATE MI PUENTE, A PROGRAM AT SCRIPPS MERCY CHULA VISTA HOSPITAL THAT USES A "NURSE + VOLUNTEER" TEAM APPROACH TO HELP HOSPITALIZED HISPANIC PATIENTS WITH MULTIPLE CHRONIC DISEASES REDUCE THEIR HOSPITALIZATIONS AND IMPROVE THEIR DAY-TO-DAY HEALTH AND QUALITY OF LIFE. INDIVIDUALS OF LOW SOCIOECONOMIC (SES) AND ETHNIC MINORITY STATUS, INCLUDING HISPANICS, THE LARGEST U.S. ETHNIC MINORITY GROUP ARE DISPROPORTIONATELY BURDENED BY CHRONIC CARDIOVASCULAR AND METABOLIC CONDITIONS ("CARDIOMETABOLIC," E.G., OBESITY, DIABETES, HYPERTENSION, HEART DISEASE). HIGH LEVELS OF UNMET BEHAVIORAL HEALTH IN THIS POPULATION CONTRIBUTE TO STRIKING DISPARITIES IN DISEASE PREVALENCE AND OUTCOMES. A BEHAVIORAL HEALTH NURSE PROVIDES IN-HOSPITAL COACHING TO PATIENTS, WHO ARE THEN FOLLOWED AFTER DISCHARGE BY A VOLUNTEER COMMUNITY PEER MENTOR TO ASSIST THEM IN OVERCOMING BARRIERS THAT MAY INTERFERE WITH ACHIEVING AND MAINTAINING GOOD HEALTH. MI PUENTE AIMS TO IMPROVE CONTINUITY OF CARE AND ADDRESS THE (PHYSICAL AND BEHAVIORAL) HEALTH NEEDS OF THE AT-RISK HISPANIC POPULATION. THIS PROGRAM HOLDS PROMISE FOR IMPACTFUL EXPANSION TO OTHER CONDITIONS AND UNDERSERVED POPULATIONS. BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES MANY PEOPLE FIND THAT THE DAY-TO-DAY TASKS ASSOCIATED WITH HAVING DIABETES TESTING ONES BLOOD SUGAR, PLANNING MEALS, GETTING ENOUGH PHYSICAL ACTIVITY AND REMEMBERING TO TAKE MEDICATIONS CAN BE STRESSFUL. A COMMON CONDITION KNOWN AS "DIABETES DISTRESS" CAN BE THE RESULT OF FEELING LIKE ITS ALL TOO MUCH. SCRIPPS DIABETES CARE AND PREVENTION HAS A DIABETES BEHAVIORAL SPECIALIST ON STAFF TO HELP PEOPLE MANAGE THEIR DIABETES WITHOUT BEING OVERWHELMED OR UNDULY DISTRESSED. THE BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES IS AN INTEGRATED, INTERDISCIPLINARY APPROACH TO MANAGING THE EMOTIONAL AND BEHAVIORAL NEEDS OF INDIVIDUALS WITH TYPE 1 AND TYPE 2 DIABETES. THE COLLOCATION OF MEDICAL AND BEHAVIORAL HEALTH SERVICES IN THE SAME FACILITY ALLOW FOR CONVENIENT, WARM HAND-OFF FROM PHYSICIAN TO BEHAVIORAL HEALTH SPECIALIST. IT ALSO AFFORDS OPPORTUNITIES FOR PHYSICIANS, DIABETES EDUCATORS AND OTHERS TO RECEIVE CONSULTATION ON BEHAVIORAL HEALTH CONCERNS, AND IN TURN, MORE COMPREHENSIVELY ADDRESS THE MULTI-FACETED NEEDS OF THEIR PATIENTS WITH DIABETES. GUIDING VETERANS TO MENTAL HEALTH SERVICES SAN DIEGO IS HOME TO MORE THAN 250,000 VETERANS. A SUBSTANTIAL NUMBER OF OUR SERVICE MEMBERS HAVE SUFFERED OR ARE STRUGGLING WITH POST-TRAUMATIC STRESS DISORDER (PTSD), DEPRESSION, ANXIETY AND OTHER PSYCHOLOGICAL CONDITIONS RELATED TO MILITARY SERVICE AND REPEATED DEPLOYMENTS. PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS, SCRIPPS IS ACTIVELY WORKING TO ASSIST THESE VETERANS THROUGH INFORMATIONAL SESSIONS DESIGNED TO IMPROVE KNOWLEDGE OF VETERANS MENTAL HEALTH ISSUES AND ACCESS TO COMMUNITY-BASED SERVICES. SCRIPPS IS WORKING WITH SAN DIEGO STATE UNIVERSITY TO IMPLEMENT A VETERANS MENTAL HEALTH COURSE IN THE SOCIAL WORK DEPARTMENT. MENTAL HEALTH SUPPORT SERVICES AT LOCAL SCHOOL-BASED CLINICS SCRIPPS FAMILY MEDICINE RESIDENCY AND SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER HAVE PARTNERED TO OFFER CLINICAL TRAINING OPPORTUNITIES FOR MASTER SOCIAL WORK STUDENTS IN TRAINING FROM SAN DIEGO STATE UNIVERSITY AT SOUTHWEST AND PALOMAR HIGH SCHOOLS. THESE STUDENTS WORK WITH LOCAL PROVIDERS THAT ADDRESS THE MENTAL HEALTH NEEDS OF VULNERABLE ADOLESCENTS. A VARIETY OF MENTAL HEALTH ISSUES ARE PRESENT FOR LOCAL HIGH SCHOOL STUDENTS. MANY OF THESE ISSUES INCLUDE DEPRESSION, ANXIETY AND SUICIDE RELATED CONCERNS. THE PROGRAM WORKS TO IMPROVE OVERALL MENTAL HEALTH CARE FOR LOCAL STUDENTS THROUGH A SCHOOL-BASED CLINIC. APPROXIMATELY 240 HOURS WERE SPENT IN THE SCHOOL-BASED CLINICS OFFERING SERVICES FOR ADOLESCENTS TO AN AVERAGE OF 12 STUDENTS PER WEEK.
FORM 990, PART III, LINE 4A (CONTINUED)	SURVIVORS OF SUICIDE LOSS SCRIPPS MERCY HOSPITAL SAN DIEGO DONATES SPACE TO THIS ORGANIZATION. SURVIVORS OF SUICIDE LOSS REACHES OUT TO AND SUPPORTS PEOPLE WHO HAVE LOST A LOVED ONE TO SUICIDE. THEIR GOAL IS TO GIVE SURVIVORS A PLACE WHERE THEY CAN BE COMFORTABLE EXPRESSING THEMSELVES, A PLACE TO FIND SUPPORT, COMFORT, RESOURCES AND HOPE IN A JUDGMENT-FREE ENVIRONMENT. WIDOW SUPPORT GROUP THIS SUPPORT GROUP OFFERS BEREAVEMENT/MENTAL HEALTH SUPPORT AND GUIDANCE TO FAMILIES WHO HAVE LOST A LOVED ONE. THE GROUP FACILITATES DISCUSSION AND GUEST LECTURES ABOUT TOPICS RELATED TO THE LOSS OF LOVED ONES. THERE ARE APPROXIMATELY 6-10 PARTICIPANTS MONTHLY THAT ATTEND AND MANY HAVE BEEN A PART OF THE GROUP FOR MORE THAN 15-20 YEARS. PATIENT COMMUNITY SERVICES PATIENTS ARE REFERRED FROM SCRIPPS MERCY HOSPITAL CHULA VISTA, FOR ASSISTANCE WITH A WIDE VARIETY OF BEHAVIORAL HEALTH NEEDS INCLUDING ADDICTION, LOSS, ANXIETY AND OTHER MENTAL HEALTH ISSUES. THE WELL-BEING CENTER OFFERS WEEKLY COUNSELING AND/OR REFER PATIENTS TO LOCAL MENTAL HEALTH COUNSELING SERVICES. SOCIAL DETERMINANTS OF HEALTH PER THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED IN THE CHNA, SOCIAL DETERMINANTS OF HEALTH WERE A KEY THEME IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. ANALYSIS OF RESULTS FROM THE COMMUNITY PARTNER DISCUSSIONS AND KEY INFORMANT INTERVIEWS REVEALED THE MOST COMMONLY ASSOCIATED SOCIAL DETERMINANTS OF HEALTH FOR EACH OF THE TOP HEALTH NEEDS. THE TOP TEN SOCIAL DETERMINANTS WERE CONSISTENTLY REFERENCED ACROSS THE DIFFERENT COMMUNITY ENGAGEMENT ACTIVITIES, FOOD INSECURITY & ACCESS TO HEALTHY FOOD, ACCESS TO CARE OR SERVICES, HOMELESS/HOUSING ISSUES, PHYSICAL ACTIVITY, EDUCATION/KNOWLEDGE, CULTURAL COMPETENCY, TRANSPORTATION, INSURANCE ISSUES, STIGMA AND POVERTY. THE IMPORTANCE OF THESE SOCIAL DETERMINANTS WAS ALSO CONFIRMED BY QUANTITATIVE DATA. BELOW ARE PROGRAMS AND ORGANIZATIONS THAT SCRIPPS SUPPORTS THAT ARE ADDRESSING SOCIAL DETERMINANTS OF HEALTH. APPROXIMATELY 80 PERCENT OF MODIFIABLE RISKS FOR DISEASES ARE ATTRIBUTABLE TO NONMEDICAL (UPSTREAM) DETERMINANTS OF HEALTH, SUCH AS HEALTH BEHAVIORS, SOCIOECONOMIC STATUS, AND ENVIRONMENTAL CONDITIONS. TO PREVENT CHRONIC CONDITIONS AND PROMOTE HEALTH, GREATER EMPHASIS SHOULD BE PLACED ON POPULATION HEALTH, WHICH HAS BEEN DEFINED TO FOCUS ON OUTCOMES AS WELL AS ON THE BROADER FACTORS THAT INFLUENCE HEALTH AT A POPULATION LEVEL, INCLUDING MEDICAL CARE SYSTEMS, THE SOCIAL ENVIRONMENT, AND THE PHYSICAL ENVIRONMENT. BELOW ARE PROGRAMS AND ORGANIZATIONS THAT SCRIPPS SUPPORTS THAT ARE ADDRESSING SOCIAL DETERMINANTS OF HEALTH. SCRIPPS MERCY HOSPITAL HAS ESTABLISHED A PARTNERSHIP AT THE CITY HEIGHTS WELLNESS CENTER (CHWC) WITH LA MAESTRA FAMILY CLINIC AND RADY CHILDRENS HOSPITAL TO ADDRESS SOME OF THE ATTRIBUTING FACTORS TO POOR HEALTH STATUS FOR LOCAL RESIDENTS. WITH LA MAESTRA SERVING AS THE LEAD AGENCY, SCRIPPS MERCY AND RADY CHILDRENS ARE CONTRIBUTING RESOURCES TO SUPPORT OPERATIONAL COSTS OF THE CENTER IN ORDER TO PROVIDE CAPACITY FOR NEED COMMUNITY LINKAGES. SOME OF THESE INCLUDE: FOOD INSECURITY FOOD INSECURITY WAS PRIORITIZED AS THE NUMBER ONE SOCIAL DETERMINANTS OF HEALTH IN THE 2016 CHNA. FOOD INSECURITY IS THE INABILITY TO AFFORD ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. ONE IN SIX SAN DIEGANS ARE "FOOD INSECURE." AN ESTIMATED 485,521 SAN DIEGO COUNTY RESIDENTS, OR 15.7 PERCENT OF THE COUNTYS POPULATION, DO NOT HAVE ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. THE PROGRAMS HIGHLIGHTED BELOW ARE WAYS THAT SCRIPPS HEALTH IS ADDRESSING FOOD INSECURITY. THE CALFRESH PROGRAM, FEDERALLY KNOWN AS THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), ISSUES MONTHLY ELECTRONIC BENEFITS THAT CAN BE USED TO BUY FOODS AT PARTICIPATING MARKETS AND STORES. MORE THAN 290,000 SAN DIEGANS RECEIVE CALFRESH. STUDIES DEMONSTRATE THAT HUNGER SIGNIFICANTLY IMPACTS HEALTH. LACK OF ACCESS TO HEALTHY FOOD, OFTEN DUE TO AVAILABILITY AND COST, ARE STRESSORS THAT CONTRIBUTE TO DIABETES, HEART DISEASE, OBESITY, AND OTHER BEHAVIORAL HEALTH ISSUES IN A MYRIAD OF WAYS: - FOOD INSECURE ADULTS WITH DIABETES HAVE HIGHER AVERAGE BLOOD SUGARS. - FOOD INSECURE ADULTS ARE MORE LIKELY TO BE OBESE. - FOOD INSECURITY IS SIGNIFICANTLY MORE PREVALENT IN ADULTS WITH MOOD DISORDERS. - FOOD INSECURITY IS ASSOCIATED WITH INCREASED RISK OF SUICIDAL THOUGHTS AND SUBSTANCE ABUSE IN ADOLESCENTS. - FOOD INSECURE SENIORS HAVE A SIGNIFICANTLY HIGHER LIKELIHOOD OF HEART DISEASE, DEPRESSION AND LIMITED ACTIVITIES OF DAILY LIVING. - FOOD INSECURE ADULTS DELAY BUYING FOOD IN ORDER TO PURCHASE MEDICATIONS. THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM LA MAESTRA FAMILY CLINIC ARE AVAILABLE TO COUNSEL PEOPLE AND ASSIST FILLING OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THE ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. APPLICATIONS AND ASSISTANCE FOR CALFRESH TO SUPPLEMENT FOOD BUDGET AND ALLOW FAMILIES/INDIVIDUALS TO BUY NUTRITIOUS FOOD. SCRIPPS MERCY WIC PROGRAM THE CITY HEIGHTS WELLNESS CENTER IS HOME TO THE SCRIPPS MERCY HOSPITAL-WIC PROGRAM THAT PROVIDES NUTRITION EDUCATION AND COUNSELING, BREASTFEEDING EDUCATION AND SUPPORT AND FOOD VOUCHERS TO PREGNANT AND PARENTING WOMEN, AND CHILDREN 0-5 YEARS OF AGE. IN ADDITION TO THE CHNA AND IMPLEMENTATION PLAN, SCRIPPS HEALTH WILL CONTINUE TO MEET COMMUNITY NEEDS BY PROVIDING CHARITY CARE AND UNCOMPENSATED CARE, PROFESSIONAL EDUCATION AND COMMUNITY BENEFIT PROGRAMS. SCRIPPS OFFERS COMMUNITY BENEFIT SERVICES THROUGH OUR FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH SERVICES, WELLNESS CENTERS AND CLINICS. SCRIPPS SERVES A QUARTER OF THE TOTAL COUNTY POPULATION, CONCENTRATING SERVICES IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTH REGIONS OF SAN DIEGO COUNTY WHERE SCRIPPS FACILITIES ARE LOCATED. UNCOMPENSATED HEALTH CARE SCRIPPS CONTRIBUTES SIGNIFICANT RESOURCES TO PROVIDE LOW AND NO-COST HEALTH CARE FOR OUR PATIENTS IN NEED. DURING FISCAL YEAR 2017, SCRIPPS CONTRIBUTED $361,114,035 IN UNCOMPENSATED HEALTH CARE, INCLUDING $21,191,733 IN CHARITY CARE, $334,783,489 IN MEDI- CAL AND MEDICARE SHORTFALL, AND $5,138,813 IN BAD DEBT. SCRIPPS PROVIDES HOSPITAL SERVICES FOR ONE-QUARTER OF THE COUNTY'S UNINSURED PATIENTS. SCRIPPS MERCY HOSPITAL, SAN DIEGO AND SCRIPPS MERCY HOSPITAL, CHULA VISTA PROVIDE 59 PERCENT OF SCRIPPS' CHARITY CARE. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. POPULATION: OVER THREE MILLION PEOPLE (3,138,265) LIVE IN THE 4,205 SQUARE MILE AREA OF SDC ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%.THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES.
FORM 990, PART III, LINE 4A (CONTINUED)	RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SAN DIEGOS UNINSURED THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3% WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). THE CHANGING LANDSCAPE UNDER THE AFFORDABLE CARE ACT* THE AFFORDABLE CARE ACT (ACA) HAS PLAYED A SIGNIFICANT ROLE IN INCREASING ACCESS TO HEALTHCARE. IN 2014, A NUMBER OF CHANGES TOOK EFFECT IN CALIFORNIA INCLUDING: - THE EXPANSION OF MEDI-CAL TO INDIVIDUALS MAKING LESS THAN 138% OF THE POVERTY LEVEL. - THE ESTABLISHMENT OF COVERED CALIFORNIA FOR INDIVIDUALS WHO MAKE UP TO 400% OF THE POVERTY LEVEL TO PURCHASE SUBSIDIZED HEALTH INSURANCE. - THE ELIMINATION OF DISCRIMINATION DUE TO PRE-EXISTING CONDITIONS. - THE REQUIREMENT TO OBTAIN HEALTH INSURANCE COVERAGE. THESE HEALTHCARE REFORMS HAVE RESULTED IN A LARGE NUMBER OF NEWLY INSURED INDIVIDUALS. RECENT DATA FROM THE US CENSUS BUREAU DEMONSTRATES THE FOLLOWING CHANGES IN COVERAGE AS OF 2014: - DECREASE IN THE PERCENTAGE OF UNINSURED OVERALL IN THE US FROM 13.3% IN 2013 TO 10.4% IN 2014. - DECREASE IN THE PERCENTAGE OF UNINSURED CHILDREN UNDER AGE 19 FROM 7.5% TO 6.2%. - DECREASE IN THE PERCENTAGE OF UNINSURED ACROSS ETHNIC GROUPS TO 19.9%, 11.8%, 9.3% AND 7.6% FOR HISPANICS, BLACKS, ASIANS, AND NON-HISPANICS WHITES, RESPECTIVELY. STILL, DISCREPANCIES REMAIN WITH THOSE AGED 19-64 LEAST LIKELY TO BE INSURED AND ROUGHLY 1 IN 5 HISPANICS STILL LACKING HEALTH INSURANCE. [*SOURCE: SMITH, JESSICA C. AND CARLA MEDALIA, U.S. CENSUS BUREAU, CURRENT POPULATION REPORTS, P60-253, HEALTH INSURANCE COVERAGE IN THE UNITED STATES: 2014, U.S. GOVERNMENT PRINTING OFFICE, WASHINGTON, DC, 2015.] THERE ARE THREE INDICATORS DETERMINED TO BE THE MOST POWERFUL PREDICTORS OF POPULATION HEALTH: POVERTY RATE, PERCENT OF POPULATION UNINSURED, AND EDUCATIONAL ATTAINMENT. LOW-INCOME, UNINSURED, AND UNDEREDUCATED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. FIVE-YEAR ESTIMATES FROM THE 2009-2013 AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY: WITHIN SDC, 14.5% OR 441,648 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). FOR CHILDREN 0-17, THE PERCENTAGE LIVING 100% BELOW THE FPL INCREASES TO 18.8%. FOR A HOUSEHOLD SIZE OF 3 THE 100% POVERTY LEVEL IS $20,090 PER YEAR. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. UNINSURED: BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SDC. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3%, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). LACK OF INSURANCE IS A PRIMARY BARRIER TO HEALTH CARE ACCESS INCLUDING REGULAR PRIMARY CARE, SPECIALTY CARE, AND OTHER HEALTH SERVICES THAT CONTRIBUTES TO POOR HEALTH STATUS. EDUCATIONAL ATTAINMENT: EDUCATIONAL ATTAINMENT IS LINKED TO POSITIVE HEALTH OUTCOMES (FREUDENBERG & RUGLIS, 2007).WITHIN THE COUNTY OF SAN DIEGO, ALMOST 15% OF THE TOTAL POPULATION AGED 25 AND OLDER (297,188) HAVE NO HIGH SCHOOL DIPLOMA (OR EQUIVALENCY) OR HIGHER. OF CHILDREN AGED 3-4, THE 2009-2013 ACS FOUND THAT 48.9% WERE ENROLLED IN SCHOOL. AS A PRIMARY SOCIAL DETERMINANT OF HEALTH, INCREASING EDUCATIONAL OPPORTUNITIES FOR YOUNG CHILDREN IS IMPORTANT IN ORDER TO IMPROVE FUTURE EDUCATIONAL ATTAINMENT AND INCREASE ECONOMIC OPPORTUNITY. ALONG WITH INCOME, EDUCATION, AND INSURANCE STATUS, CULTURE/LANGUAGE AND EMPLOYMENT STATUS ALSO HAVE PROFOUND IMPLICATIONS FOR POPULATION HEALTH: POPULATION WITH LIMITED ENGLISH PROFICIENCY: 16.3% OF SAN DIEGO RESIDENTS AGED 5 AND OLDER SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME AND SPEAK ENGLISH LESS THAN "VERY WELL." THE INABILITY TO SPEAK ENGLISH WELL CREATES BARRIERS TO HEALTH CARE ACCESS, PROVIDER COMMUNICATIONS, AND HEALTH LITERACY/EDUCATION. LINGUISTICALLY ISOLATED POPULATION: GIVEN SDCS LARGE IMMIGRANT AND REFUGEE POPULATION, THE INDICATOR LINGUISTICALLY ISOLATED IS ESPECIALLY IMPORTANT TO UNDERSTANDING HEALTH IN THE COMMUNITY. ACCORDING TO THE ACS, APPROXIMATELY 8.5% OF THE POPULATION AGED 5 AND OLDER LIVE IN A HOME IN WHICH NO PERSON 14 YEARS OLD AND OVER SPEAKS ONLY ENGLISH, OR SPEAKS A NON-ENGLISH LANGUAGE BUT DOES NOT SPEAK ENGLISH "VERY WELL." SIMILAR TO THOSE WITH LIMITED ENGLISH PROFICIENCY, LINGUISTICALLY ISOLATED POPULATIONS MAY STRUGGLE WITH ACCESSING HEALTH SERVICES, COMMUNICATING WITH HEALTH CARE PROVIDERS, AND UNDERSTANDING HEALTH INFORMATION. UNEMPLOYMENT: ACCORDING TO THE BUREAU OF LABOR STATISTICS, TOTAL UNEMPLOYMENT IN SDC FOR THE MONTH OF JULY 2015 WAS 106,822, OR 6.9%, OF THE CIVILIAN NON-INSTITUTIONALIZED POPULATION AGE 16 AND OLDER (NON-SEASONALLY ADJUSTED). UNEMPLOYMENT CREATES FINANCIAL INSTABILITY AND BARRIERS TO ACCESSING NECESSITIES SUCH AS HEALTH SERVICES AND HEALTHY FOOD THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. FINANCIAL ASSISTANCE ASSISTING LOW-INCOME, UNINSURED PATIENTS ASSISTING LOW-INCOME, UNINSURED PATIENTS THE SCRIPPS FINANCIAL ASSISTANCE POLICY IS CONSISTENT WITH THE LANGUAGE OF BOTH STATE (AB774) CALIFORNIA HOSPITAL FAIR PRICING POLICY LEGISLATION AND THE INTERNAL REVENUE CODE (IRC) 501(R) REGULATIONS. THESE PRACTICES REFLECT OUR COMMITMENT TO ASSISTING LOW-INCOME AND UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE AND FLEXIBLE BILLING AND DEBT COLLECTION PRACTICES. THESE PROGRAMS ARE AVAILABLE TO EVERYONE IN NEED, REGARDLESS OF THEIR RACE, ETHNICITY, GENDER, RELIGION OR NATIONAL ORIGIN. SCRIPPS MAKES EVERY EFFORT TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS FORGIVES THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, A PORTION OF THE BILL IS FORGIVEN. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT CHARGED MORE THAN SCRIPPS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. FOR 2018, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DEFINED A FAMILY OF FOUR AT 200 PERCENT FEDERAL POVERTY LEVEL AS $50,200. PROFESSIONAL EDUCATION & HEALTH RESEARCH QUALITY HEALTH CARE IS HIGHLY DEPENDENT UPON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS, OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WILL BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH BY DEVELOPING NEW AND INNOVATIVE TREATMENTS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH, MEDICAL EDUCATION AND HEALTH PROFESSIONAL EDUCATION. DURING FISCAL YEAR 2017 (OCTOBER 2016 TO SEPTEMBER 2017), SCRIPPS INVESTED $29,408,514 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES IN SAN DIEGO COUNTY. THIS SECTION HIGHLIGHTS SOME OF OUR PROFESSIONAL EDUCATION AND HEALTH RESEARCH ACTIVITIES.
FORM 990, PART III, LINE 4A (CONTINUED)	HEALTH PROFESSIONS TRAINING INTERNSHIPS SCRIPPS' COMMITMENT TO ONGOING LEARNING AND HEALTH CARE EXCELLENCE EXTENDS BEYOND OUR ORGANIZATION. OUR INTERNSHIP PROGRAMS HELP PROMOTE HEALTH CARE CAREERS TO A NEW GENERATION, SHAPE THE FUTURE WORKFORCE AND DEVELOP FUTURE LEADERS IN OUR COMMUNITY. INTERACTING WITH HEALTH CARE PROFESSIONALS IN THE FIELD EXPANDS EDUCATION OUTSIDE THE CLASSROOM. SCRIPPS EMPLOYEES PLAY AN IMPORTANT ROLE AS PRECEPTORS BY INVESTING THEIR TIME TO CREATE A VALUABLE EXPERIENCE FOR THE COMMUNITY. IN FISCAL YEAR 2017, SCRIPPS HOSTED 2,401 INTERNS WITHIN OUR SYSTEM AND PROVIDED 358,693 DEVELOPMENT HOURS SPANNING NURSING AND ANCILLARY SETTINGS. COLLEGE AND UNIVERSITY AFFILIATIONS SCRIPPS COLLABORATES WITH LOCAL HIGH SCHOOLS, COLLEGES AND UNIVERSITIES TO HELP STUDENTS EXPLORE HEALTH CARE ROLES AND GAIN FIRSTHAND EXPERIENCE AS THEY WORK WITH SCRIPPS PROFESSIONALS. SCRIPPS IS AFFILIATED WITH MORE THAN 110 SCHOOLS AND PROGRAMS, INCLUDING CLINICAL AND NONCLINICAL PARTNERSHIPS. LOCAL SCHOOLS INCLUDE, BUT ARE NOT LIMITED TO, POINT LOMA NAZARENE UNIVERSITY (PLNU), UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD), CALIFORNIA STATE UNIVERSITY SAN MARCOS (CSUSM), SAN DIEGO STATE UNIVERSITY (SDSU), UNIVERSITY OF SAN DIEGO (USD), MESA COLLEGE, SAN DIEGO CITY COLLEGE, GROSSMONT COLLEGE, PALOMAR COLLEGE AND MIRA COSTA COLLEGE. SCRIPPS IS REGULARLY ACCEPTING NEW PARTNERSHIPS, BASED ON COMMUNITY AND WORKFORCE NEEDS, AND MAINTAINS AN AFFILIATION AGREEMENT COMMITTEE TO REVIEW ALL REQUESTS AND PROVIDE A SYSTEMWIDE APPROACH TO SECURING NEW STUDENTS PLACEMENTS. THIS INTERDISCIPLINARY COMMITTEE REPRESENTS EDUCATION AND DEPARTMENT LEADERSHIP ACROSS THE SCRIPPS SYSTEM ENSURING A PROACTIVE APPROACH TO BUILDING A CAREER PIPELINE FOR TOP TALENT. TO ENSURE STUDENTS FROM HEALTH CARE PROFESSIONS PROGRAMS HAVE ACCESS TO APPROPRIATE EDUCATIONAL EXPERIENCES AT SCRIPPS AND FOSTER A SMOOTH, EFFICIENT PROCESS FOR STUDENT PLACEMENT REQUESTS RECEIPT AND MANAGEMENT, SCRIPPS IS A MEMBER OF THE SAN DIEGO NURSING AND ALLIED HEALTH SERVICE EDUCATION CONSORTIUM. RESEARCH STUDENTS SCRIPPS SUPPORTS GRADUATE RESEARCH FOR MASTERS AND DOCTORAL STUDENTS AT UNIVERSITIES WITH AFFILIATION AGREEMENTS. SCRIPPS CENTER FOR LEARNING & INNOVATION OVERSEES THE STUDENT PLACEMENT PROCESS. NON-PHYSICIAN STUDENTS WHO CONDUCT RESEARCH AT SCRIPPS REPRESENT A VARIETY OF HEALTH CARE DISCIPLINES, INCLUDING PUBLIC HEALTH, PHYSICAL THERAPY, PHARMACY AND NURSING. IN FISCAL YEAR 2017, SCRIPPS RESEARCH INCLUDED STUDENTS FROM USD, WESTERN GOVERNORS, UNIVERSITY, SDSU, PLNU, LOMA LINDA UNIVERSITY AND POSTDOCTORAL PHARMACY RESIDENCY PROGRAMS, INCLUDING THE PGY1 PHARMACY RESIDENCY PROGRAM. HIGH SCHOOL PROGRAMS SCRIPPS IS DEDICATED TO PROMOTING HEALTH CARE AS A REWARDING CAREER, COLLABORATING WITH A NUMBER OF HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRSTHAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. BELOW IS A SUMMARY OF THE HIGH SCHOOL PROGRAMS SCRIPPS MADE AVAILABLE TO THE COMMUNITY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM HEALTH AND SCIENCE PIPELINE INITIATIVE (HASPI) THIS PROGRAM REACHES OUT TO SCAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING A CAREER IN HEALTH CARE. IN FISCAL YEAR 2017, 25 STUDENTS PARTICIPATED IN THE PROGRAM. DURING THEIR FIVE-WEEK ROTATION, THE STUDENTS WERE EXPOSED TO DIFFERENT DEPARTMENTS, EXPLORING CAREER OPTIONS AND LEARNING VALUABLE LIFE LESSON ABOUT HEALTH AND HEALING. UC HIGH SCHOOL COLLABORATION UC HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOLS HEALTH CARE ESSENTIALS COURSE. FOR FISCAL YEAR 2017, SIXTEEN STUDENTS WERE SELECTED TO ROTATE THROUGH FIVE DIFFERENT SCRIPPS LOCATIONS, DURING THE SPRING SEMESTER, TO INCREASE THEIR AWARENESS OF HEALTH CARE CAREERS. UC HIGH STUDENTS VISITED SCRIPPS CLINIC TORREY PINES, CARMEL VALLEY, RANCHO BERNARDO, MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITAL LA JOLLA AND GREEN HOSPITAL. THE STUDENTS WERE ABLE TO VIEW SURGERIES AND SHADOWING HEALTHCARE PROFESSIONALS IN THE EMERGENCY DEPARTMENT, ICU, PHARMACY, URGENT CARE, INTERNAL MEDICINE, PEDIATRICS, AMBULATORY SERVICES, REHAB THERAPY, PATIENT LOGISTICS, LAB AND TRAUMA. YOUNG LEADER IN HEALTH CARE AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOLS STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENTS GRADES 9-12 PARTICIPATE IN THE PROGRAM, WHICH PROVIDES A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS CAREER OPPORTUNITIES. THIS COMBINED EXPERIENCE INCLUDES WEEKLY MEETING AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE PROGRAM MENTORS STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY CHALLENGES. YOUNG LEADERS IN HEALTH CARE ALSO INCLUDES A SERVICE PROJECT TO MEET HIGH SCHOOL REQUIREMENTS AND MAKE A POSITIVE IMPACT ON THE COMMUNITY. THE PROGRAM CLOSES THE YEAR WITH A PRESENTATION ALIGNED WITH THE YEARLY FOCUS. MORE THAN 100 STUDENTS, COMMUNITY MEMBERS AND HEALTH CARE SPECIALISTS ATTENDED THE YOUNG LEADER IN HEALTH CARE FINAL MEETING, CULMINATING WITH STUDENT PRESENTATIONS ON TYPES OF CANCER AND TREATMENTS. STUDENTS THAT PARTICIPATE IN THE PROGRAM ARE ELIGIBLE TO APPLY TO THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM. SCRIPPS HEALTH GRADUATE MEDICAL EDUCATION FOR MORE THAN 70 YEARS PHYSICIANS IN SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS HAVE HELPED CARE FOR UNDERSERVED POPULATIONS THROUGHOUT THE REGION. SCRIPPS HAS A COMPREHENSIVE RANGE OF GRADUATE MEDICAL EDUCATION PROGRAMS AT SCRIPPS MERCY HOSPITAL, SCRIPPS FAMILY PRACTICE RESIDENCY PROGRAM AND SCRIPPS GREEN HOSPITAL. SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS ARE WELL-RECOGNIZED FOR EXCELLENCE, PROVIDE A HANDS-ON CURRICULUM THAT FOCUSES ON PATIENTCENTERED CARE AND OFFER RESIDENCIES IN A VARIETY OF PRACTICES, INCLUDING INTERNAL MEDICINE, FAMILY MEDICINE, PODIATRY, PHARMACY AND PALLIATIVE CARE. SCRIPPS HAS A PHARMACY RESIDENCY PROGRAM WHICH TRAIN RESIDENTS WITH DOCTOR OF PHARMACY DEGREES. IN 2017, SCRIPPS HAD A TOTAL OF 146 RESIDENTS AND 37 FELLOW ENROLLED THROUGHOUT THE SCRIPPS HEALTH SYSTEM. MORE DETAILS ON THESE PROGRAMS IS INCLUDED IN THE COMMUNITY BENEFIT REPORT.
FORM 990, PART III, LINE 4A (CONTINUED)	UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP PROGRAM THE UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP PROGRAM IS A ONE-YEAR PROGRAM DESIGNED FOR PHYSICIANS WHO WISH TO BECOME SUB-SPECIALISTS AND HAVE A LONG-TERM CAREER IN HOSPICE AND PALLIATIVE MEDICINE. IN 2017, THE HOSPICE PROGRAM TRANSITIONED TO THE ELIZABETH HOSPICE AND IT BECAME THE HOSPICE ROTATION SITE FOR THE FELLOWSHIP. THIS IS A UNIQUE PARTNERSHIP IN WHICH UCSD AND SCRIPPS HEALTH SHARE RESPONSIBILITY FOR THE FELLOWS, WITH TRAINEES SPENDING EQUAL TIME IN BOTH INSTITUTIONS WITH ALL THE BENEFITS OF BOTH INSTITUTIONS. THE PROGRAM PREPARES TRAINEES TO WORK IN A VARIETY OF ROLES, INCLUDING LEADERSHIP POSITIONS IN THE FIELD. GRADUATES HAVE SUCCESSFULLY BECOME HOSPICE MEDICAL DIRECTORS AND PALLIATIVE MEDICINE CONSULTANTS IN OUTPATIENT AND INPATIENT SETTINGS ACROSS THE UNITED STATES. FELLOWS WHO COMPLETE THE UCSD/SCRIPPS HEALTH PROGRAM ARE WELL EQUIPPED TO PRACTICE IN DIVERSE SETTINGS, INCLUDING: ACUTE PALLIATIVE CARE UNITS, INPATIENT CONSULTATION, OUTPATIENT CONSULTATION, PATIENTS HOMES, AND LONG-TERM CARE FACILITIES.
FORM 990, PART VI, LINE 11	990 REVIEW PROCESS WITH THE GOVERNING BODY THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS.
FORM 990, PART VI, LINE 12C	COMPLIANCE POLICY MONITORING WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT IS REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING.
FORM 990, PART VI, LINE 15A & 15B	OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN SAN DIEGO, CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: - FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. - SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. - TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. - THE BOARD SELECTS THE 65TH PERCENTILE FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E., THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). - ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON JANUARY 25, 2017 AND MARCH 29, 2017. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES.
FORM 990, PART VI, LINE 16	JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS.
FORM 990, PART VI, LINE 19	AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS JOINT VENTURES DISTRIBUTION 2,242,065 CHANGE IN VALUE IN DEFERRED GIFTS 117,035 TRANSFER TO HORIZON HOSPICE (17,219,577) OTHER (553,550) ------------ TOTAL (15,414,027)
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYS FEES-PROVIDER SVS AGRMENT TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SVS - NON MED TOTAL FEES:77212405
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:57589112
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:26954919
FORM 990 PART IX LINE 11G	DESCRIPTION:ALL OTHER FEES FOR SERVICES TOTAL FEES:29224154

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
SCRIPPS MERCY BILLING LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	870737748	HLTHCR ADMIN	CA	$54,203,199	$0	SCRIPPS HLTH
IHS HOLDING COMPANY LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	473437677	HLTHCR ADMIN	CA	$0	$35,841,867	SCRIPPS HLTH
IMAGING HEALTHCARE SPECIALISTS LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	203872122	MED IMAGING	CA	$38,162,270	$30,667,217	IHS HOLDING
SCRIPPS CARDIO&THORACIC SURGERY BILLING
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	270620996	HLTHCR ADMIN	CA	$5,432,178	$0	SCRIPPS HLTH
SCRIPPS HOSPITAL BILLING SERVICES LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	611677183	HLTHCR ADMIN	CA	$3,773,202	$0	SCRIPPS HLTH
SCRIPPS CLINIC BILLING LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	870737749	HLTHCR ADMIN	CA	$327,876,409	$0	SCRIPPS HLTH
SCRIPPS ACCOUNTABLE CARE ORGANIZATION
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	364837441	HLTHCR ADMIN	CA	$0	$153,856	SCRIPPS HLTH

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 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
MAXWELL H & MURIEL GLUCK CHILD CARE CTR
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	350504809	CHILDCARE	CA	501(c)(3)	2	SCRIPPS HLTH	Yes (true)
MERCY HOSPITAL FOUNDATION
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	942958094	FUNDRAISING	CA	501(c)(3)	12A	SCRIPPS HLTH	Yes (true)
SCRIPPS HEALTH PLAN SERVICES INC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330782099	HLTHCARE SVCS	CA	501(c)(3)	12A	SCRIPPS HLTH	Yes (true)
HORIZON HOSPICE
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330220777	HOSPICE CARE	CA	501(c)(3)	10	SCRIPPS HLTH	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
SCRIPPS ENCINITAS SURGERY CENTER
15305 DALLAS PKWY STE 1600 LB 28	ADDISON	TX	75001	205942958	AMBUL SURGERY	CA	SCRIPPS HEALTH	Related	$1,422,386	$304,417	false	$0	false	0.55500
SCRIPPSUSP SURGERY CENTERS
15305 DALLAS PKWY STE 1600 LB 28	ADDISON	TX	75001	205942911	AMBUL SURGERY	CA	NA	Related	$496,775	$1,311,863	false	$0	false	0.50000
SCRIPPS MERCY AMBUL SURG CTR
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	450503246	AMBUL SURGERY	CA	SCRIPPS HEALTH	Related	$1,000,539	$3,682,068	false	$0	Yes (true)	0.73500
SCRIPPS IDN MANAGEMENT LLC
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	454557426	HEALTHCARE SVCS	CA	NA	Related	$0	$16,126	false	$0	Yes (true)	0.50000
SCRIPPS MEMORIAL XIMED MED CTR
9850 GENESEE AVE STE 900	LA JOLLA	CA	92037	330475481	REAL ESTATE	CA	SCRIPPS HEALTH	Related	$700,695	$2,997,213	false	$0	Yes (true)	0.15304

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
SCRIPPSCARE
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	452870638	HEALTHCARE SRVCS	CA	SCRIPPS HEALTH	C Corp	$0	$0	1.00000	Yes (true)
SCRIPPS CLINICAL SCIENCE CENTER
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	264479543	RESEARCH	CA	SCRIPPS HEALTH	C Corp	$0	$0	1.00000	Yes (true)
CHARITABLE REMAINDER TRUST (47)
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	205156965	HOSPITAL SUPPORT	CA	NA	Trust
CHARITABLE LEAD TRUST (3)
10140 CAMPUS POINT DRIVE	SAN DIEGO	CA	92121	330796247	HOSPITAL SUPPORT	CA	NA	Trust

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

Transactions Related Org TransactionsRelatedOrgGrp (8 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
SCRIPPS HEALTH PLAN SERVICES (SHPS)
m	$129,948,787	ACCRUAL
SCRIPPS HEALTH PLAN SERVICES (SHPS)
q	$29,780,355	ACCRUAL
SCRIPPS ENCINITAS SURGERY CENTER
a(iv)	$362,124	ACCRUAL
SCRIPPS MERCY AMBULATORY SURGERY CENTER
a(iv)	$564,803	ACCRUAL
SCRIPPS HEALTH PLAN SERVICES (SHPS)
b	$1,575,000	ACCRUAL
SCRIPPS HEALTH PLAN SERVICES (SHPS)
j	$1,047,878	ACCRUAL
SCRIPPS HEALTH PLAN SERVICES (SHPS)
l	$228,503,563	ACCRUAL
HORIZON HOSPICE INC
R	$17,219,577	ACCRUAL

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PART III	FormAndLineReferenceDesc
Explanation	RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS SCRIPPS ENCINITAS SURGERY CENTER, LLC EIN: 20-5942958 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS/USP SURGERY CENTERS, LLC EIN: 20-5942911 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS MERCY AMBULATORY SURGERY CENTER, LLC EIN: 45-0503246 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS IDN MANAGEMENT, LLC EIN: 45-4557426 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS MEMORIAL - XIMED MEDICAL CENTER, LP EIN: 33-0475481 ADDRESS: 9850 GENESEE AVE, STE 900, LA JOLLA, CA 92037	ExplanationTxt