2024-08-12T12:38:08+00:00 2023-09-30 346565596 ERNST & YOUNG US LLP 101 E WASHINGTON ST PHOENIX AZ 85004 990 2022-10-01 951684089 SCRIPPS HEALTH SCRI 8586787227 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 CHRISTOPHER VAN GORDER PRESIDENT & CEO/TRUSTEE 2024-08-12 false Steven T Rutti P00775456 6023223000 2024-08-02 2022 2024-08-08 14:25:15Z CHRISTOPHER VAN GORDER 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 4641734357 false X WWW.SCRIPPS.ORG X 1924 CA Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $4.3 billion, private not-for-profit integrated health system in San Diego, Ca. (see Sch O) 17 16 19788 1287 27976415 929781 55965273 75146449 3710431605 3851530919 178704764 86554526 117250614 126977440 4062352256 4140209334 731000 535437 0 0 1639300515 1841634102 0 0 7601537 2191161767 2247895981 3831193282 4090065520 231158974 50143814 7165226432 7496795108 2403384505 2391449190 4761841927 5105345918 SEE SCHEDULE O false false 3594443461 535437 3947517944 SEE SCHEDULE O. 1708540 0 2164429 The Maxwell H. and Muriel Gluck Child Care center provides child care and pre-school education for the benefit of individuals in the community of San Diego, including employees and patients of the nonprofit 501(C)(3) entities of Scripps Health and Scripps Research Institute. Special emphasis is placed on a variety of learning and play activities in the musical and visual arts field. 3596152001 true true false true false true true false true true true false false true true false true false true true false false false true false true true true false true true false false false false false true false false true true true false false false true true true true false false true 1290 0 true 19788 true true true false false false false true true false false false false true false X 17 16 false false false false false false false true true false false true true true true true true true true true true CA X BRETT TANDE 8586787227 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 Christopher Van Gorder PRESIDENT & CEO/TRUSTEE 58.0 2.0 X X 2845338 0 49258 Kevin T Hamilton TRUSTEE, VICE CHAIR 13.0 2.0 X X 0 0 0 Richard C Bigelow TRUSTEE, CHAIR 13.0 2.0 X X 0 0 0 Dan Feldman TRUSTEE 13.0 1.0 X 0 0 0 Don Goldman TRUSTEE 13.0 1.0 X 0 0 0 Elliot A Scott TRUSTEE 13.0 1.0 X 0 0 0 Gene H Barduson TRUSTEE 13.0 1.0 X 0 0 0 Honorable Irma Gonzalez TRUSTEE 13.0 1.0 X 0 0 0 Jan Caldwell TRUSTEE 13.0 1.0 X 0 0 0 Jeff Bowman TRUSTEE 13.0 1.0 X 0 0 0 John Boyer PhD TRUSTEE 13.0 1.0 X 0 0 0 Judy Churchill PhD TRUSTEE - THRU 12/2022 13.0 1.0 X 0 0 0 Katherine A Lauer TRUSTEE- THRU 12/2022 13.0 1.0 X 0 0 0 Marty J Levin TRUSTEE- THRU 12/2022 13.0 1.0 X 0 0 0 Nicole A Clay TRUSTEE 13.0 1.0 X 0 0 0 Richard Vortmann TRUSTEE 13.0 1.0 X 0 0 0 Robert Buell Esq TRUSTEE 13.0 1.0 X 0 0 0 Shireen Matthews Esq TRUSTEE 13.0 1.0 X 0 0 0 Theodore Thomas MD TRUSTEE 13.0 1.0 X 0 0 0 William D Gore TRUSTEE 13.0 1.0 X 0 0 0 Bradley Ellis Corp SR VP, Chief Legal Officer 49.0 1.0 X 876977 0 49732 Brett Tande SVP / CFO 54.0 1.0 X 779047 0 37880 Mielle Schwartz ASSISTANT SECRETARY 39.0 0 X 80088 0 37420 Monique Gonzalez ASSISTANT SECRETARY 50.0 0 X 107427 0 29234 Anil Keswani Corp Sr VP, Chief Med Officer 50.0 0.0 X 1244840 0 52082 Barbara Price Corp Sr VP, Bus&Serv Line Dev 50.0 0 X 1272712 0 60667 Carl Etter Chief Executive, Sr VP 50.0 0 X 2596064 0 40497 Eric Cole CORP SR VP, HUMAN RESOURCES 50.0 0 X 1058172 0 49281 Ghazala Sharieff Corp Sr VP, Acute Care/Clin Excl 50.0 0 X 1477836 0 48842 John Engle Corp Sr VP, Chief Development 50.0 0 X 956490 0 50981 June Komar Corp Exec VP, Strategy & Admin 50.0 0 X 1353309 0 56545 Lisa RisserThakur Corp Sr VP, Ancillary Ops 50.0 0 X 771718 0 44770 Mary Ellen Doyle Corp VP, Nursing Ops- THRU 01/2022 50.0 0 X 232451 0 5298 Richard Neale Corp Exec VP, Chief Growth Officer 10.0 40.0 X 1310198 0 53582 Shane Thielman Corp Sr VP, CIO 50.0 0 X 887313 0 57527 Shawn Forrester Corp VP, Payer Relations 20.0 20.0 X 878432 0 24795 Thomas Buchholz Corp Sr VP, MD Anderson 50.0 0 X 1424367 0 39600 Thomas Gammiere Chief Executive, Sr VP 50.0 0 X 1205312 0 48697 Cynthia M Steckel VP, Chief Ops Exec_Acute 50.0 0 X 668593 0 35183 Gerald Soderstrom Corp VP, Audit / Compliance 50.0 0 X 752372 0 51914 John Poole Corp VP, System Improvement 50.0 0 X 772659 0 31442 Timothy L Jacoby Corp VP, Construction / Facilities 50.0 0 X 611398 0 39700 Tracy Chu Corp VP, POP Hlth CHF EXEC/ACO 50.0 0 X 778062 0 32180 Richard Rothberger Former Officer 0.0 0 X 1470476 0 32586 26411649 0 1059693 4473 true true false Scripps Clinic Medical Group Inc 10666 N Torrey Pines Rd La Jolla CA 92037 Physician Services 464075732 Scripps Coastal Medical Group 501 Washington Ave San Diego CA 92103 Physician Services 76150890 Scripps Health Inpatient Providers Med Group 10010 Campus Point Dr San Diego CA 92121 Physician Services 44313107 MedImpact Healthcare Systems 10181 Scripps Gateway Ct San Diego CA 92131 Pharmaceutical Services 40779591 Bomel Construction 5150 Avenida Encinas Carlsbad CA 92008 Construction Services 14148635 145 1283729 43497986 30364734 1649069 75146449 HEALTHCARE DELIVERY REV 622110 3644664799 3643261714 1403085 PROVIDER FEE REVENUE 622110 30294670 30294670 CAPITATION PREMIUM 622110 123086603 123086603 JOINT VENTURE REVENUE 900099 22353169 22353169 RENTAL INCOME - MOB 531120 12206298 12206298 18925380 18740347 185033 0 3851530919 78039622 585904 77453718 0 0 508942694 500427790 8514904 0 8514904 8514904 546754 1283729 1097233 -550479 -550479 MANAGEMENT SERVICES 561110 52978179 27463516 25514663 PHARMACEUTICAL REVENUE 446110 41624289 41624289 ALL OTHER REVENUE 900099 32925451 29063649 287730 3574072 0 0 0 0 127527919 4140209334 3948094255 27976415 88992215 X 535437 535437 0 0 24062199 24062199 204206 204206 1521368175 1300839037 215936333 4592805 54332561 45583042 8607367 142152 127054245 126589620 0 464625 114612716 95476838 18861089 274789 20487476 1339672 19147804 1171021 1159897 11124 556027 556027 6095935 6095935 928632947 858814044 69294705 524198 1930668 49107 1880736 825 82925649 69454745 12885185 585719 82177420 44969395 37208025 0 111167923 90328273 20713996 125654 36423610 31598545 4825065 177164304 158854870 18309434 11667675 11649227 18448 MEDICAL SUPPLIES 721600161 721600161 REPAIRS & MAINTENANCE 30838104 4287122 26545531 5451 HOSPITAL FEE PROGRAM 25209063 25209063 ALL OTHER EXPENSES 9847998 8973803 874195 0 0 0 0 4090065520 3596152001 486311982 7601537 627233578 328877965 7244369 7714518 620769219 626510398 22248978 22987129 0 0 85708077 76645463 40453444 53130912 4529621230 1916534145 2383555037 2613087085 2162109044 2558568903 705379000 720177000 75901408 74349869 45109895 45109895 389514383 369635971 7165226432 7496795108 674461229 592625617 744871000 711154000 0 0 109008118 187426010 875044158 900243563 2403384505 2391449190 X 4489437218 4851868923 272404709 253476995 4761841927 5105345918 7165226432 7496795108 X 50143814 293666698 -306521 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true 120787 true 268300 false true 359439 748526 false Schedule C, Part II-B, Line 1b PERSONS AT SCRIPPS HEALTH EXCEEDED 5% OF TOTAL TIME SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES Schedule C, Part II-B, Line 1f DISCLOSURE OF A TRANSFER OF SCRIPPS FUNDS IN CALIFORNIA HOSPITAL ASSOCIATION (CHA) ACCOUNT TO THE CALIFORNIA HOSPITALS COMMITTEE ON ISSUES (CHCI) ACCOUNT. Schedule C, Part II-B, Line 1g VALUE DETERMINED UTILIZING GROSS-UP METHOD FOR DIRECT LOBBYING COSTS. LOBBYING LABOR COSTS OF PARTIAL TIME FOR (2) PERSONS AT SCRIPPS HEALTH X 175% + ALLOCABLE THIRD-PARTY COSTS (JGC CONSULTING, SD LAND LAWYERS) SPENT ON DIRECT CONTACT WITH LEGISLATORS, STAFF AND GOVERNMENT OFFICIALS TO ENGAGE IN LOBBYING ACTIVITIES ARE REFERENCED HERE. Schedule C, Part II-B, Line 1i OTHER ACTIVITIES APPROXIMATE VALUE CONSIDERS A PORTION OF THE DUES OF MEMBER ORGANIZATIONS SPENT ON LOBBYING IN ADDITION TO ANY TRAVEL EXPENSES OCCURRED FOR GOVERNMENT RELATIONS: SENIOR DIRECTOR, GOVERNMENT RELATIONS; DIRECTOR, COMMUNITY AND GOVERNMENT RELATIONS RELATED TO LOBBYING ACTIVITIES. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Government Relations INFORMATION AND EDUCATION SCRIPPS HEALTH ON ITS OWN BEHALF AND AS A MEMBER OF SEVERAL HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS PARTICIPATES IN PUBLIC AFFAIRS AND ADVOCACY ACTIVITIES. SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY AND SPECIFICALLY ON BEHALF OF SCRIPPS HEALTH. OTHER ACTIVITY IS ORGANIZED BY THESE INVOLVED ORGANIZATIONS SUPPORTED BY SCRIPPS HEALTH PARTICIPATION. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: BUDGET AND FISCAL POLICY IMPACTS; MEDICARE AND MEDICAID REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING; ACCOUNTABLE CARE ORGANIZATIONS; VIOLENCE AGAINST HEALTH CARE WORKERS; HEALTH CARE WORKERS MINIMUM WAGE; SIESMIC MANDATES; BEHAVIORAL HEALTH CLINICAL WORKFORCE AND OTHER OPERATIONAL ISSUES; HOMELESSNESS; LOCAL LAND USE ISSUES LIKE THE CONDITIONAL USE PERMITS FOR MERCY SAN DIEGO AND ENCINITAS HOSPITAL CONSTRUCTION PROJECTS. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. DIRECT COMMUNICATION (MEETINGS, EMAIL, CALLS, LETTERS) WITH SAN DIEGO LEGISLATIVE DELEGATIONS - FEDERAL AND STATE. ON SAN DIEGO LOCAL LEVEL EMPLOYED SD LAND LAWYERS TO REPRESENT INTERESTS ON LAND DEVELOPMENT NEEDS. ON CALIFORNIA STATE LEVEL EMPLOYED LOBBY FIRM JGC GOVERNMENT RELATIONS TO REPRESENT INTERESTS ON CERTAIN MEASURES. SCRIPPS DOES NOT EMPLOY FEDERAL LOBBYISTS. LOBBY FIRM ALSO WORKED WITH OTHER HEALTH SYSTEM CONTRACT LOBBYISTS AND CALIFORNIA HOSPITAL ASSOCIATION LOBBY TEAM ON SELECTED LEGISLATION. WORKED IN CONCERT WITH STATE AND NATIONAL HEALTH CARE ORGANIZATIONS THAT CONDUCTED LOBBY PROGRAMS, INCLUDING: AMERICAN HOSPITAL ASSOCIATION, CALIFORNIA HOSPITAL ASSOCIATION, HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES, PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, ALLIANCE OF CATHOLIC HEALTH CARE. SCRIPPS HEALTH DID NOT FILE FORM 5768 UNDER SECTION 501(H). THERE ARE TESTS FOR TAX EXEMPTION - A "SUBSTANTIAL PART TEST AN "EXPENDITURE TEST." AS A 501(C)(3) ORGANIZATION, WE CAN OPT TO FOLLOW THE GUIDELINE THAT "NO SUBSTANTIAL PART" OF OUR ACTIVITIES ARE CARRIED ON TO INFLUENCE LEGISLATION. UNDER SECTION 501(H), ELIGIBLE 501(C)(3) ORGANIZATIONS CAN ELECT TO MAKE LIMITED EXPENDITURES TO INFLUENCE LEGISLATION. THE "EXPENDITURE TEST" IS SUBJECT TO AMOUNTS PERMITTED BY THAT SECTION. WHILE OUR EXPENDITURES FALL WELL BELOW THE LIMITS, WE ALSO EXPEND WHAT IS GENERALLY CONSIDERED AS NO SUBSTANTIAL PART ON SUCH EXPENDITURES. THEREFORE, WE OPT NOT TO FILE FORM 5768, THE FORM REQUIRED UNDER SECTION 501(H). NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE ASSOCIATION OF ACADEMIC MEDICAL CENTERS (AAMC) SAN DIEGO REGIONAL CHAMBER OF COMMERCE NATIONAL ASSOCIATION FOR ACCOUNTABLE CARE ORGANIZATIONS (NAACOS) X 1 16.0 1 0 1 true 274.0 2645 true 0 742881 X false 117874000 208670 13935117 0 4548650 1322507 126146630 140886000 1207385 -19713562 0 3181443 1324380 117874000 129880000 540474 15126128 897549 2574215 1188838 140886000 121490000 -141903 12705109 874375 2148726 1150105 129880000 119389000 956581 4884528 844412 1820256 1075441 121490000 0.0 1.0 0.0 false false 41897333 165294579 207191912 1969109845 883629565 1085480280 116849555 90205780 26643775 1492031799 940828310 551203489 744438119 1870490 742567629 2613087085 MULTI-STRATEGY FUNDS 344672000 F PRIVATE EQUITY FUNDS 327505000 F LIMITED PARTNERSHIP 48000000 F 720177000 TAXABLE DEBT 549223767 LEASE LIABILITIES 227960477 SELF-INSURED MALPRACTICE LIABILITY 43538567 SELF-INSURED WORKER'S COMPENSATION 44268607 DEFERRED LEASE 2127473 ASSET RETIREMENT OBLIGATION 19252012 ANNUITY AND UNITRUSTS 11187658 DEFERRED RETIREMENT 2417749 PROVIDER FEE LIABILITY 0 DEPOSITS AND CONTINGENCIES 267253 INTERCOMPANY LIABILITIES 0 900243563 X Schedule D, Part II, Line 9 Conservation easements financial reporting THE HISTORICAL STRUCTURE THAT IS CONSIDERED TO BE A CONSERVATION EASEMENT IS REPORTED IN THE MERCY HOSPITAL ENTITY OF THE CONSOLIDATED FINANCIAL STATEMENTS. Schedule D, Part III, Line 4 Collections of art - description of collections SCRIPPS HEALTH ACCEPTS AND MAINTAINS GIFTS-IN-KIND CONTRIBUTIONS FOR ART AND SCULPTURES ("COLLECTIONS"). COLLECTIONS DONATED WITH AN APPRAISED VALUE GREATER THAN $10,000 ARE RECORDED IN THE GENERAL LEDGER AND CLASSIFIED AS OTHER ASSETS AND DONOR WITHOUT RESTRICTION CONTRIBUTIONS. THE COLLECTIONS ARE MAINTAINED BY SCRIPPS HEALTH AND ARE PUBLICLY DISPLAYED. AN ANNUAL INVENTORY TO ASSESS CONDITION OF THE COLLECTIONS IS PERFORMED. SCRIPPS DOES NOT INTEND TO SELL THE COLLECTIONS FOR ANY FINANCIAL BENEFIT. SCRIPPS HEALTH'S COLLECTIONS PROVIDES A CLEAR CONTRIBUTION TO MAKE AND OFFER OPPORTUNITIES IN DELIVERY OF BETTER HEALTH, WELLBEING AND IMPROVED EXPERIENCE FOR PATIENTS, SERVICE USERS AND STAFF ACROSS THE SYSTEM. Schedule D, Part V, Line 4 Intended uses of endowment funds CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES: $636,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES: $16,876,946 CONTRIBUTIONS RECEIVED FOR USE IN THE SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS: $41,413,255 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE: $12,785,414 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS: $13,325,510 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OF BUSINESS, REGULARLY CARRIED ON, AND NOT IN THE FURTHERANCE OF THE PURPOSED FOR WHICH IT WAS GRANTED EXEMPTION. UNDER FASB ASC 740, INCOME TAXES, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE ORGANIZATION RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE LIKELY THAN NOT THRESHOLD IS MET. THE ORGANIZATION RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS ONLY FOR TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAXES, INTEREST OR PENALTIES AND NO SIGNIFICANT TAX ASSETS FOR TAX BENEFITS WAS ACCRUED AT SEPTEMBER 30, 2023 OR 2022. SCRIPPS HEALTH CURRENTLY FILES FORM 990 (INFORMATIONAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAXES) AND FORM 990T (BUSINESS INCOME TAX RETURN FOR AN EXEMPT ORGANIZATION) IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. SCRIPPS HEALTH IS NOT SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2018 IN MAJOR TAX JURISDICTIONS. North America (Canada & Mexico only) 0 34 Program Services Reconstructive surgery 393349 Central America and the Caribbean 0 0 Investments 446456904 Europe (Including Iceland and Greenland) 0 0 Investments 84031653 0 34 0 0 0 34 530881906 0 530881906 true false true true true false Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements CENTRAL AMERICA AND THE CARIBBEAN-Accrual; EUROPE (INCLUDING ICELAND AND GREENLAND)-Accrual; NORTH AMERICA (CANADA & MEXICO ONLY)-Accrual Candlelight Ball 561500 432040 129460 268022 15975 159467 Mercy Ball 616889 412705 204184 134465 14393 163030 2 652094 438984 213110 234203 6475 101203 1830483 1283729 546754 636690 36843 423700 1097233 -550479 true true X true X true X true true true false true true 0 0 18248321 0 18248321 0.0045 0 0 458654744 247438261 211216483 0.0516 0 0 0 0 0 0.0 0 0 476903065 247438261 229464804 0.0561 0 0 8801989 2102477 6699512 0.0016 0 0 50199914 12693242 37506672 0.0092 0 0 16602701 13735546 2867155 0.0007 0 0 17755146 14481872 3273274 0.0008 0 0 586100 0 586100 0.0001 0 0 93945850 43013137 50932713 0.0125 0 0 570848915 290451398 280397517 0.0686 4312 4312 0.0000 27149 27149 0.0000 24800 24800 0.0000 0 0.0 35000 35000 0.0000 0 0.0 5260 5260 0.0000 261348 95248 166100 0.0000 0 0.0 0 0 357869 95248 262621 0.0001 true 13989254 476583707 596164522 -119580815 X true true SCRIPPS ENCINITAS SURGERY CENTER AMBULATORY SURGERY CENTER 0.5538 0.2525 SCRIPPS MEMORIAL XIMED MEDICAL MEDICAL OFFICE BUILDING 0.153 0.772 SCRIPPS MERCY ASC AMBULATORY SURGERY CENTER 0.825 0.265 SCRIPPSUSP SURGERY CENTERS AMBULATORY SURGERY CENTER 0.5 0.39 5 1 SCRIPPS MEMORIAL HOSPITAL LA JOLLA 9888 GENESEE AVENUE LA JOLLA CA 92037 WWW.SCRIPPS.ORG 080000050 X X X X X A 2 SCRIPPS MERCY HOSPITAL 4077 5TH AVENUE SAN DIEGO CA 92103 WWW.SCRIPPS.ORG 090000074 X X X X X A 3 SCRIPPS GREEN HOSPITAL 10666 NORTH TORREY PINES RD SAN DIEGO CA 92024 WWW.SCRIPPS.ORG 080000139 X X X X A 4 SCRIPPS MEMORIAL HOSPITAL ENCINITAS 354 SANTA FE DRIVE SAN DIEGO CA 92103 WWW.SCRIPPS.ORG 080000148 X X X X X A 5 SELECT SPECIALTY HOSPITAL - SAN DIEGO 555 WASHINGTON ST SAN DIEGO CA 92103 WWW.SELECTSPECIALTYHOSPITALS.COM 090000404 X B A 4 false false true X X X X X X X X X 21 true true true true X HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY/ADDRESSING-COMMUNITY-NEEDS X true 22 true https://www.scripps.org/sparkle-assets/documents/scripps-health-implementation-strategy-2023-2025.pd false true X 200.0 400.0 X X X X true true X X X X true X HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE X HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE X HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE X X X X X X X true X false X X X X true X false false B 1 false false true X X X X X X X X X 22 true true true true X HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/LOCATIONS-AND-TOURS/CA/SAN-DIEGO/SAN-DIEGO/ X true 22 true https://www.scripps.org/sparkle-assets/documents/scripps-health-implementation-strategy-2023-2025.pd false true X 200.0 400.0 X X X X true true X X X X true X https://www.scripps.org/patients-and-visitors/financial-assistance X https://www.scripps.org/patients-and-visitors/financial-assistance X https://www.scripps.org/patients-and-visitors/financial-assistance X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E 2022 CHNA PRIORITIZATION OF THE TOP COMMUNITY NEEDS THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH HEALTH CONDITIONS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED, THE MAGNITUDE/SCALE OF THE NEED; DISPARITIES OR INEQUITIES AND CHANGE OVER TIME. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. THROUGH THE PRIORITIZATION PROCESS DESCRIBED IN THE METHODOLOGY SECTION, THE CHNA COMMITTEE IDENTIFIED THE MOST CRITICAL TOP COMMUNITY NEEDS WITHIN SAN DIEGO COUNTY, LISTED BELOW IN ALPHABETICAL ORDER: -ACCESS TO HEALTH CARE -AGING CARE & SUPPORT -BEHAVIORAL HEALTH -CHILDREN & YOUTH WELLBEING -CHRONIC HEALTH CONDITIONS -COMMUNITY SAFETY -ECONOMIC STABILITY WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY: A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - REPORTING GROUP A. COMMUNITY ENGAGEMENT THE GOAL OF THE COMMUNITY ENGAGEMENT PROCESS WAS TO SOLICIT INPUT FROM A WIDE RANGE OF STAKEHOLDERS SO THAT THE SAMPLE WAS AS REPRESENTATIVE AS POSSIBLE OF THOSE FACING INEQUITIES IN SAN DIEGO COUNTY. SPECIAL EFFORTS WERE MADE TO INCLUDE COMMUNITY MEMBERS FROM GROUPS THAT EXPERIENCE HEALTH DISPARITIES AND SERVICE PROVIDERS WHO WORK WITH THOSE VULNERABLE POPULATIONS. A TOTAL OF 841 INDIVIDUALS PARTICIPATED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING EFFORTS: - WORKING WITH COMMUNITY HEALTH WORKERS TO CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS. - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS, COMMUNITY HEALTH WORKERS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, CIVIC LEADERS, AND HEALTH CARE LEADERS (CONDUCTED IN COLLABORATION WITH KAISER FOUNDATION HOSPITAL (KFH)-SAN DIEGO). - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH HOSPITAL AND HEALTH SYSTEM CLINICIANS, CASE MANAGERS, SOCIAL WORKERS, AND EXECUTIVE LEADERS. - DISTRIBUTING AN ONLINE SURVEY TO COMMUNITY MEMBERS, HOSPITAL STAFF, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL GOVERNMENT STAFF. THE CHNA COMMITTEE WORKED WITH COMMUNITY PARTNERS TO PLAN COMMUNITY ENGAGEMENT ACTIVITIES WITH STAKEHOLDERS REPRESENTING EVERY REGION OF SAN DIEGO COUNTY AND ALL AGE GROUPS. IN ADDITION, THE CHNA COMMITTEE EXPLICITLY SOUGHT TO ENGAGE A WIDE VARIETY OF STAKEHOLDERS REPRESENTING NUMEROUS, DIVERSE RACIAL AND ETHNIC GROUPS. KEY INFORMANT INTERVIEWS AND FOCUS GROUPS KEY INFORMANT INTERVIEWS AND FOCUS GROUPS WERE USED TO IDENTIFY AND EXPLORE PRIORITY HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO CARE, AND COMMUNITY ASSETS AND RESOURCES, WITH INTERVIEWS AND FOCUS GROUPS CONDUCTED BETWEEN OCTOBER 2021 AND APRIL 2022. INTERVIEWERS AND FACILITATORS EMPLOYED THE QUESTIONS DEVELOPED AND APPROVED BY THE CHNA COMMITTEE TO GENERATE DISCUSSION ABOUT SPECIFIC COMMUNITY HEALTH NEEDS, AS WELL AS OPEN ENDED QUESTIONS FOR BROADER DISCUSSIONS. BROAD QUESTIONS ABOUT HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH WERE ASKED AT THE BEGINNING OF EACH DISCUSSION, FOLLOWED BY MORE SPECIFIC QUESTIONS TARGETED FOR THE PARTICIPANTS. QUESTIONS VARIED DEPENDING ON THE EXPERTISE AND/OR SPECIFIC INTERESTS OF THE PERSON OR GROUP PARTICIPATING IN EACH INTERVIEW AND FOCUS GROUP. FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED VIA ZOOM. INCENTIVES, IN THE FORM OF GIFT CARDS, WERE ALSO PROVIDED WHEN THE GROUPS WERE COMPRISED OF COMMUNITY RESIDENTS. EACH INTERVIEW AND FOCUS GROUP BEGAN WITH A DISCUSSION ABOUT THE PURPOSE AND PROCESS OF THE CHNA. THE INTERVIEWER OBTAINED VERBAL AND VISUAL CONSENT TO PROCEED (AND, IN SOME CASES, RECORD) AND ASSURED PARTICIPANTS THAT THEIR PARTICIPATION WAS VOLUNTARY AND THAT THEIR FEEDBACK WOULD BE ANONYMOUS. INTERPRETATIVE AND TRANSLATION SERVICES WERE ARRANGED FOR ANY GROUP THAT REQUESTED THEM. ONE FOCUS GROUP WAS CONDUCTED IN SPANISH BY A FACILITATOR THROUGH SIMULTANEOUS ENGLISH AND SPANISH INTERPRETATION. ONLINE COMMUNITY SURVEY THE CHNA ONLINE COMMUNITY SURVEY WAS USED TO SUPPORT PRIORITIZATION OF HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH BASED ON COMMUNITY FEEDBACK ABOUT WHAT SURVEY RESPONDENTS VIEWED AS THE MOST IMPORTANT OR MOST SERIOUS CHALLENGES. THE SURVEY WAS DISTRIBUTED VIA EMAIL TO TARGETED COMMUNITY- BASED ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, RESIDENT-LED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, GOVERNMENT AGENCIES, GRANTMAKING ORGANIZATIONS, AND HOSPITALS AND HEALTH SYSTEMS THAT SERVE A DIVERSE ARRAY OF PEOPLE IN SAN DIEGO COUNTY. WHEN POSSIBLE, THESE ORGANIZATIONS SHARED THE LINK TO THE SURVEY WITH THE CLIENTS THEY SERVED. EMAIL RECIPIENTS WERE ALSO ENCOURAGED TO SHARE THE SURVEY WITH THEIR COLLEAGUES. THE SURVEY - OPEN FROM FEBRUARY 14 TO MARCH 30, 2022 - WAS ALSO WIDELY SHARED THROUGH SOCIAL EMAIL AND RESHARED BY COMMUNITY-BASED ORGANIZATIONS. THE SURVEY WAS DESIGNED TO BE TAKEN BY COMMUNITY MEMBERS AND WAS TRANSLATED FROM ENGLISH INTO FIVE ADDITIONAL LANGUAGES: ARABIC, SPANISH, SOMALI, TAGALOG, AND VIETNAMESE. MIDCITY CAN, A COMMUNITY-BASED ORGANIZATION LOCATED IN CITY HEIGHTS, WAS CONTRACTED TO COMPLETE THE TRANSLATIONS. RESEARCH PARTNERS AT THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT THE SAN DIEGO STATE UNIVERSITY (SDSU) SCHOOL OF PUBLIC HEALTH (SPH) FACILITATED TWO FOCUS GROUPS WITH COMMUNITY HEALTH WORKERS (CHWS). THE IPH CONDUCTED BOTH FOCUS GROUPS THROUGH ZOOM. ALL FOCUS GROUP PARTICIPANTS WERE COMMUNITY HEALTH WORKERS WORKING FOR A COVID-19 CONTACT TRACING PROGRAM. FOCUS GROUP PARTICIPANTS WERE RECRUITED THROUGH MULTIPLE AVENUES, INCLUDING ANNOUNCEMENTS IN THE COUNTY OF SAN DIEGO HHSA'S COMMUNITY HEALTH WORKER COLLABORATIVE NEWSLETTER, DISSEMINATED BY THE COUNTY TO PROVIDE UPDATES ON COVID-19 COMMUNICATION AND OUTREACH SERVICES TO THE INDIVIDUALS WORKING ON ONE OF THE COUNTY COVID-19 CONTRACTS. IN ADDITION, EMAILS WERE DISSEMINATED DIRECTLY TO ALL CHWS ON THE COMMUNITIES FIGHTING COVID! PROJECT AT SDSU, AND EMAILS WERE SENT TO THE LEADS ON EIGHT DIFFERENT COUNTY COVID-19 CONTRACTS, REQUESTING THAT THEY DISSEMINATE THE INFORMATION TO THEIR CHWS OR OUTREACH WORKERS. THE ANNOUNCEMENT INCLUDED AN INTEREST FORM THAT ASKED FOR THE PERSON'S CONTACT INFORMATION, DAY OF THE WEEK AND TIME OF DAY THAT WORKED BEST FOR THEM, TYPE OF GIFT CARD THEY WOULD LIKE TO RECEIVE AS A THANK YOU, AND A BRIEF DESCRIPTION OF THE TYPE OF WORK THEY CURRENTLY DO. FOCUS GROUP PARTICIPANTS WERE ASKED OPEN-ENDED QUESTIONS ABOUT IDENTIFYING SPECIFIC HEALTH CONDITIONS OF CONCERN, ABOUT INEQUITIES IN THE COMMUNITY, AND ABOUT THE NEEDS OF YOUTH AND SENIORS. GIFT CARDS WERE EMAILED TWO DAYS AFTER THE FOCUS GROUP AS A THANK YOU TO ALL PARTICIPANTS. PROMOTORAS AND COMMUNITY HEALTH WORKER INTERVIEWS/ACCESS TO HEALTH CARE INTERVIEWS TO ENSURE THE REPORT INCLUDED DIRECT COMMUNITY MEMBER FEEDBACK FROM RACIAL AND ETHNIC GROUPS EXPERIENCING DISPARATE HEALTH OUTCOMES, THE CHNA COMMITTEE EMPLOYED A NEW STRATEGY TO PARTNER WITH COMMUNITY-BASED ORGANIZATIONS THAT WORK WITH PROMOTORAS AND COMMUNITY HEALTH WORKERS. THE ONLINE COMMUNITY SURVEY WAS ADAPTED WITH A SUBSET OF THE SURVEY QUESTIONS FOR USE AS A DATA COLLECTION TOOL. THE SAN DIEGO REFUGEE COMMUNITIES COALITION AND THE CHICANO FEDERATION WERE SELECTED TO RECRUIT INTERESTED COMMUNITY HEALTH WORKERS AND PROMOTORAS TO CONDUCT THE INTERVIEWS. HASD&IC STAFF ATTENDED A SAN DIEGO REFUGEE COMMUNITIES COALITION WEEKLY COMMUNITY HEALTH WORKER MEETING TO PROVIDE TRAINING ON THE GOALS OF THE CHNA AND HOW TO ADMINISTER THE INTERVIEW. HASD&IC STAFF ALSO PROVIDED TRAINING TO THE CHICANO FEDERATION PROMOTORAS. PROMOTORAS AND COMMUNITY HEALTH WORKERS CONDUCTED INTERVIEWS EITHER IN PERSON OR OVER THE PHONE. INTERVIEWERS ASKED OPEN-ENDED QUESTIONS ABOUT THE FOLLOWING: HEALTH NEEDS, SOCIAL NEEDS, ACCESS TO CARE CHALLENGES, AND WHAT HOSPITALS COULD DO TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. INTERVIEWERS THEN CODED RESPONSES AND INPUT THEM IN AN ONLINE DATA COLLECTION TOOL. PRICE PHILANTHROPIES FOUNDATION GENEROUSLY PROVIDED GRANTS TO BOTH ORGANIZATIONS TO COMPENSATE PROMOTORAS AND COMMUNITY HEALTH WORKERS FOR COMPLETING INTERVIEWS. Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - REPORTING GROUP A. 2022 CHNA PARTICIPATING HOSPITALS AND HEALTH SYSTEMS THE CHNA RESPONDS TO IRS REGULATORY REQUIREMENTS THAT PRIVATE NOT-FOR-PROFIT (TAX- EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. ALTHOUGH ONLY NOT FOR-PROFIT 501(C)(3) HOSPITALS AND HEALTH SYSTEMS ARE SUBJECT TO STATE AND IRS REGULATORY REQUIREMENTS, THE MAJORITY OF 2022 CHNA COLLABORATIVE MEMBERS ARE HOSPITALS AND HEALTH SYSTEMS THAT ARE NOT SUBJECT TO ANY CHNA REQUIREMENTS BUT ARE DEEPLY ENGAGED IN THE COMMUNITIES THEY SERVE AND COMMITTED TO THE GOALS OF A COLLABORATIVE CHNA. EVERY HEALTH SYSTEM, HEALTH DISTRICT, PRIVATE HOSPITAL AND BEHAVIORAL HEALTH HOSPITAL IN SAN DIEGO PARTICIPATED IN THE COLLECTIVE EFFORT TO BETTER UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF SAN DIEGO COMMUNITIES. PARTICIPATING HOSPITAL AND HEALTH SYSTEMS SUPPORTED THE CHNA PROCESS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY WORKGROUP, THE COMMUNITY NEEDS ASSESSMENT COMMITTEE, AND THE HASD&IC BOARD OF DIRECTORS. -ALVARADO HOSPITAL MEDICAL CENTER -ALVARADO PARKWAY INSTITUTE BEHAVIORAL HEALTH SYSTEM -AURORA BEHAVIORAL HEALTH CARE SAN DIEGO -GROSSMONT HEALTHCARE DISTRICT -KAISER PERMANENTE SAN DIEGO -PALOMAR HEALTH -PARADISE VALLEY HOSPITAL/BAYVIEW BEHAVIORAL HEALTH CAMPUS -RADY CHILDREN'S HOSPITAL - SAN DIEGO -SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL -SCRIPPS HEALTH -SHARP HEALTHCARE -TRI-CITY MEDICAL CENTER -UC SAN DIEGO HEALTH -VA SAN DIEGO HEALTHCARE SYSTEM -SELECT MEDICAL Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - REPORTING GROUP A. THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES(HASD&IC) CONTRACTED WITH THE FOLLOWING RESEARCH PARTNERS ON THE 2022 COMMMUNITY HEALTH NEEDS ASSESSMENT. PATRICIA SINAY FROM COMMUNITY INVESTMENT STRATEGIES (CIS) SUPPORTED THE HOSPITAL ASSOCIATION TEAM WITH QUALITATIVE RESEARCH AND REPORT WRITING. CIS PROVIDES STRATEGIC VISIONING & PLANNING, MANAGEMENT TRAINING, AND PROGRAM IMPLEMENTATION SERVICES TO NONPROFITS, BUSINESSES, GOVERNMENTS, AND PHILANTHROPY. AS A LATINA IMMIGRANT, PATRICIA SPECIALIZES IN INCLUSIVE, CROSS-SECTOR EFFORTS THAT STRENGTHEN THE GREATER GOOD FOR INDIVIDUALS, FAMILIES, AND COMMUNITIES. HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU). IN THE LAST 20 YEARS, THE IPH HAS PARTNERED WITH OVER 70 LOCAL, STATE, NATIONAL AND INTERNATIONAL PUBLIC AND PRIVATE COMMUNITY-BASED AGENCIES AND ORGANIZATIONS REPRESENTING MORE THAN 120 MULTIPLE-YEAR CONTRACTS WITH A WIDE VARIETY OF NEEDS AND METHODOLOGIES. THE IPH HAS EXPERTISE IN QUALITATIVE AND QUANTITATIVE COMMUNITY-BASED RESEARCH METHODS. IN ADDITION, THE IPH HAS EXTENSIVE EXPERIENCE IN SUCCESSFUL COMMUNITY ENGAGEMENT WITH DIVERSE GROUPS, INCLUDING NON-ENGLISH SPEAKERS. THE IPH HAS BEEN WORKING ACROSS CULTURES AND WITH VULNERABLE POPULATIONS FOR 25 YEARS, INCLUDING PROGRAMS WITH ASIAN AND PACIFIC ISLANDER COMMUNITIES, AFRICAN-AMERICAN COMMUNITIES, EAST AFRICAN COMMUNITIES, LATINO COMMUNITIES, NATIVE AMERICAN COMMUNITIES, LOW-INCOME COMMUNITIES, GAY, BISEXUAL, TRANSGENDER INDIVIDUALS, PEOPLE LIVING WITH HIV/AIDS, INDIVIDUALS EXPERIENCING HOMELESSNESS, ADOLESCENTS WHO ARE PREGNANT OR PARENTING, AND SURVIVORS OF DOMESTIC VIOLENCE AND SEXUAL ASSAULT, AMONG OTHERS. IPH STAFF HAVE SPECIAL EXPERTISE IN CONDUCTING CULTURALLY COMPETENT WORK AND EXPLORING SENSITIVE ISSUES. IPH COMMUNITY ENGAGEMENT EFFORTS HAVE INCLUDED PERFORMING KEY INFORMANT INTERVIEWS, LEADING FOCUS GROUPS, FACILITATING TOWN HALL MEETINGS, AND CONDUCTING PATIENT AND PROVIDER INTERVIEWS. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - REPORTING GROUP A. SCRIPPS HEALTH IMPLEMENTATION STRATEGY SUMMARY AND COMMUNITY NEEDS IDENTIFIED. WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY; A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL-SUITED TO DEVELOPING A RESPONSE TO THE SCRIPPS CHNA. THE EVALUATION OF THE IMPLEMENTATION STRATEGY ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND ADJUSTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION STRATEGY ARE ALSO TAILORED TO EACH OBJECTIVE AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION STRATEGY IS FILED ANNUALLY WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. COMMUNITY NEEDS SCRIPPS IS ADDRESSING THE HEALTH FOCUS AREAS IDENTIFIED ABOVE WERE DETERMINED THROUGH DATA COLLECTION, ANALYSIS, AND A PRIORITIZATION PROCESS THAT INCORPORATED COMMUNITY INPUT. SCRIPPS IS ADDRESSING ACCESS TO CARE, AGING CARE & SUPPORT, BEHAVIORAL HEALTH, CHILDREN & YOUTH WELLBEING, CHRONIC HEALTH CONDITIONS WHICH INCLUDES CARDIOVASCULAR DISEASE, CANCER AND DIABETES, COMMUNITY SAFETY AND ECONOMIC STABILITY IN THE FY23-25 IMPLEMENTATION STRATEGY. SCRIPPS ADDRESSES MANY OF THE SOCIAL DETERMINANTS OF HEALTH WITHIN THE HEALTH CONDITIONS IDENTIFIED IN THIS REPORT SUCH AS, COMMUNITY AND SOCIAL SUPPORT, FOOD INSECURITY, TRANSPORTATION, EDUCATION, AND HOMELESSNESS. COMMUNITY NEEDS SCRIPPS IS NOT DIRECTLY ADDRESSING HOMELESSNESS AND HOUSING INSTABILITY ARE IDENTIFIED AS IMPORTANT FACTORS WITHIN THE CHNA FINDINGS. HOMELESSNESS AND HOUSING ARE NOT DIRECTLY ADDRESSED IN THE SCRIPPS IMPLEMENTATION STRATEGY AS WE FOCUS OUR RESOURCES ON MORE DIRECT HEALTH ISSUES AND CONDITIONS IN ACCORDANCE WITH OUR EXPERTISE AND MISSION. SCRIPPS HAS NOT DIRECTLY SCRIPPS HEALTH 14 FY2023-2025 IMPLEMENTATION STRATEGY DEVELOPED PROGRAMS THAT SPECIFICALLY ADDRESS HOUSING INSECURITY, BUT THIS IS ADDRESSED AS PART OF OUR CARE TO PATIENTS. WHEN PATIENTS' HOUSING NEEDS ARE IDENTIFIED, THE SCRIPPS MULTIDISCIPLINARY TEAM WORKS TO ADDRESS THE NEED. ADDITIONALLY, THE SCRIPPS HEALTH SYSTEM HAS SOCIAL WORK AND CASE MANAGEMENT RESOURCES IN PLACE THROUGHOUT THE INPATIENT SETTING THAT ADDRESS THIS UNMET NEED BY CONNECTING PATIENTS TO MORE PERMANENT SOURCES OF INCOME, HOUSING, AND OTHER SELF- RELIANCE MEASURES. SCRIPPS' WORK TO ADDRESS HOUSING INSECURITY IS LARGELY DONE VIA COLLABORATION AND REFERRALS TO COMMUNITY PARTNERS. IN ADDITION TO THE ABOVE INDIRECT MEASURES, SCRIPPS IS ALSO ADDRESSING THESE COMMUNITY NEEDS IN ACCORDANCE WITH CALIFORNIA'S REGULATIONS, SUCH AS SB 1152 DISCHARGE PLANNING FOR HOMELESS PATIENTS. THIS 2019 REGULATION REQUIRES HOSPITALS TO IMPLEMENT A SET OF REQUIREMENTS REGARDING DISCHARGE PLANNING FOR THEIR HOMELESS PATIENTS. SCRIPPS IS FULFILLING THIS REQUIREMENT BY PROVIDING PACKAGED MEALS, WEATHER-APPROPRIATE CLOTHING, TRANSPORTATION, DISCHARGE MEDICATIONS AND/OR PRESCRIPTIONS, INFECTIOUS DISEASE SCREENINGS AND VACCINATIONS, REFERRALS FOR BEHAVIORAL HEALTH AND OTHER REFERRALS TO SHELTERS OR HOUSING. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO CONTINUE THE SEARCH OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE AND FUTURE NEEDS. DETAIL ON THE STRATEGIES, INITIATIVES, MEASURES OF IMPLEMENTATION AND METRICS USED TO EVALUATE THE EFFECTIVENESS OF THE COMMUNITY NEEDS IS IDENTIFIED THROUGH SCRIPPS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION STRATGEY. THE COMPLETE REPORTS ARE AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMMUNITY-NEEDS Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - REPORTING GROUP A. OTHER CRITERIA TO DETEMRINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'S DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. SCRIPPS USES THE PROSPECTIVE METHOD FOR DETERMINING AGB AND ESTIMATES THE AMOUNT IT WOULD BE PAID BY MEDICARE, INCLUDING AMOUNTS PAYABLE BY A MEDICARE BENEFICIARY. AFTER A DETERMINATION OF ELIGIBILITY, THIS AMOUNT REPRESENTS THE MAXIMUM A QUALIFIED PATIENT WILL BE REQUIRED TO PAY. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 40% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. Schedule H, Part V, Section B, Line 16 Facility A, 1 Facility A, 1 - REPORTING GROUP A. THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FAP IS ACHIEVED THROUGH THE FOLLOWING METHODS, INCLUDING BUT NOT LIMITED TO: A. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL, I.E. EMERGENCY DEPARTMENT, OUTPATIENT SETTINGS, AND MAIN ADMISSION AREAS. B. PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. C. A WRITTEN NOTICE ABOUT THE AVAILABILITY OF CHARITY CARE AT A SCRIPPS HOSPITAL IS PROVIDED TO EACH PATIENT AT THE TIME OF SERVICE OR WHEN THE PATIENT LEAVES THE FACILITY. IF THE PATIENT IS NOT GIVEN THE NOTICE AT THE HOSPITAL, SCRIPPS WILL MAIL THE NOTICE TO THE PATIENT WITHIN 72 HOURS. D. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY, REFERRED TO AS, FAP SUMMARY: I. CONTAINS THE WEBSITE ADDRESS WHERE RESOURCES CAN BE FOUND ONLINE, II. PROVIDES THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED, III. IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. E. SCRIPPS WEB SITE: THE FOLLOWING RESOURCES ARE AVAILABLE ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THEY ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP): I. PATIENT FINANCIAL ASSISTANCE POLICY, INCLUDING DISCOUNTED PAYMENTS AND CHARITY CARE POLICY (FAP), II. FINANCIAL ASSISTANCE POLICY SUMMARY (FAP SUMMARY), III. PATIENT ACCOUNT MANAGEMENT BILLING AND COLLECTIONS POLICY, IV. FINANCIAL ASSISTANCE APPLICATIONS. F. SCRIPPS BILLING STATEMENTS INCLUDE: I. STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, II. TELEPHONE NUMBER FOR SCRIPPS STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS, III. WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. G. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. H. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE CALIFORNIA DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) AS REQUIRED BY LAW. Schedule H, Part V, Section B, Line 3E 2022 CHNA PRIORITIZATION OF THE TOP COMMUNITY NEEDS THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH HEALTH CONDITIONS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED, THE MAGNITUDE/SCALE OF THE NEED; DISPARITIES OR INEQUITIES AND CHANGE OVER TIME. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. THROUGH THE PRIORITIZATION PROCESS DESCRIBED IN THE METHODOLOGY SECTION, THE CHNA COMMITTEE IDENTIFIED THE MOST CRITICAL TOP COMMUNITY NEEDS WITHIN SAN DIEGO COUNTY, LISTED BELOW IN ALPHABETICAL ORDER: - ACCESS TO HEALTH CARE - AGING CARE & SUPPORT - BEHAVIORAL HEALTH - CHILDREN & YOUTH WELLBEING - CHRONIC HEALTH CONDITIONS - COMMUNITY SAFETY - ECONOMIC STABILITY Schedule H, Part V, Section B, Line 5 Facility B, 1 Facility B, 1 - SELECT HOSPITAL. COMMUNITY ENGAGEMENT THE PRIMARY OBJECTIVE OF THE COMMUNITY ENGAGEMENT PROCESS WAS TO GATHER INPUT FROM A DIVERSE RANGE OF STAKEHOLDERS TO ENSURE THAT THE SAMPLE REPRESENTED THOSE EXPERIENCING HEALTH INEQUITIES IN SAN DIEGO COUNTY AS COMPREHENSIVELY AS POSSIBLE. SPECIAL EFFORTS WERE MADE TO INCLUDE COMMUNITY MEMBERS FROM DEMOGRAPHIC GROUPS FACING HEALTH DISPARITIES AND SERVICE PROVIDERS WORKING WITH VULNERABLE POPULATIONS. IN TOTAL, 841 INDIVIDUALS PARTICIPATED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY INPUT WAS COLLECTED THROUGH VARIOUS METHODS, INCLUDING: - COLLABORATING WITH COMMUNITY HEALTH WORKERS TO CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS. - ORGANIZING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH A BROAD SPECTRUM OF STAKEHOLDERS, INCLUDING COMMUNITY MEMBERS, COMMUNITY HEALTH WORKERS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, CIVIC LEADERS, AND HEALTHCARE LEADERS (CONDUCTED IN COLLABORATION WITH KAISER FOUNDATION HOSPITAL - SAN DIEGO). - HOSTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH HOSPITAL AND HEALTH SYSTEM CLINICIANS, CASE MANAGERS, SOCIAL WORKERS, AND EXECUTIVE LEADERS. - ADMINISTERING AN ONLINE SURVEY TO COMMUNITY MEMBERS, HOSPITAL STAFF, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL GOVERNMENT PERSONNEL. THE EXTENSIVE PROCESS UNDERTAKEN FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT ENSURED THE GATHERING OF INPUT AND INSIGHTS FROM A WIDE ARRAY OF PERSPECTIVES, THUS CONTRIBUTING TO A MORE COMPREHENSIVE UNDERSTANDING OF THE HEALTH NEEDS AND DISPARITIES WITHIN THE SAN DIEGO COUNTY COMMUNITY. TO ACHIEVE THIS, THE CHNA COMMITTEE COLLABORATED WITH COMMUNITY PARTNERS TO PLAN COMMUNITY ENGAGEMENT ACTIVITIES THAT INVOLVED STAKEHOLDERS FROM EVERY REGION OF SAN DIEGO COUNTY AND ACROSS ALL AGE GROUPS. FURTHERMORE, THE COMMITTEE ACTIVELY SOUGHT TO ENGAGE A BROAD SPECTRUM OF STAKEHOLDERS REPRESENTING DIVERSE RACIAL AND ETHNIC GROUPS. THIS INCLUSIVE AND THOROUGH APPROACH TO COMMUNITY ENGAGEMENT HELPED ENSURE THAT THE ASSESSMENT ACCURATELY REPRESENTED THE HEALTH-RELATED CONCERNS AND DISPARITIES EXPERIENCED BY THE ENTIRE COMMUNITY. KEY INFORMANT INTERVIEWS AND FOCUS GROUPS PLAYED A CRUCIAL ROLE IN IDENTIFYING AND EXPLORING PRIORITY HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO CARE, AND COMMUNITY ASSETS AND RESOURCES. THESE INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED BETWEEN OCTOBER 2021 AND APRIL 2022. THE INTERVIEWERS AND FACILITATORS UTILIZED QUESTIONS DEVELOPED AND APPROVED BY THE CHNA COMMITTEE TO GUIDE DISCUSSIONS ON SPECIFIC COMMUNITY HEALTH NEEDS. OPEN-ENDED QUESTIONS WERE ALSO USED TO FACILITATE BROADER CONVERSATIONS. THE QUESTIONS ASKED DURING THESE INTERVIEWS AND FOCUS GROUPS VARIED DEPENDING ON THE EXPERTISE AND INTERESTS OF THE PARTICIPANTS. THESE INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED THROUGH VIRTUAL MEETINGS ON ZOOM. INCENTIVES, TYPICALLY IN THE FORM OF GIFT CARDS, WERE PROVIDED TO PARTICIPANTS WHEN THEY WERE COMMUNITY RESIDENTS. EACH INTERVIEW AND FOCUS GROUP BEGAN WITH AN INTRODUCTION TO THE PURPOSE AND PROCESS OF THE CHNA. PARTICIPANTS PROVIDED VERBAL AND VISUAL CONSENT TO PROCEED, AND IN SOME CASES, RECORDINGS WERE MADE. PARTICIPANTS WERE ASSURED THAT THEIR INVOLVEMENT WAS VOLUNTARY, AND THEIR FEEDBACK WOULD REMAIN ANONYMOUS. INTERPRETATIVE AND TRANSLATION SERVICES WERE ARRANGED FOR GROUPS THAT REQUESTED THEM, ENSURING THAT LANGUAGE BARRIERS DID NOT HINDER PARTICIPATION. FOR INSTANCE, ONE FOCUS GROUP WAS CONDUCTED IN SPANISH WITH A FACILITATOR PROVIDING SIMULTANEOUS ENGLISH AND SPANISH INTERPRETATION TO ACCOMMODATE A DIVERSE PARTICIPANT BASE. ONLINE COMMUNITY SURVEY THE CHNA ONLINE COMMUNITY SURVEY WAS USED TO SUPPORT PRIORITIZATION OF HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH BASED ON COMMUNITY FEEDBACK ABOUT WHAT SURVEY RESPONDENTS VIEWED AS THE MOST IMPORTANT OR MOST SERIOUS CHALLENGES. THE SURVEY WAS DISTRIBUTED VIA EMAIL TO TARGETED COMMUNITY- BASED ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, RESIDENT-LED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, GOVERNMENT AGENCIES, GRANTMAKING ORGANIZATIONS, AND HOSPITALS AND HEALTH SYSTEMS THAT SERVE A DIVERSE ARRAY OF PEOPLE IN SAN DIEGO COUNTY. WHEN POSSIBLE, THESE ORGANIZATIONS SHARED THE LINK TO THE SURVEY WITH THE CLIENTS THEY SERVED. EMAIL RECIPIENTS WERE ALSO ENCOURAGED TO SHARE THE SURVEY WITH THEIR COLLEAGUES. THE SURVEY - OPEN FROM FEBRUARY 14 TO MARCH 30, 2022 - WAS ALSO WIDELY SHARED THROUGH SOCIAL EMAIL AND RESHARED BY COMMUNITY- BASED ORGANIZATIONS. THE SURVEY WAS DESIGNED TO BE TAKEN BY COMMUNITY MEMBERS AND WAS TRANSLATED FROM ENGLISH INTO FIVE ADDITIONAL LANGUAGES: ARABIC, SPANISH, SOMALI, TAGALOG, AND VIETNAMESE. MID- CITY CAN, A COMMUNITY-BASED ORGANIZATION LOCATED IN CITY HEIGHTS, WAS CONTRACTED TO COMPLETE THE TRANSLATIONS. RESEARCH PARTNERS AT THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT THE SAN DIEGO STATE UNIVERSITY (SDSU) SCHOOL OF PUBLIC HEALTH (SPH) FACILITATED TWO FOCUS GROUPS WITH COMMUNITY HEALTH WORKERS (CHWS). THE IPH CONDUCTED BOTH FOCUS GROUPS THROUGH ZOOM. ALL FOCUS GROUP PARTICIPANTS WERE COMMUNITY HEALTH WORKERS WORKING FOR A COVID-19 CONTACT TRACING PROGRAM. FOCUS GROUP PARTICIPANTS WERE RECRUITED THROUGH MULTIPLE AVENUES, INCLUDING ANNOUNCEMENTS IN THE COUNTY OF SAN DIEGO HHSA'S COMMUNITY HEALTH WORKER COLLABORATIVE NEWSLETTER, DISSEMINATED BY THE COUNTY TO PROVIDE UPDATES ON COVID-19 COMMUNICATION AND OUTREACH SERVICES TO THE INDIVIDUALS WORKING ON ONE OF THE COUNTY COVID-19 CONTRACTS. IN ADDITION, EMAILS WERE DISSEMINATED DIRECTLY TO ALL CHWS ON THE COMMUNITIES FIGHTING COVID! PROJECT AT SDSU, AND EMAILS WERE SENT TO THE LEADS ON EIGHT DIFFERENT COUNTY COVID-19 CONTRACTS, REQUESTING THAT THEY DISSEMINATE THE INFORMATION TO THEIR CHWS OR OUTREACH WORKERS THE ANNOUNCEMENT INCLUDED AN INTEREST FORM THAT ASKED FOR THE PERSON'S CONTACT INFORMATION, DAY OF THE WEEK AND TIME OF DAY THAT WORKED BEST FOR THEM, TYPE OF GIFT CARD THEY WOULD LIKE TO RECEIVE AS A THANK YOU, AND A BRIEF DESCRIPTION OF THE TYPE OF WORK THEY CURRENTLY DO. FOCUS GROUP PARTICIPANTS WERE ASKED OPEN-ENDED QUESTIONS ABOUT IDENTIFYING SPECIFIC HEALTH CONDITIONS OF CONCERN, ABOUT INEQUITIES IN THE COMMUNITY, AND ABOUT THE NEEDS OF YOUTH AND SENIORS. GIFT CARDS WERE EMAILED TWO DAYS AFTER THE FOCUS GROUP AS A THANK YOU TO ALL PARTICIPANTS. PROMOTORAS AND COMMUNITY HEALTH WORKER INTERVIEWS/ACCESS TO HEALTH CARE INTERVIEWS TO ENSURE THE REPORT INCLUDED DIRECT COMMUNITY MEMBER FEEDBACK FROM RACIAL AND ETHNIC GROUPS EXPERIENCING DISPARATE HEALTH OUTCOMES, THE CHNA COMMITTEE EMPLOYED A NEW STRATEGY TO PARTNER WITH COMMUNITY BASED ORGANIZATIONS THAT WORK WITH PROMOTORAS AND COMMUNITY HEALTH WORKERS. THE ONLINE COMMUNITY SURVEY WAS ADAPTED WITH A SUBSET OF THE SURVEY QUESTIONS FOR USE AS A DATA COLLECTION TOOL. THE SAN DIEGO REFUGEE COMMUNITIES COALITION AND THE CHICANO FEDERATION WERE SELECTED TO RECRUIT INTERESTED COMMUNITY HEALTH WORKERS AND PROMOTORAS TO CONDUCT THE INTERVIEWS. HASD&IC STAFF ATTENDED A SAN DIEGO REFUGEE COMMUNITIES COALITION WEEKLY COMMUNITY HEALTH WORKER MEETING TO PROVIDE TRAINING ON THE GOALS OF THE CHNA AND HOW TO ADMINISTER THE INTERVIEW. HASD&IC STAFF ALSO PROVIDED TRAINING TO THE CHICANO FEDERATION PROMOTORAS. PROMOTORAS AND COMMUNITY HEALTH WORKERS CONDUCTED INTERVIEWS EITHER IN PERSON OR OVER THE PHONE. INTERVIEWERS ASKED OPEN-ENDED QUESTIONS ABOUT THE FOLLOWING: HEALTH NEEDS, SOCIAL NEEDS, ACCESS TO CARE CHALLENGES, AND WHAT HOSPITALS COULD DO TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. INTERVIEWERS THEN CODED RESPONSES AND INPUT THEM IN AN ONLINE DATA COLLECTION TOOL. PRICE PHILANTHROPIES FOUNDATION GENEROUSLY PROVIDED GRANTS TO BOTH ORGANIZATIONS TO COMPENSATE PROMOTORAS AND COMMUNITY HEALTH WORKERS FOR COMPLETING INTERVIEWS. Schedule H, Part V, Section B, Line 6a Facility B, 1 Facility B, 1 - SELECT HOSPITAL. 2022 CHNA PARTICIPATING HOSPITALS AND HEALTH SYSTEMS THE CHNA RESPONDS TO IRS REGULATORY REQUIREMENTS THAT PRIVATE NOT-FOR-PROFIT (TAX- EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. ALTHOUGH ONLY NOT-FOR-PROFIT 501(C)(3) HOSPITALS AND HEALTH SYSTEMS ARE SUBJECT TO STATE AND IRS REGULATORY REQUIREMENTS, THE MAJORITY OF 2022 CHNA COLLABORATIVE MEMBERS ARE HOSPITALS AND HEALTH SYSTEMS THAT ARE NOT SUBJECT TO ANY CHNA REQUIREMENTS BUT ARE DEEPLY ENGAGED IN THE COMMUNITIES THEY SERVE AND COMMITTED TO THE GOALS OF A COLLABORATIVE CHNA. EVERY HEALTH SYSTEM, HEALTH DISTRICT, PRIVATE HOSPITAL AND BEHAVIORAL HEALTH HOSPITAL IN SAN DIEGO PARTICIPATED IN THE COLLECTIVE EFFORT TO BETTER UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF SAN DIEGO COMMUNITIES. PARTICIPATING HOSPITAL AND HEALTH SYSTEMS SUPPORTED THE CHNA PROCESS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY WORKGROUP, THE COMMUNITY NEEDS ASSESSMENT COMMITTEE, AND THE HASD&IC BOARD OF DIRECTORS. - ALVARADO HOSPITAL MEDICAL CENTER - ALVARADO PARKWAY INSTITUTE BEHAVIORAL HEALTH SYSTEM - AURORA BEHAVIORAL HEALTH CARE SAN DIEGO - GROSSMONT HEALTHCARE DISTRICT - KAISER PERMANENTE SAN DIEGO - PALOMAR HEALTH - PARADISE VALLEY HOSPITAL/BAYVIEW BEHAVIORAL HEALTH CAMPUS - RADY CHILDREN'S HOSPITAL - SAN DIEGO - SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL - SCRIPPS HEALTH - SHARP HEALTHCARE - TRI-CITY MEDICAL CENTER - UC SAN DIEGO HEALTH - VA SAN DIEGO HEALTHCARE SYSTEM - SELECT SPECIALTY HOSPITAL Schedule H, Part V, Section B, Line 6b Facility B, 1 Facility B, 1 - REPORTING GROUP B - SELECT HOSPITAL. THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES(HASD&IC) CONTRACTED WITH THE FOLLOWING RESEARCH PARTNERS ON THE 2022 COMMMUNITY HEALTH NEEDS ASSESSMENT. PATRICIA SINAY FROM COMMUNITY INVESTMENT STRATEGIES (CIS) SUPPORTED THE HOSPITAL ASSOCIATION TEAM WITH QUALITATIVE RESEARCH AND REPORT WRITING. CIS PROVIDES STRATEGIC VISIONING & PLANNING, MANAGEMENT TRAINING, AND PROGRAM IMPLEMENTATION SERVICES TO NONPROFITS, BUSINESSES, GOVERNMENTS, AND PHILANTHROPY. AS A LATINA IMMIGRANT, PATRICIA SPECIALIZES IN INCLUSIVE, CROSS-SECTOR EFFORTS THAT STRENGTHEN THE GREATER GOOD FOR INDIVIDUALS, FAMILIES, AND COMMUNITIES. HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU). IN THE LAST 20 YEARS, THE IPH HAS PARTNERED WITH OVER 70 LOCAL, STATE, NATIONAL AND INTERNATIONAL PUBLIC AND PRIVATE COMMUNITY-BASED AGENCIES AND ORGANIZATIONS REPRESENTING MORE THAN 120 MULTIPLE-YEAR CONTRACTS WITH A WIDE VARIETY OF NEEDS AND METHODOLOGIES. THE IPH HAS EXPERTISE IN QUALITATIVE AND QUANTITATIVE COMMUNITY-BASED RESEARCH METHODS. IN ADDITION, THE IPH HAS EXTENSIVE EXPERIENCE IN SUCCESSFUL COMMUNITY ENGAGEMENT WITH DIVERSE GROUPS, INCLUDING NON-ENGLISH SPEAKERS. THE IPH HAS BEEN WORKING ACROSS CULTURES AND WITH VULNERABLE POPULATIONS FOR 25 YEARS, INCLUDING PROGRAMS WITH ASIAN AND PACIFIC ISLANDER COMMUNITIES, AFRICAN-AMERICAN COMMUNITIES, EAST AFRICAN COMMUNITIES, LATINO COMMUNITIES, NATIVE AMERICAN COMMUNITIES, LOW-INCOME COMMUNITIES, GAY, BISEXUAL, TRANSGENDER INDIVIDUALS, PEOPLE LIVING WITH HIV/AIDS, INDIVIDUALS EXPERIENCING HOMELESSNESS, ADOLESCENTS WHO ARE PREGNANT OR PARENTING, AND SURVIVORS OF DOMESTIC VIOLENCE AND SEXUAL ASSAULT, AMONG OTHERS. IPH STAFF HAVE SPECIAL EXPERTISE IN CONDUCTING CULTURALLY COMPETENT WORK AND EXPLORING SENSITIVE ISSUES. IPH COMMUNITY ENGAGEMENT EFFORTS HAVE INCLUDED PERFORMING KEY INFORMANT INTERVIEWS, LEADING FOCUS GROUPS, FACILITATING TOWN HALL MEETINGS, AND CONDUCTING PATIENT AND PROVIDER INTERVIEWS Schedule H, Part V, Section B, Line 11 Facility B, 1 Facility B, 1 - REPORTING GROUP B - SELECT HOSPITAL. SCRIPPS HEALTH AND SELECT HOSPITAL IMPLEMENTATION STRATEGY SUMMARY AND COMMUNITY NEEDS IDENTIFIED. WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH AND SELECT HOSPITAL HAVE DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY; A MULTI-FACETED, MULTI- STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS AND SELECT SPECIALTY HOSPITAL EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL-SUITED TO DEVELOPING A RESPONSE TO THE SCRIPPS CHNA. THE EVALUATION OF THE IMPLEMENTATION STRATEGY ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND ADJUSTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION STRATEGY ARE ALSO TAILORED TO EACH OBJECTIVE AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS AND SELECT DESCRIBE ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION STRATEGY IS FILED ANNUALLY WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. COMMUNITY NEEDS SCRIPPS IS ADDRESSING THE HEALTH FOCUS AREAS IDENTIFIED WERE DETERMINED THROUGH DATA COLLECTION, ANALYSIS, AND A PRIORITIZATION PROCESS THAT INCORPORATED COMMUNITY INPUT. SCRIPPS IS ADDRESSING ACCESS TO CARE, AGING CARE & SUPPORT, BEHAVIORAL HEALTH, CHILDREN & YOUTH WELLBEING, CHRONIC HEALTH CONDITIONS WHICH INCLUDES CARDIOVASCULAR DISEASE, CANCER AND DIABETES, COMMUNITY SAFETY AND ECONOMIC STABILITY IN THE FY23-25 IMPLEMENTATION STRATEGY. SCRIPPS ADDRESSES MANY OF THE SOCIAL DETERMINANTS OF HEALTH WITHIN THE HEALTH CONDITIONS IDENTIFIED SUCH AS, COMMUNITY AND SOCIAL SUPPORT, FOOD INSECURITY, TRANSPORTATION, EDUCATION, AND HOMELESSNESS. COMMUNITY NEEDS SCRIPPS IS NOT DIRECTLY ADDRESSING HOMELESSNESS AND HOUSING INSTABILITY ARE IDENTIFIED AS IMPORTANT FACTORS WITHIN THE CHNA FINDINGS. HOMELESSNESS AND HOUSING ARE NOT DIRECTLY ADDRESSED IN THE SCRIPPS IMPLEMENTATION STRATEGY AS WE FOCUS OUR RESOURCES ON MORE DIRECT HEALTH ISSUES AND CONDITIONS IN ACCORDANCE WITH OUR EXPERTISE AND MISSION. SCRIPPS HAS NOT DIRECTLY DEVELOPED PROGRAMS THAT SPECIFICALLY ADDRESS HOUSING INSECURITY, BUT THIS IS ADDRESSED AS PART OF OUR CARE TO PATIENTS. WHEN PATIENTS' HOUSING NEEDS ARE IDENTIFIED, THE SCRIPPS MULTIDISCIPLINARY TEAM WORKS TO ADDRESS THE NEED. ADDITIONALLY, THE SCRIPPS HEALTH SYSTEM HAS SOCIAL WORK AND CASE MANAGEMENT RESOURCES IN PLACE THROUGHOUT THE INPATIENT SETTING THAT ADDRESS THIS UNMET NEED BY CONNECTING PATIENTS TO MORE PERMANENT SOURCES OF INCOME, HOUSING, AND OTHER SELF-RELIANCE MEASURES. SCRIPPS WORK TO ADDRESS HOUSING INSECURITY IS LARGELY DONE VIA COLLABORATION AND REFERRALS TO COMMUNITY PARTNERS. IN ADDITION TO THE ABOVE INDIRECT MEASURES, SCRIPPS IS ALSO ADDRESSING THESE COMMUNITY NEEDS IN ACCORDANCE WITH CALIFORNIA'S REGULATIONS, SUCH AS SB 1152 DISCHARGE PLANNING FOR HOMELESS PATIENTS. THIS 2019 REGULATION REQUIRES HOSPITALS TO IMPLEMENT A SET OF REQUIREMENTS REGARDING DISCHARGE PLANNING FOR THEIR HOMELESS PATIENTS. SCRIPPS IS FULFILLING THIS REQUIREMENT BY PROVIDING PACKAGED MEALS, WEATHER-APPROPRIATE CLOTHING, TRANSPORTATION, DISCHARGE MEDICATIONS AND/OR PRESCRIPTIONS, INFECTIOUS DISEASE SCREENINGS AND VACCINATIONS, REFERRALS FOR BEHAVIORAL HEALTH AND OTHER REFERRALS TO SHELTERS OR HOUSING. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO CONTINUE THE SEARCH OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE AND FUTURE NEEDS. DETAIL ON THE STRATEGIES, INITIATIVES, MEASURES OF IMPLEMENTATION AND METRICS USED TO EVALUATE THE EFFECTIVENESS OF THE COMMUNITY NEEDS IS IDENTIFIED THROUGH SCRIPPS SPECIALTY HOSPITAL 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION STRATGEY. THE COMPLETE REPORTS ARE AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMMUNITY-NEEDS Schedule H, Part V, Section B, Line 16 Facility B, 1 Facility B, 1 - REPORTING GROUP B. SELECT SPECIALTY HOSPITAL SAN DIEGO PROVIDES FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE TO PATIENTS WHO ARE UNABLE TO PAY. THE FOLLOWING IS A SUMMARY OF FINANCIAL ASSISTANCE AVAILABLE AT SELECT SPECIALTY HOSPITAL SAN DIEGO. FINANCIAL ASSISTANCE OFFERED IF YOU DO NOT HAVE INSURANCE, WE PROVIDE FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE. ELIGIBLE CARE INCLUDES MEDICALLY NECESSARY SERVICES AS DEFINED BY MEDICARE (SERVICES OR ITEMS REASONABLE AND NECESSARY FOR THE DIAGNOSIS OR TREATMENT OF ILLNESS OR INJURY). TO RECEIVE FINANCIAL ASSISTANCE, YOU MUST MEET ONE OF THE FOLLOWING CRITERIA: (A) ARE A U.S. CITIZEN; OR (B) CARRY A UNITED STATES PERMANENT RESIDENT CARD (USCIS FORM I-551); OR (C) LIVE WITHIN 50 MILES OF THE FACILITY. YOU WILL RECEIVE FREE CARE, OR 100% WRITE OFF OF PATIENT LIABILITY AFTER INSURANCE HAS PAID, IF YOUR FAMILY INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY INCOME GUIDELINES. WRITE OFF OF THE DISCOUNTED FINANCIAL ASSISTANCE AMOUNT WHICH IS CALCULATED AS A PERCENTAGE OF TOTAL GROSS CHARGES MAY ALSO BE AVAILABLE FOR UNINSURED AND CERTAIN OTHER PATIENTS WITH FAMILY INCOME UP TO 400% OF THE FEDERAL POVERTY INCOME GUIDELINES. IF FAMILY INCOME IS OVER 400% OF FEDERAL POVERTY INCOME GUIDELINES, FINANCIAL ASSISTANCE MAY STILL BE CONSIDERED. ALL APPLICANTS WILL BE SCREENED FOR MEDICAID COVERAGE AND MUST COOPERATE WITH THE MEDICAID REPRESENTATIVES TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. ADDITIONAL WAYS TO QUALIFY IF YOU DO NOT MEET THE INCOME CRITERIA ABOVE, REGARDLESS OF YOUR INSURANCE STATUS, YOU WILL BE CONSIDERED ON A CASE-BY-CASE BASIS FOR FINANCIAL ASSISTANCE. CONTACT US TO DISCUSS EXCEPTIONAL PERSONAL OR FINANCIAL CIRCUMSTANCES, OR IF THERE ARE SPECIAL MEDICAL CIRCUMSTANCES WHERE TREATMENT CAN ONLY BE PROVIDED BY SELECT SPECIALTY HOSPITAL SAN DIEGO MEDICAL STAFF. WHAT YOU WILL BE CHARGED IF YOU RECEIVE FINANCIAL ASSISTANCE UNDER OUR POLICY, YOU WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN THE AMOUNT WE GENERALLY BILL PATIENTS HAVING MEDICARE COVERAGE.HOW TO OBTAIN COPIES OF OUR POLICY AND APPLICATION. YOU MAY OBTAIN A COPY OF OUR FULL FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION FORM FREE OF CHARGE IN ANY OF THE FOLLOWING WAYS: IN OUR ADMISSIONS AREAS OF OUR FACILITY AT 555 WASHINGTON STREET, SAN DIEGO, CA 92103; ONLINE AT HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/PATIENTS-AND-CAREGIVERS/FINANCIAL-ASSISTANCE OR BY CALLING OUR ADMISSIONS DEPARTMENT AT 619-686-4525. HOW TO APPLY AND OBTAIN ASSISTANCE YOU MAY APPLY AT ANY POINT IN THE ADMISSION OR BILLING PROCESS BY COMPLETING AND SUBMITTING AN APPLICATION, AND PROVIDING INCOME INFORMATION. ALL FINANCIAL ASSISTANCE APPLICATIONS, WHETHER COMPLETED IN PERSON, ONLINE, DELIVERED OR MAILED, WILL BE FORWARDED TO OUR CENTRAL BUSINESS OFFICE FOR EVALUATION AND PROCESSING. IF YOU NEED ANY HELP IN APPLYING, PLEASE CONTACT OUR ADMISSIONSDEPARTMENT AT THE FACILITY OR CALL OUR CENTRAL BUSINESS OFFICE AT 888.868.1103. COPIES OF OUR FINANCIAL ASSISTANCE POLICY, APPLICATION FORM AND THIS SUMMARY ARE AVAILABLE IN ENGLISH AND SPANISH. 48 Scripps Clinic - Torrey Pines 10666 N Torrey Pines Rd La Jolla CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Rancho Bernardo 15004 Innovation Dr San Diego CA 92128 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Carmel Valley 3811 Valley Center Dr San Diego CA 92130 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Medical Lab 9235 Waples St 150 San Diego CA 92121 LABORATORY SERVICES Scripps Clinic - Jefferson 2205 Vista Way Oceanside CA 92054 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Anderson Medical Pavilion 9898 Genesse Ave La Jolla CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Imaging Healthcare Specialists LLC 150 West Washington St San Diego CA 92103 MEDICAL IMAGING SERVICES Scripps Clinic - Encinitas 310 Santa Fe Dr Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Encinitas 477 N El Camino Real Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - La Jolla Memorial Campus 9850 Genesee Ave Ximed Bldg 600 San Diego CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Hospital Medical Services 10140 Campus Point Dr San Diego CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Jefferson 2205 Vista Way Oceanside CA 92054 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Mission Valley 7565 Mission Valley Rd San Diego CA 92108 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Rancho San Diego 10862 Calle Verde La Mesa CA 91941 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC Hillcrest 501 Washington St San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Carlsbad 2176 Salk Ave Carlsbad CA 92008 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Oceanside 4318 Mission Ave Oceanside CA 92057 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Mercy ASC 550 Washington St 1st Fl San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Del Mar 12395 El Camino Real 317 Del Mar CA 92130 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT La Jolla Radiology - La Jolla 9888 Genesee Ave La Jolla CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps CL Radiation Therapy Ctr - Vista 916 Sycamore Ave 100 Vista CA 92082 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Encinitas OBGYN 332 Santa Fe Dr 115 Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Encinitas Surgery Center LLC 320 Santa Fe Dr LL1-2 Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Cedar 130 Cedar Rd Vista CA 92083 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Pharmacy - Green 10666 N TORREY PINES RD LA CA 92037 MEDICAL PHARMACY La Jolla Radiology - Encinitas 354 Sant Fe Dr Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Encinitas OP Rehab Clinical 1092 El Camino Real Encinitas CA 92024 REHABILITATION SERVICES SCMC - Eastlake 971 Lane Ave Chula Vista CA 91914 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Cardio&Thor Surg Ctr - La Jolla 9850 Genesee Ave 560 La Jolla CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Mercy Campus 4020 Fifth Ave 401 San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - MD Anderson Cancer Ctr 10670 John Jay Hopkins Drive La Jolla CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Pharmacy - Encinitas 354 Santa Fe Dr Encinitas CA 92024 MEDICAL PHARMACY SCMC - San Marcos 111 Campus Way Ste 301 San Marcos CA 92078 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Santee 278 Town Center Pkwy 105 Santee CA 92071 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - San Diego OBGYN 2918 Fifth Ave San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Liberty Station 2445 Truxtun Rd San Diego CA 92106 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - Solana Beach 380 Steven Ave 100 Solana Beach CA 92075 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - La Jolla OBGYN 9850 Genesee Ave 170 San Diego CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps CL Radiation Therapy Ctr - Encinitas 477 N El Camino Real D100 Encinitas CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Hillcrest Surgery 4060 Fourth Ave 330 San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Cardio&Thor Surg Ctr - Hillcrest 501 Washington St 525 San Diego CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Coronado 1317 A Ynes Place Coronado CA 92118 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Eastlake Specialty 971 Lane Ave Chula Vista CA 91914 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Cedar Specialty 130 Cedar Rd Vista CA 92083 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Clinic - Chula Vista 450 Fourth Ave Chula Vista CA 91910 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps Home Health Services 9619 Cheaspeake Dr 300 San Diego CA 92123 HOME HEALTH SERVICES Scripps Clinic - UTC 9333 Genesee Ave 170 San Diego CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Scripps USP Surgery Centers LLC 15305 Dallas Pkwy Addison TX 75001 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT Schedule H, Part I, Line 3c SCRIPPS FINANCIAL ASSISTANCE, CHARITY CARE AND DISCOUNT PAYMENTS POLICY ("FAP") DESCRIBES THE PROCESS FOR PATIENTS WHO NEED HELP PAYING FOR THEIR EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL AND AMBULATORY CARE AT SCRIPPS HOSPITALS, (SCRIPPS MEMORIAL HOSPITAL LA JOLLA, SCRIPPS MEMORIAL HOSPITAL ENCINITAS, SCRIPPS GREEN HOSPITAL, SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA), AND SCRIPPS MEDICAL FOUNDATION. SCRIPPS PROVIDES FINANCIAL ASSISTANCE IN ACCORDANCE WITH ALL STATE AND FEDERAL REGULATIONS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS FAP IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. THE FAP APPLIES TO ALL SERVICES PROVIDED AT SCRIPPS HEALTH TO INCLUDE PHYSICIAN PROFESSIONAL SERVICES THAT ARE DELIVERED BY SCRIPPS MEDICAL FOUNDATION PHYSICIANS AND SURGEONS. GENERAL CIRCUMSTANCES REQUIRING ASSISTANCE MAY INCLUDE: 1. PATIENTS WITH NO INSURANCE, 2. PATIENTS WHO ARE NOT ELIGIBLE FOR THIRD PARTY ASSISTANCE, 3. PATIENTS WITH 3RD PARTY COVERAGE WHICH DOES NOT COVER/REIMBURSE ALL CHARGES, E.G. MEDICAID, OTHER INDIGENT CARE PROGRAMS. 4. PATIENTS WITH WHO HAVE HIGH MEDICAL COSTS AS DEFINED BY STATE AND FEDERAL LAW, WHO ARE AT OR BELOW 400% OF THE FPL. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, SCRIPPS WILL FORGIVE A PORTION OF THE BILL. FOR AN INCOME LEVEL BETWEEN 201 AND 400 PERCENT OF FPL, AND FOLLOWING A DETERMINATION OF ELIGIBILITY, THE PATIENT RESPONSIBILITY WILL NOT BE CHARGED MORE THAN THE CALCULATED DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. NET WORTH INFORMATION INCLUDED ON THE PATIENT FINANCIAL ASSESSMENT STATEMENT WILL BE USED TO EVALUATE THESE SPECIAL SITUATIONS. PATIENTS DETERMINED TO BE "HOMELESS NOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AMOUNTS GENERALLY BILLED (AGB) AS CALCULATED WITH THE PROSPECTIVE METHOD. SCRIPPS WILL OFFER EXTENDED PAYMENT PLANS WITHOUT INTEREST TO ALLOW PAYMENT OF THE DISCOUNTED PRICE OVER TIME. THE HOSPITAL AND THE PATIENT SHALL NEGOTIATE THE TERMS OF THE PAYMENT PLAN AND TAKE INTO CONSIDERATION THE PATIENT'S FAMILY INCOME AND ESSENTIAL LIVING EXPENSES. IF AGREEMENT ON TERMS CANNOT BE ACHIEVED, THE FORMULA REQUIRED BY CALIFORNIA LAW WILL BE USED TO CREATE A REASONABLE PAYMENT PLAN. ELIGIBILITY FOR CHARITY CARE OR DISCOUNTED PAYMENT MAY BE DETERMINED AT ANY TIME SCRIPPS IS IN RECEIPT OF DOCUMENTATION OF INCOME OR ASSETS. EVERY REASONABLE EFFORT WILL BE MADE TO MAKE A DETERMINATION OF ELIGIBILITY WITHIN 15 BUSINESS DAYS OF RECEIPT OF ALL REQUESTED DOCUMENTATION. DETAILS OF THE CHARITY CARE OR DISCOUNT WILL BE PROVIDED TO THE PATIENT OR THE PATIENTS REPRESENTATIVE. AN ELIGIBILITY DETERMINATION WILL BE VALID FOR A PERIOD OF SIX MONTHS FROM THE DATE OF DETERMINATION UNLESS THE PATIENT'S CIRCUMSTANCES HAVE CHANGED. AT THE TIME OF THE EVALUATION, SHOULD IT BE DETERMINED THAT THE PATIENT HAS PAID MORE THAN REQUIRED, A REFUND OF THE OVERPAYMENT, WITH INTEREST (10 PERCENT PER YEAR) WILL BE ISSUED PROMPTLY. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 50% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. Schedule H, Part I, Line 6a SCHEDULE H, PART I, LINE 6A THE 2023 COMMUNITY BENEFIT REPORT WAS ADOPTED BY THE SCRIPPS BOARD ON MARCH 2023 AND MADE PUBLIC ON HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT WAS ADOPTED BY THE SCRIPPS BOARD IN SEPTEMBER 2022, TAX YEAR 2021 AND THE CHNA WAS MADE PUBLIC ON HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. Schedule H, Part II 'DESCRIBE HOW COMM BLDG ACTIVITIES PROMOTE THE HEALTH OF THE COMM. F1 - PHYSICAL IMPROVEMENTS AND HOUSING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 1 SCRIPPS MERCY - LEADERSHIP RETREAT VOLUNTEER SERVICE DAY SCRIPPS MERCY HOSPITAL ARRANGED A LEADERSHIP RETREAT IN WHICH LEADERS HAD THE CHANCE TO PARTICIPATE IN COMMUNITY SERVICE ACTIVITIES, WHICH INVOLVED PAINTING, CLEANING, AND ENHANCING FACILITIES RUN BY NONPROFIT ORGANIZATIONS THAT PROVIDE SERVICES TO THE HOMELESS POPULATION. THESE COLLABORATIVE PROJECTS WERE CARRIED OUT IN PARTNERSHIP WITH ORGANIZATIONS LIKE CATHOLIC CHARITIES, ST. VINCENT DE PAUL, AND THE JOAN KROC CENTER. F2 - ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2 EXECUTIVE LEADERSHIP SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS. NORTH SAN DIEGO BUSINESS CHAMBER HEALTH COMMITTEE MEETING THE CHAMBER AIMS TO PROVIDE CURRENT HEALTH-RELATED INFORMATION TO IMPROVE THE WELL-BEING OF THE BUSINESS COMMUNITY. THE HEALTH COMMITTEE PLAYS A CRUCIAL ROLE IN EDUCATING SAN DIEGO NORTH BUSINESSES ABOUT HEALTHCARE ISSUES RELEVANT TO THE REGION THAT INFLUENCE FINANCIAL OUTCOMES AND EMPLOYEE PRODUCTIVITY. THE SCRIPPS DIRECTOR OF COMMUNITY BENEFIT PARTICIPATES IN THESE MEETINGS. F3 - COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3. LIGHTS ON! MICRO GRANTS LIGHTS ON! IS A CREATIVE COMMUNITY INITIATIVE THAT COLLABORATES WITH LAW ENFORCEMENT AND AUTO SERVICE PROVIDERS TO REPLACE TRAFFIC VIOLATION CITATIONS WITH REPAIR VOUCHERS. THESE VOUCHERS, VALUED AT UP TO $250, CAN BE REDEEMED AT PARTICIPATING LOCATIONS FOR REPLACING BURNT-OUT HEADLIGHTS, TAILLIGHTS, BRAKE LIGHTS, AND TURN SIGNALS. SHOULD REPAIR COSTS EXCEED $250 OR BE DUE TO OTHER VEHICLE ISSUES, THE DRIVER IS RESPONSIBLE FOR THE REMAINING AMOUNT. THE PROGRAM IS SUPPORTED BY THE SAN DIEGO PADRES FOUNDATION AND SCRIPPS HEALTH, WITH BOTH ENTITIES MATCHING ALL DONATIONS THROUGH MICROGRANTS. THESE CONTRIBUTIONS WILL SUSTAIN THE PROGRAM FOR APPROXIMATELY THREE YEARS, DEPENDING ON REPAIR EXPENSES AND VOUCHER REDEMPTION. DISASTER PREPAREDNESS - COMMUNITY SUPPORT AND OUTREACH EDUCATION SCRIPPS HEALTH PLAYS A CRUCIAL ROLE IN BOTH PROVIDING EMERGENCY SERVICES DURING LOCAL DISASTERS AND MAINTAINING ONGOING CARE FOR HOSPITALIZED PATIENTS, ADDRESSING A CRITICAL COMMUNITY NEED. THE ORGANIZATION ACTIVELY PROMOTES DISASTER PREPAREDNESS AWARENESS AND COMMUNITY PARTICIPATION TO DRIVE POSITIVE CHANGE. SCRIPPS COLLABORATES WITH SAN DIEGO COUNTY AND CALIFORNIA ADVISORY GROUPS TO DEVELOP, IMPLEMENT, AND ASSESS DISASTER PREPAREDNESS RESPONSE PLANS AND EXERCISES. FURTHERMORE, SCRIPPS SERVES AS AN ADVISOR TO SAN DIEGO COUNTY FOR FEDERAL AND STATE GRANT DEVELOPMENT AND PLANNING, CONTRIBUTING TO DISASTER PREPAREDNESS EFFORTS AT THE REGIONAL AND STATE LEVELS. HOSPITAL INCIDENT COMMAND SYSTEM (HICS) NATIONAL ADVISORY COMMITTEE SCRIPPS HEALTH IS AN ACTIVE MEMBER IN THE HOSPITAL INCIDENT COMMAND SYSTEM NATIONAL ADVISORY COMMITTEE. SAN DIEGO COUNTY HEALTHCARE DISASTER COALITION SCRIPPS PARTNERED WITH THE SAN DIEGO HEALTHCARE DISASTER COALITION FOR SURGE CAPACITY PLANNING TO INSURE EMERGENCY DEPARTMENT AND URGENT CARE READINESS IN THE EVENT OF A SURGE OF COVID/FLU PATIENTS. SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE SCRIPPS HEALTH ACTIVELY PARTICIPATES IN THE SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE, ENGAGING IN VARIOUS LEVELS, INCLUDING BUDGET, PEDIATRIC SURGE, DECONTAMINATION, BURN SURGE, AND REGIONALIZATION COMMITTEES. THESE WORKGROUPS OFFER LEADERSHIP, REPRESENTATION, AND FUNDING THROUGH GRANT APPLICATIONS AND COOPERATIVE AGREEMENTS WITH STATES, TERRITORIES, AND ELIGIBLE MUNICIPALITIES. THE PRIMARY AIM IS TO ENHANCE SURGE CAPACITY, PROMOTE HEALTH EQUITY, AND IMPROVE COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES. SAN DIEGO COUNTY OPERATIONAL AREA FULL SCALE EXERCISE IN MAY 2023, A FULL-SCALE EXERCISE PLAN TOOK PLACE, SPANNING THE ENTIRE COUNTY OF SAN DIEGO AND SIMULATING MULTIPLE WILDFIRES. THE EXERCISE EXTENDED OVER FOUR HOURS AND WAS DESIGNED TO ADDRESS THE EVACUATION OF SEVERAL MEDICAL FACILITIES THROUGHOUT THE COUNTY. FIVE MAJOR WILDFIRES OCCURRED SIMULTANEOUSLY OVER FIVE DAYS, NECESSITATING THE EVACUATION OF MULTIPLE HOSPITALS, CLINICS, AND A MENTAL HEALTH FACILITY. EXERCISE PARTICIPANTS WERE TASKED WITH EITHER EVACUATING OR SURGING, AIMING TO MOVE 1,200 PATIENTS DURING THE 4-HOUR EXERCISE. THE ASSESSMENT EXERCISE INVOLVED A COORDINATED RESPONSE FROM VARIOUS STATE AND LOCAL AGENCIES, INCLUDING POLICE, FIRE, AND TRANSPORTATION ENTITIES. ALL HOSPITALS IN SAN DIEGO COUNTY ACTIVELY PARTICIPATED IN THIS DRILL. SAN DIEGO COUNTY COALITION SURGE TEST NO NOTICE EXERCISE THE SAN DIEGO COUNTY COALITION SURGE TEST WILL CONSIST OF A TWO-STEP PROCESS, INCLUDING A TABLETOP EXERCISE AND A FULL-SCALE DRILL. PLANNING SESSIONS ARE BEING HELD TWICE A MONTH, AND THE TENTATIVE DATE FOR THE DRILL IS IN NOVEMBER. THE SCENARIO INVOLVES AN ACTIVE SHOOTER INCIDENT WITH APPROXIMATELY 100 PATIENTS, PREDOMINANTLY PEDIATRICS. SAN DIEGO COUNTY MEDICAL AND HEALTH FULL SCALE EXERCISE IN JULY, SCRIPPS PARTICIPATED IN A COUNTY-WIDE MEDICAL AND HEALTH FULL-SCALE EXERCISE. ALL HOSPITALS WERE INVOLVED IN TESTING AND EVALUATING THE CAPABILITIES OF THE COMMAND CENTER AND THE RESPONSE PLAN FOR PATIENT SURGE AND EVACUATION. THIS EXERCISE INCLUDED PARTICIPATION IN THE MEDICAL OPERATIONS CENTER (MOC) AND THE USE OF WEB-EOC. IT WAS A COUNTY-WIDE DRILL INVOLVING ALL FACILITIES, INCLUDING HOSPITALS, LONG-TERM CARE FACILITIES, AND TRANSPORTATION CAPABILITIES FOR THE COUNTY AND ITS PARTNERS. SAN DIEGO REGIONAL FULL-SCALE EXERCISE SCRIPPS HEALTH PARTICIPATED IN THE SAN DIEGO HEALTHCARE ADVISORY COMMITTEE'S REGIONAL FULL-SCALE EXERCISE IN JULY 2022. THE EXERCISE SIMULATED A MAJOR EARTHQUAKE THAT DAMAGED INFRASTRUCTURE, INCLUDING MAJOR HIGHWAYS, THROUGHOUT THE SAN DIEGO AREA. THE EARTHQUAKE ALSO AFFECTED CRITICAL INFRASTRUCTURE SUCH AS POWER AND WATER SUPPLY. HOSPITALS, CLINICS, AND LONG-TERM CARE FACILITIES, ALONG WITH THE COUNTY OF SAN DIEGO, PARTICIPATED IN THIS EXERCISE. SCRIPPS HOSPITAL COMMAND CENTERS WERE UTILIZED AT EVERY HOSPITAL, AND VARIOUS COMMUNICATION METHODS WERE TESTED, INCLUDING RADIO, HAM RADIOS, CELL PHONES, TEAMS, AND WEB-EOC CAPABILITIES. HOSPITALS WERE ALSO ASSESSED FOR THEIR SURGE CAPABILITIES DURING THE DRILL. THE SAN DIEGO LGBT COMMUNITY CENTER SCRIPPS SPONSORED THE SAN DIEGO LGBT COMMUNITY CENTER, WHICH IS ONE OF THE NATION'S LARGEST AND MOST ACTIVE LGBT COMMUNITY CENTERS. THE CENTER, LED BY A 10-MEMBER BOARD OF DIRECTORS, EMPLOYS OVER 70 STAFF MEMBERS AND ENGAGES MORE THAN 1,200 COMMUNITY VOLUNTEERS. THEIR MISSION ENCOMPASSES PROMOTING LGBT HEALTH AND HUMAN RIGHTS, PROVIDING A RANGE OF PROGRAMS AND SERVICES TO THE DIVERSE SAN DIEGO LGBT COMMUNITY, INCLUDING INDIVIDUALS OF VARIOUS DEMOGRAPHICS AND THOSE LIVING WITH HIV. THROUGH ITS EVENTS, ACTIVITIES, ADVOCACY, AND DIRECT SERVICE VISITS, THE CENTER SIGNIFICANTLY IMPACTS THE LIVES OF THOUSANDS. SCRIPPS MERCY HOSPITAL CLOTHING DRIVE FOR CATHOLIC CHARITIES IN FY23, SCRIPPS MERCY HOSPITAL CONDUCTED A CLOTHING DRIVE TO SUPPORT CATHOLIC CHARITIES, A LONG-STANDING PARTNER OF THE HOSPITAL. CATHOLIC CHARITIES HAS BEEN ASSISTING HOMELESS PATIENTS FROM BOTH THE SAN DIEGO AND CHULA VISTA CAMPUSES FOR OVER A DECADE BY PROVIDING TEMPORARY HOUSING OPTIONS. CATHOLIC CHARITIES, IN PARTNERSHIP WITH NAMI, RUNS A JOB PLACEMENT PROGRAM THAT HELPS WOMEN SECURE ENTRY-LEVEL POSITIONS IN THE LOCAL HOSPITALITY INDUSTRY. MANY OF THESE NEWLY EMPLOYED WOMEN REQUIRE SPECIFIC CLOTHING ATTIRE THAT THEY MAY NOT INITIALLY AFFORD OR EASILY OBTAIN. TO AID IN THIS ENDEAVOR, SCRIPPS MERCY HOSPITAL COLLECTED GENTLY USED OR NEW WORK POLO SHIRTS AND PANTS, VALUED AT $500, THROUGH THE CLOTHING DRIVE. F5 - LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. Schedule H, Part VI, Line 2 NEEDS ASSESSMENT (CONTINUATION) QUANTITATIVE DATA INCLUDED: - CALIFORNIA'S DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) LIMITED DATA SETS, 2017-2019 SPEEDTRACK - COMMUNITY NEED INDEX (CNI) - PUBLIC HEALTH ALLIANCE OF SOUTHERN CALIFORNIA HEALTHY PLACES INDEX (HPI) - DATA FROM NATIONAL AND STATE - WIDE DATA SETS WERE ANALYZED INCLUDING SAN DIEGO MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. THE HPI AND THE CNI WERE USED TO IDENTIFY THE MOST UNDER-RESOURCED GEOGRAPHIC COMMUNITIES. THIS INFORMATION HELPED GUIDE THE COMMUNITY ENGAGEMENT PROCESS, INCLUDING SELECTING COMMUNITIES FROM WHICH TO SOLICIT INPUT AND DEVELOPING RELEVANT AND MEANINGFUL ENGAGEMENT TOPICS AND QUESTIONS. DATA FROM THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY, INCLUDING THE FOLLOWING REPORTS AND DASHBOARDS WERE ALSO USED: REPORTS - COUNTY OF SAN DIEGO COMMUNITY HEALTH STATISTICS - HEALTH DISPARITIES EXECUTIVE SUMMARY REPORT - RACIAL EQUITY: FRAMEWORK AND OUTCOMES BRIEF - SAN DIEGO COUNTY SELF-SUFFICIENCY STANDARD, HOUSEHOLD WITH TWO ADULTS, ONE PRESCHOOL-AGE CHILD, AND ONE SCHOOL-AGE CHILD, 2021 - OVERDOSE DATA TO ACTION (OD2A) COMMUNITY HEALTH STATISTICS DASHBOARDS - LGBTQ HEALTH AND WELL-BEING DASHBOARDS - HEALTH EQUITY DASHBOARD SERIES: RACIAL EQUITY DASHBOARDS - SAN DIEGO COUNTY SELF-SUFFICIENCY STANDARD DASHBOARD - COVID-19 IN SAN DIEGO COUNTY QUALITIATIVE DATA - COMMUNITY ENGAGEMENT THE GOAL OF THE COMMUNITY ENGAGEMENT PROCESS WAS TO SOLICIT INPUT FROM A WIDE RANGE OF STAKEHOLDERS SO THAT THE SAMPLE WAS AS REPRESENTATIVE AS POSSIBLE OF THOSE FACING INEQUITIES IN SAN DIEGO COUNTY. A TOTAL OF 841 INDIVIDUAS PARTICPATED IN THE 2022 CHNA. INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING DISCUSSIONS: - WORKING WITH COMMUNITY HEALTH WORKERS TO CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS, COMMUNITY HEALTH WORKERS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, CIVIC LEADERS, AND HEALTH CARE LEADERS (CONDUCTED IN COLLABORATION WITH KAISER FOUNDATION HOSPITAL (KFH)-SAN DIEGO) - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH HOSPITAL AND HEALTH SYSTEM CLINICIANS, CASE MANAGERS, SOCIAL WORKERS, AND EXECUTIVE LEADERS - DISTRIBUTING AN ONLINE SURVEY TO COMMUNITY MEMBERS, HOSPITAL STAFF, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL GOVERNMENT STAFF 2022 CHNA PRIORITIZATION OF THE TOP COMMUNITY NEEDS THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH HEALTH CONDITIONS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED, THE MAGNITUDE/SCALE OF THE NEED; DISPARITIES OR INEQUITIES AND CHANGE OVER TIME. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. THROUGH THE PRIORITIZATION PROCESS DESCRIBED IN THE METHODOLOGY SECTION, THE CHNA COMMITTEE IDENTIFIED THE MOST CRITICAL TOP COMMUNITY NEEDS WITHIN SAN DIEGO COUNTY, LISTED BELOW IN ALPHABETICAL ORDER: - ACCESS TO HEALTH CARE - AGING CARE & SUPPORT - BEHAVIORAL HEALTH - CHILDREN & YOUTH WELLBEING - CHRONIC HEALTH CONDITIONS - COMMUNITY SAFETY - ECONOMIC STABILITY FOUNDATIONAL CHALLENGES THE 2022 CHNA RECOGNIZED HEALTH DISPARITIES AND WORKFORCE SHORTAGES AS FOUNDATIONAL CHALLENGES THAT ARE CONTRIBUTING TO THE GROWTH OF EVERY HEALTH NEED. HEALTH DISPARITIES DECADES OF RESEARCH HAS DEMONSTRATED THAT EVEN IN PRE-PANDEMIC TIMES, SOME COMMUNITIES AND POPULATIONS HAVE MUCH POORER HEALTH CARE AND OUTCOMES THAN OTHER COMMUNITIES OR POPULATIONS. THESE MAY BE ISSUES OF ACCESS ROOTED IN GEOGRAPHY, ISSUES OF FINANCE AND INSURANCE COVERAGE, OR SYSTEMIC ISSUES ROOTED IN RACISM AND DISCRIMINATION. FOR EXAMPLE, "FRONTLINE" WORKERS (PEOPLE WHO ARE MOST INVOLVED IN DIRECT CUSTOMER CONTACT) COULD NOT WORK FROM HOME DURING THE PANDEMIC AND WERE AT HIGHER RISK OF COVID EXPOSURE. THIS CONTRIBUTED TO DISPROPORTIONATELY HIGHER MORTALITY RATES COMPARED TO GROUPS THAT COULD WORK FROM HOME OR QUIT WORK. IN ADDITION, THE HEALTH OF SAN DIEGANS WHO WERE VULNERABLE BEFORE THE PANDEMIC - SUCH AS PEOPLE EXPERIENCING HOMELESSNESS, ISOLATED SENIORS, LGBTQ+ YOUTH, AND CHILDREN WITH SPECIAL NEEDS - DETERIORATED MORE ACUTELY AS THEY LOST ACCESS TO CRITICAL SERVICES AND FACED NEW BARRIERS TO THEIR SAFETY AND ECONOMIC STABILITY. WORKFORCE SHORTAGES COMMUNITY ENGAGEMENT PARTICIPANTS IN PREVIOUS CHNAS OFTEN MENTIONED THE NEED FOR MORE HEALTH CARE PROVIDERS, MOSTLY WITH A VIEW TOWARD BOLSTERING WORKFORCE PIPELINES. IN THE 2022 CHNA FOCUS GROUPS AND INTERVIEWS, WORKFORCE SHORTAGES WERE CONSISTENTLY AT THE FRONT OF DISCUSSIONS. IN MOST OCCUPATIONS, WORKERS ARE EXPERIENCING EXHAUSTION, EMOTIONAL TRAUMA, AND A SENSE OF "FEELING BURNED OUT AFTER OVER TWO YEARS OF THE COVID PANDEMIC." CLINICAL WORKERS AND SOCIAL WORK STAFF AT ALL LEVELS OF HEALTH CARE DELIVERY FACED THE SAME CHALLENGES AND FRUSTRATIONS, AS WORKFORCE SHORTAGES AND THE INCREASED MEDICAL DEMANDS OF COVID STRESSED HEALTH CARE SERVICES ACROSS THE REGION. KEY UNDERLYING THEMES STIGMA AS IN OUR 2019 CHNA FINDINGS, STIGMA AND THE BARRIERS IT CREATES AROSE ACROSS COMMUNITY ENGAGEMENT DISCUSSIONS IN 2022. STIGMA IMPACTS THE WAY PEOPLE ACCESS NEEDED SERVICES (CALFRESH, MEDI-CAL, OTHER ECONOMIC SUPPORT) THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. THIS IMPACTS THE ABILITY OF PEOPLE TO IMPROVE AND SUCCESSFULLY MANAGE HEALTH CONDITIONS. COMMUNITY ENGAGEMENT PARTICIPANTS EXPRESSED CONCERNS ABOUT THE IMPACT OF STIGMA IN RELATION TO SPECIFIC POPULATIONS INCLUDING LGBTQ+ COMMUNITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE OF COLOR, SENIORS, MEDI-CAL BENEFICIARIES, AND SURVIVORS OF DOMESTIC VIOLENCE AND HUMAN TRAFFICKING. STIGMA WAS ALSO DISCUSSED IN RELATION TO SPECIFIC HEALTH CONDITIONS SUCH AS BEHAVIORAL HEALTH, CANCER, DIABETES, AND OBESITY. TRAUMA TRAUMA AND VICARIOUS TRAUMA, WERE CITED AS FACTORS CONTRIBUTING TO COMPASSION FATIGUE AND WORKFORCE BURNOUT IN COMMUNITY INTERVIEWS AND FOCUS GROUPS. TRAUMA OCCURS BOTH AT WORK AND AT HOME, AND CONSEQUENTLY, THERE MAY BE NO ESCAPE AND DOWNTIME FROM TRAUMATIC EXPERIENCES. TRAUMATIZED COMMUNITY MEMBERS ARE SEEKING ASSISTANCE FROM HEALTH CARE PROVIDERS AND COMMUNITY-BASED ORGANIZATIONS WHO THEMSELVES HAVE EXPERIENCED GREAT STRESS SINCE THE START OF THE PANDEMIC. COMMUNITY VOICE AND EXPERIENCES THE FINDINGS OF THE 2022 CHNA ATTEMPT TO RESPOND TO THE SAN DIEGO COMMUNITY NEEDS AND CONCERNS, AS IDENTIFIED THROUGH FOCUS GROUPS, KEY INFORMANT INTERVIEWS, INTERVIEWS REGARDING ACCESS TO CARE, AND AN ONLINE SURVEY. THE QUANTITATIVE RESEARCH AND THE COMMUNITY ENGAGEMENT CONFIRMED THE INTERCONNECTEDNESS OF THE SEVEN IDENTIFIED NEEDS. WHEN DISCUSSING THE FINDINGS, THE CHNA HIGHLIGHTS HOW THEY MAY DIFFER FOR SAN DIEGANS BASED ON THEIR EXPERIENCES. THESE DIFFERING EXPERIENCES MAY INCLUDE HOMELESSNESS, IMMIGRATION STATUS, GENDER AND SEXUAL ORIENTATION, AGE AND POVERTY. COMMUNITY RECOMMENDATIONS DURING THE ACCESS TO CARE INTERVIEWS AND IN THE ONLINE COMMUNITY SURVEY, WE ASKED "WHAT ARE THE MOST IMPORTANT THINGS THAT HOSPITALS AND HEALTH SYSTEMS COULD DO TO IMPROVE HEALTH AND WELL-BEING IN OUR COMMUNITY?" OVERWHELMINGLY, RESPONDENTS AGREED THAT THERE IS A CRITICAL NEED TO HELP PATIENTS NAVIGATE AVAILABLE SERVICES THAT WILL HELP IMPROVE THEIR HEALTH AND WELL-BEING. IN BOTH THE INTERVIEWS AND THE SURVEYS, OPTIONS THAT CENTERED AROUND IMPROVED PATIENT CARE ROSE TO THE TOP. MOST RESPONSES FELL INTO FOUR CATEGORIES: NAVIGATION AND SUPPORT, CULTURALLY APPROPRIATE, WORKFORCE DEVELOPMENT, AND COMMUNITY COLLABORATION. NEXT STEPS THE CHNA REPORT IS MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND IS INTENDED TO SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTH CARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. HASD&IC AND THE CHNA COMMITTEE ARE PROUD OF THEIR COLLABORATIVE RELATIONSHIPS WITH LOCAL COMMUNITY ORGANIZATIONS AND ARE COMMITTED TO REGULARLY SEEKING INPUT FROM THE COMMUNITY TO INFORM COMMUNITY HEALTH STRATEGIES. ADDITIONALLY, THE CHNA COMMITTEE IS ACTIVELY INVOLVED IN PLANNING THE 2025 CHNA, DEMONSTRATING THEIR COMMITMENT TO ONGOING ASSESSMENTS AND IMPROVEMENTS IN COMMUNITY HEALTH. THIS COMMITMENT ENSURES THAT THE ASSESSMENT REMAINS UP-TO-DATE AND RESPONSIVE TO THE EVOLVING NEEDS OF THE COMMUNITY. Schedule H, Part VI, Line 2 NEEDS ASSESSMENT (CONTINUATION) THE CHNA REPORT WILL BE MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND IS INTENDED TO SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTH CARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. HASD&IC AND THE CHNA COMMITTEE ARE PROUD OF THEIR COLLABORATIVE RELATIONSHIPS WITH LOCAL COMMUNITY ORGANIZATIONS AND ARE COMMITTED TO REGULARLY SEEKING INPUT FROM THE COMMUNITY TO INFORM COMMUNITY HEALTH STRATEGIES. THE CHNA COMMITTEE IS IN THE PROCESS OF PLANNING PHASE 2 OF THE 2022 CHNA, WHICH WILL INCLUDE GATHERING COMMUNITY FEEDBACK ON THE 2022 CHNA PROCESS AND STRENGTHENING PARTNERSHIPS AROUND THE IDENTIFIED COMMUNITY NEEDS. SCRIPPS HEALTH IMPLEMENTATION STRATEGY WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY: A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL-SUITED TO DEVELOPING A RESPONSE TO THE CHNA. THE EVALUATION OF THE IMPLEMENTATION STRATEGY ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND ADJUSTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION STRATEGY ARE ALSO TAILORED TO EACH OBJECTIVE AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION STRATEGY IS FILED ANNUALLY WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. SCRIPPS HEALTH HAS A CONSISTENT FOCUS ON THE INITIATIVES, MEASURES OF IMPLEMENTATION AND METRICS USED TO EVALUATE THE EFFECTIVENESS OF THE COMMUNITY NEEDS IDENTIFIED THROUGH THE 2022 CHNA. THE COMPLETE FY23-FY25 IMPLEMENTATION STRATEGY REPORT IS AVAILABLE ONLINE AT https://www.scripps.org/sparkle-assets/documents/scripps-health-implementation-strategy-2023-2025.pdf Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION) DURING FISCAL YEAR 2022 (OCTOBER 2022 TO SEPTEMBER 2023), SCRIPPS INVESTED $8,588,962 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COSTS ASSOCIATED WITH PROVIDING THESE PROGRAMS, SALARIES, MATERIALS, AND SUPPLIES MINUS REVENUE. FOR MORE DETAILED INFORMATION ON THESE AND OTHER PROGRAMS SEE HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. A LACK OF HEALTH INSURANCE IS A PREDICTOR OF MANY HEALTH CONDITIONS, INCLUDING MORE POOR MENTAL HEALTH DAYS, MORE VISITS TO THE ED FOR HEART ATTACKS, A HIGHER PREVALENCE OF ASTHMA, AND OBESITY, MORE LOW BIRTH WEIGHT BABIES, AND HIGHER PREVALENCE OF SMOKING. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. ACCESS TO HEALTH CARE EMERGED AS A HIGH PRIORITY HEALTH NEED IN BOTH THE SECONDARY DATA ANALYSES AND COMMUNITY ENGAGEMENT DISCUSSIONS IN THE 2022 SCRIPPS COMMUNITY HEALTH NEEDS ASSESSMENT. THROUGH THE COMMUNITY ENGAGEMENT CONDUCTED WE HEARD FROM THE COMMUNITY THAT SEVERAL FACTORS WERE IDENTIFIED AS BEING SIGNIFICANT IN ACCESSING HEALTH CARE IN SAN DIEGO: TRANSPORTATION, LACK OF HEALTHCARE COSTS AND MEDICAL DEBT, THE LACK OF CULTURALLY COMPETENT AND LINGUISTICALLY APPROPRIATE CARE AND LGBTQ+ EXPERIENCE IN HEALTH CARE. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED A NUMBER OF PROGRAMS AND ACTIVITIES IN FISCAL YEAR 2022. BELOW ARE A FEW EXAMPLES OF ACCESS TO CARE PROGRAMS. MORE DEATILED INFORMATION ON THE BREATH AND SCOPE OF OUR PROGRAMS CAN BE FOUND IN THE 2023 SCRIPPS COMMUNITY BENEFIT PLAN AND REPORT, HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY. MERCY OUTREACH SURGICAL TEAM PROVIDES LIFE-CHANGING CARE TO CHILDREN IN MEXICO FOR THREE DECADES, THE MERCY OUTREACH SURGICAL TEAM (MOST) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. MOST IS AN INDEPENDENT, NONPROFIT ORGANIZATION FOUNDED IN 1987 AT SCRIPPS MERCY HOSPITAL WHOSE MISSION IS TO PROVIDE FREE SURGERIES AND VISION CARE TO UNDERSERVED CHILDREN IN MEXICO. AFTER THE 9/11 TERRORIST ATTACK, MOST'S MISSIONS HAD TO BE SHIFTED EXCLUSIVELY TO TRIPS IN MEXICO, DUE TO DIFFICULTY GETTING CHILDREN ACROSS THE BORDER FROM MEXICO INTO THE U.S. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. IN MEXICO, MOST VOLUNTEERS TYPICALLY PERFORM HUNDREDS OF SURGERIES PER MISSION-AND MORE THAN 14,000 OVERALL SINCE ITS FOUNDING-FOR ISSUES LIKE CLEFT LIPS, CROSSED EYES, BURN SCARS, HERNIA REPAIRS AND MORE. MOST ALSO ADDED A VISION PROGRAM IN 2004 THAT PROVIDES MORE THAN 100 PAIRS OF EYEGLASSES PER TRIP TO CHILDREN IN NEED. AS THE PAUSE IN TRAVEL FOR MOST CONTINUED INTO 2022, MOST SOUGHT ALTERNATIVE WAYS TO SERVE THOSE IN NEED. SCRIPPS PROVIDED A SPONSORSHIP OF $18,850 TO TWO ROTARY CLUBS IN MEXICO WHICH FUNDED LOCAL SURGEONS TO PERFORM LIFE CHANGING CLEFT LIP AND PALATE SURGERIES TO 27 CHILDREN. THESE ROTARY CLUBS WERE CHARGED WITH DISPERSING THE MONIES AND MAKING SURE THE FUNDS WERE UTILIZED APPROPRIATELY. THE TWO CLINICS WHERE THE SURGERIES WERE PERFORMED WERE CASA AZUL IN MONTEREY, NUEVO LEON, MEXICO AND SONRISA DE LUNA IN TEPIC, NAYARIT, MEXICO. CITY OF REFUGE (CoR) SAN DIEGO RECUPERATIVE CARE UNIT PROGRAM (RCU) RECUPERATIVE CARE (ALSO KNOWN AS MEDICAL RESPITE CARE, A LOWER LEVEL OF MEDICAL CARE PROVIDED WHERE A PATIENT CAN HEAL AND RECOVER FROM AN ILLNESS OR INJURY) PROVIDES PEOPLE WHO ARE EXPERIENCING HOMELESSNESS WITH A SAFE PLACE TO STAY AFTER BEING DISCHARGED FROM THE HOSPITAL TO PREVENT THEM FROM FALLING BACK ONTO THE STREETS WHILE ILL AND RECOVERING. WITHOUT A STABLE PLACE TO STAY, COMMUNITY MEMBERS EXPERIENCING HOMELESSNESS COULD UNDO ANY PROGRESS THEY MADE DURING THEIR HOSPITALIZATION. SCRIPPS HEALTH HAS AN AGREEMENT WITH THE CITY OF REFUGE SAN DIEGO RECUPERATIVE CARE SHELTER (RCS) WHICH PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. LACK OF FUNDING, MENTAL ILLNESS, AS WELL AS ALCOHOL AND/OR SUBSTANCE ABUSE, MAKES POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. DURING THE PANDEMIC ALL SAN DIEGO HOMELESS SHELTERS EXPERIENCED COVID-19 OUTBREAKS, MAKING RCS A TRUE PLACE OF REFUGE FOR 37 OF OUR CHRONICALLY HOMELESS PATIENTS. THE RN (REGISTERED NURSE) CASE MANAGEMENT AND SOCIAL WORK DEPARTMENTS ASSIST WITH A NEEDED SUPPLY OF MEDICATION, APPOINTMENTS, DURABLE MEDICAL EQUIPMENT (DME), SETTING UP HOME HEALTH SERVICES IF NEEDED, AND CONNECTS PATIENTS TO PSYCH AS PART OF THE HOSPITAL DISCHARGE PLAN TO THE CITY OF REFUGE. THE CITY OF REFUGE FURTHER SUPPORTS CLIENTS IN MEETING THESE GOALS USING COMMUNITY RESOURCES TO MEET INDIVIDUAL SOCIAL SERVICE NEEDS. SCRIPPS PAYS THE CITY OF REFUGE A DAILY RATE FOR HOUSING AND SERVICES THEY PROVIDE TO THE PATIENTS. THE CITY OF REFUGE PROVIDES A SAFE, SECURE ENVIRONMENT, WITH 24-HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, CASE MANAGEMENT, ASSISTANCE WITH MEDI-CAL, WITH TRANSITION TO MANAGED MEDI-CAL AND DISABILITY APPLICATIONS, REFERRALS TO REHAB AND OTHER PROGRAMS, AND HELP FINDING PERMANENT OR TRANSITIONAL HOUSING USING COUNTY RESOURCES. DME AND OTHER NEEDED SERVICES ARE PROVIDED BY SCRIPPS WHEN FUNDING IS NOT AVAILABLE. ALL PATIENTS ARE CONNECTED TO A MEDICAL HOME, AND PRIMARY CARE IN THE COMMUNITY. PATIENTS WITH PSYCH DISORDERS ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY IF THEY ARE WILLING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED BY THE CITY OF REFUGE, BUT MAY INCLUDE INSURANCE FUNDED TRANSPORT SERVICES, AND OCCASIONALLY SCRIPPS SHUTTLE, OR USE OF TAXI VOUCHER. THE CITY OF REFUGE BEGAN TAKING PATIENTS ROUTINELY IN OCTOBER OF 2019. THIS YEAR 37 PATIENTS SO FAR HAVE MET THE NEED FOR RCS ADMISSION, BUT MANY DID NOT QUALIFY DUE TO BEHAVIOR, UNSTABLE MENTAL ILLNESS, OR UNWILLINGNESS TO ABSTAIN FROM SUBSTANCE ABUSE. AS A GROUP, THE RCS PATIENTS HAD A CUMULATIVE OF 393 HOSPITAL DAYS OF STAY, AN AVERAGE OF 10.6 HOSPITAL DAYS OF STAY, BEFORE GOING TO RCS OCTOBER 2021 TO DATE. THE RCS HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: IV ANTIBIOTICS, WOUND VACS, SKIN GRAFTS, FRACTURES, ABSCESSES, OSTEOMYELITIS, AMPUTATION, DOG BITES, DKA, GI BLEEDS, PANCREATITIS, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, DIABETES, MILD ENCEPHALOPATHY, OSTOMIES, MVA, PEDESTRIAN VERSUS AUTO, PLEURAL EFFUSION, CVA, CANCER (LYMPHOMA, PANCREATIC CANCER), HIV/AIDS, SEPSIS, RESPIRATORY FAILURE, PNEUMONIA, CHF. PATIENTS WERE ASSAULT VICTIMS WITH GUNSHOT AND STAB WOUNDS, FACIAL TRAUMA, AND SURGICAL POST OP PATIENTS AND MANY ARE DIABETIC. PSYCH PROBLEMS ARE COMMON AND OCCASIONALLY THE MAIN ISSUE FOR RCS CLIENTS. OVER 67% OF THIS GROUP WERE EITHER POSITIVE FOR ALCOHOL, DRUGS OR DRUG SCREEN OR HAD A DRUG HISTORY ADDRESSED BY THE PHYSICIAN IN THE H & P. THE FOLLOWING ARE OUTCOME METRICS TRACKED BY SCRIPPS FOR THE CITY OF REFUGE PROGRAM. - FOR FY22 TOTAL COST SAVINGS FOR SCRIPPS WERE $1,428,646.00. - OF RECUPERATIVE CARE SHELTER PATIENTS, 10% HAD STANDARD MEDI-CAL INSURANCE, AND 67% MEDI-CAL HMO'S,10% HAD MEDICARE FUNDING, AND 10% WERE TRANSITIONING FROM OUT OF STATE OR OUT OF COUNTY MEDICAID/MEDI-CAL PROGRAMS. ONLY ONE PATIENT LACKED FUNDING. - APPROXIMATELY 8% OF PATIENTS SOUGHT TO SECURE INCOME FROM GOVERNMENT PROGRAMS, SOCIAL SECURITY, AND CA SHORT TERM DISABILITY; 3 TOTAL CLIENTS APPLIED OR RECEIVED INCOME BENEFITS. TWO HAVE APPLIED FOR AND RECEIVED MEDI-CAL HMO'S WHILE AT THE RCS WITH THE ASSISTANCE OF THEIR CASE MANAGEMENT DEPARTMENT. - THERE WERE SEVERAL SUCCESSES, WITH THE RCS MANAGER ASSISTING WITH ONE FAMILY REUNIFICATION OUT OF STATE. FOUR PATIENTS TRANSITIONED TO DRUG REHAB CENTERS, AND SEVERAL INTO ALPHA PROJECT OR FATHER JOE'S SHELTERS, INTERFAITH, AND MENTAL HEALTH TREATMENT PROGRAMS. - THE COMPLEX CARE MANAGER ENSURED 100 PERCENT OF RCS PATIENTS WERE SCHEDULED AND CONNECTED TO A PRIMARY CARE PROVIDER OR HAD ESTABLISHED CARE AT ONE OF THE COMMUNITY CLINICS. - FOLLOWING THEIR STAY IN THE CITY OF REFUGE: 30% OF THE RCS PATIENTS COMPLETED THEIR RECUPERATIVE CARE AND RETURNED TO THEIR PREVIOUS LIVING AND 14% WENT BACK TO THE HOSPITAL AS THEY NEEDED FURTHER TREATMENT. FATHER JOE'S VILLAGES STREET HEALTH INTERVENTION PROJECT SCRIPPS MERCY HOSPITAL SAN DIEGO SERVES A LARGE VOLUME OF SAN DIEGO'S UNSHELTERED HOMELESS POPULATION IN THE EMERGENCY SERVICES DEPARTMENT. BECAUSE OF THE SCARCITY OF SHELTER AND TREATMENT PROGRAM BEDS AVAILABLE FOR THESE PATIENTS, THEY OFTEN LEAVE THE HOSPITAL TO RETURN TO THEIR PREVIOUS OUTSIDE LOCATION. EVEN THOUGH THESE PATIENTS ARE STABLE FOR A SAFE DISCHARGE, THERE ARE MANY WHO COULD BENEFIT FROM A FOLLOW-UP HEALTH CARE AND CARE MANAGEMENT VISIT IN THE COMMUNITY SETTING. Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION) AS THE STREET MEDICINE INSTITUTE EXPLAINS, "THE FUNDAMENTAL APPROACH OF STREET MEDICINE IS TO ENGAGE PEOPLE EXPERIENCING HOMELESSNESS EXACTLY WHERE THEY ARE AND ON THEIR OWN TERMS TO MAXIMALLY REDUCE OR ELIMINATE BARRIERS TO CARE ACCESS AND FOLLOW-THROUGH". VISITING PEOPLE WHERE THEY LIVE - IN ALLEYWAYS, UNDER BRIDGES, OR WITHIN URBAN ENCAMPMENTS - IS A NECESSARY STRATEGY TO FACILITATE TRUST-BUILDING WITH THIS SOCIALLY MARGINALIZED AND HIGHLY VULNERABLE POPULATION. A COLLABORATION HAS BEEN ESTABLISHED BETWEEN FATHER JOE'S VILLAGE STREET HEALTH INTERVENTION PROJECT AND SCRIPPS MERCY HOSPITAL TARGETING UNSHELTERED DISCHARGED PATIENTS WHO COULD BENEFIT FROM A FOLLOW-UP VISIT IN THE COMMUNITY SETTING WHERE THEY RESIDE. THE STREET HEALTH INTERVENTION IS FOR ELIGIBLE, UNSHELTERED PATIENTS PRIOR TO THE EMERGENCY ROOM DISCHARGE. THE INITIATIVE ESTABLISHES A COMMUNITY-SETTING, FOLLOW-UP HEALTH CARE VISIT FROM FATHER JOE'S VILLAGES SENIOR (FJV) MULTIDISCIPLINARY STREET HEALTH TEAM THE FOLLOWING DAY. THIS PROJECT WILL HELP SUPPORT THE NEEDS OF UNSHELTERED PERSONS EXITING THE HOSPITAL BY LINKAGE WITH FJV STREET HEALTH TEAM BECAUSE: - LIMITED AVAILABILITY OF SHELTER BEDS IN THE CITY OF SAN DIEGO - DAILY, THERE IS A SUBSTANTIAL NUMBER OF UNSHELTERED PERSONS DISCHARGED FROM SCRIPPS MERCY HOSPITAL EMERGENCY DEPARTMENT WHO MAY BENEFIT FROM A NURSING FOLLOW UP VISIT - I.E., WOUND CARE AND/OR MEDICATION CHECK OR PRIMARY CARE PHYSICIAN ESTABLISHMENT. - FATHER JOE'S VILLAGES HAS THE CLINICAL STAFF AND EXPERIENCE TO PROVIDE STREET HEALTH OUTREACH TO THE UNSHELTERED IN THE CENTRAL REGION OF SAN DIEGO COUNTY. - FATHER JOE'S VILLAGES STREET HEALTH HAS A RELATIONSHIP WITH PATH OUTREACH TO ASSIST WITH HOUSING AND SOCIAL SERVICE BENEFIT NEEDS. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, RESIDENTS AND FELLOWS. GME RESIDENTS AND MANY ATTENDING PHYSICIANS MAINTAIN AN EVENING CLINIC AT ST. LEO'S MISSION COMMUNITY CLINIC IN NORTH COUNTY. TWO RESIDENTS VOLUNTEER EVERY WEDNESDAY TO PROVIDE MEDICAL CARE TO UNINSURED PATIENTS WITH A VARIETY OF CONDITIONS, INCLUDING DIABETES, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. THEY ALSO IDENTIFY MANY ACUTE CONDITIONS, INCLUDING VIRAL INFECTIONS, SKIN INFECTIONS, EYE PROBLEMS AND MUSCULOSKELETAL ISSUES, AND EDUCATE PATIENTS ABOUT THEIR HEALTH. PATIENTS MAY GET FLU VACCINATIONS AND SOME BASIC LAB TESTS. IF NEEDED, ST. LEO'S PATIENTS ARE REFERRED TO PROVIDERS WHO PROVIDE CARE AT A REDUCED COST. SCRIPPS SPONSORED AMERICAN RED CROSS BLOOD DRIVES SCRIPPS HEALTH PARTNERED WITH THE AMERICAN RED CROSS IN FISCAL YEAR 2022 TO HOSTED 10 BLOOD DRIVES; 431 SCRIPPS EMPLOYEES DONATED BLOOD THROUGHOUT THE YEAR. SCRIPPS HEALTH COLLECTED 453 PINTS OF BLOOD (FOR EVERY PINT DONATED 3 LIVES ARE SAVED), WHICH SAVED APPROXIMATELY 1,359 LIVES. SCRIPPS PROMOTED THE BLOOD DRIVES THROUGH OUR SYSTEM WIDE COMMUNICATION CHANNELS AND OUR WELLNESS ALL AROUND YOU CAMPAIGN. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2022, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $138,500 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO. THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $4.4 MILLION TO DATE. PROGRAMS FUNDED DURING FISCAL YEAR 2022 INCLUDED: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) THE CONSUMER CENTER PARTNERSHIP IS A MEDICAL LEGAL PARTNERSHIP WITH SCRIPPS MERCY HOSPITAL. THE PROGRAM HELPS TO EDUCATE CONSUMERS ABOUT HEALTH CARE BENEFITS AND CHANGES OCCURRING WITH ELIGIBILITY AND ENROLLMENT IN COVERAGE PROGRAMS. STAFF ASSIST UNINSURED/UNDERINSURED LOW-INCOME SCRIPPS PATIENTS OBTAIN ACCESS TO MEDI-CAL, COUNTY MEDICAL SERVICES (CMS), COVERED CALIFORNIA, AND PRIVATE INSURANCE. FUNDING PROVIDES LOW INCOME, UNINSURED AND BEHAVIORAL HEALTH PATIENTS HELP OBTAIN HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THIS MEDICAL LEGAL PARTNERSHIP PLACES CONSUMER CENTER PLACES STAFF ONSITE AT SCRIPPS MERCY HOSPITAL WITHIN THE BEHAVIORAL HEALTH UNIT (BHU) AND PROVIDES ACCESSIBLE LEGAL ASSISTANCE, IN ADDITION TO RECEIVING DIRECT REFERRALS FROM OTHER SCRIPPS FACILITIES. DUE TO THE SAFETY CONCERNS DURING THE PUBLIC HEALTH EMERGENCY, THE CONSUMER CENTER STAFF PROVIDED HIGH QUALITY SERVICES TO PATIENTS BASED ON DIRECT REFERRALS FROM SCRIPPS BHU AND PATIENT REPRESENTATIVE SERVICES STAFF AT MERCY AND OTHER SCRIPPS FACILITIES. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME INTENSIVE GOVERNMENT BENEFIT CASES AND THE CONSUMER CENTER STRESSES THE IMPORTANCE OF ACCESSING COMMUNITY-BASED SERVICES FOR ROUTINE HEALTH CARE INSTEAD OF USING THE ED'S AND HOSPITAL DEPARTMENTS AS WELL AS THE IMPORTANCE OF ESTABLISHING MEDICAL HOMES. ERIC PAREDES SAVE A LIFE FOUNDATION EACH YEAR, 7,000 TEENS LOSE THEIR LIVES DUE TO SUDDEN CARDIAC ARREST (SCA). SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEART'S ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE ELECTROCARDIOGRAM (EKG). UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. SAN DIEGO ALONE LOSES THREE TO FIVE TEENS FROM SCA ANNUALLY. SCRIPPS FUNDING ASSISTS WITH SCREENING FOR YOUTH ATHLETES COUNTYWIDE. CATHOLIC CHARITIES FUNDING WAS NOT PROVIDED IN FISCAL YEAR 2022, BUT THE PARTNERSHIP CONTINUED. CATHOLIC CHARITIES PROVIDES SEVERAL SHELTER BED OPTIONS FOR MEN AND WOMEN EXPERIENCING HOMELESSNESS. BECAUSE OF THE LONG-STANDING PARTNERSHIP BETWEEN SCRIPPS HEALTH AND CATHOLIC CHARITIES, CATHOLIC CHARITIES MAKES EVERY EFFORT TO ACCOMMODATE THE NEEDS OF SMH PATIENTS, IF A BED IS AVAILABLE AND THE REFERRAL IS APPROPRIATE. ONCE A BED IS SECURED, SHELTER RESIDENTS ARE ASSISTED THROUGH CASE MANAGEMENT TO OBTAINING OTHER HEALTH AND SOCIAL SUPPORTS NEEDED TO STABILIZE AND IMPROVE THEIR CURRENT LIFE SITUATION. THE MOBILE HEALTH AND RESOURCE FAIR RACIAL/ETHNIC MINORITY WOMEN CONTINUE TO EXPERIENCE DELAYED DIAGNOSIS OF BREAST CANCER, CARDIOVASCULAR DISEASE, AND DEMENTIA, AND AFRICAN AMERICAN WOMEN ARE ALSO MORE LIKELY TO BE DIAGNOSED WITH MORE AGGRESSIVE BREAST CANCERS AND TO DIE FROM BREAST CANCER AT AN EARLIER AGE. REGULAR SCREENING IS KEY TO PREVENT DELAYED DIAGNOSIS, BUT MARGINALIZED POPULATIONS SUCH AS AFRICAN AMERICAN AND UNDERSERVED HISPANIC WOMEN ARE LESS LIKELY TO GET MAMMOGRAMS AND OTHER PREVENTIVE HEALTH MEASURES. A SYSTEMATIC REVIEW FOUND THAT ONE OF THE MOST EFFECTIVE METHODOLOGIES FOR DISEASE PREVENTION IN UNDERSERVED POPULATIONS IS TO REACH OUT DIRECTLY INTO THE COMMUNITY RATHER THAN REQUIRE INDIVIDUALS TO COME TO A HEALTHCARE CENTER. THE MOBILE HEALTH AND RESOURCE FAIR HAS CONSISTENTLY SERVED HUNDREDS OF DIVERSE COMMUNITY MEMBERS EACH MONTH, MANY OF WHOM CONTINUE TO RETURN FOR SERVICES. LED BY A RETIRED PHYSICIAN AND A BREAST CANCER SURVIVOR/ADVOCATE/CEO OF COMMUNITY-BASED ORGANIZATION MANY SHADES OF PINK. THESE VOLUNTEERS HOPE TO EXPAND AND UPGRADE THEIR SERVICES (E.G., ADDING CHOLESTEROL SCREENING, ADDING ADDITIONAL DEMENTIA SCREENINGS AND MENTAL HEALTH RESOURCES). SCRIPPS FUNDING ALLOWS TO PROVIDE MORE REGULAR CARDIOVASCULAR HEALTH AND NEUROCOGNITIVE SCREENINGS, AS WELL AS RESOURCES AND REFERRALS FOR BREAST CANCER SCREENING TO THESE UNDERSERVED AND OFTEN HIGH-RISK POPULATIONS. THE OBJECTIVE OF THIS PROGRAM IS TO HELP PREVENT DELAYED DIAGNOSES OF BREAST CANCER, CARDIOVASCULAR DISEASE, AND DEMENTIA AND PROMOTE HEALTH MAINTENANCE. THE FUNDING ALSO SUPPORTS THE HIRING OF DEDICATED COMMUNITY-BASED PATIENT NAVIGATORS TO HELP CONNECT COMMUNITY MEMBERS WITH THE APPROPRIATE HEALTH CARE RESOURCES, ESPECIALLY THROUGH THE BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT THAT CAN CONNECT PATIENTS TO MEDI-CAL AND FOLLOW-UP CARE AT SCRIPPS HEALTH. IN CONJUNCTION TO ENHANCED SCREENING SERVICES, SCRIPPS CONDUCTS RESEARCH TO BETTER UNDERSTAND BARRIERS UNIQUE TO THE UNDERSERVED IN SOUTHEAST SAN DIEGO AND TO BETTER MEET THEIR HEALTH CARE NEEDS IN TERMS OF PREVENTIVE AND MAINTENANCE OF HEALTH CARE. THE RESEARCH FINDINGS WILL HELP THE TEAM TO OPTIMIZE THE DELIVERY OF SERVICES AND MAXIMIZE THEIR COMMUNITY REACH. Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION) SCRIPPS HEALTH CAL FRESH SCREENINGS AS HEALTH CARE DELIVERY SYSTEMS MOVE TOWARDS A POPULATION HEALTH PARADIGM THAT INCENTIVIZES KEEPING PATIENTS HEALTHY, HOSPITALS AND CLINICS ARE RECOGNIZING THE SIGNIFICANCE OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH, SUCH AS FOOD INSECURITY (FI). HOSPITALS HAVE BEEN MORE PROACTIVE IN INTERVENING AT SOME LEVEL OF CARE TO AID THE INDIVIDUALS SUFFERING FROM FI AND THEIR ABILITY TO GAIN CONTROL OVER THEIR HEALTH. THE PUBLIC RESOURCE SPECIALIST (PRS) TEAM SCREENS ALL UNINSURED PATIENTS WHO HAVE RECEIVED SERVICES AT ANY OF THE FIVE SCRIPPS HOSPITAL FACILITIES. SCRIPPS HEALTH BEGAN SCREENING FOR CAL FRESH IN JUNE 2017 THROUGH THE SUPPORT OF THE PRS TEAM. THE TEAM HAS BEEN SUCCESSFUL IN HAVING AN IMPORTANT CONVERSATION ABOUT FOOD INSECURITY WITH PATIENTS AND IN FISCAL YEAR 2022, THE PRS TEAM SUCCESSFULLY SCREENED 5,080 FOOD INSECURE PATIENTS. OUT OF THOSE SCREENINGS, PRS SUBMITTED 3,854 MEDI-CAL APPLICATIONS TO THE COUNTY, 674 CAL FRESH APPLICATIONS AND 382 EXPEDITED CAL FRESH APPLICATION. SCRIPPS MERCY WIC PROGRAM THE SPECIAL SUPPLEMENT NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS ESTABLISHED AS A PERMANENT PROGRAM IN 1974 TO SAFEGUARD THE HEALTH OF LOW-INCOME WOMEN, INFANTS, AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS, AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES ON AVERAGE 6,200 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FISCAL YEAR 2022, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 72,926 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW-INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS BREAST PUMPS, PADS, AND OTHER SUPPLIES DURING THE POSTPARTUM PERIOD. IDENTIFYING THE SOCIAL DETERMINANTS OF HEALTH FOR PATIENTS POST DISCHARGE SCRIPPS MERCY HOSPITAL CHULA VISTA WELL BEING CENTER STAFF MEET WITH PATIENTS AT THE BEDSIDE OR FOLLOW UP WITH PATIENTS THROUGH PHONE CALLS AND HOME VISITS TO DETERMINE THE PATIENT'S NEEDS. PATIENTS ARE SCREENED FOR BARRIERS USING A SOCIAL DETERMINANTS OF HEALTH (SDOH) SCREENING TOOL TO HELP IDENTIFY THE PATIENT'S SPECIFIC NEEDS. ADDRESSING SDOH IS VITAL FOR IMPROVING HEALTH AND REDUCING LONGSTANDING HEALTH DISPARITIES. ONCE THE PATIENT'S NEEDS AND ROOT CAUSES OF HOSPITALIZATION ARE IDENTIFIED, STAFF ASSIST THE PATIENT IN SCHEDULING FOLLOW UP DOCTOR'S APPOINTMENT(S) AND ACCESSING COMMUNITY RESOURCES/SUPPORTIVE SERVICES. THROUGH COLLABORATION WITH VARIOUS AGENCIES, STAFF CAN EFFECTIVELY LINK PATIENTS TO TRANSITIONAL CARE AND SUPPORTIVE SERVICES. FULL ACCESS AND COORDINATED TRANSPORTATION (FACT) INC. IN 2019, SCRIPPS ENTERED A PARTNERSHIP WITH A LOCAL NONPROFIT- FACILITATING ACCESS TO COORDINATED TRANSPORTATION (FACT) INC., FOR ON-DEMAND RIDES FOR PATIENTS. SCRIPPS STAFF RELIES ON FACT TO ARRANGE FOR PATIENTS TO GET TO APPOINTMENTS AND FOR DISCHARGED PATIENTS TO RETURN HOME OR GET TO OTHER FACILITIES. THIS COLLABORATIVE SERVICE HAS QUICKLY PROVED TO BE A RELIABLE, CONVENIENT, AND COST-EFFECTIVE SOLUTION TO ONE OF THE DIFFICULT AND EXPENSIVE CHALLENGES IN ACCESSING MEDICAL CARE TRANSPORTATION. THE PROGRAM STREAMLINES A VARIETY OF MEDICAL TRANSPORTATION OPTIONS THROUGH A SINGLE POINT OF CONTACT AT FACT. FACT PROVIDED RIDES FOR PATIENTS INCLUDING THOSE WHO NEED SPECIALIZED VEHICLES OR PERSONAL ASSISTANCE TO COMPLETE THE TRIP. SCRIPPS STAFF USE A SINGLE TELEPHONE NUMBER TO CONTACT STAFF AT FACT, WHO THEN HANDLE THE SELECTION OF THE APPROPRIATE VEHICLE, EQUIPMENT, AND PERSONNEL, AND DISPATCH THE RIDE. THE PROGRAM PROVIDES SAVINGS IN PROCESSING TIME, COST OF TRANSPORTATION AND IT OFFERS THE RIDER A MORE RELIABLE AND CONVENIENT TRANSPORTATION SERVICE. THE INITIAL PILOT PROJECT WAS PARTLY FUNDED BY A COMMUNITY ENHANCEMENT GRANT AWARDED TO FACT BY THE COUNTY OF SAN DIEGO. SCRIPPS REALIZED A BENEFIT USING FACT TRANSPORT AS A COST SAVINGS; RATHER THAN USING TAXI VOUCHERS, AS WELL AS TRIPS THAT COULD TAKE SCRIPPS STAFF A GREAT DEAL OF TIME TO FIND A VENDOR TO DO AS OTHER VENDORS MAY NOT BE ABLE TO DO TRIPS TO THE BORDER OR IMPERIAL COUNTY AS READILY. FACT IS A CLEARINGHOUSE OF SORTS WITH MULTIPLE VENDORS AND THEREFORE SAVES THE STAFF TIME IN FINDING THE APPROPRIATE TRANSPORT AT THE RIGHT TIME. TRANSPORTATION IS AVAILABLE 7 DAYS A WEEK FOR SCRIPPS DISCHARGED PATIENTS TO ANY LOCATION WITHIN SAN DIEGO AND BEYOND. MOST RIDES BEGIN AND END AT THE CURBSIDE, HOWEVER DOOR THROUGH DOOR RIDES, WHEELCHAIR ACCESSIBLE RIDES AND GURNEY RIDES ARE AVAILABLE ON DEMAND. FACT HAS PROVIDED 2,003 RIDES THROUGH JUNE 2022 FOR SCRIPPS PATIENTS THROUGHOUT SAN DIEGO AND AS FAR AWAY AS IMPERIAL COUNTY. THE FOLLOWING ARE THE DIFFERENT TRANSPORTATION MODALITIES THAT FACT-SD PROVIDES: - AMBULATORY - THE RIDER CAN WALK ALONE TO AND FROM THE VEHICLE - CURB-TO-CURB - THE RIDER WILL BE PICKED UP AND DROPPED OFF AT THE CURB OF THE FACILITY/RESIDENCE - DOOR-TO-DOOR - THE RIDER REQUIRES THE DRIVER TO WALK THEM FROM THE DOOR OF THE FACILITY/RESIDENCE TO THE VEHICLE AND FROM THE VEHICLE TO THE DOOR OF THE FACILITY/RESIDENCE - DOOR-THROUGH-DOOR - THE RIDER REQUIRES THE DRIVER TO COME INSIDE THE FACILITY AND TRANSPORT THEM TO THE VEHICLE, THE DRIVER WILL DROP THEM OFF AT THE DOOR OF THE FACILITY OR RESIDENCE - ACCESSIBLE VEHICLES AND MOBILITY DEVICES - WALKER, CANE, FOLDING WHEELCHAIR, WHEELCHAIR, SCOOTER, AND VEHICLES EQUIPPED WITH RAMP OR LIFT - GURNEY TRANSPORTATION SCRIPPS MOBILIZATION TO FIGHT THE COVID-19 PANDEMIC SINCE THE PANDEMIC BEGAN, SCRIPPS HAS BEEN IN OVERDRIVE - FINDING NEW WAYS TO CONNECT WITH PATIENTS, CARING FOR THOSE WHO BECOME ILL AND ADMINISTERING LIFESAVING VACCINES TO THE PEOPLE OF SAN DIEGO. ACROSS THE SCRIPPS HEALTH SYSTEM, DOCTORS, NURSES, CAREGIVERS AND SUPPORT STAFF CONTINUED TO WORK TOGETHER IN FISCAL YEAR 2022 TO FIGHT THE COVID-19 PANDEMIC. SCRIPPS CONTINUED WITH THE IMPLEMENTATION OF COMMAND CENTERS, COVID-19 NURSE LINE, TESTING AND SURGE TENTS AS TESTING CABANAS AND COMMUNITY SUPPORT IN THE EARLY PART OF 2022. IN ADDITION, AWARENESS AND EDUCATION FOR THE COMMUNITY IN VACCINE SAFETY AND AVAILABILITY INCLUDING PRODUCTION, EDUCATIONAL MATERIAL, COORDINATION OF MEDIA RESPONSE AND TELEPHONE HOTLINES FOR ANSWERING QUESTIONS CONTINUED. SCRIPPS POST-COVID CONTINUING CARE. SCRIPPS HEALTH DEVELOPED THE POST-COVID CONTINUING CARE PROGRAM TO ADDRESS THE LINGERING COMPLICATIONS ENDURED BY MANY PATIENTS PREVIOUSLY INFECTED WITH THE COVID-19 VIRUS. SOME PATIENTS EXPERIENCE ONGOING SYMPTOMS SUCH AS SHORTNESS OF BREATH, CONTINUED LOSS OF TASTE OR SMELL, DIZZINESS OR HEADACHES, FATIGUE, AND FOG. THE PROGRAM IS DESIGNED FOR SCRIPPS PATIENTS RECOVERING FROM A HOSPITAL STAY, AS WELL AS THOSE WHO DID NOT REQUIRE HOSPITALIZATIONS BUT ARE RECOVERING FROM COVID. THE GOAL OF THE PROGRAM IS TO HELP PATIENTS ON THE ROAD TO RECOVERY AND ENSURE THAT POST-COVID PATIENTS GET PROPER, COMPASSIONATE MEDICAL TREATMENT CUSTOMIZED TO THEIR NEEDS. FOR MORE INFORMATION ON THIS PROGRAM VISIT, RECOVERY PROGRAM - COVID-19 - SCRIPPS HEALTH. THE PROGRAM HAS ENROLLED 3,200 PATIENTS AS OF AUGUST 2022. THE FOCUS OF THE PROGRAM IN 2022 EVOLVED TO SCREENING COVID-19 POSITIVE PATIENTS AND COORDINATING THE MONOCLONAL TREATMENTS IF PATIENTS MET THE CRITERIA. IN ADDITION, THE COVID CARE COMPANION TEAM BEGAN WORKING WITH THE AMBULATORY PROVIDERS TO GET IMMUNOSUPPRESSED PATIENTS TO PRE-EXPOSURE PROPHYLAXIS TREATMENT. Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION) SCRIPPS EMPLOYEE FOOD SHARING PROGRAM SCRIPPS EMPLOYEES HAVE COME TOGETHER SEVERAL TIMES DURING THE COVID-19 PANDEMIC TO HELP HUNDREDS OF COLLEAGUES' FAMILIES WHO HAVE EXPERIENCED FOOD INSECURITY. WHILE MANY OF THESE COLLEAGUES HAVE BEEN ABLE TO CONTINUE WORKING, THE UNEXPECTED UNEMPLOYMENT OR REDUCTION IN WORK HOURS FOR FAMILY MEMBERS HAS IMPACTED THEIR ABILITY TO CONSISTENTLY PROVIDE THREE DAILY MEALS FOR THEMSELVES AND THEIR CHILDREN. AS A RESULT OF THESE MUTUAL CONCERNS THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM WAS ESTABLISHED TO ASSIST SCRIPPS FAMILIES EXPERIENCING FOOD INSECURITY AS THE COVID-19 CRISIS CONTINUED. A FOOD DISTRIBUTION EVENT WAS HELD ON DECEMBER 18, 2021. THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM SUCCESSFULLY DISTRIBUTED FOOD TO 391 FAMILY MEMBERS. FOOD DISTRIBUTED: 6,500 POUNDS OF GROCERIES AND EACH STAFF MEMBER RECEIVED MILK, EGGS, BREAD, FRUIT, VEGETABLES, A BOX OF NON-PERISHABLE FOOD. THE MAJORITY OF THE FOOD WAS DISTRIBUTED ON DECEMBER 18 BUT AT LEAST 25 ADDITIONAL PACKAGES OF FOOD WAS DISTRIBUTED THE FOLLOWING WEEK. MANY DEPARTMENTS WORKED COLLABORATIVELY TO MAKE THIS INITIATIVE A SUCCESS SUCH AS HUMAN RESOURCES, FOOD AND NUTRITION SERVICES, AND SECURITY AND FACILITIES TO NAME A FEW. THE SCRIPPS LEADERSHIP ACADEMY ALUMNI ALSO VOLUNTEERED TO HELP PACKAGE AND DISTRIBUTE THE FOOD. MUCH APPRECIATION TO THE EMPLOYEES, PHYSICIANS AND VENDORS WHO DONATED TO THE PROGRAM AS THEIR GENEROSITY HELPED TO MAKE A DIFFERENCE FOR MANY DURING A DIFFICULT TIME. DONATIONS FOR UKRAINE RESPONSE IN RESPONSE TO EMPLOYEE AND PHYSICIAN REQUESTS FOR UKRAINE SUPPORT, SCRIPPS PARTNERED WITH MEDSHARE, A GLOBAL ORGANIZATION PROVIDING REQUESTED AND NEEDED MEDICAL SUPPLIES TO UKRAINE. SCRIPPS FIRST LEARNED OF MEDSHARE WHEN THE SCRIPPS MEDICAL RESPONSE TEAM WAS ASSISTING IN HAITI AFTER THE COUNTRY'S EARTHQUAKE. MEDSHARE IS ACTIVELY COLLECTING CASH DONATIONS AND OTHER SUPPORT FOR THEIR EFFORTS AND HAD MORE THAN 7 SHIPMENTS SCHEDULED OVER SEVERAL WEEKS, RANGING IN SIZE AND SCOPE FROM TWO PALLETS OF WOUND CARE DRESSINGS TO A FULL 40-FOOT OCEAN CONTAINER OF ASSORTED MEDICAL SUPPLIES, BIOMEDICAL EQUIPMENT AND SURGICAL TOOLS. MEDSHARE ALSO PARTNERS WITH AN ARRAY OF OTHER INTERNATIONAL RELIEF ORGANIZATIONS TO ENSURE AID IS HANDLED APPROPRIATELY AND REACHES THE MOST CRITICAL COMMUNITIES. SCRIPPS STAFF AND PHYSICIANS RALLIED TO THE WORTHY CAUSE WITH THEIR OWN CASH CONTRIBUTIONS IN THE AMOUNT OF $10,710. (MADE THROUGH PAYROLL DEDUCTION), AND SCRIPPS HEALTH TOOK THE LEAD WITH ITS OWN LEAD GIFT OF $10,000. STAFF WERE ALSO ABLE TO MAKE DONATIONS DIRECTLY THROUGH THE MEDSHARE WEBSITE. SOCK AND BLANKET DRIVE THE SOCK AND BLANKET DRIVE WAS HELD AS PART OF SCRIPPS SPIRIT WEEK. DONATIONS ACROSS THE SCRIPPS SYSTEM WERE COLLECTED AND GIVEN TO FATHER JOE'S VILLAGES TO BENEFIT THE HOMELESS IN THE COMMUNITY. CONTRIBUTIONS WERE MADE BY JUST ABOUT EVERY SITE THROUGHOUT THE SYSTEM. FATHER JOE'S WILL INCLUDE THE DONATED ITEMS IN HYGIENE KITS FOR THE HOMELESS AND DISTRIBUTE THEM AT SHELTERS AND DAY CENTERS AND DURING WEATHER EVENTS. IN ALL THERE WERE 3,312 PAIRS OF SOCKS DONATED, ESTIMATED BY SUPPLY CHAIN AT A VALUE OF $5,862. THERE WERE ALSO 204 BLANKETS GIVEN AT AN ESTIMATED VALUE OF $5,712. Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT SCRIPPS HEALTH COMMUNITY BENEFIT PLAN AND REPORT CAN BE FOUND AT: HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY Schedule H, Part I, Line 7g Subsidized Health Services SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS THAT ARE PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. NEVERTHELESS, THE SERVICE IS PROVIDED BECAUSE IT MEETS AN IDENTIFIED COMMUNITY NEED, WHICH IF NO LONGER OFFERED WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION. SUBSIDIZED SERVICES DO NOT INCLUDE ANCILLARY SERVICES THAT SUPPORT LINES, SUCH AS LAB AND RADIOLOGY (IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE). THE TOTAL EXPENSE FOR SUBSIDIZED HEALTH SERVICES FOR SCRIPPS MERCY FISCAL YEAR 2022 WAS $2,867,155 THIS INCLUDES SCRIPPS INPATIENT BEHAVIORAL HEALTH. SCRIPPS OFFERS INPATIENT ADULT BEHAVIORAL HEALTH SERVICES AT THE SCRIPPS MERCY HOSPITAL, SAN DIEGO CAMPUS. THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM ALSO ACTIVELY SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. BEHAVIORAL HEALTH INPATIENT PROGRAMS THE SCRIPPS MERCY HOSPITAL'S BEHAVIORAL HEALTH INPATIENT PROGRAM OFFERS ESSENTIAL SUPPORT TO INDIVIDUALS FACING ACUTE PSYCHIATRIC DISORDERS. IN CASES WHERE PEOPLE ARE UNABLE TO LIVE INDEPENDENTLY OR MAY POSE A DANGER TO THEMSELVES OR OTHERS, HOSPITALIZATION BECOMES A VITAL OPTION. THIS PROGRAM AIDS PATIENTS AND THEIR FAMILIES IN ADDRESSING SHORT-TERM CRISES, MANAGING MENTAL ILLNESS, AND RESUMING THEIR DAILY LIVES. THE MULTIDISCIPLINARY TEAM OF SPECIALISTS INCLUDES PSYCHIATRISTS, PSYCHOLOGISTS, MARRIAGE AND FAMILY THERAPISTS, NURSES, SOCIAL WORKERS, ACTIVITY THERAPISTS, OCCUPATIONAL THERAPISTS, CHAPLAINS, AND PHARMACISTS. THE TREATMENT OBJECTIVES ENCOMPASS RESOLVING THE ISSUES THAT LED TO HOSPITALIZATION, REDUCING THE RISK OF DANGEROUS BEHAVIOR, ALLEVIATING THE SYMPTOMS THAT TRIGGERED HOSPITALIZATION, AND ENHANCING COPING SKILLS TO FACILITATE EFFECTIVE COMMUNITY LIVING. ONCE THESE GOALS ARE ACHIEVED, THE DEDICATED STAFF COLLABORATES ON A DISCHARGE PLAN THAT SEAMLESSLY CONNECTS WITH COMMUNITY SERVICES, ENSURING ONGOING CARE AND SUPPORTING PATIENTS IN THEIR RETURN TO THEIR FAMILIES AND COMMUNITIES. BEHAVIORAL HEALTH OUTPATIENT SERVICES SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE BEHAVIORAL HEALTH OUTPATIENT DAY PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO TO EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE MEDI-CAL POPULATION. COLLABORATION WITH HOSPITAL PARTNERS SUCH AS NAMI (NATIONAL ALLIANCE OF MENTAL ILLNESS), THE FAMILY HEALTH CENTERS OF SAN DIEGO, THE MCALISTER INSTITUTE AND HAZELDEN BETTY FORD HIGHLIGHT SCRIPPS COMMITMENT TO THE COMMUNITY WE SERVE. SCRIPPS HAS ALSO RECEIVED GRANT MONEY AS PART OF THE BEHAVIORAL HEALTH PILOT PROJECT TO EMBED SUBSTANCE USE COUNSELORS IN THE EMERGENCY DEPARTMENT TO FACILITATE LINKAGE TO MEDICATION ASSISTED OUTPATIENT PROGRAMS. BEHAVIORAL HEALTH CHALLENGES 1. FUNDING IS A SIGNIFICANT CHALLENGE, AS PAYMENT RATES HAVE NOT KEPT UP WITH THE RISING COSTS OF PROVIDING CARE. 2. IN FISCAL YEAR 2023, SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM EXPERIENCED A $7.5 MILLION LOSS IN TOTAL OPERATIONS, WITH $4.3 MILLION OF THIS LOSS ASSOCIATED WITH MEDI-CAL/CMS AND CHARITY CARE. 3. IN THE SAME FISCAL YEAR, ONLY 0.3 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance SCRIPPS UNCOMPENSATED CARE METHODOLOGY FISCAL YEAR 2023 SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. DURING FISCAL YEAR 2023, SCRIPPS CONTRIBUTED $716,656,565 IN UNCOMPENSATED HEALTH CARE, $18,248,321 IN CHARITY CARE, $693,017,958 IN MEDI-CAL AND MEDICARE SHORTFALL, AND $5,390,286 IN BAD DEBT. SCHEDULE H METHODOLOGY - SCHEDULE H REQUIRES THE UNCOMPENSATED CARE TO BE DIVIDED INTO FOUR CATEGORIES: CHARITY CARE, UNDER-REIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS, BAD DEBT, AND UNDER-REIMBURSED MEDICARE. BAD DEBT AND MEDICARE SHORTFALLS ARE REPORTABLE UNDER THE SCHEDULE H GUIDELINES BUT DO NOT COUNT TOWARDS THE COMMUNITY BENEFIT TOTALS. THUS, THE CATEGORIES ARE REPORTED IN A SPECIFIC ORDER/HIERARCHY. CHARITY CARE AND UNDER-REIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS ARE COUNTED FIRST. CHARITY CARE METHODOLOGY - UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS CHARITY ADJUSTMENTS. THE FOLLOWING COSTS ARE EXCLUDED: COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. TRADITIONAL CHARITY CARE IS INCLUDED IN THE INTERNAL REVENUE SERVICE (IRS) FORM 990 SCHEDULE H PART I LINE 7A. MEDI-CAL SHORTFALL - THE SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE, MEDICARE PPO, MEDICARE HMO, MEDICARE CAPITATED PROGRAM AT THE HOSPITALS, MEDI-CAL, MEDI-CAL HMO, AND CMS PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS REVENUE FROM UNCOMPENSATED CARE POOLS INCLUDING MEDI-CAL DSH. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE SYNTELLIS PERFORMANCE SOLUTIONS. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY ADJUSTMENTS AT COST FOR MEDI-CAL PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART I LINE 7B. IN THE STATE OF CALIFORNIA, THE MEDICAID PROGRAM IS CALLED MEDI-CAL. MEDICARE AND MEDICARE HMO HOSPITALS - SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE AND MEDICARE SENIOR PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE CAPITATION ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS OTHER REVENUE INCLUDING. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE MCKESSON HPM COST ACCOUNTING SYSTEM. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION B. BAD DEBT METHODOLOGY - UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO- COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD DEBT ADJUSTMENTS LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION A. SHORTFALL METHODOLOGY CLINICS - SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE AND MEDICARE SENIOR PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE CAPITATION ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS OTHER REVENUE INCLUDING. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE MCKESSON HPM COST ACCOUNTING SYSTEM. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION B. SELECT HOSPITAL - SCRIPPS HAS A 24.5% OWNERSHIP PERCENTAGE WITH SELECT HOSPITAL. THEREFORE, SCRIPPS REPORTED AMOUNTS IN SCHEDULE H, PARTS I THROUGH III, FROM SELECT HOSPITAL BASED ON SCRIPPS OWNERSHIP PERCENTAGE. Schedule H, Part II Community Building Activities ENLISTED LEADERSHIP FOUNDATION - THE FOUNDRY THE ENLISTED LEADERSHIP FOUNDATION, ALSO KNOWN AS THE FOUNDRY, IS A SAN DIEGO-BASED NONPROFIT ORGANIZATION (501(C)3) DEDICATED TO THE LEADERSHIP DEVELOPMENT OF NAVY SECOND CLASS, FIRST CLASS, AND CHIEF PETTY OFFICERS. THIS ORGANIZATION, FOUNDED BY ACTIVE DUTY AND RETIRED COMMAND/MASTER CHIEF PETTY OFFICERS, FOCUSES ON DEVELOPING LEADERS THROUGH MENTORING AND SHARING KNOWLEDGE BASED ON GENERATIONS OF EXPERIENCE AND GROWTH. SCRIPPS PROVIDED $35,000 IN SUPPORT TO HELP THE FOUNDRY ACHIEVE ITS PROGRAM GOALS AND REDUCE STUDENT COSTS. F7 - COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 7. SCRIPPS HEALTH PUBLIC POLICY AND ADVOCACY THE SCRIPPS HEALTH PUBLIC POLICY ADVOCAY AGENDA IS INTENDED TO ASSIST SCRIPPS IN MEETING WITH POLICYMAKERS AT LOCAL, STATE AND FEDERAL LEVELS. ADVOCACY PRIORITIES ARE DETERMINED BASED ON SCRIPPS STRATEGIC DIRECTION, LONG-TERM FINANCIAL IMPACTS OF THE POLICY IN QUESTION, AND WITH A FOCUS ON SPENDING TIME AND RESOURCES IN AREAS WHERE OUR EFFORTS HAVE THE BEST OPPORTUNITY TO CARRY OUT OUR MISSION OF PROVIDING SUPERIOR HEALTH CARE TO THE INDIVIDUALS AND COMMUNITIES WE SERVE. F8-WORKFORCE DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 8. SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL) SCRIPPS SPONSORED THE ANNUAL CONFERENCE OF THE SAN DIEGO ORGANIZATION OF HEALTHCARE LEADERS (SOHL).SOHL IS A COMBINED CHAPTER OF THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES (ACHE), AN INTERNATIONAL PROFESSIONAL SOCIETY WITH OVER 30,000 HEALTHCARE EXECUTIVES. ESTABLISHED IN 2001, SOHL PROVIDES AN ENVIRONMENT FOR ONGOING GROWTH, PROFESSIONAL DEVELOPMENT, AND RELATIONSHIP-BUILDING AMONG PEERS AND INDUSTRY LEADERS IN THE LOCAL HEALTHCARE SECTOR. ITS MEMBERSHIP INCLUDES HEALTHCARE LEADERS FROM VARIOUS SEGMENTS OF THE HEALTHCARE INDUSTRY. YOUNG LEADERS IN HEALTHCARE PROGRAM SCRIPPS HOSPITAL ENCINITAS OPERATES THE YOUNG LEADERS IN HEALTHCARE PROGRAM, WHICH IS DESIGNED FOR LOCAL HIGH SCHOOL STUDENTS (GRADES 9-12) INTERESTED IN EXPLORING HEALTHCARE CAREERS. THE PROGRAM OFFERS STUDENTS INSIGHTS INTO THE HEALTHCARE SYSTEM AND ITS CAREER POSSIBILITIES. PARTICIPANTS ENGAGE IN WEEKLY MEETINGS AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, ALONG WITH VIRTUAL MONTHLY MEETINGS. THE PROGRAM IS SUPERVISED BY ADVISORS FROM SCRIPPS HEALTH AND THE SAN DIEGUITO ALLIANCE FOR DRUG-FREE YOUTH. THE INITIATIVE MENTORS STUDENTS IN LEADERSHIP SKILLS AND EQUIPS THEM WITH TOOLS TO TACKLE DAILY CHALLENGES. EVERY YEAR, STUDENTS WORK ON A FINAL PRESENTATION BASED ON THEIR COMMUNITY SERVICE PROJECTS RELATED TO HEALTHCARE AND WELLNESS. IN FY23, OVER 100 ATTENDEES, INCLUDING STUDENTS AND HEALTHCARE PROFESSIONALS, WITNESSED STUDENT PRESENTATIONS ON VARIOUS HEALTH-RELATED TOPICS. THE PROGRAM EXPANDED ITS REACH, WITH OVER 200 STUDENTS PARTICIPATING IN MONTHLY VIRTUAL MEETINGS FOR THE 2022-2023 SCHOOL YEAR. STUDENTS CAN APPLY FOR THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM AFTER PARTICIPATING IN THIS INITIATIVE. SCRIPPS HIGH SCHOOL EXPLORATION INTERNSHIP PROGRAM SCRIPPS COLLABORATES WITH MULTIPLE HIGH SCHOOLS TO PROVIDE STUDENTS WITH AN OPPORTUNITY TO EXPLORE HEALTHCARE CAREERS AND GAIN PRACTICAL EXPERIENCE WORKING WITH SCRIPPS HEALTHCARE PROFESSIONALS. THIS PROGRAM IS DESIGNED FOR SAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN HEALTHCARE CAREERS. OVER A FIVE-WEEK PERIOD, PARTICIPATING STUDENTS VISIT VARIOUS SCRIPPS FACILITIES, INCLUDING SCRIPPS MERCY CHULA VISTA, SCRIPPS MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITALS IN LA JOLLA, ENCINITAS, AND GREEN HOSPITAL. DURING THEIR ROTATIONS, STUDENTS HAVE THE CHANCE TO OBSERVE SURGERIES, SHADOW HEALTHCARE PROFESSIONALS IN DIFFERENT DEPARTMENTS LIKE THE EMERGENCY DEPARTMENT, ICU, PHARMACY, URGENT CARE, INTERNAL MEDICINE, AMBULATORY SERVICES, REHAB THERAPY, PATIENT PLANNING, LAB, AND TRAUMA UNITS. SCRIPPS SCHOOL TO HEALTH CAREERS PATHWAY PROGRAMS SCRIPPS MERCY HOSPITAL CHULA VISTA OFFERS A RANGE OF PROGRAM ACTIVITIES AIMED AT ENGAGING AND INSPIRING YOUNG INDIVIDUALS TO PURSUE CAREERS IN HEALTHCARE. THESE ACTIVITIES ENCOMPASS MENTORING PROGRAMS, CLASSROOM PRESENTATIONS BY HEALTHCARE PROFESSIONALS, HOSPITAL TOURS, CAMP SCRIPPS, AND OPPORTUNITIES TO VIEW SURGICAL PROCEDURES. RESIDENCY LED YOUTH PROGRAMS SCRIPPS IS COMMITTED TO NURTURING THE FUTURE GENERATION OF HEALTHCARE PROFESSIONALS BY OFFERING VARIOUS YOUTH ENGAGEMENT ACTIVITIES. THESE INITIATIVES INVOLVE INTERNSHIPS AND EDUCATIONAL PROGRAMS IN COLLABORATION WITH HIGH SCHOOLS, PROVIDING STUDENTS WITH THE CHANCE TO EXPLORE HEALTHCARE ROLES AND GAIN HANDS-ON EXPERIENCE ALONGSIDE SCRIPPS HEALTHCARE PROFESSIONALS. AMONG THESE PROGRAMS, FAMILY MEDICINE MEDICAL RESIDENTS HAVE DEVELOPED THE "OUR HEALTH" INTERACTIVE CLASSROOM PRESENTATION SERIES. THIS SERIES COVERS A RANGE OF PUBLIC HEALTH CONCERNS, MEDICALLY FOCUSED TOPICS, AND INCLUDES HANDS-ON CLINICAL SKILLS WORKSHOPS AT LOCAL HIGH SCHOOLS. THE PRIMARY OBJECTIVE IS TO INTRODUCE STUDENTS TO HEALTHCARE CAREERS, AND PARTICIPANTS RECEIVE HEALTH CAREER TOOLS AND BROCHURES CONTAINING INFORMATION ON EDUCATIONAL REQUIREMENTS, SCHOLARSHIPS, AND FINANCIAL AID FOR COLLEGE. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS DERIVED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMNTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGRDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance COLLECTION POLICY THE PURPOSE OF THIS POLICY IS TO PROVIDE INFORMATION WITH RESPECT TO THE CHARGING, BILLING AND COLLECTION OF PATIENT DEBT PURSUANT TO THE CALIFORNIA HEALTH AND SAFETY CODE, THE FEDERAL PATIENT PROTECTION, AND AFFORDABILITY CARE ACT, AND THE POLICIES AND PRACTICES OF SCRIPPS HOSPITALS, (SCRIPPS MEMORIAL HOSPITAL LA JOLLA, SCRIPPS MEMORIAL HOSPITAL ENCINITAS, SCRIPPS GREEN HOSPITAL, SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA), AND SCRIPPS MEDICAL FOUNDATION. ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE. Schedule H, Part V, Section B, Line 16a FAP website A - SCRIPPS MERCY HOSPITAL: Line 16a URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16a URL: https://www.scripps.org/patients-and-visitors/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website A - SCRIPPS MERCY HOSPITAL: Line 16b URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16b URL: https://www.scripps.org/patients-and-visitors/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - SCRIPPS MERCY HOSPITAL: Line 16c URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16c URL: https://www.scripps.org/patients-and-visitors/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment NEEDS ASSESSMENT AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATION STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, AND CONSUMER GROUPS. TO CARRY OUT THIS REGULATORY REQUIREMENT, SCRIPPS HAS BEEN ACTIVELY INVOLVED IN A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. THIS PROCESS BEGAN IN 1995, IN ACCORDANCE WITH THE REQUIREMENTS OF SENATE BILL 697, COMMUNITY BENEFIT LEGISLATION THAT REQUIRES NOT-FOR-PROFIT HOSPITALS IN CALIFORNIA TO FILE A TRIENNIAL CHNA THAT IDENTIFIES COMMUNITY HEALTH NEEDS. FURTHER, SCRIPPS HEALTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT RESPONDS TO FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING PRIVATE NOT-FOR-PROFIT (TAX-EXEMPT) HOSPITALS AS DESCRIBED IN CODE SECTION 501 (C)(3) TO CONDUCT AND MAKE PUBLIC A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT AND CORRESPONDING IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IDENTIFIES, AND DETAILS CURRENT OR PLANNED STRATEGIES INTENDED TO ADDRESS THE NEEDS IDENTIFIED IN THE HOSPITAL'S CHNA. SCRIPPS HEALTH ACTIVELY PARTICIPATES IN THE COLLABORATIVE CHNA PROCESS LED BY THE HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES (HASD&IC). ALTHOUGH ONLY NOT-FOR-PROFIT 501(C)(3) HOSPITALS AND HEALTH SYSTEMS ARE SUBJECT TO STATE AND IRS REGULATORY REQUIREMENTS, THE 2022 CHNA COLLABORATIVE PROCESS ALSO INCLUDES HOSPITALS AND HEALTH SYSTEMS WHO ARE NOT SUBJECT TO ANY CHNA REQUIREMENTS BUT ARE DEEPLY ENGAGED IN THE COMMUNITIES THEY SERVE AND COMMITTED TO THE GOALS OF A COLLABORATIVE CHNA. THE 2022 CHNA INCLUDES EXTENSIVE QUANTITATIVE ANALYSIS OF SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL DISCHARGE DATA AND OTHER SECONDARY SOURCES. TAKEN TOGETHER, THESE QUALITATIVE AND QUANTITATIVE APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY NEEDS FROM MULTIPLE PERSPECTIVES. THE RESULTS OF THE 2022 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. THE 2022 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. KEEPING PATIENTS AT THE CENTER OF EVERYTHING WE DO, SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND COMMUNITY CLINICS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THEREFORE, THE REPORT WILL HELP US BETTER UNDERSTAND OUR COMMUNITY'S HEALTH NEEDS AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THIS REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. FOR MORE INFORMATION ABOUT SCRIPPS HEALTH, PLEASE VISIT WWW.SCRIPPSHEALTH.ORG. PURPOSE THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS TO IDENTIFY, UNDERSTAND, AND PRIORITIZE THE HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS FACING INEQUITIES. THE RESULTS OF THE CHNA ARE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. IN ADDITION, POLICYMAKERS, CIVIC LEADERS, NONPROFIT EXECUTIVES, AND COMMUNITY INVESTORS ARE ENCOURAGED TO USE CHNAS IN THEIR ESSENTIAL WORK. CHNA GOVERNANCE THE HOSPITAL ASSOCIATION OF SAN DIEGO & COUNTIES (HASD&IC) BOARD OF DIRECTORS REPRESENTS ALL MEMBER SECTORS AND PROVIDES POLICY DIRECTION TO ENSURE THE INTERESTS OF MEMBER HOSPITALS AND HEALTH SYSTEMS ARE PRESERVED AND PROMOTED. THE CHNA ADVISORY WORKGROUP INCLUDED REPRESENTATIVES FROM EVERY PARTICIPATING HOSPITAL AND HEALTH SYSTEM AND PROVIDED OVERARCHING GUIDANCE REGARDING THE RESEARCH APPROACH AND COMMUNITY ENGAGEMENT. THE CHNA COMMITTEE WORKED CLOSELY WITH THE CHNA ADVISORY WORKGROUP AND REPORTS TO THE HASD&IC BOARD. METHODOLOGY THERE ARE SOCIAL DRIVERS OF HEALTH AND EQUITY AT ALL LEVELS: INDIVIDUAL, COMMUNITY, AND STRUCTURAL. HISTORICAL AND SYSTEMIC INEQUITIES DISPROPORTIONATELY IMPACT VULNERABLE POPULATIONS, INCLUDING PEOPLE OF COLOR, SOCIALLY DISADVANTAGED GROUPS, AND THOSE LIVING IN POVERTY. THE CHNA COMMITTEE COMPLETED AN EXTENSIVE REVIEW OF NATIONAL BEST PRACTICES AND EVIDENCE-BASED FRAMEWORKS TO DEVELOP A RESEARCH APPROACH TO HEALTH EQUITY. THE HEALTH EQUITY FRAMEWORK DESCRIBES THE CHNA ADVISORY WORKGROUP AND CHNA COMMITTEE'S SHARED VALUES AND COMMITMENT TO UNDERSTANDING THE SOCIAL DRIVERS OF HEALTH AND EQUITY THROUGH OUR COLLECTIVE RESEARCH, ANALYSIS, AND COMMUNITY ENGAGEMENT. RESEARCH METHODS AND APPROACH TO GAIN A DEEP AND MEANINGFUL UNDERSTANDING OF THE HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS, TWO PRIMARY METHODS WERE EMPLOYED IN THE 2022 CHNA: 1. QUANTITATIVE ANALYSES OF EXISTING PUBLICLY AVAILABLE DATA WERE CONDUCTED TO PROVIDE AN OVERARCHING VIEW OF CRITICAL HEALTH ISSUES ACROSS SAN DIEGO COUNTY. 2. QUALITATIVE INFORMATION WAS GATHERED THROUGH A COMPREHENSIVE COMMUNITY ENGAGEMENT PROCESS TO UNDERSTAND PEOPLE'S LIVED EXPERIENCES AND NEEDS IN THE COMMUNITY. THE CHNA COMMITTEE REVIEWED THE FEEDBACK AND DATA TO PRIORITIZE THE TOP HEALTH NEEDS IN SAN DIEGO COUNTY. THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. THE FOLLOWING DATA WAS USED IN THE PRIORITIZATION PROCESS: QUANTITATIVE DATA: - DATA AND ANALYSIS FROM HEALTH AND HUMAN SERVICES AGENCY, PUBLIC HEALTH SERVICES INCLUDING COMMUNITY HEALTH STATISTICS, HEALTH EQUITY DASHBOARDS, MORBIDITY & MORTALITY DATA - ANALYSIS OF SECONDARY DATA, HEALTH CONDITIONS, AND SOCIAL DETERMINANTS OF HEALTH (SDOH) - COUNTY OF SAN DIEGO LEADING CAUSES OF DEATH 2019 DATA - HOSPITAL DISCHARGE TREND DATA RETRIEVED FROM CALIFORNIA'S DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) LIMITED DATA SETS, 2017-2019 SPEEDTRACK QUALITATIVE DATA: - COMMUNITY GUIDANCE FROM CHNA PLANNING INTERVIEWS - COMMUNITY ENGAGEMENT FINDINGS FROM FOCUS GROUPS - COMMUNITY ENGAGEMENT FINDINGS FROM KEY INFORMANT INTERVIEWS - COMMUNITY ENGAGEMENT FINDINGS FROM INTERVIEWS AND FOCUS GROUPS WITH PROMOTORAS AND COMMUNITY HEALTH WORKERS (CHWS) - 2022 CHNA ONLINE COMMUNITY SURVEY SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH TOP COMMUNITY NEEDS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED: THIS REFERS TO HOW SEVERE THE HEALTH NEED IS (SUCH AS ITS POTENTIAL TO CAUSE DEATH OR DISABILITY) AND ITS DEGREE OF POOR PERFORMANCE AGAINST THE RELEVANT BENCHMARK. THE MAGNITUDE/SCALE OF THE NEED-THE MAGNITUDE REFERS TO THE NUMBER OF PEOPLE AFFECTED BY THE HEALTH NEED. DISPARITIES OR INEQUITIES-THIS REFERS TO DIFFERENCES IN HEALTH OUTCOMES BY SUBGROUPS. SUBGROUPS MAY BE BASED ON GEOGRAPHY, LANGUAGES, ETHNICITY, CULTURE, CITIZENSHIP STATUS, ECONOMIC STATUS, SEXUAL ORIENTATION, AGE, GENDER, OR OTHERS. AND CHANGE OVER TIME-THIS REFERS TO WHETHER THE NEED HAS IMPROVED, STAYED THE SAME, OR WORSENED. OVER THE COURSE OF SEVERAL MEETINGS, THE HASD&IC STAFF AND CHNA COMMITTEE MEMBERS COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. EACH HEALTH CONDITION AND SOCIAL DETERMINANT OF HEALTH FOR WHICH THE COMMITTEE HAD DATA WAS CONSIDERED AND DISCUSSED IN TERMS OF THESE CRITERIA. THOSE COMMUNITY NEEDS THAT MET THE LARGEST NUMBER OF CRITERIA WERE CHOSEN AS TOP PRIORITIES. THE 2022 CHNA INCLUDED EXTENSIVE QUANTITATIVE ANALYSIS OF SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL DISCHARGE DATA AND OTHER SECONDARY SOURCES. TAKEN TOGETHER, THESE QUALITATIVE AND QUANTITATIVE APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY NEEDS FROM MULTIPLE PERSPECTIVES. THE RESULTS OF THE 2022 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. QUANTITATIVE DATA WERE USED FOR THREE PRIMARY PURPOSES: 1. DESCRIBE THE SAN DIEGO COUNTY COMMUNITY. 2. PLAN AND DESIGN THE COMMUNITY ENGAGEMENT PROCESS. 3. FACILITATE THE "PRIORITIZATION PROCESS" - IDENTIFYING THE MOST SERIOUS COMMUNITY HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS FACING INEQUITIES. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E. EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE CALIFORNIA DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI)AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENT'S UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FORPAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENT'S ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL-OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE. Schedule H, Part VI, Line 4 Community information SCRIPPS HEALTH COMMUNITY SERVED HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. SCRIPPS PROVIDES SIGNIFICANT VOLUMES OF INPATIENT, EMERGENCY, OUTPATIENT, AND PRIMARY CARE. IN FISCAL YEAR 2023, SCRIPPS PROVIDED 3,085,322 OUTPATIENT VISITS AND 73,042 HOSPITAL DISCHARGES. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. MEDI-CAL PROVIDES HEALTH INSURANCE COVERAGE FOR 1,000,000 IN SAN DIEGO COUNTY IN 2022 (ALMOST 1 OUT OF 3 PEOPLE IN SAN DIEGO COUNTY ARE MEDI-CAL BENEFICIARIES). SAN DIEGO COUNTY HAS THE 2ND LARGEST MEDI-CAL POPULATION IN CALIFORNIA. FIVE PERCENT OF ENROLLEES WITH THE HIGHEST-COST NEEDS ACCOUNT FOR OVER HALF OF MEDI-CAL SPENDING. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNDERINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED/UNDERINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. SCRIPPS MERCY HOSPITAL SAN DIEGO AND SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUSES ARE DESIGNATED BY THE GOVERNMENT IN 2023 AS A DISPROPORTIONATE SHARE HOSPITAL, IN REFLECTING THE ECONOMICALLY DISADVANTAGED POPULATION THEY SERVE. BOTH HOSPITAL CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF PATIENTS AT SCRIPPS MERCY SAN DIEGO AND CHULA VISTA ARE COVERED BY GOVERNMENT INSURANCE, INCLUDING MEDICARE AND MEDI-CAL. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) THE SAN DIEGO REGION IS KNOWN FOR ITS 70 MILES OF BEAUTIFUL BEACHES, PERFECT WEATHER, AND INNOVATIVE ECONOMY. MANY DO NOT REALIZE HOW LARGE AND DIVERSE THE COUNTY IS DEMOGRAPHICALLY AND GEOGRAPHICALLY. SAN DIEGO IS HOME TO 3.3 MILLION PEOPLE IS THE SECOND-LARGEST COUNTY IN CALIFORNIA AND IS THE FIFTH-MOST POPULOUS IN THE U.S. THE REGION INCLUDES 18 INCORPORATED CITIES AND EXPANSIVE UNINCORPORATED AREAS. FOR MORE INFORMATION ON SAN DIEGO COUNTY DEMOGRAPHIC DATA, PLEASE VIEW THE COUNTY OF SAN DIEGO'S 2021 REGION SRA DEMOGRAPHIC PROFILE STUDY. LOW-INCOME, UNINSURED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. DATA FROM THE AMERICAN COMMUNITY SURVEY SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, HOUSING, CHILDCARE, TRANSPORTATION, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. Schedule H, Part VI, Line 5 Promotion of community health SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. AND OUR PARTNERSHIPS DO NOT STOP AT OUR LOCAL BORDERS. OUR COLLABORATIONS EXTEND BEYOND OUR LOCAL COMMUNITY TO INCLUDE STATE, NATIONAL, AND GLOBAL EFFORTS IN DISASTER PREPAREDNESS AND RELIEF, EMERGENCY MEDICAL SERVICES, HEALTHCARE ADVOCACY, PHYSICIAN EDUCATION, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE IN NEED TODAY WHILE PLANNING FOR THE HEALTHCARE NEEDS OF FUTURE GENERATIONS. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. SCRIPPS CONTRIBUTES SIGNIFICANT RESOURCES PROVIDING LOW AND NO-COST HEALTH CARE FOR OUR PATIENTS IN NEED. DURING FISCAL YEAR 2023, SCRIPPS CONTRIBUTED $716,656,565 IN UNCOMPENSATED HEALTH CARE, INCLUDING $18,248,321 IN CHARITY CARE, $693,017,958 IN MEDI-CAL AND MEDICARE SHORTFALL, AND $5,390,286 IN BAD DEBT. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY23 (OCTOBER 2022 TO SEPTEMBER 2023), SCRIPPS INVESTED $40,779,944 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. FOR MORE DETAILED INFORMATION ON THESE AND OTHER PROGRAMS SEE HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES AND SCRIPPS WHITTIER DIABETES INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES; "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. DURING FISCAL YEAR 2023 (OCTOBER 2022 TO SEPTEMBER 2023), SCRIPPS INVESTED $7,285,612 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). SUBSIDIZED HEALTH SERVICES INCLUDED OUR INPATIENT BEHAVIORAL HEALTH UNIT WITH A NET COMMUNITY BENEFIT OF $2,867,155 (SUBSIDIZED COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART I-LINE 7G). THESE FIGURES REFLECTS THE COSTS ASSOCIATED WITH PROVIDING THESE PROGRAMS, SALARIES, MATERIALS, AND SUPPLIES MINUS REVENUE. COMMUNITY HEALTH SERVICES INCLUDE PREVENTION AND WELLNESS PROGRAMS, SCREENINGS, HEALTH EDUCATION, SUPPORT GROUPS, HEALTH FAIRS AND OTHER PROGRAMS SUPPORTED BY OPERATIONAL FUNDS, GRANTS, AND IN-KIND DONATIONS AND PHILANTHROPY. CALCULATIONS ARE BASED ON COST, LESS "DIRECT OFFSETTING REVENUE," WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES, "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT.FOR MORE DETAILED INFORMATION ON THESE AND OTHER PROGRAMS SEE HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. Schedule H, Part VI, Line 6 Affiliated health care system FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $4.3 BILLION PRIVATE TAX EXEMPT, INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS HEALTH CONSISTS OF FOUR ACUTE-CARE HOSPITALS ON FIVE CAMPUSES, ALONG WITH A ROBUST NETWORK OF 31 OUTPATIENT CENTERS (INCLUDING 15 HEALTH EXPRESS LOCATIONS), PALLIATIVE CARE, CLINICAL RESEARCH, AND ANCILLARY SERVICES TO SERVE OUR SAN DIEGO COMMUNITY AND BEYOND. SCRIPPS TREATS MORE THAN 600,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 3,000 AFFILIATED PHYSICIANS AND MORE THAN 17,000 EMPLOYEES. SCRIPPS ALSO OFFERS PAYER PRODUCTS AND POPULATION HEALTH SERVICES THROUGH SCRIPPS ACCOUNTABLE CARE ORGANIZATION, SCRIPPS HEALTH PLAN, AND CUSTOMIZED NARROW NETWORK PLANS IN COLLABORATION WITH THIRD-PARTY PAYERS. SCRIPPS HEALTH IS A LEADING PROVIDER OF MEDICAL CARE, IMPROVING COMMUNITY HEALTH AND ADVANCING MEDICINE IN SAN DIEGO COUNTY. SCRIPPS IS A RECOGNIZED LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, AND IS AT THE FOREFRONT OF CLINICAL RESEARCH AND THE ONLY HEALTH SYSTEM IN THE REGION WITH TWO LEVEL 1 TRAUMA CENTERS. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONGSTANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. OUR HOSPITALS ARE CONSISTENTLY RANKED AMONG THE NATION'S BEST BY U.S. NEWS & WORLD REPORT AND NUMEROUS OTHER ORGANIZATIONS. SCRIPPS IS FREQUENTLY RECOGNIZED BY FORTUNE MAGAZINE, WORKING MOTHER MAGAZINE, AND THE ADVISORY BOARD AS ONE OF THE BEST PLACES IN THE NATION TO WORK. IMPORTANTLY, SCRIPPS CULTURE IS ONE OF CARING; THE SPIRIT AND CULTURE ESTABLISHED BY TWO PIONEERING FOUNDERS, ELLEN BROWNING SCRIPPS AND MOTHER MARY MICHAEL CUMMINGS, STILL DEFINE WHO WE ARE TODAY. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. Schedule H, Part VI, Line 7 State filing of community benefit report CA true Consumer Center for Health Education and Advocacy (CCHEA) 1764 San Diego Ave Ste 200 San Diego CA 92110 751835298 501(c)(3) 120000 Program Support Enlisted Leadership Foundation - The Foundry 2307 Fenton Pkwy Ste 107-208 San Diego CA 92018 465029314 501(c)(3) 35000 Program Support Family Health Center of San Diego Internal Medicine Outpatient Teaching Cl inic Partnership 823 Gateway Center Way San Diego CA 92012 952833205 501(c)(3) 309000 Program Support Lights On - MicroGrantsSan Diego Police Department 100 North Sixth St Ste 626B Minneapolis MN 55403 204092394 501(c)(3) 18800 Program Support Father Joe's Villages 3350 E Street San Diego CA 92102 223746050 501(c)(3) 22108 Program Support Ministry of Jerusalem 235 Civic Center Dr National City CA 91950 843643967 501(c)(3) 30529 Program Support 6 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. GRANTEE SHALL SUBMIT TO SCRIPPS HEALTH, ATTENTION DIRECTOR OF COMMUNITY BENEFIT SERVICES AT 10140 CAMPUS POINT COURT, CPA 320, SAN DIEGO, CA 92121, THE FOLLOWING: A. A SEMI-ANNUAL SUMMARY PROGRESS REPORT AND A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT IS REQUIRED. REPORTS SHALL INCLUDE, BUT NOT BE LIMITED TO, PROGRESS MADE TOWARD MEETING OBJECTIVES OUTLINED IN THE GRANT APPLICATION. B. WITHIN THIRTY (30) DAYS FOLLOWING THE EXPIRATION DATE OF THE GRANT A FINAL PROGRESS REPORT SHALL BE SUBMITTED TO SCRIPPS HEALTH. IN ADDITION TO THE PROGRESS MADE TOWARD MEETING THE OBJECTIVES OUTLINED IN THE GRANT APPLICATION, THE FINAL REPORT SHOULD INCLUDE QUANTITATIVE AND QUALITATIVE RESULTS OF THE PROGRAM AGAINST ITS STATED GOALS AND OBJECTIVES. A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT AGAINST THE BUDGET MUST BE INCLUDED AS PART OF THIS FINAL REPORT. C. THE GRANTEE SHALL PROVIDE SCRIPPS HEALTH WITH ANY ADDITIONAL INFORMATION OR PROGRESS UPDATES, RELATIVE TO GRANT PROJECT, AS REASONABLY REQUESTED. D. SCRIPPS HEALTH RESERVES THE RIGHT TO AUDIT EXPENDITURES AND SUPPORTING DOCUMENTATION. X X X X X true true X X X X X X true true false false false false false false false Christopher Van Gorder PRESIDENT & CEO/TRUSTEE 1667067 0 1087364 0 90907 0 21350 0 27908 0 2894595 0 0 0 Bradley Ellis Corp SR VP, Chief Legal Officer 601520 0 155029 0 120429 0 21350 0 28382 0 926709 0 106826 0 Brett Tande SVP / CFO 569231 0 50000 0 159816 0 8512 0 29368 0 816927 0 134769 0 Richard Rothberger Former Officer 365985 0 803967 0 300525 0 21350 0 11236 0 1503062 0 128390 0 Thomas Buchholz Corp Sr VP, MD Anderson 821109 0 355172 0 248086 0 12200 0 27400 0 1463966 0 232938 0 Eric Cole CORP SR VP, HUMAN RESOURCES 572149 0 228971 0 257052 0 12200 0 37081 0 1107453 0 224932 0 Mary Ellen Doyle Corp VP, Nursing Ops- THRU 01/2022 24613 0 165755 0 42083 0 3989 0 1309 0 237749 0 0 0 John Engle Corp Sr VP, Chief Development 539505 0 242786 0 174200 0 21350 0 29631 0 1007471 0 140279 0 Carl Etter Chief Executive, Sr VP 807539 0 341171 0 1447354 0 18300 0 22197 0 2636561 0 1388311 0 Shawn Forrester Corp VP, Payer Relations 459364 0 175682 0 243387 0 0 0 24795 0 903228 0 225700 0 Thomas Gammiere Chief Executive, Sr VP 696360 0 317334 0 191618 0 21350 0 27347 0 1254009 0 161792 0 Anil Keswani Corp Sr VP, Chief Med Officer 698376 0 292436 0 254028 0 12200 0 39882 0 1296922 0 206599 0 June Komar Corp Exec VP, Strategy & Admin 705281 0 585998 0 62030 0 42360 0 14185 0 1409854 0 13209 0 Richard Neale Corp Exec VP, Chief Growth Officer 612697 0 336219 0 361282 0 15250 0 38332 0 1363780 0 311574 0 Barbara Price Corp Sr VP, Bus&Serv Line Dev 689509 0 312951 0 270251 0 21350 0 39317 0 1333379 0 244000 0 Lisa RisserThakur Corp Sr VP, Ancillary Ops 494124 0 216741 0 60854 0 21350 0 23420 0 816488 0 46905 0 Ghazala Sharieff Corp Sr VP, Acute Care/Clin Excl 875843 0 327742 0 274252 0 12200 0 36642 0 1526678 0 239712 0 Shane Thielman Corp Sr VP, CIO 577607 0 223648 0 86058 0 18300 0 39227 0 944840 0 54352 0 Tracy Chu Corp VP, POP Hlth CHF EXEC/ACO 475882 0 139829 0 162351 0 18300 0 13880 0 810242 0 133599 0 Timothy L Jacoby Corp VP, Construction / Facilities 410030 0 132864 0 68504 0 12200 0 27500 0 651098 0 54123 0 John Poole Corp VP, System Improvement 491235 0 179020 0 102404 0 12200 0 19242 0 804101 0 89549 0 Gerald Soderstrom Corp VP, Audit / Compliance 418649 0 155002 0 178721 0 12200 0 39714 0 804286 0 161075 0 Cynthia M Steckel VP, Chief Ops Exec_Acute 375747 0 131071 0 161775 0 21350 0 13833 0 703776 0 136938 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE TAX GROSS-UP PAYMENTS RELATED TO CERTAIN EXECUTIVE BENEFIT PROGRAMS. THESE AMOUNTS ARE INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR RESPECTIVE W-2. Schedule J, Part I, Line 1a Discretionary spending account CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR RESPECTIVE W-2. Schedule J, Part I, Line 1a Housing allowance or residence for personal use ONE EXECUTIVE REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVED A HOUSING ALLOWANCE FOR LESS THAN ONE YEAR AS PART OF THEIR ONBOARDING COMPENSATION PACKAGE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THE EXECUTIVE'S W-2. Schedule J, Part I, Line 1a Health or social club dues or initiation fees SCRIPPS HEALTH INCURS THE MEMBERSHIP COST OF A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR ITS CHIEF EXECUTIVE OFFICER AT AN APPROXIMATE MONTHLY COST OF $200. THE MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. Schedule J, Part I, Line 1a Personal services CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE A REIMBURSEMENT FOR FINANCIAL PLANNING SERVICES. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR RESPECTIVE W-2. Schedule J, Part I, Line 4a Severance or change-of-control payment RECEIVE A SEVERANCE PAYMENT OR CHANGE-OF CONTROL PAYMENT THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY IN CALENDAR YEAR 2022: SHAWN FORRESTER - $53,414 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2022 INCLUDED IN OTHER REPORTABLE COMPENSATION IN SCHEDULE J, (B)(III): CARL ETTER - $357,398 GHAZALA SHARIEFF - $51,460 ANIL KESWANI - $85,217 THOMAS GAMMIERE - $109,341 BARBARA PRICE - $165,403 RICHARD NEALE - $103,356 JOHN ENGLE - $74,517 ERIC COLE - $105,610 BRADLEY ELLIS - $55,312 GERALD SODERSTROM - $64,767 TRACY CHU - $56,810 SHAWN FORRESTER - $147,003 CYNTHIA STECKEL - $84,101 EFFECTIVE JANUARY 1, 2021, SCRIPPS HEALTH TRANSITIONED PART OF ITS' EXECUTIVE BENEFITS PROGRAM FROM THE 457F PLAN TO A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THIS SERP PROVIDES COMPETITIVE SUPPLEMENTAL RETIREMENT BENEFITS TO THE PARTICIPANTS TO ENCOURAGE CONTINUED EMPLOYMENT AND CONTINUED INTEREST IN THE SUCCESS OF THE SYSTEM. THE SYSTEM CREDITS A TARGETED PERCENT PER YEAR OF SERVICE, UP TO A MAXIMUM PERCENT OF THE FINAL AVERAGE SALARY AT AGE 70 FOR 25 YEARS OF SERVICE. THE TARGET BENEFIT IS OFFSET BY (I) BENEFITS UNDER THE FROZEN SARA PLAN, (II) THE SYSTEM-PAID PORTION OF SOCIAL SECURITY RETIREMENT BENEFITS, AND (III) QUALIFIED RETIREMENT PLANS ATTRIBUTABLE TO THE SYSTEM'S CREDITS UNDER THOSE PLANS. ALTHOUGH THE BENEFIT IS TARGETED AT AGE 70, THE SYSTEM MAY ELECT TO CONTINUE CREDITS TOWARD THE BENEFIT SO LONG AS THE PARTICIPANT REMAINS EMPLOYED WITH THE SYSTEM. A California Statewide Communities Development Authority 680164610 1309116Y1 2007-03-02 49995000 SEE PART VI false false true B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LFL6 2010-02-04 100000000 SEE PART VI false false false C CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LVZ7 2012-02-01 288143095 SEE PART VI false false false D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 000000000 2016-02-29 150000000 SEE PART VI false false false A 500000 0 49995000 0 0 0 146070 0 0 49848390 0 0 2007 true false true true B 8405000 0 100002530 0 0 0 0 0 0 100002530 0 0 2011 false false true true C 3870000 0 288160329 0 0 0 0 0 0 288160329 0 0 2013 false false true true D 113015000 0 150000000 0 0 0 0 0 0 150000000 0 0 2016 false false true true A false false true true true true 0.0 0.0 0.0 false false true B false false true true true true 0.0 0.0 0.0 false false true C false false true true true true 0.0 0.0 0.0 false false true D false false true true true true 0.0 0.0 0.0 false false true A true true false false true true B false false false true true false false false true C false false false true true false false false true D false false false true false false false false true A true B true C true D true Schedule K, Part I, Column (e) ISSUE PRICE BOND ISSUE 1-A (2007A): THE STATED PAR OF $49,995,000 DIFFERS FROM THE $149,875,000 REPORTED ON FORM 8038 AS THE $49,995,000 AMOUNT REPRESENTS THE SCRIPPS HEALTH'S PORTION ON IN A POOL BOND LOAN PROGRAM. Schedule K, Part II, Line 3 TOAL PROCEEDS OF ISSUE BOND ISSUE 1-B (2010B/C): THE AMOUNT SHOWN IN PART II, LINE 3 CONSISTS OF THE ISSUE PRICE OF THE BONDS $100,000,000 PLUS PROJECT FUND INVESTMENT EARNINGS OF $2,530. BOND ISSUE 1-C (2012A-C): THE AMOUNT SHOWN IN PART II, LINE 3 CONSISTS OF THE ISSUE PRICE OF THE BONDS $288,143,095 PLUS INVESTMENT EARNINGS OF $17,234. Schedule K, Part III, Line 3b THE OBLIGOR'S LEGAL DEPARTMENT REVIEWS CONTRACTS AND AGREEMENTS TO ENSURE COMPLIANCE WITH PRIVATE BUSINESS USE REGULATIONS, ENGAGING OUTSIDE LEGAL COUNSEL, AS NECESSARY. Schedule K, Part IV, Line 6 BOND ISSUE 1-A (2007A): AN AMOUNT IN THE COST OF ISSUANCE FUND NOT EXCEEDING $100,000 WAS NOT DISBURSED UNTIL MAY 2008. Schedule K, Part V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION THE ORGANIZATION HAS ADOPTED TAX-EXEMPT BOND COMPLIANCE PROCEDURES, INCLUDING PROCEDURES TO MONITOR PRIVATE BUSINESS USE OF FINANCED PROPERTY AND TAKING REMEDIAL ACTIONS, IF NECESSARY. THE ORGANIZATION IS AWARE OF THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS, AND HAS DISCUSSED THAT PROGRAM WITH COUNSEL. THE ORGANIZATION HAS REVISED ITS WRITTEN PROCEDURES TO SPECIFICALLY MAKE REFERENCE TO THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS. Schedule K, Part I, Column (f) DESCRIPTION OF PURPOSE BOND ISSUE 1-A (2007A): POOL BOND. PROCEEDS WERE USED TO REFUND COMMERCIAL PAPER REVENUE NOTES, SERIES 2005A, WHICH WERE USED TO PURCHASE EQUIPMENT. BOND ISSUE 1-B (2010B & C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 1-C (2012A-C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 1-D (2016A/B): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-A (2017A): THE $160,000,000 (2017A) REFUNDED THE 2008B-F BONDS. THE ISSUE DATE FOR THE 2008B-F BONDS WAS 8/14/2008. BOND ISSUE 2-B (2019A): THE 2019A ISSUE REFUNDED THE 2010A ISSUE. Schedule K, Part IV, Line 3 BOND ISSUE 1-C (2012A-C): THE 2012A ISSUE TOTALING $188,143,094 IS A FIXED RATE ISSUE WHEREAS THE 2010B&C TOTALING $100,000,000 IS A VARIABLE RATE ISSUE. Schedule K, Part IV, Line 2c DATE THE REBATE COMPUTATION WAS PERFORMED BOND ISSUE 1-B (2010B/C): THE 2010B/C REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 4, 2020. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE 1-C (2012A-C): THE 2012A-C REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 1, 2017. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE 1-D (2016A/B): THE 2016A/B REBATE COMPUTATION WAS RECENTLY PERFORMED ON FEBRUARY 28, 2018. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. BOND ISSUE 2-A (2017) THE 2017 REBATE COMPUTATION WAS RECENTLY PERFORMED ON JANUARY 31, 2021. NO REBATE AMOUNT HAS ACCRUED AS OF THE END OF THE COMPUTATION PERIOD. Schedule K, Part IV, Line 2c COLUMN B Issuer name: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY The calculation for computing no rebate due was performed on 02/04/2023 Schedule K, Part IV, Line 2c COLUMN C Issuer name: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY The calculation for computing no rebate due was performed on 02/01/2023 Schedule K, Part IV, Line 2c COLUMN D Issuer name: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY The calculation for computing no rebate due was performed on 02/28/2023 Schedule K, Part IV, Line 2c COLUMN A Issuer name: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY The calculation for computing no rebate due was performed on 01/31/2023 A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 000000000 2017-01-31 160000000 SEE PART VI false false false B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 000000000 2019-11-15 99360000 SEE PART VI false false false A 0 0 160000000 0 0 0 0 0 0 0 160000000 0 2017 true false true true B 4185000 0 99360000 0 0 0 0 0 0 0 99360000 0 2019 true false true true A false false true true true true 0.0 0.0 0.0 false false true B false false true true true true 0.0 0.0 0.0 false false true A false false false true false false false false true B false true false false false false false false true A true B true Chris Van Gorder Officer CUMULATIVE DEF COMP (SEE PG 186) X 10023866 13669513 false true true June Komar Executive CUMULATIVE DEF COMP (SEE PG 186) X 2769010 3776090 false true true Richard Sheridan Former Officer CUMULATIVE DEF COMP (SEE PG 186) X 4063606 5541526 false true true 22987129 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 487505027 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 84886759 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 42788569 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 28501956 COMPUTER SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 22826203 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 15030148 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 10121797 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 7271508 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 4819697 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 4678169 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 3078126 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2373317 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1990214 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1413550 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 614822 EMPLOYEE SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 457550 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 421780 COMPENSATION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 419242 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 361540 CONSTRUCTION false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 292462 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 207134 MEDICAL SERVICES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 176222 COMPENSATION false LINDSEY VAN GORDER SEE PART V 94515 SEE PART V false DAVID VAN GORDER SEE PART V 77593 SEE PART V false KATIE WOODHEAD EMPLOYEE / KEY EMPLOYEE'S DAUGHTER 32098 SEE PART V false Schedule L, Part II LOANS TO AND FROM INTERESTED PERSONS EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR FOUR PLAN PARTICIPANTS. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO THOSE FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME, WITH SUCH DEFERRED COMPENSATION ARRANGEMENTS REFLECTIVE OF THEIR CUMULATIVE SERVICE AT SCRIPPS HEALTH. Schedule L, Part IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS LINDSEY VAN GORDER, DAUGHTER-IN-LAW OF BOARD MEMBER AND OFFICER CHRIS VAN GORDER, IS EMPLOYED BY SCRIPPS HEALTH. DAVID VAN GORDER, SON OF BOARD MEMBER AND OFFICER CHRIS VAN GORDER, IS EMPLOYED BY SCRIPPS HEALTH. KATIE WOODHEAD, DAUGHTER OF KEY EMPLOYEE JOHN ENGLE, IS EMPLOYED BY SCRIPPS HEALTH. X 68 1543124 Market value X 1 105945 Market value 0 false true true Schedule M, Part I COLUMN (B) CONTRIBUTIONS REPORTED THE NUMBER OF TRANSACTION, WHICH MOST CLOSELY APPROXIMATES THE NUMBER OF ITEMS CONTIRBUTED, IS BEING REPORTED IN COLUMN B. Schedule M, Part I, Line 32b Third parties used to solicit, process, or sell noncash contributions GIFTS OF SECURITIES ARE LIQUIDATED THROUGH LICENSED SECURITIES BROKERS. GIFTS OF REAL ESTATE ARE LIQUIDATED THROUGH LICENSED REAL ESTATE BROKERS. Form 990, Part I, Line 1 FORM 990, PART III, LINE 1 (CONTINUED) FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $4.3 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS OVER HALF A MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF 3,000 AFFILIATED PHYSICIANS AND 17,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. RECOGNIZED AS A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, GENOMIC MEDICINE, WIRELESS HEALTH AND GRADUATE MEDICAL EDUCATION. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONG STANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. TODAY, THE HEALTH SYSTEM EXTENDS FROM CHULA VISTA TO OCEANSIDE, WITH 26 PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS WAS NAMED BY TRUVEN IN 2013 AS ONE OF THE TOP 15 LARGE HEALTH SYSTEMS IN THE NATION FOR PROVIDING HIGH-QUALITY, SAFE AND EFFICIENT PATIENT CARE. ON THE FOREFRONT OF GENOMIC MEDICINE AND WIRELESS HEALTH TECHNOLOGY, THE ORGANIZATION IS DEDICATED TO IMPROVING COMMUNITY HEALTH WHILE ADVANCING MEDICINE THROUGH CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. SCRIPPS HAS ALSO EARNED A NATIONAL REPUTATION AS A PREMIER EMPLOYER, NAMED BY FORTUNE MAGAZINE AS ONE OF AMERICA'S "100 BEST COMPANIES TO WORK FOR" EVERY YEAR SINCE 2008. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS See full Scripps Health Annual Community Benefit Plan and Report at https://www.scripps.org/about-us/scripps-in-the-community. Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $4.3 billion private, tax exempt integrated health system based in San Diego, California. Scripps treats more than 600,000 patients annually through the dedication of more than 3,000 affiliated physicians and more than 17,000 employees. Scripps cares for people throughout the San Diego region with four acute care hospitals on five campuses, 31 outpatient clinics, and 15 Scripps HealthExpress sites. Scripps also offers payer products and population health services through Scripps Accountable Care Organization, Scripps Health Plan, and customized narrow network plans in collaboration with third-party payers. Scripps Health is a leading provider of medical care, improving community health and advancing medicine in San Diego County. The system is recognized for expertise in women's health, cancer care, cardiovascular disease prevention and treatment, and neurocognitive care including dementia and therapy-induced cognitive sequela. Scripps is also at the forefront of clinical research, and digital health care. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. Scripps hospitals are consistently ranked among the nation's best by U.S. News & World Report and numerous other organizations. Scripps is frequently recognized by Fortune magazine, Working Mother magazine, and the Advisory Board as one of the best places in the nation to work. Importantly, Scripps culture is one of caring; the spirit and culture established by two pioneering founders, Ellen Browning Scripps and Mother Mary Michael Cummings still define who we are today. More information can be found at www.scripps.org. Scripps provides a comprehensive range of inpatient and ambulatory services through the system of hospitals and clinics. In addition, Scripps participates in dozens of partnerships with government and not-for-profit agencies across our region to improve our community's health and our partnerships do not stop at our local borders. Scripps participation at the state, national and international levels include work with government and private disaster preparedness and relief agencies, the State Commission on Emergency Medical Services, national health advocacy organizations, as well as international partnerships for physician education and training, and direct patient care. In all that we do, Scripps is committed to quality patient outcomes, service excellence, operating efficiency, caring for those who need us today and planning for those who may need us in the future. As a tax-exempt health care system, Scripps takes pride in its service to the community. The Scripps system is governed by a 19-member, volunteer Board of Trustees. This single point of authority for organizational policy ensures a unified approach to serving patients across the region. Hospitals and health care systems define the community served as those individuals residing within its service area. A hospital or health care system service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low income or underserved populations. Scripps serves the entire San Diego County region with services concentrated in North Coastal, North Central, Central and Southern region of San Diego. Scripps provides significant and growing volumes of emergency, outpatient, and primary care. In Fiscal Year 2023, Scripps provided 3,085,322 outpatient visits and 73,042 hospital discharges. The hospital's patient population includes all who receive care without regard to insurance coverage or eligibility for assistance. The Scripps Community Benefit Plan and Report was developed in response to Senate Bill 697. Passed in 1994, the bill requires California's not-for-profit hospitals to annually describe and document the full range of community benefits they provide. The report incorporates not only documentation of community benefits, but also a more detailed explanation of the specific community benefit activities provided by our five acute-care hospital campuses, wellness centers and ambulatory care clinics. Scripps Health community benefit programs are commitments Scripps makes to improve the health of both patients and the diverse San Diego communities. As a longstanding member of these communities, Scripps' goal and responsibility is to assist all who come to us for care, and to reach out especially to those who find themselves vulnerable and without support. Through our continued actions and community partnerships, we strive to raise the quality of life in the community. The report covers the period of Fiscal Year 2023 (October 1, 2022, through September 30, 2023). During this fiscal year, Scripps devoted $767,851,896 to community benefit programs and services. Community outreach efforts are focused in those areas with proximity to a Scripps facility. Scripps hosts, sponsors, and participates in many community-building events throughout the year. Our programs emphasize community-based prevention efforts and use creative approaches to reach residents at the highest risk for health problems. The report details programs and services that extend beyond standard practices of care, categorizing community benefit services into three main areas: - Community Health Improvement Services: These activities are designed to enhance community health and include community health education and prevention services, provided without generating patient bills. - Uncompensated Care: This comprises charity care, bad debt, and shortfalls from Medi-Cal and Medicare. - Professional Education and Health Research: This category includes educational programs open to all health professionals in the community, as well as research contributing to generalizable knowledge made available to the public. It encompasses the communication of findings and observations, including publication in a journal. Internally funded research and research funded by tax-exempt, or government entities are eligible for reporting. Community Health Improvement Services During Fiscal Year 2023 (October 2022 to September 2023), Scripps invested $7,285,612 in community health services (does not include subsidized health). Subsidized Health Services included our inpatient behavioral health unit with a net community benefit of $2,867,155 (subsidized costs are included in the IRS Form 990 Schedule H Part I-line 7g). These figures reflect the costs associated with providing these programs, salaries, materials, and supplies minus revenue. Community Health Services include prevention and wellness programs, screenings, health education, support groups, health fairs and other programs supported by operational funds, grants, and in-kind donations and philanthropy. Calculations are based on cost, less "direct offsetting revenue," which includes any revenue generated by the activity or program, such as payment or reimbursement for services provided to program patients. According to the Schedule H 990 IRS guidelines, "direct offsetting revenue" also includes restricted grants or contributions that the organization uses to provide a community benefit. Scripps Health strives to improve community health through collaboration with a wide range of partners and like-minded organizations. Working with other health systems, community groups, government agencies, businesses and grassroots movements, Scripps is better able to build upon efforts to achieve broad community health goals and partner with a wide variety of organizations on community health improvement programs. The documentation and activities described in the report are commitments we make to improve the health of both our patients and the diverse San Diego communities. As a longstanding member of these communities, and as a not-for-profit community resource, our goal and responsibility are to aid all who come to us for care, and to reach out especially to those who find themselves vulnerable and without support. This responsibility is an intrinsic part of our mission. Through our continued actions and community partnerships, we strive to raise the quality of life in the whole community. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) Scripps Health bases its community benefit planning on its triennial community health needs assessment (CHNA). The CHNA aims to identify, understand, and prioritize the health-related needs of San Diego County residents facing inequities. The results of the CHNA are used to inform and adapt hospital programs and strategies better to meet the health needs of San Diego County residents. The following needs are addressed in the FY23 Community Benefit Plan and Report: - Access to Care (Community Outreach) and financial support for uninsured and underinsured community members. Increase and support access to health care services for the underserved through direct programs and partnerships with community-based organizations. - Aging Care and Support - health education, fall prevention support, social support and screening activities for seniors and others with aging concerns. - Behavioral Health - strengthen the continuum of integrated primary and mental health services for patients discharged from various hospital settings (medical and behavioral health inpatient and emergency care) through a variety of timely patient engagement strategies including the expansion of community-based behavioral health services adjacent to the hospital. - Children and Youth Wellbeing - education and training for community health care professionals and collaboration with local schools to promote interest and provide career pathways in health care. - Chronic Health Conditions - education, prevention and wellness programs, screening and support programs for chronic health conditions and various other health needs including, but not limited to, cardiovascular disease, stroke, cancer, diabetes, and obesity. - Community Safety - community education to decrease preventable deaths and injuries. - Economic Stability - improve outcomes for high-risk underfunded patients and community members through facilitated referrals and connection to other services in the community. In addition, Scripps addresses many of the social determinants of health within the health conditions identified in the CHNA such as, community and social support, food insecurity, transportation, education, and homelessness. The following is a snapshot of Scripps Community Benefits provided in FY23. For more detailed information, see Scripps Health Annual Community Benefit Plan and Report at Scripps Community Benefits - San Diego - Scripps Health. These costs are included in the IRS Form 990 Schedule H Part I-line 7e, and 7i. - Recuperative Care Partnerships: This initiative offered safe discharges for chronically homeless patients with ongoing medical needs. - Father Joe's Village Street Health Intervention Project Collaboration: A joint effort with Scripps Mercy Hospital aimed at reaching unsheltered discharged patients for follow-up visits within their communities. - Support for Community Clinics: Financial assistance and other forms of support were provided to community clinics to enhance healthcare access and services. - Partnership with St Leo's Mission Community Clinic: Scripps medical residents delivered medical care to uninsured individuals in collaboration with this clinic. - American Red Cross Blood Drives: A partnership facilitated blood donation drives. - Medical Legal Partnership with Consumer Center for Health Education and Advocacy: This partnership educated consumers on healthcare benefits, eligibility, and coverage program changes. - Mobile Health and Resource Fair in Southeast San Diego: Scripps partnered with this resource fair to address healthcare needs, offering cardiovascular health and neurocognitive screenings, resources, and breast cancer screening referrals to underserved populations. - Services for Seniors: Programs included fall prevention, wellness education, and the Advanced Care Clinic for adults with multiple chronic diseases. - Behavioral Health Partnership with Family Health Centers of San Diego (FHCSD): This collaboration aimed to strengthen integrated primary and mental health services for Medi-Cal patients receiving care at Scripps Mercy Hospital. - Supportive Mental Health Services: These services were offered at local-based clinics. - Substance Use Disorder Service (SUDS): SUDS nurses assisted patients at risk for or experiencing detox from addictive substances within the Scripps Health system. - Cancer Programs and Support Services: These services included counseling, support groups, complementary therapies, and educational workshops. - Heart Health and Cardiovascular Disease Prevention: Activities and programs targeted heart health, stroke, and cardiovascular disease prevention and treatment. - Addressing Cardiovascular Disease and Sudden Cardiac Arrest (SCA) in Teens: A partnership with the Eric Paredes Save A Life Foundation focused on screening SCA in teenagers. - Diabetes Care Management Programs: Scripps provided comprehensive and culturally sensitive care to high-risk, underserved communities through Project Dulce, using a specialized team to counsel diabetes patients. - Health Education and Community Engagement: Scripps delivered various classes, prevention lectures, support groups, and participated in health fairs and events to address community needs. - Food Insecurity Support: Assistance included Cal-Fresh screening, Scripps Mercy WIC program, identifying social determinants of health, and an employee food sharing program. - Transportation Services: Scripps partnered with Facilitating Access to Coordinated Transportation (FACT) Inc. to offer on-demand rides for patients traveling to medical appointments. - Engagement in Community Initiatives: Scripps executive leadership and staff actively participated in various community organizations, committees, and coalitions to enhance community health. Uncompensated Care During Fiscal Year 2023, Scripps contributed $716,656,565 in uncompensated health care, including $18,248,321 in charity care, $693,017,958 in Medi-Cal and Medicare shortfall, and $5,390,286 in bad debt. This represents unreimbursed community benefit costs after the impact of the Medi-Cal Hospital Fee Program. The State of California enacted legislation for a provider fee program to fund certain Medi-Cal coverage expansions ("Provider Fee Program"). The Provider Fee Program charges hospitals a quality assurance fee that is used to obtain federal matching funds for Medi-Cal with the proceeds redistributed as supplemental payments to California hospitals that treat Medi-Cal patients. In September 2022, CMS approved the January 1, 2022, through December 31, 2022, Provider Fee Program ("Phase VII"). The Organization's policy is to recognize program revenues and expenses on the accrual basis once the Federal waiver has been approved. Federal and state payments received from these programs are included as provider fee revenue in total patient service revenue, and fees paid or payable to the state and California Health Foundation and Trust ("CHFT") are included in provider fee expense in operating expenses. The Provider Fee Program for the calendar year 2023 ("Phase VIII") has not yet been approved by CMS and has not been recognized in results of the Organization for the year ended September 30, 2023. Uncompensated health care costs are included in the IRS Form 990 Schedule H Part I-line 7a-7c. The health care safety net in San Diego County is highly dependent upon hospitals and community health clinics to care for uninsured and medically underserved communities. Medi-Cal provides health insurance coverage for 1,000,000 in San Diego County in 2022 (almost 1 out of 3 people in San Diego County are Medi-Cal beneficiaries). San Diego County has the 2nd largest Medi-Cal population in California. Five percent of enrollees with the highest-cost needs account for over half of Medi-Cal spending. Finding more effective ways to coordinate and enhance the safety net is a critical policy challenge. While public subsidies help finance services for San Diego County's underinsured populations, these subsidies do not cover the full cost of care. Combined with Medi-Cal and Medicare funding shortfalls, Scripps and other local hospitals absorb the cost of caring for uninsured/underinsured patients in their operating budgets. This places a significant financial burden on hospitals and physicians. Scripps Mercy Hospital (including San Diego and Chula Vista campuses) provides 56.4 percent of the charity care within the Scripps system. The service area of Scripps Mercy Hospital reflects a higher proportion of economically disadvantaged individuals compared to the county average, with notably lower rates of insured adults and a significantly higher percentage of ethnic minorities, particularly Hispanic and Asian populations. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) In 2023, both Scripps Mercy Hospital San Diego and Scripps Mercy Hospital Chula Vista were designated by the government as a Disproportionate Share Hospital, recognizing the economically disadvantaged communities they serve. Both hospital campuses play crucial roles in delivering healthcare services to the Central/Southern San Diego County area, ranging from Interstate 8 to the United States-Mexico border. Over half of the patients served by Scripps Mercy San Diego and Chula Vista are covered by government insurance programs, including Medicare and Medi-Cal. Professional Education and Health Research Quality health care is highly dependent upon health education systems and medical research programs. Without the ability to train and inspire a new generation of health care providers, or to offer continuing education to existing health care professionals, the quality of health care will be diminished. Medical research also plays a vital role in improving the community's overall health by developing new and innovative treatments. Each year, Scripps allocates resources to advance health care services through clinical research, medical education, and health professional education. During Fiscal Year 2023 (October 2022 to September 2023), Scripps invested $40,779,944 in professional training programs and clinical research to enhance service delivery and treatment practices in San Diego County. This figure reflects the costs associated with clinical research, as well as professional education for non-Scripps employees, including graduate medical education, nursing resource development and other health care professional education. Research takes place primarily at Scripps Clinical Research Services, Scripps Whittier Diabetes Institute, Scripps Genomic Medicine, and Scripps Translational Science Institute. Calculations are based on cost, less "direct offsetting revenue," which includes any revenue generated by the activity or program, such as payment or reimbursement for services provided to program patients. These costs are included in the IRS Form 990 Schedule H Part I-line 7f and 7h. A key component of Scripps Mission is to advance the education of physicians and health care professionals and sponsor graduate medical education. By investing in these areas, we help secure quality care for our community. Scripps has been training future physicians longer than any other institution in San Diego. For more than 70 years physicians in Scripps graduate medical education programs have helped care for underserved populations throughout the region. Scripps has a comprehensive range of graduate medical education programs at Scripps Mercy Hospital, Scripps Family Practice Residency Program and Scripps Green Hospital. Scripps graduate medical education programs are well-known for excellence, provide a hands-on curriculum that focuses on patient-centered care and offer residencies in a variety of practices, including internal medicine, family medicine, podiatry, pharmacy, and palliative care. In Fiscal Year 2023, Scripps enrolled a total of 162 medical residents and 50 fellows throughout the Scripps health system. In addition, Scripps has a pharmacy residency program which trains residents with Doctor of Pharmacy degrees. Scripps commitment to ongoing learning and health care excellence extends beyond our organization. Our student programs help promote health care careers to a new generation, shape the future workforce and develop future leaders in our community. Interacting with health care professionals in the field expands education outside the classroom. Scripps employees play a significant role as preceptors by investing their time to create a valuable experience for the community. In Fiscal Year 2023, Scripps hosted 1,392 students within our system and provided 243,091 development hours spanning nursing and allied health settings. Scripps collaborates extensively with local educational institutions, offering students valuable exposure to healthcare roles alongside Scripps professionals. This includes affiliations with over 110 schools and programs, both clinical and nonclinical. Notable partners include Point Loma Nazarene University (PLNU), University of California San Diego (UCSD), California State University San Marcos (CSUSM), San Diego State University (SDSU), University of San Diego (USD), Mesa College, San Diego City College, Grossmont College, Palomar College, and Mira Costa College. An affiliation agreement committee evaluates new partnerships to meet community and workforce needs, ensuring a systemic approach to student placements. Scripps is committed to cultivating the next generation of healthcare professionals through a diverse range of youth-oriented initiatives. Emphasis is placed on school-to-health career activities, including mentoring, camps, job shadowing, health education classes, health chats, support groups, health fairs, and more. The Scripps School to Health Career Pathway Program engaged over 1,900 youths in various activities, such as mentoring programs, health professional presentations, surgery viewings, work-study programs, and Scripps Camp. Through internships and educational programs, Scripps collaborates with high schools and colleges to provide students with opportunities to explore healthcare roles and gain hands-on experience with Scripps professionals. Nurses and other staff members play pivotal roles in these educational experiences, interacting with students daily. Furthermore, Family Practice Medical Residents deliver interactive classroom presentations on public health concerns, medically focused topics, and conduct hands-on clinical skills workshops at local high schools. This serves to enrich students' understanding of healthcare careers and medical practices. Select Specialty Hospital- San Diego Select Specialty Hospital - San Diego is a 110-bed free standing critical illness recovery hospital situated in the Hillcrest area of San Diego. On May 1, 2021, Scripps Health acquired 24.5% of Select Hospital's holdings through IHS Holding Company LLC. Scripps allocable portion of the financial operations are recorded in Other operating income revenues in Scripps Health's consolidated financial statements and its annual IRS Form 990 filing. According to 501(r) regulations, when a hospital operates a facility through a joint venture, the joint venture is deemed a "substantially related entity must comply with 501(r) requirements. This includes conducting a Community Health Needs Assessment (CHNA) every three years, adopting an CHNA implementation strategy, establishing financial assistance policies, limiting charges for eligible individuals, and refraining from certain collection actions. The Scripps Health Board and Select Hospital Management Committee approved an amended 2022 CHNA and a FY23-FY25 Implementation Strategy in December 2023 and January 2024, respectively. As Select Hospital is a calendar year-end taxpayer, their financial results will be incorporated in Scripps Health's IRS Form 990 based on the calendar year ended within Scripps Health's tax reporting year. (e.g., Select Hospital CY22 results of $1,945,136 community benefit contributions are included in Scripps Health's FY23 tax return). Advancing Health Equity The mission of Scripps Health is to provide superior health care services in a caring environment and to make a positive difference in the health of individuals throughout our diverse communities. That mission has been our driving force for the past 100 years and will always be at the heart of everything we do. Today, disparities exist in health care for people throughout the nation. Scripps is committed to reducing health care disparities by evaluating and addressing variations in clinical outcomes as part of our ongoing commitment to high quality care for our patients and community. Definition of Health Equity at Scripps Health At Scripps, health equity is addressing disparities in clinical quality, outcomes and experience, regardless of patients' diverse backgrounds which include, but are not limited to, race, ethnicity, disability, sexual orientation, gender identity, age and socioeconomic status. Health Equity Structure at Scripps Under the leadership of our two chief medical officers, Scripps' health equity structure is composed of an acute care council, an ambulatory council, and a system workgroup which serves to coordinate the health equity efforts across the system. Scripps Health's work of improving health equity is supported by the Scripps Health Equity Information Center. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) Health Equity Information Center (HEIC) The Health Equity Information Center was created in 2023 to help identify outcomes by race, ethnicity, language, sexual orientation, gender identity, age and location of our patients. It is a collection of the latest data, original analytics research and business intelligence information. It serves as a research and development resource for Scripps groups currently providing equity-focused care and a springboard to develop future enterprise health equity strategies. The goal is to enhance and share the collective knowledge of Scripps' regional and local efforts to address health equity, areas of need and opportunity and the holistic problems affecting patients in their communities beyond the walls of our health system. The HEIC is the source of truth for equity-focused metrics, a research and development resource for groups currently providing equity-focused care and a springboard to develop future enterprise health equity strategies. The HEIC is primarily supported and maintained by the Health Data Science team in conjunction with other analytics groups, the Scripps Collaborative for Health Equity (SCHE), and the Community Benefits and Government Relations teams. Scripps Collaborative for Health Equity The Scripps Collaborative for Health Equity (SCHE) is one initiative among our regional and local efforts that seeks to fulfill Scripps commitment to multicultural diversity and promoting equity in the delivery of health care. Established as part of Scripps Krueger-Wyeth grant the SCHE is dedicated to establishing community health equity and its outcomes in our vulnerable populations through three strategic priorities: - Focus and expand research efforts on healthcare disparities. - Improve access to culturally appropriate healthcare resources. - Expand community interventions and programs for multicultural populations. Ongoing Health Equity Programs and Services As Scripps undertakes the work of identifying and reducing disparities in clinical outcomes and ensuring our compliance with government directives regarding health equity, it is important to recognize that Scripps has been engaged in a broad range of programs and initiatives that address health disparities for the vulnerable population for many years. Below are some examples, with further details on these programs, FY23 health equity accomplishments, and FY24 health equity goals provided in the community benefit report. - Aging Care and Support: Provide, proactive, medical, and social services to adults living with multiple chronic diseases. Partner with local senior centers, churches, and senior housing and conduct senior health chats that are designed to provide health education to the older adult community. - Behavioral Health: Establish initiatives to create a more robust behavioral health care system with emphasis on vocational training, reducing opioid use and substance abuse. - Cancer: Offer wig banks to support individuals undergoing cancer treatment and/or experiencing hair loss, transportation for appointments, lodging, Survivor's Day events, breast health outreach and education and more. - Cardiovascular Disease: Address cardiovascular disease through sudden cardiac arrest (SCA) screenings, virtual cardiac rehabilitation, cardiometabolic health education, and improving food insecurities. - Diabetes: Advocate for diabetes prevention, research and education through in-person and virtual programs and events for the various communities and patients impacted by the diabetes epidemic. - Maternal Child Health and High-Risk Pregnancy: Provide perinatology services, health education and awareness and other key programs to support the health of mothers, infants and families. - Professional Education: Support physician training and clinical research, residents and fellows through various residency programs and curriculum dedicated to uplifting health equity, reducing bias, and caring for the underserved. - Health Research: Identify how to measure health equity through the work of the Scripps Collaborative for Health Equity, related research grants, the Health Equity Information Center and more. - Youth Career Pathways/Pipeline Programs: Promote health care as a rewarding career to students via internship programs, outreach programs, scholars' programs and more. - Community Outreach: Help the homeless, food insecure, and un-insured/under-insured low-income patients through programs specifically designed to supplement their overall health care and living needs. Form 990, Part VI, Line 16a JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT & COMPLIANCE COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT IS REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST. ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING. Form 990, Part VI, Line 15a Process to establish compensation of top management official OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR PRESIDENT/CEO ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS +8.0% GEOGRAPHIC DIFFERENTIAL AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE +8.0% GEROGRAPHIC DIFFERENTIAL OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. THE BOARD SELECTS THE 65TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E. THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON DECEMBER 07, 2022, JANUARY 25, 2023, AND MARCH 29, 2023. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES. Form 990, Part VI, Line 15b Process to establish compensation of other employees OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS +8.0% GEOGRAPHIC DIFFERENTIAL AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE +8.0% GEROGRAPHIC DIFFERENTIAL OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. THE BOARD SELECTS THE 65TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E. THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE +8.0% GEOGRAPHIC DIFFERENTIAL OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON DECEMBER 07, 2022, JANUARY 25, 2023, AND MARCH 29, 2023. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES. Form 990, Part VI, Line 19 Required documents available to the public FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue Other program service revenue - Total Revenue: 18925380, Related or Exempt Function Revenue: 18740347, Unrelated Business Revenue: 185033, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees PHYS FEES-PROVIDER SVS AGRMENT - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 2463936, Fundraising Expenses: 0; OTHER PURCHASED SVS - NON MED - Total Expense: 91296162, Program Service Expense: 41987021, Management and General Expenses: 49028936, Fundraising Expenses: 280205; PHYSICIAN FEES - Total Expense: 82084777, Program Service Expense: 80605786, Management and General Expenses: 1478991, Fundraising Expenses: 0; PURCHASED MEDICAL SERVICES - Total Expense: 29129298, Program Service Expense: 29129298, Management and General Expenses: 0, Fundraising Expenses: 0; ALL OTHER FEES FOR SERVICES - Total Expense: 91501354, Program Service Expense: 74934519, Management and General Expenses: 16322842, Fundraising Expenses: 243993; Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN VALUE OF DEFERRED GIFTS - -904124; JOINT VENTURE DISTRIBUTION - 609861; OTHER CHANGES IN NET ASSETS - -24012; ROUNDING - 11754; SCRIPPS CLINIC BILLING LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 870797749 HLTHCR ADMIN CA 544184596 0 SCRIPPS HLTH SCRIPPS MERCY BILLING LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 870737748 HLTHCR ADMIN CA 82784158 0 SCRIPPS HLTH IMAGING HEALTHCARE SPECIALISTS LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 203872122 MED IMAGING CA 58319903 46151029 IHS HOLDING SCRIPPS HOSPITAL BILLING SERVICES LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 611677183 HLTHCR ADMIN CA 7829580 0 SCRIPPS HLTH SCRIPPS CARDIO&THORACTIC SURGERY BILLING 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 270620996 HLTHCR ADMIN CA 5505086 0 SCRIPPS HLTH MAXWELL H & MURIEL GLUCK CHILD CARE CTR 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 831953045 CHILDCARE CA 2102718 1473733 SCRIPPS HLTH SCRIPPS ACCOUNTABLE CARE ORGANIZATION 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 364837442 HLTHCR ADMIN CA 1089263 6258946 SCRIPPS HLTH SCRIPPS ASC MANAGEMENT LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 831187975 HLTHCR ADMIN CA 0 0 SCRIPPS HLTH IHS HOLDING COMPANY LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 473437677 HLTHCR ADMIN CA 0 35779242 SCRIPPS HLTH SCRIPPS BEHAVIORIAL HEALTH LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 834326624 HLTHCR ADMIN CA 0 0 SCRIPPS HLTH SCRIPPS HOME HEALTH & HOSPICE VENTURE 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 841894278 HOME HEALTH/HOSPICE CA 663855 0 SCRIPPS HLTH HORIZON HOSPICE 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 330220777 INACTIVE CA 501(c)(3) 10 SCRIPPS HEALTH true MERCY HOSPITAL FOUNDATION SAN DIEGO 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 942958094 FUNDRAISING CA 501(c)(3) Type I SCRIPPS HEALTH true SCRIPPS HEALTH PLAN SERVICES INC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 330782099 HLTHCARE SVCS CA 501(c)(3) Type I SCRIPPS HEALTH true SCRIPPS ENCINITAS SURGERY CTR 15305 DALLAS PKWY STE 1600 LB 28 ADDISON TX 75001 205942958 AMBUL SURGERY CTR CA SCRIPPS HEALTH Related 256442 2236379 false false 0.5538 SCRIPPSUSP SURGERY CTR 15305 DALLAS PKWY STE 1600 LB 28 ADDISON TX 75001 205942911 AMBUL SURGERY CTR CA NA Related 130258 1927474 false false 0.5 SCRIPPS MERCY AMBUL SURG CTR 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 450503246 AMBUL SURGERY CTR CA SCRIPPS HEALTH Related -71934 2868067 false true 0.735 SCRIPPS MEMORIAL XIMED MED CTR 9850 GENESEE AVE STE 900 LA JOLLA CA 92037 330475481 REAL ESTATE CA SCRIPPS HEALTH Related 737134 5432551 false true 0.153 Vibra Hospital of San Diego LLC 4714 Gettysburg Road Mechanicsburg PA 10755 261466122 LT ACUTE CARE PA SCRIPPS HEALTH Related -3722044 11033432 false false 0.245 CHARITABLE LEAD TRUST (1) 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 HOSPITAL SUPPORT CA NA Trust true CHARITABLE REMAINDER TRUST (30) 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 HOSPITAL SUPPORT CA NA Trust true true false false false false false false false false true false true true false false false true false false Scripps Health Plan Services (SHPS) M 118216632 Accrual Scripps Health Plan Services (SHPS) Q 42131584 Accrual Scripps Encinitas Surgery Center A 471801 Accrual Scripps Mercy Ambulatory Surgery Center A 338564 Accrual Scripps Health Plan Services (SHPS J 163306 Accrual Scripps Health Plan Services (SHPS) L 435136989 Accrual