TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Tom Cantor........................................................................ Director	2.00 .......................0.00	X		0	0	0
(2) Sunita V Cooke........................................................................ Director	2.00 .......................0.00	X		0	0	0
(3) Michael Emerson........................................................................ Director	2.00 .......................0.00	X		0	0	0
(4) Scott Evans........................................................................ CEO-GH	50.00 .......................2.00	X	X	0	0	0
(5) Jerry Fazio........................................................................ Secretary	1.00 .......................0.00	X	X	0	0	0
(6) Dave Grundstrom........................................................................ Vice Chairman	2.00 .......................0.00	X	X	0	0	0
(7) Peter Hanson MD........................................................................ Director	1.00 .......................2.00	X		32,688	0	0
(8) Rina Jain MD........................................................................ Director	10.00 .......................0.00	X		30,000	0	0
(9) Tom Karlo........................................................................ Director	2.00 .......................2.00	X		0	0	0
(10) Shakeel Kazi........................................................................ Director	1.00 .......................0.00	X		0	0	0
(11) Jay LaSuer........................................................................ Director	2.00 .......................0.00	X		0	0	0
(12) Randolph Lenac........................................................................ Director	3.00 .......................0.00	X		0	0	0
(13) Deborah McElravy........................................................................ Director	0.50 .......................0.00	X		0	0	0
(14) Brian Moore MD........................................................................ Director	2.00 .......................0.00	X		0	0	0
(15) Michael W Murphy........................................................................ President & CEO - SHC	6.00 .......................58.00	X	X	0	1,733,581	102,962
(16) Shirley Murphy........................................................................ Director	2.00 .......................0.00	X		0	0	0
(17) Jim Parker........................................................................ Chairman	2.00 .......................0.00	X	X	0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Michael Peddecord PhD........................................................................ Director	2.00 .......................0.00	X					0	0	0
(19) Ann R Pumpian........................................................................ SR VP and CFO-SHC	2.00 .......................48.00		X				0	879,791	47,461
(20) Carlisle C Lewis III........................................................................ SR VP Legal/HR Services -	7.00 .......................48.00		X				0	732,615	55,555
(21) Daniel J Kindron........................................................................ CFO - GH	50.00 .......................0.00		X				0	159,087	6,327
(22) Maryann C Cone........................................................................ COO - GH	55.00 .......................0.00			X			0	365,195	36,974
(23) Anthony M Damico........................................................................ VP Clinical Svs - GH	55.00 .......................0.00			X			0	253,860	19,328
(24) Suzanne K Johnson........................................................................ VP Hospice - GH	40.00 .......................0.00			X			0	244,717	18,174
(25) Jason E Broad........................................................................ VP Performance Excellence	50.00 .......................0.00			X			0	183,468	17,914
(26) Michael A Murphy........................................................................ Chief Medical Officer - GH	40.00 .......................0.00				X		0	335,589	26,599
(27) Bruce D Schmidt........................................................................ Mgr Sharp Central Pharmacy	42.00 .......................0.00				X		235,024	0	40,892
(28) Vincent J Balesteri........................................................................ Pharmacist	46.50 .......................0.00				X		231,682	0	37,800
(29) Glicerio M Cid Jr........................................................................ Advanced Clinician	67.50 .......................0.00				X		230,828	0	15,562
(30) Patrick P Guo........................................................................ Medical Physicist	45.00 .......................0.00				X		211,006	0	12,033
(31) Michele T Tarbet........................................................................ Former CEO-GH	0.00 .......................0.00					X	0	530,469	34,895
(32) Kari Cornicelli........................................................................ Former CFO-GH	0.00 .......................50.00					X	0	257,924	30,037
(33) Janet L Hanley........................................................................ Former Key Employee	0.00 .......................50.00					X	0	236,926	26,959
(34) Hoangmy E Nguyen........................................................................ Former Key Employee	0.00 .......................40.00					X	0	222,719	12,686
(35) Dale Beatty........................................................................ Former Key Employee	0.00 .......................0.00					X	0	148,701	7,279

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	625,299	625,299
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	2,666,553	1,846,524	820,029
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	45,625	45,625
7	Other salaries and wages ....	246,193,454	243,171,750	3,021,704
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,929,141	9,787,206	141,935
9	Other employee benefits .......	35,661,900	35,011,143	650,757
10	Payroll taxes ...........	18,303,110	18,061,908	241,202
11	Fees for services (non-employees):
a	Management ......	21,292,378	19,962,250	1,330,128
b	Legal .........	657,572	23,743	633,829
c	Accounting ...........	6,592,246		6,592,246
d	Lobbying ...........	44,907		44,907
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	277,806		277,806
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	54,536,640	53,067,355	1,469,285
12	Advertising and promotion ....	5,077,700	32,580	5,045,120
13	Office expenses .......	18,912,765	18,142,563	770,202
14	Information technology ......	24,580,563	23,843,146	737,417
15	Royalties ..
16	Occupancy ...........	8,979,229	7,429,244	1,549,985
17	Travel ............	517,247	503,498	13,749
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	598,980	157,448	441,532
20	Interest ...........	3,333,092	2,675,004	658,088
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	24,637,657	18,385,725	6,251,932
23	Insurance ..............	2,746,485	2,348,208	398,277
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	UBI Taxes	-116,528		-116,528
b	Medical Supplies	80,014,220	80,014,220
c	Medi-Cal Provider Tax	70,531,738	70,531,738
d	System Allocation	22,145,451	12,508,377	9,637,074
e	All other expenses	11,772,730	9,470,035	1,214,890	1,087,805
25	Total functional expenses. Add lines 1 through 24e	670,557,960	627,644,589	41,825,566	1,087,805
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	25,085,898	1	41,551,543
2	Savings and temporary cash investments .........	10,685,857	2	14,313,069
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	66,503,128	4	96,581,297
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	11,499,162	8	12,631,253
9	Prepaid expenses and deferred charges ..........	8,686,288	9	9,494,022
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	628,551,360
b	Less: accumulated depreciation .....	10b	285,701,993	304,877,035	10c	342,849,367
11	Investments—publicly traded securities ..........	333,659,265	11	352,297,553
12	Investments—other securities. See Part IV, line 11 .....	1,285,391	12	1,267,507
13	Investments—program-related. See Part IV, line 11 .....	20,445,449	13	21,898,971
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	14,969,459	15	3,109,028
16	Total assets. Add lines 1 through 15 (must equal line 34)......	797,696,932	16	895,993,610
	17	Accounts payable and accrued expenses .........	44,982,068	17	58,502,550
18	Grants payable .................		18
19	Deferred revenue ................	11,774,191	19	7,347,654
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	27,454,434	23	28,195,870
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	106,545,880	25	109,185,497
26	Total liabilities. Add lines 17 through 25.........	190,756,573	26	203,231,571
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	590,759,307	27	676,593,947
28	Temporarily restricted net assets ...........	15,085,650	28	15,071,689
29	Permanently restricted net assets ...........	1,095,402	29	1,096,403
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	606,940,359	33	692,762,039
34	Total liabilities and net assets/fund balances ........	797,696,932	34	895,993,610

Section D - Distributions	Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount


Name of organization Grossmont Hospital Corporation	Employer identification number 33-0449527
Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)


Name of organization Grossmont Hospital Corporation	Employer identification number 33-0449527
Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Return Reference	Explanation
Part II-B, Line 1:	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 2015 portion of annual dues calculated to have been used for lobbying was $44,907.

	(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

		Amount
c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

	(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	4,948,052	3,952,926	3,791,203	3,277,151	3,421,590
b	Contributions ........	25,917	695,673	1,000	1,000	38
c	Net investment earnings, gains, and losses	-87,824	307,715	160,723	513,052	-112,858
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	126,414	8,262			31,619
f	Administrative expenses ....
g	End of year balance ......	4,759,731	4,948,052	3,952,926	3,791,203	3,277,151

Description of property	(a) Cost or other basis (investment)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	581,843		581,843
b	Buildings ................	325,168,048	154,959,728	170,208,320
c	Leasehold improvements ............	5,025,110	2,038,736	2,986,374
d	Equipment ................	152,066,792	119,985,367	32,081,425
e	Other .................	145,709,567	8,718,162	136,991,405
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......	342,849,367

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......	1	720,320,166
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-13,789,665
b	Donated services and use of facilities .........	2b	762
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	130,317
e	Add lines 2a through 2d .....................	2e	-13,658,586
3	Subtract line 2e from line 1.....................	3	733,978,752
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	277,806
b	Other (Describe in Part XIII.) ...........	4b	41,253,405
c	Add lines 4a and 4b.......................	4c	41,531,211
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......	5	775,509,963

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........	1	668,948,375
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	762
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	130,317
e	Add lines 2a through 2d......................	2e	131,079
3	Subtract line 2e from line 1.....................	3	668,817,296
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	277,806
b	Other (Describe in Part XIII.) ............	4b	1,462,858
c	Add lines 4a and 4b.......................	4c	1,740,664
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......	5	670,557,960

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Grossmont Hospital Corporation

Employer identification number

33-0449527

Return Reference	Explanation
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. Grossmont Hospital Corporation directors, Dave Grundstrom and Jim Parker, have a family relationship. Grossmont Hospital Corporation directors, Peter Hanson and Jim Parker, have a business relationship.
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 2014.
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.
Form 990, Part XI, line 9:	Change in Minimum Pension Liability -6,794,181. Beneficial Interest in Grossmont Hospital Foundation 1,453,523.
Form 5471	Form 5471 has been filed on behalf of Grossmont Hospital Corporation by Sharp HealthCare (FEIN 95-6077327).
Form 990, Part III, Line 4a:	Sharp HealthCare Community Benefit Plan and Report Fiscal Year 2015 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; 22 medical centers; five urgent care centers; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp 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 3.2 million in San Diego County (SDC), as of September 30, 2015, Sharp is licensed to operate 2,088 beds and has approximately 2,600 Sharp-affiliated physicians and more than 17,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 licensed beds) The largest provider of health care services in San Diego County's rapidly expanding South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the South Bay's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. SCVMC is home to the region's most comprehensive heart program, services for orthopedic care, cancer treatment, women and infants, and the only bloodless medicine and surgery center in SDC. Sharp Coronado Hospital and Healthcare Center (181 licensed beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include acute, sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. Sharp Grossmont Hospital (528 licensed beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County and has one of the busiest EDs in SDC. SGH is known for outstanding programs in heart care, orthopedics, rehabilitation, robotic surgery, stroke care and women's health. Sharp Memorial Hospital (656 licensed beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation. SMH houses San Diego's largest emergency and trauma center. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 licensed beds) A freestanding women's hospital specializing in 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 (158 licensed 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 licensed 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. The operations of Sharp HospiceCare are reported within SGH. Mission Statement It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patients' expectations and are provided in a caring, convenient, cost-effective and accessible manner. Vision Sharp's vision is to become the best health system in the universe. Sharp will attain this position by transforming the health care experience through a culture of caring, quality, safety, service, innovation and excellence. Sharp will be recognized by employees, physicians, patients, 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 - Trustworthy, Respectful, Sincere, Authentic, Committed to Organizational Mission and Values * Caring - Compassionate, Communicative, Service Oriented, Dedicated to Teamwork and Collaboration, Serves Others Above Self, Celebrates Wins, Embraces Diversity * Safety - Reliable, Competent, Inquiring, Unwavering, Resilient, Transparent, Sound Decision Making * Innovation - Creative, Drives for Continuous Improvement, Initiates Breakthroughs, Develops Self, Willing to Accept New Ideas and Change * Excellence - Quality Focused, Compelled by Operational and Service Excellence, Cost Effective, Accountable Culture: The Sharp Experience For more than 15 years, Sharp has been on a journey to transform the health care experience for patients and their families, physicians and staff. Through a sweeping organization-wide performance-and-experience-improvement initiative called The Sharp Experience, the entire Sharp team has recommitted to purposeful, worthwhile work and creating the kind of health care people want and deserve. This work has added discipline and focus to every part of the organization, helping to make Sharp one of the nation's top-ranked health care systems. Sharp is San Diego's health care leader because it remains focused on the most important element of the health care equation: the people. Through this extraordinary initiative, Sharp is transforming the health care experience in San Diego by striving to be: * The best place to work: Attracting and retaining highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration, and professional and personal growth. This commitment to serving patients and supporting one another will make Sharp "the best health system in the universe." * The best place to practice medicine: Creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers; experience unsurpassed service as valued customers; have access to state-of-the-art equipment and cutting-edge technology; and enjoy the camaraderie of the highest-caliber medical staff at San Diego's health care leader. * The best place to receive care: Providing a new standard of service in the health care industry, much like that of a five-star hotel; employing service-oriented individuals who see it as their privilege to exceed the expectations of every patient - treating them with the utmost care, compassion and respect; and creating healing environments that are pleasant, soothing, safe, immaculate, and easy to access and navigate. Through this transformation, Sharp 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, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp HealthCare made an important decision regarding these pillars as part of its continued journey toward excellence. Each year, Sharp incorporates cycles of learning into its strategic planning process. In 2014, Sharp's Executive Steering and Board of Directors enhanced Sharp's safety focus, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts:
Form 990, Part III, Line 4a (continued):	o Sensitivity to operations o A reluctance to simplify o Preoccupation with failure o Deference to expertise o Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could become better. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization ? Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. The seven pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: Quality - Demonstrate and improve clinical excellence to set industry standards and exceed customer expectations. Safety - Keep patients, employees and physicians safe and free from harm. Service - Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence. People - Create a values-driven culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp's mission and vision. 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 improving the health and well-being of the 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 and 2014 World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think tank. WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp is the only health care company in San Diego recognized in both years. 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," a survey conducted by health care data analyst IMS Health. This was the 14th consecutive year that Sharp placed among the top in the state. Sharp was named "Best Hospital Group" by U-T San Diego readers participating in the paper's 2015 "Best of San Diego" Readers Poll. In 2015, SMBHWN was named "Best Hospital," while SGH and SMH were ranked second and third "Best Hospitals." Sharp Community Medical Group (SCMG) and Sharp Rees-Stealy Medical Group (SRSM) were ranked first and second, respectively, in 2015 as San Diego's "Best Medical Group." 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 redesignated in March 2013. Sharp was named one of the nation's "Most Wired" health care systems from 1999 to 2009, and again from 2012 to 2015 by Hospitals & Health Networks magazine's annual Most Wired Survey and Benchmark Study. "Most Wired" hospitals are committed to using technology to enhance quality of care for both patients and staff. In 2014, SCVMC and its on-site Birch Patrick Convalescent Center became the first co-located hospital and skilled nursing facility in the nation to be designated as a Planetree Patient-Centered Organization. SCVMC joined both SMH and SCHHC in Planetree distinction. In 2012, SMH was designated as a Planetree Patient-Centered Hospital, and is the largest hospital-only designated facility in the U.S. In 2014, SMH achieved Planetree Designation with Distinction and was redesignated as a Planetree Patient-Centered Hospital in 2015. 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 2013, both SCHHC and SCVMC received Energy Star (ES) designation from the U.S. Environmental Protection Agency (EPA) for outstanding energy efficiency. Buildings that are awarded use an average of 40 percent less energy than other buildings and release 35 percent less carbon dioxide into the atmosphere. 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, 2013 and 2015. San Diego Gas & Electric (SDG&E) recognized Sharp for outstanding results in energy efficiency and conservation. Sharp was named San Diego's "Healthcare 2014 Energy Champion" for its successes in energy conservation. In 2013, Sharp was named a "Recycler of the Year" at the City of San Diego's annual Waste Reduction and Recycling Awards for a successful and extensive recycling program. SMH and SMBHWN were honored for their comprehensive waste reduction programs. Sharp 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. From 2013 to 2015, the Press Ganey organization recognized multiple SHC entities with Guardian of Excellence Awards. Based on one year of data, this designation recognizes recipients for having reached the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality. Awards for SHC entities included SCVMC, SCHHC, SGH, SMBHWN, SMH, SMH Outpatient Pavilion (OPP), SMV, SHC, Sharp HospiceCare, SRS, SCMG and Sharp Home Health for Employee Engagement; SMBHWN and the Sharp Senior Health Centers at SMH for Patient Satisfaction; and SCHHC, SMBHWN and SMV for Physician Engagement. In 2013, the Press Ganey organization recognized multiple SHC entities for achievement of the Beacon of Excellence Awards. This designation recognizes those who maintain consistent 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). Awarded entities included SHC for Employee Engagement; SMH for Patient Satisfaction; and SCHHC and SMV for Physician Engagement. SHP was ranked a top 100 U.S. health plan and a top three California health plan based on the National Committee for Quality Assurance's (NCQA) Private Health Insurance Rankings 2014-2015, which rated health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. SHP also received the highest level "Excellent" Accreditation status from the NCQA for the third year in a row (2013-2015). The NCQA awards accreditation status based on compliance with rigorous requirements and performance on Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. SHP was also rated highest in California among reporting California Health Plans for Rating of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating of Health Promotion and Education in NCQA's 2015 Quality Compass/CAHPS survey, which provides state, regional and national benchmarks as well as individual plan performance.
Form 990, Part III, Line 4a (continued):	In 2015, Sharp was ranked fourth in the large employers category as one of the "Best Places to Work" for Information Technology (IT) professionals by the International Data Group's (IDG) Computerworld survey. The list is compiled by the following criteria: benefits, training, retention, career development, average salary increases, employee surveys, workplace morale and more. In 2015, SGH and SMBHWN received a 2015 Women's Choice Award - a symbol of excellence in customer experience awarded by the collective of women. SGH was recognized as one of America's Best Hospitals for Cancer Care and SMBHWN was recognized as one of America's Best Hospitals for Obstetrics. For the third year in a row, and the fourth time in five years, Sharp HealthCare won the top spot in the Mega Employer category in the Rideshare 2015 Challenge. The month-long challenge encouraged the replacement of solo drivers with sustainable carpool, vanpool, bike, walk, or transit commutes. Powered by San Diego Association of Governments (SANDAG) and in cooperation with the 511 transportation information service, iCommute is the Transportation Demand Management program for the San Diego region and encourages use of transportation alternatives to help reduce traffic congestion and greenhouse gas emissions. 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 opportunities for health coverage through PointCare - a team of health coverage experts whose main product is a quick, web-based screening, enrollment and reporting technology designed to provide community members with health coverage and financial assistance options. At Sharp, patients use a simple online questionnaire through PointCare to generate personalized coverage options that are filed in their account for future reference and accessibility. The results of the questionnaire allow SHC staff to have an informed and supportive discussion about health care coverage with the patient, empowering them with options. From the inception of the program in FY 2010 through September 2015, Sharp helped guide approximately 85,910 self-pay patients through the maze of government health coverage programs while maintaining the patient's dignity throughout the process. Beginning in 2014 Sharp hospitals implemented an on-site process for real-time Medi-Cal eligibility determinations (Presumptive Eligibility). Sharp was the first hospital system in San Diego County to provide these services, and secured this benefit for 2,198 unfunded patients in the ED during FY 2015. In support of Covered California's annual open enrollment period, 14 members of Sharp's registration staff have become Certified Application Counselors in order to better assist both patients and the general community with navigating the Covered California website (CoveredCA.com) and plan enrollment. In addition, three Sharp hospitals - SCVMC, SGH and SMH - qualify as covered entities for the 340B Drug Pricing Program administered by the Health Resources and Services Administration. Hospital participation in the 340B Drug Pricing Program permits the purchase of outpatient drugs at reduced prices. The savings from this program are used to offset patient care costs for Sharp's most vulnerable patient populations, as well as to assist patient access to medications through the Patient Assistance Team. The Patient Assistance Team works hard to help those in need of assistance gain access to free or low-cost medications. Patients are identified through usage reports, or referred through case management, social work, 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 and other low-cost alternatives. 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 installments, preventing unpaid accounts from going to collections. Through this program, Sharp provides a more affordable alternative for patients struggling 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 may receive services such as assistance with transportation and placement; connections to community resources; and financial support for medical equipment and medications. SCHHC, SGH and SMH work in collaboration with the San Diego Rescue Mission (SDRM) to identify patients who may benefit from a referral 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. These referrals may include chronically homeless patients or patients who have exhausted other community housing resources. Community Health Screenings Sharp's dedication to improving community health extends beyond the walls of its health care facilities, and Sharp continues to demonstrate this commitment through its community-wide health screening program. Complimentary health screenings are provided across SDC to inform community members about their current health status and help determine their risk for common diseases including diabetes, heart disease and other health conditions. Screenings include body mass index (BMI), blood sugar, cholesterol, blood pressure and an attestation of tobacco use. From October 1, 2014 to September 30, 2015, a cross-disciplinary team of Sharp HealthCare professionals organized, promoted and hosted nearly 75 community health screening events throughout the county - screening more than 5,200 San Diegans. Participants were not asked to provide personal information, nor were they required to show proof of insurance or have any relationship with Sharp to be eligible for the screening. All participants received their results and an informational brochure that outlined strategies to improve health and well-being. Participants were then encouraged to share the results with their primary care physician to determine an appropriate, customized follow-up plan. Uninsured community members and those in need of additional services received information about available resources through 2-1-1 San Diego. Since its inception, the community screening effort has conducted events at more than 40 locations across San Diego, including communities with limited access to health care programs and resources. In addition, in April and May, Sharp offered screenings at the Health Sciences High and Middle College (HSHMC) eighth annual Internship Symposium and during parent/teacher events, serving more than 70 attendees. In FY 2015, Sharp team members devoted nearly 113,000 hours actively screening community members, including time spent on administrative support and logistics. Thirty-two team members provided screenings and 11 team members served as concierge personnel. In addition, Spanish-speaking team members were available to provide participants with health information in Spanish. In response to the community screenings, Sharp received countless emails and letters expressing heartfelt gratitude from community members, many of whom were inspired to take control of their health after their screening. Through these efforts, Sharp's community health screenings brought helpful and, at times, life-changing health information to the people of San Diego - truly exemplifying Sharp's commitment to the health of its community. Health Professions Training Internships
Form 990, Part III, Line 4a (continued):	Students and recent health care graduates are a valuable asset to the community. Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships, financial aid and career pipeline programs. In FY 2015, more than 4,600 student interns dedicated nearly 680,000 hours within the Sharp system. Students belonged to a variety of disciplines including nursing, allied health and professional educational programs. Sharp provided education and training programs for nursing students (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, imaging, cardiovascular, dietetics, lab, radiation therapy, surgical technology, paramedic, social work, psychology, business, health information management and public health. Students came from local community colleges such as Grossmont College, San Diego City College, San Diego Mesa College (MC) and Southwestern College (SWC); local and national university campuses such as Point Loma Nazarene University (PLNU), San Diego State University (SDSU), University of California, San Diego (UCSD), and University of San Diego (USD); and vocational schools such as Kaplan College. Table 1 presents the number of students and student hours at each of the Sharp entities in FY 2015. Table 1: Sharp HealthCare Internships - FY 2015 Sharp Chula Vista Medical Center Nursing 842 Students 60,662 Group Hours 20,398 Precepted Hours Ancillary 172 Students 37,627 Hours Total 1,014 Students 118,687 Hours Sharp Coronado Hospital and Healthcare Center Nursing 590 Students 92,510 Group Hours 3,024 Precepted Hours Ancillary 77 Students 21,127 Hours Total 667 Students 116,661 Hours Sharp Grossmont Hospital Nursing 732 Students 62,492 Group Hours 16,643 Precepted Hours Ancillary 238 Students 54,200 Hours Total 970 Students 133,335 Hours Sharp Mary Birch Hospital for Women & Newborns Nursing 207 Students 15,204 Group Hours 5,184 Precepted Hours Ancillary 15 Students 4,486 Hours Total 222 Students 24,874 Hours Sharp Memorial Hospital Nursing 404 Students 29,451 Group Hours 18,902 Precepted Hours Ancillary 310 Students 73,998 Hours Total 714 Students 122,351 Hours Sharp Mesa Vista Hospital Nursing 318 Students 22,642 Group Hours 3,524 Precepted Hours Ancillary 38 Students 23,106 Hours Total 356 Students 49,272 Hours Sharp HospiceCare Nursing 74 Students 674 Precepted Hours Total 74 Students 674 Hours Sharp HealthCare Nursing 387 Students 60,843 Precepted Hours Ancillary 223 Students 52,947 Hours Total 610 Students 113,790 Hours Total Nursing 3,554 Students 282,961 Group Hours 129,192 Precepted Hours Ancillary 1,073 Students 267,491 Hours Total 4,627 Students 679,644 Hours Health Sciences High and Middle College Sharp is an industry partner with charter school HSHMC to provide students broad exposure to health care careers. Through this partnership, HSHMC students connect with Sharp team members through job shadowing to explore real-world application of their school-based knowledge and skills. This collaboration 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. HSHMC students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. The HSHMC program began in 2007 with students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. Students also devote time to various SRS sites. Students begin their experience with a systemwide orientation to Sharp and their upcoming job-shadowing activities, which consist of two levels of training. Level I of the HSHMC program is the entry level for all students and is conducted over an eight-week period. Through Level I, ninth grade students shadow primarily non-nursing areas of the hospital as well as complete additional coursework in Infection Control and Mental Health Matters at Mesa College. Level II of the HSHMC program is designed for students in grades 10 through 12 and includes enhanced patient interaction, college-level clinical rotation, and hands-on experience. Level II students are placed in a new assignment each semester for a variety of patient care experiences, as well as take additional health-related coursework at Mesa College, including Anatomy, Physiology, Medical Terminology, Health 101, Psychology and Abnormal Psychology. Nearly 500 HSHMC students - including 143 Level I students and 347 Level II students - were supervised for approximately 55,000 hours on Sharp campuses in FY 2015. Students rotated through instructional pods in specialty areas, including but not limited to nursing; emergency services; obstetrics and gynecology (OB/GYN); occupational therapy; physical therapy; behavioral health; pediatrics; medical/surgical; imaging; rehabilitation; laboratory services; pharmacy; pathology; radiology; endoscopy; engineering; pulmonary services; cardiac services; and operations. Students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development as well as job and education requirements. In May 2015, the HSHMC program graduated its fifth full class. Each year, Sharp HealthCare reviews and evaluates the collaboration with HSHMC, including outcomes of students and graduates, to promote long-term sustainability. Although many HSHMC students face financial hardship - the free and reduced price meal (FRPM) eligibility rate is higher than the averages for SDC and California - the charter school excels in preparing students for high school graduation, college entrance and a future career. In 2015, 93 percent of the HSHMC graduating class went on to attend two- or four-year colleges, while 85 percent of students said they wanted to pursue careers in health care. In addition, HSHMC has a 100 percent graduation rate, which is higher than California's 80.8 percent state average as well as an Academic Performance Index score of 828, which exceeds the state's goal of 800. The California Department of Education recognizes HSHMC as a 2015 California Gold Ribbon School for its outstanding education programs and practices, and a Title I Academic Achieving school for demonstrating success in significantly reducing the gap between high and low-performing students. HSHMC is also a 2014 U.S. News & World Report Best High Schools bronze award winner, and National School Safety Advocacy Council award winner. Lectures and Continuing Education Sharp contributes to the academic environment of colleges and universities throughout San Diego. In FY 2015, Sharp staff provided hundreds of academic hours in lectures, courses and presentations on numerous college and university campuses. This included guest lectures on pharmacy practice at UCSD and USD; health information technology, nutrition and professional development at SDSU; the legalities of nursing and community nutrition and eating disorders at PLNU; advance care planning at Azusa Pacific University (APU); and a variety of health administration lectures to public health graduate students at SDSU. Sharp's Continuing Medical Education (CME) Department provides evidence-based and clinically relevant professional development opportunities to help practicing physicians and pharmacists improve patient safety and enhance clinical outcomes. In FY 2015, Sharp's CME team invested more than 1,800 hours to numerous CME activities for San Diego health care providers. This included conferences on primary care, heart failure, lung cancer, colorectal cancer, and advances in OB/GYN, as well as presentations on stroke, Ebola, infection prevention, clinical documentation improvement and HROs. In addition, the CME team organized a live video conference for orthopedic surgeons, radiologists, residents and fellows in which expert orthopedic surgeons from Sharp HeatlhCare, Germany, Austria and Switzerland presented on the European and North American Perspectives on Hip Preservation. Research Sharp HealthCare Center for Research
Form 990, Part III, Line 4a (continued):	Innovation is critical to the future of health care. The Sharp HealthCare Center for Research supports innovation through its commitment to safe, high quality research initiatives that provide valuable knowledge to the San Diego health care community, and positively impact patients and community members. Currently, more than 350 active protocols are being conducted at Sharp. The Center for Research is also seeking accreditation by the Association for the Accreditation of Human Research Protection Programs (AAHRPP) for accreditation of Sharp's HRPP. Accreditation by AAHRPP indicates that an organization follows rigorous standards for ethics, quality, and protections for human research, and acts as a public affirmation of the organization's commitment to protecting research participants. The Center for Research anticipates accreditation by March 2016. Sharp Human Research Protection Program and Institutional Review Board The Sharp Center for Research's Human Research Protection Program (HRPP) is responsible for the ethical and regulatory compliant oversight of research being conducted at Sharp. There are three components to the Center for Research's HRPP: the organization, the researchers and the Institutional Review Board (IRB). The IRB is the largest component of the HRPP and seeks to promote a culture of safety and respect for those participating in research for the greater good of the community. All proposed entity research studies with human participants are required to be reviewed by Sharp's IRB in order to protect participant safety and maintain responsible research conduct. In FY 2015, a dedicated IRB committee of 14 - including physicians, psychologists, research nurses and pharmacists - devoted hundreds of hours to the review and analysis of both ongoing and new research studies. Research is conducted on all phases of drug and device development and spans from research with newborns to older adults with Alzheimer's disease. This includes clinical trials that add to scientific knowledge and enable health care providers to learn whether a new treatment is safe and effective. Sharp conducts clinical trials in behavioral health, neonatal, cardiovascular, mechanical circulatory support, renal transplant, orthopedics, stroke and oncology, the latter of which comprises the majority of Sharp's clinical trials. The Center for Research's HRPP also provides education and support both for researchers across Sharp and the broader San Diego health and research communities on requirements regarding the protection of human research participants. As part of its mission, the Center for Research hosts quarterly meetings on relevant educational topics to the research community, including physicians, psychologists, research nurses, study coordinators and students throughout San Diego. Recent presentations have included Investigator Quality Improvement Activities; Understanding Research Noncompliance, Serious Noncompliance and Continuing Noncompliance; and Risks to Subjects - It's Not Just Physical. Sharp Outcomes Research Institute The Sharp Outcomes Research Institute (ORI) began in 2010 as a pilot initiative funded by the Sharp HealthCare Foundation. The ORI facilitates interdisciplinary research on health care practices in order to identify and promote quality patient care across the health care community. The ORI collaborates with Sharp team members by facilitating the design of patient-centered outcomes research projects; assisting with database development as well as data collection and analysis; exploring funding mechanisms for research projects; and facilitating IRB application submissions. A priority for the ORI is to seek guidance and expertise from the local and national academic community on how to effectively conduct outcomes research in order to improve patient and community health. This networking has resulted in collaborative research partnerships with investigators at SDSU and National University (NU). The ORI has also developed educational presentations for the greater health care research community that foster awareness of the importance of research for improving health outcomes. This includes presentations of peer-reviewed abstracts of research study results and training on research designs. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows (inter-professional staff) and mentors to change and improve clinical practice and patient care. This evolution in practice and care occurs through identifying a care problem, developing a plan to solve it and then incorporating this new knowledge into practice. The EBPI is part of the Consortium for 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, Palomar Health, Rady Children's Hospital - San Diego, UCSD Health System, U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, Elizabeth Hospice, PLNU, SDSU, APU and USD. The Naval Medical Center San Diego (NMCSD) is expected to join in FY 2016. Sharp actively supports the EBPI by providing instructors and mentors as well as administrative coordination. The San Diego EBPI includes six full-day class sessions featuring group activities, self-directed learning programs outside of the classroom and structured mentorship throughout the program. The 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 fellows through the process of evidence-based practice. Mentors also assist the fellows in working collaboratively with other key hospital leadership personnel. In FY 2015, the EBPI consisted of a nine-month program culminating with a community conference and graduation ceremony in November, where the project results of all EBPI fellows were shared. Thirty-four fellows graduated from the EBPI program in FY 2015 and completed projects that addressed the following issues in clinical practice and patient care: health literacy for patients; structured debriefing for critical incidents in the intensive care setting; nurse-driven protocol for urinary catheter removal; charge nurse rounding in the ED; cue-based feedings in the neonatal intensive care unit (NICU); and noise reduction in the progressive care setting. Volunteer Service Sharp Lends a Hand In FY 2015, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH). In October, Sharp team members suggested project ideas that would improve the health and well-being of San Diego in a broad, positive way; rely on Sharp for volunteer labor only; support existing nonprofit initiatives, community activities or other programs that serve SDC; and be completed by September 30, 2015. Eleven projects were selected: San Diego Blood Bank, Holiday Mail for Heroes, San Diego Food Bank (SDFB), San Diego Half Marathon, Ruffin Canyon Clean-Up, the American Diabetes Association (ADA) Tour de Cure, Stand Down for Homeless Veterans, Life Rolls On - They Will Surf Again, and the San Diego River Park Foundation's Point Loma Native Plant Garden, San Diego River Garden, and Coastal Habitat Restoration. More than 1,700 Sharp employees, family members and friends volunteered over 5,850 hours in support of these projects. In November 2014, 14 SLAH volunteers joined the San Diego Chargers football team for their 36th annual Blood Drive in Mission Valley. The event supported the San Diego Blood Bank during the vital holiday season when people tend to donate less blood. SLAH volunteers consisted of registered nurses (RNs), licensed vocational nurses, certified phlebotomists and limited phlebotomists who provided assistance with blood typing (determining what type of blood an individual has). During the 2014 holiday season, 11 SLAH volunteers joined the American Red Cross' Holiday Mail for Heroes program to support service members and veterans separated from their families during the holiday season due to deployments and hospital stays. Volunteers wrote cards of appreciation to the members of the United States Armed Forces and their families, expressing thanks for the sacrifices they make to protect our freedoms. The San Diego Food Bank (SDFB) feeds people in need throughout SDC, advocates for the hungry, and educates the public about hunger-related issues. On 16 days between February and September 2015, 960 SLAH volunteers inspected, cleaned and sorted donated food, assembled boxes and cleaned the SDFB warehouse.
Form 990, Part III, Line 4a (continued):	For two days in March, 100 SLAH volunteers provided registration, gear-check, water stop and finish-line support at the San Diego Half Marathon. This premier race raises money for vulnerable communities including the Skinny Gene Project, a division of the J. Moss Foundation that addresses the environment-based issues that affect a person's ability to prevent diabetes. With all net proceeds going towards service projects and select charitable causes in San Diego, the race inspires volunteerism as a way to help struggling communities throughout the city. Also in March, 40 SLAH volunteers joined the Friends of Ruffin Canyon in the Ruffin Canyon Clean-Up. Located in Serra Mesa, the Ruffin Canyon Open-Space Preserve consists of 84 acres of natural open space, including native plant-life and primitive trails. The Friends of Ruffin Canyon fosters community participation in the protection of Ruffin Canyon's unique habitat. Volunteers picked up trash and debris, pulled weeds, installed native plants and helped maintain the trail. To support the nearly one million San Diegans with diabetes or prediabetes, SLAH volunteers participated in the Tour de Cure 2015, a fundraising cycling event benefitting the American Diabetes Association (ADA). For two days in April, more than 60 SLAH volunteers assisted with pre-event packet pick-up, and day-of event registration, T-shirt distribution and medical care. By volunteering their time, SLAH participants helped to ensure that more funds go toward the ADA's mission to prevent, cure and improve the lives of all people affected by diabetes. On nine days in June and July, 360 volunteers participated in Stand Down for Homeless Veterans, an event sponsored by the Veterans Village of San Diego to provide community-based social services to veterans without a permanent residence. Volunteers gathered at the Veteran's Village Warehouse in El Cajon and at San Diego High School where they sorted and organized clothing donations and offered companionship to more than 800 of San Diego's homeless veterans. In addition, Sharp medical doctors and nurses offered medical assistance, while Sharp pharmacists and licensed pharmacy technicians provided support, counseling and dispensing of medications. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by spinal cord injury through action sports. With support from adaptive equipment and volunteers, the award-winning series of bicoastal events empowers paraplegics and quadriplegics to experience mobility through surfing. In September, nearly 90 volunteers assisted Life Rolls On - They Will Surf Again with event set-up and breakdown, registration, equipment distribution, lunch service and helping surfers on land and in shallow water. Founded in 2001, the San Diego River Park Foundation is a grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. Approximately 40 SLAH volunteers joined the San Diego River Park Foundation to care for California native plants and trees at the Point Loma Native Plant Garden in March and the San Diego River Garden in Mission Valley in May. Activities included trail maintenance, watering, pruning and other light gardening projects. In July, SLAH volunteers joined the foundation once again for the Coastal Habitat Restoration event in Ocean Beach to help save and restore one of the last remaining coastal dune and wetland habitats in San Diego. Twenty volunteers helped remove invasive plants, watered and cared for recent plantings, and provided trail maintenance and litter removal. Sharp Humanitarian Service Program In FY 2015, the Sharp Humanitarian Service Program funded more than 50 Sharp employees in service programs that provide health care or other supportive services to underserved or adversely affected populations in Haiti, Guatemala, Peru, southern Africa and other vulnerable areas. Through the program, a Sharp pharmacist participated in a two-week medical mission trip to the impoverished villages of Ayacucho, Peru, located in the central Andes Mountains. Sponsored by the Peruvian American Medical Society, the mission team consisted of approximately 50 professionals - including physicians, a pharmacist, nurses, translators, case workers and general volunteers - who provided medical examinations and medications for approximately 75 to 100 patients each day. In May, a Sharp nurse traveled to Zimbabwe with Operation of Hope, a nonprofit volunteer surgical team that provides free surgeries to children in developing countries who are born with or suffering from facial deformities. For approximately two weeks, the team member worked alongside surgeons, anesthesiologists and other staff who surgically repaired the cleft lips and palates of approximately 75 patients. The team also received assistance from staff at a Zimbabwe hospital and from the local rotary club. In addition, the team educated community members about cleft lip and palates on a local radio station in an effort to reduce the social stigma associated with the malformation. In April, another Sharp nurse served in the operating room (OR) on Africa Mercy. As the world's largest civilian hospital ship, Africa Mercy is operated by Mercy Ships, a global charity that brings lifesaving surgeries, hope and healing to people living in the world's poorest regions. During their two-week mission, the team member assisted with multiple surgical procedures for approximately 60 citizens of Madagascar, including the removal of large tumors on backs and necks as well as hernia repairs. International Medical Relief (IMR) is a nonprofit organization that treats underserved patients by providing medical services, medication, supplies, training and education to communities all over the globe with help from medical volunteers. For 10 days, a Sharp team member joined IMR to help treat those lacking medical services in the remote villages of Uganda. Alongside other foreign staff - such as physicians, nurse practitioners, nurses, respiratory therapists and various other nonmedical professionals - the team member provided health assessments, medications, antibiotics and wellness exams to thousands of people in need. Haitian parents without a job are often at risk of sending their children to an orphanage because they are unable to feed them. The I'mME organization empowers and sustains the structure of family to the orphans of the world through care, education, prevention and stewardship. In FY 2015, one Sharp team member participated in a trip to Haiti with I'mME, where she provided assistance to an orphanage and a feeding program that serves meals to 150 children and youth twice a week, who would otherwise never have a hot meal. In collaboration with the founder of COMPASSION IT - a nonprofit organization and social movement that inspires compassionate actions in the daily lives of individuals around the world - a Sharp team member traveled to Botswana for a two-week mission trip. Working with the Botswana Ministry of Health, the Ministry of Education and Skills Development, various nongovernment organizations, and Botho (an organization that aims to nurture compassion), they provided compassion training to more than 500 citizens of Botswana. Audience members were from education and social service sectors, including physicians, social workers, nurses, teachers, police officers, orphanage caregivers and students. With the rising prevalence of empathy fatigue and burnout among service providers, the training supports emotional resilience, broadens perspectives and provides practical application during difficult or stressful situations. The training was based on Compassion Cultivation Training (CCT) developed by the Center for Compassion and Altruism Research and Education (CCARE) at the Stanford University School of Medicine as well as other mindfulness and self-compassion curricula, and was also supported by a Sharp IRB study. Following the mission, electronic support was provided to participants for eight weeks.
Form 990, Part III, Line 4a (continued):	In February, a Sharp team member participated in a 10-day trip to San Lucas Toliman in the highlands of southwestern Guatemala to build and renovate homes for Mayan families. This trip was organized by the Global Village volunteer program through Habitat for Humanity, a nonprofit Christian housing organization that believes everyone should have a decent, safe and affordable place to live. Three teams of six volunteers rotated between working on a rural house foundation for a Mayan couple and building smokeless stoves and latrines for eight Mayan families (including water filters and basic sanitation services). InterFACE is a volunteer group of plastic and other reconstructive surgeons, anesthesiologists, nurses, pediatricians, speech therapists, psychosocial workers and other volunteers who devote their time and expertise to offer reconstructive surgery to children in Mexico. In October, a Sharp team member joined InterFACE to provide reconstructive surgery to underprivileged children - and some adults - in Mexicali. In two days, the team provided an average of 75 surgical procedures including cleft lip and palate repair, burn reconstruction, and repair to ear, hand and other congenital or acquired deformities. During a week-long medical mission trip, a Sharp team member provided care to hundreds of impoverished residents of Cao Bang, Vietnam. The trip was organized by the Good Samaritan Medical and Dental Ministry, a nonprofit organization that provides medical, dental and optometric care to the people of Vietnam through annual summer missions. The villagers were malnourished, sick and extremely dehydrated. The medical team set up a clinic in a local elementary school where they diagnosed and treated ailments, drew labs, prescribed and provided medicine, pulled teeth and performed surgeries. With no access to clean or running water, sinks, toilets or air conditioning, the team was able to help those in need despite having limited resources. Each year, Experience Camp serves hundreds of youth across the country through one-week camps for those who have experienced the death of a parent, sibling or primary caregiver. The program helps build confidence, encourages laughter, provides emotional support and allows youth to navigate their grief through friendship, teamwork, athletics and the common bond of loss. In FY 2015, a Sharp team member served as a clinician with Experience Camp during which they developed programs to meet the emotional needs of the camp's youth as well as supported other volunteer clinicians and cabin counselors. Community Walks For the past 20 years, Sharp has proudly supported the American Heart Association (AHA) annual San Diego Heart & Stroke Walk. In September 2015, more than 800 walkers represented Sharp at the 2015 San Diego Heart & Stroke Walk held at Balboa Park. Sharp was the No. 1 team in San Diego and the No. 2 team in the AHA Western Region Affiliates, raising nearly $180,000. Sharp Volunteers Volunteers are a critical component of Sharp's dedication to the San Diego community. Sharp provides many volunteer opportunities for individuals to serve the community, meet new people and assist in a wide variety of programs across the Sharp system. Volunteers of all ages and skill level 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 foundations. On average, more than 1,920 individuals actively volunteered at Sharp each month in FY 2015, contributing a total of more than 270,000 hours of service to Sharp and its initiatives throughout the year. This included more than 1,900 auxiliary members and thousands of individual volunteers from the San Diego community, including volunteers for Sharp's various foundations. These community members dedicated more than 9,600 hours to activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the average number of active volunteers per month as well as the total number of volunteer service hours provided to each Sharp entity, specifically for patient and community support. Table 2: Sharp Volunteers and Volunteer Hours - FY 2015 Sharp Chula Vista Medical Center 390 Average Active Volunteers per Month 53,136 Volunteer Hours Sharp Coronado Hospital and Healthcare Center 78 Average Active Volunteers per Month 8,226 Volunteer Hours Sharp Grossmont Hospital 729 Average Active Volunteers per Month 111,342 Volunteer Hours Sharp HospiceCare 77 Average Active Volunteers per Month 6,634 Volunteer Hours Sharp Metropolitan Medical Campus 649 Average Active Volunteers per Month 90,934 Volunteer Hours TOTAL 1,923 Average Active Volunteers per Month 270,272 Volunteer Hours In support of Sharp's foundations - including the Sharp HealthCare Foundation, Grossmont Hospital Foundation and Coronado Hospital Foundation - volunteers dedicated hours of support to various events, such as annual golf tournaments and galas. In addition, Sharp offers a systemwide Junior Volunteer Program for high school students interested in giving back to their communities and exploring future health care careers. Program requirements vary, however all require high grade point averages and long-term commitments of at least 100 hours. Junior volunteers serve in a wide range of roles throughout Sharp. They enhance patient-centered care through hospitality, such as greeting and escorting patients and families, answering questions, and creating a welcoming and relaxing environment for guests. Through volunteering in the gift shops and thrift store, they learn about merchandising, fundraising and retail sales. And on the inpatient units, they are exposed to clinical experiences that provide a glimpse into future careers. In FY 2015, more than 480 high school students contributed a total of 58,100 hours to the Junior Volunteer Program. This included 85 juniors who provided more than 6,500 hours of service at SMH and SMBHWN; 144 juniors who dedicated approximately 16,600 hours of service at SCVMC; and nearly 257 juniors who contributed nearly 35,000 hours of service at SGH. Volunteers on Sharp's various entity boards provide program oversight, administration and decision making regarding financial resources. In FY 2015, nearly 120 volunteers contributed their time to Sharp's boards. Sharp employees also donate time as volunteers for the Sharp organization, including service on the Cabrillo Credit Union Sharp Division Board, the Sharp and Children's MRI Board, the UCSD Medical Center/Sharp Bone Marrow Transplant Program Board, and the Grossmont Imaging LLC Board. This section describes the achievements of various Sharp volunteer programs in FY 2015. Sharp HospiceCare Volunteer Programs Sharp HospiceCare provided a variety of volunteer training opportunities in FY 2015. Hospice volunteers are often working towards a career in the medical field, and can gain valuable knowledge and experience through volunteering. Volunteers provide valuable services to the hospice organization and those they serve, including companionship to those near the end-of-life, support for families and caregivers and help with community outreach. Fifty-one new hospice volunteers were trained in FY 2015. Volunteers complete an extensive 32-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their patient and administrative support activities. In addition, five teenagers participated in Sharp HospiceCare's Teen Volunteer program in FY 2015, through which the teens are assigned special projects in the office or patient assignments at Sharp HospiceCare's LakeView and ParkView homes. The teens may perform grooming and hygiene tasks or provide simple acts of kindness, such as sitting with patients, listening to their stories and holding their hand. Nine nursing students from PLNU also volunteered at Sharp HospiceCare, offering assistance to family caregivers in private homes.
Form 990, Part III, Line 4a (continued):	Sharp HospiceCare provides the 11th Hour Program to ensure that no patient dies alone. Through the program, a Sharp HospiceCare volunteer accompanies patients who are in their final moments yet do not have a family member present. The volunteer offers a comforting presence by holding the patient's hand, reading softly to them and simply being by their side. Families who are present with their dying loved one may also prefer the comfort of a volunteer as their loved one passes away. Twenty-two volunteers were trained through the 11th Hour Program in FY 2015. Furthering its volunteer efforts in FY 2015, Sharp HospiceCare trained 11 volunteers in Healing Touch - a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain. After volunteers are trained in Healing Touch, they provide the therapy to family caregivers once a week while their loved one is receiving hospice care as well as a visit following the patient's death. Sharp HospiceCare is a partner in We Honor Veterans (WHV) - a national program developed by the National Hospice and Palliative Care Organization (NHPCO) in collaboration with the VA to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As a WHV partner, Sharp HospiceCare can achieve up to four levels of commitment in serving veterans. As current Level I partners, Sharp HospiceCare volunteers receive an additional eight hours of training that enables them to work with patients with military experience as well as provide weekly support, companionship and relief for caregivers of veterans. Once trained, the volunteers may also offer a special ceremony to veterans receiving hospice services and their family members, in which they honor them with a WHV pin and a certification of appreciation for their services. In FY 2015, volunteers held 17 pinning ceremonies for veterans receiving care at Sharp HospiceCare. Sharp HospiceCare offers the Memory Bear Program to support community members who have lost a loved one. Through the program, volunteers create teddy bears out of the garments from those who have passed on. The bears serve as special keepsakes and permanent reminders of the grieving family member's loved one. In FY 2015, volunteers devoted nearly 3,600 hours to handcraft approximately 900 bears for nearly 350 families. Sharp HospiceCare offers a monthly support group to enhance volunteers' education and training. Volunteers are also recognized for their valuable contribution during National Volunteer Week in April and National Hospice and Palliative Care Month in November. Sharp Metropolitan Medical Campus (SMH, SMBHWN, SMV) Volunteer Programs SMH created the Community Care Partner (CCP) program to serve and comfort patients without family or friends to support them during their hospital stay. This unique program hand-selects and trains hospital volunteers to become Community Care Partners (CCPs). The CCPs act as companions to provide comfort and help keep patients safe by notifying medical staff as needed - a task that is usually performed by a family member or friend but often overlooked for patients who lack a companion. The CCPs provide patients with company and support, share common interests, spend time together in conversation, read to patients, write letters, take walks and play games. Since February 2010, the Cushman Wellness Center Community Health Library and the SMH Volunteer Department have offered the Health Information Ambassador Program to bring the library's services directly to patients and their families, and empower them to become involved in their own health care. The Health Information Ambassadors are hospital volunteers who receive additional training through the Community Health Library. Once trained, the volunteers visit patients at SMH, the SMH Rehabilitation Center and the perinatal special care unit at SMBHWN, and ask if they or their family members would like to receive additional resources on their diagnosis. The volunteers bring requests back to the consumer health librarian who then prints consumer-oriented information from quality websites. The volunteers deliver the health information back to the patients as requested. Patients or family members who have already conducted their own research are offered a website bookmark from www.medlineplus.gov in order to guide them towards using trustworthy websites in the future. Patients and families are welcome to keep in touch with the library after discharge to ensure they have access to reliable health information at home. In FY 2015, the Health Information Ambassadors visited more than 3,000 patient rooms and filled approximately 780 information requests. At SMMC, the volunteer-run Arts for Healing Program uses art therapy to reduce feelings of fear, stress, pain and isolation among patients facing significant medical challenges and their loved ones. Arts for Healing brings a variety of activities to patients at their bedside - such as painting, beading, creative writing, card-making, scrapbooking, quilting and music - to help improve their emotional and spiritual health, and promote a faster recovery. The program also engages visitors and community members during hospital and community events. Funded completely by donations, Arts for Healing is led by Sharp's Spiritual Care Department and is implemented with help from licensed music and art therapists as well as a team of trained volunteers who serve as the primary providers of the program. The Arts for Healing program is offered across the SMMC, including at SMH, SMH OPP, SMBHWN, SMV and SMC. At SMH, Arts for Healing typically serves patients who are recovering from stroke; receiving treatment for cancer; facing life with newly acquired disabilities following catastrophic events; recovering from surgery; waiting for organ transplant; or receiving palliative care. At SMBHWN, Arts for Healing supports mothers with high-risk pregnancies who experience extended hospital stays awaiting childbirth, making them susceptible to stress and loneliness over the separation from their families. Music therapy is also provided in the NICU to promote development in premature babies. At SMV and SMC, Arts for Healing offers several art and music therapy groups, including groups for patients recovering from drug addiction, patients receiving treatment for mood and anxiety disorders, and older adults receiving treatment for dementia and depression. In FY 2015, Arts for Healing led art and music activities for hundreds of patients and community members in recognition of various holidays and systemwide events, including Saturday With Santa, a public event hosted each December by the SMH Auxiliary; Valentine's Day; Hospital Week in May; Cancer Awareness Week in June; Spiritual Care Week in October; and the Sharp Women's Health Conference in March. Additionally, in collaboration with SMMC's social workers and palliative care nurses, Arts for Healing facilitated the donation of nearly 130 blankets and quilts to patients receiving end-of-life care at SMH. Thirteen of the blankets were knitted and crocheted by patients at SMV's East County Outpatient Program, an activity that could also reduce anxiety and depression for the patients crafting and donating the blankets. In FY 2015, 42 volunteers, including several students from PLNU and MC, facilitated art activities for patients and their loved ones through Arts for Healing. Since the inception of the program in 2007, more than 60,500 patients, guests and staff have benefitted from the time and talent provided by the Arts for Healing team. Sharp Employee Volunteer Efforts In FY 2015, Sharp staff donated 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 served the community.
Form 990, Part III, Line 4a (continued):	The SGH Engineering Department engaged in a variety of volunteer initiatives in FY 2015. The team continued This Bud's for You, a special program that delivers hand-picked flowers from the campus' abundant gardens to unsuspecting patients and their loved ones. Each week, the SGH landscape team grows, cuts, bundles and delivers colorful bouquets to visitors of both the hospital and Sharp's hospice homes. The team also regularly offers single-stem roses in a small bud vase to passers-by. In FY 2015, the team delivered six to eight vases of flowers each day to patient rooms, with as many as 20 vases or more during peak flower season and upon additional requests. In addition, the team supports the SGH Senior Resource Center and Meals-on-Wheels partnership by providing floral centerpieces for their fundraising events to benefit East County seniors as well as offers roses for SGH's annual patient remembrance service. In its fifth 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. The Engineering Department further extends the spirit of caring through Cheers Bouquets. During their work day, the engineers keep an eye out for patients or visitors that appear to need encouragement or cheer. With help from Sodexo - the hospital's food service, housekeeping and engineering vendor - a bouquet is quickly assembled with balloons, ribbon, a teddy bear or Sodexo football, and an inspirational quote. The gift is delivered to bring the patient or visitor comfort and joy while at the hospital. The SGH Engineering Department, landscape team, SGH Auxiliary and local businesses collaborated to bring The Shirt Off Our Backs Program to San Diego's needy population during the 2014 holiday season. The program collects, prepares and donates a variety of items to homeless or low-income community members - ranging from small children to adults - helping to meet their basic needs and bring them holiday joy. Volunteers for The Shirt Off Our Backs Program personally collected and filled three trucks with food and other essential items, including handmade sandwiches, water bottles, clothing, socks, shoes, hygiene kits, pet food, children's toys, towels, blankets and other household items. In its fourth year, The Shirt Off Our Backs Program is committed to bringing comfort and hope to all who express need. SGH furthered its efforts to provide for those in need during the holidays through its annual Santa's Korner giving event. For more than 30 years, various hospital departments have adopted a family - who has been vetted and referred by local service agencies - and dedicated personal time to making the holidays the best they can be for each family. Special holiday gifts, including grocery gift cards, clothing, toiletries, household items, movie tickets, bicycles, children's toys, and a holiday meal, are purchased for the families by hospital staff using primarily their personal resources and through occasional fundraisers. The SGH Engineering Department also participated in the SDFB Food 4 Kids Backpack program in FY 2015. The program provides 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. Food 4 Kids strives to alleviate hunger, improve school performance, improve health and provide additional information to parents about available local community services. Between January and April, 2015, the team filled approximately 50 backpacks with roughly 600 pounds of food per week for chronically hungry elementary school students. Similarly, the Labor and Delivery Department at SMBHWN is committed to the fight against hunger through participation in the International Relief Team's (IRT) Feeding San Diego's Kids project. Based in San Diego, IRT is a relief organization providing worldwide support that combines both short-term relief efforts and long-term programs to save and change lives. Through Feeding San Diego's Kids, nutritious food is provided to children in the Linda Vista Elementary School nutrition club, a group specifically for children who have been identified as homeless by the school nurse. Every week, labor and delivery team members stuff backpacks with nonperishable, nutritious food that can feed a family of four for the weekend. The backpacks are also stuffed with weekly nutrition-related prizes to encourage students and families to learn and participate in their own nutrition as well as with occasional holiday-related gifts. Since the start of the program in May 2013, the team has dedicated more than 125 weeks of service to filling 2,800 backpacks for approximately 25 children and their families per school year. More than 475,000 people in San Diego County face the threat of hunger every day. The SDFB distributes emergency food to approximately 400,000 children and families, active duty military and fixed income seniors living in poverty every month. During the 2015 holiday season, Sharp demonstrated its commitment to fighting hunger by hosting a food drive to support the SDFB. Through the food drive, team members donated nearly 1,600 pounds of food, which supplied more than 1,300 meals to those in need. All Ways Green Initiative As San Diego's largest private employer, Sharp is committed to improving the health of the environment and therefore the communities we serve. Sharp recognizes that a healthy environment influences individual well-being, and is dedicated to minimizing any adverse impact on the environment by creating healthy green practices for employees, physicians and patients to transfer from the health care environment to home. Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego earth-friendly businesses to help identify best practices, reduce the costs of green practices and facilitate implementation of sustainable initiatives. In 2009, Sharp created the All Ways Green logo to brand its environmental activities and communicate sustainability throughout Sharp and the San Diego community. Sharp's systemwide All Ways Green committee is charged with identifying, creating and evaluating opportunities and best practices in seven distinct areas: (1) energy efficiency, (2) alternative energy generation, (2) water conservation, (3) waste minimization, (4) commuter solutions, (6) green building design and (7) sustainable food practices. Sharp's Environmental Policy serves to guide the organization in identifying and implementing green practices within the health care system. Established Green Teams at each Sharp entity are responsible for developing new programs that educate and motivate Sharp employees to conserve natural resources, reuse and recycle. Energy Conservation According to the U.S. EPA, health care ranks as the country's second most energy-intensive industry. Furthermore, the U.S. Department of Energy Information Administration states that hospitals and health care facilities account for more than eight percent of the nation's annual energy consumption and generate nearly eight percent of the country's carbon dioxide (CO2) emissions. Unlike other industries, hospitals must operate 24 hours a day, seven days a week, and provide service during power outages, natural disasters and other emergencies. The EPA estimates that 30 percent of the health care sector's current energy use could be reduced without sacrificing quality of care through a shift toward energy efficiency and use of renewable energy sources. Sharp has responded by implementing numerous green initiatives, including retro-commissioning of heating, ventilation and air conditioning (HVAC) systems; lighting retrofits; pipe insulations; infrastructure control initiatives; occupancy sensor installation; light-emitting diode (LED) light installations; energy audits; elevator modernization; and energy-efficient motor and pump replacements.
Form 990, Part III, Line 4a (continued):	In 2013, Sharp was the first health care system in San Diego to implement a computer power management program, which enables computers and monitors to go into a low-power sleep mode after a period of inactivity. Since its implementation, the program has been installed on more than 15,500 computers and has resulted in annual energy savings of approximately 1.6 million kilowatt-hours (kWh). The initiative earned Sharp a Certificate of Recognition from the EPA in 2013. In July 2015, Sharp implemented TSO Logic software to identify opportunities for replacing inefficient energy consuming hardware with energy efficiency hardware in Sharp's centralized data center. In addition, the system can detect underutilized hardware to shut down or put to sleep during periods of inactivity. This "smart software" anticipates daily usage to optimize energy efficiency. It is projected that Sharp could conservatively reduce hardware electrical consumption by more than five percent each year. Sharp remains firmly committed to identifying energy savings initiatives that bring value to the system and the community, as every dollar saved on green practices can be used to support the provision of quality health care and community-based initiatives. Sharp's energy-saving initiatives are driven by the Sharp Energy Conservation Guideline to help manage energy utilization practices throughout the system. Although there have been significant increases in energy fees over the last five years, Sharp has been able to significantly decrease energy utilization by seven percent (on a per square foot basis), resulting in energy costs savings of more than three percent. In total, Sharp's energy initiatives have reduced the system's carbon footprint equal to the removal of almost 17,000 metric tons of CO2 each year. In May 2014, SDG&E named Sharp San Diego's Healthcare Energy Champion in recognition of its commitment to the innovative programs implemented to reduce its carbon footprint. Furthering its dedication to energy efficiency, SHC participates in SDG&E's Major Customer Advisory Panel, a group of SDG&E's largest customers who meet quarterly to receive energy updates from SDG&E and provide feedback on important regional energy issues. In addition, SDG&E's staff participates in Sharp's Natural Resource Subcommittee to help Sharp identify energy savings initiatives and associated rebates and incentives to reduce the overall costs of energy savings projects. All Sharp entities participate in the EPA's ES database and monitor their ES scores on a monthly basis. ES is an international standard for energy efficiency created by the EPA. Certified ES buildings 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, 2013 and 2015. In addition, Sharp's SRS Downtown medical office building meets Leadership in Energy and Environmental Design (LEED) silver certification specifications, one of the first medical office buildings in San Diego of its kind. Water Conservation According to the EPA, hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the U.S. On any given day, Sharp uses an average of 650,000 gallons of water. Of this, approximately 25 percent is used for domestic purposes such as sinks, toilets and showers, while the remaining 75 percent is used to cool Sharp's buildings, sterilize equipment, prepare food and water the landscape. In an effort to conserve water, Sharp has researched and implemented numerous infrastructure changes and best practices to ensure its facilities are optimally operated while monitoring and measuring water consumption. These changes include installation of motion-sensing faucets and toilets in public restrooms; low-flow showerheads and toilets in patient rooms and locker rooms; mist eliminators; microfiber mops; water-saving devices and equipment; high-efficiency, low-water-use dishwashers; installation of water-efficient chillers; water monitoring and control systems; water practice and utilization evaluations; regular rounding to identify leaks; installation of low water sterile processing equipment; and landscape improvements including reduced watering times, drip irrigation systems, xeriscaping, hardscaping and planting succulents and other drought tolerant plants. To comply with the mandatory water restrictions for California issued on April 1, 2015, Sharp modified irrigation schedules, properly sized sprinkler heads, installed water-sensing equipment and reduced watering times and frequency at all sites. Over eight million pounds of textiles, such as sheets, towels, scrubs and patient gowns, are used at Sharp each year. The significant amount of laundry generated by Sharp prompted the selection of Emerald Textiles, an environmentally-friendly laundry and linen provider that demonstrates strong investment in sustainability practices. Emerald Textiles, operates a state-of-the-art plant that has been efficiently designed to reduce utility consumption and preserve natural resources. Sharp saves an estimated 50 million gallons of water per year (50 percent of total usage) through the use of a state-of-the-art water filtration system, more than 71,000 kWh of electricity through the use of energy efficient lighting, and more than 750,000 therms of gas through the use of energy-efficient laundry equipment. Waste Minimization According to Practice Greenhealth's Healthier Hospitals Initiative (HHI), hospitals generate an average of 26 pounds of waste per staffed bed each day. To significantly reduce waste at each entity and extend the lifespan of local landfills, Sharp has created a comprehensive waste minimization program, including a systemwide, multidisciplinary Waste Management committee. The committee's purpose is to provide oversight of Sharp's waste management initiatives, including proper waste segregation and enhancing recycling efforts to divert waste and extend the lifespan of local landfills. Sharp was an early adopter in its commitment to waste diversion, and now diverts more than 39 percent of waste through recycling, donating, composting, reprocessing and reusing. In FY 2015, Sharp's waste minimization efforts resulted in more than 8.8 million pounds of waste diverted from the landfill. The following initiatives highlight Sharp's waste minimization efforts in FY 2015: * SMH and SMV collected more than 252,000 pounds of food waste for composting through participation in a food waste composting program with the local greenery. * Sharp diverted more than 2.5 million pounds of trash from the landfill by recycling nonconfidential paper, cardboard, exam table paper, plastic, aluminum cans and glass containers through Sharp's single-stream waste program. * Sharp collected, reprocessed and sterilized 42,000 pounds of surgical instruments. * Sharp implemented reusable sharps containers throughout the hospitals, which saved approximately 50,000 pounds of plastic and more than 1,800 pounds of cardboard from entering the landfill. This resulted in annual CO2 emission savings of more than 28,000 pounds and is equivalent to saving more than 2,700 gallons of gas each year. * SGH, SMH, SMBHWN and SCVMC recycled surgical blue wrap, while SCVMC recycled disposable privacy curtains, diverting more than 200,000 pounds of recycled materials from the landfill. * Employees and hospital visitors donated more than 200 pairs of eyewear to people in need, both locally and globally, through the Lion's Club Recycle Sight program. Sharp's waste minimization activities are widely recognized as being innovative and making a positive difference for the communities that Sharp serves. In FY 2015, Sharp received the following recognition: * The City of San Diego's Environmental Services Department named Sharp as one of the Recyclers of the Year in the 2015 Waste Reduction and Recycling Awards Program.
Form 990, Part III, Line 4a (continued):	* Executive Insight - a leading health care publication - highlighted new horizontal syringe/sharp drop reusable containers, which were developed by Stericycle with significant input from Sharp to reduce the likelihood of needle stick injury from needle disposal. * Sharp participated at the San Diego City Council's Ssubi Proclamation Day as part of their partnership with Ssubi is Hope - a nonprofit charity organization that collects donated expired/unusable medical equipment. Through the partnership, Sharp donated more than 43,000 pounds of equipment and supplies to support a health center in rural Uganda that provides care for more than 660,000 people living in 49 nearby villages. * SCHHC was selected to develop and display a poster at the annual International Planetree Conference titled "Contributing to a Healthy Community in Uganda - Making an Impact Locally and Internationally." Table 3 presents the waste diversion rates at Sharp HealthCare in FY 2015. Table 3: Sharp HealthCare Waste Diversion - FY 2015 Sharp Chula Vista Medical Center 893,844 Recycled Waste Per Year (lbs.) 2,813,090 Total Waste Per Year (lbs.) 32% Percent Recycled Sharp Coronado Hospital and Healthcare Center 293,519 Recycled Waste Per Year (lbs.) 1,365,903 Total Waste Per Year (lbs.) 21% Percent Recycled Sharp Grossmont Hospital 2,267,597 Recycled Waste Per Year (lbs.) 5,949,660 Total Waste Per Year (lbs.) 38% Percent Recycled Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns 1,990,100 Recycled Waste Per Year (lbs.) 6,471,916 Total Waste Per Year (lbs.) 31% Percent Recycled Sharp Mesa Vista Hospital 698,333 Recycled Waste Per Year (lbs.) 1,157,254 Total Waste Per Year (lbs.) 60% Percent Recycled Sharp Rees-Stealy Medical Centers 1,217,959 Recycled Waste Per Year (lbs.) 2,814,565 Total Waste Per Year (lbs.) 43% Percent Recycled Sharp Corporate Sites 1,439,638 Recycled Waste Per Year (lbs.) 2,271,212 Total Waste Per Year (lbs.) 63% Percent Recycled Total Sharp HealthCare 8,800,990 Recycled Waste Per Year (lbs.) 22,843,601 Total Waste Per Year (lbs.) 39% Percent Recycled Sustainable Food Practices According to the Intergovernmental Panel on Climate Change, agriculture is responsible for 13.5 percent of greenhouse gas emissions worldwide. Sharp is committed to making eco-friendly food choices to minimize its environmental footprint. In 2015, Sharp implemented the Food and Nutrition Best Health Committee - a component of Sharp's larger Best Health employee wellness program - to standardize, facilitate and promote its food sustainability efforts throughout the system. This includes a systemwide focus on its sustainable Mindful Food Program to provide education and healthy food options designed to improve the health of Sharp's patients, staff, community and environment. Implemented in collaboration with Sodexo, Sharp's food service vendor, Sharp's Mindful Food program includes Meatless Mondays; wellness menus; Community Supported Agriculture (CSA); fresh and organic produce; food composting; increasing recycling activities; the promotion of sugarless beverages; the use of postconsumer recycled packaging solutions; and increasing local, organic and sustainable food purchases. In addition, Sharp participates in HHI's Healthier Food program by committing to the purchase of local and sustainable foods. In FY 2015, Sharp purchased more than 285,000 pounds of local produce, representing an increase of 5.1 percent in local purchases from FY 2014. In addition, Sharp increased its purchase of animal protein from local, sustainable sources, a 16.8 percent increase since FY 2014. Sharp expects to further increase the purchase of local, sustainable food as new, safe sources of food items are identified and credentialed. Furthering its sustainable food practices, SMH, SMV and SCHHC created the first county-approved organic gardens and use the produce from these gardens in the meals served at the hospital cafes. These organic gardens produce an average of 22 pounds of produce per week. In 2012, Sharp partnered with the City of San Diego to implement a food waste composting program in the kitchen that services SMH and SMBHWN, making Sharp the first San Diego health care organization to join the city's initiative. SMV joined this effort in 2014, and SCHHC, SCVMC and SGH plan to participate in 2016. Through the program, EDCO, a solid waste vendor, transports food waste to the Miramar Greenery - a 74-acre facility located at the Miramar Landfill in Kearny Mesa. The food waste is processed into a rich compost product and sold to commercial landscapers, non-city residents, and to city residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water and helping the environment by recycling valuable organic materials. According to the City of San Diego, such waste diversion programs contribute to the landfill's lifespan being extended from 2012 to at least 2022. In 2015, Sharp received the San Diego Recycling and Composting Award and continues to work with the City to expand food waste composting to other Sharp entities. Additional sustainable food practices at Sharp include: the use of green-label kitchen soaps and cleansers; electronic cafe menus; recycling of all cardboard, cans and grease from cafes; organic markets at each hospital and corporate office; purchasing of hormone-free milk; and partnering with vendors who are committed to reducing product packaging. In addition, beginning in April 2014, Sodexo expanded purchases of paper products made from recycled, compostable and chlorine-free renewable materials in place of the traditional foam, plastic and aluminum packaging commonly used in food service. Commuter Solutions Sharp supports ride sharing, public transit programs and other transportation efforts to reduce transportation emissions generated by Sharp and its employees. Sharp replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, saving approximately five miles per gallon. Sharp's employee parking lots offer car pool parking spaces, designated bike racks, and motorcycle spaces. Employees can also purchase discounted monthly bus passes. As part of the nationwide Electric Vehicle Project, Sharp installed 33 electric vehicle chargers (EVCs) at its corporate office location, SCVMC, and SMMC. Sharp was the first health care system in San Diego to offer EVCs, supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on foreign oil. Sharp will continue its efforts to expand EVCs at other entities. In FY 2015, Sharp's use of EVCs saved 3,700 gallons of fuel and resulted in a reduction of approximately 20,000 pounds of CO2. In partnership with the SANDAG iCommute program, Sharp offers van pool and car pool match-up opportunities to help employees find convenient ride share partners and promote sustainable commuting. Using the iCommute TripTracker, employees can also monitor the cost and carbon savings of their alternate commuting methods. In October, fifty-one organizations in SDC, representing more than 102,000 employees, participated in SANDAG's iCommute Rideshare Corporate Challenge, where employees earn points for replacing their solo drive with a greener commute choice, such as biking, walking, carpooling, vanpooling and public transit. For the second year in a row and for the third time in four years, Sharp was awarded the top spot in the Mega Employer Category. Through the challenge, more than 700 Sharp employees reported nearly 25,000 alternative commute trips, saving more than 16,000 gallons of gasoline and approximately 340,000 pounds of CO2. Sharp's Commuter Solutions Sub-Committee continuously develops innovative and accessible programs and marketing campaigns that encourage employees to participate in ride sharing and other sustainable modes of transportation. The committee has overseen the implementation of bike racks and designated car pool spots as well as adding a Bicycle Commuter Benefit, which gives employees who bike to work up to $20 per month to use toward qualified costs associated with bicycle purchase, improvement, repair and storage. Sharp also supported bicycle transportation through several bike-to-work initiatives in FY 2015. This included the county-wide Bike to Work Day event during which Sharp employees opted to ride their bike to work. During the event, Sharp Best Health provided snacks and beverages at six pit stops throughout SDC.
Form 990, Part III, Line 4a (continued):	Furthering its commitment to better commuting solutions for its employees, Sharp supplies and supports the hardware and software for more than 300 employees who are able to efficiently and effectively telecommute to work. These employees work in areas that do not require an on-site presence, such as information technology support, transcription and human resources. Sharp's ongoing efforts to promote alternative commuting choices in the workplace has led to recognition as a SANDAG iCommute Diamond Award winner consistently between 2001 and 2010, and again from 2013 through 2015. Community Education and Outreach Sharp actively communicates and educates the San Diego community about its sustainability programs. In FY 2015, Sharp participated in the following outreach activities: * E-newsletters highlighting Sharp's recycling efforts and accomplishments, as well as reminders for proper workplace recycling, carpooling, and energy and water conservation are shared with employees throughout the year. * In April, Sharp held its sixth annual system-wide All Ways Green Earth Week celebration, including Earth Fairs at each Sharp hospital and system office. During the fairs, employees learned how they can decrease water, energy and resource consumption, divert waste through recycling, and reduce their carbon footprint by using alternative transportation. Many of Sharp's key vendor partners participated in the fairs to help raise awareness of green initiatives and how Sharp is involved in those programs. * Sharp continued to participate in SDG&E's Major Customer Advisory panel to provide input and education related to energy reliability, fees and cost structure and their impact on the health care environment. * Sharp collaborated with the County of San Diego to host a complimentary community workshop on pharmaceutical waste management designed to educate participants (e.g., medical providers, pharmacy personnel, hospital personnel) about proper and safe disposal of pharmaceutical waste. Topics included pharmaceutical waste liability, regulatory compliance and cost-effective disposal strategies. * Sharp hosted two community e-waste and confidential paper shredding collection events. * Sharp partnered with the U.S. Drug Enforcement Administration on National Drug Take Back Day to provide a safe, convenient and responsible means of drug disposal and to educate the general public about the potential for prescription medication abuse. * Sharp continued participation in San Diego's Gathering of Green Teams with other San Diego business leaders to identify and discuss sustainable best practices, which can be emulated across industries. * Sharp participates in San Diego County's Hazmat (Hazardous Materials) Stakeholder meetings to discuss best practices for medical waste management with other hospital leaders in SDC Sharp's All Ways Green initiative remains committed to creating sustainable practices for employees, physicians and the community to improve the health of the environment and ultimately the health of the populations that it serves. Table 4 highlights the All Ways Green efforts at Sharp entities. Table 4: All Ways Green Initiatives by Sharp Entity - FY 2015 SCHHC -Energy Efficiency * Energy audits * Air Handler projects * HVAC projects * Lighting retrofits * LED lighting * New energy-efficient appliances in the cafe * New building management system to optimize energy usage for the cooling system -Water Conservation * Water-efficient dishwashing system * 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 sharps 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 * ES award * HVAC projects * Lighting retrofits * Energy-efficient dishwasher * Elevator upgrades -Water Conservation * Drip irrigation * Drought-tolerant plants and bark-covered ground * Electronic and low-flow faucets * Evaluation of water utilization practices * Hardscaping * Landscape water reduction systems * Mist eliminators * Replacement of 3.5gpf toilets with 1.28 gpf toilets * Cooling tower replacement (40% less water used) -Waste Minimization * Blue-wrap recycling * Compactor renovation * Electronic cafe menus * Single-stream recycling * Surgical instrument reprocessing * Reusable sharps containers * Clean Business designation by City of Chula Vista * Replacement of bottled water with spa water -Education and Outreach * America Recycles Day * Earth Week activities * Environmental policy * Green Team * No smoking policy * Organic farmer's market * Recycling education * Ride share promotion SGH -Energy Efficiency * Energy audits * ES participation * HVAC projects * Lighting retrofits * Retro-commissioning * Elevator modernization * High efficiency LED fixtures -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 * Valve and sprinkle head replacement * Water fountains off * Water-efficient cleaning chemical dispensing machines * Plumbing projects to address water leaks * GMP Weekly Fire Pump Chum Test -Waste Minimization * Blue wrap recycling * Electronic cafe menus * Single-serve paper napkin and plastic cutlery dispensers * Single-stream recycling * Surgical instrument reprocessing * Recycle bins distribution * Reusable sharps containers -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 * EVCs * Energy audits * Energy efficient chillers/motors * ES participation * HVAC projects * LED Lighting * 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 * Water dispensers to replace bottled water -Waste Minimization * Recycle bin distribution * Recycled paper * Single-serve paper napkin and plastic cutlery dispensers * Single-stream recycling * Spring cleaning events -Education and Outreach * Earth Week activities * Environmental policy * Green Team * No smoking policy * Recycling education * Ride share promotion SMH/ SMBHWN -Energy Efficiency * EVCs * Energy audits * Energy-efficient chillers/motors * ES participation * HVAC projects * LED lighting * Lighting retrofits * Occupancy sensors * Pipe insulations * Piping cross bridges * Steam trap repairs -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 * Water-efficient sterile department processing cart washer -Waste Minimization * Blue wrap recycling * Composting * Electronic cafe menus * Food waste composting * Peroxide based cleaning products * 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
Form 990, Part III, Line 4a (continued):	* Organic farmer's market * Organic gardens * Recycling education * Ride share promotion SMV/ SMC -Energy Efficiency * Air handler replacement * Energy audits * ES 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 * Composting * 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 * ES 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 2015, Sharp provided education to staff, community members, and community health 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; response concepts; containment; decontamination; and recovery. A standardized, on-scene federal emergency management training for hospital management titled National Incident Management System/Incident Command System/Hospital Incident Command System was also offered by Sharp's disaster preparedness 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. In FY 2015, 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), the Joint Advisory Committee on Public Health Emergency Preparedness, California Hospital Association Emergency Management Advisory 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 which is designed to guide local emergency planners in developing, planning and conducting emergency responses. Through the work group, Sharp helped design training materials, including an exercise guidebook and other resources, for the 2015 California Statewide Medical Health Training and Exercise Program through the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA). Sharp supports safety efforts of the state and the city of San Diego through maintenance and storage of a county decontamination trailer at SGH to be used in response to a mass decontamination event. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event the system's normal water supply is interrupted. Through participation in the U.S. Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes SCVMC, SCHHC, SGH, SMH, SRS Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital Chula Vista, Kaiser Hospital, Alvarado Hospital, Paradise Valley Hospital, the Council of Community Clinics, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriffs, Marine Corps Air Station 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 September, Sharp hosted a Disaster Preparedness Expo to educate San Diego residents on effective disaster preparedness and response in the event of an earthquake, fire, power outage, or other emergency. Approximately 300 community members attended the expo, which included a variety of local disaster vendors and emergency personnel as well as valuable disaster education and emergency demonstrations. The expo also included a Drug Take Back Program and electronic waste recycling event. In early FY 2015, global endemic events potentially impacted public health in the local San Diego community. Sharp partnered with community agencies, SDC Public Health Services and first responders to develop protocols, provide joint trainings, and establish safe treatment methods and locations. This allowed for the continued delivery of uninterrupted care to the community in the face of public health threats. Employee Wellness: Sharp Best Health Sharp recognizes that improving the health of its team members benefits the health of the broader community. In 2010, the Sharp Best Health Employee Wellness Program was established to improve the overall health, happiness and productivity of Sharp's workforce. Sharp Best Health encourages team members to incorporate healthy habits into their lifestyles and supports them on their journey to attain their personal health goals. Sharp Best Health offers team members tools, information and resources to help them stay fit and healthy. Through the Sharp Best Health Web Portal, the program's comprehensive and interactive website, employees can access a variety of digital tools to support their health improvement efforts, including a personal health assessment, meal and exercise planners, food and physical activity logs, healthy recipes and tips, nutrition for sports athletes, wellness or diet-specific dietary eating plans, a progress tracker and a health library. The web portal also provides information on available wellness workshops, health coaching, training plans, and discounts on thousands of health and wellness products including dinner delivery, gym memberships, wellness centers, training clubs, footwear, weight management, golf packages, yoga, massage and more. The web portal also provides information on the Best Health HealthyNow mobile app, an on-the-go complement to the web portal that is a convenient collection of mobile tools, allowing for easy access and engagement from a mobile device. Sharp Best Health hosts a variety of employee wellness activities throughout the year. Team members are encouraged to participate in on-site fitness classes, meditation workshops, micro-stretch breaks, relaxation and stress management workshops, mindfulness classes, walking and running clubs, and events such as bike-to-work days, wellness days and take-the-stairs days. Sharp Best Health hosted activities, such as Fit for the Holidays and "Caught in the Act" of being healthy at work (i.e., taking the stairs, walking outside, etc.) to encourage healthy habits. In May, Sharp Best Health collaborated with SANDAG to recognize National Bike to Work Day and promote a healthier alternative for commuting to work. During the event, Sharp Best Health provided six pit stops for new and experienced riders to enjoy a fun rest break, snacks and encouragement. Sharp Best Health also participated in community health events throughout the year, including the American Cancer Society (ACS) Great American Smoke Out, National Nutrition Month, the ADA Tour de Cure bike ride and National Walking Da
Form 990, Part III, Line 4a (continued):	Each Sharp hospital as well as SRS has a dedicated Best Health committee that works to promote wellness at their individual work sites. For instance, in February, approximately 460 employees and their spouses and kids participated in 5K the Sharp Way and Kid's Run at Tidelands Park in Coronado, hosted by thee Best Health Committee at SGH. In addition, committees at each Sharp hospital and most SRS locations hosted Employee Wellness Fairs throughout the summer months, reaching more than 1,000 Sharp team members. The fairs provided education and resources on a variety of topics, such as employee safety, cancer awareness, physical therapy, weight management and health coaching, as well as offered bone density screenings and a nutrition booth with healthy food samples. Sharp Best Health included healthy vending machine options on all hospital campuses as well as healthy food items in each cafeteria and retail area. In FY 2015, Sharp Best Health implemented a new initiative called "Go, Make the Healthier Choice." This initiative color-codes the food options sold in vending machines and food service areas to help employees, visitors, and guests easily discern the nutritional value of each item. According to the color-code, green-labeled items are the healthiest options and can be consumed often; yellow-labeled items are moderately healthy and should be eaten occasionally; and red-labeled items are the least healthy options and should be eaten rarely. In partnership with Sodexo in FY 2015, Sharp Best Health launched a systemwide Mindful healthy food initiative. Through the Mindful Program, Sharp's cafeteria menus were redesigned to include sustainable, nutritious and enticing food options that foster a healthy lifestyle among patients, visitors and staff. In addition, Sharp Best Health collaborated with Sodexo and Specialty Produce to offer the Green Grocers - Delivered to You program at more than 10 Sharp work sites. Through the program, employees can order seasonally available, locally-grown and organic produce online and have it delivered to their workplace twice a month at low cost. Green Grocers - Delivered to You provides a convenient method for employees and their families to incorporate more fruits and vegetables into their diet, while the purchase of locally-grown produce helps support local farmers and is a CSA service. CSA consists of a community of individuals who pledge support to a farm operation in order for it to become, either legally or spiritually, the community's farm. Since January 2015, Sharp team members have ordered approximately 3,000 pounds of produce through the program. Sharp Best Health continued to offer its free nutrition education series to help employees and their family members develop healthier eating habits. The program includes workshops with cooking demonstrations from registered dietitians and complementary online resources. Nearly 20 classes were offered to approximately 200 attendees through the series in FY 2015, with topics including eating healthy while not at home, managing sugar cravings and portion control. Activities, such as hiking and walking clubs are also available to Sharp team members, family and friends. In FY 2015, Sharp Best Health organized 11 systemwide hikes with more than 160 attendees. The walking clubs vary by location with either structured meeting points or various small walking groups. In 2015, Sharp Best Health received the AHA Fit-Friendly Worksites Honor Roll award (Gold Category) for the third consecutive year, which recognizes employers that promote a culture of health and physical activity in the workplace or community. Since 2013, Sharp Best Health has offered annual employee health screenings to raise awareness of important biometric health measures and help team members learn how to reduce their risk of related health issues. In FY 2015, more than 10,100 Sharp employees received screenings for blood pressure, BMI, blood sugar, tobacco use and cholesterol. Sharp Best Health also exceeded its goal of having at least 75 percent of employees participate in the 2015 screening program. Post-screening resources and tools are available for Sharp employees and their family members, including a free health coach as well as classes on a variety of health topics, including smoking cessation, healthy food choices, physical activity, stress management, and managing the challenges of living with a chronic condition such as diabetes, high blood pressure, asthma or arthritis. As a fun incentive for completing their health screening, employees received a Fitbit Zip wireless pedometer that tracks steps, distance and calories and syncs these statistics to computers or smartphones. Sharp Best Health encourages team members to utilize the Fitbit Zip to track their physical activity and achieve their personal fitness goals. On a monthly basis, Sharp Best Health provides a systemwide update on each entity's Fitbit Zip activity levels to inform team members of their progress, and encourage them to continue working toward the AHA recommended goal of 10,000 steps per day. Since January 2015, Sharp's Fitbit Zip users have achieved a daily average of 8,521 steps, exceeding their 8,260 average daily steps in 2014. In addition, the success of Sharp Best Health's employee health screenings prompted the design and implementation of a free health screening program for the broader San Diego community (non-Sharp employees). Through this community health screening program, Sharp team members host screening events at community sites throughout San Diego where interested community members can receive the same health screenings and follow-up resources provided through the employee health screening initiative. Through the health screening programs, Sharp connects with both its employees and community members and encourages them to achieve healthy lifestyles. Looking forward, Sharp Best Health remains committed to an environment that promotes healthy and sustainable lifestyle choices for Sharp team members and the San Diego community. Section 2 - Executive Summary This Executive Summary provides an overview of community benefit planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefit Report, and a summary of community benefit programs and services provided by Sharp in Fiscal Year (FY) 2015 (October 1, 2014, through September 30, 2015). In addition, the summary reports the economic value of community benefit provided by Sharp, according to the framework specifically identified in Senate Bill (SB) 697, for the following entities: * Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefit Planning at Sharp HealthCare Sharp bases its community benefit planning on its triennial community health needs assessments (CHNA) combined with the expertise in programs and services of each Sharp hospital. Listing of Community Needs Addressed in the Sharp HealthCare Community Benefit Plan and Report, FY 2015 The following community needs are addressed by one or more Sharp hospitals in this Community Benefit Report: * Access to care for individuals without a medical provider and support for high-risk, underserved and underfunded patients * Education and screening programs on health conditions, such as heart and vascular disease, stroke, cancer, diabetes, preterm delivery, unintentional injuries and behavioral health * Health education, support and screening activities for seniors * Welfare of seniors and disabled people * Special support services for hospice patients and their loved ones, and for the community * Support of community nonprofit health organizations * Education and training of community health care professionals * Student and intern supervision and support * Collaboration with local schools to promote interest in health care careers * Cancer education, patient navigation services and participation in clinical trials * Women's and prenatal health services and education * Meeting the needs of new mothers and their loved ones * Mental health and substance abuse education and support for the community
Form 990, Part III, Line 4a (continued):	Highlights of Community Benefit Provided by Sharp in FY 2015 The following are examples of community benefit programs and services provided by Sharp hospitals and entities in FY 2015. * 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 U.S. Department of Veterans Affairs (CHAMPVA), and TRICARE - the regionally managed health care program for active-duty, National Guard and Reserve members, retirees, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. 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; flu vaccinations and services for seniors; financial and other support to community clinics to assist in providing and improving access to health services; Project HELP; Project CARE; Meals on Wheels; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank (SDFB); financial and other support to the Sharp Humanitarian Service Program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community, as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers and made its facilities available for use by community groups at no charge. Also, Sharp 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 students and professionals, as well as supervision and support for students and interns, and time devoted to generalizable health-related research projects that were made available to the broader health care community. Economic Value of Community Benefit Provided in FY 2015 In FY 2015, Sharp provided a total of $289,082,293 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 Benefit Provided Sharp HealthCare Overall - FY 2015 SB 697 Category Programs and Services Included in SB 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal $64,584,675 Shortfall in Medicare $176,953,974 Shortfall in San Diego County Indigent Medical Services $6,153,541 Shortfall in CHAMPVA/TRICARE $7,439,083 Shortfall in Workers' Compensation $196,523 Charity Care and Bad Debt $25,830,581 Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $2,488,270 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 $2,023,606 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $3,412,040 TOTAL $289,082,293 Table 2 shows a listing of these unreimbursed costs provided by each Sharp entity and Figure 3 shows the percentage distribution by Sharp entity. Table 2: Total Economic Value of Community Benefit Provided By Sharp HealthCare Entities - FY 2015 Sharp HealthCare Entity Estimated FY 2015 Unreimbursed Costs Sharp Chula Vista Medical Center $56,723,662 Sharp Coronado Hospital and Healthcare Center $13,260,482 Sharp Grossmont Hospital $86,691,098 Sharp Mary Birch Hospital for Women & Newborns $3,923,260 Sharp Memorial Hospital $115,623,598 Sharp Mesa Vista Hospital and Sharp McDonald Center $12,749,089 Sharp Health Plan $111,104 TOTAL FOR ALL ENTITIES $289,082,293 Table 3 includes a summary of unreimbursed costs for each Sharp entity based on the categories specifically identified in SB 697. In FY 2014, Sharp led the community in unreimbursed medical care services among San Diego County's SB 697 hospitals and health care systems. Table 3: FY 2015 Detailed Economic Value of SB Bill 697 Categories Sharp HealthCare Entity SB 697 CATEGORY Medical Care Services Other Benefits for Vulnerable Populations Other Benefits for the Broader Community Health Research, Education and Training Programs Estimated FY 2015 Unreimbursed Costs Sharp Chula Vista Medical Center $55,421,166 $292,952 $258,397 $751,147 $56,723,662 Sharp Coronado Hospital and Healthcare Center $12,983,515 $28,819 $112,655 $135,493 $13,260,482 Sharp Grossmont Hospital $84,104,983 $789,946 $676,825 $1,119,344 $86,691,098 Sharp Mary Birch Hospital for Women & Newborns $3,493,414 $43,124 $153,700 $233,022 $3,923,260 Sharp Memorial Hospital $113,420,436 $776,122 $513,155 $913,885 $115,623,598 Sharp Mesa Vista Hospital and Sharp McDonald Center $11,734,863 $538,965 $224,279 $250,982 $12,749,089 Sharp Health Plan $0 $18,342 $84,595 $8,167 $111,104 ALL ENTITIES $281,158,377 $2,488,270 $2,023,606 $3,412,040 $289,082,293 Section 3 - Community Benefit Planning Process For the past 19 years, Sharp HealthCare has based its community benefit planning on findings from a triennial Community Health Needs Assessment (CHNA) process as well as from 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 collaboration 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 benefit 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 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 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 help inform current and future community benefit programs and services, especially for high-need community members. This section describes the general methodology employed for Sharp HealthCare's 2013 CHNAs.
Form 990, Part III, Line 4a (continued):	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 or contact Lindsey Wade, Vice President, Public Policy at HASD&IC at lwade@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 U.S. 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 (socioeconomic 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 of 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 2 * High-Risk Pregnancy * Obesity * Orthopedics * Senior Health 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 Benefit 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 Benefit Report On an annual basis, each Sharp hospital performs the following steps in preparation of its Community Benefit Report: * Establishes and/or reviews hospital-specific 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 or adds new identified community needs * Reports on activities conducted in the prior fiscal year - FY 2015 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken - FY 2016 Plan * Reports and categorizes the economic value of community benefit provided in FY 2015, according to the framework specifically identified in SB 697 * Reviews and approves a Community Benefit Plan * Distributes the Community Benefit Plan and Report to members of the Sharp board of directors and each of the 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
Form 990, Part III, Line 4a (continued):	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 San Diegans for Healthcare Coverage, the San Diego Food System Alliance, Hunger Advocacy Network, 2-1-1 San Diego and the Community Health Improvement Partners Behavioral Health Work Team. Section 4 - Sharp Grossmont Hospital FY 2015 Community Benefit Program Highlights Sharp Grossmont Hospital (SGH) provided $86,691,098 in community benefit in FY 2015. See Table 1 for a summary of unreimbursed costs based on the categories identified in Senate Bill (SB 697). Table 1: Economic Value of Community Benefit Provided Sharp Grossmont Hospital - FY 2015 SB 697 Category Programs and Services Included in SB 697 Category Estimated FY 2015 Unreimbursed Costs Medical Care Services Shortfall in Medi-Cal, financial support for on-site workers to process Medi-Cal eligibility forms $30,177,479 Shortfall in Medicare $43,995,016 Shortfall in CHAMPVA/TRICARE $1,554,177 Charity Care and Bad Debt $8,378,311 Other Benefits for Vulnerable Populations Patient transportation, Project HELP and other assistance for the needy $789,946 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 $676,825 Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $1,119,344 TOTAL $86,691,098 Sharp Grossmont Hospital - FY 2015 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 CHAMPVA/TRICARE; and 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; 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; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank (SDFB); the Sharp Humanitarian Service Program; support for Meals-on-Wheels Greater San Diego; the provision of durable medical equipment (DME); support services for discharged homeless patients in partnership with San Diego Rescue Mission (SDRM); the Care Transitions Intervention (CTI) program; and other assistance for vulnerable and high-risk community members. * Other Benefits for the Broader Community included health education and information on a variety of topics; support groups; participation in community health fairs and events; health screenings for stroke, blood pressure, diabetes, fall prevention, hand, lung function and carotid artery disease; community education and resources provided by the SGH Cancer Patient Navigator program; and specialized education and flu vaccinations offered through the SGH Senior Resource Center. SGH also collaborated with local schools to promote interest in health care careers and donated meeting room space to community groups. SGH staff actively participated in community boards, committees, and civic organizations, including Association of California Nurse Leaders (ACNL), East County Chamber of Commerce Health Committee, Neighborhood Healthcare Community Clinics, Santee Chamber of Commerce, Meals-on-Wheels Greater San Diego East County Advisory Board, San Diego County Social Services Advisory Board, YMCA, Caregiver Coalition of San Diego (the Caregiver Education Committee) and East County Senior Service Providers (ECSSP). See Appendix A for a listing of Sharp's involvement in community organizations in FY 2015. In addition, the category also 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 time devoted to education and training for health care professionals, student and intern supervision and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Definition of Community SGH is located at 5555 Grossmont Center Drive in La Mesa, ZIP code 91942. The community served by SGH includes the entire east region of San Diego County (SDC), including the 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 based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care and preventable hospitalizations. According to the CNI, communities served by SGH with especially high need include, but are not limited to, Lemon Grove, Spring Valley and El Cajon. Description of Community Health In SDC's east region in 2014, 99.2 percent of children ages 0 to 11 and 91.1 percent of adults ages 18 to 64 had health insurance - failing to meet the Healthy People 2020 (HP 2020) national targets for health insurance coverage. However, 100 percent of children ages 12 to 17 had health insurance and 100 percent of children ages 0 to 17 reported having a regular source of medical care, meeting multiple HP 2020 targets. See Table 2 for a summary of key indicators of access to care, and Table 3 for data regarding eligibility for Medi-Cal. In the east region in 2014, 10.6 percent of adults ages 18 to 64 did not have a usual source of care and 9.8 percent of these adults had health insurance. In addition, 13.4 percent reported fair or poor health outcomes. Further, 64.0 percent living at 200 percent below the federal poverty level (FPL) reported as food insecure. Table 2: Health Care Access in SDC's East Region, 2014 Description Rate Year 2020 Target Current Health Insurance Coverage Children 0 to 11 Years 99.2% 100% Children 12 to 17 Years 100% 100% Adults 18 to 64 Years 91.1% 100% Regular Source of Medical Care Children 0 to 11 Years 100% 100% Children 12 to 17 Years 100% 100% Adults 18 to 64 Years 89.4% 89.4% Not Currently Insured Adults 18 to 64 Years 8.9% Source: 2013-2014 California Health Interview Survey (CHIS) Table 3: Medi-Cal (Medicaid) Eligibility Among Uninsured in SDC's East Region (Adults Ages 18 to 64 Years), 2014 Description Rate Medi-Cal Eligible 35.1% Not Eligible 64.9% Source: 2013-2014 CHIS In 2012, cancer and heart disease 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, 2012 Cause of Death Number of Deaths Percent of Total Deaths Malignant neoplasms 885 24.0% Diseases of heart 868 23.6% Chronic lower respiratory diseases 225 6.1% Accidents (unintentional injuries) 208 5.6% Alzheimer's disease 187 5.1% Cerebrovascular diseases 180 4.9% Diabetes mellitus 126 3.4% Essential (primary) hypertension and hypertensive renal disease 67 1.8% Intentional self-harm (suicide) 61 1.7% Chronic liver disease and cirrhosis 57 1.5% All other causes 820 22.3% Total Deaths 3,684 100.0% Source: County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology & Immunization Services Branch
Form 990, Part III, Line 4a (continued):	Community Benefit Planning Process In addition to the steps outlined in Section 3 regarding community benefit planning, SGH: * Incorporates community priorities and community input into its strategic plan and develops service line-specific goals * Estimates an annual budget for community programs and services based on community needs, previous years' experience and current funding levels * Prepares and distributes a monthly report of community activities to its board of directors, describing community benefit programs provided, such as education, screenings and flu vaccinations * Prepares and distributes information on community benefit programs and services through its foundation and community newsletters * Consults with representatives from a variety of departments to discuss, plan and implement community activities Priority Community Needs Addressed in Community Benefit Report - SGH 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 2 * Obesity * Senior Health In alignment with these identified needs, the following pages detail programs that specifically address cardiovascular disease, diabetes and senior health. SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH lacks the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH. There are also programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy 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.[0] 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, objective(s), FY 2015 Report of Activities conducted in support of the objective(s), and FY 2016 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 SDC 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 2012, heart disease was the second leading cause of death for the east region of SDC. Cerebrovascular disease was the fourth leading cause of death for the east region. * In 2013, there were 201 deaths due to cerebrovascular diseases (stroke) in SDC's east region. The east regions' age-adjusted rate due to cerebrovascular disease was 37.3 per 100,000 population. This age-adjusted death rate was the highest in all of SDC and higher than the overall SDC age-adjusted death rate due to cerebrovascular disease of 35.3 per 100,000 population. * In 2013, there were 1,312 hospitalizations due to stroke in SDC's east region. The age-adjusted rate of hospitalizations in the east region was 250.3 per 100,000 population, which is higher than the 2013 SDC overall age-adjusted rate of 203.9 per 100,000 population. The stroke age-adjusted hospitalization rate in the east region was the highest in comparison to all SDC regions. * In 2013, there were 256 stroke-related ED visits in SDC's east region. The age-adjusted rate of visits was 48.4 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 2012 San Diego County HHSA's report titled Critical Pathways: The Disease Continuum, the most common risk factors associated with stroke include physical inactivity, tobacco use, alcohol or drug use, poor nutrition, poor medical care, stress, depression, high cholesterol and diabetes. * According to the Centers for Disease Control and Prevention (CDC), stroke is the fourth leading cause of death in the U.S. and a major cause of adult disability. About 800,000 people in the U.S. have a stroke each year. Some stroke risk factors cannot be controlled, such as heredity, age, gender, and ethnicity. Others can be controlled, such as avoiding smoking and drinking too much alcohol, eating a balanced diet, and exercising (CDC, 2014). Objective * Provide stroke education, support and screening services for the east region of SDC FY 2015 Report of Activities Note: SGH is recognized with advanced certification by the Joint Commission as a Primary Stroke Center and was re-certified in June 2014. The program is nationally recognized for its outreach, education and thorough screening procedures, as well as documentation of its success rate. SGH is a recipient of the American Heart Association (AHA)/American Stroke Association's (ASA) Get With the Guidelines (GWTG)-Stroke Gold-Plus Quality Achievement Award as well as the Target: Stroke Honor Roll Elite designation. The AHA/ASA's GWTG is a national effort focused on ensuring that evidence-based therapies are used with stroke patients. The AHA/ASA's Target: Stroke Honor Roll designation focuses on improving the timeliness of intravenous tissue plasminogen activator (IV t-PA) administration to eligible patients. In FY 2015, the SGH Stroke Center conducted 12 education and screening events in SDC's east region, providing more than 900 community members with information about stroke risk factors, warning signs and appropriate interventions, including arrival at the hospital within early onset of symptoms. Events were held at various community sites, including but not limited to: St. Michael's Parish; Lakeside Fire Station; La Mesa Fire Station; College Avenue Baptist Church; First Baptist Church of Lemon Grove; Waterford Terrace Retirement Community; the Dr. William. C. Herrick Community Health Care Library; the Spring into Healthy Living Event at Cameron Family YMCA; the Heart Health Expo at SGH; San Diego State University (SDSU); and the Jewish Family Service of San Diego's Health and Wellness Fair at College Avenue Center. SGH provided education and advised behavior modification - including smoking cessation, weight loss and stress reduction - upon the identification of health risk factors during the stroke screenings.
Form 990, Part III, Line 4a (continued):	In April, Sharp's systemwide Stroke Program participated in Strike Out Stroke Night at the Padres, held at Petco Park. This annual event is organized by the San Diego County Stroke Consortium, San Diego County HHSA, the San Diego Padres and other key partners to promote stroke awareness and celebrate stroke survivors. During the baseball game, Sharp offered education about the warning signs of stroke and how to respond F.A.S.T. (Face, Arms, Speech, Time). Free giveaways were provided throughout the evening, while stroke education was displayed on the JumboTron to the entire stadium of more than 44,400 community members. In March, Sharp provided risk education and stroke screenings with pulse checks to more than 80 attendees at the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina. Topics included different types of strokes, how to identify risk factors for stroke, strategies for risk reduction and stroke recognition. In FY 2015, SGH's Stroke Center provided a lecture in both English and Spanish on stroke recognition and prevention to nearly 40 community members at the Center for the Blind and Visually Impaired. In May, a neurologist presented to nearly 40 community members at a Meet the Physician lecture titled Stroke Is a Brain Attack, organized through the SGH Senior Resource Center. Education included emergency treatment for stroke, prevention and warning signs, and F.A.S.T. to help community members recognize the sudden signs of stroke and act accordingly. During the event, SGH's Stroke Center collaborated with Grossmont College cardiovascular students and instructors to conduct a carotid screening for more than 20 attendees. In FY 2015, the SGH Outpatient Rehabilitation Department offered a weekly support group for stroke survivors and their family members that focused on brain injury survivors with aphasia or other speech or language difficulties. SGH also actively participated in the quarterly San Diego County Stroke Consortium, a collaborative effort to improve stroke care and discuss issues impacting stroke care in SDC. Additionally, SGH collaborated with the County of San Diego Emergency Medical Services (EMS) to provide data for the SDC stroke registry. In April, the SGH Stroke Center and a physician provided stroke education and resources to approximately 40 community members and allied health professionals at the first annual San Diego Stroke Awareness & Information Day at SDSU. The event provided an overview of the many aspects of stroke including etiology, epidemiology, prevention, acute stroke care, adaptive recreational therapy, the use of adaptive technology for language rehabilitation and more information about community support after stroke. FY 2016 Plan SGH Stroke Center will do the following: * Participate in stroke screening and education events in the east region of SDC * Provide education for individuals with identified stroke risk factors * Offer a stroke support group in conjunction with the hospital's Outpatient Rehabilitation Department * Participate with other SDC hospitals in the San Diego County 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 * Provide stroke education and screenings at the Sharp 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 SDC 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. About half of all Americans (49 percent) have at least one of these three risk factors. Additional risk factors include alcohol use, obesity, diabetes and genetic factors. * In 2012, heart disease was the second leading cause of death for the east region of SDC. Cerebrovascular disease was the sixth leading cause of death for the east region. * In 2013, there were 626 deaths due to coronary heart disease in SDC's east region. The region's age-adjusted death rate due to heart disease was 132.7 per 100,000 population. This was the highest of all SDC regions and well above the SDC overall age-adjusted death rate of 107.9 deaths per 100,000 population and the HP 2020 target of 108.2 deaths per 100,000 population. * In 2013, there were 1,180 hospitalizations due to coronary heart disease in SDC's east region. The rate of hospitalizations for heart disease was 250.2 per 100,000 population. The hospitalization rate in the region was the highest in SDC overall and well above the SDC overall age-adjusted rate of 206.9 per 100,000 population. * In 2013, there were 243 coronary heart disease ED discharges in SDC's east region. The rate of discharges was 51.5 per 100,000 population, which is higher than SDC's age-adjusted average of 33.2 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 California Health Interview Survey (CHIS) in 2014 9.3 percent of adults living in SDC's east region indicated that they were ever diagnosed with heart disease, which is higher than SDC at 5.6 percent. Objectives * Provide heart and vascular education and screening services for the community, with an emphasis on adults, women and seniors * Provide expertise in cardiovascular care to community health care professionals through participation in professional conferences and collaboratives * Participate in programs to improve the care and outcomes of individuals with heart and vascular disease FY 2015 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 FY 2015, SGH's Cardiac Rehabilitation Department provided education and support to patients and community members impacted by congestive heart failure (CHF). A free, monthly CHF class and support group, held at the Grossmont Healthcare District Herrick Community Health Care Library, provided approximately 45 community members with a supportive environment to discuss various topics about living well with CHF. A free Heart and Vascular Risk Factors Education class was offered twice a month to individuals who were hospitalized within the last six months due to select heart conditions, reaching nearly 180 individuals in FY 2015.
Form 990, Part III, Line 4a (continued):	SGH's Cardiac Training Center and Cardiac Rehabilitation Departments participated in a variety of community events throughout San Diego in FY 2015. Together, they offered community members free blood pressure screenings, cardiopulmonary resuscitation (CPR) demonstrations, and education and resources on cardiac health including prevention, symptom recognition, evaluation and treatment. Events included: the annual Sharp Women's Health Conference, Health Fair Saturday at the Grossmont Center mall, East County Senior Service Providers 16th annual Senior Health Fair at Santee Trolley Square, Fiesta Del Sol family festival, December Nights, the Sharp Disaster Preparedness Expo, the SGH Heart Health Expo and the AHA Heart & Stroke Walk. The Cardiac Rehabilitation team also provided free flu shots to more than 20 community seniors during two flu clinics held at the hospital in October and November. In recognition of the AHA's Go Red for Women Day in February, an SGH-affiliated cardiologist spoke on KUSI and San Diego 6 news stations, reminding community members that heart disease is the number one killer of women and emphasizing the importance of heart health. Also in February, the team collaborated with the SGH Senior Resource Center to educate 20 seniors at the Herrick Community Health Care Library about the importance of exercise and nutrition to maintain a healthy heart. Throughout the year, SGH provided expert speakers on heart disease and heart failure for various professional events, including SGH's sixth annual Heart and Vascular Conference. More than 400 health care professionals attended the conference to enhance their knowledge of advances in cardiovascular care. In November and May, SGH participated in the seventh and eighth semiannual meetings of Southern California VOICe (Vascular Outcomes Improvement Collaborative), which includes more than 40 regional vascular physicians, nurses, epidemiologists, scientists and research personnel working together to collect and analyze vascular data in an effort to improve patient care. SGH shared its expertise on regional and national webinar management - a project that improves communication and facilitates quality data retrieval and analysis. In June, SGH's Cardiac professionals educated approximately 40 nurses on post-discharge care for cardiac surgery patients at Villa Las Palmas Healthcare Center. SGH participated in several programs in FY 2015 to improve the care and outcomes of individuals with heart and vascular disease. To assist in improving care for acutely ill patients in SDC, SGH provided data on STEMI (ST elevation myocardial infarction or acute heart attack) to SDC EMS. Sharp HealthCare also continues to host the quarterly SDC EMS County Advisory Council for STEMI at Sharp's corporate office (Spectrum). SGH continued to provide its Peripheral Vascular Disease Rehabilitation Program in FY 2015. The program provides education and coaching on exercise, diet and medication management and is designed to keep patients - particularly low-income patients - at the highest functional level. The program is funded in part by donations contributed to the SGH Foundation, to help defray cost for patients with limited resources. SGH's cardiac team is committed to supporting future health care leaders through active participation in student training and internship programs. In FY 2015, the team mentored more than 30 students from Azusa Pacific University (APU), SDSU, University of California, San Diego (UCSD), Grossmont College, National University (NU) and Western University of Health Sciences, including students with an interest in a career as a nurse, cardiovascular technician or physician assistant. FY 2016 Plan SGH will do the following: * Provide a free monthly CHF class and support group * Provide free bimonthly Heart and Vascular Risk Factor Education classes * Provide cardiac and vascular risk factor education and screening at community events * Provide one cardiac health lecture to 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 * Continue to participate in the Open Versus Endovascular Repair of Popliteal Artery Aneurysm trial for popliteal aneurysm patients * Pursue additional research opportunities to benefit patients and community members * Provide a conference on heart and vascular disease for community physicians and other health care professionals in November 2015 * 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 SDC 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 2 diabetes. * In 2012, diabetes was the seventh leading cause of death for residents of SDC's east region. * In 2013, there were 120 deaths due to diabetes in SDC's east region. The region's age-adjusted death rate due to diabetes was 25.4 per 100,000 population, the highest rate among all of the regions and higher than the overall SDC age-adjusted rate of 19.5 deaths per 100,000 population. * In 2013, there were 912 hospitalizations due to diabetes in SDC's east region. The age-adjusted rate of hospitalizations for diabetes was 193.3 per 100,000 population. This rate was the third highest in SDC overall and higher than the county age-adjusted rate of 140.0 hospitalizations due to diabetes per 100,000 population. * In 2013, there were 786 diabetes-related ED discharges in SDC's east region. The age-adjusted rate of visits was 166.6 per 100,000 population. The diabetes-related ED discharge rate in the east region was among the highest in SDC and higher than the age-adjusted rate of 145.6 ED discharges per 100,000 population for SDC overall. * According to the CHIS, in 2014, 11.1 percent of adults living in SDC's east region indicated that they were ever diagnosed with diabetes, which is higher than SDC overall at 6.8 percent and the state of California at 8.9 percent. * The 2014 National Diabetes Statistics Report from the CDC reports that a total of 29.1 million people in the U.S. have diabetes. Of those individuals, 21 million are diagnosed while 8.1 million are undiagnosed. * According to the American Diabetes Association (ADA), in 2012, the prevalence of diabetes in the U.S. was 29.1 million, or 9.3 percent of the population. The incidence of diabetes in 2012 was 1.7 million new diagnoses. * According to the ADA, in 2012, the total cost of diagnosed diabetes in the U.S. was $245 billion, with $176 billion in direct medical costs and $69 billion in reduced productivity. * According to the 2012 report from the San Diego County HHSA titled Critical Pathways: The Disease Continuum, the most common risk factors associated with Type 2 diabetes include substance use, physical inactivity, poor nutrition, poor medical care and irregular health checks (e.g., A1C, dental, eye and foot). * According to the CDC, 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 U.S. (CDC, 2011). Objectives * Provide diabetes education and screening in the east region of SDC
Form 990, Part III, Line 4a (continued):	* Collaborate with community organizations and projects to provide diabetes education to SDC's vulnerable populations * Participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community FY 2015 Report of Activities The SCVMC Diabetes Education Program is recognized by the ADA for meeting national standards for excellence and quality in diabetes education. The program provides individuals with the skills needed to successfully self-manage their diabetes and live a long, healthy life and includes blood sugar monitoring, medications, insulin pump training and wound prevention. Small group and one-on-one classes are also offered in English and Spanish. In FY 2015, the SGH Diabetes Education Program reached more than 1,770 community members through educational lectures and blood glucose screenings at hospital and off-site locations. Diabetes lectures were held at libraries, community centers, educational institutions and national conferences. Blood glucose screenings were provided at six community events including the Health & Wellness Fair at College Avenue Center, the Santee Cameron Family Health Fair at the Cameron Family YMCA, the Healthy Food Choices & Diabetes screening and lecture at the Dr. William C. Herrick Community Health Care Library, the Cuyamaca College Health Fair, the Waterford Terrace Health Fair and the 16th annual Senior Health Fair at the Santee Trolley Square. More than 250 community members were screened during these events and, as a result, more than 30 community members were identified with elevated blood glucose levels and were provided with follow-up resources. Of these individuals, more than 50 did not have a preexisting diagnosis of diabetes. At the Sharp Women's Health Conference, the Sharp HealthCare (SHC) Diabetes Education Program provided resources and education on diabetes management and nutrition. In October, the SHC Diabetes Education Program continued to support the ADA's Step Out: Walk to Stop Diabetes at Mission Bay through fundraising and team participation. This past year, the SHC Diabetes Education Program collaborated with Family Health Centers of San Diego (FHCSD) to conduct outreach and education to vulnerable community members in SDC's east region. Sharp Diabetes educators supported the expansion of FHCSD's Diabetes Management Care Coordination Project (DMCCP), which provides FHCSD patients with group diabetes education and encourages peer support and education from project "graduates" to current patients/project enrollees. The project monitors enrollees' A1C levels, and has proven successful outcomes in lowering and maintaining these levels through education and peer support. The SHC Diabetes Education Program supports the project through the provision of diabetes lectures at multiple FHCSD sites. In SDC's east region, the SHC Diabetes Education Program provided a diabetes lecture to nearly 15 attendees at the FHCSD Lemon Grove site. Topics included nutrition, physical activity, diabetes mellitus, self-management and goal setting. New in 2015, the SHC Diabetes Education Program provided diabetes education to food insecure adults enrolled in Feeding America San Diego's (FASD) Diabetes Wellness Project, a collaboration between UCSD's Student-Run Free Clinic Project, the Third Avenue Charitable Organization (TACO) and Baker Elementary School in Southeast San Diego. The Diabetes Wellness Project screens adult clinic patients with Type 2 diabetes for food insecurity, and provides them with ongoing medical treatment and diabetes management through the clinic. In addition, FASD provides Diabetes Wellness Food Boxes to project participants, in conjunction with a monthly diabetes and nutrition education course as well as CalFresh outreach. Through the project, the SHC Diabetes Education Program provided diabetes and nutrition education at both the TACO and Baker Elementary School sites. Approximately 200 participants are enrolled in the Diabetes Wellness Project, and evaluation - expected in 2016 - will include pre- and post-assessment surveys for the patients regarding diabetes control, an A1C blood test, and other metrics. The SHC Diabetes Education Program collaborated with La Maestra Community Health Centers to educate and advise underserved pregnant women and breastfeeding mothers with Type 1, Type 2 or gestational diabetes on how to manage blood sugar levels. The SHC Diabetes Education Program provided La Maestra patients with a variety of educational resources, including: gestational diabetes statistics; new diagnostic criteria; treatment and management of blood glucose levels; insulin requirements; self-care practices; information on nutrition management, weight gain, obesity and diabetes, and the risks of uncontrolled diabetes and complications. Clinic patients also received logbooks to track and manage blood sugar levels. The SHC Diabetes Education Program educated clinic patients on meal planning; blood glucose monitoring; goals for blood sugar levels before and after a meal; monitoring baby movements and kicks; and exercising after meals. In addition, the SHC Diabetes Education Program evaluated patients' management of their blood sugar levels and collaborated with La Maestra's obstetrician/gynecologist (OB/GYN) to prevent complications. At SGH, the SHC Diabetes Education Program collaborated with the hospital's OB/GYN to assist more than 130 underserved pregnant women with diabetes over the course of 530 visits. In FY 2015, the SHC Diabetes Education Program continued to provide services and resources to meet the needs of San Diego's newly immigrated Iraqi Chaldean population. The program facilitated translation as well as provided materials and resources to better understand Chaldean cultural needs. Materials included a binder with various educational resources, such as How to Live Healthy With Diabetes; What You Need to Know About Diabetes; All About Blood Glucose for People With Type 2 Diabetes; All About Carbohydrate Counting; Getting the Very Best Care for Your Diabetes; All About Insulin Resistance; All About Physical Activity With Diabetes; Gestational Diabetes Mellitus Seven-Day Menu Plan; and Food Groups. Food diaries and logbooks were given out to the community. Handouts were provided in Arabic as well as Somali, Tagalog, Vietnamese and Spanish. Education was also provided to Sharp team members regarding the different cultural needs of these communities. In FY 2015, the SHC Diabetes Education Program submitted abstracts and poster presentations to national conferences on various topics. The SHC Diabetes Education Program was selected by the Joint Commission to co-present at the Institute of Healthcare Improvement Conference in December. At this conference, the SHC Diabetes Education Program provided a poster presentation on the Safe and Effective Use of Insulin, including identified risk factors predictable of poor glycemic control. This presentation was also delivered at the 17th annual National Patient Safety Foundation Patient Safety Congress. Additionally, the SHC Diabetes Education Program provided another poster presentation titled In Search of a Single Glycemic Metric to Benchmark Institutional Diabetes Performance: The Perfect Diabetic Day, at the Association of California Nurse Leaders 37th annual conference. This poster included an assessment of the proportion of diabetic days in which all blood glucose measurements are within the recommended range for hospitalized patients. Further, the SHC Diabetes Education Program published on the predictors of poor blood sugar control for hospitalized diabetic patients. FY 2016 Plan The SGH Diabetes Education Program will do the following: * Conduct diabetes education at various community venues in SDC's east region * Continue to collaborate with FHCSD and provide education to vulnerable community members through the DMCCP * Continue to collaborate with FASD to provide diabetes education to food insecure adults in SDC * Continue to provide gestational services and resources to underserved pregnant women - both at the hospital and in collaboration with La Maestra * Conduct monthly diabetes prevention classes * Continue to foster relationships with community clinics to provide education and resources to community members * Continue to participate in ADA's Step Out: Walk to Stop Diabetes * Keep current on resources to provide community members support of diabetes treatment and prevention - particularly language and culturally appropriate resources * Continue to participate in local and national professional conferences to share best practices in diabetes treatment and control with the broader health care community
Form 990, Part III, Line 4a (continued):	* Conduct educational outpatient and inpatient symposiums for health care professionals Identified Community Need: Health Education, Screening and Support for Seniors Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent SDC 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 more than 60,000 residents, 13 .6 percent of the total population were ages 65 years or older in 2013. By the year 2020, the region expects a 51 percent increase among the 65 and older population. * In 2012, the leading causes of death among senior adults ages 65 years and older in SDC included cancer, heart disease, chronic lower respiratory diseases, diabetes, stroke, unintentional injuries, chronic liver disease and cirrhosis, Alzheimer's disease, Parkinson's disease, hypertension and hypertensive renal disease, influenza, pneumonia and septicemia. * In 2014, influenza ranked as the eleventh leading cause of death in all regions of SDC. * 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 and influenza, when compared to SDC overall. * According to the San Diego County Senior Health Report, 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), 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, 2015). * 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 911 for seniors ages 65 years and older in need of pre-hospital (ambulance) care in SDC, which represents a call for one out of every five seniors. Seniors in SDC use the 911 system at higher rates than any other age group. * 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 harmful 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 (American Association of Retired Persons (AARP) Public Policy Institute, Valuing the Invaluable, Updated November 2012). * One in five caregivers report having had training but seek additional resources. Nearly 78 percent report needing more help and information with at least 14 specific topics related to caregiving, and caregivers in high burden situations are more likely to seek help. The top four topics of concern to caregivers are keeping their loved one safe; managing their own stress; finding easy activities to do with their care recipient; and finding time for themselves (The National Alliance for Caregiving and AARP (2009), Caregiving in the U.S., Bethesda, MD: National Alliance for Caregiving. Washington, D.C., 2012.). Objectives * Provide a variety of senior health education and screening programs * Produce and mail quarterly activity calendars to community members * Act as the lead agency for East County Project CARE, ensuring the safety of homebound seniors and disabled adults in SDC's east region * In collaboration with community partners, offer seasonal flu vaccination clinics at convenient locations for seniors and high-risk adults in the community * Provide health education materials at seasonal flu clinics as well as information about additional Sharp Senior Resource Center programs * Serve as a referral resource to additional support services in the community for senior residents in SDC's east region * Provide education and community resources to caregivers FY 2015 Report of Activities Sharp Senior Resource Centers meet the unique needs of seniors and their caregivers by connecting them - through email, phone and in-person consultations - to a variety of free and low-cost programs and services. The Sharp Senior Resource Centers' compassionate staff and volunteers provide personalized support and clear, accurate information regarding health education and screenings, community referrals and caregiver resources. In addition, the SGH Senior Resource Center develops and mails quarterly calendars that highlight its programs and services to more than 7,100 households in SDC's east region. In FY 2015, the SGH Senior Resource Center provided more than 30 free health education programs at the SGH campus, the Grossmont HealthCare District Conference Center and community sites in SDC's east region, reaching nearly 800 community members. Programs were presented by various professionals, including physical therapists, speech therapists, a psychologist, a registered dietitian, an RN, a cardiologist, an audiologist and an attorney, as well as by experts from community organizations. Health education topics included balance and fall prevention, diet and fitness for a healthy heart, diabetes, senior services, patient-provider communication, Project CARE, Vials of Life, financial issues, memory loss, caregiver resources, bereavement, advance care planning, Medicare, sleep disorders, coping with grief during the holiday season, Parkinson's disease, Alzheimer's disease, maintaining a healthy voice, prediabetes, osteoporosis and bone health exercises, preventing fractures, how to talk to a doctor and brain health. As part of their educational offerings, the SGH Senior Resource Center also provided a series of physician lectures in FY 2015, covering topics such as chronic pain management, depression, stroke, digital hearing aids and hearing loss and tinnitus. In total, nearly 130 community members attended these lectures. In FY 2015, the SGH Senior Resource Center provided 14 health screening events at various sites in SDC's east region, reaching more than 250 members of the senior community. This included four balance and fall prevention screenings, four hand screenings, a carotid artery screening, medication review as well as screenings for lung function, diabetes and stroke. In addition, the SGH Senior Resource Center offered more than 40 free blood pressure screening opportunities at the SGH campus, a library, a YMCA, two local senior centers, health fairs and special events, screening nearly 580 community members.
Form 990, Part III, Line 4a (continued):	The SGH Senior Resource Center is the lead agency for Project CARE in SDC's east region. 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 its free component services, Project CARE helps people live independently in their homes. As part of Project CARE, the SGH Senior Resource Center distributed approximately 4,000 Vials of Life in FY 2015. Vials of Life are small vinyl sleeves, often magnetically placed on a refrigerator, that provide critical medical information to emergency personnel for seniors and disabled people living in their homes. Also, the SGH Senior Resource Center provided daily Are You OK? phone calls to approximately 25 isolated or homebound seniors in SDC's east region. Are You OK? participants select regularly scheduled times to receive computerized phone calls at their home. In the event that staff members - supported by the SGH Senior Resource Center and volunteers - do not connect with participants through these phone calls, the participants' family or friends are contacted to ensure their safety. In FY 2015, nearly 6,100 Are You OK? calls were placed to seniors or disabled community members, and nearly 100 follow-up phone calls were made to their family or friends. In collaboration with the Caregiver Coalition of San Diego, the SGH Senior Resource Center provided a conference titled Finding the Balance in Caregiving to more than 100 family caregivers at the College Avenue Baptist Church in San Diego. This conference provided education on emotional and legal issues, fall prevention and safety, hospice care, how to communicate with loved ones, incontinence and Medicare as well as community resources. At this conference, the Senior Resource Center coordinator spoke on the emotional issues of caregiving. In addition, the SGH Senior Resource Center participated in the Aging and Independence Services Vital Aging 2015: Boosting Your Brainpower Conference, which explored how nutrition, exercise, mental stimulation, and social connection affect memory, mood and cognitive functioning. The summit's keynote presentation was given by a nationally acclaimed neuropsychologist, and indoor and outdoor activities were featured. Other topics included, but were not limited to, Alzheimer's disease, food and mood, exercise, lifelong learning, and elements of health and well-being. The SGH Senior Resource Center provided a resource booth at the event with information on Vials of Life, screening events and other SRC programs for seniors and caregivers. The SGH Senior Resource Center participated in the San Diego Community Action Network (SanDi-CAN) end-of-life conference at the Balboa Park Club titled Planning Ahead...Crucial Conversations: Helping Families & Seniors Navigate End-of-Life Decisions. Approximately 85 community members attended the free conference, where they received education on how to make educated and informed health care decisions from a variety of end-of-life care professionals. The conference focused on assistance for community members to plan ahead regarding burial, advance directives and financial management as well as a talk on bereavement and how to reinvent oneself after loss. In addition, the SGH Senior Resource Center participated in the Caregiver Coalition of San Diego's Batter Up! Are Your Bases Covered? conference, a free event for male family caregivers held at the First United Methodist Church. The SGH Senior Resource Center provided a lecture on caregiving at home, which included strategies to help manage physical care needs, such as safely transferring, bathing, dressing and using the right equipment as well as provided resources to more than 60 community members. In FY 2015, the SGH Senior Resource Center partnered with Sharp HospiceCare, Grossmont Post Acute Care, Grossmont Gardens Senior Living Community and the City of La Mesa to provide Right Choices at the Right Time, a conference for seniors and their families on how to approach aging from a healthy perspective. Held at the Point Loma Community Presbyterian Church in April and the La Mesa Community Center in May, the conference provided more than 200 community members with education on a variety of topics, including hospice services, leaving a legacy by planning for the future, care choices, advance care planning and finding hope and healing after a loss. The conference included educational presentations by a physician, attorney and advance care planning specialist, as well as education from other experts in the field of aging and health care, to help seniors effectively navigate their later years. Throughout FY 2015, the SGH Senior Resource Center participated in health fairs in El Cajon, Rancho San Diego, Lakeside, Santee, La Mesa, Spring Valley, the College Area and San Diego. Populations served at these fairs included seniors and caregivers in rural areas, Lesbian, Gay, Bisexual and Transgender (LGBT) seniors, and In Home Supportive Services employees who provide in-home, non-medical care for frail and at-risk seniors. Through participation in these events, the SGH Senior Resource Center provided blood pressure screenings as well as educational resources on senior and caregiver services to more than 3,280 community members. Health fairs and events included the Sharp HospiceCare Resource & Education Expo at the College Avenue Baptist Church, Senior Health Fair at the Lakeside Community Center, Jewish Family Services College Avenue Center Health Fair, Superfood for Super Seniors Event at Waterford Terrace Retirement Community, Black History Month celebration at the Spring Valley Library, La Vida Real Fair, the 16th annual East County Senior Health Fair at the Santee Trolley Square shopping center and the Spring Into Healthy Living event at the Cameron Family YMCA in Santee. In October, the SGH Senior Resource Center participated in the Senior Expo at the La Mesa Community Center, which highlighted transportation options, safety resources, elder abuse and fraud prevention. The SGH Senior Resource Center also participated in the Southern Caregiver Resource Center's (SCRC's) Caring for the Caregiver, an informational workshop for family caregivers that included a resource fair as well as education on preventing senior scams, stress management techniques and caregiving at the First United Methodist Church. At the LGBT Senior Fair, the SGH Senior Resource Center provided community resources, blood pressure checks, Vials of Life, and caregiver and community resources. In addition, the SGH Senior Resource Center participated in the Sharp Women's Health Conference held at the Sheraton San Diego Hotel and Marina where they provided Vials of Life, caregiver information and community resources. Also in FY 2015, SGH's Senior Resource Center coordinated the notification of availability and provision of seasonal flu vaccines in selected community settings. Seniors were alerted through activity reminders, collaborative outreach conducted by the flu clinic site, Sharp.com and paper and electronic newspaper notices. The SGH Senior Resource Center provided more than 550 seasonal flu vaccinations at 17 community sites to high-risk adults with limited access to health care resources, including seniors without transportation and those with chronic illnesses as well as caregivers. Sites included senior centers, community centers, churches, the Salvation Army, the SGH campus, senior nutrition sites and food banks. At the community sites, the SGH Senior Resource Center also provided its activity calendars detailing upcoming community events and programs, including blood pressure and flu clinics, health screenings, 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 pregnant women and high-risk community members, many of whom were uninsured or had limited access to transportation. In FY 2015, the SGH Senior Resource Center maintained active relationships with organizations that serve seniors, enhance networking among professionals in SDC's east region and provide quality programming for seniors. These organizations included the Caregiver Coalition of San Diego (the Caregiver Education Committee), the Aging Disability Resource Connection, Project CARE, East County Action Network (ECAN), ECSSP and Meals-on-Wheels Greater San Diego East County Advisory Board.
Form 990, Part III, Line 4a (continued):	FY 2016 Plan SGH Senior Resource Center will do the following: * Provide resources and support to address relevant concerns of seniors and caregivers in the community through in-person and phone consultations * Provide community health information and resources through educational programs, monthly blood pressure clinics and at least five 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 20 community health fairs and special events targeting seniors * Collaborate with East County YMCA, AIS and ECAN 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 * Provide telephone reassurance calls to seniors and disabled adults in SDC's east region through the Are You OK? Program and provision of approximately 4,000 Vials of Life to senior community members * Produce and distribute quarterly calendars highlighting events of interest to seniors and family caregivers * In collaboration with Sharp's Advance Care Planning Program, present an Advance Directives and Health Care Decisions Program to inform seniors about advanced directives and other necessary documents available to communicate their end-of-life wishes * As funding allows, provide seasonal flu vaccinations to the community * Maintain active relationships with other organizations serving seniors 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 SDC 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 2013, cancer was the leading cause of death in SDC's east region. * In 2013, there were 907 deaths due to cancer in SDC's east region. The east region's age-adjusted death rate due to cancer was 192.3 deaths per 100,000 population, which is higher than the overall SDC age-adjusted rate due to cancer of 159.5 per 100,000 population and higher than the HP 2020 target of 161.4 deaths per 100,000 population. * 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 2012, the death rates for colorectal, female breast cancer, lung cancer, cervical cancer, and prostate cancer in SDC's east region were all higher when compared to the age-adjusted death rates for these specific cancers in SDC overall. * From 2010 to 2013, cancer was the leading cause of death in SDC, responsible for nearly 20,000 deaths overall. * HP 2020 has multiple objectives for reducing various cancer types, with an overall cancer death rate reduction goal of 10 percent, from 179.3 cancer deaths per 100,000 in 2007 (age-adjusted to 2,000 standard population) to 161.4 deaths per 100,000 population. * According to the California Cancer Registry (CCR) 2014 report, California Cancer Facts & Figures, in that year, the predicted number of new cancer cases for all sites in SDC was 13,455. Expected cancer deaths in SDC for 2014 were predicted to be 4,815. * According to the American Cancer Society (ACS), a total of 1,658,370 new cancer cases and 589,430 cancer deaths were projected to occur in the U.S. in 2015. California was projected to have the most new cancer cases (172,090) and the highest number of deaths (58,180) in 2015. * According to the ACS 2015 Cancer Facts & Figures Report, in 2015 there are an estimated 25,270 new cases of breast cancer and an estimated 4,320 breast cancer deaths for females in California. This is far higher than any other type of new cancer cases in the state. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, the mortality rate of breast cancer in SDC is 22.7 deaths per 100,000 women. This rate is higher than the HP2020 target of 20.7 breast cancer deaths per 100,000 women. * The 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report reveals SDC has a higher incidence rate (128.6 per 100,000) for breast cancer than the U.S. and the state of California (122.1 and 122.0, respectively). * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, in SDC there are 46.1 late-stage cases of breast cancer per 100,000 women, exceeding the HP2020 target of 42.1 cases per 100,000 women. It is expected that SDC will take approximately five years to meet the HP2020 target. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, in SDC black women have the highest death rates (27.7 per 100,000 women) and the highest late-stage diagnoses rates (51.6 per 100,000 women) for breast cancer. White women have the second highest rates of breast cancer deaths and late-stage diagnosis, followed by Asian-Pacific Islander (API) women. Latina women showed lower rates for breast cancer death and late-stage diagnosis compared to non-Latina women. * The same report identified the following barriers for San Diego community members in accessing breast health care cultural and language barriers, socioeconomic status, education and awareness, financial barriers including insurance, HMO authorization, transportation and childcare, lack of self-care, fear of screening/and or other aspects of the medical system, homelessness and joblessness. The study findings indicate a critical need for culturally competent outreach, especially for Hispanic, Middle Eastern, and African American women. Community efforts should also focus on improving transportation and education to reduce fear and uncertainty. * According to the 2015 Susan G. Komen for the Cure San Diego Affiliate Community Profile Report, approximately 81.9 percent of women in SDC between the ages of 50 and 74 reported having a mammogram in the past two years, exceeding the Healthy People 2020 target of 81.1 percent for breast cancer screenings. * According to a 2014 report from the ACS, California Cancer Facts & Figures, screening offers the ability for secondary prevention by detecting cancer early. Regular screening that allows for the early detection and removal of precancerous growth is known to reduce mortality for cancers of the cervix, colon, and rectum. Five-year relative survival rates for common cancers are 93 to 100 percent if they are discovered before having spread beyond the organ where the cancer began. * The ACS recommends most women should start annual breast cancer screenings between the ages of 45 and 54 and biannually after age 55, but women should have the option to continue annual screenings. Previously, the ACS recommended women begin annual breast cancer screenings at age 40. Research shows that breast cancer is uncommon for that age group and many false alarms are more likely (Oeffinger et al., Journal of the American Medical Association (JAMA), 2015). * According to a 2013 study published in the Journal of Clinical Oncology, newly diagnosed cancer patients who receive support from a patient navigator tend to experience higher satisfaction of care and fewer problems with psychological and social care, coordination of care, and health information. With patient navigation services, patients reported feeling more involved in their care, more informed and better prepared for the future (Wagner et al., 2013). * A study published in the JAMA found that even though mortality from breast cancer has declined since 1990 due to improvements in early detection and treatment, an estimated 40,290 women in the U.S. will die of breast cancer in 2015 (Oeffinger et al., 2015).
Form 990, Part III, Line 4a (continued):	* According to the National Institutes of Health (NIH), clinical trials are part of clinical research and are at the heart of all medical advances. Clinical trials look at new ways to prevent, detect or treat disease, with the goal to determine the safety and efficacy of a new test. Clinical trials also examine other aspects of care, such as improving the quality of life for people with chronic illnesses. If clinical trials are to be successful, it is critical that more people are involved. Objectives * Provide cancer education and support services to the community * Participate in cancer clinical trials, including screening and enrolling patients FY 2015 Report of Activities Note: The David and Donna Long Center for Cancer Treatment Center at SGH (SGH Cancer Center) is accredited by the National Accreditation Program for Breast Centers (NAPBC). The NAPBC grants accreditation only to 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 (CoC) as a Comprehensive Community Cancer Center. 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 patients with nutritional and genetic counseling. In FY 2015, the SGH Cancer Center provided breast self-examinations and cancer education and resources from the ACS and National Cancer Institute (NCI) to more than 500 individuals at community events, including the Cuyamaca College Health & Wellness Fair, East County Senior Service Providers 16th annual Senior Health Fair at Santee Trolley Square, the Southern Indian Health Council, Inc. Women's Wellness Health Fair, Sharp's annual Women's Health Conference, Sharp HospiceCare Resource & Education Expo and the Waterford Terrace Retirement Community Health Fair. In addition, SGH Cancer Center staff walked alongside cancer patients and families in the ACS Making Strides Against Breast Cancer Walk in October. SGH helped raise community awareness of cancer through a variety of media outlets in FY 2015. In recognition of Breast Cancer Awareness Month in October, an SGH-affiliated oncologist and former cancer patient joined a live news interview on San Diego 6 news station to express the importance of receiving a breast cancer screening and performing one's own breast self-examination. News contributions were also provided to KPBS radio and television, KUSI News, and San Diego 6 on the following topics, the overtreatment of ductal carcinoma in situ, a type of noninvasive breast cancer; skin cancer prevention; and the increased risk of cancer due to e-cigarettes. A variety of free support groups reached approximately 1,000 community members impacted by cancer. Offered twice per month, the breast cancer support group allowed women in all stages of breast cancer to share experiences and discover coping strategies. In addition, two monthly support groups, one for lung cancer and one for brain tumors, were offered to meet the educational and emotional needs of people living with or caring for someone with these cancers. Beginning in the spring of 2015, the weekly Art and Chat support group offered cancer patients, survivors and their loved ones a combination of chat and relaxing drawing methods to increase focus, creativity, self-confidence and personal well-being. The SGH Cancer Center also offered the weekly chaplain-led Sacred Circle: Spirituality and Cancer support group, through which cancer patients used a mixture of expressive arts modalities, prayer, and discussion of personal and spiritual topics to restore their spirits. Furthering its support for those with cancer, in FY 2015, the SGH Cancer Institute created the Wall of Hope and Inspiration - a special art installation for patients and visitors to write words of wisdom, advice and encouragement to those with cancer. The SGH Cancer Center hosted educational classes at no cost for patients and community members facing cancer. Offered monthly between June and September, the Chair Yoga and Relaxation class taught individuals in all stages of cancer yoga postures, breathing and meditation techniques to help lower stress and calm the nervous system. In addition, six Look Good...Feel Better classes taught approximately 30 women techniques to manage appearance-related side effects of cancer treatment and boost self-confidence. Offered through the ACS, the Look Good...Feel Better classes included a complimentary makeup kit for attendees and instruction from a licensed beauty professional on makeup application, skin care, and wearing wigs and headwear. The SGH Cancer Center also offered a 12-month Survivorship Lunch and Learn series in FY 2015, reaching approximately 10 individuals per session. Once a month, community members, patients and families were invited to hear local experts speak about a unique cancer-related topic - such as coping with the holidays, approaching survivorship with confidence, and complementary therapies - and participate in a Q&A session while enjoying a complimentary lunch. As part of the SGH Cancer Center team, a licensed clinical social worker (LCSW), cancer patient navigators (CPN), genetics counselor and certified dietician help guide and support patients and their families before, during and after the course of treatment. The LCSW offers psychosocial services (assessments, crisis intervention, counseling and stress management), support group leadership, and advocacy and resources for transportation, palliative care and hospice, food and financial assistance. In FY 2015 this included improving patient and family connections to community services, such as ACS, San Diego Brain Tumor Foundation, Leukemia and Lymphoma Society, Lung Cancer Alliance, Mama's Kitchen, 2-1-1 San Diego, Feeding America San Diego, SDFB and Jewish Family Service of San Diego's Breast Cancer Case Management program, and other food and financial assistance programs. The LCSW served approximately 230 patients and family members in FY 2015, while an additional 25 community members contacted the LCSW for consultation regarding support groups and other SGH Cancer Center services and community resources. The Breast CPN is an RN certified in breast health who personally assists breast cancer patients and their families in their navigation of the health care system. The Breast CPN offers support, guidance, financial assistance referrals and connection to community resources. Through collaboration with community clinics - including FHCSD, Neighborhood Healthcare and Borrego Health - the Breast CPN refers unfunded or underfunded women for a covered diagnostic mammogram or immediate Medi-Cal insurance should their biopsy prove positive and require treatment. The Breast CPN also identifies patients who may benefit from the Breast and Cervical Cancer Treatment Program, a program offered through the California Department of Health Care Services to provide urgently needed cancer treatment coverage, including referring patients to local clinics who help complete the enrollment process. Patients needing psychosocial support may be referred to various local or national support groups, the Jewish Family Service of San Diego's Breast Cancer Case Management program or the SGH Cancer Center Radiation Oncology Department's LCSW. In FY 2015, the Breast CPN facilitated access to care for more than 180 breast cancer patients in need - many with late-stage cancer diagnoses - through the provision of referrals to various community and national organizations. Since 2014, a CPN has been designated for patients with cancers other than breast. The CPN primarily serves patients with head and neck cancers and lung cancer, but also assists those with anal and esophageal cancers as well as any cancer patient with complex care needs. The CPN supports patients and their family members through care coordination and connection to needed resources, including transportation, translation needs, financial assistance, speech therapy, nutritional support, feeding tube support, social work services and more. In addition, the CPN offers psychosocial support and education about the side effects of radiation therapy. The CPN has assisted nearly 160 patients and their families since the inception of the program.
Form 990, Part III, Line 4a (continued):	The genetics counselor assists patients and family members at SGH, SMH and SCVMC through risk assessment, counseling, genetics testing for personal and family history of cancer, and referrals for high-risk patients. In FY 2015, the genetics counselor served approximately 250 individuals, and dedicated nearly 450 hours to genetics counseling, across each entity. The SGH Cancer Center certified dietician assists patients receiving radiation therapy or combined radiation and chemotherapy who are at high-risk for malnutrition. This most often includes patients with head and neck, esophageal, lung, pancreatic and pelvic cancers - including some cervical and rectal. In FY 2015, the dietician provided one-on-one nutrition assessments, education and follow-up to approximately 280 patients. The SGH Cancer Center conducts oncology clinical trials to support the discovery of new and improved treatments to help individuals overcome cancer and to enhance scientific knowledge for the larger health and research communities. In FY 2015, the SGH Cancer Center screened more than 100 patients for participation in oncology clinical trials. As a result, 21 patients were enrolled in cancer research studies while approximately 90 patients continued to receive follow-up care through the studies. The SGH Cancer Center supported learning opportunities for community physicians and other health care professionals through participation in professional conferences. This included the 2014 Binational Congress: Breast and Cervical Cancer, sponsored by SHC and Las Damas de San Diego Foundation in collaboration with the United States-Mexico Border Health Commission. This free, educational event was designed to raise cancer awareness among the Baja California, Mexico, and Southern California communities by promoting early cancer detection programs, health advocacy, education and goodwill. The SGH Cancer Center also supported Sharp's 2015 conference titled Colorectal Cancer: From Diagnosis to Survivorship, to educate community physicians and other health professionals about the early identification of patients at risk for colorectal cancer, the latest in screening, diagnosis, staging and treatment, and ongoing surveillance of cancer survivors. FY 2016 Plan The SGH Cancer Center will do the following: * Continue to provide cancer education, resources and demonstrations on breast self-exams at community health fairs and events * Continue to provide a free biweekly breast cancer support group for women in all stages of breast cancer * Provide free community support groups, including groups for: community members with lung cancer and their caregivers; a support group for men with cancer; a support group for young cancer patients, with a focus on those ages 45 and under; as well as art- and spiritually-themed support groups * Continue to host a free monthly Lunch and Learn educational series for cancer patients, survivors and their loved ones * Provide six Look Good...Feel Better classes to help female cancer patients manage appearance-related side effects of cancer treatment * Offer a 5K training group to support the physical activity goals of patients and community members with cancer * Continue to provide ongoing personalized education and information, support and guidance to cancer patients and their loved ones as they move through the continuum of care * Continue to provide education and resources to the community with patient navigators for cancers including breast, head and neck, lung, anal and esophageal as well as cancer patients with complex care needs * Continue to connect individuals with services and community resources to assist them in managing their illness * In collaboration with the Sharp Advance Care Planning program, provide an Advance Care Planning clinic to assist patients and community members with cancer, and their loved ones, in completing an Advance Directive * Screen and enroll cancer patients in clinical trials for research studies * Provide educational information on cancers and available treatments through community residents and community physician lectures * Provide internships to NU 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 SDC 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 2013, the number of arthritis-related hospitalizations totaled 2,047, an age-adjusted rate of 387.5 per 100,000 population. This is the highest in the county and above the county overall age-adjusted rate of 321.5 per 100,000 population. * In SDC's east region in 2013, the number of arthritis ED discharges totaled 3,231, which is an age-adjusted rate of 672.1 per 100,000 population. This was the second highest rate in SDC and above the overall age-adjusted rate of 518.3 per 100,000 population. * In SDC's east region in 2013, females had higher arthritis-related ED discharges than males (761.3 and 606.4 per 100,000 population, respectively). Blacks had a higher arthritis related ED discharge rate than other race/ethnicity groups, and persons ages 65 and older had higher arthritis-related ED discharges than those in other age groups. * According to the CDC, arthritis is the nation's most common cause of disability. An estimated 52.5 million U.S. adults (more than one in five) report doctor-diagnosed arthritis. As the U.S. population ages, these numbers are expected to increase to 67 million by 2030, and more than one-third of these adults will report arthritis-attributable activity limitations. In addition, a recent study indicated that some form of arthritis or other rheumatic condition affects one in every 250 children under the age of 18 (CDC, 2015). * Along with the financial costs, osteoporosis can reduce quality of life for many people who suffer fractures. It can also affect the lives of family members and friends who serve as caregivers (NIH, 2014). * Some of the risk factors for developing osteoporosis include body size, family history, age, sex hormone deficiencies, diet low in calcium and vitamin D, certain medications, physical inactivity, smoking and excessive alcohol use (NIH, 2014). * Fifty percent of people who fracture a hip will be unable to walk without assistance and about one in five hip fracture patients over age 50 die in the year following their fracture as a result of associated medical complications. Vertebral fractures can also have serious consequences, including chronic back pain and disability. These fractures have also been linked to increased mortality in older people (NIH, 2014). * According to the CDC, there are 250,000 hospital admissions for hip fractures among people ages 65 and older each year. 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, two to eight percent have chronic back pain (pain that lasts more than three months), three to four percent of the population is temporarily disabled due to back pain, and one percent of the working-age population is disabled completely and permanently due to LBP. * In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass (NIH, 2015). * In 2013, the direct medical costs of falls in the U.S. totaled $34 million. With an aging population in the U.S., the number of falls and the cost are expected to rise (CDC, 2013). Objective * Provide education on orthopedics and osteoporosis to the community FY 2015 Report of Activities Note: SGH was re-certified in June 2014 by the Joint Commission in Disease-Specific Care for its 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.
Form 990, Part III, Line 4a (continued):	In FY 2015, SGH offered educational sessions on hip, back, knee and shoulder problems to nearly 400 community members. Topics included management of arthritis as well as hip and knee repair and treatment, including discussions of nonsurgical options and minimally-invasive surgery using the latest technology. Held at the Grossmont Healthcare District Conference Center and the SGH Auditorium, attendance ranged from 15 to 70 individuals per event. SGH provided three seminars on the treatment of shoulder pain, reaching nearly 180 community members, including education on arthritis, torn rotator cuff, bursitis and frozen shoulder, as well as treatment options. In addition, in March, SGH provided education to 80 community members at a seminar titled The Brittle Truth - Osteoporosis Facts and Tips for Healthy Bones. Topics included risk factors such as diet, lifestyle, age, family history, treatments and physical activity to help maintain bone health. Additionally, Sharp provided more than 225 community members with osteoporosis heel screenings and education on calcium and vitamin D requirements as well as exercise tips for osteoporosis treatment and prevention at the Sharp Women's Health Conference. FY 2016 Plan SGH will do the following: * Continue to offer orthopedic, arthritis, joint health and osteoporosis educational presentations to the community * Provide a physician-led session on osteoporosis prevention and education at 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 SDC 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 2013, SDC's east region had 438 low birth weight (LBW) births, 6.8 percent of total births for the region. LBW births were higher among female infants than male infants. Infants of black mothers had an 11 percent LBW, the highest percentage when compared to mothers of other races and ethnicities. * In 2013, 36 infants died before their first birthday in SDC's east region. The infant mortality rate was 5.5 infant deaths per 1,000 live births, which is higher than the infant mortality rate for SDC overall. * There were 673 hospitalizations due to maternal complications in SDC's east region in 2013. The east region's age-adjusted rate was 301.6 per 100,000 population, which was lower than the age-adjusted rate for SDC overall (306.7 per 100,000 population). * In 2013, there were 5,217 live births with early prenatal care in SDC's east region, which translates to 81.1 percent of live births for the region. This was slightly lower than the percentage of live births receiving early prenatal care in SDC overall (84.8 percent). * In 2013, 84.8 percent of women in SDC initiated prenatal care during their pregnancy. * According to 2014 CHIS data, 24.2 percent of women (ages 18 to 65 years) were obese (BMI > 30). * 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 inter-conception care. * According to a recent study in the JAMA, one in seven women have depression in the year after they give birth (JAMA, 2013). * According to the CDC's 2014 Breastfeeding Report Card, breastfeeding provides many known benefits for infants, children, and mothers. Professional lactation support can help mothers initiate and continue breastfeeding. * The American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for approximately the first six months of life, followed by continued breastfeeding with complementary foods for one year or longer (AAP, 2012). * According to the CDC's 2014 Breastfeeding Report Card, 63.1 percent of mothers in California were breastfeeding at six months, while only 25.4 percent were exclusively breastfeeding at six months (CDC, 2014). * In California, SDC is ranked 22nd out of 50 counties for exclusive breastfeeding (California Women, Infants and Children (WIC) Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2013). * Nearly two-thirds of California women plan to breastfeed exclusively, but less than 40 percent are doing so at one month postpartum. Hospitals, health care providers, public health agencies and support groups must work together to ensure all mothers have the needed resources to breastfeed in the hospital and at home (California WIC Association and UC Davis Human Lactation Center, A Policy Update on California Breastfeeding and Hospital Performance, 2013). * According to the CDC, maternal health conditions that are not addressed before pregnancy can lead to complications for the mother and the infant. Several health-related factors known to cause adverse pregnancy outcomes include uncontrolled diabetes around the time of conception, maternal obesity, maternal smoking during pregnancy and maternal deficiency of folic acid (CDC, 2015). * Preterm birth is the birth of an infant prior to 37 weeks of pregnancy. In 2014, preterm birth affected about one of every 10 infants born in the U.S. Preterm birth is the greatest contributor to infant death, with most preterm-related deaths occurring among babies who were born before 32 weeks. Preterm birth is also a leading cause of long-term neurological disabilities in children. * Contributing factors associated with preterm birth include maternal age, race, socioeconomic status, tobacco and alcohol use, substance abuse, stress, high blood pressure, prior pre-term births, carrying more than one baby, infection and late prenatal care (CDC, 2015). Objectives * Conduct outreach and education activities for women on a variety of health topics, including prenatal care and parenting skills * Demonstrate best practices in breastfeeding and maternity care, and provide education and support to new mothers on the importance of breastfeeding * Collaborate with community organizations to help raise awareness of women's health issues and services, as well as to provide low-income and underserved women in the San Diego community with critical prenatal services * Participate in professional associations related to women's services and prenatal health and disseminate research FY 2015 Report of Activities In FY 2015, the SGH Women's Health Center provided education, outreach and support to help meet the unique needs of women, mothers and newborns throughout the community. Free support groups assisted women and families with the challenges and adaptations of having a newborn. Offered twice per week, the breastfeeding support group provides a comfortable environment to discuss the joys and challenges of breastfeeding as well as tips to improve breastfeeding success at home. Facilitated by RN lactation consultants, the group served approximately 16 attendees per session in FY 2015, including fathers who were welcome to attend. A weekly postpartum support group, led by the SGH Women's Health Center's social workers, supported approximately 10 mothers per session in FY 2015. Through the support group, mothers with babies up to 12 months of age who are suffering from "baby blues" symptoms, depression and/or anxiety can share their experiences, learn coping strategies and receive professional referrals. In addition, the weekly Little Wonders support group helped new parents transition into their role as a mother or father. Led by a perinatal educator, the group reached approximately 11 parents per session, and covered topics such as calming techniques and sleep strategies to help enhance knowledge and confidence in new parents.
Form 990, Part III, Line 4a (continued):	Educational classes covered a variety of parenting and newborn care topics. Through the breastfeeding class, moms-to-be learned basic breastfeeding tips, including understanding the advantages of breastfeeding, positioning and the use of breast pumps. Designed for first-time parents, the Baby Care Basics class provided education on infant care, including car-seat safety, infant nutrition and bathing, as well as hands-on practice with diapering, dressing and swaddling. Other offerings by the SGH Women's Health Center in FY 2015 included classes on cesarean delivery preparation, childbirth preparation, infant and child CPR, and preparing new brothers, sisters and grandparents. The SGH Women's Health Center also supported community members at Sharp's annual Women's Health Conference, where they provided education on women's health issues and offered resources for attendees with an elevated BMI. SGH anticipates Baby-Friendly USA Designation in early-to mid-2016 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. SGH has completed requirements for Baby-Friendly USA Designation including 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. The SGH Women's Health Center has implemented several critical process improvements to increase breastfeeding rates among new mothers and continues to explore and participate in opportunities to share these best practices with the broader health care community. This began in 2012 with implementation of the Ten Steps to Successful Breastfeeding, and continued in 2013 through various other quality strategies to promote exclusive breastfeeding and exclusive breast milk in the neonatal intensive care unit (NICU). In addition, educational resources provided at community clinics and in the hospital's childbirth education classes have been updated to reflect best practices in breastfeeding for mothers and their families. NICU nurses also continued to encourage mothers to use a pump log to document and increase accountability of their 24-hour breast milk volumes. Early intervention strategies were incorporated to promote the establishment of breast milk in the first couple of weeks. The SGH Women's Health Center also continued to track mothers of premature infants 28 to 34 weeks who established breast milk supply at two weeks. As a result of these comprehensive efforts, the SGH Women's Health Center increased the exclusive breastfeeding rate at discharge for newborns from 49 percent in 2011 to 68.1 percent in 2015. The documentation for 24-hour breast milk production by mothers with premature infants in the NICU also progressed from 85 percent in 2012 to 98 percent in 2015. In addition, through the provision of consistent breastfeeding education during high-risk women's prenatal care, the SGH Women's Health Center's Prenatal Clinic (SGH Prenatal Clinic) increased the exclusive breastfeeding rate at discharge from 54 percent in 2013 to as high as 75 percent in 2015. In FY 2015, staff contributed expertise in breastfeeding measurement to a report developed by UC San Diego's Lactation Supportive Environments Initiative titled Breastfeeding Measurement in the Outpatient Electronic Health Record: Current Practices and Future Possibilities. The report is expected to be available for distribution in early 2016. In addition, in 2015, the SGH Prenatal Clinic joined The Breastfeeding-Friendly Community Health Centers project (BFCHC) - an initiative of SDC's Live Well San Diego and funded through a grant from the First 5 Commission of San Diego. Through the BFCHC collaboration, the SGH Prenatal Clinic was selected as the pilot clinic - out of six participating clinics - to help establish Baby-Friendly USA guidelines around breastfeeding during the prenatal period and after discharge and support other prenatal clinics in achieving Baby-Friendly USA standards. SGH delivers more than 800 babies from community clinics each year. The SGH Prenatal Clinic offers a variety of prenatal support for high-risk and underserved women in SDC. Throughout FY 2015, SGH Prenatal Clinic midwives provided in-kind help at Neighborhood Health Centers in El Cajon to support the underserved population in SDC's east region. This included approximately 1,610 hours of care for pregnant women five days per week. The SGH Prenatal Clinic also continued to participate in the California Department of Public Health (CDPH) Comprehensive Perinatal Services Program to offer comprehensive prenatal clinical and social services to low-income, low-literacy women with Medi-Cal benefits. Services included health education, nutritional guidance, and psychological and social issue support as well as translation services for non-English-speaking women. Nutrition classes were offered as part of this effort in order to reduce the number of women who reach gestational diabetic criteria. Women with a current diabetes diagnosis were referred to the SGH Diabetes Education Program, while those with nutrition issues were referred to an SGH registered dietician (RD) or the SGH Diabetes Education Program as appropriate. At-risk women with elevated BMIs received education and glucometers in order to measure their blood sugar and prevent the development of gestational diabetes. In addition, education on gestational diabetes was provided to pregnant members of the community. The SGH Women's Health Center continued its partnership with Vista Hill ParentCare to assist drug-addicted patients with psychological and social issues during pregnancy. These approaches have been shown to reduce both LBW rates and health care costs in women and infants. The SGH Women's Health Center also provided women with referrals to a variety of community resources including, but not limited to, California Teratogen Information Service (CTIS), WIC, and the SDC Public Health Nurse. In FY 2015, the SGH Women's Health Center participated in and partnered with several community organizations and advisory boards for maternal and child health, including the local chapter of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); WIC; CTIS; Partnership for Smoke-Free Families; San Diego County Breastfeeding Coalition Advisory Board; the Beacon Council's Patient Safety Collaborative; ACNL; the regional Perinatal Care Network; Perinatal Safety Collaborative; and the Public Health Nurse Advisory Board. The SGH Women's Health Center also recently joined the California Maternal Quality Care Collaborative to improve morbidity and mortality in women as well as the California Perinatal Quality Care Collaborative to improve antibiotic stewardship in the NICU. FY 2016 Plan SGH will do the following: * Provide free breastfeeding, postpartum and new parent support groups * Provide parenting education classes * Participate in wellness events for women with a focus on lifestyle tips to enhance overall health * Share evidence-based maternity care practices through presentations at professional conferences * Implement evidence-based maternity care practices required to achieve Baby-Friendly USA Designation * With grant funding from the First 5 Commission of San Diego, participate in the BFCHC project to help establish Baby-Friendly USA guidelines for breastfeeding during the prenatal period and after discharge * Provide prenatal clinical and social services as well as education to vulnerable, community clinic patients through the SGH Prenatal Clinic * Provide a NICU graduate reunion for former NICU patients and their family members Identified Community Need: Health Education and Wellness Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent SDC community health statistics unless otherwise indicated. Rationale * The SGH 2013 CHNA identified cardiovascular disease and obesity among its six priority health issues affecting members of the communities served by SGH.
Form 990, Part III, Line 4a (continued):	* Senior community resident feedback in the SGH 2013 CHNA identified the following priority health issues and topics: Alzheimer's disease, dementia, diabetes, cardiovascular health, cancer, falls, vaccines, diet and exercise, care options and resources, and preventive care. Community input specified the need for additional education in each area through in-person lectures and screenings. * The HASD&IC 2013 CHNA process identified the following as top priority health conditions for SDC hospitals: diabetes, obesity, cardiovascular disease and stroke, mental health and mental disorders, unintentional injury, high-risk pregnancy, asthma, cancer, back pain, infectious disease and respiratory diseases. * Participants in the HASD&IC 2013 CHNA community forums recommended increased health information and community health education as the most important factor in maintaining health. Health education was also specifically recommended by participants in the community forums held in El Cajon. * Data in the HASD&IC 2013 CHNA revealed a higher rate of hospital discharges due to cardiovascular disease and obesity within SDC's more vulnerable communities (El Cajon, etc.). * According to data presented in the SGH 2013 CHNA, high blood pressure, high cholesterol and smoking are all risk factors that could lead to cardiovascular disease and stroke. About half of Americans (49 percent) have at least one of these three risk factors. Additional risk factors include alcohol use, obesity, diabetes and genetic factors. * According to 2014 data from the CHIS, the self-reported obesity rate for adults ages 18 and older in SDC's east region was 20.9 percent, which is lower than the county rate of 24.8 percent. * In 2014, 15.1 percent of adults ages 18 and older in SDC's east region self-reported eating at fast-food restaurants four or more times each week, which is higher than the county rate of 11.1 percent (CHIS, 2014). * Obesity increases the risk of many health conditions, including: coronary heart disease, stroke, Type 2 diabetes, and various cancers. Obesity is also linked to environmental factors, such as accessibility and affordability of fresh foods, park availability, social cohesion and neighborhood safety (UCLA Center for Health Policy Research, 2015). * According to the CDC, some of the leading causes of preventable death include obesity-related conditions, such as heart disease, stroke, Type 2 diabetes, and certain types of cancer. The CDC reports that approximately 35 percent of U.S. adults were obese between 2011 and 2012. Objectives * Provide a variety of health and wellness education and services at events and sites throughout the community * Offer health and wellness education to the community through various media outlets FY 2015 Report of Activities Throughout FY 2015, SGH participated in community events, offered presentations at neighborhood sites, and partnered with local media sources to educate community members about a variety of health and wellness topics. In September, SGH participated in the Kids Care Fest at the Lakeside Rodeo Grounds, a free family event hosted by the Grossmont Healthcare District and the City of La Mesa. The event featured interactive health education for children and families, including childhood fever management from the SGH ED, and injury prevention from ThinkFirst/Sharp on Survival. In March, staff from a range of hospital departments participated in Sharp's annual Women's Health Conference, where they offered wellness education and services to approximately 500 attendees, including acupuncture, balance screenings, fall prevention education, nutrition education, healthy recipes, food samples and more. In April, an SGH RD provided nutrition education to approximately 200 community members at the YMCA Healthy Kids Day event at the Cameron Family YMCA in Santee as well as presented on the benefits of mindful eating to approximately 250 community health providers at Sharp's Obesity Crisis Conference in May. SGH helped increase awareness about current news and trends impacting the health and safety of community members through television interviews on KUSI News, FOX 5 News, NBC 7 News, CBS News 8, San Diego 6, and Channel 10 News as well as through various radio stations and printed articles in The San Diego Union-Tribune. Information was shared through these outlets by hospital physicians from a variety of specialties, including emergency medicine, sleep medicine, infectious disease, OB/GYN, cardiology, gastroenterology, dermatology, oncology, hematology and neurosurgery. Topics included, but were not limited to, the Ebola virus, avoiding the norovirus, stress and health-related hair loss in women, staying safe during the holidays, the relationship between smoking and medical conditions, heart health, the relationship between poor phone posture and neck and back pain, the importance of Automated External Defibrillators for decreasing brain damage after a heart attack, acid reflux, skin cancer awareness, the risks of e-cigarettes; the effects of excessive iron intake on liver and heart function, the hazards of burn tattoos - a dangerous trend of burning patterns into the skin, the risk of soccer-related concussions; proper hydration during a heat wave and risk factors for heat-related health issues; ensuring children get enough sleep as they head back to school; and the importance of vaccinations, regular screening and lifestyle behaviors in reproductive health. Also through these media outlets, an end-of life care professional talked about the importance of advance care planning and completing an Advance Directive, while an SGH RD shared nutrition-related education, including healthy food choices during the holidays, potential causes and treatment options for eating disorders, environmental and economic benefits of farm-to-table style eating, the ban on trans fats and choosing the right amounts and types of dietary fat. FY 2016 Plan SGH will do the following: * Continue to provide health and wellness offerings to community members at a variety of community events and other sites * Continue to provide health and wellness education through local news sources Identified Community Need: Prevention of Unintentional Injuries Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent SDC 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 2013, accidents (unintentional injuries) were the fifth leading cause of death for SDC's east region. * 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 2010 and 2013, nearly 4,000 San Diegans died as a result of unintentional injuries. * In 2013, there were 192 deaths due to unintentional injury in SDC's east region. The region's age-adjusted death rate due to unintentional injuries was 37.4 deaths per 100,000 population, the highest of all regions in SDC and above the SDC age-adjusted rate of 30.6 deaths per 100,000 population. * In 2013, there were 3,995 hospitalizations related to unintentional injury in SDC's east region. The age-adjusted rate of hospitalizations was 785.0 per 100,000 population, which is above the county age-adjusted average of 691.5 per 100,000 population. * In 2013, there were 28,007 ED visits related to unintentional injury in SDC's east region. The age-adjusted rate for the east region was 5,968.2 per 100,000 population, which is the highest of all regions and above the SDC age-adjusted average of 4,984.5 ED visits per 100,000 population. * According to the California Department of Public Health's Burden of Chronic Disease and Injury Report: California, 2013 injury, including both intentional and unintentional, is the number one killer and disabler of persons ages one to 44 in California.
Form 990, Part III, Line 4a (continued):	* The same report states that every year in California, injuries cause more than 16,000 deaths, 75,000 cases of permanent disability, 240,000 hospitalizations, and 2.3 million ED visits. * 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). * Every year in California, injuries cause more than 16,000 deaths, 75,000 cases of permanent disability, 240,000 hospitalizations, and 2.3 million emergency department visits (California Burden of Disease and Injury Report, 2013). Objective * Offer an injury and violence prevention program for children, adolescents and young adults in SDC's east region FY 2015 Report of Activities In FY 2015, ThinkFirst/Sharp on Survival participated in approximately 50 programs, serving nearly 3,800 elementary, middle and high school students in SDC's east region. The programs consisted of one- to two-hour classes covering topics such as the modes of injury, disability awareness, and the anatomy and physiology of the brain and spinal cord. The programs included personal testimonies from individuals with traumatic brain injury (TBI) or spinal cord injury (SCI), known as Voices for Injury Prevention (VIPs). In addition, ThinkFirst/Sharp on Survival offered schools multiple opportunities for learning through a variety of lesson plans, including information on physical rehabilitation and careers in health care, and disability awareness panels to meet the needs of specific class curricula. Specifically, elementary school students learned about the importance of using booster seats and helmets, proper pedestrian safety and safe practices while on the playground. And at-risk teens learned about the consequences of reckless driving, violence and poor decision making. ThinkFirst/Sharp on Survival provided education to youth and their parents through participation in the annual Kids Care Fest at the Lakeside Rodeo Grounds with sponsorship from the Grossmont Healthcare District. During the event, ThinkFirst/Sharp on Survival educated more than 400 children and their parents on injury prevention topics, including proper helmet-fitting, booster and car seat use, brain and spinal cord injuries and state laws. With the partnership and financial support of the Health and Science Pipeline Initiative (HASPI), more than a dozen schools throughout SDC provided ThinkFirst/Sharp on Survival speakers to their students. The program offered classroom presentations, small assemblies and the opportunity to participate in a half-day tour of the SMH Rehabilitation Center designed specifically for students interested in pursuing careers in healthcare. In total, more than 1,200 HASPI students from schools in SDC's east region benefited from ThinkFirst/Sharp on Survival education in FY 2015. Additionally, ThinkFirst/ Sharp on Survival presented on injury prevention, TBI, SCI and disability awareness to more than 1,200 college students in SDSU's Disability in Society courses. During the annual HASPI teacher conference held at Grossmont College, ThinkFirst/Sharp on Survival participated in a panel of industry partners, including Scripps Health and SDSU, to address preparing students for healthcare careers and internships. Approximately 100 HASPI science teachers across the county attended the event. Furthermore, ThinkFirst/Sharp on Survival's community health educator and VIPs presented to members of the El Cajon, Lakeside and Sunrise Optimist groups, held at the Casa de Oro club location. FY 2016 Plan ThinkFirst/Sharp on Survival will do the following: * With funding support from grants, provide educational programming and presentations for local schools and organizations * Using grant funding, increase community awareness of ThinkFirst/Sharp on Survival through attendance and participation at community events and health fairs * As part of the HASPI partnership, continue to evolve program curricula to meet the needs of health career pathway classes * Grow partnership with HASPI through participation in conferences, round table events and collaboration on letters of support for various funding opportunities * Continue to provide booster seat education to elementary school children and their parents with funding support from grants * Continue to provide college students with injury prevention education through SDSU's Disability in Society course * Explore further opportunities to provide education to health care professionals and college students interested in health care careers * As appropriate and with funding, continue to explore opportunities for concussion education in SDC's east region 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 SDC 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 2 diabetes, mental/behavioral health and obesity). * Participants in the HASD&IC 2013 CHNA community forums held throughout SDC also strongly aligned access to care and care management with maintaining health. * In 2012, SDC's east region presented a higher rate of unemployment (10.68 percent in 2012) when compared to SDC overall (9.16 percent in 2012). * According to CHIS data, 8.9 percent of those 18 to 64 years of age in SDC's east region were currently not insured in 2014 compared to 20.1 percent in 2011. * The same data indicates that in SDC's east region in 2014 for those 18 to 64 years of age, the most common sources of health insurance coverage included employment-based coverage (58.2 percent) and public programs (23.1 percent). * In 2013, 32.5 percent of the population in SDC's east region was living below the poverty level. * In 2014, 30.4 percent of children in SDC received food stamps/SNAP/CalFresh benefits and 14.9 percent of children were living at or below 200 percent Federal Poverty Level (FPL). In the east region, both of these numbers are higher, with 44.7 percent of children receiving food stamps/SNAP/CalFresh benefits and 34.0 percent of children living in the east region at or below 200 percent FPL. * According to 2014 CHIS data, 91.1 percent of adults in SDC's east region have a usual source of care. Among these adults, 16.9 percent utilize a community clinic, government clinic or community hospital as their usual source of care. * As of September 2015, the average unemployment rate in the cities of El Cajon, La Mesa, Lakeside, Lemon Grove, Santee, and Spring Valley was 5.3 percent (Labor Market Information, State of California Employment Development Department, http:www.labormarketinfo.edd.ca.gov). * In November 2015, the overall unemployment rate in SDC was 4.8 percent, falling below the unemployment rate for the state of California in December 2015 of 5.8 percent (Bureau of Labor Statistics (BLS), 2015). * The cost of living in California is 35 percent above the U.S. 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 Community Health Improvement Partners (CHIP), between 2006 and 2009, demand for ED services in SDC increased by 11.9 percent, from 582,129 to 651,595 visits (CHIP, 2010). * In 2015, the health insurance benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA) cost a single person in California between $511 and $625 per month; for three or more participants on the plan in California, COBRA costs ranged from $1,687 to $1,961 per month (2015 COBRA Self-Pay Rates, Motion Picture Industry Pension & Health Plans).
Form 990, Part III, Line 4a (continued):	* Between 2009 and 2014, community clinics in California have experienced rising rates of primary care clinic utilization. The number of persons utilizing the clinics increased by 5.9 percent between 2013 and 2014 (Office of Statewide Health Planning and Development, 2015). * Consistent with demand, the number of community clinics in California rose from 1,010 in 2009 to 1,289 (or 27.62 percent) in 2014 (OSPHD, 2014). Objectives * Connect high-risk, underfunded patients and community members to local resources and organizations for low-cost medical equipment, housing options and follow-up care * Assist economically disadvantaged individuals through transportation and financial assistance for pharmaceuticals * Collaborate with community organizations to provide services to chronically homeless individuals * Through the Care Transitions Intervention pilot, provide high-risk, under and unfunded patients with health coaching, support and resources to ensure safe transition home and maintained health and safety FY 2015 Report of Activities In FY 2015, SGH continued to provide post-acute care facilitation for high-risk patients, including individuals who were homeless or without a safe home environment. Individuals received referrals to and assistance from a variety of local resources and organizations. These groups provided support with transportation, placement, medical equipment, medications, outpatient dialysis and nursing home stays. SGH referred high-risk patients, families, and community members to churches, shelters and other community resources for food, safe shelter and other resources. For unemployed 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 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, and in 2015, SGH provided more than 150 DME items. SGH case managers and social workers continue to provide 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, SGH provided more than $174,300 in free medications, transportation, lodging and financial assistance through its Project HELP funds. These funds assisted nearly 5,300 individuals in FY 2015. In addition, SGH pharmacists assisted more than 730 economically disadvantaged patients with more than 840 outpatient prescriptions valued at approximately $374,000. Beginning in 2014, SGH piloted a Care Transitions Intervention (CTI) program for its high-risk, Medi-Cal and unfunded patients. Modeled after the countywide Community Care Transitions Program (CCTP) funded by Medicare, the CTI program provides 30-day coaching by an RN at no cost to Medi-Cal or unfunded patients who are identified as highly vulnerable through a comprehensive risk assessment tool. The assessment tool evaluates patients for multiple factors including isolation, co-occurring health issues, food insecurity, behavioral health issues, and other conditions that impact the health and safety of vulnerable patients The project team is a collaborative effort between various team members across Sharp, including nurses, case managers, disease specialists, SGH's Senior Resource Center and others. The team ensures that vulnerable patients are connected with community resources and support to safely transition home, and keep them safe and healthy in the community. Partnerships with community organizations connect these patients to critical social services upon discharge, and have included the SDFB, Feeding America San Diego, Walmart, 2-1-1 San Diego, various churches, and refugee and other social support organizations. This outreach is critical for sustaining vulnerable patients and empowering them to manage their care in the community. One of the key barriers identified for CTI patients was access to healthy foods. In FY 2015, 149 CTI patients - about 23 percent - were identified with food insecurity. Of those patients, 12 were enrolled in CalFresh benefits through the SDFB, and hundreds of others were evaluated and provided resources for various other hunger relief programs, including the Emergency Food Assistance Program, the Senior Food Program and free food distribution sites throughout San Diego. Further, in an effort to supply food directly to those in need during the first few days after discharge, the CTI program provides medically-tailored emergency food bags for CTI patients without food in their homes. Supported by funding from the Grossmont Hospital Foundation, the food bags include nutritious items specifically designed for the complex health conditions and nutritional needs of CTI patients, in order to sustain their health until they are enrolled in a food assistance program. The coaches bring the food bag during their home visit and combine this delivery with a review of the patient's hospitalization and a plan for self-management. In FY 2015, the CTI program provided more than 20 food bags to CTI patients, and an additional estimated 20 food bags were provided to food insecure CCTP patients in SDC's east region. In addition, a significant number of CTI patients are diabetic and are challenged with adherence to their care plan because they cannot afford diabetes equipment. To address this challenge, a grant application was submitted and approved by the Neighborhood Walmart closest to SGH. As a result of this funding, 50 "diabetes kits" - including a three-month supply of strips, lancets, etc. - were put together. These kits help to keep CTI patients safe and managed until their insurance is activated. Since its inception in May, the CTI pilot has demonstrated a powerful impact. To date, the program has enrolled 845 patients, and, of those patients, 635 accepted services from a CTI coach. The average readmission rate for this cohort has remained at 12 percent in comparison to a readmission rate of more than 30 percent for those individuals who refused CTI coaching services. SGH coaches devoted hundreds of hours of time directly to these vulnerable patients. It has been the focus on care management as well as social determinants of health that has contributed to the marked success of this program. In recognition of its innovative care approach and tremendous results, SGH's CTI program was selected to be highlighted by the Health Research and Educational Trust/Robert Wood Johnson Foundation's Culture of Health Learning Collaborative, which spotlights successful hospital-community organization partnerships to improve community health. CTI has also been recognized as a semi- finalist in the Hospital Charitable Services award program from Jackson Healthcare in Georgia. In FY 2015, SGH continued to collaborate with community organizations to provide services to chronically homeless patients. Through its collaboration with the SDRM, SGH discharged chronically homeless patients to the SDRM's Recuperative Care Unit. This program allows chronically homeless patients to receive follow-up care through SGH in a safe space, and also provides psychiatric care, substance abuse counseling and guidance from the SDRM's programs in order to help these patients get back on their feet. FY 2016 Plan SGH will do the following: * Continue to provide post-acute care facilitation to high-risk patients * Continue and expand the DME donations project to improve access to necessary medical equipment for high-risk patients who cannot afford DME * Continue to administer Project HELP funds to those in need * Continue to collaborate with community organizations to provide medical care, financial assistance, psychiatric and social services to chronically homeless patients * Continue to provide high-risk, Medi-Cal and unfunded patients with CTI health coaches and connection to resources, including resources to combat food insecurity, and access to necessary medical equipment * Establish partnerships with Feeding America, San Diego and 2-1-1 San Diego to strengthen the services of the CTI program and support expansion of the program * Explore opportunities to improve communication with community clinics Identified Community Need: Health Professions Education and Training, and Collaboration with Local Schools to Promote Interest in Health Care Careers
Form 990, Part III, Line 4a (continued):	Rationale references the findings of the SGH 2013 Community Health Needs Assessment or the most recent SDC 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 U.S. will increase due to the aging population. Nurses will also be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes and obesity. 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 3.1 million RNs in the U.S. in 2024, an increase of 16 percent from 2014. * The BLS projects that the demand for home health aides will grow 38.1 percent from 2014 to 2024. As the U.S. population ages, the demand for home health aides to provide assistance will continue to increase. The older population often has health problems and will need help with daily activities. * Total employment is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. Health care and social assistance is projected to increase its employment share from 12 percent in 2014 to 13.6 percent in 2024, the fastest growing service industry. Occupations and industries related to health care are projected to add the most new jobs with an increase of 2.3 million in employment (BLS, 2015). * 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, healthcare specialty occupations expected to add employment by 12 percent (7,466 jobs) between 2013 and 2018 in San Diego County. The top six growing healthcare occupations are RNs, home health aides, nursing assistants, medical assistants and licensed vocational nurses. * According to the San Diego Workforce Partnership, there is a growing demand for health care workers, but employers express a challenge to fill open position because of an "experience gap" among recent graduates. While new graduates often possess the requisite academic knowledge to be hired, they lack professional experience. * The San Diego Workforce Partnership recommends programs that provide volunteer opportunities 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. * According to a March 2014 report from the California Hospital Association (CHA) titled Critical Roles: California's Allied Health Workforce Follow-Up Report, programs supported by local hospitals make tremendous impacts on the lives of individuals, families and communities. This includes time and resources dedicated to the thousands of interns and high school students spending time in California hospitals each year, gaining valuable work experience and career exposure. Objectives * Collaborate with local schools to provide opportunities for students to explore health care professions * Collaborate with local colleges and universities to provide professional development lectures to students from local colleges and universities * Offer professional development opportunities for community health professionals FY 2015 Report of Activities SGH continued to collaborate with the Grossmont Union High School District (GUHSD) in the Health-careers Exploration Summer Institute (HESI), providing high school students with opportunities for classroom instruction, job shadowing, observations and limited hands-on experiences. Due to increased interest in the program, the number of HESI students doubled between FY 2014 and FY 2015. In FY 2015, two groups of 10 to 12 students shadowed staff for two weeks in a variety of hospital specialties, including women's health, laboratory, pulmonary, interventional radiology, pre- and post-operative surgery, sterile processing, endoscopy, occupational and physical therapy, and the catheterization, hyperbaric and electroencephalography (EEG) laboratories. At the conclusion of the program, students presented their experiences as case studies to family members, educators and hospital staff. Those completing the program received high school credits equal to two summer school sessions. SGH also continued its participation in the Health Sciences High and Middle College (HSHMC) program in FY 2015, providing early professional development for 190 students from a broad array of backgrounds in ninth through 12th grades. Students shadowed staff in various areas throughout the hospital, including but not limited to cafeteria, nursing, engineering, occupational and physical therapy, endoscopy, women's health, cardiology, pharmacy, rehab nursing, medical intensive care unit (MICU), surgical intensive care unit (SICU), the volunteer office as well as Sharp Rees-Stealy (SRS) OB/GYN, neurology, pediatrics, family practice and orthopedics. In addition, SGH staff provided students instruction on educational requirements, career ladder development and job requirements. At the end of the academic year, SGH staff provided the students, their loved ones, community leaders and hospital mentors a symposium that showcased the lessons learned throughout the program. Throughout the academic year, SGH provided nearly 1,000 students from colleges and universities throughout San Diego with various placement and professional development opportunities. Approximately 730 nursing students spent nearly 62,500 hours at SGH, including time spent both in clinical rotations and individual preceptor training, while more than 230 ancillary students spent more than 54,000 hours on the SGH campus. In addition, the SGH Senior Resource Center provided approximately 200 hours of intern supervision to a SDSU gerontology student. Academic partners included Alliant University; Aspen University; Azusa Pacifica University; California Northstate University; California State University Dominguez Hills; California State University Long Beach; California State University Northridge; California State University San Marcos; Casa Loma College; Concorde Career College; Drexel University; EMSTA College; Grand Canyon University; Grossmont College; Grossmont Health Occupations Center; Kaplan College; Loma Linda University; Marywood University; National University; Nebraska Methodist College; Nova Southwestern University; Palomar College; PIMA Medical Institute; Point Loma Nazarene University; San Diego City College; SDSU; Southwestern College; Tennessee State University; Touro University; University of Phoenix; UCSD; University of San Diego; University of Southern California; University of St. Augustine; University of Texas Arlington; University of the Pacific; United States University (USU); West Coast Ultrasound; Western Governors University; Western University; and WestMed College. In addition, SGH also offered professional development lectures to 25 SDSU nursing students on clinical care nutrition, and 25 PLNU students on community nutrition and eating disorders. The SGH Stroke Center provided stroke education to approximately 20 SDSU nursing students. SGH offered free professional development opportunities for community and Sharp health professionals in FY 2015, including the Compassion Cultivation Training (CCT) course and the Introduction to Mindfulness class series. Developed by the Center for Compassion and Altruism Research and Education (CCARE) at the Stanford University School of Medicine, CCT helped a variety of community health professionals develop compassion for themselves and others. Taught by a Certified Compassion Cultivation teacher, the eight-week course utilizes lectures, guided compassion cultivation exercise, and group discussions to help improve communication, increase resilience to stress, and enhance feelings of wellbeing. The Certified Compassion Cultivation teacher also led the Introduction to Mindfulness series. The four-class series helped participants incorporate mindfulness into daily life, such as sitting, walking and eating meditation, and how to work with difficult thoughts and emotions, in order to achieve a range of positive benefits including greater mind-body awareness, reduced stress, improved well-being and happiness, and much more. In FY 2015
Form 990, Part III, Line 4a (continued):	FY 2016 Plan SGH will do the following: * In collaboration with GUHSD, participate in the HESI * Continue to participate in the HSHMC program * Continue to provide internship and professional development opportunities to college and university students throughout San Diego * Continue to collaborate with local universities to provide professional development lectures for students * Develop an elementary school field trip program to promote healthy decision-making as well as to provide a broad understanding of health care career options 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 AHA - GWTG * Cardiac Training Center * Computed Tomography scan * David and Donna Long Center for Cancer Treatment * EKG * EEG * Endoscopy unit * Grossmont Plaza Outpatient Surgery Center * Group and art therapies * Home health * Home infusion therapy * Hospice * Hyperbaric treatment * Intensive Care Unit * LakeView Home * 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 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 Section 4 (SGH) of this report. The following description highlights various programs and services provided by Sharp HospiceCare to San Diego County (SDC) in FY 2015 in the following SB 697 community benefit categories: * Other Benefits for Vulnerable Populations included contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank (SDFB). * Other Benefits for the Broader Community included a variety of end-of-life support for seniors, families, caregivers and veterans in the San Diego community, such as education, support groups and outreach at community health fairs and other events. In addition, Sharp HospiceCare provided volunteer training opportunities for community adults and teens. Sharp HospiceCare staff actively participated in community boards, committees and civic organizations, including San Diego County Coalition for Improving End-of-Life Care (SDCCEOLC), Caregiver Coalition of San Diego, San Diego County Hospice-Veteran Partnership (HVP), California Hospice and Palliative Care Association (CHAPCA), National Hospice and Palliative Care Organization (NHPCO), Southern Caregiver Resource Center (SCRC), San Diego Regional Home Care Council (SDRHCC), San Diego Community Action Network (SanDi-CAN), North County Community Action Network (NorCAN), South County Action Network (SoCAN), East County Senior Service Providers (ECSSP), San Diego Chapter of the Hospice and Palliative Nurses Association (HPNA), San Diego Physician Orders for Life-Sustaining Treatment (POLST) Coalition and San Diego County Medical Society Bioethics Commission. See Appendix A for a listing of Sharp's involvement in community organizations in FY 2015. This category also 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 time devoted to education and training for health care professionals, student and intern supervision and generalizable health-related research projects that were made available to the broader health care community. Definition of Community Sharp HospiceCare is located at 8881 Fletcher Parkway in La Mesa, ZIP code 91942. Sharp HospiceCare provides comprehensive end-of-life hospice care, specialized palliative care and compassionate support to patients and families throughout SDC. For SHC's 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 (U.S.) based on specific barriers to health care access, including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to the CNI, communities served by Sharp HospiceCare with especially high-need include, but are not limited to, East San Diego, City Heights, North Park, the College Area, and Downtown San Diego. Description of Community Health In SDC in 2014, 98.2 percent of children ages 0 to 11, 91.5 percent of children ages 12 to 17, and 84.3 percent of adults ages 18 to 64 had health insurance - failing to meet the Healthy People 2020 (HP 2020) national targets for health insurance coverage. See Table 1 for a summary of key indicators of access to care and Table 2 for data regarding Medi-Cal eligibility. In SDC in 2014, 20.9 percent of adults ages 18 to 64 did not have a usual source of care and 14.3 percent of these adults had health insurance. In addition 14.3 percent reported fair or poor health outcomes. Further, 43.6 percent living at 200 percent below the federal poverty level (FPL) reported as food insecure. Table 1: Health Care Access in SDC, 2014 Description Rate Year 2020 Target Current Health Insurance Coverage Children 0 to 11 Years 98.2% 100% Children 12 to 17 Years 91.5% 100% Adults 18 to 64 Years 84.3% 100% Regular Source of Medical Care Children 0 to 11 Years 97.9% 100% Children 12 to 17 Years 83.0% 100% Adults 18 to 64 Years 79.1% 89.4% Not Currently Insured Adults 18 to 64 Years 15.7% Source: 2013-2014 California Health Interview Survey (CHIS) Table 2: Medi-Cal (Medicaid) Eligibility, Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2014 Description Rate Medi-Cal Eligible 28.7% Not Eligible 71.3% Source: 2013-2014 CHIS Table 3 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 3: Leading Causes of Death in SDC, 2014 Cause of Death Number of Deaths Malignant neoplasms 4891 Diseases of heart 4586 Alzheimer's disease 1316 Cerebrovascular diseases 1155 Accidents (unintentional injuries) 1101 Chronic lower respiratory diseases 995 Diabetes mellitus 588 Intentional self-harm (suicide) 421 Chronic liver disease and cirrhosis 319 Essential hypertension and hypertensive renal disease 314 Influenza and pneumonia 304 Parkinson's disease 268 Pneumonitis due to solids and liquids 134 Viral hepatitis 118 Nephritis, nephrotic syndrome and nephrosis 112 Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Community Benefit Planning Process In addition to the steps outlined in Section 3 regarding community benefit planning, Sharp HospiceCare: * Consults with representatives from a variety of internal departments and other community organizations to discuss, plan and implement community activities * Participates in programs and workgroups to review and implement services that improve palliative and end-of-life care for the San Diego community * Incorporates end-of-life community needs into its goal development Priority Community Needs Addressed by Sharp HospiceCare
Form 990, Part III, Line 4a (continued):	The 2013 CHNAs for each SHC acute care hospital (SCVMC, SCHHC, 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, students and health care professionals * Hospice and palliative care education and training programs for health care professionals, students and volunteers * Bereavement counseling and support For each of the community programs and services described above, subsequent pages include a summary of the rationale and importance of the service(s), objective(s), FY 2015 Report of Activities conducted in support of the objective(s), and FY 2016 Plan of Activities. Identified Community Need: End-of-Life and Chronic Illness Management Education for Community Members Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * 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. * 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). 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 U.S. In 2011, the first of more than 70 million baby boomers (adults born between 1946 and 1964) turned 65. By the year 2050, this age group is projected to more than double in size, from 40.3 million to 88.5 million. The increasing number of older adults, combined with the increasing rates of obesity, diabetes, and other chronic disease, are on track to overwhelm the health care system (America's Health Rankings Senior Report, 2013). * According to the 2015 California HealthCare Almanac report Beds for Boomers: Will California's Supply of Services Meet Senior Demand?, nearly two-thirds of California seniors had two or more chronic conditions in 2012, and more than one-third had four or more (California Healthcare Foundation (CHCF), 2015). * There are an estimated four million family caregivers in California, according to the California Caregiver Resource Center. * In 2014, there was an estimated 43.5 million adults in the U.S. who have provided unpaid care to an adult or child (AARP, 2015). * Although caregivers report some positive feelings about caregiving, including family togetherness and the satisfaction of helping others, they also report high levels of stress over the course of providing care. Sixty-one percent of family caregivers of people with Alzheimer's and other dementias rated the emotional stress of caregiving as high or very high (National Alzheimer's Association, Alzheimer's Disease Facts and Figures, 2013). * While researchers have long known that caregiving can have harmful 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 Caregiving in the U.S. 2015 report). * According to the AARP's Caregiving in the U.S. 2015 report, 14 percent of caregivers who assist with medical or nursing tasks report having received some preparation or training. Additionally, 84 percent of caregivers reported needing more help and information about caregiving topics such as keeping their loved ones safe at home, managing their own stress and helping make end-of-life decisions. Caregivers responded positively to interventions such as individual/group therapy, educational/training support, home-based visits, or technology, depending on how they were delivered (National Alzheimer's Association, 2012). * According to a 2011 article in the American Family Physician Journal (AFPJ), the demand for family caregivers is expected to rise by 85 percent in the next few decades. 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. * In 2013, 140,000 Californians were served by hospice. Nearly 80 percent of hospice patients were ages 71 and older. At current rate of use, the number of hospice patients is projected to more than double between 2013 and 2040. It is projected that in 2040, 88 percent of hospice patients will be 71 and older (2015 California Health Care Almanac Beds for Boomers report). Objectives * Provide education and outreach to the San Diego community concerning advanced illness management and end-of-life care * Collaborate with community organizations to provide education and outreach to community members and their loved ones * Support the unique advanced illness management and end-of-life care needs of military veterans and their families FY 2015 Report of Activities Sharp HospiceCare supports the San Diego community in the areas of end-of-life care, aging and caregiving through participation in a variety of local organizations including SDCCEOLC, SDRHCC, San Diego County HVP, San Diego Chapter of the Hospice and Palliative Nurses Association (HPNA), San Diego POLST Coalition, San Diego County Medical Society Bioethics Commission, Caregiver Coalition of San Diego, SanDi-CAN, North County Community Action Network (NorCAN), SoCAN and ECSSP. In FY 2015, Sharp HospiceCare partnered with many of these organizations to provide more than 2,400 community members with free education and outreach on a variety of end-of-life and advance illness management topics. This included educational presentations at churches, senior living centers, and community health agencies and organizations throughout SDC as well as participation in community health fairs and events. In January, Sharp HospiceCare partnered with SanDi-CAN, Nor-CAN and other community organizations to co-host two free community conferences at the Balboa Park Club and the Ed Brown Senior Center at Rancho Bernardo titled Planning Ahead...Crucial Conversations. Through the conferences, approximately 300 seniors and their family members learned tools to identify their end-of-life values and goals of care, and communication skills for making educated and informed health care decisions. The events included resources from approximately 20 community exhibitors, as well as a variety of expert-led presentations, including Five Important Documents Everyone Should Have; Communication Tools for Crucial Conversations; Whole Body, Organ and Tissue Donations; The Ombudsman's Role as an Advocate for Long-Term Care Residents; Reinventing Yourself After a Loss: How to Find Your Way Back to Thriving; and Essential Documents & Conversations: Community Physicians Share Their Thoughts on Their Own Advance Directives.
Form 990, Part III, Line 4a (continued):	In April and May, Sharp HospiceCare partnered with SCHHC and the SMH and SGH Senior Resource Centers to provide three community conferences for approximately 300 community seniors and their families titled Aging: Right Choices at the Right Time. The free conferences were held at the Sandermann Education Center at SCHHC, the Point Loma Community Presbyterian Church and the La Mesa Community Center and offered education from Sharp HospiceCare leadership and community health experts on how to plan and communicate future health care, financial and physical needs. Presentations included Advance Care Planning: A Gift for Your Loved Ones; Leaving a Legacy: Planning for Your Future; Navigating the Minefield: Care Conundrums in the Final Years of Life; and Finding Hope and Healing After a Loss. In addition, local health and senior service agencies offered information on a variety of community resources. In June and July, Sharp HospiceCare participated in two community events presented by the Caregiver Coalition of San Diego: Finding the Balance in Caregiving held at College Avenue Baptist Church, and Batter Up! Are Your Bases Covered?, a special event held at the First United Methodist Church to support male family caregivers. Through the events, approximately 200 family members received expert education on a variety of caregiving topics, including, but not limited to, coping with the emotional issues of caregiving; managing loved ones' physical care needs; understanding hospice; Medicare; and long term care. In September, Sharp HospiceCare hosted Live Stronger Longer: Conference for Seniors and Caregivers at the Community Congregational Church of Chula Vista, a free conference that provided approximately 200 seniors and their caregivers with valuable information on how to care for themselves and their loved ones. The event included several community resource agencies, as well as expert speakers who shared knowledge on a variety of topics, including asking one's doctor the right questions, creating an advance directive, detecting fraud, improving memory, managing depression and using exercise to feel better. In addition, the conference offered free respite care to seniors in their homes while their loved one attended the conference. Sharp HospiceCare participated in a variety of community health fairs and events throughout the year, including the College Avenue Senior Center Health Fair, Spring Into Healthy Living at the neighborhood YMCA, St. Paul's Senior Services Health Fair, the Sharp Women's Health Conference, the East County Senior Service Providers 16th annual Senior Health Fair at Santee Trolley Square, Vital Aging 2015: Boosting Your Brain Power Conference and Mana de San Diego Family Health Fair at Sweetwater High School in National City. Sharp HospiceCare supports the needs of military veterans and their families through participation in veteran-oriented community events and collaboration with local and national organizations advocating for quality end-of-life care for veterans. Sharp HospiceCare is a partner in We Honor Veterans (WHV), a national program developed by the NHPCO in collaboration with the U.S. Department of Veterans Affairs (VA) to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As WHV partners, hospice organizations can achieve up to four levels of commitment in serving veterans. Sharp HospiceCare is currently a Level I Partner, indicating it is equipped to provide veteran-centric education to its staff and volunteers, including training them to identify patients with military experience. Since 2010, Sharp HospiceCare has been a member of the San Diego County HVP, a coalition of VA facilities and community hospices working together to ensure excellent end-of-life care for veterans and their families. Through the partnership, the VA San Diego Healthcare System and San Diego's community hospice organizations continually collaborate to promote and advocate for quality care for veterans experiencing a life-limiting illness and serve as a voice and resource for veterans and their families. Sharp HospiceCare also participates on the advisory board for the SCRC's Operation Family Caregiver, a comprehensive program that helps all family caregivers of veterans, including those of post-9/11 conflicts, as well as service members with traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) or other physical disabilities. In June, Sharp HospiceCare participated in the Operation Engage America Resource Fair, hosted by Operation Engage America, a non-profit organization that provides support, awareness, education and resources for veterans, community members and families living with PTSD and TBI and those who want to support them. Held at Liberty Station, the event honored military veteran Daniel Somers and others like him, who have taken their own lives. Alongside more than 70 community organizations, Sharp HospiceCare provided resources to nearly 200 veterans, families, caregivers and other members of the community at this free event. Sharp HospiceCare also provided end-of-life care resources at the SCRC's Operation Family Caregiver conference at Camp Pendleton in October. Designed for military personnel, veterans and family caregivers, this free educational event provided more than 100 attendees with practical solutions for managing TBI and PTSD, improving communication and caring for the family caregiver. In August and October, Sharp HospiceCare provided education and resources on hospice, advance care planning (ACP) and advanced illness management at the Veterans, Military and Families Expos at the War Memorial Building at Balboa Park. The free events were sponsored by the City of San Diego Parks and Recreation Department, Senior Citizen Services, SanDi-CAN, San Diego Veterans Coalition, Legacy Corps, San Diego and the Caregiver Coalition of San Diego. Reaching approximately 240 community members, the events offered presentations, workshops, resource tables and assistance with applying for veterans' benefits from a variety of non-profit organizations and federal, county, and municipal entities that support veterans and military families. In November, Sharp HospiceCare provided education on ACP and integrative therapies to approximately 50 veterans and their family members at the VA San Diego Healthcare System's health fair in La Jolla, a community event held in collaboration with the San Diego County Hospice-Veteran Partnership (HVP) and other community hospice organizations. In further support of veterans, Sharp HospiceCare joined community members and local end-of-life care organizations in the HVP's Keep the Spirit of `45 Alive wreath laying ceremonies. Held on Mt. Soledad in August, and at the Challenged Athletes Foundation building in December, the ceremonies were part of a nationwide commemoration of the 70th anniversary of the end of World War II. Sharp HospiceCare continued its wig donation program in FY 2015, providing free wigs to 49 community members who suffer from hair loss due to cancer treatment and other illnesses. Through the program, Sharp HospiceCare receives new, unused wigs from manufacturers, cleans and styles the wigs and donates them to individuals in need. Understanding that hair loss can be difficult, Sharp HospiceCare team members offer private wig appointments for community members to select their wig, and receive personalized wig fitting, styling and maintenance instructions. In addition, surplus wigs are donated to patients at the Douglas & Nancy Barnhart Cancer Center at SCVMC and to other community organizations interested in supporting those with medical-related hair loss. A total of 150 wigs were donated to those in need in FY 2015. FY 2016 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 for seniors and their loved ones on advanced illness management and end-of-life care * In collaboration with SCHHC and the Sharp Senior Resource Centers, host three free aging conferences, reaching 100 community members per conference * Continue to support the needs of military veterans and their families through the provision of education and resources at veteran-oriented community events and collaboration with local and national organizations advocating for quality end-of-life care for veterans * Achieve WHV Level II Partners to build the organizational capacity needed to provide quality care for veterans and their families
Form 990, Part III, Line 4a (continued):	Identified Community Need: Advance Care Planning Education and Outreach to Community Members, Students and Health Care Professionals Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent SDC 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 ACP, 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. * Advance directives should be filled out while people are healthy, because doing so gives them time to think about the end-of-life care they would choose if they were unable to communicate their own wishes. It also allows time to discuss these wishes with loved ones (NHPCO, 2015). * Seventy percent of Americans do not have an advance care plan (CDC, 2014). * A 2013 report, Completion of Advance Directives Among U.S. Consumers, published in The American Journal of Preventive Medicine in January 2014, shows that of more than 7,900 respondents only 26.3 percent had an advance directive, with lack of awareness cited as the primary barrier for not having one. This study also indicates racial and educational disparities in the completion of an advance directive and highlights the need for additional education about end-of-life decisions. * 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). * According to the CDC, barriers to ACP 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 ACP and to improve their quality of care at the end of life (CDC, 2010). * According to a study in the British Medical Journal, 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). * A 2014 Consumer Reports survey of 2,015 adults suggests that Americans would prefer to die at home: 86 percent said they would consider receiving end-of-life-care at home, but just 36 percent said the same about getting that care in a hospital. * Recent studies have found that end-of-life care planning is associated with significantly less aggressive and more cost-effective medical care near death, earlier and more frequent hospice referrals, and enhanced quality of life with better bereavement adjustments (CDC, 2012). * About twice as many Caucasians as African Americans completed advance directives. The difference in prevalence of advance directives is attributable to several factors, including cultural differences in family-centered decision-making, distrust of the health care system, and poor communication between health care professionals and patients (Morhaim and Pollack, 2013). Objectives * Provide education, engagement and consultation for community members on ACP and POLST * Educate community health care professionals and students on ACP and POLST FY 2015 Report of Activities SHC offers a free and confidential ACP program to support community members as they consider their future health care options. Facilitated by Sharp HospiceCare, the ACP program empowers adults of any age and health status to explore and document their beliefs, values and goals as they relate to health care. The program consists of three stages. Stage one, community engagement, focuses on bringing awareness to healthy community members about the importance of ACP. This stage includes basic education and resources, identification of an appropriate health care agent, and completion of an advance health care directive. Stage two, disease-specific outreach, focuses on education for community members with a progressive chronic illness, including decline in functional status, co-morbidities, potential for hospitalization and caregiver issues. With a goal of anticipating future needs as health declines, this stage focuses on developing a written plan that identifies goals of care, and involves the health care agent and loved ones. The third stage, late-life illness outreach, targets those with a disease prognosis of one year or less. Under these circumstances, specific or urgent decisions must be made and converted into medical orders that will guide the health care provider's actions and 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, a legal document designed for individuals with advanced progressive or terminal illness that specifies care preferences in an emergency medical situation. In FY 2015, the Sharp ACP team provided more than 130 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 health care directive. The ACP team also engaged approximately 2,500 community members and caregivers in free ACP and POLST education at a variety of community sites, including health fairs, senior centers, homecare agencies, churches and seminars. Locations included but were not limited to: Silver Crest Senior Residence, Gateway Gardens Senior Living, Los Arcos Affordable Senior Living, Lantern Crest Senior Living, Collwood Terrace Retirement Community, La Mesa Library, Point Loma Library, the Coronado Book Club, San Diego LGBT Community Center, Salvation Army, Sister Servants of the Blessed Sacrament, San Diego Gas & Electric (SDG&E) Employee Wellness Fair, Sempra Energy Wellness Fair, Rancho Santa Fe Senior Center first annual Healthy Aging Conference at Fairbanks Ranch Country Club, County of San Diego Aging and Independence Services (AIS) Vital Aging 2015: Boosting Your Brain Power Conference in Liberty Station, December Nights in Balboa Park, SanDi-CAN and Nor-CAN Planning Ahead...Crucial Conversations conferences, SDCCEOLC Quality of Life Panel, Sharp Women's Health Conference, SCVMC Heart Health Expo, SGH Cancer Center's Survivorship Lunch and Learn series, Sharp HospiceCare Aging: Right Choices at the Right Time conferences, Sharp HospiceCare Live Stronger Longer: Conference for Seniors and Caregivers, Sharp HospiceCare's annual Healing Through the Holidays event, and Sharp HospiceCare's annual Memorial Service. The Sharp ACP team participated in a variety of initiatives supporting National Healthcare Decisions Day (NHDD). Held on April 16, 2015, the national initiative encourages adults of all ages to plan ahead of a health care crisis. The team kicked off NHDD with a live discussion on San Diego 6 News station about the importance of ACP and getting the conversation started. April 16 and 17 continued with "kitchen-table talks," held at SCVMC, SGH and SMH, during which community members could meet with Sharp's ACP experts to begin their advance health care plan. Approximately 200 individuals were reached through the NHDD kitchen-table talks. NHDD presentations were also provided to more than 40 community members at Gethsemane Lutheran Church in Serra Mesa and the Serra Mesa Community Council.
Form 990, Part III, Line 4a (continued):	In further support of NHDD, Sharp HealthCare hosted Conversations Matter, a free community workshop held at the First United Methodist Church of San Diego. During the workshop, the Sharp ACP team provided approximately 40 community members with tools to select an appropriate health care agent, communicate goals of care, and document wishes for future health care needs. Presentations included Conversations Matter: Tools and Resources for Communicating/Documenting Future Health Care Wishes; Difficult Conversations: Presenters Demonstrate Conversations and Provide Tips That Address Communication Barriers; and Physician Panel: Personal Stories from Physicians and Audience Q&A. In FY 2015, the Sharp ACP team supported a variety of community efforts to raise awareness about end-of-life care issues and the importance of ACP. In September, the team joined SCHHC and inewsource, a local nonprofit investigative journalism team, in a KPBS radio broadcast to discuss inewsource's Emmy-nominated two-part film series, An Impossible Choice. Filmed in the SCHHC Subacute Unit, the story documents the difficult decisions faced by family members with a loved one who is on life support. During the broadcast, the ACP team emphasized the importance of having ACP discussions to ensure individuals receive the end-of-life care they prefer. In addition, through grant support from the California HealthCare Foundation (CHCF), Sharp HospiceCare collaborated with SDCCEOLC in August to provide free community viewings of the Public Broadcasting Service documentary, Being Mortal, including a post-film panel discussion on end-of-life care. Based on the book written by Dr. Atul Gawande, American surgeon, author and public health researcher, the movie addresses the national dialogue around death, including exploration of what matters most to patients and families experiencing serious illness and how doctors can better prepare them. Held at the Community Congregational Church of Chula Vista and the Ramona Community Library, the film screenings were attended by approximately 80 community members. Throughout the year Sharp HospiceCare educated more than 500 local, state and national health professionals on ACP and POLST, including, but not limited to case managers from the San Diego Care Transitions Partnership, Grossmont Post Acute Care, Continuum Healthcare, Senior Care Action Network (SCAN) Health Plan, the Center to Advance Palliative Care (CAPC) National Conference, SDRHCC, Caregiver Coalition of San Diego, SDCCEOLC, San Diego Dementia Consortium, the Sharp HospiceCare Resource & Education Expo, Greater San Diego Business Association and the County of San Diego Ombudsmen Program. In collaboration with the Coalition for Compassionate Care of California (CCCC), the Sharp ACP team also offered a POLST Train-the-Trainer workshop to train community health care providers on POLST, including identifying the target population for POLST completion, how to facilitate a POLST conversation and how to document patient treatment wishes on the POLST form. The Sharp ACP team supports San Diego's future health care workforce through lectures and professional training opportunities. In FY 2015, the team provided introductory education on hospice, bioethics and ACP to 36 advanced psychology students at Valhalla High School as well as delivered eight lectures on hospice, bioethics, ACP and advance directives to nearly 180 nursing students from Azusa Pacific University (APU). In addition, lectures on spiritual care in hospice were provided to more than 50 individuals in the Certified Hospice and Palliative Nursing Assistant training program through the HPNA. In FY 2014, SHC developed the Sharp HealthCare Advance Directive to guide the public in outlining their health care decisions. Made publicly available on Sharp's website in both English and Spanish, the document uses easy-to-read language to describe what an advance directive is as well as how and why to complete one. The form allows individuals to put their health care wishes into writing and to appropriately sign the advance directive. With this signature, the advance directive becomes a legal document that can be used as a tool for health care decision-making. Additional contact information is provided for community members who are interested in speaking with a Sharp ACP facilitator. FY 2016 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 collaborate with community organizations to provide educational classes and events to raise community awareness of ACP * Host a variety of community events to promote the importance of ACP in honor of NHDD * In honor of NHDD, host kitchen table talks at Sharp hospitals to assist community members with beginning an advance health care plan * Continue to provide ACP education and outreach to local, state and national health care professionals * Educate Sharp team members about the End of Life Option Act - recently approved legislation that allows terminally ill patients to request and receive a doctor-prescribed medication to end the dying process - and address community questions and concerns that may arise * Collaborate with San Diego Health Connect, County of San Diego AIS, Health Services Advisory Group, emergency medical services, and various health care providers in SDC to ensure community members have access to advance directive and POLST forms in emergency situations through the county-wide health-information exchange Identified Community Need: Health Professions and Student Education and Training, and Volunteer Training Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the 2013 SDC Healthcare Shortage Areas Atlas from the County of San Diego's 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 U.S. will increase due to the aging population. Nurses will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. 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 (BLS), 2012). * The BLS projects an employment of more than 3.1 million RNs in the U.S. in 2024, an increase of 16 percent from 2014. * The BLS projects that the demand for home health aides will grow 38.1 percent from 2014 to 2024. As the U.S. population ages, the demand for home health aides to provide assistance will continue to increase. The older population often has health problems and will need help with daily activities. * Total employment is projected to increase by 6.5 percent, or 9.8 million, from 2014 to 2024. Health care and social assistance is projected to increase its employment share from 12 percent in 2014 to 13.6 percent in 2024, the fastest growing service industry. Occupations and industries related to health care are projected to add the most new jobs with an increase of 2.3 million in employment (BLS, 2015). * Direct-care workers in California are responsible for providing 70 to 80 percent of the paid hands-on long-term care for older adults or those living with disabilities or other chronic conditions (Eldercare Workforce Alliance, 2014-15). * The number of Americans over age 65 is expected to increase 71 percent by 2030. Geriatrics health professions training programs are critical to ensuring there is a skilled eldercare workforce and knowledgeable, well-supported family caregivers available to meet the complex and unique needs of older adults (Eldercare Workforce Alliance, 2014). * The number of people reaching retirement will double by 2030, accounting for an eight percent increase in the U.S. population needing a wide range of professional health, home care, and social services. An estimated 3.5 million additional health care professionals will be needed by 2030 to care for older adults, while current levels of workforce are already stretched (Eldercare Workforce Alliance, 2014-2015).
Form 990, Part III, Line 4a (continued):	* 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. * According to the California Hospital Association (CHA) 2014 report titled Critical Roles: California's Allied Health Workforce Follow-Up Report, programs supported by local hospitals make tremendous impacts on the lives of individuals, families and communities. This includes time and resources dedicated to the thousands of interns and high school students spending time in California hospitals each year, gaining valuable work experience and career exposure. 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 2015 Report of Activities Sharp HospiceCare provided training opportunities for nearly 100 San Diego State University (SDSU) nursing students in FY 2015. Each semester, 24 students shadowed case managers out in the field, while an additional 24 students spent an eight-hour day shadowing and learning from the nursing staff at Sharp HospiceCare's LakeView home. Sharp HospiceCare also mentored three doctoral students from the Instituto Polit cnico Nacional in Mexico, as well as nursing students from Point Loma Nazarene University (PLNU). In June, Sharp HospiceCare hosted its sixth annual Resource and Education Expo titled Advanced Illness Management: Preserving Quality of Life to help community health professionals improve their approach to patient and family-centered care for the advanced illness and aging populations. The free expo featured speakers from Sharp HospiceCare and SGH leadership as well as interactive discussions and community resources from 35 community agencies supporting end-of-life needs. The expo reached approximately 200 community health care professionals in FY 2015, including physicians, nurses, case managers, social workers, chaplains, therapists and home health aides. Sharp HospiceCare leadership provided education, training and outreach to local, state and national professionals throughout FY 2015. These efforts sought to guide industry professionals in achieving person-centered, coordinated care through the advancement of innovative hospice and palliative care initiatives. Organizations included Good Samaritan Medical Center, Saddleback Memorial Medical Center, the CAPC national conference, CCCC, Highmark Health, Baylor Scott and White Health, Family Medicine Education Consortium, Kaufman, Hall & Associates, LLC, State of California Department of Justice Bureau of Medi-Cal Fraud and Elder Abuse, Lown Institute, Balboa Nephrology Medical Group; American Hospital Association (AHA) Leadership Summit, West Health Institute, Hospice Analytics, SCAN Health Plan and Continuum Care Hospice. Presentation topics included successful aging, palliative care, advanced illness management, geriatric frailty, prognostication, biometric markers and ACP. Sharp HospiceCare leadership also continued to serve on the board, and as a state hospice representative, for NHPCO and CHAPCA. Underscoring Sharp HospiceCare's commitment to quality end-of-life care for San Diego veterans, the Sharp HospiceCare interdisciplinary team is trained in ELNEC (End-of-Life Nursing Education Consortium) for Veterans. Administered by the American Association of Colleges of Nursing, the ELNEC project is a national education initiative to improve palliative care. Through Train-the-Trainer courses, the ELNEC for Veterans project trains a corps of expert nursing educators on how to provide better palliative care for veterans with life-threatening illness so that they can continue to teach this essential information to practicing nurses and other health care professionals. Since completing the Train-the-Trainer course in 2012, Sharp HospiceCare has been working with its community partners to locally expand training in ELNEC for Veterans, including sharing the curriculum with fellow members of the HVP and staff from the VA San Diego Healthcare System. Sharp HospiceCare continued to provide volunteer training opportunities in FY 2015. Hospice volunteers are often working towards a career in the medical field. In addition to gaining valuable knowledge and experience through volunteering, hospice volunteers provide valuable support to hospice organizations and those they serve, including companionship to those near the end of life, family and caregiver support, and community outreach. Sharp HospiceCare trained 51 new volunteers in FY 2015. Volunteers complete an extensive 32-hour training program to confirm their understanding of and commitment to hospice care prior to beginning their patient and administrative support activities. Sharp HospiceCare also trained five teenagers through its Teen Volunteer Program and provided volunteer opportunities for nine nursing students from PLNU. The teen volunteers devoted their time to special projects in the office or at Sharp HospiceCare's hospice homes, while the nursing students assisted family caregivers in private homes. In FY 2015, Sharp HospiceCare trained 22 volunteers through the 11th Hour Program, a special program through which a Sharp HospiceCare volunteer accompanies end-of-life patients without family members present during their final moments. The volunteers may also provide company to family members who are present as their loved one passes away. New in FY 2015, Sharp HospiceCare trained 11 volunteers in Healing Touch, a gentle energy therapy that uses the hands to help manage physical, emotional or spiritual pain. Once trained, the volunteers provide the Healing Touch therapy to family caregivers once a week while their loved one is receiving hospice care, including a visit following the patient's death. As WHV Level I partners, Sharp HospiceCare volunteers receive an additional eight hours of training that enables them to work with patients with military experience. Trained volunteers may provide a special ceremony to veterans receiving hospice services and their family members, in which they honor them with a WHV pin and a certificate of appreciation for their services. In FY 2015, volunteers held 17 pinning ceremonies for veterans receiving care at Sharp HospiceCare. In addition, volunteers may provide weekly support, companionship and relief for caregivers of veterans. FY 2016 Plan Sharp HospiceCare will do the following: * Continue to provide education and training opportunities for nursing and other health care 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 organizations to support the development and implementation of appropriate services for the needs of the aging population, including advanced illness management * Maintain active relationships and leadership roles with local and national organizations * Continue to collaborate with San Diego County HVP to provide ELNEC for Veterans training to community health care professionals * Provide volunteer training programs for at least 75 adults and teens * Continue to provide special training opportunities for hospice volunteers, including 11th Hour Program training, Healing Touch for family caregivers, and WHV Level I volunteer training to support veterans Identified Community Need: Bereavement Counseling and Support Rationale references the findings of the SHC 2013 Community Health Needs Assessments or the most recent SDC community health statistics unless otherwise indicated. Rationale * According to the Institute of Medicine (IOM) 2014 report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, clinical care is not a person's sole priority near the end of life. Patients and families may be deeply concerned with existential or spiritual issues, including bereavement, and with practical matters of coping. Appropriate support in these areas is an essential component of good care.
Form 990, Part III, Line 4a (continued):	* According to the same report, risk factors for complicated grief among bereaved caregivers include fewer years of education, younger age of the deceased and lower satisfaction with social support. The care provided by hospices may lead to positive health outcomes, including survival, among the bereaved and may help some people avoid long-term depression and other consequences of complicated grief. * 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 his or her 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). 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 community services * Provide support to loved ones of those who have passed away through the Memory Bear Program FY 2015 Report of Activities Throughout FY 2015, Sharp HospiceCare offered a variety of bereavement service options to help grieving community members learn effective ways to cope with the loss of a loved one. Services included professional bereavement counseling for individuals and families as well as free community education, support groups and monthly newsletter mailings. In FY 2015, Sharp HospiceCare devoted more than 2,100 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. Sharp HospiceCare's bereavement counselors also provided referrals to community counselors, mental health services, other bereavement support services and community resources as needed. Sharp HospiceCare continued to offer the Healing After Loss and the Widow's and Widower's bereavement support groups, reaching approximately 180 community members in FY 2015. Offered quarterly, the groups consisted of eight-week sessions facilitated by skilled mental health care professionals specializing in the needs of the bereaved. The Healing After Loss support group focused on practical concerns of adults who are grieving the loss of a loved one. Weekly themes included Introduction to the Grief Process; Strategies for Coping with Grief; Communicating with Family and Friends; Experiencing Anger in Grief; Guilt, Regret and Forgiveness; Differentiating Natural Grief and Depression; Use of Ceremony and Ritual to Promote Healing; and Who am I Now?/What Does Healing Look Like?. The Widow's and Widower's support group helped address concerns of men and women who have lost their spouse. Participants were able to share their emotional challenges, receive support and learn coping skills from group members in similar life situations. In March, Sharp HospiceCare hosted a workshop titled Tools for Hope and Healing, which taught coping tools for healing through grief, including relaxation exercises, journaling and identifying personal strengths. Sharp HospiceCare supported more than 100 community members grieving the loss of a loved one during the 2014 holiday season. In November, Sharp HospiceCare held its annual Healing Through the Holidays event at Sharp's corporate office location, including presentations on understanding grief, improving coping skills, exploring the spiritual meaning of the holidays in the face of grief, and reviving hope. Also in November, a similar event titled Coping with Grief During the Holiday Season was held at the Grossmont Healthcare District, which provided practical suggestions for community members to cope with the painful feelings of loss that often arise during the holidays. Additionally, Sharp HospiceCare provided the Support During the Holiday Season bereavement support group on two days in December, which focused on coping skills to promote healing through the holidays and remembering your loved ones. In May, the Sharp HospiceCare Spiritual Care Department offered its annual memorial service for family members of hospice patients who have died in the past year. Through music, readings, and sharing memories with other attendees, approximately 40 family members engaged in healing during their grief and keeping the memory of their loved ones alive. In further support of those who have lost a loved one, Sharp HospiceCare continued the Memory Bear program through which Sharp HospiceCare volunteers use garments of loved ones who have passed on to sew teddy bears as keepsakes for surviving family members. In FY 2015, nearly 3,600 hours were dedicated to sewing approximately 900 bears for nearly 350 families. Sharp HospiceCare also continued to mail its monthly bereavement support newsletter titled Healing Through Grief, to approximately 1,300 community members for 13 months after the loss of their loved one. FY 2016 Plan Sharp HospiceCare will do the following: * Continue to offer individual and family bereavement counseling for community members who have lost a loved one * Continue to provide referrals to community services * Continue to provide a variety of free bereavement support groups * Continue to provide events and support services for individuals grieving the loss of a loved one during the holiday season * Support at least 350 families through the Memory Bear program * Continue to provide 13 mailings of bereavement support newsletters Sharp HospiceCare Program and Service Highlights * Advance care planning * Bereavement care services * 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 * Human Immunodeficiency Virus * 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 2015. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Adult Protective Services * Aging and Independence Services * Alzheimer's Association * American Association of Colleges of Nursing * American Association of Critical Care Nurses, San Diego Chapter * American Cancer Society * American College of Healthcare Executives (ACHE) * American Diabetes Association * American Foundation for Suicide Prevention * American Health Information Management Association * American Heart Association * American Hospital Association * American Psychiatric Nurses Association * American Red Cross of San Diego * Arc of San Diego * Asian Business Association * Association for Ambulatory Behavioral Healthcare * Association for Clinical Pastoral Education * Association of Women's Health, Obstetric and Neonatal Nurses * Azusa Pacific University * Beacon Council's Patient Safety Collaborative * Boys and Girls Club of San Diego
Form 990, Part III, Line 4a (continued):	* 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 Coalition for Mental Health * California College, San Diego * California Maternal Quality Care Collaborative * California Council for Excellence * California Department of 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 Hospital Association * California Library Association * California Perinatal Quality Care Collaborative * California State University San Marcos * California Teratogen Information Service * Caregiver Coalition of San Diego * Caring Hearts Medical Clinic * Centers for Community Solutions * 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 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 * Combined Health Agencies * Community Emergency Response Team * Consortium for Nursing Excellence, San Diego * Coronado Chapter of Rotary International * Coronado Fire Department * Council of Women's and Infants' Specialty Hospitals * Cycle EastLake * Downtown San Diego Partnership * East County Senior Service Providers * El Cajon Fire Department * Emergency Nurses Association, San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Family Health Centers of San Diego * Feeding America San Diego * Gardner Group * Gary and Mary West Senior Wellness Center * Girl Scouts of San Diego Imperial Council, Inc. * Greater San Diego East County Advisory Board * Grossmont College * Grossmont Healthcare District * Grossmont Health Occupations Center * Grossmont Union High School District * Health Care Communicators Board * Health Insurance Counseling and Advocacy Program * Health Sciences High and Middle College (HSHMC) * Health Volunteers Overseas * Heart to Heart International * Helen Woodward Animal Center * Helix Charter High School * Helps International * Home of Guiding Hands * Hospice-Veteran Partnership * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * HSHMC Board * Hunger Advocacy Network * I Love a Clean San Diego * International Association of Eating Disorders Professionals * International Lactation Consultants Association * International Relief Team * Ioamai Medical Ministries * Jewish Family Service 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 Community Health Centers * La Mesa Lion's Club * La Mesa Park and Recreation Foundation Board * Las Damas de San Diego International Nonprofit Organization * Las Patronas * Las Primeras * March of Dimes * Meals-on-Wheels Greater San Diego * Medical Library Group of Southern California and Arizona * Mended Hearts * Mental Health America * Mental Health Coalition * Mental Health First Aid Program - MHA of San Diego * Miracle Babies * MRI Joint Venture Board * National Active and Retired Federal Employees Association * National Alliance on Mental Illness * National Association of Neonatal Nurses * National Association of Hispanic Nurses, San Diego Chapter * National Hospice and Palliative Care Organization * National Institute for Children's Health Quality * National Kidney Foundation * National University * Neighborhood Healthcare Community Clinic * North County Health Project * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Professional Oncology Network * Public Health Nurse Advisory Board * Recovery Innovations - California * Regional Perinatal System * Residential Care Council * Rotary Club of Chula Vista * Rotary Club of Coronado * Safety Net Connect * San Diego Community Action Network * San Diegans for Healthcare Coverage * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Association of Governments Public Health Stakeholder Group * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Brain Injury Foundation * San Diego Coalition of Mental Health * San Diego Council on Suicide Prevention * San Diego County Breastfeeding Coalition Advisory Board * San Diego County Coalition for Improving End-of-Life Care * San Diego County Council on Aging * San Diego County Emergency Medical Care Committee * San Diego County Health and Human Services Agency * San Diego County Hospice-Veteran Partnership * San Diego County Older Adult Behavioral Health System of Care Council * San Diego County Perinatal Care Network * San Diego County Social Services Advisory Board * San Diego County Stroke Consortium * San Diego County Suicide Prevention Council * San Diego County Taxpayers Association * San Diego Covered California Collaborative * San Diego Dietetic Association Board * San Diego East County Chamber of Commerce Health Committee * San Diego Emergency Medical Care Committee * San Diego Eye Bank Nurses Advisory Board * San Diego Food Bank * San Diego Food System Alliance, Healthy Food Access Committee * San Diego Half Marathon * San Diego Health Information Association * San Diego Healthcare Disaster Council * San Diego Hospice and Palliative Nurses Association * San Diego Housing Commission * San Diego Hunger Coalition * San Diego Imperial Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. * San Diego Mental Health Coalition * San Diego Mesa College * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders, a local ACHE Chapter * San Diego Patient Safety Consortium * San Diego Physician Orders for Life-Sustaining Treatment Coalition * San Diego Regional Home Care Council * San Diego Rescue Mission * San Diego River Park Foundation * San Diego-Imperial Council of Hospital Volunteers * San Diego Regional Chamber of Commerce * San Diego Rescue Mission * San Diego Science Alliance * San Diego State University * San Ysidro High School * Santee Chamber of Commerce * SAY San Diego * Second Chance * Serving Seniors * Sigma Theta Tau International Honor Society of Nursing * Society of Trauma Nurses * South Bay Community Services * South County Action Network * South County Economic Development Council * Southern California Association of Neonatal Nurses * Southern California Earthquake Alliance * Southern Caregiver Resource Center * Special Olympics * St. Paul's Retirement Homes Foundation * St. Vincent de Paul Village * Susan G. Komen Breast Cancer Foundation * Sweetwater Union High School District * The Meeting Place * Third Avenue Charitable Organization * Trauma Center Association of America * United Service Organizations Council of San Diego * University of California, San Diego * University of San Diego * VA San Diego Healthcare System * Veterans Home of California, Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * Walk San Diego * Women, Infants and Children Program * YMCA * YWCA Becky's House * YWCA Board of Directors * YWCA Executive Committee * YWCA Finance Committee * YWCA In the Company of Women Event

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Grossmont Hospital provides inpatient and outpatient medical services to the community.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	4,065
6	Total number of volunteers (estimate if necessary) .............	6	806
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	373,998
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-288,375

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	52,456,797	41,891,405
9	Program service revenue (Part VIII, line 2g) .........	606,938,186	720,940,346
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,770,943	10,473,267
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,076,689	2,204,945
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	670,242,615	775,509,963
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	280,460	625,299
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	303,458,025	312,799,783
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,087,805
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	278,354,098	357,132,878
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	582,092,583	670,557,960
19	Revenue less expenses. Subtract line 18 from line 12.......	88,150,032	104,952,003
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	797,696,932	895,993,610
21	Total liabilities (Part X, line 26).............	190,756,573	203,231,571
22	Net assets or fund balances. Subtract line 21 from line 20.....	606,940,359	692,762,039

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 627,644,589 including grants of $ 625,299 ) (Revenue $ 720,940,346 )
	Grossmont Hospital provides inpatient and outpatient services to the community. Patient days were 125,010 and outpatient visits were 281,374 for the twelve months ended 9/30/15.See Community Benefits Report on Schedule O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses627,644,589

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	971,228	6,284,642	549,437

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,458,398
e	Government grants (contributions)1e		39,348,007

f	All other contributions, gifts, grants, and similar amounts not included above1f		85,000

g	Noncash contributions included in lines 1a-1f:$		38,126,708
h	Total. Add lines 1a-1f.......			41,891,405
			Business Code
2a	Medicare/Medicaid		900099	431,204,438	431,204,438
b	Patient Services		900099	281,163,155	281,163,155
c	Medical Office Lease		531120	3,617,698	3,617,698
d	Contract Pharmacy		900099	2,528,456	2,528,456
e	EHR Incentive		900099	758,843	758,843
f	All other program service revenue .			1,667,756	1,293,758	373,998
g	Total. Add lines 2a–2f........			720,940,346
3	Investment income (including dividends, interest, and other similar amounts).......			6,870,628			6,870,628
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	28,680,834	365,027
b	Less: cost or other basis and sales expenses	25,211,284	231,938
c	Gain or (loss)	3,469,550	133,089
d	Net gain or (loss)..........			3,602,639			3,602,639
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Auxiliary		453220	1,045,620			1,045,620
b	Parking		812930	1,022,618			1,022,618
c	Cell Phone Towers		531390	74,796			74,796
d	All other revenue ....			61,911			61,911
e	Total. Add lines 11a–11d ......			2,204,945
12	Total revenue. See Instructions......			775,509,963	720,566,348	373,998	12,678,212


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			25,085,898	1	41,551,543
2	Savings and temporary cash investments .........			10,685,857	2	14,313,069
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			66,503,128	4	96,581,297
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			11,499,162	8	12,631,253
9	Prepaid expenses and deferred charges ..........			8,686,288	9	9,494,022
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	628,551,360
b	Less: accumulated depreciation .....	10b	285,701,993	304,877,035	10c	342,849,367
11	Investments—publicly traded securities ..........			333,659,265	11	352,297,553
12	Investments—other securities. See Part IV, line 11 .....			1,285,391	12	1,267,507
13	Investments—program-related. See Part IV, line 11 .....			20,445,449	13	21,898,971
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			14,969,459	15	3,109,028
16	Total assets. Add lines 1 through 15 (must equal line 34)......			797,696,932	16	895,993,610
17	Accounts payable and accrued expenses .........			44,982,068	17	58,502,550
18	Grants payable .................				18
19	Deferred revenue ................			11,774,191	19	7,347,654
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			27,454,434	23	28,195,870
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			106,545,880	25	109,185,497
26	Total liabilities. Add lines 17 through 25.........			190,756,573	26	203,231,571
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			590,759,307	27	676,593,947
28	Temporarily restricted net assets ...........			15,085,650	28	15,071,689
29	Permanently restricted net assets ...........			1,095,402	29	1,096,403
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			606,940,359	33	692,762,039
34	Total liabilities and net assets/fund balances ........			797,696,932	34	895,993,610

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

1.(a) Description of liability		(b) Book value
Federal income taxes
Mark to Market Swap		843,962
Long Term Pension Liability		21,045,034
Long Term Workers' Compensation Liability		409,333
Other Liabilities		318,358
Intercompany Payable		13,032,489
Allocated Tax Exempt Bonds		73,536,321



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		109,185,497
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Return Reference	Explanation
Part V, Line 4:	Grossmont Hospital Foundation holds 23 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.
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, 2015 and 2014, no such assets or liabilities were recorded.
Part XI, Line 2d - Other Adjustments:	Foundation Donations to Individuals 130,317.
Part XI, Line 4b - Other Adjustments:	Prop G - Donations of Capital/Donation for Capital Purchased 39,348,007. Donations of Capital/Donation for Capital Purchased 558,177. Medical Staff/Auxiliary Revenue 1,347,221.
Part XII, Line 2d - Other Adjustments:	Foundation Donations to Individuals 130,317.
Part XII, Line 4b - Other Adjustments:	Medical Staff/Auxiliary Expenses 1,462,858.

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	5,507,364		5,507,364	0.820 %
b	Medicaid (from Worksheet 3, column a) ....	265,904,494	237,052,120	28,852,374	4.300 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	440,055	471,916
d	Total Financial Assistance and Means-Tested Government Programs .	271,851,913	237,524,036	34,359,738	5.120 %
Other Benefits		755,650		755,650	0.110 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	755,650		755,650	0.110 %
f	Health professions education (from Worksheet 5) ..	626,940		626,940	0.090 %
g	Subsidized health services (from Worksheet 6) ..	48,376,271	35,564,638	12,811,633	1.910 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	652,213		652,213	0.100 %
j	Total. Other Benefits ..	50,411,074	35,564,638	14,846,436	2.210 %
k	Total. Add lines 7d and 7j .	322,262,987	273,088,674	49,206,174	7.330 %

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	15,406		15,406	0 %
2	Economic development
3	Community support	19,349	25,591	-6,242	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	34,755	25,591	9,164

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 Grossmont Imaging LLC	Joint Venture-Diagnostic Imaging	50.000 %	0 %	50.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Grossmont Hospital Corporation 5555 Grossmont Center Drive La Mesa,CA91942 www.sharp.com/grossmont 080000006	X	X	X

	Grossmont Hospital Corporation
Name of hospital facility or letter of facility reporting group

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Grossmont Hospital Corporation	Part V, Section B, Line 5: For the Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 Community Health Needs Assessment (CHNA), the Institute for Public Health at San Diego State University (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.
Grossmont Hospital Corporation	Part V, Section B, Line 6a: The Sharp Grossmont Hospital (SGH) FY2013 CHNA examines the health needs of the community members it serves in San Diego County (SDC). SGH's FY2013 CHNA draws from and is based on the collaborative 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 Health.
Grossmont Hospital Corporation	Part V, Section B, Line 6b: The Sharp Grossmont Hospital (SGH) FY2013 CHNA examines the health needs of the community members it serves in San Diego County (SDC). SGH's FY2013 CHNA draws from and is based on the collaborative HASC&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).
Grossmont Hospital Corporation	Part V, Section B, Line 7d: Grossmont Hospital Corporation's CHNA is available at http://www.sharp.com/about/community/upload/SGH_CHNA_2013.pdfGrossmont Hospital Corporation's implementation plan is available at http://www.sharp.com/about/community/upload/SGH_Implementation_Plan_FY15_FY18.pdf
Grossmont Hospital Corporation	Part V, Section B, Line 11: The results of SGH's FY2013 Community Health Needs Assessment (CHNA) revealed priority health needs impacting the communities served by SGH, particularly the most vulnerable communities, as well as provided insight gathered from direct conversations with the community. SGH reviewed its FY2013 CHNA to assist in the design and implementation of programs and services provided at SGH for its community members. In identifying these priorities, SGH also considered the expertise and mission of its programs and services, in addition to the needs of the unique, ever-changing demographics and health topics that comprise SGH's service area and region.SGH provides behavioral health services to SDC's east region through clinical programs for adults and older adults, including individuals living with psychosis, depression, grief, anxiety, traumatic stress and other disorders. SGH also provides a dedicated psychiatric assessment team in the emergency department (ED) and acute care, as well as hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues. Beyond these clinical services, SGH does not have the resources to comprehensively meet the need for community education and support in behavioral health. Consequently, the community education and support elements of behavioral health care are addressed through the programs and services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in SDC. Obesity is addressed through general nutrition and exercise education and resources provided at SGH, as well as programs that address a healthy lifestyle as part of care for heart disease, diabetes and other health issues influenced by healthy weight and exercise. In addition, Sharp Rees-Stealy clinics throughout SDC provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs.Additionally, through further analysis of SGH's community programs and in consultation with SGH's community relations team, SGH also addresses the following priority health needs for community members served by SGH:Cancer education and support, and participation in clinical trialsBone health - orthopedic / osteoporosis education and screeningWomen's and prenatal health services and educationPrevention of unintentional injuriesSupport during the transition of care process for high-risk, underserved and underfunded patientsCollaboration with local schools to promote interest in health care careersThese programs are detailed further in the SGH section of Sharp HealthCare's FY2015 Community Benefit Plan and Report, available for public viewing/download at: http://www.sharp.com/about/community/upload/Sharp_HealthCare_Community_Benefit_Plan_FY2015-2.pdf SGH's most recent implementation plan - available online at: http://www.sharp.com/about/community/upload/SGH_Implementation_Plan_FY15_FY18.pdf - details those programs that SGH provides to address needs identified in its FY2013 CHNA, as well information on identified health needs that SGH lacks resources to comprehensively address.
Grossmont Hospital Corporation	Part V, Section B, Line 16i: The FAP was widely available at https://www.sharp.com/patient/billing/financial-assistance.cfmA plaing language summary of the FAP and the FAP application was widely available at https://www.sharp.com/patient/billing/upload/Financial-Assistance-Application.pdf
Part V, Section B, Line 16	Financial Assistance Policy Website Availability
Grossmont Hospital Corporation Part V, Section B, line 16a website:	See Part V, Section C
Grossmont Hospital Corporation Part V, Section B, line 16b website:	See Part V, Section C
Grossmont Hospital Corporation Part V, Section B, line 16c website:	See Part V, Section C

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address		Type of Facility (describe)
1	Sharp Hospice Care 8881 Fletcher Parkway Suite 336 La Mesa,CA91942	Hospice
2	PMB Medical Office Building 8860 Center Drive Suite 100 La Mesa,CA91942	Outpatient Services
3	Grossmont Medical Plaza 5525 Grossmont Center Drive Suite LL La Mesa,CA91942	Outpatient Services
4	Briar Patch 9000 Wakarusa Road La Mesa,CA91942	Outpatient Services
5	Grossmont Imaging LLC 8881 Fletcher Parkway Suite 102 La Mesa,CA91942	Joint Venture-Diagnostic Imaging
6	PMB Medical Office Building 8860 Center Drive Suite 200 La Mesa,CA91942	Outpatient Services-Infusion
7	LakeView Hospice Home 9472 Loren Drive La Mesa,CA91942	Hospice Home
8	ParkView Hospice Home 5788 Lyden Way San Diego,CA92120	Hospice Home
9	Grossmont Imaging LLC 9640 Mission Gorge Road Suite H Santee,CA92071	Joint Venture-Diagnostic Imaging
10

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) San Diego East County Chamber of Commerce 201 S Magnolia Ave El Cajon,CA92020	95-1494069	501(c)(6)	6,650				Sponsorship - Health Fair, WILL Table, Breakfast
(2) California Health Foundation & Trust 1215 K Street Suite 800 Sacramento,CA95814	94-1498697	501(c)(3)	528,342				Medi-Cal Program
(3) Grossmont Hospital Foundation 8695 Spectrum Center Blvd San Diego,CA921231489	33-0124488	501(c)(3)	63,782	125	FMV	Snacks for boats	Sponsorship - Gala, Golf Tournament, Regatta

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Peter Hanson MDDirector	(i) (ii)	32,688 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	32,688 ............................... 0	0 ............................... 0
2Rina Jain MDDirector	(i) (ii)	30,000 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	30,000 ............................... 0	0 ............................... 0
3Michael W MurphyPresident & CEO - SHC	(i) (ii)	0 ............................... 1,262,468	0 ............................... 401,135	0 ............................... 69,978	0 ............................... 83,051	0 ............................... 19,911	0 ............................... 1,836,543	0 ............................... 0
4Ann R PumpianSR VP and CFO-SHC	(i) (ii)	0 ............................... 690,110	0 ............................... 163,219	0 ............................... 26,462	0 ............................... 32,465	0 ............................... 14,996	0 ............................... 927,252	0 ............................... 0
5Carlisle C Lewis IIISR VP Legal/HR Services -	(i) (ii)	0 ............................... 566,903	0 ............................... 140,691	0 ............................... 25,021	0 ............................... 36,245	0 ............................... 19,310	0 ............................... 788,170	0 ............................... 0
6Daniel J KindronCFO - GH	(i) (ii)	0 ............................... 139,661	0 ............................... 11,909	0 ............................... 7,517	0 ............................... 5,249	0 ............................... 1,078	0 ............................... 165,414	0 ............................... 0
7Maryann C ConeCOO - GH	(i) (ii)	0 ............................... 284,857	0 ............................... 48,111	0 ............................... 32,227	0 ............................... 28,793	0 ............................... 8,181	0 ............................... 402,169	0 ............................... 0
8Anthony M DamicoVP Clinical Svs - GH	(i) (ii)	0 ............................... 198,623	0 ............................... 36,680	0 ............................... 18,557	0 ............................... 11,533	0 ............................... 7,795	0 ............................... 273,188	0 ............................... 0
9Suzanne K JohnsonVP Hospice - GH	(i) (ii)	0 ............................... 193,129	0 ............................... 38,500	0 ............................... 13,088	0 ............................... 318	0 ............................... 17,856	0 ............................... 262,891	0 ............................... 0
10Jason E BroadVP Performance Excellence	(i) (ii)	0 ............................... 158,850	0 ............................... 24,298	0 ............................... 320	0 ............................... 10,384	0 ............................... 7,530	0 ............................... 201,382	0 ............................... 0
11Michael A MurphyChief Medical Officer - GH	(i) (ii)	0 ............................... 268,070	0 ............................... 47,314	0 ............................... 20,205	0 ............................... 12,980	0 ............................... 13,619	0 ............................... 362,188	0 ............................... 0
12Bruce D SchmidtMgr Sharp Central Pharmacy	(i) (ii)	205,714 ............................... 0	27,235 ............................... 0	2,075 ............................... 0	23,083 ............................... 0	17,809 ............................... 0	275,916 ............................... 0	0 ............................... 0
13Vincent J BalesteriPharmacist	(i) (ii)	225,139 ............................... 0	5,531 ............................... 0	1,012 ............................... 0	30,377 ............................... 0	7,423 ............................... 0	269,482 ............................... 0	0 ............................... 0
14Glicerio M Cid JrAdvanced Clinician	(i) (ii)	226,091 ............................... 0	481 ............................... 0	4,256 ............................... 0	8,392 ............................... 0	7,170 ............................... 0	246,390 ............................... 0	0 ............................... 0
15Patrick P GuoMedical Physicist	(i) (ii)	202,248 ............................... 0	524 ............................... 0	8,234 ............................... 0	10,404 ............................... 0	1,629 ............................... 0	223,039 ............................... 0	0 ............................... 0
16Michele T TarbetFormer CEO-GH	(i) (ii)	0 ............................... 298,117	0 ............................... 119,234	0 ............................... 113,118	0 ............................... 27,066	0 ............................... 7,829	0 ............................... 565,364	0 ............................... 0
17Kari CornicelliFormer CFO-GH	(i) (ii)	0 ............................... 219,574	0 ............................... 35,862	0 ............................... 2,488	0 ............................... 16,483	0 ............................... 13,554	0 ............................... 287,961	0 ............................... 0
18Janet L HanleyFormer Key Employee	(i) (ii)	0 ............................... 193,765	0 ............................... 42,216	0 ............................... 945	0 ............................... 13,759	0 ............................... 13,200	0 ............................... 263,885	0 ............................... 0
19Hoangmy E NguyenFormer Key Employee	(i) (ii)	0 ............................... 207,800	0 ............................... 14,457	0 ............................... 462	0 ............................... 520	0 ............................... 12,166	0 ............................... 235,405	0 ............................... 0
20Dale BeattyFormer Key Employee	(i) (ii)	0 ............................... 125,543	0 ............................... 12,802	0 ............................... 10,356	0 ............................... 0	0 ............................... 7,279	0 ............................... 155,980	0 ............................... 0

Return Reference	Explanation
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 II, Line 1 Bi	Compensation was paid to Dr. Peter Hanson through Peter B. Hanson MD Inc. by Grossmont Hospital Corporation for medical director services.
Part II, Line 2 Bi	Compensation was paid to Dr. Rina Jain through Rina Jain MD Inc. by Grossmont Hospital Corporation for past Chief of Staff services.
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.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $