SCRIPPS HEALTH: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: SCRIPPS HEALTH (EIN 95-1684089)
Tax period: 2013-10-01 to 2014-09-30
Filed: 2015-08-10
IRS object ID: 201522229349302287
Schema version: 2013v4.0
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule 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	2015-08-10T18:29:29-05:00	ReturnTs
Tax Period End	2014-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	ERNST & YOUNG US LLP	BusinessNameLine1

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	4370 LA JOLLA VILLAGE DR SUITE 500	AddressLine1
City	SAN DIEGO	City
State	CA	State
ZIP Code	92122	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2013-10-01	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	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of	% Richard Rothberger	InCareOfNm
Business Name Control	SCRI	BusinessNameControlTxt
Phone	8586787226	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	4275 CAMPUS POINT COURT	AddressLine1
Address Line2	Suite	AddressLine2
City	SAN DIEGO	City
State	CA	State
ZIP Code	92121	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Richard Rothberger	PersonNm
Person Title	EVP/CFO	PersonTitleTxt
Phone	8586787226	PhoneNum
Signature	2015-08-10	SignatureDt

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DEBRA HEISKALA	PreparerPersonNm
PTIN	P00649485	PTIN
Phone	8586787226	PhoneNum

Field	Value	IRS element (for citing)
Tax	2013	TaxYr
Build TS	2016-02-25 16:41:14Z	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	4275 CAMPUS POINT COURT	AddressLine1
City	SAN DIEGO	City
State	CA	State
ZIP Code	92121	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$3,522,281,456	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 $2.6 BILLION , PRIVATE NOT-FOR- PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. (SEE SCH O)	ActivityOrMissionDesc
Voting Members Governing Body	14	VotingMembersGoverningBodyCnt
Voting Members Independent	12	VotingMembersIndependentCnt
Total Employee	15037	TotalEmployeeCnt
Total Volunteers	3406	TotalVolunteersCnt
Total Gross UBI	$5,426,611	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$99,631	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$37,062,312	PYContributionsGrantsAmt
CY Contributions Grants	$26,873,287	CYContributionsGrantsAmt
PY Program Service Revenue	$2,478,726,147	PYProgramServiceRevenueAmt
CY Program Service Revenue	$2,395,815,994	CYProgramServiceRevenueAmt
PY Investment Income	$107,700,580	PYInvestmentIncomeAmt
CY Investment Income	$208,770,591	CYInvestmentIncomeAmt
PY Other Revenue	$31,293,491	PYOtherRevenueAmt
CY Other Revenue	$38,511,975	CYOtherRevenueAmt
PY Total Revenue	$2,654,782,530	PYTotalRevenueAmt
CY Total Revenue	$2,669,971,847	CYTotalRevenueAmt
PY Grants And Similar Paid	$1,739,993	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$781,225	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,124,361,930	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,133,685,135	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$8,711,348	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,216,952,003	PYOtherExpensesAmt
CY Other Expenses	$1,168,441,340	CYOtherExpensesAmt
PY Total Expenses	$2,343,053,926	PYTotalExpensesAmt
CY Total Expenses	$2,302,907,700	CYTotalExpensesAmt
PY Revenues Less Expenses	$311,728,604	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$367,064,147	CYRevenuesLessExpensesAmt
Total Assets BOY	$3,992,344,001	TotalAssetsBOYAmt
Total Assets EOY	$4,253,258,000	TotalAssetsEOYAmt
Total Liabilities BOY	$1,355,940,277	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,298,760,499	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$2,636,403,724	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$2,954,497,501	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.6 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	$1,976,592,685	ExpenseAmt
Grant	$1,156,448	GrantAmt
Revenue	$2,426,984,501	RevenueAmt
Desc	SEE SCHEDULE O.	Desc
Total Program Service Expenses	$1,976,592,685	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	Yes (true)	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	1189	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	15037	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	CJ	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	Yes (true)	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	14	GoverningBodyVotingMembersCnt
Independent Voting Member	12	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	4275 Campus Point Court	AddressLine1
City	San Diego	City
State	CA	State
ZIP Code	92121	ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (38 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
MARY JO ANDERSON CHS
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 PH D
VICE CHAIR / TRUSTEE	12.0	3.0	Yes (X)	$0	$0	$0	Yes (X)
GORDON R CLARK
Trustee/Vice Chair	12.0	3.0	Yes (X)	$0	$0	$0	Yes (X)
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
MAUREEN STAPLETON
CHAIRMAN/TRUSTEE	12.0	3.0	Yes (X)	$0	$0	$0	Yes (X)
ROBERT TJOSVOLD
TRUSTEE	12.0	3.0	Yes (X)	$0	$0	$0
CHRISTOPHER VAN GORDER
PRESIDENT & CEO / TRUSTEE	57.0	3.0	Yes (X)	$1,729,768	$0	$568,134	Yes (X)
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		$93,137	$0	$15,319	Yes (X)
VIRGINIA LEARY
ASSISTANT SECRETARY	39.0	1.0		$92,236	$0	$24,466	Yes (X)
RICHARD ROTHBERGER
TREASURER/EXECUTIVE VP/CFO	53.0	2.0		$1,279,910	$0	$260,087	Yes (X)
RICHARD R SHERIDAN
SEC/CORP SR VP, GEN COUNSEL	53.0	2.0		$686,371	$0	$164,020	Yes (X)
JOHN E ARMSTRONG
CORP SR VP, SPLY CHAIN/FACIL	50.0	0.0		$520,046	$0	$82,085		Yes (X)
ROBIN BROWN
CHIEF EXECUTIVE, SR VP	50.0	0.0		$627,362	$0	$162,881		Yes (X)
VICTOR V BUZACHERO
CORP SR VP INNOVAT/HR/PERF MGT	50.0	0.0		$927,768	$0	$188,997		Yes (X)
SUSAN CAMPBELL
Exec Dir, External Affairs	50.0	0.0		$473,899	$0	$96,265		Yes (X)
ARNOLD BRENT EASTMAN MD
CORP SR VP, CHIEF MED OFFICER	50.0	0.0		$477,623	$0	-$255,042		Yes (X)
JOHN ENGLE
CHIEF EXECUTIVE, SR VP, CHIEF	50.0	0.0		$518,542	$0	$84,313		Yes (X)
CARL ETTER
CHIEF EXECUTIVE, SR VP	50.0	0.0		$652,821	$0	$97,169		Yes (X)
SHIRAZ FAGAN
CHIEF EXECUTIVE, SR VP	50.0	0.0		$644,662	$0	$100,709		Yes (X)
GARY FYBEL
CHIEF EXECUTIVE, SR VP	50.0	0.0		$747,792	$0	$139,462		Yes (X)
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	50.0	0.0		$895,067	$0	$130,975		Yes (X)
LARRY HARRISON
CHIEF EXECUTIVE, SR VP	50.0	0.0		$591,762	$0	$0		Yes (X)
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	50.0	0.0		$814,897	$0	$141,581		Yes (X)
JAMES LA BELLE MD
CORP SR VP, CHIEF MED OFFICER	50.0	0.0		$710,044	$0	$123,360		Yes (X)
BARBARA PRICE
CORP SRVP BUS & SERV LINE DEV	50.0	0.0		$637,065	$0	$107,550		Yes (X)
MARC A REYNOLDS
CORP SR VP, PAYER RELATIONS	35.0	20.0		$604,020	$0	$94,878		Yes (X)
PATRIC THOMAS
CORP VP, INFORMATION SVCS	50.0	0.0		$536,536	$0	$72,263			Yes (X)
MARY ELLEN DOYLE
Corp VP, Nursing Ops	50.0	0.0		$471,965	$0	$76,411			Yes (X)
CATHY GUIBAL
VP FINANCE/CFO SCRIPPS MED FDN	50.0	0.0		$499,258	$0	$4,977			Yes (X)
ROBERT T HOFF
CORP VP, CLINICAL ANC OPS	50.0	0.0		$481,008	$0	$79,075			Yes (X)
EDWARD NAZARRO
COE CLINIC	50.0	0.0		$486,371	$0	$77,824			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$16,199,930	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$2,637,759	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	2072	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/AddressLine1	CityContractorAddress/USAddress/City	StateContractorAddress/USAddress/State	ZIP CodeContractorAddress/USAddress/ZIPCode	ServicesServicesDesc	CompensationCompensationAmt
SCRIPPS CLINIC MEDICAL GROUP
10666 N TORREY PINES RD	LA JOLLA	CA	92037	PHYSICIAN SERVICES	$237,194,654
SCRIPPS COASTAL MEDICAL GROUP
501 WASHINGTON AVE 601	SAN DIEGO	CA	92103	PHYSICIAN SERVICES	$33,330,475
MCCARTHY BUILDING COMPANIES
20401 SW BIRCH ST 300	NEWPORT BEACH	CA	92006	CONSTRUCTION	$106,234,422
EMERGENCY ACUTE CARE MED CORP
440 STEVENS AVE SUITE 150	SAN DIEGO	CA	92075	PHYSICIAN SERVICES	$11,240,054
WHITING-TURNER CONTRACTING
PO BOX 17596	BALTIMORE	MD	21297	CONSTRUCTION	$26,320,466

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Fundraising	$640,332	FundraisingAmt
All Other Contributions	$26,232,955	AllOtherContributionsAmt
Noncash Contributions	$1,972,264	NoncashContributionsAmt
Total Contributions	$26,873,287	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
HEALTHCARE DELIVERY REVENUE	622110	$2,220,013,587	$2,218,390,094	$1,623,493	$0
Capitation Premium	622110	$98,074,848	$98,074,848	$0	$0
Provider Fee Revenue	622110	$21,047,432	$21,047,432	$0	$0
Meaningful Use Incentive	900099	$14,475,560	$14,475,560	$0	$0
Rental Income - MOB	531120	$10,803,023	$10,803,023	$0	$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$31,401,544	TotalRevenueColumnAmt
Related Or Exempt Func Income	$30,653,810	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$747,734	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$2,395,815,994	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$33,574,137	TotalRevenueColumnAmt
Related Or Exempt Func Income	$504,242	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$42,832	UnrelatedBusinessRevenueAmt
Exclusion	$33,027,063	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	$1,026,393,162	SecuritiesAmt
Other	$0	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$850,536,708	SecuritiesAmt
Other	$660,000	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$175,856,454	SecuritiesAmt
Other	-$660,000	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$175,196,454	TotalRevenueColumnAmt
Exclusion	$175,196,454	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$1,623,033	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$640,332	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$1,112,901	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$510,132	TotalRevenueColumnAmt
Exclusion	$510,132	ExclusionAmt

Net Income From Gaming NetIncomeFromGamingGrp

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

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	$5,903,096	$5,903,096	$0	$0
Parking	812930	$2,479,378	$2,310,070	$169,308	$0
Gift Shop	453220	$1,245,488	$1,245,488	$0	$0

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$28,373,881	TotalRevenueColumnAmt
Related Or Exempt Func Income	$23,576,838	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$2,843,244	UnrelatedBusinessRevenueAmt
Exclusion	$1,953,799	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$38,001,843	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,669,971,847	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,426,984,501	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$5,426,611	UnrelatedBusinessRevenueAmt
Exclusion	$210,687,448	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	$781,225	TotalAmt
Program Services	$781,225	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	$16,879,040	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$16,879,040	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$85,110	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$85,110	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$865,028,223	TotalAmt
Program Services	$728,426,737	ProgramServicesAmt
Management And General	$131,766,695	ManagementAndGeneralAmt
Fundraising	$4,834,791	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$36,713,959	TotalAmt
Program Services	$29,717,186	ProgramServicesAmt
Management And General	$6,836,099	ManagementAndGeneralAmt
Fundraising	$160,674	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$150,553,630	TotalAmt
Program Services	$125,271,631	ProgramServicesAmt
Management And General	$24,727,835	ManagementAndGeneralAmt
Fundraising	$554,164	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$64,425,173	TotalAmt
Program Services	$53,671,317	ProgramServicesAmt
Management And General	$10,458,211	ManagementAndGeneralAmt
Fundraising	$295,645	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	$8,753,077	TotalAmt
Program Services	$1,355,309	ProgramServicesAmt
Management And General	$7,393,700	ManagementAndGeneralAmt
Fundraising	$4,068	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,127,916	TotalAmt
Program Services	$505,670	ProgramServicesAmt
Management And General	$622,246	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$833,962	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$833,962	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	$4,463,407	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$4,463,407	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$452,359,168	TotalAmt
Program Services	$412,481,630	ProgramServicesAmt
Management And General	$39,331,306	ManagementAndGeneralAmt
Fundraising	$546,232	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$5,159,702	TotalAmt
Program Services	$1,682,923	ProgramServicesAmt
Management And General	$3,473,999	ManagementAndGeneralAmt
Fundraising	$2,780	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$60,043,346	TotalAmt
Program Services	$41,202,191	ProgramServicesAmt
Management And General	$17,827,688	ManagementAndGeneralAmt
Fundraising	$1,013,467	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$38,642,376	TotalAmt
Program Services	$20,505,215	ProgramServicesAmt
Management And General	$18,137,161	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	$75,389,690	TotalAmt
Program Services	$65,001,578	ProgramServicesAmt
Management And General	$10,140,080	ManagementAndGeneralAmt
Fundraising	$248,032	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	$15,206,767	TotalAmt
Program Services	$12,413,823	ProgramServicesAmt
Management And General	$2,792,944	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	$101,596,549	TotalAmt
Program Services	$93,095,788	ProgramServicesAmt
Management And General	$8,500,761	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$4,173,987	TotalAmt
Program Services	$4,163,189	ProgramServicesAmt
Management And General	$10,798	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$351,586,684	$351,586,684	$0	$0
Repairs & Maintenance	$26,418,628	$17,560,905	$8,837,120	$20,603
Hospital Fee	$14,777,628	$14,777,628	$0	$0
Loss on Impairment	$4,518,048	$32,543	$4,485,505	$0

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,390,405	TotalAmt
Program Services	$2,359,513	ProgramServicesAmt
Fundraising	$1,030,892	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,302,907,700	TotalAmt
Program Services	$1,976,592,685	ProgramServicesAmt
Management And General	$317,603,667	ManagementAndGeneralAmt
Fundraising	$8,711,348	FundraisingAmt

Total Joint Costs TotalJointCostsGrp

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

Cash Non Interest Bearing CashNonInterestBearingGrp

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

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$640,782,676	BOYAmt
EOY	$458,127,487	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$25,824,669	BOYAmt
EOY	$18,291,479	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$364,180,990	BOYAmt
EOY	$307,978,390	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$16,710,695	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	$114,489	BOYAmt
EOY	$141,217	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$33,045,238	BOYAmt
EOY	$35,991,659	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$18,427,349	BOYAmt
EOY	$23,979,887	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$2,708,184,639	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$1,266,511,229	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$1,271,846,401	BOYAmt
EOY	$1,441,673,410	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,379,258,767	BOYAmt
EOY	$1,454,759,554	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$159,953,000	BOYAmt
EOY	$381,816,000	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$9,287,762	BOYAmt
EOY	$18,568,036	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$34,674,201	BOYAmt
EOY	$34,674,201	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$54,948,459	BOYAmt
EOY	$60,545,985	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,992,344,001	BOYAmt
EOY	$4,253,258,000	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$363,948,917	BOYAmt
EOY	$333,652,890	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	$14,756,262	BOYAmt
EOY	$14,845,504	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$873,346,839	BOYAmt
EOY	$858,248,606	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$1,088,630	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	$10,511,180	BOYAmt
EOY	$10,463,011	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	$92,288,449	BOYAmt
EOY	$81,550,488	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,355,940,277	BOYAmt
EOY	$1,298,760,499	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,427,513,033	BOYAmt
EOY	$2,747,774,920	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$130,729,892	BOYAmt
EOY	$127,888,120	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$78,160,799	BOYAmt
EOY	$78,834,461	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,636,403,724	BOYAmt
EOY	$2,954,497,501	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,992,344,001	BOYAmt
EOY	$4,253,258,000	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$367,064,147	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$55,532,290	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$6,561,920	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	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	false	MailingsMembersInd
Mailings Members	$0	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	$363,275	DirectContactLegislatorsAmt
Rallies Demonstrations	Yes (true)	RalliesDemonstrationsInd
Rallies Demonstrations	$40,273	RalliesDemonstrationsAmt
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$430,414	OtherActivitiesAmt
Total Lobbying Expenditures	$833,962	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. 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 (PEACH) ALLIANCE FOR CATHOLIC HEALTH CARE PROTON THERAPY CONSORTIUM SAN DIEGO REGIONAL CHAMBER OF COMMERCE SAN DIEGO TAXPAYERS ASSOCIATION SAN DIEGO ECONOMIC DEVELOPMENT CORPORATION DOWNTOWN SAN DIEGO PARTNERSHIP COMMUNITY HEALTH IMPROVEMENT PARTNERS FEDERAL LEGISLATION AND ISSUES REPRESENTED: PATIENT PROTECTION AND AFFORDABLE CARE ACT PROVISIONS - 501(R) - DISPROPORTIONATE SHARE HOSPITALS (DSH) H.R.1920/S.1555 SUSTAINABLE GROWTH RATE (PHYSICIAN PAYMENT) - H.R.4015 RECOVERY AUDIT CONTRACTOR REFORM - H.R.1250/S.1012 PROTON THERAPY PAYMENT POST ACUTE CARE PAYMENT REFORM - H.R.4994/S.2553 (IMPACT ACT) READMISSIONS REDUCTIONS PROGRAM REFORM - H.R.4188 VETERANS ACCESS TO CARE ACT - H.R.4810 FLEXIBILITY IN HEALTH IT REPORTING - H.R.5481 STATE LEGISLATION AND ISSUES REPRESENTED: COVERED CALIFORNIA (STATE HEALTH INSURANCE EXCHANGE) MEDICAID (MEDI-CAL) 1115 WAIVER SB 1094 (NON-HOSPITAL TRANSACTIONS) SB 455 (PATIENT CLASSIFICATION SYSTEM) AB 2616 (WORKERS COMPENSATION PRESUMPTION FOR MRSA) SB 503 (COMMUNITY BENEFIT/CHARITY CARE) SB 906 (ELECTIVE PERCUTANEOUS CORONARY INTERVENTION) SB 1299 (WORKPLACE VIOLENCE PREVENTION PLANS) AB 1558 (CALIFORNIA HEALTH DATA SYSTEM) SB 1276 (CHARITY CARE AND DISCOUNT PAYMENT PLANS) AB 1952 (NON-PROFIT HOSPITAL CHARITY CARE PENALTY FUND)	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	false	WrittenPolicyMonitoringInd
Staff Hours Spent Enforcement	70.00	StaffHoursSpentEnforcementCnt
Expenses Incurred Enforcement	$1,742	ExpensesIncurredEnforcementAmt
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	$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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$94,354,000	BeginningYearBalanceAmt
Contributions	$745,000	ContributionsAmt
Investment Earnings Or Losses	$12,924,000	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$798,000	GrantsOrScholarshipsAmt
Other Expenditures	$2,496,000	OtherExpendituresAmt
Administrative Expenses	$910,000	AdministrativeExpensesAmt
End Year Balance	$103,819,000	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$87,057,000	BeginningYearBalanceAmt
Contributions	$2,316,000	ContributionsAmt
Investment Earnings Or Losses	$657,000	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$703,000	GrantsOrScholarshipsAmt
Other Expenditures	$1,930,000	OtherExpendituresAmt
Administrative Expenses	$807,000	AdministrativeExpensesAmt
End Year Balance	$86,590,000	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$81,098,000	BeginningYearBalanceAmt
Contributions	$685,000	ContributionsAmt
Investment Earnings Or Losses	$7,714,000	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$36,000	GrantsOrScholarshipsAmt
Other Expenditures	$1,636,000	OtherExpendituresAmt
Administrative Expenses	$768,000	AdministrativeExpensesAmt
End Year Balance	$87,057,000	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
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	$22,843,333	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$97,001,792	OtherCostOrOtherBasisAmt
Book Value	$119,845,125	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,108,113,429	OtherCostOrOtherBasisAmt
Depreciation	$518,117,099	DepreciationAmt
Book Value	$589,996,330	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$78,196,263	OtherCostOrOtherBasisAmt
Depreciation	$49,545,814	DepreciationAmt
Book Value	$28,650,449	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$915,154,880	OtherCostOrOtherBasisAmt
Depreciation	$698,848,316	DepreciationAmt
Book Value	$216,306,564	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$486,874,942	OtherCostOrOtherBasisAmt
Book Value	$486,874,942	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$1,441,673,410	TotalBookValueLandBuildingsAmt
Financial Derivatives		FinancialDerivativesGrp
Closely Held Equity Interests		CloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
MULTI-STRATEGY HEDGE FUNDS	$368,328,000	F
PRIVATE EQUITY FUNDS	$13,488,000	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$381,816,000	TotalBookValueSecuritiesAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
SELF INSURED WORKER'S COMP LIAB	$38,107,314
Deferred Retirement Liability	$14,208,437
Self Insured Malpractice Liability	$18,495,017
Asset Retirement Obligation	$13,887,883
Annuity and Unitrusts	$11,710,608
Deposits and Contingencies	$82,822
Intercompany Liabilities	-$14,941,593

Field	Value	IRS element (for citing)
Total Liability	$81,550,488	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (5 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 FY14.
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 FINANCIALS STATEMENTS. SCHEDULE D, PART
Schedule D, Part X, Line 2	INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES $1,086,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES $17,550,421 CONTRIBUTIONS RECEIVED FOR USE IN SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS $30,671,286 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE $13,148,710. CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS $17,176,250
SCHEDULE D, PART V, ITEM 1A, COLUMN (C)	THE BEGINNING BALANCE DOES NOT ROLL FORWARD FROM THE ENDING BALANCE OF THE PREVIOUS YEAR DUE TO THE WHITTIER INSTITUTE (TWI), $7,764,000. EFFECTIVE FY12, TWI WAS CONSOLIDATED WITH SCRIPPS HEALTH AND NEEDS TO BE REFLECTED IN THIS SCHEDULE. AS THE ROLLFORWARD DOES NOT CONTAIN AN APPROPRIATE LINE FOR THIS TRANSACTION, IT WAS DETERMINED THAT THE MOST APPROPRIATE PRESENTATION WAS TO REFLECT IT IN THE BEGINNING BALANCE.
SCHEDULE D, PART XIII	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 INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN THE FURTHERANCE OF THE PURPOSE FOR WHICH IT WAS GRANTED EXEMPTION. THE ORGANIZATION ACCOUNTS FOR INCOME TAXES RELATED TO THE OPERATIONS OF ITS FOR-PROFIT SUBSIDIARIES (SCPO) UNDER THE PROVISIONS OF FASB ASC 740, INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. UNDER FASB ASC 740, 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, 2014 OR 2013. 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 2007 IN MAJOR TAX JURISDICTIONS.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (5 entries)

RegionRegionTxt	EmployeeEmployeeCnt	Type Of Activities ConductedTypeOfActivitiesConductedTxt	Specific Services ProvidedSpecificServicesProvidedTxt	Region Total ExpendituresRegionTotalExpendituresAmt
North America	105	Program services	Reconstructive Surgery	$283,347
East Asia and the Pacific	5	Program services	Med Care & Training	$13,305
Central America and the Caribbean		Investments		$143,686,670
Central America and the Caribbean		Investments		$456,953
South America		Fundraising		$24,000

Field	Value	IRS element (for citing)
Subtotal Employees	110	SubtotalEmployeesCnt
Total Employee	110	TotalEmployeeCnt
Subtotal Spent	$144,464,275	SubtotalSpentAmt
Total Spent	$144,464,275	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	false	ForeignPartnershipInd
Boycott Countries	false	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE F, PART I, LINE 2

PROCEDURES FOR MONITORING USE OF GRANTS A SEMI-ANNUAL REPORT AND A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT TO DATE IS REQUIRED. THIS SEMI-ANNUAL REPORT SHALL INCLUDE PROGRESS MADE TOWARD MEETING OBJECTIVES OUTLINED IN THE GRANT APPLICATION. A FINAL REPORT IS DUE WITHIN THIRTY (30) DAYS FOLLOWING THE EXPIRATION DATE OF THE GRANT. IN ADDITION TO THE PROGRESS MADE TOWARD MEETING THE OBJECTIVES OUTLINED IN THE GRANT APPLICATION, THE FINAL REPORT SHALL INCLUDE QUANTITATIVE AND QUALITATIVE RESULTS OF THE PROGRAM AGAINST ITS STATED GOALS AND OBJECTIVES. A FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT AGAINST THE BUDGET MUST BE INCLUDED AS PART OF THIS FINAL REPORT.

SCHEDULE F, PART I, LINE 3, COLUMN F

ACCOUNTING METHOD THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS IN COLUMN F.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Name Of Event1	CANDLELIGHTBALL	NameOfEvent1Amt
Gross Receipts Event1	$667,719	GrossReceiptsEvent1Amt
Charitable Contri Event1	$127,894	CharitableContriEvent1Amt
Gross Revenue Event1	$539,825	GrossRevenueEvent1Amt
Cash Prizes Event1	$0	CashPrizesEvent1Amt
Non Cash Prizes Event1	$0	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$111,570	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$375	FoodAndBeverageEvent1Amt
Entertainment Event1	$500	EntertainmentEvent1Amt
Other Direct Expenses Event1	$49,226	OtherDirectExpensesEvent1Amt
Name Of Event2	GOLF TOURNEY	NameOfEvent2Amt
Gross Receipts Event2	$551,276	GrossReceiptsEvent2Amt
Charitable Contri Event2	$50,655	CharitableContriEvent2Amt
Gross Revenue Event2	$500,621	GrossRevenueEvent2Amt
Cash Prizes Event2	$0	CashPrizesEvent2Amt
Non Cash Prizes Event2	$0	NonCashPrizesEvent2Amt
Rent Facility Costs Event2	$92,969	RentFacilityCostsEvent2Amt
Food And Beverage Event2	$0	FoodAndBeverageEvent2Amt
Entertainment Event2	$5,000	EntertainmentEvent2Amt
Other Direct Expenses Event2	$236,834	OtherDirectExpensesEvent2Amt
Other Events Total	8	OtherEventsTotalCnt
Gross Receipts Other Events	$1,044,370	GrossReceiptsOtherEventsAmt
Charitable Contri Other Events	$461,783	CharitableContriOtherEventsAmt
Gross Revenue Other Events	$582,587	GrossRevenueOtherEventsAmt
Cash Prizes Other Events	$0	CashPrizesOtherEventsAmt
Non Cash Prizes Other Events	$0	NonCashPrizesOtherEventsAmt
Rent Fclty Costs Other Events	$379,355	RentFcltyCostsOtherEventsAmt
Food And Beverage Other Events	$30,976	FoodAndBeverageOtherEventsAmt
Entertainment Other Events	$62,745	EntertainmentOtherEventsAmt
Oth Direct Expnss Other Events	$143,351	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$2,263,365	GrossReceiptsTotalAmt
Charitable Contributions Tot	$640,332	CharitableContributionsTotAmt
Gross Revenue Total Events	$1,623,033	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$0	CashPrizesTotalEventsAmt
Non Cash Prizes Total Events	$0	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$583,894	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$31,351	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$68,245	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$429,411	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$1,112,901	DirectExpenseSummaryEventsAmt
Net Income Summary	$510,132	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	$47,964,142	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$47,964,142	NetCommunityBenefitExpnsAmt
Total Expense	0.02130	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$211,270,948	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$165,587,210	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$45,683,738	NetCommunityBenefitExpnsAmt
Total Expense	0.02030	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,104,888	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,195,853	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$9,909,035	NetCommunityBenefitExpnsAmt
Total Expense	0.00440	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$276,339,978	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$172,783,063	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$103,556,915	NetCommunityBenefitExpnsAmt
Total Expense	0.04600	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,684,124	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$553,827	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,130,297	NetCommunityBenefitExpnsAmt
Total Expense	0.00230	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$27,575,657	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,301,189	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$21,274,468	NetCommunityBenefitExpnsAmt
Total Expense	0.00940	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,355,938	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,564,340	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,791,598	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,169,169	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,185,632	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$14,983,537	NetCommunityBenefitExpnsAmt
Total Expense	0.00670	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$821,152	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$821,152	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$69,606,040	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$20,604,988	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$49,001,052	NetCommunityBenefitExpnsAmt
Total Expense	0.02180	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$345,946,018	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$193,388,051	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$152,557,967	NetCommunityBenefitExpnsAmt
Total Expense	0.06780	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$22,857	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$22,857	NetCommunityBenefitExpnsAmt

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$67,974	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$67,974	NetCommunityBenefitExpnsAmt

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$222,916	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$40,614	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$182,302	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$130,704	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$77,122	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$53,582	NetCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,238,945	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$31,653	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,207,292	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$361,848	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$361,848	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,000	NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,048,244	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$149,389	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,898,855	NetCommunityBenefitExpnsAmt
Total Expense	0.00080	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$53,701,584	BadDebtExpenseAmt
Reimbursed By Medicare	$354,191,358	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$418,780,056	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$64,588,698	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost Accounting System	Yes (X)	CostAccountingSystemInd

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	0.55500	0.25000
Surgery Center

Scripps Memorial
Medical Office Building	0.15300	0.77200
Ximed Medical

Scripps Mercy ASC
Ambulatory Surgery Center	0.73500	0.26500
ScrippsUSP Surgery
Ambulatory Surgery Center	0.50000	0.27000
Centers

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

Hospital Facilities HospitalFacilitiesGrp (4 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Teaching HospitalTeachingHospitalInd	Research FacilityResearchFacilityInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Facility Reporting GroupFacilityReportingGroupCd
Scripps Mercy Hospital
1	4077 5th Avenue	San Diego	CA	92103	WWW.SCRIPPS.ORG	090000074	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
Scripps Memorial Hospital La Jolla
2	9888 Genesee Avenue	La Jolla	CA	92037	WWW.SCRIPPS.ORG	080000050	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
Scripps Green Hospital
3	10666 north Torrey Pines Road	San Diego	CA	92037	WWW.SCRIPPS.ORG	080000139	Yes (X)	Yes (X)	Yes (X)	Yes (X)		A
Scripps Memorial Hospital Encinitas
4	354 Santa Fe Drive	La Jolla	CA	92037	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	BusinessNameLine1

Field	Value	IRS element (for citing)
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
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	12	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C	OwnWebsiteURLTxt
Rpt Available Upon Request	Yes (X)	RptAvailableUponRequestInd
Adopt Implementation Strategy	Yes (X)	AdoptImplementationStrategyInd
Exec Implementation Strategy	Yes (X)	ExecImplementationStrategyInd
Develop Community Wide Plan	Yes (X)	DevelopCommunityWidePlanInd
Exec Community Wide Plan	Yes (X)	ExecCommunityWidePlanInd
Include Operational Plan	Yes (X)	IncludeOperationalPlanInd
Prioritize Health Needs	Yes (X)	PrioritizeHealthNeedsInd
Prioritize Services	Yes (X)	PrioritizeServicesInd
All Needs Addressed	false	AllNeedsAddressedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Used Deter Elig Free Care	Yes (true)	FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care	200.	FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt Care	Yes (true)	FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care	400.	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (true)	ExplainedBasisInd
Income Level	Yes (X)	IncomeLevelInd
Asset Level	Yes (X)	AssetLevelInd
Medical Indigency	Yes (X)	MedicalIndigencyInd
Insurance Status	Yes (X)	InsuranceStatusInd
State Regulation	Yes (X)	StateRegulationInd
Other Factors	Yes (X)	OtherFactorsInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Collection Activities	false	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Medicare Rates	Yes (X)	MedicareRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART V, LINE 3	HEALTH EXPERT, COMMUNITY LEADER AND RESIDENT FEEDBACK THE INSTITUTE OF PUBLIC HEALTH (IPH) AND CHNA ADVISORY WORKGROUP SOUGHT FEEDBACK FROM COMMUNITY LEADERS, HEALTH EXPERTS AND RESIDENTS OF VULNERABLE COMMUNITIES. THIS WAS DONE THROUGH THREE METHODS: AN ELECTRONIC SURVEY FOR COMMUNITY LEADERS AND HEALTH EXPERTS; KEY INFORMANT INTERVIEWS; AND COMMUNITY FORUMS FOR RESIDENTS IN VULNERABLE COMMUNITIES THROUGHOUT SAN DIEGO COUNTY. - ONLINE SURVEY OF HEALTH EXPERTS AND LEADERS INITIAL EMAIL SAMPLE (N=120). TOTAL SURVEYS COMPLETED (N=89). - COMMUNITY FORUMS (106 COMMUNITY RESIDENTS) EL CAJON, OCEANSIDE, ESCONDIDO, LOGAN HEIGHTS, AND SAN YSIDRO CONDUCTED IN NEIGHBORHOODS WITH HIGH COMMUNITY NEED INDEX SCORES - FIVE KEY INFORMANT INTERVIEWS LEADERS CHOSEN BASED ON DISCIPLINE EXPERTISE AND KNOWLEDGE OF HEALTH ISSUES AFFECTING COMMUNITIES - COMMUNITY FORUMS (106 COMMUNITY RESIDENTS) EL CAJON, OCEANSIDE, ESCONDIDO, LOGAN HEIGHTS AND SAN YSIDRO CONDUCTED IN NEIGHBORHOODS WITH HIGH COMMUNITY NEED INDEX SCORES. HEALTH EXPERT AND COMMUNITY LEADER ELECTRONIC SURVEY IN ORDER TO PRIORITIZE THE HEALTH CONDITIONS AND HEALTH DRIVERS IDENTIFIED, THE IPH AND THE CHNA ADVISORY WORKGROUP DEVELOPED A LIST OF OVER 100 POSSIBLE COMMUNITY HEALTH EXPERTS AND LEADERS. A HEALTH EXPERT OR LEADER WAS DEFINED AS A PERSON WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE LIST WAS COMPILED TO ENSURE REPRESENTATION OF EXPERTS IN BOTH THE 15 HEALTH CONDITIONS AND 26 HEALTH DRIVERS THAT HAD BEEN IDENTIFIED. HEALTH EXPERTS AND LEADERS WERE IDENTIFIED FROM HOSPITAL SETTINGS, COMMUNITY-BASED ORGANIZATIONS, GOVERNMENT POLICY, LEGAL, AND HEALTH ADVOCACY ORGANIZATIONS. CONTACT INFORMATION WAS VERIFIED AND INITIAL EMAILS WERE SENT TO THE LIST OF HEALTH EXPERTS AND LEADERS IN SAN DIEGO IN ORDER TO GAUGE POTENTIAL INTEREST IN PARTICIPATING IN THE CHNA HEALTH PRIORITIZATION SURVEY. AT THE TIME OF THIS INITIAL E-MAIL, INTERESTED RESPONDENTS WERE ASKED WHICH CONDITIONS THEY HAD EXPERTISE IN, WHAT POPULATIONS THEY SERVED AND WHAT REGIONS THEY WORKED IN. THIS INITIAL FEEDBACK GAVE THE IPH AND THE CHNA ADVISORY WORKGROUP AN IDEA OF THE COVERAGE OF DATA THAT WOULD ULTIMATELY BE GATHERED ON HEALTH CONDITIONS, REGIONS AND POPULATIONS SERVED. TARGETED OUTREACH TO ADDITIONAL HEALTH EXPERTS AND LEADERS WAS THEN INITIATED TO FILL GAPS OF UNDER-REPRESENTED CONDITIONS, REGIONS, OR VULNERABLE POPULATIONS. THE CHNA SURVEY WAS EMAILED TO OVER 120 HEALTH EXPERTS AND LEADERS, WITH 89 PEOPLE COMPLETING THE SURVEY. WHEN DESIGNING THE SURVEY, IT WAS TAKEN INTO ACCOUNT THE DIVERSITY OF THE KNOWLEDGE OF THE RESPONDENTS. SOME RESPONDENTS HAD KNOWLEDGE OF SPECIFIC DISEASES OR CONDITIONS AND THE HEALTH DRIVERS AFFECTING THOSE DISEASES. OTHERS HAD A MUCH MORE GENERAL KNOWLEDGE OF HEALTH DRIVERS AND HOW THEY MIGHT AFFECT MULTIPLE HEALTH OUTCOMES. TO ACCOMMODATE THESE DIFFERENT PERSPECTIVES, THE SURVEY WAS CREATED SO THAT THE RESPONDENTS COULD ANSWER THE SURVEY FROM ONE OF THE TWO PERSPECTIVES. BOTH PERSPECTIVES ALLOWED RESPONDENTS TO COMMENT ON POOR HEALTH CONDITIONS AND HEALTH DRIVERS AS THEY COMPLETED THE SURVEY. AS PART OF THE SURVEY, PARTICIPANTS WERE PROVIDED WITH ELECTRONIC LINKS TO THE 15 CONDITION BRIEFS AND THE OPPORTUNITY TO REVIEW THOSE BRIEFS, COMPARING DATA ACROSS THE CONDITIONS PRIOR TO ANSWERING THE SURVEY. USING THE LIST OF 15 HEALTH CONDITIONS AND 26 HEALTH DRIVERS, THE IPH AND CHNA ADVISORY WORKGROUP DEVELOPED AN ELECTRONIC SURVEY THAT ASKED COMMUNITY LEADERS AND HEALTH EXPERTS TO HELP PRIORITIZE HEALTH CONDITIONS THAT MET THE FOLLOWING REQUIREMENTS: - HAVE A SIGNIFICANT PREVALENCE IN THE COMMUNITY, - CONTRIBUTE SIGNIFICANTLY TO THE MORBIDITY AND MORTALITY IN SAN DIEGO COUNTY, - DISPROPORTIONATELY IMPACT VULNERABLE COMMUNITIES, - REFLECT A NEED THAT EXISTS THROUGHOUT SAN DIEGO COUNTY, AND - CAN BE ADDRESSED THROUGH EVIDENCE-BASED PRACTICES BY HOSPITALS AND HEALTHCARE SYSTEMS. KEY INFORMANT INTERVIEWS THE IPH COMPLETED FIVE KEY INFORMANT INTERVIEWS. KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH DR. WILMA WOOTEN, DR. JAMES DUNFORD, DR. CHRISTINE WOOD, DR. PHILIP HANGER, AND GREG KNOLL, ESQ. EACH INTERVIEW LASTED NO LONGER THAN ONE HOUR. THESE LEADERS WERE CHOSEN BASED ON THEIR DISCIPLINE AND KNOWLEDGE OF HEALTH ISSUES AFFECTING SAN DIEGO. KEY INFORMANTS WERE ALSO SELECTED BASED ON THEIR ABILITY TO UNDERSTAND HEALTH POLICY, AND THEIR KNOWLEDGE OF ISSUES THROUGHOUT SAN DIEGO COUNTY. THE 15 HEALTH CONDITIONS WERE SHARED WITH THE PARTICIPANTS DURING THE INTERVIEWS. THE PURPOSE OF THE KEY INFORMANT INTERVIEWS WAS TO: - GATHER MORE IN-DEPTH UNDERSTANDING OF THE HEALTH CONDITIONS MOST AFFECTING SAN DIEGO. - AID IN THE PROCESS OF PRIORITIZING HEALTH CONDITIONS. - MAKE CONNECTIONS BETWEEN THE HEALTH CONDITIONS AND ASSOCIATED HEALTH DRIVERS. - GAIN INFORMATION ABOUT THE SYSTEM OR POLICY CHANGES THAT COULD POTENTIALLY IMPACT HEALTH CONDITIONS. - GET HEALTH CONDITIONS SPECIFIC RECOMMENDATIONS AS WELL AS OVERALL RECOMMENDATIONS. COMMUNITY FORUMS THE PURPOSE OF THE COMMUNITY FORUMS WAS TO GAIN RESIDENT'S PERSPECTIVE ON THE OWN HEALTH NEEDS OF THEIR COMMUNITIES, IDENTIFY HEALTH CONDITIONS MOST AFFECTING THEIR COMMUNITIES, AND IDENTIFY COMMUNITY RECOMMENDATIONS ON HOW HOSPITALS COULD HELP TO MEET THEIR HEALTH NEEDS. IN ORDER TO ENSURE UNBIASED COMMUNITY FEEDBACK, NEITHER HEALTHCARE ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) NOR THE PARTICIPATING HOSPITALS ATTENDED. COMMUNITIES OF HIGH HEALTH NEED, BASED ON THEIR COMMUNITY NEED INDEX SCORE WERE SELECTED FOR CONDUCTING FOCUS GROUPS WITH COMMUNITY MEMBERS. THE IPH PARTNERED WITH NEIGHBORHOOD COMMUNITY COLLABORATIVE AGENCIES OR ORGANIZATIONS WITHIN EACH NEIGHBORHOOD TO RECRUIT COMMUNITY MEMBERS TO PARTICIPATE IN THE FOCUS GROUPS. RECRUITMENT INCLUDED THE STIPULATION THAT FOCUS GROUP PARTICIPANTS WERE LIVING IN THE NEIGHBORHOOD AND WERE NOT AFFILIATED WITH LOCAL HOSPITALS AND HEALTH CENTERS. FOCUS GROUPS WERE CONDUCTED IN EL CAJON, OCEANSIDE, ESCONDIDO, LOGAN HEIGHTS, AND SAN YSIDRO. DURING THE FOCUS GROUPS, GEOGRAPHICAL INFORMATIONAL SYSTEMS (GIS) MAPS DISPLAYING CNI SCORES BY ZIP CODE IN SAN DIEGO COUNTY AS WELL AS THE SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA) REGION OF THE NEIGHBORHOOD WERE DISPLAYED AND HAND-OUTS IN BOTH ENGLISH AND SPANISH EXPLAINING THE CNI SCORE WERE DISTRIBUTED TO EACH PARTICIPANT. INFORMATION WAS ALSO PROVIDED TO COMMUNITY MEMBERS OF THE HEALTH RESOURCES AVAILABLE TO THEM IN THEIR NEIGHBORHOODS.
SCHEDULE H, PART V, LINE 4	SCRIPPS CONDUCTED ONE CHNA FOR THE SYSTEM. BEGINNING IN SEPTEMBER 2012 WITH COMPLETION IN APRIL 2013, THE IPH 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 5	THIS COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTP://WWW.SCRIPPS.ORG/SPARKLE-ASSETS/DOCUMENTS/2013_CHNA_FINAL.PDF
SCHEDULE H, PART V, LINE 7	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 NEEDS: 1. FREQUENCY OF DIAGNOSIS, FROM OSHPD HOSPITAL DISCHARGE DATA 2. HIGH MORTALITY RATE IN SAN DIEGO 3. COMMUNITY CONCERN FIFTEEN CONDITIONS WERE THEN USED AS A STARTING POINT TO SOLICIT INPUT FROM THE HEALTH EXPERTS AND LEADERS, KEY INFORMANTS, AND COMMUNITY MEMBERS. BY COMBINING THE RESULTS OF ALL OF THE METHODS EMPLOYED, I.E. SECONDARY DATA SOURCES, ELECTRONIC HEALTH EXPERT AND LEADER SURVEYS, KEY INFORMANT INTERVIEWS, AND COMMUNITY FOCUS GROUPS, THE TOP 4 HEALTH CONDITIONS THAT WERE PRIORITIZED BY THIS COMMUNITY HEALTH NEEDS ASSESSMENT WERE: 1. DIABETES (TYPE 2) 2. OBESITY 3. CARDIOVASCULAR DISEASE 4. MENTAL/BEHAVIORAL HEALTH FIVE BROAD CATEGORIES OF RECOMMENDATIONS FOR HOSPITALS TO IMPROVE COMMUNITY HEALTH INCLUDED: 1. ACCESS TO CARE OR INSURANCE 2. CARE MANAGEMENT 3. COLLABORATION 4. EDUCATION 5. SCREENING SERVICES THE OTHER ELEVEN CONDITIONS (ACUTE RESPIRATORY INFECTIONS, ASTHMA, BACK PAIN, BREAST CANCER, COLORECTAL CANCER, DEMENTIA/ALZHEIMER'S, HIGH RISK PREGNANCY, LUNG CANCER, PROSTATE CANCER, SKIN CANCER AND UNINTENTIONAL INJURY) WERE NOT ADDRESSED IN DETAIL IN THE SCRIPPS CHNA DUE TO LIMITED FINANCIAL AND STAFFING ISSUES AND THAT SOME OF THESE HEALTH CONDITIONS ARE BEING ADDRESSED BY OTHER PROVIDERS IN THE COMMUNITY.
SCHEDULE H, PART V, LINE 12I	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS 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), WE WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, WE WILL FORGIVE A PORTION OF THE BILL. WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. THE DETERMINATION OF WHAT PERCENTAGE OF TOTAL CHARGES A QUALIFIED FINANCIAL ASSISTANCE PATIENT MAY BE CHARGED IS BASED ON FPL AND THE PERCENTAGE OF FPL THE PATIENT IS AT. SCRIPPS FINANCIAL ASSISTANCE PROGRAM RANGES FROM NO CHARGE FOR CARE TO PATIENTS AT OR BELOW 200 PERCENT OF FPL TO 23% OF TOTAL CHARGES FROM 201% TO 400% OF FPL.
SCHEDULE H, PART V, LINE 14G	METHODS OF PUBLISHING THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE IS WIDELY AVAILABLE ON THE SCRIPPS HEALTH WEBSITE HTTP://WWW.SCRIPPS.ORG/PATIENT-GUIDE__FINANCIAL-ASSISTANCE 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. 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 SUMMARY OF THE POLICY WILL BE MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. - THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS WILL BE CONSPICUOUSLY POSTED ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL CONTAIN THE WEB SITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED. - FINANCIAL ASSISTANCE INFORMATION WILL BE INCLUDED ON ALL PATIENT STATEMENTS. - A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. TO THE EXTENT REQUIRED BY LAW, SCRIPPS WILL PROVIDE A COPY OF THIS POLICY AND RELATED INFORMATION TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT. IN ADDITION, SCRIPPS POLICY WILL BE AVAILABLE TO THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW WILL BE 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	34	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (34 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	FacilityFacilityTxt
Scripps Clinic - Torrey Pines
10666 N Torrey Pines Rd	La Jolla	CA	92037	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Rancho Bernardo
15004 Innovation Dr	San Diego	CA	92128	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Medical Lab
9535 Waples St 150	San Diego	CA	92121	Laboratory services
Scripps Clinic - Carmel Valley
3811 Valley Centre Dr	San Diego	CA	92130	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Encinitas
310 Santa Fe Dr	Encinitas	CA	92024	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC Cedar
130 Cedar Rd	Vista	CA	92083	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic -LA JOLLA Memorial Campus
9850 Genessee Ave Ximed Bldg 600	San Diego	CA	92121	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Home Health Services
9619 Chespeake Dr 300	San Diego	CA	92123	Home health services
Scripps Clinic - Mission Valley
7565 Mission Valley Rd	San Diego	CA	92108	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Carlsbad
2176 Salk Ave	Carlsbad	CA	92008	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Rancho San Diego
10862 Calle Verde	La Mesa	CA	91941	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic -La Jolla Memorial CampuS
9850 Genessee Ave Ximed Bldg 600	San Diego	CA	92121	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Mercy ASC
550 Washington St 1st Floor	San Diego	CA	92103	Primary care and specialty care services IN AN AMBULATORY ENVIRONMNET
Encinitas Surgery Center LLC
320 Santa Fe Dr LL1-2	Encinitas	CA	92024	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Hillcrest
501 Washington St 525 600	San Diego	CA	92103	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Cardio & Thoracic Surgery Center
9850 Genessee Ave 560	La Jolla	CA	92037	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Del Mar
12395 El Camino Real 317 112 12	Del Mar	CA	92130	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Oceanside
4318 Mission Ave	Oceanside	CA	92057	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Hospital Medical Services
4275 Campus Point Court	San Diego	CA	92121	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Eastlake
971 Lane Ave	Chula Vista	CA	91914	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Encinitas
477 N El Camino Real A208 B305	Encinitas	CA	92024	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Solana Beach
380 Stevens Ave 100	Del Mar	CA	92075	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Santee
278 Town Center Pkwy 105	Santee	CA	92071	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Vista Way OBGYN
3998 Vista Way 202C	Vista	CA	92056	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Encinitas OBGYN
332 Santa Fe Dr 115	Encinitas	CA	92024	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - La Jolla OBGYN
9850 Genessee Ave 170	San Diego	CA	92121	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Escondido
488 E Valley Pkwy 411	Escondido	CA	92025	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Alvarado
6386 Alvarado Ct 310	San Diego	CA	92120	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Mercy Campus
4020 Fifth Ave 401	San Diego	CA	92103	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Coronado
1317 A Ynes Pl	Coronado	CA	92118	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
SCMC - Sycamore
2120 Thibido	Vista	CA	92084	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Mental Health
15004 Innovation Dr	San Diego	CA	92128	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic - Mission Valley
7425 Mission Valley Rd	San Diego	CA	92108	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT
Scripps Clinic Rancho San Diego
3835 Avocado Blvd	La Mesa	CA	91941	Primary care and specialty care services IN AN AMBULATORY ENVIRONMENT

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3C	ALL STANDARD EVALUATIONS FOR CHARITY ELIGIBILITY ARE DETERMINED USING FEDERAL POVERTY LEVEL. (BELOW 200% = FULL CHARITY. 201 - 400% = 77% DISCOUNT OFF CHARGES). THESE STANDARD ELIGIBILITY EVALUATIONS ARE WHEN WE HAVE FINANCIAL ASSISTANCE APPLICATIONS AND ANNUAL INCOME LEVEL VERIFICATION. THE EXCEPTION TO THIS IS WHEN PATIENTS FALL OUTSIDE THE 400% FPL LEVEL FOR THEIR FAMILY SIZE AND BASED ON THEIR FINANCIAL SITUATION AT THE TIME OF EVALUATION, WE MAY APPLY THE REGULATION IN AB774 THAT DOES NOT ALLOW US TO CHARGE THE PATIENT MORE THAN 10% OF THEIR ANNUAL GROSS FAMILY INCOME IF THEY ARE CONSIDERED A HIGH MEDICAL COST PATIENT. WHEN WE DO NOT HAVE THIS BACK-UP AND INFORMATION FROM THE PATIENT, THEN WE MAY VERIFY ELIGIBILITY THROUGH THE USE OF A CREDIT REPORT OR THROUGH AN AUTOMATED CHARITY CALCULATOR THAT USES PAYMENT HISTORY AND OUR POLICIES TO CREATE AN ALGORITHM. THIS ALGORITHM IS APPLIED TO INDIVIDUAL PATIENTS AND PRODUCES A "DOES" OR "DOES NOT" QUALIFY FOR CHARITY SCORE.
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 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 FY14 WAS $6,791,598. THIS INCLUDES SCRIPPS INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES AND MERCY CLINIC. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO FOUNDED IN 1930 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 FY14 WERE 9,459. 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 MORE THAN 50 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 FY14 WAS $2.4 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 AN ACCESS COMMUNITY BENEFIT DATABASE. THE ACCESS COMMUNITY BENEFIT DATABASE HAS BEEN 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 FY2014 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) THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW EFFECTIVE JANUARY 1, 2010. DURING THE YEAR ENDED SEPTEMBER 30, 2014, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $21,047,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $14,391,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. IN ADDITION, SCRIPPS HEALTH WAS ASSESSED AND ACCRUED CHARITABLE CONTRIBUTIONS TO CHFT OF $387,000 IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEALTH FROM PROVIDER FEE WAS $6,269,000 IN FISCAL YEAR 2014.
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, ESPECIALLY PROJECTS OF CATHOLIC CHARITIES AND THE ST. VINCENT DE PAUL AND JOAN KROC CENTER. ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2: EXECUTIVE LEADERSHIP 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). SPONSORED BY THE OFFICE OF THE PRESIDENT. COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3: 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. AMERICAN HEART ASSOCIATION HEART WALK SPONSORSHIP GIVEN TO THE AMERICAN HEART ASSOCIATION, SCRIPPS ALLOCATED MORE THAN $30,000 IN OPERATIONAL FUNDS TO SUPPORT THE AMERICAN HEART ASSOCIATION'S EFFORTS TO FIGHT HEART DISEASE AND STROKE, IN ADDITION, SCRIPPS EMPLOYEE VOLUNTEERS COORDINATED WALKER PARTICIPATION AND FUNDRAISING EFFORTS. IN 2014, MORE THAN 1,700 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES, AND FRIENDS - WALKED TO HELP RAISE MORE THAN $125,000. ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT BY PROVIDING HEALTH EDUCATION MATERIALS AND MORE. SPONSORED BY SCRIPPS HEALTH COMMUNITY BENEFIT SERVICES. SAN DIEGO COUNTY SHERIFF'S FOUNDATION SUPPORT AND REMEMBER EVENT THE DEPUTY SHERIFF'S FOUNDATION SUPPORTS AND REMEMBERS LAW ENFORCEMENT OFFICERS IN SAN DIEGO COUNTY AND THROUGHOUT CALIFORNIA. FROM THOSE WHO DEDICATE THEIR LIVES TO PROTECTING OTHERS ON A DAILY BASIS TO THOSE MEN AND WOMEN WHO PAID THE ULTIMATE SACRIFICE, LOSING THEIR LIFE IN THE LINE OF DUTY, SUPPORT & REMEMBER IS DEDICATED TO THEM. SUSAN G. KOMEN 3 DAY WALK FOR THE CURE KOMEN SAN DIEGO CONTINUES TO BE THE COUNTY'S LARGEST PROVIDER OF FREE BREAST CANCER TREATMENTS, SERVICES AND SUPPORT. IT'S AN ANNUAL FUNDRAISING EVENT FOR BREAST CANCER AWARENESS AND CURE. 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. STATEWIDE MEDICAL AND HEALTH TABLETOP EXERCISE FIRST OF THREE YEAR SERIES OF CALIFORNIA STATEWIDE EXERCISES TO BUILD AND IMPROVE MEDICAL AND COMMUNITY-BASED CAPABILITIES FOR DISASTER-RELATED HEALTH CARE RESPONSE. SAN DIEGO HUNGER COALITION - FOOD STAMP ASSISTANCE- CITY HEIGHTS WELLNESS CENTER - COMMUNITY SUPPORT THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM THE SAN DIEGO HUNGER COALITION WHO ARE AVAILABLE TO COUNSEL PEOPLE AND HELP FILL OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THIS ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. LATINOS Y LATINAS EN ACCION LATINOS Y LATINAS EN ACCION IS A GRASSROOTS LEADERSHIP DEVELOPMENT PROJECT THAT SEEKS TO INCREASE THE CAPACITY OF THE LATINO COMMUNITY OF MID-CITY TO ADVOCATE FOR ISSUES IMPORTANT TO THEM. MICRO ENTERPRISE CLASS CLASSES GIVEN TO WOMEN IN THE COMMUNITY WHO ARE INTERESTED IN OPENING THEIR OWN BUSINESS, CLASSES CONSIST OF VARIOUS TRAININGS THAT GUIDE THEM TO OBTAINING A BUSINESS LICENSE. MID-CITY CAN-SAY SAN DIEGO - CITY HEIGHTS WELLNESS CENTER - COMMUNITY SUPPORT CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN MONTHLY NETWORKING MEETINGS FOR MID-CITY CAN (COMMUNITY ADVOCACY NETWORK). THESE MEETINGS PROVIDE AN OPPORTUNITY FOR COMMUNITY RESIDENTS AND REPRESENTATIVES FROM PRIVATE AND PUBLIC ORGANIZATIONS, FAITH COMMUNITIES, SCHOOLS, AND BUSINESSES TO COME TOGETHER FOR ACTION ON AREAS OF COMMON INTEREST. IN ASSOCIATION WITH THESE MEETINGS, SELF-DIRECTED MOMENTUM TEAMS HAVE BEEN DEVELOPED TO PROVIDE DIRECTION AND LEADERSHIP AS NEEDS AND ISSUES ARISE WITHIN THE COMMUNITY. SAN DIEGO CAREGIVER ACTION NETWORK (SANDI-CAN) THE CITY HEIGHTS WELLNESS CENTER HOSTS MONTHLY MEETINGS FOR SANDI-CAN, A COMMUNITY PARTNERSHIP OF 200 CONSUMERS, VOLUNTEERS, CAREGIVERS, AND SERVICE PROVIDERS DEDICATED TO WORKING TOGETHER ON PROJECTS THAT ENHANCE THE LIVES OF OLDER ADULTS AND ADULTS WITH DISABILITIES LIVING IN THE CITY OF SAN DIEGO. SANDI-CAN OFFERS HEALTH, WELLNESS AND COMMUNITY OPTIONS FOR SENIORS AND THEIR FAMILIES AND CAREGIVERS. COUNTY OF SAN DIEGO WATERFRONT PARK GRAND OPENING THE EVENT CELEBRATED THE OPENING OF NEW WATERFRONT PARK IN SAN DIEGO. PROVIDED COMMUNITY SUPPORT, HEALTH AWARENESS AND HEALTHY EATING SAMPLES TO THE PUBLIC. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. CITY HEIGHTS EAST AFRICAN ALLIANCE-CHEA - HEALTH ADVOCACY PROJECT THE CITY HEIGHTS WELLNESS CENTER HEALTH ADVOCACY PROJECT IS SUPPORTED BY A GRANT FROM THE CALIFORNIA ENDOWMENT FOUNDATION AND IS DESIGNED TO STRENGTHEN THE CAPACITY TO DELIVER CULTURALLY AND RELIGIOUSLY COMPETENT HEALTH PROMOTION SERVICES TO SOMALI AND EAST AFRICAN WOMEN AND THEIR FAMILIES. THIS PROGRAM ADDRESSES UNMET NEEDS LIKE PRENATAL OUTREACH AND EDUCATION, CULTURALLY ADAPTED NUTRITION AND FITNESS EDUCATION, BREASTFEEDING EDUCATION, EARLY CHILDHOOD HEALTH, AND NUTRITION AND SAFETY CLASSES. THE PROJECT IS SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO COMMUNITY BENEFIT SERVICES. LEAD SAN DIEGO VISIONARY AWARDS THE LEAD VISIONARY AWARDS IS AN ANNUAL FUNDRAISING DINNER THAT HIGHLIGHTS THE PEOPLE WHO HAVE HELPED SHAPE THE SAN DIEGO REGION. IT ATTRACTS 1000 PEOPLE TO THIS AWARDS BANQUET. THIS IS A GROUP OF VISIONARIES WHO HAVE HELPED SHAPE SAN DIEGO OVER THE DECADES. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6. CASTLE PARK ELEMENTARY WELLNESS COMMITTEE MEETING CASTLE PARK ELEMENTARY WELLNESS COMMITTEE PLANS AND FACILITATES WELLNESS EVENTS, SCHOOL READINESS PRESENTATIONS, HEALTH RELATED CLASSES, AND ACTIVITIES FOR PARENTS, SCHOOL STAFF, AND STUDENTS TO INCREASE HEALTH AWARENESS AND HEALTHY LIFESTYLES IN CASTLE PARK AREA. SPONSORED BY SCRIPPS CHULA VISTA WELL-BEING CENTER. CHULA VISTA COMMUNITY COLLABORATIVE - SCRIPPS MERCY HOSPITAL CHULA VISTA -COALITION - A COALITION OF AGENCIES THAT COME TOGETHER TO SHARE PROGRESS, SERVICES, AND NETWORK. THE CHULA VISTA COMMUNITY COLLABORATIVE (CVCC) DRAWS TOGETHER ALL SECTORS OF THE LOCAL COMMUNITY TO DEVELOP COORDINATED STRATEGIES AND SYSTEMS THAT PROTECT THE HEALTH AND SAFETY OF RESIDENTS, DEVELOP ECONOMIC RESOURCES, PROMOTE LOCAL LEADERSHIP, ENHANCE THE ENVIRONMENT, AND CONTRIBUTE TO THE CELEBRATION OF AND RESPECT FOR CULTURAL DIVERSITY. THE CVCC CURRENTLY HAS OVER 150 MEMBER ORGANIZATIONS AND OVER 600 MEMBERS. CVCC ACTS AS A PLATFORM FROM WHICH TO LAUNCH EFFECTIVE NEW INITIATIVES TO IMPROVE QUALITY OF LIFE. THE CVCC IS THE UMBRELLA FOR A VARIETY OF PROGRAMS AND COMMITTEES. THE MOST NOTABLE INFRASTRUCTURE OF THE CVCC IS THE NETWORK OF FAMILY RESOURCE CENTERS THAT HAVE BEEN CREATED AND SUSTAINED BY COLLECTIVE EFFORT. FOOD JUSTICE MOMENTUM TEAM THE CITY HEIGHTS WELLNESS CENTER HOSTS AND CO-CHAIRS MONTHLY MEETINGS OF THE FOOD JUSTICE MOMENTUM TEAM. THE MISSION OF THIS TEAM IS TO GATHER A DIVERSE COMMUNITY, WORKING TOGETHER TOWARDS CREATING AN ECOLOGICALLY SOUND, ECONOMICALLY VIABLE, AND SOCIALLY JUST FOOD SYSTEM FOR ALL. HEALTHY DEVELOPMENT SERVICES PROVIDER MEETING SCRIPPS EMPLOYEES PARTICIPATE IN THE HEALTHY DEVELOPMENT SERVICES PROVIDER MEETINGS, A GROUP OF AGENCIES COLLABORATING ON GRANT FUNDED FIRST FIVE PROGRAMS. SAN DIEGO STATE UNIVERSITY FOUNDATION COMMUNI
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. DESCRIBE THE ORGANIZATION'S RATIONALE FOR THE POSITION THAT MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT 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 OR CHARITY CARE PROGRAM. 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 CANNOT PAY ON THE ACCOUNT, THE ORGANIZATION WRITES THE ACCOUNT OFF 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.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATEWIDE LEGISLATION IN THE EARLY 1990S. 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. AS PART OF THE COMMUNITY BENEFIT REPORTS FILED, NON-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A CHNA 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. 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. 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. 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 THAT NOT FOR PROFIT (TAX EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. PER GUIDANCE FROM AN ADVISORY GROUP OF HOSPITAL REPRESENTATIVES, HASD & IC CONTRACTED WITH THE INSTITUTE OF PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY TO DESIGN AND IMPLEMENT THE CHNA. THE IPH EMPLOYED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT (PRIMARY DATA SOURCES) AND QUANTITATIVE ANALYSIS (SECONDARY DATA SOURCES) TO IDENTIFY AND PRIORITIZE THE TOP HEALTH CONDITIONS IN SAN DIEGO COUNTY. 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. IN ORDER TO PRIORITIZE THE COMMUNITY HEALTH NEEDS, THE IPH DEVELOPED A METHODOLOGY THAT INCLUDED BOTH QUALITATIVE AND QUANTITATIVE DATA SOURCES. QUANTITATIVE DATA INCLUDED HOSPITAL DISCHARGE DATA, STATISTICS FROM THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY, THE US CENSUS BUREAU, THE CENTERS FOR DISEASE CONTROL, AND OTHERS. THE IPH ALSO SOUGHT DIRECT INPUT FROM THE COMMUNITY THROUGH AN ELECTRONIC SURVEY TO HEALTH EXPERTS AND COMMUNITY LEADERS, KEY INFORMANT INTERVIEWS, AND COMMUNITY FORUMS. RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE IPH USED THE DIGNITY HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. THESE HIGH NEED REGIONS WERE SELECTED AS LOCATIONS FOR THE COMMUNITY FORUMS. SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: WHEN THE IPH COMBINED THE RESULTS OF ALL THE DATA AND INFORMATION GATHERED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER): - CARDIOVASCULAR DISEASE - DIABETES (TYPE 2) - MENTAL/BEHAVIORAL HEALTH - OBESITY THE IPH THEN ASSIMILATED ALL THE COMMUNITY INPUT (SURVEY RESPONDENTS, KEY INTERVIEWEES, AND COMMUNITY FORUM PARTICIPANTS) INTO FIVE BROAD CATEGORIES OF RECOMMENDATIONS FOR HOSPITALS TO IMPROVE COMMUNITY HEALTH: - ACCESS TO CARE OR INSURANCE - CARE MANAGEMENT - EDUCATION SCREENING SERVICES - COLLABORATION THE INFORMATION ABOVE PROVIDES A HIGH-LEVEL SUMMARY OF THE HASD & IC 2013 CHNA METHODOLOGY AND FINDINGS. UPON COMPLETION OF THE HASD & IC 2013 CHNA PROCESS, THE IPH CREATED A CHNA TOOLKIT WITH IN-DEPTH INFORMATION AND DATA THAT PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS COULD USE TO EVALUATE THE HEALTH NEEDS OF THEIR PATIENTS AND DETERMINE, ADAPT, OR CREATE PROGRAMS AT THEIR FACILITIES. LINKS THROUGHOUT THIS DOCUMENT ALLOW INTERESTED PARTIES, INCLUDING PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS AND MEMBERS OF THE COMMUNITY, A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE HASD&IC 2013 CHNA. THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (HASD&IC 2013 CHNA) USED A MULTI-LEVEL, HOSPITAL-FOCUSED ANALYSIS TO IDENTIFY THE PRIORITY COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY. AS PART OF THEIR ONGOING EFFORTS TO CREATE STRONGER PARTNERSHIPS WITHIN SAN DIEGO COMMUNITIES, THE PARTICIPATING HOSPITALS DESIGNED A COLLABORATIVE FOLLOW-UP PROCESS (PHASE II) TO REVIEW METHODOLOGY AND GAIN A DEEPER UNDERSTANDING OF THE 2013 CHNA RESULTS. THE GOAL OF PHASE II WAS TO ENSURE THE RESULTS OF THE 2013 CHNA ACCURATELY REFLECTED THE HEALTH NEEDS OF THE COMMUNITY. THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) WAS CONTRACTED TO PROVIDE ASSISTANCE WITH THE IMPLEMENTATION AND INTERPRETATION OF PHASE II THROUGH TWO MAIN ACTIVITIES: 1. CONDUCT COMMUNITY DIALOGUES TO SHARE THE RESULTS OF THE 2013 CHNA WITH THE COMMUNITY AND COLLECT COMMUNITY MEMBER FEEDBACK ON HOSPITAL PROGRAMS THAT WERE GUIDED AND INFORMED BY THE RESULTS OF THE 2013 CHNA. 2. CREATE AND ANALYZE AN ELECTRONIC SURVEY FOR COMMUNITY LEADERS AND HEALTH EXPERTS TO REVIEW THE METHODOLOGY AND FINDINGS FROM THE 2013 CHNA. OVERALL THERE WAS POSITIVE FEEDBACK FROM ALL COMMUNITY DIALOGUES AND A HIGH DEGREE OF INTEREST IN PARTICIPATING IN HOSPITAL PROGRAMS. HOWEVER, THE MAJORITY OF PARTICIPANTS HAD NOT HEARD OF THE HOSPITAL PROGRAMS THAT WERE DESCRIBED. OTHER BARRIERS TO PARTICIPATION MOST OFTEN CITED DURING THE COMMUNITY DIALOGUES WERE LOCATION, LANGUAGE, TRANSPORTATION AND FEAR OF DOCUMENTATION REQUIREMENTS. BASED ON FEEDBACK FROM THE HEALTH EXPERT AND LEADER SURVEY, IT APPEARS THAT THE RESULTS OF THE 2013 CHNA ACCURATELY REFLECTED THE HEALTH NEEDS OF SAN DIEGO COUNTY AND PROVIDED USEFUL INFORMATION TO HELP RESPONDENTS DEVELOP PROGRAMMING IN THEIR ORGANIZATIONS. HOWEVER, RESPONDENTS IDENTIFIED SEVERAL AREAS THAT COULD BE IMPROVED IN FUTURE CHNAS, SUCH AS INCLUDING A LARGER SAMPLE SIZE, BROADENING THE NUMBER OF HEALTH NEEDS ADDRESSED, INCREASING DIVERSITY IN THE SAMPLE IN TERMS OF AGE, ETHNICITY, AND GEOGRAPHIC LOCATION, AND INCLUDING MORE SECTORS OF THE COMMUNITY. THE MAJORITY OF RESPONDENTS AGREED THAT A MORE FOCUSED EXAMINATION OF THE PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA WOULD BE BENEFICIAL IN FUTURE CHNAS.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY. HOSPITAL CARE CAN BE EXPENSIVE AND IS OFTEN UNEXPECTED. TO HELP MEET THE NEEDS OF LOW-INCOME UNINSURED AND UNDERINSURED PATIENTS WHO USE SCRIPPS HOSPITALS, SCRIPPS HAS A PATIENT FINANCIAL ASSISTANCE POLICY CONSISTENT WITH CALIFORNIA AB774 "FAIR PRICING POLICY" LEGISLATION, CHAPTERED IN 2006. FOLLOWING PRINCIPLES AND GUIDELINES SET BY THE AMERICAN HOSPITAL ASSOCIATION AND THE CALIFORNIA HOSPITAL ASSOCIATION, THE POLICY ESTABLISHES STANDARDS FOR CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES AND LOW-INCOME PATIENT ASSISTANCE THROUGH DISCOUNTED HOSPITAL CHARGES. 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 CHARITY CARE POLICY ON THE SCRIPPS WEB SITE 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. - COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS IN CONSPICUOUS REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). 2. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY ARE MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. 3. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE CONSPICUOUSLY POSTED ON SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED. 4. FINANCIAL ASSISTANCE INFORMATION IS INCLUDED ON ALL PATIENT STATEMENTS. 5. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. - TO THE EXTENT REQUIRED BY LAW, SCRIPPS WILL PROVIDE A COPY OF THE POLICY AND RELATED INFORMATION TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT. IN ADDITION, SCRIPPS' POLICY WILL BE AVAILABLE TO INDIVIDUALS OF THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW WILL BE FACILITATED THROUGH THE USE OF INTERPRETERS (LANGUAGE, VISION, AND HEARING) OR WRITTEN MATERIALS AS REQUESTED BY THE INDIVIDUAL. - 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 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 4,300 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. DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE BASED ON SANDAG 2010 ESTIMATES AND ARE AVAILABLE AT THE ZIP CODE LEVEL AT: HTTP://DATAWAREHOUSE.SANDAG.ORG. A BREAKDOWN OF THE REGIONAL DEMOGRAPHICS CAN BE FOUND IN THE REGIONAL FORUM SECTIONS OF THE CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY (APPENDIX SECTION) AT: HTTP://WWW.SDCHIP.ORG. 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. THERE ARE 27 OTHER HOSPITAL FACILITIES SERVING THE COMMUNITY. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 68 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 HOUSE 21.1 PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY14, SCRIPPS PROVIDED 2,221,959 OUTPATIENT VISITS. NEARLY HALF (43.2%) OF SAN DIEGO COUNTY'S 74,886 SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF PAY. OSHPD 2013 DATA (MOST RECENT YEAR AVAILABLE) SCRIPPS HAS A TOTAL OF 1,297 ACUTE CARE LICENSED BEDS. SAN DIEGO HAS A TOTAL OF 6,140 ACUTE CARE LICENSED BEDS. PERCENT OF SCRIPPS BEDS IS 1,297/6,140 =21.12% COUNTY SAFETY NET DISCHARGES CY13: - CENTRAL DISCHARGES - 18,354 - SOUTH SUBURBAN DISCHARGES - 14,026 SCRIPPS OSHPD SAFETY NET DISCHARGES CY13: - SCRIPPS CENTRAL DISCHARGES - 5,849 - SCRIPPS SOUTH SUBURBAN DISCHARGES - 4,674 COUNTY OVERVIEW ACCESS TO MEDICAL CARE IS CRUCIAL TO THE WELL-BEING OF INDIVIDUALS AND THE SAN DIEGO COMMUNITY AS A WHOLE. THERE ARE MANY BARRIERS TO CARE FOR THE SAFETY NET POPULATION THAT PREVENT THIS GROUP FROM OBTAINING MUCH NEEDED MEDICAL SERVICES. LACK OF INSURANCE IS A PRIMARY BARRIER, AS EVIDENCED BY THE 22.2 PERCENT OF ADULTS AGE 19-64 (EXCLUDING MEDICARE AND MILITARY) WHO LACK HEALTH INSURANCE IN SAN DIEGO COUNTY. CALIFORNIA HAD THE GREATEST NUMBER OF UNINSURED RESIDENTS OF ANY STATE (SEVEN MILLION) AND THE SEVENTH LARGEST PERCENTAGE OF UNINSURED UNDER 65 IN THE COUNTRY. MANY OF THE STATE'S UNINSURED ARE EMPLOYED; HOWEVER, THE PERCENTAGE OF RESIDENTS WHO RECEIVE COVERAGE THROUGH THEIR JOBS HAS DECLINED DRAMATICALLY, DROPPING FROM 63% IN 1988 TO 54% IN 2012. WHILE PUBLIC INSURANCE HAS MOSTLY OFFSET THIS GAP, 20% OF CALIFORNIANS REMAINS UNINSURED. WITH THE IMPLEMENTATION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (ACA), THE NUMBERS OF UNINSURED RESIDENTS IN CALIFORNIA WILL BE REDUCED, ALTHOUGH A SIGNIFICANT NUMBER WILL BE LEFT BEHIND. (CALIFORNIA HEALTH CARE ALMANAC, DECEMBER 2013). 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.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.6 BILLION, PRIVATE, NOT-FOR-PROFIT COMMUNITY HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS A HALF-MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 2,700 AFFILIATED PHYSICIANS AND 13,500 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIAN OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. SCRIPPS IS A RECOGNIZED LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE AND IS AT THE FOREFRONT OF CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. 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 OF 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 FY14 (OCTOBER 2013 TO SEPTEMBER 2014), SCRIPPS INVESTED $36,258,006 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. EXPENSES ARE NOT OFFSET BY GRANT REVENUE OR RESTRICTED FUNDS ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES. 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 FY14 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (MOST) REACHING OUT TO THOSE WHO HAVE LIMITED ACCESS TO HEALTH CARE, THE MERCY OUTREACH SURGICAL TEAM (MOST) PROVIDES MEDICAL AND SURGICAL CARE TO UNDERPRIVILEGED CHILDREN AND ADULTS FROM OTHER COUNTRIES. THE VOLUNTEER GROUP OF PHYSICIANS, NURSES, TECHNICIANS AND OTHERS PERFORM LIFE-CHANGING SURGERIES TO CORRECT CLEFT LIPS, CLEFT PALATES, BURN SCARS, CROSSED EYES, HERNIAS AND A VARIETY OF OTHER CONDITIONS. DURING FY14, THE MOST TEAM SERVED MORE THAN 400 INDIVIDUALS. GRADUATE MEDICAL EDUCATION STAFF SUPPORT TO ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND ST. LEO'S MISSION COMMUNITY CLINIC. THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 36 RESIDENTS AND 32 FELLOWS. THE PROGRAM ALSO GIVES BACK TO THE COMMUNITY BY STAFFING EVENING CLINICS AT ST. VINCENT DE PAUL VILLAGE AND ST. LEO'S MISSION COMMUNITY CLINIC. SCRIPPS RESIDENTS AND STAFF PROVIDED MEDICAL CARE TO APPROXIMATELY 800 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FY14. SCRIPPS HEALTH COMMUNITY BENEFIT GRANTING IN 2014, SCRIPPS AWARDED A TOTAL OF $215,000 IN COMMUNITY GRANTS TO PROGRAMS BASED THROUGHOUT SAN DIEGO, RANGING FROM $10,000 TO $120,000 EACH. THE PROJECTS THAT RECEIVED FUNDING ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH-PRIORITY HEALTH NEEDS WITH THE GOAL OF IMPROVING ACCESS TO VITAL HEALTH CARE SERVICES FOR A VARIETY OF AT-RISK POPULATIONS, INCLUDING PEOPLE WHO ARE HOMELESS, ECONOMICALLY DISADVANTAGED, AND MENTALLY ILL. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $2.8 MILLION DOLLARS. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL THESE PATIENTS ARE UNFUNDED AND MANY HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES - ADDITIONAL PROBLEMS THAT MAKE THESE PATIENTS DIFFICULT TO PLACE POST-ACUTE. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS HEALTH WITH PHYSICIAN BACKUP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24HR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, COUNSELING, ASSISTANCE WITH MEDI-CAL AND DISABILITY APPLICATION, PLUS HELP FINDING HOUSING. SCRIPPS HEALTH PAYS A DAILY FEE TO THE RCU TO SUPPORT THE PATIENT'S COST IN THE PROGRAM. FOR FY14, TOTAL COST SAVINGS FOR SCRIPPS HAS BEEN OVER $184,000.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM SCRIPPS HEALTH IS AN INTEGRATED HEALTH SYSTEM, OPERATING FIVE ACUTE CARE HOSPITALS AND TWENTY-SEVEN PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. IN 2013, SCRIPPS HOSPICE PROGRAM WAS ESTABLISHED AND PROVIDES END OF LIFE CARE.
SCHEDULE H, PART VI, LINE 7	CALIFORNIA. SCRIPPS HEALTH COMMUNITY BENEFIT REPORT CAN BE FOUND AT: HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (15 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
211 San Diego
5251 Viewridge Court	San Diego	CA	92123	331029843	501 (c) (3)	$15,000	Program Support
Alzheimer's Association
6632 Convoy Court	San Diego	CA	92111	133039601	501 (c) (3)	$32,000	Program Support
American Cancer Society Making Strides Against Br
2655 Camino del Rio N	San Diego	CA	92108	131788491	501 (c) (3)	$15,000	Program Support
American Heart Association - Sponsorship
9404 Genesee Ave	La Jolla	CA	92037	135613797	501 (c) (3)	$10,000	Program Support
American Heart Association In-Kind
9404 Genesee Ave	La Jolla	CA	92037	135613797	501 (c) (3)		Program Support	$25,225	FMV	Supplies
B'Nai B'rith International
2020 K Street NW	Washington	DC	20006	530179971	501 (c) (3)	$7,500	Program Support
California Health Foundation and Trust
1215 K Street STE 800	Sacramento	CA	95814	941498697	501 (c) (3)	$387,000	CA Hospital Fee Program
Catholic Charities
349 Cedar Street	San Diego	CA	92101	237334012	501 (c) (3)	$70,000	Program Support
Eric Paredes Save a Life Foundation
PMB79 2514 Jamacha Rd	El Cajon	CA	92019	800636157	501 (c) (3)	$15,000	Program Support
Consumer Center of Legal Aid Society of San Diego
1764 San Dieg Ave	San Diego	CA	92110	981869806	501 (c) (3)	$120,000	Program Support
Susan G Komen Race for the Cure
5005 LBJ Freeway	Dallas	TX	75244	751835298	501 (c) (3)	$5,001	Program Support
San Diego County Prescription Drug Abuse Task Forc
1600 Pacific Hwy	San Diego	CA	92101	330337244	501 (c) (3)	$19,500	Program Support
Any Body Can Youth Foundation
3131 Market St	San Diego	CA	92102	330659706	501 (c) (3)	$20,000	Program Support
Go Red for Women Luncheon
9404 Genesee Ave	San Diego	CA	92037	135613797	501 (c) (3)	$15,000	Program Support
Amercian Heart Association - Teaching Garden
9404 Genesee Ave	San Diego	CA	92037	135613797	501 (c) (3)	$25,000	Program Support

Field	Value	IRS element (for citing)
Total501c3 Org	19	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PART 1, LINE 2	FormAndLineReferenceDesc
Explanation	DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS A SEMI-ANNUAL REPORT AND A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT TO DATE IS REQUIRED. THIS SEMI-ANNUAL REPORT SHALL INCLUDE PROGRESS MADE TOWARD MEETING OBJECTIVES OUTLINED IN THE GRANT APPLICATION. A FINAL REPORT IS DUE WITHIN THIRTY (30) DAYS FOLLOWING THE EXPIRATION DATE OF THE GRANT. IN ADDITION TO THE PROGRESS MADE TOWARD MEETING THE OBJECTIVES OUTLINED IN THE GRANT APPLICATION, THE FINAL REPORT SHALL INCLUDE QUANTITATIVE AND QUALITATIVE RESULTS OF THE PROGRAM AGAINST ITS STATED GOALS AND OBJECTIVES. A FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT AGAINST THE BUDGET MUST BE INCLUDED AS PART OF THIS FINAL REPORT.	ExplanationTxt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 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
JOHN E ARMSTRONG
CORP SR VP, SPLY CHAIN/FACIL	$326,477	$0	$104,780	$0	$88,789	$0	$55,111	$0	$26,974	$0	$602,131	$0	$63,803	$0
ROBIN BROWN
CHIEF EXECUTIVE, SR VP	$458,609	$0	$156,024	$0	$12,729	$0	$137,592	$0	$25,289	$0	$790,243	$0	$0	$0
VICTOR V BUZACHERO
CORP SR VP INNOVAT/HR/PERF MGT	$529,128	$0	$207,481	$0	$191,159	$0	$159,200	$0	$29,797	$0	$1,116,765	$0	$146,164	$0
SUSAN CAMPBELL
Exec Dir, External Affairs	$384,372	$0	$65,523	$0	$24,004	$0	$64,308	$0	$31,957	$0	$570,164	$0	$0	$0
MARY ELLEN DOYLE
Corp VP, Nursing Ops	$337,406	$0	$85,679	$0	$48,880	$0	$50,197	$0	$26,214	$0	$548,376	$0	$34,683	$0
ARNOLD BRENT EASTMAN MD
CORP SR VP, CHIEF MED OFFICER	$123,693	$0	$196,456	$0	$157,474	$0	-$256,406	$0	$1,364	$0	$222,581	$0	$0	$0
JOHN ENGLE
CHIEF EXECUTIVE, SR VP, CHIEF	$336,110	$0	$116,097	$0	$66,335	$0	$55,529	$0	$28,784	$0	$602,855	$0	$39,155	$0
CARL ETTER
CHIEF EXECUTIVE, SR VP	$414,826	$0	$140,521	$0	$97,474	$0	$66,054	$0	$31,115	$0	$749,990	$0	$63,797	$0
SHIRAZ FAGAN
CHIEF EXECUTIVE, SR VP	$481,413	$0	$100,976	$0	$62,273	$0	$74,442	$0	$26,267	$0	$745,371	$0	$50,510	$0
GARY FYBEL
CHIEF EXECUTIVE, SR VP	$520,221	$0	$175,640	$0	$51,931	$0	$88,628	$0	$50,834	$0	$887,254	$0	$0	$0
THOMAS GAMMIERE
CHIEF EXECUTIVE, SR VP	$530,802	$0	$182,252	$0	$182,013	$0	$101,123	$0	$29,852	$0	$1,026,042	$0	$162,904	$0
CATHY GUIBAL
VP FINANCE/CFO SCRIPPS MED FDN	$317,256	$0	$67,219	$0	$114,783	$0	$367	$0	$4,610	$0	$504,235	$0	$44,347	$0
LARRY HARRISON
CHIEF EXECUTIVE, SR VP	$429,336	$0	$156,416	$0	$6,010	$0	$0	$0	$0	$0	$591,762	$0	$0	$0
ROBERT T HOFF
CORP VP, CLINICAL ANC OPS	$327,436	$0	$83,636	$0	$69,936	$0	$50,453	$0	$28,622	$0	$560,083	$0	$44,515	$0
JUNE KOMAR
CORP EXEC VP, STRATEGY & ADMIN	$527,982	$0	$207,420	$0	$79,495	$0	$118,559	$0	$23,022	$0	$956,478	$0	$42,865	$0
JAMES LA BELLE MD
CORP SR VP, CHIEF MED OFFICER	$552,715	$0	$130,765	$0	$26,564	$0	$93,837	$0	$29,523	$0	$833,404	$0	$0	$0
EDWARD NAZARRO
COE CLINIC	$304,609	$0	$69,189	$0	$112,573	$0	$55,829	$0	$21,995	$0	$564,195	$0	$47,715	$0
BARBARA PRICE
CORP SRVP BUS & SERV LINE DEV	$423,762	$0	$134,933	$0	$78,370	$0	$80,477	$0	$27,073	$0	$744,615	$0	$68,112	$0
MARC A REYNOLDS
CORP SR VP, PAYER RELATIONS	$342,127	$0	$116,524	$0	$145,369	$0	$75,908	$0	$18,970	$0	$698,898	$0	$128,272	$0
RICHARD ROTHBERGER
TREASURER/EXECUTIVE VP/CFO	$669,451	$0	$283,432	$0	$327,027	$0	$226,730	$0	$33,357	$0	$1,539,997	$0	$294,922	$0
RICHARD R SHERIDAN
SEC/CORP SR VP, GEN COUNSEL	$466,545	$0	$158,910	$0	$60,916	$0	$137,535	$0	$26,485	$0	$850,391	$0	$31,148	$0
PATRIC THOMAS
CORP VP, INFORMATION SVCS	$389,644	$0	$95,974	$0	$50,918	$0	$43,438	$0	$28,825	$0	$608,799	$0	$33,394	$0
CHRISTOPHER VAN GORDER
PRESIDENT & CEO / TRUSTEE	$1,110,658	$0	$581,057	$0	$38,053	$0	$524,705	$0	$43,429	$0	$2,297,902	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1A	SUPPLEMENTAL COMPENSATION INFORMATION SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE IS $110 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 4A	RECEIVE A SEVERANCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY IN CALENDAR YEAR 2013: LARRY HARRISON $429,336 ARNOLD BRENT EASTMAN, MD $100,000 CATHY GUIBAL $251,946
SCHEDULE J, PART 1, LINE 4B	SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE, AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457(F) 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 2013: JOHN ARMSTRONG - $63,803 VICTOR V. BUZACHERO - $146,164 MARY ELLEN DOYLE - $34,683 JOHN ENGLE - $39,155 CARL ETTER - $63,797 SHIRAZ FAGAN - $50,510 THOMAS GAMMIERE - $162,904 CATHY GUIBAL - $44,347 ROBERT HOFF - $44,515 JUNE KOMAR - $42,865 BARBARA PRICE - $68,112 EDWARD NAZZARO - $47,715 MARC REYNOLD - $128,272 RICHARD ROTHBERGER - $294,922 RICHARD SHERIDAN - $31,148 PATRIC THOMAS - $33,394 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 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 VI	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	13033F5L0	2008-08-14	$221,230,000	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	$0	$49,848,930	$0	2005	Yes (true)	false	Yes (true)	Yes (true)
B	$3,155,000	$0	$99,830,304	$9,909,993	$0	$0	$0	$0	$0	$0	$89,920,897	$0	2008	Yes (true)	false	Yes (true)	Yes (true)
C	$52,735,000	$0	$221,230,000	$0	$0	$0	$0	$5,544	$0	$0	$221,224,456	$0	2008	Yes (true)	false	Yes (true)	Yes (true)
D	$12,125,000	$0	$40,975,000	$0	$0	$0	$280,659	$918,283	$0	$0	$39,776,058	$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			false	false	false	Yes (true)
C	false	false	Yes (true)	Yes (true)	Yes (true)	Yes (true)	0			false	false	false	Yes (true)
D							0			false	false	false	Yes (true)

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/BusinessNameLine1	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Term Of HedgeTermOfHedgePct
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)	false	false
WELLS FARGO UBOC
C	false	Yes (true)	Yes (true)	false	0	false	Yes (true)	false	false	Yes (true)	false	false	26.
WELLS FARGo bank
D	false	Yes (true)	Yes (true)	false	0	Yes (true)	Yes (true)	false	false	Yes (true)	false	false	14.

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 2-A (2010A): PRIOR YEAR REPORTING REFLECTED THE PRINCIPAL AMOUNT RATHER THAN THE ISSUE PRICE. 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 (2008B-F): THE $221,230,000 (2008B - F) REFUNDED THE 2005B - F BONDS. THE ISSUE DATE FOR THE 2005 B - F WAS 6/17/2005 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 ORGANIZATION'S 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. SCHEDULE K, PART II, LINE 3 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, 2014. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE C (2008B-F): THE 2008B-F REBATE COMPUTATION WAS RECENTLY PERFORMED ON AUGUST 14, 2014. 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, 2014. 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, 2014. 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, 2014. 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, 2014. 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 TOTALING $188,143,094.65 IS A FIXED RATE ISSUE WHEREAS THE 2010B&C TOTALING $100,000,000 IS A VARIABLE RATE ISSUE. SCHEDULE K, PART IV, LINE 4B BOND ISSUE C (2008B-F): ON SEPTEMBER 18, 2012 THE ORGANIZATION ENTERED INTO INTEREST RATE SWAP NOVATIONS WITH WELLS FARGO BANK, N.A. AND UNION BANK, N.A., AS COUNTERPARTY, REPLACING THEN-EXISTING INTEREST RATE SWAPS WITH CITIBANK, N.A. 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. BOND ISSUE D (2005A/2008G): THE ISSUE DATE FOR THE 2005A WAS 6/17/2005. THE COST OF ISSUANCE WAS NOT EXPENDED UNTIL 1/4/2006. PER THE TAX CERTIFICATE IT WAS EXPECTED TO BE EXPENDED WITHIN 180 DAYS. 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 IS SUPPLEMENTING 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 (3 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

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 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	$2,640,000	$0	$119,581,432	$0	$0	$0	$0	$0	$0	$119,458,924	$0	$122,508	2011	false	false	Yes (true)	Yes (true)
B	$0	$0	$100,005,060	$0	$0	$0	$0	$0	$0	$100,002,530	$0	$2,530	2011	false	false	Yes (true)	Yes (true)
C	$0	$0	$288,177,563	$0	$0	$0	$0	$0	$0	$288,160,329	$0	$17,234	2013	false	false	Yes (true)	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

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

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 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	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
A	false	false	false	Yes (true)	false	false	false	false	false	0	false	Yes (true)
0
B	false	false	Yes (true)	false	Yes (true)	false	false	false	false	0	false	Yes (true)
0
C	false	false	false	Yes (true)	Yes (true)	false	false	false	false	0	false	Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (true)
B	Yes (true)
C	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
Christopher Van GordER
Officer	Deferred Compensatio	Yes (X)	$10,023,866	$10,188,334	Yes (true)	Yes (true)	Yes (true)
June Komar
Executive	Deferred Compensatio	Yes (X)	$2,769,010	$2,814,443	Yes (true)	Yes (true)	Yes (true)
Richard Sheridan
Executive	Deferred Compensatio	Yes (X)	$4,063,603	$4,130,280	Yes (true)	Yes (true)	Yes (true)
Robin Brown
Executive	Deferred Compensatio	Yes (X)	$2,668,899	$2,712,689	Yes (true)	Yes (true)	Yes (true)

Field	Value	IRS element (for citing)
Total Balance Due	$19,845,746	TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	Matthew Balogh	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	SEE PART V	RelationshipDescriptionTxt
Transaction	$79,678	TransactionAmt
Transaction	Employee of Scripps Health	TransactionDesc
Sharing Of Revenues	false	SharingOfRevenuesInd

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	BUSINESS TRANSACTIONS WITH INTERESTED PERSONS MATTHEW BALOGH, SON-IN-LAW OF BOARD MEMBER GORDON R. CLARK, IS EMPLOYED BY SCRIPPS HEALTH.

Schedule M IRS990ScheduleM

Works Of Art WorksOfArtGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$15,000	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Opinion of experts	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
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	32	ContributionCnt
Noncash Contributions Rpt F990	$1,159,055	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	3	ContributionCnt
Noncash Contributions Rpt F990	$798,209	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	2	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. HOWEVER, CONTRIBUTIONS OF EQUIPMENT INCLUDE MULTIPLE COMPONENTS.
SCHEDULE M, PART I, ITEM 32B	THIRD PARTIES ENGAGED TO SOLICIT, PROCESS, AND SELL NON-CASH CONTRIBUTIONS GIFTS. GIFTS OF REAL ESTATE ARE LIQUIDATED THROUGH LICENSED REAL ESTATE BROKERS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (25 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 $2.6 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 $372,630,231 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 CALIFORNIA SENATE BILL 697 REQUIRES THE UPDATING OF A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS. IDENTIFYING SAN DIEGO COUNTY'S HEALTH PRIORITIES IS A COMPLEX PROCESS OUTLINED IN THE FOLLOWING PAGES. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, WE ARE BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATEWIDE LEGISLATION IN THE EARLY 1990S. 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. AS PART OF THE COMMUNITY BENEFIT REPORTS FILED, NON-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A CHNA 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. 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. 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. VIEW THE FULL SUMMARY OF THE SCRIPPS HEALTH 2014 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AT https://www.scripps.org/sparkle-assets/documents/2013_chna_final.pdf. THIS DOCUMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY, A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2013 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. BACKGROUND/REQUIRED COMPONENTS OF THE ASSESSMENT SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGION'S MOST VULNERABLE POPULATIONS. SINCE 1994, THESE PROGRAMS HAVE BEEN CREATED BASED ON AN ASSESSMENT OF NEEDS IDENTIFIED THROUGH HOSPITAL DATA, COMMUNITY INPUT, AND MAJOR TRENDS. PREVIOUS COLLABORATIONS AMONG NON-PROFIT HOSPITALS, HEALTHCARE SYSTEMS, AND OTHER COMMUNITY PARTNERS HAVE RESULTED IN NUMEROUS WELL-REGARDED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) REPORTS. SEE http://www.sdchip.org/initiatives/charting-the-course-vi.aspx FOR PREVIOUS NEEDS ASSESSMENTS. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("AFFORDABLE CARE ACT" OR "ACA") OF 2010 IS BRINGING ABOUT SIGNIFICANT REGULATORY CHANGES IN THE HEALTHCARE INDUSTRY. SCRIPPS HEALTH WAS GIVEN THE TASK OF CONDUCTING AN EXPANDED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT MET THE NEW FEDERAL REQUIREMENTS. ADDITIONAL INFORMATION ON THE ACA REQUIREMENTS FOR NONPROFIT HOSPITALS CAN BE FOUND AT WWW.IRS.GOV, KEYWORD: "CHARITABLE ORGANIZATIONS". AS A NONPROFIT HOSPITAL, SCRIPPS HEALTH HAS FULFILLED THIS REQUIREMENT THROUGH THE DEVELOPMENT AND DISTRIBUTION OF THIS ASSESSMENT. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THIS REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THE IRS ALSO REQUIRED HOSPITAL ORGANIZATIONS THAT CONDUCT A CHNA TO MAKE THE REPORT WIDELY AVAILABLE BY POSTING IT ON A PUBLICLY ACCESSIBLE WEBSITE. VIEW THE FULL SUMMARY OF THE SCRIPPS HEALTH 2013 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AT https://www.scripps.org/sparkle-assets/documents/2013_chna_final.pdf. 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 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 THAT NOT FOR PROFIT (TAX EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. PER GUIDANCE FROM AN ADVISORY GROUP OF HOSPITAL REPRESENTATIVES, HASD&IC CONTRACTED WITH THE INSTITUTE OF PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY TO DESIGN AND IMPLEMENT THE CHNA. THE IPH EMPLOYED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT (PRIMARY DATA SOURCES) AND QUANTITATIVE ANALYSIS (SECONDARY DATA SOURCES) TO IDENTIFY AND PRIORITIZE THE TOP HEALTH CONDITIONS IN SAN DIEGO COUNTY. 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. IN ORDER TO PRIORITIZE THE COMMUNITY HEALTH NEEDS, THE IPH DEVELOPED A METHODOLOGY THAT INCLUDED BOTH QUALITATIVE AND QUANTITATIVE DATA SOURCES. QUANTITATIVE DATA INCLUDED HOSPITAL DISCHARGE DATA, STATISTICS FROM THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY, THE US CENSUS BUREAU, THE CENTERS FOR DISEASE CONTROL, AND OTHERS. THE IPH ALSO SOUGHT DIRECT INPUT FROM THE COMMUNITY THROUGH AN ELECTRONIC SURVEY TO HEALTH EXPERTS AND COMMUNITY LEADERS, KEY INFORMANT INTERVIEWS, AND COMMUNITY FORUMS. HEALTH EXPERT, COMMUNITY LEADER AND RESIDENT FEEDBACK THE IPH AND CHNA ADVISORY WORKGROUP SOUGHT FEEDBACK FROM COMMUNITY LEADERS, HEALTH EXPERTS AND RESIDENTS OF VULNERABLE COMMUNITIES. THIS WAS DONE THROUGH THREE METHODS: AN ELECTRONIC SURVEY FOR COMMUNITY LEADERS AND HEALTH EXPERTS; KEY INFORMANT INTERVIEWS; AND COMMUNITY FORUMS FOR RESIDENTS IN VULNERABLE COMMUNITIES THROUGHOUT SAN DIEGO COUNTY. - ONLINE SURVEY OF HEALTH EXPERTS AND LEADERS INITIAL EMAIL SAMPLE (N=120). TOTAL SURVEYS COMPLETED (N=89). - COMMUNITY FORUMS (106 COMMUNITY RESIDENTS) EL CAJON, OCEANSIDE, ESCONDIDO, LOGAN HEIGHTS, AND SAN YSIDRO CONDUCTED IN NEIGHBORHOODS WITH HIGH COMMUNITY NEED INDEX SCORES - FIVE KEY INFORMANT INTERVIEWS LEADERS CHOSEN BASED ON DISCIPLINE EXPERTISE AND KNOWLEDGE OF HEALTH ISSUES AFFECTING COMMUNITIES
FORM 990, PART III, LINE 4A (CONTINUED)	PRIORITIZED HEALTH CONDITIONS PRIORITIZED SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: THE HEALTH NEEDS WERE PRIORITIZED BASED ON THE FOLLOWING CRITERIA: - HAVE A SIGNIFICANT PREVALENCE IN THE COMMUNITY, - CONTRIBUTE SIGNIFICANTLY TO THE MORBIDITY AND MORTALITY IN SAN DIEGO COUNTY, - DISPROPORTIONATELY IMPACT VULNERABLE COMMUNITIES, - REFLECT A NEED THAT EXISTS THROUGHOUT SAN DIEGO COUNTY, AND - CAN BE ADDRESSED THROUGH EVIDENCE-BASED PRACTICES BY HOSPITALS AND HEALTH CARE SYSTEMS. REPORT FINDINGS SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS WHEN THE IPH COMBINED THE RESULTS OF ALL THE DATA AND INFORMATION GATHERED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER): - CARDIOVASCULAR DISEASE - MENTAL/BEHAVIORAL HEALTH - DIABETES (TYPE 2) - OBESITY HEALTH THEMES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT ONCE ALL THE COMMUNITY INPUT WAS INTEGRATED (SURVEY RESPONDENTS, KEY INTERVIEWEES, AND COMMUNITY FORUM PARTICIPANTS). THE FOLLOWING FIVE BROAD CATEGORIES EMERGED AS RECOMMENDATIONS FOR HOSPITALS TO ORGANIZE COMMUNITY HEALTH PROGRAMS: - ACCESS TO CARE OR INSURANCE - CARE MANAGEMENT - EDUCATION - SCREENING SERVICES - COLLABORATION SCRIPPS HEALTH IMPLEMENTATION PLAN SCRIPPS HEALTH HAS A LONG HISTORY (SINCE OCTOBER 1994) OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES THEY SERVE, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO PROVIDE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE HEALTH CARE NEEDS OF THE REGION'S MOST VULNERABLE POPULATIONS. WITH THE CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH DEVELOPED A SYSTEM-WIDE CORRESPONDING IMPLEMENTATION PLAN. 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 CONVENED AN INTERNAL WORKGROUP COMPRISED OF SCRIPPS EXECUTIVES, COMMUNITY BENEFIT REPRESENTATIVES AND CLINICAL CARE LINE LEADERS TO LEAD THE DEVELOPMENT OF THE SCRIPPS HEALTH IMPLEMENTATION PLAN. WHILE SCRIPPS HEALTH CANNOT REALISTICALLY ADDRESS EVERY ISSUE, SCRIPPS HEALTH WILL ENDEAVOR TO RESOLVE THOSE THAT MOST HEAVILY AFFECT OUR PATIENT POPULATIONS, SERVICE AREA AND ARE CONSISTENT WITH OUR STRATEGY AND RESOURCE AVAILABILITY. 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. IN SUPPORT OF THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, A DETAILED DESCRIPTION OF SCRIPPS STRATEGIES AND CORRESPONDING MEASURES/METRICS FOR THE FOUR HEALTH ISSUES CAN BE FOUND AT SCRIPPS.ORG/COMMUNITYBENEFIT. LISTED BELOW ARE THE PROGRAMS SCRIPPS HEALTH IS ADDRESSING FOR THE HEALTH PRIORITY AREAS IDENTIFIED IN THE CHNA: CARDIOVASCULAR DISEASE THE GOAL OF THE ERIC PAREDES SAVE A LIFE FOUNDATION (SCREENINGS) ARE TO PREVENT SUDDEN CARDIAC ARREST AND DEATH IN MIDDLE HIGH SCHOOL AGED CHILDREN, INCLUDING UNDERSERVED AREAS IN SAN DIEGO COUNTY, THROUGH AWARENESS, EDUCATION AND ACTION. 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 HEART'S ELECTRICAL SYSTEM THAT CAN BE EASILY 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 ANNUALLY LOSES THREE TO FIVE TEENS FROM SCA. THE SCREENINGS ARE NON-INVASIVE AND INCLUDE A HEALTH HISTORY, EKG AND IF INDICATED TO CHECK FOR AN ABNORMAL HEARTBEAT THAT COULD SIGNAL AN UNDERLYING HEART CONDITION - AN ECHOCARDIOGRAM. PARENTS ARE NOTIFIED TO THE RESULTS FOR FOLLOW UP WITH THEIR FAMILY PHYSICIANS. FOR FY14, SCRIPPS SCREENED 4,188 TEENS COUNTYWIDE, TRACKED 85 TEENS WITH HEART ABNORMALITIES, 38 TEENS WERE FOUND AT RISK AND 65 WERE UNINSURED. THIRTY- SIX PERCENT OF THE SCHOOLS REPRESENTED ARE TITLE I SCHOOLS, IN WHICH THE MAJORITY OF THE STUDENTS AT THE SCHOOLS MEET POVERTY GUIDELINES. THE SCHOOLS QUALIFY FOR GOVERNMENT FUNDING LIKE FREE OR REDUCED LUNCH PROGRAMS. DIABETES THE DIABETES COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAM IMPLEMENTS OUTREACH & EDUCATIONAL PROGRAMS THAT INCREASE KNOWLEDGE ABOUT DIABETES AND PROVIDE ACCESS FOR THE COMMUNITY AND UNDERSERVED POPULATIONS. IN FY14, SCRIPPS HEALTH FACILITATED 15 COUNTY WIDE COMMUNITY AWARENESS FAIRS AND SERVED 858 PEOPLE. 125 INDIVIDUALS AT THE HEALTH FAIRS WERE SCREENED FOR DIABETES MANAGEMENT AND THERE WERE 47 (38%) POSITIVE SCREENINGS. SCRIPPS FACILITATED 151 PEER LED HEALTH EDUCATION CLASSES AND 1,111 PEOPLE WERE TAUGHT DIABETES MANAGEMENT. RETINAL SCREENINGS ARE IMPORTANT FOR THE PREVENTION AND EARLY TREATMENT OF DIABETIC RETINOPATHY. RETINAL PHOTOGRAPHS OF PATIENTS ARE TAKEN ABOARD THE SCRIPPS MOBILE MEDICAL UNIT AND THEN THE SCREENINGS ARE INTERPRETED AND FOLLOW-UP CARE IS GIVEN IF WARRANTED. MORE THAN 100 PATIENTS, MANY SUFFERING FROM VISION COMPLICATIONS AS A RESULT OF THEIR DIABETES, RECEIVE RETINAL SCREENINGS EACH MONTH. IN FY14, SCRIPPS HEALTH FACILITATED 11 RETINAL SCREENINGS AND SERVED 282 PATIENTS. 36% (103) SCREENED POSITIVE AND 98% (276) INDIVIDUALS WERE REFERRED TO PRIMARY CARE PHYSICIANS. 12% (35) INDIVIDUALS WERE REFERRED TO A RETINAL SPECIALIST. THE PROJECT DULCE PROGRAM HAS BEEN FIGHTING THE DIABETES EPIDEMIC FOR MORE THAN 17 YEARS BY PROVIDING DIABETES CARE, SELF-MANAGEMENT EDUCATION AND CONTINUOUS SUPPORT TO LOW-INCOME AND UNINSURED POPULATIONS THROUGHOUT SAN DIEGO COUNTY. RECOGNIZED FOR ITS IMPACT, THE COMPREHENSIVE PROGRAM SERVES AS AN INTERNATIONAL MODEL OF PATIENT CARE AND ADVOCACY, HELPING INDIVIDUALS WITH THE DISEASE LEARN TO IMPROVE THEIR HEALTH. 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 FY14, OFFERED A COMPREHENSIVE CULTURALLY SENSITIVE DIABETES SELF-MANAGEMENT PROGRAM FOR UNDERSERVED AND UNINSURED POPULATIONS AT VARIOUS COMMUNITY CLINICS AND SERVED 5,990 INDIVIDUALS COUNTYWIDE. MENTAL AND BEHAVIORAL HEALTH SCRIPPS PARTICIPATED IN THE NATIONAL DEPRESSION SCREENING DAY, AN ANNUAL EVENT AIMED AT HELPING PEOPLE IDENTIFY THE SIGNS OF DEPRESSION AND PROVIDING RESOURCES TO ASSIST THOSE AT RISK. SCRIPPS HAS EXPANDED THE AVAILABILITY OF FREE DEPRESSION SCREENINGS BY MAKING THEM AVAILABLE AT ALL FIVE OF OUR HOSPITAL CAMPUSES. THE SCREENINGS ARE OPEN TO ADULTS OF ALL AGES ON A WALK-IN BASIS, AND INCLUDES REFERRALS TO MENTAL HEALTH PROFESSIONALS IF SCREENING SCORES ARE HIGH, AS WELL AS LITERATURE THAT BE SHARED WITH FRIENDS AND FAMILY MEMBERS. THE SCREENINGS ARE INFORMATIONAL, NOT DIAGNOSTIC AND THE SCREENING SCORES INDICATE WHETHER RESPONSES ON THE QUESTIONNAIRE ARE CONSISTENT WITH SYMPTOMS OF DEPRESSION. IN FY14, SCRIPPS TRACKED 134 INDIVIDUALS AND 25 WERE SCREENED. CHALLENGES: THE TRACKING LOG ONLY COLLECTED METRICS THAT WERE HISTORICALLY SENT TO THE SAN DIEGO COUNTY. SINCE THEN, WE HAVE MODIFIED THE TRACKING LOG IN ORDER TO CAPTURE MORE INFORMATION ABOUT THE UNINSURED POPULATION. INFORMATION WILL BE GIVEN TO STAFF TO MAKE SURE TO DIFFERENTIATE BETWEEN THE NUMBERS OF SCREENINGS COMPLETED VS. HOW MANY INDIVIDUALS WERE TRACKED (PERSON STOPPED BY THE BOOTH AND ASKED QUESTION OR PICKED UP LITERATURE ONLY). THE LOCATION OF THE SCREENINGS TOOK PLACE AT HOSPITAL LOBBIES AND THIS IS NOT AN IDEAL LOCATION DUE TO TRAFFIC AND PRIVACY ISSUES. FOR FUTURE SCREENINGS, SCRIPPS WILL LOOK INTO PARTNERING WITH COMMUNITY CLINICS AND HOLDING THE SCREENINGS IN THOSE NEIGHBORHOODS.
FORM 990, PART III, LINE 4A (CONTINUED)	OBESITY DULCE MOTHERS BEGAN AS A PILOT PROGRAM WITH THE GOAL OF DECREASING THE INCIDENCE OF TYPE 2 DIABETES BY MANAGING A MAJOR RISK FACTOR - OBESITY - IN UNDERSERVED, ETHNICALLY DIVERSE POPULATIONS BY TESTING THE EFFECTIVENESS OF A WEIGHT MANAGEMENT CURRICULUM DESIGNED FOR LATINO WOMEN WITH GESTATIONAL DIABETES (GDM). WOMEN WITH A HISTORY OF GDM AND WHO MEET THE CRITERIA FOR BEING OVERWEIGHT (BMI ABOVE 25) ARE REFERRED TO SCRIPPS DULCE MOTHERS. CHALLENGES: THERE WAS NO DATA CAPTURED IN FY14, AS DULCE MOTHERS HAD SOME CHALLENGES IN GETTING THE PILOT PROGRAM STARTED. THERE WERE PROBLEMS WITH SECURING COMMUNITY CLINIC PARTNERSHIPS THAT WOULD PROVIDE THE PARTICIPANTS FOR THE PROGRAM. THE CONTRACTS WITH THESE PARTNERSHIPS WERE NOT ABLE TO BE NEGOTIATED UNTIL LATE IN THE FISCAL YEAR AND ONCE THEY WERE SECURED, THE PARTNERS WERE UNABLE TO MEET THE REQUIREMENTS TO GENERATE THE NUMBER OF PEOPLE NEEDED TO HOLD THESE GROUPS. AS A RESULT, DULCE MOTHERS ADDED A SECOND ARM OF THE STUDY-PROGRAM NUESTRA VIDA, GEARED TOWARD MIDDLE AGED WOMEN WHO ARE AT HIGH-RISK FOR CARDIO METABOLIC CONDITIONS THAT ARE BEING ADMINISTERED IN CHULA VISTA AND THE DULCE MOTHER'S COMPONENT WILL BE ADMINISTERED IN NORTH COUNTY. 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 2014, SCRIPPS CONTRIBUTED $103,556,915 IN UNCOMPENSATED HEALTH CARE, INCLUDING $47,964,142 IN CHARITY CARE, $45,683,738 IN MEDI-CAL AND $9,909,035 IN COST FOR OTHER MEANS-TESTED GOVERNMENT PROGRAMS. 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 68 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. CALIFORNIA'S UNINSURED CALIFORNIA HAD THE GREATEST NUMBER OF UNINSURED RESIDENTS OF ANY STATE, SEVEN MILLION, AND THE SEVENTH LARGEST PERCENTAGE OF UNINSURED UNDER 65 IN THE COUNTRY. MANY OF THE STATE'S UNINSURED ARE EMPLOYED, HOWEVER THE PERCENTAGE OF RESIDENTS WHO RECEIVE COVERAGE THROUGH THEIR JOBS HAS DECLINED DRAMATICALLY, DROPPING FROM 63% IN 1988 TO 54% IN 2012. WHILE PUBLIC INSURANCE HAS MOSTLY OFFSET THIS GAP, 20% OF CALIFORNIANS REMAINS UNINSURED. WITH THE IMPLEMENTATION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (ACA), THE NUMBERS OF UNINSURED RESIDENTS IN CALIFORNIA WILL BE REDUCED, ALTHOUGH A SIGNIFICANT NUMBER WILL BE LEFT BEHIND. THE PERCENTAGE OF CALIFORNIANS WITH EMPLOYER-BASED COVERAGE CONTINUED TO FALL, DROPPING FROM 63 PERCENT IN 1988 TO 53.5 PERCENT IN 2012. WHILE PUBLIC INSURANCE HAS PARTIALLY FILLED THIS GAP, ALMOST 22 PERCENT OF CALIFORNIANS REMAIN UNINSURED. THIS STATISTIC SHOULD CHANGE DRAMATICALLY IN THE COMING YEARS AS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT IS IMPLEMENTED. CALIFORNIANS WITH ANNUAL FAMILY INCOMES BELOW $25,000 ARE MOST LIKELY TO BE UNINSURED. THE LIKELIHOOD OF BEING UNINSURED IS GREATER IN CALIFORNIA THAN THE UNITED STATES AS A WHOLE FOR ALL INCOME LEVELS. 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 2015, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DEFINED A FAMILY OF FOUR'S 200 PERCENT FEDERAL POVERTY LEVEL AS $48,500. COMMUNITY HEALTH SERVICES COMMUNITY HEALTH SERVICES INCLUDE PREVENTION AND WELLNESS PROGRAMS SUCH AS SCREENINGS, HEALTH EDUCATION, SUPPORT GROUPS AND HEALTH FAIRS, WHICH ARE SUPPORTED BY OPERATIONAL FUNDS, GRANTS, IN-KIND DONATIONS, AND PHILANTHROPY. THESE PROGRAMS ARE DESIGNED TO RAISE PUBLIC AWARENESS, UNDERSTANDING OF AND ACCESS TO IDENTIFIED COMMUNITY HEALTH NEEDS. SCRIPPS CATEGORIZES COMMUNITY HEALTH SERVICES ACCORDING TO THE SCHEDULE H 990 CATEGORIES MANDATED BY THE IRS. IT IS CATEGORIZED INTO FIVE MAIN AREAS: - COMMUNITY HEALTH IMPROVEMENT SERVICES - COMMUNITY BENEFIT OPERATIONS - CASH AND IN-KIND CONTRIBUTIONS - SUBSIDIZED HEALTH SERVICES - COMMUNITY BUILDING ACTIVITIES DURING THIS FISCAL YEAR, SCRIPPS INVESTED $5,951,449 IN COMMUNITY HEALTH SERVICES (INCLUDES SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. FOLLOWING ARE HIGHLIGHTS OF JUST SOME OF THE ACTIVITIES CONDUCTED BY SCRIPPS DURING THIS FISCAL YEAR. 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. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED A NUMBER OF PROGRAMS IN FISCAL YEAR 2014. MERCY OUTREACH SURGICAL TEAM WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM (MOST) PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN AT NO COST. MOST VOLUNTEERS PERFORMED RECONSTRUCTIVE SURGERIES ON CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FISCAL YEAR 2014, THE MOST TEAM PROVIDED RECONSTRUCTIVE SURGERIES FOR MORE THAN 400 CHILDREN. (SPONSORED BY SCRIPPS MERCY HOSPITAL, SAN DIEGO AND AFFILIATED PHYSICIANS.)
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL THESE PATIENTS ARE UNFUNDED AND MANY HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES - ADDITIONAL PROBLEMS THAT MAKE THESE PATIENTS DIFFICULT TO PLACE POST-ACUTE. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS HEALTH WITH PHYSICIAN BACKUP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24HR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, COUNSELING, ASSISTANCE WITH MEDI-CAL AND DISABILITY APPLICATION, PLUS HELP FINDING HOUSING. SCRIPPS HEALTH PAYS A DAILY FEE TO THE RCU TO SUPPORT THE PATIENT'S COST IN THE PROGRAM. FOR FY14, TOTAL COST SAVINGS FOR SCRIPPS HAS BEEN OVER $1.7 MILLION. 100% OF PATIENTS WERE CONNECTED TO A PRIMARY CARE PROVIDER AT ONE OF THE COMMUNITY CLINICS. 74% OF THE RCU DISCHARGED PATIENTS DID NOT RETURN TO THE STREETS. THEY EITHER WENT TO A RECOVERY PROGRAM (15%), PERMANENT HOUSING (9%), HEALTHCARE, HOSPICE OR A LOWER LEVEL OF CARE (9%), FAMILY (6%), FRIEND (21%) OR TRANSITIONAL HOUSING IN THE COMMUNITY (15%). GRADUATE MEDICAL EDUCATION STAFF SUPPORT ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND ST. LEO'S CLINIC WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. VINCENT DE PAUL AND ST. LEO'S CLINICS. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2014. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL). FIJI ALLIANCE PROJECT IN PARTNERSHIP WITH THE INTERNATIONAL RELIEF TEAMS OF SAN DIEGO AND THE LOLOMA FOUNDATION, SCRIPPS EMPLOYEES, SCRIPPS CLINIC PHYSICIANS AND OTHER SCRIPPS-AFFILIATED PHYSICIANS PROVIDED MEDICAL AND SURGICAL SERVICES IN FIJI. AS ONE OF THEIR ROTATIONS, RESIDENTS FROM SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL HAVE THE OPPORTUNITY TO PARTICIPATE IN THESE MEDICAL MISSIONS. THE TEAM PERFORMS PROCEDURES TO REMEDY CLEFT LIPS AND PALATES, EYELID, FACE AND FEET DEFORMITIES, BURN SCARS, BREAST MASSES AND HERNIAS, AS WELL AS PROVIDING DIABETES MANAGEMENT. ALL SURGICAL SUPPLIES WERE DONATED BY PROFESSIONAL HOSPITAL SUPPLY CORPORATION (PHS), THE SUPPLIER FOR SCRIPPS HEALTH. THE SUPPLIES INCLUDED SURGICAL GOWNS, GLOVES, DRAPES, DRESSINGS, BANDAGES, SUTURES, ETC. CARDINAL HEALTH SYSTEMS, WHICH PROVIDES PHARMACEUTICALS AND OTHER SUPPLIES FOR SCRIPPS HEALTH, DONATED ALL MEDICATIONS. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL) SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN 2014, SCRIPPS AWARDED $215,000 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO (SIX GRANTS RANGING FROM $10,000 TO $120,000). THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH-PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT-RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $2.49 MILLION. PROGRAMS FUNDED DURING FISCAL YEAR 2014 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. (SPONSORED BY SCRIPPS MERCY HOSPITAL ADMINISTRATION) 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 ACCESS 24/7. THERE IS AN OVERWHELMING NEED FOR A DEPENDABLE SERVICE TO HELP PEOPLE NAVIGATE TODAY'S COMPLEX HEALTH CARE SYSTEM. SINCE THE INCEPTION OF THE HEALTH CARE NAVIGATION PROGRAM, 2-1-1 HAS RESPONDED TO MORE THAN 6,000 CALLS FROM CLIENTS SEEKING HEALTH-RELATED RESOURCES. IN SEPTEMBER 2014, 2-1-1 SAN DIEGO RESPONDED TO 2,392 CALLS FROM CLIENTS SPECIALLY SEEKING HEALTH-RELATED RESOURCES. IN ADDITION, 3,483 CLIENTS HAVE BEEN SCREENED FOR BREAST HEALTH NEEDS AND 37 WERE ASSISTED BY BREAST HEALTH SPECIALISTS. 2-1-1 CLIENT SERVICE REPRESENTATIVES AND PHONE SYSTEM OUTREACHED TO 11,023 CLIENTS AND EDUCATED 575 ON COVERED CALIFORNIA. AMERICAN HEART ASSOCIATION SCRIPPS PROVIDED FUNDING FOR THE 2014 HEART WALK 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. BACK PAIN MOST PEOPLE IN THE UNITED STATES WILL EXPERIENCE LOWER BACK PAIN AT LEAST ONCE DURING THEIR LIVES. BACK PAIN IS ONE OF THE MOST COMMON REASONS PEOPLE GO TO THE DOCTOR OR MISS WORK. SOME CAUSES OF BACK PAIN INCLUDE MUSCLE OR LIGAMENT STRAIN, BULGING OR RUPTURED DISKS, ARTHRITIS, SKELETAL IRREGULARITIES AND OSTEOPOROSIS. RISK FACTORS FOR BACK PAIN INCLUDE: - EXCESS WEIGHT OR OBESITY - LACK OF EXERCISE - IMPROPER LIFTING - THOSE WITH PSYCHOLOGICAL ISSUES, SUCH AS DEPRESSION AND ANXIETY (REASONS UNKNOWN) DISPARITIES IN THE UNITED STATES (NHIS, 2010): - ADULTS WITHOUT A HIGH SCHOOL DIPLOMA WERE MORE LIKELY TO HAVE LOWER BACK PAIN. - ADULTS IN POOR FAMILIES WERE MORE LIKELY TO EXPERIENCE LOWER BACK PAIN. - WOMEN ARE MORE LIKELY THAN MALES TO HAVE EXPERIENCED PAIN IN THE LOWER BACK (30.0% VERSUS 26.0%). HEALTHY PEOPLE 2020: - GOAL: REDUCED ACTIVITY LIMITATION DUE TO CHRONIC BACK CONDITIONS. - TARGET: 27.6 PER 1,000. - BASELINE: 30.7 IN 2008 DATA SOURCE: NATIONAL HEALTH INTERVIEW SURVEY, CDC, NCHS BURDEN: - LOWER BACK PAIN HAS BEEN REPORTED AS THE 6TH MOST COSTLY CONDITION IN THE UNITED STATES. - 29% OF ADULTS OVER THE AGE OF 18 HAVE PAIN IN THE LOWER BACK. - BACK PAIN AFFECTS 60% TO 80% OF PEOPLE IN THEIR LIFETIME. DURING FISCAL YEAR 2014, SCRIPPS ENGAGED IN THE FOLLOWING HEALTHY BACK PAIN PREVENTION AND TREATMENT ACTIVITIES. SCRIPPS MENDE WELL BEING CENTER THE SCRIPPS MENDE WELL BEING OFFERED VARIOUS LECTURES ON CHRONIC PAIN MANAGEMENT AND NEW ALTERNATIVES TO HEALING. THESE LECTURES FOCUSED ON ADVANCED PROGRAMS, TREATMENTS AND RELIEF FROM PAIN AND SUFFERING. THIS ORIENTATION INCLUDED RELATED IRRITABLE BOWEL, INSOMNIA, STRESS, BACK PAIN, DEPRESSION AND CHRONIC FATIGUE INFORMATION. THESE LECTURES WERE FREE AND OPEN TO THE COMMUNITY. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA, COMMUNITY BENEFITS). CANCER/ONCOLOGY CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE U.S., EXCEEDED ONLY BY HEART DISEASE, AND ACCOUNTS FOR ALMOST ONE-QUARTER OF ALL DEATHS IN SAN DIEGO COUNTY. ACCORDING TO NATIONAL CANCER INSTITUTE (NCI) ESTIMATES, IN 2009 THERE WERE 1,479,350 NEW CANCER CASES AND AN ESTIMATED 562,540 CANCER DEATHS. CURRENTLY, LUNG, BREAST, COLORECTAL AND PROSTATE CANCERS ACCOUNT FOR 53 PERCENT OF ALL NEW CANCER CASES AND 50 PERCENT OF ALL CANCER DEATHS. BREAST CANCER BREAST CANCER IS DEFINED AS ANY CANCEROUS GROWTH THAT INHABITS THE TISSUES IN THE BREAST. IN THIS TYPE OF CANCER, THE CELLS IN THE BREAST REGION GROW ABNORMALLY AND IN AN UNCONTROLLED WAY. THOUGH BREAST CANCER IS MOSTLY FOUND IN WOMEN, IN RARE CASES IT IS ALSO FOUND IN MEN. IN THE U.S. ALONE, ONE OUT OF EVERY EIGHT WOMEN HAS THIS DISEASE. COMMON TYPES INCLUDE: DUCTUAL CARCINOMA BREAST CANCER AND LOBULAR CARCINOMA BREAST CANCER, NAMED FOR THE LOCATION OF THE BREAST IN WHICH THEY BEGAN. NOT COUNTING SOME KINDS OF SKIN CANCER, BREAST CANCER IN THE UNITED STATES IS: - THE MOST COMMON CANCER IN WOMEN, NO MATTER YOUR RACE OR ETHNICITY. - THE MOST COMMON CAUSE OF DEATH FROM CANCER AMONG HISPANIC WOMEN. - THE SECOND MOST COMMON CAUSE OF DEATH FROM CANCER AMONG WHITE, BLACK, ASIAN/PACIFIC - ISLANDER, AND AMERICAN INDIAN/ALASKA NATIVE WOMEN. BREAST CANCER DISPARITIES IN THE UNITED STATES: ALTHOUGH THE INCIDENCE OF BREAST CANCER IN WHITE, NON-HISPANIC FEMALES IS GREATER THAN THAT OF BLACK FEMALES, THE MORTALITY RATES AMONG BLACK FEMALES IS MUCH GREATER THAN THAT OF WHITE, NON-HISPANIC FEMALES.
FORM 990, PART III, LINE 4A (CONTINUED)	COLORECTAL CANCER NCI DEFINES COLORECTAL CANCER AS ANY CANCER "THAT FORMS IN THE TISSUES OF THE COLON OR RECTUM." MOST COLON CANCERS ARE ADENOCARCINOMAS (CANCERS THAT BEGIN IN CELLS THAT MAKE AND RELEASE MUCUS AND OTHER FLUIDS). OF CANCERS THAT AFFECT BOTH MEN AND WOMEN, COLORECTAL CANCER IS THE SECOND LEADING CAUSE OF CANCER-RELATED DEATHS IN THE UNITED STATES. COLORECTAL CANCER ALSO IS ONE OF THE MOST COMMONLY DIAGNOSED CANCERS IN THE UNITED STATES; AMONG ALL MEN AND WOMEN IT IS THE THIRD MOST COMMON CANCER IN THE US TODAY. CLINICAL SYMPTOMS INCLUDE BLOOD IN/ON THE STOOL, PERSISTENT CRAMPING, PAINS, AND ACHING IN THE STOMACH, AND UNEXPLAINED WEIGHT-LOSS. RISK FACTORS FOR COLORECTAL CANCER INCLUDE: - AGE: 90% OF ALL CASES DIAGNOSED ARE IN PEOPLE ABOVE THE AGE OF 50 YEARS. - INFLAMMATORY BOWEL DISEASE. - A PERSONAL OR FAMILY HISTORY OF COLORECTAL CANCER OR COLORECTAL POLYPS. - A GENETIC SYNDROME OR HEREDITARY NON-POLYPOSIS COLORECTAL CANCER (LYNCH SYNDROME). - LIFESTYLE FACTORS SUCH AS, LACK OF REGULAR PHYSICAL ACTIVITY, LOW FRUIT AND VEGETABLE INTAKE, LOW-FIBER AND HIGH-FAT DIETS, ALCOHOL CONSUMPTION, TOBACCO USE, AND BEING OVERWEIGHT OR OBESE. COLORECTAL CANCER PREVALENCE IN THE UNITED STATES: SEER ESTIMATES THAT 1,140,161 MEN AND WOMEN CURRENTLY HAVE BEEN DIAGNOSED WITH COLORECTAL CANCERS. LUNG CANCER LUNG CANCER IS THE LEADING CAUSE OF CANCER DEATH AND THE SECOND MOST DIAGNOSED CANCER IN BOTH MEN AND WOMEN IN THE UNITED STATES. IN 2008, 14% OF ALL CANCER DIAGNOSES AND 28% OF ALL CANCER DEATHS WERE DUE TO LUNG CANCER. LUNG CANCERS USUALLY ARE GROUPED INTO TWO MAIN TYPES CALLED SMALL CELL AND NON-SMALL CELL. THESE TYPES OF LUNG CANCER PROGRESS IN DIFFERENT MANNERS, AND THEREFORE REQUIRE DIFFERENT COURSES OF TREATMENT. NON-SMALL CELL LUNG CANCER IS MORE COMMON THAN SMALL CELL LUNG CANCER. CLINICAL SYMPTOMS CAN INCLUDE, CHEST PAIN, SHORTNESS OF BREATH, WHEEZING, COUGHING UP BLOOD, CONSTANT FATIGUE, UNEXPLAINED WEIGHT LOSS, AND COUGHING THAT PROGRESSIVELY WORSENS AND DOES NOT SUBSIDE. SOME FACTS ABOUT LUNG CANCER IN 2008: - 208,493 PEOPLE IN THE UNITED STATES WERE DIAGNOSED WITH LUNG CANCER, INCLUDING 111,886 MEN AND 96,607 WOMEN. - 158,592 PEOPLE IN THE UNITED STATES DIED FROM LUNG CANCER, INCLUDING 88,541 MEN AND 70,051 WOMEN. LUNG CANCER PREVALENCE IN THE UNITED STATES: ON JANUARY 1, 2009, IN THE UNITED STATES, THERE WERE APPROXIMATELY 387,762 MEN AND WOMEN ALIVE WHO HAD A HISTORY OF CANCER OF THE LUNG AND BRONCHUS -- 178,490 MEN AND 209,272 WOMEN. PROSTATE CANCER NCI DEFINES PROSTATE CANCER AS A CANCER THAT FORMS IN TISSUES OF THE PROSTATE, A GLAND IN THE MALE REPRODUCTIVE SYSTEM FOUND BELOW THE BLADDER AND IN FRONT OF THE RECTUM.1 WHILE CANCEROUS CELLS WITHIN THE PROSTATE ITSELF ARE GENERALLY NOT DEADLY ON THEIR OWN, AS A CANCEROUS TUMOR GROWS, SOME OF THE CELLS CAN BREAK OFF AND SPREAD TO OTHER PARTS OF THE BODY THROUGH THE LYMPH OR THE BLOOD, THROUGH THE PROCESS OF METASTASIS. PROSTATE CANCER USUALLY OCCURS IN OLDER MEN. CLINICAL SYMPTOMS INCLUDE: DIFFICULTY STARTING URINATION, WEAK/INTERRUPTED FLOW OF URINE, PAIN/BURNING DURING URINATION, FREQUENT URINATION, BLOOD IN URINE OR SEMEN, AND UNSPECIFIED PAIN IN THE BACK, HIPS OR PELVIS. NOT COUNTING SOME FORMS OF SKIN CANCER, PROSTATE CANCER IN THE UNITED STATES IS: - THE MOST COMMON CANCER IN MEN, NO MATTER YOUR RACE OR ETHNICITY. - THE SECOND MOST COMMON CAUSE OF DEATH FROM CANCER AMONG WHITE, AFRICAN AMERICAN, AMERICAN INDIAN/ALASKA NATIVE, AND HISPANIC MEN. - THE FOURTH MOST COMMON CAUSE OF DEATH FROM CANCER AMONG ASIAN/PACIFIC ISLANDER MEN. RISK FACTORS FOR PROSTATE CANCER INCLUDE: - AGE: THE OLDER A MAN IS, THE GREATER HIS RISK FOR GETTING PROSTATE CANCER. - FAMILY HISTORY: A MAN WITH A FATHER, BROTHER, OR SON WHO HAS HAD PROSTATE CANCER IS TWO TO THREE TIMES MORE LIKELY TO DEVELOP THE DISEASE HIMSELF. - RACE: PROSTATE CANCER IS MORE COMMON IN SOME RACIAL AND ETHNIC GROUPS THAN IN OTHERS. PROSTATE CANCER PREVALENCE IN THE UNITED STATES: SEER ESTIMATES THAT 2,496,784 MALES CURRENTLY HAVE BEEN DIAGNOSED WITH CANCER OF THE PROSTATE. SKIN CANCER SKIN CANCER IS A CANCER THAT FORMS IN THE VARIOUS TISSUES OF THE SKIN, AND IS THE MOST COMMON FORM OF CANCER IN THE UNITED STATES. THE TWO MOST PREVALENT TYPES OF SKIN CANCER-BASAL CELL (FORMS IN THE LOWER PART OF THE EPIDERMIS) AND SQUAMOUS CELL (FORMS IN THE FLAT CELLS THAT FORM THE SURFACE OF THE SKIN) CARCINOMAS-ARE HIGHLY CURABLE. HOWEVER, THE THIRD MOST COMMON SKIN CANCER, MELANOMA, FORMS IN THE CELLS THAT MAKE THE PIGMENT MELANIN AND ARE CONSIDERED MORE DANGEROUS. ABOUT 65%-90% OF MELANOMAS ARE CAUSED BY EXPOSURE TO ULTRAVIOLET (UV) LIGHT. CLINICAL SYMPTOMS INCLUDE MOLES THAT ARE ASYMMETRICAL, HAVE IRREGULAR BORDERS, UNEVEN COLORATION, EXPERIENCE INCREASES IN DIAMETER, OR HAVE EVOLVED OR CHANGED IN RECENT WEEKS OR MONTHS. RISK FACTORS FOR THE THREE MOST COMMON TYPES OF SKIN CANCER: - SUNLIGHT - SEVERE, BLISTERING SUNBURNS - LIFETIME SUN EXPOSURE - TANNING MELANOMA OF THE SKIN PREVALENCE IN THE UNITED STATES: SEER ESTIMATES THAT 876,344 PERSONS CURRENTLY HAVE BEEN DIAGNOSED WITH MELANOMA OF THE SKIN 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. HERE ARE A FEW EXAMPLES OF SCRIPPS CANCER PROGRAMS DURING FISCAL YEAR 2014. SCRIPPS GREEN HOSPITAL CANCER SUPPORT GROUPS SCRIPPS GREEN 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 THE SUPPORT GROUPS NURTURE THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING. CLASSES AT SCRIPPS GREEN HOSPITAL, SUCH AS THE FREE CANCER WRITING WORKSHOP, WHEN WORDS HEAL, USE EXPRESSIVE WRITING TO HELP PATIENTS NAVIGATE THEIR JOURNEY WITH CANCER. (SPONSORED BY SCRIPPS GREEN HOSPITAL) SCRIPPS MERCY HOSPITAL, CHULA VISTA: HEALTHY WOMEN, HEALTHY LIFESTYLES: SCRIPPS MERCY BREAST HEALTH OUTREACH AND EDUCATIONAL PROGRAM A PROMOTORA-LED HEALTH AND WELLNESS PROGRAM THAT AIMS TO IMPROVE THE LIVES OF WOMEN IN SAN DIEGO'S SOUTH BAY WITH BREAST CANCER EDUCATION, PREVENTION AND TREATMENT SUPPORT. PROMOTORA'S TEACH BREAST HEALTH TO WOMEN WHO HAVE LIMITED OR NO ACCESS TO HEALTH CARE. PROMOTORA'S TEACH WOMEN IN THEIR NATIVE LANGUAGE WITH SENSITIVITY TO A WOMAN'S 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 A 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 A FULL SUPPORT SYSTEM FOR THOSE ALREADY DIAGNOSED. MOREOVER, THE FACT THEY ARE BI-LINGUAL LATINAS LENDS AN AIR OF AUTOMATIC TRUST AMONG THE HISPANIC COMMUNITY AS THEY CAN CONNECT WITH THE RESIDENTS ON A CULTURAL LEVEL. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS.) SCRIPPS MERCY HOSPITAL, CHULA VISTA: BREAST HEALTH CLINICAL SERVICES A TOTAL OF 5,355 WOMEN WERE REFERRED TO CLINICAL BREAST HEALTH SERVICES AT COMMUNITY AND SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY SERVICES. A TOTAL OF 2,917 SERVICES WERE PROVIDED, INCLUDING TELEPHONE REMINDERS, OUTREACH AND EDUCATION, CASE MANAGEMENT AND A VARIETY OF PRESENTATIONS. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS.) PATIENT CONTINUITY OF CARE WITH SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY A TOTAL OF 71 SERVICES WAS PROVIDED, INCLUDING ENCOURAGEMENT FOR PATIENTS TO REPEAT EXAMS, ASSISTANCE TO GET PATIENTS HEALTH INSURANCE APPROVAL TO REPEAT EXAMS, SOCIAL/EMOTIONAL SUPPORT AND EDUCATION ABOUT PREVENTING BREAST CANCER. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS) SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY, POSITIVE BREAST CANCER PATIENT SUPPORT A TOTAL OF 251 SERVICES WERE PROVIDED INCLUDING PHONE CALLS, HOME VISITS, MAILED EDUCATIONAL MATERIALS AND SUPPLIES (WIGS, BRAS AND PROSTHESIS). A RESOURCE PACKAGES WITH EDUCATIONAL MATERIALS ON NUTRITION, TREATMENT OPTIONS, COMMONLY ASKED QUESTIONS AND LOCAL RESOURCES WAS PROVIDED. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS.)
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS POLSTER BREAST CARE CENTER, MUSIC AS MEDICINE PROGRAM PATIENTS AND THEIR SUPPORTERS PARTICIPATE IN THE MUSIC AS MEDICINE THERAPY CLASS. THE MUSIC THERAPIST ASKS QUESTIONS AND TAILORS THE THERAPY TO THE PARTICIPANTS' EMOTIONAL AND PHYSICAL NEEDS. SESSIONS INVOLVE LISTENING TO MUSIC, WRITING SONGS, DISCUSSING WHAT LYRICS MEAN TO THE PARTICIPANTS, USE OF SINGING BOWLS, VOCALIZATION AND DRUMMING. RESEARCH HAS SHOWN THAT MUSIC CAN BOOST IMMUNE FUNCTION, BLOCK INCOMING PAIN STIMULI, LOWER BLOOD PRESSURE AND INFLUENCE EMOTIONAL WELL-BEING.(SPONSORED BY SCRIPPS POLSTER BREAST CARE CENTER) SCRIPPS POLSTER BREAST CARE CENTER, SUPPORT GROUPS SCRIPPS POLSTER BREAST CARE CENTER SUPPORT GROUPS PROVIDE A VENUE FOR WOMEN TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES AND RECEIVE SUPPORT.(SPONSORED BY SCRIPPS POLSTER BREAST CARE CENTER) CANCER AWARENESS AND EDUCATIONAL EVENTS A SERIES OF EDUCATIONAL EVENTS ARE COORDINATED WITH 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. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA CANCER CENTER) 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 FAMILIES WHO HAVE EXPERIENCED THE LOSS OF A CHILD, CHILDREN WHO HAVE LOST A PARENT TO CANCER, INFERTILITY, PARENTING TWINS, IMPROVING CHILDREN'S READING ABILITIES, HUNTINGTON'S DISEASE, PARKINSON'S DISEASE, MENTAL ILLNESS, OSTOMY, POSTPARTUM ISSUES, GYNECOLOGICAL CANCER, CHRONIC PAIN AND MULTIPLE SCLEROSIS. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA, COMMUNITY BENEFITS) CARDIOVASCULAR DISEASE CORONARY HEART DISEASE AND STROKE ARE THE NUMBER ONE AND THREE CAUSES OF DEATH IN THE NATION. HEART DISEASE CLAIMS MORE THAN 950,000 AMERICANS EVERY YEAR. STROKE KILLED 137,119 PEOPLE IN 2006 AND IS A LEADING CAUSE OF SERIOUS, LONG-TERM DISABILITY. THE WORLD HEALTH ORGANIZATION DEFINES CARDIOVASCULAR DISEASE (CVD) AS A GROUP OF DISORDERS OF THE HEART AND BLOOD VESSELS THAT INCLUDE CORONARY HEART DISEASE, CEREBROVASCULAR DISEASE, PERIPHERAL ARTERIAL DISEASE, RHEUMATIC HEART DISEASE, CONGENITAL HEART DISEASE, DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM. 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. 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. - BETWEEN 70% AND 89% OF SUDDEN CARDIAC EVENTS OCCUR IN MEN. - ABOUT TWO-THIRDS (64%) OF WOMEN WHO DIE SUDDENLY OF CORONARY HEART DISEASE HAVE NO PREVIOUS SYMPTOMS. PREVALENCE DATA: IN 2010, 4.1% OF ADULTS LIVING IN SAN DIEGO HAD EVER HAD CORONARY HEART DISEASE. IN 2010, 3.6% OF ADULTS LIVING IN CALIFORNIA HAD EVER HAD CORONARY HEART DISEASE. DURING FISCAL YEAR 2013, SCRIPPS ENGAGED IN THE FOLLOWING HEART HEALTH, CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT ACTIVITIES. AMERICAN HEART WALK IN ADDITION, SCRIPPS EMPLOYEES VOLUNTEERED THEIR TIME TO COORDINATE WALKER PARTICIPATION AND FUNDRAISING EFFORTS. THE SAN DIEGO HEART WALK RAISED MORE THAN $1.2 MILLION. IN 2014, MORE THAN 1,700 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES, AND FRIENDS - WALKED TO HELP RAISE MORE THAN $125,000. ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT AND PROVIDED HEALTH EDUCATION MATERIALS AND GIVEAWAYS.(SPONSORED BY SCRIPPS COMMUNITY BENEFIT SERVICES) COMMUNITY HEALTH EDUCATION PROGRAMS THE COMMUNITY HEALTH EDUCATION PROGRAMS COVER A WIDE VARIETY OF TOPICS ON DISEASE MANAGEMENT, HEALTH CARE UPDATES AND PREVENTION. THE PROGRAMS COVER HYSTERECTOMY, STROKE, STRESS, VARICOSE VEINS, INFERTILITY, CARDIAC, DEPRESSION, MACULAR DEGENERATION, MEMORY, BRAIN, ORTHOPEDIC CARE, ROBOTIC SURGERY, SKIN CARE, BACK CARE, MIGRAINES, KNEE PAIN, PELVIC FLOOR INCONTINENCE, SAFETY AND FALL PREVENTION, BLADDER HEALTH, HEALTHY DINING, EXERCISE, VOICE, FLU PREVENTION, SLEEP DISORDERS, NUTRITION, HYPERTENSION, FOOT CARE, SPINE SURGERY, JOINT REPLACEMENT, BREATHING, PAIN MANAGEMENT AND MEDICATION. (SPONSORED BY SCRIPPS LA JOLLA COMMUNITY BENEFIT SERVICES) 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. (SPONSORED BY CARDIAC TREATMENT CENTER AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA) 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; FIT BALL, OFFERED TWICE A WEEK; CLASSES TO IMPROVE STRENGTH, POSTURE AND CORE STABILITY; YOGA FOR CANCER RECOVERY, OFFERED WEEKLY; CLASSES TO DECREASE STRESS, IMPROVE CIRCULATORY FLOW, AND EASE TENSION DURING HEALING; CLASSES CENTERING ON BALANCE, OFFERED WEEKLY; CLASSES TO BUILD BALANCE, POSTURE AND COORDINATION; POWER YOGA, OFFERED TWICE WEEKLY; CLASSES TO IMPROVE STRENGTH AND FLEXIBILITY; WEEKLY PILATES CLASSES, YOGA FOR MULTIPLE SCLEROSIS, OFFERED WEEKLY; CLASSES TO PROMOTE HEALING AND IMPROVE STRENGTH AND FLEXIBILITY; AND WEEKLY MEDITATION CLASSES. (SPONSORED BY THE CARDIAC TREATMENT CENTER, SCRIPPS MEMORIAL HOSPITAL LA JOLLA) STROKE CARE PROGRAMS SCRIPPS SPONSORED A WIDE VARIETY OF STROKE-RELATED EDUCATION AND AWARENESS PROGRAMS. (SPONSORED BY SCRIPPS MERCY HOSPITAL STROKE PROGRAM) HEART HEALTH, SCRIPPS HOME HEALTH SERVICES SCRIPPS HOME HEALTH PROVIDED COMMUNITY EDUCATION TO PROMOTE INDEPENDENT CONGESTIVE HEART FAILURE (CHF) MANAGEMENT TO PREVENT EXACERBATIONS AND HOSPITALIZATIONS. PATIENTS RECEIVED INFORMATION ON WHAT CHF IS, MEDICATIONS, DIET, WEIGHT AND EXERCISE. (SPONSORED BY SCRIPPS HOME HEALTH SERVICES.) 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 HEART'S 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. AS A SPONSOR FOR THE ERIC PAREDES SAVE A LIFE FOUNDATION , SCRIPPS HAS HELPED MORE THAN 10,000 FREE CARDIAC SCREENINGS TO LOCAL TEENS, INCLUDING THE HOMELESS, UNINSURED AND UNDERINSURED. IN 2014, SCRIPPS MADE A $15,000 DONATION TO HELP PAY FOR THE SCREENINGS. IN 2014, SCRIPPS SUPPORTED SCREENING EVENTS AT AREA HIGH SCHOOLS AND SCREENED 4,188 TEENS, IDENTIFYING 93 WITH ABNORMALITIES AND 30 WHO WERE AT RISK. SU VIDA, SU CORAZON/YOUR HEART, 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 IT'S ALSO ONE OF 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/LIPIDS AND DAMAGE TO THE HEART MUSCLE FROM CORONARY ARTERY DISEASE. SCRIPPS HEALTH ADDRESSES THIS HEALTH ISSUE THROUGH A 12- WEEK EDUCATIONAL BASED COMMUNITY INTERVENTION PROGRAM TO SUPPORT IMPROVED QUALITY OF LIFE FOR PATIENTS DIAGNOSED WITH HEART DISEASE. PROPER LIFESTYLE CHANGES TAKEN BY THOSE WITH HEART DISEASE CAN GREATLY REDUCE RISK OF FURTHER INTERMEDIATE AND FATAL OUTCOMES. 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 SUGGESTS 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 HEART, YOUR LIFE IS TO DECREASE THE READMISSION RATES FOR HEART FAILURE PATIENTS, WHICH REDUCES MEDICAL COSTS FOR THE PATIENT AND IMPROVES THEIR QUALITY OF LIFE. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS.)
FORM 990, PART III, LINE 4A (CONTINUED)	DIABETES THE 2011 NATIONAL DIABETES FACT SHEET (THE MOST RECENT YEAR DATA IS AVAILABLE) ESTIMATES 25.8 MILLION CHILDREN AND ADULTS IN THE U.S., 8.3 PERCENT OF THE POPULATION, HAVE DIABETES. THESE STATISTICS INCLUDE 18.8 MILLION PEOPLE WITH DIAGNOSED DIABETES AND ANOTHER 7.0 MILLION PEOPLE WITH UNDIAGNOSED DIABETES. EACH YEAR 1.9 MILLION NEW CASES OF DIABETES ARE DIAGNOSED IN PEOPLE 20 AND OLDER. MORE THAN 90 MILLION AMERICANS (33 PERCENT) LIVE WITH A CHRONIC DISEASE. WHILE THERE ARE MANY DISABLING CHRONIC DISEASES, DIABETES HAS BEEN IDENTIFIED AS ONE OF THE PRIMARY CHRONIC CONDITIONS IN SAN DIEGO COUNTY. THE DIABETES DEATH RATE WAS 17.4 PER 100,000 IN 2009. 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 II DIABETES, ONCE KNOWN AS ADULT-ONSET OR NONINSULIN-DEPENDENT DIABETES, IS A CHRONIC CONDITION THAT AFFECTS THE WAY YOUR BODY METABOLIZES SUGAR (GLUCOSE), WHICH IS YOUR BODY'S MAIN SOURCE OF FUEL. WITH TYPE 2 DIABETES, YOUR BODY EITHER RESISTS THE EFFECTS OF INSULIN - A HORMONE THAT REGULATES THE MOVEMENT OF SUGAR INTO YOUR CELLS - OR DOESN'T PRODUCE ENOUGH INSULIN TO MAINTAIN A NORMAL GLUCOSE level. IF LEFT UNTREATED, TYPE 2 DIABETES CAN BE LIFE-THREATENING. CLINICAL SYMPTOMS CAN INCLUDE: FREQUENT URINATION, EXCESSIVE THIRST, EXTREME HUNGER, SUDDEN VISION CHANGES, UNEXPLAINED WEIGHT LOSS, EXTREME FATIGUE, SORES THAT ARE SLOW TO HEAL, AND INCREASED NUMBER OF INFECTIONS. SOME ALARMING FACTS ABOUT TYPE 2 DIABETES: - ABOUT 1.9 MILLION PEOPLE AGED 20 YEARS OR OLDER WERE NEWLY DIAGNOSED WITH DIABETES IN 2010 IN THE U.S. - DIABETES IS THE LEADING CAUSE OF KIDNEY FAILURE, NON-TRAUMATIC LOWER-LIMB AMPUTATIONS, AND NEW CASES OF BLINDNESS AMONG ADULTS IN THE UNITED STATES. - DIABETES IS A MAJOR CAUSE OF HEART DISEASE AND STROKE, AND IS THE 7TH LEADING CAUSE OF DEATH IN THE UNITED STATES. SOME RISK FACTORS FOR DEVELOPING DIABETES INCLUDE: - BEING OVERWEIGHT OR OBESE. - HAVING A PARENT, BROTHER, OR SISTER WITH DIABETES. - HAVING HIGH BLOOD PRESSURE MEASURING 140/90 OR HIGHER. - BEING PHYSICALLY INACTIVE-EXERCISING FEWER THAN THREE TIMES A WEEK. DIABETES PREVALENCE: U.S. AGE-ADJUSTED PREVALENCE RATES FOR ADULT DIAGNOSED DIABETES FOR THE YEAR OF 2010 WERE 8.7%, AS COMPARED TO A RATE OF 3.7% RATE IN 1980. THE STATE OF CALIFORNIA REPORTED A RATE OF 8.9% FOR THE SAME YEAR. MORE THAN SEVEN MILLION AMERICANS ARE UNAWARE 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 2013, SCRIPPS SPONSORED THE FOLLOWING DIABETES MANAGEMENT INITIATIVES. PROJECT DULCE A COLLABORATION BETWEEN THE WHITTIER DIABETES INSTITUTE, THE COUNCIL OF COMMUNITY CLINICS AND COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP), 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 10 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. IN FISCAL YEAR 2014, PROJECT DULCE PROVIDED 7,383 DIABETES CARE AND EDUCATION VISITS FOR LOW-INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO AND ENROLLED MORE THAN 1049 NEW PATIENTS. THE PROGRAM ALSO INITIATED FOUR NEW PROJECTS: PREVENTION FOR WOMEN WITH A HISTORY OF GESTATIONAL DIABETES, REPLICATING PROJECT DULCE IN TIJUANA, DIABETES PEER CARE COORDINATION AT SCRIPPS MERCY HOSPITAL, CHULA VISTA AND THE DIABETES GENE BANK PROGRAM. THE WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING THE 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, MEDICATION UPGRADES, NUTRITIONAL ADJUSTMENTS AND CHANGES IN DIABETES-RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP CLINICIANS WITH THE LATEST INFORMATION AND CLINICAL SKILLS. THE WHITTIER INSTITUTE'S PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS, INCLUDING: ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS AND OTHER DIABETES SPECIALISTS. THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST POSSIBLE CARE FOR THEIR DIABETES PATIENTS. COURSES 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 331 PEOPLE ON INSULIN MANAGEMENT, INCRETIN THERAPY, THE DIABETES DIET AND DIABETES BASICS. PARTICIPANTS CAME FROM LOCAL HEALTH INSTITUTIONS AND THROUGHOUT THE UNITED STATES TO LEARN FROM THE WHITTIER INSTITUTE'S MOST EXPERIENCED DIABETES EXPERTS. OVER THE LAST FISCAL YEAR, THE WHITTIER INSTITUTE'S PROFESSIONAL EDUCATION DEPARTMENT PROVIDED 12 SEPARATE PROGRAMS FOR PHYSICIANS, NURSES, PHARMACISTS, DIETITIANS, MIDLEVEL PROVIDERS AND SOCIAL WORKERS. HEALTH-RELATED BEHAVIORS HEALTH-RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLE'S HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH-RELATED BEHAVIORS, SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY; ORAL HEALTH AND INJURY PREVENTION, HAVE BECOME IMPORTANT COMPONENTS OF LONG-TERM HEALTH. 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 2014, SCRIPPS SPONSORED A NUMBER OF HEALTH BEHAVIOR MODIFICATION EFFORTS. COMMUNITY PROGRAMS AND CLINICAL SERVICES OF THE SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS AND FAMILY MEDICINE RESIDENCY PROGRAMS HAS DELIVERED EXTENSIVE VALUE WITH SUPERIOR OUTCOMES. COMMUNITY SERVICES COMBINED REACHED 18,255 PROGRAM PATIENTS AND PARTICIPANTS. THERE WERE MORE THAN 16,700 CLINICAL VISITS PROVIDED BY SCRIPPS FAMILY MEDICINE RESIDENCY. COMMUNITY-BASED HEALTH IMPROVEMENT ACTIVITIES EACH MONTH APPROXIMATELY 250-300 COMMUNITY MEMBERS PARTICIPATE IN CLASSES, PREVENTION LECTURES AND SUPPORT GROUPS HELD AT THE WELL-BEING CENTER, NORMAN PARK, CONGREGATIONAL TOWERS AND CHULA VISTA MEDICAL PLAZA. A TOTAL OF 2,595 COMMUNITY MEMBERS HAVE PARTICIPATED IN CLASSES AND SUPPORT GROUPS. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA). YOUTH PROGRAM ACTIVITIES IMPLEMENTED A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES INCLUDING: CAMP SCRIPPS, MENTORING PROGRAM, HOSPITAL TOURS, IN-CLASSROOM PRESENTATIONS AND SURGERY VIEWINGS. SCRIPPS FAMILY MEDICINE RESIDENTS ALSO PROVIDE FOOTBALL GAME COVERAGE, SPORTS INJURY CLINICS AND PHYSICALS. A TOTAL OF 3,261 YOUTH PARTICIPATED IN THESE PROGRAMS. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA) SENIOR PROGRAMS EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD WITH LOCAL SENIOR CENTERS, CHURCHES AND SENIOR HOUSING. SOME OF THESE ACTIVITIES INCLUDE: SENIOR HEALTH CHATS, MEN'S GROUP, SENIOR CAMP SCRIPPS, FLU EVENT AND HEALTH FAIRS. MORE THAN 200 SENIORS PARTICIPATED IN RESIDENCY SENIOR ACTIVITIES INCLUDING GROUP VISITS AND FLU EVENTS. A TOTAL OF 902 SENIORS PARTICIPATED IN THESE PROGRAMS. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA) 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 PILOT PROJECT IN JULY 2014; 106 REFERRALS HAVE BEEN RECEIVED AND MORE THAN HALF OF PATIENTS HAVE REMAINED OUT OF THE HOSPITAL FOR MORE THAN 60 DAYS AND ARE BEING SUPPORTED THROUGH OUR STAFF, PROGRAMS AND ACTIVITIES.
FORM 990, PART III, LINE 4A (CONTINUED)	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 A PUBLIC SAFETY, ACCESS TO HEALTHY FOODS, AND INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. DEMENTIA AND ALZHEIMER'S 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. ALZHEIMER 'S DISEASE (AD) IS A PROGRESSIVE BRAIN DISORDER THAT GRADUALLY DESTROYS A PERSON'S MEMORY AND ABILITY TO LEARN, REASON, MAKE JUDGMENTS, COMMUNICATE AND CARRY OUT DAILY ACTIVITIES SUCH AS BATHING AND EATING. ALZHEIMER'S IS THE SIXTH LEADING CAUSE OF DEATH IN THE UNITED STATES. - AD IS THE MOST COMMON FORM OF DEMENTIA ACCOUNTING FOR 70% OF ALL CAUSES OF DEMENTIA. - MOST PEOPLE WITH AD ARE DIAGNOSED AT AGE 65 OR OLDER. - WOMEN ARE MORE LIKELY THAN MEN TO HAVE AD. - PEOPLE LIVING WITH DEMENTIA ARE AT GREATER RISK FOR GENERAL DISABILITY AND EXPERIENCE FREQUENT INJURY FROM FALLS. - OLDER ADULTS WITH DEMENTIA ARE 3 TIMES MORE LIKELY TO HAVE PREVENTABLE HOSPITALIZATIONS. FINANCIAL BURDEN: - PAYMENTS FOR AD CARE ARE ESTIMATED AT $200 BILLION IN 2012 WITHIN THE UNITED STATES. PREVALENCE: - THERE ARE MORE THAN 5.2 MILLION PEOPLE IN THE UNITED STATES LIVING WITH AD. AS THE POPULATION AGES THE NUMBER IS EXPECTED TO TRIPLE BY 2050. - IN CALIFORNIA THERE ARE 588,208 PEOPLE 55 YEARS AND OLDER LIVING WITH AD. ONE TENTH OF AD PATIENTS LIVE IN CALIFORNIA. DURING FISCAL YEAR 2013, SCRIPPS ENGAGED IN THE FOLLOWING ALZHEIMER'S 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, ALZHEIMER'S AND PAIN MANAGEMENT. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS) ALZHEIMER'S ASSOCIATION CAREGIVER CONFERENCE IN THIS FREE HALF-DAY CAREGIVER CONFERENCE ATTENDEES HAD AN OPPORTUNITY TO LEARN MORE ABOUT ALZHEIMER'S AND DEMENTIA FROM EXPERTS AND GET QUESTIONS ANSWERED. TOPICS INCLUDED: UNDERSTANDING THE BASICS OF ALZHEIMER'S DISEASE, HOW TO PARTNER WITH YOUR DOCTOR TO GET A DIAGNOSIS, ADDRESSING BEHAVIOR THROUGH COMPASSIONATE COMMUNICATION. OBESITY OBESITY IS A MEDICAL CONDITION IN WHICH EXCESS BODY FAT HAS ACCUMULATED TO THE EXTENT THAT IT MAY HAVE AN ADVERSE EFFECT ON HEALTH. OVERWEIGHT AND OBESITY RANGES ARE DETERMINED USING WEIGHT AND HEIGHT TO CALCULATE A NUMBER KNOWN AS "BODY MASS INDEX" (BMI). AN ADULT WITH A BMI BETWEEN 25 AND 29.9 IS CONSIDERED OVERWEIGHT, WHILE AN ADULT WHO HAS A BMI OF 30 OR HIGHER IS CONSIDERED OBESE. FOR CHILDREN AND ADOLESCENTS AGED 2-19, OVERWEIGHT IS DEFINED AS A BMI AT OR ABOVE THE 85TH PERCENTILE AND LOWER THAN THE 95TH PERCENTILE FOR CHILDREN OF THE SAME AGE AND SEX, WHILE OBESE IS DEFINED AS A BMI AT OR ABOVE THE 95TH PERCENTILE FOR CHILDREN OF THE SAME AGE AND SEX. IN SAN DIEGO COUNTY, ACCORDING TO THE 2009 CALIFORNIA HEALTH INTERVIEW SURVEY, 22.1% OF ADULTS AGED 20 YEARS AND OLDER WERE OBESE (BMI 30.0 OR HIGHER) BASED ON THEIR HEIGHT AND WEIGHT. SOME FACTS ABOUT OBESITY IN THE UNITED STATES: - IN 2009, MORE THAN ONE-THIRD OF U.S. ADULTS (35.7%) WERE OBESE AND 16.9% OF CHILDREN AND ADOLESCENTS WERE CONSIDERED OBESE. - OBESITY-RELATED CONDITIONS INCLUDE HEART DISEASE, STROKE, TYPE 2 DIABETES AND CERTAIN TYPES OF CANCER, WHICH ARE SOME OF THE LEADING CAUSES OF PREVENTABLE DEATH. HEALTH CONSEQUENCES DUE TO OVERWEIGHT AND OBESITY: RESEARCH HAS SHOWN THAT AS WEIGHT INCREASES TO REACH THE LEVELS OF "OVERWEIGHT" AND "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. DULCE MOTHERS PILOT PROGRAM IN FISCAL YEAR 2014, DULCE MOTHERS WAS PILOTED WITH THE GOAL OF DECREASING THE INCIDENCE OF TYPE 2 DIABETES BY MANAGING A MAJOR DIABETES RISK FACTOR - OBESITY - IN UNDERSERVED, ETHNICALLY DIVERSE POPULATIONS. THE PROGRAM CONTINUES TO TEST THE EFFECTIVENESS OF A WEIGHT MANAGEMENT CURRICULUM DESIGNED FOR LATINO WOMEN WITH GESTATIONAL DIABETES. . (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP) AND CHILDHOOD OBESITY INITIATIVE THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (INITIATIVE) IS A PUBLIC-PRIVATE PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS, AND ENVIRONMENTAL CHANGE. THE INITIATIVE IS FACILITATED BY COMMUNITY HEALTH IMPROVEMENT PARTNERS. 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 THIS INITIATIVE HAVE SHOWN A DECREASED CHILDHOOD OBESITY FROM 4% FROM 2005-2010, THE LARGEST DROP IN SOUTHERN CALIFORNIA (MANY AREAS HAVE SEEN INCREASES). NUTRITION IN COOKING CLASSES, A LOCAL INTERVENTION AT TWO ELEMENTARY SCHOOLS (FAMILY MEDICINE AND COMMUNITY BENEFITS COLLABORATION) STUDENTS OF SOUTHWEST HIGH SCHOOL AND THEIR PARENTS ARE TAUGHT PRACTICAL SKILLS TO PLAN AND PREPARE HEALTHY, COST-EFFECTIVE, CULTURALLY-RELEVANT MEALS IN A WEEKLY THREE SESSION HEALTHY EATING AND COOKING CLASS. THE PURPOSE OF THE STUDY IS TO UNDERSTAND IF THIS INFORMATION TRANSLATES INTO BEHAVIOR CHANGE FOR STUDENTS AND THEIR PARENTS. PARTICIPANTS IN THE PROJECT LEARN FROM MEDICAL RESIDENTS ABOUT THE CONNECTION BETWEEN HEALTHY EATING AND THE PREVENTION OR MANAGEMENT OF CHRONIC DISEASES, SUCH AS HYPERTENSION AND DIABETES MELLITUS. THE SCRIPPS FAMILY MEDICINE RESIDENCY PROGRAM PROVIDES 1,300 PATIENT VISITS PER YEAR AT THE SCHOOL-BASED CLINIC LOCATED AT SOUTHWEST HIGH SCHOOL. LEVELS OF CHILDHOOD OBESITY AND DIABETES MELLITUS ARE DISPROPORTIONATELY HIGH IN THIS COMMUNITY. LOCAL SCHOOL DATA INDICATES ENROLLMENT AT SOUTHWEST OF 2,100 STUDENTS WITH 88% LATINO AND 6% FILIPINO. OUR STUDENTS HAVE BEEN DOCUMENTED THROUGH SCHOOL TESTING TO HAVE 32-34% RATES OF UNHEALTHY BODY COMPOSITIONS FOR THEIR AGE (HIGH BMI). THEIR FITNESS SCORES INDICATE THAT LESS THAN HALF CAN COMPLETE ALL 6 OF THE FITNESS GOALS SET FOR THEIR AGE, ALTHOUGH THE SCORES DO IMPROVE AS THEY PROGRESS FROM 5TH (28%) TO 9TH GRADE (48%). 66.5% OF STUDENTS ARE ENROLLED IN THE FREE/REDUCED LUNCH PROGRAM. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS) 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 PREVENTIVE CARE, AND FETAL, PERINATAL AND OTHER INFANT DEATHS. 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 AND OLDER. BEING PREGNANT, OR TRYING TO BECOME PREGNANT, IS ONLY A SMALL PORTION OF A WOMAN'S LIFE. UNINTENDED PREGNANCY, EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION, ACCOUNTS FOR AN ESTIMATED 49 PERCENT OF PREGNANCIES IN THE U.S. THESE PREGNANCIES ARE ASSOCIATED WITH INCREASED MORBIDITY, AS WELL AS BEHAVIORS LINKED TO ADVERSE HEALTH. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THEIR CHILDREN EXPERIENCE IMPROVED HEALTH, FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND LOWER ABORTION RATES. HIGH RISK PREGNANCY HIGH RISK PREGNANCY CAN BE THE RESULT OF A MEDICAL CONDITION PRESENT BEFORE PREGNANCY OR A MEDICAL CONDITION THAT DEVELOPS DURING PREGNANCY FOR EITHER MOM OR BABY AND CAUSES THE PREGNANCY TO BECOME HIGH RISK. A HIGH RISK PREGNANCY CAN POSE PROBLEMS BEFORE, DURING OR AFTER DELIVERY AND MIGHT REQUIRE SPECIAL MONITORING THROUGHOUT THE PREGNANCY.
FORM 990, PART III, LINE 4A (CONTINUED)	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 UNITED STATES GENERAL STATISTICS: - THE NUMBER OF BIRTHS DECLINED BY 3% FROM 2009 TO 2010 - GENERAL FERTILITY RATE ALSO DECLINED BY 3% - TEENAGE BIRTH RATE FELL 10% FROM 2009 TO 2010 - THE BIRTH RATE OF WOMEN AGED 40-44 YEARS CONTINUED TO RISE - CESAREAN DELIVERY RATE WAS DOWN FOR THE FIRST YEAR SINCE 1996, TO 32.8% - IN SAN DIEGO COUNTY, THE INFANT MORTALITY RATE WAS 4.4 DEATHS PER 1,000 LIVE BIRTHS IN 2009 SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION FOR LOW-INCOME WOMEN IN SAN DIEGO COUNTY IN FISCAL YEAR 2014. THE FOLLOWING ARE SOME EXAMPLES. SCRIPPS MEMORIAL HOSPITAL LA JOLLA COMMUNITY BENEFIT SERVICES: - OFFERED MORE THAN 1,000 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY TO ENHANCE PARENTING SKILLS. LOW-INCOME WOMEN IN SAN DIEGO WHO WERE ELIGIBLE ATTEND 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 90 PERCENT - PROVIDED AND SUPPORTED WEEKLY BREASTFEEDING SUPPORT GROUPS AT FIVE LOCATIONS THROUGHOUT SAN DIEGO COUNTY, INCLUDING TWO WITH BILINGUAL SERVICES - OFFERED A MATERNAL CHILD HEALTH EDUCATION SERIES IN NORTH COUNTY COVERING DOGS AND BABIES, SAFETY, GRAND PARENTING AND BABY SITTER SAFETY - OFFERED MATERNAL CHILD HEALTH CLASSES AT THE MENDE WELL BEING CENTER, SUCH AS BASIC TRAINING FOR DADS, GETTING READY FOR THE BABY, INFANT CPR AND SAFETY, PARENT CONNECTION PROGRAMS AND REDIRECTING CHILDREN'S BEHAVIOR - OFFERED THE DOGS AND BABIES PROGRAMS QUARTERLY, WITH MORE THAN 40 ATTENDEES - OFFERED WEEKLY MOMMY AND ME YOGA PROGRAMS FOR NEW PARENTS - OFFERED A PRENATAL YOGA PROGRAM FOR EXPECTANT WOMEN IN SAN DIEGO COUNTY - OFFERED A PREGNANCY NUTRITION PROGRAM QUARTERLY AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA - OFFERED CLASSES IN PELVIC FLOOR AND PREGNANCY CHANGES FOR EXPECTANT FAMILIES AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA, COMMUNITY BENEFITS) FIRST 5 AND PROMISE NEIGHBORHOODS MORE THAN 484 SERVICES WERE RECEIVED FOR FIRST TIME MOTHERS INCLUDING: HOME VISITS, REFERRALS RECEIVED, DATA ENTRY, FOLLOW UP PHONE CALLS, PARENTING CLASSES AND OTHER SUPPORT SERVICES. A TOTAL OF 325 PARENTS PARTICIPATED IN PARENTING CLASSES; 332 SESSIONS PROVIDED. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFITS) SCRIPPS MERCY'S SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTERS THE STATE-FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN CENTRAL SAN DIEGO AREA. WIC TARGETS LOW-INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO 5). SCRIPPS MERCY WIC SERVES APPROXIMATELY 7,500 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 PERCENT), INFANTS (20 PERCENT) AND CHILDREN (56 PERCENT). IN FISCAL YEAR 2014, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 89,193 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. NUTRITION STAFF EDUCATE WOMEN ABOUT THE IMPORTANCE OF BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE-ON-ONE AND GROUP), AS WELL AS SUPPLIES - PUMPS AND BREAST PADS - DURING THE POSTPARTUM PERIOD. (SPONSORED BY SCRIPPS MERCY HOSPITAL, SAN DIEGO) SCRIPPS FAMILY MEDICINE PROGRAM AT SCRIPPS MERCY HOSPITAL, CHULA VISTA RAISING HEALTHY FAMILIES AND CARING FOR THE NEXT GENERATION OF SAN DIEGANS - BEFORE THEY'RE EVEN 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 LATINO WOMEN IN ORDER TO IMPROVE BIRTH OUTCOMES. WITH FUNDING FROM THE MARCH OF DIMES, THE PROGRAM APPLIES THE PRINCIPLES OF THE CENTERING HEALTHCARE INSTITUTE AND FOCUSES ON CHANGING THE WAY PATIENTS EXPERIENCE THEIR CARE THROUGH ASSESSMENT, EDUCATION AND GROUP SUPPORT. CENTERING PREGNANCY IS THE INSTITUTE'S MODEL DEVOTED SPECIFICALLY TO IMPROVING MATERNAL AND CHILD HEALTH, AND HAS BEEN SHOWN TO RESULT IN INCREASED PRENATAL VISITS, GREATER LEVELS OF BREAST FEEDING AND STRONGER RELATIONSHIPS BETWEEN MOTHERS AND THEIR HEALTH CARE 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 HEALTH CARE KNOWLEDGE. AS THE PROGRAM CONTINUES, PATIENT NAVIGATORS WILL FOLLOW-UP WITH PARTICIPANTS TO GAUGE OTHER IMPORTANT FACTORS AND HELP THEM MAINTAIN HEALTHY LIFESTYLES. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA COMMUNITY BENEFITS) UNINTENTIONAL INJURY AND VIOLENCE IN CALIFORNIA, INJURIES ARE THE NUMBER ONE KILLER AND DISABLER OF PEOPLE AGED 1 TO 44 (CDPH, 2010). 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 DEATH DATA ALONE. IN SAN DIEGO COUNTY DURING 2009, THERE WERE MORE THAN 949 DEATHS, MORE THAN 21,149 HOSPITALIZATIONS, AND NEARLY 150,000 EMERGENCY DEPARTMENT VISITS FOR UNINTENTIONAL INJURIES. THE NUMBER OF UNINTENTIONAL INJURIES TREATED IN PHYSICIANS' OFFICES AND CLINICS, WHILE UNKNOWN, IS LIKELY MUCH HIGHER THAN THE NUMBER OF EMERGENCY DEPARTMENT VISITS. UNINTENTIONAL INJURIES ARE ONE OF THE LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY FOR RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. FALLS WERE THE MOST COMMON CAUSE OF UNINTENTIONAL INJURY IN 2009, FOLLOWED BY MOTOR-VEHICLE INJURIES. THE FOLLOWING ARE A NUMBER OF SCRIPPS HEALTH PROGRAMS THAT ADDRESSED UNINTENTIONAL INJURIES AND VIOLENCE FOR FISCAL YEAR 2014. AARP DRIVER SAFETY PROGRAM A FOUR-HOUR SUPERVISED TRAUMA VISITATION PROGRAM FOR YOUNG DRIVERS AGES 14 AND UP TO SHOW THEM THE REALISTIC CONSEQUENCES OF DRIVING UNDER THE INFLUENCE. PARTICIPANTS VISIT THE TRAUMA ROOM, ER, ICU, CAT SCAN AND OTHER HOSPITAL AREAS. (SPONSORED BY SCRIPPS MERCY HOSPITAL) EVERY 15 MINUTES ALCOHOL CAN BE ATTRIBUTED TO MORE THAN 100,000 DEATHS IN THE U.S. ANNUALLY, INCLUDING 41% OF ALL TRAFFIC FATALITIES. 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 (SPONSORED BY SCRIPPS MERCY HOSPITAL) HEALTH AND WELLNESS, SCRIPPS HOME HEALTH SERVICES THIS PROGRAM EDUCATES SENIORS ABOUT FALL PREVENTION (THE PRIMARY CAUSE OF FRACTURES) AND FIRE SAFETY. HOME HEALTH NURSES ALSO TEACH SENIORS AND THEIR FAMILIES ABOUT CONTINUUM-OF-CARE OPTIONS. SPORTS CONCUSSION PROGRAM, REHABILITATION CENTER AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS THERE ARE NEARLY 300,000 SPORTS-RELATED CONCUSSIONS IN THE U.S EACH YEAR - 1,000 IN FOOTBALL ALONE - AND APPROXIMATELY 130,000 HIGH SCHOOL ATHLETES SUFFER A CONCUSSION. A RECENT REPORT SHOWED THAT CLOSE TO 40 PERCENT OF HIGH SCHOOL ATHLETES WHO SUSTAIN A CONCUSSION RETURN TO PLAY TOO SOON. THE REHABILITATION CENTER AT SCRIPPS ENCINITAS HAS DEVELOPED A PUBLIC EDUCATION AND COMMUNITY OUTREACH PROGRAM TO RAISE AWARENESS ABOUT CONCUSSION SIGNS AND SYMPTOMS, AS WELL AS HOW TO AVOID, TREAT AND UNDERSTAND THEIR CONSEQUENCES. APPROXIMATELY 70 STUDENTS HAVE BEEN SERVED BY THIS PROGRAM. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL ENCINITAS)
FORM 990, PART III, LINE 4A (CONTINUED)	SAN DIEGO FALL PREVENTION TASK FORCE THIS COUNTY HHSA-AGING AND INDEPENDENCE SERVICE-SUPPORTED TASK FORCE SEEKS TO REDUCE FALLS AND THEIR DEVASTATING CONSEQUENCES. THE TASK FORCE INCREASES CONNECTIONS BETWEEN PHYSICIANS AND OTHER COMMUNITY FALL PREVENTION SERVICES, AS WELL AS INCREASING AWARENESS AMONG OLDER ADULTS. SCRIPPS MERCY HOSPITAL TRAUMA CENTER PARTICIPATES IN THIS TASK FORCE. WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS THE NUMBERS SPEAK FOR THEMSELVES - 63 PERCENT OF AMERICAN ADULTS ARE EITHER OVERWEIGHT OR OBESE. NATIONALLY, THE PREVALENCE OF OBESE ADULTS (THOSE WITH A BODY MASS INDEX (BMI) OF 30 OR MORE) HAS INCREASED BY 68 PERCENT SINCE 1995, FROM 16 PERCENT TO ALMOST 27 PERCENT. DURING THIS SAME PERIOD, THE PREVALENCE OF OVERWEIGHT ADULTS (BMI BETWEEN 25.0 AND 29.99) HAS INCREASED BY ONLY TWO PERCENT, FROM 35.5 PERCENT TO 36.2 PERCENT. SAN DIEGO COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR 2009 INDICATES THAT ALMOST 59 PERCENT OF ADULTS ARE CONSIDERED EITHER OVERWEIGHT OR OBESE. SINCE 2005, THE FIRST YEAR BRFSS DATA WAS REPORTED FOR SAN DIEGO COUNTY, THE PREVALENCE OF OBESE ADULTS HAS RANGED FROM 20 PERCENT IN 2005 TO 26.7 PERCENT IN 2006, WITH THE MOST CURRENT MEASURE AT 21.6 PERCENT. SINCE 2006, THE PREVALENCE OF OVERWEIGHT ADULTS IN SAN DIEGO COUNTY HAS INCREASED SLIGHTLY FROM 36.5 PERCENT TO 37.7 PERCENT. AT THE NATIONAL, STATE AND COUNTY LEVELS, OBESITY PREVALENCE RATES AMONG LATINOS AND AFRICAN-AMERICANS ARE SIGNIFICANTLY HIGHER THAN THOSE FOR WHITES. OBESITY RATES BY GENDER ALSO VARIED SIGNIFICANTLY IN THE 2007 CHIS, THE MOST RECENT COUNTY DATA BY GENDER, WITH 25.4 PERCENT OF MALES AND 18.1 PERCENT OF FEMALES HAVING A BMI 30 OR HIGHER. MALES WERE SIGNIFICANTLY MORE LIKELY TO BE OVERWEIGHT THAN FEMALES, 40.5 PERCENT AND 25.8 PERCENT, RESPECTIVELY. CAUSES MANY FACTORS PLAY A ROLE IN OBESITY, MAKING IT A COMPLEX HEALTH ISSUE TO ADDRESS. FACTORS INCLUDE (DH&HS, 2010): - GENETIC PREDISPOSITION - BEHAVIOR (DIETARY PATTERNS AND PHYSICAL ACTIVITY) - ENVIRONMENTAL INFLUENCES - CULTURAL INFLUENCES - SOCIOECONOMIC STATUS TO IMPLEMENT PREVENTION STRATEGIES, IT IS IMPORTANT TO UNDERSTAND THE EFFECT EACH OF THESE FACTORS HAS ON OBESITY AND WHICH CAN BE CHANGED. THE FOLLOWING ARE SOME EXAMPLES OF SCRIPPS PROGRAMS THAT ADDRESS THESE HEALTH ISSUES. NUTRITION SERVICES AND PHYSICAL ACTIVITY ACCORDING TO THE 2009 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR SAN DIEGO COUNTY, MORE THAN 59 PERCENT OF ADULTS ARE OVERWEIGHT OR OBESE. OBESITY INCREASES THE RISK FOR HEART DISEASE, TYPE 2 DIABETES, HIGH BLOOD PRESSURE, STROKE AND SOME FORMS OF CANCER. THE NATION'S LOW-INCOME, MINORITY POPULATIONS ARE AT EVEN GREATER RISK. IN AN EFFORT TO ADDRESS THIS CRITICAL HEALTH CONCERN, STAFF MEMBERS AT THE CITY HEIGHTS WELLNESS CENTER HAVE ESTABLISHED A VARIETY OF NUTRITION EDUCATION PROGRAMS TO MEET THE NEEDS OF LOW-INCOME, MINORITY POPULATIONS. THE CENTER USES A COMBINATION OF APPROACHES TO ADDRESS A BROAD ARRAY OF COMMUNITY HEALTH PRIORITIES, INCLUDING NUTRITION, ACCESS TO SERVICES AND COMMUNITY ENGAGEMENT. THE GOAL IS TO PREVENT DISEASE BY STRENGTHENING COMMUNITY PARTNERSHIPS AND LINK EXISTING SERVICES TO PROVIDE CITY HEIGHTS' RESIDENTS WITH OPPORTUNITIES TO BECOME MORE INVOLVED IN MANAGING THEIR OWN HEALTH. THE "HUB" OF THE WELLNESS CENTER IS THEIR TEACHING KITCHEN - A HANDS-ON INTERACTIVE SETTING FOR COOKING DEMONSTRATIONS, WEIGHT MANAGEMENT, MEAL PREPARATION, NUTRITION EDUCATION AND COUNSELING. THE CENTER, WHICH SERVES MORE THAN 18,000 CULTURALLY DIVERSE FAMILIES A YEAR, IS BASED ON THE BELIEF THAT KEEPING PEOPLE HEALTHIER IS ONE OF THE MOST EFFECTIVE WAYS TO REDUCE HEALTH CARE COSTS. THE CENTER STRIVES TO BE THE HUB OF HEALTH EDUCATION ADDRESSING NUTRITION, HEALTHY LIFESTYLE BEHAVIORS AND CHILDHOOD INJURY PREVENTION THROUGH A VARIETY OF HEALTH AND WELLNESS PROGRAMS. THE CENTER HAS EARNED A REPUTATION FOR BEING (1) A SAFE PLACE TO COME AND SEEK HELP FOR A VARIETY OF HEALTH AND SOCIAL NEEDS; (2) A RESOURCE FOR OBTAINING EASY ACCESS TO INFORMATION ABOUT HEALTH AND COMMUNITY RESOURCES; (3) A FLEXIBLE MEETING PLACE THAT HAS THE CAPACITY TO BRING PEOPLE TOGETHER AROUND COMMUNITY HEALTH ISSUES, ESPECIALLY FOOD AND NUTRITION. (SPONSORED BY SCRIPPS MERCY HOSPITAL, SAN DIEGO COMMUNITY BENEFIT SERVICES) LET'S GET COOKING IN JANUARY 2014, THE CITY HEIGHTS WELLNESS CENTER LAUNCHED "LET'S GET COOKING", A HANDS-ON COOKING CLASS FOR MOMS, DADS, CAREGIVERS AND THEIR KIDS (AGES EIGHT AND OLDER) WHO WANT TO LEARN SIMPLE, HEALTHY RECIPES FOR THE WHOLE FAMILY. "LET'S GET COOKING" AIMS TO INSPIRE FAMILIES TO EAT FRESH, NUTRITIOUS, WHOLE FOODS AND TO MAKE HEALTHY LIFESTYLE CHOICES THROUGH COOKING, EDUCATION AND DISCUSSIONS. THE CLASSES ARE TAUGHT IN BOTH ENGLISH AND SPANISH BY BILINGUAL REGISTERED DIETITIANS. IN THE MID-CITY REGION OF SAN DIEGO, THERE ARE CURRENTLY NO OTHER HANDS-ON COOKING/NUTRITION EDUCATION/OBESITY PROGRAMS AVAILABLE. WHAT SETS THIS PROGRAM APART IS BEING ABLE TO OFFER THE HANDS-ON COOKING EXPERIENCE IN A CERTIFIED TEACHING KITCHEN. THERE ARE CURRENTLY NUTRITION EDUCATION PROGRAMS OFFERED IN THE COMMUNITY. HOWEVER, NONE OF THEM IS OFFERING NUTRITION EDUCATION THROUGH COOKING. THE TEACHING KITCHEN PROVIDES NOT ONLY A HANDS-ON LEARNING EXPERIENCE, BUT MORE IMPORTANTLY A PLACE FOR FAMILY INTERACTION AND BUILDING A SENSE OF COMMUNITY. LIVE HEALTHY FAMILY NUTRITION PROGRAM USING THE COOPERATIVE EXTENSION'S RESEARCH-BASED CURRICULUMS AND BILINGUAL STAFF, A REGISTERED DIETITIAN IMPLEMENTED WEEKLY NUTRITION EDUCATION CLASSES IN SPANISH. THE PROGRAM TARGETS LOW-INCOME PEOPLE WHO USE FOOD STAMPS AND OFFERS A SERIES OF EIGHT WEEKLY CLASSES. THE PROGRAM INCREASES RESIDENTS' KNOWLEDGE, SKILLS AND MOTIVATION TO HELP THEM PRACTICE HEALTHY EATING AND RELATED BEHAVIORS. CLASSES FOCUS ON NUTRITION, PHYSICAL FITNESS, FOOD SAFETY, MEAL PLANNING AND FOOD SHOPPING. (SPONSORED BY SCRIPPS MERCY HOSPITAL, COMMUNITY BENEFIT SERVICES) COLLABORATE FOR HEALTHY WEIGHT THIS ADVISORY GROUP MEETS MONTHLY. DRS. SERPAS AND BRANDSTEIN ARE THE LEADERS OF THIS COLLABORATION. COLLABORATE FOR HEALTHY WEIGHT IS A PROGRAM OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THE NATIONAL INITIATIVE FOR CHILDREN'S 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 SECTORS 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. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA, COMMUNITY BENEFIT SERVICES) CHULA VISTA PROMISE NEIGHBORHOOD (CVPN) SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER AND SCRIPPS FAMILY MEDICINE RESIDENCY ARE PARTNERS IN THE CHULA VISTA PROMISE NEIGHBORHOOD (CVPN) EFFORTS FUNDED BY THE DEPARTMENT OF EDUCATION. CVPN BRINGS TOGETHER A COLLABORATION OF PARTNERS FOCUSED ON FAMILY, EDUCATION, HEALTH AND COMMUNITY TO PROVIDE CHILDREN AND FAMILIES IN THE CASTLE PARK NEIGHBORHOOD WITH OPPORTUNITIES THEY NEED TO EXCEL IN SCHOOL, GET INTO COLLEGE, FIND GOOD JOBS AND LEAD HEALTHY LIVES. TOGETHER, THE SCRIPPS FAMILY MEDICINE RESIDENCY AND THE SCRIPPS MERCY HOSPITAL CHULA VISTA WELL BEING CENTER ARE IMPLEMENTING HEALTH AND WELLNESS ACTIVITIES AT CASTLE PARK ELEMENTARY FOR THE STUDENTS AND THEIR PARENTS FOCUSING ON THE 5210 MESSAGE IN AN EFFORT TO PROMOTE HEALTHY LIVING IN THE CASTLE PARK AREA. THE 5210 MESSAGE EMPHASIZES TEACHING FAMILIES ON EATING MORE FRUITS AND VEGETABLES, LIMITING SCREEN TIME, INCORPORATING ONE HOUR OF PHYSICAL ACTIVITY A DAY AND PROMOTING ZERO SUGARY DRINKS. MENTAL HEALTH AND ILLNESS MENTAL HEALTH IS DEFINED AS "A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE". MENTAL ILLNESS IS DEFINED AS "COLLECTIVELY ALL DIAGNOSABLE MENTAL DISORDERS" OR "HEALTH CONDITIONS THAT ARE CHARACTERIZED BY ALTERATIONS IN THINKING, MOOD, OR BEHAVIOR (OR SOME COMBINATION THEREOF) ASSOCIATED WITH DISTRESS AND/OR IMPAIRED FUNCTIONING". DEPRESSION: - DEPRESSION IS THE MOST COMMON TYPE OF MENTAL ILLNESS, AFFECTING MORE THAN 26% OF THE U.S. ADULT POPULATION. - IT HAS BEEN ESTIMATED THAT BY THE YEAR 2020, DEPRESSION WILL BE THE SECOND LEADING CAUSE OF DISABILITY THROUGHOUT THE WORLD, TRAILING ONLY ISCHEMIC HEART DISEASE. DISPARITIES: - MALES COMMIT SUICIDE FOUR TIMES MORE THAN FEMALES. - YOUNGER AMERICAN ADULTS, AGED 18-24 YEARS, SUFFERED THE MOST MENTAL HEALTH DISTRESS. - ADULTS WITH THE LOWEST INCOME OR EDUCATION REPORT MORE UNHEALTHY DAYS THAN THOSE WITH HIGHER INCOME OR EDUCATION. - MENTAL ILLNESS IS ASSOCIATED WITH CHRONIC DISEASES SUCH AS CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY.
FORM 990, PART III, LINE 4A (CONTINUED)	PREVALENCE: - ABOUT 25% OF U.S. ADULTS HAVE A MENTAL ILLNESS5 (BRFSS, 2004). - NEARLY 50% OF U.S. ADULTS WILL DEVELOP AT LEAST ONE MENTAL ILLNESS DURING THEIR LIFETIME. 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. IN 2010, 372 SAN DIEGANS DIED BY SUICIDE, A RATE OF 11.5 PER 100,000. THIS WAS HIGHER THAN CALIFORNIA OVERALL (9.9 PER 100,000) AND SLIGHTLY LOWER THAN THE NATIONAL RATE (11.9 PER 100,000). SUICIDE DEATHS ARE ONLY PART OF THE PROBLEM; MORE PEOPLE SURVIVE SUICIDE ATTEMPTS THAN DIE. THOSE WHO ATTEMPT SUICIDE ARE OFTEN SERIOUSLY INJURED AND REQUIRE MEDICAL AND PSYCHIATRIC CARE. BETWEEN 2000 AND 2008, 2,896 SAN DIEGANS DIED FROM SUICIDE. ON AVERAGE, ONE SUICIDE AFFECTS THE LIVES OF AT LEAST SIX PEOPLE, CAUSING CONSIDERABLE GRIEF, SOCIAL STIGMA AND, IN SOME CASES, ELEVATED RISK OF ADDITIONAL SUICIDES. IN 2010, THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA) LAUNCHED A SUICIDE PREVENTION PLANNING PROCESS, WHICH WAS INFORMED 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. SCRIPPS OFFERS BOTH INPATIENT AND OUTPATIENT ADULT BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, SAN DIEGO. 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 2014 THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM LOST $4.2 MILLION. - IN 2014, 6.9 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. SCRIPPS HEALTH BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS MERCY PROVIDES COMMUNITY-BASED ADULT PSYCHIATRIC TREATMENT AT SCRIPPS MERCY HOSPITAL, SAN DIEGO. THE INTENSIVE DAY PROGRAM HELPS PARTICIPANTS REDUCE THEIR SYMPTOMS WHILE THEY CONTINUE TO LIVE IN THE COMMUNITY. THE PROGRAM PROVIDES TWO LEVELS OF CARE: - THE OUTPATIENT PROGRAM OFFERS PATIENTS ONE TO FOUR TREATMENT DAYS PER WEEK. - THE PARTIAL HOSPITALIZATION PROGRAM PROVIDES MORE INTENSIVE TREATMENT FIVE TO SIX DAYS PER WEEK. MENTAL HEALTH OUTREACH SERVICES, A-VISION SERVICE PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, IN PARTNERSHIPS WITH THE SAN DIEGO MENTAL HEALTH ASSOCIATION, ESTABLISHED THE A-VISION VOCATIONAL TRAINING PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS) TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS. THE 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-VISION PROGRAM. TO DATE 90 CLIENTS HAVE BEEN ENROLLED IN THE PROGRAM AND 43 EMPLOYED AT SCRIPPS. CURRENTLY, 25 PEOPLE ARE VOLUNTEERING AND 23 PEOPLE ARE PARTICIPATING IN SUPPORTIVE EMPLOYMENT. THE TOTAL EXPENSE FOR THE A-VISION PROGRAM FOR FISCAL YEAR 2014 WAS $132,130. INCREASING AWARENESS OF MENTAL HEALTH AND GERIATRIC PSYCHIATRIC ISSUES IN FISCAL YEAR 2014, SCRIPPS BEHAVIORAL HEALTH SERVICES IMPROVES AWARENESS OF MENTAL HEALTH AND GERIATRIC ISSUES BY PROVIDING INFORMATION AND SUPPORTIVE SERVICES FOR MORE THAN 1,000 PEOPLE AT COMMUNITY EVENTS. DEPRESSION SCREENINGS IN OCTOBER 2014, SCRIPPS AGAIN PARTICIPATED IN NATIONAL DEPRESSION SCREENING DAY, AN ANNUAL EVENT AIMED AT HELPING PEOPLE IDENTIFY THE SIGNS OF DEPRESSION AND PROVIDING RESOURCES TO ASSIST THOSE AT RISK. IN THE PAST TWO YEARS, SCRIPPS HAS EXPANDED THE AVAILABILITY OF FREE DEPRESSION SCREENINGS BY MAILING THEM AVAILABLE AT ALL FIVE OF OUR FOUR HOSPITAL CAMPUSES. THE SCREENINGS ARE OPEN TO ADULTS OF ALL AGES ON A WALK-IN-BASIS AND INCLUDE REFERRALS TO MENTAL HEALTH PROFESSIONALS, AS WELL AS LITERATURE THAT CAN BE SHARED WITH FRIENDS AND FAMILY MEMBERS. IN 2014, SCRIPPS STAFF CARED FOR MORE THAN 151 PEOPLE AND CONDUCTED 99 DEPRESSION SCREENING SERVICES AND INFORMATION IN BOTH ENGLISH AND SPANISH. COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP) AND SUICIDE PREVENTION COUNCIL SCRIPPS IS A STRONG PARTNER OF CHIP. CHIP TRAINED APPROXIMATELY 8,000 COMMUNITY MEMBERS IN SUICIDE PREVENTION TO HELP ADDRESS RISING RATES OF SUICIDE IN THE COUNTY. MENTAL HEALTH SUPPORT SERVICES AT LOCAL SCHOOL-BASED CLINICS SCRIPPS FAMILY MEDICINE RESIDENCY AND THE 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 FACULTY TO ENGAGE HIGH SCHOOL STUDENTS IN COUNSELING AND REFERRALS TO PSYCHIATRISTS AND OTHER 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. MORE THAN 1,400 YOUTH HAVE BEEN PROVIDED CLINICAL SERVICES IN THESE CLINICS. ACUTE RESPIRATORY INFECTIONS/PNEUMONIA RESPIRATORY DISEASES, SUCH AS ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), ARE A SIGNIFICANT PUBLIC HEALTH BURDEN IN THE UNITED STATES. ASTHMA AND COPD ARE AMONG THE 10 LEADING CHRONIC CONDITIONS THAT RESTRICT ACTIVITY. AFTER CHRONIC SINUSITIS, ASTHMA IS THE MOST COMMON CHRONIC ILLNESS IN CHILDREN. DEATH RATES FROM COPD HAVE DECLINED FROM 2000 TO 2009 AT THE NATIONAL, STATE, AND LOCAL LEVELS. INFLUENZA, ALSO KNOWN AS THE "FLU", IS A CONTAGIOUS RESPIRATORY ILLNESS CAUSED BY INFLUENZA VIRUSES THAT INFECT THE NOSE, THROAT, AND LUNGS. IT CAN CAUSE MILD TO SEVERE ILLNESS, AND AT TIMES CAN LEAD TO DEATH. COMPLICATIONS OF FLU CAN INCLUDE BACTERIAL PNEUMONIA (PARTICULARLY FOR OLDER AND IMMUNOCOMPROMISED INDIVIDUALS), EAR INFECTIONS, SINUS INFECTIONS, DEHYDRATION, AND WORSENING OF CHRONIC MEDICAL CONDITIONS, SUCH AS CONGESTIVE HEART FAILURE, ASTHMA, OR DIABETES. CLINICAL SYMPTOMS INCLUDE FEVER, COUGH, SORE THROAT, CHILLS, MUSCLE AND BODY ACHES, RUNNY OR STUFFY NOSE, AND CONGESTION. SOME FACTS ABOUT ACUTE RESPIRATORY INFECTIONS AND PNEUMONIA: - ACUTE RESPIRATORY INFECTIONS, INCLUDING PNEUMONIA AND INFLUENZA, ARE THE 8TH LEADING CAUSE OF DEATH IN THE UNITED STATES, ACCOUNTING FOR 56,000 DEATHS ANNUALLY. - ON AVERAGE, INFLUENZA LEADS TO MORE THAN 200,000 HOSPITALIZATIONS AND 36,000 DEATHS EACH YEAR. - THE 2009 H1N1 INFLUENZA PANDEMIC CAUSED AN ESTIMATED 270,000 HOSPITALIZATIONS AND 12,270 DEATHS (1,270 OF WHICH WERE OF PEOPLE YOUNGER THAN AGE 18) BETWEEN APRIL 2009 AND MARCH 2010. THE POPULATIONS AT HIGHER RISK FOR COMPLICATIONS DUE TO ACUTE RESPIRATORY INFECTIONS AND PNEUMONIA: - CHILDREN YOUNGER THAN 5, BUT ESPECIALLY CHILDREN YOUNGER THAN 2 YEARS OLD. - ADULTS 65 YEARS OF AGE AND OLDER. - PREGNANT WOMEN. - ALSO, AMERICAN INDIANS AND ALASKAN NATIVES SEEM TO BE AT HIGHER RISK OF FLU COMPLICATIONS. FLU/PNEUMONIA-ASSOCIATED COSTS: PNEUMONIA AND THE FLU COST $6 BILLION IN DIRECT MEDICAL CARE AND ANOTHER $34.2 BILLION IN PROJECTED LOST EARNINGS IN 2007, ACCORDING TO THE AMERICAN LUNG ASSOCIATION. THIS REPRESENTED AN INCREASE OF NEARLY 50 PERCENT FROM 2003, THE PREVIOUSLY REPORTED YEAR. HEALTH DISPARITIES IN INFLUENZA: HISPANIC CHILDREN YOUNGER THAN 18 YEARS OF AGE ACCOUNT FOR 27% OF 210 REPORTED 2009 H1N1 INFLUENZA- ASSOCIATED DEATHS IN THE UNITED STATES. THEIR REPRESENTATION IN THE US POPULATION IS 21%. ASTHMA ASTHMA IS A CHRONIC BREATHING CONDITION DUE TO INFLAMMATION OF THE AIR PASSAGES IN THE LUNGS. ASTHMA AFFECTS THE SENSITIVITY OF THE NERVE ENDINGS IN THE AIRWAYS CAUSING THEM TO BECOME EASILY IRRITATED. DURING AN ASTHMA ATTACK, THE LINING OF THESE PASSAGES SWELL CAUSING THE AIRWAYS TO NARROW THEREBY REDUCING THE FLOW OF AIR IN AND OUT OF THE LUNGS. ASTHMA ATTACKS CAN RANGE IN SEVERITY FROM MILD TO LIFE-THREATENING. CLINICAL SYMPTOMS INCLUDE COUGHING, SHORTNESS OF BREATH, WHEEZING, AND TIGHTNESS OR PAIN IN THE CHEST. IN 2009, 12.3% OF SAN DIEGO COUNTY RESIDENTS REPORTED EVER BEING DIAGNOSED WITH ASTHMA. THE COUNTY AGE-ADJUSTED ASTHMA RATES DECREASED SLIGHTLY BETWEEN 2001 AND 2004, BEFORE INCREASING AGAIN IN 2005. IT THEN DECREASED AGAIN IN 2006 AND HIT A NEW LOW IN 20
FORM 990, PART III, LINE 4A (CONTINUED)	TRIGGERS OF ASTHMA ATTACKS INCLUDE: - ALLERGENS (LIKE POLLEN, MOLD, ANIMAL DANDER, AND DUST MITES) - EXERCISE - OCCUPATIONAL HAZARDS - TOBACCO SMOKE - AIR POLLUTION - AIRWAY INFECTIONS SOME RISK FACTORS FOR DEVELOPING ASTHMA INCLUDE: - DEMOGRAPHIC VARIABLES SUCH AS GENDER, AGE, RACE/ETHNICITY - EDUCATIONAL LEVEL - INCOME LEVEL - SMOKING - OBESITY ASTHMA-ASSOCIATED COSTS: IN 2009, IT WAS ESTIMATED THAT ASTHMA RELATED COSTS EXCEEDED $56 BILLION DOLLARS PER YEAR. THE AVERAGE YEARLY COST OF CARE FOR A CHILD WITH ASTHMA WAS $1,039 IN 2009. ASTHMA PREVALENCE: U.S. AGE-ADJUSTED PREVALENCE RATES FOR CURRENT DIAGNOSED ASTHMA FOR THE YEAR OF 2010 WERE 8.6%, AS COMPARED TO A RATE OF 7.3% IN 2001. THE STATE OF CALIFORNIA REPORTED A RATE OF 7.7% FOR ADULTS AND 5.9% FOR CHILDREN FOR THE YEAR OF 2010. DURING FISCAL YEAR 2014, SCRIPPS ENGAGED IN THE FOLLOWING RESPIRATORY DISEASE PREVENTION AND TREATMENT ACTIVITIES. HOSPITALIZED PATIENTS SMOKING CESSATION STUDY A TOTAL OF 33 PARTICIPANTS INCLUDED IN THE STAY QUIT STUDY, A PARTNERSHIP WITH THE CALIFORNIA SMOKERS HELPLINE. A TOTAL OF 821 PEOPLE HAVE BEEN SCREENED FOR THE STUDY. THE SMOKING CESSATION PILOT AND EXPANDED STUDY ARE RESPIRATORY DISEASE PREVENTION PROGRAMS AND RESPIRATORY THERAPISTS ARE CENTRAL TO THE PILOT, AS WELL AS TO THE LARGER NIH STUDY. MANY OF THE HOSPITALIZED SMOKERS ARE ADMITTED FOR PULMONARY AND RESPIRATORY DISEASES LINKED TO SMOKING. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA) 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. THE SCRIPPSASSISTS EMPLOYEE VOLUNTEER CLUB IS ONE WAY 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 2014, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS DONATED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS-SPONSORED COMMUNITY BENEFIT PROGRAMS. WITH CLOSE TO 7,529 HOURS, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $347,984.40, WHICH IS NOT INCLUDED IN THE SCRIPPS FISCAL YEAR 2014 COMMUNITY BENEFIT PROGRAMS AND SERVICES TOTALS. 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 2014 (OCTOBER 2013 TO SEPTEMBER 2014), SCRIPPS INVESTED $36,258,006 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES IN SAN DIEGO COUNTY. THIS SECTION HIGHLIGHTS SOME OF OUR PROFESSIONAL EDUCATION AND HEALTH RESEARCH ACTIVITIES. HEALTH PROFESSIONS TRAINING: 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 STAFF PLAY AN IMPORTANT ROLE AS PRECEPTORS BY INVESTING THEIR TIME TO CREATE A VALUABLE EXPERIENCE FOR THE COMMUNITY. IN FISCAL YEAR 2014, SCRIPPS HOSTED 2,321 INTERNS WITHIN OUR SYSTEM AND PROVIDED 399,107 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 90 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 (CSU.S.M), SAN DIEGO STATE UNIVERSITY (SDSU), UNIVERSITY OF SAN DIEGO (U.S.D), MESA COLLEGE, SAN DIEGO CITY COLLEGE, GROSSMONT COLLEGE AND MIRA COSTA COLLEGE. SCRIPPS IS REGULARLY ACCEPTING NEW PARTNERSHIPS, BASED ON COMMUNITY AND WORKFORCE NEEDS, AND ESTABLISHED AN AFFILIATION AGREEMENT COMMITTEE TO REVIEW ALL REQUESTS AND PROVIDE A SYSTEM WIDE APPROACH TO SECURING NEW STUDENT 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. 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 2014, SCRIPPS RESEARCH INCLUDED STUDENTS FROM U.S.D, WESTERN GOVERNORS, SDSU, PLNU AND POSTDOCTORAL PHARMACY RESIDENCY PROGRAMS, INCLUDING THE PGY1 PHARMACY RESIDENCY PROGRAM. COLLEGE COLLABORATIONS SCRIPPS PARTNERED WITH PLNU TO CREATE HEALTH CARE FOCUS COURSES, INCLUDING HEALTH CARE FINANCE AND HEALTH CARE OPERATIONS. PLNU STUDENTS (NON-SCRIPPS EMPLOYEES) MAY ELECT TO TAKE THESE COURSES TOWARDS THEIR MBA. 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. HERE IS A SUMMARY OF THE HIGH SCHOOL PROGRAMS SCRIPPS MADE AVAILABLE TO THE COMMUNITY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM AND HEALTH AND SCIENCE PIPELINE INITIATIVE (HASPI) THIS PROGRAM REACHES OUT TO SAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING A CAREER IN HEALTH CARE. IN FISCAL YEAR 2014, SCRIPPS HIRED 27 STUDENTS TO PARTICIPATE IN THE PROGRAM. DURING THEIR PAID FIVE-WEEK ROTATION, THE STUDENTS WORK IN DIFFERENT DEPARTMENTS, EXPLORING CAREER OPTIONS AND LEARNING VALUABLE LIFE LESSONS ABOUT HEALTH AND HEALING.
FORM 990, PART III, LINE 4A (CONTINUED)	UC HIGH SCHOOL COLLABORATION UC HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOL'S HEALTH CARE ESSENTIALS COURSE. FOR FISCAL YEAR 2014, TEN STUDENTS WERE SELECTED TO ROTATE THROUGH THREE DIFFERENT SCRIPPS LOCATIONS, DURING THE SPRING SEMESTER, TO INCREASE THEIR AWARENESS OF HEALTH CARE CAREERS. UC HIGH STUDENTS VISITED SCRIPPS MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITAL LA JOLLA AND GREEN. THE STUDENTS WERE ABLE TO VIEW SURGERIES AND SHADOWING HEALTHCARE PROFESSIONALS IN THE EMERGENCY DEPARTMENT, CARDIOLOGY, FOOD SERVICES, PHYSICAL THERAPY AND TRAUMA. YOUNG LEADERS IN HEALTH CARE AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENT'S 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 MEETINGS AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE PROGRAM MENTORS STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY LIFE 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 SPORTS INJURIES AND PREVENTION. WORKABILITY SCRIPPS PARTNERS WITH THE SAN DIEGUITO ACADEMY WORKABILITY PROGRAM, WHICH EDUCATES STUDENTS AND THE COMMUNITY ON HEALTH CARE CAREER OPPORTUNITIES. SCRIPPS PROVIDES FIRST HAND TOURS OF HOSPITAL FACILITIES AND EDUCATES PARTICIPANTS ABOUT THE COMPLEXITIES OF HOSPITAL OPERATIONS. THE PROGRAM IS DESIGNED TO PROVIDE PRE-EMPLOYMENT SKILLS DEVELOPMENT, WORKSITE TRAINING AND FOLLOW-UP SERVICES FOR YOUTH (AGES 12-22) WITH SPECIAL NEEDS WHO ARE MAKING THE TRANSITION FROM SCHOOL TO WORK. WHILE STUDENTS GET CLASSROOM TRAINING, SCRIPPS PARTNERS WITH THE PROGRAM TO PROVIDE ONSITE CAREER TRAINING. IN FISCAL YEAR 2014, TWO STUDENTS PARTICIPATED IN THE PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS MEMORIAL HOSPITAL ENCINITAS. NEW GRADUATE RESIDENCY PROGRAM DESIGNED FOR THE NEWLY GRADUATED REGISTERED NURSE (RN), THIS INNOVATIVE PROGRAM IMPROVES PATIENT CARE QUALITY AND SAFETY DURING THE FIRST YEAR ON THE JOB. BY TRAINING NEW NURSES AND BUILDING CONFIDENCE AT THE BEDSIDE, THE PROGRAM HELPS MAKE THE INITIAL YEAR OF A NURSE'S CAREER A LAUNCH PAD TO SUCCESS.
FORM 990, PART VI, LINE 11	990 REVIEW PROCESS WITH GOVERNING BODY THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT 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 MARCH 28, 2014. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES.
FORM 990, PART VI, LINE 16	JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS.
FORM 990, PART VI, LINE 19	AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS CHANGE IN DEFERRED GIFTS 100,008 OTHER CHANGES IN NET ASSETS 3,891,012 JOINT VENTURE DISTRIBUTION 2,570,900 ----------- TOTAL 6,561,920
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYS FEES-PROVIDER SVS AGRMNT TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASE SVS - NON MED TOTAL FEES:55209834
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:53129097
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:25638115
FORM 990 PART IX LINE 11G	DESCRIPTION:ALL OTHER FEES FOR SERVICES TOTAL FEES:25192535

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1
Scripps Cardio&Thoracic Surgery Billing
4275 Campus Point Court	San Diego	CA	92121	270620996	HLTHCR ADMIN	CA	$5,648,772	$0	SCRIPPS
Scripps Hospital Billing Services LLC
4275 Campus Point Court	San Diego	CA	92121	611677183	HLTHCR ADMIN	CA	$3,064,386	$0	SCRIPPS
Scripps Clinic Billing LLC
4275 Campus Point Court	San Diego	CA	92121	870737749	HLTHCR ADMIN	CA	$335,190,002	$0	SCRIPPS
Scripps Mercy Billing LLC
4275 Campus Point Court	San Diego	CA	92121	870737748	HLTHCR ADMIN	CA	$45,483,191	$0	SCRIPPS

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrganizationControlledOrganizationInd
Maxwell H & Muriel Gluck Child Care Ctr
10660 John J Hopkins Dr	San Diego	CA	92121	350504809	Childcare	CA	501(c)(3)	2	Scripps	Yes (true)
Mercy Hospital Foundation
4275 Campus Point Court	San Diego	CA	92121	942958094	Fundraising	CA	501(c)(3)	11, I	Scripps	Yes (true)
Scripps Fdn for Medicine & Science
4275 Campus Point Court	San Diego	CA	92121	330435949	Research	CA	501(c)(3)	11, III FI	Scripps	Yes (true)
Scripps Health Plan Services (SHPS)
4275 Campus Point Court	San Diego	CA	92121	330782099	HEALTHCARE SV	CA	501(c)(3)	11, I	Scripps	Yes (true)
Horizon Hospice
4275 Campus Point Court	San Diego	CA	92121	330220777	Hospice Care	CA	501(c)(3)	9	Scripps	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	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 LLC
15305 Dallas Pkwy Ste 1600 LB 28	Addison	TX	75001	205942958	AMBUL SURGERY	CA	Scripps Health	Related	$1,353,431	$160,207	false	$0	false	0.55500
ScrippsUSP Surgery Center LLC
15305 Dallas Pkwy Ste 1600 LB 28	Addison	TX	75001	205942911	AMBUL SURGERY	CA	NA	Related	$472,258	$1,080,730	false	$0	false	0.50000
Scripps Mercy Ambulatory Surgery Center
4275 Campus Point Court	San Diego	CA	92121	450503246	AMBUL SURGERY	CA	Scripps Health	Related	$1,151,124	$3,273,680	false	$0	Yes (true)	0.73500
Scripps IDN Management LLC
4275 Campus Point Court	San Diego	CA	92121	454557426	HEALTHCARE SV	CA	NA	Related	-$6,613	$16,126	false	$0	false	0.50000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
SC Physicians Organization Inc
4275 Campus Point Court	San Diego	CA	92121	330796247	Holding Company	DE	Scripps Health	C Corp	-$800	$0	1.00000	Yes (true)
Scripps Health & Healing Center
4275 Campus Point Court	San Diego	CA	92121	205156965	Patient Education	CA	Scripps Health	C Corp	$0	$0	1.00000	Yes (true)
ScrippsCare
4275 Campus Point Court	San Diego	CA	92121	452870638	Healthcare Svcs	CA	Scripps Health	C Corp	-$15,166	$5,000	1.00000	Yes (true)
Scripps Clinical Science Center
4275 Campus Point Court	San Diego	CA	92121	264479543	Research	CA	Scripps Health	C Corp	$0	$0	1.00000	Yes (true)
Charitable Remainder Trust (60)
4275 Campus Point Court	San Diego	CA	92121		Hospital Support	CA	NA	Trust
Charitable Lead Trust (2)
4275 Campus Point Court	San Diego	CA	92121	452870638	Hospital Support	CA	NA	Trust
Scripps Health Plan Services Inc
4275 Campus Point Court	San Diego	CA	92121	330782099	Hlthcare Svc Plan	CA	NA	C CORP	-$462,074	$56,847,085	1.00000	Yes (true)

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

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Scripps Health Plan Services (SHPS)
l	$88,021,718	Accrual
Scripps Health Plan Services (SHPS)
p	$19,297,479	Accrual
Scripps Encinitas Surgery Center LLC
a(iv)	$362,123	Accrual
Scripps Mercy Ambulatory Surgery Center
a(iv)	$564,185	Accrual
Horizon Hospice
q	$13,901,015	Accrual

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS	FormAndLineReferenceDesc
Explanation	SCHEDULE R, PART III SCRIPPS MERCY AMBULATORY SURGERY CENTER, LLC EIN: 45-0503246 ADDRESS: 4275 CAMPUS POINT COURT, SAN DIEGO, CA 92121 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 IDN MANAGEMENT, LLC EIN: 45-4557426 ADDRESS: 4275 CAMPUS POINT COURT, SAN DIEGO, CA 92121	ExplanationTxt