4A (Expenses $ 3372263235 including grants of $ 731000) (Revenue $ 3798688752)
SEE SCHEDULE O.

4B (Expenses $ 1589640 including grants of $ 0) (Revenue $ 1716223)
The Maxwell H. and Muriel Gluck Child Care center provides child care and pre-school education for the benefit of individuals in the community of San Diego, including employees and patients of the nonprofit 501(C)(3) entities of Scripps Health and Scripps Research Institute. Special emphasis is placed on a variety of learning and play activities in the musical and visual arts field.

Schedule H, Part V, Section B, Line 3E
2022 CHNA PRIORITIZATION OF THE TOP COMMUNITY NEEDS THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH HEALTH CONDITIONS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED, THE MAGNITUDE/SCALE OF THE NEED; DISPARITIES OR INEQUITIES AND CHANGE OVER TIME. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. THROUGH THE PRIORITIZATION PROCESS DESCRIBED IN THE METHODOLOGY SECTION, THE CHNA COMMITTEE IDENTIFIED THE MOST CRITICAL TOP COMMUNITY NEEDS WITHIN SAN DIEGO COUNTY, LISTED BELOW IN ALPHABETICAL ORDER: -ACCESS TO HEALTH CARE -AGING CARE SUPPORT -BEHAVIORAL HEALTH -CHILDREN YOUTH WELLBEING -CHRONIC HEALTH CONDITIONS -COMMUNITY SAFETY -ECONOMIC STABILITY WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY: A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - REPORTING GROUP A. COMMUNITY ENGAGEMENT THE GOAL OF THE COMMUNITY ENGAGEMENT PROCESS WAS TO SOLICIT INPUT FROM A WIDE RANGE OF STAKEHOLDERS SO THAT THE SAMPLE WAS AS REPRESENTATIVE AS POSSIBLE OF THOSE FACING INEQUITIES IN SAN DIEGO COUNTY. SPECIAL EFFORTS WERE MADE TO INCLUDE COMMUNITY MEMBERS FROM GROUPS THAT EXPERIENCE HEALTH DISPARITIES AND SERVICE PROVIDERS WHO WORK WITH THOSE VULNERABLE POPULATIONS. A TOTAL OF 841 INDIVIDUALS PARTICIPATED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING EFFORTS: - WORKING WITH COMMUNITY HEALTH WORKERS TO CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS. - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS, COMMUNITY HEALTH WORKERS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, CIVIC LEADERS, AND HEALTH CARE LEADERS (CONDUCTED IN COLLABORATION WITH KAISER FOUNDATION HOSPITAL (KFH)-SAN DIEGO). - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH HOSPITAL AND HEALTH SYSTEM CLINICIANS, CASE MANAGERS, SOCIAL WORKERS, AND EXECUTIVE LEADERS. - DISTRIBUTING AN ONLINE SURVEY TO COMMUNITY MEMBERS, HOSPITAL STAFF, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL GOVERNMENT STAFF. THE CHNA COMMITTEE WORKED WITH COMMUNITY PARTNERS TO PLAN COMMUNITY ENGAGEMENT ACTIVITIES WITH STAKEHOLDERS REPRESENTING EVERY REGION OF SAN DIEGO COUNTY AND ALL AGE GROUPS. IN ADDITION, THE CHNA COMMITTEE EXPLICITLY SOUGHT TO ENGAGE A WIDE VARIETY OF STAKEHOLDERS REPRESENTING NUMEROUS, DIVERSE RACIAL AND ETHNIC GROUPS. KEY INFORMANT INTERVIEWS AND FOCUS GROUPS KEY INFORMANT INTERVIEWS AND FOCUS GROUPS WERE USED TO IDENTIFY AND EXPLORE PRIORITY HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO CARE, AND COMMUNITY ASSETS AND RESOURCES, WITH INTERVIEWS AND FOCUS GROUPS CONDUCTED BETWEEN OCTOBER 2021 AND APRIL 2022. INTERVIEWERS AND FACILITATORS EMPLOYED THE QUESTIONS DEVELOPED AND APPROVED BY THE CHNA COMMITTEE TO GENERATE DISCUSSION ABOUT SPECIFIC COMMUNITY HEALTH NEEDS, AS WELL AS OPEN ENDED QUESTIONS FOR BROADER DISCUSSIONS. BROAD QUESTIONS ABOUT HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH WERE ASKED AT THE BEGINNING OF EACH DISCUSSION, FOLLOWED BY MORE SPECIFIC QUESTIONS TARGETED FOR THE PARTICIPANTS. QUESTIONS VARIED DEPENDING ON THE EXPERTISE AND/OR SPECIFIC INTERESTS OF THE PERSON OR GROUP PARTICIPATING IN EACH INTERVIEW AND FOCUS GROUP. FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED VIA ZOOM. INCENTIVES, IN THE FORM OF GIFT CARDS, WERE ALSO PROVIDED WHEN THE GROUPS WERE COMPRISED OF COMMUNITY RESIDENTS. EACH INTERVIEW AND FOCUS GROUP BEGAN WITH A DISCUSSION ABOUT THE PURPOSE AND PROCESS OF THE CHNA. THE INTERVIEWER OBTAINED VERBAL AND VISUAL CONSENT TO PROCEED (AND, IN SOME CASES, RECORD) AND ASSURED PARTICIPANTS THAT THEIR PARTICIPATION WAS VOLUNTARY AND THAT THEIR FEEDBACK WOULD BE ANONYMOUS. INTERPRETATIVE AND TRANSLATION SERVICES WERE ARRANGED FOR ANY GROUP THAT REQUESTED THEM. ONE FOCUS GROUP WAS CONDUCTED IN SPANISH BY A FACILITATOR THROUGH SIMULTANEOUS ENGLISH AND SPANISH INTERPRETATION. ONLINE COMMUNITY SURVEY THE CHNA ONLINE COMMUNITY SURVEY WAS USED TO SUPPORT PRIORITIZATION OF HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH BASED ON COMMUNITY FEEDBACK ABOUT WHAT SURVEY RESPONDENTS VIEWED AS THE MOST IMPORTANT OR MOST SERIOUS CHALLENGES. THE SURVEY WAS DISTRIBUTED VIA EMAIL TO TARGETED COMMUNITY- BASED ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, RESIDENT-LED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, GOVERNMENT AGENCIES, GRANTMAKING ORGANIZATIONS, AND HOSPITALS AND HEALTH SYSTEMS THAT SERVE A DIVERSE ARRAY OF PEOPLE IN SAN DIEGO COUNTY. WHEN POSSIBLE, THESE ORGANIZATIONS SHARED THE LINK TO THE SURVEY WITH THE CLIENTS THEY SERVED. EMAIL RECIPIENTS WERE ALSO ENCOURAGED TO SHARE THE SURVEY WITH THEIR COLLEAGUES. THE SURVEY - OPEN FROM FEBRUARY 14 TO MARCH 30, 2022 - WAS ALSO WIDELY SHARED THROUGH SOCIAL EMAIL AND RESHARED BY COMMUNITY-BASED ORGANIZATIONS. THE SURVEY WAS DESIGNED TO BE TAKEN BY COMMUNITY MEMBERS AND WAS TRANSLATED FROM ENGLISH INTO FIVE ADDITIONAL LANGUAGES: ARABIC, SPANISH, SOMALI, TAGALOG, AND VIETNAMESE. MID-CITY CAN, A COMMUNITY-BASED ORGANIZATION LOCATED IN CITY HEIGHTS, WAS CONTRACTED TO COMPLETE THE TRANSLATIONS. RESEARCH PARTNERS AT THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT THE SAN DIEGO STATE UNIVERSITY (SDSU) SCHOOL OF PUBLIC HEALTH (SPH) FACILITATED TWO FOCUS GROUPS WITH COMMUNITY HEALTH WORKERS (CHWS). THE IPH CONDUCTED BOTH FOCUS GROUPS THROUGH ZOOM. ALL FOCUS GROUP PARTICIPANTS WERE COMMUNITY HEALTH WORKERS WORKING FOR A COVID-19 CONTACT TRACING PROGRAM. FOCUS GROUP PARTICIPANTS WERE RECRUITED THROUGH MULTIPLE AVENUES, INCLUDING ANNOUNCEMENTS IN THE COUNTY OF SAN DIEGO HHSA'S COMMUNITY HEALTH WORKER COLLABORATIVE NEWSLETTER, DISSEMINATED BY THE COUNTY TO PROVIDE UPDATES ON COVID-19 COMMUNICATION AND OUTREACH SERVICES TO THE INDIVIDUALS WORKING ON ONE OF THE COUNTY COVID-19 CONTRACTS. IN ADDITION, EMAILS WERE DISSEMINATED DIRECTLY TO ALL CHWS ON THE COMMUNITIES FIGHTING COVID! PROJECT AT SDSU, AND EMAILS WERE SENT TO THE LEADS ON EIGHT DIFFERENT COUNTY COVID-19 CONTRACTS, REQUESTING THAT THEY DISSEMINATE THE INFORMATION TO THEIR CHWS OR OUTREACH WORKERS. THE ANNOUNCEMENT INCLUDED AN INTEREST FORM THAT ASKED FOR THE PERSON'S CONTACT INFORMATION, DAY OF THE WEEK AND TIME OF DAY THAT WORKED BEST FOR THEM, TYPE OF GIFT CARD THEY WOULD LIKE TO RECEIVE AS A THANK YOU, AND A BRIEF DESCRIPTION OF THE TYPE OF WORK THEY CURRENTLY DO. FOCUS GROUP PARTICIPANTS WERE ASKED OPEN-ENDED QUESTIONS ABOUT IDENTIFYING SPECIFIC HEALTH CONDITIONS OF CONCERN, ABOUT INEQUITIES IN THE COMMUNITY, AND ABOUT THE NEEDS OF YOUTH AND SENIORS. GIFT CARDS WERE EMAILED TWO DAYS AFTER THE FOCUS GROUP AS A THANK YOU TO ALL PARTICIPANTS. PROMOTORAS AND COMMUNITY HEALTH WORKER INTERVIEWS/ACCESS TO HEALTH CARE INTERVIEWS TO ENSURE THE REPORT INCLUDED DIRECT COMMUNITY MEMBER FEEDBACK FROM RACIAL AND ETHNIC GROUPS EXPERIENCING DISPARATE HEALTH OUTCOMES, THE CHNA COMMITTEE EMPLOYED A NEW STRATEGY TO PARTNER WITH COMMUNITY-BASED ORGANIZATIONS THAT WORK WITH PROMOTORAS AND COMMUNITY HEALTH WORKERS. THE ONLINE COMMUNITY SURVEY WAS ADAPTED WITH A SUBSET OF THE SURVEY QUESTIONS FOR USE AS A DATA COLLECTION TOOL. THE SAN DIEGO REFUGEE COMMUNITIES COALITION AND THE CHICANO FEDERATION WERE SELECTED TO RECRUIT INTERESTED COMMUNITY HEALTH WORKERS AND PROMOTORAS TO CONDUCT THE INTERVIEWS. HASDIC STAFF ATTENDED A SAN DIEGO REFUGEE COMMUNITIES COALITION WEEKLY COMMUNITY HEALTH WORKER MEETING TO PROVIDE TRAINING ON THE GOALS OF THE CHNA AND HOW TO ADMINISTER THE INTERVIEW. HASDIC STAFF ALSO PROVIDED TRAINING TO THE CHICANO FEDERATION PROMOTORAS. PROMOTORAS AND COMMUNITY HEALTH WORKERS CONDUCTED INTERVIEWS EITHER IN PERSON OR OVER THE PHONE. INTERVIEWERS ASKED OPEN-ENDED QUESTIONS ABOUT THE FOLLOWING: HEALTH NEEDS, SOCIAL NEEDS, ACCESS TO CARE CHALLENGES, AND WHAT HOSPITALS COULD DO TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. INTERVIEWERS THEN CODED RESPONSES AND INPUT THEM IN AN ONLINE DATA COLLECTION TOOL. PRICE PHILANTHROPIES FOUNDATION GENEROUSLY PROVIDED GRANTS TO BOTH ORGANIZATIONS TO COMPENSATE PROMOTORAS AND COMMUNITY HEALTH WORKERS FOR COMPLETING INTERVIEWS.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - REPORTING GROUP A. 2022 CHNA PARTICIPATING HOSPITALS AND HEALTH SYSTEMS THE CHNA RESPONDS TO IRS REGULATORY REQUIREMENTS THAT PRIVATE NOT-FOR-PROFIT (TAX-EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. ALTHOUGH ONLY NOT-FOR-PROFIT 501(C)(3) HOSPITALS AND HEALTH SYSTEMS ARE SUBJECT TO STATE AND IRS REGULATORY REQUIREMENTS, THE MAJORITY OF 2022 CHNA COLLABORATIVE MEMBERS ARE HOSPITALS AND HEALTH SYSTEMS THAT ARE NOT SUBJECT TO ANY CHNA REQUIREMENTS BUT ARE DEEPLY ENGAGED IN THE COMMUNITIES THEY SERVE AND COMMITTED TO THE GOALS OF A COLLABORATIVE CHNA. EVERY HEALTH SYSTEM, HEALTH DISTRICT, PRIVATE HOSPITAL AND BEHAVIORAL HEALTH HOSPITAL IN SAN DIEGO PARTICIPATED IN THE COLLECTIVE EFFORT TO BETTER UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF SAN DIEGO COMMUNITIES. PARTICIPATING HOSPITAL AND HEALTH SYSTEMS SUPPORTED THE CHNA PROCESS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY WORKGROUP, THE COMMUNITY NEEDS ASSESSMENT COMMITTEE, AND THE HASDIC BOARD OF DIRECTORS. -ALVARADO HOSPITAL MEDICAL CENTER -ALVARADO PARKWAY INSTITUTE BEHAVIORAL HEALTH SYSTEM -AURORA BEHAVIORAL HEALTH CARE SAN DIEGO -GROSSMONT HEALTHCARE DISTRICT -KAISER PERMANENTE SAN DIEGO -PALOMAR HEALTH -PARADISE VALLEY HOSPITAL/BAYVIEW BEHAVIORAL HEALTH CAMPUS -RADY CHILDREN'S HOSPITAL - SAN DIEGO -SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL -SCRIPPS HEALTH -SHARP HEALTHCARE -TRI-CITY MEDICAL CENTER -UC SAN DIEGO HEALTH -VA SAN DIEGO HEALTHCARE SYSTEM

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - REPORTING GROUP A. THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES(HASDIC) CONTRACTED WITH THE FOLLOWING RESEARCH PARTNERS ON THE 2022 COMMMUNITY HEALTH NEEDS ASSESSMENT. PATRICIA SINAY FROM COMMUNITY INVESTMENT STRATEGIES (CIS) SUPPORTED THE HOSPITAL ASSOCIATION TEAM WITH QUALITATIVE RESEARCH AND REPORT WRITING. CIS PROVIDES STRATEGIC VISIONING PLANNING, MANAGEMENT TRAINING, AND PROGRAM IMPLEMENTATION SERVICES TO NONPROFITS, BUSINESSES, GOVERNMENTS, AND PHILANTHROPY. AS A LATINA IMMIGRANT, PATRICIA SPECIALIZES IN INCLUSIVE, CROSS-SECTOR EFFORTS THAT STRENGTHEN THE GREATER GOOD FOR INDIVIDUALS, FAMILIES, AND COMMUNITIES. HASDIC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU). IN THE LAST 20 YEARS, THE IPH HAS PARTNERED WITH OVER 70 LOCAL, STATE, NATIONAL AND INTERNATIONAL PUBLIC AND PRIVATE COMMUNITY-BASED AGENCIES AND ORGANIZATIONS REPRESENTING MORE THAN 120 MULTIPLE-YEAR CONTRACTS WITH A WIDE VARIETY OF NEEDS AND METHODOLOGIES. THE IPH HAS EXPERTISE IN QUALITATIVE AND QUANTITATIVE COMMUNITY-BASED RESEARCH METHODS. IN ADDITION, THE IPH HAS EXTENSIVE EXPERIENCE IN SUCCESSFUL COMMUNITY ENGAGEMENT WITH DIVERSE GROUPS, INCLUDING NON-ENGLISH SPEAKERS. THE IPH HAS BEEN WORKING ACROSS CULTURES AND WITH VULNERABLE POPULATIONS FOR 25 YEARS, INCLUDING PROGRAMS WITH ASIAN AND PACIFIC ISLANDER COMMUNITIES, AFRICAN-AMERICAN COMMUNITIES, EAST AFRICAN COMMUNITIES, LATINO COMMUNITIES, NATIVE AMERICAN COMMUNITIES, LOW-INCOME COMMUNITIES, GAY, BISEXUAL, TRANSGENDER INDIVIDUALS, PEOPLE LIVING WITH HIV/AIDS, INDIVIDUALS EXPERIENCING HOMELESSNESS, ADOLESCENTS WHO ARE PREGNANT OR PARENTING, AND SURVIVORS OF DOMESTIC VIOLENCE AND SEXUAL ASSAULT, AMONG OTHERS. IPH STAFF HAVE SPECIAL EXPERTISE IN CONDUCTING CULTURALLY COMPETENT WORK AND EXPLORING SENSITIVE ISSUES. IPH COMMUNITY ENGAGEMENT EFFORTS HAVE INCLUDED PERFORMING KEY INFORMANT INTERVIEWS, LEADING FOCUS GROUPS, FACILITATING TOWN HALL MEETINGS, AND CONDUCTING PATIENT AND PROVIDER INTERVIEWS.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - REPORTING GROUP A. SCRIPPS HEALTH IMPLEMENTATION STRATEGY SUMMARY AND COMMUNITY NEEDS IDENTIFIED. WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY; A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL-SUITED TO DEVELOPING A RESPONSE TO THE SCRIPPS CHNA. THE EVALUATION OF THE IMPLEMENTATION STRATEGY ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND ADJUSTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION STRATEGY ARE ALSO TAILORED TO EACH OBJECTIVE AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION STRATEGY IS FILED ANNUALLY WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. COMMUNITY NEEDS SCRIPPS IS ADDRESSING THE HEALTH FOCUS AREAS IDENTIFIED ABOVE WERE DETERMINED THROUGH DATA COLLECTION, ANALYSIS, AND A PRIORITIZATION PROCESS THAT INCORPORATED COMMUNITY INPUT. SCRIPPS IS ADDRESSING ACCESS TO CARE, AGING CARE SUPPORT, BEHAVIORAL HEALTH, CHILDREN YOUTH WELLBEING, CHRONIC HEALTH CONDITIONS WHICH INCLUDES CARDIOVASCULAR DISEASE, CANCER AND DIABETES, COMMUNITY SAFETY AND ECONOMIC STABILITY IN THE FY23-25 IMPLEMENTATION STRATEGY. SCRIPPS ADDRESSES MANY OF THE SOCIAL DETERMINANTS OF HEALTH WITHIN THE HEALTH CONDITIONS IDENTIFIED IN THIS REPORT SUCH AS, COMMUNITY AND SOCIAL SUPPORT, FOOD INSECURITY, TRANSPORTATION, EDUCATION, AND HOMELESSNESS COMMUNITY NEEDS SCRIPPS IS NOT DIRECTLY ADDRESSING HOMELESSNESS AND HOUSING INSTABILITY ARE IDENTIFIED AS IMPORTANT FACTORS WITHIN THE CHNA FINDINGS. HOMELESSNESS AND HOUSING ARE NOT DIRECTLY ADDRESSED IN THE SCRIPPS IMPLEMENTATION STRATEGY AS WE FOCUS OUR RESOURCES ON MORE DIRECT HEALTH ISSUES AND CONDITIONS IN ACCORDANCE WITH OUR EXPERTISE AND MISSION. SCRIPPS HAS NOT DIRECTLY SCRIPPS HEALTH 14 FY2023-2025 IMPLEMENTATION STRATEGY DEVELOPED PROGRAMS THAT SPECIFICALLY ADDRESS HOUSING INSECURITY, BUT THIS IS ADDRESSED AS PART OF OUR CARE TO PATIENTS. WHEN PATIENTS' HOUSING NEEDS ARE IDENTIFIED, THE SCRIPPS MULTIDISCIPLINARY TEAM WORKS TO ADDRESS THE NEED. ADDITIONALLY, THE SCRIPPS HEALTH SYSTEM HAS SOCIAL WORK AND CASE MANAGEMENT RESOURCES IN PLACE THROUGHOUT THE INPATIENT SETTING THAT ADDRESS THIS UNMET NEED BY CONNECTING PATIENTS TO MORE PERMANENT SOURCES OF INCOME, HOUSING, AND OTHER SELF-RELIANCE MEASURES. SCRIPPS' WORK TO ADDRESS HOUSING INSECURITY IS LARGELY DONE VIA COLLABORATION AND REFERRALS TO COMMUNITY PARTNERS. IN ADDITION TO THE ABOVE INDIRECT MEASURES, SCRIPPS IS ALSO ADDRESSING THESE COMMUNITY NEEDS IN ACCORDANCE WITH CALIFORNIA'S REGULATIONS, SUCH AS SB 1152 DISCHARGE PLANNING FOR HOMELESS PATIENTS. THIS 2019 REGULATION REQUIRES HOSPITALS TO IMPLEMENT A SET OF REQUIREMENTS REGARDING DISCHARGE PLANNING FOR THEIR HOMELESS PATIENTS. SCRIPPS IS FULFILLING THIS REQUIREMENT BY PROVIDING PACKAGED MEALS, WEATHER-APPROPRIATE CLOTHING, TRANSPORTATION, DISCHARGE MEDICATIONS AND/OR PRESCRIPTIONS, INFECTIOUS DISEASE SCREENINGS AND VACCINATIONS, REFERRALS FOR BEHAVIORAL HEALTH AND OTHER REFERRALS TO SHELTERS OR HOUSING. SCRIPPS HEALTH REMAINS COMMITTED TO THE CARE AND IMPROVEMENT OF HEALTH FOR ALL SAN DIEGANS AND WILL LOOK TO CONTINUE THE SEARCH OF NEW OPPORTUNITIES AND NEW PARTNERSHIPS TO ADDRESS THESE AND FUTURE NEEDS. DETAIL ON THE STRATEGIES, INITIATIVES, MEASURES OF IMPLEMENTATION AND METRICS USED TO EVALUATE THE EFFECTIVENESS OF THE COMMUNITY NEEDS IS IDENTIFIED THROUGH SCRIPPS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION STRATGEY. THE COMPLETE REPORTS ARE AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMMUNITY-NEEDS

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - REPORTING GROUP A. OTHER CRITERIA TO DETEMRINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'S DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. SCRIPPS USES THE PROSPECTIVE METHOD FOR DETERMINING AGB AND ESTIMATES THE AMOUNT IT WOULD BE PAID BY MEDICARE, INCLUDING AMOUNTS PAYABLE BY A MEDICARE BENEFICIARY. AFTER A DETERMINATION OF ELIGIBILITY, THIS AMOUNT REPRESENTS THE MAXIMUM A QUALIFIED PATIENT WILL BE REQUIRED TO PAY. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 40% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS.

Schedule H, Part V, Section B, Line 16 Facility A, 1
"Facility A, 1 - REPORTING GROUP A. THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FAP IS ACHIEVED THROUGH THE FOLLOWING METHODS, INCLUDING BUT NOT LIMITED TO: A. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL, I.E. EMERGENCY DEPARTMENT, OUTPATIENT SETTINGS, AND MAIN ADMISSION AREAS. B. PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP (""FAP SUMMARY"") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. C. A WRITTEN NOTICE ABOUT THE AVAILABILITY OF CHARITY CARE AT A SCRIPPS HOSPITAL IS PROVIDED TO EACH PATIENT AT THE TIME OF SERVICE OR WHEN THE PATIENT LEAVES THE FACILITY. IF THE PATIENT IS NOT GIVEN THE NOTICE AT THE HOSPITAL, SCRIPPS WILL MAIL THE NOTICE TO THE PATIENT WITHIN 72 HOURS. D. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY, REFERRED TO AS, FAP SUMMARY: i. CONTAINS THE WEBSITE ADDRESS WHERE RESOURCES CAN BE FOUND ONLINE, ii. PROVIDES THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED, iii. IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. E. SCRIPPS WEB SITE: THE FOLLOWING RESOURCES ARE AVAILABLE ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THEY ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP): i. PATIENT FINANCIAL ASSISTANCE POLICY, INCLUDING DISCOUNTED PAYMENTS AND CHARITY CARE POLICY (FAP), ii. FINANCIAL ASSISTANCE POLICY SUMMARY (FAP SUMMARY), iii. PATIENT ACCOUNT MANAGEMENT BILLING AND COLLECTIONS POLICY, iv. FINANCIAL ASSISTANCE APPLICATIONS. F. SCRIPPS BILLING STATEMENTS INCLUDE: i. STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, ii. TELEPHONE NUMBER FOR SCRIPPS STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS, iii. WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. G. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. H. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE CALIFORNIA DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) AS REQUIRED BY LAW."

Schedule H, Part V, Section B, Line 2
SCRIPPS HEALTH ENTERED INTO A JOINT VENTURE RELATIONSHIP WITH UCSD AND SELECT MEDICAL DURING ITS YEAR ENDED SEPTEMBER 30, 2021 TO OPERATE A HOSPITAL CALLED SELECT SPECIALITY HOSPITAL-SAN DIEGO. SCRIPPS AND UCSD WOULD EACH OWN 24.5% OF THE JOINT VENTURE AND SELECT MEDICAL WOULD OWN 51%. SECTION 1.5 OF THE AGREEMENT NOTES THAT THE PURPOSE OF THE COMPANY IS TO OWN, OPERATE, AND MANAGE A LONG TERM ACUTE CARE HOSPITAL AND THAT THE COMPANY AND BUSINESS SHALL AT ALL TIMES BE OPERATED AND MANAGED IN A MANNER THAT FURTHERS THE CHARITABLE AND COMMUNITY-BASED HEALTHCARE PURPOSES, MISSION, VISION AND VALUES OF THE TAX EXEMPT MEMBERS INCLUDING: - PROVIDING ACCESS TO PATIENT CARE SERVICES BASED ON MEDICAL NECESSITY. - PROVIDING CARE TO THOSE COVERED BY MEDICARE, MEDICAID/MEDI-CAL AND OTHER FEDERAL AND STATE GOVERNMENTAL PROGRAMS. - ESTABLISHING A FINANCIAL ASSISTANCE POLICY AND CHARITY CARE POLICY. - COOPERATING WITH THE LLC MEMBERS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY.

Schedule H, Part V, Section B, Line 13 Facility B, 1
Facility B, 1 - REPORTING GROUP B. OTHER CRITERIA TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS' DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 40% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS.

Schedule H, Part V, Section B, Line 16 Facility B, 1
Facility B, 1 - REPORTING GROUP B. SELECT SPECIALTY HOSPITAL SAN DIEGO PROVIDES FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE TO PATIENTS WHO ARE UNABLE TO PAY. THE FOLLOWING IS A SUMMARY OF FINANCIAL ASSISTANCE AVAILABLE AT SELECT SPECIALTY HOSPITAL SAN DIEGO. FINANCIAL ASSISTANCE OFFERED IF YOU DO NOT HAVE INSURANCE, WE PROVIDE FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE. ELIGIBLE CARE INCLUDES MEDICALLY NECESSARY SERVICES AS DEFINED BY MEDICARE (SERVICES OR ITEMS REASONABLE AND NECESSARY FOR THE DIAGNOSIS OR TREATMENT OF ILLNESS OR INJURY). TO RECEIVE FINANCIAL ASSISTANCE, YOU MUST MEET ONE OF THE FOLLOWING CRITERIA: (A) ARE A U.S. CITIZEN; OR (B) CARRY A UNITED STATES PERMANENT RESIDENT CARD (USCIS FORM I-551); OR (C) LIVE WITHIN 50 MILES OF THE FACILITY. YOU WILL RECEIVE FREE CARE, OR 100% WRITE OFF OF PATIENT LIABILITY AFTER INSURANCE HAS PAID, IF YOUR FAMILY INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY INCOME GUIDELINES. WRITE OFF OF THE DISCOUNTED FINANCIAL ASSISTANCE AMOUNT WHICH IS CALCULATED AS A PERCENTAGE OF TOTAL GROSS CHARGES MAY ALSO BE AVAILABLE FOR UNINSURED AND CERTAIN OTHER PATIENTS WITH FAMILY INCOME UP TO 400% OF THE FEDERAL POVERTY INCOME GUIDELINES. IF FAMILY INCOME IS OVER 400% OF FEDERAL POVERTY INCOME GUIDELINES, FINANCIAL ASSISTANCE MAY STILL BE CONSIDERED. ALL APPLICANTS WILL BE SCREENED FOR MEDICAID COVERAGE AND MUST COOPERATE WITH THE MEDICAID REPRESENTATIVES TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. ADDITIONAL WAYS TO QUALIFY IF YOU DO NOT MEET THE INCOME CRITERIA ABOVE, REGARDLESS OF YOUR INSURANCE STATUS, YOU WILL BE CONSIDERED ON A CASE-BY-CASE BASIS FOR FINANCIAL ASSISTANCE. CONTACT US TO DISCUSS EXCEPTIONAL PERSONAL OR FINANCIAL CIRCUMSTANCES, OR IF THERE ARE SPECIAL MEDICAL CIRCUMSTANCES WHERE TREATMENT CAN ONLY BE PROVIDED BY SELECT SPECIALTY HOSPITAL SAN DIEGO MEDICAL STAFF. WHAT YOU WILL BE CHARGED IF YOU RECEIVE FINANCIAL ASSISTANCE UNDER OUR POLICY, YOU WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN THE AMOUNT WE GENERALLY BILL PATIENTS HAVING MEDICARE COVERAGE.HOW TO OBTAIN COPIES OF OUR POLICY AND APPLICATION. YOU MAY OBTAIN A COPY OF OUR FULL FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION FORM FREE OF CHARGE IN ANY OF THE FOLLOWING WAYS: IN OUR ADMISSIONS AREAS OF OUR FACILITY AT 555 WASHINGTON STREET, SAN DIEGO, CA 92103; ONLINE AT HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/PATIENTS-AND-CAREGIVERS/FINANCIAL-ASSISTANCE OR BY CALLING OUR ADMISSIONS DEPARTMENT AT 619-686-4525. HOW TO APPLY AND OBTAIN ASSISTANCE YOU MAY APPLY AT ANY POINT IN THE ADMISSION OR BILLING PROCESS BY COMPLETING AND SUBMITTING AN APPLICATION, AND PROVIDING INCOME INFORMATION. ALL FINANCIAL ASSISTANCE APPLICATIONS, WHETHER COMPLETED IN PERSON, ONLINE, DELIVERED OR MAILED, WILL BE FORWARDED TO OUR CENTRAL BUSINESS OFFICE FOR EVALUATION AND PROCESSING. IF YOU NEED ANY HELP IN APPLYING, PLEASE CONTACT OUR ADMISSIONSDEPARTMENT AT THE FACILITY OR CALL OUR CENTRAL BUSINESS OFFICE AT 888.868.1103. COPIES OF OUR FINANCIAL ASSISTANCE POLICY, APPLICATION FORM AND THIS SUMMARY ARE AVAILABLE IN ENGLISH AND SPANISH.

Schedule H, Part I, Line 3c
"SCRIPPS FINANCIAL ASSISTANCE, CHARITY CARE AND DSCOUNT PAYMENTS POLICY (""FAP"") DESCRIBES THE PROCESS FOR PATIENTS WHO NEED HELP PAYING FOR THEIR EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL AND AMBULATORY CARE AT SCRIPPS HOSPITALS, (SCRIPPS MEMORIAL HOSPITAL LA JOLLA, SCRIPPS MEMORIAL HOSPITAL ENCINITAS, SCRIPPS GREEN HOSPITAL, SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA), AND SCRIPPS MEDICAL FOUNDATION. SCRIPPS PROVIDES FINANCIAL ASSISTANCE IN ACCORDANCE WITH ALL STATE AND FEDERAL REGULATIONS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS FAP IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. THE FAP APPLIES TO ALL SERVICES PROVIDED AT SCRIPPS HEALTH TO INCLUDE PHYSICIAN PROFESSIONAL SERVICES THAT ARE DELIVERED BY SCRIPPS MEDICAL FOUNDATION PHYSICIANS AND SURGEONS. GENERAL CIRCUMSTANCES REQUIRING ASSISTANCE MAY INCLUDE: 1. PATIENTS WITH NO INSURANCE, 2. PATIENTS WHO ARE NOT ELIGIBLE FOR THIRD PARTY ASSISTANCE, 3. PATIENTS WITH 3RD PARTY COVERAGE WHICH DOES NOT COVER/REIMBURSE ALL CHARGES, E.G. MEDICAID, OTHER INDIGENT CARE PROGRAMS. 4. PATIENTS WITH WHO HAVE HIGH MEDICAL COSTS AS DEFINED BY STATE AND FEDERAL LAW, WHO ARE AT OR BELOW 400% OF THE FPL. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, SCRIPPS WILL FORGIVE A PORTION OF THE BILL. FOR AN INCOME LEVEL BETWEEN 201 AND 400 PERCENT OF FPL, AND FOLLOWING A DETERMINATION OF ELIGIBILITY, THE PATIENT RESPONSIBILITY WILL NOT BE CHARGED MORE THAN THE CALCULATED DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. NET WORTH INFORMATION INCLUDED ON THE PATIENT FINANCIAL ASSESSMENT STATEMENT WILL BE USED TO EVALUATE THESE SPECIAL SITUATIONS. PATIENTS DETERMINED TO BE ""HOMELESS AND NOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS'DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS' AMOUNTS GENERALLY BILLED (AGB) AS CALCULATED WITH THE PROSPECTIVE METHOD. SCRIPPS WILL OFFER EXTENDED PAYMENT PLANS WITHOUT INTEREST TO ALLOW PAYMENT OF THE DISCOUNTED PRICE OVER TIME. THE HOSPITAL AND THE PATIENT SHALL NEGOTIATE THE TERMS OF THE PAYMENT PLAN AND TAKE INTO CONSIDERATION THE PATIENT'S FAMILY INCOME AND ESSENTIAL LIVING EXPENSES. IF AGREEMENT ON TERMS CANNOT BE ACHIEVED, THE FORMULA REQUIRED BY CALIFORNIA LAW WILL BE USED TO CREATE A REASONABLE PAYMENT PLAN. ELIGIBILITY FOR CHARITY CARE OR DISCOUNTED PAYMENT MAY BE DETERMINED AT ANY TIME SCRIPPS IS IN RECEIPT OF DOCUMENTATION OF INCOME OR ASSETS. EVERY REASONABLE EFFORT WILL BE MADE TO MAKE A DETERMINATION OF ELIGIBILITY WITHIN 15 BUSINESS DAYS OF RECEIPT OF ALL REQUESTED DOCUMENTATION. DETAILS OF THE CHARITY CARE OR DISCOUNT WILL BE PROVIDED TO THE PATIENT OR THE PATIENTS REPRESENTATIVE. AN ELIGIBILITY DETERMINATION WILL BE VALID FOR A PERIOD OF SIX MONTHS FROM THE DATE OF DETERMINATION UNLESS THE PATIENT'S CIRCUMSTANCES HAVE CHANGED. AT THE TIME OF THE EVALUATION, SHOULD IT BE DETERMINED THAT THE PATIENT HAS PAID MORE THAN REQUIRED, A REFUND OF THE OVERPAYMENT, WITH INTEREST (10 PERCENT PER YEAR) WILL BE ISSUED PROMPTLY. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 50% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS."

Schedule H, Part I, Line 6a SCHEDULE H, PART I, LINE 6A
THE 2022 COMMUNITY BENEFIT REPORT WAS ADOPTED BY THE SCRIPPS BOARD ON MARCH 2022 AND MADE PUBLIC ON HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT WAS ADOPTED BY THE SCRIPPS BOARD IN SEPTEMBER 2022, TAX YEAR 2021 AND THE CHNA WAS MADE PUBLIC ON HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY.

Schedule H, Part VI, Line 2 NEEDS ASSESSMENT (CONTINUATION)
"QUANTITATIVE DATA INCLUDED: - CALIFORNIA'S DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) LIMITED DATA SETS, 2017-2019 SPEEDTRACK - COMMUNITY NEED INDEX (CNI) - PUBLIC HEALTH ALLIANCE OF SOUTHERN CALIFORNIA HEALTHY PLACES INDEX (HPI) - DATA FROM NATIONAL AND STATE - WIDE DATA SETS WERE ANALYZED INCLUDING SAN DIEGO MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH. THE HPI AND THE CNI WERE USED TO IDENTIFY THE MOST UNDER-RESOURCED GEOGRAPHIC COMMUNITIES. THIS INFORMATION HELPED GUIDE THE COMMUNITY ENGAGEMENT PROCESS, INCLUDING SELECTING COMMUNITIES FROM WHICH TO SOLICIT INPUT AND DEVELOPING RELEVANT AND MEANINGFUL ENGAGEMENT TOPICS AND QUESTIONS. DATA FROM THE COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY, INCLUDING THE FOLLOWING REPORTS AND DASHBOARDS WERE ALSO USED: REPORTS - COUNTY OF SAN DIEGO COMMUNITY HEALTH STATISTICS - HEALTH DISPARITIES EXECUTIVE SUMMARY REPORT - RACIAL EQUITY: FRAMEWORK AND OUTCOMES BRIEF - SAN DIEGO COUNTY SELF-SUFFICIENCY STANDARD, HOUSEHOLD WITH TWO ADULTS, ONE PRESCHOOL-AGE CHILD, AND ONE SCHOOL-AGE CHILD, 2021 - OVERDOSE DATA TO ACTION (OD2A) COMMUNITY HEALTH STATISTICS DASHBOARDS - LGBTQ HEALTH AND WELL-BEING DASHBOARDS - HEALTH EQUITY DASHBOARD SERIES: RACIAL EQUITY DASHBOARDS - SAN DIEGO COUNTY SELF-SUFFICIENCY STANDARD DASHBOARD - COVID-19 IN SAN DIEGO COUNTY QUALITIATIVE DATA - COMMUNITY ENGAGEMENT THE GOAL OF THE COMMUNITY ENGAGEMENT PROCESS WAS TO SOLICIT INPUT FROM A WIDE RANGE OF STAKEHOLDERS SO THAT THE SAMPLE WAS AS REPRESENTATIVE AS POSSIBLE OF THOSE FACING INEQUITIES IN SAN DIEGO COUNTY. A TOTAL OF 841 INDIVIDUAS PARTICPATED IN THE 2022 CHNA. INPUT FROM THE COMMUNITY WAS GATHERED THROUGH THE FOLLOWING DISCUSSIONS: - WORKING WITH COMMUNITY HEALTH WORKERS TO CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS, COMMUNITY HEALTH WORKERS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, CIVIC LEADERS, AND HEALTH CARE LEADERS (CONDUCTED IN COLLABORATION WITH KAISER FOUNDATION HOSPITAL (KFH)-SAN DIEGO) - CONDUCTING FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH HOSPITAL AND HEALTH SYSTEM CLINICIANS, CASE MANAGERS, SOCIAL WORKERS, AND EXECUTIVE LEADERS - DISTRIBUTING AN ONLINE SURVEY TO COMMUNITY MEMBERS, HOSPITAL STAFF, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL GOVERNMENT STAFF 2022 CHNA PRIORITIZATION OF THE TOP COMMUNITY NEEDS THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH HEALTH CONDITIONS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED, THE MAGNITUDE/SCALE OF THE NEED; DISPARITIES OR INEQUITIES AND CHANGE OVER TIME. THOSE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH (SDOH) THAT MET THE LARGEST NUMBER OF CRITERIA WERE THEN SELECTED AS TOP PRIORITY COMMUNITY HEALTH NEEDS. THROUGH THE PRIORITIZATION PROCESS DESCRIBED IN THE METHODOLOGY SECTION, THE CHNA COMMITTEE IDENTIFIED THE MOST CRITICAL TOP COMMUNITY NEEDS WITHIN SAN DIEGO COUNTY, LISTED BELOW IN ALPHABETICAL ORDER: - ACCESS TO HEALTH CARE - AGING CARE SUPPORT - BEHAVIORAL HEALTH - CHILDREN YOUTH WELLBEING - CHRONIC HEALTH CONDITIONS - COMMUNITY SAFETY - ECONOMIC STABILITY FOUNDATIONAL CHALLENGES THE 2022 CHNA RECOGNIZED HEALTH DISPARITIES AND WORKFORCE SHORTAGES AS FOUNDATIONAL CHALLENGES THAT ARE CONTRIBUTING TO THE GROWTH OF EVERY HEALTH NEED. HEALTH DISPARITIES DECADES OF RESEARCH HAS DEMONSTRATED THAT EVEN IN PRE-PANDEMIC TIMES, SOME COMMUNITIES AND POPULATIONS HAVE MUCH POORER HEALTH CARE AND OUTCOMES THAN OTHER COMMUNITIES OR POPULATIONS. THESE MAY BE ISSUES OF ACCESS ROOTED IN GEOGRAPHY, ISSUES OF FINANCE AND INSURANCE COVERAGE, OR SYSTEMIC ISSUES ROOTED IN RACISM AND DISCRIMINATION. FOR EXAMPLE, ""FRONTLINE"" WORKERS (PEOPLE WHO ARE MOST INVOLVED IN DIRECT CUSTOMER CONTACT) COULD NOT WORK FROM HOME DURING THE PANDEMIC AND WERE AT HIGHER RISK OF COVID EXPOSURE. THIS CONTRIBUTED TO DISPROPORTIONATELY HIGHER MORTALITY RATES COMPARED TO GROUPS THAT COULD WORK FROM HOME OR QUIT WORK. IN ADDITION, THE HEALTH OF SAN DIEGANS WHO WERE VULNERABLE BEFORE THE PANDEMIC - SUCH AS PEOPLE EXPERIENCING HOMELESSNESS, ISOLATED SENIORS, LGBTQ+ YOUTH, AND CHILDREN WITH SPECIAL NEEDS - DETERIORATED MORE ACUTELY AS THEY LOST ACCESS TO CRITICAL SERVICES AND FACED NEW BARRIERS TO THEIR SAFETY AND ECONOMIC STABILITY. WORKFORCE SHORTAGES COMMUNITY ENGAGEMENT PARTICIPANTS IN PREVIOUS CHNAS OFTEN MENTIONED THE NEED FOR MORE HEALTH CARE PROVIDERS, MOSTLY WITH A VIEW TOWARD BOLSTERING WORKFORCE PIPELINES. IN THE 2022 CHNA FOCUS GROUPS AND INTERVIEWS, WORKFORCE SHORTAGES WERE CONSISTENTLY AT THE FRONT OF DISCUSSIONS. IN MOST OCCUPATIONS, WORKERS ARE EXPERIENCING EXHAUSTION, EMOTIONAL TRAUMA, AND A SENSE OF ""FEELING BURNED OUT AFTER OVER TWO YEARS OF THE COVID PANDEMIC."" CLINICAL WORKERS AND SOCIAL WORK STAFF AT ALL LEVELS OF HEALTH CARE DELIVERY FACED THE SAME CHALLENGES AND FRUSTRATIONS, AS WORKFORCE SHORTAGES AND THE INCREASED MEDICAL DEMANDS OF COVID STRESSED HEALTH CARE SERVICES ACROSS THE REGION. KEY UNDERLYING THEMES STIGMA AS IN OUR 2019 CHNA FINDINGS, STIGMA AND THE BARRIERS IT CREATES AROSE ACROSS COMMUNITY ENGAGEMENT DISCUSSIONS IN 2022. STIGMA IMPACTS THE WAY PEOPLE ACCESS NEEDED SERVICES (CALFRESH, MEDI-CAL, OTHER ECONOMIC SUPPORT) THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. THIS IMPACTS THE ABILITY OF PEOPLE TO IMPROVE AND SUCCESSFULLY MANAGE HEALTH CONDITIONS. COMMUNITY ENGAGEMENT PARTICIPANTS EXPRESSED CONCERNS ABOUT THE IMPACT OF STIGMA IN RELATION TO SPECIFIC POPULATIONS INCLUDING LGBTQ+ COMMUNITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE OF COLOR, SENIORS, MEDI-CAL BENEFICIARIES, AND SURVIVORS OF DOMESTIC VIOLENCE AND HUMAN TRAFFICKING. STIGMA WAS ALSO DISCUSSED IN RELATION TO SPECIFIC HEALTH CONDITIONS SUCH AS BEHAVIORAL HEALTH, CANCER, DIABETES, AND OBESITY. TRAUMA TRAUMA AND VICARIOUS TRAUMA, WERE CITED AS FACTORS CONTRIBUTING TO COMPASSION FATIGUE AND WORKFORCE BURNOUT IN COMMUNITY INTERVIEWS AND FOCUS GROUPS. TRAUMA OCCURS BOTH AT WORK AND AT HOME, AND CONSEQUENTLY, THERE MAY BE NO ESCAPE AND DOWNTIME FROM TRAUMATIC EXPERIENCES. TRAUMATIZED COMMUNITY MEMBERS ARE SEEKING ASSISTANCE FROM HEALTH CARE PROVIDERS AND COMMUNITY-BASED ORGANIZATIONS WHO THEMSELVES HAVE EXPERIENCED GREAT STRESS SINCE THE START OF THE PANDEMIC. COMMUNITY VOICE AND EXPERIENCES THE FINDINGS OF THE 2022 CHNA ATTEMPT TO RESPOND TO THE SAN DIEGO COMMUNITY NEEDS AND CONCERNS, AS IDENTIFIED THROUGH FOCUS GROUPS, KEY INFORMANT INTERVIEWS, INTERVIEWS REGARDING ACCESS TO CARE, AND AN ONLINE SURVEY. THE QUANTITATIVE RESEARCH AND THE COMMUNITY ENGAGEMENT CONFIRMED THE INTERCONNECTEDNESS OF THE SEVEN IDENTIFIED NEEDS. WHEN DISCUSSING THE FINDINGS, THE CHNA HIGHLIGHTS HOW THEY MAY DIFFER FOR SAN DIEGANS BASED ON THEIR EXPERIENCES. THESE DIFFERING EXPERIENCES MAY INCLUDE HOMELESSNESS, IMMIGRATION STATUS, GENDER AND SEXUAL ORIENTATION, AGE AND POVERTY. COMMUNITY RECOMMENDATIONS DURING THE ACCESS TO CARE INTERVIEWS AND IN THE ONLINE COMMUNITY SURVEY, WE ASKED ""WHAT ARE THE MOST IMPORTANT THINGS THAT HOSPITALS AND HEALTH SYSTEMS COULD DO TO IMPROVE HEALTH AND WELL-BEING IN OUR COMMUNITY?"" OVERWHELMINGLY, RESPONDENTS AGREED THAT THERE IS A CRITICAL NEED TO HELP PATIENTS NAVIGATE AVAILABLE SERVICES THAT WILL HELP IMPROVE THEIR HEALTH AND WELL-BEING. IN BOTH THE INTERVIEWS AND THE SURVEYS, OPTIONS THAT CENTERED AROUND IMPROVED PATIENT CARE ROSE TO THE TOP. MOST RESPONSES FELL INTO FOUR CATEGORIES: NAVIGATION AND SUPPORT, CULTURALLY APPROPRIATE, WORKFORCE DEVELOPMENT, AND COMMUNITY COLLABORATION. NEXT STEPS HOSPITALS AND HEALTH SYSTEMS THAT PARTICIPATED IN THE HASDIC 2022 CHNA PROCESS HAVE VARYING REQUIREMENTS FOR NEXT STEPS. PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS AND HEALTH SYSTEMS ARE REQUIRED TO DEVELOP HOSPITAL OR HEALTH SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS AND IMPLEMENTATION STRATEGY PLANS TO ADDRESS SELECTED IDENTIFIED HEALTH NEEDS. THE PARTICIPATING HEALTH DISTRICTS AND DISTRICT HEALTH SYSTEMS DO NOT HAVE THE SAME CHNA REQUIREMENTS BUT WORK VERY CLOSELY WITH THEIR PATIENT COMMUNITIES TO ADDRESS HEALTH NEEDS BY PROVIDING PROGRAMS, RESOURCES, AND OPPORTUNITIES FOR COLLABORATION WITH PARTNERS. EVERY PARTICIPATING HOSPITAL AND HEALTH CARE SYSTEM WILL REVIEW THE CHNA DATA AND FINDINGS IN ACCORDANCE WITH THEIR OWN PATIENT COMMUNITIES AND PRINCIPAL FUNCTIONS AND EVALUATE OPPORTUNITIES FOR NEXT STEPS TO ADDRESS THE TOP IDENTIFIED HEALTH NEEDS IN THEIR RESPECTIVE PATIENT COMMUNITIES."

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION)
DURING FISCAL YEAR 2022 (OCTOBER 2021 TO SEPTEMBER 2022), SCRIPPS INVESTED $8,588,962 IN COMMUNITY HEALTH SERVICES (DOES NOT INCLUDE SUBSIDIZED HEALTH). THIS FIGURE REFLECTS THE COSTS ASSOCIATED WITH PROVIDING THESE PROGRAMS, SALARIES, MATERIALS, AND SUPPLIES MINUS REVENUE. FOR MORE DETAILED INFORMATION ON THESE AND OTHER PROGRAMS SEE HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. A LACK OF HEALTH INSURANCE IS A PREDICTOR OF MANY HEALTH CONDITIONS, INCLUDING MORE POOR MENTAL HEALTH DAYS, MORE VISITS TO THE ED FOR HEART ATTACKS, A HIGHER PREVALENCE OF ASTHMA, AND OBESITY, MORE LOW BIRTH WEIGHT BABIES, AND HIGHER PREVALENCE OF SMOKING. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. ACCESS TO HEALTH CARE EMERGED AS A HIGH PRIORITY HEALTH NEED IN BOTH THE SECONDARY DATA ANALYSES AND COMMUNITY ENGAGEMENT DISCUSSIONS IN THE 2022 SCRIPPS COMMUNITY HEALTH NEEDS ASSESSMENT. THROUGH THE COMMUNITY ENGAGEMENT CONDUCTED WE HEARD FROM THE COMMUNITY THAT SEVERAL FACTORS WERE IDENTIFIED AS BEING SIGNIFICANT IN ACCESSING HEALTH CARE IN SAN DIEGO: TRANSPORTATION, LACK OF HEALTHCARE COSTS AND MEDICAL DEBT, THE LACK OF CULTURALLY COMPETENT AND LINGUISTICALLY APPROPRIATE CARE AND LGBTQ+ EXPERIENCE IN HEALTH CARE. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED A NUMBER OF PROGRAMS AND ACTIVITIES IN FISCAL YEAR 2022. BELOW ARE A FEW EXAMPLES OF ACCESS TO CARE PROGRAMS. MORE DEATILED INFORMATION ON THE BREATH AND SCOPE OF OUR PROGRAMS CAN BE FOUND IN THE 2023 SCRIPPS COMMUNITY BENEFIT PLAN AND REPORT, HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY. MERCY OUTREACH SURGICAL TEAM PROVIDES LIFE-CHANGING CARE TO CHILDREN IN MEXICO FOR THREE DECADES, THE MERCY OUTREACH SURGICAL TEAM (MOST) HAS BEEN CROSSING BORDERS AND CHANGING LIVES. MOST IS AN INDEPENDENT, NONPROFIT ORGANIZATION FOUNDED IN 1987 AT SCRIPPS MERCY HOSPITAL WHOSE MISSION IS TO PROVIDE FREE SURGERIES AND VISION CARE TO UNDERSERVED CHILDREN IN MEXICO. AFTER THE 9/11 TERRORIST ATTACK, MOST'S MISSIONS HAD TO BE SHIFTED EXCLUSIVELY TO TRIPS IN MEXICO, DUE TO DIFFICULTY GETTING CHILDREN ACROSS THE BORDER FROM MEXICO INTO THE U.S. WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. IN MEXICO, MOST VOLUNTEERS TYPICALLY PERFORM HUNDREDS OF SURGERIES PER MISSION-AND MORE THAN 14,000 OVERALL SINCE ITS FOUNDING-FOR ISSUES LIKE CLEFT LIPS, CROSSED EYES, BURN SCARS, HERNIA REPAIRS AND MORE. MOST ALSO ADDED A VISION PROGRAM IN 2004 THAT PROVIDES MORE THAN 100 PAIRS OF EYEGLASSES PER TRIP TO CHILDREN IN NEED. AS THE PAUSE IN TRAVEL FOR MOST CONTINUED INTO 2022, MOST SOUGHT ALTERNATIVE WAYS TO SERVE THOSE IN NEED. SCRIPPS PROVIDED A SPONSORSHIP OF $18,850 TO TWO ROTARY CLUBS IN MEXICO WHICH FUNDED LOCAL SURGEONS TO PERFORM LIFE CHANGING CLEFT LIP AND PALATE SURGERIES TO 27 CHILDREN. THESE ROTARY CLUBS WERE CHARGED WITH DISPERSING THE MONIES AND MAKING SURE THE FUNDS WERE UTILIZED APPROPRIATELY. THE TWO CLINICS WHERE THE SURGERIES WERE PERFORMED WERE CASA AZUL IN MONTEREY, NUEVO LEON, MEXICO AND SONRISA DE LUNA IN TEPIC, NAYARIT, MEXICO. CITY OF REFUGE (CoR) SAN DIEGO RECUPERATIVE CARE UNIT PROGRAM (RCU) RECUPERATIVE CARE (ALSO KNOWN AS MEDICAL RESPITE CARE, A LOWER LEVEL OF MEDICAL CARE PROVIDED WHERE A PATIENT CAN HEAL AND RECOVER FROM AN ILLNESS OR INJURY) PROVIDES PEOPLE WHO ARE EXPERIENCING HOMELESSNESS WITH A SAFE PLACE TO STAY AFTER BEING DISCHARGED FROM THE HOSPITAL TO PREVENT THEM FROM FALLING BACK ONTO THE STREETS WHILE ILL AND RECOVERING. WITHOUT A STABLE PLACE TO STAY, COMMUNITY MEMBERS EXPERIENCING HOMELESSNESS COULD UNDO ANY PROGRESS THEY MADE DURING THEIR HOSPITALIZATION. SCRIPPS HEALTH HAS AN AGREEMENT WITH THE CITY OF REFUGE SAN DIEGO RECUPERATIVE CARE SHELTER (RCS) WHICH PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. LACK OF FUNDING, MENTAL ILLNESS, AS WELL AS ALCOHOL AND/OR SUBSTANCE ABUSE, MAKES POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. DURING THE PANDEMIC ALL SAN DIEGO HOMELESS SHELTERS EXPERIENCED COVID-19 OUTBREAKS, MAKING RCS A TRUE PLACE OF REFUGE FOR 37 OF OUR CHRONICALLY HOMELESS PATIENTS. THE RN (REGISTERED NURSE) CASE MANAGEMENT AND SOCIAL WORK DEPARTMENTS ASSIST WITH A NEEDED SUPPLY OF MEDICATION, APPOINTMENTS, DURABLE MEDICAL EQUIPMENT (DME), SETTING UP HOME HEALTH SERVICES IF NEEDED, AND CONNECTS PATIENTS TO PSYCH AS PART OF THE HOSPITAL DISCHARGE PLAN TO THE CITY OF REFUGE. THE CITY OF REFUGE FURTHER SUPPORTS CLIENTS IN MEETING THESE GOALS USING COMMUNITY RESOURCES TO MEET INDIVIDUAL SOCIAL SERVICE NEEDS. SCRIPPS PAYS THE CITY OF REFUGE A DAILY RATE FOR HOUSING AND SERVICES THEY PROVIDE TO THE PATIENTS. THE CITY OF REFUGE PROVIDES A SAFE, SECURE ENVIRONMENT, WITH 24-HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, CASE MANAGEMENT, ASSISTANCE WITH MEDI-CAL, WITH TRANSITION TO MANAGED MEDI-CAL AND DISABILITY APPLICATIONS, REFERRALS TO REHAB AND OTHER PROGRAMS, AND HELP FINDING PERMANENT OR TRANSITIONAL HOUSING USING COUNTY RESOURCES. DME AND OTHER NEEDED SERVICES ARE PROVIDED BY SCRIPPS WHEN FUNDING IS NOT AVAILABLE. ALL PATIENTS ARE CONNECTED TO A MEDICAL HOME, AND PRIMARY CARE IN THE COMMUNITY. PATIENTS WITH PSYCH DISORDERS ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY IF THEY ARE WILLING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED BY THE CITY OF REFUGE, BUT MAY INCLUDE INSURANCE FUNDED TRANSPORT SERVICES, AND OCCASIONALLY SCRIPPS SHUTTLE, OR USE OF TAXI VOUCHER. THE CITY OF REFUGE BEGAN TAKING PATIENTS ROUTINELY IN OCTOBER OF 2019. THIS YEAR 37 PATIENTS SO FAR HAVE MET THE NEED FOR RCS ADMISSION, BUT MANY DID NOT QUALIFY DUE TO BEHAVIOR, UNSTABLE MENTAL ILLNESS, OR UNWILLINGNESS TO ABSTAIN FROM SUBSTANCE ABUSE. AS A GROUP, THE RCS PATIENTS HAD A CUMULATIVE OF 393 HOSPITAL DAYS OF STAY, AN AVERAGE OF 10.6 HOSPITAL DAYS OF STAY, BEFORE GOING TO RCS OCTOBER 2021 TO DATE. THE RCS HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: IV ANTIBIOTICS, WOUND VACS, SKIN GRAFTS, FRACTURES, ABSCESSES, OSTEOMYELITIS, AMPUTATION, DOG BITES, DKA, GI BLEEDS, PANCREATITIS, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, DIABETES, MILD ENCEPHALOPATHY, OSTOMIES, MVA, PEDESTRIAN VERSUS AUTO, PLEURAL EFFUSION, CVA, CANCER (LYMPHOMA, PANCREATIC CANCER), HIV/AIDS, SEPSIS, RESPIRATORY FAILURE, PNEUMONIA, CHF. PATIENTS WERE ASSAULT VICTIMS WITH GUNSHOT AND STAB WOUNDS, FACIAL TRAUMA, AND SURGICAL POST OP PATIENTS AND MANY ARE DIABETIC. PSYCH PROBLEMS ARE COMMON AND OCCASIONALLY THE MAIN ISSUE FOR RCS CLIENTS. OVER 67% OF THIS GROUP WERE EITHER POSITIVE FOR ALCOHOL, DRUGS OR DRUG SCREEN OR HAD A DRUG HISTORY ADDRESSED BY THE PHYSICIAN IN THE H P. THE FOLLOWING ARE OUTCOME METRICS TRACKED BY SCRIPPS FOR THE CITY OF REFUGE PROGRAM. - FOR FY22 TOTAL COST SAVINGS FOR SCRIPPS WERE $1,428,646.00. - OF RECUPERATIVE CARE SHELTER PATIENTS, 10% HAD STANDARD MEDI-CAL INSURANCE, AND 67% MEDI-CAL HMO'S,10% HAD MEDICARE FUNDING, AND 10% WERE TRANSITIONING FROM OUT OF STATE OR OUT OF COUNTY MEDICAID/MEDI-CAL PROGRAMS. ONLY ONE PATIENT LACKED FUNDING. - APPROXIMATELY 8% OF PATIENTS SOUGHT TO SECURE INCOME FROM GOVERNMENT PROGRAMS, SOCIAL SECURITY, AND CA SHORT TERM DISABILITY; 3 TOTAL CLIENTS APPLIED OR RECEIVED INCOME BENEFITS. TWO HAVE APPLIED FOR AND RECEIVED MEDI-CAL HMO'S WHILE AT THE RCS WITH THE ASSISTANCE OF THEIR CASE MANAGEMENT DEPARTMENT. - THERE WERE SEVERAL SUCCESSES, WITH THE RCS MANAGER ASSISTING WITH ONE FAMILY REUNIFICATION OUT OF STATE. FOUR PATIENTS TRANSITIONED TO DRUG REHAB CENTERS, AND SEVERAL INTO ALPHA PROJECT OR FATHER JOE'S SHELTERS, INTERFAITH, AND MENTAL HEALTH TREATMENT PROGRAMS. - THE COMPLEX CARE MANAGER ENSURED 100 PERCENT OF RCS PATIENTS WERE SCHEDULED AND CONNECTED TO A PRIMARY CARE PROVIDER OR HAD ESTABLISHED CARE AT ONE OF THE COMMUNITY CLINICS. - FOLLOWING THEIR STAY IN THE CITY OF REFUGE: 30% OF THE RCS PATIENTS COMPLETED THEIR RECUPERATIVE CARE AND RETURNED TO THEIR PREVIOUS LIVING AND 14% WENT BACK TO THE HOSPITAL AS THEY NEEDED FURTHER TREATMENT. FATHER JOE'S VILLAGES STREET HEALTH INTERVENTION PROJECT SCRIPPS MERCY HOSPITAL SAN DIEGO SERVES A LARGE VOLUME OF SAN DIEGO'S UNSHELTERED HOMELESS POPULATION IN THE EMERGENCY SERVICES DEPARTMENT. BECAUSE OF THE SCARCITY OF SHELTER AND TREATMENT PROGRAM BEDS AVAILABLE FOR THESE PATIENTS, THEY OFTEN LEAVE THE HOSPITAL TO RETURN TO THEIR PREVIOUS OUTSIDE LOCATION. EVEN THOUGH THESE PATIENTS ARE STABLE FOR A SAFE DISCHARGE, THERE ARE MANY WHO COULD BENEFIT FROM A FOLLOW-UP HEALTH CARE AND CARE MANAGEMENT VISIT IN THE COMMUNITY SETTING.

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION)
"AS THE STREET MEDICINE INSTITUTE EXPLAINS, ""THE FUNDAMENTAL APPROACH OF STREET MEDICINE IS TO ENGAGE PEOPLE EXPERIENCING HOMELESSNESS EXACTLY WHERE THEY ARE AND ON THEIR OWN TERMS TO MAXIMALLY REDUCE OR ELIMINATE BARRIERS TO CARE ACCESS AND FOLLOW-THROUGH. VISITING PEOPLE WHERE THEY LIVE - IN ALLEYWAYS, UNDER BRIDGES, OR WITHIN URBAN ENCAMPMENTS - IS A NECESSARY STRATEGY TO FACILITATE TRUST-BUILDING WITH THIS SOCIALLY MARGINALIZED AND HIGHLY VULNERABLE POPULATION. A COLLABORATION HAS BEEN ESTABLISHED BETWEEN FATHER JOE'S VILLAGE STREET HEALTH INTERVENTION PROJECT AND SCRIPPS MERCY HOSPITAL TARGETING UNSHELTERED DISCHARGED PATIENTS WHO COULD BENEFIT FROM A FOLLOW-UP VISIT IN THE COMMUNITY SETTING WHERE THEY RESIDE. THE STREET HEALTH INTERVENTION IS FOR ELIGIBLE, UNSHELTERED PATIENTS PRIOR TO THE EMERGENCY ROOM DISCHARGE. THE INITIATIVE ESTABLISHES A COMMUNITY-SETTING, FOLLOW-UP HEALTH CARE VISIT FROM FATHER JOE'S VILLAGES SENIOR (FJV) MULTIDISCIPLINARY STREET HEALTH TEAM THE FOLLOWING DAY. THIS PROJECT WILL HELP SUPPORT THE NEEDS OF UNSHELTERED PERSONS EXITING THE HOSPITAL BY LINKAGE WITH FJV STREET HEALTH TEAM BECAUSE: - LIMITED AVAILABILITY OF SHELTER BEDS IN THE CITY OF SAN DIEGO - DAILY, THERE IS A SUBSTANTIAL NUMBER OF UNSHELTERED PERSONS DISCHARGED FROM SCRIPPS MERCY HOSPITAL EMERGENCY DEPARTMENT WHO MAY BENEFIT FROM A NURSING FOLLOW UP VISIT - I.E., WOUND CARE AND/OR MEDICATION CHECK OR PRIMARY CARE PHYSICIAN ESTABLISHMENT. - FATHER JOE'S VILLAGES HAS THE CLINICAL STAFF AND EXPERIENCE TO PROVIDE STREET HEALTH OUTREACH TO THE UNSHELTERED IN THE CENTRAL REGION OF SAN DIEGO COUNTY. - FATHER JOE'S VILLAGES STREET HEALTH HAS A RELATIONSHIP WITH PATH OUTREACH TO ASSIST WITH HOUSING AND SOCIAL SERVICE BENEFIT NEEDS. GRADUATE MEDICAL EDUCATION STAFF SUPPORT, ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, RESIDENTS AND FELLOWS. GME RESIDENTS AND MANY ATTENDING PHYSICIANS MAINTAIN AN EVENING CLINIC AT ST. LEO'S MISSION COMMUNITY CLINIC IN NORTH COUNTY. TWO RESIDENTS VOLUNTEER EVERY WEDNESDAY TO PROVIDE MEDICAL CARE TO UNINSURED PATIENTS WITH A VARIETY OF CONDITIONS, INCLUDING DIABETES, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. THEY ALSO IDENTIFY MANY ACUTE CONDITIONS, INCLUDING VIRAL INFECTIONS, SKIN INFECTIONS, EYE PROBLEMS AND MUSCULOSKELETAL ISSUES, AND EDUCATE PATIENTS ABOUT THEIR HEALTH. PATIENTS MAY GET FLU VACCINATIONS AND SOME BASIC LAB TESTS. IF NEEDED, ST. LEO'S PATIENTS ARE REFERRED TO PROVIDERS WHO PROVIDE CARE AT A REDUCED COST. SCRIPPS SPONSORED AMERICAN RED CROSS BLOOD DRIVES SCRIPPS HEALTH PARTNERED WITH THE AMERICAN RED CROSS IN FISCAL YEAR 2022 TO HOSTED 10 BLOOD DRIVES; 431 SCRIPPS EMPLOYEES DONATED BLOOD THROUGHOUT THE YEAR. SCRIPPS HEALTH COLLECTED 453 PINTS OF BLOOD (FOR EVERY PINT DONATED 3 LIVES ARE SAVED), WHICH SAVED APPROXIMATELY 1,359 LIVES. SCRIPPS PROMOTED THE BLOOD DRIVES THROUGH OUR SYSTEM WIDE COMMUNICATION CHANNELS AND OUR WELLNESS ALL AROUND YOU CAMPAIGN. SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2022, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $138,500 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO. THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $4.4 MILLION TO DATE. PROGRAMS FUNDED DURING FISCAL YEAR 2022 INCLUDED: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) THE CONSUMER CENTER PARTNERSHIP IS A MEDICAL LEGAL PARTNERSHIP WITH SCRIPPS MERCY HOSPITAL. THE PROGRAM HELPS TO EDUCATE CONSUMERS ABOUT HEALTH CARE BENEFITS AND CHANGES OCCURRING WITH ELIGIBILITY AND ENROLLMENT IN COVERAGE PROGRAMS. STAFF ASSIST UNINSURED/UNDERINSURED LOW-INCOME SCRIPPS PATIENTS OBTAIN ACCESS TO MEDI-CAL, COUNTY MEDICAL SERVICES (CMS), COVERED CALIFORNIA, AND PRIVATE INSURANCE. FUNDING PROVIDES LOW INCOME, UNINSURED AND BEHAVIORAL HEALTH PATIENTS HELP OBTAIN HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THIS MEDICAL LEGAL PARTNERSHIP PLACES CONSUMER CENTER PLACES STAFF ONSITE AT SCRIPPS MERCY HOSPITAL WITHIN THE BEHAVIORAL HEALTH UNIT (BHU) AND PROVIDES ACCESSIBLE LEGAL ASSISTANCE, IN ADDITION TO RECEIVING DIRECT REFERRALS FROM OTHER SCRIPPS FACILITIES. DUE TO THE SAFETY CONCERNS DURING THE PUBLIC HEALTH EMERGENCY, THE CONSUMER CENTER STAFF PROVIDED HIGH QUALITY SERVICES TO PATIENTS BASED ON DIRECT REFERRALS FROM SCRIPPS BHU AND PATIENT REPRESENTATIVE SERVICES STAFF AT MERCY AND OTHER SCRIPPS FACILITIES. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME INTENSIVE GOVERNMENT BENEFIT CASES AND THE CONSUMER CENTER STRESSES THE IMPORTANCE OF ACCESSING COMMUNITY-BASED SERVICES FOR ROUTINE HEALTH CARE INSTEAD OF USING THE ED'S AND HOSPITAL DEPARTMENTS AS WELL AS THE IMPORTANCE OF ESTABLISHING MEDICAL HOMES. ERIC PAREDES SAVE A LIFE FOUNDATION EACH YEAR, 7,000 TEENS LOSE THEIR LIVES DUE TO SUDDEN CARDIAC ARREST (SCA). SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEART'S ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE ELECTROCARDIOGRAM (EKG). UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. SAN DIEGO ALONE LOSES THREE TO FIVE TEENS FROM SCA ANNUALLY. SCRIPPS FUNDING ASSISTS WITH SCREENING FOR YOUTH ATHLETES COUNTYWIDE. CATHOLIC CHARITIES FUNDING WAS NOT PROVIDED IN FISCAL YEAR 2022, BUT THE PARTNERSHIP CONTINUED. CATHOLIC CHARITIES PROVIDES SEVERAL SHELTER BED OPTIONS FOR MEN AND WOMEN EXPERIENCING HOMELESSNESS. BECAUSE OF THE LONG-STANDING PARTNERSHIP BETWEEN SCRIPPS HEALTH AND CATHOLIC CHARITIES, CATHOLIC CHARITIES MAKES EVERY EFFORT TO ACCOMMODATE THE NEEDS OF SMH PATIENTS, IF A BED IS AVAILABLE AND THE REFERRAL IS APPROPRIATE. ONCE A BED IS SECURED, SHELTER RESIDENTS ARE ASSISTED THROUGH CASE MANAGEMENT TO OBTAINING OTHER HEALTH AND SOCIAL SUPPORTS NEEDED TO STABILIZE AND IMPROVE THEIR CURRENT LIFE SITUATION. THE MOBILE HEALTH AND RESOURCE FAIR RACIAL/ETHNIC MINORITY WOMEN CONTINUE TO EXPERIENCE DELAYED DIAGNOSIS OF BREAST CANCER, CARDIOVASCULAR DISEASE, AND DEMENTIA, AND AFRICAN AMERICAN WOMEN ARE ALSO MORE LIKELY TO BE DIAGNOSED WITH MORE AGGRESSIVE BREAST CANCERS AND TO DIE FROM BREAST CANCER AT AN EARLIER AGE. REGULAR SCREENING IS KEY TO PREVENT DELAYED DIAGNOSIS, BUT MARGINALIZED POPULATIONS SUCH AS AFRICAN AMERICAN AND UNDERSERVED HISPANIC WOMEN ARE LESS LIKELY TO GET MAMMOGRAMS AND OTHER PREVENTIVE HEALTH MEASURES. A SYSTEMATIC REVIEW FOUND THAT ONE OF THE MOST EFFECTIVE METHODOLOGIES FOR DISEASE PREVENTION IN UNDERSERVED POPULATIONS IS TO REACH OUT DIRECTLY INTO THE COMMUNITY RATHER THAN REQUIRE INDIVIDUALS TO COME TO A HEALTHCARE CENTER. THE MOBILE HEALTH AND RESOURCE FAIR HAS CONSISTENTLY SERVED HUNDREDS OF DIVERSE COMMUNITY MEMBERS EACH MONTH, MANY OF WHOM CONTINUE TO RETURN FOR SERVICES. LED BY A RETIRED PHYSICIAN AND A BREAST CANCER SURVIVOR/ADVOCATE/CEO OF COMMUNITY-BASED ORGANIZATION MANY SHADES OF PINK. THESE VOLUNTEERS HOPE TO EXPAND AND UPGRADE THEIR SERVICES (E.G., ADDING CHOLESTEROL SCREENING, ADDING ADDITIONAL DEMENTIA SCREENINGS AND MENTAL HEALTH RESOURCES). SCRIPPS FUNDING ALLOWS TO PROVIDE MORE REGULAR CARDIOVASCULAR HEALTH AND NEUROCOGNITIVE SCREENINGS, AS WELL AS RESOURCES AND REFERRALS FOR BREAST CANCER SCREENING TO THESE UNDERSERVED AND OFTEN HIGH-RISK POPULATIONS. THE OBJECTIVE OF THIS PROGRAM IS TO HELP PREVENT DELAYED DIAGNOSES OF BREAST CANCER, CARDIOVASCULAR DISEASE, AND DEMENTIA AND PROMOTE HEALTH MAINTENANCE. THE FUNDING ALSO SUPPORTS THE HIRING OF DEDICATED COMMUNITY-BASED PATIENT NAVIGATORS TO HELP CONNECT COMMUNITY MEMBERS WITH THE APPROPRIATE HEALTH CARE RESOURCES, ESPECIALLY THROUGH THE BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT THAT CAN CONNECT PATIENTS TO MEDI-CAL AND FOLLOW-UP CARE AT SCRIPPS HEALTH. IN CONJUNCTION TO ENHANCED SCREENING SERVICES, SCRIPPS CONDUCTS RESEARCH TO BETTER UNDERSTAND BARRIERS UNIQUE TO THE UNDERSERVED IN SOUTHEAST SAN DIEGO AND TO BETTER MEET THEIR HEALTH CARE NEEDS IN TERMS OF PREVENTIVE AND MAINTENANCE OF HEALTH CARE. THE RESEARCH FINDINGS WILL HELP THE TEAM TO OPTIMIZE THE DELIVERY OF SERVICES AND MAXIMIZE THEIR COMMUNITY REACH."

Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT
SCRIPPS HEALTH COMMUNITY BENEFIT PLAN AND REPORT CAN BE FOUND AT: HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY

Schedule H, Part V Reporting Group A
REPORTING GROUP A INCLUDES THE FOLLOWING HOSPITAL FACILITIES: 1 SCRIPPS MERCY HOSPITAL 2 SCRIPPS MEMORIAL HOSPITAL LA JOLLA 3 SCRIPPS GREEN HOSPITAL 4 SCRIPPS MEMORIAL HOSPITAL ENCINITAS

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BAD DEBT WRITE-OFFS REPRESENT THE AMOUNT A PATIENT OR OTHER PAYER CANNOT (OR WILL NOT) PAY OF ITS PORTION OF THE BILL. THE HOSPITAL CONSIDERS BAD DEBT UNRECOVERABLE AND, THEREFORE, IT DIRECTLY DECREASES REVENUE AND IS CONSIDERED A COMMUNITY BENEFIT.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES.

Schedule H, Part V, Section B, Line 16a FAP website
A - SCRIPPS MERCY HOSPITAL: Line 16a URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16a URL: https://www.selectspecialtyhospitals.com/locations-and-tours/ca/san-diego/san-diego/;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SCRIPPS MERCY HOSPITAL: Line 16b URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16b URL: https://www.selectspecialtyhospitals.com/locations-and-tours/ca/san-diego/san-diego/;

Schedule H, Part II DESCRIBE HOW COMM BLDG ACTIVITIES PROMOTE THE HEALTH OF THE COMM (CONT.)
"F7 - COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 7. SCRIPPS HEALTH PUBLIC POLICY AND ADVOCACY THE SCRIPPS HEALTH PUBLIC POLICY ADVOCAY AGENDA IS INTENDED TO ASSIST SCRIPPS IN MEETING WITH POLICYMAKERS AT LOCAL, STATE AND FEDERAL LEVELS. ADVOCACY PRIORITIES ARE DETERMINED BASED ON SCRIPPS STRATEGIC DIRECTION, LONG-TERM FINANCIAL IMPACTS OF THE POLICY IN QUESTION, AND WITH A FOCUS ON SPENDING TIME AND RESOURCES IN AREAS WHERE OUR EFFORTS HAVE THE BEST OPPORTUNITY TO CARRY OUT OUR MISSION OF PROVIDING SUPERIOR HEALTH CARE TO THE INDIVIDUALS AND COMMUNITIES WE SERVE. THE SAN DIEGO LGBT COMMUNITY CENTER SCRIPPS SPONSORED THE SAN DIEGO LESBIAN, GAY, BISEXUAL, AND TRANSGENDER COMMUNITY CENTER INC., (D.B.A., THE CENTER). THE CENTER IS ONE OF THE LARGEST AND MOST VIBRANT LGBT COMMUNITY CENTERS IN THE NATION. FUNCTIONING AS THE SAN DIEGO LGBT COMMUNITY'S ANCHOR ORGANIZATION, THE CENTER IS LED BY A 10-MEMBER BOARD OF DIRECTORS, EMPLOYS MORE THAN 70 PAID STAFF AND UTILIZES MORE THAN 1,200 COMMUNITY VOLUNTEERS TO ACHIEVE ITS TWIN GOALS OF PROMOTING LGBT HEALTH/WELLNESS AND HUMAN RIGHTS. THE CENTER PROVIDES TARGETED PROGRAMS AND SERVICES TO THE FULL DIVERSITY OF THE SAN DIEGO LGBT COMMUNITY, INCLUDING MEN, WOMEN, YOUTH, SENIORS, TRANSGENDER AND NON-BINARY INDIVIDUALS, FAMILIES, LGBT LATINO COMMUNITY MEMBERS AND THEIR FAMILIES, AND THOSE LIVING WITH HIV. LAST YEAR, THE CENTER PROVIDES DIRECT SERVICE VISITS TO SAN DIEGO COMMUNITY MEMBERS, THROUGH ITS EVENTS, ACTIVITIES AND ADVOCACY, AND TOUCHES THE LIVES OF THOUSANDS MORE. F8-WORKFORCE DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 8. YOUNG LEADERS IN HEALTHCARE PROGRAM AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOLS' STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENTS IN GRADES 9-12 PARTICIPATE IN THE PROGRAM, WHICH PROVIDES A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS CAREER OPPORTUNITIES. THE MISSION OF THE YOUNG LEADERS IN HEALTH CARE IS: - TO PROVIDE A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS BREADTH OF CAREER OPPORTUNITIES. - MENTOR STUDENTS IN THE ACT OF LEADERSHIP, GIVING THEM TOOLS TO USE IN THEIR DAILY LIFE CHALLENGES. - PROVIDE A SERVICE PROJECT TO SATISFY HIGH SCHOOL REQUIREMENTS AND MAKE A POSITIVE IMPACT ON THE COMMUNITY. - PROVIDE A VENUE FOR A STUDENT-RUN COMPETITION WHERE EACH SCHOOL PRESENTS A TOPIC IN LINE WITH THE YEAR'S GOAL. THIS COMBINED EXPERIENCE INCLUDES WEEKLY MEETINGS AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE ADVISORS FOR THE PROGRAM ARE PART OF THE SAN DIEGO ALLIANCE FOR DRUG FREE YOUTH. THE PROGRAM MENTORS' STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY CHALLENGES. EACH YEAR THE STUDENTS WORK TOWARD A FINAL PRESENTATION BASED ON THEIR COMMUNITY SERVICE PROJECTS RELATED TO HEALTH CARE AND WELLNESS. THE 2022 CLASS TOUCHED A VARIETY OF TOPICS FROM MENTAL ILLNESS TO THE OPIOID CRISIS. MORE THAN 170 STUDENTS, COMMUNITY MEMBERS AND HEALTH CARE SPECIALISTS ATTENDED THE YOUNG LEADER IN HEALTH CARE FINAL MEETING, CULMINATING WITH STUDENT PRESENTATIONS ON TYPES OF CANCER AND TREATMENTS. STUDENTS THAT PARTICIPATE IN THE PROGRAM ARE ELIGIBLE TO APPLY TO THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM. MEETINGS WERE CONDUCTED AS VIRTUAL TEAMS MEETINGS FOR THE 2021-2022 SCHOOL YEAR AND THE VIRTUAL FORMAT ALLOWED TO INCREASE/EXPAND THE HIGH SCHOOLS. OVER 200 STUDENTS ACTIVELY PARTICIPATE MONTHLY. SCRIPPS SCHOOL TO HEALTH CAREERS PATHWAY PROGRAMS SCRIPPS MERCY HOSPITAL CHULA VISTA PROVIDES PROGRAM ACTIVITIES DESIGNED TO PIQUE THE INTEREST OF YOUTH TO PURSUING A CAREER IN HEALTHCARE. ACTIVITIES INCLUDE MENTORING PROGRAMS, HEALTH PROFESSIONALS IN THE CLASSROOM PRESENTATIONS, HOSPITAL TOURS, CAMP SCRIPPS AND SURGERY VIEWINGS. A TOTAL OF 1,137 STUDENTS PARTICIPATED IN THESE PROGRAMS IN FISCAL YEAR 2022. RESIDENCY LED YOUTH PROGRAMS SCRIPPS IS DEDICATED TO BUILDING THE FUTURE PIPELINE OF HEALTH PROFESSIONALS. SCRIPPS IMPLEMENTS A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES. THROUGH SEVERAL INTERNSHIPS AND OTHER EDUCATIONAL PROGRAMS, SCRIPPS COLLABORATES WITH HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRST-HAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. FAMILY MEDICINE MEDICAL RESIDENTS HAVE DEVELOPED AN INTERACTIVE CLASSROOM PRESENTATIONS SERIES CALLED ""OUR HEALTH"". THE PRESENTATIONS FOCUS ON A VARIETY OF PUBLIC HEALTH CONCERNS, MEDICALLY FOCUSED TOPICS AS WELL AS HANDS-ON CLINICAL SKILLS WORKSHOPS AT THE LOCAL HIGH SCHOOLS. THE GOAL IS TO INTRODUCE THE STUDENTS TO HEALTH CAREERS AND THE STUDENTS RECEIVE HEALTH CAREER TOOLS/BROCHURES THAT INCLUDE INFORMATION ON EDUCATION REQUIREMENTS, SCHOLARSHIPS, AND WAYS TO PAY FOR COLLEGE. A TOTAL OF 1,014 STUDENTS PARTCIPATED IN FISCAL YEAR 2022."

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SCRIPPS MERCY HOSPITAL: Line 16c URL: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE; B - SELECT SPECIALTY HOSPITAL - SAN DIEGO: Line 16c URL: https://www.selectspecialtyhospitals.com/locations-and-tours/ca/san-diego/san-diego/;

Schedule H, Part VI, Line 2 Needs assessment
"NEEDS ASSESSMENT AS PART OF THE FEDERAL REPORTING REQUIREMENT FOR PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS, SCRIPPS CONDUCTS A CONSOLIDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING JOINT IMPLEMENTATION STRATEGY FOR ITS LICENSED HOSPITAL FACILITIES. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, AND CONSUMER GROUPS. TO CARRY OUT THIS REGULATORY REQUIREMENT, SCRIPPS HAS BEEN ACTIVELY INVOLVED IN A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. THIS PROCESS BEGAN IN 1995, IN ACCORDANCE WITH THE REQUIREMENTS OF SENATE BILL 697, COMMUNITY BENEFIT LEGISLATION THAT REQUIRES NOT-FOR-PROFIT HOSPITALS IN CALIFORNIA TO FILE A TRIENNIAL CHNA THAT IDENTIFIES COMMUNITY HEALTH NEEDS. FURTHER, SCRIPPS HEALTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT RESPONDS TO FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING PRIVATE NOT-FOR-PROFIT (TAX-EXEMPT) HOSPITALS AS DESCRIBED IN CODE SECTION 501 (C)(3) TO CONDUCT AND MAKE PUBLIC A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT AND CORRESPONDING IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IDENTIFIES, AND DETAILS CURRENT OR PLANNED STRATEGIES INTENDED TO ADDRESS THE NEEDS IDENTIFIED IN THE HOSPITAL'S CHNA. SCRIPPS HEALTH ACTIVELY PARTICIPATES IN THE COLLABORATIVE CHNA PROCESS LED BY THE HOSPITAL ASSOCIATION OF SAN DIEGO IMPERIAL COUNTIES (HASDIC). ALTHOUGH ONLY NOT-FOR-PROFIT 501(C)(3) HOSPITALS AND HEALTH SYSTEMS ARE SUBJECT TO STATE AND IRS REGULATORY REQUIREMENTS, THE 2022 CHNA COLLABORATIVE PROCESS ALSO INCLUDES HOSPITALS AND HEALTH SYSTEMS WHO ARE NOT SUBJECT TO ANY CHNA REQUIREMENTS BUT ARE DEEPLY ENGAGED IN THE COMMUNITIES THEY SERVE AND COMMITTED TO THE GOALS OF A COLLABORATIVE CHNA. THE 2022 CHNA INCLUDES EXTENSIVE QUANTITATIVE ANALYSIS OF SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL DISCHARGE DATA AND OTHER SECONDARY SOURCES. TAKEN TOGETHER, THESE QUALITATIVE AND QUANTITATIVE APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY NEEDS FROM MULTIPLE PERSPECTIVES. THE RESULTS OF THE 2022 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. THE 2022 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. KEEPING PATIENTS AT THE CENTER OF EVERYTHING WE DO, SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND COMMUNITY CLINICS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THEREFORE, THE REPORT WILL HELP US BETTER UNDERSTAND OUR COMMUNITY'S HEALTH NEEDS AND INFORM COMMUNITY BENEFIT PLANNING AND THE IMPLEMENTATION STRATEGY FOR SCRIPPS HEALTH. IN ADDITION, THE ASSESSMENT ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THIS REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. FOR MORE INFORMATION ABOUT SCRIPPS HEALTH, PLEASE VISIT WWW.SCRIPPSHEALTH.ORG. PURPOSE THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS TO IDENTIFY, UNDERSTAND, AND PRIORITIZE THE HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS FACING INEQUITIES. THE RESULTS OF THE CHNA ARE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. IN ADDITION, POLICYMAKERS, CIVIC LEADERS, NONPROFIT EXECUTIVES, AND COMMUNITY INVESTORS ARE ENCOURAGED TO USE CHNAS IN THEIR ESSENTIAL WORK. CHNA GOVERNANCE THE HOSPITAL ASSOCIATION OF SAN DIEGO COUNTIES (HASDIC) BOARD OF DIRECTORS REPRESENTS ALL MEMBER SECTORS AND PROVIDES POLICY DIRECTION TO ENSURE THE INTERESTS OF MEMBER HOSPITALS AND HEALTH SYSTEMS ARE PRESERVED AND PROMOTED. THE CHNA ADVISORY WORKGROUP INCLUDED REPRESENTATIVES FROM EVERY PARTICIPATING HOSPITAL AND HEALTH SYSTEM AND PROVIDED OVERARCHING GUIDANCE REGARDING THE RESEARCH APPROACH AND COMMUNITY ENGAGEMENT. THE CHNA COMMITTEE WORKED CLOSELY WITH THE CHNA ADVISORY WORKGROUP AND REPORTS TO THE HASDIC BOARD. METHODOLOGY THERE ARE SOCIAL DRIVERS OF HEALTH AND EQUITY AT ALL LEVELS: INDIVIDUAL, COMMUNITY, AND STRUCTURAL. HISTORICAL AND SYSTEMIC INEQUITIES DISPROPORTIONATELY IMPACT VULNERABLE POPULATIONS, INCLUDING PEOPLE OF COLOR, SOCIALLY DISADVANTAGED GROUPS, AND THOSE LIVING IN POVERTY. THE CHNA COMMITTEE COMPLETED AN EXTENSIVE REVIEW OF NATIONAL BEST PRACTICES AND EVIDENCE-BASED FRAMEWORKS TO DEVELOP A RESEARCH APPROACH TO HEALTH EQUITY. THE HEALTH EQUITY FRAMEWORK DESCRIBES THE CHNA ADVISORY WORKGROUP AND CHNA COMMITTEE'S SHARED VALUES AND COMMITMENT TO UNDERSTANDING THE SOCIAL DRIVERS OF HEALTH AND EQUITY THROUGH OUR COLLECTIVE RESEARCH, ANALYSIS, AND COMMUNITY ENGAGEMENT. RESEARCH METHODS AND APPROACH TO GAIN A DEEP AND MEANINGFUL UNDERSTANDING OF THE HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS, TWO PRIMARY METHODS WERE EMPLOYED IN THE 2022 CHNA: 1. QUANTITATIVE ANALYSES OF EXISTING PUBLICLY AVAILABLE DATA WERE CONDUCTED TO PROVIDE AN OVERARCHING VIEW OF CRITICAL HEALTH ISSUES ACROSS SAN DIEGO COUNTY. 2. QUALITATIVE INFORMATION WAS GATHERED THROUGH A COMPREHENSIVE COMMUNITY ENGAGEMENT PROCESS TO UNDERSTAND PEOPLE'S LIVED EXPERIENCES AND NEEDS IN THE COMMUNITY. THE CHNA COMMITTEE REVIEWED THE FEEDBACK AND DATA TO PRIORITIZE THE TOP HEALTH NEEDS IN SAN DIEGO COUNTY. THE CHNA COMMITTEE COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. THE FOLLOWING DATA WAS USED IN THE PRIORITIZATION PROCESS: QUANTITATIVE DATA: - DATA AND ANALYSIS FROM HEALTH AND HUMAN SERVICES AGENCY, PUBLIC HEALTH SERVICES INCLUDING COMMUNITY HEALTH STATISTICS, HEALTH EQUITY DASHBOARDS, MORBIDITY MORTALITY DATA - ANALYSIS OF SECONDARY DATA, HEALTH CONDITIONS, AND SOCIAL DETERMINANTS OF HEALTH (SDOH) - COUNTY OF SAN DIEGO LEADING CAUSES OF DEATH 2019 DATA - HOSPITAL DISCHARGE TREND DATA RETRIEVED FROM CALIFORNIA'S DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION (HCAI) LIMITED DATA SETS, 2017-2019 SPEEDTRACK QUALITATIVE DATA: - COMMUNITY GUIDANCE FROM CHNA PLANNING INTERVIEWS - COMMUNITY ENGAGEMENT FINDINGS FROM FOCUS GROUPS - COMMUNITY ENGAGEMENT FINDINGS FROM KEY INFORMANT INTERVIEWS - COMMUNITY ENGAGEMENT FINDINGS FROM INTERVIEWS AND FOCUS GROUPS WITH PROMOTORAS AND COMMUNITY HEALTH WORKERS (CHWS) - 2022 CHNA ONLINE COMMUNITY SURVEY SEVERAL CRITERIA WERE APPLIED TO THE DATA TO DETERMINE WHICH TOP COMMUNITY NEEDS WERE OF THE HIGHEST PRIORITY IN SAN DIEGO COUNTY. THESE CRITERIA INCLUDED: THE SEVERITY OF THE NEED: THIS REFERS TO HOW SEVERE THE HEALTH NEED IS (SUCH AS ITS POTENTIAL TO CAUSE DEATH OR DISABILITY) AND ITS DEGREE OF POOR PERFORMANCE AGAINST THE RELEVANT BENCHMARK. THE MAGNITUDE/SCALE OF THE NEED-THE MAGNITUDE REFERS TO THE NUMBER OF PEOPLE AFFECTED BY THE HEALTH NEED. DISPARITIES OR INEQUITIES-THIS REFERS TO DIFFERENCES IN HEALTH OUTCOMES BY SUBGROUPS. SUBGROUPS MAY BE BASED ON GEOGRAPHY, LANGUAGES, ETHNICITY, CULTURE, CITIZENSHIP STATUS, ECONOMIC STATUS, SEXUAL ORIENTATION, AGE, GENDER, OR OTHERS. AND CHANGE OVER TIME-THIS REFERS TO WHETHER THE NEED HAS IMPROVED, STAYED THE SAME, OR WORSENED. OVER THE COURSE OF SEVERAL MEETINGS, THE HASDIC STAFF AND CHNA COMMITTEE MEMBERS COLLECTIVELY REVIEWED THE QUANTITATIVE AND QUALITATIVE DATA AND FINDINGS. EACH HEALTH CONDITION AND SOCIAL DETERMINANT OF HEALTH FOR WHICH THE COMMITTEE HAD DATA WAS CONSIDERED AND DISCUSSED IN TERMS OF THESE CRITERIA. THOSE COMMUNITY NEEDS THAT MET THE LARGEST NUMBER OF CRITERIA WERE CHOSEN AS TOP PRIORITIES. THE 2022 CHNA INCLUDED EXTENSIVE QUANTITATIVE ANALYSIS OF SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL DISCHARGE DATA AND OTHER SECONDARY SOURCES. TAKEN TOGETHER, THESE QUALITATIVE AND QUANTITATIVE APPROACHES ALLOWED THE CHNA COMMITTEE TO VIEW COMMUNITY NEEDS FROM MULTIPLE PERSPECTIVES. THE RESULTS OF THE 2022 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. QUANTITATIVE DATA WERE USED FOR THREE PRIMARY PURPOSES: 1. DESCRIBE THE SAN DIEGO COUNTY COMMUNITY. 2. PLAN AND DESIGN THE COMMUNITY ENGAGEMENT PROCESS. 3. FACILITATE THE ""PRIORITIZATION PROCESS"" - IDENTIFYING THE MOST SERIOUS COMMUNITY HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS FACING INEQUITIES."

Schedule H, Part VI, Line 5 Promotion of community health
"PROMOTION OF COMMUNITY HEALTH SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. AND OUR PARTNERSHIPS DO NOT STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDE WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS, AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE. 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 FY22 OCTOBER 2021 TO SEPTEMBER 2022), SCRIPPS INVESTED $36,406,050 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. FOR MORE DETAILED INFORMATION ON THESE AND OTHER PROGRAMS SEE HTTPS://WWW.SCRIPPS.ORG/ABOUT-US/SCRIPPS-IN-THE-COMMUNITY. 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 AND SCRIPPS WHITTIER DIABETES INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES; ""DIRECT OFFSETTING REVENUE"" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. ONE EXAMPLE OF OUR PROFESSIONAL EDUCATION GRADUATE MEDICAL EDUCATION IS THE SCRIPPS RESIDENT CLINIC AT FAMILY HEALTH CENTER OF SAN DIEGO (FHCSD). THE COLLABORATIVE RELATIONSHIP BETWEEN SCRIPPS MERCY HOSPITAL AND FHCSD HAS BEEN WELL ESTABLISHED WITH MANY TREMENDOUSLY PRODUCTIVE SHARED ENDEAVORS. THE TWO ORGANIZATIONS HAVE JOINTLY APPROACHED OPPORTUNITIES AND CHALLENGES IN THE COMMUNITY THAT FACE THE MEDICALLY UNDERSERVED. SOME OF THESE PROJECTS INCLUDE A FAMILY MEDICINE RESIDENCY PROGRAM, A PEDIATRIC RESIDENCY TRAINING PROGRAM AT FHCSD NORTH PARK FAMILY HEALTH CENTER, A SUCCESSFUL COLLABORATIVE PRENATAL CARE AND DELIVERY PROGRAM, EMERGENCY ROOM REFERRALS OF MEDICALLY UNDERSERVED PATIENTS WITHOUT A PRIMARY CARE PROVIDER/MEDICAL HOME AND A COORDINATED OUTPATIENT BEHAVIORAL HEALTH PROGRAM FOR PATIENTS DISCHARGED FROM SMH'S INPATIENT BEHAVIORAL HEALTH FACILITY. SCRIPPS MERCY HOSPITAL TRANSITIONED THE INTERNAL MEDICINE AMBULATORY TEACHING PROGRAM FROM SCRIPPS MERCY HOSPITAL TO FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) HILLCREST FAMILY HEALTH CENTER. THE SCRIPPS RESIDENT CLINIC HAS BEEN SUCCESSFULLY INCORPORATED INTO THE OPERATIONS OF THE HILLCREST FAMILY HEALTH CENTER. THE GME AFFILIATION WITH FHCSD HAS PROVEN TO BE A SIGNIFICANT OPPORTUNITY FOR THE CONTINUITY OF CARE PATIENTS TO HAVE ACCESS TO MUCH MORE COMPREHENSIVE INTERDISCIPLINARY CARE INCLUDING DENTAL, BEHAVIORAL HEALTH OUTPATIENT SERVICES AND A VARIETY OF SOCIAL CARE SUPPORT INTERVENTIONS. IT HAS ALSO BEEN AN OPPORTUNITY FOR OUR RESIDENTS TO LEARN MORE ABOUT FUNCTIONING IN AN INTERDISCIPLINARY SETTING AND COLLABORATING WITH OTHER HEALTHCARE PROVIDERS. ADDITIONAL TRAINING OPPORTUNITIES HAVE RESULTED WITH THIS AFFILIATION IN SPECIALTY CARE CLINICS, SUCH AS HIV AND HBV CLINICS TO NAME A FEW. AS WELL, THE AFFILIATION WITH FHCSD HAS IMPROVED THE PATIENT'S TRANSITION OF CARE FROM THE HOSPITAL'S INPATIENT SETTING TO OUTPATIENT / FOLLOW-UP CARE WITH THE SUPPORT OF FHCSD CARE COORDINATION PROCESSES. THE AGREEMENT TO CO-LOCATE THE GME PROGRAM WITH FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) IS AN EXPANSION OF THE ONGOING, COLLABORATIVE RELATIONSHIP WITH THIS FEDERALLY QUALIFIED HEALTH CENTER. SCRIPPS AND FHCSD ALREADY WORK TOGETHER IN A NUMBER OF AREAS THAT BENEFIT THE MEDICALLY UNDERSERVED, INCLUDING A PEDIATRIC RESIDENCY TRAINING PROGRAM, A COLLABORATIVE PRENATAL CARE AND DELIVERY PROGRAM, A COORDINATED BEHAVIORAL HEALTH PROGRAM, AND A TRANSITIONS OF CARE (TOC) PROGRAM. THE TOC PROGRAMS HAS TWO (2) SUCCESSFUL STRATEGIES:(1) SMH SD AND CV STAFF HAVE THE CAPABILITY OF LOGGING ONTO THE FHCSD APPOINTMENT SYSTEM WITH PATIENTS IN THE HOSPITAL SETTING TO SCHEDULE MEDICAL AND BEHAVIORAL HEALTH FOLLOW UP VISITS POST-DISCHARGE, AND (2) FHCSD SOCIAL WORK STAFF ARE HOUSED AT BOTH THE SAN DIEGO AND CHULA VISTA CAMPUS MEET PATIENTS IN THE EMERGENCY DEPARTMENT OR INPATIENT SETTING TO ASSIST THEM WITH VARIOUS POST-DISCHARGE NEEDS. IN ADDITION, SINCE 2013, SCRIPPS MERCY MEDICAL EDUCATION HAS SUPPORTED THE TEACHING HEALTH CENTERS FAMILY MEDICINE RESIDENCY AT FAMILY HEALTH CENTERS, WITH ALL INPATIENT TEACHING EXCEPT FOR PEDIATRICS OCCURRING AT SCRIPPS MERCY HOSPITAL SAN DIEGO. UNDERSERVED MEDICINE CURRICULUM THE INTERNAL MEDICINE FACULTY ARE CURRENTLY DEVELOPING A NEW OPTIONAL ROTATION GEARED TOWARD LEARNING ABOUT MODALITIES TO SERVE VULNERABLE POPULATIONS. THIS ONE OR TWO-WEEK ROTATION EXPERIENCE WILL INCLUDE TRAINING WITH VARIOUS COMMUNITY-BASED LOCATIONS THAT SERVE MEDICALLY UNDERSERVED POPULATIONS ALONG WITH INDEPENDENT LITERATURE STUDY RELATED TO CARING FOR THESE POPULATIONS. DURING THE INDEPENDENT STUDY PART OF THE CURRICULUM THE RESIDENTS WILL LEARN ABOUT DISPARITIES (INTRODUCTION AND DEFINITIONS), CLINICAL CARE OF LGBTQ PATIENTS AND SYSTEM BASED PRACTICE. THE CURRICULUM SITES MAY CHANGE YEAR TO YEAR BASED ON RESIDENT INTERESTS AND SITE AVAILABILITY. THE GOALS AND OBJECTIVES OF THE CURRICULUM ARE TO GAIN A DEEPER UNDERSTANDING OF THE RESOURCES AVAILABLE WITHIN THE SAN DIEGO COMMUNITY THAT PROVIDE CARE FOR THE UNDERSERVED PATIENTS IN VARIOUS SETTINGS, TO LEARN MORE ABOUT THE DISPARITIES THAT CURRENTLY EXIST WITHIN THE HEALTHCARE SYSTEM AND TO REFLECT ON WAYS THE CURRENT SYSTEM CAN BE IMPROVED, TO PARTICIPATE IN THE EDUCATION AND HEALTHCARE OF UNDERSERVED PATIENTS. SOME OF THE ROTATIONS IN THE CURRICULUM INCLUDE THE FOLLOWING: - ASYLUM SEEKERS CLINIC - RURAL HEALTH EXPERIENCE - PACE (PROGRAM OF ALL-INCLUSIVE CARE OF THE ELDERLY) - FATHER JOE'S VILLAGE HEALTH CENTER - RIDE ALONG WITH THE FATHER JOE'S VILLAGE STREET HEALTH TEAM TO IDENTIFY UNSHELTERED PERSONS LIVING OUT IN THE COMMUNITY WHO ARE IN NEED OF MEDICAL CARE. - SAN DIEGO AMERICAN INDIAN HEALTH CENTER - TREATING THE NATIVE AMERICAN AND INDIGENOUS POPULATIONS - HOMELESS OUTREACH TEAM - FAMILY HEALTH CENTER - THE RESIDENT WILL JOIN THE HOMELESS OUTREACH TEAM THAT TRAVELS TO CHULA VISTA - MEDICATION ASSISTED TREATMENT THROUGH FAMILY HEALTH CENTER - SAN DIEGO RESCUE MISSION - PARTICIPATION IN THE EDUCATION OF RESIDENTS AND JOIN THE HOMELESS OUTREACH TEAM. - SALVATION ARMY - LEARN WHAT PROGRAMS ARE BEING OFFERED THROUGH THE SALVATION ARMY THAT ADDRESS HEALTH DISPARITIES AND OBSERVE A GRADUATION CEREMONY. - SAN YSIDRO HEALTH CLINIC: BORDER HEALTH - LA MAESTRA COMMUNITY HEALTH CENTER - ASSISTING PROVIDERS AT LA MAESTRA COMMUNITY HEALTH CENTER IN CITY HEIGHT, SERVING A WIDELY DIVERSE REFUGEE AND IMMIGRANT POPULATIONS"

Schedule H, Part VI, Line 7 State filing of community benefit report
CA

Schedule H, Part VI, Line 2 NEEDS ASSESSMENT (CONTINUATION)
THE CHNA REPORT WILL BE MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND IS INTENDED TO SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTH CARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. HASDIC AND THE CHNA COMMITTEE ARE PROUD OF THEIR COLLABORATIVE RELATIONSHIPS WITH LOCAL COMMUNITY ORGANIZATIONS AND ARE COMMITTED TO REGULARLY SEEKING INPUT FROM THE COMMUNITY TO INFORM COMMUNITY HEALTH STRATEGIES. THE CHNA COMMITTEE IS IN THE PROCESS OF PLANNING PHASE 2 OF THE 2022 CHNA, WHICH WILL INCLUDE GATHERING COMMUNITY FEEDBACK ON THE 2022 CHNA PROCESS AND STRENGTHENING PARTNERSHIPS AROUND THE IDENTIFIED COMMUNITY NEEDS. SCRIPPS HEALTH IMPLEMENTATION STRATEGY WITH THE 2022 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED; SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY: A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION STRATEGY TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS EVALUATES THE IMPLEMENTATION STRATEGY ANNUALLY BECAUSE A FLEXIBLE APPROACH IS WELL-SUITED TO DEVELOPING A RESPONSE TO THE CHNA. THE EVALUATION OF THE IMPLEMENTATION STRATEGY ASSESSES AVAILABLE RESOURCES AND INTERVENTIONS AND ADJUSTS AS NEEDED TO ACHIEVE THE IMPLEMENTATION STRATEGY'S STATED GOALS AND OUTCOME MEASURES. PLANS TO MONITOR THE IMPLEMENTATION STRATEGY ARE ALSO TAILORED TO EACH OBJECTIVE AND INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES. SCRIPPS DESCRIBES CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN ADDITION, SCRIPPS HEALTH IMPLEMENTATION STRATEGY IS FILED ANNUALLY WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. SCRIPPS HEALTH HAS A CONSISTENT FOCUS ON THE INITIATIVES, MEASURES OF IMPLEMENTATION AND METRICS USED TO EVALUATE THE EFFECTIVENESS OF THE COMMUNITY NEEDS IDENTIFIED THROUGH THE 2022 CHNA. THE COMPLETE FY23-FY25 IMPLEMENTATION STRATEGY REPORT IS AVAILABLE ONLINE AT SCRIPPS.ORG.

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION)
SCRIPPS EMPLOYEE FOOD SHARING PROGRAM SCRIPPS EMPLOYEES HAVE COME TOGETHER SEVERAL TIMES DURING THE COVID-19 PANDEMIC TO HELP HUNDREDS OF COLLEAGUES' FAMILIES WHO HAVE EXPERIENCED FOOD INSECURITY. WHILE MANY OF THESE COLLEAGUES HAVE BEEN ABLE TO CONTINUE WORKING, THE UNEXPECTED UNEMPLOYMENT OR REDUCTION IN WORK HOURS FOR FAMILY MEMBERS HAS IMPACTED THEIR ABILITY TO CONSISTENTLY PROVIDE THREE DAILY MEALS FOR THEMSELVES AND THEIR CHILDREN. AS A RESULT OF THESE MUTUAL CONCERNS THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM WAS ESTABLISHED TO ASSIST SCRIPPS FAMILIES EXPERIENCING FOOD INSECURITY AS THE COVID-19 CRISIS CONTINUED. A FOOD DISTRIBUTION EVENT WAS HELD ON DECEMBER 18, 2021. THE SCRIPPS EMPLOYEE FOOD SHARING PROGRAM SUCCESSFULLY DISTRIBUTED FOOD TO 391 FAMILY MEMBERS. FOOD DISTRIBUTED: 6,500 POUNDS OF GROCERIES AND EACH STAFF MEMBER RECEIVED MILK, EGGS, BREAD, FRUIT, VEGETABLES, A BOX OF NON-PERISHABLE FOOD. THE MAJORITY OF THE FOOD WAS DISTRIBUTED ON DECEMBER 18 BUT AT LEAST 25 ADDITIONAL PACKAGES OF FOOD WAS DISTRIBUTED THE FOLLOWING WEEK. MANY DEPARTMENTS WORKED COLLABORATIVELY TO MAKE THIS INITIATIVE A SUCCESS SUCH AS HUMAN RESOURCES, FOOD AND NUTRITION SERVICES, AND SECURITY AND FACILITIES TO NAME A FEW. THE SCRIPPS LEADERSHIP ACADEMY ALUMNI ALSO VOLUNTEERED TO HELP PACKAGE AND DISTRIBUTE THE FOOD. MUCH APPRECIATION TO THE EMPLOYEES, PHYSICIANS AND VENDORS WHO DONATED TO THE PROGRAM AS THEIR GENEROSITY HELPED TO MAKE A DIFFERENCE FOR MANY DURING A DIFFICULT TIME. DONATIONS FOR UKRAINE RESPONSE IN RESPONSE TO EMPLOYEE AND PHYSICIAN REQUESTS FOR UKRAINE SUPPORT, SCRIPPS PARTNERED WITH MEDSHARE, A GLOBAL ORGANIZATION PROVIDING REQUESTED AND NEEDED MEDICAL SUPPLIES TO UKRAINE. SCRIPPS FIRST LEARNED OF MEDSHARE WHEN THE SCRIPPS MEDICAL RESPONSE TEAM WAS ASSISTING IN HAITI AFTER THE COUNTRY'S EARTHQUAKE. MEDSHARE IS ACTIVELY COLLECTING CASH DONATIONS AND OTHER SUPPORT FOR THEIR EFFORTS AND HAD MORE THAN 7 SHIPMENTS SCHEDULED OVER SEVERAL WEEKS, RANGING IN SIZE AND SCOPE FROM TWO PALLETS OF WOUND CARE DRESSINGS TO A FULL 40-FOOT OCEAN CONTAINER OF ASSORTED MEDICAL SUPPLIES, BIOMEDICAL EQUIPMENT AND SURGICAL TOOLS. MEDSHARE ALSO PARTNERS WITH AN ARRAY OF OTHER INTERNATIONAL RELIEF ORGANIZATIONS TO ENSURE AID IS HANDLED APPROPRIATELY AND REACHES THE MOST CRITICAL COMMUNITIES. SCRIPPS STAFF AND PHYSICIANS RALLIED TO THE WORTHY CAUSE WITH THEIR OWN CASH CONTRIBUTIONS IN THE AMOUNT OF $10,710. (MADE THROUGH PAYROLL DEDUCTION), AND SCRIPPS HEALTH TOOK THE LEAD WITH ITS OWN LEAD GIFT OF $10,000. STAFF WERE ALSO ABLE TO MAKE DONATIONS DIRECTLY THROUGH THE MEDSHARE WEBSITE. SOCK AND BLANKET DRIVE THE SOCK AND BLANKET DRIVE WAS HELD AS PART OF SCRIPPS SPIRIT WEEK. DONATIONS ACROSS THE SCRIPPS SYSTEM WERE COLLECTED AND GIVEN TO FATHER JOE'S VILLAGES TO BENEFIT THE HOMELESS IN THE COMMUNITY. CONTRIBUTIONS WERE MADE BY JUST ABOUT EVERY SITE THROUGHOUT THE SYSTEM. FATHER JOE'S WILL INCLUDE THE DONATED ITEMS IN HYGIENE KITS FOR THE HOMELESS AND DISTRIBUTE THEM AT SHELTERS AND DAY CENTERS AND DURING WEATHER EVENTS. IN ALL THERE WERE 3,312 PAIRS OF SOCKS DONATED, ESTIMATED BY SUPPLY CHAIN AT A VALUE OF $5,862. THERE WERE ALSO 204 BLANKETS GIVEN AT AN ESTIMATED VALUE OF $5,712.

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUATION)
SCRIPPS HEALTH CAL FRESH SCREENINGS AS HEALTH CARE DELIVERY SYSTEMS MOVE TOWARDS A POPULATION HEALTH PARADIGM THAT INCENTIVIZES KEEPING PATIENTS HEALTHY, HOSPITALS AND CLINICS ARE RECOGNIZING THE SIGNIFICANCE OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH, SUCH AS FOOD INSECURITY (FI). HOSPITALS HAVE BEEN MORE PROACTIVE IN INTERVENING AT SOME LEVEL OF CARE TO AID THE INDIVIDUALS SUFFERING FROM FI AND THEIR ABILITY TO GAIN CONTROL OVER THEIR HEALTH. THE PUBLIC RESOURCE SPECIALIST (PRS) TEAM SCREENS ALL UNINSURED PATIENTS WHO HAVE RECEIVED SERVICES AT ANY OF THE FIVE SCRIPPS HOSPITAL FACILITIES. SCRIPPS HEALTH BEGAN SCREENING FOR CAL FRESH IN JUNE 2017 THROUGH THE SUPPORT OF THE PRS TEAM. THE TEAM HAS BEEN SUCCESSFUL IN HAVING AN IMPORTANT CONVERSATION ABOUT FOOD INSECURITY WITH PATIENTS AND IN FISCAL YEAR 2022, THE PRS TEAM SUCCESSFULLY SCREENED 5,080 FOOD INSECURE PATIENTS. OUT OF THOSE SCREENINGS, PRS SUBMITTED 3,854 MEDI-CAL APPLICATIONS TO THE COUNTY, 674 CAL FRESH APPLICATIONS AND 382 EXPEDITED CAL FRESH APPLICATION. SCRIPPS MERCY WIC PROGRAM THE SPECIAL SUPPLEMENT NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) WAS ESTABLISHED AS A PERMANENT PROGRAM IN 1974 TO SAFEGUARD THE HEALTH OF LOW-INCOME WOMEN, INFANTS, AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS, AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES ON AVERAGE 6,200 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FISCAL YEAR 2022, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 72,926 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW-INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS BREAST PUMPS, PADS, AND OTHER SUPPLIES DURING THE POSTPARTUM PERIOD. IDENTIFYING THE SOCIAL DETERMINANTS OF HEALTH FOR PATIENTS POST DISCHARGE SCRIPPS MERCY HOSPITAL CHULA VISTA WELL BEING CENTER STAFF MEET WITH PATIENTS AT THE BEDSIDE OR FOLLOW UP WITH PATIENTS THROUGH PHONE CALLS AND HOME VISITS TO DETERMINE THE PATIENT'S NEEDS. PATIENTS ARE SCREENED FOR BARRIERS USING A SOCIAL DETERMINANTS OF HEALTH (SDOH) SCREENING TOOL TO HELP IDENTIFY THE PATIENT'S SPECIFIC NEEDS. ADDRESSING SDOH IS VITAL FOR IMPROVING HEALTH AND REDUCING LONGSTANDING HEALTH DISPARITIES. ONCE THE PATIENT'S NEEDS AND ROOT CAUSES OF HOSPITALIZATION ARE IDENTIFIED, STAFF ASSIST THE PATIENT IN SCHEDULING FOLLOW UP DOCTOR'S APPOINTMENT(S) AND ACCESSING COMMUNITY RESOURCES/SUPPORTIVE SERVICES. THROUGH COLLABORATION WITH VARIOUS AGENCIES, STAFF CAN EFFECTIVELY LINK PATIENTS TO TRANSITIONAL CARE AND SUPPORTIVE SERVICES. FULL ACCESS AND COORDINATED TRANSPORTATION (FACT) INC. IN 2019, SCRIPPS ENTERED A PARTNERSHIP WITH A LOCAL NONPROFIT- FACILITATING ACCESS TO COORDINATED TRANSPORTATION (FACT) INC., FOR ON-DEMAND RIDES FOR PATIENTS. SCRIPPS STAFF RELIES ON FACT TO ARRANGE FOR PATIENTS TO GET TO APPOINTMENTS AND FOR DISCHARGED PATIENTS TO RETURN HOME OR GET TO OTHER FACILITIES. THIS COLLABORATIVE SERVICE HAS QUICKLY PROVED TO BE A RELIABLE, CONVENIENT, AND COST-EFFECTIVE SOLUTION TO ONE OF THE DIFFICULT AND EXPENSIVE CHALLENGES IN ACCESSING MEDICAL CARE TRANSPORTATION. THE PROGRAM STREAMLINES A VARIETY OF MEDICAL TRANSPORTATION OPTIONS THROUGH A SINGLE POINT OF CONTACT AT FACT. FACT PROVIDED RIDES FOR PATIENTS INCLUDING THOSE WHO NEED SPECIALIZED VEHICLES OR PERSONAL ASSISTANCE TO COMPLETE THE TRIP. SCRIPPS STAFF USE A SINGLE TELEPHONE NUMBER TO CONTACT STAFF AT FACT, WHO THEN HANDLE THE SELECTION OF THE APPROPRIATE VEHICLE, EQUIPMENT, AND PERSONNEL, AND DISPATCH THE RIDE. THE PROGRAM PROVIDES SAVINGS IN PROCESSING TIME, COST OF TRANSPORTATION AND IT OFFERS THE RIDER A MORE RELIABLE AND CONVENIENT TRANSPORTATION SERVICE. THE INITIAL PILOT PROJECT WAS PARTLY FUNDED BY A COMMUNITY ENHANCEMENT GRANT AWARDED TO FACT BY THE COUNTY OF SAN DIEGO. SCRIPPS REALIZED A BENEFIT USING FACT TRANSPORT AS A COST SAVINGS; RATHER THAN USING TAXI VOUCHERS, AS WELL AS TRIPS THAT COULD TAKE SCRIPPS STAFF A GREAT DEAL OF TIME TO FIND A VENDOR TO DO AS OTHER VENDORS MAY NOT BE ABLE TO DO TRIPS TO THE BORDER OR IMPERIAL COUNTY AS READILY. FACT IS A CLEARINGHOUSE OF SORTS WITH MULTIPLE VENDORS AND THEREFORE SAVES THE STAFF TIME IN FINDING THE APPROPRIATE TRANSPORT AT THE RIGHT TIME. TRANSPORTATION IS AVAILABLE 7 DAYS A WEEK FOR SCRIPPS DISCHARGED PATIENTS TO ANY LOCATION WITHIN SAN DIEGO AND BEYOND. MOST RIDES BEGIN AND END AT THE CURBSIDE, HOWEVER DOOR THROUGH DOOR RIDES, WHEELCHAIR ACCESSIBLE RIDES AND GURNEY RIDES ARE AVAILABLE ON DEMAND. FACT HAS PROVIDED 2,003 RIDES THROUGH JUNE 2022 FOR SCRIPPS PATIENTS THROUGHOUT SAN DIEGO AND AS FAR AWAY AS IMPERIAL COUNTY. THE FOLLOWING ARE THE DIFFERENT TRANSPORTATION MODALITIES THAT FACT-SD PROVIDES: - AMBULATORY - THE RIDER CAN WALK ALONE TO AND FROM THE VEHICLE - CURB-TO-CURB - THE RIDER WILL BE PICKED UP AND DROPPED OFF AT THE CURB OF THE FACILITY/RESIDENCE - DOOR-TO-DOOR - THE RIDER REQUIRES THE DRIVER TO WALK THEM FROM THE DOOR OF THE FACILITY/RESIDENCE TO THE VEHICLE AND FROM THE VEHICLE TO THE DOOR OF THE FACILITY/RESIDENCE - DOOR-THROUGH-DOOR - THE RIDER REQUIRES THE DRIVER TO COME INSIDE THE FACILITY AND TRANSPORT THEM TO THE VEHICLE, THE DRIVER WILL DROP THEM OFF AT THE DOOR OF THE FACILITY OR RESIDENCE - ACCESSIBLE VEHICLES AND MOBILITY DEVICES - WALKER, CANE, FOLDING WHEELCHAIR, WHEELCHAIR, SCOOTER, AND VEHICLES EQUIPPED WITH RAMP OR LIFT - GURNEY TRANSPORTATION SCRIPPS MOBILIZATION TO FIGHT THE COVID-19 PANDEMIC SINCE THE PANDEMIC BEGAN, SCRIPPS HAS BEEN IN OVERDRIVE - FINDING NEW WAYS TO CONNECT WITH PATIENTS, CARING FOR THOSE WHO BECOME ILL AND ADMINISTERING LIFESAVING VACCINES TO THE PEOPLE OF SAN DIEGO. ACROSS THE SCRIPPS HEALTH SYSTEM, DOCTORS, NURSES, CAREGIVERS AND SUPPORT STAFF CONTINUED TO WORK TOGETHER IN FISCAL YEAR 2022 TO FIGHT THE COVID-19 PANDEMIC. SCRIPPS CONTINUED WITH THE IMPLEMENTATION OF COMMAND CENTERS, COVID-19 NURSE LINE, TESTING AND SURGE TENTS AS TESTING CABANAS AND COMMUNITY SUPPORT IN THE EARLY PART OF 2022. IN ADDITION, AWARENESS AND EDUCATION FOR THE COMMUNITY IN VACCINE SAFETY AND AVAILABILITY INCLUDING PRODUCTION, EDUCATIONAL MATERIAL, COORDINATION OF MEDIA RESPONSE AND TELEPHONE HOTLINES FOR ANSWERING QUESTIONS CONTINUED. SCRIPPS POST-COVID CONTINUING CARE. SCRIPPS HEALTH DEVELOPED THE POST-COVID CONTINUING CARE PROGRAM TO ADDRESS THE LINGERING COMPLICATIONS ENDURED BY MANY PATIENTS PREVIOUSLY INFECTED WITH THE COVID-19 VIRUS. SOME PATIENTS EXPERIENCE ONGOING SYMPTOMS SUCH AS SHORTNESS OF BREATH, CONTINUED LOSS OF TASTE OR SMELL, DIZZINESS OR HEADACHES, FATIGUE, AND FOG. THE PROGRAM IS DESIGNED FOR SCRIPPS PATIENTS RECOVERING FROM A HOSPITAL STAY, AS WELL AS THOSE WHO DID NOT REQUIRE HOSPITALIZATIONS BUT ARE RECOVERING FROM COVID. THE GOAL OF THE PROGRAM IS TO HELP PATIENTS ON THE ROAD TO RECOVERY AND ENSURE THAT POST-COVID PATIENTS GET PROPER, COMPASSIONATE MEDICAL TREATMENT CUSTOMIZED TO THEIR NEEDS. FOR MORE INFORMATION ON THIS PROGRAM VISIT, RECOVERY PROGRAM - COVID-19 - SCRIPPS HEALTH. THE PROGRAM HAS ENROLLED 3,200 PATIENTS AS OF AUGUST 2022. THE FOCUS OF THE PROGRAM IN 2022 EVOLVED TO SCREENING COVID-19 POSITIVE PATIENTS AND COORDINATING THE MONOCLONAL TREATMENTS IF PATIENTS MET THE CRITERIA. IN ADDITION, THE COVID CARE COMPANION TEAM BEGAN WORKING WITH THE AMBULATORY PROVIDERS TO GET IMMUNOSUPPRESSED PATIENTS TO PRE-EXPOSURE PROPHYLAXIS TREATMENT.

Schedule H, Part I, Line 7g Subsidized Health Services
SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS THAT ARE PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. NEVERTHELESS, THE SERVICE IS PROVIDED BECAUSE IT MEETS AN IDENTIFIED COMMUNITY NEED, WHICH IF NO LONGER OFFERED WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION. SUBSIDIZED SERVICES DO NOT INCLUDE ANCILLARY SERVICES THAT SUPPORT LINES, SUCH AS LAB AND RADIOLOGY (IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE). THE TOTAL EXPENSE FOR SUBSIDIZED HEALTH SERVICES FOR SCRIPPS MERCY FISCAL YEAR 2022 WAS $3,157,043. THIS INCLUDES SCRIPPS INPATIENT BEHAVIORAL HEALTH . SCRIPPS OFFERS INPATIENT ADULT BEHAVIORAL HEALTH SERVICES AT THE SCRIPPS MERCY HOSPITAL, SAN DIEGO CAMPUS. THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM ALSO ACTIVELY SUPPORTS COMMUNITY PROGRAMS TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. THE BEHAVIORAL HEALTH INPATIENT PROGRAM AT SCRIPPS MERCY HOSPITAL HELPS PATIENTS AND THEIR LOVED ONE'S WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. TEAM OF SPECIALISTS INCLUDE PSYCHIATRISTS, PSYCHOLOGISTS, MARRIAGE AND FAMILY THERAPISTS, NURSES, SOCIAL WORKERS, ACTIVITY THERAPISTS, OCCUPATIONAL THERAPISTS, CHAPLAINS AND PHARMACISTS. TREATMENT GOALS INCLUDE RESOLVING ISSUES THAT LED TO HOSPITALIZATION, REDUCING THE RISK OF DANGEROUS BEHAVIOR, ALLEVIATING THE SYMPTOMS THAT LED TO HOSPITALIZATION AND INCREASING COPING SKILLS TO LIVE MORE EFFECTIVELY IN THE COMMUNITY. WHEN THESE GOALS ARE MET, OUR DEDICATED STAFF DEVELOP A DISCHARGE PLAN CLOSELY INTEGRATED WITH COMMUNITY SERVICES TO ENCOURAGE ONGOING CARE AND HELP PATIENTS RETURN TO THEIR FAMILIES AND COMMUNITIES. IN FY22, AS PART OF A SUCCESSFUL JOINT COMMISSION VISIT THE BEHAVIORAL HEALTH INPATIENT UNIT RECEIVED NEW LIGATURE RESISTANT FURNITURE AS PART OF AN OVERALL INITIATIVE TO REDUCE SUICIDE RISK. BEHAVIORAL HEALTH OUTPATIENT SERVICES SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE BEHAVIORAL HEALTH OUTPATIENT DAY PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO TO EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE MEDI-CAL POPULATION. COLLABORATION WITH HOSPITAL PARTNERS SUCH AS NAMI (NATIONAL ALLIANCE OF MENTAL ILLNESS), THE FAMILY HEALTH CENTERS OF SAN DIEGO, THE MCALISTER INSTITUTE AND HAZELDEN BETTY FORD HIGHLIGHT SCRIPPS COMMITMENT TO THE COMMUNITY WE SERVE. SCRIPPS HAS ALSO RECEIVED GRANT MONEY AS PART OF THE BEHAVIORAL HEALTH PILOT PROJECT TO EMBED SUBSTANCE USE COUNSELORS IN THE EMERGENCY DEPARTMENT TO FACILITATE LINKAGE TO MEDICATION ASSISTED OUTPATIENT PROGRAMS. BEHAVIORAL HEALTH CHALLENGES - LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. - IN FISCAL YEAR 2022, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM EXPERIENCED A $7.8 MILLION LOSS IN TOTAL OPERATIONS WITH $4.3 MILLION OF THIS LOSS BEING CAPTURED IN MEDI-CAL/CMS AND CHARITY CARE. - IN FISCAL YEAR 2022, 1 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS DERIVED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMNTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGRDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED.

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

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
SCRIPPS UNCOMPENSATED CARE METHODOLOGY FISCAL YEAR 2022 SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. DURING FISCAL YEAR 2022, SCRIPPS CONTRIBUTED $643,952,528 IN UNCOMPENSATED HEALTH CARE, $17456,417 IN CHARITY CARE, $619,090,066 IN MEDI-CAL AND MEDICARE SHORTFALL, AND $7,406,044 IN BAD DEBT. SCHEDULE H METHODOLOGY - SCHEDULE H REQUIRES THE UNCOMPENSATED CARE TO BE DIVIDED INTO FOUR CATEGORIES: CHARITY CARE, UNDER-REIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS, BAD DEBT, AND UNDER-REIMBURSED MEDICARE. BAD DEBT AND MEDICARE SHORTFALLS ARE REPORTABLE UNDER THE SCHEDULE H GUIDELINES BUT DO NOT COUNT TOWARDS THE COMMUNITY BENEFIT TOTALS. THUS, THE CATEGORIES ARE REPORTED IN A SPECIFIC ORDER/HIERARCHY. CHARITY CARE AND UNDER-REIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS ARE COUNTED FIRST. CHARITY CARE METHODOLOGY - UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS CHARITY ADJUSTMENTS. THE FOLLOWING COSTS ARE EXCLUDED: COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. TRADITIONAL CHARITY CARE IS INCLUDED IN THE INTERNAL REVENUE SERVICE (IRS) FORM 990 SCHEDULE H PART I LINE 7A. MEDI-CAL SHORTFALL - THE SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE, MEDICARE PPO, MEDICARE HMO, MEDICARE CAPITATED PROGRAM AT THE HOSPITALS, MEDI-CAL, MEDI-CAL HMO, AND CMS PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS REVENUE FROM UNCOMPENSATED CARE POOLS INCLUDING MEDI-CAL DSH. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE SYNTELLIS PERFORMANCE SOLUTIONS. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY ADJUSTMENTS AT COST FOR MEDI-CAL PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART I LINE 7B. IN THE STATE OF CALIFORNIA, THE MEDICAID PROGRAM IS CALLED MEDI-CAL. MEDICARE AND MEDICARE HMO HOSPITALS - SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE AND MEDICARE SENIOR PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE CAPITATION ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS OTHER REVENUE INCLUDING. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE MCKESSON HPM COST ACCOUNTING SYSTEM. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION B. BAD DEBT METHODOLOGY - UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO- COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD DEBT ADJUSTMENTS LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION A. SHORTFALL METHODOLOGY CLINICS - SHORTFALL IS DERIVED BY COMPUTING OPERATING MARGIN AT THE PATIENT LEVEL AND SUMMARIZING THE PATIENTS WITH MEDICARE AND MEDICARE SENIOR PRIMARY INSURANCE CARRIERS. OPERATING MARGIN IS DEFINED AS NET REVENUE LESS ALL VARIABLE, FIXED, AND OVERHEAD COSTS. PROFITABILITY IS ESTIMATED AS FOLLOWS: NET REVENUE IS EQUIVALENT TO PAYMENTS PLUS AN ESTIMATION OF THE CAPITATION ACCOUNT BALANCE FOR ALL OPEN ACCOUNTS, PLUS OTHER REVENUE INCLUDING. COST IS DERIVED USING THE RELATIVE VALUE ALLOCATION METHODOLOGY PER THE MCKESSON HPM COST ACCOUNTING SYSTEM. THESE COSTS ARE INCLUDED IN THE IRS FORM 990 SCHEDULE H PART III SECTION B.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
COLLECTION POLICY THE PURPOSE OF THIS POLICY IS TO PROVIDE INFORMATION WITH RESPECT TO THE CHARGING, BILLING AND COLLECTION OF PATIENT DEBT PURSUANT TO THE CALIFORNIA HEALTH AND SAFETY CODE, THE FEDERAL PATIENT PROTECTION, AND AFFORDABILITY CARE ACT, AND THE POLICIES AND PRACTICES OF SCRIPPS HOSPITALS, (SCRIPPS MEMORIAL HOSPITAL LA JOLLA, SCRIPPS MEMORIAL HOSPITAL ENCINITAS, SCRIPPS GREEN HOSPITAL, SCRIPPS MERCY HOSPITAL, SAN DIEGO AND CHULA VISTA), AND SCRIPPS MEDICAL FOUNDATION. ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE.

Schedule H, Part II Community Building Activities
F1 - PHYSICAL IMPROVEMENTS AND HOUSING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 1 F2 - ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2 EXECUTIVE LEADERSHIP SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS; SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). NORTH SAN DIEGO BUSINESS CHAMBER HEALTH COMMITTEE MEETING THE CHAMBER STRIVES TO DELIVER UP-TO-DATE, HEALTH-RELATED INFORMATION GO ENHANCE THE QUALITY OF LIFE TO THE BUSINESS COMMUNITY. THE HEALTH COMMITTEE SERVES AS A FRONT LINE TO EDUCATE SAN DIEGO NORTH BUSINESS ABOUT HEALTH CARE ISSUES SPECIFIC TO THE REGION THAT IMPACT BOTTOM LINES AND WORKFORCE PRODUCTIVITY. THE SCRIPPS DIRECTOR OF COMMUNITY BENEFIT ATTENDS THESE MEETINGS. F3 - COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3. DISASTER PREPAREDNESS - COMMUNITY SUPPORT AND OUTREACH 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 HEALTH MAXIMIZES AWARENESS AND ENCOURAGES PARTICIPATION IN DISASTER PREPAREDNESS ACTIVITIES TO AFFECT CHANGE AT THE COMMUNITY LEVEL. SCRIPPS PARTICIPATES IN SAN DIEGO COUNTY AND STATE OF CALIFORNIA ADVISORY GROUPS TO PLAN, IMPLEMENT AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND EXERCISES. IN ADDITION, SCRIPPS IS AN ADVISOR TO SAN DIEGO COUNTY FOR FEDERAL AND STATE GRANT DEVELOPMENT AND PLANNING. HOSPITAL INCIDENT COMMAND SYSTEM (HICS) NATIONAL ADVISORY COMMITTEE SCRIPPS HEALTH IS AN ACTIVE MEMBER IN THE HOSPITAL INCIDENT COMMAND SYSTEM NATIONAL ADVISORY COMMITTEE. SAN DIEGO COUNTY HEALTHCARE DISASTER COALITION SCRIPPS PARTNERED WITH THE SAN DIEGO HEALTHCARE DISASTER COALITION FOR SURGE CAPACITY PLANNING TO INSURE EMERGENCY DEPARTMENT AND URGENT CARE READINESS IN THE EVENT OF A SURGE OF COVID/FLU PATIENTS. SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE SCRIPPS HEALTH PARTICIPATES IN THE SAN DIEGO HEALTHCARE COALITION ADVISORY COMMITTEE AT VARIOUS LEVELS TO INCLUDE BUDGET, PEIDATRIC SURGE, DECONTAMINATION, BURN SURGE AND REGIONALIZATION COMMITTEE'S. THE WORKGROUPS PROVIDE LEADERSHIP, REPRESENATION AND FUNDING THROUGH THE APPLICATION OF GRANTS, COOPERATIVE AGREEMENTS TO STATE, TERRITORIES AND ELIGIBLE MUNICIPALITIES TO IMPROVE SURGE CAPACITY, HEALTH EQUITY AND ENHANCED COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH. SAN DIEGO COUNTY OPERATIONAL AREA FULL SCALE EXERCISE FULL SCALE EXERCISE PLANNED FOR EIGHT HOURS, SPANNING ONE HALF MILE OFF OF OCEAN BEACH AND INTO MISSION BAY. THE EXRERISE CONSISTED OF A PEDIATRIC SURGE FROM MULTIPLE SIMULTAINOUS INCIDENTS THROUGHOUT THE COUNTY OF SAN DIEGO SURGING THE ENTIRE SYSTEM ALL AT ONCE. EXERCISE PLAY IS LIMITED TO THE RESCUE, TRANSPORT AND TREATMENT OF A SIMULATED BUS CRASH AND AN SUSPECTED TERRIORIST INCIDENT AT A CHILD DEVELOPMENT CENTER LOCATED IN SAN DIEGO COUNTY. THE ASSESMENT OF THE EXERCISE WAS A CORRDINATED RESPONSE FOR FEDERAL, STATE AND LOCAL AGENCIES TO INCLUDE BUT NOT LIMITED TO FEDERAL AGENCIES, MILITARY, STATE AND LOCAL POLICE, FIRE AGENCIES. ALL SAN DIEGO OUNTY HOSPITALS PARTICIPATED IN THE DRILL. SAN DIEGO COUNTY COALITION SURGE TEST NO NOTICE EXERCISE THE SURGE DRILL IS POSTPPONED TO NEXT YEAR DUE TO THE CURRENT PEDIATRIC SURGE AT CHILDREN'S HOSPITAL. THE DRILL IS CURRENTLY BEING PLANNED AND WILL BE A SYSTEM WIDE PEDIATRIC SURGE DRILL. SAN DIEGO COUNTY MEDICAL AND HEALTH FULL SCALE EXERCISE IN JULY, SCRIPPS PARTICIPATED IN THE COUNTY WIDE EXERCISE. ALL HOSPITALS PARTICIPATED, TESTED AND EVALUATED THE CAPABILITIES OF THE COMMAND CENTER AND THE RESPONSE PLAN FOR PATIENT SURGE AND EVACUATION. THIS INCLUDE MOC PARTICIPATION TO INCLUDE USE OF WEB-EOC. THIS WAS A COUNTY WIDE DRILL THAT INCLUDE ALL FACILITIES TO INCLUDE HOSPITALS, LONG TERM CARE AND TRANSPORT CAPABILITIES FOR THE COUNTY AND ITS PARTNERS. SAN DIEGO REGIONAL FULL-SCALE EXERCISE SCRIPPS HEALTH PARTICIPATES IN THE SAN DIEGO HEALTHCARE ADVISORRY COMMITTEE REGIONAL FULL-SCALE EXERCISE. THE EXERCISE WAS CONDUCTED IN JULY 2022 CONSISTING OF A MAJOR EARTHQUAKE THAT DAMAGED THE CURRENT INFASTRUCTURE TO INCLUDE MAJOR HIGHWAYS LOCATED THROUGHOUT THE SAN DIEGO AREA. THE EARTHQUAKE IMPACTED FACILITIES VITAL INFASTRUCTURE TO INCLUDE POWER AND WATER. HOSPITALS, CLINICS AND LONGTERM CARE FACILITIES PARTICIPATED ALONG WITH THE COUNTY OF SAN DIEGO. SCRIPPS HOSPITAL COMMAND CENTERS WERE UTILIZED AT EVERY HOSPITAL AND COMMUNICATIONS WERE TESTED TO INCLUDE RADIO, HAM RADIOS, CELL PHONES, TEAMS AND WEB-EOC CAPABILITIES. HOSPITALS WERE ALSO TESTED ON SURGE CAPABILITIES DURING THE DRILL. F4 - ENVIRONMENTAL IMPROVEMENTS F5 - LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. ENLISTED LEADERSHIP FOUNDATION - THE FOUNDRY ENLISTED LEADERSHIP FOUNDATION IS A SAN DIEGO BASED NON-PROFIT GROUP 501(C)3 DEDICATED TO LEADERSHIP DEVELOPMENT OF NAVY SECOND CLASS, FIRST CLASS, AND CHIEF PETTY OFFICERS. THIS ORGANIZATION WAS FORMED BY A TEAM OF ACTIVE DUTY AND RETIRED COMMAND / MASTER CHIEF PETTY OFFICERS TO DEVELOP CURRENT AND FUTURE LEADERS THROUGH A PHILOSOPHY OF SHARING AND MENTORING BASED ON COMBINED GENERATIONS OF GROWTH AND GROOMING. THE FOUNDRY HELD THREE CLASSES IN 2022 FOR A TTOAL OF 348 STUDENTS AND SENIOR ELISTED MENTORS. THE LEADING PETTY OFFICE ACADEMY HELD THREE WORKSHOPS WITH A TOTAL OF 136 STUDENTS, PRIMARLY THE NAVY. THE CHIEF PETTY OFFICER PRODE DAY WAS HELD AT THE SILVER STRAND BEACH AND HAD 2,500 PEOPLE IN ATTENDANCE. THE $35,000 SCRIPPS SUPPORT ENABLED THE FOUNDRY TO ACCOMPLISH THESE PROGRAMS AND KEEP STUDENTS COST LOWER. SAN DIEGO SHERRIFF'S SEARCH RESCUE ACADEMY - EMERGENCY REPONSE MODULE THE AMERICAN RED CROSS EMERGENCY MEDICAL RESPONSE COURSE PROVIDES THE PARTICIPANT WITH THE KNOWLEDGE AND SKILLS NECESSARY TO WORK AS AN EMERGENCY MEDICAL RESPONDER (EMR). THE CLASS INSTRUCTED BY CHRIS VAN GORDER, SCRIPPS PRESIDENT AND CEO. F6 - COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6 INJURY PREVENTION AND COUNTY'S HEALTH AND SAFTEY COALITION GROUPS AND TASK FORCES SCRIPPS HEALTH INJURY PREVENTION COMMUNITY OUTREACH PARTICIPATES IN A VARIETY OF HEALTH AND SAFETY COALITION GROUPS AND TASK FORCES FOR THE COUNTY'S HEALTH AND HUMAN SERVICES AGENCY. THESE INCLUDE WORKGROUPS THAT FOCUS ON BEHAVIORAL HEALTH, ECONOMIC DEVELOPMENT, FOOD INSECURITY, HOMELESSNESS, AGING AND INDEPENDENCE SERVICES, FALL PREVENTION TASK FORCE, GUN VIOLENCE REDUCTION ADVISORY WORK GROUP, GANG VIOLENCE, DOMESTIC VIOLENCE, HIGHWAY SAFETY, CALIFORNIA TEEN SAFE DRIVING COALITION, SUICIDE PREVENTION COUNCIL, METH STRIKE FORCE, AND THE SAN DIEGO ALCOHOL POLICY PANEL. STAFF HOURS TO BE CAPTURED IN FY23.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E. EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP (""FAP SUMMARY"") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENT'S UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FORPAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENT'S ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL-OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE."

Schedule H, Part VI, Line 4 Community information
SCRIPPS HEALTH COMMUNITY SERVED HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT, AND PRIMARY CARE. IN FISCAL YEAR 2022, SCRIPPS PROVIDED 2,871,687 OUTPATIENT VISITS AND 69,817 HOSPITAL DISCHARGES. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNDERINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED/UNDERINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 65 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. SCRIPPS MERCY HOSPITAL SAN DIEGO AND SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUSES ARE DESIGNATED BY THE GOVERNMENT AS A DISPROPORTIONATE SHARE HOSPITAL, IN REFLECTION OF THE DIVERSITY OF THE POPULATION THEY SERVE. BOTH HOSPITAL CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED MEDICARE AND MEDI-CAL. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) LOW-INCOME, UNINSURED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. DATA FROM THE AMERICAN COMMUNITY SURVEY SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, HOUSING, CHILDCARE, TRANSPORTATION, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DEFINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE DISTRIBUTION OF A POPULATION ARE ALL IMPORTANT FACTORS IN UNDERSTANDING COMMUNITIES AND THEIR RESIDENTS. IDENTIFYING HIGH-NEED AREAS A CRITICAL COMPONENT OF UNDERSTANDING COMMUNITY HEALTH IS TO IDENTIFY GEOGRAPHIC AREAS OF INEQUITIES. THE CHNA COMMITTEE UTILIZED TWO METRICS TO DETERMINE WHICH AREAS OF SAN DIEGO COUNTY LIKELY EXPERIENCE THE GREATEST HEALTH DISPARITIES: (1) THE HEALTHY PEOPLE INDEX (HPI) WHICH ANALYZES HEALTH OPPORTUNITIES BY CENSUS TRACT; AND (2) THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI), WHICH MEASURES BARRIERS TO SOCIO-ECONOMIC SECURITY BY ZIP CODE. DATA FROM THESE TWO SOURCES PROVIDED KEY INFORMATION ABOUT RESOURCES AND DISPARITIES IN DIFFERENT REGIONS OF SAN DIEGO COUNTY AND GUIDED THE SELECTION PROCESS FOR THE COMMUNITY ENGAGEMENT. CITIES WITH HIGH NEED INDEX SCORES (4.2-5.0) BY SAN DIEGO COUNTY HHSA - CENTRAL SAN DIEGO - 92102, 92015, 92113, 92115 - NORTH CENTRAL SAN DIEGO - 92111 - EAST SAN DIEGO - 91905,91917,92020,92021,91934,91963,91980 - NORTH COASTAL SAN DIEGO - 92083 - NORTH INLAND SAN DIEGO - 92025, 2069 - SOUTH SAN DIEGO -91910, 91911, 91932, 91950, 92154, 92173 ADDITIONAL INFORMATION ON SOCIOECONOMIC FACTORS, ACCESS TO CARE, HEALTH BEHAVIORS, AND THE PHYSICAL ENVIRONMENT CAN BE FOUND IN THE SCRIPPS HEALTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. FURTHER BREAKDOWNS IN SAN DIEGO COUNTY DEMOGRAPHICS ARE DISPLAYED BELOW. SAN DIEGO IS THE SECOND MOST POPULOUS COUNTY IN CALIFORNIA AND FIFTH MOST POPULOUS IN THE UNITED STATES. SAN DIEGO HAS : - OVER 3.3 MILLION RESIDENTS - MAJORITY MINORITY POPULATION -- ASIAN - 11.6% -- BLACK - 4.7% -- HISPANIC/LATINO - 33.7% -- NATIVE AMERICAN/ALASKA NATIVE - 0.4% -- PACIFIC ISLANDER/NATIVE HAWAIIAN - 0.4% -- SOME OTHER RACE - 0.2% -- MULTIPLE RACES - 3.4% - BUSIEST LAND BORDER CROSSING IN THE WORLD - 1 OF EVERY 13 PEOPLE WHO ENTER THE US COME THROUGH SAN YSIDRO - 70 MILES OF COASTLINE - 16 NAVAL AND MILITARY INSTALLATIONS - 18 FEDERALLY QUALIFIED RECOGNIZED INDIAN RESERVATIONS - A TOTAL OF 4,526 SQUARE MILES, LARGER THAN RHODE ISLAND AND DELAWARE COMBINED - SAN DIEGO COUNTY AGE GROUPS -- 6.3% AGES 0-4; 14% AGES 5-14; 29.8% AGES 25-44; 24.3% AGES 45-64 AND 13.7% AGES 65+ - SOCIOECONOMIC -- LIVING IN POVERTY (LESS-THAN 100% FEDERAL POVERTY LEVEL) - 11.6% -- CHILDREN IN POVERTY - 14.7% -- UNEMPLOYMENT - 3.1% - HEALTH INSURANCE -- 92.2% HAD HEALTH INSURANCE IN 2019 AND 7.8% HAD NO HEALTH INSURANCE.

Schedule H, Part VI, Line 6 Affiliated health care system
AFFILIATED HEALTH CARE SYSTEM FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $4 BILLION PRIVATE TAX EXEMPT, INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 600,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 3,000 AFFILIATED PHYSICIANS AND MORE THAN 16,000 EMPLOYEES. SCRIPPS CARES FOR PEOPLE THROUGHOUT THE SAN DIEGO REGION WITH FOUR ACUTE CARE HOSPITALS ON FIVE CAMPUSES, 31 OUTPATIENT CLINICS, AND 15 SCRIPPS HEALTHEXPRESS SITES. SCRIPPS ALSO OFFERS PAYER PRODUCTS AND POPULATION HEALTH SERVICES THROUGH SCRIPPS ACCOUNTABLE CARE ORGANIZATION, SCRIPPS HEALTH PLAN, ANDCUSTOMIZED NARROW NETWORK PLANS IN COLLABORATION WITH THIRD-PARTY PAYERS. SCRIPPS HEALTH IS A LEADING PROVIDER OF MEDICAL CARE, IMPROVING COMMUNITY HEALTH AND ADVANCING MEDICINE IN SAN DIEGO COUNTY. THE SYSTEM IS RECOGNIZED FOR EXPERTISE IN WOMEN'S HEALTH, CANCER CARE, CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT, AND NEUROCOGNITIVE CARE INCLUDING DEMENTIA AND THERAPY-INDUCED COGNITIVE SEQUELA. SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, AND DIGITAL HEALTH CARE. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONGSTANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. OUR HOSPITALS ARE CONSISTENTLY RANKED AMONG THE NATION'S BEST BY U.S. NEWS WORLD REPORT AND NUMEROUS OTHER ORGANIZATIONS. SCRIPPS IS FREQUENTLY RECOGNIZED BY FORTUNE MAGAZINE, WORKING MOTHER MAGAZINE, AND THE ADVISORY BOARD AS ONE OF THE BEST PLACES IN THE NATION TO WORK. IMPORTANTLY, SCRIPPS CULTURE IS ONE OF CARING; THE SPIRIT AND CULTURE ESTABLISHED BY TWO PIONEERING FOUNDERS, ELLEN BROWNING SCRIPPS AND MOTHER MARY MICHAEL CUMMINGS STILL DEFINE WHO WE ARE TODAY. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. AS A TAX-EXEMPT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 20-MEMBER, VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. AND OUR PARTNERSHIPS DO NOT STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDE WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS, AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE.