4A (Expenses $ 925707297 including grants of $ 5389098) (Revenue $ 1086576280)
SEE SCHEDULE ORADY CHILDREN'S HOSPITAL SAN DIEGO (THE HOSPITAL) IS A REGIONAL TERTIARY AND QUATERNARY REFERRAL CENTER AND PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT ACUTE, PSYCHIATRIC AND INTENSIVE CARE PEDIATRIC SERVICES. THE HOSPITAL ALSO IS THE SOLE PEDIATRIC PROVIDER AND DESIGNATED PEDIATRIC TRAUMA CENTER FOR SAN DIEGO COUNTY AND IS THE PRIMARY SOURCE OF PEDIATRIC AND NEONATAL INTENSIVE CARE SERVICES FOR BOTH SAN DIEGO AND IMPERIAL COUNTIES. ON ITS MAIN CAMPUS THE HOSPITAL OPERATES THE ONLY LEVEL 4 FULL SCOPE NEONATAL INTENSIVE CARE UNIT IN SAN DIEGO, RIVERSIDE AND IMPERIAL COUNTIES. IN ADDITION, THE HOSPITAL OPERATES AN 11-BED LEVEL 3 NEONATAL INTENSIVE CARE UNIT AT SOUTHWEST HEALTHCARE SYSTEM IN RANCHO SPRINGS, AN 8-BED LEVEL 2 NEONATAL INTENSIVE CARE UNIT FOR SCRIPPS MEMORIAL HOSPITAL IN ENCINITAS, AN 18-BED LEVEL 3 NEONATAL INTENSIVE CARE UNIT FOR SCRIPPS MEMORITAL HOSPITAL IN LA JOLLA, AND TWO LEVEL 2 NEONATAL INTENSIVE CARE UNITS FOR SCRIPPS MERCY HOSPITAL LOCATED IN SAN DIEGO AND CHULA VISTA; AN 11-BED PEDIATRIC MEDICAL UNIT FOR SHARP HEALTH LOCATED AT ITS SHARP GROSSMONT CAMPUS; AND A LEVEL 3, 4-BED NEONATAL INTENSIVE CARE UNIT, LOCATED AT PALOMAR MEDICAL CENTER IN ESCONDIDO. THE HOSPITAL IS AMALGAMATED WITH THE UNIVERSITY OF CALIFORNIA, SAN DIEGO, HEALTH SCIENCES, AND SERVES AS A CENTER FOR GRADUATE AND POST-GRADUATE EDUCATION IN THE FIELD OF PEDIATRICS. ANNUALLY, THE HOSPITAL HAS APPROXIMATELY 15,000 INPATIENT ADMISSIONS AND APPROXIMATELY 344,000 VISITS PER YEAR IN ITS OUTPATIENT DEPARTMENTS. ADDITIONALLY, THE EMERGENCY DEPARTMENT AND URGENT CARE CENTERS PROVIDE APPROXIMATELY 65,000 AND 24,000 VISITS, RESPECTIVELY, PER YEAR.

RADY CHILDREN'S HOSPITAL SAN DIEGO
PART V, SECTION B, LINE 5: THE CHNA IS IMPLEMENTED AND MANAGED BY A STANDING CHNA COMMITTEE COMPRISED OF REPRESENTATIVES FROM SEVEN HOSPITALS AND HEALTH SYSTEMS. THE 2019 CHNA BUILT ON THE RESULTS OF THE 2016 CHNA AND INCLUDED THREE TYPES OF COMMUNITY ENGAGEMENT EFFORTS: FOCUS GROUPS WITH RESIDENTS, COMMUNITY-BASED ORGANIZATIONS, SERVICE PROVIDERS, AND HEALTH CARE LEADERS; KEY INFORMANT INTERVIEWS WITH HEALTH CARE EXPERTS; AND AN ONLINE SURVEY FOR RESIDENTS AND STAKEHOLDERS. IN ADDITION, THE CHNA INCLUDED EXTENSIVE QUANTITATIVE ANALYSIS OF NATIONAL AND STATE-WIDE DATA SETS, SAN DIEGO COUNTY EMERGENCY DEPARTMENT AND INPATIENT HOSPITAL DISCHARGE DATA, COMMUNITY CLINIC USAGE DATA, COUNTY MORTALITY AND MORBIDITY DATA, AND DATA RELATED TO SOCIAL DETERMINANTS OF HEALTH.TWO PRIMARY METHODS WERE EMPLOYED IN THE 2019 CHNA. FIRST, QUANTITATIVE ANALYSES WERE CONDUCTED OF EXISTING PUBLICLY AVAILABLE DATA TO PROVIDE AN OVERARCHING VIEW OF CRITICAL HEALTH ISSUES ACROSS SAN DIEGO COUNTY. SECOND, EXTENSIVE FEEDBACK WAS GATHERED FROM COMMUNITY RESIDENTS, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS), HOSPITALS AND HEALTH SYSTEMS, LOCAL GOVERNMENT AGENCIES, PHILANTHROPIC ORGANIZATIONS AND SAN DIEGO COUNTY PUBLIC HEALTH SERVICES THROUGH A COMPREHENSIVE COMMUNITY ENGAGEMENT PROCESS TO UNDERSTAND THE EXPERIENCES AND NEEDS OF PEOPLE IN THE COMMUNITY. ONCE THESE ANALYSES WERE COMPLETE, THE CHNA COMMITTEE REVIEWED THESE DATA, ALONG WITH OTHER CRITERIA, TO PRIORITIZE THE TOP HEALTH NEEDS IN SAN DIEGO COUNTY. THE CHNA COMMITTEE WORKED WITH COMMUNITY PARTNERS TO PLAN COMMUNITY ENGAGEMENT ACTIVITIES WITH STAKEHOLDERS REPRESENTING EVERY REGION OF SANDIEGO COUNTY AND ALL AGE GROUPS. IN ADDITION, THE CHNA COMMITTEE EXPLICITLY SOUGHT TO ENGAGE A WIDE VARIETY OF STAKEHOLDERS REPRESENTING DIVERSE NUMEROUS RACIAL AND ETHNIC GROUPS. HEALTH LEADERS AND A DIVERSE SET OF ADVOCACY GROUPS AND ORGANIZATIONS WERE ALSO RECRUITED FOR THEPROCESS. A TOTAL OF 579 INDIVIDUALS PARTICIPATED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT: 138 COMMUNITY RESIDENTS AND 441 LEADERS AND EXPERTS.KEY INFORMANT INTERVIEWS AND FOCUS GROUPS WERE UTILIZED TO IDENTIFY AND EXPLORE PRIORITY HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO CARE, AND COMMUNITY ASSETS AND RESOURCES.THE CHNA ONLINE SURVEY WAS USED TO RANK HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH IN ORDER OF IMPORTANCE WITHIN THE COMMUNITY. THE SURVEY WAS DISTRIBUTED VIA EMAIL TO TARGETED COMMUNITY-BASED ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, RESIDENT LED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, GOVERNMENTAL AGENCIES, AND HOSPITALS AND HEALTH SYSTEMS WHO SERVE A DIVERSE ARRAY OF PEOPLE IN SAN DIEGO COUNTY.

RADY CHILDREN'S HOSPITAL SAN DIEGO
PART V, SECTION B, LINE 6A: RADY CHILDREN'S HOSPITAL - SAN DIEGO CONDUCTED ITS CHNA WITH THE FOLLOWING HOSPITALS (SEE CHNA, PAGE 9):- KAISER FOUNDATION HOSPITAL- PALOMAR HEALTH- SCRIPPS HEALTH- SHARP HEALTHCARE- TRI-CITY MEDICAL CENTER- UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM

RADY CHILDREN'S HOSPITAL SAN DIEGO
"PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS ADDRESSED:ACCORDING TO CHNA COMMITTEE FINDINGS, THE FOLLOWING HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH ARE CONSIDERED TOP PRIORITIES FOR SAN DIEGO COUNTY FOR ALL AGE GROUPS (LIST IS IN ALPHABETICAL ORDER):1) ACCESS TO HEALTH CARE;2) AGING CONCERNS;3) BEHAVIORAL HEALTH;4) CANCER;5) CHRONIC HEALTH CONDITIONS (OBESITY, DIABETES);6) COMMUNITY AND SOCIAL SUPPORT;7) ECONOMIC SECURITY;8) EDUCATION;9) HOUSING AND HOMELESSNESS;10) SAFETY AND VIOLENCE.RECOGNIZING THAT CHILDREN HAVE UNIQUE HEALTHCARE NEEDS, RADY CHILDREN'S SUPPLEMENTED THE FINDINGS OF THE CHNA WITH THE 2017 SAN DIEGO COUNTY REPORT CARD ON CHILDREN & FAMILIES. MANAGEMENT AND CLINICAL LEADERSHIP ALSO CONSIDERED OTHER PEDIATRIC ASSESSMENTS.TOP HEALTH PRIORITIES IDENTIFIED FOR CHILDREN INCLUDE:1) BEHAVIORAL AND MENTAL HEALTH- DEPRESSION AND SUICIDE SCREENING INITIATIVE - RCHSD INSTITUTED THE DEPRESSION AND SUICIDE SCREENING INITIATIVE TO PROVIDE PATIENT HEALTH QUESTIONNAIRE (PHQ-2) SCREENINGS, INCLUDING PHQ9, A BRIEF, 9-ITEM SELF-REPORT SCREENING TOOL. THE QUESTIONNAIRE IS BEING USED TO IDENTIFY YOUTH WITH DEPRESSION AND SUICIDE IDEATION REGARDLESS OF WHETHER THEY ARE SEEN IN AN AMBULATORY CLINIC, THE EMERGENCY DEPARTMENT, OR ADMITTED AS AN INPATIENT. THE IDENTIFICATION OF AT-RISK YOUTH (BASED ON A HIGH PHQ-9 SCORE OR ANSWERING YES TO THE QUESTION OF WHETHER THE CHILD/TEEN WAS CONSIDERING SUICIDE) ALLOW ACTIONS TO BE TAKEN TO ENSURE THAT THE YOUTH ARE KEPT SAFE, RECEIVE IMMEDIATE CARE, AND ARE CONNECTED TO FOLLOW-UP CARE AS NEEDED.- SUICIDE PREVENTION: RADY CHILDREN'S CENTER FOR HEALTHIER COMMUNITIES (CHC) IS WORKING COLLABORATIVELY WITH THE 9TH DISTRICT PTA AND QUALITY DEPARTMENT TO HOST ANNUAL SYMPOSIUMS TO EDUCATE PARENTS IN SUICIDE PREVENTION. IN ADDITION, CHC STAFF ATTENDS SUICIDE PREVENTIONCOALITION MEETINGS MONTHLY.- MENTAL AND BEHAVIORAL HEALTH PSYCHIATRIC EMERGENCY DEPARTMENT - RADY CHILDREN'S WILL ESTABLISH A FULLY-FUNCTIONING, 6-BED PSYCHIATRIC EMERGENCY DEPARTMENT IN SPRING 2020, DEDICATED TO RESPONDING TO MENTAL AND BEHAVIORAL HEALTH EMERGENCIES OF CHILDREN AND ADOLESCENTS. RADY CHILDREN'S ALSO WILL PROVIDE PATIENTS AND THEIR FAMILIES REFERRALS TO APPROPRIATE CARE AND CARE COORDINATION SERVICES THROUGH A BEHAVIORAL HEALTH CARE CONNECTION CENTER LAUNCHED AS PART OF THE PSYCHIATRIC EMERGENCY DEPARTMENT.2) CHRONIC HEALTH CONDITIONS (OBESITY) - THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (COI) IS A PUBLIC-PRIVATE PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS AND ENVIRONMENTAL CHANGE. TO FULFILL ITS MISSION, THE COI CREATES, SUPPORTSAND MOBILIZES PARTNERS FROM MULTIPLE DOMAINS (I.E., SECTORS: GOVERNMENT, HEALTHCARE, SCHOOLS & AFTER SCHOOL, EARLY CHILDHOOD, COMMUNITY, MEDIA AND BUSINESS), PROVIDES LEADERSHIP AND VISION, AND COORDINATES COUNTY-WIDE EFFORTS IN THE PREVENTION AND REDUCTION OF CHILDHOOD OBESITY. THE DIRECTOR OF THE CENTER FOR HEALTHIER COMMUNITIES CHAIRS THE HEALTHCARE DOMAIN SUB-COMMITTEE, WHICH BRINGS TOGETHER HEALTHCARE SYSTEMS, PLANS AND PROVIDERS TO ENHANCE CARE AND RESOURCES FOR THE PREVENTION AND REDUCTION OF CHILDHOOD OBESITY. THE CENTER FOR HEALTHIER COMMUNITIES HAS PARTICIPATED IN, AND PROVIDED LEADERSHIP FOR, THE COI HEALTH DOMAIN SINCE ITS INCEPTION IN 2006.3) OTHER (INJURY PREVENTION, AUTISM).THE DEVELOPMENTAL SERVICES DEPARTMENT AT RADY CHILDREN'S PROVIDES A CONTINUUM OF INTEGRATED SERVICES ACROSS VARIOUS DISCIPLINES AND COMMUNITY PARTNERS TO SUPPORT EARLY BRAIN DEVELOPMENT, SOCIAL/EMOTIONAL DEVELOPMENT, AND THE NEEDS OF THE WHOLE CHILD THROUGH EVERY ASPECT OF CARE DELIVERY. EMPHASIZING EARLY IDENTIFICATION, DIAGNOSIS AND INTERVENTION, A VARIETY OF PROGRAMS ARE PROVIDED, INCLUDING PROGRAMS FOCUSED ON AUTISM AND ADHD.MANY OF OUR PROGRAMS DEAL WITH SOCIAL DETERMINANTS OF HEALTH INCLUDING:1) ACCESS TO HEALTH CARE2) EDUCATION3) SAFETY AND VIOLENCE4) COMMUNITY AND SOCIAL SUPPORTMID-CITY BEHAVIORAL HEALTH URGENT CARE (BHUC)SOCIAL DETERMINANTS NEEDS ADDRESSED: ACCESS TO CARE, BEHAVIOR AND MENTAL HEALTH, EDUCATION, SAFETY AND VIOLENCE PREVENTION, COMMUNITY AND SOCIAL SUPPORT.THE MID-CITY BEHAVIORAL HEALTH URGENT CARE CLINIC ADDRESSES THE NEED FOR IMMEDIATE ACCESS TO MENTAL HEALTH SERVICES FOR FAMILIES CONCERNED ABOUT THEIR CHILD OR ADOLESCENT'S URGENT MENTAL HEALTH OR BEHAVIORAL SYMPTOMS. THE MID-CITY FACILITY ADDRESSES THIS COMMUNITY'S UNMET MENTAL HEALTH NEEDS BY MAKING SERVICES DIRECTLY AVAILABLE TO CHILDREN AND FAMILIES IN THEIR OWN NEIGHBORHOOD. THE COMPREHENSIVE BEHAVIORAL HEALTH PROGRAM INCLUDES A RANGE OF HIGH-QUALITY BEHAVIORAL HEALTH SERVICES, INCLUDING ASSESSMENT, CRISIS INTERVENTION, MEDICATION EVALUATION, CASE MANAGEMENT AND REFERRAL TO ON-GOING TREATMENT, IF NEEDED. THE SERVICES ARE AVAILABLE ON A ""WALK-IN"", NO APPOINTMENT REQUIRED BASIS. THE BHUC SERVES CHILDREN AND TEENS AGES 5 TO 17 IN THE MID-CITY COMMUNITY AND SURROUNDING AREAS, ACCEPTS MEDI-CAL AND IS ABLE TO PROVIDE SERVICES TO THE UNINSURED. AFTER RECEIVING SERVICES AT THE BHUC, RADY CHILDREN'S STAFF CONNECTS PATIENTS WITH REFERRALS TO FOLLOW-UP SERVICES WITH COMMUNITY PROVIDERS AND PARTNERS.HEALTH STARSSOCIAL DETERMINANT OF HEALTH ADDRESSED: EDUCATION, ACCESS TO CARE, SAFETY & VIOLENCETHE HEALTH STARS LITERACY PROGRAM HOLDS EDUCATION SESSIONS FOR LOW-INCOME AND HOMELESS PARENTS WITH CHILDREN AGES 0-5. THESE FAMILIES MAY LIVE IN AFFORDABLE HOUSING COMPLEXES OR HOMELESS SHELTERS. HEALTH STARS BRINGS VOLUNTEER PEDIATRICIANS INTO THE COMMUNITIES THEY SERVE TO ENGAGE WITH FAMILIES IN THEIR OWN NEIGHBORHOODS. THIS IS DONE TO BETTER UNDERSTAND THE CHALLENGES THESE FAMILIES FACE IN ACHIEVING A HEALTHY LIFESTYLE. FAMILIES LEARN HEALTHY HABITS DURING A SERIES OF READING AND PLAY SESSIONS, EACH FOCUSED ON A SPECIFIC HEALTH TOPIC. THE PROGRAM ADDRESSES KEY CHILD HEALTH ISSUES, INCLUDING DISCIPLINE, NUTRITION, SAFETY, SLEEP AND ORAL HEALTH, PROVIDING FAMILIES WITH CHILDREN'S BOOKS TO REINFORCE HEALTHY BEHAVIORS AND ENCOURAGE DAILY READING WITH CHILDREN. CLINICIANS LEAD INTERACTIVE DISCUSSIONS IN A FUN, ENGAGING ENVIRONMENT WITH THE GOAL OF BUILDING PARENTS' TRUST AS WELL AS THEIR CONFIDENCE WITH THEIR OWN CHILD INTERACTIONS AND PARENTING SKILLS. HEALTH STARS ALSO WORKS TO CONNECT FAMILIES WITH LOCAL RESOURCES TO MEET THEIR HEALTH, SOCIAL AND BEHAVIORAL NEEDS.SAFE ROUTES TO SCHOOL (SRTS)SOCIAL DETERMINANT OF HEALTH ADDRESSED: EDUCATION; SAFETY & VIOLENCE SAFE ROUTES TO SCHOOL (SRTS) IS A COLLABORATION BETWEEN RADY CHILDREN'S, LOCAL GOVERNMENT AND SCHOOL DISTRICTS TO MAKE BIKING AND WALKING TO SCHOOL SAFE AND HEALTHY ALTERNATIVES TO DRIVING. A MAJORITY OF ELEMENTARY AND MIDDLE SCHOOLERS ARRIVE TO SCHOOL IN A FAMILY CAR. SRTS IS A SERIES OF STRATEGIES THAT WILL MOVE PARENTS AWAY FROM DRIVING THEIR STUDENTS TO SCHOOL AND INSTEAD, WALK THEM EITHER PART OR THE ENTIRE WAY, OR DROP THEM IN A SECURE LOCATION WITH ADULTS (WALKING SCHOOL BUS) SO THE KIDS CAN ALL WALK TOGETHER.NEEDS NOT ADDRESSED:PRIORITIES NOT ADDRESSED IN THIS REPORT AND THE REASONS INCLUDE: CANCER (HIGH INCIDENCE IN THE CHNA PERTAINED TO ADULTS); ECONOMIC SECURITY (NOT WITHIN THE PURVIEW OF A CHILDREN'S HOSPITAL); HOUSING AND HOMELESSNESS (NOT A MAJOR FACTOR FOR A CHILDREN'S HOSPITAL, ALTHOUGH HOUSING INSECURE PATIENTS ARE SERVED)."

RADY CHILDREN'S HOSPITAL SAN DIEGO
PART V, SECTION B, LINE 16J: ALL LANGUAGE REGARDING THE POLICY IS COMMUNICATED TO PATIENTS VIA SIGNAGE IN ALL ADMITTING AREAS. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS; ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDES VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE CHARITY CARE APPLICATION. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE.

SCHEDULE H, PART V, SECTION B, LINE 7A
HTTPS://WWW.RCHSD.ORG/DOCUMENTS/2019/06/2019-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF/

SCHEDULE H, PART V, SECTION B, LINE 10A
HTTPS://WWW.RCHSD.ORG/DOCUMENTS/2019/11/COMMUNITY-HEALTH-NEEDS-IMPLEMENTATION-STRATEGY.PDF/

SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, 16C
THE FAP, THE FAP APPLICATION, AND THE PLAIN LANGUAGE FAP WERE ALL MADE AVAILABLE ONLINE AT:HTTPS://WWW.RCHSD.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, SECTION B, LINE 22D
THE HOSPITAL DETERMINED, DURING THE TAX YEAR, THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, BASED ON MEDI-CAL RATES (AB 774).

PART I, LINE 7:
THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, THE COST TO CHARGE RATIO WAS CALCULATED USING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES AND APPLIED TO THOSE CATEGORIES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S DETAILED FINANCIAL INFORMATION.

PART II, COMMUNITY BUILDING ACTIVITIES:
RADY CHILDREN'S CENTER FOR HEALTHIER COMMUNITIES PROVIDES THE FACES FOR THE FUTURE PROGRAM AT A LOCAL HIGH SCHOOL. THE FACES PROGRAM IS A YOUTH AND FUTURE HEALTHCARE WORKFORCE DEVELOPMENT PROGRAM THAT PREPARES UNDERREPRESENTED, ETHNICALLY DIVERSE YOUTH FOR CAREERS IN ALL AREAS OF THE HEALTH PROFESSIONS. THE PROGRAM ALSO AIMS TO ASSIST LOCAL PUBLIC SCHOOLS IN MOTIVATING AND PREPARING UNDERREPRESENTED HIGH SCHOOL STUDENTS FOR ENTRY INTO COLLEGE, HEALTHCARE/RESEARCH CAREERS AND OTHER VIABLE EMPLOYMENT OPPORTUNITIES IN THE HEALTHCARE INDUSTRY. THE PARTICIPATING STUDENTS ROTATE THROUGH CLINICAL DEPARTMENTS AT RADY CHILDREN'S HOSPITAL -SAN DIEGO AND RECEIVE MENTORSHIP.

PART III, LINE 2:
FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, RCHSD RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED, OR ON THE BASIS OF DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF RCHSD'S UNINSURED PATIENTS ARE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. RCHSD RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS RELATED TO UNINSURED PATIENTS IN THE PERIOD SERVICES ARE PROVIDED. RCHSD RECORDS IMPLICIT PRICE CONCESSIONS BASED UPON THE HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES.

PART III, LINE 3:
RCHSD DOES NOT TREAT ANY PART OF THE BAD DEBT AS COMMUNITY BENEFIT EXPENSE.

PART III, LINE 4:
SEE PAGE 13-17 OF THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 ARE DETERMINED USING A PRO FORMA COST REPORT AS DESCRIBED IN PART I, LINE 7 ABOVE. THE ORGANIZATION BELIEVES THAT THE TEFRA COST LIMITATION SHOULD BE INCLUDED AS A COMMUNITY BENEFIT, BASED ON THE INPATIENT COST OVER THE TEFRA LIMITS.

PART III, LINE 9B:
"IN ITS BILLING AND COLLECTION ACTIVITY, RADY CHILDREN'S HOSPITAL - SAN DIEGO TREATS ALL PATIENTS AND PATIENT FAMILIES OR REPRESENTATIVES WITH FAIRNESS, DIGNITY AND RESPECT. RCHSD DOES NOT UTILIZE WAGE GARNISHMENTS, LIENS ON A PATIENT'S PRIMARY RESIDENCE, OR WRIT OF BODY ATTACHMENTS IN ITS COLLECTION ACTIVITIES. RCHSD ONLY UTILIZES THOSE OUTSIDE OR THIRD PARTY COLLECTION AGENCIES THAT AGREE TO COMPLY WITH APPLICABLE STATE AND FEDERAL LAWS AND WITH RCHSD POLICIES, AND RCHSD DEBT COLLECTION STANDARDS AND PRACTICES. IN DETERMINING THE DEBT THAT RCHSD SEEKS TO RECOVER, RCHSD WILL CONSIDER ONLY THE INCOME AND CERTAIN MONETARY ASSETS OF THE PATIENT/GUARANTOR ELIGIBLE FOR THE RCHSD FINANCIAL ASSISTANCE PROGRAM. IN MAKING THIS DETERMINATION, RCHSD WILL NOT CONSIDER RETIREMENT OR DEFERRED COMPENSATION PLANS (EITHER QUALIFIED OR NON-QUALIFIED UNDER THE INTERNAL REVENUE CODE), THE FIRST $10,000 OR THE REMAINING 50 PERCENT OF THEPATIENT/GUARANTOR'S MONETARY ASSETS. RCHSD SHALL NOT SEND AN ACCOUNT TO A COLLECTION AGENCY IF THE PATIENT HAS A PENDING APPLICATION FOR THE RCHSD FINANCIAL ASSISTANCE PROGRAM OR GOVERNMENT-SPONSORED INSURANCE PROGRAM OR IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL BY NEGOTIATING AN INTEREST FREE, EXTENDED PAYMENT PLAN OR BY MAKING REGULAR PARTIAL PAYMENTS OF A REASONABLE AMOUNT. A ""PENDING APPLICATION"" IS DEFINED AS AN APPLICATION THAT HAS BEEN FULLY COMPLETED AND INCLUDES COPIES OF THE REQUIRED DOCUMENTATION BY THE PATIENT/GUARANTOR, SUBMITTED TO THE RELEVANT PUBLIC AGENCY IN THE CASE OF GOVERNMENT PROGRAMS AND TO RCHSD IN THE CASE OF THE RCHSD FINANCIAL ASSISTANCE PROGRAM. IF A PATIENT ACCOUNT IS SENT TO COLLECTIONS AND IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT ACCOUNT IS REMOVED FROM THE COLLECTION PROCESS AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS IS IMPLEMENTED."

PART VI, LINE 2:
NEEDS ASSESMENTCONTINUING A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, RADY CHILDREN'S AND SIX OTHER HEALTHCARE SYSTEMS RECONVENED IN 2018-2019 THROUGH THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC), WITH THE INSTITUTE OF PUBLIC HEALTH, TO COMPLETE A 2019 TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNAIDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY AND INCLUDES FEEDBACK FROM COMMUNITY RESIDENTS IN VULNERABLE NEIGHBORHOODS.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCERCHSD PROVIDES WRITTEN INFORMATION ABOUT THE AVAILABILITY OF THE RCHSD FINANCIAL ASSISTANCE PROGRAM, INCLUDING A BROCHURE THAT IS DISSEMINATED THROUGHOUT OUR PATIENT CLINICS. THIS INFORMATION IS PROVIDED AT PATIENT REGISTRATION, INCLUDING PATIENT INFORMATIONAL MATERIALS, EMERGENCY DEPARTMENT, OUTPATIENT CLINICS, AND PATIENT FINANCIAL SERVICES. IN ADDITION, A STATEMENT REGARDING THE FINANCIAL ASSISTANCE PROGRAM IS INCLUDED ON PATIENT BILLING STATEMENTS. WRITTEN NOTICE IS PROVIDED TO POTENTIALLY ELIGIBLE PATIENTS DURING THE REGISTRATION PROCESS OR AS SOON AS POSSIBLE THEREAFTER AND DURING THE BILLING PROCESS. THIS INFORMATIONIS PROVIDED IN ENGLISH AND SPANISH AND IS TRANSLATED FOR PATIENTS/GUARANTORS WHO SPEAK OTHER LANGUAGES. NOTIFICATION OF FINANCIAL ASSISTANCE DISCUSSES, AT A MINIMUM, THE FOLLOWING:- IF A PATIENT MEETS CERTAIN INCOME REQUIREMENTS, THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED HEALTH INSURANCE PROGRAM OR THE RCHSD FINANCIAL ASSISTANCE PROGRAM.IDENTIFICATION OF RCHSD FINANCIAL COUNSELING- PATIENT FINANCIAL SERVICES PHONE NUMBER WITH HOURS OF AVAILABILITY SO THAT PATIENTS MAY CALL TO OBTAIN FURTHER INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM. RADY CHILDREN'S PROVIDES HEALTHCARE SUPPORT SERVICES TO THE COMMUNITY THROUGH THE FINANCIAL COUNSELING TEAM. RADY CHILDREN'S FINANCIAL COUNSELORS PROACTIVELY EXPLORE AND ASSIST PATIENTS/GUARANTORS IN APPLYING FOR HEALTH INSURANCE COVERAGE FROM PUBLIC AND PRIVATE PAYMENT PROGRAMS.- THE RCHSD WEBSITE PROVIDES INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM, AND THE FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE PROGRAM APPLICATION ARE POSTED ON THE RCHSD WEBSITE.

SCHEDULE H, PART VI, LINE 7
RCHSD FILES A COMMUNITY BENEFIT REPORT IN THE STATE OF CALIFORNIA.

PART VI, LINE 4:
COMMUNITY INFORMATIONSAN DIEGO COUNTY (SAN DIEGO) IS THE SECOND MOST POPULOUS OF CALIFORNIA'S 58 COUNTIES, AND THE FIFTH LARGEST COUNTY IN THE UNITED STATES AND IS CURRENTLY HOME TO 3.4 MILLION RESIDENTS, AND IS ANTICIPATED TO GROW TO FOUR MILLION BY 2050. THE REGION IS SOCIALLY AND ETHNICALLY DIVERSE, WITH OVER 22% OF THE POPULATION UNDER THE AGE OF EIGHTEEN AND ON AVERAGE, 230,000 VETERAN RESIDE HERE. WHILE THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $75,000, OVER 16% OF PERSONS ARE LIVING BELOW POVERTY LEVEL; CHILDREN UNDER AGE 18 ARE DISPROPORTIONATELY AFFECTED. IN ADDITION, 38% OF PERSONS SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME. RADY CHILDREN'S HOSPITAL SAN DIEGO (THE HOSPITAL) IS A REGIONAL TERTIARY AND QUATERNARY REFERRAL CENTER AND PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT ACUTE, PSYCHIATRIC AND INTENSIVE CARE PEDIATRIC SERVICES. THE HOSPITAL ALSO IS THE SOLE PEDIATRIC PROVIDER AND DESIGNATED PEDIATRIC TRAUMA CENTER FOR SAN DIEGO COUNTY AND IS THE PRIMARY SOURCE OF PEDIATRIC AND NEONATAL INTENSIVE CARE SERVICES FOR BOTH SAN DIEGO AND IMPERIAL COUNTIES. ALSO, RCHSD IS THE PEDIATRIC SAFETY NET HOSPITAL FOR THE REGION WITH A MEDI-CAL PAYOR MIX HOVERING OVER 50%. RCHSD SERVES AS THE TEACHING HOSPITAL FOR THE SCHOOL OF MEDICINE AT THE UNIVERSITY OF CALIFORNIA, SAN DIEGO (UCSD) AND, IN 2001, RCHSD AND UCSD AMALGAMATED WHERE RCHSD BECAMETHE PEDIATRIC PROVIDER OF INPATIENT AND OUTPATIENT MEDICAL AND SURGERY SERVICES AND CERTAIN OTHER CLINICAL SERVICES FOR UCSD PEDIATRIC PATIENTS. THERE ARE THREE LARGE HEALTH SYSTEMS OPERATING IN SAN DIEGO, SHARP HEALTHCARE, SCRIPPS HEALTH AND KAISER PERMANENTE, AS WELL AS OTHER HOSPITAL PROVIDERS. TO HELP CARE FOR PEDIATRIC PATIENTS, RCHSD COLLABORATES WITH SHARP HEALTHCARE, SCRIPPS HEALTH AND PALOMAR POMERADO HEALTH THROUGH AFFILIATED PROGRAM AGREEMENTS.

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PROMOTION OF COMMUNITY HEALTHTHE RADY CHILDREN'S HOSPITAL - SAN DIEGO IS GOVERNED BY A 24-MEMBER BOARD OF TRUSTEES. THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING THE SAN DIEGO COMMUNITY, WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. RCHSD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. RCHSD APPLIES ITS SURPLUS FUNDS TO SUPPORT THE HIGHEST AND MOST URGENT NEEDS OF THE ORGANIZATION AND THE COMMUNITY INCLUDING IMPROVING PATIENT CARE; PROVIDING SUPPORT FOR OUR PATIENTS' FAMILIES; RESEARCH; DEVELOPMENTAL SERVICES; MENTAL HEALTH SERVICES; CHILD ABUSE PREVENTION AND TREATMENT SERVICES; EDUCATION PROGRAMS; AND PURCHASING STATE-OF-THE ART EQUIPMENT AND TECHNOLOGY TO FURTHER ENHANCE PATIENT CARE. RCHSD PROMOTES THE HEALTH OF THE COMMUNITY IT SERVES THROUGH A VARIETY OF MECHANISMS. THE RCHSD COMMUNITY BENEFIT REPORT FOR FISCAL YEAR 2019 (JULY 1, 2018 THROUGH JUNE 30, 2019) PROVIDES DETAILED INFORMATION ON OVER 30 PROGRAMS AND RELATED ACTIVITIES RCHSD CONDUCTS EACH YEAR TO IMPROVE PATIENT'S HEALTH STATUS. FROM PROVIDING FREE MEDICAL EDUCATION TRAINING SEMINARS TO COMMUNITY-BASED PHYSICIANS AND OTHER HEALTH PROVIDERS, SUPPORT GROUPS, PARENT EDUCATIONAL RESOURCE MATERIALS, PEDIATRIC RESEARCH, TO PROGRAMS DIRECTED TO IMPROVE THE HEALTH NEEDS OF PATIENTS, RCHSD USES A MULTI-PRONGED APPROACH TO PROVIDE BENEFIT TO THE COMMUNITY.