4A (Expenses $ 360750815 including grants of $ 130800) (Revenue $ 388371832)
Operation of a 385-bed acute care hospital located in Marion County, FL. During the current year there were 17,508 patient admissions, 87,108 patient days, and 121,129 outpatient visits.

AdventHealth Ocala
Part V, Section B, Line 5: In order to ensure broad community input, AdventHealth Ocala (AHO or the Hospital) created a Community Health Needs Assessment Committee (CHNAC) to help guide the Hospital through its 2019 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 2018-2019 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: - Marion County Literacy Council- Marion County United Way- Interfaith Emergency Services- Heart of Florida Health Center- City of Ocala- Florida Department of Health in Marion County; and- Marion County Hospital District AdventHealth Ocala 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 better understand feedback from community members related to barriers to accessing care, challenges to accessing care for children's health, health behaviors and other social determinants of health. The primary data included a joint community survey implemented in partnership with the Florida Department of Health in Marion County as well as stakeholder interviews. The community surveys were completed online and in person by participants in community settings such as local clinics, community events, department of motor vehicle locations and other community locations throughout the county. A total of 935 Marion County residents completed the Community Health Needs Assessment survey, over 18% of which were minorities. Secondary data sources included internal Hospital utilization data (inpatient and emergency department). This utilization data showed the top reasons for visits to AdventHealth Ocala over the past year. In addition, publicly available data from state and nationally recognized data sources were utilized.

AdventHealth Ocala
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 Ocala
"Part V, Section B, Line 11: Florida Hospital Ocala Inc., d/b/a AdventHealth Ocala will be referred to in this document as ""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 Ocala is part of the West Florida Division of AdventHealth (the Division). The Division includes 11 hospital facilities. This is the second-year update for AdventHealth Ocala's 2020-2022 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2020 as part of its 2019 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Ocala worked to define and address the needs of low-income, minority and underserved populations in its service area.The 2019 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 2020-2022 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the prioritized issues identified in 2019 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 Ocala chose four priorities for its 2020-2022 Community Health Plan: 1. Behavioral Health 2. Obesity/Overweight/Obese, Lack of Physical Activity and Diabetes 3. Poor Dental Health and Uninsured/Underinsured (Lack of Medical Insurance) 4. Low Food Access/Food Insecurity Priority 1: Behavioral Health 2019 Description of the Issue:The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability for adults, children, and adolescents. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. Mental health disorders are the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people aged 25 to 34. In the AdventHealth Ocala primary service areas (PSA), the rate of death due to self-harm (suicide) is 19 per 100,000 population, which is higher than the state rate of 14 per 100,000 population. Roughly 20% of the Medicare-fee-for-service PSA population are depressed, which is slightly higher than the state average of 18%. Since 1964, 20 million people in the U.S. have died from using tobacco. Tobacco use can cause a wide range of health issues including cancer, heart disease, diabetes, oral health diseases, and harmful reproductive effects. More than 30 million adults in the U.S. smoke cigarettes and more than 50 million are exposed to secondhand smoke, which is just as harmful as smoking. Secondhand smoke can still cause heart disease and lung cancer in nonsmokers and asthma, sudden infant death syndrome (SIDS) and other respiratory infections in infants and children. In the AdventHealth Ocala primary service area, an estimated 50,096.34, or 21% of adults aged 18 or older selfreport currently smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease. In the Hospital PSA, 24.1% of adults are currently smoking cigarettes, which is higher than the state percentage of 19%. Excessive use of alcohol can have immediate health effects, including unintentional injury, violence, alcohol poisoning, risky sexual behaviors, and miscarriage among pregnant women. It can also have long-term health effects, including high blood pressure, heart disease, liver disease, dementia, depression, and cancer. Underage drinking, or alcohol consumption by those under the age of 21, has been linked to death from alcohol poisoning, suicide, unintentional injury, and alcohol dependence later in life. In the U.S., excessive alcohol use was the cause of 1 in 10 deaths among adults between the ages of 20-64. In 2010, people under the age of 21 accounted for 189,000 ER visits for injuries and other conditions related to alcohol use. In the AdventHealth Ocala primary service area, an estimated 34,566, or 15% of adults aged 18 and older selfreport heavy alcohol consumption (defined as more than two drinks per day on average for men and one drink per day on average for women). This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as cirrhosis, cancers, and untreated mental and behavioral health needs. 2021 Update: The AdventHealth Ocala Community Health Plan has three desired goal statements under the Behavioral Health priority.1. Improve access to behavioral health care by providing funding for in-patient care treatment2. Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disorders3. Increase community-level partnerships to enhance local efforts to address social determinants of health that impact mental healthGoal 1: Improve access to behavioral health care by providing funding for in-patient care treatmentObjective 1: The first objective is to increase the number of in-patient treatment days for underinsured/uninsured individuals with acute or chronic mental illness residing in the Hospital's PSA to three days of in-patient treatment at The Centers (a healing place, offering mental health services and substance abuse services) from a baseline of zero days by the end of year three. The in-patient treatment days initiative is funded and managed through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The in-patient treatment days initiative ensures that uninsured/underinsured individuals can have access to in-patient behavioral health services in times of crisis. The Hospital met its set metric of funding three in-patient treatment days with three in-patient treatment days provided. This outcome was achieved through a strong partnership with The Centers and an increased emphasis internally on the importance of mental health. AdventHealth Ocala has an agreement with The Centers where five beds are reserved for patients each day for uninsured patients which includes coverage for up to three days of in-patient treatment for these patients. Over the course of 2021, 37 patients were covered for a total of 67 in-patient treatment days. This means that 155 patients received coverage for 305 in-patient treatment days across years 1 and 2.See continuation 2."

AdventHealth Ocala
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.

Schedule H, Part V, Section B, Line 11 - Continuation 2:
Goal 2: Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disordersObjective 1:The first objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA to three certification classes from a baseline of zero by the end of year three.The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth Ocala, AdventHealth Carrollwood, AdventHealth Connerton, AdventHealth Dade City, AdventHealth North Pinellas, AdventHealth Tampa, AdventHealth Zephyrhills, AdventHealth Wauchula, AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital and all reported outcomes are specific to the reporting Hospital.The initiative provides Mental Health First Aid USA certification classes to the community for free. The class is a course that teaches you how to help someone who may be experiencing mental health or substance use challenges. The training helps you identify, understand, and respond to signs of addictions and mental illnesses.The Hospital progressed on its metric of providing three free Mental Health First Aid USA certification training classes to community members residing in the Hospital's PSA from a baseline of zero certification classes by the end of year three. In 2021, four team members became certified instructors for Mental Health First Aid (adult curriculum). Strong interest in receiving this training makes us confident that we will be able to meet or exceed this objective by using 2022 to schedule and hold classes.Objective 2:The second objective is to increase Hospital support of local advocacy groups that provide resources, interventions and support to adults and youth who are affected by mental illness in the Hospital's PSA by supporting three advocacy groups from a baseline of zero by the end of year three.The local advocacy group support initiative is funded through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The local advocacy group initiative provides support to mental health advocacy groups to promote the work that they do to ensure health equity and parity for persons living with mental health disorders and reduce stigma associated with mental health disorders and services. The Hospital progressed on its set metric of supporting three advocacy groups by the end of year three. We have partnered with the National Alliance on Mental Health (NAMI) Marion, the Marion County Children's Alliance, and the Ora Clubhouse. These three organizations work to decrease stigma associated with mental illness and substance abuse and promote local, state, and federal legislation that provides more rights and recognition to individuals with behavioral health disorders.AdventHealth has progressed on this objective by providing financial support to NAMI Marion to support their advocacy efforts. These funds can be used to cover the cost of food, printed materials, and marketing expenses for the organization, as well as support the training of support group facilitators and teleconference subscription costs to enable support groups to be held virtually.Objective 3:The third objective is to partner with The Centers, and the Marion County National Alliance on Mental Illness to create and implement three local social media campaigns to raise awareness of mental health (sharing both the challenges of the problem and success stories of overcomers) from a baseline of zero by the end of year three. The social media campaign initiative is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. The National Alliance on Mental Illness provides mental health support services, advocacy, and resources to individuals and family members of individuals living with a mental health disorder. The Centers is a private, non-profit organization licensed by the State of Florida and accredited by CARF (Commission on Accreditation of Rehabilitation Facilities) International which provides adult crisis stabilization, adult residential substance abuse treatment and outpatient behavioral health services. The campaigns will promote local and online mental health resources, including services, support groups and self-management tools. The Hospital progressed on its set metric of the creation and implementation of three social media campaigns held by the end of year three. Throughout 2020 and 2021, our teams connected with additional mental health partners to help guide the messaging, targeting, and methods for launching a social media campaign. We also collected information on resources, local services, and self-management tools to be shared through the campaign and a division-level community benefit website.We expanded our coalition of mental health service providers to include The Vines, The Pace Center for Girls, Lifestream Behavioral Health Services, and others for a total of 10 behavioral health partners. This coalition will focus the first social media campaign on stress and anxiety, the second on stress and burnout, and the third on substance misuse. These campaigns will focus on the effects on individuals experiencing the disorders as well as the impact on caregivers and loved ones. The campaigns will link individuals back to a list of behavioral health service providers and resources maintained by the Hospital.Goal 3: Increase community-level partnerships to enhance local efforts to address social determinants of health that impact mental healthObjective 1:The first objective is to increase the number of Marion County National Alliance on Mental Illness (NAMI) Connection Recovery Support Groups provided for free to adults residing in the Hospital's PSA by providing support for six support group sessions from a baseline of zero by the end of year three. The support group initiative is funded through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. NAMI Connection Recovery Support Groups are free, peer-led support groups for adults who have experienced symptoms of a mental health condition. By supporting the operational costs of the groups (rental cost of space, refreshments, marketing/printed materials) and referring patients to support groups, NAMI has a greater ability to support the needs of individuals and families of individuals living with a mental health disorder. The Hospital met its set metric of providing cash and in-kind support for six support groups supported by the end of year three. AdventHealth Ocala provided a cash donation to support the cost of NAMI's Zoom license to allow for virtual support group sessions. The donation was also able to cover the cost of materials, manuals, instruction guides, travel, and lodging for the training of four new support group facilitators. The cost of food during these sessions was also covered.Objective 2:The second objective is to increase the number of underinsured and uninsured community members referred to The Centers for behavioral health services to 75 community members from a baseline of zero by the end of year three. The behavioral health referral program is funded and conducted through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The behavioral health referral program provides underinsured and uninsured patients with access to behavioral health services and follow up care in response to crisis events. The Hospital exceeded its set metric of 75 patients referred by December 31st, 2022.Over the course of 2021, 37 patients received coverage for 67 in-patient treatment days for a combined total of 155 patients receiving coverage for 305 in-patient treatment days throughout years 1 and 2.See continuation 3.

Schedule H, Part V, Section B, Line 11 - Continuation 3:
"Objective 3:The third objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours to 300 hours by the end of year three. The paid volunteerism program is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations that address this priority area. The Hospital progressed on its set metric of 300 volunteer hours served by December 31st, 2022. Division employees created a volunteer portal to market volunteer opportunities to team members, track volunteer hours and notify community partners when team members sign up for an event. The Hospital is working with The Centers, Marion County Senior Services, and the United Way of Marion County to promote volunteer opportunities to Hospital team members. Our internal volunteer portal informs team members about opportunities, tracks sign-ups and notifies sponsoring organizations when team members register for events. In-person and virtual opportunities are available. During 2021, 5 team members volunteered a total of 10 hours of paid staff time to write letters of encouragement to individuals with a lived experience of a mental health challenge and/or their caregivers.Priority 2: Obesity/Overweight/Obese, Lack of Physical Activity and Diabetes 2019 Description of the Issue:Obesity occurs when an individual's weight is higher than what is considered healthy. Obesity can be caused by behavioral and genetic factors. Another factor that contributes to obesity is the built environment; for example, where you live, your access to healthy food, and the ability to exercise outside. Obesity can cause serious health complications including high blood pressure, high cholesterol, heart disease, osteoarthritis, and some cancers. From 2015-2016, obesity affected about 93 million adults and 13 million children in the U.S. In the AdventHealth Ocala primary service area (PSA), 31% of adults are obese (BMI greater than 30) which is higher than the state average of 26.6%. Additionally, 37% of adults in the PSA are considered overweight (BMI between 25 and 30) and 30% of adults aged 20 and older selfreport no leisure time for physical activity. Diabetes is the seventh leading cause of death in the U.S. affecting 29 million people. More than 80 million people in the U.S. are pre-diabetic meaning they are at an increased risk of developing diabetes in the next few years. When diabetes goes untreated it can lead to more serious health issues such as vision loss, heart disease, stroke, nerve, and kidney diseases. In the AdventHealth Ocala primary service area, 10% (33,664) of adults have been diagnosed with diabetes, which is higher than the state average of 9%. This indicator is relevant because diabetes is a prevalent problem in the U.S.; it may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.2021 Update: The AdventHealth Ocala Community Health Plan has two desired goal statements under the Obesity/Overweight/Obese, Lack of Physical Activity and Diabetes priority.1. Increase access to diabetes education by supporting community organizations and other stakeholders offering health education and resources2. Implement strategies that support existing community health education initiatives aimed to address the problem of diabetes in the Hospital's PSAGoal 1: Increase access to diabetes education by supporting community organizations and other stakeholders offering health education and resourcesObjective 1: The first objective is to increase access to diabetes education among underserved community members residing in the Hospital's PSA by sponsoring costs of six Diabetes Self-Management Education and Support (DSMES) community classes which are offered by the Florida Department of Health in Marion County from a baseline of zero by the end of year three. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. The DSMES sponsorship program is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. The Hospital met its set metric of sponsoring six classes by the end of year three. Objective 2: The second objective is to increase access to Diabetes Self-Management Education and Support (DSMES) classes at the Florida Department of Health for Marion County by referring 150 underserved/uninsured adults residing in the Hospital's PSA from a baseline of zero adults by the end of year three. The DSMES referral program is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. The DSMES referral program connects diabetic and pre-diabetic individuals to health education that provides them with knowledge and tools to self-manage their chronic condition, improve health behaviors, and change health outcomes. The Hospital progressed on its set metric of 150 adults referred by the end of year three. Due to the COVID-19 pandemic, the Florida Department of Health for Marion County temporarily cancelled DSMES classes. Nevertheless, we have utilized this time to develop a tentative timeline and internal plan for referring participants to DSMES classes at the Florida Department of Health for Marion County, once classes resume. The internal plan for referring participants to the DSMES classes involved a tremendous collaborative effort with our AdventHealth Care 360 team to create an ""at discharge"" referral system to connect patients to our Community Benefit programs and initiatives. Initially, the referral system was piloted to connect patients (at discharge) with a history of smoking to free smoking cessation classes offered by the Suwanee River Area Health Education Center. This same referral system will soon be expanded to refer patients to DSMES classes once in-person classes resume, ensuring that the Hospital will be able to refer 150 patients to these classes by the end of 2022. Goal 2: Implement strategies to support existing community initiatives aimed to address the problem of obesity in the Hospital's PSAObjective 1: The first objective is to increase access to chronic disease management classes offered by the Florida Department of Health in Marion County for underserved adults in the Hospital's PSA by sponsoring costs of six classes from a baseline of zero classes by the end of year three. The chronic disease management sponsorship program is funded through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. By supporting the cost of chronic disease management classes, AdventHealth Ocala extends the reach and capacity of the Florida Department of Health in Marion County to teach individuals living with chronic conditions how to manage their symptoms, promote healthy behaviors, and prevent worsening of symptoms through lifestyle changes. The Hospital progressed on its set metric of six chronic disease management classes sponsored by the end of year three. Due to the COVID-19 pandemic, the Florida Department of Health for Marion County temporarily cancelled all community education classes. However, we have fostered a strong partnership with the Florida Department of Health Marion County throughout the pandemic and will sponsor the costs of these classes once they resume. Classes are scheduled to resume in the beginning of 2022.See continuation 4."

Schedule H, Part V, Section B, Line 11 - Continuation 4:
"Objective 2: The second objective is to increase access to community lunch-n-learn health education series sessions offered by the Active Marion Project (AMP) for underserved adults in the Hospital's PSA by sponsoring the cost of three classes from a baseline of zero by the end of year three. The AMP lunch and learn program is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. AMP is a project of the Marion County Hospital District that acts to challenge residents to lead healthier lifestyles through community and workplace initiatives, health education and team engagement. The AMP lunch and learn program provides community members with knowledge of nutrition, exercise, and lifestyle skills to help live a healthier life and prevent or manage obesity or chronic conditions caused by obesity. The Hospital met its set metric of sponsoring three classes by the end of year three. AdventHealth provided financial support to the Active Marion Project to cover the cost of educational materials for instructors and attendees. AdventHealth Ocala also covered the cost to screen class participants. Priority 3: Poor Dental Health and Uninsured/Underinsured (Lack of Medical Insurance)2019 Description of the Issue:Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth, and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth Ocala primary service area, the access to dentists' rate (per 100,000 pop.) is 38 (in 2015 year), as compared to the state rate of 56.Access to health care is the equitable use of health services to achieve the highest level of health. Barriers to accessing health care services include cost of care, insurance coverage, availability of services and culturally competent care. Failure to overcome these barriers leads to delayed care, health complications and financial burdens. Accessing healthcare services is vital to prevent and treat diseases thereby reducing the likelihood of disability and premature death. In the AdventHealth Ocala primary service area, 19% of adults (slightly higher than the state average of 18%) and 6% of children are uninsured or without medical insurance. This indicator is relevant because lack of insurance is a primary barrier to healthcare access including regular primary care, specialty care, and other health services that contributes to poor health status.2021 Update: The AdventHealth Ocala Community Health Plan has two desired goal statements under the Poor Dental Health and Uninsured/Underinsured (Lack of Medical Insurance) priority.1. Implement strategies to support community efforts to improve access to primary care and dental care providers2. Increase partnerships with local community organizations with existing resources to offer community members assistance with enrolling in health insurance coverage Goal 1: Implement strategies to support community efforts to improve access to primary care and dental care providersObjective 1: The first objective is to create a volunteer network of local dentists to volunteer at local community mobile dental clinics to provide free dental services to underinsured/uninsured adults residing in the Hospital's PSA by mobilizing three volunteer dentists from a baseline of zero by the end of year three. The local dentist volunteer network initiative is conducted through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The volunteer network of dentists provides additional dentists to FreeD.O.M. Clinic USA to staff mobile dental clinic events, increasing their capacity to see patients during these events. FreeD.O.M. Clinic USA provides free dental, optical and medical care for the low income, uninsured and underinsured in Marion County. The Hospital progressed on its set metric of recruiting three volunteer dentists convened by December 31st, 2022.Objective 2: The second objective is to partner with FreeD.O.M. Clinic USA to offer oral health training workshops to staff from local community organizations to increase access to oral health education and dental services for underinsured/uninsured adults residing in the Hospital's PSA. The Hospital will sponsor costs to train six community health providers from a baseline of zero by the end of year three. The community health provider training program is conducted through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The community health provider training program equips medical personnel with additional training to provide dental blocks, which provide a temporary solution to dental pain until recipients can secure dental appointments, to uninsured and underinsured patients. Additionally, this provides medical providers the skills to volunteer at mobile dental clinics and provide services to uninsured patients. The Hospital progressed on its set metric of training six community providers by the end of year three.A virtual training, created by FreeD.O.M. Clinic USA, on how to provide dental blocks was provided to six community health providers. In 2022, AdventHealth Ocala will connect these newly trained providers to mobile clinic events to ensure that uninsured and underinsured residents attending these events have access to more comprehensive, free dental health services.Goal 2: Increase partnerships with local community organizations with existing resources to offer community members assistance with enrolling in health insurance coverageObjective 1: The first objective is to partner with Florida Department of Health in Marion County to create and implement workshops on ""Navigating the Healthcare Plan"" for adults residing in the Hospital's PSA by six workshops from a baseline of zero workshops by the end of year three. The Navigating the Healthcare Plan workshop series is conducted through AdventHealth Ocala and all outcomes are specific to the reporting Hospital. The workshop series provides health education to uninsured and underinsured residents to help them understand how to enroll in affordable health insurance, how to utilize health insurance and how to seek out primary care services. The Hospital progressed on its set metric of six workshops held by December 31st, 2022.Our collaborative team of providers has partnered with the Suwanee River Area Health Education Center to provide Navigating the Healthcare Plan workshops and drafted a curriculum collaboratively. We have also identified several community organizations that could be audiences for workshops. Finally, our team has worked with GrubHub to be able to offer vouchers to attendees of virtual versions of the workshop.Priority 4: Low Food Access/Food Insecurity 2019 Description of the Issue:Food insecurity is the household level economic and social condition of limited or uncertain access to adequate food. Low food access is defined as living more than half a mile from the nearest supermarket, supercenter, or large grocery store. The ability to easily access and afford food greatly influences diet and overall health. People who have low food access face greater barriers to access affordable and healthy food which can negatively affect health and wellness. Food insecurity also increases risks for obesity. In the AdventHealth Ocala primary service area, a total of 50,435 households are food insecure, which represents an estimated 16.8% of the total population that experienced food insecurity at some point during the 2014 report year but are ineligible for State or Federal nutrition assistance. Furthermore, an estimated 28% (16,007) of the population under age 18 experienced food insecurity at some point during the 2014 report year. 2021 Update: The AdventHealth Ocala Community Health Plan has two desired goal statements under the Low Food Access/Food Insecurity priority.1. Increase access to culturally appropriate nutritious food options in food desert or low income/low access areas 2. Implement strategies that support existing community initiatives aimed to address the problem of low food access in the Hospital's PSASee continuation 5."

Schedule H, Part V, Section B, Line 11 - Continuation 5:
Goal 1: Increase access to culturally appropriate nutritious food options in food desert or low income/low access areasObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective is to provide the Food is Health program to low-income families in the PSA by offering two class series from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners the program connects with low income/low access communities and provides free health education, health screenings, and produce vouchers which are used to purchase fresh fruits and vegetables.The Hospital progressed on its set metric of two class series offered by December 31st, 2022, by offering one class in 2021.Objective 2:The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective is to increase participation in the Food is Health program among low-income individuals and families in the Hospital's PSA to 20 participants from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital exceeded its set metric of increasing program participation to 20 participants by December 31st, 2022, by having 30 new participants.Objective 3:The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. This objective uses the Food is Health program to increase access to health screenings among adults living in food deserts or low-income/low-access communities to 30 screenings from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital progressed on its set metric of 30 screenings by December 31st, 2022. The first year focused on establishing partnerships with local produce vendors, educational partners, and community sites. Due to COVID-19, we modified several components of the Food is Health program to offer it virtually. We switched from paper to electronic produce vouchers, created a process to allow drive-thru produce pick-up and consulted with our educational partners to convert classes to a virtual format. The modifications will make it easy to relaunch the Food is Health program safely for our communities.Objective 4:The fourth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. This objective is to increase access to culturally appropriate nutritious food options among Food is Health program participants through 80 produce vouchers distributed from a baseline of zero produce vouchers by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital exceeded its set metric of 80 produce vouchers distributed by December 31st, 2022, by distributing 239 produce vouchers by December 31, 2021.Goal 2: Implement strategies that support existing community initiatives aimed to address the problem of low food access in the Hospital's PSAObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. This objective is to increase new partnerships with local community organizations in the Food is Health program to four partners from a baseline of zero partners by the end of year three. The objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital progressed on its set metric of recruiting four community partners with three community partners recruited in year one and two. We recruited Tim Stokes from Farming 4 U, Heather Wyman from the Active Marion Project and Lamar Rembert from Howard Middle School to launch our first Food is Health class series in Marion County. We also partnered with the Belleview Community Center and the Marion County Bus Drivers Association. AdventHealth's Food is Health classes will be scheduled with these respective organizations in 2022.Objective 2:The second objective is to increase Hospital staff/team volunteer participation efforts with organizations addressing food insecurity from a baseline of zero hours to 500 hours by the end of year three. The Food is Health community employee volunteer initiative is funded and managed through AdventHealth Ocala, and all outcomes are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital progressed on its set metric of 500 volunteer hours served by December 31st, 2022. We created a volunteer portal to market volunteer opportunities to team members, track volunteer hours and notify community partners when team members sign up for an event. Unfortunately, the COVID-19 pandemic led to many of our community partners cancelling their volunteer opportunities for 2020.In year one, we built out a robust volunteer portal for AdventHealth team members. This portal allows us to promote volunteer opportunities to our team members, track sign-ups, market opportunities and notify community organizations when team members sign up. We have also partnered with the United Way of Marion County to have recurring volunteer opportunities through the Salvation Army, Brother's Keeper, the Assist Hope Outreach Center, and the Community Garden of Gratitude. We promoted the volunteer portal internally and there are several hospital team members currently using the volunteer portal. We hope to add more opportunities throughout 2022 and to market individual opportunities to team members to help gain more volunteer hours among our team members. Community Needs Not Chosen by AdventHealth Ocala: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. Heart Disease: Heart disease is the leading cause of death in the U.S. The major risk factors for heart disease are high blood pressure, high cholesterol, being overweight/obese and having an unhealthy diet. One in four deaths in the U.S. are due to heart disease. By managing blood pressure and cholesterol, eating a healthy diet, and incorporating physical activity daily, the risk of developing heart disease could be greatly reduced. In the AdventHealth Ocala primary service area (PSA), the rate of death due to heart disease per 100,000 population is roughly 196, which is higher than the state rate of 150. The percentage of adults in the PSA with high blood pressure is 30% (71,776), 42% (111,261) of adults have high cholesterol and 7% (21,006) have been diagnosed with heart disease. The CHNAC agreed that this issue is an important issue for the community. The Hospital decided that addressing this individual problem would be positively impacted by efforts to address food security, access to care and obesity.

Schedule H, Part V, Section B, Line 7a:
The CHNA report can be found at URL:https://www.adventhealth.com/community-health-needs-assessments

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

Schedule H, Part V, Section B, Line 16a, b, c:
The Financial Assistance Policy can be found at URL:https://www.adventhealth.com/legal/financial-assistance The Financial Assistance Policy application can be found at:https://www.adventhealth.com/legal/financial-assistance The plain language summary is available at:https://www.adventhealth.com/legal/financial-assistance

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 II, Community Building Activities:
The filing organization is involved with and supportive of various other organizations in its community that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The filing organization supports and participates with a number of other community organizations to address the healthcare needs of the community.

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 and 9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands.

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

Part III, Line 8:
Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community.Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government.In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government.

Part III, Line 9b:
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.

Schedule H, Part III, Section B, Line 8:
Supplemental Schedule to Schedule H, Part III, Section B Ln 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: $ (1,686,283)- Difference in costing methodology: (10,679,886)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (27,266,867) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting: $(39,633,036)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 a community health needs assessment (CHNA) every three years. Its 2019 CHNA was adopted by its governing board by December 31, 2019, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2019 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:
Florida Hospital Ocala, Inc. d/b/a AdventHealth Ocala (AHO or the Hospital) is a 385-bed, full-service acute-care facility that provides healthcare services to residents in Marion County, Florida and the surrounding areas. The main Hospital campus is 640,000 square feet and sits on 15-acres. Within the Hospital network there are three 24/7 ER facilities, one onsite and two offsite, to better meet the needs of Marion County. The onsite ER has both an adult and children's emergency department that has over 50 combined beds with the ability to treat many conditions and injuries. The offsite ER, AdventHealth Belleview, opened October 12, 2021, is a 24-hour full-service emergency department with 12 beds. The offsite ER, AdventHealth Timber Ridge ER, is a 24-hour full-service emergency department with 16 private rooms and was the first offsite ER in the state of Florida. The Hospital offers many inpatient services including, labor and delivery through The Baby Place, an Orthopedic unit, a comprehensive cardiovascular surgery unit, and a wound care center. 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 79.2% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 55.0% - Medicaid Patients 16.4% - Self-Pay Patients 4.6%The demographic makeup of the Hospital's community is as follows: - Population 359,977 - Population Over 65 28.90% - Poverty (Below 100% FPL) 11.80% - Unemployment Rate 7.30% - Violent Crime Rate (Per 100,000 Pop.) 441.5 - Pop. Age 25+ with No High School Diploma 13.00% - Uninsured Adults 19.44% - Uninsured Children 6.40% - Food Insecurity Rate 16.80% - Pop. with Low Food Access 31.94%

Part VI, Line 5:
"The provision of community benefit is central to the filing organization'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. During the current year, the Hospital provided $451,424 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. 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 $53,924,959 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:
The filing organization 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 AdventHealth 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.