4A (Expenses $ 1793802192 including grants of $ 9880004) (Revenue $ 2085904099)
SEE SCHEDULE O

REPORTING FACILITY: A
SCHEDULE H, PART V, SECTION B, LINE 5 SUTTER MEDICAL CENTER SACRAMENTO (A, 1, 3 & 6): SUTTER MEDICAL CENTER SACRAMENTO INCLUDES THE FOLLOWING FACILITIES LISTED IN PART V SECTION A: SUTTER GENERAL HOSPITAL, SUTTER MEMORIAL HOSPITAL, AND SUTTER CENTER FOR PSYCHIATRY. IN CONDUCTING ITS MOST RECENT CHNA, SUTTER MEDICAL CENTER SACRAMENTO, A FACILITY OF SUTTER HEALTH SACRAMENTO SIERRA REGION (SSR), DID TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY IN THE HOSPITAL'S SERVICE AREA (HSA). KEY INFORMANTS ARE HEALTH AND COMMUNITY EXPERTS FAMILIAR WITH POPULATIONS AND GEOGRAPHIC AREAS RESIDING WITHIN THE HSA. TO GAIN A DEEPER UNDERSTANDING OF THE HEALTH ISSUES PERTAINING TO CHRONIC DISEASE AND THE POPULATIONS LIVING IN THESE VULNERABLE COMMUNITIES, INPUT FROM 40 KEY INFORMANTS WAS GATHERED THROUGH INTERVIEWS CONDUCTED USING A THEORETICALLY GROUNDED INTERVIEW GUIDE. EACH INTERVIEW WAS RECORDED AND THOROUGH CONTENT ANALYSIS WAS CONDUCTED TO IDENTIFY KEY THEMES AND IMPORTANT POINTS PERTAINING TO EACH GEOGRAPHIC AREA. FINDINGS FROM THESE INTERVIEWS WERE USED TO HELP IDENTIFY COMMUNITIES IN WHICH FOCUS GROUPS WOULD MOST APTLY BE PERFORMED. INTERVIEWS WERE CONDUCTED WITH THE FOLLOWING PEOPLE: - KATY ROBB AND DANIELLE LAWRENCE, SOCIAL WORKERS FOR MUTUAL ASSISTANCE ORGANIZATION WITH EXPERTISE IN COMMUNITY HEALTH AND SOCIAL SUPPORT SERVICES. (INTERVIEW DATE: 4/20/12) - CHRISTINE GONZALES, FAMILY RESOURCE CENTER (FRC) COORDINATOR AND MICHELLE ALLEE, TEAM LEADER FOR BIRTH AND BEYOND - THE EFFORT NORTH HIGHLANDS WITH EXPERTISE IN COMMUNITY HEALTH SERVICES. (INTERVIEW DATE: 4/27/12) - GINA WARREN, PHARMACIST FOR PRIMARY HEALTH SERVICES WITH EXPERTISE IN CHRONIC DISEASE MANAGEMENT AND COMMUNITY HEALTH. (INTERVIEW DATE: 5/7/12) - ROMAN ROMASO, EXECUTIVE DIRECTOR FOR SLAVIC ASSISTANCE NETWORK WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 4/27/12) - GENEVIEVE DIEGNAN, PROGRAM DIRECTOR FOR SACRAMENTO FOOD BANK WITH EXPERTISE IN COMMUNITY SUPPORT SERVICES. (INTERVIEW DATE: 4/1/12) - MARTY KEALE, EXECUTIVE DIRECTOR FOR CAPITOL COMMUNITY HEALTH NETWORK WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/2/12) - DR. PATRICIA SAMUELSON, PHYSICIAN FOR MERCY CLINIC NORWOOD WITH EXPERTISE IN COMMUNITY CLINIC SERVICES. (INTERVIEW DATE: 5/11/12) - ABRAHAM DANIELS, PROGRAM OFFICER FOR SIERRA HEALTH FOUNDATION WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/15/12) - CAROLYN MARTIN, EXECUTIVE DIRECTOR FOR CALIFORNIA TOBACCO CONTROL ALLIANCE WITH EXPERTISE IN TOBACCO PREVENTION. (INTERVIEW DATE: 5/22/12) - SISTER LIBBY FERNANDEZ, EXECUTIVE DIRECTOR FOR LOAVES AND FISHES HOMELESS CLINIC WITH EXPERTISE IN COMMUNITY HEALTH AND HOMELESSNESS. (INTERVIEW DATE: 5/5/12) - HEALTH NAVIGATORS GROUP FOR CAPITOL COMMUNITY HEALTH NETWORK WITH EXPERTISE IN COMMUNITY HEALTH AND PATIENT NAVIGATION. (INTERVIEW DATE: 5/29/12) - CAROL MENNEL, NURSING ADMINISTRATOR FOR MERCY SAN JUAN WITH EXPERTISE IN EMERGENCY CARE. (INTERVIEW DATE: 5/29/12) - DR. OLIVIA KASIRYE, PUBLIC HEALTH OFFICER FOR SACRAMENTO COUNTY WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/30/12) - DR. LEONARD RANASINGHE, PHYSICIAN FOR NATOMAS CROSSROADS CLINIC WITH EXPERTISE IN COMMUNITY HEALTH CLINICS. (INTERVIEW DATE: 6/2/12) - CAROL MOSES, PASTOR AND DENISE ALDRED, MANAGER FOR NATOMAS CROSSROADS CLINIC WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 6/2/12) - MARCELLA GONSALVES, PROGRAM ADMINISTRATOR FOR HEALTH EDUCATION COUNCIL WITH EXPERTISE IN COMMUNITY HEALTH PROMOTION (INTERVIEW DATE: 6/11/12) - DR. JONATHAN PORTEUS, CEO FOR THE EFFORT, INC. WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 6/11/12) - ROBERT SANGER, EXECUTIVE DIRECTOR FOR FOLSOM CORDOVA COMMUNITY PARTNERSHIP WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 6/11/12) - KOUA FRANZ, CHIEF FAMILY AND COMMUNITY ENGAGEMENT CENTER OFFICER FOR SACRAMENTO CITY UNIFIED SCHOOL DISTRICT WITH EXPERTISE IN SCHOOL AND FAMILY HEALTH. (INTERVIEW DATE: 6/13/12) - DR. CATHERINE VIGRAN, PHYSICIAN FOR KAISER PERMANENTE WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 6/14/12) - SENG VANG, STAFF, AND PENNY LO, PROGRAM MANAGER, FOR HMONG WOMEN'S HERITAGE ASSOCIATION WITH EXPERTISE IN COMMUNITY HEALTH AND SOCIAL SUPPORT SERVICES IN HMONG POPULATION. (INTERVIEW DATE: 4/23/12) - TASHA BRYANT, MANAGER OF CLOTHING PROGRAM AND LORENA CARRANZA, MANAGER OF PARENT EDUCATION PROGRAM FOR SACRAMENTO FOOD BANK WITH EXPERTISE IN COMMUNITY SUPPORT SERVICES. (INTERVIEW DATE: 4/30/12) - JULIE DEBBS, PROGRAM COORDINATOR FOR COMMUNITIES AGAINST SEXUAL HARM WITH EXPERTISE IN COMMUNITY VIOLENCE AND HEALTH PROMOTION. (INTERVIEW DATE: 5/2/12) - DR. MAYA LEGGETT, TRAUMA SURGEON FOR KAISER PERMANENTE WITH EXPERTISE IN EMERGENCY HEALTH CARE. (INTERVIEW DATE: 5/31/12) - STEPHANIE NGUYEN, EXECUTIVE DIRECTOR FOR ASIAN RESOURCES WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/31/12) - DR. MELISSA BAYNE, PHYSICIAN, DEANGELO MACK AND DUANTE MOORE OF SACRAMENTO VIOLENCE INTERVENTION PROGRAM WITH EXPERTISE IN COMMUNITY VIOLENCE PREVENTION. (INTERVIEW DATE: 6/6/12) - MARCELLA GONSALVES, PROGRAM ADMINISTRATOR FOR HEALTH EDUCATION COUNCIL WITH EXPERTISE IN COMMUNITY HEALTH PROMOTION. (INTERVIEW DATE: 6/11/12) MEMBERS OF THE COMMUNITY REPRESENTING DEMOGRAPHIC SUBGROUPS, DEFINED AS GROUPS WITH UNIQUE ATTRIBUTES (RACE & ETHNICITY, AGE, SEX, CULTURE, LIFESTYLE, OR RESIDENTS OF A PARTICULAR AREA OF THE HSA), WERE RECRUITED TO PARTICIPATE IN FOCUS GROUPS. A STANDARD PROTOCOL WAS USED FOR ALL FOCUS GROUPS TO UNDERSTAND THE EXPERIENCES OF THESE COMMUNITY MEMBERS AS THEY RELATE TO HEALTH DISPARITIES AND CHRONIC DISEASE. IN ALL, 10 FOCUS GROUPS WITH 129 PARTICIPANTS WERE CONDUCTED. CONTENT ANALYSIS WAS PERFORMED ON FOCUS GROUP INTERVIEW NOTES AND/OR TRANSCRIPTS TO IDENTIFY KEY THEMES AND SALIENT HEALTH ISSUES AFFECTING THE COMMUNITY RESIDENTS. THE FINDINGS FROM KEY INFORMANT INTERVIEWS AND FOCUS GROUPS IN SUTTER MEDICAL CENTER'S CHNA ARE AVAILABLE AT HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML. SUTTER ROSEVILLE MEDICAL CENTER (A, 2): IN CONDUCTING ITS MOST RECENT CHNA, SUTTER ROSEVILLE MEDICAL CENTER, A FACILITY OF SUTTER HEALTH SACRAMENTO SIERRA REGION (SSR), DID TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY IN THE HOSPITAL'S SERVICE AREA (HSA). KEY INFORMANTS ARE HEALTH AND COMMUNITY EXPERTS FAMILIAR WITH POPULATIONS AND GEOGRAPHIC AREAS RESIDING WITHIN THE HSA. TO GAIN A DEEPER UNDERSTANDING OF THE HEALTH ISSUES PERTAINING TO CHRONIC DISEASE AND THE POPULATIONS LIVING IN THESE VULNERABLE COMMUNITIES, INPUT FROM 21 KEY INFORMANTS WAS GATHERED THROUGH INTERVIEWS CONDUCTED USING A THEORETICALLY GROUNDED INTERVIEW GUIDE. EACH INTERVIEW WAS RECORDED AND CONTENT ANALYSIS WAS CONDUCTED TO IDENTIFY KEY THEMES AND IMPORTANT POINTS PERTAINING TO EACH GEOGRAPHIC AREA. FINDINGS FROM THESE INTERVIEWS WERE USED TO HELP IDENTIFY COMMUNITIES IN WHICH FOCUS GROUPS WOULD MOST APTLY BE PERFORMED. INTERVIEWS WERE CONDUCTED WITH THE FOLLOWING PEOPLE: - DR. RICHARD BURTON, COUNTY HEALTH OFFICER FOR PLACER COUNTY HEALTH AND HUMAN SERVICES WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/22/12) - DR. DARLA CLARK, PHYSICIAN FOR CHAPA-DE INDIAN HEALTH WITH EXPERTISE IN LOW INCOME AND NATIVE AMERICAN COMMUNITY HEALTH. (INTERVIEW DATE: 5/21/12) - MARION CASTRO, CASE MANAGER FOR KIDS FIRST WITH EXPERTISE IN COMMUNITY HEALTH, YOUTH AND ADOLESCENT HEALTH. (INTERVIEW DATE: 2/9/13) - MARION CASTRO, DARYL MORALES, RINA ROJAS, SANTIAGO MAGANA, CASE WORKERS AND STAFF FOR LIGHTHOUSE FAMILY RESOURCE CENTER WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 10/9/12) - CHRISTINE GONZALES, FRC COORDINATOR AND MICHELLE ALLEE, TEAM LEADER FOR BIRTH AND BEYOND - THE EFFORT NORTH HIGHLANDS WITH EXPERTISE IN COMMUNITY HEALTH SERVICES. (INTERVIEW DATE: 4/27/12) - GINA WARREN, PHARMACIST FOR PRIMARY HEALTH SERVICES WITH EXPERTISE IN CHRONIC DISEASE MANAGEMENT AND COMMUNITY HEALTH. (INTERVIEW DATE: 5/7/12) - ROMAN ROMASO, EXECUTIVE DIRECTOR FOR SLAVIC ASSISTANCE NETWORK WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 4/27/12) - MARTY KEALE, EXECUTIVE DIRECTOR FOR CAPITOL COMMUNITY HEALTH NETWORK WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/2/12) - DR. PATRICIA SAMUELSON, PHYSICIAN FOR MERCY CLINIC NORWOOD WITH EXPERTISE IN COMMUNITY CLINIC SERVICES. (INTERVIEW DATE: 5/11/12) - ABRAHAM DANIELS, PROGRAM OFFICER FOR SIERRA HEALTH FOUNDATION WITH EXPERTISE IN COMMUNITY HEALTH. (INTERVIEW DATE: 5/15/12) - CAROLE MCCOOKFUL, NURSE PRACTITIONER FOR MERCY CLINIC NORTH HIGHLANDS WITH EXPERTISE IN PUBLIC HEALTH NURSING. (INTERVIEW DATE: 5/21/12) - CAROLYN MARTIN, EXECUTIVE DIRECTOR FOR CALIFORNIA TOBACCO CONTROL ALLIANCE WITH EXPERTISE IN TOBACCO PREVENTION. (INTERVIEW DATE: 5/22/12) - HEALTH NAVIGATORS GROUP OF CAPITOL COMMUNITY HEALTH NETWORK WITH EXPERTISE IN COMMUNITY HEALTH AND PATIENT NAVIGATION. (INTERVIEW DATE: 5/29/12) - CAROL MENNEL, NURSING ADMINISTRATOR FOR MERCY SAN JUAN WITH EXPER

SCHEDULE H, PART V, SECTION B, LINE 6A
SUTTER GENERAL HOSPITAL, SUTTER ROSEVILLE MEDICAL CENTER, SUTTER MEMORIAL HOSPITAL, SUTTER SOLANO MEDICAL CENTER, SUTTER AUBURN FAITH HOSPITAL, SUTTER CENTER FOR PSYCHIATRY, SUTTER AMADOR HOSPITAL, AND SUTTER DAVIS HOSPITAL (A, 1-8) A COLLECTION OF FOUR NONPROFIT HOSPITALS, ALL SERVING PORTIONS OF OR THE SAME COMMUNITIES, COLLABORATED TO SPONSOR AND PARTICIPATE IN THE CHNA INCLUDING SUTTER HEALTH, DIGNITY HEALTH, KAISER PERMANENTE AND UC DAVIS MEDICAL CENTER.

SCHEDULE H, PART V, SECTION B, LINE 7A, 7B AND 10A
FILING ORG WEBSITES: - SUTTER GENERAL HOSPITAL, SUTTER MEMORIAL HOSPITAL, AND SUTTER CENTER FOR PSYCHIATRY (A, 1, 3 & 6): HTTP://WWW.SUTTERMEDICALCENTER.ORG/CHNA/FINAL_SUTTERMEDCENTER_CHNA.PDF - SUTTER ROSEVILLE MEDICAL CENTER (A, 2): HTTP://WWW.SUTTERROSEVILLE.ORG/ABOUT/COMMUNITY-NEEDS-ASSESSMENT.HTML - SUTTER SOLANO MEDICAL CENTER (A, 4): HTTP://WWW.SUTTERSOLANO.ORG/ABOUT/COMMUNITY-NEEDS-ASSESSMENT.HTML - SUTTER AUBURN FAITH HOSPITAL (A, 5): HTTP://WWW.SUTTERAUBURNFAITH.ORG/ABOUT/COMMUNITY-NEEDS-ASSESSMENT.HTML - SUTTER AMADOR HOSPITAL (A, 7): HTTP://WWW.SUTTERAMADOR.ORG/ABOUT/COMMUNITY-NEEDS-ASSESSMENT.HTML - SUTTER DAVIS HOSPITAL (A, 8): HTTP://WWW.SUTTERDAVIS.ORG/ABOUT/COMMUNITY-NEEDS-ASSESSMENT.HTML OTHER WEBSITE: HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML

SCHEDULE H, PART V, SECTION B, LINE 11
"SUTTER GENERAL HOSPITAL, SUTTER MEMORIAL HOSPITAL, AND SUTTER CENTER FOR PSYCHIATRY (A, 1, 3 & 6): THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND ARE NEEDS THAT SUTTER MEDICAL CENTER, SACRAMENTO INTENDS TO ADDRESS THROUGH ITS IMPLEMENTATION STRATEGY: - LACK OF ACCESS TO PRIMARY AND PREVENTATIVE SERVICES - LACK OF ADEQUATE COUNTY (SACRAMENTO) SAFETY NET/HEALTH NETWORK FOR LOW INCOME RESIDENTS; LACK OF CHRONIC DISEASE MANAGEMENT PROGRAMS; NO APPOINTMENTS AVAILABLE IN LOW COST/FREE CLINICS; RECENT JOB LOSSES RESULTING IN LOSS OF INCOME AND BENEFITS; NAVIGATING THE COMPLEX SYSTEM OF SOCIAL SERVICES; AND DISCRIMINATION BY PHYSICIAN TOWARDS LOW INCOME/MEDI-CAL INSURED POPULATIONS. - LACK OF ACCESS TO MENTAL HEALTH SERVICES - INADEQUATE MENTAL HEALTH SERVICES; STIGMAS IN SEEING MENTAL HEALTH SERVICES; DIFFICULTY NAVIGATING THE SYSTEM FOR PUBLIC ASSISTANCE TO RECEIVE MENTAL HEALTH SERVICES; REDUCTION IN SERVICES OFFERED BY COUNTY AND FINDING PRIVATE PRACTICE COUNSELORS THAT TAKE MEDI-CAL. - LACK OF ACCESS TO DENTAL CARE - LIMITED ACCESS TO DENTAL CARE (ALL FORMS OF ORAL HEALTH). - LACK OF ACCESS TO SPECIALTY CARE - LIMITED SPECIALISTS THAT ACCEPT MEDI-CAL PATIENTS. - LACK OF COORDINATION OF CARE AMONG PROVIDERS - LACK OF CHRONIC DISEASE MANAGEMENT AND CARE TRANSITION PROGRAMS; PATIENTS RECEIVING CARE FROM MULTIPLE PROVIDERS WORKING INDEPENDENTLY OF ONE ANOTHER. - LACK OF HOUSING, BASIC SHELTER - HOUSING INSTABILITY AND FEAR OF LOSING HOME. DESCRIPTIONS OF THE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THESE SIGNIFICANT HEALTH NEEDS CAN BE FOUND IN PART VI. NO HOSPITAL CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. SUTTER MEDICAL CENTER, SACRAMENTO (SMCS) IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, USING ITS SKILLS AND CAPABILITIES, AND REMAINING A STRONG ORGANIZATION SO THAT IT CAN CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. LIVING IN AN UNHEALTHY FOOD ENVIRONMENT: NOT ONLY IS THERE A LACK OF EFFECTIVE INTERVENTIONS TO ADDRESS THIS NEED, THIS IS NOT SOMETHING THAT WE ARE ABLE TO GREATLY AFFECT THROUGH COMMUNITY BENEFIT; THEREFORE, WE ARE FOCUSING OUR RESOURCES ELSEWHERE. PERCEIVED OR REAL FEAR FOR PERSONAL SAFETY: THIS IS PRIMARILY A LAW ENFORCEMENT ISSUE AND NOT SOMETHING THAT SMCS HAS THE EXPERTISE TO EFFECTIVELY ADDRESS. INABILITY TO EXERCISE AND BE ACTIVE: EXERCISE IS VERY IMPORTANT; HOWEVER SURROUNDING HEALTH SYSTEMS LIKE KAISER PUT GREAT EMPHASIS ON EXERCISE THROUGH THEIR ""THRIVE"" CAMPAIGN AND ORGANIZATIONS LIKE SPIRIT, WHO HOST THE ""WALK WITH A DOC"" EVENTS, WHICH ALLOWS US TO DEDICATE OUR RESOURCES TO MEETING OTHER NEEDS OUTLINED IN THE CHNA. ACCULTURATION/LIMITED CULTURAL COMPETENCE IN HEALTH AND RELATED SYSTEMS: WHILE WE WORK HARD TO PARTNER WITH CULTURALLY SENSITIVE/COMPETENT STAFF MEMBERS AND ATTEMPT TO MEET THE NEEDS OF DIVERSE GROUPS THROUGH OUR SPONSORSHIP AND COMMUNITY INVESTMENT AWARD FUNDING, THIS IS NOT A KEY PRIORITY AS THIS TIME, AS THE NEED IS NOT AS PRESSING AS OTHER PROBLEMS. LACK OF HEALTH LITERACY: WHILE THIS IS IMPORTANT AND WE SCRATCH THE SURFACE OF THIS ISSUE THROUGH THE HEALTHY ACCESS PROGRAM, THIS NEED IS NOT OUR PRIMARY FOCUS, WHICH IS EXPANDING ACCESS TO CARE AND BUILDING THE CAPACITY WE SO DESPERATELY NEED IN THE SACRAMENTO REGION. SUTTER ROSEVILLE MEDICAL CENTER (A, 2): THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND ARE NEEDS THAT SUTTER ROSEVILLE MEDICAL CENTER INTENDS TO ADDRESS THROUGH ITS IMPLEMENTATION STRATEGY: - LACK OF ACCESS TO PRIMARY AND PREVENTATIVE SERVICES - LACK OF ADEQUATE COUNTY (SACRAMENTO) SAFETY NET/HEALTH NETWORK FOR LOW INCOME RESIDENTS; LACK OF CHRONIC DISEASE MANAGEMENT PROGRAMS; NO APPOINTMENTS AVAILABLE IN LOW COST/FREE CLINICS; RECENT JOB LOSSES RESULTING IN LOSS OF INCOME AND BENEFITS; NAVIGATING THE COMPLEX SYSTEM OF SOCIAL SERVICES; DISCRIMINATION BY PHYSICIAN TOWARDS LOW INCOME/MEDI-CAL INSURED POPULATIONS. - LACK OF ACCESS TO MENTAL HEALTH SERVICES - INADEQUATE MENTAL HEALTH SERVICES; STIGMAS IN SEEING MENTAL HEALTH SERVICES; DIFFICULTY NAVIGATING THE SYSTEM FOR PUBLIC ASSISTANCE TO RECEIVE MENTAL HEALTH SERVICES; REDUCTION IN SERVICES OFFERED BY SACRAMENTO COUNTY; FINDING PRIVATE PRACTICE COUNSELORS THAT TAKE MEDI-CAL. - LACK OF ACCESS TO DENTAL CARE - LIMITED DENTAL CARE. - LACK OF ACCESS TO SPECIALTY CARE - LIMITED SPECIALISTS THAT ACCEPT MEDI-CAL PATIENTS. - LACK OF COORDINATION OF CARE AMONG PROVIDERS - LACK OF CHRONIC DISEASE MANAGEMENT AND CARE TRANSITION PROGRAMS AND PATIENT RECEIVING CARE FROM MULTIPLE PROVIDERS WORKING INDEPENDENTLY OF ONE ANOTHER. - ACCULTURATION/LIMITED CULTURAL COMPETENCE IN HEALTH AND RELATED SYSTEMS - LACK OF CULTURAL COMPETENCE AMONG HEALTHCARE PROVIDERS; RACISM AND RELATED STRESS CAUSED BY; OVER RELIANCE ON PRESCRIPTIONS BY ""WESTERN"" DOCTORS; AND SUSPICION OF ""WESTERN"" MEDICINE, RELUCTANCE TO GET VACCINES, ETC. DESCRIPTIONS OF THE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THESE SIGNIFICANT HEALTH NEEDS CAN BE FOUND IN PART VI. NO HOSPITAL CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. SUTTER ROSEVILLE MEDICAL CENTER (SRMC) IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, USING ITS SKILLS AND CAPABILITIES, AND REMAINING A STRONG ORGANIZATION SO THAT IT CAN CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. LIVING IN AN UNHEALTHY FOOD ENVIRONMENT: NOT ONLY IS THERE A LACK OF EFFECTIVE INTERVENTIONS TO ADDRESS THIS NEED, THIS IS NOT SOMETHING THAT WE ARE ABLE TO GREATLY AFFECT THROUGH COMMUNITY BENEFIT; THEREFORE, WE ARE FOCUSING OUR RESOURCES ELSEWHERE. PERCEIVED OR REAL FEAR FOR PERSONAL SAFETY: THIS IS PRIMARILY A LAW ENFORCEMENT ISSUE AND NOT SOMETHING THAT SRMC HAS THE EXPERTISE TO EFFECTIVELY ADDRESS. LACK OF HEALTH LITERACY: WHILE THIS IS IMPORTANT, THIS NEED IS NOT AS OUR PRIMARY FOCUS, WHICH IS EXPANDING ACCESS TO CARE AND BUILDING THE CAPACITY WE SO DESPERATELY NEED IN THE PLACER COUNTY AND THE GREATER SACRAMENTO REGION. SUTTER SOLANO MEDICAL CENTER (A, 4): THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND ARE NEEDS THAT SUTTER SOLANO MEDICAL CENTER INTENDS TO ADDRESS THROUGH ITS IMPLEMENTATION STRATEGY: - LACK OF OR LIMITED ACCESS TO HEALTH EDUCATION - NEED FOR MORE CLASSES AND SERVICES TO EDUCATE RESIDENTS ABOUT MAINTAINING THEIR HEALTH AND/OR MANAGING CHRONIC HEALTH CONDITIONS; MAY HELP AVOID A HEALTH CONDITION BECOMING A CRISIS. - LIMITED ACCESS TO FOLLOW-UP TREATMENT AND SPECIALTY CARE - DIFFICULTY GETTING REFERRALS THROUGH MEDI-CAL; MEDI-CAL REIMBURSEMENTS ARE TOO LOW; RESIDENTS ARE DIAGNOSED WITH A CONDITION BUT LACK THE FINANCIAL RESOURCES TO OBTAIN CARE. - TRANSPORTATION - PUBLIC TRANSIT MAY NOT HAVE STOPS NEAR HEALTHCARE OR SOCIAL SERVICE AND CLIENTS MAY NOT HAVE A CAR OR ABILITY TO PAY FOR GAS; MORE ROUTE AND BUS STOP LOCATION ISSUES IN URBAN SETTINGS; SIMPLE LACK OF TRANSIT AND TRANSIT THAT DOES NOT GO OUT OF TOWN IN THE RURAL AREAS. - LACK OF OR LIMITED ACCESS TO DENTAL CARE - MEDI-CAL NO LONGER COVERS DENTAL SERVICES AND PAYING FOR SERVICES IS TOO EXPENSIVE. - LIMITED ACCESS TO MEDICATIONS AND PRESCRIPTION DRUGS - PRESCRIPTIONS AND CO-PAYS ARE EXPENSIVE SO RESIDENTS GO WITHOUT OR HAVE TO SPACE APART DOSAGES. - LACK OF PREVENTIVE SERVICES AND COMMUNITY PROGRAMS - MANY CITY OR PARK PROGRAMS CHARGE A FEE; BUDGET CUTS HAVE LIMITED PUBLIC SERVICE AVAILABILITY; EXERCISE CLASSES AND GYM MEMBERSHIPS ARE EXPENSIVE. DESCRIPTIONS OF THE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THESE SIGNIFICANT HEALTH NEEDS CAN BE FOUND IN PART VI. NO HOSPITAL CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. SUTTER SOLANO MEDICAL CENTER (SSMC) IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, USING ITS SKILLS AND CAPABILITIES, AND REMAINING A STRONG ORGANIZATION SO THAT IT CAN CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. LIMITED ACCESS TO HEALTHY FOODS: NOT ONLY IS THERE A LACK OF EFFECTIVE INTERVENTIONS TO ADDRESS THIS NEED, THIS IS NOT SOMETHING THAT WE ARE ABLE TO GREATLY AFFECT THROUGH COMMUNITY BENEFIT; THEREFORE, WE ARE FOCUSING OUR RESOURCES ELSEWHERE. PERSONAL SAFETY: THIS IS PRIMARILY A LAW ENFORCEMENT ISSUE AND NOT SOMETHING THAT SSMC HAS THE EXPERTISE TO EFFECTIVELY ADDRESS. LIMITED PLACES TO WALK, BIKE, EXERCISE, OR PLAY: THIS IS PRIMARILY AN ISSUE THAT NEEDS TO BE REVIEWED BY THE CITY/COUNTY PLANNING AND PARKS AND RECREATION DEPARTMENTS AND IS NOT SOMETHING THAT SSMC HAS THE EXPERTISE OR RESOURCES TO EFFECTIVELY ADDRESS. LIMITED PLACES AND SOCIAL SPACE FOR CIVIC ENGAGEMENT: THIS IS PRIMARILY A CITY PLANNING AND BUSINESS ISSUE AND NOT SOMETHING THAT SSMC HAS THE EXPERTISE TO EFFECTIVELY ADDRESS. SUTTER AUBURN FAITH HOSPITAL (A, 5): THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND ARE NEEDS THAT SUTTER AUBURN FAITH HOSPITAL INTENDS TO ADDRESS THROUGH ITS IMPLEMENTATION STRATEGY: - LACK OF HEALT"

SCHEDULE H, PART V, SECTION B, LINE 15E
SUTTER GENERAL HOSPITAL, SUTTER ROSEVILLE MEDICAL CENTER, SUTTER MEMORIAL HOSPITAL, SUTTER SOLANO MEDICAL CENTER, SUTTER AUBURN FAITH HOSPITAL, SUTTER CENTER FOR PSYCHIATRY, SUTTER AMADOR HOSPITAL, AND SUTTER DAVIS HOSPITAL (A, 1-8) METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE-OTHER: PATIENTS MAY REQUEST ASSISTANCE WITH COMPLETING THE APPLICATION FOR FINANCIAL ASSISTANCE IN PERSON AT THE HOSPITAL, OVER THE PHONE, THROUGH THE MAIL, OR VIA THE SUTTER HEALTH WEBSITE.

SCHEDULE H, PART V, SECTION B, LINE 16I
SUTTER GENERAL HOSPITAL, SUTTER ROSEVILLE MEDICAL CENTER, SUTTER MEMORIAL HOSPITAL, SUTTER SOLANO MEDICAL CENTER, SUTTER AUBURN FAITH HOSPITAL, SUTTER CENTER FOR PSYCHIATRY, SUTTER AMADOR HOSPITAL, AND SUTTER DAVIS HOSPITAL (A, 1-8) MEASURES USED TO PUBLICIZE THE FACILITYS FINANCIAL ASSISTANCE POLICY: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN THE PRIMARY LANGUAGES OF THE HOSPITALS' SERVICE AREA. DURING PREADMISSION OR REGISTRATION ALL PATIENTS WILL BE PROVIDED A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ALSO INFORMATION REGARDING THE RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES. PATIENTS WHO MAY BE UNINSURED WILL BE ASSIGNED A FINANCIAL COUNSELOR WHO WILL VISIT WITH THE PATIENT IN PERSON AT THE HOSPITAL AND CAN PROVIDE ADDITIONAL INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY AND ASSIST WITH THE APPLICATION PROCESS. AT THE TIME OF DISCHARGE ALL PATIENTS WILL BE PROVIDED THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY. ON AN ANNUAL BASIS SUTTER HEALTH WILL PLACE AN ADVERTISEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AT THE ORGANIZATION IN THE PRINCIPAL NEWSPAPER IN THE COMMUNITY OR WHEN DOING SO IS NOT PRACTICAL SUTTER WILL ISSUE A PRESS RELEASE CONTAINING THE INFORMATION OR USE OTHER MEANS THAT WILL WIDELY PUBLICIZE THE AVAILABILITY OF THE POLICY. SUTTER HEALTH WILL WORK WITH AFFILIATED ORGANIZATIONS, PHYSICIANS, COMMUNITY CLINICS AND OTHER HEALTH CARE PROVIDERS TO NOTIFY MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE.

SCHEDULE H, PART V, SECTION B, LINE 22D
SUTTER GENERAL HOSPITAL, SUTTER ROSEVILLE MEDICAL CENTER, SUTTER MEMORIAL HOSPITAL, SUTTER SOLANO MEDICAL CENTER, SUTTER AUBURN FAITH HOSPITAL, SUTTER CENTER FOR PSYCHIATRY, SUTTER AMADOR HOSPITAL, AND SUTTER DAVIS HOSPITAL (A, 1-8) AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR FULL WRITE OFF OF ALL CHARGES FOR AN UNINSURED PATIENT WITH A FAMILY INCOME AT OR BELOW 400% OF THE MOST RECENT FEDERAL POVERTY LEVEL. IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 1.501(R)-5, THIS ORGANIZATION ADOPTS THE PROSPECTIVE MEDICARE METHOD FOR AMOUNTS GENERALLY BILLED; HOWEVER, PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT FINANCIALLY RESPONSIBLE FOR MORE THAN THE AMOUNTS GENERALLY BILLED BECAUSE ELIGIBLE PATIENTS DO NOT PAY ANY AMOUNT.

SUTTER MEDICAL CENTER, SACRAMENTO (WOMEN'S AND CHILDREN'S) (9)
SCHEDULE H, PART V, SECTION B, LINE 2 SUTTER MEDICAL CENTER, SACRAMENTO (WOMENS AND CHILDRENS HOSPITAL) WAS UNDER CONSTRUCTION DURING 2015. CONSTRUCTION WAS COMPLETED AND THE HOSPITAL BECAME LICENSED IN AUGUST 2015.

SCHEDULE H, PART V, SECTION B, LINE 15E
SUTTER MEDICAL CENTER, SACRAMENTO (WOMEN'S AND CHILDREN'S) (9) METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE-OTHER: PATIENTS MAY REQUEST ASSISTANCE WITH COMPLETING THE APPLICATION FOR FINANCIAL ASSISTANCE IN PERSON AT THE HOSPITAL, OVER THE PHONE, THROUGH THE MAIL, OR VIA THE SUTTER HEALTH WEBSITE.

SCHEDULE H, PART V, SECTION B, LINE 16I
SUTTER MEDICAL CENTER, SACRAMENTO (WOMEN'S AND CHILDREN'S) (9) MEASURES USED TO PUBLICIZE THE FACILITYS FINANCIAL ASSISTANCE POLICY: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN THE PRIMARY LANGUAGES OF THE HOSPITAL'S SERVICE AREA. DURING PREADMISSION OR REGISTRATION ALL PATIENTS WILL BE PROVIDED A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ALSO INFORMATION REGARDING THE RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES. PATIENTS WHO MAY BE UNINSURED WILL BE ASSIGNED A FINANCIAL COUNSELOR WHO WILL VISIT WITH THE PATIENT IN PERSON AT THE HOSPITAL AND CAN PROVIDE ADDITIONAL INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY AND ASSIST WITH THE APPLICATION PROCESS. AT THE TIME OF DISCHARGE ALL PATIENTS WILL BE PROVIDED THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY. ON AN ANNUAL BASIS SUTTER HEALTH WILL PLACE AN ADVERTISEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AT THE ORGANIZATION IN THE PRINCIPAL NEWSPAPER IN THE COMMUNITY OR WHEN DOING SO IS NOT PRACTICAL SUTTER WILL ISSUE A PRESS RELEASE CONTAINING THE INFORMATION OR USE OTHER MEANS THAT WILL WIDELY PUBLICIZE THE AVAILABILITY OF THE POLICY. SUTTER HEALTH WILL WORK WITH AFFILIATED ORGANIZATIONS, PHYSICIANS, COMMUNITY CLINICS AND OTHER HEALTH CARE PROVIDERS TO NOTIFY MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE.

SCHEDULE H, PART V, SECTION B, LINE 22D
SUTTER MEDICAL CENTER, SACRAMENTO (WOMEN'S AND CHILDREN'S) (9) AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR FULL WRITE OFF OF ALL CHARGES FOR AN UNINSURED PATIENT WITH A FAMILY INCOME AT OR BELOW 400% OF THE MOST RECENT FEDERAL POVERTY LEVEL. IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 1.501(R)-5, THIS ORGANIZATION ADOPTS THE PROSPECTIVE MEDICARE METHOD FOR AMOUNTS GENERALLY BILLED; HOWEVER, PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT FINANCIALLY RESPONSIBLE FOR MORE THAN THE AMOUNTS GENERALLY BILLED BECAUSE ELIGIBLE PATIENTS DO NOT PAY ANY AMOUNT.

SCHEDULE H, PART I, LINE 3C
FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA: FOR UNINSURED PATIENTS TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION THE ORGANIZATION HAS A HIGH MEDICAL COST CHARITY CARE CATEGORY IN WHICH A WRITE OFF OF THE PATIENT RESPONSIBILITY FOR HOSPITAL SERVICES CAN OCCUR IF THE INSURED PATIENT HAS FAMILY INCOME AT OR BELOW 400% FPG AND EXPENSES INCURRED FOR THEMSELVES OR THEIR FAMILY EXCEED 10% OF THE PATIENTS FAMILY INCOME.

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.

SCHEDULE H, PART III, LINE 2
METHODOLOGY FOR CALCULATING BAD DEBT (AT COST): THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.

SCHEDULE H, PART III, LINE 3
METHODOLOGY FOR DETERMINING THE AMOUNT OF BAD DEBT LIKELY ATTRIBUTABLE TO CHARITY CARE: AMOUNTS MAY BE INCLUDED IN BAD DEBT PENDING A CHARITY CARE DETERMINATION. UPON ELIGIBILITY THESE AMOUNTS WOULD BE RECLASSIFIED AS CHARITY CARE.

SCHEDULE H, PART III, LINE 4
AUDIT FOOTNOTE THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. PROVISION FOR BAD DEBTS IS LISTED ON A SEPARATE LINE ITEM IN THE FINANCIAL STATEMENTS. THE AUDIT DOES INCLUDE A FOOTNOTE FOR PATIENT SERVICE REVENUES LESS PROVISION FOR BAD DEBTS. PATIENT SERVICE REVENUES FOOTNOTE: PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS AND THIRD-PARTY PAYERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYERS. ESTIMATED SETTLEMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, PRIMARILY AS A RESULT OF FINAL COST REPORT SETTLEMENTS WITH GOVERNMENTAL AGENCIES. PATIENT SERVICE REVENUES LESS PROVISION FOR BAD DEBTS ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. SUTTER'S SELF-PAY WRITE-OFFS WERE $192 MILLION AND $287 MILLION FOR 2015 AND 2014, RESPECTIVELY.

SCHEDULE H, PART III, LINE 7
MEDICARE COSTS: MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS.

SCHEDULE H, PART III, LINE 8
COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. COMMUNITY BENEFIT MEDICARE SHORTFALL: THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE DEFICIT.

SCHEDULE H, PART III, LINE 9B
DEBT COLLECTION POLICY: COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF FEDERAL AND CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. AT DISCHARGE PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 210 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.

SCHEDULE H, PART VI, LINE 2
"SUTTER MEDICAL CENTER SACRAMENTO: BEGINNING IN EARLY 2012 THROUGH FEBRUARY 2013, VALLEY VISION, INC. CONDUCTED AN ASSESSMENT OF THE HEALTH NEEDS OF RESIDENTS LIVING IN THE SERVICE AREA OF SUTTER MEDICAL CENTER, SACRAMENTO (SMCS). FOR THE PURPOSES OF THE ASSESSMENT, A HEALTH NEED WAS DEFINED AS: ""A POOR HEALTH OUTCOME AND ITS ASSOCIATED DRIVER."" A HEALTH DRIVER WAS DEFINED AS: ""A BEHAVIORAL, ENVIRONMENTAL, AND/OR CLINICAL FACTOR, AS WELL AS MORE UPSTREAM SOCIAL ECONOMIC FACTORS THAT IMPACT HEALTH."" A COMMUNITY-BASED PARTICIPATORY RESEARCH ORIENTATION WAS USED TO CONDUCT THE ASSESSMENT THAT INCLUDED BOTH PRIMARY AND SECONDARY DATA. PRIMARY DATA COLLECTION INCLUDED INPUT FROM THE HEALTHY SACRAMENTO COALITION (FOCUSED ON SACRAMENTO COUNTY ONLY), EXPERT INTERVIEWS WITH 40 KEY INFORMANTS AND 10 FOCUS GROUP INTERVIEWS COMPRISED OF 129 COMMUNITY MEMBERS. IN ADDITION, A COMMUNITY HEALTH ASSETS ASSESSMENT COLLECTED DATA ON MORE THAN 200 HEALTH RELATED ASSETS IN ALL OF THE COUNTIES IN WHICH THE SMCS HOSPITAL SERVICE AREA (HSA) EXTENDED. SECONDARY DATA USED INCLUDED HEALTH OUTCOME DATA, SOCIO-DEMOGRAPHIC DATA, AND BEHAVIORAL AND ENVIRONMENTAL DATA AT THE ZIP CODE OR CENSUS TRACT LEVEL. HEALTH OUTCOME DATA INCLUDED EMERGENCY DEPARTMENT (ED) VISITS, HOSPITALIZATION, AND MORTALITY RATES RELATED TO HEART DISEASE, DIABETES, STROKE, HYPERTENSION, COPD, ASTHMA, AND SAFETY AND MENTAL HEALTH CONDITIONS. SOCIO-DEMOGRAPHIC DATA INCLUDED DATA ON RACE AND ETHNICITY, POVERTY (FEMALE-HEADED HOUSEHOLDS, FAMILIES WITH CHILDREN, PEOPLE OVER 65 YEARS OF AGE), EDUCATIONAL ATTAINMENT, INSURANCE STATUS, AND HOUSING ARRANGEMENT (RENT OR OWN). BEHAVIORAL AND ENVIRONMENTAL DATA HELPED DESCRIBE GENERAL LIVING CONDITIONS OF THE HOSPITAL SERVICE AREA (HSA) SUCH AS CRIME RATES, ACCESS TO PARKS, AVAILABILITY OF HEALTHY FOOD, AND LEADING CAUSES OF DEATH. ANALYSIS OF BOTH PRIMARY AND SECONDARY DATA REVEALED SIX SPECIFIC ZIP CODE COMMUNITIES OF CONCERN WITHIN THE HSA THAT WERE LIVING WITH A HIGH BURDEN OF DISEASE. THESE SIX COMMUNITIES HAD CONSISTENTLY HIGH RATES OF NEGATIVE HEALTH OUTCOMES THAT FREQUENTLY EXCEEDED COUNTY, STATE, AND HEALTHY PEOPLE 2020 BENCHMARKS. THEY WERE CONFIRMED BY EXPERTS AS AREAS PRONE TO EXPERIENCE POORER HEALTH OUTCOMES RELATIVE TO OTHER COMMUNITIES IN THE HSA. AGE-ADJUSTED RATES OF ED VISITS AND HOSPITALIZATION DUE TO HEART DISEASE, DIABETES, STROKE, AND HYPERTENSION WERE NOTABLY HIGHER IN THESE ZIP CODES COMPARED TO OTHERS WITHIN THE HSA. WITH A FEW EXCEPTIONS, BLACKS AND WHITES HAD THE HIGHEST RATES FOR THESE CONDITIONS COMPARED TO OTHER RACIAL AND ETHNIC GROUPS. MORTALITY DATA FOR THESE CONDITIONS SHOWED HIGH RATES AS WELL. ANALYSIS OF ENVIRONMENTAL INDICATORS SHOWED THAT MANY OF THESE COMMUNITIES HAD CONDITIONS THAT WERE BARRIERS TO ACTIVE LIFESTYLES, SUCH AS ELEVATED CRIME RATES AND A TRAFFIC CLIMATE THAT IS UNFRIENDLY TO BICYCLISTS AND PEDESTRIANS. FURTHERMORE, THESE COMMUNITIES FREQUENTLY HAD HIGHER PERCENTAGES OF RESIDENTS THAT WERE OBESE OR OVERWEIGHT. ACCESS TO HEALTHY FOOD OUTLETS WAS LIMITED, WHILE THE CONCENTRATION OF FAST FOOD OUTLETS AND CONVENIENCE STORES WERE HIGH. ANALYSIS OF THE HEALTH BEHAVIORS OF THESE RESIDENTS ALSO SHOWED MANY BEHAVIORS THAT CORRELATE TO POOR HEALTH, SUCH AS HAVING A DIET THAT IS LIMITED IN FRUIT AND VEGETABLE CONSUMPTION. WHEN EXAMINING THESE FINDINGS WITH THOSE OF THE QUALITATIVE DATA (KEY INFORMANT INTERVIEW AND FOCUS GROUPS), A CONSOLIDATED LIST OF PRIORITY HEALTH NEEDS OF THESE COMMUNITIES WAS COMPILED. THESE PRIORITIZED HEALTH NEEDS ARE: 1. LACK OF ACCESS TO PRIMARY AND PREVENTATIVE SERVICES 2. LACK OF ACCESS TO MENTAL HEALTH SERVICES 3. LIVING IN AN UNHEALTHY FOOD ENVIRONMENT 4. PERCEIVED OR REAL FEAR FOR PERSONAL SAFETY 5. INABILITY TO EXERCISE AND BE ACTIVE 6. LACK OF ACCESS TO DENTAL CARE 7. LACK OF ACCESS TO SPECIALTY CARE 8. LACK OF COORDINATION OF CARE AMONG PROVIDERS 9. ACCULTURATION/LIMITED CULTURAL COMPETENCE IN HEALTH AND RELATED SYSTEMS 10. LACK OF HEALTH LITERACY 11. LACK OF HOUSING, BASIC SHELTER THE ENTIRE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT FOR SUTTER MEDICAL CENTER, SACRAMENTO IS AVAILABLE AT HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML SUTTER ROSEVILLE MEDICAL CENTER: BEGINNING IN EARLY 2012 THROUGH FEBRUARY 2013, VALLEY VISION, INC. CONDUCTED AN ASSESSMENT OF THE HEALTH NEEDS OF RESIDENTS LIVING IN THE SUTTER ROSEVILLE MEDICAL CENTER (SRMC) SERVICE AREA. FOR THE PURPOSES OF THE ASSESSMENT, A HEALTH NEED WAS DEFINED AS, ""A POOR HEALTH OUTCOME AND ITS ASSOCIATED DRIVER."" A HEALTH DRIVER WAS DEFINED AS, ""A BEHAVIORAL, ENVIRONMENTAL, AND/OR CLINIC FACTOR, AS WELL AS MORE UPSTREAM SOCIAL ECONOMIC FACTORS, THAT IMPACT HEALTH."" A COMMUNITY-BASED PARTICIPATORY RESEARCH ORIENTATION WAS USED TO CONDUCT THE ASSESSMENT THAT INCLUDED BOTH PRIMARY AND SECONDARY DATA. PRIMARY DATA COLLECTION INCLUDED INPUT FROM THE HEALTHY SACRAMENTO COALITION (FOCUSED ON SACRAMENTO COUNTY ONLY), EXPERT INTERVIEWS WITH 21 KEY INFORMANTS, AND 12 FOCUS GROUP INTERVIEWS COMPRISED OF 148 COMMUNITY MEMBERS. IN ADDITION, A COMMUNITY HEALTH ASSETS ASSESSMENT COLLECTED DATA ON MORE THAN 260 HEALTH-RELATED ASSETS THROUGHOUT THE SRMC HOSPITAL SERVICE AREA (HSA) IN SACRAMENTO COUNTY AND PLACER COUNTY. SECONDARY DATA USED INCLUDED HEALTH OUTCOME DATA, SOCIO-DEMOGRAPHIC DATA, AND BEHAVIORAL AND ENVIRONMENTAL DATA AT THE ZIP CODE OR CENSUS TRACT LEVEL. HEALTH OUTCOME DATA INCLUDED EMERGENCY DEPARTMENT (ED) VISITS, HOSPITALIZATION, AND MORTALITY RATES RELATED TO HEART DISEASE, DIABETES, STROKE, HYPERTENSION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ASTHMA, AND SAFETY AND MENTAL HEALTH CONDITIONS. SOCIO-DEMOGRAPHIC DATA INCLUDED DATA ON RACE AND ETHNICITY, POVERTY (FEMALE-HEADED HOUSEHOLDS, FAMILIES WITH CHILDREN, PEOPLE OVER 65 YEARS OF AGE), EDUCATIONAL ATTAINMENT, INSURANCE STATUS, AND HOUSING ARRANGEMENT (OWN OR RENT). FURTHER, HEALTH BEHAVIORAL AND ENVIRONMENTAL DATA HELPED DESCRIBE GENERAL LIVING CONDITIONS OF THE HSA, SUCH AS CRIME RATES, ACCESS TO PARKS, HEALTHY FOOD AVAILABILITY, AND LEADING CAUSES OF DEATH. ANALYSIS OF BOTH PRIMARY AND SECONDARY DATA REVEALED SEVEN SPECIFIC ZIP CODE COMMUNITIES OF CONCERN THAT WERE LIVING WITH A HIGH BURDEN OF DISEASE. THESE SEVEN COMMUNITIES HAD CONSISTENTLY HIGH RATES OF NEGATIVE HEALTH OUTCOMES THAT FREQUENTLY EXCEEDED COUNTY, STATE, AND HEALTHY PEOPLE 2020 BENCHMARKS. THEY WERE CONFIRMED BY EXPERTS AS AREAS PRONE TO EXPERIENCE POORER HEALTH OUTCOMES RELATIVE TO OTHER COMMUNITIES IN THE HSA. AGE-ADJUSTED RATES OF ED VISITS AND HOSPITALIZATION DUE TO HEART DISEASE, DIABETES, STROKE, AND HYPERTENSION WERE NOTABLY HIGHER IN THESE ZIP CODES COMPARED TO OTHER ZIP CODES IN THE HSA. IN GENERAL, BLACKS AND WHITES HAD THE HIGHEST RATES FOR THESE CONDITIONS COMPARED TO OTHER RACIAL AND ETHNIC GROUPS WITH A FEW EXCEPTIONS. MORTALITY DATA FOR THESE CONDITIONS SHOWED HIGH RATES AS WELL. ANALYSIS OF ENVIRONMENTAL INDICATORS SHOWED THAT MANY OF THESE COMMUNITIES HAD CONDITIONS THAT WERE BARRIERS TO ACTIVE LIFESTYLES, SUCH AS ELEVATED RATES OF CRIME AND A TRAFFIC CLIMATE THAT WAS UNFRIENDLY TO BICYCLISTS AND PEDESTRIANS. FURTHERMORE, THESE COMMUNITIES FREQUENTLY HAD HIGHER PERCENTAGES OF RESIDENTS THAT WERE OBESE OR OVERWEIGHT. ACCESS TO HEALTHY FOOD OUTLETS WAS LIMITED, WHILE THE CONCENTRATION OF FAST FOOD AND CONVENIENCE STORES WAS HIGH. ANALYSIS OF THE HEALTH BEHAVIORS OF THESE RESIDENTS SHOWED MANY BEHAVIORS THAT CORRELATE TO POOR HEALTH, SUCH AS HAVING A DIET THAT IS LIMITED IN FRUIT AND VEGETABLE CONSUMPTION. WHEN EXAMINING THESE FINDINGS WITH THOSE OF THE QUALITATIVE DATA (KEY INFORMANT INTERVIEW AND FOCUS GROUPS), A CONSOLIDATED LIST OF PRIORITY HEALTH NEEDS OF THESE COMMUNITIES WAS COMPILED. THESE PRIORITIZED HEALTH NEEDS ARE: 1. LACK OF ACCESS TO PRIMARY AND PREVENTATIVE SERVICES 2. LACK OF ACCESS TO MENTAL HEALTH SERVICES 3. LIVING IN AN UNHEALTHY FOOD ENVIRONMENT 4. PERCEIVED OR REAL FEAR FOR PERSONAL SAFETY 5. INABILITY TO EXERCISE AND BE ACTIVE 6. LACK OF ACCESS TO DENTAL CARE 7. LACK OF ACCESS TO SPECIALTY CARE 8. LACK OF COORDINATION OF CARE AMONG PROVIDERS 9. ACCULTURATION/LIMITED CULTURAL COMPETENCE IN HEALTH AND RELATED SYSTEMS 10. LACK OF HEALTH LITERACY THE ENTIRE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT FOR SUTTER ROSEVILLE MEDICAL CENTER IS AVAILABLE AT HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML SUTTER SOLANO MEDICAL CENTER: BEGINNING IN EARLY 2012 THROUGH FEBRUARY 2013, VALLEY VISION, INC. COMPLETED AN ASSESSMENT OF THE HEALTH NEEDS OF RESIDENTS LIVING IN THE SOLANO COUNTY HEALTH SERVICE AREA (HSA). FOR THE PURPOSES OF THE ASSESSMENT, A HEALTH NEED WAS DEFINED AS: ""A POOR HEALTH OUTCOME AND ITS ASSOCIATED DRIVER."" A HEALTH DRIVER WAS DEFINED AS: ""A BEHAVIORAL, ENVIRONMENTAL, AND/OR CLINICAL FACTOR, AS WELL AS MORE UPSTREAM SOCIAL ECONOMIC FACTORS THAT IMPACT HEALTH."" A COMMUNITY-BASED PARTICIPATORY RESEARCH ORIENTATION WAS USED TO CONDUCT THE ASSESSMENT, WHICH INCLUDED BOTH PRIMARY AND SECONDARY DATA. PRIMARY"

SCHEDULE H, PART VI, LINE 3
"PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SACRAMENTO SIERRA REGION FOLLOWS A SUTTER HEALTH SYSTEM-WIDE CHARITY CARE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. FOR A MORE DETAILED LOOK AT OUR CHARITY CARE POLICIES BY REGION, PLEASE VISIT THE OFFICE OF STATEWIDE AND HEALTH PLANNING'S WEBSITE AT HTTP://SYFPHR.OSHPD.CA.GOV. COMMUNICATIONS OF FINANCIAL ASSISTANCE AVAILABILITY: A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL AFFILIATES SHALL PROVIDE: A. ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS). B. PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, ""STATEMENT OF FINANCIAL CONDITION"". 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL AFFILIATES SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION FORM, ""STATEMENT OF FINANCIAL CONDITION"". B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE SUTTER HEALTH WEBSITE AND EACH HOSPITAL AFFILIATE WEBSITE, IF ANY. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE, COLLECTION PRACTICES, HOSPITAL AFFILIATE THIRD-PARTY LIENS, AND AFFILIATE DISPUTE INITIATION POLICY (FINANCE POLICY 14-227). C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL AFFILIATES SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF THE AFFILIATE'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATIONS TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL PROVIDE THE PATIENT WITH AN ESTIMATE OF THE AMOUNT THE HOSPITAL AFFILIATE WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS."

SCHEDULE H, PART VI, LINE 4
SUTTER MEDICAL CENTER SACRAMENTO: THE ASSESSMENT STUDY AREA INCLUDED THE SMCS HOSPITAL SERVICE AREA (HSA). A KEY FOCUS WAS TO SHOW SPECIFIC COMMUNITIES (DEFINED GEOGRAPHICALLY) EXPERIENCING DISPARITIES AS THEY RELATED TO CHRONIC DISEASE AND MENTAL HEALTH. TO THIS END, ZIP CODE BOUNDARIES WERE SELECTED AS THE UNIT-OF-ANALYSIS FOR MOST INDICATORS. THIS LEVEL OF ANALYSIS ALLOWED FOR EXAMINATION OF HEALTH OUTCOMES AT THE COMMUNITY LEVEL THAT ARE OFTEN HIDDEN WHEN DATA ARE AGGREGATED AT THE COUNTY LEVEL. SOME INDICATORS (DEMOGRAPHIC, BEHAVIORAL, AND ENVIRONMENTAL IN NATURE) WERE INCLUDED IN THE ASSESSMENT AT THE CENSUS TRACT, CENSUS BLOCK, OR POINT PREVALENCE LEVEL, WHICH ALLOWED FOR DEEPER COMMUNITY LEVEL EXAMINATION. THERE ARE FOUR HOSPITALS THAT SERVE THE COMMUNITY. THE HSA WAS DETERMINED BY ANALYZING PATIENT DISCHARGE DATA FROM TWO OF THE THREE FACILITIES THAT MAKE UP SMCS. COLLECTION AND ANALYSIS OF THE ZIP CODES OF PATIENTS DISCHARGED FROM THE HOSPITALS OVER A SIX-MONTH PERIOD ALLOWED THE PRIMARY GEOGRAPHIC AREA SERVED BY THE HOSPITALS TO BE IDENTIFIED. THE HSA IDENTIFIED AS THE FOCUS OF THE NEEDS ASSESSMENT IS DEPICTED IN FIGURE 2 IN THE FINAL CHNA. BECAUSE THE HOSPITALS REPRESENTED IN SMCS (SUTTER GENERAL HOSPITAL, SUTTER MEMORIAL HOSPITAL, AND SUTTER CENTER FOR PSYCHIATRY) ARE CLOSE IN PROXIMITY, ANALYSIS REVEALED THAT THE HOSPITALS SERVED THE SAME GEOGRAPHIC AREAS. TO IDENTIFY COMMUNITIES OF CONCERN, INPUT FROM THE CHNA TEAM, PRIMARY DATA FROM KEY INFORMANT INTERVIEWS AND FOCUS GROUPS, ALONG WITH DETAILED ANALYSIS OF SECONDARY DATA, HEALTH OUTCOME INDICATORS, AND SOCIO-DEMOGRAPHICS WERE EXAMINED. ZIP CODE COMMUNITIES WITH RATES THAT CONSISTENTLY EXCEEDED COUNTY, STATE, OR HEALTHY PEOPLE 2020 BENCHMARKS FOR ED UTILIZATION, HOSPITALIZATION, AND MORTALITY WERE CONSIDERED. ZIP CODES WITH RATES THAT CONSISTENTLY FELL IN THE TOP 20% WERE NOTED AND THEN TRIANGULATED WITH PRIMARY DATA INPUT AND SOCIO-DEMOGRAPHIC DATA TO IDENTIFY SPECIFIC COMMUNITIES OF CONCERN. DATA ON SOCIO-DEMOGRAPHICS OF RESIDENTS IN THESE COMMUNITIES, WHICH INCLUDED SOCIO-ECONOMIC STATUS, RACE AND ETHNICITY, EDUCATIONAL ATTAINMENT, HOUSING ARRANGEMENT, EMPLOYMENT STATUS, AND HEALTH INSURANCE STATUS, WERE EXAMINED. AREA HEALTH NEEDS WERE DETERMINED VIA IN-DEPTH ANALYSIS OF QUALITATIVE AND QUANTITATIVE DATA, AND THEN CONFIRMED WITH SOCIO-DEMOGRAPHIC DATA. AS NOTED EARLIER, A HEALTH NEED WAS DEFINED AS A POOR HEALTH OUTCOME AND ITS ASSOCIATED DRIVER. A HEALTH NEED WAS INCLUDED AS A PRIORITY IF IT WAS REPRESENTED BY RATES WORSE THAN THE ESTABLISHED QUANTITATIVE BENCHMARKS OR WAS CONSISTENTLY MENTIONED IN THE QUALITATIVE DATA. THE COMMUNITIES OF CONCERN ARE HOME TO MORE THAN 200,000 RESIDENTS. THE AREAS CONSIST OF ZIP CODE COMMUNITIES OCCUPYING THE NORTHERN, DOWNTOWN, AND SOUTHERN PORTIONS OF THE SACRAMENTO COUNTY AREA. ALL OF THE ZIP CODE COMMUNITIES ARE DENSELY POPULATED, WITH THE SOUTH SACRAMENTO AREA HAVING THE HIGHEST POPULATION AND THE DOWNTOWN AREA HAVING THE LOWEST POPULATION. THE COMMUNITIES OF CONCERN ARE ZIP CODES 95660, 95814, 95815, 95823, 95824 AND 95838. SOCIO-DEMOGRAPHIC CONDITIONS, OR SOCIAL DETERMINANTS OF HEALTH, HELP PREDICT WHICH COMMUNITIES IN A BROAD GEOGRAPHIC AREA ARE MOST SUSCEPTIBLE TO POOR HEALTH OUTCOMES. IN GENERAL, THE VAST MAJORITY OF RESIDENTS LIVING IN THE COMMUNITIES OF CONCERN FELL INTO MULTIPLE CATEGORIES OF SOCIAL DETERMINANTS OFTEN ASSOCIATED WITH POOR HEALTH OUTCOMES. FOR EXAMPLE, ALL ZIP CODE COMMUNITIES FAR EXCEEDED THE NATIONAL BENCHMARKS FOR THE PERCENT OF FAMILIES IN A LIVING IN POVERTY WITH CHILDREN AND SINGLE-FEMALE HEADED HOUSEHOLDS WITH CHILDREN LIVING IN POVERTY. ALL COMMUNITIES HAD HIGH PERCENTAGES OF NON-WHITE OR HISPANIC RESIDENTS, WITH 84% IN 95823 AND 83% IN 95824 FALLING INTO THIS CATEGORY. FURTHER, ALL COMMUNITIES OF CONCERN HAD HIGH PERCENTAGES OF RESIDENTS WITHOUT HEALTH INSURANCE COMPARED TO STATE AND NATIONAL BENCHMARKS. AN IN-DEPTH VIEW OF THE DEMOGRAPHICS AND GEOGRAPHY OF THE SERVICE AREA IS AVAILABLE IN THE SUTTER MEDICAL CENTER CHNA AT HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML SUTTER MEDICAL CENTER, SACRAMENTO WOMENS AND CHILDRENS CENTER (ANDERSON LUCCHETTI WOMENS & CHILDRENS CENTER) THE ASSESSMENT STUDY AREA INCLUDED THE SMCS HOSPITAL SERVICE AREA (HSA). A KEY FOCUS WAS TO SHOW SPECIFIC COMMUNITIES (DEFINED GEOGRAPHICALLY) EXPERIENCING DISPARITIES AS THEY RELATED TO CHRONIC DISEASE AND MENTAL HEALTH. TO THIS END, ZIP CODE BOUNDARIES WERE SELECTED AS THE UNIT-OF-ANALYSIS FOR MOST INDICATORS. THIS LEVEL OF ANALYSIS ALLOWED FOR EXAMINATION OF HEALTH OUTCOMES AT THE COMMUNITY LEVEL THAT ARE OFTEN HIDDEN WHEN DATA ARE AGGREGATED AT THE COUNTY LEVEL. SOME INDICATORS (DEMOGRAPHIC, BEHAVIORAL, AND ENVIRONMENTAL IN NATURE) WERE INCLUDED IN THE ASSESSMENT AT THE CENSUS TRACT, CENSUS BLOCK, OR POINT PREVALENCE LEVEL, WHICH ALLOWED FOR DEEPER COMMUNITY LEVEL EXAMINATION. THERE ARE FOUR HOSPITALS THAT SERVE THE COMMUNITY. THE HSA WAS DETERMINED BY ANALYZING PATIENT DISCHARGE DATA FROM TWO OF THE THREE FACILITIES THAT MAKE UP SMCS. COLLECTION AND ANALYSIS OF THE ZIP CODES OF PATIENTS DISCHARGED FROM THE HOSPITALS OVER A SIX-MONTH PERIOD ALLOWED THE PRIMARY GEOGRAPHIC AREA SERVED BY THE HOSPITALS TO BE IDENTIFIED. THE HSA IDENTIFIED AS THE FOCUS OF THE NEEDS ASSESSMENT IS DEPICTED IN FIGURE 2 IN THE FINAL CHNA. BECAUSE THE HOSPITALS REPRESENTED IN SMCS (SUTTER GENERAL HOSPITAL, SUTTER MEMORIAL HOSPITAL, AND SUTTER CENTER FOR PSYCHIATRY) ARE CLOSE IN PROXIMITY, ANALYSIS REVEALED THAT THE HOSPITALS SERVED THE SAME GEOGRAPHIC AREAS. TO IDENTIFY COMMUNITIES OF CONCERN, INPUT FROM THE CHNA TEAM, PRIMARY DATA FROM KEY INFORMANT INTERVIEWS AND FOCUS GROUPS, ALONG WITH DETAILED ANALYSIS OF SECONDARY DATA, HEALTH OUTCOME INDICATORS, AND SOCIO-DEMOGRAPHICS WERE EXAMINED. ZIP CODE COMMUNITIES WITH RATES THAT CONSISTENTLY EXCEEDED COUNTY, STATE, OR HEALTHY PEOPLE 2020 BENCHMARKS FOR ED UTILIZATION, HOSPITALIZATION, AND MORTALITY WERE CONSIDERED. ZIP CODES WITH RATES THAT CONSISTENTLY FELL IN THE TOP 20% WERE NOTED AND THEN TRIANGULATED WITH PRIMARY DATA INPUT AND SOCIO-DEMOGRAPHIC DATA TO IDENTIFY SPECIFIC COMMUNITIES OF CONCERN. DATA ON SOCIO-DEMOGRAPHICS OF RESIDENTS IN THESE COMMUNITIES, WHICH INCLUDED SOCIO-ECONOMIC STATUS, RACE AND ETHNICITY, EDUCATIONAL ATTAINMENT, HOUSING ARRANGEMENT, EMPLOYMENT STATUS, AND HEALTH INSURANCE STATUS, WERE EXAMINED. AREA HEALTH NEEDS WERE DETERMINED VIA IN-DEPTH ANALYSIS OF QUALITATIVE AND QUANTITATIVE DATA, AND THEN CONFIRMED WITH SOCIO-DEMOGRAPHIC DATA. AS NOTED EARLIER, A HEALTH NEED WAS DEFINED AS A POOR HEALTH OUTCOME AND ITS ASSOCIATED DRIVER. A HEALTH NEED WAS INCLUDED AS A PRIORITY IF IT WAS REPRESENTED BY RATES WORSE THAN THE ESTABLISHED QUANTITATIVE BENCHMARKS OR WAS CONSISTENTLY MENTIONED IN THE QUALITATIVE DATA. THE COMMUNITIES OF CONCERN ARE HOME TO MORE THAN 200,000 RESIDENTS. THE AREAS CONSIST OF ZIP CODE COMMUNITIES OCCUPYING THE NORTHERN, DOWNTOWN, AND SOUTHERN PORTIONS OF THE SACRAMENTO COUNTY AREA. ALL OF THE ZIP CODE COMMUNITIES ARE DENSELY POPULATED, WITH THE SOUTH SACRAMENTO AREA HAVING THE HIGHEST POPULATION AND THE DOWNTOWN AREA HAVING THE LOWEST POPULATION. THE COMMUNITIES OF CONCERN ARE ZIP CODES 95660, 95814, 95815, 95823, 95824 AND 95838. SOCIO-DEMOGRAPHIC CONDITIONS, OR SOCIAL DETERMINANTS OF HEALTH, HELP PREDICT WHICH COMMUNITIES IN A BROAD GEOGRAPHIC AREA ARE MOST SUSCEPTIBLE TO POOR HEALTH OUTCOMES. IN GENERAL, THE VAST MAJORITY OF RESIDENTS LIVING IN THE COMMUNITIES OF CONCERN FELL INTO MULTIPLE CATEGORIES OF SOCIAL DETERMINANTS OFTEN ASSOCIATED WITH POOR HEALTH OUTCOMES. FOR EXAMPLE, ALL ZIP CODE COMMUNITIES FAR EXCEEDED THE NATIONAL BENCHMARKS FOR THE PERCENT OF FAMILIES IN A LIVING IN POVERTY WITH CHILDREN AND SINGLE-FEMALE HEADED HOUSEHOLDS WITH CHILDREN LIVING IN POVERTY. ALL COMMUNITIES HAD HIGH PERCENTAGES OF NON-WHITE OR HISPANIC RESIDENTS, WITH 84% IN 95823 AND 83% IN 95824 FALLING INTO THIS CATEGORY. FURTHER, ALL COMMUNITIES OF CONCERN HAD HIGH PERCENTAGES OF RESIDENTS WITHOUT HEALTH INSURANCE COMPARED TO STATE AND NATIONAL BENCHMARKS. SUTTER ROSEVILLE MEDICAL CENTER: THE HOSPITAL SERVICE AREA (HSA) WAS DETERMINED BY ANALYZING PATIENT DISCHARGE DATA. COLLECTING AND ANALYZING THE ZIP CODES OF PATIENTS DISCHARGED FROM THE HOSPITAL OVER A SIX-MONTH PERIOD ALLOWED THE PRIMARY GEOGRAPHIC AREA SERVED BY THE HOSPITAL TO BE IDENTIFIED. THE HSA DETERMINED TO BE THE FOCUS OF THE NEEDS ASSESSMENT IS DEPICTED IN FIGURE 2 IN THE FULL REPORT. THERE ARE FOUR HOSPITALS THAT SERVE THE COMMUNITY. THE FIRST STEP IN IDENTIFYING VULNERABLE COMMUNITIES WAS TO EXAMINE SOCIO-DEMOGRAPHICS IN ORDER TO IDENTIFY AREAS OF THE HSA WITH HIGH VULNERABILITY TO CHRONIC DISEASE DISPARITIES AND POOR MENTAL HEALTH OUTCOMES. RACE/ETHNICITY, HOUSEHOLD MAKE-UP, INCOME, AND AGE VARIABLES WERE COMBINED INTO A VULNERABILITY INDEX THAT DESCRIBED THE LEVEL OF VULNERABILITY OF EACH CENSUS TRACT. THIS INDEX WAS THEN MAPPED FOR THE ENTIRE HSA. A TRACT WAS CONS

SCHEDULE H, PART VI, LINE 5
"PROMOTION OF COMMUNITY HEALTH: SUTTER HEALTH'S MISSION IS TO ""ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES."" SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST BY WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS; - SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM; AND - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. THE 2013 - 2015 IMPLEMENTATION STRATEGIES FOR SUTTER HEALTH SACRAMENTO SIERRA REGION HOSPITALS DEFINE A VARIETY OF PROGRAMS AND PARTNERSHIPS THAT ADDRESS IDENTIFIED PRIORITY HEALTH NEEDS AND IMPROVE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVES. A FEW OF THOSE PROGRAMS AND PARTNERSHIPS ARE DESCRIBED BELOW. SUTTER MEDICAL CENTER SACRAMENTO: THE INTERIM CARE PROGRAM (ICP) AND ICP PLUS HELPS SUTTER MEDICAL CENTER, SACRAMENTO (SMCS) FULFILL ITS MISSION TO PROVIDE ACCESS TO CARE FOR VULNERABLE AND TRADITIONALLY UNDERSERVED RESIDENTS. A COLLABORATIVE OF THE FOUR HEALTH CARE SYSTEMS, COMMUNITY BASED ORGANIZATIONS AND THE COUNTY GOVERNMENT CAME TOGETHER IN SACRAMENTO TO CREATE A RESPITE CARE SHELTER FOR HOMELESS PATIENTS DISCHARGED FROM HOSPITALS, ESTABLISHING AN 18-BED SHELTER FOR HOMELESS MEN AND WOMEN TO RECUPERATE FROM MEDICAL CONDITIONS. STARTED IN 2004, THE INTERIM CARE PROGRAM LINKS PEOPLE IN NEED TO VITAL COMMUNITY SERVICES WHILE GIVING THEM A PLACE TO HEAL. THE CLIENTS WHO ARE ENROLLED IN THE ICP ARE HOMELESS ADULT INDIVIDUALS WHO OTHERWISE WOULD BE DISCHARGED TO THE STREET OR CARED FOR IN AN INPATIENT SETTING ONLY. THE PROGRAM IS DESIGNED TO OFFER CLIENTS UP TO SIX WEEKS DURING WHICH THEY CAN FOCUS ON RECOVERY AND DEVELOPING A PLAN FOR THEIR HOUSING AND CARE UPON DISCHARGE. THIS INNOVATIVE COMMUNITY PARTNERSHIP PROVIDES TEMPORARY RESPITE HOUSING IN SACRAMENTO THAT OFFER HOMELESS MEN AND WOMEN A PLACE TO RECUPERATE FROM THEIR MEDICAL CONDITIONS, LINK THEM TO VITAL COMMUNITY SERVICES, AND PROVIDE THEM A PLACE TO HEAL. ICP PLUS IS A PROGRAM DESIGNED FOR HOMELESS PATIENTS DISCHARGING FROM SMCS, AND IS AN ENHANCED VERSION OF THE ICP, WITH PATIENTS NEEDING A GREATER LEVEL OF SUPPORT AND SPECIAL RESOURCES. SMCS AND THE OTHER HEALTH SYSTEMS PROVIDE FINANCIAL SUPPORT FOR THIS PROGRAM. WELLSPACE HEALTH, SACRAMENTO'S FEDERALLY QUALIFIED HEALTH CENTER, PROVIDES ON-SITE NURSING AND SOCIAL SERVICES TO SUPPORT CLIENTS IN THEIR RECUPERATION AND HELP THEM MOVE OUT OF HOMELESSNESS. THE WELLSPACE CASE MANAGER LINKS CLIENTS WITH MENTAL HEALTH SERVICES, SUBSTANCE ABUSE RECOVERY, HOUSING WORKSHOPS AND PROVIDES DISABILITY APPLICATION ASSISTANCE. THE SALVATION ARMY PROVIDES 18 BEDS IN A DESIGNATED WING OF THE SHELTER WHERE CLIENTS HAVE THREE MEALS A DAY AND A SAFE, CLEAN PLACE TO RECOVER FROM THEIR HOSPITALIZATIONS. IN 2015, 44 SUTTER HEALTH PATIENTS WERE SERVED, WITH 42 OF THOSE PATIENTS SUCCESSFULLY CONNECTING TO A PRIMARY CARE PROVIDER. ICP PATIENTS SHOWED A 61% REDUCTION IN INPATIENT STAYS, POST-ICP AND A 56% REDUCTION IN INPATIENT BED DAYS, POST-ICP. ICP PATIENTS SHOWED A 56% REDUCTION IN NON-URGENT ED USAGE AND A 22% REDUCTION IN OVERALL HOSPITAL USAGE POST-ICP. MORE THAN 1,500 REFERRALS PROVIDED TO ICP CLIENTS IN 2015. TYPES OF REFERRALS PROVIDED TO ICP PATIENTS: ALCOHOL AND DRUG TREATMENT, PRIMARY AND MENTAL HEALTH CARE, GENERAL ASSISTANCE, SSI/SDI, TRANSPORTATION, HOUSING, INSURANCE, VA AND OTHER SOCIAL SERVICES. THE ICP+ PROGRAM WAS DISCONTINUED. SMCS IS A FOUNDING PARTNER OF TRIAGE, TRANSPORT, AND TREATMENT (T3), A PROGRAM LAUNCHED IN 2006 THAT PROVIDES SERVICES TO PATIENTS WHO SEEK EMERGENCY DEPARTMENT CARE FOR NEEDS THAT ARE BEST ADDRESSED THROUGH PREVENTIVE MEASURES AND BY PRIMARY CARE PROVIDERS. THIS PROGRAM IS A MODEL FOR THE KIND OF CHANGE BEING CALLED FOR IN VARIOUS HEALTH CARE REFORM PLANS. A HUGE OBSTACLE FOR HEALTHCARE PROVIDERS, INCLUDING SMSC, IS THE INAPPROPRIATE USE OF THE EMERGENCY DEPARTMENT. THIS ISSUE IS NOT ONLY PROBLEMATIC FOR THE HEALTHCARE PROVIDER, BUT ALSO FOR THE PATIENTS WHO ARE NOT RECEIVING THE APPROPRIATE CARE IN THE APPROPRIATE PLACE, AT THE APPROPRIATE TIME. PROGRAMS LIKE T3 SEEK TO CONNECT PEOPLE WHO FREQUENTLY AND INAPPROPRIATELY USE THE EMERGENCY DEPARTMENT TO THE CORRECT RESOURCES, INCLUDING HOUSING AND MENTAL HEALTH SERVICES, WHICH IS KEY TO THE POPULATION WHO UTILIZES T3. MOVING THESE PATIENTS FROM THE EMERGENCY DEPARTMENT IMPROVES THE PATIENTS' HEALTH BY PROVIDING THEM WITH THE APPROPRIATE CARE IN THE RIGHT SETTING, WHILE REDUCING THE WAIT FOR THOSE SEEKING CARE FOR REAL MEDICAL EMERGENCIES, AND DRAMATICALLY REDUCING COSTS TO OUR HEALTH CARE SYSTEM. SMCS PARTNERS WITH AND PROVIDES FUNDING TO WELLSPACE HEALTH, THE SACRAMENTO REGION'S LARGEST FEDERALLY QUALIFIED HEALTH CLINIC (FQHC), TO OFFER THIS PROGRAM TO SOME OF THE MOST VULNERABLE PATIENTS IN OUR SERVICE AREA. WE TRACK AND MEASURE THE OUTCOMES OF OUR T3 PROGRAM VERY CAREFULLY. T3 SACRAMENTO SERVES AN AVERAGE OF APPROXIMATELY 185 ACTIVE CLIENTS PER QUARTER. PATIENTS SHOWED A 44% REDUCTION IN INPATIENT STAYS AND A 37% REDUCTION IN HOSPITAL BED DAYS USED, POST-T3. 41% OF THE PATIENTS WHO WORKED WITH THE SMCS ED NAVIGATOR IN 2015 WERE SUCCESSFULLY ENROLLED IN T3. AT THE END OF 2015, T3 HAD 192 ACTIVE CLIENTS AND 473 PATIENTS WERE SERVED OVERALL. BETWEEN THE PLACER AND SACRAMENTO T3 PROGRAMS (WHICH COLLECTIVELY HAD MORE THAN 260 PATIENTS AT THE END OF 2015 AND SERVED MORE THAN 700 PEOPLE OVERALL), PATIENTS RECEIVED MORE THAN 7,000 REFERRALS TO SERVICES INCLUDING PRIMARY AND MENTAL HEALTH CARE, COMMUNITY RESOURCES, FOOD BANKS, TRANSPORTATION, HOUSING, INSURANCE, INCOME AND MANY OTHER SOCIAL SERVICES. ED NAVIGATORS ATTEND TO PATIENTS IN THE EMERGENCY DEPARTMENT (UPON REFERRAL FROM A SMCS EMPLOYEE AND AFTER PATIENT AGREEMENT) TO PROVIDE ASSISTANCE IN IDENTIFYING PRIMARY CARE PROVIDERS AND TO DETERMINE OTHER CLIENT NEEDS. SMCS PROVIDES FUNDING TO WELLSPACE TO OFFER THIS IMPORTANT PROGRAM TO THE UNDERSERVED IN OUR COMMUNITY. THE ED NAVIGATOR IS AN EMPLOYEE OF WELLSPACE HEALTH AND SERVES AS A VISIBLE ED BASED STAFF MEMBER WHO IS ABLE TO PROVIDE REFERRALS TO TREATMENT FOR THOSE WHO ARE SEEKING CARE IN THE ED FOR NON-URGENT MATTERS. THE ED NAVIGATOR WILL CONNECT WITH PATIENTS AND PROVIDE REFERRALS TO PRIMARY CARE APPOINTMENTS, THE T3 PROGRAM FOR PERSONS WHO ARE FREQUENT NON-URGENT USERS, WELLSPACE AND OTHER CLINICS FOR THOSE WHO NEED A MEDICAL HOME AND OTHER IMPORTANT COMMUNITY RESOURCES, SUCH AS INSURANCE AND HOUSING. THE ED NAVIGATORS ARE CRITICAL IN DIRECTING THOSE WHO NEED MEDICAL HOMES OR ACCESS TO SERVICES, TO THE RIGHT CARE IN THE RIGHT PLACE AT THE RIGHT TIME. THE ED NAVIGATOR PROGRAM IS ANOTHER EXAMPLE OF THE COLLABORATIVE AND INNOVATIVE RELATIONSHIP SHARED BETWEEN SMCS AND WELLSPACE HEALTH. IN 2015, SMCS NAVIGATORS CONNECTED WITH 461 PATIENTS, PROVIDING ALL OF THEM WITH VARIOUS HEALTH AND COMMUNITY RELATED SERVICES. 187 (OR 41%) OF THOSE PATIENTS WERE SUCCESSFULLY REFERRED TO THE T3 PROGRAM. BETWEEN THE SUTTER ROSEVILLE MEDICAL CENTER AND SMCS ED NAVIGATOR PROGRAMS, ED NAVIGATORS PROVIDED 1,062 REFERRALS TO PRIMARY AND MENTAL HEALTH APPOINTMENTS, TRANSPORTATION, SOCIAL SERVICES, FOOD BANKS, INSURANCE AND OTHER VITAL RESOURCES TO THE UNDERSERVED POPULATION. IN CONJUNCTION WITH WELLSPACE HEALTH, SMCS IS EXAMINING THE POSSIBILITY OF IMPLEMENTING AN INPATIENT NAVIGATION PROGRAM. THE VISION FOR THIS SERVICE IS WHERE ED NAVIGATORS, T3 AND THE INTERIM CARE PROGRAM INTERSECT. WE ARE REFERRING TO THIS PROGRAM AS T3+, AS PATIENTS WOULD RECEIVE CASE MANAGEMENT SERVICES LIKE IN THE REGULAR T3 PROGRAM, BUT FOR MORE INTENSIVE ISSUES AND NEEDS. WE CONTINUE TO SEE PATIENTS STAY IN THE HOSPITAL LONGER THAN NECESSARY, DUE TO HEALTH, SUBSTANCE ABUSE, MENTAL HEALTH AND OTHER ISSUES. THIS SERVICE WILL HELP CONNECT WITH PATIENTS WHO WOULD BE BETTER SERVED IF THEY HAD A SAFE PLACE TO GO, OR FOLLOW UP CASE MANAGEMENT UPON DISCHARGE. USING FQHC STAFF AS NAVIGATORS/T3+ CASE MANAGERS WITHIN THE WALLS OF OUR HOSPITALS, WE CAN INTEGRATE OUR CASE MANAGEMENT WITH THEIRS AND ENSURE SEAMLESS TRANSITION FOR PATIENTS WHO NEED TO BE DISCHARGED TO ANOTHER CARE ENVIRONMENT. THESE T3+ NAVIGATORS WOULD FOLLOW THE PATIENTS AFTER DISCHARGE AND WORK WITH STAFF TO PROVIDE A FOLLOW-UP HEALTH PLAN, TELE-HEALTH, PAIN MANAGEMENT, ETC. ALL OF THIS IS WHILE THE T3+ NAVIGATORS ENSURE THE SUCCESS OF THE PATIENTS OTHER NEEDS (E.G. HOUSING, INSURANCE ENROLLMENT, ETC.) AND ENSURE PREVENTIVE FUTURE CARE. IN ADDITION TO ADDRESSING THE LACK OF ACCESS TO PRIMARY AND PREVENTATIVE SERVICES, THE T3+ PROGRAM WOULD ALSO TACKLE LACK OF ACCESS TO MENTAL HEALTH SERVICES AND LACK OF HOUSING/BASIC SHELTER. T3+ HAS SERVED 41 PATIEN"

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: THE ORGANIZATION IS AFFILIATED WITH SUTTER HEALTH, A NOT-FOR-PROFIT NETWORK OF HOSPITALS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS WHO CARE FOR PEOPLE WHO LIVE IN MORE THAN 100 NORTHERN CALIFORNIA TOWNS AND CITIES. TOGETHER, WE'RE CREATING A MORE INTEGRATED, SEAMLESS AND AFFORDABLE APPROACH TO CARING FOR PATIENTS. THE HOSPITAL'S MISSION IS TO ENHANCE THE WELL-BEING OF THE PEOPLE IN OUR COMMUNITIES THROUGH COMPASSION, EXCELLENCE AND INNOVATION IN HEALTH CARE SERVICES, RESEARCH AND EDUCATION. OVER THE PAST FIVE YEARS, SUTTER HEALTH HAS COMMITTED NEARLY $4 BILLION TO CARE FOR PATIENTS WHO COULDN'T AFFORD TO PAY, AND TO SUPPORT PROGRAMS THAT IMPROVE COMMUNITY HEALTH. OUR 2015 COMMITMENT OF $843 MILLION INCLUDES UNREIMBURSED COSTS OF PROVIDING CARE TO MEDI-CAL PATIENTS, TRADITIONAL CHARITY CARE AND INVESTMENTS IN HEALTH EDUCATION AND PUBLIC BENEFIT PROGRAMS. FOR EXAMPLE: - TO PROVIDE CARE TO MEDI-CAL PATIENTS IN 2015, SUTTER HEALTH INVESTED $712 MILLION MORE THAN THE STATE PAID. SUTTER HEALTH HOSPITALS PROUDLY SERVE MORE MEDI-CAL PATIENTS IN OUR NORTHERN CALIFORNIA SERVICE AREA THAN ANY OTHER HEALTH CARE PROVIDER. - IN 2015, SUTTER HEALTH'S COMMITMENT TO DELIVERING CHARITY CARE TO PATIENTS WAS $52 MILLION. - THROUGHOUT OUR HEALTH CARE SYSTEM, WE PARTNER WITH AND SUPPORT COMMUNITY HEALTH CENTERS TO ENSURE THAT THOSE IN NEED HAVE ACCESS TO PRIMARY AND SPECIALTY CARE. WE ALSO SUPPORT CHILDREN'S HEALTH CENTERS, FOOD BANKS, YOUTH EDUCATION, JOB TRAINING PROGRAMS AND SERVICES THAT PROVIDE COUNSELING TO DOMESTIC VIOLENCE VICTIMS. EVERY THREE YEARS, SUTTER HEALTH HOSPITALS PARTICIPATE IN A COMPREHENSIVE AND COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IDENTIFIES LOCAL HEALTH CARE PRIORITIES AND GUIDES OUR COMMUNITY BENEFIT STRATEGIES. THE ASSESSMENTS HELP ENSURE THAT WE INVEST OUR COMMUNITY BENEFIT DOLLARS IN A WAY THAT TARGETS AND ADDRESSES REAL COMMUNITY NEEDS.

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT: CALIFORNIA