4A (Expenses $ 1159629620 including grants of $ 480303) (Revenue $ 1364821287)
Sharp Memorial Hospital provides inpatient and outpatient healthcare services to the community. For fiscal year 2022, patient days totaled 199,099 and outpatient visits totaled 330,250. See Community Benefits Report on Schedule O

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SHARP MEMORIAL HOSPITAL. Based on the results of the community health statistics scan and feedback from community partners received during the FY2022 CHNA planning process, a number of community engagement activities were conducted across San Diego County (SDC) as part of the collaborative, countywide FY2022 CHNA - led under the auspices of the Hospital Association of San Diego Imperial Counites (HASDIC) through the FY2022 CHNA Committee, of which Sharp was Chair. Additional community engagement activities were conducted specific to Sharp/SMH, in order to provide a more comprehensive understanding of identified health needs - including their associated social determinants of health (SDOH) and potential system and policy changes that may impact them - for the patients and community members served by the hospital. The CHNA process also included a detailed analysis of how these top needs impact the health of San Diego residents. Community engagement activities of the collaborative 2022 CHNA included 16 focus groups (90 participants), key informant interviews (26 participants), and an online survey (502 respondents) as well as Community Health Worker and promotor interviews (223 participants) which targeted stakeholders from every region of San Diego County, all age groups, and numerous racial and ethnic groups. Collaboration with the County of San Diego Health Human Services Agency, Public Health Services was vital to this process. Community engagement participants included county public health officers, health care and social service providers, and members of community-based organizations, including advocacy groups that represent communities facing inequities. A total of 841 individuals participated in the FY2022 collaborative CHNA. In addition to participation and leadership in the collaborative HASDIC FY2022 CHNA process, Sharp contracted separately with the Institute for Public Health (IPH) at San Diego State University (SDSU) to collect input from Sharp HealthCare providers as well as from patients and community members served by Sharp hospitals, including SMH. This input focused on the health and equity issues that were identified in Sharp's 2019 CHNA, including the impact of COVID-19 on those issues. This included two surveys designed in partnership with IPH engaging a total of 92 Sharp providers and 16 HR staff. Lastly, the SMH FY2022 CHNA community engagement process included a robust online survey conducted through the Sharp Insight Community. The Sharp Insight Community is a private online environment for Sharp patients and their families, community members, Sharp employees, and Sharp-affiliated physicians. The FY2022 CHNA Sharp Insight Community online survey sought to obtain feedback on the top health and social needs faced by community members in lieu of COVID-19, as well as assess their awareness of community outreach programs offered by Sharp. The online survey also provided participants the opportunity to provide specific suggestions for Sharp to improve community health and well-being. A total of 619 community members completed the Sharp Insight Community Survey. SMH/Sharp-specific community engagement activities concluded in Spring 2022.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SHARP MEMORIAL HOSPITAL. The HASDIC Board of Directors convened a CHNA Committee to plan and implement the collaborative FY2022 CHNA process. The CHNA Committee is comprised of representatives from the following hospitals and health care systems: * Kaiser Foundation Hospital - San Diego * Rady Children's Hospital - San Diego * Scripps Health (Vice Chair) * Sharp HealthCare (Chair) * Tri-City Medical Center * University of California San Diego Health * Grossmont Healthcare District The process and findings of the collaborative HASDIC FY2022 CHNA significantly informed the SMH FY2022 CHNA and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - SHARP MEMORIAL HOSPITAL. The Sharp Memorial Hospital FY2022 Community Health Needs Assessment (CHNA) examines the health needs of the community members it serves in San Diego County. SMH's FY2022 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASDIC) FY2022 Community Health Needs Assessment process and findings for San Diego County. This collaborative process was conducted under the auspices of HASDIC and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SHARP MEMORIAL HOSPITAL. The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Memorial Hospital (SMH), Sharp Mary Birch Hospital for Women Newborns (SMBHWN), Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC). In accordance with federal regulations, the SMH FY2022 Community Health Needs Assessment (CHNA) also includes needs identified for communities served by SMBHWN, as the two hospitals share a license and report all utilization and financial data as a single entity to the Department of Healthcare Access and Information (HCAI). Thus, the SMH FY2022 CHNA summarizes the processes and findings for communities served by both hospital entities (SMH and SMBHWN). SMV and SMC completed separate and distinct CHNAs in FY2022 (TY 2021). The findings of each of the entities' (SMH - including SMBHWN, SMV and SMC) FY2022 Community Health Needs Assessments (CHNA) further dove into priority health needs impacting the communities served by each entity, particularly those community members facing inequities, as well as provided insight gathered from direct conversations with the community. Through the SMMC FY2022 CHNAs, the following priority health needs were identified for the communities served by SMMC (listed in alphabetical order): * Access to Health Care * Aging Care Support * Behavioral Health * Children Youth Well-Being * Chronic Health Conditions * Community Safety * Economic Stability * Maternal and Prenatal Care, including High-Risk Pregnancy The hospital entities of SMMC (SMH, SMBHWN, SMV, and SMC) reviewed the findings of their FY2022 CHNAs to assist in the design and implementation of programs and services provided at these entities for community members. In identifying these priorities, all entities considered the expertise and mission of their programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise their service area and region (San Diego County). the unique, ever-changing demographics and health topics that comprise their service areas and regions. The hospital entities of SMMC collectively provide programming and services that specifically address these needs, either directly or indirectly. In FY 2022, many programs continued as virtual offerings in response to COVID-19. SMH does not have the resources to comprehensively address the identified need of behavioral health (including substance use). Consequently, this identified need is addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and substance use treatment services in SDC. SMH and SMV are conveniently located on the Sharp Metropolitan Medical Campus (SMMC). The identified need of maternal and prenatal care, including high-risk pregnancy, is addressed at SMBHWN, a specialty hospital providing care for women, newborns and expectant mothers in SDC, also located on the SMMC campus. SMH addresses chronic health conditions by providing education and healthy lifestyle programs as part of care for cardiovascular disease (CVD), cancer, diabetes, obesity and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Centers throughout SDC provide community members with structured weight management and health education programs, such as smoking cessation and stress management, long-term support for weight management and personalized weight-loss programs. To address multiple needs - particularly social - identified in the FY2022 CHNA, SMH participates in Sharp's systemwide pilot partnership with 2-1-1 San Diego's Community Information Exchange (CIE) to better understand and address the social determinants of health (SDOH) that influence the health and well-being of their patients. SMH's case management and social work staff received training on CIE as a tool to serve patients in the acute care setting, including those patients experiencing food insecurity and homelessness. Although delays and obstacles to CIE implementation and adoption persisted due to the COVID-19 pandemic during Year 3 of the CIE pilot, utilization metrics were sustained between Years 2 and 3 following significant improvement over Year 1. Community members across SDC were assisted through the CIE, and top community referrals included utilities, food, housing and economic support. Sharp teams continue to work closely with 2-1-1 on the implementation and data integration plans for CIE, which includes evaluation of ongoing metrics, such as system utilization of CIE, referral tracking, case management efficiency, successful connection to community referrals and more. Data will be used to re-evaluate the value and sustainability of CIE for Sharp upon completion of the pilot's fourth year. The most recently completed (FY 2023 - FY 2026) implementation strategies for each of SMMC's hospital entities are available online at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm. These implementation strategies detail the programs that each hospital provides to address needs identified in their FY2022 CHNAs.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - SHARP MEMORIAL HOSPITAL. The Sharp Metropolitan Medical Campus (SMMC) does not make presumptive FAP-eligibility determinations based on third-party information as defined in section 501(r)-6(c)(2). Instead, SMMC makes reasonable efforts based on notification and processing of applications as defined in 501(r)-6(c)(3).

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SHARP MARY BIRCH HOSPITAL FOR WOMEN. Based on the results of the community health statistics scan and feedback from community partners received during the FY2022 CHNA planning process, a number of community engagement activities were conducted across San Diego County (SDC) as part of the collaborative, countywide FY2022 CHNA - led under the auspices of the Hospital Association of San Diego Imperial Counites (HASDIC) through the FY2022 CHNA Committee, of which Sharp was Chair. Additional community engagement activities were conducted specific to Sharp/SMH, in order to provide a more comprehensive understanding of identified health needs - including their associated social determinants of health (SDOH) and potential system and policy changes that may impact them - for the patients and community members served by the hospital. The CHNA process also included a detailed analysis of how these top needs impact the health of San Diego residents. Community engagement activities of the collaborative FY2022 CHNA included 16 focus groups (90 participants), key informant interviews (26 participants), and an online survey (502 respondents) as well as Community Health Worker and promotora interviews (223 participants) which targeted stakeholders from every region of San Diego County, all age groups, and numerous racial and ethnic groups. Collaboration with the County of San Diego Health Human Services Agency, Public Health Services was vital to this process. Community engagement participants included county public health officers, health care and social service providers, and members of community-based organizations, including advocacy groups that represent communities facing inequities. A total of 841 individuals participated in the FY2022 collaborative CHNA. In addition to participation and leadership in the collaborative HASDIC FY2022 CHNA process, Sharp contracted separately with the Institute for Public Health (IPH) at San Diego State University (SDSU) to collect input from Sharp HealthCare providers as well as from patients and community members served by Sharp hospitals, including SMH. This input focused on the health and equity issues that were identified in Sharp's 2019 CHNA, including the impact of COVID-19 on those issues. This included two surveys designed in partnership with IPH engaging a total of 92 Sharp providers and 16 HR staff. Lastly, the SMH FY2022 CHNA community engagement process included a robust online survey conducted through the Sharp Insight Community. The Sharp Insight Community is a private online environment for Sharp patients and their families, community members, Sharp employees, and Sharp-affiliated physicians. The FY2022 CHNA Sharp Insight Community online survey sought to obtain feedback on the top health and social needs faced by community members in lieu of COVID-19, as well as assess their awareness of community outreach programs offered by Sharp. The online survey also provided participants the opportunity to provide specific suggestions for Sharp to improve community health and well-being. A total of 619 community members completed the Sharp Insight Community Survey. SMH/Sharp-specific community engagement activities concluded in Spring 2022.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SHARP MARY BIRCH HOSPITAL FOR WOMEN. The HASDIC Board of Directors convened a CHNA Committee to plan and implement the collaborative FY2022 CHNA process. The CHNA Committee is comprised of representatives from the following hospitals and health care systems: * Kaiser Foundation Hospital - San Diego * Rady Children's Hospital - San Diego * Scripps Health (Vice Chair) * Sharp HealthCare (Chair) * Tri-City Medical Center * University of California San Diego Health * Grossmont Healthcare District The process and findings of the collaborative HASDIC FY2022 CHNA significantly informed the SMH FY2022 CHNA and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - SHARP MARY BIRCH HOSPITAL FOR WOMEN. The Sharp Memorial Hospital FY2022 Community Health Needs Assessment (CHNA) examines the health needs of the community members it serves in San Diego County. SMH's FY2022 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASDIC) FY2022 Community Health Needs Assessment process and findings for San Diego County. This collaborative process was conducted under the auspices of HASDIC and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SHARP MARY BIRCH HOSPITAL FOR WOMEN. The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Memorial Hospital (SMH), Sharp Mary Birch Hospital for Women Newborns (SMBHWN), Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC). In accordance with federal regulations, the SMH FY2022 Community Health Needs Assessment (CHNA) also includes needs identified for communities served by SMBHWN, as the two hospitals share a license and report all utilization and financial data as a single entity to the Department of Healthcare Access and Information (HCAI). Thus, the SMH FY2022 CHNA summarizes the processes and findings for communities served by both hospital entities (SMH and SMBHWN). SMV and SMC completed separate and distinct CHNAs in FY2022 (TY 2021). The findings of each of the entities' (SMH - including SMBHWN, SMV and SMC) FY2022 Community Health Needs Assessments (CHNA) further dove into priority health needs impacting the communities served by each entity, particularly those community members facing inequities, as well as provided insight gathered from direct conversations with the community. Through the SMMC FY2022 CHNAs, the following priority health needs were identified for the communities served by SMMC (listed in alphabetical order): * Access to Health Care * Aging Care Support * Behavioral Health * Children Youth Well-Being * Chronic Health Conditions * Community Safety * Economic Stability * Maternal and Prenatal Care, including High-Risk Pregnancy The hospital entities of SMMC (SMH, SMBHWN, SMV, and SMC) reviewed the findings of their FY2022 CHNAs to assist in the design and implementation of programs and services provided at these entities for community members. In identifying these priorities, all entities considered the expertise and mission of their programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise their service area and region (San Diego County). the unique, ever-changing demographics and health topics that comprise their service areas and regions. The hospital entities of SMMC collectively provide programming and services that specifically address these needs, either directly or indirectly. In FY 2022, many programs continued as virtual offerings in response to COVID-19. SMH does not have the resources to comprehensively address the identified need of behavioral health (including substance use). Consequently, this identified need is addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and substance use treatment services in SDC. SMH and SMV are conveniently located on the Sharp Metropolitan Medical Campus (SMMC). The identified need of maternal and prenatal care, including high-risk pregnancy, is addressed at SMBHWN, a specialty hospital providing care for women, newborns and expectant mothers in SDC, also located on the SMMC campus. SMH addresses chronic health conditions by providing education and healthy lifestyle programs as part of care for cardiovascular disease (CVD), cancer, diabetes, obesity and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Centers throughout SDC provide community members with structured weight management and health education programs, such as smoking cessation and stress management, long-term support for weight management and personalized weight-loss programs. To address multiple needs - particularly social - identified in the FY2022 CHNA, SMH participates in Sharp's systemwide pilot partnership with 2-1-1 San Diego's Community Information Exchange (CIE) to better understand and address the social determinants of health (SDOH) that influence the health and well-being of their patients. SMH's case management and social work staff received training on CIE as a tool to serve patients in the acute care setting, including those patients experiencing food insecurity and homelessness. Although delays and obstacles to CIE implementation and adoption persisted due to the COVID-19 pandemic during Year 3 of the CIE pilot, utilization metrics were sustained between Years 2 and 3 following significant improvement over Year 1. Community members across SDC were assisted through the CIE, and top community referrals included utilities, food, housing and economic support. Sharp teams continue to work closely with 2-1-1 on the implementation and data integration plans for CIE, which includes evaluation of ongoing metrics, such as system utilization of CIE, referral tracking, case management efficiency, successful connection to community referrals and more. Data will be used to re-evaluate the value and sustainability of CIE for Sharp upon completion of the pilot's fourth year. The most recently completed (FY 2023 - FY 2026) implementation strategies for each of SMMC's hospital entities are available online at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm. These implementation strategies detail the programs that each hospital provides to address needs identified in their FY2022 CHNAs.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - Sharp Mary Birch Hospital for Women Newborns. The Sharp Metropolitan Medical Campus (SMMC) does not make presumptive FAP-eligibility determinations based on third-party information as defined in section 501(r)-6(c)(2). Instead, SMMC makes reasonable efforts based on notification and processing of applications as defined in 501(r)-6(c)(3).

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SHARP MESA VISTA HOSPITAL. Based on the results of the community health statistics scan and feedback from community partners received during the FY2022 CHNA planning process, a number of community engagement activities were conducted across San Diego County (SDC) as part of the collaborative, countywide FY2022 CHNA - led under the auspices of the Hospital Association of San Diego Imperial Counites (HASDIC) through the FY2022 CHNA Committee, of which Sharp was Chair. Additional community engagement activities were conducted specific to Sharp/SMH, in order to provide a more comprehensive understanding of identified health needs - including their associated social determinants of health (SDOH) and potential system and policy changes that may impact them - for the patients and community members served by the hospital. The CHNA process also included a detailed analysis of how these top needs impact the health of San Diego residents. Community engagement activities of the collaborative FY2022 CHNA included 16 focus groups (90 participants), key informant interviews (26 participants), and an online survey (502 respondents) as well as Community Health Worker and promotora interviews (223 participants) which targeted stakeholders from every region of San Diego County, all age groups, and numerous racial and ethnic groups. Collaboration with the County of San Diego Health Human Services Agency, Public Health Services was vital to this process. Community engagement participants included county public health officers, health care and social service providers, and members of community-based organizations, including advocacy groups that represent communities facing inequities. A total of 841 individuals participated in the FY2022 collaborative CHNA. In addition to participation and leadership in the collaborative HASDIC 2022 FYCHNA process, Sharp contracted separately with the Institute for Public Health (IPH) at San Diego State University (SDSU) to collect input from Sharp HealthCare providers as well as from patients and community members served by Sharp hospitals, including SMH. This input focused on the health and equity issues that were identified in Sharp's 2019 CHNA, including the impact of COVID-19 on those issues. This included two surveys designed in partnership with IPH engaging a total of 92 Sharp providers and 16 HR staff. Lastly, the SMH FY2022 CHNA community engagement process included a robust online survey conducted through the Sharp Insight Community. The Sharp Insight Community is a private online environment for Sharp patients and their families, community members, Sharp employees, and Sharp-affiliated physicians. The FY2022 CHNA Sharp Insight Community online survey sought to obtain feedback on the top health and social needs faced by community members in lieu of COVID-19, as well as assess their awareness of community outreach programs offered by Sharp. The online survey also provided participants the opportunity to provide specific suggestions for Sharp to improve community health and well-being. A total of 619 community members completed the Sharp Insight Community Survey. SMH/Sharp-specific community engagement activities concluded in Spring 2022.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SHARP MESA VISTA HOSPITAL. The HASDIC Board of Directors convened a CHNA Committee to plan and implement the collaborative FY2022 CHNA process. The CHNA Committee is comprised of representatives from the following hospitals and health care systems: * Kaiser Foundation Hospital - San Diego * Rady Children's Hospital - San Diego * Scripps Health (Vice Chair) * Sharp HealthCare (Chair) * Tri-City Medical Center * University of California San Diego Health * Grossmont Healthcare District The process and findings of the collaborative HASDIC 2022 CHNA significantly informed the SMH FY2022 CHNA and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - SHARP MESA VISTA HOSPITAL. The Sharp Memorial Hospital FY2022 Community Health Needs Assessment (CHNA) examines the health needs of the community members it serves in San Diego County. SMH's FY2022 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASDIC) FY2022 Community Health Needs Assessment process and findings for San Diego County. This collaborative process was conducted under the auspices of HASDIC and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SHARP MESA VISTA HOSPITAL. The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Memorial Hospital (SMH), Sharp Mary Birch Hospital for Women Newborns (SMBHWN), Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC). In accordance with federal regulations, the SMH FY2022 Community Health Needs Assessment (CHNA) also includes needs identified for communities served by SMBHWN, as the two hospitals share a license and report all utilization and financial data as a single entity to the Department of Healthcare Access and Information (HCAI). Thus, the SMH FY2022 CHNA summarizes the processes and findings for communities served by both hospital entities (SMH and SMBHWN). SMV and SMC completed separate and distinct CHNAs in FY2022 (TY 2021). The findings of each of the entities' (SMH - including SMBHWN, SMV and SMC) FY2022 Community Health Needs Assessments (CHNA) further dove into priority health needs impacting the communities served by each entity, particularly those community members facing inequities, as well as provided insight gathered from direct conversations with the community. Through the SMMC FY2022 CHNAs, the following priority health needs were identified for the communities served by SMMC (listed in alphabetical order): * Access to Health Care * Aging Care Support * Behavioral Health * Children Youth Well-Being * Chronic Health Conditions * Community Safety * Economic Stability * Maternal and Prenatal Care, including High-Risk Pregnancy The hospital entities of SMMC (SMH, SMBHWN, SMV, and SMC) reviewed the findings of their FY2022 CHNAs to assist in the design and implementation of programs and services provided at these entities for community members. In identifying these priorities, all entities considered the expertise and mission of their programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise their service area and region (San Diego County). the unique, ever-changing demographics and health topics that comprise their service areas and regions. The hospital entities of SMMC collectively provide programming and services that specifically address these needs, either directly or indirectly. In FY 2022, many programs continued as virtual offerings in response to COVID-19. SMH does not have the resources to comprehensively address the identified need of behavioral health (including substance use). Consequently, this identified need is addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and substance use treatment services in SDC. SMH and SMV are conveniently located on the Sharp Metropolitan Medical Campus (SMMC). The identified need of maternal and prenatal care, including high-risk pregnancy, is addressed at SMBHWN, a specialty hospital providing care for women, newborns and expectant mothers in SDC, also located on the SMMC campus. SMH addresses chronic health conditions by providing education and healthy lifestyle programs as part of care for cardiovascular disease (CVD), cancer, diabetes, obesity and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Centers throughout SDC provide community members with structured weight management and health education programs, such as smoking cessation and stress management, long-term support for weight management and personalized weight-loss programs. To address multiple needs - particularly social - identified in the FY2022 CHNA, SMH participates in Sharp's systemwide pilot partnership with 2-1-1 San Diego's Community Information Exchange (CIE) to better understand and address the social determinants of health (SDOH) that influence the health and well-being of their patients. SMH's case management and social work staff received training on CIE as a tool to serve patients in the acute care setting, including those patients experiencing food insecurity and homelessness. Although delays and obstacles to CIE implementation and adoption persisted due to the COVID-19 pandemic during Year 3 of the CIE pilot, utilization metrics were sustained between Years 2 and 3 following significant improvement over Year 1. Community members across SDC were assisted through the CIE, and top community referrals included utilities, food, housing and economic support. Sharp teams continue to work closely with 2-1-1 on the implementation and data integration plans for CIE, which includes evaluation of ongoing metrics, such as system utilization of CIE, referral tracking, case management efficiency, successful connection to community referrals and more. Data will be used to re-evaluate the value and sustainability of CIE for Sharp upon completion of the pilot's fourth year. The most recently completed (FY 2023 - FY 2026) implementation strategies for each of SMMC's hospital entities are available online at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm. These implementation strategies detail the programs that each hospital provides to address needs identified in their FY2022 CHNAs.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - SHARP MESA VISTA HOSPITAL. The Sharp Metropolitan Medical Campus (SMMC) does not make presumptive FAP-eligibility determinations based on third-party information as defined in section 501(r)-6(c)(2). Instead, SMMC makes reasonable efforts based on notification and processing of applications as defined in 501(r)-6(c)(3).

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SHARP MCDONALD CENTER. Based on the results of the community health statistics scan and feedback from community partners received during the FY2022 CHNA planning process, a number of community engagement activities were conducted across San Diego County (SDC) as part of the collaborative, countywide FY2022 CHNA - led under the auspices of the Hospital Association of San Diego Imperial Counites (HASDIC) through the FY2022 CHNA Committee, of which Sharp was Chair. Additional community engagement activities were conducted specific to Sharp/SMH, in order to provide a more comprehensive understanding of identified health needs - including their associated social determinants of health (SDOH) and potential system and policy changes that may impact them - for the patients and community members served by the hospital. The CHNA process also included a detailed analysis of how these top needs impact the health of San Diego residents. Community engagement activities of the collaborative FY2022 CHNA included 16 focus groups (90 participants), key informant interviews (26 participants), and an online survey (502 respondents) as well as Community Health Worker and promotora interviews (223 participants) which targeted stakeholders from every region of San Diego County, all age groups, and numerous racial and ethnic groups. Collaboration with the County of San Diego Health Human Services Agency, Public Health Services was vital to this process. Community engagement participants included county public health officers, health care and social service providers, and members of community-based organizations, including advocacy groups that represent communities facing inequities. A total of 841 individuals participated in the FY2022 collaborative CHNA. In addition to participation and leadership in the collaborative HASDIC FY2022 CHNA process, Sharp contracted separately with the Institute for Public Health (IPH) at San Diego State University (SDSU) to collect input from Sharp HealthCare providers as well as from patients and community members served by Sharp hospitals, including SMH. This input focused on the health and equity issues that were identified in Sharp's 2019 CHNA, including the impact of COVID-19 on those issues. This included two surveys designed in partnership with IPH engaging a total of 92 Sharp providers and 16 HR staff. Lastly, the SMH FY2022 CHNA community engagement process included a robust online survey conducted through the Sharp Insight Community. The Sharp Insight Community is a private online environment for Sharp patients and their families, community members, Sharp employees, and Sharp-affiliated physicians. The FY2022 CHNA Sharp Insight Community online survey sought to obtain feedback on the top health and social needs faced by community members in lieu of COVID-19, as well as assess their awareness of community outreach programs offered by Sharp. The online survey also provided participants the opportunity to provide specific suggestions for Sharp to improve community health and well-being. A total of 619 community members completed the Sharp Insight Community Survey. SMH/Sharp-specific community engagement activities concluded in Spring 2022.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SHARP MCDONALD CENTER. The HASDIC Board of Directors convened a CHNA Committee to plan and implement the collaborative FY2022 CHNA process. The CHNA Committee is comprised of representatives from the following hospitals and health care systems: * Kaiser Foundation Hospital - San Diego * Rady Children's Hospital - San Diego * Scripps Health (Vice Chair) * Sharp HealthCare (Chair) * Tri-City Medical Center * University of California San Diego Health * Grossmont Healthcare District The process and findings of the collaborative HASDIC 2022 CHNA significantly informed the SMH FY2022 CHNA and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - SHARP MCDONALD CENTER. The Sharp Memorial Hospital FY2022 Community Health Needs Assessment (CHNA) examines the health needs of the community members it serves in San Diego County. SMH's FY2022 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASDIC) FY2022 Community Health Needs Assessment process and findings for San Diego County. This collaborative process was conducted under the auspices of HASDIC and was further supported by additional data analysis and community engagement activities specific to the community served by SMH (the latter is described in Question 5).

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SHARP MCDONALD CENTER. The Sharp Metropolitan Medical Campus (SMMC) comprises Sharp Memorial Hospital (SMH), Sharp Mary Birch Hospital for Women Newborns (SMBHWN), Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC). In accordance with federal regulations, the SMH FY2022 Community Health Needs Assessment (CHNA) also includes needs identified for communities served by SMBHWN, as the two hospitals share a license and report all utilization and financial data as a single entity to the Department of Healthcare Access and Information (HCAI). Thus, the SMH FY2022 CHNA summarizes the processes and findings for communities served by both hospital entities (SMH and SMBHWN). SMV and SMC completed separate and distinct CHNAs in FY2022 (TY 2021). The findings of each of the entities' (SMH - including SMBHWN, SMV and SMC) FY2022 Community Health Needs Assessments (CHNA) further dove into priority health needs impacting the communities served by each entity, particularly those community members facing inequities, as well as provided insight gathered from direct conversations with the community. Through the SMMC FY2022 CHNAs, the following priority health needs were identified for the communities served by SMMC (listed in alphabetical order): * Access to Health Care * Aging Care Support * Behavioral Health * Children Youth Well-Being * Chronic Health Conditions * Community Safety * Economic Stability * Maternal and Prenatal Care, including High-Risk Pregnancy The hospital entities of SMMC (SMH, SMBHWN, SMV, and SMC) reviewed the findings of their FY2022 CHNAs to assist in the design and implementation of programs and services provided at these entities for community members. In identifying these priorities, all entities considered the expertise and mission of their programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise their service area and region (San Diego County). the unique, ever-changing demographics and health topics that comprise their service areas and regions. The hospital entities of SMMC collectively provide programming and services that specifically address these needs, either directly or indirectly. In FY2022, many programs continued as virtual offerings in response to COVID-19. SMH does not have the resources to comprehensively address the identified need of behavioral health (including substance use). Consequently, this identified need is addressed through the programs and services provided through Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center, which are the major providers of behavioral health and substance use treatment services in SDC. SMH and SMV are conveniently located on the Sharp Metropolitan Medical Campus (SMMC). The identified need of maternal and prenatal care, including high-risk pregnancy, is addressed at SMBHWN, a specialty hospital providing care for women, newborns and expectant mothers in SDC, also located on the SMMC campus. SMH addresses chronic health conditions by providing education and healthy lifestyle programs as part of care for cardiovascular disease (CVD), cancer, diabetes, obesity and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy Medical Centers throughout SDC provide community members with structured weight management and health education programs, such as smoking cessation and stress management, long-term support for weight management and personalized weight-loss programs. To address multiple needs - particularly social - identified in the FY2022 CHNA, SMH participates in Sharp's systemwide pilot partnership with 2-1-1 San Diego's Community Information Exchange (CIE) to better understand and address the social determinants of health (SDOH) that influence the health and well-being of their patients. SMH's case management and social work staff received training on CIE as a tool to serve patients in the acute care setting, including those patients experiencing food insecurity and homelessness. Although delays and obstacles to CIE implementation and adoption persisted due to the COVID-19 pandemic during Year 3 of the CIE pilot, utilization metrics were sustained between Years 2 and 3 following significant improvement over Year 1. Community members across SDC were assisted through the CIE, and top community referrals included utilities, food, housing and economic support. Sharp teams continue to work closely with 2-1-1 on the implementation and data integration plans for CIE, which includes evaluation of ongoing metrics, such as system utilization of CIE, referral tracking, case management efficiency, successful connection to community referrals and more. Data will be used to re-evaluate the value and sustainability of CIE for Sharp upon completion of the pilot's fourth year. The most recently completed (FY 2023 - FY 2026) implementation strategies for each of SMMC's hospital entities are available online at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm. These implementation strategies detail the programs that each hospital provides to address needs identified in their FY2022 CHNAs.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - SHARP MCDONALD CENTER. The Sharp Metropolitan Medical Campus (SMMC) does not make presumptive FAP-eligibility determinations based on third-party information as defined in section 501(r)-6(c)(2). Instead, SMMC makes reasonable efforts based on notification and processing of applications as defined in 501(r)-6(c)(3).

Schedule H, Part VI, Line 7 SCH H, PART VI, LINE 7
Sharp HealthCare prepares an annual Community Benefit Report in accordance with the requirements of California Senate Bill (SB) 697, community benefit legislation (According to SB 697, hospitals under the common control of a single corporation or another entity may file a consolidated report with the Calif. Office of Statewide Health Planning and Development (OSHPD)). Sharp HealthCare submits an annual Community Benefit Report to the California OSHPD. For purposes of the Sharp HealthCare Community Benefit Plan and Report, financials and narratives are provided in distinct sections for each hospital noted under Sharp Memorial Hospital's Tax ID, including Sharp Mary Birch Hospital for Women Newborns, Sharp Memorial Hospital, Sharp Mesa Vista Hospital and Sharp McDonald Center. In addition, consolidated financials for these hospitals are also provided in the FY 2022 Sharp HealthCare Community Benefit Plan and Report under the section entitled Sharp Metropolitan Medical Campus. The Sharp HealthCare Community Benefit Plan and Report, Fiscal Year 2022 is available online at https://www.sharp.com/about/community/community-benefits/benefit-report.cfm

Schedule H, Part III, Line 3 SCH H, PART III, LINE 3
No figure is reported on Part III, line 3 (estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy) due to all amounts attributable to patients eligible under the charity care policy being reported as charity. Medicare revenue received reported on Parts I and III $156,022,720 Medicare allowable costs reported on Parts I and III $188,372,251 Shortfall included on Parts I and III $(32,349,531) Actual Medicare revenue received $156,530,887 Actual Medicare cost $198,038,892 Actual Medicare shortfall $(41,508,005) Additional Medicare shortfall not on Parts I and III $(9,158,474)

Schedule H, Part VI, Line 5 Schedule H, Part VI, Line 5 continued
Sharp's disaster leadership also participated in the County of San Diego Healthcare Disaster Coalition, a multi-agency group of representatives who assist the county in improving mitigation, preparedness, response and recovery activities during emergencies and disasters. As part of this coalition, Sharp's disaster preparedness team participated in the Hospital Preparedness Program (HPP) budget, decontamination and SharePoint subcommittees. The HPP budget subcommittee strives to improve readiness by building supply caches of readily available health care supplies that can be used during a disaster. In addition, the decontamination subcommittee aims to standardize equipment and processes for hospitals, while the SharePoint committee is designed to build a coalition SharePoint site to provide members with disaster health care education and information. Through participation in the U.S. DHHS Public Health Emergency HPP grant, Sharp created the Sharp HealthCare HPP Disaster Preparedness Partnership. The partnership includes local hospitals, health clinics and other health providers, and provides resources, trainings and information to prepare non-hospital entities in SDC for a collaborative response to an emergency or disaster. The partnership seeks to continually identify and develop relationships with health care entities, nonprofit organizations, law enforcement, military installations and other organizations that serve SDC and are located near partner health care facilities. In FY 2022, the COVID-19 pandemic continued to reinforce the importance of Sharp's existing relationships with other hospital systems in SDC, as well as with the Hospital Association of San Diego and Imperial Counties (HASDIC) and CHA. As part of a workgroup established to collaboratively address public health threats, Sharp participated in ongoing virtual meetings with Scripps Health, Palomar Health, UC San Diego Health, Kaiser Permanente San Diego, HASDIC and CHA to share best practices in patient care; strategies to ensure provider safety and well-being; and plans for a continuously successful disaster response that aligns with current public health guidelines. Currently, the group is formalizing a cybersecurity readiness plan for San Diego hospitals and other health care delivery systems to effectively respond in the event of a cybersecurity incident. Further, Sharp's disaster leadership collaboratively steers the Highly Infectious Disease Advisory Committee. This committee prepares the Sharp workforce to care for patients infected with COVID-19 and other emerging infectious diseases. This committee remains in close contact with local, state and national health officials to report and monitor cases and secure sustainable supply chains for necessary equipment and supplies. The Highly Infectious Disease Advisory Committee also disseminates relevant guidance and recommendations to Sharp's workforce, community partners and patients. Sharp supports the safety efforts of California and the County of San Diego through maintenance and storage of a federally funded decontamination trailer at SGH to be used in response to an event requiring mass decontamination. Although the trailer is strategically located at SGH to respond to the needs of East County, it can be relocated elsewhere in the event of an emergency. Additionally, all Sharp hospitals are prepared for an emergency with backup water supplies that will last up to 96 hours in the event of an interruption to the system's normal water supply. The ongoing impact of COVID-19 has demonstrated more clearly than ever the ways in which a global pandemic can impact public health in SDC at any time. Sharp will continue to collaborate with other health care systems, first responders and community partners to deliver uninterrupted care in the face of an emergency or disaster.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
SHARP HEALTHCARE

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
No figure is reported on Part III, line 3 (estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy) due to all amounts attributable to patients eligible under the charity care policy being reported as charity.

Schedule H, Part III, Line 8 Community benefit methodology for determining medicare costs
Medicare should be included as a community benefit because participation in the Medicare program requires all patients be accepted whether through the Emergency Room or as a referral and Sharp Memorial Hospital must accept the Medicare established rates whether they cover the cost or not. Ratio of Cost to Charges (RCC) were calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, representing direct revenue and expense plus stepdown from Overhead departments. The RCC by CMS line was then applied to the applicable revenue departments broken down by payor to obtain the fully weighted cost by payer.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Sharp does not initiate collection activities on accounts known to be eligible for Financial Assistance or Charity care. It is also Sharp's policy to recall/cancel accounts assigned to a collection agency if it is determined, at any time, a patient account is eligible for Financial Assistance or Charity care.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Historical charity care percentages are applied to current revenues to estimate charity on a monthly basis. Actual charity transactions are applied against the estimate and any increase or decrease over estimated amounts is accounted for. Other Cost includes State/County programs included in the S-10 for Medicare Cost Reporting primarily for prison/in custody patient care. RCC were calculated using the Medicare Cost Report from Worksheet C. The Revenue and Expense tie to the general ledger with no exclusions, so worksheet C represents direct revenue and expense plus stepdown from Overhead departments. The RCC by CMS line was then applied to the applicable revenue departments broken down by payer to obtain the fully weighted cost by payer.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE HOSPITAL ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ACCOUNTING STANDARDS UPDATE 2014-09 TOPIC 606 (ASU 606) EFFECTIVE OCTOBER 1, 2018. ASU 606 AND THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) DIFFERENTIATE BAD DEBT FROM IMPLICIT PRICE CONCESSIONS. THE HOSPITAL MAKES A DETERMINATION REGARDING A PRICE CONCESSION TO STANDARD PRICING ON A PORTFOLIO BASIS. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS SHARP EXPECTS TO COLLECT BASED ON COLLECTION HISTORY WITH EACH PORTFOLIO OF PATIENTS. PATIENT SERVICE REVENUE IS RECORDED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS, INCLUDING AN ESTIMATE FOR IMPLICIT PRICE CONCESSIONS. BAD DEBT IS RECORDED AS AN OPERATING EXPENSE AND RESULTS WHEN A PATIENT, DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES, IS UNWILLING TO DO SO. FOR THE TAX YEAR ENDED SEPTEMBER 30, 2022, THE HOSPITAL DETERMINED $18,641,756 AS BAD DEBT EXPENSE. BAD DEBT EXPENSE IS NETTED AGAINST REVENUE. AS SUCH, $0.00 WAS BACKED OUT OF TOTAL EXPENSES FOR COLUMN (F) CALCULATION. ALSO APPLIES TO SCHEDULE H, PART I, LINE 7, COLUMN F.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
FN4: Net Patient Service Revenues Patient Service Revenues Sharp has agreements with third-party payors that provide for payments to Sharp at amounts different from its established rates. Inpatient and outpatient services provided to patients not covered by third-party payors are paid based on Sharp's policies and the patient's ability to pay. Sharp reduces the transaction price by implicit price concessions to uninsured patients and patients with uninsured balances, such as copays and deductibles. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts Sharp expects to collect based on its collection history with this portfolio of patients. Subsequent changes to the estimates are considered variable consideration and are included in patient service revenue when information becomes available.

Schedule H, Part V, Section B, Line 16a FAP website
- SHARP MEMORIAL HOSPITAL: Line 16a URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MARY BIRCH HOSPITAL FOR WOMEN AND NEWBORNS: Line 16a URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MESA VISTA HOSPITAL: Line 16a URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MCDONALD CENTER: Line 16a URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;

Schedule H, Part V, Section B, Line 16b FAP Application website
- SHARP MEMORIAL HOSPITAL: Line 16b URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MARY BIRCH HOSPITAL FOR WOMEN AND NEWBORNS: Line 16b URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MESA VISTA HOSPITAL: Line 16b URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MCDONALD CENTER: Line 16b URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- SHARP MEMORIAL HOSPITAL: Line 16c URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MARY BIRCH HOSPITAL FOR WOMEN AND NEWBORNS: Line 16c URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MESA VISTA HOSPITAL: Line 16c URL: https://www.sharp.com/patient/billing/financial-assistance.cfm; - SHARP MCDONALD CENTER: Line 16c URL: https://www.sharp.com/patient/billing/financial-assistance.cfm;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"Sharp HealthCare's financial assistance policy is in furtherance of its charitable mission. The policy identifies eligibility for, and circumstances under which, financial assistance will be extended to Sharp HealthCare's hospital patients for medically necessary services. ""Charity Care"" is that portion of Sharp HealthCare's charges for medically necessary patient care services provided by a hospital that a patient (either individually or through a third party payer) is unable to pay. Charity Care does not include bad debt, contractual adjustments, or un-reimbursed costs of providing care to patients eligible under government programs for health care services to low-income and medically indigent patients. ""Financial Assistance,"" means any reduction of charges for medically necessary services as defined herein that may be made by Sharp HealthCare either for, or on behalf of, a patient who applies to Sharp HealthCare for Financial Assistance and meets Sharp HealthCare's financial eligibility requirements or criteria as described in this policy. For purposes of the policy Financial Assistance includes ""charity care"" which means a 100% reduction in charges for medically necessary services and ""partial charity care"" which means a reduction in a portion of charges for such services. All patients should be screened at the time of admission or at registration for ability to pay for services, including whether or not they are candidates for Financial Assistance. Care for patients presenting with a known or possible emergency medical condition or in active labor shall not be delayed in order to assess financial status. In order to both inform patients of the various programs they may be entitled to, and assist them in the application process, Uncompensated Care Specialists provide patient(s) with a Financial Assistance Form. The Uncompensated Care Specialists direct the patient (or their guarantor) to complete a Patient Financial Statement, include specified financial items for both the patient and spouse (if any), direct the patient to return all information within ten days and document in patient's account history notes the substance of any patient discussions and that the Patient Financial Statement was provided. Following internal processing of the Financial Assistance Form, Sharp Uncompensated Care Specialists and/or Private Pay Representatives notify patient of Financial Assistance Application results, document the decision in all approved and denied Financial Assistance Accounts and secure payment arrangements for remaining balance of partial Financial Assistance or denied Financial Assistance accounts. All follow-up and patient interaction is documented in the patient's account history notes."

Schedule H, Part VI, Line 2 Needs assessment
Sharp HealthCare (Sharp) has been a long-time partner in the process of identifying and responding to the health needs of the San Diego community. This partnership has included a broad range of hospitals, health care organizations, and community agencies in order to conduct triennial Community Health Needs Assessments (CHNAs) for more than 25 years. Sharp hospitals, including those comprising the Sharp Metropolitan Medical Campus (SMMC) - Sharp Mary Birch Hospital for Women Newborns (SMBHWN), Sharp Memorial Hospital (SMH), Sharp Mesa Vista Hospital (SMV) and Sharp McDonald Center (SMC) - base their community benefit and community health programs on both the findings of these needs assessments and the combination of expertise in programs and services offered and the knowledge of the populations and communities served by each Sharp hospital. The complete 2022 Community Health Needs Assessments for SMH, SMV and SMC are available online at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm or by contacting Sharp HealthCare Community Benefit at: communitybenefits@sharp.com. In accordance with federal regulations, the SMH 2022 CHNA also includes needs identified for communities served by SMBHWN, as the two hospitals share a license, and report all utilization and financial data as a single entity to the Office of Statewide Health Planning and Development (OSHPD). Thus, the SMH 2022 CHNA summarizes the processes and findings for communities served by both hospital entities (SMH and SMBHWN). SMV and SMC completed distinct CHNAs in 2022. SMMC's hospitals reviewed the findings from their most recent (2022) CHNAs and used the assessments to help inform priority needs for members of the communities they serve. In identifying these priorities, the entities also considered the expertise and mission of their programs and services, as well as the needs of the unique, ever-changing demographics and health topics that comprise their service area and region. SMMC's hospitals are committed to the health and well-being of their communities, and the findings of their 2022 CHNAs help inform the activities and services provided to improve the health of their community members. These programs are detailed in the hospitals' FY 23-FY 26 implementation strategies, which are also available online to the community at: https://www.sharp.com/about/community/community-benefits/health-needs-assessments.cfm. Both SMH and SMBHWN do not have the capacity to provide the community education and support elements for the identified health need of behavioral health. Thus, these programs and services are provided by the other hospital entities that make up SMMC (SMV and SMC), which are the major providers of behavioral health and substance use services in SDC. Conversely, as SMV and SMC are specialty hospital facilities providing behavioral health and chemical dependency programs and services, these hospitals do not have the capacity, resources and expertise to address the identified health needs of: cancer, cardiovascular disease, diabetes type 2, high risk pregnancy, obesity and senior health). These additional identified health issues (cardiovascular health, diabetes, obesity), fall outside the scope of services provided by SMV and SMC, and thus are not addressed by programs/services provided by these two hospital entities. Further, SMH addresses obesity through both clinical programs, as well as general nutrition and exercise education and resources provided at SMH and programs address a healthy lifestyle as part of care for heart disease, cancer, diabetes and other health issues influenced by healthy weight and exercise. Sharp Rees-Stealy clinics throughout SDC - which includes the community served by SMMC - provide structured weight management and health education programs to community members, such as smoking cessation and stress management; long-term support for weight management and fat loss; and personalized weight-loss programs. Please refer to Part V, Sections B and C, for additional details on the process, findings and strategies to address findings from the 2022 CHNAs for SMH, SMV and SMC. Programs that address CHNA-identified needs are also detailed in the SMBHWN, SMH and SMV/SMC sections of Sharp HealthCare's FY 2022 Community Benefit Plan and Report, available for public viewing/download at: https://www.sharp.com/about/community/community-benefits/benefit-report.cfm. In addition, the entities of SMMC: * Incorporate community priorities and community relations into its strategic plan and develops service line-specific goals (SMBHWN, SMH, SMV/SMC) * Estimate an annual budget for community programs and services based on community needs, the prior years' experience and current funding levels (SMBHWN, SMH, SMV/SMC) * Consults with representatives from a variety of departments to discuss, plan, and implement community activities (SMH) * Hosts a bimonthly committee to discuss, plan, and implement community activities (SMV/SMC) * Participates in programs and workgroups to review and implement services to improve the health status and emotional well-being of women and infants (SMBHWN)

Schedule H, Part VI, Line 5 Promotion of community health
Sharp Memorial Hospital has an open medical staff and a community board. Surplus funds generated by hospital operations are re-invested by the organization to fund capital improvements and acquire state of the art medical equipment with the intent of continually improving patient care. Further, as San Diego's largest private employer, Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego earth-friendly businesses to help identify best practices to reduce the costs of green practices and facilitate implementation of sustainable initiatives. Through various strategies, in FY 2022 SMH (including SMBHWN) diverted more than 2.3 million pounds of waste, 35% of its generated waste. SMV diverted more than 403,840 pounds of waste, 52% of its generated waste in FY 2022. Sharp believes the promotion of healthy food choices is necessary to improve the health of patients, employees and the community. Sharp's recommitment to healthy food and sustainable nutrition practices began more than six years ago with a strategy to increase the availability of healthy food options at Sharp facilities. Since that time, Sharp, in collaboration with Sodexo - Sharp's food service partner - has been an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers to adopt healthier eating habits, combat obesity and minimize waste. Sharp's Food and Nutrition Best Health Committee supports these efforts by promoting food sustainability awareness throughout the health care system and within the greater San Diego community. Since FY 2018, Sodexo teams at SMH have used LeanPath - a pilot program funded by a City of San Diego grant to combat food waste and facilitate compliance with new composting and recycling laws. LeanPath provides an advanced food waste tracking software system to help kitchen teams measure food prior to discarding or donating in order to prevent pre-consumer food waste (waste generated in the kitchen) as well as post-consumer food waste (food the consumer throws away) from entering the landfill. In addition, since 2016, SMH has collaborated with the San Diego Rescue Mission and San Diego Food Bank to donate surplus food to more than 45 hunger relief organizations in San Diego County. Further, beginning in 2012, SMH was the first hospital to participate in the City of San Diego's food scraps composting program, and continues to divert food waste to rich compost through this program. Combined with the composting programs at other Sharp entities, these composting programs diverted approximately 11 tons of food waste from landfills in FY 2022. SMH and SMV also continue to operate the first county-approved hospital-based organic gardens and serve this food through their cafeterias and cafes. Sharp is an active member of San Diego's Nutrition in Healthcare Leadership Team. The group of more than a dozen SDC hospitals and health care systems collaborates to ensure that all food and beverages served by the county's hospitals are healthy, fresh, affordable, and produced in a manner that supports the local economy, environment and community. In addition, Sharp continues to participate in Practice Greenhealth's Healthier Food Challenge. Through the program, Sharp commits to reducing its purchase of animal protein and increasing its purchase of locally grown food and sustainable animal proteins (grass-fed, antibiotic- and hormone-free beef and cage-free chicken). Further, as San Diego's largest private employer, Sharp promotes a culture of environmental responsibility through education, outreach, and collaboration with San Diego earth-friendly businesses to help identify best practices, reduce the costs of green practices and facilitate implementation of sustainable initiatives. Through various strategies, in FY 2022 SCVMC diverted nearly 649,912 pounds of waste, approximately 20% of its generated waste. Sharp believes the promotion of healthy food choices is necessary to improve the health of patients, employees and the community. Sharp's recommitment to healthy food and sustainable nutrition practices began approximately a decade ago with a strategy to increase the availability of healthy food options at Sharp facilities. Since that time, Sharp, in collaboration with Sodexo - Sharp's food service partner - has been an innovator and early adopter of a variety of sustainable, healthy practices to help educate and motivate consumers to adopt healthier eating habits, combat obesity and minimize waste. These programs include but are not limited to regular donations of surplus food at SCVMC to other nonprofit hunger relief organizations. All Sharp hospitals participate in food waste composting. Through these programs, food waste at Sharp locations is processed into a rich compost product, which is provided to residents at no charge for volumes of up to two cubic yards. The compost offers several benefits including improving the health and fertility of soil, reducing the need to purchase commercial fertilizers, increasing the soil's ability to retain water, and helping the environment by recycling valuable organic materials. Since 2017, SCVMC has partnered with the City of Chula Vista on a food scraps composting program, which contributes to overall Sharp composting programs. In FY 2022, Sharp's composting programs diverted approximately 11 tons of waste from landfills. Sharp is an active member of the Community Health Improvement Partners Farm to Institution Center's Nutrition in Healthcare Leadership Team. The group, which represents more than a dozen SDC hospitals and health care systems, collaborates to ensure that all food and beverages served in county hospitals are healthy, fresh, affordable, and produced in a manner that supports the local economy, environment and community. In addition, Sharp continues to participate in Practice Greenhealth's Healthier Food Challenge. Through the program, Sharp commits to reducing its purchase of animal protein and increasing its purchase of locally grown food and sustainable animal proteins (grass-fed, antibiotic- and hormone-free beef and cage-free chicken). In FY 2022, the disaster preparedness team offered training programs to first responders and community health care providers throughout SDC. Programs included: a standardized, on-scene federal emergency management training for hospital leaders called National Incident Management System/Incident Command System/Hospital Incident Command System; and a training focused specifically on Hospital Incident Command System, an incident management system that can be used by hospitals to manage threats, planned events or emergencies. A training course was also offered on the WebEOC (Web Emergency Operations Center) crisis information management system, which provides real-time information sharing between health care systems and other agencies during a disaster. Traditionally held in-person, these trainings continued to take place virtually due to the COVID-19 pandemic. In addition, in FY 2022 Sharp partnered with the County of San Diego - including the Emergency Medical Services, Public Health Preparedness and Response, and Medical Operations Center branches - as well as other regional health care partners in two disaster preparedness exercises. The San Diego Medical and Health Facility Evacuation Preparation Full Scale Exercise tested the San Diego region's ability to respond and evacuate patients in the event of a large-scale earthquake. Sharp conducted a drill at each of its acute care hospitals and SRSMC locations and represented health care operations on behalf of the exercise planning committee. Further, Sharp served on the planning team for the San Diego County Medical and Health Facility Burn Surge Table-Top Exercise, a virtual drill to test the region's ability to respond to a surge of patients requiring burn care. Through these countywide exercises, Sharp shared best practices to better prepare community partners to collaboratively respond to a disaster. Members of Sharp's disaster leadership team donate their time to various state and local organizations and committees. Due to the ongoing impact of the COVID-19 pandemic, meetings continued to operate virtually in FY 2022. Groups included the County of San Diego Emergency Medical Care Committee, the California Hospital Association (CHA) Emergency Management Advisory Committee, the California Department of Public Health's (CDPH) Joint Advisory Committee, the Ronald McDonald House Operations Committee, the CDPH Statewide Medical and Health Exercise Workgroup, and the San Diego International Airport Aviation Security and Public Safety Department.

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

Schedule H, Part VI, Line 4 Community information
The community served by SMMC (SMBHWN, SMH, SMV and SMC) encompasses the entire community of San Diego County (SDC), including all six regions: central, east, north central, north coastal, north inland and south. In 2022, there were 525,919 residents ages 65 and older in SDC, representing 15.8% of the population. Between 2022 and 2027, it is anticipated that SDC's senior population will grow by 14.1%. For SMMC's 2022 CHNA processes, the IBM/Dignity Health Community Need Index (CNI) was utilized to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States of America (U.S.) based on specific barriers to health care access, including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations. According to the CNI, communities served by the SMMC hospitals with especially high need include, but are not limited to, East San Diego, City Heights, Linda Vista, the College Area and Downtown San Diego. In SDC in 2020, 96.1% of children age 18 and under, 87.8% of young adults ages 19 to 25, 88.2% of adults ages 26 to 44, 91.8% of adults ages 45 to 64, and 98.9% of seniors age 65 and older had health insurance.337 Health insurance coverage for each age group was lower than the Healthy People 2030 (HP2030) national target of 92.4% health insurance coverage for all individuals under age 65, with the exception of children ages 0 to 18 years. In 2020, 10.9% of the SDC population reported living below 100% of the federal poverty level (FPL). The county's unemployment rate was 5.9% and 5.1% of households received Supplemental Security Income. According to the San Diego Hunger Coalition, while nutrition insecurity has declined since 2021, high rates remain due to long-standing economic disparities that were exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. As of March 2022, 28% of San Diegans experienced nutrition insecurity and 35% of children lived in nutrition-insecure households. In 2020, 7.1% of households in SDC received Supplemental Nutrition Assistance Program (SNAP) benefits, while 16.7% of the population lived at or below 138% FPL and were eligible for the program.

Schedule H, Part VI, Line 6 Affiliated health care system
Sharp HealthCare (Sharp) is an integrated, regional health care delivery system based in San Diego, California. The Sharp system includes four acute care hospitals; three specialty hospitals; three affiliated medical groups; 28 medical centers; five urgent care centers; three skilled nursing facilities (SNF); two inpatient rehabilitation centers; home health, hospice and home infusion programs; numerous outpatient facilities and programs; three charitable foundations; and a variety of other community health education programs and related services. Sharp also offers individual and group health maintenance organization coverage through Sharp Health Plan (SHP). Serving a population of approximately 3.3 million in San Diego County (SDC), as of September 30, 2022, Sharp is licensed to operate 2,209 beds and has approximately 2,800 Sharp-affiliated physicians and 19,000 employees. It is Sharp's mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp's goal is to offer quality care and services that set community standards, exceed patient expectations and are provided in a caring, convenient, cost-effective and accessible manner. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen, embodying an organization of people working together to do the right thing every day to improve the health and wellbeing of those it serves. In support of Sharp's organizational commitment to transform the health care experience, Sharp's Pillars of Excellence serve as a guide for its team members, providing framework and alignment for everything Sharp does. In 2014, Sharp made an important decision regarding these pillars as part of its continued journey toward excellence. Each year, Sharp incorporates cycles of learning into its strategic planning process. Since 2014, Sharp has had an enhanced focus on safety resulting in the seven-pillar organization that Sharp is today, further driving the organization's emphasis on its culture of safety and incorporating the commitment to become a High Reliability Organization (HRO) in all aspects of the organization. At the core of HROs are five key concepts: * Sensitivity to operations * A reluctance to simplify * Preoccupation with failure * Deference to expertise * Resilience Applying high-reliability concepts in an organization begins when leaders at all levels start thinking about how the care they provide could improve. It begins with a culture of safety. With this learning, Sharp is a seven-pillar organization - Quality, Safety, Service, People, Finance, Growth and Community. The foundational elements of Sharp's strategic plan have been enhanced to emphasize Sharp's desire to do no harm. This strategic plan continues Sharp's transformation of the health care experience, focusing on safe, high-quality and efficient care provided in a caring, convenient, cost-effective and accessible manner. With 1,036 licensed beds, SMMC (including SMH, SMBHWN, SMV and SMC) features private patient rooms, sleeper sofas for loved ones, state-of-the-art surgery suites and the largest and most modern emergency and trauma center in San Diego. SMH is also a Magnet hospital for nursing and patient care excellence. SMH received Magnet Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program is the highest level of honor awarded by the ANCC and is accepted nationally as the gold standard in nursing excellence. In January 2012, SMH was designated a Planetree Patient-Centered Hospital. Planetree is a coalition of more than 100 hospitals worldwide that is committed to improving medical care from the patient's perspective. In 2014, SMH achieved Planetree Designation with Distinction and was re-designated as a Planetree Patient-Centered Hospital in 2015, with a Gold Certification for Excellence in Person-Centered Care following in 2019. SMH has been a part of San Diego health care history for more than 50 years. A freestanding women's hospital specializing in obstetrics, gynecology, gynecologic oncology, and neonatal intensive care, SMBHWN delivers more babies than any other private hospital in California. The largest private freestanding psychiatric hospital in California, SMV is a premier provider of behavioral health services. SMC is SDC's only licensed chemical dependency recovery hospital.