4A (Expenses $ 47942713 including grants of $ 5100) (Revenue $ 53231207)
Provision of medical care to both inpatients and outpatients. During the current year, the hospital had 1,156 patient admissions which resulted in 3,691 patient days, 37,814 outpatient visits, and 48,707 physician practice patient visits. The hospital is a 44-bed acute care hospital located in Franklin County, Kansas.

AdventHealth Ottawa
Part V, Section B, Line 5: In order to ensure broad community input, AdventHealth Ottawa (AHO or the Hospital) created a Community Health Needs Assessment Committee (CHNAC) to help guide the Hospital through its 2020 Community Health Needs Assessment process. The CHNAC included representation from the Hospital, public health experts, and the broad community. This included intentional representation from low-income, minority and other underserved populations. The CHNAC met three times in 2019-2020 to review primary and secondary data, help define the priority issues to be addressed by the Hospital and help develop the Community Health Plan to address the priority issues. In addition to representation from the Hospital, the listing below reflects all of the organizations/community areas represented on the Hospital's CHNAC: - Elizabeth Layton Center- Franklin County EMS- Health Partnership Clinic- Franklin County Health Department- Kansas State University Research & Extension- Blue Cross Blue Shield Pathways; and- ECKAN AdventHealth Ottawa collected both primary and secondary data for the purpose of the Community Health Needs Assessment process. In addition to the input received from the individuals/organizations serving on the CHNAC, primary data was collected to identify the top 11 aggregate issues from the various sources of data. The primary data included a joint community survey implemented in partnership with the Health Partnership Clinic. The community surveys were completed online and email/text. Adjustments for collecting data were necessary as a result of the COVID 19 pandemic. With the cancellation of community events planned to engage community participation, additional efforts for on-line completion were implemented. The Franklin County CHIP committee made the survey link available to their clients through social media and forwarded the survey to their community partners to expand the reach. In addition, the Ottawa's Minister's Association, representing 12 faith communities, promoted survey completion to their congregations. Online surveys captured the input and feedback from community health leaders. Leaders were identified through the County's CHIP committee and Hospital leadership. Secondary data sources included internal Hospital utilization data (inpatient and emergency department). This utilization data showed the top reasons for visits to AdventHealth Ottawa over the past year. In addition, publicly available data from state and nationally recognized data sources were utilized.

AdventHealth Ottawa
Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the Hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the Hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.

AdventHealth Ottawa
"Part V, Section B, Line 11: AdventHealth Ransom Memorial, Inc. d/b/a AdventHealth Ottawa will be referred to in this document as AdventHealth Ottawa or ""the Hospital"". The Hospital is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a hospital and healthcare system known as AdventHealth. In January 2019, every wholly-owned entity of AHSSHC adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Any references to our prior Community Health Needs Assessments (CHNAs) or prior Community Health Plans (CHPs) will utilize our new name for consistency. AdventHealth Ottawa is part of the Multi-State Division of AdventHealth. The division includes 15 hospital facilities. This is the first-year update for AdventHealth Ottawa's 2021-2022 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2021 as part of its 2020 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Ottawa worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2020 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the community health needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2021-2022 Community Health Plan. The first-year progress on the Community Health Plan is noted below. The narrative describes the prioritized issues identified in 2020 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital did not address. AdventHealth Ottawa chose two priorities for its 2021-2022 Community Health Plan: 1. Chronic Disease Prevention and Management2. Mental HealthPriority 1: Chronic Disease Prevention and Management 2020 Description of the Issue:Heart disease is the leading cause of death in the Hospital's service area. When adjusted for age, 182 per 100,000 deaths are due to heart disease compared to the state rate at 158 per 100,000 deaths. Nearly 32% of adults have high blood pressure and 42% in the Hospital's primary service area have high cholesterol, both are risk factors for heart disease, which can be improved considerably with proper nutrition. More than 60% of individuals in the service area are overweight and/or obese and the age adjusted rate of diabetes in the population over the age of 18 is 8.4%.2021 Update: The AdventHealth Ottawa Community Health Plan has two desired goal statements under the Chronic Disease Prevention and Management priority. 1. Increase access to healthy food for low income residents in low-food access areas in Franklin County 2. Increase knowledge, improve lifestyle behaviors and provide support to prevent and manage chronic disease in the Hospital's community Goal 1: Increase access to healthy food for low income residents in low-food access areas in Franklin County Objective 1: The Hospital will support the Franklin County Food Policy Council's goals and objectives by providing professional expertise and actively participating in 10 meetings per year. The Franklin County Food Policy Council is funded and deployed through the Franklin County Health Department. The Food Policy Council (FPC) is a broad representation of individuals and organizations throughout the county that support the provision of nutritious foods to all county residents. The Hospital met its set metric of attending 10 meetings. FPC initiatives in 2021 included coordination and support for a mobile food pantry, and planning to pilot a new produce bundles program, in addition to ongoing promotion of farmers markets and other methods for increasing access to healthy food. Hospital participation included monthly FPC meetings as well as work group meetings on the produce bundles program (called Harvest to Home). The hospital also contributed graphic design support for a Harvest to Home logo.Objective 2: The Hospital will conduct four food collection drives and provide 20 volunteer hours for the Food Policy Council's identified food access initiatives. The Franklin County Food Policy Council is funded and deployed through the Franklin County Health. The Food Policy Council (FPC) is a broad representation of individuals and organizations throughout the county that support the provision of nutritious foods to all county residents. The first metric for the objective was fallen short of, with 2 food drives accomplished and 2 canceled/changed in scope due to the COVID surge. Additionally, the Hospital met its second metric of providing 20 volunteer hours for FPC initiatives. In June, the Hospital provided 20+ volunteer hours participating in a fresh food drive in collaboration with Ottawa Ministerial Association (followed by a community event to support low-income neighborhood clean-up/home improvement projects). In September, Hospital Nursing Leadership collected/delivered food items (and household cleaning/disinfectant items to support/mitigate COVID transmission) to area ""blessing boxes."" Due to COVID-19, two planned collection events were delayed. As a result of the continued pandemic, AdventHealth has pivoted where necessary to address the immediate needs of our community. We are working to identify ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop.Goal 2: Increase knowledge, improve lifestyle behaviors and provide support to prevent and manage chronic disease in the Hospital's community Objective 1: The Hospital, in partnership with the Franklin County Health Department, will increase knowledge or improve health behaviors for 50 individuals participating in the Chronic Disease Self-Management Program. Participants will demonstrate increased knowledge from the pre-test to the post-test. The Chronic Disease Self-Management Program is funded and deployed through the Franklin County Health Department and K-State Research and Extension. The program increases access to and education about diabetes and self-care information, meal planning and healthy snack ideas, information for reading food labels, and ideas for low-impact physical activity. The Hospital progressed on its set metric of improving knowledge or behavior for 50 participants with 8 community members participating and showing a 100% increase in knowledge. The Hospital helped advertise this on Facebook and word of mouth during patient visits with the Dietician. K-State Research and Extension conducted the online class. The participants were those who have prediabetes or type 2 diabetes as well as family members who care for someone who has prediabetes or type 2 diabetes. The four-week program was self-paced and participants completed four online modules (including educational videos), one each week, on their own time. Based on the pre and post surveys for the program, participants indicated that they increased their knowledge and awareness regarding foods that will raise blood sugar and contain carbohydrates. They also indicated that they were fitting exercise into their daily routine, cooking more at home, eating smaller portions, and using the recipes shared through the program. As a result of the continued pandemic, AdventHealth has pivoted where necessary to address the immediate needs of our community. We are working to identify ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop.See continuation"

AdventHealth Ottawa
Part V, Section B, Line 13h: Effective March 1, 2020, the filing organization's hospital facility (or facilities) augmented their Financial Assistance Policy with a COVID-19 Financial Grace Addendum. Pursuant to the COVID-19 Financial Grace Addendum, uninsured patients treated for COVID-19 related evaluations are to receive free or discounted care depending on the patient's cooperation in submitting necessary financial assistance information. Insured patients tested for COVID-19 are not expected to have out-of-pocket expenses based on insurance community response to waive patient financial responsibility. If a payer unexpectedly fails to waive patient responsibility for COVID-19 related testing, the filing organization will not balance bill patients for any out-of-pocket expenses related to COVID-19. In addition, patients with existing payment plans are provided opportunities for reducing their monthly payments.

Part V, Section B, Line 11 - continuation
Objective 2: The Hospital will implement a Whole-Person health promotion and disease prevention campaign to 12,500 community members in the primary service area through the distribution of the MyHealth magazine and social media. One percent (125 community members) will demonstrate engagement by sharing on social media, requesting additional information, or signing up for an education program. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The campaign provides Whole-Person health promotion and disease prevention education, including lifestyle behaviors and tips to help prevent and manage chronic disease. The Hospital exceeded its set metric by including relevant content in the Spring 2021 MyHealth magazine and over 13,000 houses reached. The second metric for the objective was not met yet, as engagement was not measured. Additional MyHealth issues and multiple social media posts are planned to expand reach and ensure engagement. Priority 2: Mental Health 2020 Description of the Issue:Eleven percent of the Hospital's community survey respondents were unable to receive mental health or substance abuse treatment. Key stakeholder surveys indicated a very high importance and low satisfaction to the community's response on the issue of prescription drug addiction. Prescription related drug overdose deaths in Kansas dramatically increased from 1999 to 2018. This graph displays trends of drug overdose deaths among Kansas residents between 1999-2018. Drug categories presented are not mutually exclusive, as deaths might have involved more than one substance. Kansas psychostimulant overdose death rates almost doubled from 2018 to 2019 and accounted for 39% of all fatal overdoses statewide.Suicide and mental health issues were in the top four issues identified by the Community Health Needs Assessment Committee. Thirteen percent of respondents in the Hospital's community health survey reported a lack of emotional support. In the survey, 13.7% reported that their mental health was not good in the past month. and the Hospital admission rate for mental health needs in Franklin County was 73.8 per 10,000.2021 Update: The AdventHealth Ottawa Community Health Plan has two desired goal statements under the Mental Health priority. 1. Reduce prescription overdoses and deaths 2. Reduce suicide attempts and deaths in Franklin County Goal 1: Reduce prescription overdoses and deathsObjective 1: The Hospital will provide professional expertise to support the vision and strategic plan of the Franklin County Substance Use Prevention Coalition by actively participating in eight meetings per year. The Franklin County Substance Use Prevention (FCSUP) Coalition is funded and deployed through the Franklin County Health Department. The coalition works to make substance use reduction a priority in Franklin County through: prevention, collaboration, and pursuing resources. The Hospital met its set metric of attending 8 meetings. The Hospital is further contributing by one of its leadership staff serving as the FCSUP Coalition Chair starting March 2022. Objective 2: The Hospital will increase the knowledge of health professionals on best practices for prevention of opioid misuse and provide resources for patients with opioid dependency. Fifty health professionals will participate in education and 75% will indicate increased knowledge through post survey. The professional education is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The Hospital progressed on its set metric of 50 health professionals participating in education with 0 attaining thus far, but the AdventHealth Learning Network (ALN) administrator is working on the module for all health professionals and staff are confident this will be met in 2022. Objective 3:The Hospital will implement a community education and awareness campaign on the proper handling of unused prescriptions reaching 12,500 community members in the Hospital's primary service area through the distribution of the MyHealth magazine and social media. One percent (125 community members) will demonstrate engagement by sharing on social media, requesting additional information, or signing up for an education program. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The Hospital exceeded its set metric by including relevant content in the Fall 2021 MyHealth magazine and over 13,000 houses reached. This included content on how to properly dispose of unused medications. The second metric for the objective was progressed on yet, with 3 requests for take-back kits received in response to the MyHealth article. Additional MyHealth issues and multiple social media posts are planned to expand reach and track engagement. Goal 2: Reduce suicide attempts and deaths in Franklin CountyObjective 1: The Hospital will provide professional expertise and support for the development and implementation of the Healthy Minds Franklin County Committee's goals by actively participating in 15 meetings in two years. The Healthy Minds Franklin County Committee is funded and deployed through the Franklin County Health Department. The Healthy Minds Franklin County Committee is made up of a collaborative of organizations that meet regularly to discuss improving mental well-being of residents of Franklin County, KS and strive to implement strategies throughout the county that impact overall well being. The Hospital did not meet its set metric, as no meetings were attended before the Committee disbanded in 2021 due to limited staff capacity amidst the pandemic.As a result of the continued pandemic, AdventHealth has pivoted where necessary to address the immediate needs of our community. We are working to identify ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop.Objective 2: The Hospital will increase the knowledge and skills of 50 community members to effectively respond to those who may be contemplating suicide with the evidence-based program QPR (Question-Persuade-Refer) through financial support, marketing and promotion of the program to the community, is funded solely through the reporting Hospital and does not appear on other community health plans within the Multi-State Division. This support increases access to education classes that improve knowledge and skills to effectively respond to those who may be contemplating suicide. The Hospital did not meet its set metric of $1000, with 0 dollars provided. The invoice was submitted a couple of times in 2021, but it was not paid due to miscommunications during staff transitions and process changes. This will be remedied in 2022 as a $2000 invoice has now been submitted and will be monitored until payment occurs. QPR sessions are scheduled for June 30, 2022.Objective 3: The Hospital will implement a messaging campaign on suicide prevention to 12,500 community members through the MyHealth magazine and social media. One percent (125 community members will demonstrate engagement by either sharing on social media, requesting additional information, registering for an educational program, or downloading resources. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The Hospital did not meet its set metric as this has not been included in a MyHealth magazine yet but is planned for 2022. The second metric for the objective was not met yet, as engagement has not been measured. Additional MyHealth issues and multiple social media posts are planned to expand reach and track engagement. See continuation

Part V, Section B, Line 11 - continuation
Community Needs Not Chosen by AdventHealth Ottawa:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. The Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. RISING HEALTH CARE COSTS AND LACK OF HEALTH INSURANCE One third of the AdventHealth Ottawa Community Survey responses indicated cost as a barrier to health care and 9.41% did not have health insurance. AdventHealth will continue to advocate for the expansion of Medicaid in Kansas. The Hospital currently provides financial assistance for those without health insurance and struggling to pay their medical bills. The Hospital will assist in connecting patients and the community to resources for accessing health coverage. 2. ISSUE 2: DENTAL CARE FOR ADULTS The 2017 Franklin County Health Department Quality of Life Survey conducted by Community Health Assessment team, survey indicated 38% of adults had not seen a dentist in the last 12 months and 18% of adults have poor dental health. While poor dental health leads to other health issues, it is not feasible for the Hospital to provide dental services. Health Partnership Clinic (Federally Qualified Health Center) currently offers dental services, but on a limited basis. 3. ISSUE 3: ACCESS TO HEALTH SPECIALISTS Through the prioritization process, the CHNAC identified the lack of access to specialty services as the third priority the Hospital should consider. Key Stakeholder surveys also highlighted this need through their comments. Types of specialists mentioned included mental and dental health providers. Patients needing to see health specialists not available in their community need to travel to southern Johnson County or Kansas City for services. More analysis and information are needed. It is not feasible for the Hospital to address this issue in a 2-year plan.

Schedule H, Part V, Line 16a, 16b, and 16c
Line 16AThe Financial Assistance Policy can be found at the following website: https://www.adventhealth.com/legal/financial-assistanceLine 16BThe Financial Assistance Policy Application can be found at the following website: https://www.adventhealth.com/legal/financial-assistanceLine 16CThe Plain Language Summary can be found at the following website: https://www.adventhealth.com/legal/financial-assistance

Schedule H, Part V, Section B, Line 7a and 10a:
Line 7a: The CHNA report can be found at URL:https://www.adventhealth.com/community-health-needs-assessmentsLine 10a: The Hospital's most recently adopted implementation strategy can be found at URL:https://www.adventhealth.com/community-health-needs-assessments

Part I, Line 6a:
"The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 30 tax-exempt 501(c)(3) hospital organizations and a number of other health care facilities that operated in 10 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as ""AdventHealth"".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organization's most recently conducted community health needs assessment and associated implementation strategy can be accessed on the filing organization's website."

Part I, Line 7:
The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions.

Part III, Line 2:
The amount of bad debt expense reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense.

Part III, Line 3:
Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who Could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool is the amount shown on line 3 of Section A of Part III. Rationale for Including Certain Bad Debts in Community Benefit:The filing organization is dedicated to the view that medically necessary health care for emergency and non-elective patients should be accessible to all, regardless of age, gender, geographic location, cultural background, physician mobility, or ability to pay. The filing organization treats emergency and non-elective patients regardless of their ability to pay or the availability of third-party coverage. By providing health care to all who require emergency or non-elective care in a non-discriminatory manner, the filing organization is providing health care to the broad community it serves. As a 501(c)(3) hospital organization, the filing organization maintains a 24/7 emergency room providing care to all whom present. When a patient's arrival and/or admission to the facility begins within the Emergency Department, triage and medical screening are always completed prior to registration staff proceeding with the determination of a patient's source of payment. If the patient requires admission and continued non-elective care, the filing organization provides the necessary care regardless of the patient's ability to pay. The filing organization's operation of a 24/7 Emergency Department that accepts all individuals in need of care promotes the health of the community through the provision of care to all whom present. Current Internal Revenue Service guidance that tax-exempt hospitals maintain such emergency rooms was established to ensure that emergency care would be provided to all without discrimination. The treatment of all at the filing organization's Emergency Department is a community benefit. Under the filing organization's Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. In this case, a patient's portion of a bill that remains unpaid for a certain stipulated time period is wholly or partially classified as bad debt. Bad debts associated with patients who have received care through the filing organization's Emergency Department should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community.

Part III, Line 4:
Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8-9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands.

Part III, Line 8:
Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.

Schedule H, Part VI, Line 7:
The filing organization does not file an annual community benefit report with any state agencies.

Part III, Line 9b:
Collection Policies:The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made.

Supplemental Schedule to Schedule H, Part III, Section B, line 8:
Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by AdventHealth. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ 1,442,214- Difference in costing methodology: (2,203,729)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (2,468,486) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (3,230,001) As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization.

Part VI, Line 2:
The Hospital conducts community health needs assessments (CHNA) every three years. Its 2020 CHNA was adopted by its governing board by December 31, 2020, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2020 CHNA complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of its community.Such practices and processes involve the following:1.A hospital operating/community board composed of individuals broadly representative of the community, community leaders, and those with specialized medical training and expertise;2.Post-discharge patient follow-up related to the on-going care and treatment of patients who suffer from chronic diseases; 3.Sponsorship and participation in community health and wellness activities that reach a broad spectrum of the filing organization's community; and 4.Collaboration with other local community groups to address the health care needs of the filing organization's community.

Part VI, Line 3:
The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facility are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on the filing organization's hospital facility's website. The website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains the hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of the hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facility's financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facility who are classified as self-pay during the course of their hospital stay or at time of discharge to explain the FAP and FAA Form and to provide information concerning other sources of assistance that may be available, such as Medicaid. A paper copy of the hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of the community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance.

Part VI, Line 4:
The filing organization (the hospital) is located in Ottawa, Kansas, and is licensed for 44 acute care beds. In May 2019 Ransom Memorial Hospital became AdventHealth Ottawa, joining AdventHealth's connected system of care comprised of nearly 50 hospital campses and hundreds of care sites in diverse markets throughout almost a dozen states. AdventHealth Ottawa delivers a wide range of inpatient, outpatient and surgical health care services across Franklin County and its surrounding areas. In addition to operating a hospital, the filing organization also runs two off-site locations which include rehabilitation and specialty services. The filing organization employs more than 300 local residents. AdventHealth Ottawa is a crucial community asset and strives to have a positive impact on the lives of patients, their families, and their healthcare partners no matter what their needs may be. Key servicecs include cardiology, obstetrics, emergency medicine, gynecology, sleep medicine, urology, pediatrics, pulmonology, oncology, neurology, occupational medicine, wound care, orthropedics, diagnostic imaging with digital mammography, general surgery, physical, occupational, speech therapy, family/internal medicine and much more. The closest competing hospital is located approximately 30 mintues away. During 2021, the Hospital's patient percentage population was made up of the below payors with the remaining percentage of the patients being covered under commercial insurance. In 2021, about 83% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 52.4% - Medicaid Patients 11.4% - Self-Pay Patients 4% The demographic makeup of the county that the Hospital serves is as follows: - Population 23,898 - Population Over 65 17% - Poverty (Below 100% FPL) 11.7% - Unemployment Rate 3.2% - Violent Crime Rate (Per 100,000 Pop.) 265.3 - Pop. Age 25+ with No High School Diploma 7.6% - Uninsured Adults 9.4% - Uninsured Children 3.78% - Food Insecurity Rate 13% - Pop. with Low Food Access 50.88%

Part VI, Line 5:
"The provision of community benefit is central to AdventHealth Ransom Memorial's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the Hospital is a function of ""extending the healing ministry of Christ and embodies the Hospital's commitment to its values and principles. The Hospital commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $1,641,969 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community."

Part VI, Line 6:
AdventHealth Ransom Memorial is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 48 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 10 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AHS subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth.