2014-08-11T18:25:28-05:00 2013-09-30 346565596 Ernst & Young US LLP 4370 La Jolla Village Dr Suite 500 San Diego CA 92122 990 2012-10-01 956077327 Sharp HealthCare SHAR 8584995150 8695 Spectrum Center Blvd San Diego CA 921231489 Ann Pumpian 8584995150 2014-08-06 0 8585357200 2012 2015-11-30 17:44:51Z Michael Murphy 8695 Spectrum Center Blvd San Diego CA 921231489 1259956898 0 X www.sharp.com X 1946 CA See Schedule O for Organization's most significant activities 25 18 10884 0 158175 0 2179833 2082745 1024741362 1090373452 16871853 25046482 39728264 41052027 1083521312 1158554706 194667 175166 0 0 295638904 330136314 0 0 2875638 797311057 839692934 1093144628 1170004414 -9623316 -11449708 1760015079 1947347894 1809895697 1968700517 -49880618 -21352623 X See Schedule O. 0 0 446012966 175166 627986073 Sharp HealthCare provides administrative support to its subsidiaries. Its general purpose is to promote healthcare through supporting and/or operating its subsidiaries. 399225374 0 462387379 Sharp HealthCare operates a number of outpatient clinics throughout San Diego County which provide outpatient and urgent care services to the community. Total patient visits were 1,662,237 for the twelve months ended 9/30/2013. See Community Benefit Report on Schedule O. 845238340 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 1000 0 1 10884 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 25 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA NC X Staci Dickerson 8584995150 8695 Spectrum Center Blvd San Diego CA 92123 Deirdre Alpert 4.00 0.00 X 0 0 0 Donald C Balfour III MD 8.00 0.00 X 0 0 0 Timothy Considine 6.00 0.00 X X 0 0 0 VAdm Walter J Davis Jr USN Ret 2.00 0.00 X 0 0 0 Barbara DeMichele 2.00 3.00 X 0 0 0 John M Dunn 1.50 0.00 X 0 0 0 Margaret Elizondo MD 2.00 0.00 X 0 177054 0 Richard Freeman 2.00 0.00 X X 0 0 0 William Geppert 1.00 0.00 X 0 0 0 Peter Hanson MD 2.00 2.00 X 0 36000 0 Robert Kelly 3.00 0.00 X X 0 0 0 Henry M Killmar 2.00 0.50 X 0 0 0 Errol Korn MD 1.00 1.00 X 0 29400 0 Scott McMillin 1.30 1.30 X 0 0 0 Cary Miller 2.00 1.00 X 0 0 0 Lori Moore 2.00 2.00 X 0 0 0 Michael A Morton 3.00 0.00 X 0 0 0 Vincent Mudd 2.00 0.00 X 0 0 0 Michael W Murphy 30.00 30.00 X X 1371056 0 93706 Regina A Petty 2.00 0.00 X 0 0 0 Kenneth Roth MD 10.00 2.00 X 0 46250 0 James B SmithIII 6.00 0.00 X X 0 0 0 Geoffrey Stiles MD 2.00 0.00 X 159531 112841 7652 Joseph J Strazzeri Esq 2.00 2.00 X 0 0 0 Julie Meier Wright 2.00 0.00 X 0 0 0 Ann Pumpian 50.00 10.00 X 717542 0 40099 Carlisle C Lewis III 20.00 27.00 X 622252 0 48524 Daniel Gross 45.00 15.00 X 923905 0 52311 William Spooner 60.00 0.00 X 563362 0 16081 Timothy B Smith 0.10 56.00 X 631899 0 15376 Michele T Tarbet 0.10 50.00 X 564445 0 40338 Pablo Velez-Carillo 0.10 50.00 X 423139 0 10435 Anastasia H Baini 65.00 0.00 X 409956 0 16994 William Littlejohn 0.10 40.00 X 386518 0 29720 Kathleen Lencioni 0.10 50.00 X 390571 0 3054 Marcia Hall 0.10 40.00 X 372524 0 32819 Patricia Khaleghi 0.10 55.00 X 315393 0 30964 John E Jenrette 60.00 0.00 X 572189 0 13853 Alison J Fleury 50.00 4.00 X 399765 0 35903 Michael G Plopper 0.10 43.00 X 406737 0 26084 Jeffrey A Hay 50.00 0.00 X 373184 0 28228 Lynne H Milgram 40.00 0.00 X 365793 0 25632 Donna J Mills 11.00 0.00 X 376712 0 1231 10346473 401545 569004 1362 1 1 0 Accumen 4650 Overland Ave San Diego CA 92123 Medical Services 86564753 Sharp Rees-Stealy Medical Group 4000 Ruffin Road Suite E San Diego CA 92123 Medical Services 48238724 Sodexho & Affiliates PO Box 536922 Atlanta GA 303536922 Management/Catering 48218259 Swinerton Builders Inc 17731 Mitchell N Suite 200 Irvine CA 92614 Construction 28914452 Rady Childrens Hospital San Diego 3020 Childrens Way San Diego CA 92123 Medical Services 16448048 446 2082745 3619 2082745 Capitation Revenue 900099 445689160 445689160 Outpatient Care 621110 441891234 441758900 132334 Revenue fm Affiliated Entities 900099 168965633 168965633 Medicare/Medicaid Payments 621110 18498568 18498568 Rental Income 900099 6701703 6701703 8627154 8601313 25841 1090373452 17939197 17939197 4 4 108500467 9006 101400566 1626 7099901 7380 7107281 7107281 SCMG Management Fee 561000 40088631 40088631 Medical Records 900099 247927 247927 Parking Lot 812930 117074 117074 598395 598395 41052027 1158554706 1090215277 158175 66098509 X 169700 169700 5466 5466 5552204 5552204 254962995 103494646 151468349 9469398 3410556 6058842 41280993 17071456 24209537 18870724 7971552 10899172 861465 21990 839475 4126034 4126034 213295 213295 634783 634783 333391044 316034540 17356504 4725780 47511 4678269 19050903 12287900 6763003 45197827 712953 44484874 28548162 21764844 6783318 848008 240579 607429 21736 21736 5403951 414675 4989276 39147280 11391748 27755532 5231478 4964194 267284 Capitation Paid to Affi 317767380 317767380 Medical Supplies 23053583 23053583 Equipment Maint/Repair 4019342 2653767 1365575 Fundraising 2875638 2875638 4575245 1759300 2815945 1170004414 845238340 321890436 2875638 399664 224903 193351827 178235389 30848489 22182109 4200000 4200000 5606241 7275060 35072633 34835331 623006986 371045422 246018281 251961564 702388592 903267191 6326583 7650527 47337089 48144047 488465680 489371773 1760015079 1947347894 170355749 158260970 3882328 4393760 504503898 497780821 1131153722 1308264966 1809895697 1968700517 X -93078505 -63720901 38708730 37398853 4489157 4969425 -49880618 -21352623 1760015079 1947347894 X -11449708 36204075 3773628 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 21329 1 191965 0 213294 0 Explanation of Lobbying Activities: Part II-B, Line 1: Sharp HealthCare attempts to influence local, state and national legislation related to reimbursement, regulatory requirements, and any other issues that could potentially affect the quality and/or ability to effectively provide healthcare to the San Diego community. 4920225 402825 636863 70909 5000 5884004 4614953 -62948 455055 86835 4920225 4780027 32761 -115580 82255 4614953 4126569 7529 711976 66047 4780027 4261998 -18528 -50397 66504 4126569 0.01000 0.99000 0.00000 0 1 1 30901440 30901440 152279369 36853092 115426277 59541835 31466575 28075260 362576729 302725755 59850974 17707613 17707613 251961564 Unamortized Financing Costs 1984862 Yield Curve Swap 5272751 Long-Term Assets 11307501 Basis Swap 698186 Rec fm Related Org for Alloc Tax Exempt Bond Balance 468124253 Miscellaneous Receivables 1984220 489371773 Intercompany Payables 1132186670 Deferred Rent Expense 11216127 Reserve for Malpractice 2200554 LT Pension Liability 10956305 LT Workers Compensation 34760272 Other LT Liabilities 13898484 Mark to Market Swaps 4257156 Capital Leases 59474298 New Market Tax Credit Debt 39315100 1308264966 X 1189408345 36204075 36204075 1153204270 634783 4715653 5350436 1158554706 1169367605 0 1169367605 634783 2026 636809 1170004414 Description of Intended Use of Endowment Funds: Part V, Line 4: Sharp HealthCare Foundation holds 9 board designated and permanent endowments for Sharp HealthCare that are restricted for a variety of purposes, such as rehabilitation, nursing education and scholarships, clinical equipment and technology, and more. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Sharp recognizes tax benefits from any uncertain tax positions only if it is more likely than not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. Sharp records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period that the more likely than not threshold is not met. Sharp recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more likely than not recognition criteria. At September 30, 2013 and 2012, no such assets or liabilities were recorded. Part XI, Line 4b - Other Adjustments: Foundation contributed capital 1,027,718. Book/tax difference on partnership interest - Premier 916,689. Book/tax difference on partnership interest - MRI 230,862. Book/tax difference on partnership interest - Sharp ACO LLC 526,371. Book/tax difference on partnership interest - BMT Program 2,014,013. Part XII, Line 4b - Other Adjustments: Book/tax difference on partnership interest - Premier 14. Book/tax difference on partnership interest - MRI 2,012. 1 Central America and the Caribbean 0 1 Program Services See Part V 5601056 Central America and the Caribbean 0 Investments Investments required to be held by offshore insurance captive 9031164 North America 0 Program Services See Part V 58350 Europe 0 Program Services Participate in International Travel & Health Insurance conference 7327 0 1 0 0 0 1 14697897 0 14697897 1 0 1 0 0 0 Procedure for Monitoring Grants Outside the U.S.: Schedule F, Part I, Line 2: The Management team evaluates requests for contributions from outside organizations taking into account how they align with the organization's mission. No monitoring is done after grants are made. Method Used to Acccount for Expenditures: Schedule F, Part I, Line 3: The accrual method of accounting was used to determine the amounts reported. Region: Central America and the Caribbean Part I, line 3, Column (e): (e) Specific Types of Services in Region: Payments for management of insurance captive services and insurance premium payments to captive. Region: North America Part I, line 3, Column (e): (e) Specific Types of Services in Region: Provide basic life support and advanced cardiac life support training to Mexican physicians, nurses, and paramedics. Provide community outreach programs promoting Sharp HealthCare's program for emergency evacuations. 1 Bare Root Inc dba Flowers 4 the Float PO Box 250 Pauma Valley CA 92061 208917472 501(c)(3) 30000 Tournament of Roses Parade Nurse Rider Donation Chelseas Light Foundation 12463 Rancho Bernardo Road Suite 519 San Diego CA 921282143 320304624 501(c)(3) 25000 Donation in support of Chelseas law. YWCA of San Diego County 1012 C Street San Diego CA 92101 951661119 501(c)(3) 15000 In the Company of Women and TWIN Award and Recognition luncheon sponsorship CAHHSCHA 1215 K Street Suite 800 Volunteer Services Department Sacramento CA 95814 941205908 501(c)(6) 10000 Platinum Sponsorship for Volunteer Leadership Conference American Heart Association 9404 Genesee Avenue Suite 240 La Jolla CA 92037 135613797 501(c)(3) 10000 Pledge balance San Diego Hall of Champions 2131 Pan American Plaza San Diego CA 92101 952856451 501(c)(3) 10000 December Nights Sponsorship San Diego North Chamber of Commerce 10875 Ranco Bernardo Road Suite 104 104 San Diego CA 92127 203185588 501(c)(6) 10000 Women's Week Title Partner 5 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Management team evaluates requests for contributions from outside organizations taking into account how they align with the organization's mission. No monitoring is done after grants are made. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 Margaret Elizondo MD 0 177054 0 0 0 0 0 0 0 0 0 177054 0 0 Michael W Murphy 1127582 0 188024 0 55450 0 78289 0 15417 0 1464762 0 0 0 Geoffrey Stiles MD 141660 112841 0 0 17871 0 6912 0 740 0 167183 112841 0 0 Ann Pumpian 603249 0 97293 0 17000 0 28887 0 11212 0 757641 0 0 0 Carlisle C Lewis III 503103 0 85280 0 33869 0 33547 0 14977 0 670776 0 0 0 Daniel Gross 761578 0 119777 0 42550 0 41084 0 11227 0 976216 0 0 0 William Spooner 468231 0 78131 0 17000 0 4869 0 11213 0 579444 0 0 0 Timothy B Smith 520881 0 94018 0 17000 0 0 0 15376 0 647275 0 0 0 Michele T Tarbet 475755 0 71690 0 17000 0 24962 0 15376 0 604783 0 0 0 Pablo Velez-Carillo 373163 0 49976 0 0 0 4033 0 6403 0 433575 0 0 0 Anastasia H Baini 363078 0 42995 0 3883 0 1456 0 15538 0 426950 0 0 0 William Littlejohn 303496 0 54074 0 28948 0 14344 0 15376 0 416238 0 0 0 Kathleen Lencioni 316942 0 56629 0 17000 0 2132 0 922 0 393625 0 0 0 Marcia Hall 292975 0 52092 0 27457 0 26417 0 6403 0 405344 0 0 0 Patricia Khaleghi 272506 0 35957 0 6930 0 20319 0 10645 0 346357 0 0 0 John E Jenrette 464866 0 75348 0 31975 0 2626 0 11227 0 586042 0 0 0 Alison J Fleury 331582 0 51183 0 17000 0 20713 0 15190 0 435668 0 0 0 Michael G Plopper 326438 0 46330 0 33969 0 18741 0 7343 0 432821 0 0 0 Jeffrey A Hay 294592 0 48000 0 30592 0 11815 0 16413 0 401412 0 0 0 Lynne H Milgram 291102 0 47266 0 27425 0 18251 0 7381 0 391425 0 0 0 Donna J Mills 227917 0 145525 0 3270 0 0 0 1231 0 377943 0 0 0 Part I, Line 1a Monthly dues paid to the University Club for Michael Murphy, President/CEO and Daniel Gross, EVP Hospital Operations. The University Club memberships are used for business puposes. Part I, Line 4b Sharp HealthCare ("Company") sponsors an Executive Flexible Benefit Plan ("Plan") to provide designated executives with a reasonable level of benefits in return for their continued employment with the Company. The Plan is administered on a Plan Year basis of January 1 to December 31. Changes in Flexible Benefit Options are permitted annually, effective January 1 of the new Plan Year. The provisions of the Plan, which were restated effective as of December 31, 2008, are described below as restated. The Plan is available to the Chief Executive Officer, Executive Vice President of Hospital Operations, and Senior Vice Presidents. The Flexible Benefit Allowance available to each participant each plan year shall equal the sum of the following: - A company provided base allowance equal to 18% of the participant's base salary - A participant deferral up to 6% of the participant's pre-tax base salary for such plan year as elected by the participant - A company match should the participant make an elective deferral for a plan year. The company match begins at 2% for the first 1% elective deferral and increases 0.5% for each additional 1% elective deferral, to a maximum match of 4.5% on a 6% elective deferral. The Plan allows participants to use the Flexible Benefit Allowance to purchase additional long-term disability coverage, long-term care coverage, and flexible survivor coverage/accumulation benefits (life insurance). Participants in the flexible survivor coverage/accumulation benefits plan previously could elect to apply Flexible Benefit Allowance to acquire additional survivor coverage, or toward deposits to the Supplemental Survivor Accumulation Benefit Plan ("SSAB") to fund post-retirement survivor benefits, subject to the ERISA limit provided their policies were issued prior to September 18, 2003. The Company shall automatically continue whatever elective coverage and additional deposit elections that were in place for the SSAB during the 2008 plan year. No elective coverage or additional deposits were available to participants whose policies were issued on or after September 18, 2003. Any Flexible Benefit Allowance that remains after purchasing these additional coverages shall be paid to the participant in cash in equal installments throughout the Plan Year, not less frequently than quarterly. If the participant separates from service during the Plan Year, the participant forfeits any unpaid Allowance. A ABAG Finance Authority for Nonprofit Corporations 943130123 00037CFB1 2003-07-23 29872264 See Part VI 0 0 0 B ABAG Finance Authority for Nonprofit Corporations 943130123 00037CNR7 2009-02-12 60000000 See Part VI 0 0 0 C ABAG Finance Authority for Nonprofit Corporations 943130123 00037CPH7 2009-07-22 137265605 See Part VI 0 0 0 D ABAG Finance Authority for Nonprofit Corporations 943130123 00037CPN4 2009-09-02 99880000 See Part VI 0 0 0 A 30856296 3108762 3106694 246575 27392721 2010 0 0 1 1 B 60000000 60000000 1 0 1 1 C 138037297 12756584 112571362 12500000 1 0 1 1 D 99880000 99880000 1 0 1 1 A 0 1 0 1 1 0.00990 0.00000 0.00990 0 0 0 B 0 1 1 1 1 1 0 0 0 C 0 1 0 1 1 0.02000 0.00020 0.02020 0 0 0 D 0 1 1 1 1 1 0.05370 0.00000 0.05370 1 0 0 A 0 0 0 1 0 0 NA 0 0 0 NA 0 0 0 B 0 1 0 0 1 0 NA 0 0 0 NA 0 0 0 C 0 1 0 0 0 0 NA 0 0 0 NA 0 0 0 D 0 1 0 0 1 1 Citibank NA 21.200000000000 0 0 0 NA 0 0 0 A 0 B 0 C 0 D 0 Schedule K, Part I, Entity 1,Line A Tax Exempt Bond Issue 2003C The purpose of this bond issuance is to provide funds for the expansion and capital improvements at two hospital entities and to provide for a debt service reserve fund. Schedule K, Part I, Entity 1, Line B Tax Exempt Bond Issue 2009A The purpose of this bond issuance is to refund the Series 2003A&B Auction Rate Securities Schedule K, Part I, Entity 1, Line C Tax Exempt Bond Issue 2009B The purpose of this bond issuance is to provide funds for capital improvements, capacity expansion, and building renovations at four hospital entities, to purchase major equipment, to refund a portion of the 2003B Auction Rate Securities and to provide for a debt service reserve fund. Schedule K, Part I, Entity 1, Line D Tax Exempt Bond Issue 2009CD The purpose of this bond issuance is to refund the Series 2007A&B Statewide Easy Equipment Program (SWEEP) bonds. Schedule K, Part I, Entity 2, Line A Tax Exempt Bond Issue 2010A The purpose of this bond issuance is to finance the acquisition, construction, equipping and improvement of facilities at four hospital entities. Schedule K, Part I, Entity 2, Line B Tax Exempt Bond Issue 2011A The purpose of this bond issuance is to refund the Series 2001A Revenue bonds and to partially refund the 1998 County of San Diego Certificates of Participation bonds. Schedule K, Part I, Entity 2, Line C Tax Exempt Bond Issue 2012A The purpose of the bond issuance is to refund the 1998 County of San Diego Certificates of Participation bonds. Schedule K, Part II, Line 3 Tax Exempt Bond Issue 2003C, 2009B & 2010A Total proceeds are different than issue price due to investment earnings. Schedule K, Part II, Line 13 Tax Exempt Bond Issue 2003C Stephen Birch HealthCare Center - 2010 Remaining projects - 2006 Schedule K, Part II, Line 13 Tax Exempt Bond Issue 2009B Stephen Birch HealthCare Center - 2010 Sharp Chula Vista Inpatient Capacity Expansion - 2011 Chiller piping at Grossmont Hospital - 2011 East Tower Renovation at Grossmont Hospital - 2011 Sharp Mary Birch Expansion and Remodel - 2012 Remaining projects - 2011 Schedule K, Part II, Line 13 Tax Exempt Bond Issue 2010A Sharp Memorial Central and South Tower Retrofit - project still ongoing Sharp Mary Birch Expansion and Remodel - 2012 Chiller Piping at Grossmont Hospital - 2011 Sharp Chula Vista Emergency Department Expansion - 2012 Sharp Chula Vista Cancer Center - 2012 Schedule K, Part III, Line 4 Tax Exempt Bond Issue 2009CD Life to date private business use is 4.60% and is expected to remain under 5.00% over the life of the bond. Schedule K, Part III, Line 9 Tax Exempt Bond Issue 2003C, 2009A, 2009B, 2009CD, 2010A, 2011A & 2012A Procedures were in place for the entire 12 month period, however, they were not formally documented. As of 09/30/13, formal written procedures were in place. Schedule K, Part IV, Entity 1, Line 2c Tax Exempt Bond Issue 2003C Final 2003C calculations (as bond was refunded in March 2014) were completed in April 2014. Schedule K, Part IV, Line 7 Tax Exempt Bond Issue 2003C, 2009A, 2009B, 2009CD, 2010A, 2011A & 2012A Procedures were in place for the entire 12 month period however, they were not formally documented. As of 09/30/13, formal written procedures were in place. Schedule K, Part V Tax Exempt Bond Issue 2003C, 2009A, 2009B, 2009CD, 2010A, 2011A & 2012A Procedures were in place for the entire 12 month period however, they were not formally documented. As of 09/30/13, formal written procedures were in place. A ABAG Finance Authority for Nonprofit Corporations 943130123 2010-12-16 30000000 See Part VI 0 0 0 B ABAG Finance Authority for Nonprofit Corporations 943130123 00037CRG7 2011-02-10 78140374 See Part VI 0 0 0 C ABAG Finance Authority for Nonprofit Corporations 943130123 00037GSJO 2012-01-24 51889934 See Part VI 0 0 0 A 30305092 30305092 0 0 1 1 B 78140374 3642 78136732 1 0 1 1 C 51889934 51889934 1 0 1 1 A 0 1 0 1 1 0.00710 0.00000 0.00710 0 0 0 B 0 1 1 1 1 1 0 0 0 C 0 1 1 1 1 1 0 0 0 A 0 1 0 0 1 0 NA 0 0 0 NA 0 0 0 B 0 1 0 0 0 0 NA 0 0 0 NA 0 0 0 C 0 1 0 0 0 0 NA 0 0 0 NA 0 0 0 A 0 B 0 C 0 Sharp Rees-Stealy Medical Group See Part V 154505141 See Part V 0 Sharp Rees-Stealy Medical Group See Part V 50921469 See Part V 0 Schedule L, Part IV, Line 1 Business Transactions Involving Interested Persons Donald C. Balfour, M.D. is a director on Sharp HealthCare's Board and is the President and Medical Director of Sharp Rees-Stealy Medical Group ("SRSMG"). SRSMG has contracted with Sharp HealthCare ("SHC") to provide professional medical services in clinic facilities owned and operated by SHC for which SRSMG pays SHC a percentage of SRSMG's professional services revenue. SHC's revenues resulting from the SRSMG contract totaled $154,505,141. Schedule L, Part IV, Line 2 Business Transactions Involving Interested Persons Donald C. Balfour, M.D. is a director on Sharp HealthCare's Board and is the President and Medical Director of Sharp Rees-Stealy Medical Group ("SRSMG"). SHC pays SRSMG for certain medical fees and medical related purchased services. These payments from SHC to SRSMG totaled $50,921,469. Organizations's Most Significant Activities Form 990, Part I, Line 1: The organization's primary exempt purpose is to provide administrative support to its tax-exempt subsidiaries. In addition, outpatient services are provided to patients within the greater San Diego area through multispecialty medical group practices. Community members are offered a number of benefit services to assist them in obtaining treatment, and information is provided on topics ranging from disease prevention to improvement of health status. Program Service Statement Form 990, Part III, Line 1: To promote health care through supporting and/or operating, directly or through wholly-owned subsidiaries and other appropriate management arrangements, hospitals and other medically-related facilities and activities in the State of California. The specific and primary purposes for which this corporation is formed are to support and be responsive to the needs of its publicly supported, tax-exempt subsidiaries. Tax Exempt Bond Issue Form 990, Part IV, Line 24A: Tax Exempt Bonds are issued for the Sharp HealthCare Obligated Group. As a result, all tax exempt bond balances, including those allocated to other members of the Obligated Group, are reported on the Sharp HealthCare return (EIN 95-6077327). The Sharp HealthCare Obligated Group is comprised of Sharp HealthCare (EIN 95-6077327), Sharp Memorial Hospital (EIN 95-3782169), Grossmont Hospital Corporation (EIN 33-0449527), and Sharp Chula Vista Medical Center (EIN 95-2367304). Form 990, Part VI, Section B, line 11 The final Form 990 is placed on the organization's intranet, prior to the filing date, where it is viewable for comment from all members of the governing body. The review process includes multiple levels of review including key corporate and entity finance department personnel comprised of the Director, Tax & Accounting, Vice President of Finance and Senior Vice President and Chief Financial Officer. Additionally, the organization contracts with Ernst & Young, an independent accounting firm, for review of the Form 990. Form 990, Part VI, Section B, line 12c Sharp HealthCare has a written conflict of interest policy which has been reviewed and approved by the Sharp HealthCare governing board. Sharp HealthCare is committed to preventing any Participant of the Corporation from gaining any personal benefit from information received or from any transaction of Sharp. One component of the written conflict of interest policy requires that Board Members, Corporate Officers, Senior Vice Presidents and Chief Executive Officer(s) submit a conflict of interest statement annually to Legal Services/Senior Vice President of Legal Services who will review all statements. In addition, all Vice Presidents and any employees in the Purchasing/Supply Chain, Audit and Compliance, and Case Management/Discharge Planning departments are required to complete an online conflict of interest questionnaire annually that is reviewed by the Conflict Review Committee comprised of employees from Sharp's Legal, Compliance, and Internal Audit departments. In connection with any transaction or arrangement, which may create an actual or possible conflict of interest, the person shall disclose in writing the existence and nature of his/her financial interest and all material facts. Board Members, Corporate Officers, Senior Vice Presidents, and the Chief Executive Officer(s) shall make such disclosures directly to the Chairman of the Board, and to the members of the committee with the board designated powers considering the proposed transaction or arrangement. Upon disclosure of the financial interest and all material facts, the Board Member, Corporate Officer, Senior Vice President or the Chief Executive Officer(s) making such disclosures shall leave the board or the committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In certain instances, such as if someone takes a board seat on a competitor's board of directors or has a role with an organization whereby the information that they may obtain from Sharp would put them in a consistent conflict with their two roles, the conflict could call for the individual's removal from the board. The bylaws for the organization provide for the ability to remove directors in accordance with Section 5222 of the California Corporations Code. This can generally be done on a "for cause" or a "no cause" basis by the action of the member. Form 990, Part VI, Section B, line 15 The Personnel Committee of Sharp HealthCare retains an independent compensation consulting firm to review the total compensation paid to executive management (CEO/President, Executive Vice President of Hospital Operations, and Senior Vice Presidents) and compares it to the total compensation paid to similar positions with like institutions. The information is presented to the Personnel Committee of the Board of Directors by the independent consultant. The Personnel Committee is comprised of Board members who are not physicians and who are not compensated in any way by the organization. The Personnel Committee approves the total compensation for the President/Chief Executive Officer and reviews and approves the compensation and compensation salary ranges for the remainder of the executive team. The Personnel Committee presents its decision to the Board of Directors. The Personnel Committee retains minutes of its meetings. The Compensation and Benefits department engages a third party independent consultant to conduct a compensation study covering officers and key employees. The independent third party compares base salaries to similar positions with like institutions. The information is reviewed by the Compensation and Benefits department and is presented to the President/Chief Executive Officer, the Executive Vice President of Hospital Operations and the appropriate Senior Vice President for review and approval. The compensation study was last conducted in November/December 2012. Form 990, Part VI, Section C, line 19 Policies are considered proprietary information, however in Sharp HealthCare's publicly available Code of Conduct, Sharp outlines its Conflict of Interest policies in a user friendly manner. The annual audited financial statements of the consolidated group are published on the dacbond.com website (www.dacbond.com), are attached to the Form 990 filed for each of the Sharp hospitals, and are available upon request. The annual audited financial statements include combining schedules which disclose the financial results (Balance Sheet, Statement of Operations, Statement of Changes in Net Assets) for each entity of the consolidated group. Quarterly financial statements of Sharp's obligated group are published on the dacbond.com website (www.dacbond.com). Other Fees Form 990, Part IX, line 11g Medical Fees: Program service expenses 227,803,945. Management and general expenses 253,824. Fundraising expenses 0. Total expenses 228,057,769. Registry: Program service expenses 195,426. Management and general expenses 1,092,637. Fundraising expenses 0. Total expenses 1,288,063. Purchased Services: Program service expenses 88,035,169. Management and general expenses 16,010,043. Fundraising expenses 0. Total expenses 104,045,212. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Current Year Other Comprehensive Income 6,652,579. Beneficial Interest in Sharp HealthCare Foundation 806,958. Book/tax difference on partnership interest - Premier -916,675. Book/tax difference on partnership interest - MRI -228,850. Book/tax difference on partnership interest - Sharp ACO, LLC -526,371. Book/tax difference on partnership interest - BMT Program -2,014,013. Form 5471 Attachment to 2012 Form 990 and Form 5471 Transferee Corporation's Information Statement Filed in Accordance with Reg. Section 1.351-3(b) Transferor Name: SHARP HEALTHCARE Taxable Year End: 9/30/2013 FEIN: 95-6077327 Transferee Name: CONTINUOUS QUALITY INSURANCE SPC (FKA CONTINUOUS QUALITY INSURANCE COMPANY, LTD.) FEIN: N/A Transferee Address: 23 LIME TREE BAY AVENUE, P.O. Box 1363, GRAND CAYMAN CAYMAN ISLANDS, BRITISH WEST INDIES This statement is being filed with Sharp HealthCare, the transferee's, Form 5471, Information Return of U.S. Persons, with respect to the transferee, for the taxable year ended 9/30/2013. This statement is filed in accordance with Reg. Section 1.351-3(b) to disclose the details of property transferred to the above controlled corporation. The exchange took place during the year ended 9/30/2013. 1. Property received from the transferor: Contribution of cash. 2. The cost or other basis thereof in the hands of the transferor adjusted to the date of transfer: $ 5,601,056.19 3. Transferee's Corporation Stock: N/A 4. Securities of the transferee corporation: N/A 5. Amount of money paid in the exchange to the transferor: N/A 6. Other property passing to the transferor in the exchange: N/A 7. Each of the transferor's liabilities assumed by the transferee corporation: N/A Attachment to 2012 Form 990 and Form 5471 Transferor Corporation's Information Statement Filed in Accordance with Reg. Section 1.351-3(a) Transferor Name: SHARP HEALTHCARE Taxable Year End: 9/30/2013 FEIN: 95-6077327 Transferee Name: CONTINUOUS QUALITY INSURANCE SPC (FKA CONTINUOUS QUALITY INSURANCE COMPANY, LTD.) FEIN: N/A Transferee Address: 23 LIME TREE BAY AVENUE, P.O. Box 1363, GRAND CAYMAN CAYMAN ISLANDS, BRITISH WEST INDIES This statement is being filed with Sharp HealthCare, the transferor's, Form 5471, Information Return of U.S. Persons, with respect to the transferor for the taxable year ended 9/30/2013. This statement is also being filed with Sharp HealthCare, the transferor's, Form 990, Return of Organization Exempt from Income Tax. This statement is filed in accordance with Reg. Section 1.351-3(a) to disclose the details of property transferred to the above controlled corporation. The exchange took place during the tax year ended 9/30/2013. 1. Property transferred to the transferee: Contribution of $5,601,056.19 cash 2. Information with respect to the transferee corporation's stock: (i) The kind of stock and preferences: N/A (ii) The number of shares of each class at the date of the exchange: Before the exchange: N/A After the exchange: N/A (iii) The fair market value per share of each class at the date of the exchange: N/A 3. Securities of the transferee corporation received in the exchange: N/A 4. Amount of money received: N/A 5. Other property received: N/A 6. Liabilities of the transferor assumed by the transferee Corporation: N/A Community Benefits Report Form 990, Part III, Line 4c: Fiscal Year 2013 Community Benefits Report Section 1 An Overview of Sharp HealthCare Sharp HealthCare (Sharp or SHC) is an integrated, regional health care delivery system based in San Diego, Calif. The Sharp system includes four acute care hospitals; three specialty hospitals; two affiliated medical groups; 20 medical clinics; five urgent care facilities; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp offers a full continuum of care, including: emergency care, home care, hospice care, inpatient care, long-term care, mental health care, outpatient care, primary and specialty care, rehabilitation, and urgent care. Sharp also has a Knox-Keene-licensed care service plan, Sharp Health Plan (SHP). Serving a population of approximately 3 million in San Diego County (SDC), as of September 30, 2013, Sharp is licensed to operate 2,110 beds, and has approximately 2,600 Sharp-affiliated physicians and more than 16,000 employees. FOUR ACUTE CARE HOSPITALS: Sharp Chula Vista Medical Center (343 beds) The largest provider of health care services in San Diego's rapidly expanding South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region's busiest emergency department (ED) and is the closest hospital to the busiest international border in the world. Sharp Coronado Hospital and Healthcare Center (181 beds) Sharp Coronado Hospital and Healthcare Center (SCHHC) provides services that include sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, and hospice and emergency services. SCHHC is the largest provider of total joint surgeries in all of SDC. Sharp Grossmont Hospital (540 beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego's East County, and has one of the busiest EDs in SDC. Sharp Memorial Hospital (675 beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation. THREE SPECIALTY CARE HOSPITALS: Sharp Mary Birch Hospital for Women & Newborns (206 beds) A freestanding women's hospital specializing in obstetrics, gynecology, gynecologic oncology, and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other private hospital in California. Sharp Mesa Vista Hospital (149 beds) The largest private freestanding psychiatric hospital in California, Sharp Mesa Vista Hospital (SMV) is a premier provider of behavioral health services. Sharp McDonald Center (16 beds) Sharp McDonald Center (SMC) is San Diego County's only licensed chemical dependency recovery hospital. Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH, and are referred to herein as The Sharp Metropolitan Medical Campus (SMMC). The operations of Sharp Rees-Stealy Medical Centers (SRS) are included within the not-for-profit public benefit corporation of Sharp, the parent organization. The operations of SGH are reported under the not-for-profit public benefit corporation of Grossmont Hospital Corporation. Mission Statement It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patient expectations, and are provided in a caring, convenient, cost-effective and accessible manner. Vision Sharp's vision is to become the best health system in the universe. Sharp will attain this position by transforming the health care experience through a culture of caring, quality, service, innovation and excellence. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen, embodying an organization of people working together to do the right thing every day to improve the health and well-being of those it serves. Values * Integrity Trustworthiness, Respect, Commitment to Organizational Values, and Decision Making * Caring Service Orientation, Communication, Teamwork and Collaboration, Serving and Developing Others, and Celebration * Innovation Creativity, Continuous Improvement, Initiating Breakthroughs, and Self-Development * Excellence Quality, Safety, Operational and Service Excellence, Financial Results, and Accountability Culture: The Sharp Experience For more than 13 years, Sharp has been on a journey to transform the health care experience for patients and their families, physicians and staff. Through a sweeping organization-wide performance and experience improvement initiative called The Sharp Experience, the entire Sharp team has recommitted to purpose, worthwhile work, and creating the kind of health care people want and deserve. This work has added discipline and focus to every part of the organization, helping to make Sharp one of the nation's top-ranked health care systems. Sharp is San Diego's health care leader because it remains focused on the most important element of the health care equation: the people. Through this extraordinary initiative, Sharp is transforming the health care experience in San Diego by striving to be: * The best place to work: Attracting and retaining highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration, and professional and personal growth. This commitment to serving patients and supporting one another will make Sharp "the best health system in the universe." * The best place to practice medicine: Creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers; experience unsurpassed service as valued customers; have access to state-of-the-art equipment and cutting-edge technology; and enjoy the camaraderie of the highest-caliber medical staff at San Diego's health care leader. * The best place to receive care: Providing a new standard of service in the health care industry, much like that of a five-star hotel; employing service-oriented individuals who see it as their privilege to exceed the expectations of every patient treating them with the utmost care, compassion and respect; and creating healing environments that are pleasant, soothing, safe, immaculate, and easy to access and navigate. Through all of this transformation, Sharp will continue to live its mission to care for all people, with special concern for the underserved and San Diego's diverse population. This is something Sharp has been doing for more than half a century. Pillars of Excellence In support of Sharp's organizational commitment to transform the health care experience, the six Pillars of Excellence serve as a guide for team members, providing a framework and alignment for everything Sharp does. The six pillars listed below are a visible testament to Sharp's commitment to become the best health care system in the universe by achieving excellence in these areas: * Quality - Demonstrate and improve clinical excellence and patient safety to set community standards and exceed patient expectations * Service - Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence * People - Create a workforce culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp's mission, vision and values * Finance - Achieve financial results to ensure Sharp's ability to provide quality health care services, new technology and investment in the organization * Growth - Achieve consistent net revenue growth to enhance market dominance, sustain infrastructure improvements and support innovative development *Community - Be an exemplary community citizen by making a difference in our community and supporting the stewardship of our environment Awards Sharp has received the following recognition: Sharp is a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation's highest presidential honor for quality and organizational performance excellence. Sharp was the first health care system in California and eighth in the nation to receive this recognition. Sharp was recognized as one of the 2013 World's Most Ethical (WME) Companies by the Ethisphere Institute, the leading business ethics think-tank. The list highlights companies that outperform industry peers when it comes to ethical behavior. The 2013 WME companies are those that truly embrace ethical business practices and demonstrate industry leadership, forcing peers to follow suit or fall behind. Sharp was the only San Diego company named to the list. Sharp was named the No. 1 "best integrated health-care network" in California and No. 12 nationally by Modern Healthcare magazine in 2012. The rankings are part of the "Top 100 Most Highly Integrated Healthcare Networks (IHN)," an annual survey conducted by health care data analyst IMS Health. This is the 14th year running that Sharp has placed among the top in the state in the survey. Sharp Rees-Stealy Medical Group, practicing as the Sharp Rees-Stealy Medical Centers, was named "Best Medical Group" by U-T San Diego readers participating in the paper's 2012 "Best of San Diego" Readers Poll. SMH and SGH were ranked second and third "Best Hospitals" while SCVMC, SCHHC and SMBHWN were honored as finalists. SGH and SMH have both received MAGNET Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor bestowed by the ANCC and is accepted nationally as the gold standard in nursing excellence. SMH was re-designated in March 2013. Sharp was named one of the nation's "Most Wired" health care systems in 2012 and 2013, as well as 1999 2009, by Hospitals & Health Networks magazine in the annual Most Wired Survey and Benchmark Study. "Most Wired" hospitals are committed to using technology to enhance quality of care for both patients and staff. In July 2010, SMH was named the "Most Beautiful Hospital in America" by Soliant Health, one of the largest medical staffing companies in the country. With over 10,000 votes from visitors to the Soliant Health website, SMH was voted to the top of the second annual "20 Most Beautiful Hospitals in America" list. In 2012, SMH was designated as a Planetree Patient-Centered Hospital, joining SCHHC as the second hospital in the state to earn the honor. SMH is the largest and most complex hospital in the world to receive designation. SCHHC was originally designated in 2007 and is the only hospital in the state to be re-designated twice, occurring in both 2010 and 2013. Additionally, SCHHC was named a Planetree Hospital with Distinction for its leadership and innovation in patient-centered care. Planetree is a coalition of more than 100 hospitals worldwide that is committed to improving medical care from the patient's perspective. In 2010, Sharp received the Morehead Apex Workplace of Excellence Award. Morehead awards the health care industry's top achiever by objectively identifying the highest performer and acknowledging their contributions to health care. With this singular award, Morehead annually recognizes a client who has reached and sustained the 90th percentile on their employee engagement surveys. Sharp reached the 98th percentile in 2010 and the 99th percentile in 2011. In FY 2013, SCHHC received Energy Star designation from the US Environmental Protection Agency (EPA) for outstanding energy efficiency for the fourth consecutive year. Buildings that are awarded the designation use an average of 40 percent less energy than other buildings and release 35 percent less carbon dioxide into the atmosphere. SCVMC also received the designation in 2013, and had received the award in previous years (2009-2011). Sharp HealthCare was named the Crystal Winner of the 2011 Workplace Excellence Awards from the San Diego Society for Human Resource Management. This designation recognizes Sharp's Human Resources Department as an innovative and valuable asset to overall company performance. In 2013, multiple SHC entities were recognized by the Press Ganey organization for achievement of the Guardian of Excellence Awards in: Employee Engagement (recipients were: SCVMC, SCHHC, SMBHWN, SMV, SRS and SHC); Patient Satisfaction (SMH Sharp Senior Health Centers); and Physician Engagement (SCHHC, SMV). This designation recognizes awardees for having reached the 95th percentile for patient satisfaction, employee engagement, physician engagement surveys or clinical quality performance based on one year of data. In 2013, multiple SHC entities were recognized by the Press Ganey organization for achievement of the Beacon of Excellence Awards in: Employee Engagement (SHC); Patient Satisfaction (SMH); and Physician Engagement (SCHHC and SMV). This designation recognizes awardees for maintaining consistently high levels of excellence in patient satisfaction (based on a three-year period), employee engagement, or physician engagement (the latter two based on the two most recent survey periods). Patient Access to Care Programs Uninsured patients with no ability to pay, and insured patients with inadequate coverage receive financial assistance for medically necessary services through Sharp's Financial Assistance Program. Sharp does not refuse any patient requiring emergency medical care. Sharp provides services to help every unfunded patient received in the ED find coverage options. Patients use a quick, simple online questionnaire through PointCare to generate personalized coverage options that are filed in their account for future reference and accessibility. The results of the questionnaire allow SHC staff to have an informed discussion about coverage options with the patient, empowering the patient with options. By September 2013, Sharp helped guide approximately 56,700 self-pay patients through the maze of government health coverage programs while maintaining the patient's dignity through this program. In addition, Sharp has three hospitals that qualify as covered entities for the 340B Drug Pricing Program administered by the Health Resources and Services Administration (HRSA). Participation in the 340B Drug Pricing Program allows SMH, SCVMC and SGH to purchase outpatient drugs at reduced prices. The savings from this program are utilized to offset patient care costs for the most vulnerable patient populations and assist patients in obtaining access to medications through the Patient Assistance Team. The Patient Assistance Team works hard to help patients in need of assistance gain access to free or low-cost medications. Patients are identified through usage reports, or referred through case management, nursing, physicians or even other patients. If eligible, uninsured patients are offered assistance, which can help decrease readmissions resulting from lack of medication access. The team members research all options available, including programs offered by drug manufacturers, grant-based programs offered by foundations, copay assistance, low-cost alternatives, or research where the patient might find their medication at a lower cost. Sharp also continues to offer ClearBalance a specialized loan program for patients facing high medical bills. Through this collaboration with San Diego-based CSI Financial Services, both insured and uninsured patients have the opportunity to secure small bank loans in order to pay off their medical bills in low monthly payments as low as $25 per month and thus prevent unpaid accounts from going to collections. Through this program, Sharp provides a more affordable alternative for patients that struggle with the ability to resolve their hospital bills. In addition, Sharp provides post-acute care facilitation for high-risk patients, including the homeless and patients lacking a safe home environment. Patients receive assistance with transportation and placement; connections to community resources; and financial support for medical equipment, medications, and even outpatient dialysis and nursing home stays. Through collaboration with the San Diego Rescue Mission, SCHHC, SGH and SMH discharge their chronically homeless patients to the Rescue Mission's Recuperative Care Unit, where patients not only receive follow-up medical care through Sharp in a safe environment, but also receive psychiatric care, substance abuse counseling and guidance to help get them off the street. Sharp also continued to collaborate with the United Way's Project 25 program to provide financial information that will help the program gauge the effectiveness of its interventions to reduce use of emergent and other front line public resources. Project 25 is a partnership between United Way of San Diego County and the City and County of San Diego with a goal to provide permanent housing (via the San Diego Housing Commission) and supportive services (via the County of San Diego) to at least 25 of San Diego County's chronically homeless, who are often the most frequent users of public resources. Community Health Screenings Sharp's commitment to improving community health extends beyond the walls of its health care facilities, and beginning in FY 2013, Sharp provided free health screenings directly to community members at sites throughout San Diego. Screenings were open to adults over the age of 18, and were completely confidential only community members retained a copy of their results. Throughout the year, Sharp health care professionals offered health screenings for cholesterol, blood sugar, body mass index (BMI), blood pressure and tobacco use. Approximately 50 screening events were held at nearly 20 sites across the County, and thousands of community members received screening results as well as personalized strategies to improve their overall health and well-being. In the upcoming year, Sharp will continue its community health screenings with the goal of screening 5,000 community members throughout San Diego. Health Professions Training Internships Students and recent health care graduates are a valuable asset to the community, and Sharp demonstrates a deep investment in these potential and newest members of the health care workforce through internships, financial aid and career pipeline programs. In FY 2013, there were more than 4,000 student interns within the Sharp system, providing nearly 550,000 hours in disciplines that included nursing, allied health and professional educational programs. Sharp provides education and training programs for students across the continuum of nursing (e.g., critical care, medical/surgical, behavioral health, women's services and wound care) and allied health professions such as rehabilitation therapies (speech, physical, occupational and recreational therapy), pharmacy, respiratory therapy, dietetics, lab, radiology, social work, psychology, business, health information management, and public health. Students from local community colleges such as Grossmont College (GC), San Diego Mesa College (MC), and Southwestern College (SWC); local and national university campuses such as San Diego State University (SDSU), University of California, San Diego (UCSD), University of San Diego (USD), and Point Loma Nazarene University (PLNU); and vocational schools such as Kaplan College (KC) participate in Sharp's health professions training. Table 1 presents the students and student hours at each of the Sharp entities in FY 2013. Table 1: Sharp HealthCare Internships FY 2013 Sharp Chula Vista Medical Center Nursing Students - 837 Nursing Group Hours - 56,252 Nursing Precepted Hours - 21,107 Ancillary Students 165 Ancillary Hours - 39,053 Total Students - 1,002 Total Hours - 116,412 Sharp Coronado Hospital and Healthcare Center Nursing Students - 496 Nursing Group Hours 76,219 Nursing Precepted Hours 2,636 Ancillary Students 110 Ancillary Hours 21,121 Total Students - 606 Total Hours 99,976 Sharp Grossmont Hospital Nursing Students - 565 Nursing Group Hours 38,754 Nursing Precepted Hours 13,570 Ancillary Students 210 Ancillary Hours 48,273 Total Students - 775 Total Hours 100,597 Sharp Mary Birch Hospital for Women & Newborns Nursing Students - 195 Nursing Group Hours 14,420 Nursing Precepted Hours 4,456 Ancillary Students 23 Ancillary Hours 4,864 Total Students - 218 Total Hours 23,740 Sharp Memorial Hospital Nursing Students 393 Nursing Group Hours 28,370 Nursing Precepted Hours 16,462 Ancillary Students 305 Ancillary Hours 56,276 Total Students - 698 Total Hours 101,108 Sharp Mesa Vista Hospital Nursing Students 307 Nursing Group Hours 23,628 Nursing Precepted Hours 3,272 Ancillary Students 26 Ancillary Hours 10,708 Total Students - 333 Total Hours 37,608 Sharp Hospice Care Nursing Students 87 Nursing Group Hours 0 Nursing Precepted Hours 696 Ancillary Students 2 Ancillary Hours 650 Total Students - 89 Total Hours 1,346 Sharp HealthCare Nursing Students 230 Nursing Group Hours 0 Nursing Precepted Hours 35,665 Ancillary Students 132 Ancillary Hours 32,138 Total Students - 362 Total Hours 67,803 Total Nursing Students 3,110 Nursing Group Hours 237,643 Nursing Precepted Hours 97,864 Ancillary Students 973 Ancillary Hours 213,083 Total Students 4,083 Total Hours 548,590 Health Sciences High and Middle College Sharp has teamed up as an industry partner with charter school Health Sciences High and Middle College (HSHMC) to provide students broad exposure to careers available in health care. During FY 2013, more than 330 HSHMC students spent thousands of hours on various Sharp campuses. The collaboration between Sharp and HSHMC prepares high school students to enter health science and medical technology careers in the following five career pathways: biotechnology research and development, diagnostic services, health informatics, support services and therapeutic services. Throughout the school year, supervised HSHMC students rotated through instructional pods in various departments such as nursing, OB/GYN, occupational and physical therapy, behavioral health, Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), imaging, rehabilitation, laboratory, pharmacy, engineering, pulmonary, cardiac services, and operations. The students not only had the opportunity to observe patient care, but also received guidance from Sharp staff on career ladder development and job/education requirements. HSHMC students earn high school diplomas, complete college entrance requirements and have opportunities to earn community college credits, degrees or vocational certificates. With the HSHMC program, Sharp links students with health care professionals through job shadowing to explore real world applications of their school-based knowledge and skills. The program began in 2007 with HSHMC students on the campuses of SGH and SMH, and expanded to include SMV and SMBHWN in 2009, SCHHC in 2010, and SCVMC in 2011. HSHMC students also devote time to various SRS sites in San Diego. Lectures and Continuing Education Sharp contributes to the academic environment of many colleges and universities in San Diego. In FY 2013, Sharp staff committed hundreds of hours to the academic community by providing lectures, courses and presentations on numerous college/university campuses throughout San Diego. Through the delivery of a variety of guest lectures, including pharmacy practice lectures, health information technology lectures at MC, clinical nurse specialist education at PLNU, and a variety of health administration lectures to public health graduate students at SDSU, Sharp staff remain active and engaged with San Diego's academic health care community. Sharp's Continuing Medical Education (CME) department assesses, designs, implements and evaluates educational initiatives for Sharp's affiliated physicians, pharmacists and other health care professionals to better serve the health care needs of the San Diego community. In FY 2013, the professionals at Sharp HealthCare CME invested more than 2,200 hours in numerous CME activities open to San Diego health care providers, ranging from conferences on patient safety, readmissions, breast cancer, orthopedics, kidney transplant and diabetes, to presentations on the hospitalist's experience and hospital overcrowding. Research Innovation is critical to the future of health care, and Sharp HealthCare supports this innovation through its commitment to quality research initiatives that are safe and effective, provide valuable knowledge to the San Diego health care community, and positively impact patients and community members. Sharp HealthCare Institutional Review Board Sharp HealthCare's Institutional Review Board (IRB) seeks to promote a culture of safety and respect for individuals who choose to participate in research for the greater good of the community. All proposed Sharp entity research studies with human participants are required to be reviewed by the Sharp HealthCare IRB. The purpose of this review is to protect participant safety and maintain responsible research conduct. In FY 2013, a dedicated IRB committee of 12 individuals including physicians, psychologists, research nurses and pharmacists devoted hundreds of hours to the review and analysis of both ongoing and new research studies. The Sharp HealthCare IRB also provides education and guidance for researchers across Sharp as well as in the community. Nurses, pharmacy residents and other members of the health care community receive education on various study-specific requirements regarding the protection of human subjects and HIPAA compliance. Additionally, Sharp HealthCare's Research Department works with the IRB to provide quarterly research meetings (QRM) that are open to physicians, psychologists, research nurses and study coordinators throughout San Diego. Recent presentations have covered topics such as the administration of clinical trials, the use of statistical analysis in assessing test bias, the importance of outcomes-based research and the development of effective research questions. Outcomes Research Institute The Outcomes Research Institute (ORI) at Sharp was formed to measure long-term results of care and to promote and develop best practices of health care delivery for members of the professional health care community. With both inpatient and ambulatory locations and a diverse patient population, Sharp is well-positioned to study care processes and outcomes in a real world setting, reflecting an authentic picture of the health care environment. The ORI collaborates with all Sharp team members interested in optimizing patient care by: facilitating the creation and design of patient-centered outcomes research projects; assisting in database development as well as data collection and analysis; assisting with grant writing and exploring funding mechanisms for research projects; and facilitating IRB application submissions. Among its current and future goals, the ORI aims to ensure patient care produces outcomes consistent with evidence-based medical literature; to analyze the relationships between processes and outcomes for treatments, interventions and quality improvement initiatives; to establish associations between practice, costs and outcomes for patient care; and to develop and disseminate effective approaches to quality care delivery in the health care community. The ORI has completed a number of pilot studies to collect data on optimal sample sizes and variables for expanded research measuring long-term influence of quality interventions on: heart failure readmission, optimal glycemic control in the hospital setting, and inpatient complication rates and length of stay after bowel surgery. Currently the ORI has 12 active studies in various phases of development and analysis. The ORI is committed to educational outreach for Sharp HealthCare's clinicians and the health care community at large, and offers numerous educational presentations about outcomes research and health care research methods to nurses, physicians and the broader community throughout the year. ORI staff have also been invited to present lectures on outcomes research and outcomes research designs to the broader health care community and at regional and national conferences. Additionally, the ORI collaborates with SDC education and research communities to develop and strengthen those connections. The ORI Student Research Intern Program offers advanced nursing and public health students an opportunity to learn about and become involved in outcomes research. Since its inception in 2011, the program has enrolled 11 students (approximately two per semester). The interns learn about outcomes research, and produce presentations that document their research study experience. Furthermore, the ORI has reached out to the academic community to foster partnership for outcomes research. As a result, the ORI currently is in discussion with researchers at National University (NU), SDSU's Cancer Center Comprehensive Partnership, and the Health Research and Educational Trust to develop common themes as the basis for future research collaborations. Evidence-Based Practice Institute Sharp participates in the Evidence-Based Practice Institute (EBPI), which prepares teams of staff fellows (interprofessional staff) and mentors to change and improve clinical practice and patient care. This change occurs through identifying a care problem, developing a plan to solve it, and then incorporating the new knowledge into practice. The EBPI is part of the Consortium of Nursing Excellence, San Diego, which promotes evidence-based practice in the nursing community. The consortium is a partnership between SCVMC, SGH, SMBHWN, SMH, Scripps Health, Rady Children's Hospital San Diego, UC San Diego Health System, San Diego VA Medical Center and Elizabeth Hospice, as well as PLNU, SDSU, Azusa Pacific University (APU), and USD. In FY 2013, the EBPI consisted of a nine-month program culminating with a community conference and graduation ceremony in November. The project results of all EBPI fellows are shared at the ceremony. EBPI fellows partner with their mentors and participate in a variety of learning strategies. Mentors facilitate the process of conducting an evidence-based practice change and navigating the hospital system to support the fellow through the process of evidence-based practice. Mentors also assist the fellow in working collaboratively with other key hospital leadership personnel. The San Diego EBPI includes six full-day class sessions that incorporate group activities, as well as self-directed learning programs outside of the classroom, in addition to the structured mentorship provided throughout the program. In FY 2013, 42 fellows graduated from the EBPI program, and completed projects that addressed compelling issues in the health care community, such as: reducing ED recidivism in the homeless and underinsured population, pain reduction in the post-surgical open heart cardiac patients, noise reduction in the Intensive Care Unit (ICU) setting; and early mobilization of mechanically ventilated patients in the ICU setting. Sharp actively participates in the EBPI through the provision of instructors and mentors, as well as administrative coordination. Volunteer Service Sharp Lends a Hand In FY 2013, Sharp continued its systemwide community service program, Sharp Lends a Hand (SLAH), to further support the San Diego communities it serves. In October, Sharp team members suggested project ideas that: focused on improving the health and well-being of San Diego in a broad, positive way; relied on Sharp for volunteer labor; supported nonprofit initiatives, community activities or other programs that serve the residents of SDC; and could be completed by September 30, 2013. Eleven projects were selected: Stand Down for Homeless Veterans; San Diego Food Bank; Serra Mesa Food Pantry; Feeding America San Diego; Life Rolls On They Will Surf Again; Just in Time for Foster Youth; Helen Woodward Animal Center: Puppy Love 5K Run/Walk; USS Midway Foreign Object Damage Walk-Down; San Diego River Park Foundation Habitat Restoration; San Diego River Park Foundation River Mouth Restoration; and Waste Collection. In support of these projects, more than 1,400 Sharp employees, family members and friends volunteered over 4,600 hours. During eight days in June and July, more than 375 Sharp employees, family members and friends volunteered at Veterans Village of San Diego and San Diego High School. The volunteers sorted and organized clothing donations and provided on-site support, medical services and companionship to hundreds of homeless veterans at Stand Down for Homeless Veterans, an annual event sponsored by Veterans Village of San Diego. The San Diego Food Bank feeds people in need throughout SDC, and advocates and educates the public about hunger-related issues. During ten days in March, April, May, June and August, more than 560 SLAH volunteers inspected and sorted donated food, assembled boxes, and cleaned the San Diego Food Bank warehouse. The Serra Mesa Food Pantry was created to provide food to individuals and families who live in the Serra Mesa area and who are experiencing temporary struggles in obtaining basic necessities during illness, unemployment, or other crisis. In April and May, 20 SLAH volunteers participated in the Serra Mesa Food Pantry to help lessen the impact of hunger in our community. Feeding America San Diego is SDC's largest distributor of food and the only Feeding America affiliate in the county. In partnership with more than 160 local school districts, agencies and a network of volunteers, the organization serves 73,000 children, families and seniors in need each week. In June, more than 120 SLAH volunteers joined Feeding America in an effort to create a hunger-free and healthy San Diego. More than 75 SLAH volunteers provided assistance to Life Rolls On They Will Surf Again in September. The Life Rolls On Foundation is dedicated to improving the quality of life for young people affected by spinal cord injury (SCI) through action sports. The award-winning series of bi-coastal events empowers paraplegics and quadriplegics to experience mobility through surfing, with support from adaptive equipment and volunteers. In June, nearly 20 SLAH volunteers joined Just in Time for Foster Youth, an organization dedicated to helping foster youth achieve self-sufficiency and well-being as they transition into adulthood. Each year, Just in Time volunteers come together to give dozens of transitioning foster youth the resources and encouragement they need to begin a new life chapter as college students. Participating youth connect with potential lifelong mentors and successful Just in Time alumni, receive laptops and printers, learn valuable tips on money management, legal matters and practical purchases, and pair up with a volunteer shopper to buy essential dorm furnishings and school supplies. During two days in February, nearly 30 SLAH volunteers provided support for the Helen Woodward Animal Center's Puppy Love 5K Run/Walk on Highway 101 in Solana Beach, including setting up exhibit booths, assisting with registration and working as route/road marshals. The Helen Woodward Animal Center is a San Diego-based nonprofit organization committed to saving the lives of animals by providing humane care, animal adoption, and other programs and resources for individuals who care for animals. In April, approximately 20 SLAH volunteers helped keep the USS Midway decks clean during the USS Midway Foreign Object Damage Walk-Down, a routine activity on an active aircraft carrier to prevent debris from getting sucked into and damaging the aircraft engines. Founded in 2001, the San Diego River Park Foundation is a community-based grassroots nonprofit organization that works to protect the greenbelt from the mountains to the ocean along the 52-mile San Diego River. The Foundation works with community groups and other organizations dedicated to the San Diego River, the River Park, and its wildlife, recreation, water, cultural and community values. In January and May, nearly 80 SLAH volunteers joined the San Diego River Park Foundation's Habitat and River Mouth Restoration efforts. In support of waste reduction for a healthier environment, 16 SLAH volunteers participated in Sharp HealthCare's Waste Collection event for the community during Earth Week in April. At the event, community members and employees recycled approximately 150 pounds of pharmaceutical waste, 3,250 pounds of electronic waste and 1,200 pounds of shredded paper documents. Volunteers assisted attending collection agencies with set-up, clean-up, traffic control, and guiding event visitors. Sharp Humanitarian Service Program In FY 2013, the Sharp Humanitarian Service Program funded 50 Sharp employees, enabling them to participate in service programs that provide health care or other supportive services to underserved or adversely affected populations, including residents of Haiti, rural Guatemala and other impoverished areas. Sharp employees devoted their time and expertise to a variety of humanitarian organizations, including Camp Beyond the Scars, an effort of the San Diego Burn Institute that has been offered since 1994, and that provides one week of free summer camp in July for approximately 50 children between the ages of 5 and 17 with burn injuries. Another Sharp team member traveled to impoverished communities in India to assess the needs of the Tibetans, which included an interview with the Health Kalon for the Tibetan people living in exile in North India and Nepal. The trip also included time volunteering to provide Math and English lessons at a local school called "Shrestra," which translates to the idea that every child is a container of possibilities. In addition to providing academic lessons, the school serves as a safe haven for these children, providing some nutrition, care, and a refuge from their impoverished living conditions. The experience was not only beneficial for the children, but also inspiring and life-changing for the volunteers. Sharp staff also participated in multiple week-long medical/surgical mission trips to the northwest mountains of Guatemala in FY 2013. This included teams of 60 to 100 individuals consisting of Sharp-affiliated physicians, surgeons, anesthesiologists, nurses, technical staff, therapists, students, chaplains, and many others. Teams participated in this effort in partnership with the Ioamai Medical Ministries and Helps International. Over the course of each trip about ten days the teams provided surgeries under different specialties, such as General Surgery, OB/GYN, Plastics, ENT, Cleft Palate Repair, and Urology. Basic clinic and dentistry services were also available. In addition, a team built stoves in rural houses to keep fires off the floor and reduce burns and smoke inhalation exposure, and other teams provided a water purification unit. In the five days provided as a functioning temporary hospital, teams performed an average of 100 to 150 surgeries and saw 1,000 to 2,000 patients in clinic. The teams served rural and urban populations surrounding the sites at no cost, and in some cases, members of the impoverished mountain community traveled many hours to receive care at the hospital. Sharp also donated numerous supplies and equipment to this life-changing experience for both patients and participants. Community Walks For the past 18 years, Sharp has proudly supported the American Heart Association (AHA) annual San Diego Heart & Stroke Walk. In September 2013, more than 1,000 walkers represented Sharp at the 2013 San Diego Heart & Stroke Walk held at Petco Park in the downtown area. Sharp was the No. 1 team in San Diego and the AHA Western Region Affiliates, raising nearly $205,000. Sharp Volunteers Sharp volunteers are a critical component of Sharp's dedication to the San Diego community. Sharp provides a multitude of volunteer opportunities throughout SDC for individuals to serve the community, meet new people and assist programs ranging from pediatrics to Senior Resource Centers. Volunteers devote their time and compassion to patients as well as to the general public, and are an essential element to many of Sharp's programs, events and initiatives. Sharp volunteers spend their time within hospitals, in the community, and in support of the Sharp HealthCare Foundation, Grossmont Hospital Foundation, and Coronado Hospital Foundation. Sharp employees also donate time as volunteers for the Sharp organization. In FY 2013, Sharp HospiceCare provided extensive training for nearly 50 new volunteers in FY 2013. Volunteers underwent a rigorous 32-hour training program to confirm their understanding of and commitment to hospice care prior to serving as part of the hospice interdisciplinary team. Once trained, volunteers devoted their time to both patient care and clerical and administrative support. In addition, Sharp HospiceCare offered its Teen Volunteer Program, training five teenagers in FY 2013. Through the program, teens are assigned special projects in the office or patient assignments at Sharp HospiceCare's LakeView and ParkView homes, including simple acts of kindness such as sitting with patients, listening to their stories, providing grooming and hygiene tasks, and being a comforting presence by just holding their hand. Sharp HospiceCare also hosted a student volunteer from San Diego Metropolitan Regional & Technical High School during FY 2013. The student spent time in both Sharp HospiceCare's administrative office and a Sharp HospiceCare home, and experienced hospice care through case conferences, interdisciplinary team (IDT) meetings and a variety of other tasks. Sharp HospiceCare also coordinates a volunteer-run wig donation program for community members who suffer from hair loss. In FY 2013, Sharp HospiceCare and its volunteers met with 29 individuals and provided approximately 58 wigs, as well as donated wigs to patients at the Douglas and Nancy Barnhart Cancer Center at SCVMC. Volunteers also participated in the Sharp HospiceCare Memory Bear Program to support community members who have lost a loved one. Through the program, volunteers sew teddy bears out of garments of those who have passed on, which serve as special keepsakes and permanent reminders of the grieving family member's loved one. In FY 2013, Sharp HospiceCare volunteers devoted approximately 3,400 hours to handcraft more than 750 bears for more than 260 families. Sharp HospiceCare recognized its volunteers by providing a monthly volunteer support group and acknowledging their valuable contribution during National Volunteer Month and National Hospice Month. At Sharp Metropolitan Medical Campus (SMMC), the volunteer-run Arts for Healing program was established to improve the spiritual and emotional health of patients that face significant medical challenges by utilizing the power of art and music to enhance the healing process. The program provides services at SMH, SMH Outpatient Pavilion (OPP), SMBHWN, SMV and SMC. Since the inception of the program in 2007, more than 36,000 patients and their families, guests and staff have benefitted from the time and talent provided by Arts for Healing staff and volunteers. Trained volunteers are the primary providers of the program, which is coordinated by a chaplain of the Spiritual Care program. In FY 2013, 50 volunteers, including several students from PLNU and San Diego Mesa College (MC), supported Arts for Healing by facilitating art activities for patients and their loved ones. In FY 2013, nearly 3,400 individuals volunteered for various programs across the Sharp system, contributing more than 247,000 hours of their time in service to Sharp and its initiatives. This includes more than 930 auxiliary members and thousands more individual volunteers from the San Diego community. More than 9,800 of these hours were provided externally to the community through activities such as delivering meals to homebound seniors and assisting with health fairs and events. Table 2 details the number of individual volunteers and the hours provided in service to each of Sharp's entities, specifically for patient and community support. Volunteers also spent additional hours supporting Sharp's three foundations for events like the Grossmont Hospital Foundation's annual Golf Tournament; galas held for SCHHC and SGH, and other events in support of Sharp entities and services. Table 2: Sharp Individual Volunteers and Volunteer Hours FY 2013 Sharp Chula Vista Medical Center Number of Individual Volunteers 368 Volunteer Hours - 4,935 Sharp Coronado Hospital and Healthcare Center Number of Individual Volunteers 132 Volunteer Hours 8,394 Sharp Grossmont Hospital Number of Individual Volunteers 738 Volunteer Hours 112,309 Sharp HospiceCare Number of Individual Volunteers 146 Volunteer Hours 12,356 Sharp Metropolitan Medical Campus Number of Individual Volunteers 1,862 Volunteer Hours 100,733 TOTAL Number of Individual Volunteers 3,246 Volunteer Hours 238,727 Sharp employees also volunteer their time for the Cabrillo Credit Union Sharp Division Board, the Sharp and Children's MRI Board, the UCSD Medical Center/Sharp Bone Marrow Transplant Program Board, Grossmont Imaging LLC Board, and the SCVMC San Diego Imaging (SDi) Center. Volunteers on Sharp's auxiliary boards and the various Sharp entity Boards volunteer their time to provide program oversight, administration and decision making regarding financial resources. In FY 2013, 138 community members contributed their time to Sharp's boards. Other Sharp Volunteer Efforts In FY 2013, Sharp staff volunteered their time and passion to a number of unique initiatives, underscoring Sharp's commitment to the health and welfare of San Diegans. Below are just a few examples of how Sharp employees gave of themselves to the San Diego community. SGH's Engineering Department participated in a number of initiatives in FY 2013, including the This Bud's for You program. The program brought comfort to unsuspecting patients and their loved ones with the delivery of hand-picked flowers from the medical campus's abundant gardens. The SGH landscape team grew, cut, bundled and delivered colorful bouquets each week, bringing an element of natural beauty to patients and visitors of both the hospital and Sharp's hospice homes. The team also regularly offered single-stem roses in a small bud vase to passers-by. In its third year, This Bud's for You has become a natural part of the landscape team's day, an act that is simply part of what they do to enhance the experience of visitors to the hospital. SGH also continued to provide the Shirt Off Our Backs program during the 2012 holiday season. Also in its third year, this program brought clothing, shoes, blankets and household items directly to San Diego's homeless population. The SGH landscape team and Engineering Department, the SGH Auxiliary and local businesses collaborated to implement the program, while SGH's Waste Management team provided ancillary support with loaner recycle bins to use for collection. Hundreds of pounds of clothing, shoes, towels, blankets, toiletries and other items that could be put to use immediately were collected, washed, folded, boxed/bagged and prepared for delivery to the San Diego population in need. This year three pickup trucks were required to deliver the collected items. The efforts provided food and comfort to all who expressed need ranging from small children to adults of all sizes. The SGH Engineering Department also participated in the Food Bank's Food 4 Kids Backpack program in FY 2013. The goal of the program is to provide a backpack full of child-friendly, shelf-stable food for elementary school children who receive a free meal at school, but are suffering from hunger over the weekends when little or no food is available. The objective of the program is to alleviate hunger, improve school performance, improve health and provide additional information to parents about other local community services. Through hospital-wide support at SGH, approximately 2,000 pounds of food were collected, filling more than 200 backpacks for chronically hungry elementary school students. All Ways Green Initiative As San Diego's largest private employer, Sharp recognizes that the health of its patients, employees and the community is directly tied to the health of their environment. Sharp promotes a culture of environmental responsibility by providing education and outreach to employees to improve their health and the health of those they serve. Sharp created its All Ways Green logo to brand its environmental activities and communicate sustainable activities throughout Sharp and the San Diego community. Sharp's systemwide All Ways Green Committee is charged with evaluating opportunities and recognizing best practices in seven distinct areas: (1) energy efficiency, (2) alternative energy generation, (3) water conservation, (4) waste minimization, (5) cleaner means of transportation, (6) green building design, and (7) sustainable food practices. Established Green Teams at each entity are responsible for developing new programs that educate Sharp employees to conserve natural resources and reduce, reuse and recycle. Sharp has also partnered with its vendors and other organizations in the community to develop new programs and initiatives to help achieve its environmental goals. Sharp's Environmental Policy serves to affirm its commitment to improving the health of the environment and therefore the communities it serves. According to the US Environmental Protection Agency (EPA), inpatient hospital facilities are the second-most energy-intensive industry after food service and sales, with energy utilization rates 2.7 times greater than that of office buildings on a square-foot basis. Unlike other industries, hospitals must operate 24 hours a day, seven days a week, and must provide service during power outages, natural disasters and other emergencies. Given this reality, Sharp has embarked on several green initiatives to enhance energy efficiency, including: retro-commissioning of heating, ventilation and air conditioning (HVAC) systems; lighting retrofits; pipe insulations; infrastructure control initiatives; occupancy sensor installation; energy audits; energy-efficient motor and pump replacements; equipment modernization; and development of a Sharp HealthCare Energy Guideline to help manage energy utilization practices throughout the system. In FY 2013, Sharp underwent a significant lighting retrofit project that resulted in energy savings of more than 1.7 million kilowatt hours, and decreased carbon dioxide production by nearly 1,305 tons that year. Furthermore, Sharp was awarded a Certificate of Recognition from the EPA for instituting a power management program on more than 10,000 computers within the system in May. This effort enables computers and monitors to go into a low-power sleep mode after a period of inactivity, and has the potential for an annual savings of up to $50.00 per computer by conserving unnecessary electricity. All Sharp entities participate in the EPA's Energy Star (ES) database and monitor their ES scores on a monthly basis. ES is an international standard for energy efficiency created by the EPA. Buildings that are certified by ES must earn a 75 or higher on the EPA's energy performance scale, indicating that the building performs better than at least 75 percent of similar buildings nationwide, without sacrifices in comfort or quality. According to the EPA, buildings that qualify for the ES typically use 35 percent or less energy than buildings of similar size and function. As a result of Sharp's commitment to superior energy performance and responsible use of natural resources, SCHHC first earned the ES certification in 2007, and then again each year from 2010 through 2013, while SCVMC received ES certification in 2009, 2010, 2011 and 2013. In addition, Sharp's new SRS Downtown medical office building is the first Leadership in Energy and Environmental Design (LEED) gold-certified medical office building in San Diego. According to the EPA, hospital water use constitutes seven percent of the total water used in commercial and institutional buildings in the US. In an effort to conserve water, Sharp has researched and implemented numerous infrastructure changes and best practices to ensure Sharp's facilities are optimally operated while monitoring and measuring water consumption, including: installation of motion-sensing faucets and toilets in public restrooms; low-flow showerheads and toilets in patient rooms and locker rooms; drip irrigation systems; mist eliminators; micro-fiber mops; water-saving devices and equipment; water monitoring and control systems; water practice and utilization evaluations; regular rounding to identify leaks; reduced landscape watering times; hardscaping; and redesigning areas with low-water plant species. The EPA and Hospitals for a Healthy Environment report that each patient generates approximately 15 pounds of waste each day, while US medical centers generate approximately two million tons of waste each year. Sharp has implemented a comprehensive waste minimization program to significantly reduce the waste generated at each entity, including single-stream recycling; reprocessing of surgical instruments; use of reusable sharps and pharmaceutical waste containers; hard-sided surgical cases to reduce blue wrap used during the instrument sterilization process; use of recyclable paper for printing brochures, newsletters and other marketing materials; electronic patient bills and paperless payroll; recycling of exam table paper; repurposing of supplies, equipment and furniture; encouragement of reduced paper use at meetings through electronic correspondence; and use of one-at-a-time paper napkin and plastic cutlery dispensers. To reduce their carbon footprint, Sharp's primary office supply vendor, Office Depot, created the GreenerOffice Delivery Service in which they replaced its small and mid-sized cardboard boxes with paper bags composed of 40 percent post-consumer recycled material. The paper bags are protected during shipping by reusable plastic totes, which are returned to Office Depot for reuse. Sharp was an early adopter of the program in an effort to make their delivery requests more environmentally friendly. Sharp's participation in this program will result in an estimated annual reduction of 22,000 less pounds of wood, 24,000 pounds of CO2, 82,000 gallons of wastewater and 8,000 pounds of solid waste. Furthermore, Office Depot and Sharp have arranged for 30 percent recycled copy paper to be used at all Sharp entities. In April, Sharp was named Recycler of the Year at the City of San Diego's 21st annual Waste Reduction and Recycling Award program for SMH and SMBHWN. Also in April, Sharp held its fourth-annual systemwide All Ways Green Earth Week event, including Earth Fairs at each of the Sharp entities. During the fairs, employees learned how they can contribute to recycling, waste minimization, healthy eating practices and other sustainability efforts. Many of Sharp's key vendor partners participated in the Earth Fairs to help raise awareness of green initiatives and how they involve Sharp. During Earth Week Sharp hosted a free community waste collection event at their corporate office location where community members and employees recycled approximately 150 pounds of pharmaceutical waste, 3,250 pounds of electronic waste and 1,200 pounds of shredded paper documents. Throughout FY 2013 Sharp continued its recycling efforts with the Lion's Club Recycle Sight program, through which employees recycle their personal eyeglasses and sunglasses by donating them to people in need both locally and globally. On average, Sharp employees donated approximately 250 pairs of glasses through the program in FY 2013. Sharp also recognizes America Recycles Day each November through a systemwide electronic announcement highlighting Sharp's recycling efforts and accomplishments, and offering reminders for proper workplace recycling. The impact of Sharp's waste reduction programs has been significant. In FY 2013, Sharp facilities diverted over 7.6 million pounds of paper, cardboard, glass, metals, polystyrene, batteries, ink and toner, medical equipment and electronic waste from local landfills. This included, but was not limited to 36,827 pounds of waste diverted through utilization of reusable sharps and pharmaceutical waste containers at SCHHC and SMMC, as well as systemwide recycling of 210,694 pounds of hazardous and universal waste (e.g., batteries, solvents and fluorescent light bulbs), and 37,246 pounds of waste diverted through surgical device reprocessing. Table 3 presents the quantity of waste diversion at Sharp shown as pounds (lbs.) diverted. In the coming year, Sharp aims to reduce its waste generation by two percent, or approximately 430,000 pounds. Table 3: Sharp HealthCare Waste Diversion FY 2013 Sharp Chula Vista Medical Center Recycled Waste Per Year (lbs.) 713,872 Total Waste Per Year (lbs.) 2,513,406 Percent Recycled 28% Sharp Coronado Hospital and Healthcare Center Recycled Waste Per Year (lbs.) 229,586 Total Waste Per Year (lbs.) 1,307,361 Percent Recycled 18% Sharp Grossmont Hospital Recycled Waste Per Year (lbs.) 1,617,209 Total Waste Per Year (lbs.) 4,887,676 Percent Recycled 33% Sharp Metropolitan Medical Campus Recycled Waste Per Year (lbs.) 2,335,655 Total Waste Per Year (lbs.) 6,814,358 Percent Recycled 34% Total Sharp HealthCare Recycled Waste Per Year (lbs.) 7,649,727 Total Waste Per Year (lbs.) 20,580,271 Percent Recycled 37% *Total Sharp HealthCare includes all Sharp System Services and Sharp Rees-Stealy Sharp implements sustainable food practices throughout the system, including removal of styrofoam from cafeterias; use of green-label kitchen soaps and cleansers; electronic cafe menus; recycling of all cardboard, cans and grease from cafes; and partnering with vendors who are committed to reducing product packaging. Other sustainable food practices include organic markets at each of Sharp's hospitals and corporate office; Meatless Mondays, purchasing of hormone-free milk; and increased purchasing of locally grown fruits and vegetables, approaching 65 percent at some entities. Both SMH and SCHHC have also created the first County-approved organic gardens with produce to be used at employee cafes. Since 2012, SMH and SMBHWN have partnered with the City of San Diego to implement a Food Waste Composting Program, making Sharp the first San Diego health care organization to join the city's initiative. Through this program, food waste is picked up weekly by EDCO, a solid waste vendor, for transport to the Miramar Greenery, a 74-acre facility located at the Miramar Landfill in Kearny Mesa. The composted rich soil is sold to commercial landscapers and non-city residents, and provided at no charge to city residents at volumes of up to two cubic yards. According to the City of San Diego, such waste diversion programs contribute to the landfill's lifespan being extended from 2012 to at least 2022. Sharp continues to work with the City to expand food waste composting to other Sharp entities. Ride sharing, public transit programs and other transportation efforts contribute to the reduction of Sharp's transportation emissions. Sharp uses centralized patient scheduling to improve patient vanpools, and has replaced higher fuel-consuming cargo vans with economy Ford transit vehicles, saving approximately five miles per gallon. Sharp also ensures carpool parking spaces, designated bike racks and motorcycle spaces are available at each employee parking lot, as well as offers discounted monthly bus passes for purchase by employees. Throughout the year, Sharp's Commuter Solutions Sub-Committee works to develop new programs and marketing campaigns to educate employees on the benefits of ride sharing to further reduce the number of cars on the road. In partnership with the San Diego Association of Governments (SANDAG), a vanpool and carpool match-up program exists at Sharp to help employees find convenient ride share partners. Sharp employees also utilize SANDAG's online iCommute TripTracker tool to monitor the cost and carbon savings of their alternate methods of commuting. In FY 2013, Sharp employees saved more than two million miles and reduced more than 1,383,000 pounds of carbon dioxide through carpooling, vanpooling, biking, walking, telecommuting and the use of public transportation. Through these efforts, Sharp achieved second place in the Mega Employer category through the SANDAG Rideshare 2013 Corporate Challenge. In March, Sharp was the only health care organization in SDC to be named an All-Star Award winner in SANDAG's 2013 Diamond Award program, which recognizes participants in SANDAG's iCommute program for their outstanding contributions to reducing traffic congestion and greenhouse gases in SDC. Sharp furthered its support of green transportation through several bike to work initiatives in FY 2013. In October, nearly 130 Sharp employees pedaled to work for Sharp HealthCare's first Bike to Work Day, while in May, Sharp encouraged employees to ride their bikes to work in recognition of National Bike to Work Day. In fact, Sharp participated in the 4th annual iCommute Bike to Work 2013 Corporate Challenge for the entire month of May (National Bike Month), competing with similar-sized organizations for the highest percentage of bike ridership for the month. In June, Sharp also promoted National Dump the Pump Day to employees by sharing special Dump the Pump Day promotions from iCommute, such as vanpool discounts and gift card drawings, for individuals who pledged to "Dump the Pump" and make green transportation choices. As part of the nationwide Electric Vehicle Project, Sharp has installed electric vehicle chargers (EVCs) at its corporate office location and SMMC. Sharp is the first health care system in San Diego to offer EVCs, supporting the creation of a national infrastructure required for the promotion of EVCs to reduce carbon emissions and dependence on foreign oil. Sharp will continue its efforts to expand EVCs at other entities. In FY 2013, Sharp hosted two community workshops to share its waste minimization best practices. SMH and SMBHWN partnered with the City of San Diego to host a workshop for local companies to learn about the hospitals' food waste composting experiences and exploring composting at their own organizations. Sharp also partnered with SDC to host a complimentary community workshop on proper disposal of pharmaceuticals, including pharmaceutical waste liability, regulatory compliance and cost effective disposal strategies. Participants included hospital and pharmacy personnel, and medical providers who handle pharmaceuticals. Sharp's waste minimization initiatives have been recognized by several publications, including BioCycle, a national magazine about composting, renewable energy and sustainability; San Diego Business Journal; and by the California State CalRecycle website, which cited Sharp HealthCare as one California's models for health care industry food scraps management. Table 4 below highlights the All Ways Green efforts at Sharp entities. Going forward, Sharp remains committed to the All Ways Green initiative and will continue to investigate opportunities to reduce its carbon footprint. Sharp's All Ways Green Committee continues to work with system employees, physicians and corporate partners to develop new and creative ways to reduce Sharp's impact on the environment and meet their goal of being an outstanding community citizen through environmental responsibility. Table 4: All Ways Green Initiatives by Sharp Entity FY 2013 SCHHC *Energy Efficiency - Update elevators/chillers - Energy audits - Energy-efficient chillers/motors - Energy Star Award HVAC projects - Lighting retrofits *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Reusable sharp containers - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Organic gardens - Recycling education - Ride share promotion SCVMC *Energy Efficiency - Energy audits - Energy-efficient chillers/motors - Energy Star participation and award eligible - HVAC projects - Lighting retrofits *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Compactor renovation - Electronic cafe menus - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion SGH *Energy Efficiency - Energy audits - Energy Star participation - HVAC projects - Lighting retrofits - Retro-commissioning *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Electronic cafe menus - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion Sharp System Services *Energy Efficiency - Electric vehicle chargers - Energy audits - Energy efficient chillers/motors - Energy Star participation - HVAC projects - Lighting retrofits - Occupancy sensors - Thermostat control software *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Electronic patient bills and paperless payroll - Electronic and pharmaceutical waste recycling events - Green Grocer's market - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion SHP *Energy Efficiency - Energy audits - HVAC projects - Lighting retrofits - Occupancy sensors *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Education and Outreach - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Spring cleaning events - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion SMH/SMBHWN *Energy Efficiency - Electric vehicle chargers - Energy audits - Energy-efficient chillers/motors - Energy Star participation - HVAC projects - Lighting retrofits - Occupancy sensors - Pipe insulations *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Electronic cafe menus - Food waste composting - Single-serve paper napkin and plastic cutlery dispensers - Reusable sharp waste containers - Single-stream recycling - Surgical instrument reprocessing *Education and Outreach - Drought tolerant rooftop garden - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Organic gardens - Recycling education - Ride share promotion SMV/SMC *Energy Efficiency - Energy audits - Energy Star participation - HVAC projects - Lighting retrofits - Motor and pump replacements *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Mist eliminators *Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Single-stream recycling - Styrofoam elimination - Surgical instrument reprocessing *Education and Outreach - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Organic farmer's market - Recycling education - Ride share promotion SRS *Energy Efficiency - Energy audits - Energy Star participation - Lighting retrofits *Water Conservation - Drip irrigation - Drought-tolerant plants and bark-covered ground - Electronic faucets - Evaluation of water utilization practices - Hardscaping - Landscape water reduction systems - Low-flow systems - Mist eliminators *Waste Minimization - Single-serve paper napkin and plastic cutlery dispensers - Recycling of exam paper - Single-stream recycling - Styrofoam elimination *Education and Outreach - Contractor education - Earth Week activities - Environmental policy - Green Team - No Smoking Policy - Recycling education - Ride share promotion Emergency and Disaster Preparedness Sharp contributes to the health and safety of the San Diego community through essential emergency and disaster planning activities and services. Throughout FY 2013, Sharp provided education to community members, staff and other health care professionals on emergency and disaster preparedness. Sharp's disaster preparedness team offered several disaster education courses to first responders, health care providers and community members across SDC. The Hospital-Based First Receiver Awareness Course and First Receiver Operations Course were offered as a two-part series to educate and prepare hospital staff for a decontamination event. Course topics included decontamination principles and best practices, basic hazards, utilization of appropriate Personal Protective Equipment (PPE), response concepts, containment, decontamination and recovery. A standardized, on-scene federal emergency management training for hospital management entitled, NIMS (National Incident Management System)/ ICS (Incident Command System)/ HICS (Hospital Incident Command System), was also offered by Sharp's disaster team, as well as a START (Simple Triage and Rapid Treatment) Triage/ Jump START Triage class to train emergency responders at all levels to triage a large volume of trauma victims within a short period of time. Sharp's disaster team also led a Pediatric/Burn Surge course to train hospital staff, health care providers and other emergency responders to effectively manage specific patient populations during a surge or abnormal event. In October 2012, Sharp's disaster preparedness team hosted a Domestic Chemical All-Hazards Conference for approximately 90 community health care and emergency preparedness professionals. The conference included a key note speaker from San Diego's Hazardous Materials (HAZMAT) Team, as well as presentations including Current Trends in Hazardous Material Response, Chemical Suicide, Chemical Agents Review, and Personal Readiness During Chemical Events. That same month, Sharp's disaster leadership presented at a statewide conference of more than 900 hospital staff, state and local officials, and key preparedness and response partners at the California Hospital Association's (CHA) eighth annual Disaster Planning for California Hospitals Conference in Sacramento, Calif. Presentations aimed at helping hospitals strengthen their disaster planning efforts, and included Business Continuity Planning Tips, Tools and Implementation, and Continuing Care During Loss of Power. In FY 2013, Sharp's disaster leadership donated their time to state and local organizations and committees, including Southern California Earthquake Alliance, County of San Diego Emergency Medical Care Committee (EMCC), San Diego Disaster Committee, and the County of San Diego Healthcare Disaster Council, a group of representatives from SDC hospitals, other health care delivery agencies, county officials, fire agencies, law enforcement, American Red Cross and others who meet monthly to share best practices for emergency preparedness. In addition, Sharp's disaster leadership served on the Statewide Medical Health Exercise work group that designed training materials, including an exercise guidebook and other resources, for the 2013 California Statewide Medical Health Training and Exercise Program through the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA). The program is designed to guide local emergency planners in developing, planning and conducting emergency responses. Furthermore, Sharp disaster leadership is part of the San Diego Patient Tracking Committee, which is designing a Family Assistance Center (FAC) for the county in an effort to aid community members in finding their loved ones during a disaster event. Sharp supports safety efforts of the state and the City of San Diego through maintenance and storage of a county decontamination trailer at SGH, to be used in response to a mass decontamination event. In addition, Sharp stores and maintains 24 state hospital ventilators at three of its hospitals, and is exploring opportunities to join the EMSA Mobile Field Hospital (MFH) program to provide maintenance and storage for a state MFH. The MFH is designed to increase disaster preparedness by rapidly responding to emergencies such as earthquakes, fires and floods that impact hospital surge needs. Within 72 hours of an emergency, the MFH can provide up to 600 acute care hospital beds for patient treatment and transport anywhere in the state. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that last up to 96 hours in the event the system's normal water supply is interrupted. As part of its participation in the US Department of Health & Human Services Public Health Emergency Hospital Preparedness Program (HPP) grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership (the Partnership). The Partnership includes SCVMC, SCHHC, SGH, SMH, SRS Urgent Care Centers and Clinics, San Diego's Ronald McDonald House, Rady Children's Hospital, Scripps Mercy Hospital, Kaiser Hospital, Alvarado Hospital, Paradise Valley Hospital, the Council of Community Clinics, Naval Air Station North Island/Naval Medical Services, San Diego County Sheriffs, MCAS Miramar Fire Department and Fresenius Medical Centers. The Partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. Through networking, planning, and the sharing of resources, trainings and information, the partners will be better prepared for a collaborative response to an emergency or disaster affecting SDC. In FY 2013, the Partnership drafted a SDC NICU Evacuation Plan to guide health care providers in the safe evacuation of the neonatal patient population during a disaster. Next, the Partnership will begin drafting a similar evacuation plan for the maternal and newborn patient population. In FY 2014, Sharp will host a Household Disaster Preparedness Expo to educate San Diego community members on effective disaster preparedness and response in the event of an earthquake, fire, power outage, or other emergency. The expo will include a variety of local disaster vendors and emergency personnel, and include valuable disaster education and emergency demonstrations. Sharp also plans to collaborate with other SDC hospitals to create regional decontamination teams of health care personnel trained to respond to a community decontamination event. Internally, Sharp plans to develop employee disaster teams who will be trained to provide leadership, order and safety during an emergency or disaster. Section 2 Executive Summary This Executive Summary provides an overview of community benefits planning at Sharp HealthCare (Sharp), a listing of community needs addressed in this Community Benefits Report, and a summary of community benefits programs and services provided by Sharp in Fiscal Year (FY) 2013 (October 1, 2012, through September 30, 2013). In addition, the summary reports the economic value of community benefits provided by Sharp, according to the framework specifically identified in SB 697, for the following entities: * Sharp Chula Vista Medical Center * Sharp Coronado Hospital and Healthcare Center * Sharp Grossmont Hospital * Sharp HospiceCare * Sharp Mary Birch Hospital for Women & Newborns * Sharp Memorial Hospital * Sharp Mesa Vista Hospital and Sharp McDonald Center * Sharp Health Plan Community Benefits Planning at Sharp HealthCare Sharp bases its community benefits planning on its triennial community health needs assessments (CHNA) combined with the expertise in programs and services of each Sharp hospital. Listing of Community Needs Addressed in this Community Benefits Report The following community needs are addressed by one or more Sharp hospitals in this Community Benefits Report: * Access to care for individuals without a medical provider, and support for high-risk, underserved and underfunded patients * Education and screening programs on health conditions such as heart and vascular disease, stroke, cancer, diabetes, preterm delivery, unintentional injuries and behavioral health * Health education and screening activities for seniors * Special support services for hospice patients and their loved ones, and for the community * Support of community nonprofit health organizations * Education and training of health care professionals * Collaboration with local schools to promote interest in health care careers * Welfare of seniors and disabled people * Cancer education, patient navigator services, and participation in clinical trials * Women's and prenatal health services and education * Meeting the needs of new mothers and their loved ones * Mental health and substance abuse education for the community Highlights of Community Benefits Provided by Sharp in FY 2013 The following are examples of community benefits programs and services provided by Sharp hospitals and entities in FY 2013. * Unreimbursed Medical Care Services included uncompensated care for patients who are unable to pay for services, and the unreimbursed costs of public programs such as Medi-Cal, Medicare, San Diego County Indigent Medical Services, Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and TRICARE the regionally managed health care program for active-duty and retired members of the uniformed services, their loved ones and survivors; and unreimbursed costs of workers' compensation programs. This also included financial support for on-site workers to process Medi-Cal eligibility forms. * Other Benefits for Vulnerable Populations included van transportation for patients to and from medical appointments; financial and other support to community clinics to assist in providing health services, and improving access to health services; Project HELP; Project CARE; contribution of time to Stand Down for Homeless Veterans and the San Diego Food Bank; financial and other support to the Sharp Humanitarian Service Program; and other assistance for the needy. * Other Benefits for the Broader Community included health education and information, and participation in community health fairs and events addressing the unique needs of the community, as well as providing flu vaccinations, health screenings and support groups to the community. Sharp collaborated with local schools to promote interest in health care careers; made Sharp facilities available for use by community groups at no charge; and executive leadership and staff actively participated in numerous community organizations, committees and coalitions to improve the health of the community. See Appendix A for a listing of Sharp's involvement in community organizations. In addition, the category included costs associated with planning and operating community benefit programs, such as community health needs assessments and administration. * Health Research, Education and Training Programs included education and training programs for medical, nursing and other health care professionals, as well as student and intern supervision and time devoted to generalizable, health-related research projects that were made available to the broader health care community. Economic Value of Community Benefits Provided in FY 2013 In FY 2013, Sharp provided a total of $331,338,317 in community benefit programs and services that were unreimbursed. Table 1 displays a summary of unreimbursed costs based on the categories specifically identified in SB 697. Table 1: Total Economic Value of Community Benefits Provided Sharp HealthCare Overall FY 2013 Senate Bill 697 Category Programs and Services Included in Senate Bill 697 Category Estimated FY 2013Unreimbursed Costs *Medical Care Services Shortfall in Medi-Cal $78,779,825 Shortfall in Medicare $144,932,844 Shortfall in San Diego County Indigent Medical Services $37,738,890 Shortfall in CHAMPVA/TRICARE $4,374,145 Shortfall in Workers' Compensation $228,311 Charity Care and Bad Debt $54,315,585 *Other Benefits for Vulnerable Populations Patient transportation and other assistance for the needy $2,336,152 *Other Benefits for the Broader Community Health education and information, support groups, health fairs, meeting room space, donations of time to community organizations and cost of fundraising for community events $2,019,316 *Health Research, Education and Training Programs Education and training programs for students, interns and health care professionals $6,613,249 TOTAL $331,338,317 Table 2 shows a listing of these unreimbursed costs provided by each Sharp entity. Table 2: Total Economic Value of Community Benefits Provided By Sharp HealthCare Entities FY 2013 Estimated FY 2013 Unreimbursed Costs *Sharp Chula Vista Medical Center $58,068,422 *Sharp Coronado Hospital and Healthcare Center $12,816,465 *Sharp Grossmont Hospital $91,752,299 *Sharp Mary Birch Hospital for Women & Newborns $16,555,900 *Sharp Memorial Hospital $142,526,818 *Sharp Mesa Vista Hospital and Sharp McDonald Center $9,506,932 *Sharp Health Plan $111,481 *ALL ENTITIES $331,338,317 Table 3 includes a summary of unreimbursed costs for each Sharp entity based on the categories specifically identified in SB 697. In FY 2012, Sharp lead the community in unreimbursed medical care services among San Diego County's SB 697 hospitals and health care systems. Table 3: FY 2013 Detailed Economic Value of Community Benefits at Sharp HealthCare Entities Based on Senate Bill 697 Categories Sharp Chula Vista Medical Center *Medical Care Services - $55,459,890 *Other Benefits for Vulnerable Populations - $298,638 *Other Benefits for the Broader Community - $357,808 *Health Research, Education and Training Programs - $1,952,086 *Estimated FY 2013 Unreimbursed Costs - $58,068,422 Sharp Coronado Hospital and Healthcare Center *Medical Care Services - $11,632,883 *Other Benefits for Vulnerable Populations - $45,919 *Other Benefits for the Broader Community - $73,897 *Health Research, Education and Training Programs - $1,063,766 *Estimated FY 2013 Unreimbursed Costs - $12,816,465 Sharp Grossmont Hospital *Medical Care Services - $89,362,696 *Other Benefits for Vulnerable Populations - $714,579 *Other Benefits for the Broader Community - $675,348 *Health Research, Education and Training Programs - $999,676 *Estimated FY 2013 Unreimbursed Costs - $91,752,299 Sharp Mary Birch Hospital for Women & Newborns *Medical Care Services - $16,080,737 *Other Benefits for Vulnerable Populations - $43,972 *Other Benefits for the Broader Community - $130,528 *Health Research, Education and Training Programs - $300,663 *Estimated FY 2013 Unreimbursed Costs - $16,555,900 Sharp Memorial Hospital *Medical Care Services - $139,240,414 *Other Benefits for Vulnerable Populations - $742,030 *Other Benefits for the Broader Community - $563,455 *Health Research, Education and Training Programs - $1,980,919 *Estimated FY 2013 Unreimbursed Costs - $142,526,818 Sharp Mesa Vista Hospital and Sharp McDonald Center *Medical Care Services - $8,592,980 *Other Benefits for Vulnerable Populations - $484,130 *Other Benefits for the Broader Community - $113,683 *Health Research, Education and Training Programs - $316,139 *Estimated FY 2013 Unreimbursed Costs - $9,506,932 Sharp Health Plan *Medical Care Services - $0 *Other Benefits for Vulnerable Populations - $6,884 *Other Benefits for the Broader Community - $104,597 *Health Research, Education and Training Programs - $0 *Estimated FY 2013 Unreimbursed Costs - $111,481 ALL ENTITIES *Medical Care Services - $320,369,600 *Other Benefits for Vulnerable Populations - $2,336,152 *Other Benefits for the Broader Community - $2,019,316 *Health Research, Education and Training Programs - $6,613,249 *Estimated FY 2013 Unreimbursed Costs - $331,338,317 Section 3 Community Benefits Planning Process For the past 17 years, Sharp HealthCare (Sharp or SHC) has based its community benefits planning on findings from a triennial Community Health Needs Assessment (CHNA) process, as well as the combination of expertise in programs and services of each Sharp hospital and knowledge of the populations and communities served by those hospitals. Methodology to Conduct the 2013 Sharp HealthCare Community Health Needs Assessments Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations, and community agencies to conduct a triennial CHNA. Findings from the CHNA, the program and services expertise of each Sharp hospital, and knowledge of the populations and communities served by those hospitals combine to provide a foundation for community benefits planning and program implementation. To address the new requirements under Section 501(r) within Section 9007 of the Affordable Care Act, and IRS Form 990, Schedule H for not-for-profit hospitals, San Diego County (SDC) hospitals engaged in a new, collaborative CHNA process. This process gathered both salient hospital data and the perspectives of community health leaders and residents in order to identify and prioritize health needs for community members across the county, with a particular focus on vulnerable populations. Additionally, the process aimed to highlight health issues that hospitals could impact through programs, services and collaboration. In this endeavor, Sharp collaborated with the Hospital Association of San Diego and Imperial Counties (HASD&IC), the Institute for Public Health (IPH) at San Diego State University (SDSU), and SDC hospital systems including: Kaiser Foundation Hospital, San Diego; Palomar Health; Rady Children's Hospital; Scripps Health; Tri-City Medical Center and UC San Diego Health System. The complete report of this collaborative process the HASD&IC 2013 CHNA is available for public viewing at http://www.hasdic.org. The results of this collaborative CHNA process significantly informed the 2013 CHNAs for each Sharp hospital, and individual hospital assessments were further supported by additional data collection and analysis and community outreach specific to the primary communities served by each Sharp hospital. Additionally, in accordance with federal regulations, the Sharp Memorial Hospital (SMH) 2013 CHNA also includes needs identified for communities served by Sharp Mary Birch Hospital for Women & Newborns (SMBHWN), as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). As such, the SMH 2013 CHNA summarizes the processes and findings for communities served by both hospital entities. The 2013 CHNAs for each Sharp hospital will guide current and future community benefit programs and services, especially for high-need community members. This section describes the general methodology employed for each of Sharp HealthCare's 2013 CHNAs. Data Collection and Analysis As the study area for both the collaborative HASD&IC 2013 CHNA and the Sharp 2013 CHNAs cover SDC, the HASD&IC 2013 CHNA process and findings significantly informed Sharp's CHNA process and as such, are described as applicable throughout the various CHNA reports. For complete details on the HASD&IC 2013 CHNA process, please visit the HASD&IC website at: http://www.hasdic.org. For the HASD&IC 2013 CHNA process, the IPH employed a rigorous methodology using both community input (primary data sources) and quantitative analysis (secondary data sources) to identify and prioritize the top health conditions in SDC. These health needs were prioritized based on the following criteria: * Has a significant prevalence in the community * Contributes significantly to the morbidity and mortality in SDC * Disproportionately impacts vulnerable communities * Reflects a need that exists throughout SDC * Can be addressed through evidence-based practices by hospitals and health care systems Quantitative data (secondary sources) for both the HASD&IC 2013 CHNA and the individual Sharp hospital CHNAs included 2011 calendar year hospital discharge data at the ZIP code level, health statistics from the San Diego County Health and Human Services Agency (HHSA), the US Census Bureau, the Centers for Disease Control and Prevention, and others. The variables analyzed are included in Table 1 below, and were analyzed at the ZIP code level wherever possible: Table 1: Variables Analyzed in the HASD&IC and Sharp HealthCare 2013 CHNAs *Secondary Data Variables - Inpatient Hospitalizations by Cause - Emergency Department Visits by Cause - Demographic Data (socio-economic indicators) - Mortality Data - Regional Disease-Specific Health Data (County HHSA) - Self-Reported Health Data (California Health Interview Survey) - Specialized Health Data /Reports (various) Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC's 2013 CHNA and Sharp's 2013 CHNA processes utilized the Dignity Health/Truven Community Need Index (CNI) to identify communities in SDC with the highest level of health disparities and needs. Residents in five of these high-need neighborhoods across SDC were asked to provide input in a community forum setting. For the HASD&IC 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across SDC, reaching a total of 106 community residents. In addition, IPH conducted five key informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers, and members of community-based organizations. Following consultation with the CHNA Planning Teams at each Sharp hospital, additional, specific feedback from additional key informants and community residents was also collected. Community members were asked for open-ended feedback on the health issues of greatest importance to them, as well as any significant barriers they face in maintaining health and well-being. Findings Through the combined analyses of the results for all the data and information gathered, the following conditions were identified as priority health needs for the primary communities served by Sharp hospitals (listed in alphabetical order): * Behavioral Health (Mental Health) * Cancer * Cardiovascular Disease * Diabetes, Type II * High-Risk Pregnancy * Obesity * Orthopedics * Senior Health (including end-of-life care) As the CHNAs were hospital-specific, not all of Sharp's hospitals identified all of the above priority health needs through their CHNA process, given the specific services the individual hospitals provide to the community. For instance, Sharp Mesa Vista Hospital, the largest provider of mental health, chemical dependency and substance abuse treatment in SDC, identified behavioral health as a priority health need for the community members it serves, however it did not identify other needs such as cancer, high-risk pregnancy, etc. In addition, as part of the collaborative CHNA process, the IPH conducted a content analysis of all qualitative feedback collected through the HASD&IC 2013 CHNA process key informants, online survey respondents and community members and found that the input fell into one of the following five categories: * Access to Care or Insurance * Care Management * Education * Screening Services * Collaboration Sharp is committed to the health and well-being of the community, and the findings of Sharp's 2013 CHNAs will help to inform the activities and services provided by Sharp to improve the health of the community members it serves. The 2013 CHNA process also generated a list of currently existing resources in SDC, an asset map, that address the health needs identified through the CHNA process. While not an exhaustive list of the available resources in San Diego, this map will serve as a resource for Sharp to help continue, refine and create programs that meet the needs of their most vulnerable community members. With the challenging and uncertain future of health care, there are many factors to consider in the development of programs to best serve members of the San Diego community. The health conditions and health issues identified in this CHNA, including, but not limited to health care and insurance access and education and information for all community members, will not be resolved with a quick fix. On the contrary, these resolutions will be a journey requiring time, persistence, collaboration and innovation. It is a journey that the entire Sharp system is committed to making, and Sharp remains steadfastly dedicated to the care and improvement of health and well-being for all San Diegans. The 2013 CHNAs for each Sharp hospital are available online at http://www.sharp.com/about/community/community-health-needs-assessments or by contacting Sharp HealthCare Community Benefits at communitybenefits@sharp.com. Determination of Priority Community Needs: Sharp HealthCare Sharp entities reviewed their 2013 CHNAs and used these assessments to help determine priority needs for the communities served by their hospitals. In identifying these priorities, Sharp entities also considered the expertise and mission of its programs and services, in addition to the needs of the unique, ever-changing demographics and health topics that comprise Sharp's service area and region. Steps Completed to Prepare an Annual Community Benefits Report On an annual basis, each Sharp hospital performs the following steps in preparation of its Community Benefits Report: * Establishes and/or reviews hospital-specific measurable objectives taking into account results of the entity CHNA and evaluation of the entity's service area and expertise/services provided to the community * Verifies the need for an ongoing focus on identified community needs and/or adds new identified community needs * Reports on activities conducted in the prior fiscal year FY 2013 Report of Activities * Develops a plan for the upcoming fiscal year, including specific steps to be undertaken FY 2014 Plan * Reports and categorizes the economic value of community benefits provided in FY 2013, according to the framework specifically identified in SB 697 * Reviews and approves a Community Benefits Plan * Distributes the Community Benefits Plan and Report to members of the Sharp Board of Directors and Sharp hospital boards of directors, highlighting activities provided in the prior fiscal year as well as specific action steps to be undertaken in the upcoming fiscal year Ongoing Commitment to Collaboration In support of its ongoing commitment to working with others on addressing community health priorities to improve the health status of SDC residents, Sharp executive leadership, operational experts and other staff are actively engaged in the national American Hospital Association, statewide California Hospital Association, HASD&IC, and other local collaboratives such as Combined Health Agencies and the Community Health Improvement Partners Behavioral Health Work Team. Appendix A Sharp HealthCare Involvement in Community Organizations The list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2013. Community organizations are listed alphabetically. * 2-1-1 San Diego Board * A New PATH (Parents for Addiction, Treatment and Healing) * Access to Independence * Adult Protective Services * Aging and Independence Services (AIS) * Alzheimer's Association * American Association of Critical Care Nurses, San Diego Chapter * American Cancer Society (ACS) * American College of Cardiology * American College of Healthcare Executives (ACHE) * American Diabetes Association (ADA) * American Foundation for Suicide Prevention * American Health Information Management Association * American Heart Association (AHA) * American Hospital Association (AhA) * American Lung Association * American Liver Foundation * American Parkinson Disease Association, Inc. * American Psychiatric Nurses Association * American Red Cross of San Diego * Arc of San Diego * Arthritis Foundation * Asian Business Association * Association for Ambulatory Behavioral Health Care (National) * Association for Ambulatory Behavioral Health Care of Southern California * Association for Clinical Pastoral Education (ACPE) * Association of California Nurse Leaders (ACNL) * Association of periOperative Registered Nurses (AORN) * Association of Practical and Professional Ethics * Association of Rehabilitation Nurses * Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) * Azusa Pacific University (APU) * Bankers Hill Park West Community Development Corporation * Beacon Council Patient Safety Collaborative * Boys and Girls Club of San Diego * Bonita Business and Professional Organization * California Association of Health Plans * California Association of Hospitals and Health Systems * California Association of Marriage and Family Therapists * California Association of Physician Groups * California Board of Behavioral Health Sciences * California College, San Diego * California Council for Excellence * California Department for Public Health * California Dietetic Association, Executive Board * California HealthCare Foundation * California Health Information Association * California Hospice and Palliative Care Association * California Hospital Association Center for Behavioral Health * California Library Association * California Nursing Student Association * California State Bar, Health Subcommittee * California State University San Marcos * California Teratogen Information Service * California Women Lead * Caregiver Coalition of San Diego * Caring Hearts Medical Clinic * Chelsea's Light Foundation * Chicano Federation of San Diego County * Community Health Improvement Partners (CHIP) Behavioral Health Work Team * CHIP Board * CHIP Health Literacy Task Force * CHIP Suicide Prevention Work Team * CHIP Independent Living Association (ILA) Advisory Board and Peer Review Advisory Team * Chula Vista Chamber of Commerce * Chula Vista Community Collaborative * Chula Vista Family Health Center * Chula Vista Rotary * City of Chula Vista Wellness Program * Coalition to Transform Advanced Care (CTAC) * Combined Health Agencies * Community Emergency Response Team (CERT) * Consortium for Nursing Excellence, San Diego * Coronado Chapter of Rotary International * Coronado Christmas Parade * Coronado Fire Department * Creative Arts Consortium * Council of Women's and Infants' Specialty Hospitals (CWISH) * Cycle EastLake * Behavioral Diabetes Institute * Disabled Services Advisory Board * Downtown San Diego Partnership * East County Senior Service Providers * El Cajon Community Collaborative Council * El Cajon Fire Department * El Cajon Rotary * Elderhelp of San Diego * Emergency Nurses Association, San Diego Chapter * Employee Assistance Professionals Association * EMSTA College * Facing Futures * Family Health Centers of San Diego (FHCSD) * Gardner Group * Gary and Mary West Senior Wellness Center * Girl Scouts of San Diego Imperial Council, Inc. * Grossmont College (GC) * Grossmont Healthcare District * Grossmont Union High School District (GUHD) * Health Care Communicators Board * Health Insurance Counseling and Advocacy Program (HICAP) * Helen Woodward Animal Center * Helix Charter High School * Helping Older People Equally (HOPE) * Home of Guiding Hands * Hospital Association of San Diego and Imperial Counties (HASD&IC) * HASD&IC Community Health Needs Assessment Advisory Group * Health Sciences High and Middle College (HSHMC) Board * I Love a Clean San Diego * International Association of Eating Disorders Professionals (IAEDP) * International Lactation Consultants Association (ILCA) * Jewish Family Services of San Diego * Jewish Federation of San Diego County Jewish Senior Services Council * John Brockington Foundation * Journal for Nursing Care Quality Editorial Board * Kaplan College Advisory Board * Kiwanis Club of Chula Vista * Komen Latina Advisory Council * Komen Race for the Cure Committee * La Maestra Family Clinics * La Mesa Lion's Club * La Mesa Park and Recreation Foundation Board * Las Hermanas * LEAD, San Diego, Inc. * Leukemia & Lymphoma Society * Liberty Charter High School * Mama's Kitchen * March of Dimes * Meals-on-Wheels * Medical Library Group of Southern California and Arizona * Mended Hearts * Mental Health America Board * Mental Health Coalition * Mesa College HEIT Program Advisory Board * Miracle Babies * MRI Joint Venture Board * National Alliance on Mental Illness (NAMI) * National Association of Neonatal Nurses (NANN) * National Association of Hispanic Nurses (NAHN), San Diego Chapter * National Association of Psychiatric Healthcare Systems * National Council on Alcoholism and Drug Dependence (NCADD) * National Hospice and Palliative Care Association * National Initiative for Children's Healthcare Quality * National Kidney Foundation * National Perinatal Information Center * National University * Neighborhood Healthcare Community Clinic Board of Directors * North County Health Project * NurseWeek * Orchard Apartments * Pacific Arts Movement (Pac-Arts, formerly the San Diego Asian Film Foundation) * Palliative Care Action Community * Partnership for Philanthropic Planning of San Diego (formerly San Diego Planned Giving Roundtable) * Partnership for Smoke-Free Families * Peninsula Shepherd Senior Center * Perinatal Safety Collaborative * Perinatal Social Work Cluster * Planetree Board of Directors * Professional Oncology Network (PON) * Project CARE Council * Public Health Nurse Advisory Board * Recovery Innovations of California (RICA) * Regional Home Care Council * Regional Perinatal System (RPS) * Residential Care Council * Safety Net Connect * San Diego Community Action Network (SanDi-CAN) * San Diegans for Healthcare Coverage * San Diego Association of Diabetes Educators * San Diego Association of Directors of Volunteer Services * San Diego Association for Healthcare Recruitment * San Diego Black Nurses Association * San Diego Blood Bank * San Diego Brain Injury Foundation * San Diego Care Transitions Partnership (SDCTP) * San Diego City College * San Diego City Parks and Recreation * San Diego Committee on Employment of People with Disabilities * San Diego Council on Suicide Prevention * San Diego County Breastfeeding Coalition * San Diego County Council on Aging (SDCCOA) * San Diego County Perinatal Care Network * San Diego County Taxpayers Association * San Diego Diabetes Coalition * San Diego Dietetic Association Board * San Diego East County Chamber of Commerce Board * San Diego Emergency Medical Care Committee * San Diego Eye Bank Nurses Advisory Board * San Diego Food Bank * San Diego Foundation * San Diego Health and Human Services Agency, Live Well San Diego * San Diego Health Information Association * San Diego Healthcare Disaster Council * San Diego Housing Commission (SDHC) * San Diego Immunization Coalition * San Diego Imperial Council of Hospital Volunteers * San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. (The Center) * San Diego Mental Health Coalition * San Diego Mesa College * San Diego Military Family Collaborative * San Diego North Chamber of Commerce * San Diego Nutrition Council * San Diego Older Adult Council * San Diego Organization of Healthcare Leaders (SOHL), a local ACHE Chapter * San Diego Patient Safety Consortium * San Diego Physician Orders for Life Sustaining Treatment (POLST) Coalition * San Diego Regional Energy Office * San Diego Regional Homecare Council * San Diego Rescue Mission * San Diego Restorative Justice Mediation Program * San Diego Stroke Consortium * San Diego Urban League * San Diego-Imperial Council of Hospital Volunteers * San Diego Regional Chamber of Commerce * San Diego Science Alliance * San Ysidro High School * San Ysidro Middle School * Santee Chamber of Commerce * SAY San Diego * Schizophrenics in Transition * San Diego State University (SDSU) * Senior Community Centers of San Diego * Sigma Theta Tau International Honor Society of Nursing * Society of Trauma Nurses * South Bay Community Services * South County Economic Development Council * Southern California Association of Neonatal Nurses * Southern Caregiver Resource Center * St. Paul's Retirement Homes Foundation * St. Vincent de Paul Village * Susan G. Komen Breast Cancer Foundation * Sustainable San Diego * Sweetwater Union High School District (SUHSD) * The Meeting Place * Third Avenue Charitable Organization (TACO) * Trauma Center Association of America * United Service Organizations Council of San Diego * United Way of San Diego County * University of California, San Diego (UCSD) * University of San Diego (USD) * VA San Diego Healthcare System * Veterans Home of Chula Vista * Veterans Village of San Diego * Vista Hill ParentCare * Walk San Diego * Women, Infants and Children Program (WIC) * YMCA * YWCA Becky's House * YWCA Board of Directors * YWCA Executive Committee * YWCA In the Company of Women Event Sharp Memorial Hospital (SMH) 8695 Spectrum Center Blvd San Diego CA 921231489 953782169 Hospital CA 501(c)3 3 Sharp HealthCare 1 Grossmont Hospital Corporation (SGH) 8695 Spectrum Center Blvd san Diego CA 921231489 330449527 Hospital CA 501(c)3 3 Sharp HealthCare 1 Sharp Chula Vista Medical Center (SCVMC) 8695 Spectrum Center Blvd San Diego CA 921231489 952367304 Hospital CA 501(c)3 3 Sharp HealthCare 1 Sharp Coronado and Healthcare Center (SCHHC) 8695 Spectrum Center Blvd San Diego CA 921231489 950651579 Hospital CA 501(c)3 3 Sharp HealthCare 1 Sharp Health Plan (SHP) 8695 Spectrum Center Blvd San Diego CA 921231489 330519730 Health Plan CA 501(c)4 N/A Sharp HealthCare 1 Sharp HealthCare Foundation 8695 Spectrum Center Blvd San Diego CA 921231489 953492461 Healthcare foundation CA 501(c)3 7 Sharp HealthCare 1 Grossmont Hospital Foundation 8695 Spectrum Center Blvd San Diego CA 921231489 330124488 Hospital foundation CA 501(c)3 7 Grossmont Hospital Corporation 1 Sharp and Children's MRI Center LLC 7901 Frost Street San Diego CA 92123 330520955 Imaging CA N/A Related 1173585 1819443 0 1 0.33330 Sharp HealthCare ACO LLC 8695 Spectrum Center Blvd San Diego CA 92123 452724833 Accountable Care Organization CA N/A Related -237682 5565695 0 1 0.56500 Continuous Quality Insurance SPC 23 Lime Tree Bay Avenue PO Box 1 Grand Cayman CJ Captive Insurance Company CJ Sharp HealthCare C 59872 16228250 1.00000 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Sharp Memorial Hospital J 153348 Accrual Accounting Sharp Memorial Hospital K 283571 Accrual Accounting Sharp Memorial Hospital L 391690 Accrual Accounting Sharp Memorial Hospital M 8608536 Accrual Accounting Sharp Memorial Hospital P 195590 Accrual Accounting Sharp Memorial Hospital Q 862931901 Accrual Accounting Sharp Memorial Hospital R 3057797 Accrual Accounting Sharp Memorial Hospital S 162437440 Accrual Accounting Grossmont Hospital Corporation K 2509978 Accrual Accounting Grossmont Hospital Corporation M 4995404 Accrual Accounting Grossmont Hospital Corporation P 157815 Accrual Accounting Grossmont Hospital Corporation Q 583977696 Accrual Accounting Grossmont Hospital Corporation R 514938 Accrual Accounting Grossmont Hospital Corporation S 3295585 Accrual Accounting Sharp Chula Vista Medical Center L 74780 Accrual Accounting Sharp Chula Vista Medical Center M 798820 Accrual Accounting Sharp Chula Vista Medical Center Q 311570570 Accrual Accounting Sharp Chula Vista Medical Center R 2025073 Accrual Accounting Sharp Chula Vista Medical Center S 11860446 Accrual Accounting Sharp Coronado Hospital and Healthcare Center Q 78961396 Accrual Accounting Sharp Coronado Hospital and Healthcare Center R 205701 Accrual Accounting Sharp Coronado Hospital and Healthcare Center S 6500565 Accrual Accounting Sharp Health Plan J 499570 Accrual Accounting Sharp Health Plan L 409558 Accrual Accounting Sharp Health Plan M 125379082 Accrual Accounting Sharp Health Plan Q 7187609 Accrual Accounting Sharp Health Plan S 89723 Accrual Accounting Sharp HealthCare Foundation C 1929229 Accrual Accounting Sharp HealthCare Foundation M 2875638 Accrual Accounting Sharp HealthCare Foundation N 122320 Accrual Accounting Grossmont Hospital Foundation C 153516 Accrual Accounting Continuous Quality Insurance SPC R 5601056 Accrual Accounting