GROSSMONT HOSPITAL CORPORATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: GROSSMONT HOSPITAL CORPORATION (EIN 33-0449527)
Tax period: 2012-10-01 to 2013-09-30
Filed: 2014-08-11
IRS object ID: 201432239349302358
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-08-11T18:27:45-05:00	Timestamp
Tax Period End Date	2013-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	346565596	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Ernst & Young US LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	4370 La Jolla Village DrSuite 500	AddressLine1
City	San Diego	City
State	CA	State
ZIP Code	92122	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	330449527	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Grossmont Hospital Corporation	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GROS	NameControl
Phone	8584995150	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8695 Spectrum Center Blvd	AddressLine1
City	San Diego	City
State	CA	State
ZIP Code	921231489	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Ann Pumpian	Name
Title	Asst Treasurer	Title
Phone	8584994041	Phone
Date Signed	2014-08-06	DateSigned
Authorize Third Party	0	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	8585357200	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Daniel Gross	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	8695 Spectrum Center Blvd	AddressLine1
City	San Diego	City
State	CA	State
ZIP Code	921231489	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	697190712	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.sharp.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1991	YearFormation
State Legal Domicile	CA	StateLegalDomicile
Activity Or Mission Description	Grossmont Hospital provides inpatient and outpatient medical services to the community.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	15	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	3777	TotalNbrEmployees
Total Nbr Volunteers	738	TotalNbrVolunteers
Total Gross UBI	408713	TotalGrossUBI
Net Unrelated Business Txbl Income	78992	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	19501123	ContributionsGrantsPriorYear
Contributions Grants Current Year	33549646	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	588093300	ProgramServiceRevenuePriorYear
Program Service Revenue CY	631566176	ProgramServiceRevenueCY
Investment Income Prior Year	3981349	InvestmentIncomePriorYear
Investment Income Current Year	6629949	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1924635	OtherRevenuePriorYear
Other Revenue Current Year	2074565	OtherRevenueCurrentYear
Total Revenue Prior Year	613500407	TotalRevenuePriorYear
Total Revenue Current Year	673820336	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1088165	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	1057002	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	278617440	SalariesEtcPriorYear
Salaries Etc Current Year	291847277	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	1010667	TotalFundrsngExpCurrentYear
Other Expense Prior Year	274572290	OtherExpensePriorYear
Other Expenses Current Year	287577943	OtherExpensesCurrentYear
Total Expenses Prior Year	554277895	TotalExpensesPriorYear
Total Expenses Current Year	580482222	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	59222512	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	93338114	RevenuesLessExpensesCY
Total Assets BOY	526222992	TotalAssetsBOY
Total Assets EOY	627744937	TotalAssetsEOY
Total Liabilities BOY	123937919	TotalLiabilitiesBOY
Total Liabilities EOY	114968466	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	402285073	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	512776471	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	See Schedule O.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	538358208	Expense
Grants	1057002	Grants
Revenue	631566176	Revenue
Description	Grossmont Hospital provides inpatient and outpatient services to the community. Patient days were 123,273 and outpatient visits were 235,834 for the twelve months ended 9/30/13.See Community Benefits Report on Schedule O.	Description
Total Program Service Expense	538358208	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	3777	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	15	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

Field	Value	IRS element (for citing)
Telephone Number	8584995150	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	8695 Spetrum Center Blvd	AddressLine1
City	San Diego	City
State	CA	State
ZIP Code	921231489	ZIPCode

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

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Tom Cantor
Director	3.00	0.00	X	0	0	0
Sunita V Cooke
Secretary	1.50	0.00	X	0	0	0	X
Jerry Fazio
Director	2.00	0.00	X	0	0	0
Dave Grundstrom
Director	2.00	0.00	X	0	0	0
Peter Hanson MD
Director	2.00	2.00	X	36000	0	0
Rina Jain MD
Chief of Staff	8.00	0.00	X	60000	0	0
Tom Karlo
Chairman	4.00	0.00	X	0	0	0	X
Marc Kobernick MD
Director	2.00	2.00	X	30000	0	0
Jay LaSuer
Director	2.00	0.00	X	0	0	0
Randolph Lenac
Director	1.00	0.00	X	0	0	0
Michael Long MD
Director	1.50	0.00	X	0	0	0
Deborah McElravy
Director	1.00	0.00	X	0	0	0
Michael W Murphy
President & CEO-SHC	6.00	54.00	X	0	1371056	93706	X
Shirley Murphy
Director	3.00	0.00	X	0	0	0
Jim Parker
Vice Chairman/Treasurer	2.00	0.00	X	0	0	0	X
Michele Tarbet
Assist Secretary/CEO-GH	50.00	0.10	X	0	564445	40338	X
Ann R Pumpian
SR VP and CFO-SHC	2.00	58.00		0	717542	40099	X
Carlisle C Lewis III
SR VP Legal/HR Services-SHC	10.00	37.00		0	622252	48524	X
Kari Cornicelli
CFO - GH	60.00	0.00		0	222636	29697	X
Maryann C Cone
COO - GH	50.00	0.00		0	316848	34050		X
Suzanne K Johnson
VP Hospice - GH	43.00	0.00		0	229314	16104		X
Anthony M Damico
VP Clinical Services - GH	55.00	0.00		0	229885	16857		X
Patrick J Craychee
Director of Pharmacy - GH	42.00	0.00		215450	0	20516		X
Janet L Hanley
VP Patient Care - GH	40.00	0.00		0	205296	27726		X
Michael A Murphy
Chief Medical Officer - GH	50.00	0.00		0	283103	27504			X
Vincent J Balesteri
Pharmacist - GH	44.00	0.00		215549	0	33370			X
Bruce D Schmidt
Mgr Sharp Central Pharmacy - GH	40.00	0.00		207569	0	36242			X
Glicerio M Cid Jr
Advanced Clinician - GH	64.00	0.00		207562	0	13904			X
Pauline J Lew
Pharmacist - GH	42.00	0.00		191281	0	28851			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1163411	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	4762377	TotalReportableCompFrmRltdOrgs
Total Other Compensation	507488	TotalOtherCompensation
Number Individuals GT100 K	493	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	1	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
Related Organizations	2199044	RelatedOrganizations
Government Grants	31173693	GovernmentGrants
All Other Contributions	176909	AllOtherContributions
Noncash Contributions	30992239	NoncashContributions
Total Contributions	33549646	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Medicare/Medicaid	900099	356311037	356311037
Patient Services	900099	264998932	264998932
EHR Incentive	900099	4278528	4278528
Medical Office Lease	531120	3375295	3375295
OP and Contract Pharmacy	900099	919923	919923

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1682461	TotalRevenueColumn
Related Or Exempt Function Income	1273748	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	408713	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	631566176	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	4152071	TotalRevenueColumn
Exclusion	$4,152,071	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	25747386	Securities
Other	100868	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	23322531	Securities
Other	47845	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	2424855	Securities
Other	53023	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	2477878	TotalRevenueColumn
Exclusion	$2,477,878	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
Parking	812930	961346	$961,346
Auxiliary	453220	842739	$842,739
SEMPRA Energy Incentives	900099	124798	$124,798

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	145682	TotalRevenueColumn
Exclusion	$145,682	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	2074565	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	673820336	TotalRevenueColumn
Related Or Exempt Function Income	631157463	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	408713	UnrelatedBusinessRevenue
Exclusion	$8,704,514	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	1057002	Total
Program Services	1057002	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	2555547	Total
Program Services	1460984	ProgramServices
Management And General	1094563	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	42737	Total
Program Services	42737	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	232339241	Total
Program Services	229033796	ProgramServices
Management And General	3305445	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	9735609	Total
Program Services	9566482	ProgramServices
Management And General	169127	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	30057324	Total
Program Services	29450949	ProgramServices
Management And General	606375	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	17116819	Total
Program Services	16866222	ProgramServices
Management And General	250597	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	20381737	Total
Program Services	19080365	ProgramServices
Management And General	1301372	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	685125	Total
Program Services	24730	ProgramServices
Management And General	660395	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	5714912	Total
Management And General	5714912	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	40277	Total
Management And General	40277	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	151173	Total
Management And General	151173	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	39844494	Total
Program Services	38792949	ProgramServices
Management And General	1051545	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	5279040	Total
Program Services	66448	ProgramServices
Management And General	5212592	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	16937794	Total
Program Services	16166413	ProgramServices
Management And General	771381	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	22234804	Total
Program Services	21567760	ProgramServices
Management And General	667044	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	8892001	Total
Program Services	7307152	ProgramServices
Management And General	1584849	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	624415	Total
Program Services	604050	ProgramServices
Management And General	20365	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	587758	Total
Program Services	142743	ProgramServices
Management And General	445015	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	1788061	Total
Program Services	1024356	ProgramServices
Management And General	763705	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	22971475	Total
Program Services	16026182	ProgramServices
Management And General	6945293	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2169015	Total
Program Services	1712177	ProgramServices
Management And General	456838	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral	Program ServicesProgramServices
UBI Taxes	47331	47331
Medical Supplies	72201073		72201073
Medi-Cal Provider Tax	38735136		38735136
System Allocation	19172622	8731784	10440838

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	9119700	Total
Program Services	6987664	ProgramServices
Management And General	1121369	ManagementAndGeneral
Fundraising	1010667	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	580482222	Total
Program Services	538358208	ProgramServices
Management And General	41113347	ManagementAndGeneral
Fundraising	1010667	Fundraising

Field	Value	IRS element (for citing)
Info In Schedule O Part X	X	InfoInScheduleOPartX

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	4776870	BOY
EOY	7070333	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	30810103	BOY
EOY	15604753	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	73993762	BOY
EOY	76610692	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	136754	BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	9728590	BOY
EOY	10707184	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2682956	BOY
EOY	5011926	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	503950602	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	255878332	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	220713300	BOY
EOY	248072270	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	159126454	BOY
EOY	237268833	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	1274902	BOY
EOY	1433149	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	22979301	BOY
EOY	25965797	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	526222992	BOY
EOY	627744937	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	51959857	BOY
EOY	46506075	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	7648311	BOY
EOY	7596309	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	16007230	BOY
EOY	21536602	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	48322521	BOY
EOY	39329480	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	123937919	BOY
EOY	114968466	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	389738135	BOY
EOY	497216681	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	11474535	BOY
EOY	14486387	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1072403	BOY
EOY	1073403	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	402285073	BOY
EOY	512776471	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	526222992	BOY
EOY	627744937	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	93338114	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	8231068	ReconciliationUnrealizedInvest
Reconcilation Other Changes	8922216	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$40,277	OtherActivitiesAmount
Total Lobbying Expenditures IIB	40277	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1:	ReturnReference
Explanation	Grossmont Hospital Corporation (GHC) pays annual dues to the California Hospital Association (CHA), the Healthcare Association of San Diego and Imperial Counties (HASDIC), the California Association of Hospitals and Health Systems (CAHHS), the American Hospital Association (AHA) and the California Hospice and Palliative Care Association (CHAPCA). CHA, HASDIC, CAHHS, AHA, and CHAPCA have determined that a portion of their membership dues are used for lobbying purposes. GHC's FY 2013 portion of annual dues calculated to have been used for lobbying was $40,277.	Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	3791203	BeginningOfYearBalance
Contributions	1000	Contributions
Investment Earnings Or Losses	160723	InvestmentEarningsOrLosses
End Of Year Balance	3952926	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	3277151	BeginningOfYearBalance
Contributions	1000	Contributions
Investment Earnings Or Losses	513052	InvestmentEarningsOrLosses
End Of Year Balance	3791203	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	3421590	BeginningOfYearBalance
Contributions	38	Contributions
Investment Earnings Or Losses	-112858	InvestmentEarningsOrLosses
Other Expenditures	31619	OtherExpenditures
End Of Year Balance	3277151	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2331612	BeginningOfYearBalance
Contributions	821647	Contributions
Investment Earnings Or Losses	268716	InvestmentEarningsOrLosses
Other Expenditures	385	OtherExpenditures
End Of Year Balance	3421590	EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2245171	BeginningOfYearBalance
Contributions	75087	Contributions
Investment Earnings Or Losses	11354	InvestmentEarningsOrLosses
End Of Year Balance	2331612	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.55000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.45000	PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	581843	OtherCostOrOtherBasis
Book Value	581843	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	276058656	OtherCostOrOtherBasis
Depreciation	136296109	Depreciation
Book Value	139762547	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4180776	OtherCostOrOtherBasis
Depreciation	1543885	Depreciation
Book Value	2636891	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	137693817	OtherCostOrOtherBasis
Depreciation	109859170	Depreciation
Book Value	27834647	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	85435510	OtherCostOrOtherBasis
Depreciation	8179168	Depreciation
Book Value	77256342	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	248072270	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescription	AmountAmount
Capital Leases Payable	$30,910
Mark to Market Swap	$843,962
Long Term Pension Liability	$11,486,949
Long Term Workers' Compensation Liability	$417,909
Other Liabilities	$22,957
Allocated Tax Exempt Bonds	$26,526,793

Field	Value	IRS element (for citing)
Total Of Amounts	39329480	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	648470663	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	8231068	NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities	4266	DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990	8235334	RevenueNotRptdF990
Revenue Subtotal	640235329	RevenueSubtotal
Investment Expenses Not Included	151173	InvestmentExpensesNotIncluded
Other Revenues Not Included	33433834	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	33585007	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	673820336	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	579380472	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	4266	DonatedServicesUseOfFacilities
Expenses Not Rptd F990	4266	ExpensesNotRptdF990
Expenses Subtotal	579376206	ExpensesSubtotal
Investment Expenses Not Included2	151173	InvestmentExpensesNotIncluded2
Other Expenses Not Included	954843	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	1106016	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	580482222	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of Intended Use of Endowment Funds:	Part V, Line 4:	Grossmont Hospital Foundation holds 21 board designated and permanent endowments for Grossmont Hospital Corporation that are restricted for a variety of purposes, such as hospice and hospice homes, diabetes, nursing education, cancer treatment, hospital equipment and technology, and more.
Description of Uncertain Tax Positions Under FIN 48:	Part X, Line 2:	Sharp recognizes tax benefits from any uncertain tax positions only if it is more likely than not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. Sharp records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period that the more likely than not threshold is not met. Sharp recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more likely than not recognition criteria. At September 30, 2013 and 2012, no such assets or liabilities were recorded.
Part XI, Line 4b - Other Adjustments:		Prop G - Donations of Capital/Donations for Capital Purchases 31,173,692. Donations used to Purchase Capital Equipment 1,233,428. Medical Staff/Auxiliary Revenue 1,026,714.
Part XII, Line 4b - Other Adjustments:		Medical Staff/Auxiliary Expenses 954,843.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	500.000000000000	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	0	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	15761433	TotalCommunityBenefitExpense
Net Community Benefit Expense	15761433	NetCommunityBenefitExpense
Percent Of Total Expense	0.02720	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	168747517	TotalCommunityBenefitExpense
Direct Offsetting Revenue	142050721	DirectOffsettingRevenue
Net Community Benefit Expense	26696796	NetCommunityBenefitExpense
Percent Of Total Expense	0.04600	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	31117894	TotalCommunityBenefitExpense
Direct Offsetting Revenue	15024082	DirectOffsettingRevenue
Net Community Benefit Expense	16093812	NetCommunityBenefitExpense
Percent Of Total Expense	0.02770	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	215626844	TotalCommunityBenefitExpense
Direct Offsetting Revenue	157074803	DirectOffsettingRevenue
Net Community Benefit Expense	58552041	NetCommunityBenefitExpense
Percent Of Total Expense	0.10090	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	682159	TotalCommunityBenefitExpense
Net Community Benefit Expense	682159	NetCommunityBenefitExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	496524	TotalCommunityBenefitExpense
Net Community Benefit Expense	496524	NetCommunityBenefitExpense
Percent Of Total Expense	0.00090	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	77709073	TotalCommunityBenefitExpense
Direct Offsetting Revenue	66161926	DirectOffsettingRevenue
Net Community Benefit Expense	11547147	NetCommunityBenefitExpense
Percent Of Total Expense	0.01990	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	950191	TotalCommunityBenefitExpense
Net Community Benefit Expense	950191	NetCommunityBenefitExpense
Percent Of Total Expense	0.00160	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	79837947	TotalCommunityBenefitExpense
Direct Offsetting Revenue	66161926	DirectOffsettingRevenue
Net Community Benefit Expense	13676021	NetCommunityBenefitExpense
Percent Of Total Expense	0.02360	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	295464791	TotalCommunityBenefitExpense
Direct Offsetting Revenue	223236729	DirectOffsettingRevenue
Net Community Benefit Expense	72228062	NetCommunityBenefitExpense
Percent Of Total Expense	0.12450	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	7769	TotalCommunityBuildingExpense
Net Community Building Expense	7769	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	56461	TotalCommunityBuildingExpense
Net Community Building Expense	56461	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	64230	TotalCommunityBuildingExpense
Net Community Building Expense	64230	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$9,409,881	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	126168890	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	121583817	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	4585073	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	1 Grossmont Imaging LLC	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	Joint Venture-Diagnostic Imaging	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.50000	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0.00000	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.50000	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Grossmont Hospital Corporation	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	5555 Grossmont Center Drive	AddressLine1
City	La Mesa	City
State	CA	State
ZIP Code	91942	ZIPCode

Field	Value	IRS element (for citing)
Website Address	www.sharp.com/grossmont	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Grossmont Hospital Corporation	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	1	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Other	X	Other
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	1	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Include Operational Plans	X	IncludeOperationalPlans
Prioritize Health Needs	X	PrioritizeHealthNeeds
All Needs Addressed	0	AllNeedsAddressed
Organization Incur Excise Tax	0	OrganizationIncurExciseTax
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	200.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	500.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Medicare Rate	X	MedicareRate
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	9	NumberOfOtherFacilities

Other Facilities OtherFacilities (9 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType	Address Line2Address/AddressLine2
Sharp Hospice Care
8881 Fletcher Parkway Suite 336	La Mesa	CA	91942	Hospice
PMB Medical Office Building
8860 Center Drive Suite 100	La Mesa	CA	91942	Outpatient Services
Grossmont Medical Plaza
5525 Grossmont Center Drive Suite	La Mesa	CA	91942	Outpatient Services	LL
Briar Patch
9000 Wakarusa Road	La Mesa	CA	91942	Outpatient Services
Grossmont Imaging LLC
8881 Fletcher Parkway Suite 102	La Mesa	CA	91942	Joint Venture-Diagnostic Imaging
PMB Medical Office Building
8860 Center Drive Suite 200	La Mesa	CA	91942	Outpatient Services-Infusion
LakeView Hospice Home
9472 Loren Drive	La Mesa	CA	91942	Hospice Home
ParkView Hospice Home
5788 Lyden Way	San Diego	CA	92120	Hospice Home
Grossmont Imaging LLC
9640 Mission Gorge Road Suite H	Santee	CA	92071	Joint Venture-Diagnostic Imaging

Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)

ExplanationExplanation	Return ReferenceReturnReference	IdentifierIdentifier
Part I, Line 6a: Grossmont Hospital Corporation's community benefit report is prepared by Sharp HealthCare.
Part I, Line 7: Historical charity care percentages are applied to current revenues to estimate charity on a monthly basis. Actual charity transactions are applied against the estimate and any increase or decrease over estimated amounts is accounted for. Other Cost includes State/County programs included in the S-10 for Medicare Cost Reporting primarily for prison/in custody patient care. Ratio of Cost to Charge (RCC) was calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, thus including direct revenue and expense plus stepdown from Overhead departments. The RCC by CMS line was then applied to the applicable revenue departments broken down by payer to obtain the fully weighted cost by payer.
Part I, L7 Col(f): Bad debt expense is netted against revenue. As such, $0.00 was backed out of total expenses for column (f) calculation.
Part II: Grossmont Hospital Corporation at times provides a provision for housing for vulnerable patients upon discharge from the hospital.Grossmont Hospital Corporation incurred expenses for disaster preparedness training and capital expenditures.
Part III, Line 4: Bad Debt represents amounts that go unpaid where the patient was determined to have the ability to pay. If an inability to pay is demonstrated, then full or partial Charity is granted and not considered Bad Debt. Bad Debt at Cost should be included as a Community Benefit because, like other shortfall programs, we are required to accept these patients through the Emergency Room or as a referral with "good faith" in collecting.Grossmont Hospital Corporation consolidates into Sharp HealthCare's audited financial statements. The audited financial statements of Sharp HealthCare include a footnote discussing accounts receivable and allowance for doubtful accounts which is included below.*Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, Sharp analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, Sharp analyzes contractually due amounts and provides an allowance for doubtful accounts, if necessary. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), Sharp records a provision for doubtful accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.Sharp HealthCare's audited financial statements include a deduction from revenue line on the Combined Statement of Operations titled Provision for Doubtful Accounts. Additionally, the accounts receivable line on the Combined Balance Sheet details the amount of allowance for doubtful accounts that is netted against the receivable balance.
Part III, Line 8: Medicare should be included as a community benefit because participation in the Medicare program requires all patients be accepted whether through the Emergency Room or as a referral and Grossmont Hospital Corporation must accept the Medicare established rates whether they cover the cost or not. Ratio of Cost to Charges (RCC) were calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, representing direct revenue and expense plus stepdown from Overhead departments. The RCC by CMS line was then applied to the applicable revenue departments broken down by payor to obtain the fully weighted cost by payer.
Part III, Line 9b: It is Sharp's policy to recall/cancel accounts assigned to a collection agency if it is determined, at any time, a patient is eligible for Financial Assistance or Charity care.
The Institute for Public Health (IPH) conducted a content analysis of all qualitative feedback collected through the HASD&IC 2013 CHNA process key informants, online survey respondents and community members and found that input fell into one of the following five categories:- Access to Care or Insurance- Care Management - Education- Screening Services- Collaboration	Part V, Section B, Line 1j
For the Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews, and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved, and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across SDC including El Cajon, a high-need community served by Grossmont Hospital Corporation (GHC) reaching a total of 106 community residents. In addition, IPH conducted five key informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers, and members of community-based organizations.Following consultation with the GHC 2013 CHNA Planning Team, additional, specific feedback from key informants with insight into the concerns and health needs of seniors was collected. Four more key informant interviews provided expertise in senior health and end-of-life care as well as health disparities among older adults. GHC also collected nine community feedback surveys from senior volunteers at the hospital. Community members were asked for open-ended feedback on the health issues of greatest importance to them, as well as any significant barriers they face in maintaining health and well-being.	Part V, Section B, Line 3
The Grossmont Hospital Corporation (GHC) 2013 CHNA examines the health needs of the community members it serves in San Diego County (SDC). GHC's 2013 CHNA draws from and is based on the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA process and findings for SDC overall. This collaborative process was conducted under the auspices of HASD&IC, and included partnerships with the Institute for Public Health at San Diego State University (IPH), and hospitals throughout the county, with which Sharp was a key collaborator. The collaboration included the following SDC hospitals and health systems: Sharp HealthCare, Scripps Health, UC San Diego Health System, Tri-City Medical Center, Kaiser Foundation Hospital San Diego and Palomar	Part V, Section B, Line 4
GHC reviewed its CHNA and used the assessment to help inform priority needs for members of the communities it serves. In identifying these priorities, GHC also considered the expertise and mission of its programs and services, in addition to the needs of the unique, ever-changing demographics and health topics that comprise GHC's service area and region.GHC provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. GHC also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, GHC does not have the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at GHC, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs.Additionally, through further analysis of GHC's community programs and in consultation with GHC's community relations team, GHC also addresses the following health needs through its community benefits programs:- Cancer education and support, and participation in clinical trials- Bone Health Orthopedic / osteoporosis education and screening- Women's and prenatal health services and education- Prevention of unintentional injuries- Support during the transition of care process for high-risk, underserved, and underfunded patients- Collaboration with local schools to promote interest in health care careers	Part V, Section B, Line 7
The hospital has notices posted in the Emergency Department and waiting rooms to notify patients the hospital has a charity care/discounted care policy for financially qualified patients that is available upon request, as the business office, or by calling the phone number provided. Additionally, patients are provided a notice of the hospital policy for charity care and/or partial charity care (discounted care). This notice lists the criteria to qualify for charity care and/or discounted care and informs patients where they may obtain an application.	Part V, Section B, Line 14g
Part VI, Line 2: Sharp HealthCare (Sharp) has been a long-time partner in the process of identifying and responding to the health needs of the San Diego community. This partnership has included a broad range of hospitals, health care organizations, and community agencies in order to conduct triennial Community Health Needs Assessments (CHNAs) over the past 17 years. Previous collaborations among not-for-profit hospitals and other community partners have resulted in numerous well-regarded CHNA reports. Sharp hospitals, including Grossmont Hospital Corporation (GHC), base their community benefit and community health programs on both the findings of these needs assessments and the combination of expertise in programs and services offered and the knowledge of the populations and communities served by each Sharp hospital.The GHC 2013 CHNA examines the health needs of the community members it serves in San Diego County (SDC). GHC's 2013 CHNA draws from and is based on the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA process and findings for SDC overall. This collaborative process was conducted under the auspices of HASD&IC, and included partnerships with the Institute for Public Health at San Diego State University (IPH), and hospitals throughout the county, with which Sharp was a key collaborator.CHNA ObjectivesThe objectives of GHC's 2013 CHNA are: 1. Identify the top health conditions and health care needs of community members in its patient community.2. Understand the challenges that community members particularly those in communities of high-need - face in their attempts to access health care and maintain health and well-being.3. Identify currently available community resources that support identified health conditions and health challenges.4. Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community.Study Area DefinedThe community served by GHC includes the entire east region of SDC, including the sub-regional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. Table 1 below presents the ZIP codes where the majority of GHC patients reside.Table 1: Primary Communities Served by GHCZIP Code Community91941 La Mesa91942 La Mesa91945 Lemon Grove91977 Spring Valley92019 El Cajon92020 El Cajon92021 El Cajon92040 Lakeside92071 SanteeSource: SpeedTrack California Universal Patient Information Discovery, OSHPD CY 2011 Hospital Discharge DataData Collection and AnalysisThe HASD&IC 2013 CHNA process and findings significantly informed the GHC 2013 CHNA process and as such are described as applicable throughout this report. For complete details on the HASD&IC 2013 CHNA process, please visit the HASD&IC website at: www.hasdic.org.For the collaborative HASD&IC 2013 CHNA process, 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 SDC.Quantitative data (secondary sources) for both the HASD&IC 20013 CHNA and GHC 2013 CHNA included the 2011 calendar year hospital discharge data at the ZIP code level, statistics from the San Diego County Health and Human Services Agency (HHSA), the U.S. Census Bureau, the Centers for Disease Control, and others. The variables analyzed are included in Table 2 below and were analyzed at the ZIP code level wherever possible.Table 2: Variables Analyzed in the HASD&IC and GHC 2013 CHNASecondary Data VariablesInpatient Hospitalizations by CauseEmergency Department Visits by CauseDemographic Data (socio-economic indicators)Mortality DataRegional Disease-Specific Health Data (County HHSA)Self-Reported Health Data (California Health Interview Survey)Specialized Health Data /Reports (various)Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC's and GHC's 2013 CHNA processes utilized the Dignity Health Community Need Index (CNI) to identify communities with the highest level of health disparities and needs. Residents in five of these neighborhoods across SDC were asked to provide input in a community forum setting. Table 3 below presents communities (by ZIP code) served by GHC that have especially high need based on their CNI score (score = 4).Table 3: High-Need Communities Served in Sharp Grossmont Hospital's Primary Service AreaZIP Code Community91945 Lemon Grove91977 Spring Valley92020 El Cajon92021 El CajonSource: Dignity Health, 2011 CNI DataFor the HASD&IC 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews, and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved, and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across SDC including El Cajon, a high-need community served by GHC reaching a total of 106 community residents. In addition, IPH conducted five key informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers, and members of community-based organizations.Following consultation with the GHC 2013 CHNA Planning Team, additional, specific feedback from key informants with insight into the concerns and health needs of seniors was collected. Four more key informant interviews provided expertise in senior health and end-of-life care as well as health disparities among older adults. GHC also collected nine community feedback surveys from senior volunteers at the hospital. Community members were asked for open-ended feedback on the health issues of greatest importance to them, as well as any significant barriers they face in maintaining health and well-being.FindingsThrough the combined analyses of the results for all the data and information gathered, the following conditions were identified as priority health needs for the communities served by GHC (listed in alphabetical order):* Behavioral Health (Mental Health)* Cardiovascular Disease* Diabetes, Type II* Obesity* Senior Health (including end-of-life care)In addition, the IPH conducted a content analysis of all qualitative feedback collected through the HASD&IC 2013 CHNA process key informants, online survey respondents and community members and found that input fell into one of the following five categories:* Access to Care or Insurance* Care Management * Education* Screening Services* CollaborationGHC is committed to the health and well-being of its community, and the findings of GHC's 2013 CHNA will help to inform the activities and services provided by GHC to improve the health of its community members. The 2013 CHNA process also generated a list of currently existing resources in SDC, an asset map, that address the health needs identified through the CHNA process. While not an exhaustive list of the available resources in San Diego, this map will serve as a resource for GHC to help continue, refine and create programs that meet the needs of its most vulnerable community members.The complete Grossmont Hospital Corporation 2013 Community Health Needs Assessment is available online at: http://www.sharp.com/about/community/community-health-needs-assessments.cfm or by contacting Sharp HealthCare Community Benefits at: communitybenefits@sharp.com.
Part VI, Line 2: Determination of Priority Community NeedsGHC reviewed its CHNA and used the assessment to help inform priority needs for members of the communities it serves. In identifying these priorities, GHC also considered the expertise and mission of its programs and services, in addition to the needs of the unique, ever-changing demographics and health topics that comprise GHC's service area and region.GHC provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. GHC also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, GHC does not have the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at GHC, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs.Additionally, through further analysis of GHC's community programs and in consultation with GHC's community relations team, this section also addresses the following priority health needs for community members served by GHC:* Cancer education and support, and participation in clinical trials* Bone Health Orthopedic / osteoporosis education and screening* Women's and prenatal health services and education* Prevention of unintentional injuries* Support during the transition of care process for high-risk, underserved, and underfunded patients* Collaboration with local schools to promote interest in health care careersIn addition, GHC:* Incorporates community priorities and community input into its strategic plan and develops service line-specific goals* Estimates an annual budget for community programs and services based on community needs, the prior year's experience and current funding levels* Prepares and distributes a monthly report of community activities to its board of directors, describing community benefits provided, such as education, screenings and flu shots * Prepares and distributes information on community benefits programs and services through its foundation and community newsletters* Consults with representatives from a variety of departments, to discuss, plan and implement community activities
Part VI, Line 3: Sharp HealthCare's financial assistance policy is in furtherance of its charitable mission. The policy identifies eligibility for, and circumstances under which, financial assistance will be extended to Sharp HealthCare's hospital patients for medically necessary services. "Charity Care" is that portion of Sharp HealthCare's charges for medically necessary patient care services provided by a hospital that a patient (either individually or through a third party payer) is unable to pay. Charity Care does not include bad debt, contractual adjustments, or un-reimbursed costs of providing care to patients eligible under government programs for health care services to low-income and medically indigent patients."Financial Assistance," means any reduction of charges for medically necessary services as defined herein that may be made by Sharp HealthCare either for, or on behalf of, a patient who applies to Sharp HealthCare for Financial Assistance and meets Sharp HealthCare's financial eligibility requirements or criteria as described in this policy. For purposes of the policy Financial Assistance includes "charity care" which means a 100% reduction in charges for medically necessary services and "partial charity care" which means a reduction in a portion of charges for such services.All patients should be screened at the time of admission or at registration for ability to pay for services, including whether or not they are candidates for Financial Assistance. Care for patients presenting with a known or possible emergency medical condition or in active labor shall not be delayed in order to assess financial status.In order to both inform patients of the various programs they may be entitled to, and assist them in the application process, Uncompensated Care Specialists provide patient(s) with a Financial Assistance Form. The Uncompensated Care Specialists direct the patient (or their guarantor) to complete a Patient Financial Statement, include specified financial items for both the patient and spouse (if any), direct the patient to return all information within ten days and document in patient's account history notes the substance of any patient discussions and that the Patient Financial Statement was provided.Following internal processing of the Financial Assistance Form, Sharp Uncompensated Care Specialists and/or Private Pay Representatives notify patient of Financial Assistance Application results, document the decision in all approved and denied Financial Assistance Accounts and secure payment arrangements for remaining balance of partial Financial Assistance or denied Financial Assistance accounts. All follow-up and patient interaction is documented in the patient's account history notes.
Part VI, Line 4: The community served by Grossmont Hospital Corporation includes the entire east region of San Diego County, including the sub-regional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. The race/ethnicity breakdown of the community served by Grossmont Hospital is: 48.4% White; 30.1% Hispanic; 8.3% Black; 9.0% Asian/Pacific Islander; and 0.5% Native American. In the County's east region in 2011, 93.6 percent of children ages 0 to 11, 95.7 percent of children ages 12 to 17 and 82.7 percent of adults ages 18 and older had health insurance. Further, 98.8 percent of children ages 0 to 11 and 89.3 percent of children ages 12 to 17 had a regular source of medical care failing to meet the Healthy People (HP) 2020 national targets for health insurance coverage and regular source of medical care. Among uninsured adults ages 18 to 64 years in SDC's east region, 15.7 percent were not currently insured in 2011.
Part VI, Line 5: Grossmont Hospital Corporation has an open medical staff and a community board. Surplus funds generated by hospital operations are re-invested by the organization to fund capital improvements and acquire state of the art medical equipment with the intent of continually improving patient care.
Part VI, Line 6: Sharp HealthCare is an integrated, regional health care delivery system based in San Diego, Calif. The Sharp system includes four acute care hospitals, three specialty hospitals, two affiliated medical groups, 20 medical clinics, five urgent care facilities, four skilled nursing facilities, two inpatient rehabilitation programs, home health, hospice and home infusion programs, numerous outpatient facilities and programs, and a variety of other community health education programs and related services. Sharp also has a Knox-Keene-licensed care service plan, Sharp Health Plan. Serving a population of approximately three million in San Diego County, Sharp is licensed to operate 2,069 beds, has approximately 2,600 Sharp-affiliated physicians and more than 15,000 employees.It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patient expectations and are provided in a caring, convenient, cost-effective and accessible manner. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp is known as an excellent community citizen embodying an organization of people working together to do the right thing every day to improve the health and wellbeing of those it serves. With 540 licensed beds, Grossmont Hospital Corporation is the largest provider of health care services in San Diego's East County, and operates one of the busiest emergency rooms in San Diego County. Grossmont Hospital Corporation received Magnet Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor awarded by the ANCC and is accepted nationally as the gold standard in nursing excellence
CA	Part VI, Line 7	Reports Filed With States
Sharp HealthCare prepares an annual Community Benefits Report in accordance with the requirements of California Senate Bill (SB) 697, community benefits legislation (According to SB 697, hospitals under the common control of a single corporation or another entity may file a consolidated report with the Calif. Office of Statewide Health Planning and Development (OSHPD)). Sharp HealthCare submits an annual Community Benefits Report to the California OSHPD.The Sharp HealthCare Community Benefits Plan and Report, Fiscal Year 2013 is available online at www.sharp.com/community.No figure is reported on Part III, line 3 (estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy) due to all amounts attributable to patients eligible under the charity care policy being reported as charity.The organization incurred additional Medicare shortfall that is not allowed to be reported on Parts I and III, due to the definition of Medicare shortfall as prescribed by the IRS. This additional shortfall arises from the use of the Medicare cost report data which excludes fee based services, non-billable services, and disallowed operating expenses which the organization has determined to be revenues and expenses of the Medicare program and should be included in the total shortfall. A reconciliation of what the organization classifies as Medicare shortfall is as follows:Medicare revenue received reported on Parts I and III - 160,269,238Medicare allowable costs reported on Parts I and III - 164,339,616Shortfall included on Parts I and III - (4,070,378)Actual Medicare revenue received - 160,494,674Actual Medicare cost - 181,636,115Actual Medicare shortfall - (21,141,441)Additional Medicare shortfall not on Parts I and III - (17,071,063)

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
KPBSSan Diego State University Research Foundation
5200 Campanile Drive	San Diego	CA	921825400	956042721	501(c)(3)	10000	Sponsorship - KPBS Gala
East County Family YMCA
8881 Dallas Street	La Mesa	CA	91942	952088013	501(c)(3)	5100	Donation - 2013 Pledge
Boys & Girls Clubs of East County
8820 Tamberly Way	Santee	CA	92071	952088013	501(c)(3)	10200	Sponsorship - East County Children's Ball, Golf Day
San Diego East County Chamber of Commerce
201 S Magnolia Ave	El Cajon	CA	92020	951494069	501(c)(6)	10650	Sponsorship - Women in Leadership, Grip It and Rip It Golf
California Health Foundation & Trust
1215 K Street Suite 800	Sacramento	CA	95814	941498697	501(c)(3)	796600	Medi-Cal Program
Grossmont Hospital Foundation
8695 Spectrum Center Blvd	San Diego	CA	92123	330124488	501(c)(3)	55150	Donations

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	4	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	1	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: The Management team evaluates requests for contributions from outside organizations taking into account how they align with the organization's mission. No monitoring is done after grants are made.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Peter Hanson MD
Director	36000	0	0	0	0	0	0	0	0	0	36000	0	0	0
Rina Jain MD
Chief of Staff	60000	0	0	0	0	0	0	0	0	0	60000	0	0	0
Marc Kobernick MD
Director	30000	0	0	0	0	0	0	0	0	0	30000	0	0	0
Michael W Murphy
President & CEO-SHC	0	1127582	0	188024	0	55450	0	78289	0	15417	0	1464762	0	0
Michele Tarbet
Assist Secretary/CEO-GH	0	475755	0	71690	0	17000	0	24962	0	15376	0	604783	0	0
Ann R Pumpian
SR VP and CFO-SHC	0	603249	0	97293	0	17000	0	28887	0	11212	0	757641	0	0
Carlisle C Lewis III
SR VP Legal/HR Services-SHC	0	503103	0	85280	0	33869	0	33547	0	14977	0	670776	0	0
Kari Cornicelli
CFO - GH	0	194093	0	27578	0	965	0	13850	0	15847	0	252333	0	0
Maryann C Cone
COO - GH	0	250083	0	36976	0	29789	0	25898	0	8152	0	350898	0	0
Suzanne K Johnson
VP Hospice - GH	0	182860	0	32319	0	14135	0	283	0	15821	0	245418	0	0
Anthony M Damico
VP Clinical Services - GH	0	184423	0	27489	0	17973	0	9978	0	6879	0	246742	0	0
Patrick J Craychee
Director of Pharmacy - GH	180576	0	18567	0	16307	0	9000	0	11516	0	235966	0	0	0
Janet L Hanley
VP Patient Care - GH	0	179824	0	24599	0	873	0	11957	0	15769	0	233022	0	0
Michael A Murphy
Chief Medical Officer - GH	0	256976	0	7219	0	18908	0	11423	0	16081	0	310607	0	0
Vincent J Balesteri
Pharmacist - GH	206316	0	8274	0	959	0	26840	0	6530	0	248919	0	0	0
Bruce D Schmidt
Mgr Sharp Central Pharmacy - GH	193168	0	13148	0	1253	0	20497	0	15745	0	243811	0	0	0
Glicerio M Cid Jr
Advanced Clinician - GH	203081	0	474	0	4007	0	7619	0	6285	0	221466	0	0	0
Pauline J Lew
Pharmacist - GH	190473	0	474	0	334	0	13348	0	15503	0	220132	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (6 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 1a	Non-management staff were paid superior performance awards which were grossed up so the net payment would be a specified amount based on each staff member's productive hours worked during the year. The net payments per staff member ranged from $100 to $300.
Part I, Line 4b	Sharp HealthCare ("Company") sponsors an Executive Flexible Benefit Plan ("Plan") to provide designated executives with a reasonable level of benefits in return for their continued employment with the Company. The Plan is administered on a Plan Year basis of January 1 to December 31. Changes in Flexible Benefit Options are permitted annually, effective January 1 of the new Plan Year. The provisions of the Plan, which were restated effective as of December 31, 2008, are described below as restated. The Plan is available to the Chief Executive Officer, Executive Vice President of Hospital Operations, and Senior Vice Presidents. The Flexible Benefit Allowance available to each participant each plan year shall equal the sum of the following: - A company provided base allowance equal to 18% of the participant's base salary - A participant deferral up to 6% of the participant's pre-tax base salary for such plan year as elected by the participant - A company match should the participant make an elective deferral for a plan year. The company match begins at 2% for the first 1% elective deferral and increases 0.5% for each additional 1% elective deferral, to a maximum match of 4.5% on a 6% elective deferral. The Plan allows participants to use the Flexible Benefit Allowance to purchase additional long-term disability coverage, long-term care coverage, and flexible survivor coverage/accumulation benefits (life insurance). Participants in the flexible survivor coverage/accumulation benefits plan previously could elect to apply Flexible Benefit Allowance to acquire additional survivor coverage, or toward deposits to the Supplemental Survivor Accumulation Benefit Plan ("SSAB") to fund post-retirement survivor benefits, subject to the ERISA limit provided their policies were issued prior to September 18, 2003. The Company shall automatically continue whatever elective coverage and additional deposit elections that were in place for the SSAB during the 2008 plan year. No elective coverage or additional deposits were available to participants whose policies were issued on or after September 18, 2003. Any Flexible Benefit Allowance that remains after purchasing these additional coverages shall be paid to the participant in cash in equal installments throughout the Plan Year, not less frequently than quarterly. If the participant separates from service during the Plan Year, the participant forfeits any unpaid Allowance.
Part III	Compensation was paid to Dr. Peter Hanson through Peter B Hanson MD Inc., for medical director services, by Grossmont Hospital Corporation. He was compensated directly by Peter B Hanson MD Inc.	Supplemental Information
Part III	Compensation was paid to Dr. Marc Kobernick through his professional corporation, for medical director and chief of staff services, by Grossmont Hospital Corporation. He was compensated directly by the professional corporation.	Supplemental Information
Part III	Compensation was paid to Dr. Rina Jain through Rina Jain MD Inc. by Grossmont Hospital Corporation for Chief of Staff services.	Supplemental Information
Part III	Part I, Line 3: The Compensation Committee of Sharp HealthCare, the parent organization, establishes the compensation of the Chief Executive Officer. The Compensation Committee engages independent compensation consultants and the amount is approved by both the Compensation Committee and Board of Directors.	Supplemental Information

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Stephen Hanley
See Part V	42737	Employment	0
Grossmont Imaging LLC
See Part V	647581	See Part V	0

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	Schedule L, Part IV:	Identifier
Explanation	Stephen Hanley, an employee of Grossmont Hospital Corporation, is the son of Janet Hanley, a key employee of Grossmont Hospital Corporation.Kari Cornicelli, Chief Financial Officer of Grossmont Hospital Corporation, sits on the Board of Directors of Grossmont Imaging LLC, a partnership 50% owned by Grossmont Hospital Corporation.Michele Tarbet, Chief Executive Officer of Grossmont Hospital Corporation, sits on the Board of Directors of Grossmont Imaging LLC, a partnership 50% owned by Grossmont Hospital Corporation.Anthony Damico, a key employee of Grossmont Hospital Corporation, sits on the Board of Directors of Grossmont Imaging LLC, a partnership 50% owned by Grossmont Hospital Corporation.	Explanation

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable (4 entries)

Non Cash CheckboxNonCashCheckbox	DescriptionDescription	Number Of ContributionsNumberOfContributions	Noncash Contribs Rptd F990NoncashContribsRptdF990	Method Of Determining RevenuesMethodOfDeterminingRevenues
X	Heart/Vas Center	12	12875617	Cost
X	Central Power Plant	12	10235440	Cost
X	East Tower	12	7703544	Cost
X	Equipment	3	177638	Cost

Field	Value	IRS element (for citing)
Number Of8283 Received	0	NumberOf8283Received
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	1	ReviewProcessUnusualNCGifts
Third Parties Used	0	ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

Field	Value	IRS element (for citing)
Identifier	Method for Determining Number of Contributions:	Identifier
Return Reference	Part I, Column (b):	ReturnReference
Explanation	Number of Contributions	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (44 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Program Service Statement	Form 990, Part III, Line 1:	To establish, maintain, conduct, and operate a hospital or hospitals related, associated and complimentary facilities and services, such as, but not limited to, skilled nursing, extended care, outpatient care, home care, and other health care programs, activities, services and facilities. To carry on any educational activities related to rendering care to the sick and injured, or to the promotion of health. To promote and carry on scientific research related to the care of the sick and injured, or to the promotion of health. To participate in any activity designed and carried on to promote the general health of the community. To operate and maintain this corporation and its assets for the benefit of the communities served by Grossmont Healthcare District, a political subdivision of the State of California, organized pursuant to Local Hospital District Law (Division 23 of the California Health & Safety Code), and which is located in San Diego County, California. Generally do anything and everything necessary, expedient or incidental to the foregoing.
	Form 990, Part IV, Line 24a:	Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327). This organization's allocated portion is included in Part X, Line 25.
	Form 990, Part VI, Section A, line 2	Michele Tarbet, Kari Cornicelli, and Anthony Damico were all directors on the governing board of the Grossmont Imaging Joint Venture.
	Form 990, Part VI, Section A, line 6	Sharp HealthCare (FEIN 95-6077327)is the sole member of Grossmont Hospital Corporation.
	Form 990, Part VI, Section A, line 7a	Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members.
	Form 990, Part VI, Section A, line 7b	Sharp HealthCare, as the sole member of the corporation, has the right to elect and remove most board members. Sharp HealthCare also retains the approval rights afforded members for certain significant transactions (e.g. dissolution or sale or transfer of all or substantially all of the assets.)
	Form 990, Part VI, Section B, line 11	The final Form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the Director of Accounting & Tax, Vice President of Finance, Senior Vice President and Chief Financial Officer, and entity Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990.
	Form 990, Part VI, Section B, line 12c	Grossmont Hospital has a written conflict of interest policy which has been reviewed and approved by the Grossmont Hospital governing board. Grossmont Hospital is committed to preventing any Participant of the Corporation from gaining any personal benefit from information received or from any transaction of Sharp. One component of the written conflict of interest policy requires that Board Members, Corporate Officers, Senior Vice Presidents and Chief Executive Officer(s) submit a conflict of interest statement annually to Legal Services/Senior Vice President of Legal Services who will review all statements. In addition, all Vice Presidents and any employees in the Purchasing/Supply Chain, Audit and Compliance, and Case Management/Discharge Planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the Conflict Review Committee comprised of employees from Sharp's Legal, Compliance, and Internal Audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board Members, Corporate Officers, Senior Vice Presidents, and the Chief Executive Officer(s) shall make such disclosures directly to the Chairman of the Board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the Board Member, Corporate Officer, Senior Vice President or the Chief Executive Officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from Sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with Section 5222 of the California Corporations Code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member.
	Form 990, Part VI, Section B, line 15	The Personnel Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Personnel Committee of the Board of Directors by the independent consultant. The Personnel Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Personnel Committee approves the total compensation for the President/Chief Executive Officer and reviews and approves the compensation and compensation salary ranges for the remainder of the executive team. The Personnel Committee presents its decision to the Board of Directors. The Personnel Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November/December 2012.
	Form 990, Part VI, Section C, line 19	Policies are considered proprietary information, however in Sharp HealthCare's publicly available Code of Conduct, Sharp outlines its Conflict of Interest policies in a user friendly manner. The annual audited financial statements of the consolidated group are published on the dacbond.com website (www.dacbond.com), are attached to the Form 990 filed for each of the Sharp hospitals, and are available upon request. The annual audited financial statements include combining schedules which disclose the financial results (Balance Sheet, Statement of Operations, Statement of Changes in Net Assets) for each entity of the consolidated group. Quarterly financial statements of Sharp's obligated group are published on the dacbond.com website (www.dacbond.com).
	Form 990, Part VII, Section B:	Independent contractors are paid under Sharp HealthCare's tax identification number (95-6077327) and are reported on Sharp HealthCare's tax return.
	Form 990, Part X, Line 25:	Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, the tax exempt bond balances are reported on the Sharp HealthCare return (EIN 95-6077327) and this organization has reported zero on Form 990, Part X, Line 20 and has reported the allocated balance on Line 25.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 9:	Change in minimum pension liability 5,828,768. Beneficial Interest in Grossmont Hospital Foundation 3,093,448.
	Form 5471	Form 5471 has been filed on behalf of Grossmont Hospital Corporation by Sharp HealthCare (FEIN 95-6077327).
FY 2013 Community Benefits Report	Form 990, Part III, Line 4a:	Fiscal Year 2013 Community Benefits Report Section 1 An Overview of Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, Calif. The Sharp system includes four acute care hospitals; three specialty hospitals; two affiliated medical groups; 20 medical clinics; five urgent care facilities; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp offers a full continuum of care, including: emergency care, home care, hospice care, inpatient care, long-term care, mental health care, outpatient care, primary and specialty care, rehabilitation, and urgent care. Sharp also has a Knox-Keene-licensed care service plan, Sharp Health Plan (SHP). Serving a population of approximately 3 million in San Diego County (SDC), as of September 30, 2013, Sharp is licensed to operate 2,110 beds, and has approximately 2,600 Sharp-affiliated physicians and more than 16,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 beds) The largest provider of health care services in San Diego's rapidly expanding South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. Sharp Coronado Hospital and Healthcare Center (181 beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. SCHHC is the largest provider of total joint surgeries in all of SDC. Sharp Grossmont Hospital (540 beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County, and has one of the busiest EDs in SDC. Sharp Memorial Hospital (675 beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 beds) A freestanding women's hospital specializing in obstetrics, gynecology, gynecologic oncology, and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other private hospital in California. Sharp Mesa Vista Hospital (149 beds) The largest private freestanding psychiatric hospital in California, Sharp Mesa Vista Hospital (SMV) is a premier provider of behavioral health services. Sharp McDonald Center (16 beds) Sharp McDonald Center (SMC) is San Diego County's only licensed chemical dependency recovery hospital. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH, and are referred to herein as The Sharp Metropolitan Medical Campus (SMMC). The operations of Sharp Rees-Stealy Medical Centers (SRS) are included within the not-for-profit public benefit corporation of Sharp, the parent organization. The operations of SGH are reported under the not-for-profit public benefit corporation of Grossmont Hospital Corporation. Mission Statement It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patient expectations, and are provided in a caring, convenient, cost-effective and accessible manner. Vision Sharp's vision is to become the best health system in the universe. Sharp will attain this position by transforming the health care experience through a culture of caring, quality, service, innovation and excellence. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen, embodying an organization of people working together to do the right thing every day to improve the health and well-being of those it serves. Values * Integrity Trustworthiness, Respect, Commitment to Organizational Values, and Decision Making * Caring Service Orientation, Communication, Teamwork and Collaboration, Serving and Developing Others, and Celebration * Innovation Creativity, Continuous Improvement, Initiating Breakthroughs, and Self-Development * Excellence Quality, Safety, Operational and Service Excellence, Financial Results, and Accountability Culture: The Sharp Experience For more than 13 years, Sharp has been on a journey to transform the health care experience for patients and their families, physicians and staff. Through a sweeping organization-wide performance and experience improvement initiative called The Sharp Experience, the entire Sharp team has recommitted to purpose, worthwhile work, and creating the kind of health care people want and deserve. This work has added discipline and focus to every part of the organization, helping to make Sharp one of the nation's top-ranked health care systems. Sharp is San Diego's health care leader because it remains focused on the most important element of the health care equation: the people. Through this extraordinary initiative, Sharp is transforming the health care experience in San Diego by striving to be: * The best place to work: Attracting and retaining highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration, and professional and personal growth. This commitment to serving patients and supporting one another will make Sharp "the best health system in the universe." * The best place to practice medicine: Creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers; experience unsurpassed service as valued customers; have access to state-of-the-art equipment and cutting-edge technology; and enjoy the camaraderie of the highest-caliber medical staff at San Diego's health care leader. * The best place to receive care: Providing a new standard of service in the health care industry, much like that of a five-star hotel; employing service-oriented individuals who see it as their privilege to exceed the expectations of every patient treating them with the utmost care, compassion and respect; and creating healing environments that are pleasant, soothing, safe, immaculate, and easy to access and navigate. Through all of this transformation, Sharp will continue to live its mission to care for all people, with special concern for the underserved and San Diego's diverse population. This is something Sharp has been doing for more than half a century. Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, the six Pillars of Excellence serve as a guide for team members, providing a framework and alignment for everything Sharp does. The six pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: * Quality - Demonstrate and improve clinical excellence and patient safety to set community standards and exceed patient expectations * Service - Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence * People - Create a workforce culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp's mission, vision and values * Finance - Achieve financial results to ensure Sharp's ability to provide quality health care services, new technology and investment in the organization * Growth - Achieve consistent net revenue growth to enhance market dominance, sustain infrastructure improvements and support innovative development *Community - Be an exemplary community citizen by making a difference in our community and supporting the stewardship of our environment
		Awards Sharp has received the following recognition: Sharp is a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation's highest presidential honor for quality and organizational performance excellence. Sharp was the first health care system in California and eighth in the nation to receive this recognition. Sharp was recognized as one of the 2013 World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think-tank. The list highlights companies that outperform industry peers when it comes to ethical behavior. The 2013 WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was the only San Diego company named to the list. Sharp was named the No. 1 "best integrated health-care network" in California and No. 12 nationally by Modern Healthcare magazine in 2012. The rankings are part of the "Top 100 Most Highly Integrated Healthcare Networks (IHN)," an annual survey conducted by health care data analyst IMS Health. This is the 14th year running that Sharp has placed among the top in the state in the survey. Sharp Rees-Stealy Medical Group, practicing as the Sharp Rees-Stealy Medical Centers, was named "Best Medical Group" by U-T San Diego readers participating in the paper's 2012 "Best of San Diego" Readers Poll. SMH and SGH were ranked second and third "Best Hospitals" while SCVMC, SCHHC and SMBHWN were honored as finalists. SGH and SMH have both received MAGNET Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor bestowed by the ANCC and is accepted nationally as the gold standard in nursing excellence. SMH was re-designated in March 2013. Sharp was named one of the nation's "Most Wired" health care systems in 2012 and 2013, as well as 1999 2009, by Hospitals & Health Networks magazine in the annual Most Wired Survey and Benchmark Study. "Most Wired" hospitals are committed to using technology to enhance quality of care for both patients and staff. In July 2010, SMH was named the "Most Beautiful Hospital in America" by Soliant Health, one of the largest medical staffing companies in the country. With over 10,000 votes from visitors to the Soliant Health website, SMH was voted to the top of the second annual "20 Most Beautiful Hospitals in America" list. In 2012, SMH was designated as a Planetree Patient-Centered Hospital, joining SCHHC as the second hospital in the state to earn the honor. SMH is the largest and most complex hospital in the world to receive designation. SCHHC was originally designated in 2007 and is the only hospital in the state to be re-designated twice, occurring in both 2010 and 2013. Additionally, SCHHC was named a Planetree Hospital with Distinction for its leadership and innovation in patient-centered care. Planetree is a coalition of more than 100 hospitals worldwide that is committed to improving medical care from the patient's perspective. In 2010, Sharp received the Morehead Apex Workplace of Excellence Award. Morehead awards the health care industry's top achiever by objectively identifying the highest performer and acknowledging their contributions to health care. With this singular award, Morehead annually recognizes a client who has reached and sustained the 90th percentile on their employee engagement surveys. Sharp reached the 98th percentile in 2010 and the 99th percentile in 2011. In FY 2013, SCHHC received Energy Star designation from the US Environmental Protection Agency (EPA) for outstanding energy efficiency for the fourth consecutive year. Buildings that are awarded the designation use an average of 40 percent less energy than other buildings and release 35 percent less carbon dioxide into the atmosphere. SCVMC also received the designation in 2013, and had received the award in previous years (2009-2011). Sharp HealthCare was named the Crystal Winner of the 2011 Workplace Excellence Awards from the San Diego Society for Human Resource Management. This designation recognizes Sharp's Human Resources Department as an innovative and valuable asset to overall company performance. In 2013, multiple SHC entities were recognized by the Press Ganey organization for achievement of the Guardian of Excellence Awards in: Employee Engagement (recipients were: SCVMC, SCHHC, SMBHWN, SMV, SRS and SHC); Patient Satisfaction (SMH Sharp Senior Health Centers); and Physician Engagement (SCHHC, SMV). This designation recognizes awardees for having reached the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality performance based on one year of data. In 2013, multiple SHC entities were recognized by the Press Ganey organization for achievement of the Beacon of Excellence Awards in: Employee Engagement (SHC); Patient Satisfaction (SMH); and Physician Engagement (SCHHC and SMV). This designation recognizes awardees for maintaining consistently high levels of excellence in patient satisfaction (based on a three-year period), employee engagement, or physician engagement (the latter two based on the two most recent survey periods). Patient Access to Care Programs Uninsured patients with no ability to pay, and insured patients with inadequate coverage receive financial assistance for medically necessary services through Sharp's Financial Assistance Program. Sharp does not refuse any patient requiring emergency medical care. Sharp provides services to help every unfunded patient received in the ED find coverage options. Patients use a quick, simple online questionnaire through PointCare to generate personalized coverage options that are filed in their account for future reference and accessibility. The results of the questionnaire allow SHC staff to have an informed discussion about coverage options with the patient, empowering the patient with options. By September 2013, Sharp helped guide approximately 56,700 self-pay patients through the maze of government health coverage programs while maintaining the patient's dignity through this program. In addition, Sharp has three hospitals that qualify as covered entities for the 340B Drug Pricing Program administered by the Health Resources and Services Administration (HRSA). Participation in the 340B Drug Pricing Program allows SMH, SCVMC and SGH to purchase outpatient drugs at reduced prices. The savings from this program are utilized to offset patient care costs for the most vulnerable patient populations and assist patients in obtaining access to medications through the Patient Assistance Team. The Patient Assistance Team works hard to help patients in need of assistance gain access to free or low-cost medications. Patients are identified through usage reports, or referred through case management, nursing, physicians or even other patients. If eligible, uninsured patients are offered assistance, which can help decrease readmissions resulting from lack of medication access. The team members research all options available, including programs offered by drug manufacturers, grant-based programs offered by foundations, copay assistance, low-cost alternatives, or research where the patient might find their medication at a lower cost. Sharp also continues to offer ClearBalance a specialized loan program for patients facing high medical bills. Through this collaboration with San Diego-based CSI Financial Services, both insured and uninsured patients have the opportunity to secure small bank loans in order to pay off their medical bills in low monthly payments as low as $25 per month and thus prevent unpaid accounts from going to collections. Through this program, Sharp provides a more affordable alternative for patients that struggle with the ability to resolve their hospital bills. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients receive assistance with transportation and placement; connections to community resources; and financial support for medical equipment, medications, and even outpatient dialysis and nursing home stays.
		Through collaboration with the San Diego Rescue Mission, SCHHC, SGH and SMH discharge their chronically homeless patients to the Rescue Mission's Recuperative Care Unit, where patients not only receive follow-up medical care through Sharp in a safe environment, but also receive psychiatric care, substance abuse counseling and guidance to help get them off the street. Sharp also continued to collaborate with the United Way's Project 25 program to provide financial information that will help the program gauge the effectiveness of its interventions to reduce use of emergent and other front line public resources. Project 25 is a partnership between United Way of San Diego County and the City and County of San Diego with a goal to provide permanent housing (via the San Diego Housing Commission) and supportive services (via the County of San Diego) to at least 25 of San Diego County's chronically homeless, who are often the most frequent users of public resources. Community Health Screenings Sharp's commitment to improving community health extends beyond the walls of its health care facilities, and beginning in FY 2013, Sharp provided free health screenings directly to community members at sites throughout San Diego. Screenings were open to adults over the age of 18, and were completely confidential only community members retained a copy of their results. Throughout the year, Sharp health care professionals offered health screenings for cholesterol, blood sugar, body mass index (BMI), blood pressure and tobacco use. Approximately 50 screening events were held at nearly 20 sites across the County, and thousands of community members received screening results as well as personalized strategies to improve their overall health and well-being. In the upcoming year, Sharp will continue its community health screenings with the goal of screening 5,000 community members throughout San Diego. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community, and Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships, financial aid and career pipeline programs. In FY 2013, there were more than 4,000 student interns within the Sharp system, providing nearly 550,000 hours in disciplines that included nursing, allied health and professional educational programs. Sharp provides education and training programs for students across the continuum of nursing (e.g., critical care, medical/surgical, behavioral health, women's services and wound care) and allied health professions such as rehabilitation therapies (speech, physical, occupational and recreational therapy), pharmacy, respiratory therapy, dietetics, lab, radiology, social work, psychology, business, health information management, and public health. Students from local community colleges such as Grossmont College (GC), San Diego Mesa College (MC), and Southwestern College (SWC); local and national university campuses such as San Diego State University (SDSU), University of California, San Diego (UCSD), University of San Diego (USD), and Point Loma Nazarene University (PLNU); and vocational schools such as Kaplan College (KC) participate in Sharp's health professions training. Table 1 presents the students and student hours at each of the Sharp entities in FY 2013. Table 1: Sharp HealthCare Internships FY 2013 Sharp Chula Vista Medical Center Nursing Students - 837 Nursing Group Hours - 56,252 Nursing Precepted Hours - 21,107 Ancillary Students 165 Ancillary Hours - 39,053 Total Students - 1,002 Total Hours - 116,412 Sharp Coronado Hospital and Healthcare Center Nursing Students - 496 Nursing Group Hours 76,219 Nursing Precepted Hours 2,636 Ancillary Students 110 Ancillary Hours 21,121 Total Students - 606 Total Hours 99,976 Sharp Grossmont Hospital Nursing Students - 565 Nursing Group Hours 38,754 Nursing Precepted Hours 13,570 Ancillary Students 210 Ancillary Hours 48,273 Total Students - 775 Total Hours 100,597 Sharp Mary Birch Hospital for Women & Newborns Nursing Students - 195 Nursing Group Hours 14,420 Nursing Precepted Hours 4,456 Ancillary Students 23 Ancillary Hours 4,864 Total Students - 218 Total Hours 23,740 Sharp Memorial Hospital Nursing Students 393 Nursing Group Hours 28,370 Nursing Precepted Hours 16,462 Ancillary Students 305 Ancillary Hours 56,276 Total Students - 698 Total Hours 101,108 Sharp Mesa Vista Hospital Nursing Students 307 Nursing Group Hours 23,628 Nursing Precepted Hours 3,272 Ancillary Students 26 Ancillary Hours 10,708 Total Students - 333 Total Hours 37,608 Sharp Hospice Care Nursing Students 87 Nursing Group Hours 0 Nursing Precepted Hours 696 Ancillary Students 2 Ancillary Hours 650 Total Students - 89 Total Hours 1,346 Sharp HealthCare Nursing Students 230 Nursing Group Hours 0 Nursing Precepted Hours 35,665 Ancillary Students 132 Ancillary Hours 32,138 Total Students - 362 Total Hours 67,803 Total Nursing Students 3,110 Nursing Group Hours 237,643 Nursing Precepted Hours 97,864 Ancillary Students 973 Ancillary Hours 213,083 Total Students 4,083 Total Hours 548,590 Health Sciences High and Middle College Sharp has teamed up as an industry partner with charter school Health Sciences High and Middle College (HSHMC) to provide students broad exposure to careers available in health care. During FY 2013, more than 330 HSHMC students spent thousands of hours on various Sharp campuses. The collaboration between Sharp and HSHMC prepares high school students to enter health science and medical technology careers in the following five career pathways: biotechnology research and development, diagnostic services, health informatics, support services and therapeutic services. Throughout the school year, supervised HSHMC students rotated through instructional pods in various departments such as nursing, OB/GYN, occupational and physical therapy, behavioral health, Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), imaging, rehabilitation, laboratory, pharmacy, engineering, pulmonary, cardiac services, and operations. The students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development and job/education requirements. HSHMC students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. With the HSHMC program, Sharp links students with health care professionals through job shadowing to explore real world applications of their school-based knowledge and skills. The program began in 2007 with HSHMC students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. HSHMC students also devote time to various SRS sites in San Diego. Lectures and Continuing Education Sharp contributes to the academic environment of many colleges and universities in San Diego. In FY 2013, Sharp staff committed hundreds of hours to the academic community by providing lectures, courses and presentations on numerous college/university campuses throughout San Diego. Through the delivery of a variety of guest lectures, including pharmacy practice lectures, health information technology lectures at MC, clinical nurse specialist education at PLNU, and a variety of health administration lectures to public health graduate students at SDSU, Sharp staff remain active and engaged with San Diego's academic health care community. Sharp's Continuing Medical Education (CME) department assesses, designs, implements and evaluates educational initiatives for Sharp's affiliated physicians, pharmacists and other health care professionals to better serve the health care needs of the San Diego community. In FY 2013, the professionals at Sharp HealthCare CME invested more than 2,200 hours in numerous CME activities open to San Diego health care providers, ranging from conferences on patient safety, readmissions, breast cancer, orthopedics, kidney transplant and diabetes, to presentations on the hospitalist's experience and hospital overcrowding. Research Innovation is critical to the future of health care, and Sharp HealthCare supports this innovation through its commitment to quality research initiatives that are safe and effective, provide valuable knowledge to the San Diego health care community, and positively impact patients and community members. Sharp HealthCare Institutional Review Board
		Sharp HealthCare's Institutional Review Board (IRB) seeks to promote a culture of safety and respect for individuals who choose to participate in research for the greater good of the community. All proposed Sharp entity research studies with human participants are required to be reviewed by the Sharp HealthCare IRB. The purpose of this review is to protect participant safety and maintain responsible research conduct. In FY 2013, a dedicated IRB committee of 12 individuals including physicians, psychologists, research nurses and pharmacists devoted hundreds of hours to the review and analysis of both ongoing and new research studies. The Sharp HealthCare IRB also provides education and guidance for researchers across Sharp as well as in the community. Nurses, pharmacy residents and other members of the health care community receive education on various study-specific requirements regarding the protection of human subjects and HIPAA compliance. Additionally, Sharp HealthCare's Research Department works with the IRB to provide quarterly research meetings (QRM) that are open to physicians, psychologists, research nurses and study coordinators throughout San Diego. Recent presentations have covered topics such as the administration of clinical trials, the use of statistical analysis in assessing test bias, the importance of outcomes-based research and the development of effective research questions. Outcomes Research Institute The Outcomes Research Institute (ORI) at Sharp was formed to measure long-term results of care and to promote and develop best practices of health care delivery for members of the professional health care community. With both inpatient and ambulatory locations and a diverse patient population, Sharp is well-positioned to study care processes and outcomes in a real world setting, reflecting an authentic picture of the health care environment. The ORI collaborates with all Sharp team members interested in optimizing patient care by: facilitating the creation and design of patient-centered outcomes research projects; assisting in database development as well as data collection and analysis; assisting with grant writing and exploring funding mechanisms for research projects; and facilitating IRB application submissions. Among its current and future goals, the ORI aims to ensure patient care produces outcomes consistent with evidence-based medical literature; to analyze the relationships between processes and outcomes for treatments, interventions and quality improvement initiatives; to establish associations between practice, costs and outcomes for patient care; and to develop and disseminate effective approaches to quality care delivery in the health care community. The ORI has completed a number of pilot studies to collect data on optimal sample sizes and variables for expanded research measuring long-term influence of quality interventions on: heart failure readmission, optimal glycemic control in the hospital setting, and inpatient complication rates and length of stay after bowel surgery. Currently the ORI has 12 active studies in various phases of development and analysis. The ORI is committed to educational outreach for Sharp HealthCare's clinicians and the health care community at large, and offers numerous educational presentations about outcomes research and health care research methods to nurses, physicians and the broader community throughout the year. ORI staff have also been invited to present lectures on outcomes research and outcomes research designs to the broader health care community and at regional and national conferences. Additionally, the ORI collaborates with SDC education and research communities to develop and strengthen those connections. The ORI Student Research Intern Program offers advanced nursing and public health students an opportunity to learn about and become involved in outcomes research. Since its inception in 2011, the program has enrolled 11 students (approximately two per semester). The interns learn about outcomes research, and produce presentations that document their research study experience. Furthermore, the ORI has reached out to the academic community to foster partnership for outcomes research. As a result, the ORI currently is in discussion with researchers at National University (NU), SDSU's Cancer Center Comprehensive Partnership, and the Health Research and Educational Trust to develop common themes as the basis for future research collaborations. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows (interprofessional staff) and mentors to change and improve clinical practice and patient care. This change occurs through identifying a care problem, developing a plan to solve it, and then incorporating the new knowledge into practice. The EBPI is part of the Consortium of Nursing Excellence, San Diego, which promotes evidence-based practice in the nursing community. The consortium is a partnership between SCVMC, SGH, SMBHWN, SMH, Scripps Health, Rady Children's Hospital San Diego, UC San Diego Health System, San Diego VA Medical Center and Elizabeth Hospice, as well as PLNU, SDSU, Azusa Pacific University (APU), and USD. In FY 2013, the EBPI consisted of a nine-month program culminating with a community conference and graduation ceremony in November. The project results of all EBPI fellows are shared at the ceremony. EBPI fellows partner with their mentors and participate in a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellow through the process of evidence-based practice. Mentors also assist the fellow in working collaboratively with other key hospital leadership personnel. The San Diego EBPI includes six full-day class sessions that incorporate group activities, as well as self-directed learning programs outside of the classroom, in addition to the structured mentorship provided throughout the program. In FY 2013, 42 fellows graduated from the EBPI program, and completed projects that addressed compelling issues in the health care community, such as: reducing ED recidivism in the homeless and underinsured population, pain reduction in the post-surgical open heart cardiac patients, noise reduction in the Intensive Care Unit (ICU) setting; and early mobilization of mechanically ventilated patients in the ICU setting. Sharp actively participates in the EBPI through the provision of instructors and mentors, as well as administrative coordination. Volunteer Service Sharp Lends a Hand In FY 2013, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH), to further support the San Diego communities it serves. In October, Sharp team members suggested project ideas that: focused on improving the health and well-being of San Diego in a broad, positive way; relied on Sharp for volunteer labor; supported nonprofit initiatives, community activities or other programs that serve the residents of SDC; and could be completed by September 30, 2013. Eleven projects were selected: Stand Down for Homeless Veterans; San Diego Food Bank; Serra Mesa Food Pantry; Feeding America San Diego; Life Rolls On They Will Surf Again; Just in Time for Foster Youth; Helen Woodward Animal Center: Puppy Love 5K Run/Walk; USS Midway Foreign Object Damage Walk-Down; San Diego River Park Foundation Habitat Restoration; San Diego River Park Foundation River Mouth Restoration; and Waste Collection. In support of these projects, more than 1,400 Sharp employees, family members and friends volunteered over 4,600 hours. During eight days in June and July, more than 375 Sharp employees, family members and friends volunteered at Veterans Village of San Diego and San Diego High School. The volunteers sorted and organized clothing donations and provided on-site support, medical services and companionship to hundreds of homeless veterans at Stand Down for Homeless Veterans, an annual event sponsored by Veterans Village of San Diego. The San Diego Food Bank feeds people in need throughout SDC, and advocates and educates the public about hunger-related issues. During ten days in March, April, May, June and August, more than 560 SLAH volunteers inspected and sorted donated food, assembled boxes, and cleaned the San Diego Food Bank warehouse.
		The Serra Mesa Food Pantry was created to provide food to individuals and families who live in the Serra Mesa area and who are experiencing temporary struggles in obtaining basic necessities during illness, unemployment, or other crisis. In April and May, 20 SLAH volunteers participated in the Serra Mesa Food Pantry to help lessen the impact of hunger in our community. Feeding America San Diego is SDC's largest distributor of food and the only Feeding America affiliate in the county. In partnership with more than 160 local school districts, agencies and a network of volunteers, the organization serves 73,000 children, families and seniors in need each week. In June, more than 120 SLAH volunteers joined Feeding America in an effort to create a hunger-free and healthy San Diego. More than 75 SLAH volunteers provided assistance to Life Rolls On They Will Surf Again in September. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by spinal cord injury (SCI) through action sports. The award-winning series of bi-coastal events empowers paraplegics and quadriplegics to experience mobility through surfing, with support from adaptive equipment and volunteers. In June, nearly 20 SLAH volunteers joined Just in Time for Foster Youth, an organization dedicated to helping foster youth achieve self-sufficiency and well-being as they transition into adulthood. Each year, Just in Time volunteers come together to give dozens of transitioning foster youth the resources and encouragement they need to begin a new life chapter as college students. Participating youth connect with potential lifelong mentors and successful Just in Time alumni, receive laptops and printers, learn valuable tips on money management, legal matters and practical purchases, and pair up with a volunteer shopper to buy essential dorm furnishings and school supplies. During two days in February, nearly 30 SLAH volunteers provided support for the Helen Woodward Animal Center's Puppy Love 5K Run/Walk on Highway 101 in Solana Beach, including setting up exhibit booths, assisting with registration and working as route/road marshals. The Helen Woodward Animal Center is a San Diego-based nonprofit organization committed to saving the lives of animals by providing humane care, animal adoption, and other programs and resources for individuals who care for animals. In April, approximately 20 SLAH volunteers helped keep the USS Midway decks clean during the USS Midway Foreign Object Damage Walk-Down, a routine activity on an active aircraft carrier to prevent debris from getting sucked into and damaging the aircraft engines. Founded in 2001, the San Diego River Park Foundation is a community-based grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. The Foundation works with community groups and other organizations dedicated to the San Diego River, the River Park, and its wildlife, recreation, water, cultural and community values. In January and May, nearly 80 SLAH volunteers joined the San Diego River Park Foundation's Habitat and River Mouth Restoration efforts. In support of waste reduction for a healthier environment, 16 SLAH volunteers participated in Sharp HealthCare's Waste Collection event for the community during Earth Week in April. At the event, community members and employees recycled approximately 150 pounds of pharmaceutical waste, 3,250 pounds of electronic waste and 1,200 pounds of shredded paper documents. Volunteers assisted attending collection agencies with set-up, clean-up, traffic control, and guiding event visitors. Sharp Humanitarian Service Program In FY 2013, the Sharp Humanitarian Service Program funded 50 Sharp employees, enabling them to participate in service programs that provide health care or other supportive services to underserved or adversely affected populations, including residents of Haiti, rural Guatemala and other impoverished areas. Sharp employees devoted their time and expertise to a variety of humanitarian organizations, including Camp Beyond the Scars, an effort of the San Diego Burn Institute that has been offered since 1994, and that provides one week of free summer camp in July for approximately 50 children between the ages of 5 and 17 with burn injuries. Another Sharp team member traveled to impoverished communities in India to assess the needs of the Tibetans, which included an interview with the Health Kalon for the Tibetan people living in exile in North India and Nepal. The trip also included time volunteering to provide Math and English lessons at a local school called "Shrestra," which translates to the idea that every child is a container of possibilities. In addition to providing academic lessons, the school serves as a safe haven for these children, providing some nutrition, care, and a refuge from their impoverished living conditions. The experience was not only beneficial for the children, but also inspiring and life-changing for the volunteers. Sharp staff also participated in multiple week-long medical/surgical mission trips to the northwest mountains of Guatemala in FY 2013. This included teams of 60 to 100 individuals consisting of Sharp-affiliated physicians, surgeons, anesthesiologists, nurses, technical staff, therapists, students, chaplains, and many others. Teams participated in this effort in partnership with the Ioamai Medical Ministries and Helps International. Over the course of each trip about ten days the teams provided surgeries under different specialties, such as General Surgery, OB/GYN, Plastics, ENT, Cleft Palate Repair, and Urology. Basic clinic and dentistry services were also available. In addition, a team built stoves in rural houses to keep fires off the floor and reduce burns and smoke inhalation exposure, and other teams provided a water purification unit. In the five days provided as a functioning temporary hospital, teams performed an average of 100 to 150 surgeries and saw 1,000 to 2,000 patients in clinic. The teams served rural and urban populations surrounding the sites at no cost, and in some cases, members of the impoverished mountain community traveled many hours to receive care at the hospital. Sharp also donated numerous supplies and equipment to this life-changing experience for both patients and participants. Community Walks For the past 18 years, Sharp has proudly supported the American Heart Association (AHA) annual San Diego Heart & Stroke Walk. In September 2013, more than 1,000 walkers represented Sharp at the 2013 San Diego Heart & Stroke Walk held at Petco Park in the downtown area. Sharp was the No. 1 team in San Diego and the AHA Western Region Affiliates, raising nearly $205,000. Sharp Volunteers Sharp volunteers are a critical component of Sharp's dedication to the San Diego community. Sharp provides a multitude of volunteer opportunities throughout SDC for individuals to serve the community, meet new people and assist programs ranging from pediatrics to Senior Resource Centers. Volunteers devote their time and compassion to patients as well as to the general public, and are an essential element to many of Sharp's programs, events and initiatives. Sharp volunteers spend their time within hospitals, in the community, and in support of the Sharp HealthCare Foundation, Grossmont Hospital Foundation, and Coronado Hospital Foundation. Sharp employees also donate time as volunteers for the Sharp organization.
		In FY 2013, Sharp HospiceCare provided extensive training for nearly 50 new volunteers in FY 2013. Volunteers underwent a rigorous 32-hour training program to confirm their understanding of and commitment to hospice care prior to serving as part of the hospice interdisciplinary team. Once trained, volunteers devoted their time to both patient care and clerical and administrative support. In addition, Sharp HospiceCare offered its Teen Volunteer Program, training five teenagers in FY 2013. Through the program, teens are assigned special projects in the office or patient assignments at Sharp HospiceCare's LakeView and ParkView homes, including simple acts of kindness such as sitting with patients, listening to their stories, providing grooming and hygiene tasks, and being a comforting presence by just holding their hand. Sharp HospiceCare also hosted a student volunteer from San Diego Metropolitan Regional & Technical High School during FY 2013. The student spent time in both Sharp HospiceCare's administrative office and a Sharp HospiceCare home, and experienced hospice care through case conferences, interdisciplinary team (IDT) meetings and a variety of other tasks. Sharp HospiceCare also coordinates a volunteer-run wig donation program for community members who suffer from hair loss. In FY 2013, Sharp HospiceCare and its volunteers met with 29 individuals and provided approximately 58 wigs, as well as donated wigs to patients at the Douglas and Nancy Barnhart Cancer Center at SCVMC. Volunteers also participated in the Sharp HospiceCare Memory Bear Program to support community members who have lost a loved one. Through the program, volunteers sew teddy bears out of garments of those who have passed on, which serve as special keepsakes and permanent reminders of the grieving family member's loved one. In FY 2013, Sharp HospiceCare volunteers devoted approximately 3,400 hours to handcraft more than 750 bears for more than 260 families. Sharp HospiceCare recognized its volunteers by providing a monthly volunteer support group and acknowledging their valuable contribution during National Volunteer Month and National Hospice Month. At Sharp Metropolitan Medical Campus (SMMC), the volunteer-run Arts for Healing program was established to improve the spiritual and emotional health of patients that face significant medical challenges by utilizing the power of art and music to enhance the healing process. The program provides services at SMH, SMH Outpatient Pavilion (OPP), SMBHWN, SMV and SMC. Since the inception of the program in 2007, more than 36,000 patients and their families, guests and staff have benefitted from the time and talent provided by Arts for Healing staff and volunteers. Trained volunteers are the primary providers of the program, which is coordinated by a chaplain of the Spiritual Care program. In FY 2013, 50 volunteers, including several students from PLNU and San Diego Mesa College (MC), supported Arts for Healing by facilitating art activities for patients and their loved ones. In FY 2013, nearly 3,400 individuals volunteered for various programs across the Sharp system, contributing more than 247,000 hours of their time in service to Sharp and its initiatives. This includes more than 930 auxiliary members and thousands more individual volunteers from the San Diego community. More than 9,800 of these hours were provided externally to the community through activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the number of individual volunteers and the hours provided in service to each of Sharp's entities, specifically for patient and community support. Volunteers also spent additional hours supporting Sharp's three foundations for events like the Grossmont Hospital Foundation's annual Golf Tournament; galas held for SCHHC and SGH, and other events in support of Sharp entities and services. Table 2: Sharp Individual Volunteers and Volunteer Hours FY 2013 Sharp Chula Vista Medical Center Number of Individual Volunteers 368 Volunteer Hours - 4,935 Sharp Coronado Hospital and Healthcare Center Number of Individual Volunteers 132 Volunteer Hours 8,394 Sharp Grossmont Hospital Number of Individual Volunteers 738 Volunteer Hours 112,309 Sharp HospiceCare Number of Individual Volunteers 146 Volunteer Hours 12,356 Sharp Metropolitan Medical Campus Number of Individual Volunteers 1,862 Volunteer Hours 100,733 TOTAL Number of Individual Volunteers 3,246 Volunteer Hours 238,727 Sharp employees also volunteer their time for the Cabrillo Credit Union Sharp Division Board, the Sharp and Children's MRI Board, the UCSD Medical Center/Sharp Bone Marrow Transplant Program Board, Grossmont Imaging LLC Board, and the SCVMC San Diego Imaging (SDi) Center. Volunteers on Sharp's auxiliary boards and the various Sharp entity Boards volunteer their time to provide program oversight, administration and decision making regarding financial resources. In FY 2013, 138 community members contributed their time to Sharp's boards. Other Sharp Volunteer Efforts In FY 2013, Sharp staff volunteered their time and passion to a number of unique initiatives, underscoring Sharp's commitment to the health and welfare of San Diegans. Below are just a few examples of how Sharp employees gave of themselves to the San Diego community. SGH's Engineering Department participated in a number of initiatives in FY 2013, including the This Bud's for You program. The program brought comfort to unsuspecting patients and their loved ones with the delivery of hand-picked flowers from the medical campus's abundant gardens. The SGH landscape team grew, cut, bundled and delivered colorful bouquets each week, bringing an element of natural beauty to patients and visitors of both the hospital and Sharp's hospice homes. The team also regularly offered single-stem roses in a small bud vase to passers-by. In its third year, This Bud's for You has become a natural part of the landscape team's day, an act that is simply part of what they do to enhance the experience of visitors to the hospital. SGH also continued to provide the Shirt Off Our Backs program during the 2012 holiday season. Also in its third year, this program brought clothing, shoes, blankets and household items directly to San Diego's homeless population. The SGH landscape team and Engineering Department, the SGH Auxiliary and local businesses collaborated to implement the program, while SGH's Waste Management team provided ancillary support with loaner recycle bins to use for collection. Hundreds of pounds of clothing, shoes, towels, blankets, toiletries and other items that could be put to use immediately were collected, washed, folded, boxed/bagged and prepared for delivery to the San Diego population in need. This year three pickup trucks were required to deliver the collected items. The efforts provided food and comfort to all who expressed need ranging from small children to adults of all sizes. The SGH Engineering Department also participated in the Food Bank's Food 4 Kids Backpack program in FY 2013. The goal of the program is to provide a backpack full of child-friendly, shelf-stable food for elementary school children who receive a free meal at school, but are suffering from hunger over the weekends when little or no food is available. The objective of the program is to alleviate hunger, improve school performance, improve health and provide additional information to parents about other local community services. Through hospital-wide support at SGH, approximately 2,000 pounds of food were collected, filling more than 200 backpacks for chronically hungry elementary school students. All Ways Green Initiative
		As San Diego's largest private employer, Sharp recognizes that the health of its patients, employees and the community is directly tied to the health of their environment. Sharp promotes a culture of environmental responsibility by providing education and outreach to employees to improve their health and the health of those they serve. Sharp created its All Ways Green logo to brand its environmental activities and communicate sustainable activities throughout Sharp and the San Diego community. Sharp's systemwide All Ways Green Committee is charged with evaluating opportunities and recognizing best practices in seven distinct areas: (1) energy efficiency, (2) alternative energy generation, (3) water conservation, (4) waste minimization, (5) cleaner means of transportation, (6) green building design, and (7) sustainable food practices. Established Green Teams at each entity are responsible for developing new programs that educate Sharp employees to conserve natural resources and reduce, reuse and recycle. Sharp has also partnered with its vendors and other organizations in the community to develop new programs and initiatives to help achieve its environmental goals. Sharp's Environmental Policy serves to affirm its commitment to improving the health of the environment and therefore the communities it serves. According to the US Environmental Protection Agency (EPA), inpatient hospital facilities are the second-most energy-intensive industry after food service and sales, with energy utilization rates 2.7 times greater than that of office buildings on a square-foot basis. Unlike other industries, hospitals must operate 24 hours a day, seven days a week, and must provide service during power outages, natural disasters and other emergencies. Given this reality, Sharp has embarked on several green initiatives to enhance energy efficiency, including: retro-commissioning of heating, ventilation and air conditioning (HVAC) systems; lighting retrofits; pipe insulations; infrastructure control initiatives; occupancy sensor installation; energy audits; energy-efficient motor and pump replacements; equipment modernization; and development of a Sharp HealthCare Energy Guideline to help manage energy utilization practices throughout the system. In FY 2013, Sharp underwent a significant lighting retrofit project that resulted in energy savings of more than 1.7 million kilowatt hours, and decreased carbon dioxide production by nearly 1,305 tons that year. Furthermore, Sharp was awarded a Certificate of Recognition from the EPA for instituting a power management program on more than 10,000 computers within the system in May. This effort enables computers and monitors to go into a low-power sleep mode after a period of inactivity, and has the potential for an annual savings of up to $50.00 per computer by conserving unnecessary electricity. All Sharp entities participate in the EPA's Energy Star (ES) database and monitor their ES scores on a monthly basis. ES is an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide, without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification in 2009, 2010, 2011 and 2013. In addition, Sharp's new SRS Downtown medical office building is the first Leadership in Energy and Environmental Design (LEED) gold-certified medical office building in San Diego. According to the EPA, hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the US. In an effort to conserve water, Sharp has researched and implemented numerous infrastructure changes and best practices to ensure Sharp's facilities are optimally operated while monitoring and measuring water consumption, including: installation of motion-sensing faucets and toilets in public restrooms; low-flow showerheads and toilets in patient rooms and locker rooms; drip irrigation systems; mist eliminators; micro-fiber mops; water-saving devices and equipment; water monitoring and control systems; water practice and utilization evaluations; regular rounding to identify leaks; reduced landscape watering times; hardscaping; and redesigning areas with low-water plant species. The EPA and Hospitals for a Healthy Environment report that each patient generates approximately 15 pounds of waste each day, while US medical centers generate approximately two million tons of waste each year. Sharp has implemented a comprehensive waste minimization program to significantly reduce the waste generated at each entity, including single-stream recycling; reprocessing of surgical instruments; use of reusable sharps and pharmaceutical waste containers; hard-sided surgical cases to reduce blue wrap used during the instrument sterilization process; use of recyclable paper for printing brochures, newsletters and other marketing materials; electronic patient bills and paperless payroll; recycling of exam table paper; repurposing of supplies, equipment and furniture; encouragement of reduced paper use at meetings through electronic correspondence; and use of one-at-a-time paper napkin and plastic cutlery dispensers. To reduce their carbon footprint, Sharp's primary office supply vendor, Office Depot, created the GreenerOffice Delivery Service in which they replaced its small and mid-sized cardboard boxes with paper bags composed of 40 percent post-consumer recycled material. The paper bags are protected during shipping by reusable plastic totes, which are returned to Office Depot for reuse. Sharp was an early adopter of the program in an effort to make their delivery requests more environmentally friendly. Sharp's participation in this program will result in an estimated annual reduction of 22,000 less pounds of wood, 24,000 pounds of CO2, 82,000 gallons of wastewater and 8,000 pounds of solid waste. Furthermore, Office Depot and Sharp have arranged for 30 percent recycled copy paper to be used at all Sharp entities. In April, Sharp was named Recycler of the Year at the City of San Diego's 21st annual Waste Reduction and Recycling Award program for SMH and SMBHWN. Also in April, Sharp held its fourth-annual systemwide All Ways Green Earth Week event, including Earth Fairs at each of the Sharp entities. During the fairs, employees learned how they can contribute to recycling, waste minimization, healthy eating practices and other sustainability efforts. Many of Sharp's key vendor partners participated in the Earth Fairs to help raise awareness of green initiatives and how they involve Sharp. During Earth Week Sharp hosted a free community waste collection event at their corporate office location where community members and employees recycled approximately 150 pounds of pharmaceutical waste, 3,250 pounds of electronic waste and 1,200 pounds of shredded paper documents. Throughout FY 2013 Sharp continued its recycling efforts with the Lion's Club Recycle Sight program, through which employees recycle their personal eyeglasses and sunglasses by donating them to people in need both locally and globally. On average, Sharp employees donated approximately 250 pairs of glasses through the program in FY 2013. Sharp also recognizes America Recycles Day each November through a systemwide electronic announcement highlighting Sharp's recycling efforts and accomplishments, and offering reminders for proper workplace recycling.
		The impact of Sharp's waste reduction programs has been significant. In FY 2013, Sharp facilities diverted over 7.6 million pounds of paper, cardboard, glass, metals, polystyrene, batteries, ink and toner, medical equipment and electronic waste from local landfills. This included, but was not limited to 36,827 pounds of waste diverted through utilization of reusable sharps and pharmaceutical waste containers at SCHHC and SMMC, as well as systemwide recycling of 210,694 pounds of hazardous and universal waste (e.g., batteries, solvents and fluorescent light bulbs), and 37,246 pounds of waste diverted through surgical device reprocessing. Table 3 presents the quantity of waste diversion at Sharp shown as pounds (lbs.) diverted. In the coming year, Sharp aims to reduce its waste generation by two percent, or approximately 430,000 pounds. Table 3: Sharp HealthCare Waste Diversion FY 2013 Sharp Chula Vista Medical Center Recycled Waste Per Year (lbs.) 713,872 Total Waste Per Year (lbs.) 2,513,406 Percent Recycled 28% Sharp Coronado Hospital and Healthcare Center Recycled Waste Per Year (lbs.) 229,586 Total Waste Per Year (lbs.) 1,307,361 Percent Recycled 18% Sharp Grossmont Hospital Recycled Waste Per Year (lbs.) 1,617,209 Total Waste Per Year (lbs.) 4,887,676 Percent Recycled 33% Sharp Metropolitan Medical Campus Recycled Waste Per Year (lbs.) 2,335,655 Total Waste Per Year (lbs.) 6,814,358 Percent Recycled 34% Total Sharp HealthCare Recycled Waste Per Year (lbs.) 7,649,727 Total Waste Per Year (lbs.) 20,580,271 Percent Recycled 37% Total Sharp HealthCare includes all Sharp System Services and Sharp Rees-Stealy Sharp implements sustainable food practices throughout the system, including removal of styrofoam from cafeterias; use of green-label kitchen soaps and cleansers; electronic cafe menus; recycling of all cardboard, cans and grease from cafes; and partnering with vendors who are committed to reducing product packaging. Other sustainable food practices include organic markets at each of Sharp's hospitals and corporate office; Meatless Mondays, purchasing of hormone-free milk; and increased purchasing of locally grown fruits and vegetables, approaching 65 percent at some entities. Both SMH and SCHHC have also created the first County-approved organic gardens with produce to be used at employee cafes. Since 2012, SMH and SMBHWN have partnered with the City of San Diego to implement a Food Waste Composting Program, making Sharp the first San Diego health care organization to join the city's initiative. Through this program, food waste is picked up weekly by EDCO, a solid waste vendor, for transport to the Miramar Greenery, a 74-acre facility located at the Miramar Landfill in Kearny Mesa. The composted rich soil is sold to commercial landscapers and non-city residents, and provided at no charge to city residents at volumes of up to two cubic yards. According to the City of San Diego, such waste diversion programs contribute to the landfill's lifespan being extended from 2012 to at least 2022. Sharp continues to work with the City to expand food waste composting to other Sharp entities. Ride sharing, public transit programs and other transportation efforts contribute to the reduction of Sharp's transportation emissions. Sharp uses centralized patient scheduling to improve patient vanpools, and has replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, saving approximately five miles per gallon. Sharp also ensures carpool parking spaces, designated bike racks and motorcycle spaces are available at each employee parking lot, as well as offers discounted monthly bus passes for purchase by employees. Throughout the year, Sharp's Commuter Solutions Sub-Committee works to develop new programs and marketing campaigns to educate employees on the benefits of ride sharing to further reduce the number of cars on the road. In partnership with the San Diego Association of Governments (SANDAG), a vanpool and carpool match-up program exists at Sharp to help employees find convenient ride share partners. Sharp employees also utilize SANDAG's online iCommute TripTracker tool to monitor the cost and carbon savings of their alternate methods of commuting. In FY 2013, Sharp employees saved more than two million miles and reduced more than 1,383,000 pounds of carbon dioxide through carpooling, vanpooling, biking, walking, telecommuting and the use of public transportation. Through these efforts, Sharp achieved second place in the Mega Employer category through the SANDAG Rideshare 2013 Corporate Challenge. In March, Sharp was the only health care organization in SDC to be named an All-Star Award winner in SANDAG's 2013 Diamond Award program, which recognizes participants in SANDAG's iCommute program for their outstanding contributions to reducing traffic congestion and greenhouse gases in SDC. Sharp furthered its support of green transportation through several bike to work initiatives in FY 2013. In October, nearly 130 Sharp employees pedaled to work for Sharp HealthCare's first Bike to Work Day, while in May, Sharp encouraged employees to ride their bikes to work in recognition of National Bike to Work Day. In fact, Sharp participated in the 4th annual iCommute Bike to Work 2013 Corporate Challenge for the entire month of May (National Bike Month), competing with similar-sized organizations for the highest percentage of bike ridership for the month. In June, Sharp also promoted National Dump the Pump Day to employees by sharing special Dump the Pump Day promotions from iCommute, such as vanpool discounts and gift card drawings, for individuals who pledged to "Dump the Pump" and make green transportation choices. As part of the nationwide Electric Vehicle Project, Sharp has installed electric vehicle chargers (EVCs) at its corporate office location and SMMC. Sharp is the first health care system in San Diego to offer EVCs, supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on foreign oil. Sharp will continue its efforts to expand EVCs at other entities. In FY 2013, Sharp hosted two community workshops to share its waste minimization best practices. SMH and SMBHWN partnered with the City of San Diego to host a workshop for local companies to learn about the hospitals' food waste composting experiences and exploring composting at their own organizations. Sharp also partnered with SDC to host a complimentary community workshop on proper disposal of pharmaceuticals, including pharmaceutical waste liability, regulatory compliance and cost effective disposal strategies. Participants included hospital and pharmacy personnel, and medical providers who handle pharmaceuticals. Sharp's waste minimization initiatives have been recognized by several publications, including BioCycle, a national magazine about composting, renewable energy and sustainability; San Diego Business Journal; and by the California State CalRecycle website, which cited Sharp HealthCare as one California's models for health care industry food scraps management. Table 4 below highlights the All Ways Green efforts at Sharp entities. Going forward, Sharp remains committed to the All Ways Green initiative and will continue to investigate opportunities to reduce its carbon footprint. Sharp's All Ways Green Committee continues to work with system employees, physicians and corporate partners to develop new and creative ways to reduce Sharp's impact on the environment and meet their goal of being an outstanding community citizen through environmental responsibility. Table 4: All Ways Green Initiatives by Sharp Entity FY 2013 SCHHC Energy Efficiency - Update elevators/chillers - Energy audits - Energy-efficient chillers/motors - Energy Star Award HVAC projects - Lighting retrofits Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Reusable sharp containers - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market
		- Organic gardens - Recycling education - Ride share promotion SCVMC Energy Efficiency - Energy audits - Energy-efficient chillers/motors - Energy Star participation and award eligible - HVAC projects - Lighting retrofits Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Compactor renovation - Electronic cafe menus - Single-stream recycling - Surgical instrument reprocessing Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion SGH Energy Efficiency - Energy audits - Energy Star participation - HVAC projects - Lighting retrofits - Retro-commissioning Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Electronic cafe menus - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Surgical instrument reprocessing Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion Sharp System Services Energy Efficiency - Electric vehicle chargers - Energy audits - Energy efficient chillers/motors - Energy Star participation - HVAC projects - Lighting retrofits - Occupancy sensors - Thermostat control software Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Electronic patient bills and paperless payroll - Electronic and pharmaceutical waste recycling events - Green Grocer's market - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion SHP Energy Efficiency - Energy audits - HVAC projects - Lighting retrofits - Occupancy sensors Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Education and Outreach - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Spring cleaning events - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion SMH/SMBHWN Energy Efficiency - Electric vehicle chargers - Energy audits - Energy-efficient chillers/motors - Energy Star participation - HVAC projects - Lighting retrofits - Occupancy sensors - Pipe insulations Water Conservation Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Electronic cafe menus - Food waste composting - Single-serve paper napkin and plastic cutlery dispensers - Reusable sharp waste containers - Single-stream recycling - Surgical instrument reprocessing Education and Outreach - Drought tolerant rooftop garden - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Organic gardens - Recycling education - Ride share promotion SMV/ SMC Energy Efficiency - Energy audits - Energy Star participation - HVAC projects - Lighting retrofits - Motor and pump replacements Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Styrofoam elimination - Surgical instrument reprocessing Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion SRS Energy Efficiency - Energy audits - Energy Star participation - Lighting retrofits Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Low-flow systems - Mist eliminators Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Recycling of exam paper - Single-stream recycling - Styrofoam elimination *Education and Outreach - Contractor education - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion Emergency and Disaster Preparedness Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. Throughout FY 2013, Sharp provided education to community members, staff and other health care professionals on emergency and disaster preparedness. Sharp's disaster preparedness team offered several disaster education courses to first responders, health care providers and community members across SDC. The Hospital-Based First Receiver Awareness Course and First Receiver Operations Course were offered as a two-part series to educate and prepare hospital staff for a decontamination event. Course topics included decontamination principles and best practices, basic hazards, utilization of appropriate Personal Protective Equipment (PPE), response concepts, containment, decontamination and recovery. A standardized, on-scene federal emergency management training for hospital management entitled, NIMS (National Incident Management System)/ ICS (Incident Command System)/ HICS (Hospital Incident Command System), was also offered by Sharp's disaster team, as well as a START (Simple Triage and Rapid Treatment) Triage/ Jump START Triage class to train emergency responders at all levels to triage a large volume of trauma victims within a short period of time. Sharp's disaster team also led a Pediatric/Burn Surge course to train hospital staff, health care providers and other emergency responders to effectively manage specific patient populations during a surge or abnormal event. In October 2012, Sharp's disaster preparedness team hosted a Domestic Chemical All-Hazards Conference for approximately 90 community health care and emergency preparedness professionals. The conference included a key note speaker from San Diego's Hazardous Materials (HAZMAT) Team, as well as presentations including Current Trends in Hazardous Material Response, Chemical Suicide, Chemical Agents Review, and Personal Readiness During Chemical Events. That same month, Sharp's disaster leadership presented at a statewide conference of more than 900 hospital staff, state and local officials, and key preparedness and response partners at the California Hospital Association's (CHA) eighth annual Disaster Planning for California Hospitals Conference in Sacramento, Calif. Presentations aimed at helping hospitals strengthen their disaster planning efforts, and included Business Continuity Planning Tips, Tools and Implementation, and Continuing Care During Loss of Power. In FY 2013, Sharp's disaster leadership donated their time to state and local organizations and committees, including Southern California Earthquake Alliance, County of San Diego Emergency Medical Care Committee (EMCC), San Diego Disaster Committee, and the County of San Diego Healthcare Disaster Council, a group of representatives from SDC hospitals, other health care delivery agencies, county officials, fire agencies, law enforcement, American Red Cross and others who meet monthly to share best practices for emergency preparedness. In addition, Sharp's disaster leadership served on the Statewide Medical Health Exercise work group that designed training materials, including an exercise guidebook and other resources, for the 2013 California Statewide Medical Health Training and Exercise Program through the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA). The program is designed to guide local
		emergency planners in developing,planning and conducting emergency responses. Furthermore, Sharp disaster leadership is part of the San Diego Patient Tracking Committee, which is designing a Family Assistance Center (FAC) for the county in an effort to aid community members in finding their loved ones during a disaster event. Sharp supports safety efforts of the state and the City of San Diego through maintenance and storage of a county decontamination trailer at SGH, to be used in response to a mass decontamination event. In addition, Sharp stores and maintains 24 state hospital ventilators at three of its hospitals, and is exploring opportunities to join the EMSA Mobile Field Hospital (MFH) program to provide maintenance and storage for a state MFH. The MFH is designed to increase disaster preparedness by rapidly responding to emergencies such as earthquakes, fires and floods that impact hospital surge needs. Within 72 hours of an emergency, the MFH can provide up to 600 acute care hospital beds for patient treatment and transport anywhere in the state. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event the system's normal water supply is interrupted. As part of its participation in the US Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership (the Partnership). The Partnership includes SCVMC, SCHHC, SGH, SMH, SRS Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital, Kaiser Hospital, Alvarado Hospital, Paradise Valley Hospital, the Council of Community Clinics, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriffs, MCAS Miramar Fire Department and Fresenius Medical Centers. The Partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. Through networking, planning, and the sharing of resources, trainings and information, the partners will be better prepared for a collaborative response to an emergency or disaster affecting SDC. In FY 2013, the Partnership drafted a SDC NICU Evacuation Plan to guide health care providers in the safe evacuation of the neonatal patient population during a disaster. Next, the Partnership will begin drafting a similar evacuation plan for the maternal and newborn patient population. In FY 2014, Sharp will host a Household Disaster Preparedness Expo to educate San Diego community members on effective disaster preparedness and response in the event of an earthquake, fire, power outage, or other emergency. The expo will include a variety of local disaster vendors and emergency personnel, and include valuable disaster education and emergency demonstrations. Sharp also plans to collaborate with other SDC hospitals to create regional decontamination teams of health care personnel trained to respond to a community decontamination event. Internally, Sharp plans to develop employee disaster teams who will be trained to provide leadership, order and safety during an emergency or disaster. Section 2 Executive Summary This Executive Summary provides an overview of community benefits planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefits Report, and a summary of community benefits programs and services provided by Sharp in Fiscal Year (FY) 2013 (October 1, 2012, through September 30, 2013). In addition, the summary reports the economic value of community benefits provided by Sharp, according to the framework specifically identified in SB 697, for the following entities: * Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp HospiceCare * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefits Planning at Sharp HealthCare Sharp bases its community benefits planning on its triennial community health needs assessments (CHNA) combined with the expertise in programs and services of each Sharp hospital. Listing of Community Needs Addressed in this Community Benefits Report The following community needs are addressed by one or more Sharp hospitals in this Community Benefits Report: * Access to care for individuals without a medical provider, and support for high-risk, underserved and underfunded patients * Education and screening programs on health conditions such as heart and vascular disease, stroke, cancer, diabetes, preterm delivery, unintentional injuries and behavioral health * Health education and screening activities for seniors * Special support services for hospice patients and their loved ones, and for the community * Support of community nonprofit health organizations * Education and training of health care professionals * Collaboration with local schools to promote interest in health care careers * Welfare of seniors and disabled people * Cancer education, patient navigator services, and participation in clinical trials * Women's and prenatal health services and education * Meeting the needs of new mothers and their loved ones * Mental health and substance abuse education for the community Highlights of Community Benefits Provided by Sharp in FY 2013 The following are examples of community benefits programs and services provided by Sharp hospitals and entities in FY 2013. * Unreimbursed Medical Care Services included uncompensated care for patients who are unable to pay for services, and the unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services, Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and TRICARE the regionally managed health care program for active-duty and retired members of the uniformed services, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. This also included financial support for on-site workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; financial and other support to community clinics to assist in providing health services, and improving access to health services; Project HELP; Project CARE; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank; financial and other support to the Sharp Humanitarian Service Program; and other assistance for the needy. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community, as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers; made Sharp facilities available for use by community groups at no charge; and executive leadership and staff actively participated in numerous community organizations, committees and coalitions to improve the health of the community. See Appendix A for a listing of Sharp's involvement in community organizations. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care professionals, as well as student and intern supervision and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Economic Value of Community Benefits Provided in FY 2013 In FY 2013, Sharp provided a total of $331,338,317 in community benefit programs and services that were unreimbursed. Table 1 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Total Economic Value of Community Benefits Provided Sharp HealthCare Overall FY 2013 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2013 Unreimbursed Costs
		Medical Care Services Shortfall in Medi-Cal $78,779,825 Shortfall in Medicare $144,932,844 Shortfall in San Diego County Indigent Medical Services $37,738,890 Shortfall in CHAMPVA/TRICARE $4,374,145 Shortfall in Workers' Compensation $228,311 Charity Care and Bad Debt $54,315,585 Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $2,336,152 Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events $2,019,316 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $6,613,249 TOTAL $331,338,317 Table 2 shows a listing of these unreimbursed costs provided by each Sharp entity. Table 2: Total Economic Value of Community Benefits Provided By Sharp HealthCare Entities FY 2013 Estimated FY 2013 Unreimbursed Costs Sharp Chula Vista Medical Center $58,068,422 Sharp Coronado Hospital and Healthcare Center $12,816,465 Sharp Grossmont Hospital $91,752,299 Sharp Mary Birch Hospital for Women & Newborns $16,555,900 Sharp Memorial Hospital $142,526,818 Sharp Mesa Vista Hospital and Sharp McDonald Center $9,506,932 Sharp Health Plan $111,481 ALL ENTITIES $331,338,317 Table 3 includes a summary of unreimbursed costs for each Sharp entity based on the categories specifically identified in SB 697. In FY 2012, Sharp lead the community in unreimbursed medical care services among San Diego County's SB 697 hospitals and health care systems. Table 3: FY 2013 Detailed Economic Value of Community Benefits at Sharp HealthCare Entities Based on Senate Bill 697 Categories Sharp Chula Vista Medical Center Medical Care Services - $55,459,890 Other Benefits for Vulnerable Populations - $298,638 Other Benefits for the Broader Community - $357,808 Health Research, Education and Training Programs - $1,952,086 Estimated FY 2013 Unreimbursed Costs - $58,068,422 Sharp Coronado Hospital and Healthcare Center Medical Care Services - $11,632,883 Other Benefits for Vulnerable Populations - $45,919 Other Benefits for the Broader Community - $73,897 Health Research, Education and Training Programs - $1,063,766 Estimated FY 2013 Unreimbursed Costs - $12,816,465 Sharp Grossmont Hospital Medical Care Services - $89,362,696 Other Benefits for Vulnerable Populations - $714,579 Other Benefits for the Broader Community - $675,348 Health Research, Education and Training Programs - $999,676 Estimated FY 2013 Unreimbursed Costs - $91,752,299 Sharp Mary Birch Hospital for Women & Newborns Medical Care Services - $16,080,737 Other Benefits for Vulnerable Populations - $43,972 Other Benefits for the Broader Community - $130,528 Health Research, Education and Training Programs - $300,663 Estimated FY 2013 Unreimbursed Costs - $16,555,900 Sharp Memorial Hospital Medical Care Services - $139,240,414 Other Benefits for Vulnerable Populations - $742,030 Other Benefits for the Broader Community - $563,455 Health Research, Education and Training Programs - $1,980,919 Estimated FY 2013 Unreimbursed Costs - $142,526,818 Sharp Mesa Vista Hospital and Sharp McDonald Center Medical Care Services - $8,592,980 Other Benefits for Vulnerable Populations - $484,130 Other Benefits for the Broader Community - $113,683 Health Research, Education and Training Programs - $316,139 Estimated FY 2013 Unreimbursed Costs - $9,506,932 Sharp Health Plan Medical Care Services - $0 Other Benefits for Vulnerable Populations - $6,884 Other Benefits for the Broader Community - $104,597 Health Research, Education and Training Programs - $0 Estimated FY 2013 Unreimbursed Costs - $111,481 ALL ENTITIES Medical Care Services - $320,369,600 Other Benefits for Vulnerable Populations - $2,336,152 Other Benefits for the Broader Community - $2,019,316 Health Research, Education and Training Programs - $6,613,249 Estimated FY 2013 Unreimbursed Costs - $331,338,317 Section 3 Community Benefits Planning Process For the past 17 years, Sharp HealthCare (Sharp or SHC) has based its community benefits planning on findings from a triennial Community Health Needs Assessment (CHNA) process, as well as the combination of expertise in programs and services of each Sharp hospital and knowledge of the populations and communities served by those hospitals. Methodology to Conduct the 2013 Sharp HealthCare Community Health Needs Assessments Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations, and community agencies to conduct a triennial CHNA. Findings from the CHNA, the program and services expertise of each Sharp hospital, and knowledge of the populations and communities served by those hospitals combine to provide a foundation for community benefits planning and program implementation. To address the new requirements under Section 501(r) within Section 9007 of the Affordable Care Act, and IRS Form 990, Schedule H for not-for-profit hospitals, San Diego County (SDC) hospitals engaged in a new, collaborative CHNA process. This process gathered both salient hospital data and the perspectives of community health leaders and residents in order to identify and prioritize health needs for community members across the county, with a particular focus on vulnerable populations. Additionally, the process aimed to highlight health issues that hospitals could impact through programs, services and collaboration. In this endeavor, Sharp collaborated with the Hospital Association of San Diego and Imperial Counties (HASD&IC), the Institute for Public Health (IPH) at San Diego State University (SDSU), and SDC hospital systems including: Kaiser Foundation Hospital, San Diego; Palomar Health; Rady Children's Hospital; Scripps Health; Tri-City Medical Center and UC San Diego Health System. The complete report of this collaborative process the HASD&IC 2013 CHNA is available for public viewing at http://www.hasdic.org. The results of this collaborative CHNA process significantly informed the 2013 CHNAs for each Sharp hospital, and individual hospital assessments were further supported by additional data collection and analysis and community outreach specific to the primary communities served by each Sharp hospital. Additionally, in accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2013 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns (SMBHWN), as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2013 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2013 CHNAs for each Sharp hospital will guide current and future community benefit programs and services, especially for high-need community members. This section describes the general methodology employed for each of Sharp HealthCare's 2013 CHNAs. Data Collection and Analysis As the study area for both the collaborative HASD&IC 2013 CHNA and the Sharp 2013 CHNAs cover SDC, the HASD&IC 2013 CHNA process and findings significantly informed Sharp's CHNA process and as such, are described as applicable throughout the various CHNA reports. For complete details on the HASD&IC 2013 CHNA process, please visit the HASD&IC website at: http://www.hasdic.org. For the HASD&IC 2013 CHNA process, 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 SDC. These health needs were prioritized based on the following criteria: * Has a significant prevalence in the community * Contributes significantly to the morbidity and mortality in SDC * Disproportionately impacts vulnerable communities * Reflects a need that exists throughout SDC * Can be addressed through evidence-based practices by hospitals and health care systems Quantitative data (secondary sources) for both the HASD&IC 2013 CHNA and the individual Sharp hospital CHNAs included 2011 calendar year hospital discharge data at the ZIP code level, health statistics from the San Diego County Health and Human Services Agency (HHSA), the US Census Bureau, the Centers for Disease Control and Prevention, and others. The variables analyzed are included in Table 1 below, and were analyzed at the ZIP code level wherever possible: Table 1: Variables Analyzed in the HASD&IC and Sharp HealthCare 2013 CHNAs
		Secondary Data Variables - Inpatient Hospitalizations by Cause - Emergency Department Visits by Cause - Demographic Data (socio-economic indicators) - Mortality Data - Regional Disease-Specific Health Data (County HHSA) - Self-Reported Health Data (California Health Interview Survey) - Specialized Health Data /Reports (various) Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC's 2013 CHNA and Sharp's 2013 CHNA processes utilized the Dignity Health/Truven Community Need Index (CNI) to identify communities in SDC with the highest level of health disparities and needs. Residents in five of these high-need neighborhoods across SDC were asked to provide input in a community forum setting. For the HASD&IC 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across SDC, reaching a total of 106 community residents. In addition, IPH conducted five key informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers, and members of community-based organizations. Following consultation with the CHNA Planning Teams at each Sharp hospital, additional, specific feedback from additional key informants and community residents was also collected. Community members were asked for open-ended feedback on the health issues of greatest importance to them, as well as any significant barriers they face in maintaining health and well-being. Findings Through the combined analyses of the results for all the data and information gathered, the following conditions were identified as priority health needs for the primary communities served by Sharp hospitals (listed in alphabetical order): Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type II * High-Risk Pregnancy * Obesity * Orthopedics * Senior Health (including end-of-life care) As the CHNAs were hospital-specific, not all of Sharp's hospitals identified all of the above priority health needs through their CHNA process, given the specific services the individual hospitals provide to the community. For instance, Sharp Mesa Vista Hospital, the largest provider of mental health, chemical dependency and substance abuse treatment in SDC, identified behavioral health as a priority health need for the community members it serves, however it did not identify other needs such as cancer, high-risk pregnancy, etc. In addition, as part of the collaborative CHNA process, the IPH conducted a content analysis of all qualitative feedback collected through the HASD&IC 2013 CHNA process key informants, online survey respondents and community members and found that the input fell into one of the following five categories: * Access to Care or Insurance * Care Management * Education * Screening Services * Collaboration Sharp is committed to the health and well-being of the community, and the findings of Sharp's 2013 CHNAs will help to inform the activities and services provided by Sharp to improve the health of the community members it serves. The 2013 CHNA process also generated a list of currently existing resources in SDC, an asset map, that address the health needs identified through the CHNA process. While not an exhaustive list of the available resources in San Diego, this map will serve as a resource for Sharp to help continue, refine and create programs that meet the needs of their most vulnerable community members. With the challenging and uncertain future of health care, there are many factors to consider in the development of programs to best serve members of the San Diego community. The health conditions and health issues identified in this CHNA, including, but not limited to health care and insurance access and education and information for all community members, will not be resolved with a quick fix. On the contrary, these resolutions will be a journey requiring time, persistence, collaboration and innovation. It is a journey that the entire Sharp system is committed to making, and Sharp remains steadfastly dedicated to the care and improvement of health and well-being for all San Diegans. The 2013 CHNAs for each Sharp hospital are available online at http://www.sharp.com/about/community/community-health-needs-assessments or by contacting Sharp HealthCare Community Benefits at communitybenefits@sharp.com. Determination of Priority Community Needs: Sharp HealthCare Sharp entities reviewed their 2013 CHNAs and used these assessments to help determine priority needs for the communities served by their hospitals. In identifying these priorities, Sharp entities also considered the expertise and mission of its programs and services, in addition to the needs of the unique, ever-changing demographics and health topics that comprise Sharp's service area and region. Steps Completed to Prepare an Annual Community Benefits Report On an annual basis, each Sharp hospital performs the following steps in preparation of its Community Benefits Report: * Establishes and/or reviews hospital-specific measurable objectives taking into account results of the entity CHNA and evaluation of the entity's service area and expertise/services provided to the community * Verifies the need for an ongoing focus on identified community needs and/or adds new identified community needs * Reports on activities conducted in the prior fiscal year FY 2013 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken FY 2014 Plan * Reports and categorizes the economic value of community benefits provided in FY 2013, according to the framework specifically identified in SB 697 * Reviews and approves a Community Benefits Plan * Distributes the Community Benefits Plan and Report to members of the Sharp Board of Directors and Sharp hospital boards of directors, highlighting activities provided in the prior fiscal year as well as specific action steps to be undertaken in the upcoming fiscal year Ongoing Commitment to Collaboration In support of its ongoing commitment to working with others on addressing community health priorities to improve the health status of SDC residents, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, statewide California Hospital Association, HASD&IC, and other local collaboratives such as Combined Health Agencies and the Community Health Improvement Partners Behavioral Health Work Team. Section 4 Sharp Grossmont Hospital Sharp Grossmont Hospital (SGH) is located at 5555 Grossmont Center Drive, in La Mesa, ZIP code 91942. FY 2013 Community Benefits Program Highlights SGH provided $91,752,299 in community benefits in FY 2013. See Table 1 for a summary of unreimbursed costs based on the categories identified in SB 697. Table 1: Economic Value of Community Benefits Provided Sharp Grossmont Hospital FY 2013 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2013 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal, financial support for on-site workers to process Medi-Cal eligibility forms $28,023,330 Shortfall in Medicare $26,211,316 Shortfall in San Diego County Indigent Medical Services $16,632,636 Shortfall in CHAMPVA/TRICARE $416,032 Charity Care and Bad Debt $18,079,382 Other Benefits for Vulnerable Populations Patient transportation, Project HELP and other assistance for the needy $714,579 Other Benefits for the Broader Community Health education and information, health screenings, health fairs, flu vaccinations, support groups, meeting room space, donations of time to community organizations and cost of fundraising for community events $675,348 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $999,676
		TOTAL $91,752,299 Key highlights: * Unreimbursed Medical Care Services included uncompensated care for patients who were unable to pay for services; the unreimbursed costs of public programs such as Medi-Cal, Medicare, and San Diego County Indigent Medical Services; and financial support for onsite workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits; financial and other support to Neighborhood Healthcare; Project HELP; Project CARE; flu vaccination clinics for high-risk adults, including seniors and heart disease patients; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank; the Sharp Humanitarian Service Program; Meals-on-Wheels; and other assistance for the needy. * Other Benefits for the Broader Community included health education and information on a variety of topics; support groups; participation in community health fairs and events and health screenings for stroke, blood pressure, glucose, balance/fall prevention, hand, depression, lung function, peripheral artery disease, vascular disease and carotid artery disease; and the Breast Cancer Patient Navigator Program. The hospital's Senior Resource Center also offered flu vaccinations and specialized education and information. SGH staff collaborated with local schools to promote interest in health care careers. SGH also offered meeting room space at no charge to community groups. In addition, staff at the hospital actively participated in community boards, committees, and civic organizations, such as Aging and Independence Services (AIS), East County Chamber of Commerce Health Committee, Neighborhood Healthcare Community Clinics, Santee Chamber of Commerce, Meals-on-Wheels Greater San Diego Advisory Board, San Diego County Social Services Advisory Board, YMCA, Caregiver Coalition of San Diego, East County Senior Service Providers (ECSSP) and the Caregiver Education Committee. See Appendix A for a listing of Sharp's community involvement. * Health Research, Education and Training Programs included education and training of health care professionals, and student and intern supervision. Definition of Community The community served by SGH includes the entire east region of San Diego County (SDC), including the sub-regional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. For SGH's 2013 Community Health Needs Assessment (CHNA) process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States (US) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to Dignity Health's CNI, communities served by SGH with especially high need include but are not limited to: Lemon Grove, Spring Valley and El Cajon. Description of Community Health In SDC's east region in 2011, 93.6 percent of children ages 0 to 11, 95.7 percent of children ages 12 to 17 and 82.7 percent of adults ages 18 and older had health insurance failing to meet the Healthy People (HP) 2020 national targets for health insurance coverage. See Table 2 for a summary of key indicators of access to care, and Table 3 for data regarding eligibility for Medi-Cal Healthy Families. Table 2: Health Care Access in SDC's East Region, 2011 Current Health Insurance Coverage Children 0 to 11 Years Rate - 93.6 Year 2020 Target 100% Children 12 to 17 Years Rate - 95.7 Year 2020 Target 100% Adults 18 + Years Rate - 82.7 Year 2020 Target 100% Regular Source of Medical Care Children 0 to 11 Years Rate - 98.8% Year 2020 Target 100% Children 12 to 17 Years Rate - 89.3% Year 2020 Target 100% Adults 18 + Years Rate - 87.1% Year 2020 Target 89.4% Not Currently Insured Adults 18 to 64 Years Rate - 15.7% Source: 2011-2012 Community Health Interview Survey (CHIS) Table 3: Medi-Cal (Medicaid)/Healthy Families Eligibility, Among Uninsured in SDC's East Region (Adults ages 18- 64 yrs), 2011 Description/Rate Medi-Cal Eligible - 7.5% Healthy Families Eligible - 1.3% Not Eligible - 91.2% Source: 2011-2012 CHIS Heart disease and cancer were the top two leading causes of death in SDC's east region. See Table 4 for a summary of leading causes of death in the east region. For additional demographic and health data for communities served by SGH, please refer to the SGH 2013 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments Table 4: Leading Causes of Death in SDC's East Region, 2011 Cause of Death Number of Deaths Percent of Total Deaths Diseases of heart 937 25.3% Malignant neoplasms 863 23.3% Chronic lower respiratory disease 226 6.1% Cerebrovascular diseases 195 5.3% Accidents (unintentional injuries) 189 5.1% Alzheimer's disease 187 5.0% Diabetes mellitus 111 3.0% Intentional self-harm (suicide) 73 2.0% Chronic liver disease and cirrhosis 65 1.8% Influenza and pneumonia 62 1.7% All other causes 800 21.6% Total Deaths 3,708 100.0% Source: County of San Diego, HHSA, Public Health Services, Community Epidemiology Branch Community Benefits Planning Process In addition to the steps outlined in Section 3 regarding community benefits planning, SGH: Incorporates community priorities and community input into its strategic plan and develops service line-specific goals * Estimates an annual budget for community programs and services based on community needs, the prior year's experience and current funding levels * Prepares and distributes a monthly report of community activities to its board of directors, describing community benefits provided such as education, screenings and flu vaccinations * Prepares and distributes information on community benefits programs and services through its foundation and community newsletters * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefits Report SGH 2013 CHNA Through the SGH 2013 CHNA, the following priority health needs were identified for the communities served by SGH (in alphabetical order): * Behavioral Health (Mental Health) * Cardiovascular Disease * Diabetes, Type II * Obesity * Senior Health (including end-of-life care) In alignment with these identified needs, the following pages detail programs that specifically address cardiovascular disease, diabetes and senior health. SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH does not have the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. In addition, through further analysis of SGH's community programs and in consultation with SGH's community relations team, this section also addresses the following priority health needs for community members served by SGH:
		* Cancer education and support, and participation in clinical trials * Bone Health Orthopedic / osteoporosis education and screening * Women's and prenatal health services and education * Prevention of unintentional injuries * Support during the transition of care process for high-risk, underserved, and underfunded patients * Collaboration with local schools to promote interest in health care careers For each priority community need identified above, subsequent pages include a summary of the rationale and importance of the need, measurable objective(s), FY 2013 Report of Activities conducted in support of the objective(s), and FY 2014 Plan of Activities. Identified Community Need: Stroke Education and Screening Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * The SGH 2013 CHNA identified cardiovascular disease (including cerebrovascular disease/stroke) as one of five priority health issues affecting members of the communities served by SGH. * The Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA identified cardiovascular disease (including cerebrovascular disease/stroke) as one of the top four priority health issues for community members in SDC. * Feedback from key informant interviews conducted during the HASD&IC 2013 CHNA process aligned access to care and insurance coverage closely with care for cardiovascular disease. * In 2011, heart disease was the leading cause of death for the east region of SDC. Cerebrovascular disease was the fourth leading cause of death for the region. * In 2011, there were 195 deaths due to cerebrovascular diseases (stroke) in SDC's east region. The region's age-adjusted death rate due to cerebrovascular diseases was 38.2 deaths per 100,000 population. The region's age-adjusted death rate was the second highest of all regions and higher than the SDC age-adjusted rate of 32.2 deaths per 100,000 population. * In 2011, there were 1,279 hospitalizations due to stroke in SDC's east region. The rate of hospitalizations in the east region was 274.1 discharges per 100,000 population, also higher than the SDC age-adjusted rate of 235.1 discharges per 100,000 population. The stroke hospitalization rate in the east region was the highest in comparison to all SDC's regions. * In 2011, there were 279 stroke-related ED visits in the SDC's east region. The rate of visits was 59.8 per 100,000 population. The stroke-related ED visit rate in the region was comparable to the SDC average of 56.1 per 100,000 population. * According to the 3-4-50 Chronic Disease in San Diego County 2010 report, if no changes are made in risk behavior, based on current disease rates, it is projected that by the year 2020, the total number of deaths from heart disease and stroke will both increase by 38 percent. * According to the 3-4-50 Chronic Disease in San Diego County 2010 report, the most common risk factors associated with stroke include physical inactivity, obesity, hypertension, cigarette smoking, high cholesterol and diabetes. * According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 3 deaths in the US each year is caused by heart disease and stroke. At least 200,000 of these deaths could have been prevented through changes in health habits, such as stopping smoking, more physical activity, and less salt in the diet; community changes to create healthier living spaces, such as safe places to exercise and smoke-free areas; and managing high blood pressure, high cholesterol, and diabetes (CDC, 2013). Measurable Objective * Provide stroke education and screening services for the community FY 2013 Report of Activities Note: SGH is recognized with advanced certification by The Joint Commission as a Primary Stroke Center. The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SGH is a recipient of the American Heart Association's (AHA) Get With the Guidelines (GWTG) Gold Plus Achievement Awards for Stroke and the Target: Stroke Award. The AHA's GWTG is a national effort focused on ensuring that evidence-based therapies are used with stroke patients. The AHA's Target: Stroke award focuses on improving the timeliness of intravenous tissue plasmogen activator (IV rt-PA) administration to eligible patients. SGH's Stroke Center conducted stroke screening and educational events to educate the public on stroke risk factors, warning signs and appropriate interventions, including arrival at hospitals within early onset of symptoms. In FY 2013, the hospital conducted fourteen community screenings and educational events in SDC's east region, serving more than 1,000 attendees from the community. The events were held at various community sites, including but not limited to St. Michael's Parish, Waterford Terrace retirement community, Rancho San Diego YMCA, La Vida Real senior living community, First Presbyterian Church of El Cajon, Lakeside Fire Station, Grossmont District Library, and the 14th Annual Senior Health Fair at the Santee Trolley Square. In addition to offering stroke screenings at these events, SGH provided education and advised behavior modification, including smoking cessation, weight reduction and stress reduction for community members with health risk factors identified during the stroke screenings. In addition, in May SGH's Stroke Center presented to more than 50 community members at a Meet the Physician lecture entitled Stroke Is a Brain Attack organized through the SGH Senior Resource Center. In June, Sharp's systemwide stroke program participated in the Strike Out Stroke Night at the Padres event, held at Petco Park. The event was a collaboration with the San Diego Stroke Consortium and the County of San Diego. Sharp participated along with Scripps Health, Palomar Health, Tri City Medical Center, Alvarado Hospital, Kaiser Foundation Hospital San Diego, UC San Diego Health System and the San Diego Padres to promote an evening of stroke awareness and survivor celebration. Stroke education was provided throughout the evening to the entire stadium of more than 43,000 community members via the prominently displayed JumboTron. In addition, in October Sharp provided stroke screening and risk education to more than 200 attendees at the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina. In FY 2013, the SGH Outpatient Rehabilitation Department offered a stroke support group for stroke survivors and their family members at no charge. In addition, SGH actively participated in the quarterly San Diego Stroke Consortium, a collaborative effort to improve SDC stroke care and discuss issues impacting stroke care in SDC. Additionally, SGH collaborated with SDC to provide data for the County's stroke registry. FY 2014 Plan SGH Stroke Center will do the following: * Participate in stroke screening and education events in the east region of SDC * Provide education for individuals with identified risk factors * Offer a stroke support group, in conjunction with the hospital's Outpatient Rehabilitation Department * Participate with other SDC hospitals in the San Diego Stroke Consortium * Continue to provide data to the SDC stroke registry * Continue to collaborate with the state of California to develop a stroke registry * Provide at least one physician speaking event around stroke care and prevention * Participate in the SGH Heart and Vascular Conference for community physicians and nurses * Provide stroke education and screenings for Sharp's Women's Health Conference Identified Community Need: Heart and Vascular Disease Education and Screening Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * The SGH 2013 CHNA identified cardiovascular disease as one of five priority health issues affecting members of the communities served by SGH. * The HASD&IC 2013 CHNA identified cardiovascular disease as one of the top four priority health issues for community members in SDC.
		* In general, data presented in the HASD&IC 2013 CHNA revealed a higher rate of hospital discharges due to cardiovascular disease in more vulnerable communities within SDC's east region. * Feedback from key informant interviews conducted during the HASD&IC 2013 CHNA process aligned access to care and insurance coverage closely with care for cardiovascular disease. * According to the SGH 2013 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. Additional risk factors include alcohol use, obesity, diabetes, and genetic factors. About half of Americans (49 percent) have at least one of these three risk factors. * In 2011, heart disease was the leading cause of death for the east region of SDC. Cerebrovascular disease was the fourth leading cause of death for the region. * In 2011, there were 649 deaths due to heart disease in SDC's east region. The region's age-adjusted death rate due to heart disease was 139.1 per 100,000 population, and was the highest of all regions, as well as higher than the SDC age-adjusted rate of 104.4 deaths per 100,000 population, and higher than the HP 2020 target of 108.2 deaths per 100,000. * In 2011, there were 1,577 hospitalizations due to coronary heart disease in SDC's east region. The rate of hospitalizations for coronary heart disease was 337.9 per 100,000 population. The hospitalization rate in the region was among the highest in SDC and higher than the County average of 283.4 coronary heart disease hospitalizations per 100,000 population. * In 2011, there were 262 coronary heart disease-related ED visits in SDC's east region. The rate of visits was 56.1 per 100,000 population. The coronary heart disease-related ED visit rate in the region was the highest of the regions with a County average of 36.1 per 100,000 population. * According to the 3-4-50 Chronic Disease in San Diego County 2010 report, if no changes are made in risk behavior, based on current disease rates, it is projected that by the year 2020, the total number of deaths from heart disease and stroke will both increase by 38 percent. Measurable Objectives * Provide heart and vascular education and screening services for the community, with an emphasis on adults, women and seniors * Participate in programs to improve the care and outcomes of individuals with heart and vascular disease FY 2013 Report of Activities SGH is recognized as a Blue Distinction Center for Cardiac Care by Blue Cross Blue Shield for demonstrated expertise in delivering quality cardiac health care. In November, SGH provided a multicultural cardiopulmonary resuscitation (CPR) and automated external defibrillator training to approximately 15 community members in Ensenada, Mexico. The training focused on CPR techniques for the lay rescuer, including friends and family members. In March, SGH also provided a congestive heart failure (CHF) class covering topics such as exercise, nutrition, treatment plans and symptoms. In addition, SGH's Cardiac Rehabilitation Department served approximately 280 individuals through cardiac education classes throughout FY 2013. These classes, offered twice per month, were open to community members and provided education and resources on heart disease and its risk factors. Throughout FY 2013 SGH's cardiac training department provided education and resources on cardiac health at various community events throughout San Diego, such as the Valley View Health Fair, the Union Tribune Health Expo, La Jolla Country Day School, Celebrando, December Nights, and the Sharp Women's Health Conference. Nearly 9,000 community members were reached through these and additional events attended by the SGH cardiac training program. The program offered education on critical issues of cardiac health, including prevention, evaluation and treatment. SGH also provided cardiovascular disease preventative screenings throughout FY 2013, serving approximately 90 community members. Additionally, SGH continued to provide meeting space for the La Mesa chapter of Mended Hearts a cardiac support group for community members. In addition, SGH's Cardiac Rehabilitation Program participated in the Summer Healthcare Saturday Health Fair at Grossmont Center, as well as the 14th Annual Senior Health Fair at the Santee Trolley Square, serving more than 200 community members through these events. In October, the SGH Cardiac Rehabilitation Program also conducted a flu vaccination clinic for heart disease patients and their family members, as well as seniors and high-risk adults, reaching approximately 45 individuals through these efforts. Throughout the year, SGH provided expert speakers on heart disease and heart failure for various professional events, including SGH's Heart and Vascular Symposium. At this symposium, cardiac team members provided lectures on patient management. In addition, staff taught a class in cardiovascular health and treatment options to 40 senior community members at La Vida Real senior living community. In addition, in October SGH hosted the Southern California VOICe (Vascular Outcomes Improvement Collaborative) semi-annual meeting, which included regional vascular physicians, nurses, epidemiologists, scientists and research personnel with a goal to collect common vascular datasets in order to pool information that will improve patient care. SGH also participated in several programs to improve the care and outcomes of individuals with heart and vascular disease. To assist in improving care for acutely ill patients in the County, SGH provided data on STEMI (ST elevation myocardial infarction or acute heart attack) to San Diego County Emergency Medical Services (EMS). Starting in May, SGH began collaborating with Scripps Health providing STEMI data for a research study involving stem cell implantation in patients with low cardiac function. Also, Sharp HealthCare is now hosting the quarterly San Diego County Emergency Medical Services County Advisory Council for STEMI at Sharp's corporate office (Spectrum). Also in 2013, SGH designed and implemented a Peripheral Arterial Disease Rehabilitation program, which involves teaching and exercise designed to keep patients particularly low-income patients at the highest functional level. This program is funded in part by donations contributed to the SGH Foundation, to help defray cost for patients with limited funding options. SGH's cardiac team is committed to supporting future health care leaders through active participation in student training and internship programs. The SGH Cardiac Catheterization Lab hosted a Grossmont College (GC) cardiovascular technologist student for eight months, for a total of more than 750 hours. In addition, the catheterization lab RN and staff worked with a nursing student every Tuesday during the school year, while the Noninvasive Cardiology Department hosted students in echocardiography, electrocardiography and vascular laboratory two days per week during the school year. FY 2014 Plan SGH will do the following: - Provide free bimonthly cardiac education classes by the Cardiac Rehabilitation Department - Provide free CHF education classes, three times per year - Provide cardiac and/or vascular risk factor education or screening through participation in one to two community events, including an education event for seniors - Provide weekly preventive heart and vascular screenings - In collaboration with the SGH Stroke Center, provide carotid artery screenings for community members - Provide a complimentary flu vaccination clinic to cardiac rehabilitation patients and other senior community members - Offer educational speakers to the professional community on topics such as performance improvements in CHF and acute myocardial infarction, and cardiovascular treatment options as invited - Provide data on STEMI patients to San Diego County EMS - Enroll patients in two new clinical trials: OVERPAR for popliteal aneurysm patients and Stentys APPOSITION V studying self-expanding coronary stents - Pursue additional research opportunities to benefit patients and community members - Provide a conference on heart and vascular disease for community nurses and physicians in fall 2014 - Continue to provide student learning opportunities Identified Community Need: Diabetes Education and Screening Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated.
		Rationale * The SGH 2013 CHNA identified diabetes as one of five priority health issues for community members served by SGH. * The HASD&IC 2013 CHNA identified diabetes as one of the top four priority health issues for community members in SDC. * In general, data in the HASD&IC 2013 CHNA revealed a higher rate of hospital discharges due to diabetes in more vulnerable communities within SDC's east region (e.g., El Cajon, Jacumba, etc.). * Input collected from San Diego community health leaders and experts in the HASD&IC 2013 CHNA strongly aligned access to care, care management, education and screening with care for Type II diabetes. * In 2011, diabetes was the seventh leading cause of death for community members in SDC's east region. * In 2011, there were 111 deaths due to diabetes in SDC's east region. The region's age-adjusted death rate due to diabetes was 23.8 per 100,000 population, the second highest of all regions and higher than the SDC age-adjusted rate of 18.8 deaths per 100,000 population. * In 2011, there were 825 hospitalizations due to diabetes in SDC's east region. The rate of hospitalizations for diabetes was 176.8 per 100,000 population. The hospitalization rate in the region was the highest in SDC's regions and higher than the SDC average of 132.6 diabetes hospitalizations per 100,000 population. * In 2011, there were 722 diabetes-related ED visits in SDC's east region. The rate of visits was 154.7 per 100,000 population. The diabetes-related ED visit rate in the east region was among the highest in SDC and higher than the County average of 137.1 per 100,000 population. * According to the California Health Interview Survey (CHIS), in 2011, 15.3 percent of adults living in SDC's east region indicated that they were ever diagnosed with diabetes, higher than SDC at 13.7 percent. * According to the 3-4-50 Chronic Disease in San Diego County 2010 report from the County's HHSA, the most common risk factors associated with Type II diabetes include overweight and obesity, physical inactivity, smoking, hypertension and abnormal cholesterol. * According to the Centers for Disease Control and Prevention (CDC), diabetes is a major cause of heart disease and stroke as well as the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the US (CDC, 2011). Measurable Objective * Provide diabetes education and screening in the east region of SDC FY 2013 Report of Activities The SGH Diabetes Education Program is recognized by the American Diabetes Association (ADA) and meets national standards for excellence and quality in diabetes education. In FY 2013, the SGH Diabetes Education Program conducted a community educational lecture and seven blood glucose screening events at hospital and off-site locations, reaching more than 1,000 community members. The SGH Diabetes Education Program screened nearly 250 community members during these events. As a result of the screenings, nearly 50 individuals were identified with elevated blood glucose levels and provided with follow-up resources. Screening events were located throughout SDC's east region, including the Grossmont Healthcare District Library, the Women's Health Event at SGH, the 14th Annual Senior Health Fair at the Santee Trolley Square, the McGrath Family YMCA Family Center, the Waterford Terrace retirement community health fair and the Grossmont Center Health Fair. SGH's Diabetes Education Program conducted community lectures on diabetes at libraries, community centers, educational institutions, national conferences and other hospitals. Screenings and education events were developed with input from the Behavioral Diabetes Institute, a San Diego-based organization that focuses on addressing the social, emotional, and psychological barriers in order to help individuals with diabetes live a long and healthy life. The SGH Diabetes Education Program also continued to support the ADA's Step Out: Walk to Stop Diabetes held in October at Mission Bay through fundraising and team participation. As part of these screenings, the Sharp HealthCare (Sharp or SHC) Diabetes Education Program conducted an event at the student health fair at Cuyamaca College, providing education to and screening more than 200 community members. As a result of these screenings, three individuals were identified with elevated blood glucose levels and received follow-up resources. In FY 2013, the SGH Diabetes Education Program continued to provide targeted outreach to the newly immigrated Iraqi Chaldean population in San Diego. The program facilitated translation, as well as provided materials and resources to better understand the cultural needs of newly immigrated Chaldeans. The resources provided included an information binder on topics, such as: How to Live Healthy With Diabetes; What You Need to Know About Diabetes; All About Blood Glucose for People With Type II Diabetes; All About Carbohydrate Counting; Getting the Very Best Care for Your Diabetes; All About Insulin Resistance; and All About Physical Activity With Diabetes. Handouts were provided in Arabic as well as Somali, Tagalog, Vietnamese and Spanish for additional populations. Education was also provided to staff members regarding the different cultural needs of these communities. FY 2014 Plan The SGH Diabetes Education Program will do the following: * Coordinate and implement blood glucose screenings at community and hospital sites in SDC's east region * Conduct educational lectures at various community venues * Continue to support ADA's Step Out: Walk to Stop Diabetes * Continue to collaborate with the Behavioral Diabetes Institute to host community lectures that will assist diabetes patients and their loved ones * Continue to provide resources for culturally competent diabetes education and/or outreach to newly immigrated populations * Keep current on resources to give to the community for support of diabetes treatment and prevention * Foster relationships with community clinics to provide education and resources to community members * Develop partnerships with YMCAs in SDC's east region to provide screenings, education, and resources to community members * Explore opportunities for further collaboration with community organizations to provide diabetes education to refugee communities and other high-risk populations Identified Community Need: Health Education, Screening and Support for Seniors Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * The SGH 2013 CHNA identified senior health as one of five priority health issues for community members served by SGH. * In the HASD&IC 2013 CHNA, dementia and Alzheimer's disease were identified among the top 15 priority health conditions seen in SDC hospitals. * Attendees of community forums held during the HASD&IC 2013 CHNA process identified Alzheimer's disease and dementia as priority health needs for SDC. * In SDC's east region, there were 58,491 residents (12.53 percent of the population) ages 65 years or older in 2011, and by the year 2020, the region expects a 51 percent growth among this population. * In 2011, the leading causes of death among senior adults ages 65 years and older in SDC were heart disease, cancer, Alzheimer's disease, stroke, chronic lower respiratory diseases, diabetes, influenza and pneumonia, unintentional injuries, hypertension and hypertensive renal disease, chronic liver disease and cirrhosis, Parkinson's disease, and intentional self-harm. * In 2011, influenza ranked as the tenth leading cause of death in SDC's east region. * In 2011, 108,853 seniors were treated and discharged from SDC EDs, representing nearly one out of every three senior residents. Additionally, seniors in SDC's east region experience higher ED visit rates for falls, coronary heart disease, Alzheimer's disease and influenza in comparison to SDC overall. * In 2011, 97,647 seniors ages 65 and over were hospitalized in SDC. Seniors in SDC's east region experienced higher rates of hospitalization for falls, coronary heart disease, stroke, pneumonia, Chronic Obstructive Pulmonary Disease, diabetes, Alzheimer's disease, and influenza, when compared to SDC overall.
		* According to the San Diego County Senior Health Report: Update and Leading Indicators, significant health issues for seniors include obesity, diabetes, stroke, chronic lower respiratory diseases, influenza and pneumonia, mental health issues including dementia and Alzheimer's disease, and cancer and heart disease. In addition, seniors are at high risk for falls, which is the leading cause of death due to unintentional injury (HHSA, 2013). * According to the San Diego County Senior Falls Report, adults ages 65 and older are the largest consumers of health care services, as the process of aging brings upon the need for more frequent care (HHSA, 2012). * In 2011, 68,817 calls were made to 9-1-1 for seniors ages 65 years and older in need of pre-hospital (ambulance) care in SDC, representing a call for one out of every five seniors. Seniors in SDC use the 9-1-1 system at higher rates than any other age group. * Among the populations that the CDC recommends annual vaccination against influenza are: people ages 50 years and older; adults with a chronic health condition; people who live in nursing homes and other long-term care facilities; and people who live with or care for those at high risk for complications from flu, including household contacts of persons at high risk for complications from the flu. Flu clinics offered in community settings at no or low cost improve access for those who may experience transportation, cost or other barriers. * While researchers have long known that caregiving can have deleterious mental health effects for caregivers, research shows that caregiving can have serious physical health consequences as well. Seventeen percent of caregivers feel their health in general has gotten worse as a result of their caregiving responsibilities (AARP Public Policy Institute, Valuing the Invaluable, Updated November 2012). * Project CARE is a cooperative safety net designed to ensure the well-being and independence of older persons and persons with disabilities in the community. Through its component services, Project CARE helps people live independently in their homes. SDC's east region autonomously administers a local Project CARE site, located at SGH's Senior Resource Center, to meet the unique needs of the community's seniors. Measurable Objectives * Provide a variety of senior health education and screening programs * Produce activity calendars four times a year * Act as lead agency for East County Project CARE, ensuring the safety of homebound seniors in SDC's east region * In collaboration with community partners, offer seasonal flu vaccination clinics at convenient locations for seniors and high-risk adults in the community * Provide information at the seasonal flu clinics about other Sharp Senior Resource Center programs and other health education materials * Serve as a referral resource for members of the senior community in SDC's east region FY 2013 Report of Activities Sharp Senior Resource Centers connect seniors and their caregivers to a variety of free and low-cost programs and services, including educational seminars, community referrals and health screenings. Compassionate staff and volunteers at the Sharp Senior Resource Centers understand the unique needs of seniors and can provide personalized support and clear, accurate information on everything from health education to caregiver services and resources. Calendars highlighting SGH's Senior Resource Center activities are mailed four times a year to more than 7,550 households. In FY 2013, the SGH Senior Resource Center provided approximately 100 free health education programs to nearly 1,300 community members. Health education topics included hearing, stroke, arthritis, balance/fall prevention, the power of touch, cardiovascular disease, osteoporosis, fitness, diabetes, senior services, patient-provider communication, Project CARE, Vials of Life, advance directives for health care, financial issues, memory loss, back health, caregiver resources, end-of-life issues, Medicare, depression, chronic pain management, sleep disorders, Parkinson's disease, and maintaining a healthy voice. Educational programs were offered at the hospital campus, the Dr. William C. Herrick Community Health Care Library in the Grossmont Healthcare District, and at various community sites in SDC's east region. As part of their educational offerings, the SGH Senior Resource Center also provided a series of physician lectures in FY 2013, covering topics such as back pain, stroke and hearing loss. In total, more than 130 community members attended these lectures. In FY 2013, the SGH Senior Resource Center provided 12 health screening events, serving more than 275 members of the senior community. In addition, the SGH Senior Resource Center offered free monthly blood pressure screenings, at two locations on-site and at several locations in the community, screening more than 435 community members. Additionally, the SGH Senior Resource Center provided three balance/fall prevention screenings, and four hand screenings. The hospital also offered health screenings for lung function, diabetes, carotid artery disease, peripheral artery disease and stroke. From these screenings, 30 attendees were referred to physicians for follow-up. The SGH Senior Resource Center distributed approximately 100 advance directives for health care, and 4,000 Vials of Life, which provide important medical information to emergency personnel for seniors and disabled people living in their homes. Project CARE is a community program that includes the County of San Diego's Aging and Independence Services (AIS), Jewish Family Services, San Diego Gas and Electric (SDG&E), local senior centers, sheriff and police, and many others. Through this program, the SGH Senior Resource Center provided daily Are You OK? phone calls to approximately 40 isolated or homebound seniors in SDC's east region. Are You OK? program participants select regularly scheduled times to receive computerized phone calls at their home. In the event that staff members do not connect with participants through these phone calls, the participants' family or friends are contacted to ensure the participants' safety. In FY 2013, nearly 9,500 Are You OK? phone calls were placed to seniors or disabled individuals, and 125 follow-up phone calls were placed to their family or friends. In collaboration with the Caregiver Coalition of San Diego, the SGH Senior Resource Center provided caregiver conferences at the La Mesa Community Center, First United Methodist Church of Mission Valley, and College Avenue Baptist Church for more than 200 family caregivers. These conferences provided education on emotional issues and physical aspects of care giving, as well as community resources. At the First United Methodist Church of Mission Valley, the conference entitled Batter Up! Getting into the Game of Caregiving targeted male caregivers in the community. Topics included strategies to manage the challenging and stressful aspects of caregiving, knowing when to ask for help, and other important caregiver issues. The conference also featured a panel of male caregivers from the community who shared their insights and experiences with the conference attendees. The SGH Senior Resource Center also coordinated a conference on chronic disease management with Sharp HospiceCare entitled Living with a Chronic Illness. The conference provided information on chronic care management, warning signs for specific chronic diseases, and when to access care to nearly 60 community members. Additional topics included how to plan future health care needs and understand available resources, how to cope with life's transitions, and healing touch for self-care. The conference featured a physician, psychologist, lawyer and other experts in the field of aging and health care to assist seniors to more effectively navigate their golden years.
		The SGH Senior Resource Center also participated in health fairs in El Cajon, Rancho San Diego, Lakeside, Santee, La Mesa, the College Area, and San Diego. In addition, the SGH Senior Resource Center participated in the Sharp HospiceCare Resource and Education Expo at the College Avenue Baptist Church, serving 70 community health care professionals. The SGH Senior Resource Center provided blood pressure screenings at the event, as well as educational resources on senior and caregiver services. Through a presence at these community venues, the SGH Senior Resource Center provided education and resources to nearly 1,750 community members. Additionally, the SGH Senior Resource Center collaborated with the Caregiver Coalition of San Diego to provide a webinar that provided education and resources to 15 attendees on the challenges and resources for traveling and caregiving. The webinar is widely available to community members via the Caregiver Coalition of San Diego website. Also in FY 2013, SGH's Senior Resource Center coordinated notification of availability and provision of seasonal flu vaccines in selected community settings through activity reminders, collaborative outreach conducted by the flu clinic site, 2-1-1 San Diego, Sharp.com and newspaper notices. The SGH Senior Resource Center provided more than 1,000 seasonal flu vaccinations at 17 community sites to high-risk adults with limited access to health care resources, including seniors with limited resources for transportation and those with chronic illnesses. Sites included senior centers, community centers, churches, senior nutrition sites, the Salvation Army, food banks and hospital departments. At these community sites, SGH provided activity calendars for the Senior Resource Center detailing upcoming community events, including blood pressure and flu clinics, Vials of Life, community senior programs and Project CARE. At the food banks, the SGH Senior Resource Center provided vaccines not only to seniors, but also to high-risk community members, many of whom were uninsured or had limited access to transportation. In FY 2013, the Senior Resource Center maintained active relationships with organizations serving seniors, enhancing networking among professionals in SDC's east region and providing quality programming for seniors. These organizations included AIS (Project CARE and the Caregiver Coalition of San Diego), ECSSP, Meals-on-Wheels Greater San Diego, the Caregiver Education Committee and the Aging Disability Resource Connection. FY 2014 Plan SGH's Senior Resource Center will conduct the following activities: * Provide resources and support to address relevant concerns of seniors in the community through in-person and phone consultations * Provide community health information and resources through educational programs, monthly blood pressure clinics, and four to eight types of health screenings annually * Utilize Sharp experts and community partners to provide approximately 35 seminars per year that focus on issues of concern to seniors * Participate in 18 community health fairs and special events targeting seniors * Collaborate with East County YMCA, AIS and East County Action Network on a healthy living for seniors conference * Coordinate two conferences one dedicated to family caregiver issues in collaboration with the Caregiver Coalition of San Diego and one in collaboration with Sharp HospiceCare * Maintain daily contact through phone calls with individuals (many are homebound) in rural and suburban settings who are at risk for injury or illness, and continue supporting Project CARE services for the East County community * Produce and distribute quarterly calendars highlighting events of interest to seniors and family caregivers * Provide 4,000 Vials of Life to seniors * In collaboration with Sharp Advance Care Planning through Sharp HospiceCare, present an Advanced Directives and Health Care Decisions program to inform seniors about advance directives and other necessary documents available to communicate their end-of-life wishes * Provide seasonal flu vaccinations at 15 community sites for seniors with limited mobility and access to transportation, as well as high-risk adults, including low-income, minority, homeless and populations with chronic disease * In collaboration with community agencies, coordinate the notification of the availability and provision of seasonal flu vaccines at a variety of community sites convenient to high-risk adults and seniors, including physicians' offices, pharmacies and public health centers; publicize through media and community partners * Continue to provide seasonal flu immunizations at food bank sites in SDC's east region Identified Community Need: Cancer Education and Support, and Participation in Clinical Trials Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * In the HASD&IC 2013 CHNA, various types of cancer were identified among the top priority health conditions seen in SDC hospitals. * In 2011, cancer was the second-leading cause of death in SDC's east region. * In 2011, there were 861 deaths due to cancer (all sites) in SDC's east region. The region's age-adjusted death rate due to cancer was 184.5 deaths per 100,000 population, higher than the SDC age-adjusted rate of 155.2 deaths per 100,000 population, and higher than the HP 2020 target of 160.6 deaths per 100,000. * In 2011, 25 percent of all cancer deaths in SDC's east region were due to lung cancer, nine percent to colorectal cancer, eight percent to female breast cancer, five percent to prostate cancer, and less than one percent to cervical cancer. * In 2011, the death rates for colorectal, female breast cancer and lung cancer in SDC's east region were all higher when compared to the age-adjusted death rates for these specific cancers in SDC overall. * According to the 2011 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, San Diego had the highest incidence rate for breast cancer (163.95 per 100,000) compared to the neighboring counties of Imperial, Los Angeles, Orange and Riverside. San Diego's incidence rate for breast cancer is also above that of the state (151.82 per 100,000). * According to a 2012 report from the California Cancer Registry, breast cancer is the most common cancer among women in California, with an estimated 292,400 existing cases (42 percent of all cancers). * In SDC, minority women have high breast cancer mortality rates and were less likely to have breast cancer detected at an early stage, according to the 2011 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report. In addition, Latinos were least likely to receive a mammogram compared to other ethnic groups, with 37.3 percent reporting never having had the screening. * According to the 2011 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, the most common barriers to receiving effective breast health care included lack of awareness and knowledge, financial barriers, cultural barriers and emotional factors. The most common challenges in the current breast health care system included cost of care, quality of providers, lack of communication, and education and language barriers. Increased advocacy, education, funding and partnerships were among the suggestions for improving programs, services and the breast health care system overall. * According to the American Cancer Society (ACS), a total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the US in 2014. California is projected to have the most new cancer cases (171,730) and the highest number of deaths (57,950) (ACS, 2014). * According to the CDC, cancer survivors face many physical, psychological, social, spiritual and financial issues at diagnosis, during treatment and for the remainder of their lives. Breast cancer patient navigation is an intervention that addresses barriers to quality standard care by providing individualized assistance to patients, cancer survivors and their families.
		Measurable Objectives * Provide cancer education and support services to the community * Participate in cancer clinical trials, including screening and enrolling patients FY 2013 Report of Activities Note: The SGH Cancer Center is accredited by the National Accreditation Program for Breast Centers (NAPBC). The NAPBC grants accreditation to only those centers that voluntarily commit to providing the best possible care to patients with diseases of the breast. The SGH Cancer Center is also accredited by the American College of Surgeons Commission on Cancer Program (CoC). CoC accreditation standards promote comprehensive cancer services, including consultation among surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialists, resulting in improved patient care. As part of its journey in comprehensive cancer care, the SGH Cancer Center provides nutritional and genetic counseling services to the patients. In FY 2013, the SGH Cancer Center participated in a variety of community cancer educational events. These events served more than 900 community members, and included the East County Senior Health Fair at Santee Trolley Station; Learn and Live Events for Breast, Colon and Prostate Cancer; the Summer Healthcare Saturday Event at Grossmont Center, Jewish Family Services Health Fair, Jewish Family Services Breast Cancer Talk; Sharp's annual Women's Health Conference and the SGH Cancer Expo. SGH Cancer Center staff also supported the ACS Making Strides Against Breast Cancer Walk, as well as held a resource booth to provide educational materials on breast cancer at the Susan G. Komen Race for the Cure in Balboa Park. In addition, SGH Cancer Center staff served as health and science project judges for more than 30 junior high and high school students at the San Diego Science Fair held in Balboa Park. Throughout FY 2013, SGH provided educational sessions to community members whose lives are impacted by cancer through its Learn and Live Events for Breast, Colon and Prostate Cancer. Two Live and Learn Prostate Cancer educational seminars were provided to 50 community members, and sessions covered critical issues around prostate cancer, including treatment options with radiation. In September, the SGH Cancer Center held a Cancer Awareness Expo that included a panel of physicians to answer questions from the community on topics such as preventative measures, screening, detection and diagnosis. The seminar included educational information from different departments, a tour of the SGH Cancer Center and also featured a breast cancer survivor who shared her story with seminar attendees. In addition, SGH presented an educational session on breast cancer to 50 residents at Waterford Terrace retirement community. The SGH Cancer Center continued to offer support programs for cancer patients in FY 2013, including biweekly breast cancer support group meetings. These meetings were held at no cost to participants, with an average attendance of 12 to 15 community members. In addition, the Look Good...Feel Better program offered through the ACS provided six classes throughout FY 2013 to approximately 40 women in the community. The program boosts women's self-confidence by teaching them techniques to help manage the side effects of cancer treatment, such as using cosmetic and skin care products, wigs, scarves and other accessories to manage skin changes and hair loss. In FY 2013, SGH continued its Breast Health Navigator Program, where an RN certified in breast health personally assists breast cancer patients in their navigation of the health care system. The Breast Health Navigator offers support, guidance, financial assistance referrals and connection to community resources. Through collaboration with community clinics including Family Health Centers of San Diego (FHCSD), Neighborhood Healthcare and Centro Medico the Breast Health Navigator refers unfunded or underfunded women to local community clinics for a covered mammogram diagnostic work-up, or immediate Medi-Cal insurance should their biopsy prove positive and require treatment. Patients needing psychosocial support are referred to a breast cancer case management program through Jewish Family Services. The Breast Health Navigator also plays an active role in community education, providing presentations and educational resources about breast cancer, mammography guidelines and early detection, at no charge to the community. In addition, the Breast Health Navigator facilitated access to care for approximately 170 breast cancer patients in need many with late-stage cancer diagnoses through the provision of referrals to various community and national organizations. Also in FY 2013, the SGH Cancer Center screened approximately 150 patients for participation in cancer clinical trials. As a result, eight new patients were enrolled in cancer research studies, while 63 patients continued to receive follow-up care through the studies. In addition, the SGH Cancer Center trained eight Pima Medical Institute X-ray students who observed and participated in clinical rotations in radiology, as well as a student from the National University Radiation Therapy Program. FY 2014 Plan SGH Cancer Center will conduct the following: * Provide biweekly breast cancer support groups to participants at no charge * Provide six Look Good...Feel Better classes * Continue to provide education and resources to the community with the Breast Health Navigator; also provide ongoing personalized education and information, support and guidance to breast cancer patients and their loved ones as they move through the continuum of care * Provide community members with an additional Cancer Navigator for all cancers other than breast * Screen and enroll oncology patients in clinical trials for research studies * Screen and provide genetic testing for patients and family members * Provide educational information on cancers and available treatments through community residents and community physician lectures, and participation in health fairs and events with demonstrations on breast self-exams * Continue to train and intern National University Radiation Therapy Students Identified Community Need: Bone Health - Orthopedic / Osteoporosis Education and Screening Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * In the HASD&IC 2013 CHNA, back pain was identified among the top 15 priority health conditions seen in SDC hospitals. * In SDC's east region in 2011, the number of arthritis-related hospitalizations totaled 1,781 among the highest in the county. The east region's rate of arthritis-related hospitalizations was 381.7 per 100,000 population, higher than the age-adjusted SDC average of 309.3 arthritis hospitalizations per 100,000 population, as well as higher than all other SDC regions. * In SDC's east region from 2009 to 2011, the number of arthritis-related ED discharges increased from 2,241 to 3,668, while the rate of arthritis-related ED discharges increased from 475.9 to 786 per 100,000 population. The region's 2011 arthritis-related ED discharge rate of 786 per 100,000 population was higher than the 2011 age-adjusted County average of 647.8 per 100,000 population. * In SDC's east region in 2011, females had a higher ED discharge rate for arthritis-related diagnosis than males (932.6 and 634.9 per 100,000 population, respectively). Blacks had a higher ED discharge rate for arthritis-related diagnosis than persons of other racial or ethnic groups, and persons ages 25 to 44 had higher ED discharge rates for arthritis-related diagnosis than other persons. * According to the CDC, arthritis is the nation's most common cause of disability. An estimated 50 million US adults (about one in five) report doctor-diagnosed arthritis. As the US population ages, these numbers are expected to increase sharply to 67 million by 2030, and more than one-third of these adults will have limited activity as a result. In addition, a recent study indicated that some form of arthritis or other rheumatic condition affects one in every 250 children (CDC, 2011). * According to the National Institutes of Health (NIH), more than 40 million people either already have osteoporosis or are at high risk due to low bone mass in the US (NIH, 2012).
		* The various risk factors for developing osteoporosis include: family history, thinness or small frame, having had early menopause, being postmenopausal, abnormal absence of menstrual periods (amenorrhea), prolonged use of certain medications, low calcium intake, physical inactivity, smoking and excessive alcohol intake (NIH, 2012). * According to the NIH, osteoporosis is the most common type of bone disease. The NIH reveals that about half of all women over the age of 50 will experience a fracture of the spine, wrist or hip during their lifetime (NIH, 2012). * According to the CDC, there were 258,000 hospital admissions for fractures of the hip among people ages 65 and older. By 2030, the number of hip fractures is projected to increase by 12 percent (CDC, 2013). * According to HP 2020, approximately 80 percent of Americans experience low back pain (LBP) in their lifetime. Each year, it is estimated that 15 to 20 percent of the population develops protracted back pain, 2 to 8 percent have chronic back pain (pain that lasts more than three months), 3 to 4 percent of the population is temporarily disabled due to back pain, and 1 percent of the working-age population is disabled completely and permanently due to LBP. Measurable Objective * Provide education on orthopedics and osteoporosis to the community FY 2013 Report of Activities Note: SGH is certified by The Joint Commission in Disease-Specific Care for their Total Knee and Total Hip Replacement Programs. The programs are nationally recognized for their outreach, education and utilization of evidence-based practices, as well as documentation of their performance measures and success rates. In FY 2013, SGH offered quarterly educational sessions on hip and knee problems to more than 400 community members. Topics included management of arthritis, and hip and knee repair and treatment, from non-surgical options to minimally-invasive surgery using the latest technology. Sessions were held at the Grossmont Healthcare District Conference Center, and at the Vi at La Jolla Village an independent senior living community in La Jolla. Attendance ranged from 50 to 90 individuals at each event. In addition, SGH provided three seminars for treatment of shoulder pain, reaching approximately 225 community members and providing education on arthritis, torn rotator cuff, bursitis and frozen shoulder, as well as treatment options. Additionally, Sharp offered specialized education on osteoporosis prevention and treatment, as well as osteoporosis heel scan screenings to the community during the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina in October. More than 650 community members attended the event, and approximately 200 attendees received education regarding osteoporosis, calcium and vitamin D requirements, and exercise for osteoporosis treatment and prevention. FY 2014 Plan SGH will do the following: * Continue to offer orthopedic, arthritis, joint health and osteoporosis educational presentations to the community * Provide education and resources to the Sharp Women's Health Conference Identified Community Need: Women's and Prenatal Health Services and Education Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * In the HASD&IC 2013 CHNA, high-risk pregnancy was identified as one of the top 15 priority health conditions seen in SDC hospitals. * In 2011, in SDC's east region there were 410 low birth weight (LBW) births, 6.5 percent of total births for the region. LBW births were higher among female infants than male infants and were highest among white infants when compared to infants of other race/ethnicity. * In 2011, 26 infants died before their first birthday in SDC's east region. The infant mortality rate was 4.1 infant deaths per 1,000 live births. Infant mortality was similar for males and females and was highest among white infants when compared to infants of other race/ethnicity. * There were 662 hospitalizations due to maternal complications in SDC's east region in 2011. The region's age-adjusted rate was 279.5 per 100,000 population, which was lower than the actual rate for SDC overall (307.9 per 100,000). * In 2011, there were 4,916 live births with prenatal care in SDC's east region, which translates to 77.6 percent of live births for the region. This was lower than the percentage of live births receiving prenatal care in SDC overall (83.1 percent). * Between 2009 and 2011, mothers in SDC beginning their prenatal care during their first trimester increased from 70.1 percent to 72.2 percent. * According to 2011 CHIS data, 22.6 percent of women (ages 18 to 65 years) were obese (BMI > 30). This statistic increases to 30.9 percent for women in SDC's east region. * According to 2011 CHIS data, 10.8 percent of women in SDC's east region eat fast food four or more times per week. * According to HP 2020, the risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception and interconception care. Healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential. * According to the CDC, maternal health conditions that are not addressed before pregnancy can lead to complications for the mother and the infant. Several health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, maternal obesity, maternal smoking during pregnancy and maternal deficiency of folic acid. In the US, the number of births declined by 3 percent from 2009 to 2010 and the general fertility rate declined by 3 percent. Teenage birth rate fell 10 percent from 2009 to 2010, while the birth rate of women ages 40-44 years continued to rise. * According to a report from the National Center for Health Statistics (NCHS), preterm infants are at increased risk of life-long disability and early death compared with infants born later in pregnancy. The US preterm birth rate (less than 37 weeks of gestation) rose by more than one-third from the early 1980s through 2006. The first two-year decline in nearly three decades occurred from 2006 to 2008, during which the preterm birth rate decreased from 12.8 percent to 12.3 percent (NCHS, 2010). Measurable Objectives * Conduct outreach and education activities for women on a variety of health topics, including prenatal care and parenting skills * Collaborate with community organizations to help raise awareness of women's health issues and services, as well as to provide low-income and underserved women in the San Diego community with critical prenatal services * Participate in professional associations related to women's services and prenatal health and disseminate research * Demonstrate best practices in breastfeeding and maternity care, and provide education and support to new mothers on the importance of breastfeeding FY 2013 Report of Activities In FY 2013, SGH offered two wellness and prevention-related community expos that addressed women's health topics. These classes led by physicians and topic-experts reached approximately 120 women. The expos included a series of experts that discussed methods to improve heart health, eating habits and emotional and mental well-being. In addition, a free health screening offered information about cholesterol and glucose levels, blood pressure and BMI. Attendees also had the opportunity to have their personal health questions answered by health care professionals. Additionally, in FY 2013 SGH offered three educational seminars to the community on gynecologic robotic procedures, and provided education and resources on treatment options to 98 women through these sessions.
		Throughout FY 2013, SGH provided free breastfeeding support groups to the community twice per week. Facilitated by RN Lactation Consultants, each session provided education and support to approximately 25 mothers in the community. SGH also offered weekly postpartum depression support groups for women and families. The support groups are led by the SGH Women's Health Center's social workers, and provide support to women and families struggling with the challenges and adaptations of having a newborn. SGH participated in and partnered with a number of community organizations and advisory boards for maternal and child health in FY 2013, including the local chapter of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), Women, Infants, and Children (WIC), California Teratogen Information Service (CTIS), Partnership for Smoke-Free Families, San Diego County Breastfeeding Coalition Advisory Board, the Beacon Council's Patient Safety Collaborative, Association of California Nurse Leaders (ACNL), the regional Perinatal Care Network (PCN), Perinatal Safety Collaborative, and the Public Health Nurse Advisory Board. In FY 2013, SGH provided both a poster presentation to the ACNL titled Ending Early Elective Deliveries as well as a webinar on this topic provided through the Centers for Medicare and Medicaid Services (CMMS) Partnership for Patients and Health Research and Educational Trust (HRET). The SGH Women's Health Center also presented a podium presentation entitled Exclusive Breastfeeding at Discharge at the CMMS Call for Innovations. Over the past fiscal year, SGH implemented critical process improvements to improve breastfeeding rates among new mothers, and continued to explore and participate in opportunities to share these best practices with the broader health care community. The Ten Steps to Successful Breastfeeding were implemented along with other quality strategies on each unit to promote exclusive breastfeeding and exclusive breast milk in the NICU. The initiatives included but were not limited to: facilitating skin-to-skin contact with the newborn immediately after delivery; implementing early intervention strategies for women identified as having difficulty with breastfeeding; and standardizing an interdisciplinary plan of care to identify mothers having difficulty with breastfeeding. These strategies promote the nutritional health of high-risk infants and prevent inflammatory disease processes that can cause serious bacterial infection in the intestine of sick premature infants, which can result in death of intestinal tissue and even progression to blood poisoning or septicemia. In addition, SGH revamped all of the breastfeeding educational resources provided at the community clinics and the childbirth education classes to reflect best practices in breastfeeding for mothers and their families. In the NICU, nurses promoted the use of a mothers' pump log to increase accountability for the mothers' documentation of their 24 hour totals of breast milk volumes. The daily totals of exclusive breast milk volumes were documented by an RN, and nurses tracked the percentage of infants exclusively provided breast milk or some breast milk until discharge, incorporating early intervention strategies to promote the establishment of breast milk in the first couple of weeks. Additionally, the SGH Women's Health Center tracked the mothers of premature infants 28-34 weeks who established breast milk supply at two weeks. This interdisciplinary approach resulted in a 70 percent exclusive breastfeeding rate for newborns as well as an 83 percent exclusive breast milk rate for premature infants in the NICU. This abstract was approved by AHWONN for poster presentation in June 2014. In addition, the SGH Women's Health Center participated in the San Diego County Breastfeeding Coalition Poster competition for all of their quality initiatives surrounding exclusive breastfeeding at discharge. The SGH Women's Health Center was awarded second place at this competition during World Health Breastfeeding Week in August 2013. SGH is also currently seeking Baby-Friendly USA Designation by September 2014 through the implementation of evidence-based maternity care practices. Established by the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) in 1991, the Baby-Friendly Hospital Initiative (BFHI) recognizes and encourages hospitals and birthing centers that offer high-quality breastfeeding care. The BFHI has been implemented in more than 170 countries, resulting in the designation of more than 20,000 birthing facilities. The requirements for a Baby-Friendly USA Designation include but are not limited to: training health care staff to properly implement a breastfeeding policy; providing education to pregnant women on the benefits of breastfeeding; demonstrating how to breastfeed and maintain lactation to new mothers; encouraging breastfeeding on demand; allowing mothers and infants to remain together 24 hours a day; and establishing breastfeeding support groups and referring mothers to these resources following discharge from the hospital or clinic. Throughout FY 2013, SGH incorporated the requirements of a Baby-Friendly hospital along with other process improvements in order to improve exclusive breastfeeding at discharge. As a result of these comprehensive efforts, the SGH Women's Health Center was successful in raising the exclusive breastfeeding rate at discharge from 49 percent in 2011 to 70 percent in 2013. The SGH Women's Health Center's Prenatal Clinic (SGH Prenatal Clinic) midwives continued to provide in-kind help at Neighborhood Health Centers in El Cajon and Lakeside, and FHCSD throughout FY 2013. The midwives provide care for pregnant women five days per week approximately 1,400 hours at the El Cajon and Lakeside sites to support the underserved population in SDC's east region. The hospital also delivers approximately 720 babies from community clinics each year. The SGH Prenatal Clinic participated in the California Department of Public Health (CDPH) Comprehensive Perinatal Services Program (CPSP) to offer comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits. Services included health education, nutritional guidance and psychological/social issue support, as well as translation services for non-English speaking women. As part of this effort, and in order to reduce the number of women that reach gestational diabetic criteria, women were offered nutrition classes, and those with nutrition issues were referred to an SGH registered dietician or the SGH Diabetes Education Program as appropriate. At-risk women with elevated BMIs received education and glucometers in order to measure their sugars and help prevent the development of gestational diabetes. Women with a current diabetes diagnosis were referred to the SGH Diabetes Education Program. Free education on gestational diabetes was also provided to pregnant members of the community. The SGH Prenatal Clinic also provided educational resources tailored specifically to the increasing Chaldean population. In addition, the SGH Women's Health Center continued its partnership with Vista Hill ParentCare to assist drug-addicted patients with psychological and social issues during pregnancy. These approaches have been shown to reduce both low birth weight rates and health care costs in women and infants. The SGH Women's Health Center also provided women with referrals to a variety of community resources including but not limited to CTIS, WIC and the SDC Public Health Nurse. FY 2014 Plan SGH will do the following: * Provide wellness and prevention events for women that focus on lifestyle tips to enhance overall health * Provide videos on various nutrition topics through the SGH website and social media * Provide education on cardiovascular health and wellness as part of the second Women's Heart Health Expo * Provide free breastfeeding and postpartum support groups * Provide parenting education classes * Participate in community events targeting women in the community, such as the Sharp Women's Health Conference * Provide medical services to low-income patients through the SGH Prenatal Clinic * Share evidence-based practices regarding improvements in elective deliveries less than 39 weeks as well as breastfeeding rates at discharge through presentations at national conferences and research publications Identified Community Need: Prevention of Unintentional Injuries Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale
		* In the HASD&IC 2013 CHNA, unintentional injury was identified as one of the top priority health conditions seen in SDC hospitals. * In 2011, accidents (unintentional injuries) were the fifth leading cause of death for SDC's east region. * In 2011, accidents (unintentional injuries) were the sixth leading cause of death overall in SDC. * Unintentional injuries motor vehicle accidents, falls, pedestrian-related, firearms, fire/burns, drowning, explosion, poisoning (including drugs and alcohol, gas, cleaners and caustic substances), choking/suffocation, cut/pierce, exposure to electric current/radiation/fire/smoke, natural disasters and injuries at work are one of the leading causes of death for SDC residents of all ages, regardless of gender, race or region. * Between 2009 and 2011, 2,889 San Diegans died as a result of unintentional injuries, and since 2000, the rate of death has increased by 5 percent. * In 2011, there were 188 deaths due to unintentional injury in SDC's east region. The region's age-adjusted death rate due to unintentional injuries was 40.3 deaths per 100,000 population, the highest of all regions and higher than the SDC age-adjusted rate of 31.4 deaths per 100,000 population. * In 2011, there were 4,085 hospitalizations related to unintentional injury in SDC's east region. The rate of hospitalizations was 875.4 per 100,000 population, the highest of all regions and higher than the SDC average of 686.3 per 100,000 population. * In 2011, there were 27,619 ED visits related to unintentional injury in SDC's east region. The rate of visits was 5,918.6 per 100,000 population, the highest of all regions and higher than the SDC average of 5,094.2 per 100,000 population. * Injury, including both intentional and unintentional, is the number one killer and disabler of persons ages 1 to 44 in California (California Department of Public Health, 2010). * According to HP 2020, most events resulting in injury, disability or death are predictable and preventable. There are many risk factors for unintentional injury and violence, including individual behaviors and choices, such as alcohol use or risk-taking; the physical environment both at home and in the community; access to health services and systems created for injury-related care; and the social environment, including individual social experiences (social norms, education, victimization history), social relationships (parental monitoring and supervision of youth, peer group associations, family interactions), the community environment (cohesion in schools, neighborhoods and communities) and societal-level factors (cultural beliefs, attitudes, incentives and disincentives, laws and regulations). Measurable Objective * To offer an injury and violence prevention program for children, adolescents and young adults in SDC's east region FY 2013 Report of Activities In FY 2013, ThinkFirst/Sharp on Survival participated in 56 programs that served more than 3,600 elementary, middle and high school students in SDC's east region. The programs consisted of one- to two-hour classes on the modes of injury, disability awareness, and the anatomy and physiology of the brain and spinal cord. They also heard personal testimonies from individuals, known as Voices for Injury Prevention (VIPs), with traumatic brain or spinal cord injuries (SCI). In addition, ThinkFirst/Sharp on Survival offered schools multiple opportunities for learning with the provision of a variety of lesson plans, including information on physical rehabilitation, careers in health care, and disability awareness panels to meet the needs of specific class curricula. ThinkFirst/Sharp on Survival also spoke to at-risk youth about the consequences of reckless driving, violence, and poor decision making. ThinkFirst/Sharp on Survival participated in a variety of community events throughout FY 2013, including presentations for youth and their parents, health- and safety-related fairs, and community groups. These community-based events and presentations served more than 900 participants. Think First/Sharp on Survival participated in the annual Kids Care Fest event sponsored by the Grossmont Healthcare District in La Mesa, providing helmet-fitting information and education on booster and car seats to approximately 400 community members. In October, ThinkFirst/Sharp on Survival also provided proper helmet-fitting information and booster seat education at the El Cajon Fire Department Safety Fair and Open House, serving 500 people. With the partnership and financial support of the Health and Science Pipeline Initiative (HASPI), dozens of schools throughout SDC had the opportunity to provide ThinkFirst/Sharp on Survival speakers to their students. These students, who all have an interest in pursuing careers in health care, were provided with classroom presentations and the opportunity to participate in a half-day tour of the SMH Rehabilitation Center. In 2013, a dozen high school seniors from Granite Hills High School toured the center and received an in-depth look at occupational, physical, speech, recreation therapy and nursing careers. Students also rotated through several "stations" run by VIP speakers to practice their wheelchair mobility, lower body dressing and driving skills using the driving simulator. Additionally, students conducted small group patient therapy activities to test memory, organization and a variety of executive cognitive skills. In addition, more than 200 college students enrolled in San Diego State University's (SDSU's) Disability in Society course and received education on injury prevention, brain injury, SCI and disability awareness. Beginning in FY 2012, ThinkFirst/Sharp on Survival implemented a booster seat project funded by the Grossmont Healthcare District. The project was developed in response to the California law change implemented in January 2012 when requirements for booster seats changed from age six or 60 pounds to age eight or a height of four feet nine inches. The project was modeled after a larger, successful booster seat project implemented by ThinkFirst San Diego, in partnership with the ThinkFirst National Office, and funded by the National Health and Transportation Safety Administration (NHTSA) in 2004. This program not only provided education to parents on specifics of the law and consequences of misuse, but also offered guidance to alter children's misconceptions that booster seats are for "babies." After two years, the program successfully increased booster seat use in six schools by an average of 19 percent. The ThinkFirst/Sharp on Survival booster seat project modeled the best practices from this previous program, and provided more than 3,000 students and their parents with potentially lifesaving information. The education directed toward the students was conducted in four different schools with both assembly and classroom education formats. Each child was also measured and information on the child' height, the new law and best practices for booster seat use was sent home with the child. Additionally, over 70 students at these schools were provided with a free booster seat and a few additional seats given out to community members whose children participated in a booster seat drawing competition. The program came to its conclusion in January 2013. FY 2014 Plan ThinkFirst/Sharp on Survival will do the following: * With funding support from grants, provide educational programming and presentations for local schools and organizations * Increase community awareness of the program through attendance and participation at community events and health fairs using grant funding * Continue to evolve program curricula to meet the needs of health career pathway classes as part of the HASPI partnership * Continue to address the needs of elementary school children and their parents by providing booster seat education with funding support from grants * Continue to provide college students with injury prevention education through SDSU's Disability in Society course * Explore further opportunities to provide education to health care professionals and college students interested in health care careers Identified Community Need: Support During the Transition of Care Process for High-Risk, Underserved and Underfunded Patients Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale
		* Community health leaders participating in the HASD&IC 2013 CHNA process strongly aligned and recommended further work in access to care, health insurance and care management with each of the priority health issues identified for SDC (cardiovascular disease, Type II diabetes, mental/behavioral health, and obesity). * Community members participating in the HASD&IC 2013 CHNA community forums (throughout SDC) also strongly aligned access to care and care management with maintaining health. * In 2011, SDC's east region presented a higher rate of unemployment (9.9 percent in 2011) when compared to SDC overall (8.5 percent in 2011). * According to 2011 CHIS data, 20.1 percent of those 18 to 64 years of age in SDC's east region were currently uninsured. * According to 2011 CHIS data, in SDC's east region for those 18 to 65 years of age, the most common sources of health insurance coverage included employment-based coverage (62.9 percent) and public programs (13.7 percent). In 2011, 13.1 percent of the population in SDC's east region was living below the poverty level, with more than 22 percent of those being families. * In 2011, nearly 20 percent of families in the east region received some form of cash public assistance, compared to 14.9 percent of families in SDC overall. * According to 2011 CHIS data, 86 percent of adults in SDC's east region have a usual source of care. Among these adults, 22 percent utilize a community clinic, government clinic or community hospital as their usual source of care. * As of March 2012, the average unemployment rate in the cities of El Cajon, La Mesa, Lakeside, Lemon Grove, Santee, and Spring Valley was 10.4 percent (Labor Market Information, State of California Employment Development Department, http:www.labormarketinfo.edd.ca.gov). * According to the Bureau of Labor Statistics (BLS), 37.7 percent of unemployed persons nationally remained so for 27 weeks or greater. * The cost of living in California is 35 percent above the US average, with health spending per capita in California growing by 5.9 percent between 1994 to 2004 (California Hospital Association Special Report, October 2011). * According to HASD&IC, between 2006 and 2009, demand for ED services in SDC increased by 11.9 percent, from 582,129 to 651,595 visits (HASD&IC, 2010). * In 2013, the health insurance benefits available under the Consolidated Omnibus Budget Reconciliation Act (COBRA) cost a single person in California between $468 to $550 per month; for a family of three or more in California, COBRA costs ranged from $1,461.73 to $1,699.76 per month. These rates represent anywhere from 20 to 78 percent of a person's income (2013 COBRA Self-Pay Rates, Motion Picture Industry Pension & Health Plans). * Community clinics in California have experienced rising rates of primary care clinic utilization; the number of persons utilizing the clinics increased by 27.3 percent between 2007 and 2011 (OSHPD, 2011). Measurable Objectives * Connect high-risk, underfunded patients and community members to community resources and organizations for low-cost medical equipment, housing options, and follow-up care * Assist economically disadvantaged individuals through transportation and financial assistance for pharmaceuticals * Collaborate with community organizations to provide follow-up medical care, financial assistance, psychiatric and social services to chronically homeless individuals FY 2013 Report of Activities In FY 2013 SGH continued to provide post-acute care facilitation for high-risk patients, including individuals who were homeless or without a safe home environment. Individuals received referrals to and assistance from a variety of local resources and organizations that provided support with transportation, placement, medical equipment, medications, as well as outpatient dialysis and nursing home stays. SGH referred high-risk patients, families, and community members to churches, shelters and other community resources for food, safe shelter and other resources. For unemployed and underfunded patients, or for those who simply cannot afford the expense of a wheelchair, walker or cane due to a fixed income, SGH has committed to improving access to Durable Medical Equipment (DME) for high-risk patients upon discharge. SGH case managers actively recruit DME donations from the community in order to provide for patients in need. Also in FY 2013, SGH continued to provide information on DME in the pre-recorded message that callers to SGH hear when they are placed on hold. SGH case managers and social workers provide and track DME items to patients who are uninsured, underinsured, or who are otherwise unable to afford the equipment required to keep them safe and healthy. To assist economically disadvantaged individuals, in FY 2013 SGH provided more than $127,000 in free medications, transportation, lodging, and financial assistance through its Project HELP funds. These funds assisted more than 4,000 individuals in FY 2013. In addition, SGH pharmacists assisted more than 250 economically disadvantaged patients with more than 700 outpatient prescriptions valued at approximately $319,000. In FY 2013 SGH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the San Diego Rescue Mission, SGH discharged chronically homeless patients to the Rescue Mission's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up care through SGH in a safe space, and also provides psychiatric care, substance abuse counseling, and guidance from the Rescue Mission's programs in order to help these patients get back on their feet. FY 2014 Plan SGH will conduct the following: * Continue to provide post-acute care facilitation to high-risk patients * Continue and expand the DME donations project to improve access to necessary medical equipment for high-risk patients who cannot afford DME * Continue to administer Project HELP funds to those in need * Continue to collaborate with community organizations to provide medical care, financial assistance, psychiatric and social services to chronically homeless patients Identified Community Need: Collaboration With Local Schools to Promote Interest in Health Care Careers Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * According to the 2013 Healthcare Shortage Areas Atlas from the County of San Diego Health and Human Services Agency (HHSA), SDC is one of 28 counties in California listed as a Registered Nurse (RN) Shortage Area. * The demand for RNs and other health care personnel in the US will increase due to the aging population, and nurses also will be needed to educate and to care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. In addition, the number of individuals who have access to health care services will increase as a result of federal health insurance reform. More nurses will be needed to care for these patients (BLS, 2012). * The BLS projects an employment of more than 3.2 million RNs in 2022, an increase of 19 percent from 2012. RNs are projected to have the most new jobs in 2020, when compared to other health care practitioners and technical occupations in health care. * The BLS projects that health care support occupations (home health aides, etc.) will be the fastest growing occupational group from 2010 to 2020 (BLS, 2010). * Overall employment is projected to increase by about 14 percent during the 20102020 decade with more than half a million new jobs expected for each of four occupations-RNs, retail salespersons, home health aides, and personal care aides (BLS, 2012). * According to the San Diego Workforce Partnership 2011 report titled, Healthcare Workforce Development in SDC: Recommendations for Changing Times, health care occupations that will be in highest demand in the next three to five years include physical therapists, medical assistants, occupational therapists, RNs, medical record and health information technicians, radiology technologists and technicians, pharmacists and medical and clinical laboratory technologists.
		* According to the San Diego Workforce Partnership, despite the growing demand for health care workers, employers express an "experience gap" among recent graduates as a challenge to filling open positions. While new graduates often possess the requisite academic knowledge to be hired, they lack necessary real world experience. * The San Diego Workforce Partnership recommends programs that provide volunteer experiences to high school and post-secondary students, as on-the- job training could provide real world experience for workers. Programs that target underrepresented groups and disadvantaged students could help increase the number of culturally competent health care workers. Measurable Objective * In collaboration with local schools, offer opportunities for students to explore a vast array of health care professions FY 2013 Report of Activities In collaboration with the Grossmont Union High School District (GUHSD), SGH participated in the Health-careers Exploration Summer Institute (HESI), providing 12 students with opportunities for classroom instruction, job shadowing observations and limited hands-on experiences in hospital departments. At the conclusion of the program, students presented their experiences as case studies to family members, educators and hospital staff. Those completing the program received high school credits equal to two summer school sessions. SGH also continued its participation in the Health Sciences High and Middle College (HSHMC) program in FY 2013, providing early professional development for 153 students from a broad array of backgrounds in grades nine through 12. Students shadowed an estimated 50 health professionals in 33 departments and nursing areas throughout the hospital. During each semester, students rotated through instructional pods in areas such as nursing, obstetrics, occupational and physical therapy, behavioral health, SICU, MICU, imaging, engineering, rehabilitation, laboratory, pharmacy, pulmonary, cardiac services and food services. In May 2013, the HSHMC program graduated its third full class of students. Level I of the HSHMC program is the entry level for all students and is conducted over a 16-week period. For FY 2013, 59 ninth-graders shadowed primarily in non-nursing areas of the hospital, including physical therapy, food services, laboratory, cardiac services, imaging, physician offices, pulmonary, pharmacy and radiation therapy. Ninth-graders spent a greater length of time within each department in order to more fully experience different clinical areas of the hospital. Level II of the HSHMC program offers patient interaction, where students are trained in Tender Loving Care (TLC) functions by a Certified Nursing Assistant (CNA) on nursing floors. In FY 2013, 51 tenth-graders, 20 eleventh-graders and 23 twelfth-graders participated in the Level II TLC program, experiencing college-level clinical rotations, hands-on experience, TLC function patient care and mentoring. Students were placed in a new assignment each semester for a variety of patient care experiences, and also took additional health-related coursework at San Diego Mesa College, including Anatomy, Physiology, Medical Terminology and Human Behavior courses. In FY 2013, twelfth-graders continued to receive training in First Touch the patient-centered model of care provided by SGH to help ease patient anxiety and increase trust in their caregiver. In addition, SGH staff provided HSHMC students instruction on educational requirements, career ladder development and job requirements. At the end of the academic year, SGH staff provided HSHMC students, their loved ones, community leaders and hospital mentors a symposium that showcased the lessons learned throughout the program. Also in FY 2013, SGH provided 775 students from colleges and universities throughout San Diego with various placement and professional development opportunities. Throughout the academic year, 565 nursing students spent more than 52,000 hours at SGH, including both time spent both in clinical rotations and individual preceptor training. Among the nursing programs, academic partners included but were not limited to SDSU, Point Loma Nazarene University (PLNU), University of San Diego (USD), National University (NU), California State University-San Marcos, Southwestern College (SWC) and Kaplan College (KC). Allied health students spent more than 48,000 hours on the SGH campus, and came from academic institutions throughout San Diego including GC, EMSTA College, Alliant University, San Diego Mesa College (MC), NU, University of Southern California and SDSU, among others. FY 2014 Plan SGH will do the following: * In collaboration with GUHSD, participate in the HESI * Continue to track and report outcomes of HSHMC students and graduates to promote long-term program sustainability * Continue to provide internship and professional development opportunities to college and university students throughout San Diego SGH Program and Service Highlights * 24-hour emergency services with heliport and paramedic base station designated STEMI Center * Acute care * Ambulatory care services, including infusion therapy * Behavioral Health Unit * Breast Health Center, including mammography * Cardiac services, recognized by the American Heart Association GWTG * Cardiac Training Center * CT scan * David and Donna Long Center for Cancer Treatment * Electrocardiogram (EKG) * Electroencephalography (EEG) * Endoscopy unit * Grossmont Plaza Outpatient Surgery Center * Group and art therapies * Home health * Home infusion therapy * Hospice * Hyperbaric treatment * Intensive Care Unit (ICU) * LakeView Home * Neonatal Intensive Care Unit (NICU) * Orthopedics * Outpatient diabetes services, recognized by the American Diabetes Association * Outpatient Imaging Centers * Laboratory services (inpatient and outpatient) * ParkView Home * Pathology services * Pediatric services * Pulmonary services * Radiology services * Rehabilitation Center * Robotic surgery * Senior Resource Center * Sleep Disorders Center * Spiritual care services * Stroke Center * Surgical services * Transitional Care Unit * Van services * Vascular services * Women's Health Center * Wound Care Center Section 5 Sharp HospiceCare Sharp HospiceCare is located at 8881 Fletcher Parkway in La Mesa, ZIP code 91942. As a systemwide program, Sharp HospiceCare provides programs and services to all of Sharp HealthCare's (Sharp's or SHC's) hospital entities. However, Sharp HospiceCare is licensed under Sharp Grossmont Hospital (SGH) and as such, the financial value of its community benefit programs and services are included in the SGH section of this report. The following description highlights the variety of community benefit programs and services provided by Sharp HospiceCare to San Diego County (SDC) in FY 2013: * Other Benefits for Vulnerable Populations included contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank. * Other Benefits for the Broader Community included a variety of end-of-life support for seniors, families and caregivers in the San Diego community, including education, support groups, and outreach at community health fairs and events. Sharp HospiceCare also provided volunteer training opportunities for community members, including both adults and teens. In addition, Sharp HospiceCare staff actively participated in community boards, committees and civic organizations, such as San Diego County Coalition for Improving End-of-Life Care (SDCCEOL), San Diego Regional Home Care Council (SDRHCC), San Diego Community Action Network (SanDi-CAN), East County Senior Service Providers (ECSSP), and South County Action Network (SoCAN). See Appendix A for a listing of Sharp's community involvement. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Programs included education and training of health care professionals, student and intern supervision and time devoted to generalizable health-related research projects that were made available to the broader health care community. Definition of Community Sharp HospiceCare provides comprehensive end-of-life hospice care, specialized palliative care and compassionate support to patients and families throughout SDC.
		For SHC's 2013 Community Health Needs Assessment (CHNA) process, the Dignity Health/Truven Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States (US) based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to Dignity Health's CNI, communities served by Sharp HospiceCare with especially high-need include but are not limited to: East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In SDC, 93.8 percent of children ages 0 to 11, 93.5 percent of children ages 12 to 17, and 81.3 percent of adults were currently insured in 2011 failing to meet the Healthy People (HP) 2020 national targets for health insurance coverage. See Table 2 for a summary of key indicators of access to care, and Table 3 for data regarding eligibility for Medi-Cal Healthy Families. Table 2: Health Care Access in SDC, 2011 Current Health Insurance Coverage Children 0 to 11 Years Rate - 93.8% Year 2020 Target - 100% Children 12 to 17 Years Rate - 93.5% Year 2020 Target - 100% Adults 18 + Years Rate - 81.3% Year 2020 Target - 100% Regular Source of Medical Care Children 0 to 11 Years Rate - 98.1% Year 2020 Target - 100% Children 12 to 17 Years Rate - 82.2% Year 2020 Target - 100% Adults 18 + Years Rate - 85.6% Year 2020 Target - 89.4% Not Currently Insured Adults 18 to 64 Years Rate - 17.7% Source: 2011-2012 Community Health Interview Survey (CHIS) Table 3: Medi-Cal (Medicaid)/Healthy Families Eligibility, Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2011 Description/Rate Medi-Cal Eligible - 6.9% Healthy Families Eligible - 0.4% Not Eligible - 92.6% Source: 2011-2012 CHIS Table 4 summarizes the leading causes of death in SDC. For additional demographic and health data for communities served by Sharp HospiceCare please refer to the Sharp Memorial Hospital (SMH) 2013 CHNA at http://www.sharp.com/about/community/community-health-needs-assessments which includes data for the primary communities served by Sharp HospiceCare. Table 4: Leading Causes of Death in SDC, 2011 Cause of Death Number of Deaths Percent of Total Deaths Malignant neoplasms 4,812 24.2% Disease of heart 4,758 24.0% Alzheimer's disease 1,221 6.2% Chronic lower respiratory diseases 1,045 5.3% Cerebrovascular diseases 1,031 5.2% Accidents (unintentional injuries) 1,017 5.1% Diabetes mellitus 581 2.9% Intentional self-harm (suicide) 383 1.9% Chronic liver disease and cirrhosis 331 1.7% Influenza and pneumonia 311 1.6% Essential (primary) hypertension and hypertensive renal disease 269 1.4% Parkinson's disease 211 1.1% Pneumonitis due to solids and liquids 147 0.7% Septicemia 128 0.6% Viral hepatitis 113 0.6% All other causes 3,494 17.6% Total Deaths 19,852 100.0% Source: County of San Diego, HHSA, Public Health Services, Community Epidemiology Branch Community Benefits Planning Process In addition to the steps outlined in Section 3 regarding community benefits planning, Sharp HospiceCare: Consults with representatives from a variety of internal departments and other community organizations to discuss, plan and implement community activities * Participates in programs and workgroups to review and implement services that improve palliative and end-of-life care for the San Diego community * Incorporates end-of-life community needs into its goal development Priority Community Needs Addressed by Sharp HospiceCare The 2013 CHNAs for each SHC acute care hospital (Sharp Chula Vista Medical Center, Sharp Coronado Hospital and Healthcare Center, SGH, SMH) identify senior health as a priority health need for the community. Sharp HospiceCare provides hospice and palliative care services across the SHC care continuum, and helps to address senior health issues through the following community programs and services: * End-of-life and chronic illness management education for community members * Advance care planning education and outreach for community members and health care professionals * Hospice and palliative care education and training programs for health care professionals, students and volunteers * Bereavement counseling and support For each of the community programs and services described above, subsequent pages include a summary of the rationale and importance of the service(s), measurable objective(s), FY 2013 Report of Activities conducted in support of the objective(s), and FY 2014 Plan of Activities. Identified Community Need: End-of-Life and Chronic Illness Management Education for Community Members Rationale references the findings of the Sharp HealthCare (SHC) 2013 Community Health Needs Assessments or the most recent San Diego County community health statistics, unless otherwise indicated. * In SHC's 2013 CHNAs, senior health was identified as one of the priority health issues for community members served by SHC. * Research presented in the SHC 2013 CHNAs revealed that seniors are at high-risk for developing chronic illnesses and related disabilities, and chronic conditions are the leading cause of death among older adults. Nationwide, about 80 percent of seniors are living with at least one chronic condition, while 50 percent of seniors have two or more chronic conditions, thus increasing their need for care (Centers for Disease Control and Prevention, 2007). * Findings presented in the SHC 2013 CHNAs revealed the following health conditions as chief concerns for seniors in SDC: cardiovascular disease, Alzheimer's disease, pain management, hearing loss (many seniors cannot afford treatment), and mobility issues (falls and resulting immobility). In addition, health issues such as medication management, social planning for the future (including housing, advance care planning, etc.), and lack of education, management and support for behavioral changes were identified. * According to research presented in the SHC 2013 CHNAs, older adults are among the fastest growing age groups in the US. In 2011, the first of more than 70 million baby boomers (adults born between 1946 and 1964) turned 65, and in the next two decades, another 79 million baby boomers will move into this demographic (American Hospital Association First Consulting Group, 2007; Pew Research Center Social and Demographic Trends, 2010; United Health Foundation, America's Health Ranking Senior Report, 2013). * There are an estimated four million family caregivers in California, according to the California Caregiver Resource Center (CRC). * The close relationship between a caregiver and care recipient is a shared relationship with involved emotions, experiences, and memories, which can place a caregiver at higher risk for psychological and physical illness (National Alzheimer's Association, 2012). * While researchers have long known that caregiving can have deleterious mental health effects for caregivers, research shows that caregiving can have serious physical health consequences as well. Seventeen percent of caregivers feel their health in general has gotten worse as a result of their caregiving responsibilities. Furthermore, an estimated 17 to 35 percent of family caregivers view their health as fair to poor (AARP Public Policy Institute, 2011; AARP Public Policy 2012). * The demand for information by caregivers increased from 67 percent to 77 percent over the five years period from 2004 to 2009 (The National Alliance for Caregiving and AARP, 2009). * According to the National Alzheimer's Association, caregivers responded positively to interventions such as individual/group therapy, educational/training support, home-based visits or technology, depending on how they are delivered (National Alzheimer's Association, 2012). * According to a 2011 article in the American Family Physician Journal (AFPJ), in the next few decades, the demand for family caregivers is expected to rise by 85 percent. Furthermore, family caregiving has been affected in several important ways over the past five years: caregivers and care recipients are older and have higher levels of disability than in years past; the duration, intensity and burden of care has increased; the financial cost associated with informal caregiving has risen; and the use of paid formal care has declined significantly.
		Measurable Objectives * Provide education and outreach to the San Diego community concerning end-of-life care and chronic illness management * Collaborate with community organizations to provide education and outreach to community seniors and their loved ones FY 2013 Report of Activities In an effort to support the San Diego community in the areas of end-of-life care, aging and caregiving, Sharp HospiceCare is a member of a variety of organizations including San Diego County Coalition for Improving End-of-Life Care (SDCCEOL), San Diego Regional Home Care Council (SDRHCC), San Diego Community Action Network (SanDi-CAN), East County Senior Service Providers (ECSSP), and South County Action Network (SoCAN), and collaborated with these organizations for a variety of events throughout FY 2013. Through these collaborations, nearly 2,500 community members received end-of-life education and outreach at an assortment of seminars, health fairs, expos, classes and other events. Education covered end-of-life issues and chronic illness management, including introduction to hospice, eligibility and other key facts about hospice. Events took place at a variety of churches, senior living centers, and community health agencies and organizations throughout San Diego, including the College Avenue Senior Center, La Mesa Community Center, San Diego Gas & Electric (SDG&E), The Rock Church, Skyline Church, St. Paul's Senior Living, and American Association of Retired Persons (AARP), to name a few. In honor of California Health Care Decisions Week, in October Sharp HospiceCare partnered with SanDi-CAN and other community organizations to co-host a large community event at the Balboa Park Club entitled Navigating End-of-Life Decisions. This free half-day conference provided 120 seniors and families with tools to help them identify their values and goals, as well as communication tips to make educated and informed health care decisions. The event included resources from 35 community exhibitors, as well as presentations from a variety of community experts, including: The Five Essential Documents Everyone Should Have; Family Decision Making: Pearls and Pitfalls; ABC's of End-of-Life Care Decisions; Burial: All You Need to Know and Plan For; Benefits of Whole Body Donation; and Healing Touch for Self-Care. In honor of the 2nd Annual National Health Care Decisions Day in April, Sharp HospiceCare and the SGH Senior Resource Center provided a conference for approximately 100 community seniors and caregivers at the La Mesa Community Center entitled Living with a Chronic Illness. Through presentations from Sharp HospiceCare leadership and community health experts, as well as resources from community health and senior service agencies, attendees received education and support for living with chronic illness, including: identifying and managing disease specific symptoms; when and where to access care; assessing and communicating values, beliefs and health care goals; coping with life's transitions; and tools for self-care, relaxation, healing and prevention of caregiver burnout. In September, this conference was repeated for approximately 75 seniors and caregivers at the Point Loma Community Presbyterian Church. In further support of National Health Care Decisions Day, Sharp HospiceCare played a lead role in the planning, organization and delivery of a countywide event entitled Planning Ahead for Your Future Healthcare Needs, hosted by SDCCEOL. Held at the First United Methodist Church in Mission Valley, this dynamic, free conference was a collaboration of a variety of community hospice agencies and mortuaries that provided more than 125 community members with tools and resources for selecting an appropriate health care agent and end-of-life planning. The conference included community physicians who shared their personal experiences with completing an advance directive, including crucial conversations with their loved ones, and how they selected their health care agent. Presentations entitled Family Decision Making: Pearls and Pitfalls, and Physician Orders for Life Sustaining Treatment (POLST) were also provided, as well as a community physician panel entitled How Physicians Plan to Die. In collaboration with Sharp Chula Vista Medical Center, the County of San Diego Health and Human Services Agency (HHSA), Live Well San Diego, the Braille Institute, Health Net and SoCAN, Sharp HospiceCare participated in the Walk a Day in Someone Else's Shoes Expo in September. This free event focused on the challenges of aging and provided approximately 150 community members with free screenings for bone density, vision, blood sugar, blood pressure, dental health and depression. Additionally, the event featured education and resource booths for Alzheimer's disease, Parkinson's disease, blindness, cancer, health care planning, Medicare and elder law and advocacy. In addition, in April, Sharp HospiceCare participated in the Dia de la Mujer Latina event at Sweetwater High School in National City, providing information and relaxation techniques to approximately 200 Spanish-speaking women. Also in FY 2013, the Sharp HospiceCare Integrative Therapies team provided a monthly stress management class called The Power of Touch Healing for the Family Caregiver. With a goal of preventing caregiver burnout and promoting healing, approximately 150 family caregivers learned simple techniques for self-care and relaxation through an educational lecture, hands-on demonstrations and self-practice. FY 2014 Plan Sharp HospiceCare will do the following: * Continue to collaborate with a variety of local networking groups and community-oriented agencies to provide education and resources to community seniors and their loved ones on end-of-life and palliative care issues * In collaboration with Sharp Coronado Hospital and Healthcare Center and the SMH and SGH Senior Resource Centers, host three free end-of-life conferences, reaching 100 community members per conference Identified Community Need: Advance Care Planning Education and Outreach to Community Members and Health Care Professionals Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * Participants in the HASD&IC 2013 CHNA community forums recommended increased educational resources on advance directives to help address the health concerns of seniors in SDC. * Key informant interviews from the SHC 2013 CHNAs identified social planning for the future, including education on advance care planning, among chief concerns for seniors in SDC. * Greater community education regarding care options and care management to ensure a positive experience as seniors approach the later stages of life were identified as areas of improvement for seniors in the SHC 2013 CHNAs. * According to the CDC, barriers to advance care planning include: lack of awareness, denial of death and dying, denial of being in a circumstance in which we are unable to make our own decisions and speak for ourselves, confusion between whether to choose palliative care and doing whatever it takes to extend life, and cultural differences (CDC, 2012). * According to the CDC, planning for the end of life is increasingly being viewed as a public health issue, given its potential to prevent unnecessary suffering and to support an individual's decisions and preferences related to the end of life. In addition, the CDC recognizes the public health opportunity to educate Americans, and especially older adults, about advance care planning and to improve their quality of care at the end of life (CDC, 2010). * Most people say they would prefer to die at home, yet only about one-third of adults have an advance directive expressing their wishes for end-of-life care. Among those 60 and older, that number rises to about half of older adults completing an advance directive (Pew Research Center, 2006; AARP, 2008). * Only 28 percent of home health care patients, 65 percent of nursing home residents and 88 percent of hospice care patients have an advance directive on record (National Center for Health Statistics, 2011). * Although making decisions on end-of-life care can be traumatic, providing information to family members, involving them in discussions and using advance directives has shown to reduce their symptoms of post-traumatic stress, anxiety, and depression (Detering et al., 2010, The Impact of Advance Care Planning on End of Life Care In Elderly Patient: Randomized Controlled Trial, British Medical Journal).
		Measurable Objectives * Provide advance care planning education, engagement and consultation for community members and health care professionals FY 2013 Report of Activities SHC offers a free and confidential Advance Care Planning (ACP) program through Sharp HospiceCare. The program is designed to empower adults of any age and health status in the community to explore and document their beliefs, values and goals as they relate to health care. The program consists of three stages. Stage one, community engagement, focuses on bringing awareness to healthy community members about the importance of ACP. This stage includes basic education and resources, identification of an appropriate health care agent, and completion of an advance directive. The next stage, disease-specific outreach, focuses on education for community members with a progressive chronic illness, including decline in functional status, co-morbidities, potential for hospitalization and caregiver issues. With a goal of anticipating future needs as health declines, this stage focuses on developing a written plan that identifies goals of care, and involves the health care agent and loved ones. The third stage, late life illness outreach, targets those with a disease prognosis of one year or less, when specific or urgent decisions must be made and converted into medical orders that will guide the health care provider's actions and be consistent with goals of care. The focus of this stage is to assist the individual or appointed health care agent with navigating complex medical decisions related to immediate life sustaining or prolonging measures, including completion of the POLST form. In FY 2013, the Sharp ACP team provided printed educational resources, as well as phone and in-person consultations to community members seeking guidance with identifying their personal goals of care and health care preferences, appointing an appropriate health care agent, and completing an advance directive. In addition, the program engaged more than 1,600 community members in free ACP education at a variety of community sites, including health fairs, senior centers, homecare agencies, churches and seminars. The team also provided ACP lectures to more than 400 community health care professionals, including attendees of the Aging and Independence Services (AIS) Vital Aging Conference, SDCCEOL, SanDi-CAN, San Diego County Council on Aging (SDCCOA), United Health Group, Coalition to Transform Advanced Care (CTAC), case managers from the San Diego Care Transitions Partnership (SDCTP) and social workers from UC San Diego Health System. FY 2014 Plan Sharp HospiceCare will do the following: * Continue to provide free ACP education and outreach to community members through phone and in-person consultations * Continue to provide free ACP education and outreach to health care professionals * Continue to collaborate with community organizations to provide at least 50 educational classes and events to raise awareness of ACP * Participate in National Healthcare Decisions Day in April as part of a national collaborative effort to motivate and educate community members and providers about the importance of advance care planning * Develop a new SHC Advance Directive for distribution to community members to clearly articulate and communicate personal health care preferences Identified Community Need: Professional and Student Education, and Volunteer Training Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * According to the 2013 SDC Healthcare Shortage Areas Atlas from the County of San Diego's Health and Human Services Agency (HHSA), SDC is one of 28 counties in California listed as a Registered Nurse (RN) Shortage Area. * The demand for RNs and other health care personnel in the US will increase due to the aging population, and nurses also will be needed to educate and to care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. In addition, the number of individuals who have access to health care services will increase as a result of federal health insurance reform. More nurses will be needed to care for these patients (Bureau of Labor Statistics, 2012). * The Bureau of Labor Statistics (BLS) projects employment of more than 3.2 million RNs in 2022, an increase of 19 percent from 2012. RNs are projected to have the most new jobs in 2020, when compared to other health care practitioners and technical occupations in health care. * The BLS projects that health care support occupations (home health aides, etc.) will be the fastest growing occupational group from 2010 to 2020 (BLS, 2010). * Overall employment is projected to increase about 14 percent during the 20102020 decade with more than half a million new jobs expected for each of four occupations - RNs, retail salespersons, home health aides, and personal care aides. * According to the Institute of Medicine (IOM), the nation faces an impending health care crisis as the number of older patients with more complex health needs increasingly outpaces the number of health care providers with the knowledge and skills to adequately care for them (IOM, 2008). * An estimated 3.5 million additional health care professionals will be needed by 2030 to care for older adults, while current levels of workforce are already stretched (Eldercare Workforce Alliance, 2011). * The San Diego Workforce Partnership recommends programs that provide volunteer experiences to high school and post-secondary students, as on-the- job training could provide real world experience for workers. Programs that target underrepresented groups and disadvantaged students could help increase the number of culturally competent health care workers. Measurable Objectives * Provide education and training opportunities for students and interns * Provide a Sharp HospiceCare Resource & Education Expo for community health care professionals * Through education, training and outreach, guide local, state and national health care organizations in the development and implementation of appropriate services for the needs of the aging population, including individuals in need of advanced illness management * Maintain active relationships and leadership roles with local and national organizations * Provide volunteer opportunities for adults and teens in the San Diego community FY 2013 Report of Activities Between the fall 2012 and spring 2013 semesters, Sharp HospiceCare provided 56 San Diego State University (SDSU) nursing students with opportunities to shadow case managers out in the field. In addition, Sharp HospiceCare's LakeView and ParkView homes served as training sites for 21 SDSU nursing students who spent an eight-hour day shadowing and learning from the highly skilled and compassionate nursing staff at each of the homes. Sharp HospiceCare also provided 200 hours of training, supervision and shadowing for a student intern from the SDSU Gerontology Program, as well as trained and supervised six premedical students through the SDSU Pre-Professional Program. Additionally, lectures on hospice and ACP were provided to more than 20 students at the University of Phoenix and nearly 40 students at University City High School. In June 2013, Sharp HospiceCare hosted its fourth annual Resource and Education Expo, reaching approximately 100 community health care professionals. The Expo featured 50 resource exhibits representing a variety of community agencies supporting end-of-life needs. Education was provided by various community agencies including the La Mesa Police Department, Southern Caregiver Resource Center, Alzheimer's Association and Butler Counseling, as well as Sharp Nutrition Services and Injury Prevention.
		In FY 2013, Sharp HospiceCare leadership provided education, training and outreach to local, state and national health care professionals. These efforts sought to guide industry professionals in achieving person-centered, coordinated care through the advancement of innovative hospice and palliative care initiatives. Educational outreach to local organizations included SDCCOA, San Diego Medical Group Management Association (SDMGMA), San Diego POLST Coalition and UC San Diego Moore's Cancer Center. State and national presentations included the American Hospital Association (AhA) Annual Membership Meeting, the National Hospice and Palliative Care Organization (NHPCO) Clinical Team Conference, the California Hospice and Palliative Care Association (CHAPCA) Annual Conference, the Coalition for Compassionate Care of California (CCCC) Conference, California Physicians Medical Group, and Scott and White Medical Group of Central, TX. Presentation topics included advanced illness management, hospice economics, prognostication, ACP and geriatric frailty. In addition, Sharp HospiceCare leadership served as part of the California HealthCare Foundation's (CHCF) Palliative Care Action Community, a one-year learning collaborative comprised of 21 California-based provider organizations seeking to share implementation strategies, experiences and lessons learned in the implementation of community-based palliative care services. Also in FY 2013, Sharp HospiceCare provided print, radio and television interviews for KPBS, Fox 5 and the San Diego Union-Tribune, discussing issues pertaining to end-of-life care. A research article was also published in the September 2013 issue of Journal of Clinical Outcomes Management, entitled, Development and Preliminary Evaluation of an Innovative Advanced Chronic Disease Care Model. In addition, Sharp HospiceCare provided training for nearly 50 new volunteers throughout the year. Prior to providing patient care and administrative support activities, volunteers participated in an extensive 32-hour training program to confirm their understanding of and commitment to hospice care. Sharp HospiceCare also trained five teenagers through its Teen Volunteer Program, as well as hosted a student volunteer from San Diego Metropolitan Regional & Technical High School. The teen and high school student volunteers devoted their time to special projects in the office or at Sharp HospiceCare's hospice homes. In addition, Sharp HospiceCare continued its volunteer-run wig donation program to provide free wigs for community members who suffer from hair loss. FY 2014 Plan Sharp HospiceCare will do the following: * Continue to provide education and training opportunities for nursing and premedical students and interns * Provide an end-of-life learning environment in community-based hospice homes * Continue to provide education, training and outreach to local, state and national health care organizations to support the development and implementation of appropriate services for the needs of the aging population, including individuals in need of advanced illness management * Maintain active relationships and leadership roles with local and national organizations * Provide volunteer training programs for at least 75 adults and teens * Continue to provide a volunteer-run wig donation program Identified Community Need: Bereavement Counseling and Support Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent San Diego County community health statistics, unless otherwise indicated. Rationale * According to the NHPCO, grief may be experienced in response to physical losses, such as death, or in response to symbolic or social losses such as divorce or loss of a job. The grief experience can be affected by one's history and support system. Taking care of one's self and accessing counseling and support services can be a guide through some of the challenges of grieving as a person adjusts to their loss. * According to a 2010 article in Journal of the American Medical Association (JAMA), when compared with nursing homes or home health nursing services, bereaved family members report fewer unmet needs for pain and emotional support when the last place of care was hospice. In addition, lower spousal mortality at 18 months was found among bereaved wives of decedents who used hospice care versus those who did not. * A 2004 JAMA study titled, "Quality of End-of-Life Care and Last Place of Care," examined 1,578 family members of people who died in the year 2000 of non-traumatic causes. Families were asked about the quality of patients' experiences at the last place where they spent more than 48 hours. Significant findings of the study include more than one-third of those cared for by nursing homes, hospitals and home health agencies reported either insufficient or problematic emotional support for the patient and/or family, compared to one-fifth of those in hospice (JAMA, January 7, 2004). Measurable Objectives * Provide bereavement education, resources, counseling and support to community members with life-limiting illness and their loved ones * Provide individuals and their families referrals to needed community services * Provide support to loved ones of those who have passed away through the Memory Bear Program FY 2013 Report of Activities Throughout FY 2013, Sharp HospiceCare offered a variety of bereavement service options to help grieving community members learn effective ways to cope with the loss of a loved one. Services were provided in both Spanish and English, and included professional bereavement counseling for individuals and families, as well as community education, support groups and monthly newsletter mailings. In FY 2013, Sharp HospiceCare devoted more than 1,460 hours to home and office counseling and phone contacts with patients and their loved ones, providing them with bereavement counseling services from Master's-level social workers with specific training in grief and loss. In addition, free quarterly bereavement support groups facilitated by skilled mental health care professionals specializing in the needs of the bereaved reached more than 350 participants in FY 2013. Groups included Straight Talk about Grief and Loss and the Widow's/Widower's group. Straight Talk about Grief and Loss consisted of eight weekly sessions each quarter, including: Introduction to the Grief Process; Strategies for Coping with Grief; Communicating with Family and Friends; Experiencing Anger in Grief; Guilt, Regret and Forgiveness; Differentiating Natural Grief and Depression; Use of Ceremony and Ritual to Promote Healing; and What Does Healing Look Like?/Who Am I Now? In addition, Straight Talk About Grief and Loss was provided for the Spanish-speaking population in the Spring, Fall and Winter quarters. The Widow's/Widower's group welcomed community members who lost a spouse, and provided them with an opportunity to share their emotional challenges and receive support and coping skills from other group members. Additionally, a support group entitled Support During the Holiday Season, was offered on three days in November, while a special event entitled Healing Through the Holidays was offered on two days in December. More than 70 adults attended the groups, receiving presentations and support around understanding grief, improving coping skills, exploring the spiritual meaning of the holidays in the face of grief, remembering loved ones and reviving hope. A similar group was provided in the spring titled Remembering Your Parents, which focused on coping with grief around Mother's and Father's Day, and served approximately 30 community members. In further support of community members who have lost a loved one, 1,660 people received 13 monthly issues of the bereavement support newsletters, Healing Through Grief (for adults) and Journey to My Heart (for children under 12 years). In addition, Sharp HospiceCare bereavement counselors provided referrals to community counselors, mental health services, other bereavement support services and community resources as needed. Furthermore, Sharp HospiceCare volunteers supported grieving community members through the Memory Bear program, in which they used garments of loved ones who have passed on to sew teddy bears as keepsakes for surviving family members. FY 2014 Plan
		Sharp HospiceCare will do the following: * Continue to offer individual and family bereavement education, counseling and support groups in English and Spanish * Continue to provide referrals to needed community services * Provide Healing Through the Holidays events and support services * Provide 13 mailings of bereavement support newsletters * Continue to provide a Memory Bear program to serve 250 families Sharp HospiceCare Program and Service Highlights * Advance care planning * Bereavement care services * Homes for Hospice program * Hospice nursing services * Integrative therapies * Spiritual care services * Volunteer program * Management for various hospice patient conditions, including: * Alzheimer's disease * Cancer * Debility * Dementia * Heart disease * HIV * Kidney disease * Liver disease * Pulmonary disease * Stroke Appendix A Sharp HealthCare Involvement in Community Organizations The list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2013. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Access to Independence * Adult Protective Services * Aging and Independence Services (AIS) * Alzheimer's Association * American Association of Critical Care Nurses, San Diego Chapter * American Cancer Society (ACS) * American College of Cardiology * American College of Healthcare Executives (ACHE) * American Diabetes Association (ADA) * American Foundation for Suicide Prevention * American Health Information Management Association * American Heart Association (AHA) * American Hospital Association (AhA) * American Lung Association * American Liver Foundation * American Parkinson Disease Association, Inc. * American Psychiatric Nurses Association * American Red Cross of San Diego * Arc of San Diego * Arthritis Foundation * Asian Business Association * Association for Ambulatory Behavioral Health Care (National) * Association for Ambulatory Behavioral Health Care of Southern California * Association for Clinical Pastoral Education (ACPE) * Association of California Nurse Leaders (ACNL) * Association of periOperative Registered Nurses (AORN) * Association of Practical and Professional Ethics * Association of Rehabilitation Nurses * Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) * Azusa Pacific University (APU) * Bankers Hill Park West Community Development Corporation * Beacon Council Patient Safety Collaborative * Boys and Girls Club of San Diego * Bonita Business and Professional Organization * California Association of Health Plans * California Association of Hospitals and Health Systems * California Association of Marriage and Family Therapists * California Association of Physician Groups * California Board of Behavioral Health Sciences * California College, San Diego * California Council for Excellence * California Department for Public Health * California Dietetic Association, Executive Board * California HealthCare Foundation * California Health Information Association * California Hospice and Palliative Care Association * California Hospital Association Center for Behavioral Health * California Library Association * California Nursing Student Association * California State Bar, Health Subcommittee * California State University San Marcos * California Teratogen Information Service * California Women Lead * Caregiver Coalition of San Diego * Caring Hearts Medical Clinic * Chelsea's Light Foundation * Chicano Federation of San Diego County * Community Health Improvement Partners (CHIP) Behavioral Health Work Team * CHIP Board * CHIP Health Literacy Task Force * CHIP Suicide Prevention Work Team * CHIP Independent Living Association (ILA) Advisory Board and Peer Review Advisory Team * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Family Health Center * Chula Vista Rotary * City of Chula Vista Wellness Program * Coalition to Transform Advanced Care (CTAC) * Combined Health Agencies * Community Emergency Response Team (CERT) * Consortium for Nursing Excellence, San Diego * Coronado Chapter of Rotary International * Coronado Christmas Parade * Coronado Fire Department * Creative Arts Consortium * Council of Women's and Infants' Specialty Hospitals (CWISH) * Cycle EastLake * Behavioral Diabetes Institute * Disabled Services Advisory Board * Downtown San Diego Partnership * East County Senior Service Providers * El Cajon Community Collaborative Council * El Cajon Fire Department * El Cajon Rotary * Elderhelp of San Diego * Emergency Nurses Association, San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Facing Futures * Family Health Centers of San Diego (FHCSD) * Gardner Group * Gary and Mary West Senior Wellness Center * Girl Scouts of San Diego Imperial Council, Inc. * Grossmont College (GC) * Grossmont Healthcare District * Grossmont Union High School District (GUHD) * Health Care Communicators Board * Health Insurance Counseling and Advocacy Program (HICAP) * Helen Woodward Animal Center * Helix Charter High School * Helping Older People Equally (HOPE) * Home of Guiding Hands * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * Health Sciences High and Middle College (HSHMC) Board * I Love a Clean San Diego * International Association of Eating Disorders Professionals (IAEDP) * International Lactation Consultants Association (ILCA) * Jewish Family Services of San Diego * Jewish Federation of San Diego County Jewish Senior Services Council * John Brockington Foundation * Journal for Nursing Care Quality Editorial Board * Kaplan College Advisory Board * Kiwanis Club of Chula Vista * Komen Latina Advisory Council * Komen Race for the Cure Committee * La Maestra Family Clinics * La Mesa Lion's Club * La Mesa Park and Recreation Foundation Board * Las Hermanas * LEAD, San Diego, Inc. * Leukemia & Lymphoma Society * Liberty Charter High School * Mama's Kitchen * March of Dimes * Meals-on-Wheels * Medical Library Group of Southern California and Arizona * Mended Hearts * Mental Health America Board * Mental Health Coalition * Mesa College HEIT Program Advisory Board * Miracle Babies * MRI Joint Venture Board * National Alliance on Mental Illness (NAMI) * National Association of Neonatal Nurses (NANN) * National Association of Hispanic Nurses (NAHN), San Diego Chapter * National Association of Psychiatric Healthcare Systems * National Council on Alcoholism and Drug Dependence (NCADD) * National Hospice and Palliative Care Association * National Initiative for Childrens Healthcare Quality * National Kidney Foundation * National Perinatal Information Center * National University * Neighborhood Healthcare Community Clinic Board of Directors * North County Health Project * NurseWeek * Orchard Apartments * Pacific Arts Movement (Pac-Arts, formerly the San Diego Asian Film Foundation) * Palliative Care Action Community * Partnership for Philanthropic Planning of San Diego (formerly San Diego Planned Giving Roundtable) * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Professional Oncology Network (PON) * Project CARE Council * Public Health Nurse Advisory Board * Recovery Innovations of California (RICA) * Regional Home Care Council * Regional Perinatal System (RPS) * Residential Care Council * Safety Net Connect * San Diego Community Action Network (SanDi-CAN) * San Diegans for Healthcare Coverage * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Association for Healthcare Recruitment * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Brain Injury Foundation * San Diego Care Transitions Partnership (SDCTP) * San Diego City College * San Diego City Parks and Recreation * San Diego Committee on Employment of People with Disabilities * San Diego Council on Suicide Prevention * San Diego County Breastfeeding Coalition * San Diego County Council on Aging (SDCCOA) * San Diego County Perinatal Care Network * San Diego County Taxpayers Association * San Diego Diabetes Coalition
		* San Diego Dietetic Association Board * San Diego East County Chamber of Commerce Board * San Diego Emergency Medical Care Committee * San Diego Eye Bank Nurses Advisory Board * San Diego Food Bank * San Diego Foundation * San Diego Health and Human Services Agency, Live Well San Diego * San Diego Health Information Association * San Diego Healthcare Disaster Council * San Diego Housing Commission (SDHC) * San Diego Immunization Coalition * San Diego Imperial Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. (The Center) * San Diego Mental Health Coalition * San Diego Mesa College * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Nutrition Council * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders (SOHL), a local ACHE Chapter * San Diego Patient Safety Consortium * San Diego Physician Orders for Life Sustaining Treatment (POLST) Coalition * San Diego Regional Energy Office * San Diego Regional Homecare Council * San Diego Rescue Mission * San Diego Restorative Justice Mediation Program * San Diego Stroke Consortium * San Diego Urban League * San Diego-Imperial Council of Hospital Volunteers * San Diego Regional Chamber of Commerce * San Diego Science Alliance * San Ysidro High School * San Ysidro Middle School * Santee Chamber of Commerce * SAY San Diego * Schizophrenics in Transition * San Diego State University (SDSU) * Senior Community Centers of San Diego * Sigma Theta Tau International Honor Society of Nursing * Society of Trauma Nurses * South Bay Community Services * South County Economic Development Council * Southern California Association of Neonatal Nurses * Southern Caregiver Resource Center * St. Paul's Retirement Homes Foundation * St. Vincent de Paul Village * Susan G. Komen Breast Cancer Foundation * Sustainable San Diego * Sweetwater Union High School District (SUHSD) * The Meeting Place * Third Avenue Charitable Organization (TACO) * Trauma Center Association of America * United Service Organizations Council of San Diego * United Way of San Diego County * University of California, San Diego (UCSD) * University of San Diego (USD) * VA San Diego Healthcare System * Veterans Home of Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * Walk San Diego * Women, Infants and Children Program (WIC) * YMCA * YWCA Becky's House * YWCA Board of Directors * YWCA Executive Committee * YWCA In the Company of Women Event

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg	Business Name Line1DirectControllingEntityName/BusinessNameLine1
Sharp HealthCare (SHC)
8695 Spectrum Center Blvd	San Diego	CA	921231489	956077327	Healthcare Organization	CA	501 (c)(3)	3	N/A	0
Sharp Memorial Hospital (SMH)
8695 Spectrum Center Blvd	San Diego	CA	921231489	953782169	Hospital	CA	501 (c)(3)	3		1	Sharp HealthCare
Sharp Chula Vista Medical Center (SCVMC)
8695 Spectrum Center Blvd	San Diego	CA	921231489	952367304	Hospital	CA	501 (c)(3)	3		1	Sharp HealthCare
Sharp HealthCare Foundation (SHF)
8695 Spectrum Center Blvd	San Diego	CA	921231489	953492461	Healthcare Foundation	CA	501 (c)(3)	7		1	Sharp HealthCare
Grossmont Hospital Foundation
8695 Spectrum Center Blvd	San Diego	CA	921231489	330124488	Hospital Foundation	CA	501 (c)(3)	7		1	Grossmont Hospital Corporation
Sharp Health Plan (SHP)
8695 Spectrum Center Blvd	San Diego	CA	921231489	330519730	Health Plan	CA	501 (c)(4)	N/A		1	Sharp HealthCare
Sharp Coronado Hospital and Healthcare Center
8695 Spectrum Center Blvd	San Diego	CA	921231489	950651579	Hospital	CA	501 (c)(3)	3		1	Sharp HealthCare

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	Grossmont Imaging LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	7777 Alvarado Road Suite 108	AddressLine1
City	La Mesa	City
State	CA	State
ZIP Code	91941	ZIPCode

Field	Value	IRS element (for citing)
EIN	202655131	EIN
Primary Activity	Diagnostic Imaging	PrimaryActivity
Legal Domicile State	CA	LegalDomicileState
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Predominant Income Type	Related	PredominantIncomeType
Share Of Total Income	647581	ShareOfTotalIncome
Share Of EOY Assets	1663375	ShareOfEOYAssets
Disproportionate Allocations	0	DisproportionateAllocations
General Or Managing Partner	1	GeneralOrManagingPartner
Percentage Ownership	0.50000	PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	Continuous Quality Insurance SPC	BusinessNameLine1

Address Foreign AddressForeign

Field	Value	IRS element (for citing)
Address Line1	23 Lime Tree Bay Avenue PO Box 1	AddressLine1
City	Grand Cayman	City
Country	CJ	Country

Field	Value	IRS element (for citing)
Primary Activity	Captive Insurance Company	PrimaryActivity
Legal Domicile Foreign Country	CJ	LegalDomicileForeignCountry
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Type Of Entity	C	TypeOfEntity
Controlled Org	0	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	1	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	1	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (17 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Sharp Memorial Hospital
L	1142722	Accrual
Sharp Memorial Hospital
M	3315685	Accrual
Sharp Memorial Hospital
Q	75790	Accrual
Sharp Memorial Hospital
R	59914	Accrual
Sharp Memorial Hospital
S	152589	Accrual
Sharp Chula Vista Medical Center
M	424635	Accrual
Sharp Chula Vista Medical Center
L	794943	Accrual
Sharp Chula Vista Medical Center
Q	53912	Accrual
Sharp Coronado Hospital and Healthcare Center
A	4874	Accrual
Sharp Coronado Hospital and Healthcare Center
D	135000	Accrual
Sharp Coronado Hospital and Healthcare Center
M	529793	Accrual
Sharp Coronado Hospital and Healthcare Center
L	102775	Accrual
Grossmont Hospital Foundation
Q	885143	Accrual
Grossmont Hospital Foundation
C	2199044	Accrual
Grossmont Hospital Foundation
B	1121136	Accrual
Grossmont Hospital Foundation
N	58781	Accrual
Sharp Health Plan
L	547149	Accrual

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Return Reference	Part V, Line 2, Transaction 9:	ReturnReference
Explanation	The transaction between Grossmont Hospital Corporation and Sharp Coronado Hospital and Healthcare Center totaling $4,874 is transaction type A(i).	Explanation