TY 2017 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) MARY JO ANDERSON CHS...................................................................... CHAIR/TRUSTEE	12.0 ................. 3.0	X	X	0	0
(2) CHRISTOPHER VAN GORDER...................................................................... PRESIDENT & CEO/TRUSTEE	57.0 ................. 3.0	X	X	8,696,338	1,144,618
(3) GORDON R CLARK...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(4) GENE H BARDUSON...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(5) RICHARD C BIGELOW...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(6) DOUGLAS A BINGHAM ESQ...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(7) JEFF BOWMAN...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(8) JAN CALDWELL...................................................................... VICE CHAIR/TRUSTEE	12.0 ................. 3.0	X	X	0	0
(9) JUDY CHURCHILL PHD...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(10) NICOLE A CLAY...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(11) DON GOLDMAN...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(12) ADOLFO GONZALES...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(13) KATHERINE A LAUER...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(14) MARTY J LEVIN...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(15) RICHARD VORTMANN...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(16) ABBY SILVERMAN WEISS...................................................................... TRUSTEE	12.0 ................. 3.0	X		0	0
(17) GALE D KEEL...................................................................... ASSISTANT SECRETARY	39.0 ................. 1.0		X	71,321	16,792

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) RICHARD ROTHBERGER........................................................................ TREASURER/EXECUTIVE VP/CFO	53.0 .......................2.0	X				1,855,884	102,287
(19) RICHARD R SHERIDAN........................................................................ SEC/CORP SR VP-HR/GEN COUNSL	53.0 .......................2.0	X				2,399,485	477,845
(20) ROBIN BROWN........................................................................ CHIEF EXECUTIVE, SR VP	50.0 .......................0.0		X			3,395,257	288,940
(21) MARY ELLEN DOYLE........................................................................ CORP VP, NURSING OPS	50.0 .......................0.0		X			583,715	43,274
(22) JOHN ENGLE........................................................................ CORP SR VP, CHIEF DEVELOPMENT	50.0 .......................0.0		X			672,310	125,804
(23) CARL ETTER........................................................................ CHIEF EXECUTIVE, SR VP	50.0 .......................0.0		X			823,859	134,833
(24) SHIRAZ FAGAN........................................................................ CHIEF EXECUTIVE, SR VP	50.0 .......................0.0		X			968,097	180,203
(25) GARY FYBEL........................................................................ CHIEF EXECUTIVE, SR VP	50.0 .......................0.0		X			1,179,195	70,001
(26) THOMAS GAMMIERE........................................................................ CHIEF EXECUTIVE, SR VP	50.0 .......................0.0		X			950,534	188,625
(27) JAMES LABELLE MD........................................................................ CORP SR VP, CHIEF MED OFFICER	50.0 .......................0.0		X			959,555	183,990
(28) JUNE KOMAR........................................................................ CORP EXEC VP, STRATEGY & ADMIN	50.0 .......................0.0		X			5,366,811	346,217
(29) RICHARD NEALE........................................................................ CORP EXEC VP, CHIEF GROWTH OFF	50.0 .......................0.0		X			708,260	119,751
(30) BARBARA PRICE........................................................................ CORP SRVP, BUS & SERV LINE DEV	50.0 .......................0.0		X			814,869	164,782
(31) MARC A REYNOLDS........................................................................ CORP SR VP, PAYER RELATIONS	30.0 .......................20.0		X			723,248	62,597
(32) JAMES CROWDER........................................................................ CORP SR VP, CIO	50.0 .......................0.0		X			582,651	127,719
(33) DAVID COHN........................................................................ CORP VP, REVENUE CYCLE	50.0 .......................0.0			X		515,274	102,705
(34) BRADLEY ELLIS........................................................................ CORP VP, ASST GENERAL COUNSEL	49.0 .......................1.0			X		480,520	93,747
(35) ROBERT T HOFF........................................................................ CORP VP, HORIZONTAL OPS	50.0 .......................0.0			X		560,760	94,668
(36) JOHN POOLE........................................................................ CORP VP, SYSTEM IMPROVEMENT	50.0 .......................0.0			X		508,422	103,107
(37) BRUCE RAINEY........................................................................ CORP VP, CONSTRUCTION/FACS	50.0 .......................0.0			X		546,739	87,574
(38) VICTOR V BUZACHERO........................................................................ FORMER KEY EMPLOYEE	0.0 .......................0.0				X	944,067	24,546

(A) Name and business address	(B) Description of services	(C) Compensation
SCRIPPS CLINIC MEDICAL GROUP INC, 10666 N TORREY PINES ROAD LA JOLLA,CA92037	PHYSICIAN SERVICES	287,891,979
SCRIPPS COASTAL MEDICAL GROUP, 501 WASHINGTON AVENUE SAN DIEGO,CA92103	PHYSICIAN SERVICES	46,992,729
MEDIMPACT HEALTHCARE SYSTEMS, 10181 SCRIPPS GATEWAY COURT SAN DIEGO,CA92131	PHARMACEUTICAL SVCS	27,285,099
SCRIPPS HOSPITAL INPATIENT PROVIDER, 10010 CAMPUS POINT DRIVE SAN DIEGO,CA92121	PHYSICIAN SERVICES	20,025,677
EMERGENCY ACUTE CARE MED CORP, 440 STEVENS AVE STE 150 SAN DIEGO,CA92075	PHYSICIAN SERVICES	14,983,561
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 140

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(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

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SCRIPPS HEALTH

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SCRIPPS HEALTH		Employer identification number 95-1684089

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SCRIPPS HEALTH			Employer identification number 95-1684089
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Yes

100

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

624,302

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

244,850

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

240,505

Total. Add lines 1c through 1i ....................................................................................................

1,109,757

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B	PUBLIC AFFAIRS INFORMATION AND EDUCATION SCRIPPS HEALTH ON ITS OWN BEHALF AND AS A MEMBER OF SEVERAL HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS PARTICIPATES IN PUBLIC AFFAIRS AND ADVOCACY ACTIVITIES. SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY AND SPECIFICALLY ON BEHALF OF SCRIPPS HEALTH. OTHER ACTIVITY IS ORGANIZED BY THESE INVOLVED ORGANIZATIONS SUPPORTED BY SCRIPPS HEALTH PARTICIPATION. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: ACCOUNTABLE CARE ACT (HEALTH REFORM); BUDGET AND FISCAL POLICY IMPACTS; REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY AND THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; UNINSURED, COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING, VALUE-BASED PURCHASING; BUNDLED PAYMENTS; ACCOUNTABLE CARE ORGANIZATIONS, MEDICARE, MEDICAID. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. DIRECT COMMUNICATION (MEETINGS, EMAIL, CALLS, LETTERS) WITH SAN DIEGO LEGISLATIVE DELEGATIONS FEDERAL AND STATE. ON SAN DIEGO LOCAL LEVEL EMPLOYED SD LAND LAWYERS TO REPRESENT INTERESTS ON LAND DEVELOPMENT NEEDS. ON CALIFORNIA STATE LEVEL EMPLOYED LOBBY FIRM JGC GOVERNMENT RELATIONS TO REPRESENT INTERESTS ON CERTAIN MEASURES. LOBBY FIRM ALSO WORKED WITH OTHER HEALTH SYSTEM CONTRACT LOBBYISTS AND CALIFORNIA HOSPITAL ASSOCIATION LOBBY TEAM ON SELECTED LEGISLATION. WORKED FREQUENTLY IN CONCERT WITH STATE AND NATIONAL HEALTH CARE ORGANIZATIONS THAT CONDUCTED LOBBY PROGRAMS, INCLUDING: AMERICAN HOSPITAL ASSOCIATION, CALIFORNIA HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES, PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, ALLIANCE OF CATHOLIC HEALTH CARE. SCRIPPS HEALTH DID NOT FILE FORM 5768 UNDER SECTION 501(H). THERE ARE TESTS FOR TAX EXEMPTION A "SUBSTANTIAL PART TESTAN "EXPENDITURE TEST." AS A 501(C)(3) ORGANIZATION, WE CAN OPT TO FOLLOW THE GUIDELINE THAT "NO SUBSTANTIAL PART" OF OUR ACTIVITIES ARE CARRIED ON TO INFLUENCE LEGISLATION. UNDER SECTION 501(H), ELIGIBLE 501(C)(3) ORGANIZATIONS CAN ELECT TO MAKE LIMITED EXPENDITURES TO INFLUENCE LEGISLATION. THE "EXPENDITURE TEST" IS SUBJECT TO AMOUNTS PERMITTED BY THAT SECTION. WHILE OUR EXPENDITURES FALL WELL BELOW THE LIMITS, WE ALSO EXPEND WHAT IS GENERALLY CONSIDERED AS NO SUBSTANTIAL PART ON SUCH EXPENDITURES. THEREFORE, WE OPT NOT TO FILE FORM 5768, THE FORM REQUIRED UNDER SECTION 501(H). NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE SCHEDULE C, PART II - B, LINE 1B PERSONS AT SCRIPPS HEALTH EXCEEDED 5% OF TOTAL TIME SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES. SCHEDULE C, PART II - B, LINE 1D POSTAGE FOR COMMUNITY LETTER SENT TO NEIGHBORS ADJACENT TO SCRIPPS PROPOSED MEDICAL OFFICE BUILDING IN OCEANSIDE AS PART OF PERMITTING REQUIREMENTS AT THE CITY. SCHEDULE C, PART II - B, LINE 1F TRANSFER OF SCRIPPS FUNDS FROM CHA ACCOUNT TO CALIFORNIA HOSPITALS COMMITTEE ON ISSUES ID #880212. SCHEDULE C, PART II - B, LINE 1G VALUE DETERMINED UTILIZING GROSS-UP METHOD FOR DIRECT LOBBYING COSTS. LOBBYING LABOR COSTS OF (2) PERSONS AT SCRIPPS HEALTH X 175% + ALLOCABLE THIRD-PARTY COSTS (JGC CONSULTING, SD LAND LAWYERS) SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES ARE REFERENCED HERE. SCHEDULE C, PART II - B, LINE 1I OTHER ACTIVITIES APPROXIMATE VALUE CONSIDERS A PORTION OF THE DUES OF MEMBER ORGANIZATIONS SPENT ON LOBBYING IN ADDITION TO ANY TRAVEL EXPENSES OCCURRED FOR GOVERNMENT RELATIONS: SENIOR DIRECTOR, GOVERNMENT RELATIONS; DIRECTOR, COMMUNITY RELATIONS RELATED TO LOBBYING ACTIVITIES.

Return Reference

Explanation

SCHEDULE C, PART II-B

PUBLIC AFFAIRS INFORMATION AND EDUCATION SCRIPPS HEALTH ON ITS OWN BEHALF AND AS A MEMBER OF SEVERAL HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS PARTICIPATES IN PUBLIC AFFAIRS AND ADVOCACY ACTIVITIES. SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY AND SPECIFICALLY ON BEHALF OF SCRIPPS HEALTH. OTHER ACTIVITY IS ORGANIZED BY THESE INVOLVED ORGANIZATIONS SUPPORTED BY SCRIPPS HEALTH PARTICIPATION. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: ACCOUNTABLE CARE ACT (HEALTH REFORM); BUDGET AND FISCAL POLICY IMPACTS; REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY AND THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; UNINSURED, COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING, VALUE-BASED PURCHASING; BUNDLED PAYMENTS; ACCOUNTABLE CARE ORGANIZATIONS, MEDICARE, MEDICAID. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. DIRECT COMMUNICATION (MEETINGS, EMAIL, CALLS, LETTERS) WITH SAN DIEGO LEGISLATIVE DELEGATIONS FEDERAL AND STATE. ON SAN DIEGO LOCAL LEVEL EMPLOYED SD LAND LAWYERS TO REPRESENT INTERESTS ON LAND DEVELOPMENT NEEDS. ON CALIFORNIA STATE LEVEL EMPLOYED LOBBY FIRM JGC GOVERNMENT RELATIONS TO REPRESENT INTERESTS ON CERTAIN MEASURES. LOBBY FIRM ALSO WORKED WITH OTHER HEALTH SYSTEM CONTRACT LOBBYISTS AND CALIFORNIA HOSPITAL ASSOCIATION LOBBY TEAM ON SELECTED LEGISLATION. WORKED FREQUENTLY IN CONCERT WITH STATE AND NATIONAL HEALTH CARE ORGANIZATIONS THAT CONDUCTED LOBBY PROGRAMS, INCLUDING: AMERICAN HOSPITAL ASSOCIATION, CALIFORNIA HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES, PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, ALLIANCE OF CATHOLIC HEALTH CARE. SCRIPPS HEALTH DID NOT FILE FORM 5768 UNDER SECTION 501(H). THERE ARE TESTS FOR TAX EXEMPTION A "SUBSTANTIAL PART TESTAN "EXPENDITURE TEST." AS A 501(C)(3) ORGANIZATION, WE CAN OPT TO FOLLOW THE GUIDELINE THAT "NO SUBSTANTIAL PART" OF OUR ACTIVITIES ARE CARRIED ON TO INFLUENCE LEGISLATION. UNDER SECTION 501(H), ELIGIBLE 501(C)(3) ORGANIZATIONS CAN ELECT TO MAKE LIMITED EXPENDITURES TO INFLUENCE LEGISLATION. THE "EXPENDITURE TEST" IS SUBJECT TO AMOUNTS PERMITTED BY THAT SECTION. WHILE OUR EXPENDITURES FALL WELL BELOW THE LIMITS, WE ALSO EXPEND WHAT IS GENERALLY CONSIDERED AS NO SUBSTANTIAL PART ON SUCH EXPENDITURES. THEREFORE, WE OPT NOT TO FILE FORM 5768, THE FORM REQUIRED UNDER SECTION 501(H). NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE SCHEDULE C, PART II - B, LINE 1B PERSONS AT SCRIPPS HEALTH EXCEEDED 5% OF TOTAL TIME SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES. SCHEDULE C, PART II - B, LINE 1D POSTAGE FOR COMMUNITY LETTER SENT TO NEIGHBORS ADJACENT TO SCRIPPS PROPOSED MEDICAL OFFICE BUILDING IN OCEANSIDE AS PART OF PERMITTING REQUIREMENTS AT THE CITY. SCHEDULE C, PART II - B, LINE 1F TRANSFER OF SCRIPPS FUNDS FROM CHA ACCOUNT TO CALIFORNIA HOSPITALS COMMITTEE ON ISSUES ID #880212. SCHEDULE C, PART II - B, LINE 1G VALUE DETERMINED UTILIZING GROSS-UP METHOD FOR DIRECT LOBBYING COSTS. LOBBYING LABOR COSTS OF (2) PERSONS AT SCRIPPS HEALTH X 175% + ALLOCABLE THIRD-PARTY COSTS (JGC CONSULTING, SD LAND LAWYERS) SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES ARE REFERENCED HERE. SCHEDULE C, PART II - B, LINE 1I OTHER ACTIVITIES APPROXIMATE VALUE CONSIDERS A PORTION OF THE DUES OF MEMBER ORGANIZATIONS SPENT ON LOBBYING IN ADDITION TO ANY TRAVEL EXPENSES OCCURRED FOR GOVERNMENT RELATIONS: SENIOR DIRECTOR, GOVERNMENT RELATIONS; DIRECTOR, COMMUNITY RELATIONS RELATED TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(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 ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.

			Held at the End of the Year
a	Total number of conservation easements ......................	2a	1
b	Total acreage restricted by conservation easements ....................	2b	16.00
c	Number of conservation easements on a certified historic structure included in (a) .....	2c	1
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

75.00

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

$ 431,342

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	124,841,000	116,324,000	108,926,000	117,167,000	112,290,000
b	Contributions ...	1,966,841	317,621	6,315,759	1,388,206	1,480,000
c	Net investment earnings, gains, and losses	6,490,061	13,011,507	7,473,883	-3,512,026	9,068,000
d	Grants or scholarships ...	810,928	925,456	1,437,223	1,345,734	871,000
e	Other expenditures for facilities and programs ...	11,995,794	2,761,983	3,833,012	3,632,176	3,853,000
f	Administrative expenses ....	1,102,180	1,124,689	1,121,407	1,139,270	947,000
g	End of year balance ......	119,389,000	124,841,000	116,324,000	108,926,000	117,167,000

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	22,362,333	98,325,541		120,687,874
b	Buildings ....		1,754,982,300	709,905,252	1,045,077,048
c	Leasehold improvements		94,246,916	72,554,102	21,692,814
d	Equipment ....		1,518,553,455	1,012,170,757	506,382,698
e	Other .....		124,509,433	1,889,964	122,619,469
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					1,816,459,903

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(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........
(3) Other (A) MULTI-STRATEGY FUNDS	325,408,000	F
(B) PRIVATE EQUITY FUNDS	56,290,000	F
(C) DEFENSIVE EQUITY FUNDS	47,198,000	F
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	428,896,000

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	111,525,650
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

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART II, LINE 3	CHANGES TO CONSERVATION EASEMENTS THE JONES' HOUSE WAS SOLD IN JUNE 2018. SCHEDULE D, PART II, LINE 9 CONSERVATION EASEMENT THE HISTORICAL STRUCTURE THAT IS CONSIDERED TO BE A CONSERVATIVE EASEMENT IS REPORTED IN THE MERCY HOSPITAL ENTITY OF THE CONSOLIDATED FINANCIAL STATEMENTS.
SCHEDULE D, PART V, LINE 1E	IN FEBRUARY 2018, SCRIPPS HEALTH TRANSFERRED AN ENDOWMENT TO ANOTHER ORGANIZATION AS SCRIPPS HEALTH NO LONGER PROVIDED THE SERVICES FOR WHICH THE MONIES WERE DONATED TO SUPPORT. THIS TRANSFER INCLUDED $5,000,000 OF CORPUS AND $2,330,000 OF UNDISTRIBUTED INVESTMENT EARNINGS THEREON, WHICH HAS BEEN INCLUDED AS AN EXPENSE HERE. SCHEDULE D, PART V, LINE 4 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES: $636,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES: $16,790,676 CONTRIBUTIONS RECEIVED FOR USE IN SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS: $39,818,206 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE: $12,784,795 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS: $12,225,243
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS UNDER ASC 740 (AKA FIN 48) SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSE FOR WHICH IT WAS GRANTED EXEMPTION. UNDER FASB ASC 740, INCOME TAXES, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE ORGANIZATION RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE ORGANIZATION RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS ONLY FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AT SEPTEMBER 30, 2018 OR 2017. SCRIPPS HEALTH CURRENTLY FILES FORM 990 (INFORMATIONAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAXES) AND FORM 990-T (BUSINESS INCOME TAX RETURN FOR AN EXEMPT ORGANIZATION) IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. SCRIPPS HEALTH IS NOT SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2014 IN MAJOR TAX JURISDICTIONS.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	North America	58	Program Services	RECONSTRUCTIVE SURGERY	300,650
	East Asia and the Pacific	7	Program Services	MED CARE & TRAINING	19,565
	Central America and the Caribbean		Investments		50,472,858
	Europe (Including Iceland and Greenland)		Investments		38,840,627













3a	Sub-total ....	65			89,633,700
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	65			89,633,700

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2019

Schedule F (Form 990) 2019

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2019

Schedule F (Form 990) 2019Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2019

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2019

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
SCHEDULE F, PART I, LINE 3, COLUMN F	ACCOUNTING METHOD THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS IN COLUMN F.

Schedule F (Form 990) 2019

Additional Data

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Software Version:

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SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Mercy Ball (event type)	(b) Event #2 Spinoff (event type)	(c) Other events 4 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	659,575	525,622	1,398,276	2,583,473
2	Less: Contributions . . . .	607,792	482,147	1,231,221	2,321,160
3	Gross income (line 1 minus line 2) . . . . . .	51,783	43,475	167,055	262,313

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	138,020	118,402	456,336	712,758
7	Food and beverages . . .	4,827	2,274	1,056	8,157
8	Entertainment . . . .	9,200	5,750	11,728	26,678
9	Other direct expenses . . .	38,512	54,256	162,457	255,225
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				1,002,818
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-740,505

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

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) . . .	20,245,366		20,245,366	0.680 %
b	Medicaid (from Worksheet 3, column a) . . . . .	295,179,522	247,707,203	47,472,319	1.590 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	472,607	209,321	263,286	0.010 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	315,897,495	247,916,524	67,980,971	2.280 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	5,130,396	2,860,610	2,269,786	0.080 %
f	Health professions education (from Worksheet 5) . . .	33,075,388	8,091,014	24,984,374	0.840 %
g	Subsidized health services (from Worksheet 6) . . . .	18,264,402	14,446,617	3,817,785	0.130 %
h	Research (from Worksheet 7) .	12,429,137	10,655,685	1,773,452	0.060 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	3,075,871	10,974	3,064,897	0.100 %
j	Total. Other Benefits . .	71,975,194	36,064,900	35,910,294	1.200 %
k	Total. Add lines 7d and 7j .	387,872,689	283,981,424	103,891,265	3.480 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	39,971		39,971	0 %
3	Community support	721,938		721,938	0.020 %
4	Environmental improvements
5	Leadership development and training for community members	25,000		25,000	0 %
6	Coalition building	39,853	27,393	12,460
7	Community health improvement advocacy	31,976		31,976	0 %
8	Workforce development	424,223	122,547	301,676	0.010 %
9	Other
10	Total	1,282,961	149,940	1,133,021	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

44,399,429

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

421,488,134

Enter Medicare allowable costs of care relating to payments on line 5.....

501,521,149

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-80,033,015

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1SCRIPPS ENCINITAS	AMBULATORY SURGERY CENTER	55.5 %	25 %
2SURGERY CENTER
3SCRIPPS MEMORIAL	MEDICAL OFFICE BUILDING	15.3 %	77.2 %
4XIMED MEDICAL
5SCRIPPS MERCY ASC	AMBULATORY SURGERY CENTER	73.5 %	26.5 %
6SCRIPPSUSP SURGERY	AMBULATORY SURGERY CENTER	50 %	39 %
7CENTERS
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

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?4Name, 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)							Facility reporting group
1	SCRIPPS MERCY HOSPITAL 4077 5TH AVENUE SAN DIEGO,CA92103 WWW.SCRIPPS.ORG 090000074	X	X	X	X	X	A
2	SCRIPPS MEMORIAL HOSPITAL LA JOLLA 9888 GENESEE AVENUE LA JOLLA,CA92037 WWW.SCRIPPS.ORG 080000050	X	X	X	X	X	A
3	SCRIPPS GREEN HOSPITAL 10666 NORTH TORREY PINES ROAD LA JOLLA,CA92037 WWW.SCRIPPS.ORG 080000139	X	X	X	X		A
4	SCRIPPS MEMORIAL HOSPITAL ENCINITAS 354 SANTA FE DRIVE SAN DIEGO,CA92024 WWW.SCRIPPS.ORG 080000148	X	X	X	X	X	A

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
SCHEDULE H, PART V, LINE 3E	THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. WITH THE HEALTH AND SOCIAL PRIORITY AREAS IDENTIFIED, SCRIPPS HAS DEVELOPED VARIOUS INITIATIVES, STRATEGIES AND METRICS TO MEASURE AND EVALUATE THE EFFECTIVNESS OF THE NEEDS IDENTIFIED IN THE CHNA. SCHEDULE H, PART V, LINE 5 REPORTING GROUP A HEALTH EXPERTS, COMMUNITY LEADERS AND RESIDENTS FEEDBACK COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED IN THE 2016 CHNA WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATIONS SURVEY - SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY - BEHAVIORAL HEALTH DISCUSSIONS THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN-DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY PARTNER DISCUSSIONS COMMUNITY PARTNER DISCUSSIONS WERE CONDUCTED IN ALL REGIONS OF THE COUNTY BETWEEN JULY AND OCTOBER OF 2015, WITH 87 TOTAL PARTICIPANTS. NON-TRADITIONAL STAKEHOLDERS WERE RECRUITED THROUGH EXISTING COMMUNITY PARTNERSHIPS IN ORDER TO SOLICIT INPUT FROM THOSE WHO WORK DIRECTLY WITH MORE VULNERABLE POPULATIONS. A NON-TRADITIONAL STAKEHOLDER IS DEFINED AS AN INDIVIDUAL OR GROUP WHO HAS NOT BEEN CONSISTENTLY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGHOUT PREVIOUS CYCLES OF THE CHNA. THESE STAKEHOLDERS (COMMUNITY PARTNERS) WERE COMPRISED OF INDIVIDUALS FROM A VARIETY OF BACKGROUNDS INCLUDING: CARE COORDINATORS, OUTREACH WORKERS, COMMUNITY EDUCATION SPECIALISTS, WELLNESS COORDINATORS, SCHOOL NURSES, BEHAVIORAL HEALTH MANAGERS AND WORKERS, CALFRESH OUTREACH COORDINATORS, AND CALFRESH CAPACITY COORDINATORS (CAPACITY COORDINATORS HELP TO BUILD CAPACITY AND COMMUNITY SUPPORT, IMPLEMENT NEW PROJECTS AND PROVIDE TECHNICAL SUPPORT TO BETTER ADDRESS POVERTY AND HUNGER). BEHAVIORAL HEALTH DISCUSSIONS THREE BEHAVIORAL HEALTH DISCUSSIONS TOOK PLACE BETWEEN DECEMBER 2015 AND JANUARY 2016. THE COMBINED TOTAL NUMBER OF ATTENDEES WAS ROUGHLY 58 PEOPLE BETWEEN THE TWO MEETINGS. DUE TO THE COMPLEXITY OF BEHAVIORAL HEALTH, ADDITIONAL DISCUSSIONS WERE HELD SPECIFICALLY TO ENSURE THE QUANTITATIVE DATA THAT WAS GATHERED ACCURATELY REFLECTED CURRENT TRENDS AND AREAS OF TRUE NEED. THE PURPOSE OF THE BEHAVIORAL HEALTH DISCUSSIONS WAS TO GATHER FEEDBACK FROM BEHAVIORAL HEALTH EXPERTS TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY AND AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN BEHAVIORAL HEALTH. MEETINGS FOCUSED ON BEHAVIORAL HEALTH WERE TARGETED TO SOLICIT FEEDBACK FROM STAKEHOLDERS INCLUDING PATIENT ADVOCATES AS WELL AS REPRESENTATIVES FROM HOSPITALS, CLINICS, COUNTY HEALTH & HUMAN SERVICES AGENCY (HHSA), SMALLER BEHAVIORAL OR MENTAL HEALTH FACILITIES, AND HEALTH PLANS. THE BEHAVIORAL HEALTH DISCUSSION TEMPLATE WAS DEVELOPED BASED ON HOSPITAL DISCHARGE DATA ANALYSIS AND INCORPORATED A SYNTHESIS OF THE COMMUNITY PARTNER DISCUSSION DATA. A SUMMARY OF DATA AS IT RELATES TO BEHAVIORAL HEALTH NEEDS WAS PROVIDED TO THE BEHAVIORAL HEALTH EXPERTS PRIOR TO GAINING THEIR FEEDBACK. KEY INFORMANT INTERVIEWS IN RESPONSE TO FEEDBACK FROM THE 2013 CHNA, THE NUMBER OF KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE 2016 CHNA WAS EXPANDED TO INCLUDE EXPERTS WORKING WITH A WIDER VARIETY OF PATIENT POPULATIONS. PARTICIPANTS WERE SELECTED BASED ON THEIR EXPERTISE IN A SPECIFIC CONDITION, AGE GROUP, AND/OR POPULATION. MORE SPECIFICALLY, INDIVIDUALS WHO PARTICIPATED IN THE 2016 CHNA HAD KNOWLEDGE IN AT LEAST ONE OF THE FOLLOWING AREAS: CHILDHOOD ISSUES, SENIOR HEALTH, NATIVE AMERICANS, LATINOS, ASIAN AMERICANS, REFUGEE AND FAMILIES, HOMELESS, LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ) POPULATION, VETERANS, ALCOHOL AND DRUG ADDICTION, CARDIOVASCULAR HEALTH, BEHAVIORAL HEALTH, DIABETES, OBESITY, AND FOOD INSECURITY. IN ADDITION, THERE WAS REPRESENTATION ACROSS MULTIPLE AGENCIES AND ORGANIZATIONS INCLUDING THE SAN DIEGO COUNTY HHSA, LOCAL SCHOOLS, YOUTH PROGRAMS, COMMUNITY CLINICS, AND COMMUNITY-BASED ORGANIZATIONS. THE DEVELOPMENT OF THE KEY INFORMANT INTERVIEW TOOL BEGAN WITH THE RESULTS FROM THE HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES (HASD&IC) 2013 CHNA. THE INTERVIEW QUESTIONS WERE DESIGNED TO PROVIDE IN-DEPTH DETAIL ON THE TOP FOUR HEALTH NEEDS. NINETEEN KEY INFORMANT INTERVIEWS TOOK PLACE EITHER IN-PERSON OR VIA PHONE INTERVIEW BETWEEN JULY 2015 AND FEBRUARY 2016. EACH INTERVIEW LASTED NO LONGER THAN ONE HOUR. SIX QUESTIONS WERE ASKED DURING THE INTERVIEWS, WITH A PARTICULAR FOCUS ON THE TOP FOUR HEALTH NEEDS THAT WERE IDENTIFIED IN THE 2013 CHNA. ALTHOUGH THERE WERE SPECIFIC QUESTIONS ASKED, THE FORMAT OF THE INTERVIEWS ALLOWED FOR AMPLE OPPORTUNITY FOR OPEN DISCUSSION ON HEALTH NEEDS THAT THE KEY INFORMANTS FELT WERE MOST IMPORTANT IN SAN DIEGO COUNTY, INCLUDING THOSE NOT DIRECTLY RELATED TO THE TOP FOUR HEALTH NEEDS. SOME IMPORTANT STRATEGIES THAT KEY INFORMANTS SUGGESTED INCLUDED BEHAVIORAL HEALTH PREVENTION AND STIGMA REDUCTION, EDUCATION ON DISEASE MANAGEMENT AND FOOD INSECURITY, IMPROVING CULTURAL COMPETENCY AND DIVERSITY, AND INTEGRATING PHYSICAL AND MENTAL HEALTH, COORDINATING SERVICES ACROSS THE CONTINUUM, AND ENGAGING CASE MANAGERS AND PATIENT NAVIGATORS IN THE COMMUNITY AND INCORPORATING THEM AS A ROUTINE PART OF THE CONTINUUM OF CARE. SURVEYS TWO DIFFERENT SURVEYS WERE DEVELOPED AND DISSEMINATED THROUGH DIFFERENT AVENUES AS PART OF THE 2016 CHNA PROCESS - THE HEALTH ACCESS AND NAVIGATION SURVEY AND THE COLLABORATIVE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY. HEALTH ACCESS AND NAVIGATION SURVEY THE HEALTH ACCESS AND NAVIGATION SURVEY WAS DEVELOPED IN PARTNERSHIP WITH THE SAN DIEGO COUNTY RESIDENT LEADERSHIP ACADEMY (RLA). AFTER COMPARING RESULTS OF THE RLA'S 2014 COMMUNITY NEEDS ASSESSMENT AND WITH THE FINDINGS FROM THE HASD&IC 2013 CHNA, ACCESS AND NAVIGATION OF HEALTH CARE EMERGED AS A COMMON BARRIER IDENTIFIED BY THE SAN DIEGO COMMUNITY. THE CHNA COMMITTEE COLLABORATED WITH THE RLA TO DESIGN A SURVEY TOOL THAT COULD IDENTIFY SPECIFIC BARRIERS RESIDENTS FACE WHEN THEY TRY TO ACCESS HEALTH CARE SERVICES. RLA LEADERS AGREED TO DISSEMINATE THE HEALTH ACCESS AND NAVIGATION SURVEY TO RESIDENTS IN THEIR NEIGHBORHOODS. THE ROADMAP SURVEY WAS DESIGNED TO IDENTIFY PARTICULAR AREAS IN WHICH RESIDENTS STRUGGLE WHEN THEY ARE USING THE HEALTH SYSTEM. THE SURVEYS WERE FIELDED ON SEPTEMBER 22, 2015 AND CLOSED NOVEMBER 2, 2015. SURVEY RESPONSES WERE COLLECTED BOTH ELECTRONICALLY AND VIA PAPER AND PENCIL FORMAT FROM COMMUNITY RESIDENTS. PAPER AND ELECTRONIC COPIES OF THE SURVEY WERE MADE AVAILABLE TO THE RLA LEADERS IN SPANISH, ENGLISH, AND ARABIC. AN ONLINE SURVEY LINK WAS ALSO EMAILED OUT IN BOTH SPANISH AND ENGLISH. A TOTAL OF 235 SURVEYS WERE COMPLETED WITH THE MAJORITY BEING COMPLETED ON PAPER (181) AND 54 COMPLETED VIA THE ONLINE SURVEY. ONE HUNDRED AND ELEVEN PAPER SURVEYS AND ZERO ONLINE SURVEYS WERE COMPLETED IN SPANISH. SEVENTY PAPER AND 54 ONLINE SURVEYS WERE COMPLETED IN ENGLISH. NO ARABIC SURVEYS WERE COLLECTED OR COMPLETED. SURVEY PARTICIPANTS WERE ASKED TO CHOOSE THE TOP FIVE BARRIERS THE PARTICIPANTS OR THE POPULATION THEY WORK WITH EXPERIENCE, AND TO RANK THE FIVE BARRIERS FROM ONE TO FIVE, WITH ONE BEING THE MOST TROUBLESOME. MOST STRIKING WAS THAT THE TOP FOUR BARRIERS CITED AS MOST TROUBLESOME WERE ALL PRECURSORS TO SEEING A HEALTH CARE PROVIDER, INDICATING THAT COMMUNITY MEMBERS ARE OFTEN STRUGGLING TO MAKE IT PAST THE FIRST STEPS OF ACCESSING HEALTHCARE. BASED ON THE SURVEY RESPONSES, THE TOP FIVE BARRIERS TO ACCESSING HEALTH CARE WERE: - UNDERSTANDING HEALTH INSURANCE - GETTING HEALTH INSURANCE - USING HEALTH INSURANCE - KNOWING WHERE TO GO FOR CARE - FOLLOW UP CARE AND/OR APPOINTMENT AS THE NUMBER OF INDIVIDUALS WHO HAVE HEALTH INSURANCE IN THE NATION AND WITHIN SAN DIEGO COUNTY HAS INCREASED, SO HAS THE IMPORTANCE OF HELPING PEOPLE UNDERSTAND HOW TO OBTAI
SCHEDULE H, PART V, LINE 6A	REPORTING GROUP A GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTHCARE SYSTEMS CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND TO MEET IRS REGULATORY REQUIREMENTS. SCRIPPS CONDUCTED ONE CHNA FOR THE SYSTEM. BEGINNING IN MAY 2015 WITH COMPLETION IN APRIL 2016, THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY MANAGED THE DESIGN, IMPLEMENTATION AND INTERPRETATION OF THE CHNA PROCESS. PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WERE ALL REPRESENTED IN THE CHNA ADVISORY WORKGROUP: - KAISER FOUNDATION HOSPITAL - SAN DIEGO - PALOMAR HEALTH - RADY CHILDREN'S HOSPITAL - SAN DIEGO - SCRIPPS HEALTH - SHARP HEALTHCARE - TRI-CITY MEDICAL CENTER - UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM
SCHEDULE H, PART V, LINE 6B	REPORTING GROUP A IN MAY 2015, THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. SCRIPPS CONDUCTED ONE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE SYSTEM. SCHEDULE H, PART V, LINE 7A REPORTING GROUP A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS
SCHEDULE H, PART V, LINE 10A	REPORTING GROUP A THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS
SCHEDULE H, PART V, LINE 11	REPORTING GROUP A IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT SCRIPPS HEALTH IS FOCUSING ON THE FOUR PRIORITIZED HEALTH NEEDS (CARDIOVASCULAR DISEASE AND STROKE, DIABETES TYPE 2, BEHAVIORAL HEALTH, AND OBESITY). SCRIPPS HAS DEVELOPED VARIOUS INITIATIVES, STRATEGIES AND METRICS TO MEASURE AND EVALUATE THE EFFECTIVENESS OF THE PROGRAMS. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: https://www.scripps.org/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ASSESSING-COMMUN ITY-NEEDS SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO PROVIDE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE HEALTH CARE NEEDS OF THE REGION'S MOST VULNERABLE POPULATIONS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 CHNA IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES (TYPE 2), AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITHIN EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMER'S DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATIONS RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMER'S DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY - A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO THE CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES DESCRIBED AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED IN THE 2016 CHNA (BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, DIABETES TYPE 2 AND OBESITY), TEN SOCIAL DETERMINANTS OF HEALTH NEEDS WERE ALSO KEY THEMES AND REFERENCES IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. THESE TEN SOCIAL DETERMINANTS OF HEALTH NEEDS ARE OUTLINED IN ORDER OF PRIORITY: FOOD INSECURITY AND ACCESS TO HEALTHY FOOD, ACCESS TO CARE OR SERVICES, HOMELESSNESS/HOUSING, PHYSICAL ACTIVITY, EDUCATION/KNOWLEDGE, CULTURAL COMPETENCY, TRANSPORTATION, INSURANCE ISSUES, STIGMA, AND POVERTY. SOME OF THESE SOCIAL DETERMINANTS OF HEALTH NEEDS ARE ADDRESSED WITHIN THE FOUR HEALTH CONDITIONS IDENTIFIED IN THE SCRIPPS IMPLEMENTATION PLAN SUCH AS ACCESS TO CARE, PHYSICAL ACTIVITY, AND EDUCATION/KNOWLEDGE THROUGH VARIOUS PROGRAM INTERVENTIONS. THE OTHER NEEDS WERE NOT ADDRESSED IN DETAIL IN THE SCRIPPS IMPLEMENTATION STRATEGY DUE TO LIMITED FINANCIAL AND/OR STAFFING CONSTRAINTS AND A LACK OF EXPERTISE OR COMPETENCY TO EFFECTIVELY ADDRESS THE NEEDS. IN ADDITION, SOME OF THESE ISSUES ARE BEING ADDRESSED BY OTHER PROVIDERS IN THE SAN DIEGO COMMUNITY WHO HAVE MORE EXPERTISE. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO THE EXPLORATION OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE NEEDS AND FUTURE NEEDS IDENTIFIED.
SCHEDULE H, PART V, LINE 13H	REPORTING GROUP A OTHER CRITERIA TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'S DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS.
SCHEDULE H, PART V, LINES 16A, 16B, & 16C	REPORTING GROUP A THE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY IS WIDELY AVAILABLE ON THE SCRIPPS HEALTH WEBSITE AT: https://www.scripps.org/patients-and-visitors/financial-assistance
SCHEDULE H, PART V, LINE 16J	REPORTING GROUP A THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO; - POSTERS IN CONSPICUOUS REGISTRATION AREAS I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS. - PAPER COPIES OF SCRIPPS FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSION AREAS. PATIENTS MAY ALTERNATIVELY REQUEST COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. - THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE CONSPICUOUSLY POSTED ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CONTAINS THE WEB SITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. - THE FINANCIAL ASSISTANCE SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT OF SERVICES AT A SCRIPPS FACILITY. - ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDES ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. - THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). - A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT COMMUNITY EVENTS AND IS PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. - SCRIPPS PROVIDES A COPY OF ITS POLICY AND RELATED INFORMATION TO THE CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. IN ADDITION, SCRIPPS POLICY IS AVAILABLE TO THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW IS FACILITATED THROUGH THE USE OF INTERPRETERS (LANGUAGE, VISION, AND HEARING) OR WRITTEN MATERIALS AS REQUESTED BY THE INDIVIDUAL.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

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?45
Name and address		Type of Facility (describe)
1	Scripps Clinic - Torrey Pines 10666 N Torrey Pines Road La Jolla,CA92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
2	Scripps Clinic - Rancho Bernardo 15004 Innovation Drive San Diego,CA92128	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
3	Scripps Clinic - Carmel Valley 3811 Valley Center Drive San Diego,CA92130	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
4	Scripps Medical Lab 9235 Waples Street 150 San Diego,CA92121	LABORATORY SERVICES
5	Scripps Clinic Anderson Medical Pavilion 9898 Genesee Avenue La Jolla,CA92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
6	Imaging Healthcare Specialists LLC 150 West Washington Street San Diego,CA92103	MEDICAL IMAGING SERVICES
7	Scripps Clinic - Encinitas 310 Santa Fe Drive Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
8	Scripps Home Health Services 9619 Cheaspeake Drive 300 San Diego,CA92123	Home Health Services
9	SCMC - Cedar 130 Cedar Road Vista,CA92083	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
10	SCMC - Encinitas 477 N El Camino Real A208 B305 Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
11	Scripps Clinic - Mission Valley 7565 Mission Valley Road San Diego,CA92108	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
12	SCMC - Carlsbad 2176 Salk Avenue Carlsbad,CA92008	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
13	SCMC - Hillcrest 501 Washington Steet 525 600 San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
14	Scripps Clinic - Rancho San Diego 10862 Calle Verde La Mesa,CA91941	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
15	Scripps Clinic-La Jolla Memorial Campus 9850 Genesee Avenue Ximed Bldg 60 San Diego,CA92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
16	Mercy ASC 550 Washington Street 1st Floor San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
17	Scripps Hospital Medical Services 10140 Campus Point Drive San Diego,CA92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
18	SCMC - Oceanside 4318 Mission Avenue Oceanside,CA92057	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
19	Encinitas Surgery Center LLC 320 Santa Fe Drive LL1-2 Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
20	SCMC - Encinitas OBGYN 332 Santa Fe Drive 115 Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
21	La Jolla Radiology - La Jolla 9888 Genesee Avenue La Jolla,CA92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
22	Scripps Cl Radiation Therapy Ctr - VISTA 916 Sycamore Avenue Suite 100 Vista,CA92082	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
23	Scripps Clinic - Del Mar 12395 El Camino Real 317 112 12 Del Mar,CA92130	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
24	Scripps Pharmacy - Green 10666 North Torrey Pines Road La Jolla,CA92037	MEDICAL PHARMACY
25	La Jolla Radiology - Encinitas 354 Santa Fe Drive Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
26	Scripps Cardio & Thor Surg CTR -LA JOLLA 9850 Genesee Avenue 560 La Jolla,CA92037	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
27	SCMC - Eastlake 971 Lane Avenue Chula Vista,CA91914	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
28	Scripps Clinic - San Diego OBGYN 2918 Fifth Avenue Suite 100 San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
29	La Jolla Radiology - MercyCV 4077 Fifth Avenue San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
30	SCMC - Solana Beach 380 Stevens Avenue 100 Solana Beach,CA92075	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
31	Scripps Clinic - Santee 278 Town Center Pkwy 105 Santee,CA92071	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
32	SCMC - Escondido 488 E Valley Pkwy 411 Escondido,CA92025	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
33	Scripps Clinic - La Jolla OBGYN 9850 Genesee Avenue 170 San Diego,CA92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
34	SCRIPPS CL RADIATION THRPY CTR ENCINITAS 477 N El Camino Real Suite D100 Encinitas,CA92024	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
35	Scripps Clinic - Hillcrest Surgery 4060 Fourth Avenue 330 San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
36	Scripps Pharmacy - Encinitas 354 Santa Fe Drive Encinitas,CA92024	MEDICAL PHARMACY
37	Scripps Clinic Mercy Campus 4020 Fifth Avenue 401 San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
38	Scripps Cardio & Thor Surg Ctr HILLCREST 501 Washington Steet 525 600 San Diego,CA92103	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
39	Scripps Clinic - Coronado 1317 A Ynes Place Coronado,CA92118	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
40	Scripps Clinic - Eastlake Specialty 971 Lane Avenue Chula Vista,CA91914	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
41	Scripps Clinic - UTC 9333 Genesee Avenue Suite 170 San Diego,CA92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
42	Scripps Clinic - Cedar Specialty 130 Cedar Road Vista,CA92083	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
43	SCRIPPS CLINIC - MD ANDERSON CANCER CTR 10670 John Jay Hopkins Drive La Jolla,CA92121	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
44	Scripps Clinic - Mental Health 15004 Innovation Drive San Diego,CA92128	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT
45	SCRIPPSUSP SURGERY CENTERS LLC 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001	PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

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.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE, AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS FINANCIAL ASSISTANCE POLICY (FAP) IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), Scripps WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, Scripps WILL FORGIVE A PORTION OF THE BILL. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AMOUNTS GENERALLY BILLED (AGB) AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. PATIENTS DETERMINED TO BE 'HOMELESSNOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100% FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART I, LINE 6A	SCRIPPS HEALTH COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY SCHEDULE H, PART I, LINE 7, COLUMN F A COST-TO-CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL PATIENT SEGMENTS REPORTED AS CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN EVEN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. SCRIPPS PROVIDES SUCH SERVICES BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, THEY WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION TO PROVIDE. SUBSIDIZED SERVICES DO NOT INCLUDE SUCH ANCILLARY SERVICES AS LAB WORK AND RADIOLOGY. IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE. SCRIPPS' TOTAL NET COST FOR SUBSIDIZED HEALTH SERVICES FOR FY18 WAS $3,817,785 THIS INCLUDES SCRIPPS INPATIENT AND BEHAVIORAL HEALTH SERVICES AND MERCY CLINIC. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO - FACILITY A-1 FOUNDED IN 1944 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 1,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY18 WERE $11,836. A FULL TIME CLINIC STAFF OF NURSES AND OTHER PERSONNEL WORK HAND-IN-HAND WITH PHYSICIANS FROM SCRIPPS MERCY HOSPITAL. AS AN INTEGRAL PART OF TREATING ITS PATIENTS, MERCY CLINIC SERVES AS A TRAINING GROUND FOR NEARLY 100 RESIDENTS EACH YEAR FROM THE SCRIPPS MERCY HOSPITAL GRADUATE MEDICAL EDUCATION PROGRAM. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S "WORKING AND DISABLED POOR". EACH YEAR, 90 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 10 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME, MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED NET COST FOR MERCY CLINIC FOR FY18 WAS $2.3 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE). SCHEDULE H, PART I, LINE 7 FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES, AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA LYON SOFTWARE'S COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CBISA WAS DEVELOPED IN COOPERATION WITH LYON SOFTWARE, THE CATHOLIC HEALTH ASSOCIATION (CHA) AND THE VETERANS HEALTH ADMINISTRATION. THE SOFTWARE SUPPLEMENTED THE ORIGINAL SOCIAL ACCOUNTABILITY BUDGET: A PROCESS FOR PLANNING AND REPORTING COMMUNITY SERVICE IN A TIME FOR FISCAL CONSTRAINT, PUBLISHED IN 1989, AND HAS BEEN REGULARLY UPGRADED AS COMMUNITY BENEFIT ACCOUNTING AND REPORTING METHODS HAVE EVOLVED AND AS COMMUNITY BENEFIT REPORTING HAS BECOME A FEDERAL REPORTING REQUIREMENT. THE CBISA DATABASE HELPS COLLECT, TRACK AND REPORT COMMUNITY BENEFIT EFFORTS AND IS ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN "ACTIVITY". FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. WHERE COST ACCOUNTING IS USED, SCRIPPS HEALTH ADDRESSES ALL PATIENT SEGMENTS FOR HOSPITAL FACILITIES. SCRIPPS UNCOMPENSATED CARE FY2018 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR CHARITY CARE ARE ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. HOSPITAL FEE PROGRAM (REFLECTED IN PART I, LINE 7B & 7I) THIRTY-MONTH HOSPITAL FEE PROGRAM DURING THE YEAR ENDED SEPTEMBER 30, 2018, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $241,538,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $183,990,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECORDED $2,295,000 FOR CHARITABLE CONTRIBUTIONS TO CHFT IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEALTH FROM PROVIDER FEE WAS $55,253,000 IN FISCAL YEAR 2018. CALENDAR YEAR 2014 - CALENDAR YEAR 2016 HOSPITAL FEE PROGRAM IN SEPTEMBER 2013, SB 239 WAS APPROVED AND CREATED A THREE-YEAR HOSPITAL FEE PROGRAM EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2016. ON DECEMBER 10, 2014, CALIFORNIA HOSPITAL ASSOCIATION (CHA) ANNOUNCED THAT CMS APPROVED THE FEE-FOR-SERVICE PAYMENTS FOR THE PERIOD JANUARY 1, 2014 TO DECEMBER 31, 2016. ON JUNE 30, 2015, CMS APPROVED THE NON-EXPANSION MANAGED CARE RATES FOR THE FIRST SIX MONTHS OF THE THIRTY-SIX MONTH HOSPITAL FEE PROGRAM.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2: EXECUTIVE LEADERSHIP EXECUTIVE LEADERSHIP, SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). NORTH SAN DIEGO BUSINESS CHAMBER HEALTH COMMITTEE MEETING - THE CHAMBER STRIVES TO DELIVER UP-TO-DATE, HEALTH-RELATED INFORMATION GO ENHANCE THE QUALITY OF LIFE TO THE BUSINESS COMMUNITY. THE HEALTH COMMITTEE SERVES AS A FRONT LINE TO EDUCATE SAN DIEGO NORTH BUSINESS ABOUT HEALTH CARE ISSUES SPECIFIC TO THE REGION THAT IMPACT BOTTOM LINES AND WORKFORCE PRODUCTIVITY. THE SCRIPPS DIRECTOR OF COMMUNITY RELATIONS ATTENDS THESE MEETINGS. COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3: NORTH SAN DIEGO BUSINESS CHAMBER HONORING OUR REGIONS HEROES HONORING OUR REGION'S HEROES AWARDS LUNCHEON, PRESENTED BY SCRIPPS HEALTH, HONORS THE DEDICATED OFFICERS, FIRST RESPONDERS, AND PUBLIC SAFETY LEADERS WHO HAVE GONE ABOVE AND BEYOND IN THEIR DUTIES. HOSPITAL PREPAREDNESS PROGRAM DEVELOPMENTAL COMMITTEE THE HOSPITAL PREPAREDNESS PROGRAM (HPP) PROVIDES LEADERSHIP AND FUNDING THROUGH GRANTS AND COOPERATIVE AGREEMENTS TO STATES, TERRITORIES, AND ELIGIBLE MUNICIPALITIES TO IMPROVE SURGE CAPACITY AND ENHANCE COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES. SCRIPPS HEALTH PARTICIPATES IN THE HPP GRANT FUNDING WORKGROUP. DISASTER PREPAREDNESS - COMMUNITY OUTREACH AND EDUCATION HAVING THE ABILITY TO PROVIDE EMERGENCY SERVICES TO THOSE INJURED IN A LOCAL DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS PARTICIPATES IN SAN DIEGO COUNTY AND STATE OF CALIFORNIA ADVISORY GROUPS TO PLAN, IMPLEMENT, AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND FUNDING EFFORTS. IN ADDITION, SCRIPPS MAINTAINS ACTIVE READINESS FOR THE SCRIPPS HOSPITAL MEDICAL RESPONSE TEAM OR THE SCRIPPS HOSPITAL ADMINISTRATION UNIT. BOTH ARE LEAD TEAMS FOR THE STATE OF CALIFORNIA MOBILE FIELD HOSPITAL DEPLOYMENT. THESE EFFORTS ARE LED BY THE DISASTER PREPAREDNESS PROGRAM UNDER THE DIRECTION OF THE CHIEF MEDICAL OFFICER. SAN DIEGO SHERRIFFS SEARCH & RESCUE ACADEMY EMERGENCY RESPONSE MODULE THE AMERICAN RED CROSS EMERGENCY MEDICAL RESPONSE COURSE IS TO PROVIDE THE PARTICIPANT WITH THE KNOWLEDGE AND SKILLS NECESSARY TO WORK AS AN EMERGENCY MEDICAL RESPONDER (EMR). THE CLASS IS INSTRUCTED BY CHRIS VAN GORDER, SCRIPPS PRESIDENT AND CEO. SAN DIEGO COUNTY HEALTHCARE DISASTER COUNCIL THE SAN DIEGO COUNTY DISASTER COUNCIL ADVISES THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY, PUBLIC HEALTH SERVICES, AND DIVISION OF EMERGENCY MEDICAL (EMS) ON THE COMMUNITYS HEALTH AND MEDICAL DISASTER PREPAREDNESS. SAN DIEGO SEAFOOD SATURDAYS THIS PROGRAM IS A COLLABORATIVE EDUCATIONAL CAMPAIGN ENCOURAGING SAN DIEGANS CONSUMPTION OF LOCAL SEAFOOD AT LEAST ONE DAY A WEEK. SCRIPPS CHEF SUPERVISOR GIVES DEMONSTRATIONS AND LECTURES ON PREPARING MEALS WITH LOCALLY CAUGHT SEAFOOD. SCRIPPS IN-LIEU OF FUNDS SCRIPPS IN-LIEU OF FUNDS ARE USED FOR UNFUNDED OR UNDERFUNDED PATIENTS AND THEIR POST-DISCHARGE NEEDS INCLUDING BOARD AND CARE, SKILLED NURSING FACILITIES, LONG-TERM ACUTE CARE AND HOME HEALTH. IN ADDITION, THE FUNDS MAY BE USED FOR MEDICATIONS, EQUIPMENT AND TRANSPORTATION SERVICES. SAN DIEGO POLICE FOUNDATION SCRIPPS HEALTH SPONSORED THE TRUE BLUE LUNCHEON. THE SAN DIEGO POLICE FOUNDATION SUPPORTS THE DEDICATED OFFICERS OF THE SAN DIEGO POLICE DEPARTMENT, ENABLING NEW PROTECTIVE GEAR, IMPROVED TECHNOLOGY, NEW POLICE DOGS AND MUCH MORE. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5: ENLISTED LEADERSHIP FOUNDATION THE FOUNDRY ENLISTED LEADERSHIP FOUNDATION IS A SAN DIEGO BASED NON-PROFIT GROUP 501(C)3 DEDICATED TO LEADERSHIP DEVELOPMENT OF NAVY SECOND CLASS, FIRST CLASS, AND CHIEF PETTY OFFICERS. THIS ORGANIZATION WAS FORMED BY A TEAM OF ACTIVE DUTY AND RETIRED COMMAND / MASTER CHIEF PETTY OFFICERS TO DEVELOP CURRENT AND FUTURE LEADERS THROUGH A PHILOSOPHY OF SHARING AND MENTORING BASED ON COMBINED GENERATIONS OF GROWTH AND GROOMING. THE LEADERSHIP LECTURE IS GIVEN BY CHRIS VAN GORDER, PRESIDENT AND CEO. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6: HEALTHY DEVELOPMENT SERVICES (HDS) PROVIDER MEETING COLLABORATION OF HDS PARTNERS AND SERVICE PROVIDERS COMING TOGETHER TO DISCUSS AND REVIEW SPECIFIC CASES OF THOSE RECEIVING SERVICES FROM PESE, CARE COORDINATION, DEVELOPMENTAL AND BEHAVIORAL HEALTH SERVICES OF CHILDREN AGES ZERO - 5 YEARS OF AGE. PESE (PARENT, EDUCATION, SUPPORT AND EMPOWERMENT) A WORKGROUP MEETING MADE UP OF SUBCONTRACTORS OF HEALTHY DEVELOPMENT SERVICES COMING TOGETHER TO GIVE PROGRAM UPDATES AND TO DISCUSS OUTCOMES AND EVALUATION OF SERVICES. SAN DIEGO REGIONAL TASK FORCE ON THE HOMELESS THE MISSION OF THE REGIONAL TASK FORCE ON THE HOMELESS IS TO ENGAGE STAKEHOLDERS IN A COMMUNITY-BASED PROCESS THAT WORKS TO: 1) END HOMELESSNESS FOR ALL INDIVIDUALS AND FAMILIES THROUGHOUT THE REGION. 2) ADDRESS THE UNDERLYING CAUSES OF HOMELESSNESS. 3) LESSEN THE NEGATIVE IMPACT OF HOMELESSNESS ON INDIVIDUALS, FAMILIES AND COMMUNITIES. MEMBERS OF THE GOVERNANCE BOARD ARE BEING SELECTED BY A COMMUNITY PROCESS. BOARD SEATS ARE IDENTIFIED BY THE TYPE OF ORGANIZATION OR REPRESENTATIVE THAT IS NEEDED. SCRIPPS MERCY HOSPITAL CHIEF EXECUTIVE WAS DESIGNATED TO PARTICIPATE REPRESENTING THE HEALTH CARE SECTOR; THE DIRECTOR OF COMMUNITY PROGRAMS DEVELOPMENT ATTENDS ON THE CHIEF EXECUTIVES BEHALF. SAN DIEGO HEALTH CONNECT REFERRALS WORK GROUP SAN DIEGO HEALTH CONNECT SECURELY CONNECTS HOSPITALS, HEALTH SYSTEMS, AND PATIENTS, PRIVATE HEALTH INFORMATION EXCHANGES (HIES) AND OTHER HEALTHCARE STAKEHOLDERS SO THEY CAN SHARE IMPORTANT HEALTH INFORMATION, IN ORDER TO SERVE AND IMPROVE HEALTH CARE FOR ALL COMMUNITY MEMBERS. IMPROVING PATIENT CARE WHILE REDUCING COSTS THROUGH HEALTH INFORMATION TECHNOLOGY AMONG COUNTY HEALTH PROVIDERS. COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 7: HEALTH CARE PUBLIC AND GOVERNMENT ADVOCACY SCRIPPS PUBLIC AND GOVERNMENT AFFAIRS SUPPORTS RELATIONSHIP BUILDING AMONG INTERESTED AND AFFECTED PARTIES RELATIVE TO THE NATION'S HEALTH CARE REFORM DEBATE AND DECISION MAKING. THE GOAL IS TO EDUCATE AND INFORM RELATIVE TO ALL ASPECTS OF REFORM DISCUSSION, FROM HEALTH INFORMATION TECHNOLOGY TO THE ENACTMENT AND IMPLEMENTATION OF THE PATIENT PROTECTION AND ACCOUNTABLE CARE ACT. WORKFORCE DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 8: SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) SCRIPPS SPONSORED THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS ANNUAL CONFERENCE WHICH FOCUSED ON OPIOID USAGE. FOUNDED IN 2001, THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) IS AN OFFICIAL COMBINED CHAPTER OF THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES (ACHE), AN INTERNATIONAL PROFESSIONAL SOCIETY OF MORE THAN 30,000 HEALTHCARE EXECUTIVES. SOHL OFFERS AN ENVIRONMENT FOR CONTINUAL GROWTH AND PROFESSIONAL DEVELOPMENT, AND BUILDING RELATIONSHIPS AMONG PEERS AND INDUSTRY LEADERS AT THE LOCAL LEVEL. MEMBERS REPRESENT HEALTHCARE LEADERS IN ALL SECTORS OF THE HEALTHCARE INDUSTRY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM SCRIPPS PARTNERS WITH THE REGIONAL ALLIED HEALTH AND SCIENCE INITIATIVE (RASHI) TO PROVIDE CONTINUING EDUCATION INTERNSHIPS FOR THEIR STUDENTS. THIS IS AN EIGHT (8) WEEK PAID INTERNSHIP WHERE STUDENTS ROTATE THROUGH CLINICAL AND NON-CLINICAL DEPARTMENTS TO LEARN ABOUT HEALTHCARE. THE PROGRAM IS DESIGNED TO REACH OUT TO YOUNG PEOPLE AND PIQUE THEIR INTEREST IN HEALTH CARE OCCUPATIONS. UNIVERSITY CITY (UC) HIGH SCHOOL EXPLORATION PROGRAM SCRIPPS PARTNERS WITH UC HIGH SCHOOL EXPLORATION PROGRAM TO PROVIDE OPPORTUNITIES FOR STUDENTS TO LEARN ABOUT CAREERS IN HEALTHCARE THROUGH HEALTHCARE FOCUSED CURRICULUM. SCRIPPS AND CENTER FOR LEARNING & INNOVATION PARTNERED WITH UC HIGH SCHOOL HEALTH ESSENTIALS TO PROVIDE WORKFORCE PREPAREDNESS IN A HEALTHCARE SETTING AS AN EXTENSION OF THEIR CLASSROOM LEARNING EXPERIENCE. THIRTEEN HIGH SCHOOL SENIORS WERE SELECTED TO ROTATE THROUGH VARIOUS CLINIC DEPARTMENTS THROUGHOUT THEIR SPRING SEMESTER. YOUTH EDUCATIONAL PROGRAMS SCRIPPS MERCY HOSPITAL CHULA VISTA PROVIDES PROGRAM
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD-DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THE AMOUNT ON PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGARDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED.
SCHEDULE H, PART III, LINE 4	FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES.
SCHEDULE H, PART III, LINE 8	MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT.
SCHEDULE H, PART III, LINE 9B	COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN SAN DIEGO COUNTY, THE LONG HISTORY OF COLLABORATION AMONG HOSPITALS, HEALTHCARE SYSTEMS AND COMMUNITY PARTNERS HAS RESULTED IN SUCCESSFUL PARTNERSHIP ON PAST CHNAS. WHILE PUBLIC INSTITUTIONS AND DISTRICT HOSPITALS DO NOT HAVE TO REPORT UNDER SB 697, THESE INSTITUTIONS HAVE BECOME AN INTEGRAL PART OF THE CHNA IN SAN DIEGO COUNTY. INFORMATION IS GATHERED THROUGH THE CHNA FOR THE PURPOSES OF REPORTING COMMUNITY BENEFIT, DEVELOPING STRATEGIC PLANS, CREATING ANNUAL REPORTS, PROVIDING INPUT ON LEGISLATIVE DECISIONS, AND INFORMING THE GENERAL COMMUNITY OF HEALTH ISSUES AND TRENDS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THE REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THIS REPORT COMPLIES WITH FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING HOSPITAL FACILITIES OWNED AND OPERATED BY AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS. FOR MORE DETAILED INFORMATION ON THE CHNA REGULATORY REQUIREMENTS AND IMPLEMENTATION STRATEGY SEE: https://www.scripps.org/about-us/Scripps-in-the-community/assessing-commun ity-needs SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COMMITTEE DESIGNED THE 2016 CHNA PROCESS BASED ON THE FINDINGS FROM THE 2013 CHNA AND RECOMMENDATIONS FROM THE COMMUNITY. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER): - BEHAVIORAL/MENTAL HEALTH - CARDIOVASCULAR DISEASE - DIABETES (TYPE 2) - OBESITY THE CHNA COMMITTEE COMPLETED A COLLABORATIVE FOLLOW-UP PROCESS (PHASE 2) TO ENSURE THE 2013 CHNA FINDINGS ACCURATELY REFLECTED THE HEALTH NEEDS OF THE COMMUNITY. PHASE 2 COLLECTED COMMUNITY FEEDBACK ON BOTH THE PROCESS AND FINDINGS OF THE 2013 CHNA, AS WELL AS RECOMMENDATIONS FOR THE NEXT CHNA PROCESS. 87% OF RESPONDENTS AGREED THE 2013 CHNA IDENTIFIED THE TOP HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. 78% OF RESPONDENTS AGREED THE METHODOLOGY FOR THE NEXT CHNA SHOULD INCLUDE A DEEPER DIVE INTO THE TOP FOUR HEALTH ISSUES MENTIONED ABOVE. BASED ON THE FINDINGS AND FEEDBACK FROM BOTH PHASES OF THE 2013 CHNA, THE CHNA COMMITTEE MADE A DEEPER ANALYSIS OF THE TOP FOUR IDENTIFIED COMMUNITY HEALTH NEEDS (BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, TYPE 2 DIABETES AND OBESITY). PRIOR TO DESIGNING THE 2016 METHODOLOGY, THE CHNA COMMITTEE MET WITH LEADERS FROM COMMUNITY PARTNER ORGANIZATIONS WHO PARTICIPATED IN THE PRIOR ASSESSMENT. THEY ADVISED THE COMMITTEE ON WAYS TO ENGAGE THEIR STAFF WHO WORK WITH LARGE NUMBERS OF RESIDENTS IN HIGH NEED AND VULNERABLE COMMUNITIES. THE 2016 PROCESS BEGAN WITH A COMPREHENSIVE SCAN OF RECENT COMMUNITY HEALTH STATISTICS IN ORDER TO VALIDATE THE REGIONAL SIGNIFICANCE OF THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. BASED ON THE RESULTS OF THE SCAN AND FEEDBACK FROM COMMUNITY PARTNERS RECEIVED DURING THE 2016 PLANNING PROCESS, A NUMBER OF COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED TO PROVIDE A MORE COMPREHENSIVE UNDERSTANDING OF THE IDENTIFIED HEALTH NEEDS, INCLUDING THEIR ASSOCIATED SOCIAL DETERMINANTS OF HEALTH AND POTENTIAL SYSTEM AND POLICY CHANGES THAT MAY POSITIVELY IMPACT THEM. IN ADDITION, A DETAILED ANALYSIS OF HOW THE TOP FOUR NEEDS IMPACT THE HEALTH OF SAN DIEGO RESIDENTS WAS CONDUCTED. QUANTITATIVE DATA COLLECTION AND ANALYSIS CALIFORNIA'S OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) IS RESPONSIBLE FOR COLLECTING DATA AND DISSEMINATING INFORMATION ABOUT THE UTILIZATION OF HEALTH CARE IN CALIFORNIA. AS PART OF THE 2016 CHNA DATA COLLECTION PROCESS, 2013 OSHPD DEMOGRAPHIC DATA FOR HOSPITAL INPATIENT, EMERGENCY DEPARTMENT, AND AMBULATORY CARE ENCOUNTERS FROM ALL HOSPITALS WITHIN SAN DIEGO COUNTY WERE ANALYZED TO UNDERSTAND THE HOSPITAL PATIENT POPULATION. CLINIC DATA WAS ALSO GATHERED FROM OSHPD'S WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SAN DIEGO, AS HOSPITAL DISCHARGES MAY NOT REPRESENT ALL THE HEALTH CONDITIONS IN THE COMMUNITY. AFTER COMPARING RESULTS OF THE QUANTITATIVE ANALYSES OF THE SAN DIEGO COUNTY MORTALITY DATA, KP COMMUNITY BENEFIT DATA ANALYSIS TOOL, AND HOSPITAL DISCHARGE DATA, THE FINDINGS DEMONSTRATED THAT BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY CONTINUE TO BE AMONG THE TOP PRIORITY HEALTH NEEDS IN SAN DIEGO COUNTY ACROSS DIFFERENT QUANTITATIVE DATA SOURCES. QUALITATIVE AND COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF COMMUNITY MEMBERS, INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. FOR MORE INFORMATION ON THE COMMUNITY ENGAGEMENT ACTIVITIES SEE NARRATIVE FOR QUESTION 5, SCHEDULE H, PART V, SECTION B. 2016 PRIORITIZATION OF THE TOP FOUR IDENTIFIED HEALTH NEEDS THE PURPOSE OF THIS CHNA WAS TO IDENTIFY AND PRIORITIZE HEALTH ISSUES AND NEEDS IN SAN DIEGO COUNTY USING MULTIPLE SOURCES OF INFORMATION. THE ANALYSIS OF SECONDARY DATA INCORPORATED THE FOLLOWING CRITERIA FOR INCLUSION AS AN IDENTIFIED COMMUNITY HEALTH NEED: 1. MAGNITUDE OR PREVALENCE: THE HEALTH NEED AFFECTS A LARGE NUMBER OF PEOPLE IN ALL REGIONS OF SAN DIEGO. 2. SEVERITY: THE HEALTH NEED HAS SERIOUS CONSEQUENCES (MORBIDITY, MORTALITY, AND/OR ECONOMIC BURDEN). 3. HEALTH DISPARITIES: THE HEALTH NEED DISPROPORTIONATELY IMPACTS THE HEALTH STATUS OF ONE OR MORE VULNERABLE POPULATION GROUPS. 4. TRENDS: THE HEALTH NEED IS EITHER STABLE OR CHANGING OVER TIME, E.G., IMPROVING OR GETTING WORSE. 5. COMMUNITY CONCERN: STAKEHOLDERS, COMMUNITY MEMBERS, AND VULNERABLE POPULATIONS WITHIN THE COMMUNITY VIEW THE HEALTH NEED AS A PRIORITY. USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE. TAKING INTO ACCOUNT THE RESULTS OF THE QUANTITATIVE DATA COLLECTION AND THE FINDINGS FROM THE COMMUNITY ENGAGEMENT ACTIVITIES, A RANK FROM 1 TO 4, WITH 1 BEING THE MOST SIGNIFICANT, WAS APPLIED TO EACH CRITERION. AN OVERALL SCORE WAS GIVEN TO EACH HEALTH NEED BY AVERAGING THE RANKINGS ACROSS ALL FIVE CRITERIA. IN ADDITION, THE SOCIAL DETERMINANTS OF HEALTH WERE ANALYZED AND IDENTIFIED ACROSS ALL HEALTH NEEDS. THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITHIN EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMER'S DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E., EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENT'S UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FOR PAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENT'S ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION FOR THE PURPOSES OF THE 2016 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE BY ZIP CODE LEVEL. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,526 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTS THE REGIONS POPULATION WILL GROW BY NEARLY ONE MILLION PEOPLE BY 2050. THIS FORECAST IS CONSISTENT WITH PREVIOUS EXPECTATIONS ALTHOUGH FUTURE GROWTH RATES HAVE BEEN REDUCED DUE TO INCREASED DOMESTIC MIGRATION OUT OF THE REGION. RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE INSTITUTE FOR PUBLIC HEALTH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. IN ADDITION, GEOGRAPHIC INFORMATION SYSTEMS (GIS) MAPS WERE CREATED, OVERLAYING CNI DATA AND THE HOSPITAL DISCHARGE RATE BY PRIMARY DIAGNOSIS FOR THE HEALTH CONDITIONS: TYPE 2 DIABETES, CARDIOVASCULAR DISEASE, AND BEHAVIORAL HEALTH. GIS MAPS WERE NOT CREATED FOR OBESITY DUE TO THE FACT THAT OBESITY IS NOT A COMMON PRIMARY DIAGNOSIS, BUT RATHER A SECONDARY CONDITION THAT CONTRIBUTES TO THE PRIMARY REASON FOR A HOSPITAL VISIT. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. POPULATION: OVER 3 MILLION PEOPLE (3,138,265) LIVE IN THE 4,526 SQUARE MILE AREA OF SDC ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%. THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES. RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. PER CALENDAR YEAR 2017 OSHPD ANNUAL FINANCIAL DATA THERE ARE 19 OTHER HOSPITAL FACILITIES SERVING THE SAN DIEGO COMMUNITY. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 64 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. AS A DISPROPORTIONATE-SHARE HOSPITAL, SCRIPPS MERCY SAN DIEGO AND CHULA VISTA CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED-MEDICARE AND MEDI-CAL. SCRIPPS HOSPITALS HOUSED 24.5 PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY18, SCRIPPS PROVIDED 2,513,440 OUTPATIENT VISITS. NEARLY HALF (38.8%) OF SAN DIEGO COUNTY'S 60,325 SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF-PAY. OSHPD 2017 DATA (MOST RECENT YEAR AVAILABLE) SCRIPPS HAS A TOTAL OF 1,387 ACUTE CARE LICENSED BEDS. SAN DIEGO HAS A TOTAL OF 5,652 GENERAL ACUTE CARE LICENSED BEDS. % OF SCRIPPS BEDS IS 1,387/5,652 = 24.5% SAN DIEGO COUNTY SAFETY NET DISCHARGES CY18: SAFETY NET DISCHARGES INCLUDE PAYER CATEGORIES: COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF-PAY. - CENTRAL DISCHARGES 12,199 - SOUTH SUBURBAN DISCHARGES 6,297 SCRIPPS OSHPD SAFETY NET DISCHARGES CY18: - SCRIPPS CENTRAL DISCHARGES - 3,759 - SCRIPPS SOUTH SUBURBAN DISCHARGES 1,770 THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE. SAN DIEGO'S UNINSURED THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. BETWEEN 2010 AND 2013 THE UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3%, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). SOURCE: U.S. CENSUS BUREAU, 2010 TO 2014 1-YEAR AMERICAN COMMUNITY SURVEYS. ACS UNINSURED RATE IS BASED ON WHETHER AN INDIVIDUAL HAD INSURANCE AT THE TIME OF THE SURVEY. NOTE: THE AMERICAN COMMUNITY SURVEY, ESTIMATES ARE FOR THE CIVILIAN NONINSTITUTIONALIZED POPULATION. THERE ARE THREE INDICATORS DETERMINED TO BE THE MOST POWERFUL PREDICTORS OF POPULATION HEALTH: POVERTY RATE, PERCENT OF POPULATION UNINSURED, AND EDUCATIONAL ATTAINMENT. LOW-INCOME, UNINSURED, AND UNDEREDUCATED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. FIVE-YEAR ESTIMATES FROM THE 2009-2013 AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY: WITHIN SDC, 14.5% OR 441,648 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). FOR CHILDREN 0-17, THE PERCENTAGE LIVING 100% BELOW THE FPL INCREASES TO 18.8%. FOR A HOUSEHOLD SIZE OF 3 THE 100% POVERTY LEVEL IS $20,090 PER YEAR. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. UNINSURED: BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SDC. IN 2014, THE UNINSURED RATE SHARPLY DECREASED, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). LACK OF INSURANCE IS A PRIMARY BARRIER TO HEALTH CARE ACCESS INCLUDING REGULAR PRIMARY CARE, SPECIALTY CARE, AND OTHER HEALTH SERVICES THAT CONTRIBUTES TO POOR HEA
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH AS A TAX-EXEMPT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY18 (OCTOBER 2017 TO SEPTEMBER 2018), SCRIPPS INVESTED $26,757,826 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE SCHEDULE H FORM 990 IRS GUIDELINES; "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. LACK OF INSURANCE ALSO INCREASES THE BURDEN ON HOSPITALS AND HEALTH PROVIDERS. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY18 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (M.O.S.T.) WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM (M.O.S.T.) PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FISCAL YEAR 2018, THE M.O.S.T. TEAM SERVED IN THREE OUTREACH MISSION TRIPS. THE M.O.S.T. TEAM VOLUNTEERED 2,243 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 700 PEOPLE SERVED. THE M.O.S.T. PROGRAM CELEBRATED ITS 31ST ANNIVERSARY THIS YEAR. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING, AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACK UP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, AND COUNSELING ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDER ARE CONNECTED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. IN 2018, 54 PATIENTS ACCOUNTED FOR 65 RCU ADMISSIONS. AS A GROUP, THE RCU PATIENTS HAS A CUMULATIVE 646 HOSPITAL DAYS OF STAY, AN AVERAGE OF 10 HOSPITAL DAYS OF STAY, BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: IV ANTIBIOTICS, WOUND VACS, SKIN GRAFTS, FRACTURES, ABSCESSES, OSTEOMYELITIS, AMPUTATION, PARAPLEGIA, DOG BITES, DKA, G BLEEDS, PANCREATITIS, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, COMPLEX TRAUMA, MVA, PEDESTRIAN VERSUS AUTO, PLEURAL EFFUSION, CVA, CANCER (LYMPHOMA, PANCREATIC CANCER, BRAIN MASS), HIV/AIDS, SEPSIS, RESPIRATORY FAILURE, PNEUMONIA, CHF. PATIENTS WERE ASSAULT VICTIMS WITH GUNSHOT AND STAB WOUNDS, FACIAL TRAUMA, AND SURGICAL POST OP PATIENTS. MANY ARE DIABETIC AND PSYCH PROBLEMS ARE COMMON, OCCASIONALLY THE MAIN PROBLEM FOR RCU CLIENTS. OVER 70% THIS GROUP WERE EITHER POSITIVE FOR ALCOHOL, DRUGS ON DRUG SCREEN OR HAD A DRUG HISTORY ADDRESSED BY THE PHYSICIAN IN THE H & P. MORE SPECIFICALLY, 43% OF RCU CLIENTS WERE NOTED TO HAVE USED HEROIN OR METH. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEOS CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 45+ RESIDENTS AND 38 FELLOWS. WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. LEOS CLINIC. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTYS MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2018. FIJI SOLOMON ISLANDS MEDICAL MISSION THE MEDICAL MISSION CONSISTS OF SCRIPPS HEALTH GENERAL MEDICAL SPECIALISTS AND RESIDENTS SETTING UP CLINICS ON RURAL ISLANDS FOR THE PURPOSE OF PROVIDING MUCH NEEDED MEDICAL CARE, MEDICAL SUPPLIES AND SURGICAL SCREENING FOR AN UNDERSERVED POPULATION THAT HAVE NO ACCESS TO BASIC MEDICAL CARE. THE INTERNATIONAL MEDICAL MISSIONS PROVIDE AN EXCEPTIONAL CLINICAL EDUCATION EXPERIENCE TO OUR SENIOR INTERNAL MEDICINE RESIDENTS AT SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL. AMERICAN RED CROSS BLOOD DRIVES SCRIPPS HEALTH PARTNERED WITH THE AMERICAN RED CROSS IN FY18 TO HOST SIX BLOOD DRIVES AND 421 SCRIPPS EMPLOYEES DONATED BLOOD THROUGHOUT THE YEAR. SCRIPPS HEALTH COLLECTED 365 PINTS OF BLOOD (FOR EVERY PINT DONATED 3 LIVES ARE SAVED), WHICH SAVED APPROXIMATELY 1,095 LIVES. SCRIPPS HEPATITIS OUTBREAK RESPONSE SCRIPPS HEALTH BUILDS AWARENESS OF DISASTER PREPAREDNESS AND ACTIVELY RESPONDS TO EVENTS TO AFFECT CHANGE AT THE COMMUNITY LEVEL. FOLLOWING THE TERRORIST ATTACK OF SEPTEMBER 11, 2001, SCRIPPS DEVELOPED A SYSTEM-WIDE DISASTER PREPAREDNESS PROGRAM AND MOVED QUICKLY TO MAKE DISASTER PREPAREDNESS AN INTEGRAL ELEMENT THROUGHOUT THE ORGANIZATIONS OPERATIONS. THE SCRIPPS MEDICAL RESPONSE TEAM (SMRT) AROSE FROM THESE EFFORTS. IN 2017, WHEN SAN DIEGO MAYOR KEVIN FAULCONER ASKED SCRIPPS TO HELP ADDRESS THE HEPATITIS A OUTBREAK, THE SCRIPPS SMRT TEAM WORKED DIRECTLY WITH CITY AND COUNTY PUBLIC HEALTH OFFICIALS TO MAKE VACCINATIONS ACCESSIBLE TO INDIVIDUALS AT RISK. SMRT TEAMS INCLUDING PHYSICIANS, NURSES AND SUPPORT PERSONNEL ADMINISTERED VACCINATIONS AND PROVIDED EDUCATION ON HEPATITIS A AT THREE COUNTY-SPONSORED HOUSING SITES OVER MULTIPLE DATES AND TIMES. EACH SITE HOUSED NUMEROUS OCCUPANTS, MANY OF WHOM HAD RISK FACTORS INCLUDING HOMELESSNESS OR SUBSTANCE ABUSE RECOVERY. OCCUPANTS WERE NOTIFIED IN ADVANCE THAT WE WOULD BE
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $3.2 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 700,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF 3,000 AFFILIATED PHYSICIANS AND 15,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE SERVICES, AND AN AMBULATORY CARE NETWORK OF PHYSICIAN OFFICES AND 29 OUTPATIENT CENTERS AND CLINICS. SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. OUR PARTNERSHIPS DON'T STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDES WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS; AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE.
SCHEDULE H, PART VI, LINE 7	CALIFORNIA SCRIPPS HEALTH COMMUNITY BENEFIT REPORT CAN BE FOUND AT: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SCRIPPS HEALTH

Employer identification number
95-1684089

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(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 noncash assistance	(h) Purpose of grant or assistance
(1) 211 SAN DIEGO - HEALTHCARE NAVIGATION 3860 CALLE PORTUNADA SAN DIEGO,CA92123	33-1029843	501(C)(3)	12,000				PROGRAM SUPPORT
(2) ACS MAKING STRIDES AGAINST BREAST CANCER 2655 CAMINO DEL RIO N SAN DIEGO,CA92108	13-1788491	501(C)(3)	10,000				PROGRAM SUPPORT
(3) AMERICAN HEART ASSOCIATION - SPONSORSHIP 9404 GENESEE AVE 240 LA JOLLA,CA92037	13-5613797	501(C)(3)	10,000				PROGRAM SUPPORT
(4) AMERICAN HEART ASSOCIATION IN-KIND DONATION 9404 GENESEE AVE 240 LA JOLLA,CA92037	13-5613797	501(C)(3)		7,400	FMV	Supplies	PROGRAM SUPPORT
(5) CALIFORNIA HEALTH FOUNDATION & TRUST (CHFT) 1215 K STREET STE 800 SACRAMENTO,CA95814	94-1498697	501(C)(3)	2,295,000				CA HOSPITAL FEE PROGRAM
(6) CATHOLIC CHARITIES 349 CEDAR STREET SAN DIEGO,CA92101	23-7334012	501(C)(3)	70,000				PROGRAM SUPPORT
(7) CONSUMER CENTER OF LEGAL AID SOCIETY 1764 SAN DIEGO AVE 200 SAN DIEGO,CA92110	95-1869806	501(C)(3)	120,000				PROGRAM SUPPORT
(8) ENLISTED LEADERSHIP FOUNDATION-THE FOUNDRY 2307 FENTON PARKWAY SAN DIEGO,CA92108	46-5029314	501(C)(3)	25,000				PROGRAM SUPPORT
(9) ERIC PAREDES SAVE A LIFE FOUNDATION 2514 JAMACHA RD STE 502 EL CAJON,CA92019	80-0636157	501(C)(3)	8,500				PROGRAM SUPPORT
(10) FAMILY HEALTH CENTERS OF SAN DIEGO 823 GATEWAY CENTER WAY SAN DIEGO,CA92102	95-2833205	501(C)(3)	300,000	0			PROGRAM SUPPORT
(11) THE CITY HEIGHTS WELLNESS CTR - LA MAESTRA 4305 UNIVERSITY AVE 150 SAN DIEGO,CA92105	33-0473171	501(C)(3)	40,000	0			PROGRAM SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PART I, LINE 2

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

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(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 on 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)
1CHRISTOPHER VAN GORDER PRESIDENT & CEO/TRUSTEE	(i) (ii)	1,318,797 ------------- 0	906,126 ------------- 0	6,471,415 ------------- 0	1,121,931 ------------- 0	22,687 ------------- 0	9,840,956 ------------- 0	6,413,502 ------------- 0
2RICHARD ROTHBERGER TREASURER/EXECUTIVE VP/CFO	(i) (ii)	782,070 ------------- 0	420,922 ------------- 0	652,892 ------------- 0	72,716 ------------- 0	29,571 ------------- 0	1,958,171 ------------- 0	516,750 ------------- 0
3RICHARD R SHERIDAN SEC/CORP SR VP-HR/GEN COUNSL	(i) (ii)	575,877 ------------- 0	232,331 ------------- 0	1,591,277 ------------- 0	447,194 ------------- 0	30,651 ------------- 0	2,877,330 ------------- 0	1,555,329 ------------- 0
4ROBIN BROWN CHIEF EXECUTIVE, SR VP	(i) (ii)	525,613 ------------- 0	217,438 ------------- 0	2,652,206 ------------- 0	269,226 ------------- 0	19,714 ------------- 0	3,684,197 ------------- 0	2,554,311 ------------- 0
5MARY ELLEN DOYLE CORP VP, NURSING OPS	(i) (ii)	358,647 ------------- 0	118,696 ------------- 0	106,372 ------------- 0	19,348 ------------- 0	23,926 ------------- 0	626,989 ------------- 0	90,143 ------------- 0
6JOHN ENGLE CORP SR VP, CHIEF DEVELOPMENT	(i) (ii)	418,740 ------------- 0	168,564 ------------- 0	85,006 ------------- 0	97,827 ------------- 0	27,977 ------------- 0	798,114 ------------- 0	41,486 ------------- 0
7CARL ETTER CHIEF EXECUTIVE, SR VP	(i) (ii)	506,681 ------------- 0	206,003 ------------- 0	111,175 ------------- 0	114,313 ------------- 0	20,520 ------------- 0	958,692 ------------- 0	68,396 ------------- 0
8SHIRAZ FAGAN CHIEF EXECUTIVE, SR VP	(i) (ii)	622,280 ------------- 0	237,978 ------------- 0	107,839 ------------- 0	147,950 ------------- 0	32,253 ------------- 0	1,148,300 ------------- 0	95,500 ------------- 0
9GARY FYBEL CHIEF EXECUTIVE, SR VP	(i) (ii)	586,689 ------------- 0	242,337 ------------- 0	350,169 ------------- 0	50,121 ------------- 0	19,880 ------------- 0	1,249,196 ------------- 0	256,194 ------------- 0
10THOMAS GAMMIERE CHIEF EXECUTIVE, SR VP	(i) (ii)	587,497 ------------- 0	248,224 ------------- 0	114,813 ------------- 0	157,607 ------------- 0	31,018 ------------- 0	1,139,159 ------------- 0	91,573 ------------- 0
11JAMES LABELLE MD CORP SR VP, CHIEF MED OFFICER	(i) (ii)	640,832 ------------- 0	283,840 ------------- 0	34,883 ------------- 0	150,204 ------------- 0	33,786 ------------- 0	1,143,545 ------------- 0	0 ------------- 0
12JUNE KOMAR CORP EXEC VP, STRATEGY & ADMIN	(i) (ii)	585,810 ------------- 0	322,816 ------------- 0	4,458,185 ------------- 0	334,305 ------------- 0	11,912 ------------- 0	5,713,028 ------------- 0	4,421,052 ------------- 0
13RICHARD NEALE CORP EXEC VP, CHIEF GROWTH OFF	(i) (ii)	448,683 ------------- 0	183,467 ------------- 0	76,110 ------------- 0	72,586 ------------- 0	47,165 ------------- 0	828,011 ------------- 0	44,441 ------------- 0
14BARBARA PRICE CORP SRVP, BUS & SERV LINE DEV	(i) (ii)	509,467 ------------- 0	211,424 ------------- 0	93,978 ------------- 0	132,625 ------------- 0	32,157 ------------- 0	979,651 ------------- 0	83,220 ------------- 0
15MARC A REYNOLDS CORP SR VP, PAYER RELATIONS	(i) (ii)	397,880 ------------- 0	167,452 ------------- 0	157,916 ------------- 0	39,862 ------------- 0	22,735 ------------- 0	785,845 ------------- 0	141,216 ------------- 0
16JAMES CROWDER CORP SR VP, CIO	(i) (ii)	462,870 ------------- 0	104,561 ------------- 0	15,220 ------------- 0	99,810 ------------- 0	27,909 ------------- 0	710,370 ------------- 0	0 ------------- 0
17DAVID COHN CORP VP, REVENUE CYCLE	(i) (ii)	351,480 ------------- 0	116,873 ------------- 0	46,921 ------------- 0	61,438 ------------- 0	41,267 ------------- 0	617,979 ------------- 0	34,891 ------------- 0
18BRADLEY ELLIS CORP VP, ASST GENERAL COUNSEL	(i) (ii)	323,448 ------------- 0	106,568 ------------- 0	50,504 ------------- 0	60,710 ------------- 0	33,037 ------------- 0	574,267 ------------- 0	26,555 ------------- 0
19ROBERT T HOFF CORP VP, HORIZONTAL OPS	(i) (ii)	347,755 ------------- 0	114,724 ------------- 0	98,281 ------------- 0	61,337 ------------- 0	33,331 ------------- 0	655,428 ------------- 0	70,838 ------------- 0
20JOHN POOLE CORP VP, SYSTEM IMPROVEMENT	(i) (ii)	411,501 ------------- 0	85,441 ------------- 0	11,480 ------------- 0	84,304 ------------- 0	18,803 ------------- 0	611,529 ------------- 0	0 ------------- 0
21BRUCE RAINEY CORP VP, CONSTRUCTION/FACS	(i) (ii)	361,438 ------------- 0	107,228 ------------- 0	78,073 ------------- 0	68,295 ------------- 0	19,279 ------------- 0	634,313 ------------- 0	41,097 ------------- 0
22VICTOR V BUZACHERO FORMER KEY EMPLOYEE	(i) (ii)	170,970 ------------- 0	335,615 ------------- 0	437,482 ------------- 0	16,200 ------------- 0	8,346 ------------- 0	968,613 ------------- 0	226,456 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SCHEDULE J, PART I, LINE 1A

SUPPLEMENTAL COMPENSATION INFORMATION SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE COST APPROXIMATELY $1,466 DURING FY18. CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2S.

SCHEDULE J, PART I, LINE 4B

SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE, AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR THE PARTICIPANTS. EFFECTIVE DECEMBER 31, 2017, SCRIPPS HEALTH TERMINATED THIS 409(A) PLAN AND DISTRIBUTED TO EACH PARTICIPANT AN AMOUNT EQUAL TO THE INCOME TAX WITHHOLDING AND FICA TAXES DUE ON THE VESTED BENEFITS. THE REMAINING AMOUNTS WERE DISTRIBUTED APPROXIMATELY 1 YEAR LATER. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SERP PLAN IN CALENDAR YEAR 2017: CHRISTOPHER VAN GORDER - $3,350,352 RICHARD R. SHERIDAN - $820,944 JUNE KOMAR - $2,228,895 ROBIN BROWN - $1,327,005 EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2017: CHRISTOPHER VAN GORDER - $237,738 RICHARD ROTHBERGER - $516,750 RICHARD R. SHERIDAN - $25,809 VICTOR V. BUZACHERO - $226,456 THOMAS GAMMIERE - $91,573 GARY FYBEL - $256,194 BARBARA PRICE - $83,220 CARL ETTER - $68,396 ROBIN BROWN - $108,219 MARC. A REYNOLDS - $141,216 JOHN ENGLE - $41,486 SHIRAZ FAGAN - $95,500 BRUCE RAINEY - $41,097 MARY ELLEN DOYLE - $90,143 ROBERT T. HOFF - $70,838 RICHARD NEALE - $44,441 DAVID COHN - $34,891 BRADLEY ELLIS - $26,555

Schedule J (Form 990) 2019

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SCRIPPS HEALTH

Employer identification number
95-1684089

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTH	68-0164610	1309116Y1	03-02-2007	49,995,000	SEE PART IV		X		X	X
B	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033F5A4	08-14-2008	99,830,304	SEE PART VI		X		X		X
C	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	000000000	01-31-2017	160,000,000	SEE PART VI		X		X		X
D	California Health Facilities Financing Authority	52-1643828	13033FWK2	06-02-2005	40,975,000	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LFH5	02-04-2010	119,458,924	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LFL6	02-04-2010	100,000,000	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LVZ7	02-01-2012	288,143,095	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	000000000	02-29-2016	150,000,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0		29,615,000		0		37,325,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	49,995,000		99,830,304		160,000,000		40,975,000
4 Gross proceeds in reserve funds .............	0		9,902,000		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	146,070		0		0		280,659
8 Credit enhancement from proceeds .............	0		0		0		918,283
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	49,848,390		0		0		0
11 Other spent proceeds .............	0		0		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2007		2008		2017		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...	X			X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X	X			X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X			X	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X	X
b Name of provider ..........	0		0		0		WELLS FARGO
c Term of hedge .........							14 %
d Was the hedge superintegrated? ......								X
e Was the hedge terminated? ........								X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?	X			X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN (C) - CUSIP NUMBER

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

Schedule K (Form 990) 2019

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SCRIPPS HEALTH

Employer identification number
95-1684089

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTH	68-0164610	1309116Y1	03-02-2007	49,995,000	SEE PART IV		X		X	X
B	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033F5A4	08-14-2008	99,830,304	SEE PART VI		X		X		X
C	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	000000000	01-31-2017	160,000,000	SEE PART VI		X		X		X
D	California Health Facilities Financing Authority	52-1643828	13033FWK2	06-02-2005	40,975,000	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LFH5	02-04-2010	119,458,924	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LFL6	02-04-2010	100,000,000	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	13033LVZ7	02-01-2012	288,143,095	SEE PART VI		X		X		X
	California Health Facilities Financing Authority	52-1643828	000000000	02-29-2016	150,000,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0		29,615,000		0		37,325,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	49,995,000		99,830,304		160,000,000		40,975,000
4 Gross proceeds in reserve funds .............	0		9,902,000		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	146,070		0		0		280,659
8 Credit enhancement from proceeds .............	0		0		0		918,283
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	49,848,390		0		0		0
11 Other spent proceeds .............	0		0		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2007		2008		2017		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...	X			X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X	X			X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X			X	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X	X
b Name of provider ..........	0		0		0		WELLS FARGO
c Term of hedge .........							14 %
d Was the hedge superintegrated? ......								X
e Was the hedge terminated? ........								X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?	X			X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN (C) - CUSIP NUMBER

Schedule K (Form 990) 2019

Additional Data

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(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
(1) Chris Van Gorder	OFFICER	Def Comp		X	10,023,866	11,610,229		No	Yes		Yes
(2) June Komar	EXECUTIVE	Def Comp		X	2,769,010	3,207,229		No	Yes		Yes
(3) Richard Sheridan	OFFICER	Def Comp		X	4,063,606	4,706,706		No	Yes		Yes
(4) Robin Brown	EXECUTIVE	Def Comp		X	2,668,899	3,091,276		No	Yes		Yes


Total ............... $						22,615,440

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MATHEW BALOGH	SEE PART V	53,381	SEE PART V		No
(2) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	163,612	COMPENSATINON		No
(3) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	134,587	COMPENSATINON		No
(4) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	298,617,085	PHYSICIAN SERVICES		No
(5) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	50,523,622	PHYSICIAN SERVICES		No
(6) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	25,692,079	PHYSICIAN SERVICES		No
(7) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	67,297,687	MEDICAL SERVICES		No
(8) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	29,369,133	MEDICAL SERVICES		No
(9) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	9,574,505	MEDICAL SERVICES		No
(10) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	8,487,343	MEDICAL SERVICES		No
(11) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	5,032,819	MEDICAL SERVICES		No
(12) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	4,209,999	MEDICAL SERVICES		No
(13) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	2,682,439	MEDICAL SERVICES		No
(14) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	622,859	MEDICAL SERVICES		No
(15) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	605,146	MEDICAL SERVICES		No
(16) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	331,333	MEDICAL SERVICES		No
(17) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	258,612	MEDICAL SERVICES		No
(18) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	249,100	MEDICAL SERVICES		No
(19) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	122,400	MEDICAL SERVICES		No
(20) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	3,942,681	INSURANCE SERVICES		No
(21) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	1,954,420	OFFICE SUPPLIES		No
(22) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	1,011,045	PARKING SERVICES		No
(23) SUBSTANTIAL CONTRIBUTOR	SUBSTANTIAL CONTRIBUTOR	931,993	LEGAL SERVICES		No
(24) LINDSEY VAN GORDER	SEE PART V	74,239	SEE PART V		No
(25) KATIE WOODHEAD	SEE PART V	76,806	SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART II	LOANS TO AND FROM INTERESTED PERSONS EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR FOUR PLAN PARTICIPANTS. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO THOSE FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME.
SCHEDULE L, PART IV	MATHEW BALOGH, SON-IN-LAW OF BOARD MEMBER GORDON R. CLARK, IS EMPLOYED BY SCRIPPS HEALTH. LINDSEY VAN GORDER, DAUGHTER-IN-LAW OF BOARD MEMBER AND OFFICER CHRIS VAN GORDER, IS EMPLOYED BY SCRIPPS HEALTH. KATIE WOODHEAD, DAUGHTER OF KEY EMPLOYEE JOHN ENGLE, IS EMPLOYED BY SCRIPPS HEALTH.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....	X	1	65,000	OPINION of Experts
8 Intellectual property ...
9 Securities—Publicly traded .	X	29	4,066,211	FMV
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .	X	1	750,000	Opinion of Experts
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

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

Schedule M (Form 990) (2019)

Additional Data

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Software Version:

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Return Reference	Explanation
FORM 990, PART I AND PART III, LINE 1	MISSION STATEMENT FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $3.2 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS OVER HALF A MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF 2,600 AFFILIATED PHYSICIANS AND 13,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. RECOGNIZED AS A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, GENOMIC MEDICINE, WIRELESS HEALTH AND GRADUATE MEDICAL EDUCATION. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONG STANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. TODAY, THE HEALTH SYSTEM EXTENDS FROM CHULA VISTA TO OCEANSIDE, WITH 26 PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS WAS NAMED BY TRUVEN IN 2013 AS ONE OF THE TOP 15 LARGE HEALTH SYSTEMS IN THE NATION FOR PROVIDING HIGH-QUALITY, SAFE AND EFFICIENT PATIENT CARE. ON THE FOREFRONT OF GENOMIC MEDICINE AND WIRELESS HEALTH TECHNOLOGY, THE ORGANIZATION IS DEDICATED TO IMPROVING COMMUNITY HEALTH WHILE ADVANCING MEDICINE THROUGH CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. SCRIPPS HAS ALSO EARNED A NATIONAL REPUTATION AS A PREMIER EMPLOYER, NAMED BY FORTUNE MAGAZINE AS ONE OF AMERICA'S "100 BEST COMPANIES TO WORK FOR" EVERY YEAR SINCE 2008. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS FULFILLING THE SCRIPPS MISSION DURING THIS FISCAL YEAR, SCRIPPS DEVOTED $395,361,567 TO COMMUNITY BENEFIT PROGRAMS AND SERVICES IN THE AREAS OF UNCOMPENSATED CARE, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND HEALTH RESEARCH. OUR PROGRAMS EMPHASIZE COMMUNITY-BASED PREVENTION EFFORTS AND USE INNOVATIVE APPROACHES TO REACH RESIDENTS AT GREATEST RISK FOR HEALTH PROBLEMS. WE MAKE COMMITMENTS TO IMPROVE THE HEALTH OF OUR PATIENTS AND OUR SAN DIEGO COMMUNITIES. AS A LONG-STANDING MEMBER OF THESE COMMUNITIES, AND AS A NOT-FOR-PROFIT COMMUNITY RESOURCE, OUR GOAL AND RESPONSIBILITY ARE TO PROVIDE HELP AND ASSISTANCE FOR ALL WHO COME TO US FOR CARE, AND TO REACH OUT ESPECIALLY TO THOSE WHO FIND THEMSELVES VULNERABLE AND WITHOUT SUPPORT. THIS RESPONSIBILITY IS AN INTRINSIC PART OF OUR MISSION. THROUGH OUR CONTINUED ACTIONS AND COMMUNITY PARTNERSHIPS, WE STRIVE TO RAISE THE QUALITY OF LIFE IN THE COMMUNITY AS A WHOLE. ASSESSING COMMUNITY NEED SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGIONS MOST VULNERABLE POPULATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATE WIDE LEGISLATION IN THE EARLY 1990'S. SB 697 TOOK EFFECT IN 1995, WHICH REQUIRED PRIVATE NON-PROFIT HOSPITALS TO SUBMIT DETAILED INFORMATION TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) ON THEIR COMMUNITY BENEFIT CONTRIBUTIONS. ANNUAL HOSPITAL COMMUNITY BENEFIT REPORTS ARE SUMMARIZED BY OSHPD IN A REPORT TO THE LEGISLATURE, WHICH PROVIDES VALUABLE INFORMATION FOR GOVERNMENT OFFICIALS TO ASSESS THE CARE AND SERVICES PROVIDED TO THEIR CONSTITUENTS. THE SB 697 REQUIREMENT WAS SUPPLEMENTED IN 2010 BY REQUIREMENTS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OR ACA THAT NOT-FOR-PROFIT HOSPITALS CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS WITH COMMUNITY STAKE HOLDERS TO DETERMINE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY THEY SERVE AND IMPLEMENTATION STRATEGIES TO HELP MEET THOSE NEEDS. AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATIONS STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES EVERY THREE YEARS. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS AND CONSUMER GROUPS. THE 2016 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. THE REPORT WILL HELP US BETTER UNDERSTAND OUR COMMUNITYS HEALTH NEEDS, AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE COMPLETE REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/about-us/scripps-in-the-community/assessing-commun ity-needs. REQUIRED COMPONENTS OF THE ASSESSMENT PER IRS REQUIREMENTS. THERE ARE FIVE COMPONENTS THE CHNA MUST INCLUDE: - A DESCRIPTION OF THE COMMUNITY SERVED BY THE HEALTH SYSTEM AND HOW IT WAS DETERMINED. - A DESCRIPTION OF THE PROCESSES AND METHODS USED TO CONDUCT THE ASSESSMENT. - A DESCRIPTION OF HOW THE HOSPITAL ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS. WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. - A PRIORITIZED DESCRIPTION OF ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, AS WELL AS A DESCRIPTION OF THE PROCESS AND CRITERIA USED IN PRIORITIZING SUCH HEALTH NEEDS. - A DESCRIPTION OF THE EXISTING HEALTH CARE FACILITIES AND OTHER RESOURCES WITHIN THE COMMUNITY AVAILABLE TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. EXECUTIVE SUMMARY THE FULL CHNA REPORT CONTAINS IN-DEPTH INFORMATION AND EXPLANATIONS OF THE DATA THAT PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WILL USE TO EVALUATE THE HEALTH NEEDS OF THEIR PATIENTS AND DETERMINE, ADAPT, OR CREATE PROGRAMS AT THEIR FACILITIES. GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTH CARE SYSTEMS, INCLUDING SCRIPPS HEALTH CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND MEET IRS REGULATORY REQUIREMENTS. PER LEGISLATION HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. BASED ON THE FINDINGS FROM THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND RECOMMENDATIONS FROM THE COMMUNITY, THE 2016 CHNA WAS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. PARTICIPATING HOSPITALS WILL USE THIS INFORMATION TO INFORM AND GUIDE HOSPITAL PROGRAMS AND STRATEGIES. THIS REPORT INCLUDES AN ANALYSIS OF HEALTH OUTCOMES AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH WHICH CREATE HEALTH INEQUITIESTHE UNFAIR AND AVOIDABLE DIFFERENCES IN HEALTH STATUS SEEN WITHIN AND BETWEEN COUNTRIES AND COMMUNITIES - WITH THE UNDERSTANDING THAT THE BURDEN OF ILLNESS, PREMATURE DEATH, AND DISABILITY DISPROPORTIONALLY AFFECTS RACIAL AND MINORITY POPULATION GROUPS AND OTHER UNDERSERVED POPULATIONS. UNDERSTANDING REGIONAL AND POPULATION-SPECIFIC DIFFERENCES IS AN IMPORTANT STEP TO UNDERSTANDING AND ULTIMATELY STRATEGIZING WAYS TO MAKE COLLECTIVE IMPACT. THESE NEW INSIGHTS WILL ALLOW PARTICIPATING HOSPITALS TO IDENTIFY EFFECTIVE STRATEGIES TO ADDRESS THE MOST PREVALENT AND CHALLENGING HEALTH NEEDS IN THE COMMUNITY.
FORM 990, PART III, LINE 4A (CONTINUED)	OVERVIEW AND BACKGROUND IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH-RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. COMMUNITY DEFINED FOR THE PURPOSES OF THIS 2016 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. OVER THREE MILLION PEOPLE LIVE IN THE SOCIALLY AND ETHNICALLY DIVERSE COUNTY OF SAN DIEGO. BELOW ARE SELECTED COMMUNITY STATISTICS: - NEARLY 15% OF SAN DIEGANS LIVE IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL. - ALMOST 15% OF SAN DIEGANS AGED 25 AND OLDER HAVE NO HIGH SCHOOL DIPLOMA. - A GREATER PROPORTION OF LATINOS, AFRICAN AMERICANS, NATIVE AMERICANS, AND INDIVIDUALS OF OTHER RACES LIVE IN POVERTY COMPARED TO THE OVERALL SAN DIEGO POPULATION. - APPROXIMATELY 46% OF HOUSEHOLDS IN SAN DIEGO HAVE HOUSING COSTS THAT EXCEED 30% OF THEIR INCOME. - APPROXIMATELY 1 IN 7 SAN DIEGANS ARE FOOD INSECURE. - APPROXIMATELY 16% OF SAN DIEGANS AGED 5 AND OLDER HAVE LIMITED ENGLISH PROFICIENCY AND 8.5% ARE LINGUISTICALLY ISOLATED. ADDITIONAL INFORMATION ON SOCIOECONOMIC FACTORS, ACCESS TO CARE, HEALTH BEHAVIORS, AND THE PHYSICAL ENVIRONMENT CAN BE FOUND IN THE FULL SCRIPPS 2016 CHNA REPORT AT SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. BECAUSE OF ITS LARGE GEOGRAPHIC SIZE AND POPULATION, THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ORGANIZED THEIR SERVICE AREAS INTO SIX GEOGRAPHIC REGIONS. CENTRAL, EAST, NORTH CENTRAL, NORTH COASTAL, NORTH INLAND AND SOUTH. WHEN POSSIBLE, DATA IS PRESENTED AT A REGIONAL LEVEL TO PROVIDE MORE DETAILED UNDERSTANDING OF THE POPULATION. SCRIPPS HEALTH COMMUNITY SERVED HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGIONS OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. COMMUNITY PRIORITY PROCESS (CHNA METHODOLOGY) THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. SAN DIEGO COUNTY IS A SOCIALLY AND ETHNICALLY DIVERSE COMMUNITY WITH A POPULATION OF 3.2 MILLION PEOPLE. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE AT ZIP CODE LEVEL. HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. FOR A COMPLETE DESCRIPTION OF THE HASD&IC 2016 PROCESS AND FINDINGS, SEE FULL REPORT AVAILABLE AT http://hasdic.org/2016-chna/. WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER). 1. BEHAVIORAL/MENTAL HEALTH 2. CARDIOVASCULAR DISEASE 3. DIABETES (TYPE 2) 4. OBESITY FOR THE COLLABORATIVE HASD&IC CHNA PROCESS, THE IPH IMPLIED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT AND QUANTITATIVE ANALYSIS TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SDC. FOR THE PURPOSES OF THE CHNA, A "HEALTH NEED" IS DEFINED AS A HEALTH OUTCOME AND/OR THE RELATED CONDITIONS THAT CONTRIBUTE TO A DEFINED HEALTH OUTCOME. THE 2016 CHNA PROCESS BEGAN WITH A COMPREHENSIVE SCAN OF RECENT COMMUNITY HEALTH STATISTICS IN ORDER TO VALIDATE THE REGIONAL SIGNIFICANCE OF THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. QUANTITATIVE DATA FOR BOTH THE HASD&IC 2016 CHNA AND SMH 2016 CHNA INCLUDED 2013 OSHPD DEMOGRAPHIC DATA FOR HOSPITAL INPATIENT, EMERGENCY DEPARTMENT (ED), AND AMBULATORY CARE ENCOUNTERS TO UNDERSTAND THE HOSPITAL PATIENT POPULATION. CLINIC DATA WAS ALSO GATHERED FROM OSHPDS WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SDC. THE VARIABLES ANALYZED WERE ANALYZED AT THE ZIP CODE LEVEL WHEREVER POSSIBLE. IDENTIFY VULNERABLE COMMUNITIES RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE IPH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITHIN SAN DIEGO COUNTY WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. THE CNI SCORE IS AN AVERAGE OF FIVE DIFFERENT BARRIER SCORES THAT MEASURE VARIOUS SOCIOECONOMIC INDICATORS OF EACH COMMUNITY USING THE 2013 SOURCE DATA. COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - BEHAVIORAL HEALTH DISCUSSIONS - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATION SURVEY - SAN DIEGO COUNTY HHSA SURVEY THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. FINDINGS AND PRIORITIZED HEALTH CONDITIONS THE COLLABORATIVE, HASD&IC 2016 CHNA PRIORITIZED THE TOP HEALTH NEEDS FOR SAN DIEGO COUNTY OVERALL THROUGH THE APPLICATION OF THE FOLLOWING FIVE CRITERIA: 1. MAGNITUDE OR PREVALENCE 2. SEVERITY 3. HEALTH DISPARITIES 4. TRENDS 5. COMMUNITY CONCERN USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE.
FORM 990, PART III, LINE 4A (CONTINUED)	AS A RESULT OF THIS REVIEW, THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SDC. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITH EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMER'S DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITH SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATION RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMER'S DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. SOCIAL DETERMINANTS OF HEALTH IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED, SOCIAL DETERMINANTS OF HEALTH WERE A KEY THEME IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. ANALYSIS OF RESULTS FROM THE COMMUNITY PARTNER DISCUSSIONS AND KEY INFORMANT INTERVIEWS REVEALED THE MOST COMMONLY ASSOCIATED SOCIAL DETERMINANTS OF HEALTH FOR EACH OF THE TOP HEALTH NEEDS ABOVE. TEN SOCIAL DETERMINANTS WERE CONSISTENTLY REFERENCED ACROSS THE DIFFERENT COMMUNITY ENGAGEMENT ACTIVITIES. THE IMPORTANCE OF THESE SOCIAL DETERMINANTS WAS ALSO CONFIRMED BY QUANTITATIVE DATA. HOSPITAL PROGRAMS AND COMMUNITY COLLABORATIONS HAVE THE POTENTIAL TO IMPACT THESE SOCIAL DETERMINANTS, WHICH ARE OUTLINED BELOW IN ORDER OF PRIORITY. - FOOD INSECURITY AND ACCESS TO HEALTHY FOOD - ACCESS TO CARE OR SERVICES - HOMELESSNESS/HOUSING ISSUES - PHYSICAL ACTIVITY - EDUCATION/KNOWLEDGE - CULTURAL COMPETENCY - TRANSPORTATION - INSURANCE ISSUES - STIGMA - POVERTY 2016 CHNA FOLLOW UP SURVEY, PHASE 2 THE CHNA COMMITTEE COMPLETED PHASE 2 OF THE 2016 CHNA, WHICH INCLUDED GATHERING COMMUNITY FEEDBACK ON THE 2016 CHNA PROCESS AND STRENGTHENING PARTNERSHIPS AROUND THE IDENTIFIED HEALTH NEEDS AND SOCIAL DETERMINANTS. A SURVEY WAS CONDUCTED IN THE FALL OF 2016 AS A FOLLOW-UP TO THE COLLABORATIVE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THAT WAS COMPLETED IN MAY OF 2016. THE PURPOSE WAS TO GATHER FEEDBACK ON THE IDENTIFIED TOP FOUR HEALTH NEEDS AND THE TOP 10 SOCIAL DETERMINANTS OF HEALTH THAT WERE IDENTIFIED IN THE 2016 CHNA. IN ADDITION, ORGANIZATIONS WERE ASKED ABOUT THEIR SCREENING METHODS FOR BEHAVIORAL HEALTH ISSUES AND METHODS FOR IDENTIFYING SOCIAL DETERMINANTS OF HEALTH. AN ELECTRONIC SURVEY WAS CREATED AND A SURVEY LINK WAS EMAILED TO COMMUNITY PARTNERS. DUE TO THE FACT THAT COMMUNITY PARTNERS WERE ABLE TO FORWARD THE EMAIL TO THEIR COLLEAGUES THE TOTAL RESPONSE RATE WAS UNABLE TO BE CALCULATED. THE SURVEY WAS OPEN FROM OCTOBER 10TH THROUGH NOVEMBER 7TH, APPROXIMATELY FOUR WEEKS. A TOTAL OF 132 RESPONDENTS COMPLETED THE SURVEY. OF THE 132 RESPONDENTS THAT COMPLETED THE SURVEY, 30 WORKED IN HOSPITALS OR HOSPITAL-BASED SETTINGS, WHILE THE REMAINING 102 RESPONDENTS SELF-IDENTIFIED AS WORKING FOR A RANGE OF ENTITIES INCLUDING BUT NOT LIMITED TO COMMUNITY CLINICS, NOT-FOR-PROFITS, COMMUNITY BASED ORGANIZATIONS, LOCAL GOVERNMENT, AND HEALTH INSURANCE PLANS. IN ADDITION TO SOLICITING FEEDBACK ON THE FINDINGS, THE SURVEY ALSO INCLUDED QUESTIONS SEEKING TO DETERMINE WHETHER THE INTEGRATION OF BEHAVIORAL HEALTH AND PHYSICAL HEALTH IS BEING INTEGRATED LOCALLY, AS WELL AS WHETHER ORGANIZATIONS ARE SCREENING FOR AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH. NINETY-NINE RESPONDENTS STATED THAT THEIR ORGANIZATION SCREENS PATIENTS AND CLIENTS ABOUT THEIR SOCIAL DETERMINANTS OF HEALTH. ACCESS TO CARE OF SERVICES TOPPED THE LIST, ALONG WITH HOMELESS/HOUSING ISSUES AND INSURANCE ISSUES. NINETY-FOUR RESPONDENTS SHARED INFORMATION ABOUT HOW THEY SCREEN PATIENTS AND DOCUMENT THE INFORMATION. FINDINGS CLEARLY INDICATE THAT THESE ORGANIZATIONS ARE SCREENING PATIENTS FOR SOCIAL DETERMINANTS AND MAKING REFERRALS, BUT INDICATIONS ARE THAT FOLLOW-UP IS SOMEWHAT LIMITED. THERE IS STRONG INTEREST ON THE PART OF RESPONDENTS IN LEARNING MORE ABOUT THE WAYS THAT OUR COMMUNITY PARTNERS ARE SCREENING CLIENTS AND PATIENTS. COLLABORATIVE 2016 CHNA FOLLOW-UP SURVEY RESULTS WHAT HAS CHANGED? SUMMER 2017 ANOTHER COMMUNITY FEEDBACK SURVEY WAS CONDUCTED IN THE SUMMER OF 2017 AS A FOLLOW UP TO THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. COMMUNITY PARTNERS FEEDBACK WAS GATHERED IN ORDER TO UNDERSTAND HOW THE HEALTH AND SOCIAL NEEDS OF COMMUNITIES FACING INEQUITY HAVE CHANGED OVER THE PAST YEAR. FEEDBACK WAS COLLECTED IN SEVERAL KEY AREAS, INCLUDING: 1. HOW HAS ACCESS TO CARE CHANGED OVER THE PAST 12 MONTHS. 2. WAYS THAT HOSPITALS CAN WORK MORE EFFECTIVELY WITH COMMUNITY ORGANIZATIONS TO ENSURE THAT PATIENTS ARE TREATED IN THE MOST APPROPRIATE SETTING. 3. HOW ARE PATIENTS/CLIENTS CONCERNS ABOUT THEIR IMMIGRATION STATUS IMPACTING THEIR ACCESS TO NEEDED HEALTH CARE. 4. GIVEN THE FEDERAL POLICIES AND BUDGET CUTS THAT ARE UNDER CONSIDERATION, WHAT ARE THE GREATEST CHALLENGES IN THE COMMUNITYS ABILITY TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. AN ELECTRONIC SURVEY WAS CREATED AND A SURVEY LINK WAS EMAILED TO COMMUNITY PARTNERS. DUE TO THE FACT THAT COMMUNITY PARTNERS WERE ABLE TO FORWARD THE EMAIL TO THEIR COLLEAGUES THE TOTAL RESPONSE RATE WAS UNABLE TO BE CALCULATED. THE SURVEY WAS OPEN FROM JULY 24TH THROUGH AUGUST 16TH, APPROXIMATELY THREE WEEKS. A TOTAL OF 66 RESPONDENTS COMPLETED THE SURVEY. NEXT STEPS THE RESULTS OF THE COMMUNITY SURVEY WILL GUIDE INDIVIDUAL HOSPITAL PROGRAMS AND PLANS, AND WILL ALSO HELP REFINE THE CHNA PROCESS FOR 2019. HOSPITAL AND HEALTHCARE SYSTEMS THAT PARTICIPATED IN THE HASD-IC 2016 CHNA PROCESS HAVE VARYING REQUIREMENTS FOR NEXT STEPS. PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS AND HEALTHCARE SYSTEMS ARE REQUIRED TO DEVELOP HOSPITAL OR HEALTHCARE SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS AND IMPLEMENTATION STRATEGY PLANS TO ADDRESS SELECTED IDENTIFIED HEALTH NEEDS. THE PARTICIPATING PUBLIC HOSPITALS AND HEALTHCARE SYSTEMS DO NOT HAVE FEDERAL OR STATE CHNA REQUIREMENTS, BUT WORK VERY CLOSELY WITH THEIR PATIENT COMMUNITIES TO ADDRESS HEALTH NEEDS BY PROVIDING PROGRAMS, RESOURCES, AND OPPORTUNITIES FOR COLLABORATION WITH PARTNERS. EVERY PARTICIPATING HOSPITAL AND HEALTHCARE SYSTEM WILL REVIEW THE CHNA DATA AND FINDINGS IN ACCORDANCE WITH THEIR OWN PATIENT COMMUNITIES AND PRINCIPAL FUNCTIONS, AND EVALUATE OPPORTUNITIES FOR NEXT STEPS TO ADDRESS THE TOP IDENTIFIED HEALTH NEEDS IN THEIR RESPECTIVE PATIENT COMMUNITIES. THE CHNA REPORT IS MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND MAY SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTHCARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. SCRIPPS HEALTH IMPLEMENTATION PLAN WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY A MULTIFACETED, MULTI-STAKEHOLDER, PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, DURING FY17-FY19 SCRIPPS HEALTH IS FOCUSING ON THE STRATEGIES AND INITIATIVES, THEIR MEASURES OF IMPLEMENTATION AND THE METRICS USED TO EVALUATE THEIR EFFECTIVENESS.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS WILL MONITOR AND EVALUATE THE STRATEGIES LISTED IN THE IMPLEMENTATION PLAN FOR THE PURPOSE OF TRACKING THE IMPLEMENTATION OF THOSE STRATEGIES AS WELL AS DOCUMENT THE ANTICIPATED IMPACT. PLANS TO MONITOR WILL BE TAILORED TO EACH STRATEGY AND WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURE. THE COMPLETE FY17-FY19 IMPLEMENTATION PLAN REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/about-us/scripps-in-the-community/assessing-commun ity-needs. IN SUPPORT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, A DETAILED DESCRIPTION OF SCRIPPS STRATEGIES AND CORRESPONDING MEASURES/METRICS FOR THE FOUR HEALTH PRIORITY AREAS IDENTIFIED IN THE CHNA CAN BE FOUND AT SCRIPPS.ORG/COMMUNITYBENEFIT. METRICS ARE AS CURRENT AS FY18. DURING THIS FISCAL YEAR, SCRIPPS INVESTED $5,334,683 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. SCRIPPS HEALTH STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS AND PARTNER WITH A WIDE VARIETY OF ORGANIZATIONS ON COMMUNITY HEALTH IMPROVEMENT PROGRAMS. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED/ENGAGED IN THE FOLLOWING PROGRAMS IN FISCAL YEAR 2018. ACCESS TO CARE TWO PRIMARY BARRIERS TO OBTAINING HEALTH CARE, ON BOTH THE LOCAL AND NATIONAL LEVEL, ARE LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. MORE PEOPLE WITHOUT INSURANCE TRANSLATES INTO HIGHER USE OF EMERGENCY DEPARTMENTS, WHICH BY LAW MUST PROVIDE STABILIZING CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. MERCY OUTREACH SURGICAL TEAM FOR THREE DECADES, MERCY OUTREACH SURGICAL TEAM (M.O.S.T) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FY18, THE M.O.S.T TEAM SERVED IN THREE OUTREACH MISSION TRIPS. THE M.O.S.T TEAM VOLUNTEERED 2,243 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 700 PEOPLE SERVED. THE M.O.S.T PROGRAM CELEBRATED ITS 31ST ANNIVERSARY THIS YEAR. OCTOBER 2017 IN OCTOBER 2017, A TEAM OF 52 M.O.S.T. VOLUNTEERS INCLUDING TWO PLASTIC SURGEONS, ONE UROLOGIST, AND A GENERAL SURGEON TRAVELED OVER 1,500 MILES FROM SAN DIEGO TO LEON, MEXICO. THE TEAM HELPED 164 PATIENTS ON THIS MISSION. APRIL 2018 WITH SO MANY PATIENTS IN NEED, M.O.S.T. RETURNED FOR THEIR SECOND MISSION TO QURETARO, MEXICO IN APRIL 2018. THE TEAMS OF 58 VOLUNTEERS INCLUDED FOUR PLASTIC SURGEONS, ONE GENERAL SURGEON, ONE UROLOGIST, AND ONE OPHTHALMOLOGIST. THE TEAM PROVIDED 271 CHILDREN WITH SERVICES. JUNE 2018 IN JUNE 2018, M.O.S.T TRAVELED TO THE COASTAL CITY OF ENSENADA, MEXICO AT THE INVITATION OF THE LOCAL DESARROLLO INTEGRAL DE LA FAMILIA (DIF), A PROGRAM THAT PROVIDES ASSISTANCE TO FAMILIES LIVING IN POVERTY. THE WEEKEND MISSION WAS FOCUSED ON CORRECTIVE EYE SURGERY AND OPHTHALMOLOGY. THE TEAM PERFORMED 58 LIFE CHANGING SURGERIES AND 20 EYE EXAMS DURING THE 48 HOUR TRIP. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS/SAN DIEGO RESCUE MISSION RECUPERATIVE CARE UNIT (RCU) PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACK UP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THE RESCUE MISSION PROVIDES A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, AND COUNSELING ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDER ARE CONNECTED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. IN FY18, 54 PATIENTS ACCOUNTED FOR 65 RCU ADMISSIONS. AS A GROUP, THE RCU PATIENTS HAS A CUMULATIVE 646 HOSPITAL DAYS OF STAY, AN AVERAGE OF 10 HOSPITAL DAYS OF STAY, BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: IV ANTIBIOTICS, WOUND VACS, SKIN GRAFTS, FRACTURES, ABSCESSES, OSTEOMYELITIS, AMPUTATION, PARAPLEGIA, DOG BITES, DKA, G BLEEDS, PANCREATITIS, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, COMPLEX TRAUMA, MVA, PEDESTRIAN VERSUS AUTO, PLEURAL EFFUSION, CVA, CANCER (LYMPHOMA, PANCREATIC CANCER, BRAIN MASS), HIV/AIDS, SEPSIS, RESPIRATORY FAILURE, PNEUMONIA AND CHF. PATIENTS WERE ASSAULT VICTIMS WITH GUNSHOT AND STAB WOUNDS, FACIAL TRAUMA, AND SURGICAL POST OP PATIENTS. MANY ARE DIABETIC AND PSYCH PROBLEMS ARE COMMON, OCCASIONALLY THE MAIN PROBLEM FOR RCU CLIENTS. OVER 70% OF THIS GROUP WERE EITHER POSITIVE FOR ALCOHOL, DRUGS OR HAD A DRUG HISTORY ADDRESSED BY THE PHYSICIAN IN THE H & P. MORE SPECIFICALLY, 43 % OF RCU CLIENTS WERE NOTED TO HAVE USED HEROIN OR METH. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 45+ RESIDENTS AND 38 FELLOWS. WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. LEOS CLINIC. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTYS MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2018. FIJI SOLOMON ISLANDS MEDICAL MISSION THE MEDICAL MISSION CONSISTS OF SCRIPPS HEALTH GENERAL MEDICAL SPECIALISTS AND RESIDENTS SETTING UP CLINICS ON RURAL ISLANDS FOR THE PURPOSE OF PROVIDING MUCH NEEDED MEDICAL CARE, MEDICAL SUPPLIES AND SURGICAL SCREENING FOR AN UNDERSERVED POPULATION THAT HAVE NO ACCESS TO BASIC MEDICAL CARE. THE INTERNATIONAL MEDICAL MISSIONS PROVIDE AN EXCEPTIONAL CLINICAL EDUCATION EXPERIENCE TO OUR SENIOR INTERNAL MEDICINE RESIDENTS AT SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL. AMERICAN RED CROSS BLOOD DRIVES SCRIPPS HEALTH PARTNERED WITH THE AMERICAN RED CROSS IN FY18 TO HOST SIX BLOOD DRIVES; 421 SCRIPPS EMPLOYEES DONATED BLOOD THROUGHOUT THE YEAR. SCRIPPS HEALTH COLLECTED 365 PINTS OF BLOOD (FOR EVERY PINT DONATED 3 LIVES ARE SAVED), WHICH SAVED APPROXIMATELY 1,095 LIVES. SCRIPPS HEALTH HEPATITIS A OUTBREAK RESPONSE SCRIPPS HEALTH BUILDS AWARENESS OF DISASTER PREPAREDNESS AND ACTIVELY RESPONDS TO EVENTS TO AFFECT CHANGE AT THE COMMUNITY LEVEL. FOLLOWING THE TERRORIST ATTACK OF SEPTEMBER 11, 2001, SCRIPPS DEVELOPED A SYSTEM-WIDE DISASTER PREPAREDNESS PROGRAM AND MOVED QUICKLY TO MAKE DISASTER PREPAREDNESS AN INTEGRAL ELEMENT THROUGHOUT THE ORGANIZATIONS OPERATIONS. THE SCRIPPS MEDICAL RESPONSE TEAM (SMRT) AROSE FROM THESE EFFORTS. IN 2017, WHEN SAN DIEGO MAYOR KEVIN FAULCONER ASKED SCRIPPS TO HELP ADDRESS THE HEPATITIS A OUTBREAK, THE SCRIPPS SMRT TEAM WORKED DIRECTLY WITH CITY AND COUNTY PUBLIC HEALTH OFFICIALS TO MAKE VACCINATIONS ACCESSIBLE TO INDIVIDUALS AT RISK. SMRT TEAMS INCLUDING PHYSICIANS, NURSES AND SUPPORT PERSONNEL ADMINISTERED VACCINATIONS AND PROVIDED EDUCATION ON HEPATITIS A AT THREE COUNTY-SPONSORED HOUSING SITES OVER MULTIPLE DATES AND TIMES. EACH SITE HOUSED NUMEROUS OCCUPANTS, MANY OF WHOM HAD RISK FACTORS INCLUDING HOMELESSNESS OR SUBSTANCE ABUSE RECOVERY. OCCUPANTS WERE NOTIFIED IN ADVANCE THAT WE WOULD BE OFFERING VACCINATIONS WITHOUT COST. FOR THEIR OWN PROTECTION, ALL VOLUNTEERS WERE REQUIRED TO SHOW PROOF OF IMMUNITY TO HEPATITIS A OR GET VACCINATED PRIOR TO THE OUTREACH. SMRT VOLUNTEERS VACCINATED APPROXIMATELY 100 PEOPLE AGAINST HEPATITIS A; SCRIPPS STAFF THEN ENTERED THEIR VACCINATION HISTORY INTO THE SAN DIEGO IMMUNIZATION PROGRAM WEBPAGE TO TRACK ALL INDIVIDUALS WHO RECEIVED THE VACCINE. THIS HELPED PREVENT UNNECESSARY REVACCINATION OF PEOPLE WHO CAME TO LOCAL EMERGENCY DEPARTMENTS AND PRIMARY CARE OFFICES FOR CARE.
FORM 990, PART III, LINE 4A (CONTINUED)	BECAUSE THE RISK FACTORS ASSOCIATED WITH THE OUTBREAK PERSIST IN OUR COMMUNITY, SCRIPPS EMPLOYEE HEALTH SCREENS AND OFFERS HEP A VACCINATIONS TO ALL EMPLOYEES CONSIDERED AT RISK, ESPECIALLY THOSE WHO WORK IN THE EMERGENCY DEPARTMENT, BEHAVIORAL HEALTH AND FOOD SERVICE. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FY18, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $221,000 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO (FOUR GRANTS RANGING FROM $10,000 TO $120,000). THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTYS HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $3.7 MILLION. PROGRAMS FUNDED DURING FY18 INCLUDE: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW INCOME, UNINSURED MERCY CLINIC AND BEHAVIORAL HEALTH PATIENTS HELP OBTAINING HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME INTENSIVE GOVERNMENT BENEFIT CASES. THE CONSUMER CENTER STRESSES THE IMPORTANCE OF ACCESSING COMMUNITY-BASED SERVICES FOR ROUTINE HEALTH CARE INSTEAD OF USING THE EDS AND HOSPITAL DEPARTMENTS. THEY ALSO EMPHASIZE THE IMPORTANCE OF ESTABLISHING MEDICAL HOMES. CATHOLIC CHARITIES FUNDING PROVIDES SHORT TERM EMERGENCY SHELTER FOR MEDICALLY FRAGILE HOMELESS PATIENTS BEING DISCHARGED FROM SCRIPPS MERCY HOSPITAL, SAN DIEGO. THE PROGRAM IS BEING EXPANDED TO SCRIPPS MERCY HOSPITAL, CHULA VISTA. CASE MANAGEMENT AND SHELTER ARE PROVIDED FOR HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL. WHILE THESE PATIENTS NO LONGER REQUIRE HOSPITAL CARE, THEY DO NEED A SHORT TERM RECUPERATIVE ENVIRONMENT. PATIENTS WHO DEMONSTRATE A WILLINGNESS TO CHANGE RECEIVE ONE WEEK IN A HOTEL, ALONG WITH FOOD AND BUS FARE TO PURSUE A CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. THE PARTNERSHIP SEEKS TO REDUCE EMERGENCY ROOM RECIDIVISM IN THIS POPULATION AND IMPROVE THEIR QUALITY OF LIFE. 2-1-1 HEALTH CARE NAVIGATION PROGRAM LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005 AS A MULTILINGUAL AND CONFIDENTIAL SERVICE COMMITTED TO PROVIDING 24/7 ACCESS. THERE WAS AN OVERWHELMING NEED FOR A DEPENDABLE SERVICE TO HELP PEOPLE NAVIGATE TODAYS COMPLEX HEALTH CARE SYSTEM. SCRIPPS HEALTH HAS BEEN A LONGTIME SUPPORTER OF 2-1-1 SAN DIEGOS HEALTH NAVIGATION PROGRAM WHICH CREATES A RECORD FOR EVERY PERSON WHO CALLS, IN ORDER TO PROVIDE A SERVICE THAT NAVIGATES CLIENTS THROUGH DIFFERENT REFERRALS AND TRACKS THEIR SUCCESS TOWARD ACHIEVING IMPROVED SOCIAL DETERMINANTS OF HEALTH. ALL 2-1-1 STAFF ARE TRAINED TO IDENTIFY INDIVIDUALS WHO ARE IN NEED OF CARE COORDINATION SERVICES, PARTICULARLY INDIVIDUALS WHO ARE HAVING DIFFICULTIES MANAGING THEIR CHRONIC HEALTH CONDITIONS. HEALTH NAVIGATORS ARE TRAINED TO DETERMINE CLIENT RISK USING THE RISK RATING SCALE (RRS). THE RRS DETERMINES A CLIENT'S STATUS RANGING FROM "IN CRISIS" TO "THRIVING" USING SOCIAL DETERMINANTS OF HEALTH SUCH AS HOUSING, NUTRITION, PRIMARY CARE AND HEALTH MANAGEMENT. HEALTH NAVIGATORS ASSESS ON THE FOLLOWING TO DETERMINE WHETHER A CLIENT HAS DECREASED IN VULNERABILITY FOR HEALTH MANAGEMENT: - UNDERSTANDING OF PRESCRIPTION MEDICATION: DOES THE CLIENT UNDERSTAND HOW AND WHEN TO TAKE THEIR MEDICINE AND DO THEY UNDERSTAND THE USE/IMPORTANCE OF EACH MEDICATION? - HEALTH CONDITION MANAGEMENT: DOES THE CLIENT UNDERSTAND THE ILLNESS/DISEASE THAT THEY HAVE BEEN DIAGNOSED WITH, WHAT THEIR PROGNOSIS IS, AND WHAT THEY NEED TO DO IN ORDER TO REMAIN HEALTHY? - HEALTH INSURANCE/ MEDICAL HOME: DOES THE CLIENT HAVE HEALTH INSURANCE AND DO THEY KNOW HOW TO UTILIZE IT? DOES THE CLIENT HAVE A PRIMARY CARE DOCTOR AND/OR SPECIALISTS THAT THEY SEE AND DO THEY KNOW HOW TO MAKE APPOINTMENTS WITH EACH? DOES THE CLIENT KNOW IN WHAT SITUATION THEY SHOULD MAKE AN APPOINTMENT WITH THEIR PCP VS GOING TO AN EMERGENCY ROOM FOR AN IMMEDIATE MEDICAL NEED? - TRANSPORTATION: DOES THE CLIENT HAVE THE MEANS TO GET TO THEIR DOCTOR'S APPOINTMENTS? DURING THIS GRANT PERIOD 2-1-1 PROVIDED CARE COORDINATION SERVICES TO 576 CLIENTS WITH COMPLEX CHRONIC CONDITIONS. CLIENTS DECREASED VULNERABILITY IN THE FOLLOWING SOCIAL DETERMINANTS OF HEALTH: HOUSING, NUTRITION, PRIMARY CARE, AND HEALTH MANAGEMENT BY 67%. CLIENTS ALSO REPORTED FEELING BETTER TO MANAGE THEIR HEALTH CONDITION BY 71% INCREASE. 2-1-1 HEALTH NAVIGATORS PROVIDED INDIVIDUALIZED NEEDS ASSESSMENTS, CASE PLANNING, INFORMATION, EDUCATION AND REFERRALS AND PROVIDED ONGOING CLIENT CONTACT AND PROGRESS CHECKS VIA PHONE OVER A PERIOD OF TIME RELEVANT TO THE CLIENT'S NEEDS TO CHECK ON AND DOCUMENT CLIENT PROGRESS CANCER/ONCOLOGY CANCER IS A TERM USED TO DESCRIBE A GROUP OF DISEASES THAT CAUSE THE UNCONTROLLED GROWTH, INVASION, AND SPREAD (METASTASIS) OF ABNORMAL CELLS. CANCER IS CAUSED BY EXTERNAL FACTORS SUCH AS ENVIRONMENTAL CONDITIONS, RADIATION, INFECTIOUS ORGANISMS, POOR DIET AND LACK OF EXERCISE, AND TOBACCO USE, AS WELL AS INTERNAL FACTORS SUCH AS GENETIC MUTATIONS, AND HORMONES. CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES. CANCER CAUSES ONE OUT OF EVERY FOUR DEATHS IN THE UNITED STATES. ACCORDING TO THE AMERICAN CANCER SOCIETY, CANCER SURVIVAL IS MORE LIKELY TO BE SUCCESSFUL IF THE CANCER IS DIAGNOSED AT AN EARLY STAGE. SUCH DIAGNOSIS IS AN INDICATION OF SCREENING AND EARLY DETECTION. REGULAR SCREENING THAT ALLOW FOR THE EARLY DETECTION AND REMOVAL OF PRECANCEROUS GROWTHS ARE KNOWN TO REDUCE MORTALITY FOR CANCERS OF THE CERVIX, COLON AND RECTUM. FIVE YEAR RELATIVE SURVIVAL RATES FOR COMMON CANCERS, SUCH AS BREAST, PROSTATE, COLON AND RECTUM, CERVIX, AND MELANOMA OF THE SKIN, ARE 93 PERCENT TO 100 PERCENT IF THEY ARE DISCOVERED BEFORE HAVING SPREAD BEYOND THE ORGAN WHERE THE CANCER BEGAN. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF CANCER IS DESCRIBED BELOW: - THE HASD&IC 2016 CHNA CONTINUED TO IDENTIFY ALZHEIMER'S DISEASE AS ONE OF THE TOP 15 PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS. - IN 2016, CANCER WAS THE LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY, RESPONSIBLE FOR 24.1 PERCENT OF DEATHS. - IN 2016, THERE WERE 5,096 DEATHS DUE TO CANCER (ALL SITES) , AND AN AGE ADJUSTED DEATH RATE OF 146.6 DEATHS PER 100,000 POPULATION. - IN 2016, 19.3 PERCENT OF ALL CANCER DEATHS IN SAN DIEGO COUNTY WERE DUE TO LUNG CANCER, 9.3 PERCENT TO COLORECTAL CANCER, 7.4 PERCENT TO FEMALE BREAST CANCER, 7.2 PERCENT TO PANCREATIC CANCER, 6.7 PERCENT TO PROSTATE CANCER, 5.7 PERCENT TO LIVER AND FEMALE REPRODUCTIVE CANCERS, AND 3.6 PERCENT TO LEUKEMIA. - ACCORDING TO THE AMERICAN CANCER SOCIETY (ACS) 2017 CALIFORNIA CANCER FACTS & FIGURES REPORT, IN 2014 THERE WERE 13,625 OBSERVED NEW CANCER CASES AND 4,868 C ACCORDING TO THE ACS CANCER STATISTICS CENTER, IN 2018 THERE WILL BE AN ESTIMATED 29,360 NEW CASES OF BREAST CANCER AND 4,500 BREAST CANCER DEATHS FOR FEMALES IN CALIFORNIA. - IN 2016, THE AGE-ADJUSTED MORTALITY RATE OF BREAST CANCER IN SAN DIEGO COUNTY WAS 20.0 PER 100,000 WOMEN. THIS FALLS SLIGHTLY BELOW THE HP2020 TARGET OF 20.7 BREAST CANCER DEATHS PER 100,000 WOMEN. - ACCORDING TO THE 2015 SUSAN G. KOMEN FOR THE CURE SAN DIEGO AFFILIATE COMMUNITY PROFILE REPORT, IN SDC THERE WERE 46.1 LATE-STAGE CASES OF BREAST CANCER PER 100,000 WOMEN, EXCEEDING THE HP2020 TARGET OF 42.4 CASES PER 100,000 WOMEN. THE REPORT PROJECTS THAT SDC WILL MEET THE HP2020 TARGET WITHIN FIVE YEARS. - THE 2015 SUSAN G. KOMEN FOR THE CURE SAN DIEGO AFFILIATE COMMUNITY PROFILE ALSO REPORTED THAT, IN 2013, BREAST CANCER MORTALITY RATES IN SDC WERE HIGHEST AMONG AFRICAN AMERICAN WOMEN, AT 27.7 DEATHS PER 100,000. THIS EXCEEDED THE MORTALITY RATE FOR CAUCASIAN (23.9), LATINA (17.3) AND ASIAN/PACIFIC ISLANDER (13.2). - ACCORDING TO THE ACS 2017 CALIFORNIA CANCER FACTS & FIGURES REPORT, 72.4 PERCENT OF BREAST CANCER CASES AMONG NON-HISPANIC WHITE WOMEN IN SAN DIEGO COUNTY WERE DIAGNOSED AT AN EARLY STAGE, COMPARED TO 69.3 PERCENT OF AFRICAN AMERICAN CASES, 68.1 PERCENT OF HISPANIC CASES AND 70.4 PERCENT OF ASIAN/PACIFIC ISLANDER CASES. DATA SUGGESTS THAT EARLY BREAST CANCER DETECTION RESOURCES ARE NEEDED IN MINORITY COMMUNITIES. - ACCORDING TO 2015-2016 CHIS DATA, 85.6 PERCENT OF WOMEN IN SAN DIEGO COUNTY BETWEEN THE AGES OF 50 TO 74 REPORTED HAVING A MAMMOGRAM IN THE PAST TWO YEARS. THIS EXCEEDS THE HP2020 TARGET OF 81.1 PERCENT FOR BREAST CANCER SCREENINGS. APPROXIMATELY 2.9 PERCENT OF WOMEN IN THIS AGE RANGE IN SDC REPORTED THAT THEY HAD NEVER HAD A MAMMOGRAM.
FORM 990, PART III, LINE 4A (CONTINUED)	- ACCORDING TO FINDINGS FROM THE ACS 2018 CANCER FACTS & FIGURES REPORT, SCREENING OFFERS THE ABILITY FOR SECONDARY PREVENTION BY DETECTING CANCER EARLY. FOR EXAMPLE, THE 39 PERCENT DECREASE IN THE FEMALE BREAST CANCER DEATH RATE BETWEEN 1989 AND 2015 IS ATTRIBUTED TO IMPROVEMENTS IN EARLY DETECTION, NAMELY SCREENING AND INCREASED AWARENESS. IN ADDITION, OVER THE PAST THREE DECADES, FIVE-YEAR RELATIVE SURVIVAL RATES FOR ALL CANCERS COMBINED INCREASED BY 20 PERCENT AMONG WHITES AND 24 PERCENT AMONG BLACKS, REFLECTING EARLIER DIAGNOSIS FOR SOME CANCERS AS WELL AS IMPROVEMENTS IN TREATMENT (ACS, 2018). - STUDY FINDINGS FROM THE 2015 SUSAN G. KOMEN FOR THE CURE SAN DIEGO AFFILIATE COMMUNITY PROFILE INDICATE A CRITICAL NEED FOR CULTURALLY COMPETENT OUTREACH, ESPECIALLY FOR HISPANIC, MIDDLE EASTERN AND AFRICAN AMERICAN WOMEN (SUSAN G. KOMEN, 2015). - A RECENT STUDY BY THE ACS FOUND THAT 42 PERCENT OF NEWLY DIAGNOSED CANCER CASES IN THE U.S. ARE POTENTIALLY AVOIDABLE. MANY OF THE KNOWN CAUSES OF THE CANCER - AND OTHER NON-COMMUNICABLE DISEASES - ARE ATTRIBUTABLE TO BEHAVIORAL FACTORS INCLUDING TOBACCO USE AND EXCESS BODY WEIGHT DUE TO POOR DIETARY HABITS AND LACK OF PHYSICAL ACTIVITY (ACS, 2018). - THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO) EMPHASIZES THE IMPORTANCE OF PATIENT NAVIGATORS AS PART OF A MULTIDISCIPLINARY ONCOLOGY TEAM WITH THE GOAL OF REDUCING MORTALITY AMONG UNDERSERVED PATIENTS. A PATIENT NAVIGATOR MAY ASSIST WITH VARIOUS TASKS, INCLUDING: PSYCHOSOCIAL SUPPORT; ASSISTANCE WITH TREATMENT DECISIONS; ASSISTANCE WITH INSURANCE ISSUES; ARRANGEMENT OF TRANSPORTATION; COORDINATION OF ADDITIONAL SERVICES (I.E., FERTILITY PRESERVATION); AND TRACKING OF INTERVENTIONS AND OUTCOMES. THE NAVIGATOR WORKS WITH THE PATIENT ACROSS THE CARE CONTINUUM, ENSURING COORDINATION AND EFFICIENCY OF CARE, AND REMOVAL OF BARRIERS TO CARE (ASCO, 2016). - ACCORDING TO THE NIH, CLINICAL TRIALS, A PART OF CLINICAL RESEARCH, ARE AT THE HEART OF ALL MEDICAL ADVANCES. CLINICAL TRIALS LOOK AT NEW WAYS TO PREVENT, DETECT OR TREAT DISEASE BY DETERMINING THE SAFETY AND EFFICACY OF A NEW TEST OR TREATMENT. GREATER CLINICAL TRIAL ENROLLMENT BENEFITS MEDICAL RESEARCH AND INCREASES THE HEALTH OF FUTURE GENERATIONS AS WELL AS IMPROVES DISEASE OUTCOMES, QUALITY OF LIFE AND HEALTH OF TRIAL PARTICIPANTS. SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS TO EDUCATE PEOPLE ABOUT THE IMPORTANCE OF EARLY DETECTION AND TREATMENT FOR SOME OF THE MOST COMMON FORMS OF CANCER. AT SCRIPPS, CANCER CARE IS MORE THAN JUST MEDICAL TREATMENT, AND A WIDE ARRAY OF RESOURCES ARE PROVIDED SUCH AS COUNSELING, SUPPORT GROUPS, COMPLEMENTARY THERAPIES AND EDUCATIONAL WORKSHOPS. HERE ARE A FEW EXAMPLES OF SCRIPPS CANCER PROGRAMS DURING FISCAL YEAR 2018: SCRIPPS MD ANDERSON CANCER CENTER DIRECTORY OF COMMUNITY RESOURCES SCRIPPS COLLABORATES WITH THE COMMUNITY AND DEVELOPS A CANCER DIRECTORY OF A COMPREHENSIVE LIST OF RESOURCES AVAILABLE FOR CANCER SURVIVORS, THEIR FAMILIES, AND THE COMMUNITY. SCRIPPS MD ANDERSON GREEN CANCER CENTER SUPPORT GROUPS SCRIPPS GREEN HOSPITAL SUPPORT GROUPS OFFER CANCER PATIENTS THE OPPORTUNITY TO EXPRESS THE EMOTIONS THAT COME WITH A CANCER DIAGNOSIS AND HELP THEM COPE MORE EFFECTIVELY WITH THEIR TREATMENT REGIMENS BY SUPPORT GROUPS THAT NURTURE THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING. SCRIPPS MD ANDERSON CANCER CENTER REGISTERED NURSE NAVIGATOR PROGRAM SCRIPPS PROVIDED A REGISTERED NURSE, DEDICATED TO ASSISTING CANCER PATIENTS AND THEIR FAMILIES WITH NAVIGATING THROUGH THE JOURNEY FROM DIAGNOSIS, TREATMENT AND SURVIVORSHIP FROM CANCER. THE FOCUS IS ON EDUCATION AND OUTREACH, AS WELL AS, SUPPORT SERVICES IN THIS POPULATION. SCRIPPS MD ANDERSON CANCER CENTER OUTPATIENT HEREDITY AND CANCER GENETIC COUNSELING PROGRAM THIS PROGRAM PROVIDES GENETIC TESTING AND COUNSELING TO CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. SCRIPPS MD ANDERSON CANCER CENTER OUTPATIENT SOCIAL WORKER & LIAISON PROGRAM SCRIPPS PROVIDES A SOCIAL WORKER, DEDICATED TO ASSISTING CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. SCRIPPS MD ANDERSON CANCER CENTER HEAD AND NECK SUPPORT GROUP SCRIPPS PROVIDES SUPPORT GROUPS DESIGNED FOR INDIVIDUALS DIAGNOSED WITH HEAD AND NECK CANCER. THIS GROUP PROVIDES EDUCATION AND RESOURCES TO HELP MANAGE EMOTIONAL AND PHYSICAL CHALLENGES NORMALLY ENCOUNTERED DURING AND AFTER CANCER TREATMENT. SCRIPPS MD ANDERSON CANCER CENTER LYMPHEDEMA SUPPORT GROUP SCRIPPS PROVIDES EDUCATION AND SUPPORT FOR THOSE DIAGNOSED WITH LYMPHEDEMA AND UNDERGOING TREATMENT FOR THE DISEASE. SCRIPPS MD ANDERSON CANCER SURVIVORS DAY NATIONAL CANCER SURVIVORS DAY EVENTS ARE HELD IN HUNDREDS OF COMMUNITIES NATIONWIDE THROUGHOUT THE MONTH OF JUNE. SCRIPPS HOLDS A CELEBRATORY EVENT AT EACH SCRIPPS HOSPITAL EACH YEAR TO PROVIDE AN OPPORTUNITY FOR THOSE THAT HAVE BATTLED CANCER TO COME TOGETHER AND ENJOY THE COMPANY OF FRIENDS, FAMILY AND THE CAMARADERIE OF FELLOW CANCER SURVIVORS. THROUGHOUT THE MONTH OF JUNE CANCER SURVIVORS AND OTHER GUESTS SHARE INSPIRATIONAL STORIES, LEARN ABOUT ADVANCES IN CANCER TREATMENT AND RESEARCH, AND ENJOY THE OPPORTUNITY TO CONNECT WITH CAREGIVERS AND FELLOW SURVIVORS. EACH YEAR THE CANCER SURVIVOR EVENT HELPS CELEBRATE LIFE, INSPIRE THOSE RECENTLY DIAGNOSED, OFFER SUPPORT TO FAMILY AND LOVED ONES AND RECOGNIZE ALL WHO PROVIDED SUPPORT ALONG THE WAY. THEY ALSO PROVIDE A FORUM FOR DISCUSSING THE PHYSICAL, FINANCIAL AND SOCIAL ISSUES THAT MANY CANCER SURVIVORS FACE FOLLOWING COMPLETION OF TREATMENT. SCRIPPS MD ANDERSON CANCER CENTER GYNECOLOGICAL SUPPORT GROUP SCRIPPS HEALTH PROVIDES MEETING SPACE FOR WOMEN FACING GYNECOLOGICAL CANCERS. FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS SKIN CANCER SCREENINGS A TOTAL OF 280 FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS WERE SCREENED FOR SKIN CANCER. LOCAL STATE BEACHES LIFEGUARD SKIN CANCER SCREENINGS A TOTAL OF 55 LOCAL STATE BEACHES LIFEGUARDS WERE SCREENED FOR SKIN CANCER. THIS IS THE FIRST YEAR SCRIPPS PARTICIPATED IN THIS PROGRAM. HEALTHY WOMEN, HEALTHY LIFESTYLES: SCRIPPS MERCY BREAST HEALTH OUTREACH AND EDUCATION PROGRAM A PROMOTORA LED HEALTH AND WELLNESS PROGRAM THAT AIMS TO IMPROVE THE LIVES OF WOMEN IN SAN DIEGOS SOUTH BAY WITH BREAST CANCER EDUCATION, PREVENTION AND TREATMENT SUPPORT. PROMOTORAS TEACH BREAST HEALTH TO WOMEN WHO HAVE LIMITED OR NO ACCESS TO HEALTH CARE. PROMOTORAS TEACH WOMEN IN THEIR NATIVE LANGUAGE WITH SENSITIVITY TO A WOMANS ETHNIC AND CULTURAL NORMS. THE PROGRAM MODEL INCLUDES A PROMOTORA, CANCER SURVIVOR AND A NURSE NAVIGATOR. THE PROMOTORA HAS KNOWLEDGE OF BREAST CANCER, OFFERS EDUCATION AND EMOTIONAL SUPPORT. SHE ALSO PROVIDES REFERRALS IN CULTURALLY APPROPRIATE AND LANGUAGE SENSITIVE WAY. A BREAST CANCER SURVIVOR AND VOLUNTEER STRENGTHENS THE BENEFITS OF BREAST CANCER EDUCATION AND PREVENTION BY TALKING TO SOMEONE WHO HAS BEEN THERE AND CAN PROVIDE INSIGHT AND SUGGESTIONS, AND IS LIVING PROOF THAT THE DISEASE IS NOT FATAL. WORKING HAND-IN-HAND, THE PROMOTORA AND VOLUNTEER PRESENT A VERY STRONG FRONT FOR BREAST CANCER AWARENESS AND FULL SUPPORT SYSTEM FOR THOSE ALREADY DIAGNOSED. MOREOVER, THE FACT THEY ARE BI-LINGUAL LATINAS LEND AN AIR OF AUTOMATIC TRUST AMONG THE HISPANIC COMMUNITY AS THEY CAN CONNECT WITH THE RESIDENTS ON A CULTURAL LEVEL. SCRIPPS MERCY HOSPITAL, CHULA VISTA: BREAST HEALTH CLINICAL SERVICES A TOTAL OF 548 WOMEN ARE REFERRED TO CLINICAL BREAST HEALTH SERVICES AT COMMUNITY AND SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY SERVICES. MORE THAN 2,000 SERVICES WERE PROVIDED, INCLUDING TELEPHONE REMINDERS, OUTREACH AND EDUCATION, CASE MANAGEMENT AND A VARIETY OF PRESENTATIONS. SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY FOLLOW UP SERVICES MORE THAN 160 WOMEN WERE PROVIDED SERVICES. SERVICES -PROVIDED, INCLUDE ENCOURAGEMENT FOR PATIENTS TO REPEAT EXAMS, ASSISTANCE TO GET PATIENTS HEALTH INSURANCE APPROVAL FOR REPEAT EXAMS, SOCIAL/EMOTIONAL SUPPORT AND EDUCATION ABOUT PREVENTING BREAST CANCER. SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY, POSITIVE BREAST CANCER PATIENT SUPPORT MORE THAN 340 SERVICES WERE PROVIDED INCLUDING PHONE CALLS, HOME VISITS, MAILED EDUCATIONAL MATERIALS AND SUPPLIES (WIGS, BRAS, PROSTHESIS AND MEDICAL RECORD ORGANIZER BINDER). A RESOURCE PACKAGE WITH EDUCATIONAL MATERIALS ON NUTRITION, TREATMENT OPTIONS, COMMONLY ASKED QUESTIONS AND LOCAL RESOURCES WERE ALSO PROVIDED. SCRIPPS MERCY HOSPITAL, CHULA VISTA BREAST CANCER SUPPORT GROUP TOGETHER PROMOTORAS AND CANCER SURVIVORS HOLD A BI-MONTHLY SUPPORT GROUP THAT HELPS INDIVIDUALS COPE WITH LIVING WITH CANCER. MORE THAN 20 WOMEN PARTICIPATE AS PART OF THIS GROUP MONTHLY. GROUP SUPPORT INCLUDING NAVIGATING THE CANCER SYSTEM AND EDUCATIONAL PRESENTATIONS BY LOCAL PROVIDERS ARE OFFERED.
FORM 990, PART III, LINE 4A (CONTINUED)	SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SPONSORS THE YOUNG WOMENS SUPPORT GROUP WHICH PROVIDE A VENUE FOR WOMEN UNDER THE AGE OF 40 TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES AND RECEIVE SUPPORT. THE GROUPS ARE OFFERED TO WOMEN IN THE SAN DIEGO COMMUNITY. TOPICS RELATED TO BREAST HEALTH ARE ALSO OFFERED TO THE COMMUNITY. AMERICAN CANCER SOCIETY (ACS) MAKING STRIDES AGAINST BREAST CANCER SCRIPPS HEALTH PARTICIPATED AND SPONSORED THE MAKING STRIDES AGAINST BREAST CANCER WALK IN THE AMOUNT OF $10,000 TO RAISE MONEY FOR BREAST CANCER RESEARCH. A SERIES OF EDUCATIONAL EVENTS ARE COORDINATED WITH THE AMERICAN CANCER SOCIETY AWARENESS MONTHS. THE EVENTS FOCUS ON VARIOUS TYPES OF CANCER, INCLUDING BREAST, LUNG, CERVICAL, COLORECTAL, SKIN, OVARIAN/GYNECOLOGICAL AND PROSTATE. A REGISTERED NURSE CLINICIAN ANSWERS QUESTIONS AND PROVIDES EDUCATIONAL MATERIALS. SUSAN G. KOMEN 3 DAY BREAST CANCER WALK FIRST AID SUPPORT STATION SCRIPPS IS THE OFFICIAL PHYSICAL THERAPY SPORTS MEDICINE CREW FOR THE FIRST AID STATION AT THE SUSAN G. KOMEN CANCER WALK. THIS VITAL STATION PROVIDES TREATMENTS TO THOSE PARTICIPATING SUCH AS WOUND CARE, ORTHOPEDIC EVALUATION TREATMENTS, LIMB AND JOINT TAPING, ASSISTANCE WITH STRETCHING AND EDUCATION. SCRIPPS MD ANDERSON CANCER CENTER ALOHA LOCK CANCER WIG PROGRAM THIS PROGRAM PROVIDES WIGS AND HAIR ACCESSORIES TO CANCER PATIENTS SUFFERING FROM ALOPECIA OR EXPECTED TO SUFFER FROM ALOPECIA. CARDIOVASCULAR DISEASE "DISEASES OF THE HEART" WERE THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY IN 2016. IN ADDITION "CEREBROVASCULAR DISEASES" WERE THE FOURTH LEADING CAUSE OF DEATH, AND ESSENTIAL (HYPERTENSION AND HYPERTENSIVE RENAL DISEASE) WAS THE TENTH. CORONARY HEART DISEASE IS THE MOST COMMON FORM OF HEART DISEASE. HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CVD AND STROKE. ABOUT HALF OF AMERICANS (49%) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS. RISK FACTORS FOR CARDIOVASCULAR DISEASE: BEHAVIORS: TOBACCO USE, OBESITY, POOR DIET THAT IS HIGH IN SATURATED FATS, AND EXCESSIVE ALCOHOL USE. CONDITIONS: HIGH CHOLESTEROL LEVELS, HIGH BLOOD PRESSURE AND DIABETES. HEREDITY: GENETIC FACTORS LIKELY PLAY A ROLE IN HEART DISEASE AND CAN INCREASE RISK. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF CARDIOVASCULAR DISEASE IS DESCRIBED BELOW: - THE SCRIPPS 2016 CHNA CONTINUED TO IDENTIFY CARDIOVASCULAR DISEASE (INCLUDING CEREBROVASCULAR DISEASE/STROKE) AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - ACCORDING TO DATA PRESENTED IN THE SCRIPPS 2016 CHNA, HIGH BLOOD PRESSURE, HIGH C DISEASE AND STROKE. ABOUT HALF OF ALL AMERICANS (47 PERCENT) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS. ADDITIONAL RISK FACTORS INCLUDE ALCOHOL USE, OBESITY, PHYSICAL INACTIVITY, POOR DIET, DIABETES AND GENETIC FACTORS (CDC, 2015). - HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST RACIAL/ETHNIC GROUPS IN THE UNITED STATES, INCLUDING AFRICAN AMERICANS, HISPANICS AND WHITES. - IN 2016, CEREBROVASCULAR DISEASES INCLUDING STROKE WERE THE FOURTH LEADING CAUSE OF DEATH FOR SAN DIEGO COUNTY OVERALL. - IN 2016, THERE WERE 1,362 DEATHS DUE TO STROKE IN SAN DIEGO COUNTY , A 17.2 PERCENT INCREASE FROM 2015. THE AGE-ADJUSTED DEATH RATE DUE TO STROKE WAS 38.3 PER 100,000 POPULATION, WHICH WAS HIGHER THAN THE HP2020 TARGET OF 34.8 DEATHS PER 100,000. - IN 2016, THERE WERE 6,346 HOSPITALIZATIONS FOR STROKE IN SAN DIEGO COUNTY, WITH AN AGE-ADJUSTED RATE OF 183 PER 100,000 POPULATION. THE RATE OF HOSPITALIZATION FOR STROKE INCREASED 2.8 PERCENT FROM 2015 TO 2016 - THE FIRST INCREASE SINCE 2011, WHEN SAN DIEGO COUNTY RECORDED A STROKE RATE OF 218.4 PER 100,000 POPULATION. - IN 2016, THERE WERE 2,371 STROKE-RELATED ED VISITS IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF ED VISITS WAS 68.9 PER 100,000 POPULATION. - ACCORDING TO 2016-2017 CHIS DATA, AN ESTIMATED 23.9 PERCENT OF ADULTS IN SAN DIEGO COUNTY WERE OBESE, 9.7 PERCENT SMOKED CIGARETTES AND 62.0 PERCENT DID NOT REGULARLY WALK FOR TRANSPORTATION, FUN, OR EXERCISE. IN 2016, 16.3 PERCENT OF ADULTS IN SDC REPORTED EATING FAST FOOD FOUR OR MORE TIMES IN THE PAST WEEK. - THE NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS) REPORTS THAT 25 PERCENT OF PEOPLE WHO RECOVER FROM THEIR FIRST STROKE WILL HAVE ANOTHER STROKE WITHIN FIVE YEARS (NINDS, 2016). - THE CDC ESTIMATES THAT UP TO 80 PERCENT OF STROKES ARE PREVENTABLE THROUGH THE RECOGNITION OF EARLY SIGNS/SYMPTOMS AND THE ELIMINATION OF STROKE RISK FACTORS. - ACCORDING TO THE CDC, HEALTHY LIFESTYLE CHOICES CAN HELP PREVENT STROKE. BEHAVIORS THAT CAN MITIGATE THE RISK OF STROKE INCLUDE CHOOSING A HEALTHY DIET FULL OF FRUITS AND VEGETABLES, MAINTAINING A HEALTHY WEIGHT, ENGAGING IN AT LEAST 2.5 HOLESTEROL AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CARDIOVASCULAR HOURS OF MODERATE-INTENSITY AEROBIC PHYSICAL ACTIVITY EACH WEEK, REFRAINING FROM OR QUITTING SMOKING, AND LIMITING ALCOHOL INTAKE (CDC, 2018). NOT ONLY IS SCRIPPS A NATIONALLY RECOGNIZED HEART CARE LEADER, CONSISTENTLY RANKED BY U.S. NEWS & WORLD REPORT AS ONE OF AMERICAS BEST HOSPITALS FOR CARDIOLOGY AND HEART SURGERY, BUT WE TREAT MORE HEART PATIENTS THAN ANY OTHER HEALTH CARE PROVIDER IN SAN DIEGO. WE HAVE STATE-OF-THE-ART TECHNOLOGY AND HIGHLY TRAINED HEART CARE SPECIALISTS, PROVIDING AN INNOVATIVE AND EXPANSIVE SCOPE OF SERVICES AND HIGH-QUALITY OUTCOMES. ALONG WITH THE TREMENDOUS CARE SCRIPPS PROVIDES WITHIN OUR HOSPITALS AND OUTPATIENT CLINICS, SCRIPPS ALSO SUPPORTS OUR SURROUNDING COMMUNITIES WITH RESOURCES, OUTREACH PROGRAMS AND PARTNERSHIPS TO ENSURE THE HEARTBEAT OF OUR COMMUNITY CONTINUES ON. DURING FISCAL YEAR 2018, SCRIPPS ENGAGED IN THE FOLLOWING HEART HEALTH, CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT ACTIVITIES. AMERICAN HEART ASSOCIATION HEART WALK SCRIPPS PARTNERS WITH THE AMERICAN HEART ASSOCIATION ON ITS ANNUAL HEART WALK TO RAISE FUNDS FOR RESEARCH, PROFESSIONAL AND PUBLIC EDUCATION AND ADVOCACY. HEART DISEASE AND STROKE ARE THE NUMBER ONE AND THREE CAUSES OF DEATH IN THE NATION. HEART DISEASE CLAIMS MORE THAN 950,000 AMERICANS EACH YEAR. SCRIPPS HAS PROUDLY SUPPORTED THE AHAS ANNUAL SAN DIEGO HEART & STROKE WALK, WHICH PROMOTES PHYSICAL ACTIVITY TO BUILD HEALTHIER LIVES, FREE OF CARDIOVASCULAR DISEASES AND STROKE. IN SEPTEMBER 2018, SCRIPPS EMPLOYEES VOLUNTEERED THEIR TIME TO COORDINATE WALKER PARTICIPATION AND FUNDRAISING EFFORTS. THE SAN DIEGO HEART WALK RAISED MORE THAN $1.1 MILLION. IN FY18, MORE THAN 1,063 SCRIPPS HEART WALK PARTICIPANTS, (EMPLOYEES, FAMILIES, AND FRIENDS) AND MORE THAN 114 TEAMS REPRESENTING ENTITIES ACROSS SCRIPPS HEALTH WALKED TO HELP RAISE MORE THAN $74,954. TO DATE, SCRIPPS HAS RAISED MORE THAN $3 MILLION THROUGH ITS SAN DIEGO HEART & STROKE WALK FUNDRAISING EFFORTS. AMERICAN HEART ASSOCIATION GO RED FOR WOMENS LUNCHEON SCRIPPS SPONSORS THIS ANNUAL EVENT THAT BRINGS PHILANTHROPISTS, CARDIOLOGISTS, AND SURVIVORS TOGETHER TO CREATE AWARENESS AROUND HEART DISEASE AND STROKE. FUNDS RAISED HELP SUPPORT LOCAL RESEARCH PROJECTS IN SAN DIEGO. COMMUNITY HEALTH EDUCATION PROGRAMS SCRIPPS HEALTH HAS A ROBUST COMMUNITY HEALTH EDUCATION PROGRAM IN WHICH PHYSICIANS AND EXPERTS COVER A WIDE VARIETY OF TOPICS. CARDIOVASCULAR RELATED TALKS INCLUDE HEALTHY HEARTS AT EVERY AGE, BEYOND BLOOD THINNERS, AND LIVING WELL WITH HEART DISEASE. THESE LECTURES ARE DELIVERED PUBLIC EVENTS HOSTED BY THE SCRIPPS MARKETING DEPARTMENT AND THROUGH ONGOING PARTNERSHIPS WITH OASIS SAN DIEGO AND THE LAWRENCE FAMILY JEWISH COMMUNITY CENTER. CPR CLASSES FOR PATIENTS AND FAMILIES OF THE CARDIAC TREATMENT CENTER CPR CLASSES ARE OFFERED FOUR TIMES A YEAR TO CARDIAC TREATMENT CENTER PATIENTS AND THEIR FAMILIES. THE PROGRAM IMPROVES COMMUNITY HEALTH BY INCREASING KNOWLEDGE OF CARDIOPULMONARY RESUSCITATION PRACTICES. CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS ARE DESIGNED FOR CARDIOVASCULAR HEALTH IMPROVEMENT. CLASSES INCLUDE TRAINING IN BALANCE, HATHA YOGA, LEBED METHOD OF FITNESS, TAI CHI, FITBALL, CHAIR YOGA AND MEDITATION. THE CARDIAC TREATMENT CENTER ALSO PROVIDES EXERCISE PROGRAMS THAT INCLUDE NUTRITIONAL EDUCATION THROUGH THE PULMONARY CLASS, DIETARY ONE-ON-ONE COUNSELING, AND THE CARDIAC LIFE PROJECT. THE BETTER BREATHERS AND SELF-DEFENSE FITNESS CLASSES PROVIDE ADDITIONAL EDUCATION IN CARDIOVASCULAR HEALTH. CARDIAC LIFE PROJECT THE CARDIAC TREATMENT CENTERS LIFE PROJECT IS A SUPPORT GROUP FOR PEOPLE WITH HEART DISEASE AND THEIR FAMILY MEMBERS. THE GOAL IS TO PROVIDE EDUCATION AND RESOURCES ON COPING WITH HEART DISEASE IN A FRIENDLY AND SUPPORTIVE ENVIRONMENT. PULMONARY CARDIAC CLASS THIS EDUCATIONAL CLASS PROVIDED BY THE SCRIPPS CARDIAC TREATMENT CENTER IS A COMPREHENSIVE SIX WEEK EDUCATION PROGRAM FOR PULMONARY PATIENTS TO HELP THEM TO MANAGE THEIR DISEASE. THEY WILL LEARN LIFESTYLE MANAGEMENT FOR A HEALTHY LIFE, NUTRITION AND EXERCISE ARE PART OF THE SERIES.
FORM 990, PART III, LINE 4A (CONTINUED)	STROKE CARE PROGRAMS SCRIPPS SPONSORS A WIDE VARIETY OF STROKE RELATED EDUCATION AND AWARENESS PROGRAMS. THESE INCLUDE SUPPORT GROUPS AND EDUCATION FOR STROKE AND BRAIN INJURY SURVIVORS AND THEIR LOVED ONE. INFORMATION AND RESOURCES ARE PROVIDED, ALONG WITH SKILLS TO HELP REINFORCE INNER STRENGTHS AND LEARN SELF-CARE STRATEGIES. SUPPORT GROUPS OFFER THE ABILITY TO DEVELOP ENCOURAGING PEER RELATIONSHIPS ALONG WITH THE GOAL OF RETURNING TO AND CONTINUING A LIFE OF MEANING AND PURPOSE. STUDENT PRECEPTORSHIPS AT CARDIAC TREATMENT CENTER SCRIPPS PROVIDES PRECEPTORSHIPS FOR STUDENT RN'S, EXERCISE PHYSIOLOGIST'S AND CARDIAC SONOGRAPHERS. THE SCRIPPS CARDIAC TREATMENT CENTER NURSES MENTOR THE STUDENTS THROUGH EDUCATION AND MODELING. THE STUDENTS LEARN THE ROLES AND RESPONSIBILITIES REQUIRED OF THE POSITIONS. VENTRICULAR ASSIST DEVICE (VAD) SUPPORT GROUP SCRIPPS OFFERS A SUPPORT GROUP FOR PATIENTS WITH A VENTRICULAR ASSIST DEVICE. THIS GROUP PROVIDES EDUCATION AND SUPPORT TO THOSE PATIENTS AND THEIR CAREGIVERS/PARTNERS. TOPICS INCLUDE: SAFETY AND PROPER MECHANICS REQUIRED FOR THE DEVICE. JOE NIEKRO FOUNDATION SCRIPPS HEALTH PROVIDES MEETING SPACE FOR THE JOE NIEKRO FOUNDATION FOR SUPPORT GROUPS FOR PATIENT, FAMILIES AND FRIENDS WHO HAVE BEEN AFFECTED WITH BRAIN ANEURYSMS OR HEMORRHAGIC STROKE. THE PROGRAM IS OPENED TO THE PUBLIC. SAN DIEGO ECHO SOCIETY SCRIPPS HEALTH PROVIDES MEETING SPACE TO THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY. THIS IS AN ORGANIZATION OF PROFESSIONALS COMMITTED TO EXCELLENCE IN CARDIOVASCULAR ULTRASOUND AND ITS APPLICATION TO PATIENT CARE THROUGH EDUCATION, ADVOCACY, RESEARCH, INNOVATION AND SERVICE TO OUR MEMBERS AND THE PUBLIC. WOMEN HEART THE NATIONAL COALITION FOR WOMEN WITH HEART DISEASE - SUPPORT GROUP SCRIPPS HEALTH PROVIDES MEETING SPACE FOR WOMENS HEART SUPPORT GROUP. WOMEN HEART'S MISSION IS TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF WOMEN LIVING WITH OR AT RISK OF HEART DISEASE, AND TO ADVOCATE FOR THEIR BENEFIT. WOMEN WITH HEART DISEASE HAVE THE OPPORTUNITY TO SHARE THEIR STORIES, SUPPORT EACH OTHER AND HEAL TOGETHER. EXPERTS ARE INVITED TO TALK TO THE GROUP ABOUT DIFFERENT KINDS OF HEART CONDITIONS, HEART ATTACK PREVENTION, BLOOD PRESSURE, EXERCISE AND NUTRITION. EDUCATING WOMEN ABOUT HEART HEALTH TOGETHER WITH WOMEN HEART NATIONAL HOSPITAL ALLIANCE, SCRIPPS CARDIOVASCULAR DEVELOPED A WOMEN AND HEART DISEASE EDUCATION PROGRAM. THE EFFORTS EDUCATE WOMEN ON THE IMPORTANCE OF HEART HEALTH, PROVIDE SUPPORT GROUPS AND ADVOCATE FOR RESEARCH FUNDING AND POLICIES. SENIOR HEALTH CHATS A WIDE VARIETY OF SENIOR CHATS ARE OFFERED AT LOCAL SENIOR CENTERS IN SOUTH BAY TO ADDRESS EDUCATION AND PREVENTION OF HEART DISEASE. SOME TOPICS INCLUDE HEART HEALTH 101, STROKE, AND A VARIETY OF PREVENTION EDUCATION. A TOTAL OF 10 PRESENTATIONS ARE GIVEN YEARLY TO MORE THAN 223 INDIVIDUALS. THE ERIC PAREDES SAVE A LIFE FOUNDATION EACH YEAR, 7,000 TEENS LOSE THEIR LIVES DUE TO SUDDEN CARDIAC ARREST (SCA). SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE EKG. UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. SAN DIEGO ALONE LOSES THREE TO FIVE TEENS FROM SCA ANNUALLY. SCRIPPS EFFORTS BEGAN WHEN A REGISTERED NURSE AT SCRIPPS CREATED THE FOUNDATION AFTER HER 15 YEAR OLD SON, ERIC PASSED AWAY FROM SUDDEN CARDIAC ARREST IN 2009. TURNING TRAGEDY INTO AN OPPORTUNITY, THE PAREDES ESTABLISHED THE ORGANIZATION TO PREVENT SUDDEN CARDIAC ARREST IN SCHOOL-AGE CHILDREN AND ADOLESCENTS. AS A SPONSOR FOR THE ERIC PAREDES SAVE A LIFE FOUNDATION, SCRIPPS HAS HELD MORE THAN 20,000 FREE CARDIAC SCREENINGS TO LOCAL TEENS, INCLUDING THE HOMELESS, UNINSURED AND UNDERINSURED. IN FY18, SCRIPPS MADE AN $8,500 DONATION TO HELP PAY FOR SCREENINGS. IN FY18, SCRIPPS SUPPORTED SCREENING EVENTS AT AREA HIGH SCHOOLS AND SCREENED 4,915 TEENS, IDENTIFYING 42 WITH ABNORMALITIES AND 24 WHO WERE AT RISK. SWEETWATER UNION HIGH SCHOOL DISTRICT SPORTS SCREENINGS EVERY YEAR, THREE TO FIVE STUDENT ATHLETES IN SAN DIEGO COUNTY DIE SUDDENLY AND UNEXPECTEDLY FROM SUDDEN CARDIAC ARREST/DEATH (SCA/D). SCA IS AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN HAPPEN WITHOUT SYMPTOMS OR WARNING SIGNS. HOWEVER, THIS LIFE-THREATENING CONDITION CAN BE DETECTED WITH A CARDIAC SCREENING EXAM. SCRIPPS MERCY HOSPITAL CHULA VISTA FAMILY MEDICINE RESIDENCY, SOUTHWEST SPORTS WELLNESS FOUNDATION AND THE SWEETWATER UNION HIGH SCHOOL DISTRICT PARTNER TO PREVENT SUDDEN CARDIAC ARREST AND DEATH AMONG HIGH SCHOOL STUDENTS BY INCREASING AWARENESS OF THE IMPORTANCE OF HEALTHY LIFESTYLES AND CARDIOVASCULAR SCREENINGS AMONG ACTIVE STUDENTS. FAMILY MEDICINE RESIDENTS OFFER YEARLY CARDIAC SCREENING AND SPORTS PHYSICALS BEFORE STUDENTS PARTICIPATE IN ORGANIZED SPORTS, AND IMPLEMENT AN INJURY CLINIC DURING FOOTBALL SEASON TO EVALUATE AND TREAT POSSIBLE CONCUSSIONS AND OTHER INJURIES. SU VIDA, SU CORAZON / YOUR LIFE, YOUR HEART COMMUNITY INTERVENTION TO IMPROVE EDUCATION AND AWARENESS OF HEART DISEASE HEART DISEASE IS ONE OF THE MOST WIDESPREAD AND COSTLY HEALTH PROBLEMS FACING OUR NATION, EVEN THOUGH ITS ALSO ONE OF THE MOST PREVENTABLE. HEART FAILURE AND STROKE ACCOUNT FOR MORE THAN $500 BILLION IN HEALTH CARE COSTS PER YEAR. HEART FAILURE IS A PROGRESSIVE DISEASE, PRIMARILY CAUSED BY HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND DAMAGE TO THE HEART MUSCLE FROM CORONARY ARTERY DISEASE. SCRIPPS HEALTH OFFERS A FIVE WEEK EDUCATIONAL BASED COMMUNITY INTERVENTION PROGRAM TO SUPPORT IMPROVED QUALITY OF LIFE FOR PATIENTS DIAGNOSED WITH HEART DISEASE. TOBACCO USE, ALCOHOL ABUSE, LACK OF PHYSICAL ACTIVITY, POOR NUTRITION, STRESS AND DEPRESSION ARE SOME OF THE MAJOR CONTRIBUTING FACTORS LEADING TO HEART DISEASE, HEART FAILURE AND READMISSION. RECENT LITERATURE SUGGEST THAT A LACK OF POST DISCHARGE SOCIAL SUPPORT AND EDUCATION ARE IMPORTANT TO PREVENT READMISSION. GROUP SESSIONS PROVIDE EDUCATION AND SOCIAL SUPPORT. DISCHARGE PLANNING THAT USES TRANSITIONAL COACHES HAS BEEN PROVEN TO REDUCE READMISSION RATES. THE OVERALL GOAL OF YOUR LIFE, YOUR HEART IS TO DECREASE THE READMISSION RATES FOR HEART FAILURE PATIENTS, WHICH REDUCES MEDICAL COSTS FOR THE PATIENT AND IMPROVES THEIR QUALITY OF LIFE. A TOTAL OF 33 COMMUNITY MEMBERS HAVE PARTICIPATED IN THIS EDUCATIONAL SERIES FOR THOSE AFFECTED BY HYPERTENSION, ANGINA, CARDIAC HEART FAILURE OR ANY OTHER HEART HEALTH CONCERNS. TOPICS COVERED INCLUDE THE RISK OF HEART DISEASE, SIGNS OF HEART ATTACK, DIABETES, CHOLESTEROL, PHYSICAL ACTIVITY, HEALTHY EATING AND MUCH MORE. HEALTH ASSESSMENTS ARE REVIEWED INCLUDING WAIST CIRCUMFERENCE, WEIGHT, HEIGHT, BMI AND BLOOD PRESSURE. OVERALL, PARTICIPANTS HAVE MADE A POSITIVE IMPACT FROM THE COURSE. 2018 BE THERE SAN DIEGO PREVENTING HEART ATTACKS AND STROKES SUMMIT BE THERE SAN DIEGO IS AN UNPRECEDENTED, NATIONALLY-RECOGNIZED COLLABORATION AND COMMUNITY-WIDE ACTIVATION FOCUSED ON PREVENTING HEART ATTACKS AND STROKES IN THE SAN DIEGO REGION. SCRIPPS SPONSORED THE 2018 SUMMIT AS IT IS A UNIQUE OPPORTUNITY TO BRING TOGETHER PHYSICIANS, COMMUNITY LEADERS, HEALTHCARE SYSTEMS, AND COMMUNITY PARTNERS TO IMPACT THE REGIONS HEALTH BY SHARING BEST PRACTICES AND DISCUSSING STRATEGIES FOR FUTURE PROGRESS. DIABETES DIABETES IS AN IMPORTANT HEALTH NEED BECAUSE OF ITS PREVALENCE, ITS IMPACT ON MORBIDITY AND MORTALITY, AND ITS PREVENTABILITY. AN ANALYSIS OF MORTALITY DATA FOR SAN DIEGO COUNTY FOUND THAT IN 2016 "DIABETES MELLITUS" WAS THE SEVENTH LEADING CAUSE OF DEATH. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF DIABETES IS DESCRIBED BELOW: - THE SCRIPPS 2016 CHNA CONTINUED TO IDENTIFY DIABETES AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) IDENTIFY DIABETES AS THE SEVENTH LEADING CAUSE OF DEATH IN THE U.S., AS WELL AS THE LEADING CAUSE OF KIDNEY FAILURE, NON-TRAUMATIC LOWER-LIMB AMPUTATIONS AND NEW CASES OF BLINDNESS AMONG ADULTS. - THE NUMBER OF ADULTS DIAGNOSED WITH DIABETES IN THE U.S. HAS MORE THAN TRIPLED IN THE LAST 20 YEARS (CDC, 2017). - IN 2016, THERE WERE 734 DEATHS DUE TO DIABETES IN SAN DIEGO COUNTY OVERALL , A 3.7 PERCENT INCREASE WHEN COMPARED TO 2015 (708 DEATHS). THE AGE-ADJUSTED DEATH RATE DUE TO DIABETES WAS 20.7 PER 100,000 POPULATION. - IN 2016, THERE WERE 4,132 HOSPITALIZATIONS DUE TO DIABETES IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF HOSPITALIZATION WAS 120.9 PER 100,000 POPULATION IN 2016, WHICH WAS SLIGHTLY LOWER THAN THE AGE-ADJUSTED RATE IN 2015 (123.1 PER 100,000 POPULATION). - IN 2016, THERE WERE 5,168 DIABETES-RELATED ED DISCHARGES IN SDC, AN 8 PERCENT I RELATED ED DISCHARGES WAS 151.9 PER 100,000 POPULATION IN 2016, WHICH WAS HIGHER THAN THE AGE-ADJUSTED RATE IN 2015 (143.5 PER 100,000 POPULATION).
FORM 990, PART III, LINE 4A (CONTINUED)	- ACCORDING TO 2016-2017 CHIS DATA, 8.6 PERCENT OF ADULTS LIVING IN SAN DIEGO COUNTY INDICATED THAT THEY HAD EVER BEEN DIAGNOSED WITH DIABETES, WHICH WAS LOWER THAN THE STATE OF CALIFORNIA (9.9 PERCENT). DIABETES RATES AMONG SENIORS WERE PARTICULARLY HIGH, WITH 18.8 PERCENT OF SAN DIEGO COUNTY ADULTS OVER 65 REPORTING THAT THEY HAD EVER BEEN DIAGNOSED WITH DIABETES. - ACCORDING TO 2016-2017 CHIS DATA, 12.3 PERCENT OF SAN DIEGO COUNTY RESIDENTS HAD BEEN TOLD BY THEIR DOCTOR THAT THEY HAVE PRE- OR BORDERLINE DIABETES. - ACCORDING TO THE CDCS 2017 NATIONAL DIABETES STATISTICS REPORT, 87.5 PERCENT OF ADULTS DIAGNOSED WITH DIABETES WERE OVERWEIGHT OR OBESE. TO PREVENT OR DELAY THE ONSET OF DIABETES, THE CDC RECOMMENDS LIFESTYLE CHANGES SUCH AS LOSING WEIGHT, EATING HEALTHIER, AND GETTING REGULAR PHYSICAL ACTIVITY. THE CDC ESTIMATES THAT 30.3 MILLION PEOPLE IN THE U.S. HAVE DIABETES. OF THOSE INDIVIDUALS, 1 IN 4 IS NOT AWARE THEY HAVE THE DISEASE (CDC NATIONAL DIABETES STATISTICS REPORT, 2017). THE PERCENTAGE OF ADULTS AGED 20 AND OLDER WHO HAVE EVER BEEN DIAGNOSED WITH DIABETES WAS 9.4% IN 2017 IN SAN DIEGO COUNTY AND HAS BEEN STEADILY RISING SINCE 2005 ACCORDING TO THE NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION. TYPE 2 DIABETES IS AN IMPORTANT TARGET FOR INTERVENTION BECAUSE HOSPITALIZATIONS DUE TO DIABETES RELATED COMPLICATIONS ARE POTENTIALLY PREVENTABLE WITH PROPER MANAGEMENT AND A HEALTHY LIFESTYLE. THERE ARE THREE MAJOR TYPES OF DIABETES: TYPE 1, TYPE 2 AND GESTATIONAL. ALL THREE TYPES SHARE SIMILAR CHARACTERISTICS, THE BODY LOSES THE ABILITY TO EITHER MAKE OR USE INSULIN. WITHOUT ENOUGH INSULIN, GLUCOSE STAYS IN THE BLOOD, CREATING DANGEROUS BLOOD SUGAR LEVELS. OVER TIME, THIS BUILDUP DAMAGES KIDNEYS, HEART, NERVES, EYES AND OTHER ORGANS. TYPE 2 DIABETES, ONCE KNOWN AS ADULT ONSET OR NONINSULIN DEPENDENT DIABETES, IS A CHRONIC CONDITION THAT AFFECTS THE WAY YOUR BODY METABOLIZES SUGAR (GLUCOSE), WHICH IS YOUR BODYS MAIN SOURCE OF FUEL. WITH TYPE 2 DIABETES, YOUR BODY EITHER RESISTS THE EFFECTS OF INSULIN, A HORMONE THAT REGULATES THE MOVEMENT OF SUGAR INTO YOUR CELLS OR DOESNT PRODUCE ENOUGH INSULIN TO MAINTAIN A NORMAL GLUCOSE LEVEL. IF LEFT UNTREATED, TYPE 2 DIABETES CAN BE LIFE THREATENING. CLINICAL SYMPTOMS CAN INCLUDE: FREQUENT URINATION, EXCESSIVE THIRST, EXTREME HUNGER, SUDDEN VISION CHANGES, UNEXPLAINED WEIGHT LOSS, EXTREME FATIGUE, SORES THAT ARE SLOW TO HEAL, AND INCREASED NUMBER OF INFECTIONS. TYPE 2 DIABETES HAS REACHED EPIDEMIC PROPORTIONS, AND PEOPLE OF HISPANIC ORIGIN HAVE DRAMATICALLY HIGHER RATES OF THE DISEASE AND THE COMPLICATIONS THAT GO ALONG WITH ITS POOR MANAGEMENT, INCLUDING CARDIOVASCULAR DISEASE, EYE DISEASE AND LIMB AMPUTATION. IN FACT, IT IS ESTIMATED THAT ONE OUT OF EVERY TWO HISPANIC CHILDREN BORN IN 2000 WILL DEVELOP DIABETES IN ADULTHOOD. THIS IS ESPECIALLY TRUE IN THE SOUTH BAY COMMUNITIES IN SAN DIEGO. SPECIFICALLY, THE CITY OF CHULA VISTA IS HOME TO 26,000 LATINOS WITH DIAGNOSED DIABETES AND TENS OF THOUSANDS MORE WHO ARE UNDIAGNOSED, HAVE PRE- DIABETES AND ARE AT HIGH RISK OF DEVELOPING DIABETES. SOME ALARMING FACTS ABOUT TYPE 2 DIABETES: - DIABETES IS A MAJOR CAUSE OF HEART DISEASE AND STROKE, AND IS THE 7TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND CALIFORNIA. - MORE THAN 1 OUT OF 3 ADULTS HAVE PREDIABETES AND 15 TO 30% OF THOSE WITH PREDIABETES WILL DEVELOP TYPE 2 DIABETES WITHIN 5 YEARS. - NINE OUT OF 10 PEOPLE WITH PREDIABETES DONT KNOW THEY HAVE IT. SOME RISK FACTORS FOR DEVELOPING DIABETES INCLUDE: - BEING OVERWEIGHT OR OBESE - HAVING A PARENT, BROTHER OR SISTER WITH DIABETES. - SMOKING - HAVING BLOOD PRESSURE MEASURING 140/90 OR HIGHER. - BEING PHYSICALLY INACTIVE, EXERCISING FEWER THAN THREE TIMES A WEEK. - A HISTORY OF GESTATIONAL DIABETES - IF YOU ARE 65 YEARS OF AGE OR OLDER A STUDY BY THE UNIVERSITY OF CALIFORNIA, LOS ANGELES (UCLA) CENTER FOR HEALTH POLICY RESEARCH FOUND THAT 13 MILLION ADULTS IN CALIFORNIA (46 PERCENT) ARE ESTIMATED TO HAVE PREDIABETES OR UNDIAGNOSED DIABETES, WHILE ANOTHER 2.5 MILLION (9 PERCENT) HAVE ALREADY BEEN DIAGNOSED WITH DIABETES (UCLA CENTER FOR HEALTH POLICY RESEARCH, 2016). THE COMPLICATIONS RELATED TO DIABETES ARE SERIOUS AND CAN BE REDUCED WITH PREVENTIVE PRACTICES. DIABETES IS A SERIOUS COMMUNITY HEALTH PROBLEM, LEADING TO SCHOOL AND WORK ABSENTEEISM, ELEVATED HOSPITALIZATION RATES, FREQUENT EMERGENCY ROOM VISITS, PERMANENT PHYSICAL DISABILITIES AND SOMETIMES DEATH. DURING FISCAL YEAR 2018, SCRIPPS SPONSORED THE FOLLOWING DIABETES MANAGEMENT INITIATIVES: WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA THE WOLTMAN FAMILY DIABETES CARE AND PREVENTION CENTER IN CHULA VISTA SERVES ONE OF SAN DIEGOS COMMUNITIES HIT HARDEST BY THE DIABETES EPIDEMIC. NEARLY 40 PERCENT OF PATIENTS ADMITTED TO SCRIPPS MEMORIAL HOSPITAL CHULA VISTA, AND NEARLY 32 PERCENT OF PATIENTS IN THE HEART CATHETERIZATION LAB, HAVE DIABETES. COUNTY STATISTICS TELL US THAT THE RATES OF DEATH, HOSPITALIZATIONS AND EMERGENCY ROOM VISITS ARE TWICE AS HIGH IN CHULA VISTA COMPARED TO ALL OF SAN DIEGO COUNTY. WITH THE GENEROUS SUPPORT OF PHILANTHROPIST RICHARD WOLTMAN, THE CENTER ADDED CRITICAL CLASSROOM SPACE IN 2017 TO MEET THE HIGH DEMAND FOR SERVICES. THE CENTER OFFERS A FULL RANGE OF WELLNESS, PREVENTION, DIABETES EDUCATION AND NUTRITION SERVICES IN ENGLISH AND SPANISH. PROJECT DULCE PROJECT DULCE IS A COMPREHENSIVE, CULTURALLY SENSITIVE DIABETES MANAGEMENT PROGRAM FOR UNDERSERVED AND UNINSURED PEOPLE IN SAN DIEGO COUNTY. THE PROGRAM IS TEAM BASED AND INCORPORATES THE CHRONIC CARE MODEL. PROJECT DULCE HAS BEEN ACTIVE IN COMMUNITIES ACROSS SAN DIEGO FOR THE PAST 19 YEARS, PROVIDING DIABETES CARE AND SELF-MANAGEMENT EDUCATION. NURSE LED TEAMS STRIVE FOR MEASURABLE IMPROVEMENTS IN THEIR PATIENTS HEALTH, NURSE EDUCATORS LEAD MULTIDISCIPLINARY TEAMS THAT PROVIDE CLINICAL MANAGEMENT; AND PEER EDUCATORS FROM EACH CULTURAL GROUP, KNOWN AS PROMOTORAS, PROVIDE PUBLIC AND PATIENT EDUCATION FOR THEIR COMMUNITIES. THIS INNOVATIVE PROGRAM COMBINES STATE OF THE ART CLINICAL DIABETES MANAGEMENT WITH PROVEN EDUCATIONAL AND BEHAVIORAL INTERVENTIONS. ONE OF THE PRIMARY COMPONENTS OF THE PROGRAM IS RECRUITING PEER EDUCATORS FROM THE COMMUNITY TO WORK DIRECTLY WITH PATIENTS. THESE EDUCATORS REFLECT THE DIVERSE POPULATION AFFECTED BY DIABETES AND HELP TEACH OTHERS ABOUT CHANGING EATING HABITS, ADOPTING EXERCISE ROUTINES AND OTHER WAYS TO HELP MANAGE THIS CHRONIC DISEASE. IN FY18, PROJECT DULCE PROVIDED 5,699 DIABETES CARE, RETINAL SCREENINGS AND EDUCATION VISITS FOR LOW INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO AND ENROLLED 1,067 NEW PROJECT DULCE PATIENTS. MEDICAL ASSISTANT HEALTH COACHING (MAC) DIABETES AFFECTS NEARLY 30 MILLION INDIVIDUALS IN THE U.S., AND IF CURRENT TRENDS CONTINUE, 1 OF 3 ADULTS WILL HAVE DIABETES BY 2050. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSME) IS A CORNERSTONE OF EFFECTIVE CARE THAT IMPROVES CLINICAL CONTROL AND HEALTH OUTCOMES; HOWEVER, DSME PARTICIPATION IS LOW, PARTICULAR AMONG UNDERSERVED POPULATIONS, AND ONGOING SUPPORT IS OFTEN NEEDED TO MAINTAIN DSME GAINS. IN 2015, THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES (NIH/NIDDK) GRANTED SCRIPPS WHITTIER DIABETES INSTITUTE $2.1 MILLION TO FUND THE MAC TRIAL, WHICH IS STUDYING AN INNOVATIVE TEAM CARE APPROACH THAT TRAINS MEDICAL ASSISTANTS (MAS) TO PROVIDE HEALTH COACHING IN THE PRIMARY CARE SETTING TO PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES, HELP THEM PROBLEM SOLVE, AND IMPROVE THEIR DIABETES-RELATED HEALTH OUTCOMES. THE GOALS INCLUDE IMPROVING DIABETES SELF-MANAGEMENT AND CLINICAL OUTCOMES, SUCH AS BLOOD GLUCOSE LEVELS, CHOLESTEROL AND BLOOD PRESSURE. THE STUDY IS BEING CONDUCTED IN TWO DIVERSE SETTINGS: A SCRIPPS HEALTH PRIMARY CARE PRACTICE, AND A COMMUNITY HEALTH CENTER, NEIGHBORHOOD HEALTHCARE.
FORM 990, PART III, LINE 4A (CONTINUED)	DIABETES PREVENTION THE UCLA CENTER FOR HEALTH POLICY AND RESEARCH RECENTLY PUBLISHED DATA THAT REVEALED NEARLY HALF OF CALIFORNIA ADULTS HAVE PREDIABETES OR DIABETES. WHILE THE SCRIPPS WHITTIER DIABETES INSTITUTE HAS BEEN PROVIDING THE BEST CARE FOR PEOPLE WITH DIABETES FOR DECADES, THE INSTITUTE CONTINUED WITH THE SCRIPPS DIABETES PREVENTION PROGRAM (DPP), WHICH IS A YEARLONG INTERVENTION WHERE PEOPLE WITH PREDIABETES MEET WEEKLY FOR 16 WEEKS, THEN MONTHLY THEREAFTER. THE DPP IS AN INTENSIVE LIFESTYLE INTERVENTION PROGRAM THAT HAS BEEN PROVEN TO PREVENT DIABETES IN LARGE-SCALE NATIONAL STUDIES. THE PRIMARY OBJECTIVE IS TO LOSE 5 TO 7% OF BODY WEIGHT THROUGH HEALTHY EATING AND PHYSICAL ACTIVITY. THE DIABETES PREVENTION PROGRAM (DPP) HAS BEEN THOROUGHLY EVALUATED IN NIH SPONSORED RANDOMIZED CONTROLLED TRIALS, AND HAS BEEN FOUND TO DECREASE THE NUMBER OF NEW CASES OF DIABETES AMONG THOSE WITH PREDIABETES BY 58%. AMONG PEOPLE OVER AGE 60, THERE WAS A 71% REDUCTION IN NEW CASES. IN 2018, 212 PATIENTS ATTENDED 78 SCRIPPS DPP ORIENTATION SESSIONS. MUCH OF THE EFFORT IS FOCUSED IN THE SOUTH BAY FOR THE LATINO POPULATION, WHICH IS AT HIGHER RISK OF GETTING DIABETES THAN THEIR WHITE COUNTERPARTS. DIGITAL DIABETES- ME: AN ADAPTIVE MHEALTH INTERVENTION FOR UNDERSERVED HISPANICS WITH DIABETES DIABETES IS A FAST-GROWING EPIDEMIC, AFFLICTING 29.1 MILLION AMERICANS AND COSTING MORE THAN $245 BILLION A YEAR, ACCORDING TO THE AMERICAN DIABETES INSTITUTE. HISPANICS FACE A HIGHER RISK OF DEVELOPING THE DISEASE 13.9 PERCENT COMPARED WITH 7.6 PERCENT FOR NON-HISPANIC WHITES. THE NIHS NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES AWARDED $2.9 MILLION, THE LARGEST NIH AWARD TO SCRIPPS WHITTIER DIABETES INSTITUTE TO DATE, TO STUDY AN INNOVATIVE APPROACH TO HELPING HISPANICS WITH DIABETES BETTER MANAGE THEIR DISEASE. DULCE DIGITAL-ME PROVIDED PATIENTS WITH TOOLS TO HELP THEM MANAGE THEIR DIABETES DAY TO DAY AND IMPROVE THEIR HEALTH, INCLUDING TEXT MESSAGING, WIRELESS BLOOD GLUCOSE AND MEDICATION MONITORING, DIET AND EXERCISE ASSESSMENTS, AND PERSONALIZED FEEDBACK AND GOAL-SETTING. THIS STUDY WAS CONDUCTED IN COLLABORATION WITH NEIGHBORHOOD HEALTHCARE, SAN DIEGO STATE UNIVERSITY AND THE UNIVERSITY OF CALIFORNIA SAN DIEGO. THE PARTICIPANTS RECEIVED HEALTH-RELATED TEXT MESSAGES EVERY DAY FOR SIX MONTHS AND THEY SAW IMPROVEMENTS IN THEIR BLOOD SUGAR LEVELS THAT EQUALED THOSE RESULTING FROM SOME GLUCOSE-LOWERING MEDICATIONS. THE DULCE DIGITAL CLINICAL TRIAL REPRESENTS THE FIRST RANDOMIZED CONTROLLED STUDY TO LOOK AT THE USE OF TEXT MESSAGES TO HELP UNDERSERVED HISPANICS BETTER SELF-MANAGE THEIR DIABETES THROUGH GLYCEMIC CONTROL. THE RESULTS WERE PUBLISHED BY DIABETES CARE IN AN ONLINE PRE-PRINT VERSION OF THE STUDY, WHICH IS SCHEDULED TO BE PUBLISHED IN A FUTURE ISSUE OF THE JOURNAL. HEALTHY LIVING IN 2015, SCRIPPS BEGAN HEALTHY LIVING CLASSES WHICH ARE OPEN TO ANYONE INTERESTED IN LEARNING ABOUT THE BENEFITS OF GOOD NUTRITION, PHYSICAL ACTIVITY, AND AVOIDING TOBACCO. THESE BEHAVIORS CAN HELP TO PREVENT THE FOUR CHRONIC DISEASES (LUNG DISEASE, CANCER, TYPE 2 DIABETES AND, CARDIOVASCULAR DISEASE) THAT CONTRIBUTE TO 50 PERCENT OF ALL THE DEATHS IN THE US. THE THREE-CLASS SERIES IS HELD AT LOCATIONS THROUGHOUT THE COMMUNITY. TWO HUNDRED AND EIGHT PEOPLE ATTENDED HEALTHY LIVING CLASSES THAT WERE PROVIDED THROUGHOUT THE COUNTY, AGAIN WITH SPECIAL ATTENTION TO THE LATINO COMMUNITY OF THE SOUTH BAY. SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION TEAMS PROVIDE STATE OF THE ART EDUCATION AND TRAINING FOR PEOPLE WHO WISH TO INCREASE THEIR DIABETES MANAGEMENT KNOWLEDGE AND SKILLS. WITH THE RISE IN DIABETES RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP CLINICIANS WITH THE LATEST INFORMATION AND CLINICAL SKILLS. THE WHITTIERS PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS, INCLUDING: ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS AND OTHER DIABETES SPECIALIST. THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST POSSIBLE CARE FOR THEIR DIABETES PATIENTS. COURSES RESPOND TO THE NEEDS OF ALLIED HEALTH PROFESSIONALS SEEKING TO UNDERSTAND NEW AND COMPLEX CLINICAL TREATMENT OPTIONS FOR TYPE 1, TYPE 2 AND GESTATIONAL DIABETES. PROFESSIONAL EDUCATION WAS PROVIDED FOR 528 PEOPLE ON INSULIN MANAGEMENT, INCRETIN THERAPY, AND DIABETES DIET AND DIABETES BASICS. PARTICIPANTS CAME FROM LOCAL HEALTH INSTITUTIONS AND THROUGHOUT THE UNITED STATES TO LEARN FROM THE WHITTIER INSTITUTES MOST EXPERIENCED DIABETES EXPERTS. OVER THE LAST FISCAL YEAR, THE WHITTIER INSTITUTES PROFESSIONAL EDUCATION DEPARTMENT PROVIDED FOUR CME PROGRAMS FOR PHYSICIANS, NURSES, PHARMACISTS, DIETITIANS, MIDLEVEL PROVIDERS AND SOCIAL WORKERS AND MADE NUMEROUS ACADEMIC AND RESEARCH PRESENTATIONS AT PROFESSIONAL ASSOCIATION MEETINGS. RETINAL SCREENING PROGRAM IT IS ESTIMATED THAT EVERY 24 HOURS, 55 PEOPLE WILL LOSE THEIR VISION AS A RESULT OF DIABETIC-RELATED EYE DISEASE (DIABETIC RETINOPATHY) EVEN THOUGH 95 PERCENT OF DIABETIC BLINDNESS COULD BE PREVENTED WITH EARLY DIAGNOSIS AND TREATMENT. FOR MORE THAN A DECADE, SCRIPPS HAS BEEN SCREENING PEOPLE IN UNDERSERVED COMMUNITIES FOR DIABETIC RETINOPATHY USING A MOBILE CAMERA. OUR FREE OR LOW-COST EYE EXAMS DIAGNOSE INDIVIDUALS AT HIGH RISK FOR RETINAL DAMAGE AND HELP PATIENTS GET TREATMENT AND REFERRALS TO SPECIALISTS. IN FY18, 534 PEOPLE WERE SCREENED, AND 33.52 PERCENT HAD SOME DEGREE OF DIABETES-RELATED EYE DISEASE. THIS PROGRAM REFERRED 31 PEOPLE WHO HAD ADVANCED DISEASE, 5.81 PERCENT OF ALL SCREENED OR NEARLY 17.32 PERCENT OF POSITIVES, TO SPECIALISTS FOR FURTHER CARE. HEALTH RELATED BEHAVIORS HEALTH RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLES HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH RELATED BEHAVIORS, SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY, ORAL HEALTH AND INJURY PREVENTION, HAVE BECOME IMPORTANT COMPONENTS OF LONG TERM LIFE. THE RISK FACTORS FOR MANY CHRONIC DISEASES ARE WELL KNOWN. IN PARTICULAR, AN UNHEALTHY DIET, PHYSICAL INACTIVITY AND SUBSTANCE ABUSE HAVE NEED CITED BY THE WORLD HEALTH ORGANIZATION (HTTP://WWW.WHO.INT/CHP) AS IMPORTANT HEALTH BEHAVIORS THAT CONTRIBUTE TO ILLNESSES SUCH AS CARDIOVASCULAR DISEASE, CANCER, CHRONIC RESPIRATORY DISEASE, DIABETES, AND OTHERS INCLUDING MENTAL DISORDERS AND ORAL DISEASES. - THE HASD&IC 2016 CHNA PROCESS CONTINUED TO IDENTIFY THE FOLLOWING AMONG THE TOP PRIORITY HEALTH CONDITIONS IN SAN DIEGO COUNTY 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.RESULTS OF THE FITNESSGRAM PHYSICAL FITNESS TEST SHOW THAT 29.35% OF CHILDREN IN GRADES 5,7 AND 9 RANKED WITHIN THE "HIGH RISK"NEEDS IMPROVEMENT" ZONES FOR AEROBIC CAPACITY FOR THE 20132014 YEAR. THE PERCENTAGE OF CHILDREN THAT ARE NOT IN THE HEALTHY FITNESS ZONE VARIES AMONG ETHNIC GROUPS WITH THE LOWEST BEING NON-HISPANIC ASIANS AT 20.6% AND THE HIGHEST BEING HISPANIC OR LATINOS AT 42.1%. ALTHOUGH THIS IS SMALLER THAN THE STATE AVERAGE OF 36.9%, IT IS STILL CAUSE FOR CONCERN AND MAY LEAD TO SIGNIFICANT HEALTH ISSUES, SUCH AS OBESITY, DIABETES, AND POOR CARDIOVASCULAR HEALTH. - ALCOHOL CONSUMPTION: THE PERCENTAGE OF ADULTS AGE 18 AND OLDER WHO SELF-REPORT HEAVY ALCOHOL CONSUMPTION (DEFINED AS MORE THAN TWO DRINKS PER DAY ON AVERAGE FOR MEN AND ONE DRINK PER DAY ON AVERAGE FOR WOMEN) IS 17.2% IN SAN DIEGO COUNTY ACCORDING TO THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). BEHAVIORS SUCH AS EXCESSIVE ALCOHOL CONSUMPTION ARE DETRIMENTAL TO FUTURE HEALTH AND MAY ILLUSTRATE OR PRECLUDE SIGNIFICANT HEALTH ISSUES, SUCH AS CIRRHOSIS, CANCER, AND UNTREATED MENTAL AND BEHAVIORAL HEALTH NEEDS. - TOBACCO USAGE: THE BFRSS ALSO REPORTS THAT 12.1% OF ADULTS AGE 18 AND OLDER SELF-REPORTED CURRENTLY SMOKING CIGARETTES SOME DAYS OR EVERY DAY COMPARE TO 18.1% IN THE UNITED STATES, ADJUSTED FOR AGE. TOBACCO USE IS LINKED TO LEADING CAUSES OF DEATH INCLUDING CANCER AND CARDIOVASCULAR DISEASE. - THE HHSAS LIVE WELL SAN DIEGO (LWSD) 3-4-50 INITIATIVE IDENTIFIED THREE BEHAVIORS (POOR DIET, PHYSICAL INACTIVITY AND TOBACCO USE) THAT CONTRIBUTE TO FOUR CHRONIC CONDITIONS (CANCER, HEART DISEASE/STROKE, TYPE 2 DIABETES AND PULMONARY DISEASES), WHICH RESULT IN MORE THAN 50 PERCENT OF DEATHS WORLDWIDE. IN 2015, 54 PERCENT OF ALL DEATHS IN SDC WERE ATTRIBUTED TO 3-4-50 CONDITIONS. - IN 2016, 16.3 PERCENT OF ADULTS AGES 18 AND OLDER IN SDC SELF-REPORTED EATING AT FAST-FOOD RESTAURANTS FOUR OR MORE TIMES EACH WEEK (CHIS, 2016).
FORM 990, PART III, LINE 4A (CONTINUED)	- THE HASD&IC AND SCRIPPS 2016 CHNA COMMUNITY ENGAGEMENT ACTIVITIES EMPHASIZED 10 SOCIAL DETERMINANTS OF HEALTH (SDOH) AS HAVING A SERIOUS IMPACT ON THE FOUR PRIORITY HEALTH ISSUES IN SAN DIEGO COUNTY (CARDIOVASCULAR DISEASE, TYPE 2 DIABETES, BEHAVIORAL HEALTH AND OBESITY). THESE 10 SOCIAL DETERMINANTS ARE: FOOD INSECURITY AND ACCESS TO HEALTHY FOOD; ACCESS TO CARE OR SERVICES; HOMELESS/HOUSING ISSUES; PHYSICAL ACTIVITY; EDUCATION/KNOWLEDGE; CULTURAL COMPETENCY; TRANSPORTATION; INSURANCE ISSUES; STIGMA; AND POVERTY. - KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE HASD&IC 2016 CHNA SUGGESTED SEVERAL HEALTH IMPROVEMENT STRATEGIES TO ADDRESS THE FOUR PRIORITY HEALTH ISSUES IDENTIFIED FOR SAN DIEGO COUNTY. THESE STRATEGIES INCLUDE: BEHAVIORAL HEALTH PREVENTION AND STIGMA REDUCTION; EDUCATION ON DISEASE MANAGEMENT AND FOOD INSECURITY; INTEGRATING PHYSICAL AND MENTAL HEALTH CARE; BETTER COORDINATION OF CARE; GREATER CULTURAL COMPETENCE AND DIVERSITY; AND ENGAGEMENT OF PATIENT NAVIGATORS AND CASE MANAGERS IN THE COMMUNITY. - FRUIT/VEGETABLE CONSUMPTION: ACCORDING TO DATA FROM CALIFORNIA HEALTH INTERVIEW SURVEY, 48.3% OF CHILDREN AGE 2 AND OLDER REPORTED CONSUMING LESS THAN FIVE SERVINGS OF FRUITS AND VEGETABLES A DAY COMPARED TO 47.7% IN CALIFORNIA OVERALL. ADULTS AGE 18 AND OVER REPORTED EVEN LESS FRUIT AND VEGETABLE CONSUMPTION. APPROXIMATELY 70.5% OF ADULTS REPORTED EATING THE RECOMMENDED AMOUNT EACH DAY. UNHEALTHY EATING HABITS ARE A SIGNIFICANT CONTRIBUTING FACTOR TO FUTURE HEALTH ISSUES INCLUDING OBESITY AND DIABETES. - PHYSICAL INACTIVITY: ACCORDING TO THE CDCS NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, 14.9% OF ADULTS AGE 20 AND OLDER SELF-REPORTED THAT THEY PERFORM NO LEISURE TIME PHYSICAL ACTIVITY. HIGHER RATES OF LIMITED LEISURE TIME ACTIVITY WERE REPORTED AT THE STATE AND NATIONAL LEVEL (16.6% AND 22.6% RESPECTIVELY). FOR YOUTH RESULTS OF THE FITNESSGRAM PHYSICAL FITNESS TEST SHOW THAT 29.35% OF CHILDREN IN GRADES 5,7 AND 9 RANKED WITHIN THE HIGH RISK OR NEEDS IMPROVEMENT ZONES FOR AEROBIC CAPACITY FOR THE 20132014 YEAR. THE PERCENTAGE OF CHILDREN THAT ARE NOT IN THE HEALTHY FITNESS ZONE VARIES AMONG ETHNIC GROUPS WITH THE LOWEST BEING NON-HISPANIC ASIANS AT 20.6% AND THE HIGHEST BEING HISPANIC OR LATINOS AT 42.1%. ALTHOUGH THIS IS SMALLER THAN THE STATE AVERAGE OF 36.9%, IT IS STILL CAUSE FOR CONCERN AND MAY LEAD TO SIGNIFICANT HEALTH ISSUES, SUCH AS OBESITY, DIABETES, AND POOR CARDIOVASCULAR HEALTH. - ALCOHOL CONSUMPTION: THE PERCENTAGE OF ADULTS AGE 18 AND OLDER WHO SELF-REPORT HEAVY ALCOHOL CONSUMPTION (DEFINED AS MORE THAN TWO DRINKS PER DAY ON AVERAGE FOR MEN AND ONE DRINK PER DAY ON AVERAGE FOR WOMEN) IS 17.2% IN SAN DIEGO COUNTY ACCORDING TO THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). BEHAVIORS SUCH AS EXCESSIVE ALCOHOL CONSUMPTION ARE DETRIMENTAL TO FUTURE HEALTH AND MAY ILLUSTRATE OR PRECLUDE SIGNIFICANT HEALTH ISSUES, SUCH AS CIRRHOSIS, CANCER, AND UNTREATED MENTAL AND BEHAVIORAL HEALTH NEEDS. - TOBACCO USAGE: THE BFRSS ALSO REPORTS THAT 12.1% OF ADULTS AGE 18 AND OLDER SELF-REPORTED CURRENTLY SMOKING CIGARETTES SOME DAYS OR EVERY DAY COMPARE TO 18.1% IN THE UNITED STATES, ADJUSTED FOR AGE. TOBACCO USE IS LINKED TO LEADING CAUSES OF DEATH INCLUDING CANCER AND CARDIOVASCULAR DISEASE. - THE HHSAS LIVE WELL SAN DIEGO (LWSD) 3-4-50 INITIATIVE IDENTIFIED THREE BEHAVIORS (POOR DIET, PHYSICAL INACTIVITY AND TOBACCO USE) THAT CONTRIBUTE TO FOUR CHRONIC CONDITIONS (CANCER, HEART DISEASE/STROKE, TYPE 2 DIABETES AND PULMONARY DISEASES), WHICH RESULT IN MORE THAN 50 PERCENT OF DEATHS WORLDWIDE. IN 2015, 54 PERCENT OF ALL DEATHS IN SDC WERE ATTRIBUTED TO 3-4-50 CONDITIONS. - IN 2016, 16.3 PERCENT OF ADULTS AGES 18 AND OLDER IN SDC SELF-REPORTED EATING AT FAST-FOOD RESTAURANTS FOUR OR MORE TIMES EACH WEEK (CHIS, 2016). UNDERSTANDING THAT PERSONAL BEHAVIORS PLAY A SIGNIFICANT ROLE IN AN INDIVIDUALS OVERALL HEALTH STATUS, SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS THAT HELP PEOPLE TAKE CHARGE OF THEIR OWN, AND THEIR FAMILIES, HEALTH. DURING FISCAL YEAR 2018, SCRIPPS SPONSORED A NUMBER OF HEALTH BEHAVIOR MODIFICATION EFFORTS: COMMUNITY PROGRAMS AND CLINICAL SERVICES OF SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS AND FAMILY MEDICINE RESIDENCY PROGRAMS HAVE DELIVERED EXTENSIVE VALUE WITH SUPERIOR OUTCOMES. COMMUNITY SERVICES COMBINED REACHED 43,872 (11,400 SCRIPPS MERCY HOSPITAL + 2,000 PROGRAM PARTICIPANTS RESIDENCY + 30,472 RESIDENCY CLINIC VISITS) PROGRAM PATIENTS AND PARTICIPANTS. THERE WERE MORE THAN 30,472 (24,849 RESIDENCY CLINICAL SERVICES + 2523 SCHOOL BASED CLINIC + 3100 OTHER COMMUNITY CLINICS AND RESIDENCY) CLINICAL VISITS PROVIDED BY SCRIPPS FAMILY MEDICINE RESIDENCY. COMMUNITY BASED HEALTH IMPROVEMENT ACTIVITIES EACH MONTH APPROXIMATELY 11,400 COMMUNITY MEMBERS PARTICIPATE IN CLASSES, PREVENTION LECTURES AND SUPPORT GROUPS HELD AT THE WELL BEING CENTER. SENIOR FOCUSED ACTIVITIES AT ST. CHARLES NUTRITION CENTER AND NORMAN PARK SENIOR CENTER REACHED OVER 200 PARTICIPANTS. YOUTH EDUCATIONAL PROGRAM ACTIVITIES SCRIPPS CHULA VISTA COMMUNITY BENEFITS SERVICES IMPLEMENTED A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES INCLUDING: CAMP SCRIPPS, MENTORING PROGRAMS, HOSPITAL TOURS, IN- CLASSROOM PRESENTATIONS AND SURGERY VIEWINGS. SCRIPPS FAMILY MEDICINE RESIDENTS ALSO PROVIDE FOOTBALL GAME COVERAGE, SPORT INJURY CLINICS AND PHYSICALS. A TOTAL OF 3,391 YOUTH PARTICIPATED IN THESE PROGRAMS. CAMP SCRIPPS DESIGNED TO INTRODUCE YOUTH TO HEALTH CAREERS, THIS PROGRAM IS A THREE-WEEK CAMP EXPERIENCE TO EDUCATE YOUTH PARTICIPANTS ON THE DUTIES PERFORMED BY HEALTH CARE PROFESSIONALS IN VARIOUS MEDICAL FIELDS. PARTICIPANTS RECEIVE OPPORTUNITIES FOR INTERACTIONS WITH THE HEALTH PROFESSIONALS. CAMP ACTIVITIES INCLUDE TOURS OF HOSPITAL DEPARTMENTS, HANDS-ON ACTIVITIES WITH HEALTH CARE PROFESSIONALS AND PRESENTATIONS ON SPECIFIC HEALTH CAREERS AND/OR HEALTH-RELATED ISSUES. EXAMPLES OF ACTIVITIES INCLUDE VISITS TO THE LABORATORY, RADIOLOGY, NURSING UNITS AND THE CATH LAB. FAMILY MEDICINE RESIDENTS PROVIDE A VARIETY OF PRESENTATIONS AND INTERACTION ACTIVITIES FOR THE YOUTH. SOME OF THESE INCLUDE "DOC 101VISITS TO SPECIFIC HOSPITAL DEPARTMENTS. MENTORING PROGRAM DESIGNED TO HELP HIGH SCHOOL STUDENTS SET A COURSE FOR A SUCCESSFUL CAREER IN HEALTH CARE, PARTICIPANTS ARE PAIRED WITH VARIOUS HEALTH AND SOCIAL SERVICE PROFESSIONALS FOR HOURLY SESSIONS TWICE A WEEK FOR FIVE WEEKS IN THE HOSPITAL SETTING. STUDENTS ARE EXPOSED TO A VARIETY OF DUTIES AND ROLES AND VARIOUS DEPARTMENTS. STUDENTS LEARN FIRST-HAND FROM THEIR MENTORS ABOUT THE PARTICULARS OF THAT DEPARTMENT AND POSITION INCLUDING THE PATH THEY NEED TO TAKE IN ORDER TO ACHIEVE A CAREER GOAL. STUDENTS ALSO RECEIVE PRESENTATIONS ON VARIOUS HEALTH CAREERS AND JOB READINESS. FAMILY MEDICINE RESIDENTS ARE MENTORS FOR THIS PROGRAM AND MEET WITH THE STUDENTS EACH WEEK. STUDENTS WILL SHADOW RESIDENTS DURING ROUNDS AND THROUGHOUT THE EXPERIENCE. HEALTH PROFESSIONS OVERVIEW 101 STUDENTS FROM LOCAL HIGH SCHOOLS TOUR THE HOSPITAL IN DEPARTMENTS WHERE PATIENTS ARE NOT PRESENT. FAMILY MEDICINE RESIDENTS EXPOSE STUDENTS TO THE 80 OR MORE HEALTH PROFESSIONS IN THE HOSPITAL. THESE TOURS ARE DESIGNED TO PEAK STUDENTS INTEREST IN PURSUING A CAREER IN HEALTH CARE. HEALTH PROFESSIONALS IN THE CLASSROOM HEALTH CARE PROFESSIONALS, SUCH AS MEDICAL RESIDENTS, DIETICIANS, NURSES AND DOCTORS, ENLIGHTEN STUDENTS ON HEALTH CARE CAREERS AND HEALTH RELATED TOPICS. THESE ARE INTERACTIVE SESSIONS ON NURSING 101, DOC 101, HEALTH AND NUTRITION, STROKE PREVENTION, BREAST HEALTH, TEEN PREGNANCY, SUBSTANCE ABUSE, STDS, HEALTH PROFESSIONS 101 AND MENTAL HEALTH ISSUES THAT IMPACT HIGH SCHOOL STUDENTS. STUDENTS RECEIVE HEALTH CAREER TOOLS/BROCHURES THAT INCLUDE INFORMATION ON EDUCATION REQUIREMENTS, SCHOLARSHIPS AND WAY TO PAY FOR COLLEGE. FAMILY MEDICINE RESIDENTS THROUGHOUT THE YEAR WILL PRESENT IN THE CLASSROOM. SURGERY VIEWING INTERESTED STUDENTS HAVE AN OPPORTUNITY TO OBSERVE ELECTIVE SURGERIES SUCH AS TOTAL KNEE AND HIP REPLACEMENTS. STUDENTS ARE ABLE TO INTERACT AND TO ASK ON THE SPOT QUESTIONS WITH THE SURGEONS AND OTHER OPERATING ROOM STAFF MEMBERS. SCHOOL BASED CLINICS TWO HEALTH CLINICS AT PALOMAR AND SOUTHWEST HIGH SCHOOL ARE ESTABLISHED FOR MEDICAL RESIDENTS TO GAIN ADDITIONAL SKILLS IN ADOLESCENT MEDICINE AND FOR YOUTH TO GAIN THE KNOWLEDGE, ATTITUDES, AND SKILLS NECESSARY TO PURSUE HEALTH CAREERS. DESIGNED BY STUDENTS, FAMILY MEDICINE RESIDENTS AND FACULTY BASED ON YOUTH NEEDS ASSESSMENT SURVEYS, RESIDENTS AND STUDENTS INTERACT TWICE PER WEEK AT THE CLINIC PROVIDING ADOLESCENT MEDICINE.
FORM 990, PART III, LINE 4A (CONTINUED)	SENIOR PROGRAMS EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD IN PARTNERSHIP WITH LOCAL SENIOR CENTERS, CHURCHES, AND SENIOR HOUSING. THE FOLLOWING PROGRAMS ARE CONDUCTED AS PART OF SCRIPPS MERCY HOSPITAL CHULA VISTAS SAN DIEGO BORDER AREA HEALTH EDUCATION CENTER AND SCRIPPS FAMILY MEDICINE RESIDENCY PROGRAM. THESE SENIOR HEALTH CHATS ARE DESIGNED TO PROVIDE HEALTH EDUCATION TO THE OLDER ADULT COMMUNITY. APPROXIMATELY 20-25 SENIORS ATTEND THESE MONTHLY THROUGHOUT THE YEAR. THESE PRESENTATIONS INCLUDE A VARIETY OF HEALTH AND AGE RELATED TOPICS THAT INCLUDE NUTRITION, HEARING LOSS, AND MAINTAINING A HEALTHY LIFE STYLE. THESE PRESENTATIONS ARE FACILITATED BY VARIOUS HEALTH CARE PROFESSIONS AND RESIDENTS. TOPICS ARE ALL CHOSEN BY THE SENIORS THEMSELVES SO AS TO MEET THEIR LOCAL NEEDS. ALSO, THE HEALTH CHATS PROVIDE AN INTERCHANGE BETWEEN THE COMMUNITY MEMBERS AND OUR MEDICAL RESIDENTS AND OTHER HEALTH CARE PROFESSIONALS TO FOSTER HEALTHY LIFESTYLES AND HEALTH PREVENTION. THE PROGRAM ARE CONDUCTED IN COLLABORATION WITH NORMAN PARK CENTER, CONGREGATIONAL TOWERS SENIOR LIVING AND ST CHARLES NUTRITION CENTER. FAMILY MEDICINE RESIDENTS ROTATE THROUGH THESE PROGRAMS TO LEARN MORE ABOUT GERIATRIC MEDICINE, HEALTH AND WELLNESS AND OVERALL PUBLIC HEALTH AND COMMUNITY TRAINING. OVER 223 SENIORS PARTICIPATED IN THESE PROGRAMS. PATIENT COMMUNITY SERVICES SERVICES ARE OFFERED DIRECTLY TO PATIENTS AND THEIR FAMILY POST DISCHARGE TO DECREASE THE RISKS OF READMISSION AND TO INCREASE PATIENT CONTINUITY. SUPPORT SERVICES ARE REFERRAL BASED AND PROVIDE ASSISTANCE WITH THE FOLLOWING: HOUSING/HOMELESSNESS, SENIOR ISSUES, CHRONIC DISEASE ISSUES, DRUG/ALCOHOL AND MENTAL HEALTH, CANCER AND MORE. THIS SERVICE IS CURRENTLY ONLY AVAILABLE AT THE SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUS. SINCE THE START OF THE PROJECT IN JULY 2014, 1,539 REFERRALS HAVE BEEN RECEIVED COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND RESIDENT LEADERSHIP ACADEMY MODEL SCRIPPS IS A PARTNER WITH CHIP AND COLLABORATIVELY WORKS ON A RESIDENT LEADERSHIP MODEL THAT HAS EMPOWERED 700+ CITIZENS ACROSS THE COUNTY (AND BEYOND) TO AFFECT CHANGE IN A WIDE RANGE OF COMMUNITY HEALTH AREAS SUCH AS PUBLIC SAFETY, ACCESS TO HEALTHY FOODS, AND INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. HEALTH EDUCATION AND SUPPORT GROUPS EDUCATION AND SUPPORT GROUPS ARE PROVIDED TO SAN DIEGO COUNTY RESIDENTS FOR A WIDE VARIETY OF HEALTH CONCERNS. TOPICS INCLUDE, MACULAR DEGENERATION, FALL PREVENTION, STROKE AWARENESS, MENOPAUSE, SLEEP DISORDERS, FOOT HEALTH, BLADDER AND PELVIC FLOOR WELLNESS, MENTAL ILLNESS, POSTPARTUM ISSUES, GYNECOLOGICAL CANCER, AND MULTIPLE SCLEROSIS. PRESCRIPTION TAKE BACK DAY PRESCRIPTION DRUG ABUSE IS A GROWING PROBLEM IN THE UNITED STATES. ABOUT 54 MILLION PEOPLE, OR MORE THAN 20 PERCENT OF THOSE AGED 12 AND OLDER, HAVE USED PRESCRIPTION MEDICATIONS SUCH AS POWERFUL PAIN-REDUCING OPIOIDS LIKE OXYCODONE AND HYDROCODONE FOR NONMEDICAL REASONS AT LEAST ONCE IN THEIR LIFETIME, ACCORDING TO THE MOST RECENT NATIONAL SURVEY ON DRUG USE AND HEALTH. EVERY DAY, 5,750 MORE AMERICANS MISUSE PRESCRIPTION DRUGS FOR THE FIRST TIME. AND 62 PERCENT OF TEENS WHO ADMIT TAKING MEDICATIONS FOR NON-MEDICAL REASONS SAY THEY GOT THOSE DRUGS FROM MEDICINE CABINETS IN THEIR HOMES. SCRIPPS ENCOURAGES PATIENTS TO REMOVE EXPIRED, UNWANTED AND UNUSED MEDICINES FROM THEIR HOMES AS QUICKLY AS POSSIBLE AND TO AVOID THROWING THEM INTO THE TRASH OR FLUSHING THEM DOWN THE TOILET BECAUSE THIS UNWITTINGLY RISKS EXPOSING OTHERS TO THE DRUGS AND DAMAGES THE ENVIRONMENT. THE SEMI-ANNUAL EVENT OFFERS A NO-QUESTIONS-ASKED METHOD TO SAFELY DISPOSE OF SUCH MEDICATIONS, SUCH AS THE REMAINDER OF THE 20-DAY OXYCODONE SUPPLY FROM THAT OUTPATIENT PROCEDURE LAST YEAR. FLUSHING DRUGS DOWN THE TOILET CAN HARM THE ENVIRONMENT. SCRIPPS COLLABORATES WITH THE COUNTY OF SAN DIEGO ON THE PRESCRIPTION DRUG TAKE BACK DAY WHICH PROVIDES AN OPPORTUNITY FOR SAFE DISPOSAL OF LEFT OVER MEDICATIONS. THE U.S. DRUG ENFORCEMENT ADMINISTRATION, LOCAL LAW ENFORCEMENT AGENCIES AND COUNTY OFFICIALS HOST COLLECTION EVENTS FOR UNWANTED PRESCRIPTION DRUGS AT 44 SITES ACROSS THE COUNTY. OPIOID STEWARDSHIP PROGRAM (OSP) THE OPIOID STEWARDSHIP PROGRAM HAS SPEARHEADED MULTIPLE PROJECTS AT SCRIPPS TO EDUCATE PATIENTS AND PROVIDERS ABOUT THE RISKS OF OPIOIDS AND THE BENEFITS OF ALTERNATIVE MULTI-MODAL PAIN MANAGEMENT OPTIONS TO REDUCE OPIOID USE. THE PROGRAM HAS ESTABLISHED PRESCRIBING STANDARDS FOR OPIOIDS, RESULTING IN A 25 PERCENT REDUCTION IN THE NUMBER OF OPIOID PILLS PER PRESCRIPTION AT SCRIPPS HOSPITALS AND OUTPATIENT CENTERS IN 2018. SCRIPPS ALSO HAS OPENED THREE DRUG TAKE-BACK KIOSKS AT ITS ON-SITE PHARMACIES, OFFERING PATIENTS YEAR-ROUND ACCESS TO DISPOSE OF UNUSED, UNNEEDED OR OUTDATED MEDICATIONS SPONDYLITIS ASSOCIATION SCRIPPS HEALTH PROVIDES MEETING SPACE TO THE SPONDYLITIS ASSOCIATION OF AMERICA (SAA). THIS IS A NONPROFIT ORGANIZATION FOUNDED IN 1983 TO ADDRESS THE NEEDS OF PEOPLE AFFECTED BY SPONDYLOARTHRITIS. SINCE THAT TIME, SAA HAS BEEN AT THE FOREFRONT OF THE FIGHT TO PROMOTE MEDICAL RESEARCH, EDUCATE BOTH THE MEDICAL COMMUNITY AND GENERAL PUBLIC AND ADVOCATE ON BEHALF OF THE PEOPLE THEY SERVE. DEMENTIA AND ALZHEIMERS DISEASE DEMENTIA IS A CLINICAL SYNDROME OF DECLINE IN MEMORY AND OTHER THINKING ABILITIES. IT IS CAUSED BY VARIOUS DISEASES AND CONDITIONS THAT RESULT IN DAMAGE TO BRAIN CELLS AND LEAD TO DISTINCT SYMPTOM PATTERNS AND DISTINGUISHING BRAIN ABNORMALITIES. ALZHEIMERS DISEASE (AD) IS A PROGRESSIVE BRAIN DISORDER THAT GRADUALLY DESTROYS A PERSONS MEMORY AND ABILITY TO LEARN, REASON, MAKE JUDGEMENTS, COMMUNICATE AND CARRY OUT DAILY ACTIVITIES SUCH AS BATHING AND EATING. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF DEMENTIA AND ALZHEIMERS DISEASE IS DESCRIBED BELOW: - THE HASD&IC 2016 CHNA CONTINUED TO IDENTIFY ALZHEIMERS DISEASE AS ONE OF THE TOP 15 PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS. - IN 2016, ALZHEIMERS DISEASE WAS THE 6TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND 3RD LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. - IN 2016, THE TOP 10 LEADING CAUSES OF DEATH AMONG ADULTS AGES 65 AND OLDER IN SAN DIEGO COUNTY WERE (IN RANK ORDER): OVERALL CANCER, ALZHEIMERS DISEASE AND OTHER DEMENTIAS (ADOD), CORONARY HEART DISEASE (CHD), STROKE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)/CHRONIC LOWER RESPIRATORY DISEASES, OVERALL HYPERTENSIVE DISEASES, DIABETES, UNINTENTIONAL INJURIES, PARKINSONS DISEASE AND FALLS. - IN 2016, HOSPITALIZATION RATES AMONG SENIORS WERE HIGHER THAN THE GENERAL POPULATION DUE TO CHD, STROKE, COPD, NONFATAL UNINTENTIONAL INJURIES (INCLUDING FALLS), OVERALL CANCER AND ARTHRITIS. - THE TOP THREE CAUSES OF ED UTILIZATION AMONG SAN DIEGO COUNTY RESIDENTS AGES 65 AND OLDER IN 2016 WERE UNINTENTIONAL INJURIES, FALLS AND ARTHRITIS/OTHER RHEUMATIC CONDITIONS. - SENIORS IN SAN DIEGO COUNTY USE THE 911 SYSTEM AT HIGHER RATES THAN ANY OTHER AGE GROUP. THE MOST COMMON COMPLAINTS INCLUDE GENERAL MEDICAL, ALTERED NEUROLOGICAL STATE, RESPIRATORY DISTRESS, CARDIAC CHEST PAIN AND TRAUMA TO THE EXTREMITIES (HHSA, 2015). - ACCORDING TO THE CDC, 2.8 MILLION OLDER ADULTS, OR MORE THAN ONE IN FOUR, ARE TREATED IN THE ED FOR FALLS EVERY YEAR. ONE IN FIVE FALLS CAUSES A SERIOUS INJURY, SUCH AS BROKEN BONES OR A HEAD INJURY, AND WITH EACH FALL, THE CHANCE OF FALLING AGAIN DOUBLES. THESE INJURIES MAY RESULT IN SERIOUS MOBILITY ISSUES AND DIFFICULTY WITH EVERYDAY TASKS OR LIVING INDEPENDENTLY. THE DIRECT MEDICAL COSTS FOR FALL INJURIES ARE ESTIMATED AT $31 BILLION ANNUALLY (CDC, 2018). - IN 2013, AN ESTIMATED 62,000 SAN DIEGANS AGES 55 AND OLDER WERE LIVING WITH ALZHEIMERS DISEASE AND OTHER DEMENTIAS (ADOD), WHICH ACCOUNTED FOR 8.3 PERCENT OF THIS AGE GROUP. ASSUMING CURRENT TRENDS CONTINUE, BY 2030, NEARLY 94,000 RESIDENTS 55 YEARS AND OLDER WILL BE LIVING WITH ADOD, WHICH IS A 51 PERCENT INCREASE FROM 2013 (ALZHEIMERS DISEASE AND OTHER DEMENTIAS IN SAN DIEGO COUNTY, HHSA, 2016). - IN 2016, AN ESTIMATED 71.4 PERCENT OF SAN DIEGO COUNTY RESIDENTS AGES 65 AND OLDER REPORTED THAT THEY WERE VACCINATED FOR INFLUENZA IN THE PAST 12 MONTHS (CHIS, 2016). IN 2016, 26 OF THE 46 RECORDED INFLUENZA DEATHS IN SAN DIEGO COUNTY OCCURRED AMONG RESIDENTS AGES 65 AND OLDER. THE AGE-ADJUSTED RATE OF INFLUENZA DEATH AMONG THIS GROUP WAS 6.0 PER 100,000 (HHSA, 2016). - RESEARCH SHOWS THAT CAREGIVING CAN HAVE SERIOUS PHYSICAL AND MENTAL HEALTH CONSEQUENCES. ACCORDING TO FINDINGS FROM THE STRESS IN AMERICA SURVEY DESCRIBED IN A REPORT TITLED "VALUING THE INVALUABLE", CAREGIVERS TO OLDER RELATIVES REPORT POORER HEALTH AND HIGHER STRESS LEVELS THAN THE GENERAL POPULATION. FIFTY-FIVE PERCENT OF SURVEYED CAREGIVERS REPORTED FEELING OVERWHELMED BY THE AMOUNT OF CARE THEIR FAMILY MEMBER NEEDS (AARP PUBLIC POLICY INSTITUTE, UPDATED JULY 2015).
FORM 990, PART III, LINE 4A (CONTINUED)	- ACCORDING TO AARP, MORE THAN 40 MILLION PEOPLE IN THE U.S. ACT AS UNPAID CAREGIVERS TO PEOPLE AGES 65 AND OLDER. MORE THAN 10 MILLION OF THESE CAREGIVERS ARE MILLENNIALS WITH SEPARATE FULL- OR PART-TIME JOBS, AND ONE IN THREE EMPLOYED MILLENNIAL CAREGIVERS EARNS LESS THAN $30,000 PER YEAR (AARP, 2018). - ACCORDING TO A REPORT FROM THE NATIONAL ALLIANCE FOR CAREGIVING (NAC) AND AARP TITLED CAREGIVING IN THE U.S. 2015, 60 PERCENT OF UNPAID CAREGIVERS ARE FEMALE, AND NEARLY 1 IN 10 CAREGIVERS ARE AGES 75 OR OLDER (AARP AND NAC, 2015). - THE UCLA CENTER FOR HEALTH POLICY RESEARCH CONDUCTED A STUDY HIGHLIGHTING THE PLIGHT OF CALIFORNIAS HIDDEN POOR, FINDING 772,000 SENIORS WHO LIVE IN THE GAP BETWEEN THE FPL AND THE ELDER ECONOMIC SECURITY STANDARD. THE HIGHEST PROPORTION OF SENIORS LIVING IN THIS GAP INCLUDES RENTERS, LATINOS, WOMEN AND GRANDPARENTS RAISING GRANDCHILDREN (PADILLA-FRAUSTO & WALLACE, 2015). DURING FISCAL YEAR 2018, SCRIPPS ENGAGED IN THE FOLLOWING ALZHEIMERS AND DEMENTIA PREVENTION AND TREATMENT ACTIVITIES: SENIOR HEALTH AND WELL BEING PROGRAMS SENIOR HEALTH CHATS ARE DESIGNED TO INCREASE HEALTH CARE INFORMATION AND PREVENTATIVE SERVICES FOR SENIORS/OLDER ADULTS IN THE SOUTH BAY. EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD AT LOCAL SENIOR CENTERS, CHURCHES AND SENIOR HOUSING. APPROXIMATELY 20-25 SENIORS ATTEND THESE MONTHLY THROUGHOUT THE YEAR, THESE PRESENTATIONS INCLUDE A VARIETY OF HEALTH AND AGE RELATED TOPICS THAT INCLUDE NUTRITION, HEARING LOSS, DEMENTIA, ALZHEIMERS AND PAIN MANAGEMENT, NUTRITION AND WELLNESS AND MAINTAINING A HEALTHY LIFE STYLE. THESE PRESENTATIONS ARE FACILITATED BY VARIOUS HEALTH CARE PROFESSIONALS AND RESIDENTS. TOPICS ARE ALL CHOSEN BY SENIORS THEMSELVES SO AS TO MEET THEIR LOCAL NEEDS. ALSO, THE HEALTH CHATS PROVIDE AN INTERCHANGE BETWEEN THE COMMUNITY MEMBERS AND THE MEDICAL RESIDENTS AND OTHER HEALTH CARE PROFESSIONALS TO FOSTER HEALTHY LIFESTYLES AND HEALTH PREVENTION. THE ALZHEIMERS PROJECT SAN DIEGO UNITES FOR A CURE AND CARE THE ALZHEIMERS PROJECT IS A COUNTYWIDE INITIATIVE AIMED AT ACCELERATING THE SEARCH FOR A CURE AND HELPING THE ESTIMATED 60,000 SAN DIEGANS WITH THE DISEASE, ALONG WITH THEIR CAREGIVERS. PARTICIPANTS BEGAN MEETING IN EARLY 2014 TO CRAFT A REGIONAL ROADMAP TO ADDRESS THE DISEASE, FOCUSING ON CURE, CARE, CLINICAL, AND PUBLIC AWARENESS AND EDUCATION INITIATIVES. THE BOARD OF SUPERVISORS APPROVED THE ROADMAP IN DECEMBER 2014 AND LATER VOTED IN SUPPORT OF AN IMPLEMENTATION TIMETABLE. DR. MICHAEL LOBATZ FROM SCRIPPS HEALTH IS A LEADING PARTICIPANT OF THIS INITIATIVE AS A CO-CHAIRPERSON OF THE CLINICAL ROUND TABLE AND IS A MEMBER OF THE STEERING COMMITTEE. THE SCRIPPS HEALTH ALZHEIMERS CARE CONFERENCE THE SCRIPPS HEALTH ALZHEIMERS CARE CONFERENCE TOOK PLACE ON FEBRUARY 10, 2018 AND WAS OFFERED TO HEALTH CARE PROFESSIONALS WHO CARE FOR THE PATIENT WITH OR AT RISK FOR ALZHEIMERS DISEASE AND RELATED DEMENTIAS, IN ORDER TO SUPPORT THEM WITH THE BEST IN ADVANCED TOOLS FOR SCREENING, EVALUATING, DIAGNOSING AND TREATING. THE CARE CONFERENCE ADDRESSED STATISTICAL NATIONAL LOCAL TRENDS IN ALZHEIMERS DISEASE AND RELATED DEMENTIAS, FOCUSING ON PREVALENCE, MORTALITY, COST AND BURDEN TO HEALTHCARE PROVIDERS AND CAREGIVERS. PARKINSONS LSVT (LEE SILVERMAN TRAINING) BIG EXERCISE: SCRIPPS PROVIDES A MAINTENANCE CLASS FOR THOSE WHO HAVE COMPLETED THE LSVT BIG EXERCISE PROTOCOL. THIS CLASS IS TAUGHT BY A PHYSICAL THERAPIST AND IS DESIGNED FOR PARKINSONS PATIENTS TO IMPROVE STRENGTH AND MOBILITY FOR A HEALTHIER LIFE. EMPOWERMENT PARKINSONS EVENT SCRIPPS OFFERED A CONFERENCE IN 2018 TO MORE THAN 300 GUESTS WHERE THEY LEARNED NEW WAYS TO TAKE CONTROL OF THEIR HEALTH AT THE EMPOWERMENT FOR PARKINSONS DAY AT MARINA VILLAGE. ATTENDEES LEARNED THE BENEFITS OF EXERCISE AND DIET CHANGE, MASSAGE, ACUPUNCTURE, MUSIC THERAPY AND WERE ARMED WITH KNOWLEDGE TO HELP THEM MAKE POSITIVE CHANGES. OBESITY, WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS OBESITY IS AN IMPORTANT HEALTH NEED DUE TO ITS HIGH PREVALENCE IN THE U.S. AND SAN DIEGO. ALTHOUGH IT IS NOT A LEADING CAUSE OF DEATH, IT IS A SIGNIFICANT CONTRIBUTOR TO THE DEVELOPMENT OF OTHER CHRONIC CONDITIONS. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF OBESITY, WEIGHT STATUS, NUTRITION AND ACTIVITY & FITNESS IS DESCRIBED BELOW: - THE SCRIPPS 2016 CHNA CONTINUED TO IDENTIFY OBESITY AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - ACCORDING TO 2017 CHIS DATA, THE SELF-REPORTED OBESITY RATE FOR ADULTS AGES 18 AND OLDER IN SAN DIEGO COUNTY WAS 22.5 PERCENT. - IN 2017, BETWEEN 25 AND 30 PERCENT OF ADULTS IN CALIFORNIA SELF-REPORTED BEING OBESE. OBESITY LEVELS DECREASED AS EDUCATION LEVELS INCREASED, INDICATING A NEED FOR HEALTH EDUCATION AS A TOOL FOR REDUCING OBESITY RATES (CDC, 2017). - OBESITY HAS BEEN 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 DATA FROM THE 2016 NATIONAL STUDY OF CHILDRENS HEALTH, NEARLY ONE-THIRD OF CHILDREN IN CALIFORNIA ARE OBESE. CALIFORNIA HAS ONE OF THE HIGHEST CHILDHOOD OBESITY RATES IN WESTERN STATES (THE STATE OF OBESITY, 2018). - ACCORDING TO THE CDC, SOME OF THE LEADING CAUSES OF PREVENTABLE DEATH INCLUDE OBESITY-RELATED CONDITIONS, SUCH AS HEART DISEASE, STROKE, TYPE 2 DIABETES AND CERTAIN TYPES OF CANCER. IN 2016, 39.8 PERCENT OF AMERICANS WERE OBESE (CDC, 2017). - OBESITY IS LARGELY CATEGORIZED AS A SECONDARY DIAGNOSIS IN HOSPITAL DISCHARGE DATA. WHEN EXAMINING INPATIENT HOSPITAL DISCHARGE DATA WITH OBESITY AS A SECONDARY DIAGNOSIS, IT WAS FOUND THAT THE MOST COMMON PRIMARY DIAGNOSIS OF THOSE PATIENTS WERE NONSPECIFIC CHEST PAIN IN AGES 25-64, ABNORMAL PAIN FOR THOSE AGES 15-24, AND THOSE OVER 65 YEARS THEIR PRIMARY DIAGNOSIS WAS OSTEOARTHRITIS, SEPTICEMIA FOLLOWED BY CONGESTIVE HEART FAILURE. - RESEARCH HAS SHOWN THAT AS WEIGHT INCREASES TO REACH THE LEVELS OF "OVERWEIGHT"OBESITY" THE RISKS FOR THE FOLLOWING CONDITIONS ALSO INCREASES: - CORONARY HEART DISEASE - TYPE 2 DIABETES - CANCERS (ENDOMETRIAL, BREAST AND COLON) - HYPERTENSION (HIGH BLOOD PRESSURE) - STROKE - LIVER AND GALLBLADDER DISEASE - SLEEP APNEA AND RESPIRATORY PROBLEMS - OSTEOARTHRITIS OBESITY IS ADDRESSED THROUGH GENERAL NUTRITION AND EXERCISE EDUCATION AND RESOURCES PROVIDED AT SCRIPPS AS WELL AS PROGRAMS THAT ADDRESS A HEALTHY LIFESTYLE AS PART OF CARE FOR HEART DISEASE, CANCER, DIABETES AND OTHER HEALTH ISSUES INFLUENCED BY HEALTHY WEIGHT AND EXERCISE. DURING FY18, SCRIPPS ENGAGED IN THE FOLLOWING OBESITY PREVENTION AND TREATMENT ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP) AND CHILDHOOD OBESITY INITIATIVE THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (THE INITIATIVE) IS A PRIVATE PUBLIC PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS, AND ENVIRONMENT CHANGE. THE INITIATIVE IS FACILITATED BY COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). CORE FUNDING FOR THE INITIATIVE IS PROVIDED BY THE COUNTY OF SAN DIEGO, FIRST 5 COMMISSION OF SAN DIEGO COUNTY, THE CALIFORNIA ENDOWMENT, AND KAISER-PERMANENTE. SCRIPPS IS A STRONG PARTNER WITH CHIP AND THE OUTCOMES OF THE INITIATIVE HAVE SHOWN A DECREASED CHILDHOOD OBESITY FROM 4% FROM 2005-2010, THE LARGEST DROP IN SOUTHERN CALIFORNIA (MANY AREAS HAVE SEEN INCREASES). ACCORDING TO THE 2016 SAN DIEGO COUNTY STATE OF CHILDHOOD OBESITY REPORT, THE RATE OF OBESITY FOR HISPANIC STUDENTS IS MORE THAN TWICE THAT OF WHITE STUDENTS. THE RATE OF OBESITY FOR ECONOMICALLY DISADVANTAGED STUDENTS IS MORE THAN TWICE THAT OF STUDENTS WHO ARE NOT ECONOMICALLY DISADVANTAGED. HISPANIC STUDENTS REPRESENT APPROXIMATELY HALF OF ALL PUBLIC SCHOOL STUDENTS IN SAN DIEGO COUNTY WITH RESPECT TO RACE/ETHNICITY, AND LOW-INCOME STUDENTS ACCOUNT FOR HALF OF ALL PUBLIC SCHOOL STUDENTS. DIABETES PREVENTION PROGRAM (DPP) BASED ON A LARGE CLINICAL TRIAL CONCLUDED THAT PEOPLE WITH PREDIABETES COULD REDUCE THEIR LIKELIHOOD OF DEVELOPING DIABETES BY 5870 PERCENT IF THEY LOST JUST 57 PERCENT OF THEIR BODY WEIGHT. THE DIABETES PREVENTION PROGRAM IS A SCIENTIFICALLY VALIDATED LIFESTYLE INTERVENTION BASED MODEL. THE CENTERS FOR DISEASE CONTROL (CDC) AND THE NATIONAL INSTITUTES OF HEALTH (NIH) PROMOTE WIDESPREAD ADOPTION OF THE DPP DUE TO ITS DEMONSTRATED EFFECTIVENESS. SCRIPPS IS RECOGNIZED BY THE CENTERS FOR DISEASE CONTROL AS A NATIONAL DPP PROVIDER, AND ROLLED OUT THE PROGRAM TO PATIENTS AND COMMUNITY MEMBERS IN 2016. SCRIPPS AIMS TO DECREASE THE INCIDENCE OF TYPE 2 DIABETES BY MANAGING A MAJOR DIABETES RISK FACTOR, OBESITY IN THE UNDERSERVED, ETHNICALLY DIVERSE POPULATIONS BY TESTING THE EFFECTIVENESS OF LIFESTYLE CURRICULUM. THE PROGRAM USES TRAINED LIFESTYLE COACHES AND A STANDARDIZED CURRICULUM; PARTICIPANTS MEET IN GROUPS WITH A COACH FOR 16 WEEKLY SESSIONS AND SIX TO EIGHT MONTHLY FOLLOW-UP SESSIONS.
FORM 990, PART III, LINE 4A (CONTINUED)	PARTICIPANTS MUST HAVE PREDIABETES AND BE OVERWEIGHT TO ENROLL. NO PHYSICIAN REFERRAL IS REQUIRED, ALTHOUGH MANY PHYSICIANS DO REFER THEIR PATIENTS TO THIS VALUABLE RESOURCE. ORIENTATION SESSIONS ARE HELD IN SPANISH AND ENGLISH THROUGHOUT THE COUNTY. HEALTHY LIVING PROGRAM DIABETES, HEART DISEASE, CANCER AND RESPIRATORY DISEASE ARE THE FOUR MOST PREVALENT SERIOUS CHRONIC DISEASES IN CALIFORNIA. THESE DISEASES CAUSE 50 PERCENT OF ALL DEATHS IN SAN DIEGO AND THROUGHOUT THE U.S., AND MANY PEOPLE HAVE MORE THAN ONE OF THESE CONDITIONS. BECAUSE LIFESTYLE CAN PLAY A MAJOR ROLE IN PREVENTING THESE CHRONIC ILLNESSES, SCRIPPS INTRODUCED HEALTHY LIVING, A FREE, INTERACTIVE EDUCATION PROGRAM TO HELP THE SAN DIEGO COMMUNITY LEARN ABOUT AND ADOPT PRACTICAL WAYS TO IMPROVE THREE BEHAVIORS SMOKING, POOR DIET AND PHYSICAL INACTIVITY THAT CONTRIBUTE TO THESE FOUR DISEASES. PARTICIPANTS LEARN HOW TO MAKE HEALTHY FOOD CHOICES USING LOW COST OPTIONS, MAKE PHYSICAL ACTIVITY PART OF THEIR DAILY LIFE AND LEARN HOW TO STAY MOTIVATED AND MAINTAIN HEALTHY HABITS. SCRIPPS IMPLEMENTS A SERIES OF THREE FREE SESSIONS THAT ENCOURAGE PARTICIPANTS TO IDENTIFY AND ADOPT PRACTICAL WAYS TO IMPROVE THEIR HEALTH HABITS. SESSIONS ARE OFFERED THROUGHOUT SAN DIEGO COUNTY IN ENGLISH AND SPANISH, WITH SPECIAL EMPHASIS ON THE LATINO AND UNDERSERVED COMMUNITIES. SESSIONS INCLUDE HEALTH SCREENING, HEALTHY COOKING TIPS, AND MINDFUL EATING AND PRACTICE SESSIONS. PARTICIPANTS ALSO RECEIVE A PREDIABETES SCREENING; THOSE WHO SCORE HIGH ARE THEN REFERRED TO THE SCRIPPS DIABETES PREVENTION PROGRAM. PROMISE NEIGHBORHOOD INITIATIVE SCRIPPS ALSO ADDRESSES CHILDHOOD OBESITY AT THE HIGH SCHOOL LEVEL IN SAN DIEGOS SOUTH BAY COMMUNITIES THROUGH ITS PARTNERSHIP WITH THE PROMISE NEIGHBORHOOD INITIATIVE, WHICH IMPLEMENTS ACTIVITIES RELATED TO THE NATIONAL 5210 CAMPAIGN. SCRIPPS PARTNERS WITH THE PROMISE NEIGHBORHOOD INITIATIVE AND CASTLE PARK ELEMENTARY SCHOOL TO INCREASE EDUCATION AND AWARENESS ABOUT HEALTHY LIFESTYLES FOR STUDENTS, THEIR PARENTS AND SCHOOL STAFF. PROMISE NEIGHBORHOOD DEVELOPED A WELLNESS COMMITTEE COMPOSED OF THE SCHOOL PRINCIPAL, TEACHERS, PARENTS AND SCRIPPS STAFF AIMED TO IMPLEMENT ACTIVITIES THAT SUPPORT 5-2-1-0: 5 FRUITS OR MORE A DAY, 2 HOURS OR LESS OF SCREEN TIME, 1 HOUR OF PHYSICAL ACTIVITY AND 0 SUGARY JUICES. SCHOOL ADMINISTRATORS AND STAFF ARE CLOSELY INVOLVED IN THE PROGRAM, WHICH INCLUDES FIVE EDUCATIONAL SESSIONS, A HEALTH ASSESSMENT SURVEY AND HEALTH PLAN, AND SUPPORT TO HELP THE STUDENTS PASS THEIR YEARLY PHYSICAL EDUCATION REQUIREMENTS. SINCE 2013, MORE THAN 400 CHILDREN AND 200 PARENTS HAVE PARTICIPATED IN WELLNESS ACTIVITIES ON CAMPUS. AS A RESULT OF ACTIVITIES, LESSON PLANS AND ADVOCACY FOR HEALTHY LIVING, THE AMOUNT OF PHYSICAL ACTIVITY AND CONSUMPTION OF FRUITS AND VEGETABLES BY CHILDREN, PARENTS AND STAFF HAS INCREASED. STUDENT RESPONSES VIA A 5210 POST HEALTH ASSESSMENT SURVEY SHOWED THAT THERE WAS AN 80% IMPROVEMENT RATE FOR KNOWLEDGE AFTER PARTICIPATING IN THE 5210 SESSIONS. AND A 38% IMPROVEMENT RATE FOR BEHAVIOR AFTER PARTICIPATING IN THE 5210 SESSIONS. CITY HEIGHTS WELLNESS CENTER LA MAESTRA FAMILY CLINIC, INC. JOINED THE CITY HEIGHTS WELLNESS CENTER COLLABORATIVE PARTNERSHIP WITH SCRIPPS MERCY HOSPITAL AND RADY CHILDRENS HOSPITAL AS THE LEASE HOLDER OF THE WELLNESS CENTER STARTING SEPTEMBER 1, 2016. SINCE ITS INCEPTION IN 2002, THE CITY HEIGHTS WELLNESS CENTER HAS BEEN A DYNAMIC, COMMUNITY BASED PROGRAM DEVELOPED BY SCRIPPS MERCY HOSPITAL AND RADY CHILDRENS HOSPITAL, WORKING WITH RESIDENTS TO IMPROVE THEIR LIFESTYLE BEHAVIORS AND SELF-SUFFICIENCY SKILLS. MULTIPLE NOT-FOR-PROFIT AND GOVERNMENTAL ORGANIZATIONS, PHILANTHROPIC FOUNDATIONS AND GRASSROOTS GROUPS HAVE JOINED THE EFFORT CONDUCTING HEALTH PROMOTION AND EDUCATIONAL ACTIVITIES FOR COMMUNITY RESIDENTS. A UNIQUE ASPECT OF THE CITY HEIGHTS WELLNESS CENTER IS THE TEACHING KITCHEN THAT IS KNOWN THROUGHOUT THE COMMUNITY AS A PLACE WHERE RESIDENTS AND PROVIDERS COME TOGETHER TO COOK, DISCOVER AND COMMUNICATE IN A SAFE AND TRUSTED ENVIRONMENT. LA MAESTRA FAMILY CLINIC BRINGS A NEW PERSPECTIVE TO THE PARTNERSHIP AS A COMMUNITY HEALTH CENTER AND PRIMARY CARE PROVIDER SERVING THE CULTURALLY DIVERSE POPULATIONS WITHIN THE CITY HEIGHTS COMMUNITY. LA MAESTRA IS COMMITTED TO MAINTAINING THE COLLABORATIVE NATURE OF THE PARTNERSHIP, AND CONTINUES TO WORK WITH CURRENT CHWC AGENCIES AS WELL AS LOOK FOR OPPORTUNITIES TO EXPAND HEALTH PROMOTION SERVICES. THE SCRIPPS MERCY SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC), COLLOCATED IN THE WELLNESS CENTER, WILL CONTINUE TO PROVIDE WIC SERVICES AS ONE PROGRAM WITHIN THE CITY HEIGHTS WELLNESS CENTER. COLLABORATIVE FOR HEALTHY WEIGHT COLLABORATE FOR HEALTHY WEIGHT IS A PROGRAM OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THE NATIONAL INITIATIVE FOR CHILDRENS HEALTHCARE QUALITY (NICHQ). THE SHARED VISION IS TO CREATE PARTNERSHIPS BETWEEN PRIMARY CARE, PUBLIC HEALTH, AND COMMUNITY ORGANIZATIONS TO DISCOVER SUSTAINABLE WAYS TO PROMOTE HEALTHY WEIGHT AND ELIMINATE HEALTH DISPARITIES IN COMMUNITIES ACROSS THE UNITED STATES. COLLABORATE FOR HEALTHY WEIGHT MEETS MONTHLY AND ALL THREE SECTORS COLLABORATE, USING EVIDENCE-BASED APPROACHES, TO REVERSE THE OBESITY EPIDEMIC AND IMPROVE THE HEALTH OF OUR COMMUNITIES. THIS PROGRAM WILL CONTINUE IN 2019 AND SEVERAL MANUSCRIPTS ARE UNDER DEVELOPMENT. FOOD ADDICTS ANONYMOUS SCRIPPS HEALTH PROVIDES FOOD ADDICTS ANONYMOUS MEETING SPACE TO MEET. FOOD ADDICTS ANONYMOUS IS AN INTERNATIONAL FELLOWSHIP OF MEN AND WOMEN WHO HAVE EXPERIENCED DIFFICULTIES IN LIFE AS A RESULT OF THE WAY THEY EAT. TAKE OFF POUNDS SENSIBLY (TOPS) MEETING SCRIPPS HEALTH PROVIDES MEETING SPACE TO TAKE OFF POUNDS SENSIBLY (TOPS). TOPS (TAKE OFF POUNDS SENSIBLY) IS THE SHORT NAME FOR TOPS CLUB, INC., THE ORIGINAL NONPROFIT, NONCOMMERCIAL NETWORK OF WEIGHT-LOSS SUPPORT GROUPS AND WELLNESS EDUCATION ORGANIZATION. OVEREATERS ANONYMOUS SPANISH SCRIPPS HEALTH PROVIDES MEETING SPACE TO OVEREATERS ANONYMOUS. THIS IS A SUPPORT GROUP THAT PROVIDES DIETARY EDUCATION FOR INDIVIDUALS WHO DESIRE TO LOSE WEIGHT. THE GROUPS IS HELD IN SPANISH. GREATER LA JOLLA MEALS ON WHEELS GREATER LA JOLLA MEALS ON WHEELS IS A NON-PROFIT SENIOR SERVICE ORGANIZATION. IT PROVIDES NUTRITIOUS MEALS TO SENIORS, THE HOMEBOUND AND THE DISABLED RESIDING IN THE COMMUNITIES OF LA JOLLA AND UNIVERSITY CITY. SCRIPPS HEALTH PROVIDES OFFICE SPACE TO THE GREATER LA JOLLA MEALS ON WHEELS PROGRAM IN THE VOLUNTEER SERVICE OFFICE. THIS SHARED SPACE IS USED BY MEALS ON WHEELS FOR ITS COORDINATORS TO CONDUCT BUSINESS ON BEHALF OF THE PROGRAM. FOOD HANDLERS TRAINING COURSE SCRIPPS HEALTH PROVIDES THE USE OF A CLASSROOM TO FULL SPECTRUM NUTRITION SERVICES TO PROVIDE A THREE HOUR COURSE WHICH PROVIDES CERTIFICATION FOR FOOD HANDLERS AND MEETS REQUIREMENTS OF THE SAN DIEGO COUNTY FOOD HANDLERS ORDINANCE. MATERNAL CHILD HEALTH & HIGH RISK PREGNANCY MOTHERS, INFANTS AND CHILDREN MAKEUP A LARGE SEGMENT OF THE U.S. POPULATION AND THEIR WELL-BEING IS A HEALTH PREDICTOR FOR THE NEXT GENERATION. THERE IS TREMENDOUS FOCUS ON MATERNAL ILLNESS AND DEATH, AND INFANT HEALTH AND SURVIVAL, INCLUDING INFANT MORTALITY RATES, ACCESS TO PREVENTATIVE CARE, AND FETAL, PERINATAL AND OTHER INFANT DEATHS. MATERNAL AND INFANT HEALTH ISSUES INCLUDE: - ALCOHOL, TOBACCO AND ILLEGAL SUBSTANCES DURING PREGNANCY, WHICH ARE MAJOR RISK FACTORS FOR LOW BIRTH WEIGHT AND OTHER POOR OUTCOMES. - VERY LOW BIRTH WEIGHT ASSOCIATED WITH PRETERM BIRTH, SPONTANEOUS ABORTION, LOW PRE-PREGNANCY WEIGHT AND SMOKING. - INFANT DEATH RATES ARE HIGHEST AMONG INFANTS BORN TO YOUNG TEENAGERS AND MOTHERS 44 YEARS AND OLDER. BEING PREGNANT, OR TRYING TO BECOME PREGNANT, IS ONLY A SMALL PORTION OF A WOMANS LIFE. UNINTENDED PREGNANCY, EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION, ACCOUNTS FOR AN ESTIMATED 49 PERCENT OF PREGNANCIES IN THE U.S. THESE PREGNANCIES ARE ASSOCIATED WITH INCREASED MORBIDITY, AS WELL AS BEHAVIORS LINKED TO ADVERSE HEALTH. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THEIR CHILDREN EXPERIENCE IMPROVED HEALTH, FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND LOWER ABORTION RATES. HIGH RISK PREGNANCY HIGH RISK PREGNANCY CAN BE THE RESULT OF A MEDICAL CONDITION PRESENT BEFORE PREGNANCY OR A MEDICAL CONDITION THAT DEVELOPS DURING PREGNANCY FOR EITHER MOM OR BABY AND CAUSES THE PREGNANCY TO BECOME HIGH RISK. A HIGH RISK PREGNANCY CAN POSE PROBLEMS BEFORE, DURING OR AFTER DELIVERY AND MIGHT REQUIRE SPECIAL MONITORING THROUGHOUT THE PREGNANCY. RISK FACTORS: - ADVANCED MATERNAL AGE: INCREASED RISK FOR MOTHER'S 35 YEARS AND OLDER. - LIFESTYLE CHOICES: SMOKING, ALCOHOL CONSUMPTION, USE OF ILLEGAL DRUGS. - MEDICAL HISTORY: PRIOR HIGH RISK PREGNANCIES OR DELIVERIES, FETAL GENETIC CONDITIONS, FAMILY HISTORY OF GENETIC CONDITIONS. - UNDERLYING CONDITIONS: DIABETES, HIGH BLOOD PRESSURE AND EPILEPSY. - MULTIPLE PREGNANCY. - OBESITY DURING PREGNANCY
FORM 990, PART III, LINE 4A (CONTINUED)	A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF MATERNAL AND CHILD HEALTH & HIGH RISK PREGNANCIES ARE DESCRIBED BELOW: - THE HASD&IC 2016 CHNA CONTINUED TO IDENTIFY HIGH RISK PREGNANCIES AS ONE OF THE TOP 15 PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS - IN 2016, THERE WERE 42,654 LIVE BIRTHS IN SDC OVERALL. THE 2016 FETAL MORTALITY RATE WAS 3.2 INFANT DEATHS PER 1,000 LIVE BIRTHS IN THE NORTH INLAND REGION, 3.4 IN THE NORTH COASTAL REGION, 3.7 IN THE EAST REGION AND SDC OVERALL, 3.8 IN THE CENTRAL REGION, 3.9 IN THE NORTH CENTRAL REGION, AND 4.3 IN THE SOUTH REGION.7 - IN 2016, 159 INFANTS DIED BEFORE THEIR FIRST BIRTHDAY IN SDC. INFANT MORTALITY WAS HIGHER AMONG MALE INFANTS (93 DEATHS) THAN FEMALE INFANTS (66 DEATHS). AFRICAN AMERICAN/BLACK INFANTS HAD THE HIGHEST MORTALITY RATE (10.7 INFANT DEATHS PER 1,000 LIVE BIRTHS) WHEN COMPARED TO INFANTS OF ALL OTHER RACES AND ETHNICITIES. HISPANIC INFANTS HAD THE SECOND HIGHEST MORTALITY RATE OF 4.5 DEATHS PER 1,000 LIVE BIRTHS. IN ADDITION, THERE WERE 3,628 PRETERM BIRTHS (LESS THAN 37 WEEKS GESTATION) IN SDC DURING 2016. COMPARED TO ALL OTHER RACES AND ETHNICITIES, HISPANIC MOTHERS HAD THE HIGHEST TOTAL NUMBER OF BIRTHS (16,978), 8.2 PERCENT OF WHICH WERE PRETERM. DESPITE HAVING FEWER TOTAL BIRTHS THAN HISPANIC MOTHERS (1,781), 11.6 PERCENT OF BIRTHS BY AFRICAN AMERICAN/BLACK MOTHERS WERE PRETERM. SIMILARLY, ALTHOUGH WOMEN AGES 25 TO 39 HAD THE HIGHEST TOTAL NUMBER OF BIRTHS COMPARED TO OTHER AGE GROUPS, MOTHERS AGE 40 AND ABOVE WERE MORE LIKELY TO GIVE BIRTH PRETERM COMPARED TO YOUNGER AGE GROUPS (45.8 PERCENT PRETERM BIRTHS AMONG MOTHERS AGE 40 AND ABOVE COMPARED TO 15.4 PERCENT PRETERM BIRTHS AMONG MOTHERS AGES 25 TO 39). - IN 2016, ALL SDC REGIONS MET THE HP2020 NATIONAL TARGETS FOR PRENATAL CARE, PRETERM BIRTHS, LOW BIRTH WEIGHT (LBW) INFANTS, VERY LOW BIRTH WEIGHT (VLBW) INFANTS AND INFANT MORTALITY. SEE TABLE 2 FOR A SUMMARY OF MATERNAL AND INFANT HEALTH INDICATORS IN SAN DIEGO COUNTY IN 2016 AND TABLE 3 FOR A SUMMARY OF MATERNAL AND INFANT HEALTH INDICATORS BY REGION. SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION FOR LOW INCOME WOMEN IN SAN DIEGO COUNTY IN FISCAL YEAR 2018. THE FOLLOWING ARE SOME EXAMPLES: COMMUNITY BENEFIT SERVICES - OFFERED MORE THAN 1,200 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY TO ENHANCE PARENTING SKILLS. LOW INCOME WOMEN IN SAN DIEGO WHO WERE ELIGIBLE ATTENDED CLASSES AT NO CHARGE OR ON A SLIDING FEE SCHEDULE. - MAINTAINED EXISTING PRENATAL EDUCATION SERVICES IN ALL REGIONS OF THE COUNTY, ENSURING THAT PROGRAMS CONTINUED TO DEMONSTRATE A SATISFACTION RATING ABOVE 90 PERCENT. - PROVIDED AND SUPPORTED WEEKLY BREASTFEEDING SUPPORT GROUPS AT SIX LOCATIONS THROUGHOUT SAN DIEGO COUNTY, INCLUDING THREE WITH BILINGUAL SERVICES. - OFFERED MATERNAL CHILD HEALTH CLASSES THROUGHOUT THE COMMUNITY, SUCH AS GETTING READY FOR THE BABY AND GRAND PARENTING TODAY. - OFFERED THE DOGS AND BABIES PROGRAMS QUARTERLY, WITH MORE THAN 40 ATTENDEES. - OFFERED A PRENATAL YOGA PROGRAM FOR EXPECTANT WOMEN IN SAN DIEGO COUNTY. - OFFERED CLASSES IN PELVIC FLOOR AND POSTPARTUM CHANGES FOR NEW MOTHERS THROUGHOUT THE COMMUNITY. FIRST 5 AND PROMISE NEIGHBORHOOD PARENTING CLASSES ARE OFFERED AT THE SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER FOR PARENTS WITH INFANTS, TODDLERS AND PRESCHOOLERS. A WIDE VARIETY OF TOPICS ARE COVERED INCLUDING ISSUES RELATED TO HEALTH, LEARNING/DEVELOPMENT, FAMILY/SAFETY, ADVOCACY AS WELL AS PARENTING TIPS. DEVELOPMENTAL ASSESSMENTS ARE CONDUCTED BY RADY CHILDRENS HOSPITAL. MORE THAN 400 SERVICES WERE RECEIVED FOR FIRST TIME MOTHERS INCLUDING: HOME VISITS, REFERRALS RECEIVED, DATA ENTRY, FOLLOW UP PHONE CALLS, PARENTING CLASSES AND OTHER SUPPORT SERVICES. A TOTAL OF 209 PARENTS PARTICIPATED IN PARENTING CLASSES, 180 SESSIONS PROVIDED. MATERNAL CHILD HEALTH NURSING STUDENTS SCRIPPS PERINATAL EDUCATION PROGRAM SUPPORTS LOCAL NURSING STUDENTS WITH THE OPPORTUNITY TO OBSERVE PRENATAL EDUCATIONAL CLASSES. THIS CRITICAL ASPECT OF THE NURSING EDUCATION ALLOWS THE HOURS AND INFORMATION TO MEET THEIR CLINICAL ROTATION REQUIREMENTS IN MATERNAL CHILD HEALTH. SCRIPPS MERCY'S SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) THE SPECIAL SUPPLEMENT NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS ESTABLISHED AS A PERMANENT PROGRAM IN 1974 TO SAFEGUARD THE HEALTH OF LOW-INCOME WOMEN, INFANTS AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES APPROXIMATELY 6,500 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FISCAL YEAR 2017, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 71,357 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS SUPPLIES, PUMPS AND BREAST PADS, DURING THE POSTPARTUM PERIOD. CENTERING PREGNANCY, SCRIPPS FAMILY MEDICINE RESIDENCY RAISING HEALTHY FAMILIES AND CARING FOR THE NEXT GENERATION OF SAN DIEGANS BEFORE THEYRE BORN HELP CREATE A HEALTHIER COMMUNITY FOR YEARS TO COME. THE SCRIPPS FAMILY MEDICINE PROGRAM AT SCRIPPS MERCY HOSPITAL CHULA VISTA, IS PROVIDING ACCESS, EDUCATION AND CLINICAL SERVICES TO NEARLY 200 PREGNANT WOMEN IN SOUTH SAN DIEGO COUNTY. THE GOAL OF THE PROGRAM, "IMPROVING PERINATAL CARE FOR UNDERSERVED LATINA WOMEN - HEALTHY WOMEN, HEALTHY BABIES", IS TO PROVIDE ACCESS TO PERINATAL CARE FOR UNDERSERVED LATINA WOMEN IN ORDER TO IMPROVE BIRTH OUTCOMES. THE PROGRAM APPLIES THE PRINCIPLES OF THE CENTER HEALTH CARE INSTITUTE AND FOCUSES ON CHANGING THE WAY PATIENTS EXPERIENCE THEIR CARE THROUGH ASSESSMENT, EDUCATION AND GROUP SUPPORT. CENTERING PREGNANCY IS THE INSTITUTES MODEL DEVOTED SPECIFICALLY TO IMPROVING MATERNAL AND CHILD HEALTH, AND HAS BEEN SHOWN TO RESULT IN INCREASED PRENATAL VISITS, GREATER LEVELS OF BREASTFEEDING AND STRONGER RELATIONSHIPS BETWEEN MOTHERS AND THEIR HEALTHCARE PROVIDERS BEFORE, DURING AND AFTER PREGNANCY. THE RESULTS ARE PROMISING. WOMEN WHO GAVE BIRTH REPORTED AN ENHANCED PRENATAL EXPERIENCE, GAINED LESS WEIGHT THROUGHOUT THEIR PREGNANCY AND SHOWED IMPROVED HEALTHCARE KNOWLEDGE. AS THE PROGRAM CONTINUES, PATIENT NAVIGATORS WILL FOLLOW-UP WITH PARTICIPANTS TO GAUGE OTHER IMPORTANT FACTORS AND HELP THEM MAINTAIN HEALTHY LIFESTYLES. UNINTENTIONAL INJURY AND VIOLENCE UNINTENTIONAL INJURIES OCCUR AT HOME, AT WORK, WHILE PARTICIPATING IN SPORTS AND RECREATION, ON THE STREETS AND AT SCHOOL AND ARE ASSOCIATED WITH MOTOR VEHICLE ACCIDENTS, FALLS, FIREARMS, FIRE/BURNS, DROWNING, POISONING (INCLUDING DRUGS AND CAUSTIC SUBSTANCES), ALCOHOL, GAS, CLEANERS AND MANY OTHER CAUSES. THE DEATHS ASSOCIATED WITH UNINTENTIONAL INJURIES ARE SIGNIFICANT, YET REPRESENT ONLY A SMALL PART OF A MUCH LARGER PUBLIC HEALTH PROBLEM. HOSPITALIZATION DATA IS A BETTER MEASURE OF THE INJURY PROBLEM THAN THE DEATH DATA ALONE. UNINTENTIONAL INJURIES, MOTOR VEHICLE ACCIDENTS, FALLS, PEDESTRIAN RELATED, FIREARMS, FIRE/BURNS, DROWNING, EXPLOSION, POISONING (INCLUDING DRUGS AND ALCOHOL, GAS, CLEANERS AND CAUSTIC SUBSTANCES) CHOKING/SUFFOCATION, CUT/PIERCE, EXPOSURE TO ELECTRIC CURRENT/RADIATION/FIRE/SMOKE, NATURAL DISASTERS AND INJURIES AT WORK, ARE ONE OF THE LEADING CAUSES OF DEATH FOR SDC RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. MOST EVENTS RESULTING IN INJURY, DISABILITY OR DEATH ARE PREDICTABLE AND PREVENTABLE. THERE ARE MANY RISK FACTORS FOR UNINTENTIONAL INJURY AND VIOLENCE, INCLUDING INDIVIDUAL BEHAVIORS AND CHOICES, SUCH AS ALCOHOL USE OR RISK TAKING; THE PHYSICAL ENVIRONMENT BOTH AT HOME AND IN THE COMMUNITY; ACCESS TO HEALTH SERVICES AND SYSTEMS CREATED FOR INJURY RELATED CARE; THE SOCIAL ENVIRONMENT, INCLUDING INDIVIDUAL SOCIAL EXPERIENCES. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF UNINTENTIONAL INJURY AND VIOLENCE IS DESCRIBED BELOW: - THE HASD&IC 2016 CHNA CONTINUED TO IDENTIFY UNINTENTIONAL INJURY AS ONE OF THE TOP 15 PRIORITY HEALTH CONDITIONS AMONG SAN DIEGO COUNTY HOSPITALS.
FORM 990, PART III, LINE 4A (CONTINUED)	- IN 2016, ACCIDENTS (UNINTENTIONAL INJURIES) WERE THE FIFTH LEADING CAUSE OF DEATH FOR SAN DIEGO COUNTY OVERALL. UNINTENTIONAL INJURIES (I.E., MOTOR VEHICLE ACCIDENTS, FALLS, PEDESTRIAN-RELATED, FIREARMS, FIRE/BURNS, DROWNING, EXPLOSIONS, POISONING (INCLUDING DRUGS AND ALCOHOL, GAS, CLEANERS AND CAUSTIC SUBSTANCES), CHOKING/SUFFOCATION, CUT/PIERCE, EXPOSURE TO ELECTRICAL CURRENT/RADIATION/FIRE/SMOKE, NATURAL DISASTERS AND WORKPLACE INJURIES) ARE ONE OF THE LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE OR REGION. - BETWEEN 2012 AND 2016, MORE THAN 5,700 SAN DIEGANS DIED FROM UNINTENTIONAL INJURIES. - IN 2016, THERE WERE 1,071 DEATHS DUE TO UNINTENTIONAL INJURY IN SAN DIEGO COUNTY THE COUNTYS AGE-ADJUSTED DEATH RATE DUE TO UNINTENTIONAL INJURY WAS 31.1 DEATHS PER 100,000 POPULATION. IN 2016, UNINTENTIONAL INJURY ACCOUNTED FOR 5.1 PERCENT OF TOTAL DEATHS IN SAN DIEGO COUNTY. - IN 2016, THERE WERE 20,247 HOSPITALIZATIONS RELATED TO UNINTENTIONAL INJURY IN SAN DIEGO COUNTY. THE AGE-ADJUSTED RATE OF HOSPITALIZATIONS DUE TO UNINTENTIONAL INJURY WAS 589.4 PER 100,000 POPULATION. - IN 2016, THERE WERE 169,017 ED DISCHARGES RELATED TO UNINTENTIONAL INJURY IN SDC. THE AGE-ADJUSTED RATE OF DISCHARGES DUE TO UNINTENTIONAL INJURY WAS 5,160.3 PER 100,000 POPULATION. - CDPH INJURY DATA REPORTS THAT IN 2016, UNINTENTIONAL INJURIES CAUSED OVER 13,000 DEATHS, 200,000 NON-FATAL HOSPITALIZATIONS, AND 2.3 MILLION NON-FATAL ED VISITS (CDPH, SAFE AND ACTIVE COMMUNITIES BRANCH, 2016). - IN 2015, THE CDC RECORDED APPROXIMATELY 30.8 MILLION ED VISITS IN THE U.S. FOR UNINTENTIONAL INJURIES (CDC, 2015). - IN 2015, THE CDC RECORDED APPROXIMATELY 30.8 MILLION ED VISITS IN THE U.S. FOR UNINTENTIONAL INJURIES (CDC, 2015). - IN 2016, UNINTENTIONAL INJURY WAS THE THIRD LEADING CAUSE OF DEATH ACROSS ALL AGE GROUPS IN THE U.S., ACCOUNTING FOR OVER 160,000 DEATHS. UNINTENTIONAL INJURY WAS THE LEADING CAUSE OF DEATH IN THE U.S. FOR PEOPLE AGES 1 TO 44, AND THE SEVENTH LEADING CAUSE OF DEATH FOR THOSE OVER AGE 65 (CDC, 2018). - ACCORDING TO DATA FROM NCHS, IN 2016, OVER 130,000 DEATHS IN THE U.S. WERE ATTRIBUTED TO THREE CAUSES: POISONING (26 PERCENT), MOTOR VEHICLE TRAFFIC ACCIDENTS (16.9 PERCENT), AND FALLS (16.5 PERCENT). - UNINTENTIONAL INJURIES ARE THE LEADING CAUSE OF DEATH AMONG CHILDREN IN THE U.S., WHILE NONFATAL UNINTENTIONAL INJURIES CAN RESULT IN CHILDREN HAVING LONG-TERM DISABILITIES (LWSD REPORT CARD ON CHILDREN, FAMILIES, AND COMMUNITY, 2017). - TRAUMATIC INJURY IS THE LEADING CAUSE OF DEATH AMONG CHILDREN, WITH MANY SURVIVORS ENDURING THE CONSEQUENCES OF BRAIN AND SPINAL CORD INJURIES. THE PHYSICAL, EMOTIONAL, PSYCHOLOGICAL AND LEARNING PROBLEMS THAT AFFECT INJURED CHILDREN, ALONG WITH THE ASSOCIATED COSTS, MAKE REDUCING TRAUMATIC INJURIES A HIGH PRIORITY FOR HEALTH AND SAFETY ADVOCATES THROUGHOUT THE NATION. EDUCATIONAL PROGRAMS LIKE THINKFIRST INCREASE KNOWLEDGE AND AWARENESS OF THE CAUSES AND RISK FACTORS OF BRAIN AND SCI, INJURY PREVENTION MEASURES, AND THE USE OF SAFETY HABITS AT AN EARLY AGE (WWW.THINKFIRST.ORG/KIDS, 2015). - SAN DIEGO COUNTY HAS MADE STRIDES TO DECREASE DEATHS FROM UNINTENTIONAL INJURIES AS WELL AS NON-FATAL UNINTENTIONAL INJURY RATES, THOUGH NON-FATAL UNINTENTIONAL INJURY RATES CONTINUE TO EXCEED STATE AND FEDERAL RATES. SDC HAS FOCUSED INJURY PREVENTION EFFORTS ON THE MOST VULNERABLE POPULATIONS, INCLUDING CHILDREN OF ALL AGES (ESPECIALLY OLDER CHILDREN), NATIVE AMERICAN AND RURAL CHILDREN. SUCCESSFUL INTERVENTIONS INCLUDE SAFETY CAMPAIGNS, EDUCATIONAL STRATEGIES AND CHANGES IN PARENTING PRACTICES (LWSD REPORT CARD ON CHILDREN, FAMILIES, AND COMMUNITY, 2017). - ACCORDING TO HP2020, MOST EVENTS RESULTING IN INJURY, DISABILITY OR DEATH ARE PREDICTABLE AND PREVENTABLE. THERE ARE MANY RISK FACTORS FOR UNINTENTIONAL INJURY AND VIOLENCE, INCLUDING INDIVIDUAL BEHAVIORS AND CHOICES, SUCH AS ALCOHOL USE OR RISK-TAKING; PHYSICAL ENVIRONMENT BOTH AT HOME AND IN THE COMMUNITY; ACCESS TO HEALTH SERVICES AND SYSTEMS FOR INJURY-RELATED CARE; AND SOCIAL ENVIRONMENT, INCLUDING INDIVIDUAL SOCIAL EXPERIENCES (E.G., SOCIAL NORMS, EDUCATION AND VICTIMIZATION HISTORY), SOCIAL RELATIONSHIPS (E.G., PARENTAL MONITORING AND SUPERVISION OF YOUTH, PEER GROUP ASSOCIATIONS AND FAMILY INTERACTIONS), COMMUNITY ENVIRONMENT (E.G., COHESION IN SCHOOLS, NEIGHBORHOODS AND COMMUNITIES) AND SOCIETAL FACTORS (E.G., CULTURAL BELIEFS, ATTITUDES, INCENTIVES AND DISINCENTIVES, LAWS AND REGULATIONS). SCRIPPS HEALTH CONTINUES TO ADDRESS UNINTENTIONAL INJURY AND VIOLENCE IN FISCAL YEAR 2018. THE FOLLOWING ARE SOME EXAMPLES: AGING SUMMIT EXPO SCRIPPS PROVIDED A CONFERENCE ON HOME AND MEDICATION SAFETY AND FALL PREVENTION. THIS CONFERENCE WAS DESIGNED TO PROVIDE SENIORS WITH EDUCATION AND RESOURCES FOR HEALTHY LIVING. FALL PREVENTION AND HOME SAFETY SCRIPPS SOCIAL WORKER AND RN LECTURE ON WAYS TO REDUCE FALL RISK, IMPROVE SAFETY AWARENESS AND UTILIZE AVAILABLE RESOURCES TO PROMOTE INDEPENDENCE AND OVERALL SAFETY. BALANCE CLASSES ARE DESIGNED TO HELP BUILDING BALANCE, POSTURE AND COORDINATION THROUGH STRENGTHENING AND BALANCE EXERCISES. THIS IMPORTANCE ASPECT TO HEALTHY LIVING FOR SENIORS PROVIDES EDUCATION ON PREVENTING FALLS THROUGH EXERCISE AND BEING PROACTIVE THROUGH SAFETY MEASURES IN THE HOME. SAN DIEGO BRAIN INJURY FOUNDATION PROVIDE QUALITY OF LIFE IMPROVEMENTS FOR BRAIN INJURY SURVIVORS AND SUPPORT TO FAMILY MEMBERS. SCRIPPS MEMORIAL HOSPITAL ENCINITAS DONATES SPACE TO THIS ORGANIZATION FOR MEETINGS. BRAINMASTERS BRAINMASTERS IS A SUPPORTIVE COMMUNICATION GROUP FOR ADULTS COPING WITH ACQUIRED BRAIN INJURY. IT IS OFFERED AS COMMUNITY BENEFIT THROUGH THE REHABILITATION CENTER AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS. THE MAIN GOAL OF BRAINMASTERS IS TO HELP BRAIN INJURY SURVIVORS TO BUILD CONFIDENCE BY PRACTICING THINKING ON THEIR FEET. THIS HELPS TO ALLEVIATE CHALLENGES WITH COMMUNICATION AND SOCIAL ISOLATION THAT SO MANY BRAIN INJURY SURVIVORS EXPERIENCE. EVERY 15 MINUTES ALCOHOL CAN BE ATTRIBUTED TO MORE THAN 100,000 DEATHS IN THE U.S. ANNUALLY, INCLUDING 41% OF ALL TRAFFIC FATALITIES. THE EVERY 15 MINUTES PROGRAM IS A TWO-DAY IMMERSION EXPERIENCE FOR TEENS ON THE REALISTIC CONSEQUENCES OF DRINKING AND DRIVING, WHICH INVOLVES THE SCHOOLS, LAW ENFORCEMENT, COURTS, EMERGENCY SERVICE PROVIDERS, AND THE MORTUARY. THE "INJURED" STUDENTS ARE TAKEN TO SCRIPPS MERCY TRAUMA CENTER. THIS PROGRAM IS SPONSORED JOINTLY BY LOCAL HIGH SCHOOLS, COUNTY POLICE AND SHERIFFS DEPARTMENTS, AMBULANCE SERVICES, AND EMERGENCY DEPARTMENTS. BEACH AREA COMMUNITY COURT PROGRAM THE PROGRAM IS AN EDUCATIONAL PROGRAM FOR FIRST TIME OFFENDERS FOR QUALITY OF LIFE CRIMES. THIS IS A COLLABORATION WITH THE SAN DIEGO POLICE DEPARTMENT, PARKS AND RECREATION, DISTRICT ATTORNEYS OFFICE AND DISCOVER PACIFIC BEACH. EDUCATION IS PROVIDED TO THE PARTICIPANTS REGARDING THESE QUALITY OF LIFE CRIMES AND THEIR EFFECTS ON THE COMMUNITY, THE EFFECTS OF SMOKING AND ALCOHOL CONSUMPTION AND THE RULES AND REGULATIONS FOR THE BEACH COMMUNITY. SAN DIEGO COUNTY LIFEGUARD EDUCATION CONFERENCE IN FY18, THE TRAUMA DEPARTMENT AT SCRIPPS LA JOLLA HOSTED THE FIRST EVER SAN DIEGO COUNTY LIFEGUARD EDUCATION CONFERENCE. MORE THAN 150 LIFEGUARDS REPRESENTING ALL 11 SAN DIEGO COUNTY LIFEGUARD AGENCIES WERE IN ATTENDANCE AT THE EVENT. INFORMATION WAS SHARED ON A NUMBER OF TOPICS CRITICAL FOR LIFEGUARDS, INCLUDING DOWNING RESUSCITATION, SAND ENTRAPMENT AND SKIN CANCER PREVENTION. A PHYSICIAN PRESENTED ON SHARK BITE ATTACK SURVIVAL. THE TRAUMA DEPARTMENT PLANS TO CONTINUE THIS PARTNERSHIP WITH THE COUNTY LIFEGUARDS TO PROVIDE EDUCATION AND HELP THEM FURTHER IDENTIFY OPPORTUNITIES FOR COMMUNITY OUTREACH AND INJURY PREVENTION. SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE SCRIPPS HAS PARTNERED WITH THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE AND PROJECT LIFE TO OFFER "SOFT ROOMS" AT ALL SCRIPPS HOSPITAL FACILITIES EXCEPT SCRIPPS GREEN HOSPITAL. THESE SOFT ROOMS WILL BE AVAILABLE TO PROJECT LIFE ON A MOMENTS NOTICE TO SERVE AS A SAFE, CONFIDENTIAL ENVIRONMENT FOR LAW ENFORCEMENT TO INTERVIEW VICTIMS OF HUMAN TRAFFICKING AND FOR SERVICE PROVIDERS TO CONNECT WITH THE VICTIMS WITH EMERGENCY SHELTER AND COMMUNITY RESOURCES. THE SAN DIEGO HUMAN TRAFFICKING TASK FORCE RECEIVES 3,000 TO 8,000 HUMAN TRAFFICKING VICTIMS EVERY YEAR IN SAN DIEGO COUNTY. APPROXIMATELY 80 PERCENT ARE BORN IN THE UNITED STATES. SAVING LIVES THROUGH STOP THE BLEED CAMPAIGN WHETHER FROM A BULLET WOUND OR OTHER TRAUMATIC INJURY, SEVERE BLOOD LOSS CAN KILL IN JUST FIVE MINUTES. HOWEVER, ONE-FIFTH OF TRAUMA DEATHS, THE LEADING CAUSE OF DEATH FOR AMERICANS UNDER AGE 46, COULD BE PREVENTED BY STANCHING THE BLEEDING. SCRIPPS DOCTORS PARTICIPATE AND CONVEY THE IMPORTANT MESSAGES OF THE NATIONAL STOP THE BLEED CAMPAIGN.
FORM 990, PART III, LINE 4A (CONTINUED)	TRAUMA AWARENESS CONFERENCE SCRIPPS PARTICIPATES WITH LOCAL AGENCIES GIVING ATTENDEE THE OPPORTUNITY TO LEARN MORE ABOUT TRAUMA SERVICES. EDUCATION IS PROVIDED ON INJURY PREVENTION AND THE LATEST TRAUMA RESEARCH. ACTIVITIES INCLUDE: CONCUSSION PREVENTION, FATAL VISION GOGGLES, AND LEARNING THE CONSEQUENCES OF DISTRACTED DRIVING BEHAVIORAL HEALTH BEHAVIORAL HEALTH IS AN IMPORTANT HEALTH NEED BECAUSE IT IMPACTS AN INDIVIDUALS OVERALL HEALTH STATUS AND IS A COMORBIDITY OFTEN ASSOCIATED WITH MULTIPLE CHRONIC CONDITIONS, SUCH AS DIABETES, OBESITY AND ASTHMA. BEHAVIORAL HEALTH ENCOMPASSES MANY DIFFERENT AREAS INCLUDING MENTAL HEALTH, MENTAL ILLNESS AND SUBSTANCE ABUSE. BECAUSE OF ITS BROADNESS, IT IS OFTEN DIFFICULT TO CAPTURE THE NEED FOR BEHAVIORAL HEALTH SERVICES WITH A SINGLE MEASURE. AN ANALYSIS OF MORTALITY DATA IN SAN DIEGO COUNTY FOUND THAT IN 2016, ALZHEIMERS DISEASE AND SUICIDE AS THE THIRD AND NINTH LEADING CAUSES OF DEATH IN SAN DIEGO COUNTY, RESPECTIVELY. A SUMMARY OF THE MAGNITUDE AND PREVALENCE OF BEHAVIORAL HEALTH IS DESCRIBED BELOW: - THE SCRIPPS 2016 CHNA CONTINUED TO IDENTIFY BEHAVIORAL HEALTH AS A PRIORITY HEALTH ISSUE AFFECTING MEMBERS OF THE COMMUNITIES SERVED BY SCRIPPS. - THE HASD&IC 2016 CHNA IDENTIFIED BEHAVIORAL HEALTH AS THE TOP PRIORITY HEALTH ISSUE FOR COMMUNITY MEMBERS IN SAN DIEGO COUNTY. - IN THE HASD&IC 2016 CHNA MENTAL HEALTH ISSUES AND ALCOHOL/DRUG ABUSE ISSUES WERE CONSISTENTLY SELECTED BY THE HIGHEST NUMBER OF HHSA SURVEY PARTICIPANTS IN ALL REGIONS AS HEALTH PROBLEMS THAT HAVE THE GREATEST IMPACT ON OVERALL COMMUNITY HEALTH. IN ADDITION, AGING CONCERNS INCLUDING ALZHEIMERS DISEASE WAS CITED AMONG THE TOP FIVE MOST IMPORTANT HEALTH NEEDS IN ALL REGIONS IN SAN DIEGO COUNTY EXCEPT THE CENTRAL REGION. THE FOLLOWING CATEGORIES WERE FOUND TO BE IMPORTANT HEALTH NEEDS WITH BEHAVIORAL HEALTH IN SAN DIEGO COUNTY: - ALZHEIMERS DISEASE (SENIORS) - ANXIETY (ALL AGE GROUPS) - DRUG AND ALCOHOL ISSUES (TEENS AND ADULTS) - MOOD DISORDERS (ALL AGE GROUPS) - FEEDBACK FROM THE BEHAVIORAL HEALTH DISCUSSIONS IN THE 2016 CHNA FOUND THAT HIGH RATES OF PSYCHOTIC DISCHARGES IN AGES 25 TO 44 WERE LIKELY LINKED TO UNDERLYING SUBSTANCE ABUSE PROBLEMS. ALTHOUGH PARTICIPANTS AGREED WITH THE FINDINGS, IT WAS FOUND THAT HOSPITAL CODING MAY POTENTIALLY UNDERREPRESENT THE PREVALENCE OF UNDERLYING ISSUES AND MISS CERTAIN CONDITIONS. MOST NOTABLY MISSING FROM OSHPD DATA WAS DEVELOPMENTAL DISORDERS. THE GROUPS ALSO POINTED OUT THE IMPORTANCE OF EMERGING DATA TRENDS. IN RECENT YEARS, DISCUSSION PARTICIPANTS CITED A SIGNIFICANT INCREASE IN DRUG-RELATED DISCHARGES, PARTICULARLY METHAMPHETAMINE (~OVER 100%). - AN ANALYSIS OF 2016 MORTALITY DATA FOR SAN DIEGO COUNTY REVEALED ALZHEIMERS DISEASE AND SUICIDE AS THE THIRD AND NINTH LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY, RESPECTIVELY. - AMONG ADULTS: 14.6% OF MEDICARE BENEFICIARIES SUFFER FROM DEPRESSION, 10.3% HAVE SERIOUSLY CONSIDERED SUICIDE AND 12.4% PER 100,000 COMMIT SUICIDE EACH YEAR. - IN 2016, 5,692 INDIVIDUALS WERE DISCHARGED FROM THE EMERGENCY DEPARTMENT (ED) FOR SELF-INFLICTED INJURY IN SAN DIEGO COUNTY, AN AGE-ADJUSTED RATE OF 173.20 PER 100,000 POPULATION. THIS INCLUDED 191 INDIVIDUALS AGES 65 AND OLDER, AN AGE-ADJUSTED RATE OF 44.37 PER 100,000 POPULATION. OF THESE SENIORS, 90 WERE HOSPITALIZED (20.91 PER 100,000 POPULATION). DURING THE SAME YEAR, THE AGE-ADJUSTED DEATH RATE DUE TO SUICIDE IN SAN DIEGO COUNTY WAS 11.89 DEATHS PER 100,000 POPULATION, OR 406 DEATHS. THE RATE FOR SENIORS WAS MUCH GREATER AT 18.35 DEATHS PER 100,000 POPULATION. BOTH RATES ARE HIGHER THAN THE HP2020 TARGET OF NO MORE THAN 10.2 DEATHS PER 100,000 POPULATION. - ACCORDING TO 2017 DATA FROM THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD), ANXIETY DISORDERS WERE THE TOP PRIMARY DIAGNOSIS FOR BEHAVIORAL HEALTH-RELATED ED DISCHARGES AMONG THOSE AGES FIVE TO 44 AND AGES 65 AND OLDER. FOR THOSE AGES 45 TO 64, THE TOP ED DISCHARGE FOR BEHAVIORAL HEALTH WAS ALCOHOL-RELATED DISORDERS, FOLLOWED BY ANXIETY AND MOOD DISORDERS. - ACCORDING TO 2017 CHIS DATA, 11.8 PERCENT OF ADULTS IN SDC HAVE EVER SERIOUSLY THOUGHT ABOUT COMMITTING SUICIDE, A 40.5 PERCENT INCREASE SINCE 2013 (8.4 PERCENT). - IN 2016, THERE WERE 1,080 HOSPITALIZATIONS DUE TO OVERDOSE/POISONING IN SDC. THE AGE-ADJUSTED RATE OF HOSPITALIZATIONS DUE TO OVERDOSE/POISONING WAS 31.2 PER 100,000 POPULATION. - IN 2016, THE AGE-ADJUSTED RATE OF OVERDOSE/POISONING-RELATED ED DISCHARGES IN SDC WAS 162.3 PER 100,000 POPULATION. AGE-ADJUSTED RATES FOR OVERDOSE/POISONING-RELATED ED DISCHARGES WERE HIGHER AMONG MALES, BLACKS AND INDIVIDUALS AGES 15 TO 24 YEARS IN COMPARISON AMONG GROUPS. - IN 2014-2015, 12.3 PERCENT OF CALIFORNIA ADOLESCENTS AGES 12 TO 17 EXPERIENCED A MAJOR DEPRESSIVE EPISODE (MDE). THIS RATE HAS INCREASED 3.1 PERCENT SINCE 2011-2012 (SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA), BEHAVIORAL HEALTH BAROMETER CALIFORNIA VOLUME 4, 2017). - FROM 2011 TO 2015, LESS THAN A THIRD OF CALIFORNIA ADOLESCENTS AGES 12 TO 17 WHO EXPERIENCED AN MDE IN THE PAST YEAR RECEIVED TREATMENT (SAMHSA, BEHAVIORAL HEALTH BAROMETER CALIFORNIA VOLUME 4, 2017). - APPROXIMATELY 10.2 MILLION U.S. ADULTS HAVE CO-OCCURRING MENTAL HEALTH AND ADDICTION DISORDERS (NAMI, 2016). SUICIDE AND SUICIDE ATTEMPTS SUICIDE IS A MAJOR COMPLICATION OF DEPRESSION AND A LEADING CAUSE OF NON-NATURAL DEATH FOR ALL AGES IN SAN DIEGO COUNTY, SECOND ONLY TO MOTOR VEHICLE ACCIDENTS. COMPARED TO 2016, THE COUNTYS SUICIDE RATE IN 2017 INCREASED 5% FROM 13.1 TO 13.8 PER 100,000 POPULATION. THIS INCREASE FOLLOWS A 5% DECREASE IN REGIONAL SUICIDE RATES FROM 2013-TO 2016. IN CONTRAST, THE RATE OF REGIONAL EMERGENCY DEPARTMENT DISCHARGES DUE TO NON-FATAL SELF-HARM DECREASED 5% BETWEEN 2015 AND 2016 (MOST RECENT DATA AVAILABLE). IN ADDITION, SIGNIFICANT GAINS IN HELP-SEEKING ARE EVIDENT. CRISIS CALLS TO THE LOCAL ACCESS & CRISIS HOTLINE IN 2017 INCREASED 22% TO AN UNPRECEDENTED 31.4% OF ALL CALL VOLUME. FOR MORE INFORMATION ON THE STATUS OF SUICIDE AND SUICIDE PREVENTION IN SAN DIEGO COUNTY: 2018 REPORT CARD. http://www.sdchip.org/initiatives/suicide-prevention-council/reports-resou rces/. IN 2010, THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY (HHSA) LAUNCHED A SUICIDE PREVENTION PLANNING PROCESS, WHICH WAS FORMED BY THE NATIONAL STRATEGY FOR SUICIDE PREVENTION AND THE CALIFORNIA STRATEGIC PLAN ON SUICIDE PREVENTION. SCRIPPS IS A MEMBER OF THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP), WHICH COLLABORATES WITH THE COUNTY ON THIS INITIATIVE. THE BEHAVIORAL HEALTH PROGRAM AT SCRIPPS MERCY ALSO SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. SCRIPPS HEALTH BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. THE BEHAVIORAL HEALTH INPATIENT PROGRAM AT SCRIPPS MERCY HOSPITAL HELPS PATIENTS AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. CHALLENGES - LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. - IN FISCAL YEAR 2018, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM EXPERIENCED A $4.7 MILLION LOSS IN TOTAL OPERATIONS, HOWEVER 3.3 MILLION OF THIS IS CAPTURED IN MEDI-CAL/CMS AND CHARITY CARE - IN 2018, 2.0 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE INTENSIVE BEHAVIORAL HEALTH OUTPATIENT PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO AND EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE POPULATION SERVED. SCRIPPS MERCY AND FAMILY HEALTH CENTERS BEHAVIORAL HEALTH PARTNERSHIP SCRIPPS MERCY HAS ESTABLISHED AN INITIATIVE WITH FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) TO CREATE A MORE ROBUST BEHAVIORAL HEALTH CARE SYSTEM FOR MEDI-CAL PATIENTS THAT RECEIVE CARE AT SMH. THE GOAL IS TO STRENGTHEN THE CONTINUUM OF INTEGRATED PRIMARY AND MENTAL HEALTH SERVICES FOR PATIENTS DISCHARGED FROM VARIOUS HOSPITAL SETTINGS (MEDICAL AND BEHAVIORAL HEALTH INPATIENT AND EMERGENCY CARE) THROUGH A VARIETY OF TIMELY PATIENT ENGAGEMENT STRATEGIES INCLUDING THE EXPANSION OF COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES ADJACENT TO THE HOSPITAL. THE ULTIMATE GOAL IS TO INVOLVE PATIENTS IN APPROPRIATE OUTPATIENT CARE BEFORE THEIR BEHAVIORAL HEALTH ISSUES BECOME ACUTE SO THEY DO NOT RETURN TO THE EMERGENCY DEPARTMENT.
FORM 990, PART III, LINE 4A (CONTINUED)	MENTAL HEALTH OUTREACH SERVICES, A-VISIONS VOCATIONAL TRAINING PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, IN PARTNERSHIP WITH THE SAN DIEGO CHAPTER OF MENTAL HEALTH OF AMERICA ESTABLISHED THE A-VISIONS VOCATIONAL TRAINING PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS) TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS AND OFFER VOLUNTEER AND EMPLOYMENT OPPORTUNITIES TO PERSONS WITH MENTAL ILLNESS. THIS SUPPORTIVE EMPLOYMENT PROGRAM PROVIDES VOCATIONAL TRAINING FOR PEOPLE RECEIVING MENTAL HEALTH TREATMENT, POTENTIALLY LEADING TO GREATER INDEPENDENCE. THIS YEAR, BEHAVIORAL HEALTH SERVICES CONTINUED PARTICIPATING IN THE A-VISIONS PROGRAM. SINCE ITS INCEPTION, 577 CLIENTS HAVE BEEN ENROLLED AND 96 HAVE BEEN SCRIPPS VOLUNTEERS AND 52 HAVE BEEN EMPLOYED AT SCRIPPS HEALTH. CURRENTLY, THERE ARE A TOTAL OF 20 EMPLOYEES AND FOUR VOLUNTEERS PARTICIPATING IN THIS SUPPORTIVE EMPLOYMENT PROGRAM. A-VISIONS PARTICIPANTS HAVE BEEN EMPLOYED ON A CASUAL/PER DIEM BASIS BY SCRIPPS ENVIRONMENTAL SERVICES, FOOD SERVICES AND CLERICAL SUPPORT FOR HEALTH AND INFORMATION SERVICES, EMERGENCY SERVICES, NURSING RESEARCH, HUMAN RESOURCES, ACCESS, BEHAVIORAL HEALTH, CREDENTIALING, LABOR AND DELIVERY, LABORATORY, MEDICAL STAFFING, PERFORMANCE IMPROVEMENT, SPIRITUAL CARE AND PALLIATIVE CARE SERVICES. PAID A-VISIONS CANDIDATES TYPICALLY LIMIT THEIR WORK TO EIGHT HOURS PER WEEK, WHICH ALLOWS THEM TO MAINTAIN ELIGIBILITY FOR THE DISABILITY BENEFITS, MEDICATIONS AND ONGOING BEHAVIORAL HEALTHCARE THAT SUPPORTS THEIR WORK. INCREASING AWARENESS OF MENTAL HEALTH ISSUES IN FISCAL YEAR 2018, SCRIPPS BEHAVIORAL HEALTH SERVICES IMPROVED AWARENESS OF MENTAL HEALTH ISSUES BY PROVIDING INFORMATION AND SUPPORTIVE SERVICES FOR MORE THAN 900 PEOPLE AT COMMUNITY EVENTS. COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND SUICIDE PREVENTION COUNCIL THE SAN DIEGO COUNTY SUICIDE PREVENTION COUNCIL (SPC) IS A COLLABORATIVE COMMUNITY-WIDE EFFORT FOCUSED ON REALIZING A VISION OF ZERO SUICIDES IN SAN DIEGO COUNTY. ITS GOAL IS TO PREVENT SUICIDE AND ITS DEVASTATING CONSEQUENCES IN SAN DIEGO COUNTY. SINCE 2010, WITH SUPPORT FROM THE COUNTY OF SAN DIEGO BEHAVIORAL HEALTH SERVICES, CHIP PROVIDES DIRECT OVERSIGHT AND GUIDANCE TOWARD THE IMPLEMENTATION OF THE SUICIDE PREVENTION ACTION PLAN. THE CORE STRATEGIES OF THE SPC ARE: -ENHANCING COLLABORATIONS TO PROMOTE A SUICIDE-FREE COMMUNITY - CONDUCTING NEEDS ASSESSMENTS TO IDENTIFY GAPS IN SUICIDE PREVENTION SERVICES AND SUPPORTS - DISSEMINATING VITAL INFORMATION ON THE SIGNS OF SUICIDE AND EFFECTIVE HELP-SEEKING -PROVIDING RESOURCES TO THOSE AFFECTED BY SUICIDE AND SUICIDAL BEHAVIOR - ADVANCING POLICIES AND PRACTICES THAT CONTRIBUTE TO THE PREVENTION OF SUICIDE PSYCHIATRIC LIAISON TEAM (PLT) THE PSYCHIATRIC LIAISON TEAM IS A MOBILE PSYCHIATRIC ASSESSMENT TEAM. CLINICIANS PROVIDE MENTAL HEALTH EVALUATION AND TRIAGE SERVICES TO ACCURATELY ASSESS PATIENTS AND PROVIDE THEM WITH BEST AND SAFEST COMMUNITY RESOURCES TO PROMOTE ONGOING CARE. THE TEAM AIMS TO HELP PEOPLE ADHERE TO TREATMENT PLANS, REDUCE HOSPITAL READMISSION RATES, RELIEVE SYMPTOMS AND ULTIMATELY ENSURE THE LONG-TERM STABILIZATION OF THE PATIENT'S MENTAL HEALTH. SCRIPPS WILL CONTINUE TO PROVIDE A DEDICATED PSYCHIATRIC LIAISON TEAM AT ALL SCRIPPS HOSPITALS EMERGENCY DEPARTMENTS AND URGENT CARE SETTINGS (RANCHO BERNARDO AND TORREY PINES). MI PUENTE/MY BRIDGE-SCRIPPS MERCY HOSPITAL CHULA VISTA SCRIPPS WHITTIER DIABETES INSTITUTE ALSO RECEIVED A $2.4 MILLION STUDY GRANT FROM THE NIH'S NATIONAL INSTITUTE OF NURSING RESEARCH IN 2015 TO EVALUATE MI PUENTE, A PROGRAM AT SCRIPPS MERCY CHULA VISTA HOSPITAL THAT USES A "NURSE + VOLUNTEER" TEAM APPROACH TO HELP HOSPITALIZED HISPANIC PATIENTS WITH MULTIPLE CHRONIC DISEASES REDUCE THEIR HOSPITALIZATIONS AND IMPROVE THEIR DAY-TO-DAY HEALTH AND QUALITY OF LIFE. INDIVIDUALS OF LOW SOCIOECONOMIC (SES) AND ETHNIC MINORITY STATUS, INCLUDING HISPANICS, THE LARGEST U.S. ETHNIC MINORITY GROUP ARE DISPROPORTIONATELY BURDENED BY CHRONIC CARDIOVASCULAR AND METABOLIC CONDITIONS ("CARDIOMETABOLIC" E.G. OBESITY, DIABETES, HYPERTENSION, HEART DISEASE). HIGH LEVELS OF UNMET BEHAVIORAL HEALTH IN THIS POPULATION CONTRIBUTE TO STRIKING DISPARITIES IN DISEASE PREVALENCE AND OUTCOMES. A BEHAVIORAL HEALTH NURSE PROVIDES IN-HOSPITAL COACHING TO PATIENTS, WHO ARE THEN FOLLOWED AFTER DISCHARGE BY A VOLUNTEER COMMUNITY PEER MENTOR TO ASSIST THEM IN OVERCOMING BARRIERS THAT MAY INTERFERE WITH ACHIEVING AND MAINTAINING GOOD HEALTH. MI PUENTE AIMS TO IMPROVE CONTINUITY OF CARE AND ADDRESS THE (PHYSICAL AND BEHAVIORAL) HEALTH NEEDS OF THE AT-RISK HISPANIC POPULATION. THIS PROGRAM HOLDS PROMISE FOR IMPACTFUL EXPANSION TO OTHER CONDITIONS AND UNDERSERVED POPULATIONS. BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES MANY PEOPLE FIND THAT THE DAY-TO-DAY TASKS ASSOCIATED WITH HAVING DIABETES TESTING ONES BLOOD SUGAR, PLANNING MEALS, GETTING ENOUGH PHYSICAL ACTIVITY AND REMEMBERING TO TAKE MEDICATIONS CAN BE STRESSFUL. A COMMON CONDITION KNOWN AS "DIABETES DISTRESS" CAN BE THE RESULT OF FEELING LIKE IT'S ALL TOO MUCH. SCRIPPS DIABETES CARE AND PREVENTION HAS A DIABETES BEHAVIORAL SPECIALIST ON STAFF TO HELP PEOPLE MANAGE THEIR DIABETES WITHOUT BEING OVERWHELMED OR UNDULY DISTRESSED. THE BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES IS AN INTEGRATED, INTERDISCIPLINARY APPROACH TO MANAGING THE EMOTIONAL AND BEHAVIORAL NEEDS OF INDIVIDUALS WITH TYPE 1 AND TYPE 2 DIABETES. THE COLLOCATION OF MEDICAL AND BEHAVIORAL HEALTH SERVICES IN THE SAME FACILITY ALLOW FOR CONVENIENT, WARM HAND-OFF FROM PHYSICIAN TO BEHAVIORAL HEALTH SPECIALIST. IT ALSO AFFORDS OPPORTUNITIES FOR PHYSICIANS, DIABETES EDUCATORS AND OTHERS TO RECEIVE CONSULTATION ON BEHAVIORAL HEALTH CONCERNS, AND IN TURN, MORE COMPREHENSIVELY ADDRESS THE MULTI-FACETED NEEDS OF THEIR PATIENTS WITH DIABETES. GUIDING VETERANS TO MENTAL HEALTH SERVICES SAN DIEGO IS HOME TO MORE THAN 250,000 VETERANS. A SUBSTANTIAL NUMBER OF OUR SERVICE MEMBERS HAVE SUFFERED OR ARE STRUGGLING WITH POST-TRAUMATIC STRESS DISORDER (PTSD), DEPRESSION, ANXIETY AND OTHER PSYCHOLOGICAL CONDITIONS RELATED TO MILITARY SERVICE AND REPEATED DEPLOYMENTS. PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS, SCRIPPS IS ACTIVELY WORKING TO ASSIST THESE VETERANS THROUGH INFORMATIONAL SESSIONS DESIGNED TO IMPROVE KNOWLEDGE OF VETERANS MENTAL HEALTH ISSUES AND ACCESS TO COMMUNITY-BASED SERVICES. SCRIPPS IS WORKING WITH SAN DIEGO STATE UNIVERSITY TO IMPLEMENT A VETERANS MENTAL HEALTH COURSE IN THE SOCIAL WORK DEPARTMENT. MENTAL HEALTH SUPPORT SERVICES AT LOCAL SCHOOL-BASED CLINICS SCRIPPS FAMILY MEDICINE RESIDENCY AND SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER HAVE PARTNERED TO OFFER CLINICAL TRAINING OPPORTUNITIES FOR MASTER SOCIAL WORK STUDENTS IN TRAINING FROM SAN DIEGO STATE UNIVERSITY AT SOUTHWEST AND PALOMAR HIGH SCHOOLS. THESE STUDENTS WORK WITH LOCAL PROVIDERS THAT ADDRESS THE MENTAL HEALTH NEEDS OF VULNERABLE ADOLESCENTS. A VARIETY OF MENTAL HEALTH ISSUES ARE PRESENT FOR LOCAL HIGH SCHOOL STUDENTS. MANY OF THESE ISSUES INCLUDE DEPRESSION, ANXIETY AND SUICIDE RELATED CONCERNS. THE PROGRAM WORKS TO IMPROVE OVERALL MENTAL HEALTH CARE FOR LOCAL STUDENTS THROUGH A SCHOOL-BASED CLINIC. APPROXIMATELY 240 HOURS WERE SPENT IN THE SCHOOL-BASED CLINICS OFFERING SERVICES FOR ADOLESCENTS TO AN AVERAGE OF 12 STUDENTS PER WEEK. WIDOWED SUPPORT GROUP THIS SUPPORT GROUP OFFERS BEREAVEMENT/MENTAL HEALTH SUPPORT AND GUIDANCE TO FAMILIES WHO HAVE LOST A LOVED ONE. THE GROUP FACILITATES DISCUSSION AND GUEST LECTURES ABOUT TOPICS RELATED TO THE LOSS OF LOVED ONES. THERE ARE APPROXIMATELY 6-10 PARTICIPANTS MONTHLY THAT ATTEND AND MANY HAVE BEEN A PART OF THE GROUP FOR MORE THAN 15-20 YEARS. PATIENT COMMUNITY SERVICES PATIENTS ARE REFERRED FROM SCRIPPS MERCY HOSPITAL CHULA VISTA, FOR ASSISTANCE WITH A WIDE VARIETY OF BEHAVIORAL HEALTH NEEDS INCLUDING ADDICTION, LOSS, ANXIETY AND OTHER MENTAL HEALTH ISSUES. THE WELL-BEING CENTER OFFERS WEEKLY COUNSELING AND/OR REFER PATIENTS TO LOCAL MENTAL HEALTH COUNSELING SERVICES. ALCOHOLIC ANONYMOUS SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF ALCOHOLIC ANONYMOUS. A FELLOWSHIPS OF MEN AND WOMEN WHO SHARE THEIR EXPERIENCE, STRENGTH AND SUPPORT OF EACH OTHER. GRIEF RECOVERY AFTER A SUBSTANCE PASSING (GRASP) SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF GRASP. GRASP WAS FOUNDED TO HELP PROVIDE SOURCES OF HELP, COMPASSION AND MOST OF ALL, UNDERSTANDING, FOR FAMILIES OR INDIVIDUALS WHO HAVE HAD A LOVED ONE DIE AS A RESULT OF SUBSTANCE ABUSE OR ADDICTION. NATIONAL ALLIANCE OF MENTAL ILLNESS (NAMI) SIBLINGS SUPPORT SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF NAMI SIBLING SUPPORT. THIS IS A CONFIDENTIAL SUPPORT GROUP FOR SIBLINGS OF PERSON WITH MENTAL ILLNESS AND ADULT CHILDREN OF PARENTS WITH MENTAL ILLNESS.
FORM 990, PART III, LINE 4A (CONTINUED)	SURVIVORS OF SUICIDE LOSS SAN DIEGO CHAPTER SCRIPPS HEALTH PROVIDES MEETING SPACE FOR MEMBERS OF THE SURVIVORS OF SUICIDE LOSS SAN DIEGO CHAPTER. THE ORGANIZATION REACHES OUT TO AND SUPPORTS PEOPLE WHO HAVE LOST A LOVED ONE TO SUICIDE. THE GOAL IS TO GIVE SURVIVORS A PLACE WHERE THEY CAN BE COMFORTABLE EXPRESSING THEMSELVES, A PLACE TO FIND SUPPORT, COMFORT, RESOURCES AND HOPE IN A JUDGMENT-FREE ENVIRONMENT. SCRIPPS DRUG AND ALCOHOL RESOURCES THERE ARE IN EXCESS OF 25 MILLION ILLICIT DRUG USERS IN THE US. THERE ARE AN ESTIMATED 136.9 MILLION CURRENT DRINKERS OF ALCOHOLIC BEVERAGES AND OF THOSE, APPROXIMATELY 23 PERCENT BINGE DRANK IN THE LAST 30 DAYS AND 6.3 PERCENT ARE CONSIDERED HEAVY DRINKERS. IT IS ESTIMATED THERE ARE 8.7 MILLION UNDER-AGE DRINKERS. SUBSTANCE USE, PARTICULARLY OPIOID MISUSE, IS A HEALTH CRISIS THAT HAS REACHED EPIDEMIC PROPORTIONS BOTH NATIONALLY AND LOCALLY. IN SAN DIEGO, THE RATE OF DISCHARGE FROM EMERGENCY DEPARTMENTS FOR CHRONIC SUBSTANCE ABUSE INCREASED BY 559% FROM 2014-2016; RATES FOR THOSE 65 YEARS AND OLDER INCREASED THE MOST BY 714%. THE RATE OF DISCHARGE FOR OPIOID MISUSE FOR THIS AGE GROUP WAS EVEN MORE STARTLING IT ROSE BY 1.734% OVER THIS TWO YEAR PERIOD. RATES OF DISCHARGE FROM EMERGENCY DEPARTMENTS FOR ACUTE SUBSTANCE ABUSE ALSO ROSE. RATES INCREASED FOR PEOPLE OF ALL RACIAL AND ETHNIC BACKGROUNDS; HOWEVER, THE MOST SUBSTANTIAL INCREASES (177%) WAS FOR BLACKS. HEAVY ALCOHOL CONSUMPTION IS ALSO A PROBLEM IN SAN DIEGO. NEARLY 20% OF ALL ADULTS AGES 18 AND OLDER SELF-REPORT EXCESSIVE ALCOHOL USE. SCRIPPS SUBSTANCE USE DISORDER SERVICE (SUDS) NURSES AWARE OF THE IMPACT DRUGS AND ALCOHOL CAN HAVE ON OUR COMMUNITY, SCRIPPS HAS DEVELOPED INNOVATIVE WAYS TO TREATING THIS DESTRUCTIVE DISEASE. SCRIPPS HAS DEPLOYED SPECIALIZED NURSES CERTIFIED IN ADDICTION; THEY SEE PATIENTS AT THEIR BEDSIDE AND WORK CLOSELY WITH THE PATIENTS ENTIRE HEALTH CARE TEAM TO HELP FACILITATE A SAFE DETOX WHILE HOSPITALIZED. THE SUBSTANCE USE DISORDER SERVICE (SUDS) NURSES ACT IN A PROACTIVE AND REACTIVE ROLE IN ALL OF THE SCRIPPS HOSPITALS, HELPING TO IDENTIFY PATIENTS WHO ARE AT RISK, OR ARE CURRENTLY EXPERIENCING WITHDRAWAL FROM ADDICTIVE SUBSTANCES. THIS MOBILE GROUP OF SPECIALLY TRAINED DRUG AND ALCOHOL RESOURCE NURSES PROVIDE EDUCATION, INTERVENTIONS AND DISCHARGE PLACEMENT ASSISTANCE TO PATIENTS IN THE SCRIPPS HOSPITALS. THE RESOURCE NURSES WORK DIRECTLY WITH THE NURSING STAFF AT EACH OF THE HOSPITALS IN SEARCH OF PATIENTS WHO MAY BE AT RISK FOR ALCOHOL/DRUG WITHDRAWAL AND ASSIST WITH IMPLEMENTING A STANDARDIZED PROTOCOL WITHDRAWAL PROCESS. SCRIPPS HAS CHANGED THE WAY WE DELIVER DRUG AND ALCOHOL TREATMENT BY COLLABORATING WITH OTHERS TO DELIVER A CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. WHEN PATIENTS NEED ADDITIONAL CARE, SCRIPPS HAS LINKED ITSELF TO TWO SEPARATE TREATMENT PROGRAMS DESIGNED TO MEET THE COMMUNITY NEEDS. BETTY FORD CENTER IN 2016, SCRIPPS PARTNERED WITH THE BETTY FORD CENTER, WHICH EXPANDED ITS DRUG AND ALCOHOL TREATMENT PROGRAMMING INTO SAN DIEGO. THIS TREATMENT CENTER BRINGS WORLD-RENOWNED ALCOHOL AND DRUG REHAB TO MORE PEOPLE THROUGH WEEKDAY AND WEEKNIGHT OUTPATIENT SERVICES. FAMILY HEALTH CENTERS OF SAN DIEGO FAMILY HEALTH CENTERS OF SAN DIEGO PROVIDES AN ARRAY OF SERVICES, INCLUDING OUTPATIENT DRUG AND ALCOHOL TREATMENT ALONG WITH MEDICATION-ASSISTED TREATMENT AND HARM REDUCTION PROGRAMS. THEIR SERVICE ALSO INCLUDE INDIVIDUAL COUNSELING AND ONE-ON-ONE SUPPORT, EDUCATIONAL SESSIONS, HIV RESTING, HEPATITIS B& C TESTING AND TREATMENT. OPIOID STEWARDSHIP PROGRAM (OSP) THE OPIOID STEWARDSHIP PROGRAM HAS SPEARHEADED MULTIPLE PROJECTS AT SCRIPPS TO EDUCATE PATIENTS AND PROVIDERS ABOUT THE RISKS OF OPIOIDS AND THE BENEFITS OF ALTERNATIVE MULTI-MODAL PAIN MANAGEMENT OPTIONS TO REDUCE OPIOID USE. THE PROGRAM HAS ESTABLISHED PRESCRIBING STANDARDS FOR OPIOIDS, RESULTING IN A 25 PERCENT REDUCTION IN THE NUMBER OF OPIOID PILLS PER PRESCRIPTION AT SCRIPPS HOSPITALS AND OUTPATIENT CENTERS IN 2018. SCRIPPS ALSO HAS OPENED THREE DRUG TAKE-BACK KIOSKS AT ITS ON-SITE PHARMACIES, OFFERING PATIENTS YEAR-ROUND ACCESS TO DISPOSE OF UNUSED, UNNEEDED OR OUTDATED MEDICATIONS. SOCIAL DETERMINANTS OF HEALTH PER SECTION 2, COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED IN THE CHNA, SOCIAL DETERMINANTS OF HEALTH WERE A KEY THEME IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. ANALYSIS OF RESULTS FROM THE COMMUNITY PARTNER DISCUSSIONS AND KEY INFORMANT INTERVIEWS REVEALED THE MOST COMMONLY ASSOCIATED SOCIAL DETERMINANTS OF HEALTH FOR EACH OF THE TOP HEALTH NEEDS. THE TOP TEN SOCIAL DETERMINANTS WERE CONSISTENTLY REFERENCED ACROSS THE DIFFERENT COMMUNITY ENGAGEMENT ACTIVITIES, FOOD INSECURITY & ACCESS TO HEALTHY FOOD, ACCESS TO CARE OR SERVICES, HOMELESS/HOUSING ISSUES, PHYSICAL ACTIVITY, EDUCATION/KNOWLEDGE, CULTURAL COMPETENCY, TRANSPORTATION, INSURANCE ISSUES, STIGMA AND POVERTY. THE IMPORTANCE OF THESE SOCIAL DETERMINANTS WAS ALSO CONFIRMED BY QUANTITATIVE DATA. APPROXIMATELY 80 PERCENT OF MODIFIABLE RISKS FOR DISEASES ARE ATTRIBUTABLE TO NONMEDICAL (UPSTREAM) DETERMINANTS OF HEALTH, SUCH AS HEALTH BEHAVIORS, SOCIOECONOMIC STATUS, AND ENVIRONMENTAL CONDITIONS. TO PREVENT CHRONIC CONDITIONS AND PROMOTE HEALTH, GREATER EMPHASIS SHOULD BE PLACED ON POPULATION HEALTH, WHICH HAS BEEN DEFINED TO FOCUS ON OUTCOMES AS WELL AS ON THE BROADER FACTORS THAT INFLUENCE HEALTH AT A POPULATION LEVEL, INCLUDING MEDICAL CARE SYSTEMS, THE SOCIAL ENVIRONMENT, AND THE PHYSICAL ENVIRONMENT. FOOD INSECURITY FOOD INSECURITY IS THE INABILITY TO AFFORD ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. THE HASD&IC 2016 CHNA IDENTIFIED FOOD INSECURITY AND ACCESS TO HEALTHY FOOD AS THE TOP SOCIAL DETERMINANT IMPACTING SAN DIEGOS PRIORITY HEALTH NEEDS (DIABETES, OBESITY, CARDIOVASCULAR DISEASE AND BEHAVIORAL HEALTH). ACCORDING TO THE LATEST RESEARCH FROM THE SAN DIEGO HUNGER COALITION, ALMOST HALF A MILLION SAN DIEGANS, 1 IN 7 RESIDENTS, OR 15 PERCENT OF THE SAN DIEGO COUNTY POPULATION ARE CONSIDERED TO BE FOOD INSECURE, AN ECONOMIC AND SOCIAL CONDITION CHARACTERIZED BY LIMITED OR UNCERTAIN ACCESS TO ADEQUATE FOOD. TO PUT THE TOTAL NUMBER OF FOOD INSECURE SAN DIEGANS INTO PERSPECTIVE, IT IS ROUGHLY EQUIVALENT TO THE ENTIRE POPULATIONS OF CHULA VISTA, OCEANSIDE, IMPERIAL BEACH, CORONADO, AND SOLANA BEACH COMBINED. RATES IN IMPERIAL COUNTY ARE EVEN HIGHER, WITH 17% OF THE GENERAL POPULATION SUFFERING FOOD INSECURITY. EVEN MORE ALARMING IS THAT THE RATE OF FOOD INSECURITY AMONG CHILDREN IN IMPERIAL COUNTY IS THE HIGHEST IN CALIFORNIA AT OVER 33%. THE CALFRESH PROGRAM, FEDERALLY KNOWN AS THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), ISSUES MONTHLY ELECTRONIC BENEFITS THAT CAN BE USED TO BUY FOODS AT PARTICIPATING MARKETS AND STORES. MORE THAN 290,000 SAN DIEGANS RECEIVE CALFRESH. AN ADDITIONAL ONE IN FIVE SAN DIEGANS WERE FOOD SECURE BUT RELIED ON SUPPLEMENTAL NUTRITION ASSISTANCE TO SUPPORT THEIR FOOD BUDGET. IN 2016, 21 PERCENT OF HOUSEHOLDS IN SAN DIEGO COUNTY PARTICIPATED IN SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS, WHILE 23.3 PERCENT OF THOSE BELOW 138 PERCENT OF THE FPL WERE ELIGIBLE FOR SUCH BENEFITS. REFER TO TABLE 4 FOR SNAP PARTICIPATION AND ELIGIBILITY IN SAN DIEGO COUNTY. STUDIES DEMONSTRATE THAT HUNGER SIGNIFICANTLY IMPACTS HEALTH. LACK OF ACCESS TO HEALTHY FOOD, OFTEN DUE TO AVAILABILITY AND COST, ARE STRESSORS THAT CONTRIBUTE TO DIABETES, HEART DISEASE, OBESITY, AND OTHER BEHAVIORAL HEALTH ISSUES IN A MYRIAD OF WAYS: - FOOD INSECURE ADULTS WITH DIABETES HAVE HIGHER AVERAGE BLOOD SUGARS. - FOOD INSECURE ADULTS ARE MORE LIKELY TO BE OBESE. - FOOD INSECURITY IS SIGNIFICANTLY MORE PREVALENT IN ADULTS WITH MOOD DISORDERS. - FOOD INSECURITY IS ASSOCIATED WITH INCREASED RISK OF SUICIDAL THOUGHTS AND SUBSTANCE ABUSE IN ADOLESCENTS. - FOOD INSECURE SENIORS HAVE A SIGNIFICANTLY HIGHER LIKELIHOOD OF HEART DISEASE, DEPRESSION AND LIMITED ACTIVITIES OF DAILY LIVING. - FOOD INSECURE ADULTS DELAY BUYING FOOD IN ORDER TO PURCHASE MEDICATIONS. THE PROGRAMS HIGHLIGHTED BELOW ARE WAYS THAT SCRIPPS HEALTH IS ADDRESSING FOOD INSECURITY; SCREENINGS AND ELIGIBILITY BENEFITS. SCRIPPS HEALTH CALFRESH SCREENINGS AS HEALTH CARE DELIVERY SYSTEMS MOVES TOWARDS A POPULATION HEALTH PARADIGM THAT INCENTIVIZES KEEPING PATIENTS HEALTHY, HOSPITALS AND CLINICS ARE RECOGNIZING THE SIGNIFICANCE OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH, SUCH AS FOOD INSECURITY (FI). HOSPITALS HAVE BEEN MORE PROACTIVE IN INTERVENING AT SOME LEVEL OF CARE TO AID THE INDIVIDUALS SUFFERING FROM FI AND THEIR ABILITY TO GAIN CONTROL OVER THEIR HEALTH.
FORM 990, PART III, LINE 4A (CONTINUED)	ACCORDINGLY, FOOD ASSISTANCE PROVIDED BY THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) KNOWN AS CALFRESH IN CALIFORNIA, SIGNIFICANTLY REDUCES THE RATE AND SEVERITY OF POVERTY THROUGHOUT THE STATE (CALIFORNIA BUDGET & POLICY CENTER, 2018). WHILE SNAP AND WOMENS, INFANTS, CHILDREN (WIC) HAVE BEEN SUCCESSFUL IN ASSISTING LOW-INCOME CHILDREN AND THEIR FAMILIES WITH ADDITIONAL FUNDING FOR PURCHASING HEALTHY FOODS, THERE IS EVIDENCE THAT SUGGESTS SCREENING FOR FI IN HEALTHCARE SETTINGS IS THE BEST INDICATOR FOR PATIENTS TO ACCESS FOOD-RELATED ASSISTANCE. SCRIPPS HEALTH BEGAN SCREENING FOR CALFRESH IN JUNE 2017 THROUGH THE SUPPORT OF THE PUBLIC RESOURCE SPECIALIST (PRS) TEAM. THE PRS ARE EXPERIENCED STAFF WITH STRONG KNOWLEDGE OF THE COUNTY PROGRAMS. THEY SCREEN ALL UNINSURED PATIENTS WHO HAVE RECEIVED SERVICES AT ANY OF THE FIVE SCRIPPS HOSPITAL FACILITIES. THE IN-HOUSE APPLICATION PROCESS CAN TAKE UP TO 45 MINUTES AS THEY ARE SCREENING FOR MULTIPLE PROGRAMS CONCURRENTLY. ONCE AN APPLICATION HAS BEEN COMPLETED, THE PRS STAFF SUBMITS IT TO THE COUNTY VIA THE HOSPITAL OUTSTATION SERVICES (HOS) PROGRAM. ONCE SUBMITTED, A COUNTY HOS WORKER IS ASSIGNED AND THE PRS TEAM TRACKS THE APPLICATION, ADVOCATING FOR THE PATIENTS THROUGHOUT THE PROCESS THAT CAN TAKE UP TO 45 DAYS TO RECEIVE AN ELIGIBILITY RESPONSE. IN SOME INSTANCES HAVING TO GO THROUGH THE APPEAL PROCESS THAT MAY ADD AN ADDITIONAL 30 DAYS. IN DOING SO, THE PRS TEAM HELPS PATIENTS MANEUVER A COMPLEX APPLICATION PROCESS THAT OTHERWISE MAY DETER THEM FROM SEEKING MUCH NEEDED ACUTE AND PREVENTATIVE CARE. THE TEAM HAS BEEN SUCCESSFUL IN HAVING THE IMPORTANT CONVERSATION ABOUT FOOD INSECURITY WITH 36% OF THE PATIENTS THEY HAVE SCREENED IN THIS PAST FISCAL YEAR. THE CITY HEIGHTS WELLNESS CENTER (CHWC) SCRIPPS MERCY HOSPITAL HAS ESTABLISHED A PARTNERSHIP AT THE CITY HEIGHTS WELLNESS CENTER (CHWC) WITH LA MAESTRA FAMILY CLINIC AND RADY CHILDRENS HOSPITAL TO ADDRESS SOME OF THE ATTRIBUTING FACTORS TO POOR HEALTH STATUS FOR LOCAL RESIDENTS. WITH LA MAESTRA SERVING AS THE LEAD AGENCY, SCRIPPS MERCY AND RADY CHILDRENS ARE CONTRIBUTING RESOURCES TO SUPPORT OPERATIONAL COSTS OF THE CENTER IN ORDER TO PROVIDE CAPACITY FOR NEED COMMUNITY LINKAGES. ELIGIBILITY WORKERS FROM LA MAESTRA FAMILY CLINIC ARE AVAILABLE TO COUNSEL PEOPLE AND ASSIST FILLING OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THE ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. APPLICATIONS AND ASSISTANCE FOR CALFRESH TO SUPPLEMENT FOOD BUDGET AND ALLOW FAMILIES/INDIVIDUALS TO BUY NUTRITIOUS FOOD. SCRIPPS MERCY WIC PROGRAM THE CITY HEIGHTS WELLNESS CENTER IS HOME TO THE SCRIPPS MERCY HOSPITAL-WIC PROGRAM THAT PROVIDES NUTRITION EDUCATION AND COUNSELING, BREASTFEEDING EDUCATION AND SUPPORT AND FOOD VOUCHERS TO PREGNANT AND PARENTING WOMEN, AND CHILDREN 0-5 YEARS OF AGE. FOOD FINDERS RESCUING FOOD, REDUCING HUNGER SCRIPPS CORPORATE FOOD SERVICE PARTNERED WITH FOOD FINDERS, A MULTI-REGIONAL FOOD BANK AND FOOD RESCUE PROGRAM THAT CONNECTS BUSINESSES TO CHARITABLE INSTITUTIONS IN NEED OF DONATIONS. FOOD FINDERS CONNECTED SCRIPPS WITH INTERFAITH COMMUNITY SERVICES IN ESCONDIDO, WHICH DISTRIBUTES FOOD TO PEOPLE IN NEED. ALL LEFTOVER FOOD FROM SCRIPPS CORPORATE FACILITIES IS PACKAGED, PICKED UP EACH DAY AND TRANSFERRED TO THE SCRIPPS 4S RANCH FOOD AND NUTRITION SERVICES FREEZER FOR STORAGE. THE COST IS MINIMAL, AS SCRIPPS USES THE SAME AMOUNT OF LABOR TO PACKAGE THE FOOD AS IT WOULD TO DISPOSE OF IT, AND UNSOLD "GRAB AND GO" ITEMS ARE ALREADY PACKAGED. INTERFAITH COMMUNITY SERVICES PICKS UP THE FROZEN FOOD TWICE PER WEEK AND TRANSPORTS IT TO ONE OF THEIR FACILITIES TO HELP FEED THE COMMUNITY. BETWEEN FOOD DONATED BY SCRIPPS AND OTHERS, INTERFAITH DISTRIBUTES AN AVERAGE OF 126,000 HOT MEALS AND PACKED LUNCHES AND 23,000 EMERGENCY MEALS, FEEDING APPROXIMATELY 17,000 PEOPLE EVERY YEAR. FOSTERING VOLUNTEERISM SCRIPPS BELIEVES THAT HEALTH IMPROVEMENT BEGINS WHEN PEOPLE TAKE AN ACTIVE ROLE IN MAKING A POSITIVE IMPACT ON THEIR COMMUNITY. FOR THIS REASON, SCRIPPS SUPPORTS VOLUNTEER PROGRAMS FOR SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS WHO WANT TO MAKE AN EVEN LARGER IMPACT ON THEIR COMMUNITY. SCRIPPS MATCHES THE TALENTS AND INTERESTS OF EMPLOYEES AND PHYSICIANS WITH COMMUNITY NEEDS, SUCH AS MENTORING PARTNERSHIPS WITH LOCAL SCHOOLS AND PROVIDING FREE MEDICAL AND SURGICAL CARE FOR PATIENTS IN NEED. IN ADDITION TO THE FINANCIAL COMMUNITY BENEFIT CONTRIBUTIONS MADE DURING FY18, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS DONATED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS SPONSORED COMMUNITY BENEFIT PROGRAMS. WITH CLOSE TO 10,191 HOURS, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $507,887.44, WHICH IS NOT INCLUDED IN THE SCRIPPS FY18 COMMUNITY BENEFIT PROGRAMS AND SERVICES TOTALS. (CALCULATION BASED UPON AN AVERAGE HOURLY WAGE FOR THE SCRIPPS HEALTH SYSTEM PLUS BENEFITS.) UNCOMPENSATED HEALTH CARE SCRIPPS CONTRIBUTES SIGNIFICANT RESOURCES TO PROVIDE LOW AND NO-COST HEALTH CARE FOR OUR PATIENTS IN NEED. DURING FY18, SCRIPPS CONTRIBUTED $358,318,252 IN UNCOMPENSATED HEALTH CARE, INCLUDING $20,245,366 IN CHARITY CARE, $331,743,910 IN MEDI- CAL AND MEDICARE SHORTFALL, AND $6,328,976 IN BAD DEBT. SCRIPPS PROVIDES HOSPITAL SERVICES FOR ONE-QUARTER OF THE COUNTYS UNINSURED PATIENTS. SCRIPPS MERCY HOSPITAL, SAN DIEGO AND SCRIPPS MERCY HOSPITAL, CHULA VISTA PROVIDE 64 PERCENT OF SCRIPPS CHARITY CARE. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. SAN DIEGO IS THE SECOND MOST POPULOUS COUNTY IN CALIFORNIA AND FIFTH MOST POPULOUS IN THE UNITED STATES. SAN DIEGO HAS: - CLOSE TO 3.3 MILLION RESIDENTS - MAJORITY MINORITY POPULATION - BUSIEST LAND BORDER CROSSING IN THE WORLD 1 OF EVERY 13 PEOPLE WHO ENTER THE US COME THROUGH SAN YSIDRO - 70 MILES OF COASTLINE - 16 NAVAL AND MILITARY INSTALLATIONS - 18 FEDERALLY QUALIFIED RECOGNIZED INDIAN RESERVATIONS - A TOTAL OF 4,526 SQUARE MILES, LARGER THAN RHODE ISLAND AND DELAWARE COMBINED. POPULATION: OVER THREE MILLION PEOPLE (3,337,685) LIVE IN THE 4,526 SQUARE MILE AREA OF SAN DIEGO COUNTY (SDC) ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%.THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES. RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SAN DIEGOS UNINSURED THE LACK OF HEALTH INSURANCE IS A SIGNIFICANT BARRIER TO ACCESSING NEEDED HEALTH CARE AND TO MAINTAINING FINANCIAL SECURITY. BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY.
FORM 990, PART III, LINE 4A (CONTINUED)	IN THE PAST, GAPS IN THE PUBLIC INSURANCE SYSTEM AND LACK OF ACCESS TO AFFORDABLE PRIVATE COVERAGE LEFT MILLIONS WITHOUT HEALTH INSURANCE, AND THE NUMBER OF UNINSURED AMERICANS GREW OVER TIME, PARTICULARLY DURING ECONOMIC DOWNTURNS. BY 2013, THE YEAR BEFORE THE MAJOR COVERAGE PROVISIONS OF THE AFFORDABLE CARE ACT (ACA) WENT INTO EFFECT, MORE THAN 44 MILLION NONELDERLY INDIVIDUALS LACKED COVERAGE. UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA), MILLIONS OF CALIFORNIANS HAVE GAINED HEALTH COVERAGE. THESE GAINS HAVE COME EITHER THROUGH THE EXPANSION OF MEDICAID (CALLED MEDI-CAL IN CALIFORNIA) TO LOW INCOME ADULTS EARNING UP TO 138% OF THE FEDERAL POVERTY GUIDELINE (FPG), OR THROUGH COVERED CALIFORNIA, THE STATES ACA HEALTH INSURANCE MARKETPLACE, WHERE PEOPLE EARNING UP TO 400% FPG CAN PURCHASE SUBSIDIZED INSURANCE COVERAGE. THE MAJOR COVERAGE EXPANSIONS OF THE ACA WERE IMPLEMENTED STARTING IN 2014, AND BY 2016 THE UNINURED RATE AMONG NONELDERLY CALIFORNIANS HAD FALLEN FROM 15.5% TO A HISTORIC LOW OF 8.5%. (THIS PERCENTAGE INCLUDES CHILDREN). KEY FINDINGS SINCE 2010, GENERALLY ALL AGE GROUPS EXPERIENCED A DECLINE IN THE PERCENT UNINSURED FOR BOTH THE COUNTY AND STATE. THE 18-64 YEAR AGE GROUP EXPERIENCED THE GREATEST DECLINE IN NUMBER OF PEOPLE UNINSURED UNDER THE ACA. FINANCIAL ASSISTANCE ASSISTING LOW-INCOME, UNINSURED PATIENTS ASSISTING LOW-INCOME, UNINSURED PATIENTS THE SCRIPPS FINANCIAL ASSISTANCE POLICY IS CONSISTENT WITH THE LANGUAGE OF BOTH STATE (AB774) CALIFORNIA HOSPITAL FAIR PRICING POLICY LEGISLATION AND THE INTERNAL REVENUE CODE (IRC) 501(R) REGULATIONS. THESE PRACTICES REFLECT OUR COMMITMENT TO ASSISTING LOW-INCOME AND UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE AND FLEXIBLE BILLING AND DEBT COLLECTION PRACTICES. THESE PROGRAMS ARE AVAILABLE TO EVERYONE IN NEED, REGARDLESS OF THEIR RACE, ETHNICITY, GENDER, RELIGION OR NATIONAL ORIGIN. SCRIPPS MAKES EVERY EFFORT TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS FORGIVES THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, A PORTION OF THE BILL IS FORGIVEN. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT CHARGED MORE THAN SCRIPPS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. FOR 2019, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DEFINED A FAMILY OF FOUR AT 200 PERCENT FEDERAL POVERTY LEVEL AS $51,500. PROFESSIONAL EDUCATION & HEALTH RESEARCH QUALITY HEALTH CARE IS HIGHLY DEPENDENT UPON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS, OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WILL BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH BY DEVELOPING NEW AND INNOVATIVE TREATMENTS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH, MEDICAL EDUCATION AND HEALTH PROFESSIONAL EDUCATION. DURING FISCAL YEAR 2018 (OCTOBER 2017 TO SEPTEMBER 2018), SCRIPPS INVESTED $26,757,826 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES IN SAN DIEGO COUNTY. THIS SECTION HIGHLIGHTS SOME OF OUR PROFESSIONAL EDUCATION AND HEALTH RESEARCH ACTIVITIES. HEALTH PROFESSIONS TRAINING INTERNSHIPS SCRIPPS COMMITMENT TO ONGOING LEARNING AND HEALTH CARE EXCELLENCE EXTENDS BEYOND OUR ORGANIZATION. OUR STUDENT PROGRAMS HELP PROMOTE HEALTH CARE CAREERS TO A NEW GENERATION, SHAPE THE FUTURE WORKFORCE AND DEVELOP FUTURE LEADERS IN OUR COMMUNITY. INTERACTING WITH HEALTH CARE PROFESSIONALS IN THE FIELD EXPANDS EDUCATION OUTSIDE THE CLASSROOM. SCRIPPS EMPLOYEES PLAY AN IMPORTANT ROLE AS PRECEPTORS BY INVESTING THEIR TIME TO CREATE A VALUABLE EXPERIENCE FOR THE COMMUNITY. IN FY18, SCRIPPS HOSTED 1,927 STUDENTS WITHIN OUR SYSTEM AND PROVIDED 277,789 DEVELOPMENT HOURS SPANNING NURSING AND ALLIED HEALTH SETTINGS. COLLEGE AND UNIVERSITY AFFILIATIONS SCRIPPS COLLABORATES WITH LOCAL HIGH SCHOOLS, COLLEGES AND UNIVERSITIES TO HELP STUDENTS EXPLORE HEALTH CARE ROLES AND GAIN FIRSTHAND EXPERIENCE AS THEY WORK WITH SCRIPPS PROFESSIONALS. SCRIPPS IS AFFILIATED WITH MORE THAN 110 SCHOOLS AND PROGRAMS, INCLUDING CLINICAL AND NONCLINICAL PARTNERSHIPS. LOCAL SCHOOLS INCLUDE, BUT ARE NOT LIMITED TO, POINT LOMA NAZARENE UNIVERSITY (PLNU), UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD), CALIFORNIA STATE UNIVERSITY SAN MARCOS (CSUSM), SAN DIEGO STATE UNIVERSITY (SDSU), UNIVERSITY OF SAN DIEGO (USD), MESA COLLEGE, SAN DIEGO CITY COLLEGE, GROSSMONT COLLEGE, PALOMAR COLLEGE AND MIRA COSTA COLLEGE. SCRIPPS IS REGULARLY ACCEPTING NEW PARTNERSHIPS, BASED ON COMMUNITY AND WORKFORCE NEEDS, AND MAINTAINS AN AFFILIATION AGREEMENT COMMITTEE TO REVIEW ALL REQUESTS AND PROVIDE A SYSTEMWIDE APPROACH TO SECURING NEW STUDENTS PLACEMENTS. THIS INTERDISCIPLINARY COMMITTEE REPRESENTS EDUCATION AND DEPARTMENT LEADERSHIP ACROSS THE SCRIPPS SYSTEM ENSURING A PROACTIVE APPROACH TO BUILDING A CAREER PIPELINE FOR TOP TALENT. TO ENSURE STUDENTS FROM HEALTH CARE PROFESSIONS PROGRAMS HAVE ACCESS TO APPROPRIATE EDUCATIONAL EXPERIENCES AT SCRIPPS AND FOSTER A SMOOTH, EFFICIENT PROCESS FOR STUDENT PLACEMENT REQUESTS RECEIPT AND MANAGEMENT, SCRIPPS IS A MEMBER OF THE SAN DIEGO NURSING AND ALLIED HEALTH SERVICE EDUCATION CONSORTIUM AND AMERICAN DATABANKS COMPLIO ONLINE COMPLIANCE TRACKING SYSTEM. RESEARCH STUDENTS SCRIPPS SUPPORTS GRADUATE RESEARCH FOR MASTERS AND DOCTORAL STUDENT AT UNIVERSITIES WITH AFFILIATION AGREEMENTS. SCRIPPS TALENT DEVELOPMENT OVERSEES THE STUDENTS PLACEMENT PROCESS. NON-PHYSICIAN STUDENTS WHO CONDUCT RESEARCH AT SCRIPPS REPRESENT A VARIETY OF HEALTH CARE DISCIPLINES, INCLUDING PUBLIC HEALTH, PHYSICAL THERAPY, PHARMACY AND NURSING. IN FY18, SCRIPPS RESEARCH INCLUDED STUDENTS FROM USD, WESTERN GOVERNORS UNIVERSITY, SDSU, PLNU, LOMA LINDA UNIVERSITY AND POSTDOCTORAL PHARMACY RESIDENCY PROGRAMS, INCLUDING THE PGY1 PHARMACY RESIDENCY PROGRAM. HIGH SCHOOL PROGRAMS SCRIPPS IS DEDICATED TO PROMOTING HEALTH CARE AS A REWARDING CAREER, COLLABORATING WITH A NUMBER OF HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRSTHAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. BELOW IS A SUMMARY OF THE HIGH SCHOOL PROGRAMS SCRIPPS MADE AVAILABLE TO THE COMMUNITY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM HEALTH AND SCIENCE PIPELINE INITIATIVE (HASPI) THIS PROGRAM REACHES OUT TO SCAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING A CAREER IN HEALTH CARE. IN FISCAL YEAR 2018, 25 STUDENTS PARTICIPATED IN THE PROGRAM. DURING THEIR FIVE-WEEK ROTATION, THE STUDENTS WERE EXPOSED TO DIFFERENT DEPARTMENTS, EXPLORING CAREER OPTIONS AND LEARNING VALUABLE LIFE LESSON ABOUT HEALTH AND HEALING. UNIVERSITY CITY HIGH SCHOOL COLLABORATION UC HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOLS HEALTH CARE ESSENTIALS COURSE. FOR FY18, 14 STUDENTS WERE SELECTED TO ROTATE THROUGH FIVE DIFFERENT SCRIPPS LOCATIONS, DURING THE SPRING SEMESTER, TO INCREASE THEIR AWARENESS OF HEALTH CARE CAREERS. UC HIGH STUDENTS VISITED SCRIPPS CLINIC CARMEL VALLEY, RANCHO BERNARDO, MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITAL LA JOLLA, ENCINITAS AND GREEN HOSPITAL. THE STUDENTS WERE ABLE TO VIEW SURGERIES AND SHADOWING HEALTHCARE PROFESSIONALS IN THE EMERGENCY DEPARTMENT, ICU, PHARMACY, URGENT CARE, INTERNAL MEDICINE, PHARMACY, CARDIAC CATHETER LAB, DEFINITIVE OBSERVATION UNIT, AMBULATORY SERVICES, REHAB THERAPY, PATIENT LOGISTICS, LAB AND TRAUMA. YOUNG LEADER IN HEALTH CARE AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOLS STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENTS GRADES 9-12 PARTICIPATE IN THE PROGRAM, WHICH PROVIDES A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS CAREER OPPORTUNITIES. THE MISSION OF THE YOUNG LEADERS IN HEALTH CARE IS: - TO PROVIDE A FORUM FOR HIGH SCHOOLS STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS BREADTH OF CAREER OPPORTUNITIES. - MENTOR STUDENTS IN THE ACT OF LEADERSHIP GIVING THEM TOOLS TO USE IN THEIR DAILY LIFE CHALLENGES. - PROVIDE A SERVICE PROJECT TO SATISFY HIGH SCHOOL REQUIREMENTS AND MAKE A POSITIVE IMPACT ON THE COMMUNITY. - PROVIDE A VENUE FOR A STUDENT-RUN COMPETITION WHERE EACH SCHOOL PRESENTS A TOPIC IN LINE WITH THE YEARS GOAL.
FORM 990, PART III, LINE 4A (CONTINUED)	THIS COMBINED EXPERIENCE INCLUDES WEEKLY MEETINGS AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE PROGRAM MENTORS STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY CHALLENGES. EACH YEAR THE STUDENTS WORK TOWARD A FINAL PRESENTATION BASED ON THEIR COMMUNITY SERVICE PROJECTS RELATED TO HEALTH CARE AND WELLNESS. THE 2018 CLASS TOUCHED A VARIETY OF TOPICS FROM MENTAL ILLNESS TO INFLUENZA. MORE THAN 100 STUDENTS, COMMUNITY MEMBERS AND HEALTH CARE SPECIALISTS ATTENDED THE YOUNG LEADER IN HEALTH CARE FINAL MEETING, CULMINATING WITH STUDENT PRESENTATIONS ON TYPES OF CANCER AND TREATMENTS. STUDENTS THAT PARTICIPATE IN THE PROGRAM ARE ELIGIBLE TO APPLY TO THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM. THIS YEARS 2018 YLHC SERVICE PROJECT PRESENTATION AWARDS WERE GIVEN TO: - 1ST PLACE: MISSION VISTA HIGH SCHOOL FOR THEIR PRESENTATION ON MENTAL HEALTH - 2ND PLACE: WESTVIEW HIGH SCHOOL FOR THEIR PRESENTATION ON ALZHEIMERS - 3RD PLACE: FRANCIS PARKER HIGH SCHOOL FOR THEIR PRESENTATION ON INFLUENZA - 4TH PLACE: SAN DIEGUITO HIGH SCHOOL FOR THEIR PRESENTATION ON EPIDEMIOLOGY - 5TH PLACE: CANYON CREST ACADEMY FOR THEIR PRESENTATION ON STEM CELLS SCRIPPS HEALTH GRADUATE MEDICAL EDUCATION FOR MORE THAN 70 YEARS PHYSICIANS IN SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS HAVE HELPED CARE FOR UNDERSERVED POPULATIONS THROUGHOUT THE REGION. SCRIPPS HAS A COMPREHENSIVE RANGE OF GRADUATE MEDICAL EDUCATION PROGRAMS AT SCRIPPS MERCY HOSPITAL, SCRIPPS FAMILY PRACTICE RESIDENCY PROGRAM AND SCRIPPS GREEN HOSPITAL. SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS ARE WELL-KNOWN FOR EXCELLENCE, PROVIDE A HANDS-ON CURRICULUM THAT FOCUSES ON PATIENT-CENTERED CARE AND OFFER RESIDENCIES IN A VARIETY OF PRACTICES, INCLUDING INTERNAL MEDICINE, FAMILY MEDICINE, PODIATRY, PHARMACY AND PALLIATIVE CARE. SCRIPPS HAS A PHARMACY RESIDENCY PROGRAM WHICH TRAIN RESIDENTS WITH DOCTOR OF PHARMACY DEGREES. IN FY18, SCRIPPS HAD A TOTAL OF 149 RESIDENTS AND 38 FELLOWS ENROLLED THROUGHOUT THE SCRIPPS HEALTH SYSTEM. MORE DETAILS ON THESE PROGRAMS ARE INCLUDED IN THE COMMUNITY BENEFIT REPORT. UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP PROGRAM THE UCSD/SCRIPPS HEALTH HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP PROGRAM IS A ONE-YEAR PROGRAM DESIGNED FOR PHYSICIANS WHO WISH TO BECOME SUB-SPECIALISTS AND HAVE A LONG-TERM CAREER IN HOSPICE AND PALLIATIVE MEDICINE. IN 2017, THE HOSPICE PROGRAM TRANSITIONED TO THE ELIZABETH HOSPICE AND IT BECAME THE HOSPICE ROTATION SITE FOR THE FELLOWSHIP. THIS IS A UNIQUE PARTNERSHIP IN WHICH UCSD AND SCRIPPS HEALTH SHARE RESPONSIBILITY FOR THE FELLOWS, WITH TRAINEES SPENDING EQUAL TIME IN BOTH INSTITUTIONS WITH ALL THE BENEFITS OF BOTH INSTITUTIONS. THE PROGRAM PREPARES TRAINEES TO WORK IN A VARIETY OF ROLES, INCLUDING LEADERSHIP POSITIONS IN THE FIELD. GRADUATES HAVE SUCCESSFULLY BECOME HOSPICE MEDICAL DIRECTORS AND PALLIATIVE MEDICINE CONSULTANTS IN OUTPATIENT AND INPATIENT SETTINGS ACROSS THE UNITED STATES. FELLOWS WHO COMPLETE THE UCSD/SCRIPPS HEALTH PROGRAM ARE WELL EQUIPPED TO PRACTICE IN DIVERSE SETTINGS, INCLUDING: ACUTE PALLIATIVE CARE UNITS, INPATIENT CONSULTATION, OUTPATIENT CONSULTATION, PATIENTS' HOMES, AND LONG-TERM CARE FACILITIES. FORM 990, PART VI, LINE 11 990 REVIEW PROCESS WITH THE GOVERNING BODY THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS. FORM 990, PART VI, LINE 12C COMPLIANCE POLICY MONITORING WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT IS REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING.
FORM 990, PART VI, LINE 15A & 15B	OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN SAN DIEGO, CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: - FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. - SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. - TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. - THE BOARD SELECTS THE 65TH PERCENTILE FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E., THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). - ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON JANUARY 24, 2018 AND MARCH 28, 2018. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES. FORM 990, PART VI, LINE 16 JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS.
FORM 990, PART VI, LINE 19	AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS JOINT VENTURES DISTRIBUTION 1,931,964 TRANSFER FROM GLUCK FOR THE GLUCK LLC MERGER 1,707,949 TRANSFER OF ENDOWMENT FUNDS (7,329,791) OTHER CHANGES IN NET ASSETS 551,964 CHANGE IN VALUE IN DEFERRED GIFTS (485,937) ROUNDING (19,007) ------------ TOTAL (3,642,858)
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYS FEES-PROVIDER SVS AGRMENT TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SVS - NON MED TOTAL FEES:83028528
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:59072263
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:27317652
FORM 990 PART IX LINE 11G	DESCRIPTION:ALL OTHER FEES FOR SERVICES TOTAL FEES:22552736

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SCRIPPS HEALTH

Employer identification number

95-1684089

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) Scripps Mercy Billing LLC 10140 Campus Point Drive San Diego,CA92121 87-0737748	HLTHCR ADMIN	CA	50,332,512	0	SCRIPPS HLTH
(2) IHS Holding Company LLC 10140 Campus Point Drive San Diego,CA92121 47-3437677	HLTHCR ADMIN	CA	0	35,800,118	SCRIPPS HLTH
(3) Imaging Healthcare Specialists LLC 10140 Campus Point Drive San Diego,CA92121 20-3872122	MED IMAGING	CA	39,576,674	29,325,240	IHS Holding
(4) Scripps Cardio&Thoractic Surgery Billing 10140 Campus Point Drive San Diego,CA92121 27-0620996	HLTHCR ADMIN	CA	4,940,124	0	SCRIPPS HLTH
(5) Scripps Hospital Billing Services LLC 10140 Campus Point Drive San Diego,CA92121 61-1677183	HLTHCR ADMIN	CA	4,999,120	0	SCRIPPS HLTH
(6) Scripps Clinic Billing LLC 10140 Campus Point Drive San Diego,CA92121 87-0737749	HLTHCR ADMIN	CA	347,154,581	0	SCRIPPS HLTH
(7) Scripps Accountable Care Organization 10140 Campus Point Drive San Diego,CA92121 36-4837441	HLTHCR ADMIN	CA	171,388	4,546,442	SCRIPPS HLTH
(8) Maxwell H & Muriel Gluck Child Care Ctr 10140 Campus Point Drive San Diego,CA92121 83-1953045	Childcare	CA	1,458,492	1,550,388	SCRIPPS HLTH
(9) Scripps ASC Management LLC 10140 Campus Point Drive San Diego,CA92121 83-1187975	HLTHCR ADMIN	CA	0	0	IHS HOLDING

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Maxwell H & Muriel Gluck Child Care Ctr 10140 Campus Point Drive San Diego,CA92121 35-0504809	Childcare	CA	501(c)(3)	2	SCRIPPS HLTH	Yes
(2)Mercy Hospital Foundation 10140 Campus Point Drive San Diego,CA92121 94-2958094	Fundraising	CA	501(c)(3)	12a	SCRIPPS HLTH	Yes
(3)Scripps Health Plan Services Inc 10140 Campus Point Drive San Diego,CA92121 33-0782099	HLTHCARE SVCS	CA	501(c)(3)	12a	SCRIPPS HLTH	Yes
(4)Horizon Hospice 10140 Campus Point Drive San Diego,CA92121 33-0220777	Hospice Care	CA	501(c)(3)	10	SCRIPPS HLTH	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Scripps Encinitas Surgery Ctr 15305 DALLAS PKWY STE 1600 LB 28 Addison,TX75001 20-5942958	AMBUL SURGERY	CA	Scripps Health	Related	1,603,130	613,674		No	0		No	55.500 %
(2) Scripps Mercy Ambulatory Surgical Center 10140 Campus Point Drive San Diego,CA92121 45-0503246	AMBUL SURGERY	CA	Scripps Health	Related	1,138,189	4,316,490		No	0	Yes		73.500 %
(3) ScrippsUSP Surgery Centers 15305 Dallas Pkwy Ste 1600 LB 28 Addison,TX75001 20-5942911	AMBUL SURGERY	CA	NA	Related	558,825	2,009,046		No	0		No	50.000 %
(4) Scripps IDN Management LLC 10140 Campus Point Drive San Diego,CA92121 45-4557426	HEALTHCARE SVCS	CA	NA	Related	0	16,126		No	0	Yes		50.000 %
(5) Scripps Memorial Ximed Med Center 9850 Genesee Ave Ste 900 La Jolla,CA92037 33-0475481	Real Estate	CA	Scripps Health	Related	646,917	2,701,071		No	0	Yes		15.300 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) Scripps Care 10140 Campus Point Drive San Diego,CA92121 45-2870638	HEALTHCARE SRVCS	CA	Scripps Health	C Corp	0	0	100.000 %	Yes
(2) Scripps Clinical Science Center 10140 Campus Point Drive San Diego,CA92121 26-4479543	Research	CA	Scripps Health	C Corp	0	0	100.000 %	Yes
(3) Charitable Remainder Trust (46) 10140 Campus Point Drive San Diego,CA92121 20-5156965	Hospital Support	CA	NA	Trust
(4) Charitable Lead Trust (3) 10140 Campus Point Drive San Diego,CA92121 33-0796247	Hospital Support	CA	NA	Trust

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Scripps Health Plan Services (SHPS)	m	139,219,727	Accrual
(2) Scripps Health Plan Services (SHPS)	q	19,491,376	Accrual
(3) Scripps Encinitas Surgery Center	a(IV)	362,124	Accrual
(4) Scripps Mercy Ambulatory Surgery Center	a(IV)	564,803	Accrual
(5) Scripps Health Plan Services (SHPS)	b	2,500,000	Accrual
(6) Scripps Health Plan Services (SHPS)	j	163,306	Accrual
(7) Scripps Health Plan Services (SHPS)	l	283,368,002	Accrual
(8) MAXWELL H & MURIEL GLUCK CHILD CARE CTR	s	1,707,949	Accrual

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference

Explanation

SCHEDULE R, PART III

RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS SCRIPPS ENCINITAS SURGERY CENTER, LLC EIN: 20-5942958 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS MERCY AMBULATORY SURGERY CENTER, LLC EIN: 45-0503246 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS/USP SURGERY CENTERS, LLC EIN: 20-5942911 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS IDN MANAGEMENT, LLC EIN: 45-4557426 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS MEMORIAL - XIMED MEDICAL CENTER, LP EIN: 33-0475481 ADDRESS: 9850 GENESEE AVE, STE 900, LA JOLLA, CA 92037

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $3.2 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CA. (SEE SCH O)
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	17,443
6	Total number of volunteers (estimate if necessary) .............	6	2,101
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,143,684
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	192,874

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	50,694,014	50,586,862
9	Program service revenue (Part VIII, line 2g) .........	2,634,688,367	2,955,048,501
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	51,577,904	104,412,796
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	87,712,048	83,483,093
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	2,824,672,333	3,193,531,252
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	468,506	2,897,900
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)	1,218,359,741	1,282,650,238
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 8,615,529
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,466,079,709	1,697,236,521
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	2,684,907,956	2,982,784,659
19	Revenue less expenses. Subtract line 18 from line 12.......	139,764,377	210,746,593
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	5,265,457,446	5,528,192,508
21	Total liabilities (Part X, line 26).............	1,518,445,750	1,527,867,365
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,747,011,696	4,000,325,143

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,644,658,647 including grants of $ 2,897,900 ) (Revenue $ 3,031,229,250 )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 762,192 including grants of $ 0 ) (Revenue $ 1,278,641 )
	THE MAXWELL H. AND MURIEL GLUCK CHILD CARE CENTER PROVIDES CHILD CARE AND PRE-SCHOOL EDUCATION FOR THE BENEFIT OF INDIVIDUALS IN THE COMMUNITY OF SAN DIEGO, INCLUDING EMPLOYEES AND PATIENTS OF THE NONPROFIT 501(C)(3) ENTITIES OF SCRIPPS HEALTH AND SCRIPPS RESEARCH INSTITUTE. SPECIAL EMPHASIS IS PLACED ON A VARIETY OF LEARNING AND PLAY ACTIVITIES IN THE MUSICAL AND VISUAL ARTS FIELD.

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses2,645,420,839

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	34,307,171	0	4,284,625

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	2,321,160
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	48,265,702

g	Noncash contributions included in lines 1a - 1f:$		1g	4,881,211

h Total. Add lines 1a-1f.......		50,586,862

		Business Code
2a	HEALTHCARE DELIVERY REV	622110	2,509,652,904	2,508,576,955	1,075,949	0
b	CAPITATION PREMIUM	622110	159,307,860	159,307,860	0	0
c	PROVIDER FEE REVENUE	622110	241,538,337	241,538,337	0	0
d	JOINT VENTURE REVENUE	900099	11,854,426	11,854,426	0	0
e	RENTAL INCOME - MOB	531120	13,221,919	13,221,919	0	0
f	All other program service revenue.		19,473,055	19,357,427	115,628	0
g	Total. Add lines 2a–2f .....		2,955,048,501

3 Investment income (including dividends, interest, and othersimilar amounts) ......			49,519,374	268,784	20,688	49,229,902
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0	506,632,166	7a
b	Less: cost or other basis and sales expenses	0	451,738,744	7b
c	Gain or (loss)	0	54,893,422	7c
d	Net gain or (loss).........			54,893,422			54,893,422
8a	Gross income from fundraising events (not including $ 2,321,160of contributions reported on line 1c). See Part IV, line 18 ....
			8a	262,313
b	Less: direct expenses ...		8b	1,002,818
c	Net income or (loss) from fundraising events..			-740,505			-740,505
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Cafeteria		722310	7,666,360	7,666,360	0	0
b	Pharmaceutical Revenue		446110	13,493,769	13,493,769	0	0
c	Management Services		561110	37,285,830	34,672,602	2,190,518	422,710
d	All other revenue ....			25,777,639	21,357,875	740,901	3,678,863
e	Total. Add lines 11a–11d ......			84,223,598
12	Total revenue. See instructions.....			3,193,531,252	3,031,316,314	4,143,684	107,484,392

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,897,900	2,897,900
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	37,759,860		37,759,860	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	385,301	0	385,301	0
7	Other salaries and wages........	1,024,213,094	906,628,865	112,445,457	5,138,772
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	40,646,121	32,723,114	7,756,796	166,211
9	Other employee benefits .......	100,747,823	100,214,432	0	533,391
10	Payroll taxes ...........	78,898,039	66,636,059	11,956,069	305,911
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	5,986,766	777,010	5,209,756	0
c	Accounting ...........	1,015,042	94,064	920,978	0
d	Lobbying ...........	298,645	0	298,645	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	5,067,940	0	5,067,940	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	581,709,100	541,355,740	39,918,818	434,542
12	Advertising and promotion ....	2,833,614	341,340	2,490,402	1,872
13	Office expenses .......	65,628,091	51,573,753	13,099,446	954,892
14	Information technology ......	56,240,527	39,380,067	16,860,460	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	75,509,823	69,395,765	5,950,339	163,719
17	Travel ............	0	0	0	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	0	0	0	0
20	Interest ...........	26,395,260	22,284,460	4,110,800	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	169,560,604	120,566,506	48,994,098	0
23	Insurance ...	8,209,501	8,162,334	47,167	0
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	Medical Supplies	474,292,907	474,292,776	0	131
b	Repairs and Maintenance	28,036,387	12,518,000	15,475,959	42,428
c	Hospital Fee Program	186,284,807	186,284,807	0	0
d	ALL OTHER EXPENSES	10,167,507	9,293,847	0	873,660
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	2,982,784,659	2,645,420,839	328,748,291	8,615,529
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).	0

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			414,047,110	2	424,914,438
3	Pledges and grants receivable, net ......			16,915,196	3	12,504,759
4	Accounts receivable, net .............			471,092,320	4	526,273,677
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				19,161,401	5	20,941,313
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			168,071	7	78,018
8	Inventories for sale or use ............			44,073,896	8	46,286,623
9	Prepaid expenses and deferred charges ......			36,361,957	9	23,711,540
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,612,979,978
b	Less: accumulated depreciation	10b	1,796,520,075	1,774,613,035	10c	1,816,459,903
11	Investments—publicly traded securities .			1,881,002,655	11	1,938,880,165
12	Investments—other securities. See Part IV, line 11 .....			440,320,000	12	428,896,000
13	Investments—program-related. See Part IV, line 11 ..			64,637,570	13	66,494,850
14	Intangible assets ...............			46,004,678	14	45,167,870
15	Other assets. See Part IV, line 11 ...........			57,059,557	15	177,583,352
16	Total assets. Add lines 1 through 15 (must equal line 33)...			5,265,457,446	16	5,528,192,508

17	Accounts payable and accrued expenses .....	372,241,581	17	406,674,339
18	Grants payable ...	0	18	0
19	Deferred revenue .........	13,828,654	19	13,004,279
20	Tax-exempt bond liabilities .........	933,879,690	20	904,472,043
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	95,502,060	23	92,191,054
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	102,993,765	25	111,525,650
26	Total liabilities. Add lines 17 through 25..	1,518,445,750	26	1,527,867,365

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	3,747,011,696	32	4,000,325,143
33	Total liabilities and net assets/fund balances ........	5,265,457,446	33	5,528,192,508

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No