4A (Expenses $ 1946297403 including grants of $ 1807000) (Revenue $ 2351857161)
SEE SCHEDULE O

SCHEDULE H, PART I, LINE 3C
FPG ARE USED TO DETERMINE CHARITY CARE ELIGIBILITY.

SCHEDULE H, PART I, LINE 6A
SCRIPPS HEALTH COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE- COMMUNITY.

SCHEDULE H, PART I, LINE 7G
"SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN EVEN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. SCRIPPS PROVIDES SUCH SERVICES BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, THEY WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION TO PROVIDE. SUBSIDIZED SERVICES DO NOT INCLUDE SUCH ANCILLARY SERVICES AS LAB WORK AND RADIOLOGY. IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE. SCRIPPS' TOTAL NET COST FOR SUBSIDIZED HEALTH SERVICES FOR FY11 WAS $9,118,616. THIS INCLUDES SCRIPPS INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES, MERCY CLINIC AND SCRIPPS IN-LIEU OF FUNDS, WHICH ARE USED FOR UNFUNDED OR UNDERFUNDED PATIENTS AND THEIR POST-DISCHARGE NEEDS INCLUDING BOARD AND CARE, SKILLED NURSING FACILITIES, LONG-TERM ACUTE CARE AND HOME HEALTH. IN ADDITION, THE FUNDS MAY BE USED FOR MEDICATIONS, EQUIPMENT AND TRANSPORTATION SERVICES. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO FOUNDED IN 1930 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 1,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY11 WERE 12,715. A FULL TIME CLINIC STAFF OF NURSES AND OTHER PERSONNEL WORK HAND-IN-HAND WITH PHYSICIANS FROM SCRIPPS MERCY HOSPITAL. AS AN INTEGRAL PART OF TREATING ITS PATIENTS, MERCY CLINIC SERVES AS A TRAINING GROUND FOR MORE THAN 50 RESIDENTS EACH YEAR FROM THE SCRIPPS MERCY HOSPITAL GRADUATE MEDICAL EDUCATION PROGRAM. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S ""WORKING AND DISABLED POOR"". EACH YEAR, 90 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 10 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME, MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED NET COST FOR MERCY CLINIC FOR FY11 WAS $2.3 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE)."

SCHEDULE H, PART I, LINE 7, COLUMN F
$89,492 IS THE AMOUNT OF BAD DEBT INCLUDED IN PART IX, LINE 25 BUT ADDED BACK FOR THE PURPOSE OF CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN (F).

SCHEDULE H, PART I, LINE 7
"FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES, AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA AN ACCESS COMMUNITY BENEFIT DATABASE. THE ACCESS COMMUNITY BENEFIT DATABASE HAS BEEN ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN ""ACTIVITY"". ALL COMMUNITY BENEFIT PROGRAMS/ACTIVITIES ARE THEN ENTERED INTO THE ""COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY"" (CBISA) DATABASE. CBISA SERVES AS THE ROLL UP AND OR END PRODUCT OF COMMUNITY BENEFIT TRACKING. IT IS ALIGNED WITH THE NEW SCHEDULE H REQUIREMENTS AND HOUSES THE SCHEDULE H WORKSHEETS THAT CAN BE USED FOR AUDIT PURPOSES. FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. SCRIPPS UNCOMPENSATED CARE FY2011 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR BAD DEBT AND CHARITY CARE IS ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF BAD DEBT AND CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS- TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. PROVIDER TAX PROGRAM (REFLECTED IN PART I, LINE 7B) IN JANUARY 2010, THE STATE OF CALIFORNIA ENACTED LEGISLATION THAT PROVIDED FOR SUPPLEMENTAL MEDI-CAL PAYMENTS TO CERTAIN HOSPITALS FUNDED BY A QUALITY ASSURANCE FEE PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS (""THE 2010 HOSPITAL FEE PROGRAM""). THE LEGISLATION COVERED THE PERIOD OF APRIL 1, 2009 THROUGH DECEMBER 31, 2010 (21 MONTHS). THE CENTERS FOR MEDICARE & MEDICAID SERVICES (""CMS"") APPROVED THE 2010 HOSPITAL FEE PROGRAM IN ITS ENTIRETY IN DECEMBER 2010, AND, THEREFORE, ALL ACTIVITY OF THE PROGRAM WAS RECOGNIZED DURING THE YEAR ENDED SEPTEMBER 30, 2011, RESULTING IN NET ADDITIONAL INCOME OF $22,620,000. THE SUPPLEMENTAL PAYMENTS RECEIVED DURING THE YEAR ENDED SEPTEMBER 30, 2011 ENCOMPASSED FEE-FOR-SERVICE PAYMENTS TO THE ORGANIZATION DIRECTLY FROM THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES AS WELL AS PAYMENTS ROUTED THROUGH MANAGED CARE PLANS, AMOUNTING IN TOTAL TO APPROXIMATELY $102,072,000. THESE PAYMENTS WERE RECORDED IN NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. QUALITY ASSURANCE FEES ASSESSED TO AND PAID BY THE ORGANIZATION RELATED TO THE 2010 HOSPITAL FEE PROGRAM DURING THE YEAR ENDED SEPTEMBER 30, 2011, WERE $77,850,000 AND WERE RECORDED AS PROVIDER TAX FEES IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST (CHFT), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA (TOGETHER WITH THE SUPPLEMENTAL PAYMENTS AND THE QUALITY ASSURANCE FEE DISCUSSED ABOVE, THE 2010 PROVIDER FEE PROGRAM). DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE ORGANIZATION MADE CHARITABLE CONTRIBUTIONS OF $1,602,000 RELATED TO THE 2010 PROVIDER FEE PROGRAM TO CHFT, WHICH WERE RECORDED AS PROVIDER TAX FEES IN THE CONSOLIDATED STATEMENTS OF OPERATIONS."

SCHEDULE H, PART II
"COMMUNITY BUILDING ACTIVITIES. ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2 EXECUTIVE LEADERSHIP, SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3. THE CITY HEIGHTS WELLNESS CENTER (CHWC) IS A UNIQUE RESOURCE, AS THERE IS NO OTHER COMMUNITY-BASED FACILITY PROMOTING HEALTH AND WELLNESS IN CENTRAL SAN DIEGO. THE OVERALL GOAL OF CHWC IS TO PREVENT DISEASE AND PROMOTE HEALTH, STRENGTHEN COMMUNITY PARTNERSHIPS AND PROVIDE OPPORTUNITIES TO RESIDENTS TO BECOME SELF-EMPOWERED AND BECOME MORE INVOLVED IN MANAGING THEIR OWN HEALTH. IN FY11, THE CENTER PROVIDED COMMUNITY MEETINGS FOCUSED ON ACCESS TO HEALTH CARE SERVICES, CREATING A SAFER COMMUNITY ENVIRONMENT AND COMMUNITY-WIDE COMMUNICATION AND COMMUNITY BUILDING STRATEGIES. THE CENTER IS OPERATED JOINTLY BY SCRIPPS MERCY HOSPITAL AND CHILDREN'S HOSPITAL. HOLIDAY CARDS TO OVERSEAS MILITARY HOLIDAYS CARDS SEND ENCOURAGEMENT TO OVERSEE MILITARY PERSONNEL. THE CARDS WERE SIGNED AND THE ENVELOPES WERE LEFT OPEN FOR FINAL INSPECTION BY PITNEY BOWES. SCRIPPS GATHERED THE CARDS AND MAILED TO PITNEY BOWES SO THEY WOULD RECEIVE THE CARDS ON TIME. IN ADDITION, SCRIPPS COLLECTED DONATED GIFTS MAILED TO A NAVY SHIP AT SEA ON ACTIVE DUTY FOR ONE YEAR. EAT LIKE A MARINE FUNDRAISER SCRIPPS HEALTH AND MEDASSETS WORKED TOGETHER WITH THEIR VENDORS TO RAISE MORE THAN $155,000 TO SPONSOR A MAKE-UP HOMECOMING BALL FOR THE MARINES FROM THE DARK HORSE BATTALION. MARINES AND THEIR FAMILY MEMBERS TRAVELED FROM AROUND THE COUNTRY TO LAS VEGAS TO ATTEND THEIR SPECIAL HOMECOMING BALL. SCRIPPS HEALTH AND MEDASSETS THANKED THOSE VENDORS WHO HELPED FUND THE ENTIRE HOMECOMING BALL BY INVITING THEM TO ""EAT LIKE A MARINE"". THIS THANK YOU RECEPTION PROVIDED A CHANCE FOR ALL WHO CONTRIBUTED TO MEET SOME OF OUR COUNTRY'S BRAVEST MARINES FROM THE DARK HORSE BATTALION. THEY WERE ON HAND TO SHARE THEIR STORIES AND TEACH GUESTS HOW TO PREPARE MEALS READY TO EAT (MRE'S). DISASTER PREPAREDNESS - COMMUNITY OUTREACH AND EDUCATION HAVING THE ABILITY TO PROVIDE EMERGENCY SERVICES TO THOSE INJURED IN A LOCAL DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS DELEGATES PARTICIPATION IN SD COUNTY AND STATE OF CA ADVISORY GROUPS TO PLAN, IMPLEMENT AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND FUNDING. EFFORTS LED BY THE DISASTER PREPAREDNESS PROGRAM UNDER THE DIRECTION OF THE CHIEF MEDICAL OFFICER. AMERICAN HEART ASSOCIATION HEART WALK AMERICAN HEART WALK -SCRIPPS ALLOCATED $29,010 IN OPERATIONAL FUNDS TO SUPPORT THE AMERICAN HEART ASSOCIATION'S EFFORTS TO FIGHT HEART DISEASE AND STROKE. IN ADDITION, THE SCRIPPSASSISTS EMPLOYEE VOLUNTEER PROGRAM COORDINATED WALKER PARTICIPATION AND FUND RAISING EFFORTS. THE SAN DIEGO HEART WALK RAISED MORE THAN $1.2 MILLION. IN 2011, MORE THAN 2,000 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES AND FRIENDS - WALKED TO HELP RAISE MORE THAN $138,000. ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT BY PROVIDING BLOOD PRESSURE SCREENINGS, HEALTH EDUCATION MATERIALS, AND MORE. FOOD STAMP ASSISTANCE THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM THE SAN DIEGO HUNGER COALITION WHO ARE AVAILABLE TO COUNSEL PEOPLE AND HELP FILL OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THIS ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. MID-CITY CAN, SAN DIEGO CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN MONTHLY NETWORKING MEETINGS FOR MID-CITY CAN (COMMUNITY ADVOCACY NETWORK). THESE MEETINGS PROVIDE AN OPPORTUNITY FOR COMMUNITY RESIDENTS AND REPRESENTATIVES FROM PRIVATE AND PUBLIC ORGANIZATIONS, FAITH COMMUNITIES, SCHOOLS AND BUSINESSES TO COME TOGETHER FOR ACTION ON AREAS OF COMMON INTEREST. IN ASSOCIATION WITH THESE MEETINGS, SELF-DIRECTED MOMENTUM TEAMS HAVE BEEN DEVELOPED TO PROVIDE DIRECTION AND LEADERSHIP AS NEEDS AND ISSUES ARISE WITHIN THE COMMUNITY. SAN DIEGO CAREGIVER ACTION NETWORK (SANDI-CAN) THE CITY HEIGHTS WELLNESS CENTER HOSTS MONTHLY MEETINGS FOR SANDI-CAN, A COMMUNITY PARTNERSHIP OF 200 CONSUMERS, VOLUNTEERS, CAREGIVERS, AND SERVICE PROVIDERS DEDICATED TO WORKING TOGETHER ON PROJECTS THAT ENHANCE THE LIVES OF OLDER ADULTS AND ADULTS WITH DISABILITIES LIVING IN THE CITY OF SAN DIEGO. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS -- THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. CITY HEIGHTS WELLNESS CENTER - HEALTH ADVOCACY PROJECT THE CITY HEIGHTS WELLNESS CENTER HEALTH ADVOCACY PROJECT IS SUPPORTED BY A GRANT FROM THE CALIFORNIA ENDOWMENT FOUNDATION AND IS DESIGNED TO STRENGTHEN THE CAPACITY TO DELIVER CULTURALLY AND RELIGIOUSLY COMPETENT HEALTH PROMOTION SERVICES TO SOMALI AND EAST AFRICAN WOMEN AND THEIR FAMILIES. THIS PROGRAM ADDRESSES UNMET NEEDS LIKE PRENATAL OUTREACH AND EDUCATION, CULTURALLY ADAPTED NUTRITION AND FITNESS EDUCATION, BREASTFEEDING EDUCATION, EARLY CHILDHOOD HEALTH, AND NUTRITION AND SAFETY CLASSES. THE PROJECT IS SPONSORED BY SCRIPPS MERCY SAN DIEGO COMMUNITY BENEFIT SERVICES. LEAD SAN DIEGO VISIONARY AWARDS THROUGH THE OFFICE OF THE PRESIDENT, SCRIPPS SPONSORED THE LEAD SAN DIEGO VISIONARY AWARD. LEAD SAN DIEGO MEMBERS AND INVESTORS PLAY A VITAL ROLE IN DEVELOPING DIVERSE LEADERS. THE VISIONARY AWARDS STRIVE TO INSPIRE INNOVATIONS AND SHARE SUCCESSES IN COMMUNITY LEADERSHIP. LEARNING FOR LIFE SAN DIEGO - IMPERIAL COUNCIL BOY SCOUTS OF AMERICA SCRIPPS SPONSORSHIP, PROVIDED BY SCRIPPS OFFICE OF THE PRESIDENT, SUPPORTED THE DISTINGUISHED CITIZEN'S DINNER. THE EVENT RAISED FUNDS FOR OUTREACH PROGRAMS DELIVERED BOTH IN SCHOOL AND AFTER SCHOOL TO SUPPORT YOUTH IN HIGH-RISK AREAS OF SAN DIEGO COUNTY, AFFORDING THEM THE OPPORTUNITY TO BUILD LEADERSHIP SKILLS, DEVELOP CHARACTER AND LEARN JOB SKILLS. FOUNDATION OF THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES DONATION MADE TO THE FOUNDATION OF THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES, FUND FOR INNOVATION IN HEALTHCARE LEADERSHIP. THIS DONATION WILL HELP FUND THE IMPLEMENTATION AND APPLICATION OF HEALTH SERVICES RESEARCH AND TO HELP DEVELOP FUTURE LEADERSHIP. SPONSORED BY SCRIPPS OFFICE OF THE PRESIDENT. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6. CALIFORNIA ENDOWMENT MEETING THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS MEETINGS OF THE CALIFORNIA ENDOWMENT (A PRIVATE, STATEWIDE HEALTH FOUNDATION) FOR ITS 10-YEAR BUILDING HEALTHY COMMUNITIES INITIATIVE, WHICH AIMS TO SUPPORT THE DEVELOPMENT OF COMMUNITIES WHERE YOUTH ARE HEALTHY, SAFE AND READY TO LEARN. THE CHWC HAS BEEN INVOLVED, PARTICIPATORY AND SUPPORTIVE OF THE ENDOWMENT AND THEIR EFFORTS IN THIS INITIATIVE. CALIFORNIA PARTNERSHIP LATINOS Y LATINAS EN ACCIN (LLEA), A PROJECT OF MID-CITY CAN (COMMUNITY ADVOCACY NETWORK), SUPPORTS LATINOS IN USING THEIR COLLECTIVE VOICE EFFECTIVELY AND INCREASING LATINO INVOLVEMENT IN ALL LEVELS OF COMMUNITY DECISION MAKING AND CIVIC PARTICIPATION. LLEA HAS BEEN IN EXISTENCE SINCE 2002, AS A GRASSROOTS EFFORT LEAD BY CONCERNED PARENTS, RESIDENTS AND TEACHERS OF THE CITY HEIGHTS COMMUNITY. MOVILIZANDO EL VOTO INMIGRANTE IS A CAMPAIGN IN WHICH LLEA COLLABORATED WITH CALIFORNIA PARTNERSHIP, A COALITION OF COMMUNITY GRASSROOTS ORGANIZATIONS THROUGHOUT THE STATE OF CALIFORNIA. OVER THE LAST THREE YEARS LLEA MEMBERS HAVE WALKED PRECINCTS IN CITY HEIGHTS BEFORE, DURING AND AFTER ELECTORAL CAMPAIGNS WITH THE GOAL OF IDENTIFYING POTENTIAL IMMIGRANT VOTERS AND ENGAGING THEM IN DIALOGUE ABOUT ISSUES FACING THE LATINO COMMUNITY IN CITY HEIGHTS. DURING THE NOVEMBER PRESIDENTIAL ELECTIONS RETURNED OUT MORE THAN 2,500 CITY HEIGHTS VOTERS WHO WERE KEY IN A HISTORIC SUCCESS FOR PEOPLE OF COLOR IN THIS COUNTRY. SPONSORED BY SCRIPPS CITY HEIGHTS WELLNESS CENTER. FOOD JUSTICE MOMENTUM TEAM THE CITY HEIGHTS WELLNESS CENTER HOSTS AND CO-CHAIRS MONTHLY MEETINGS OF THE FOOD JUSTICE MOMENTUM TEAM. THE MISSION OF THIS TEAM IS TO GATHER A DIVERSE COMMUNITY WORKING TOGETHER TOWARDS CREATING AN ECOLOGICALLY SOUND, ECONOMICALLY VIABLE AND SOCIALLY JUST FOOD SYSTEM FOR ALL. ACCESS TO HEALTH CARE THE CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN MONTHLY MEETINGS OF THE ACCESS TO HEALTH CARE MOMENTUM TEAM."

SCHEDULE H, PART III, LINE 4
FOOTNOTE FOR PART III, LINE 4 - BAD DEBT FOOTNOTE: 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. The provision for bad debts for fiscal year 2010 was reclassified as a reduction of net patient service revenues. 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. THE AMOUNT ON PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGARDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED. DESCRIBE HOW THE ORGANIZATION HAS ACCOUNTED FOR DISCOUNTS IN DETERMINING BAD DEBT EXPENSE (E.G. SELF-PAY DISCOUNTS): A PROMPT-PAY DISCOUNT OF 50 PERCENT IS AVAILABLE. BAD DEBT DOES NOT INCLUDE ANY AMOUNTS RELATED TO DISCOUNTS.

SCHEDULE H, PART III, LINE 8
MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. DESCRIBE THE ORGANIZATION'S RATIONALE FOR THE POSITION THAT MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT.

SCHEDULE H, PART III, LINE 9B
COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE PROGRAM. 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 CANNOT PAY ON THE ACCOUNT, THE ORGANIZATION WRITES THE ACCOUNT OFF 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.

NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2
"DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. CALIFORNIA SENATE BILL 697 (CHAPTERED IN 1994) REQUIRES AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS. IDENTIFYING SAN DIEGO COUNTY'S HEALTH PRIORITIES IS A COMPLEX PROCESS. THE WORKING GROUP KNOWN AS THE SAN DIEGO COUNTY SB697 COALITION WAS INITIALLY ATTENDED BY REPRESENTATIVES FROM OVER 25 HEALTH CARE-RELATED ORGANIZATIONS WITH THE GOAL OF PRODUCING ONE NEEDS ASSESSMENT TO MAXIMIZE RESOURCES AND DEVELOP A MORE COMPREHENSIVE REPORT FOR THE COUNTY OF SAN DIEGO. THE COALITION, RENAMED COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) SHORTLY AFTER THE COMPLETION OF THE FIRST ASSESSMENT, FORMALIZED ITS ROLE TO PROVIDE OVERSIGHT AND DIRECTION TO THE PERIODIC NEEDS-ASSESSMENT PROCESS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, THE ORGANIZATION IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. COMMUNITY HEALTH IMPROVEMENT PARTNERS SCRIPPS IS AN OFFICIAL PARTNER AND AN ACTIVE PARTICIPANT IN COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). THROUGH CHIP, MORE THAN 25 COMMUNITY HEALTH-RELATED ORGANIZATIONS COME TOGETHER TO JOINTLY ADDRESS THE COUNTY'S HEALTH NEEDS. SCRIPPS WORKS WITH CHIP AND OTHER HEALTH CARE SYSTEMS AND PARTNERS TO DEVELOP A COMPREHENSIVE COUNTY HEALTH NEEDS ASSESSMENT, UPDATED EVERY THREE YEARS, INCLUDING COUNTY, STATE AND NATIONAL HEALTH STATISTIC COMPARISONS. THE COLLABORATIVE ASSESSMENT PROCESS IS ONE OF THE MOST RESPECTED IN CALIFORNIA. CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY ""CHARTING THE COURSE VI,"" CHIP'S 2010 HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY, BUILDS ON THE WORK DONE IN THE FIVE PREVIOUS ASSESSMENTS IN 1995, 1998, 2001, 2004 AND 2007. THE CHIP HEALTH NEEDS ASSESSMENTS MONITOR CHANGES AND TRENDS IN HEALTH STATUS AMONG SAN DIEGO COUNTY RESIDENTS. THIS INFORMATION PROVIDES THE BASIS UPON WHICH PROGRAMS AND INTERVENTIONS CAN BE TARGETED, DEVELOPED AND EVALUATED, WITH THE ULTIMATE GOAL OF IMPROVING THE HEALTH OF THE COMMUNITY AND ITS MEMBERS. IN ADDITION TO FULFILLING LEGISLATIVE REQUIREMENTS, ""CHARTING THE COURSE VI"" PROVIDES A RESOURCE FOR INDIVIDUALS, AGENCIES AND INSTITUTIONS TO IDENTIFY COMMUNITY HEALTH NEEDS AND CONCERNS. IT IS AVAILABLE VIA THE CHIP WEBSITE (WWW.SDCHIP.ORG)."

PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI LINE 3
"DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY. HOSPITAL CARE CAN BE EXPENSIVE AND IS OFTEN UNEXPECTED. TO HELP MEET THE NEEDS OF LOW-INCOME UNINSURED AND UNDERINSURED PATIENTS WHO USE SCRIPPS HOSPITALS, SCRIPPS HAS A PATIENT FINANCIAL ASSISTANCE POLICY CONSISTENT WITH CALIFORNIA AB774 ""FAIR PRICING POLICY"" LEGISLATION, CHAPTERED IN 2006. FOLLOWING PRINCIPLES AND GUIDELINES SET BY THE AMERICAN HOSPITAL ASSOCIATION AND THE CALIFORNIA HOSPITAL ASSOCIATION, THE POLICY ESTABLISHES STANDARDS FOR CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES AND LOW-INCOME PATIENT ASSISTANCE THROUGH DISCOUNTED HOSPITAL CHARGES. 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 CHARITY CARE POLICY ON THE SCRIPPS WEB SITE 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 IS IN WRITTEN FORM TO GUIDE AND DIRECT STAFF AND EFFECTIVELY COMMUNICATES HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH AB774 ""FAIR PRICING POLICY"" 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. - FINANCIAL ASSISTANCE INFORMATION IS POSTED IN CONSPICUOUS REGISTRATION AREAS INCLUDING THE EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION, AND ANCILLARY SERVICE LOCATIONS. PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. 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. - PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. LANGUAGE INTERPRETIVE SERVICES ARE UTILIZED FREE OF CHARGE WHENEVER NECESSARY TO FACILITATE THE PATIENTS UNDERSTANDING AND PARTICIPATION IN FINANCIAL ASSISTANCE OPTIONS. - 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."

COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4
"DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES. (E.G., URBAN, SUBURBAN, RURAL), THE COMMUNITY OR COMMUNITIES (E.G., POPULATION, AVERAGE INCOME, PERCENTAGES OF COMMUNITY RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINE, PERCENTAGE OF THE HOSPITAL'S AND COMMUNITY'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS), THE NUMBER OF OTHER HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES, AND WHETHER ONE OR MORE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE COMMUNITY. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,300 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTIONS ARE JUST OVER 1 PERCENT PER YEAR, EXTENDING OUT 25 YEARS TO THE YEAR 2030. THE SANDAG 2050 SUB-REGIONAL GROWTH FORECAST PROJECTS POPULATION GROWTH TO 4.4 MILLION BY 2050. THIS IS A 40.0% INCREASE IN POPULATION GROWTH. DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE BASED ON SANDAG 2010 ESTIMATES AND ARE AVAILABLE AT THE ZIP CODE LEVEL AT HTTP://DATAWAREHOUSE.SANDAG.ORG. A BREAKDOWN OF THE REGIONAL DEMOGRAPHICS CAN BE FOUND IN THE REGIONAL FORUM SECTIONS OF THE CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY (APPENDIX SECTION) HTTP://WWW.SDCHIP.ORG. SCRIPPS SERVES A QUARTER OF THE TOTAL COUNTY POPULATION, CONCENTRATING SERVICES IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTH REGIONS OF SAN DIEGO COUNTY WHERE SCRIPPS FACILITIES ARE LOCATED. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 67 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. AS A DISPROPORTIONATE-SHARE HOSPITAL, SCRIPPS MERCY SAN DIEGO AND CHULA VISTA CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED-MEDICARE AND MEDI-CAL. SCRIPPS HOSPITALS HOUSE 26.0 PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY11, SCRIPPS PROVIDED 2.1 MILLION OUTPATIENT VISITS. ALMOST HALF (43.7 PERCENT) OF SAN DIEGO SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF PAY. COUNTY SAFETY NET DISCHARGES CY10: - CENTRAL DISCHARGES - 17,493 - SOUTH SUBURBAN DISCHARGES - 13,404 SCRIPPS OSHPD SAFETY NET DISCHARGES CY10: - SCRIPPS CENTRAL DISCHARGES - 5,359 - SCRIPPS SOUTH SUBURBAN DISCHARGES - 4,252 COUNTY OVERVIEW ACCESS TO MEDICAL CARE IS CRUCIAL TO THE WELL-BEING OF INDIVIDUALS AND THE SAN DIEGO COMMUNITY AS A WHOLE. THERE ARE MANY BARRIERS TO CARE FOR THE SAFETY NET POPULATION THAT PREVENT THEM FROM OBTAINING MUCH NEEDED MEDICAL SERVICES. LACK OF INSURANCE IS A PRIMARY BARRIER, AS EVIDENCED BY THE 17.2 PERCENT OF ADULTS AGE 19-64 (EXCLUDING MEDICARE AND MILITARY) WHO LACK HEALTH INSURANCE IN SAN DIEGO COUNTY. THE CALIFORNIA HEALTHCARE FOUNDATION (CHCF) REPORTED ESTIMATES THAT 21% OF STATE RESIDENTS HAD NO INSURANCE IN 2010, THE SAME PERCENTAGES OF 2009 BUT UP FROM 19.3% IN 2000. CALIFORNIA HAD THE HIGHEST NUMBER OF UNINSURED RESIDENTS IN THE NATION AT 6.9 MILLION - A FUNCTION OF IT BEING THE MOST POPULOUS STATE IN THE U.S.- AND THE EIGHTH HIGHEST PERCENTAGE AMONG STATES. CALIFORNIA'S HIGH RATE OF UNINSURED RESIDENTS IS ATTRIBUTABLE TO SEVERAL FACTORS, INCLUDING A STEADY DECLINE IN EMPLOYER-BASED HEALTH COVERAGE. THE CHCF REPORT NOTED THAT ""THE PERCENTAGE OF CALIFORNIANS WHO OBTAIN THEIR INSURANCE THROUGH THEIR JOB HAS CONTINUED TO FALL,"" DECLINING FROM 61.9% IN 2000 TO 53% IN 2010. DURING THE SAME TIME PERIOD, THE PERCENTAGE OF STATE RESIDENTS COVERED BY MEDI-CAL INCREASED FROM 13.3% IN 2000 TO 19.3% IN 2010. INCOME WAS ALSO A FACTOR, WITH 35.1% OF STATE RESIDENTS WITH ANNUAL INCOMES UNDER $25,000 LACKING INSURANCE. BUT EVEN MORE AFFLUENT RESIDENTS WERE NOT IMMUNE, WITH 18.3% OF RESIDENTS WITH HOUSEHOLD INCOMES BETWEEN $50,000 AND $75,000 GOING WITHOUT HEALTH INSURANCE IN 2010. THE RATES OF UNINSURED RESIDENTS IN THE STATE COULD DECLINE IN 2011 AS MORE ADULTS WITHOUT INSURANCE FIND COVERAGE THROUGH THE STATE'S BRIDGE TO REFORM PROGRAM. SINCE THE START OF 2011, A DOZEN COUNTIES HAVE LAUNCHED LOW-INCOME HEALTH PLANS TO COVER UNINSURED ADULTS WHO DO NOT QUALIFY FOR MEDI-CAL, PROVIDING COVERAGE FOR MORE THAN 200,000 RESIDENTS (CALIFORNIA HEALTHCARE FOUNDATION. CALIFORNIA HEALTH CARE ALMANAC, DECEMBER 2011). ACCORDING TO A 2006 SAN DIEGO COUNTY HEALTH CARE SAFETY NET STUDY, NEARLY ONE-THIRD OF SAN DIEGO COUNTY'S POPULATION (909,661) IS UNINSURED OR UNDERINSURED, WITH THE HIGHEST CONCENTRATION - HALF OF THE TOTAL - SOUTH OF INTERSTATE 8. THE HOSPITALS AND COMMUNITY CLINICS THAT PROVIDE HEALTH CARE TO THIS POPULATION COMPRISE THE SAFETY NET. SINCE SAN DIEGO COUNTY DOES NOT OPERATE A PUBLIC HOSPITAL, THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO PROVIDE CARE TO UNINSURED AND MEDICALLY UNDERSERVED POPULATIONS. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE CURRENT SAFETY NET IS A CRITICAL POLICY CHALLENGE. THE SAN DIEGO COUNTY HEALTH CARE SAFETY NET STUDY FOUND THAT THE CENTRAL AND SOUTH REGIONS HAVE THE LARGEST PROPORTION OF UNINSURED. NORTH CENTRAL HAS THE LEAST NUMBER OF UNINSURED. THE COUNTY HAS 14.3 PERCENT OF ITS POPULATION ON MEDI-CAL (434,936). CENTRAL AND SOUTH REGIONS HAVE THE LARGEST NUMBER OF MEDI-CAL BENEFICIARIES (22.3 AND 19.4 PERCENT, RESPECTIVELY). COMBINED, THE SAFETY NET CONSUMER COMPRISES 29.5 PERCENT OF THE POPULATION (907,661). WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE."

PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5
PROVIDE ANY OTHER IMPORTANT INFORMATION TO DESCRIBING HOW THE ORGANIZATION'S HOSPITALS OR HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G., OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS ETC). FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.4 BILLION, PRIVATE, NOT-FOR-PROFIT COMMUNITY HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS A HALF-MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 2,563 AFFILIATED PHYSICIANS AND 13,323 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIAN OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. SCRIPPS IS A RECOGNIZED LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE AND IS AT THE FOREFRONT OF CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. AS A NOT-FOR-PROFIT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT OF ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY11 (OCTOBER 2010 TO SEPTEMBER 2011), SCRIPPS INVESTED $35,486,538 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE. EXPENSES ARE NOT OFFSET BY GRANT REVENUE OR RESTRICTED FUNDS ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES. A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. LACK OF INSURANCE ALSO INCREASES THE BURDEN ON HOSPITALS AND HEALTH PROVIDERS. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY11 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (MOST) REACHING OUT TO THOSE WHO HAVE LIMITED ACCESS TO HEALTH CARE, THE MERCY OUTREACH SURGICAL TEAM (MOST) PROVIDES MEDICAL AND SURGICAL CARE TO UNDERPRIVILEGED CHILDREN AND ADULTS FROM OTHER COUNTRIES. THE VOLUNTEER GROUP OF PHYSICIANS, NURSES, TECHNICIANS AND OTHERS PERFORM LIFE-CHANGING SURGERIES TO CORRECT CLEFT LIPS, CLEFT PALATES, BURN SCARS, CROSSED EYES, HERNIAS AND A VARIETY OF OTHER CONDITIONS. DURING FY11, THE MOST TEAM SERVED 233 INDIVIDUALS. GRADUATE MEDICAL EDUCATION STAFF SUPPORT TO ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND MID-CITY COMMUNITY CLINICS THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 28 RESIDENTS AND 37 FELLOWS. THE PROGRAM ALSO GIVES BACK TO THE COMMUNITY BY STAFFING EVENING CLINICS AT ST. VINCENT DE PAUL VILLAGE AND THE MID-CITY COMMUNITY CLINIC, WHERE SCRIPPS RESIDENTS AND STAFF PROVIDED MEDICAL CARE TO APPROXIMATELY 295 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FY11. SCRIPPS HEALTH COMMUNITY BENEFIT GRANTING IN 2011, SCRIPPS AWARDED A TOTAL OF $215,000 IN SEVEN COMMUNITY GRANTS TO PROGRAMS BASED THROUGHOUT SAN DIEGO, RANGING FROM $10,000 TO $120,000 EACH. THE PROJECTS THAT RECEIVED FUNDING ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH-PRIORITY HEALTH NEEDS WITH THE GOAL OF IMPROVING ACCESS TO VITAL HEALTH CARE SERVICES FOR A VARIETY OF AT-RISK POPULATIONS, INCLUDING PEOPLE WHO ARE HOMELESS, ECONOMICALLY DISADVANTAGED, AND MENTALLY ILL. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $2.2 MILLION DOLLARS.

AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6
IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. SCRIPPS HEALTH IS AN INTEGRATED HEALTH SYSTEM, OPERATING FIVE ACUTE CARE HOSPITALS AND TWENTY-TWO OUT PATIENT CLINICS IN SAN DIEGO COUNTY. IN ADDITION, SCRIPPS HEALTH IS THE PARENT ORGANIZATION OF THE WHITTIER INSTITUTE OF DIABETES WHICH OFFERS IMPROVED QUALITY OF LIFE FOR INDIVIDUALS WITH DIABETES THROUGH INNOVATIVE EDUCATION PROGRAMS, CLINICAL CARE, RESEARCH AND COLLABORATION THAT PURSUES PREVENTION AND A CURE.

STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7
California. Scripps Health Community Benefit Report can be found at: http://www.scripps.org/about-us__scripps-in-the-community