4A (Expenses $ 231121636 including grants of $ 424224) (Revenue $ 283677284)
PROVISION OF MEDICAL CARE TO BOTH INPATIENTS AND OUTPATIENTS. DURING THE CURRENT YEAR, THE HOSPITAL HAD 8,586 PATIENT ADMISSIONS WHICH RESULTED IN 44,867 PATIENT DAYS, 169,263 OUTPATIENT VISITS, AND 174,631 PHYSICIAN PRACTICE PATIENT VISITS. THE HOSPITAL IS A 99-BED ACUTE CARE HOSPITAL LOCATED IN FLAGLER COUNTY, FLORIDA.

MEMORIAL HOSPITAL FLAGLER, INC.
PART V, SECTION B, LINE 5: MEMORIAL HOSPITAL FLAGLER INC., D/B/A ADVENTHEALTH PALM COAST, (AHPC OR THE HOSPITAL) OPERATES A HOSPITAL IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 99 LICENSED BEDS. FOR PURPOSES OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 82% OF ITS PATIENTS COME. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE CHNAC INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. THE FOLLOWING ORGANIZATIONS WERE MEMBERS OF THE CHNAC. AZALEA HEALTH, A FEDERALLY QUALIFIED HEALTH CENTER,COQUINA CONSTRUCTION,COMMUNITY PARTNERSHIP FOR CHILDREN,FLORIDA DEPARTMENT OF HEALTH - FLAGLER,FLAGLER CARES,THE DEPARTMENT OF CHILDREN AND FAMILIES,THE EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA COUNTIES,FLAGLER FREE CLINIC,COUNTY OF FLAGLER,FLAGLER COUNTY SCHOOLS,FAMILY LIFE CENTER,HALIFAX HEALTH,CITY OF PALM COAST,CITY OF FLAGLER BEACH,CITY OF BUNNELL,UNITED WAY OF VOLUSIA/FLAGLER,SMA HEALTHCARE,VOLUSIA/FLAGLER BEHAVIORAL HEALTH CONSORTIUM, ANDVOLUSIA/FLAGLER COALITION FOR THE HOMELESS.COMMUNITY INPUT WAS GATHERED THROUGH COMMUNITY SURVEYS ADMINISTERED BY THE VOLUSIA COUNTY DEPARTMENT OF HEALTH. THE INTERVIEWS WERE PRIMARILY INTERNET BASED AND WERE COMPLETED BY 3,692 INDIVIDUALS, INCLUDING 966 FLAGLER RESIDENTS.

MEMORIAL HOSPITAL FLAGLER, INC.
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.

MEMORIAL HOSPITAL FLAGLER, INC.
"PART V, SECTION B, LINE 11: MEMORIAL HOSPITAL - FLAGLER, INC. D/B/A ADVENTHEALTH PALM COAST WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH PALM COAST 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 PALM COAST IS PART OF THE CENTRAL FLORIDA DIVISION (THE DIVISION) OF ADVENTHEALTH. IN 2020, THE CENTRAL FLORIDA DIVISION NORTH-REGION (CFD-N), WHICH INCLUDES ADVENTHEALTH DAYTONA BEACH, ADVENTHEALTH DELAND, ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH NEW SMYRNA, ADVENTHEALTH PALM COAST AND ADVENTHEALTH WATERMAN WAS COMBINED WITH THE CENTRAL FLORIDA DIVISION SOUTH-REGION (CFD-S), WHICH INCLUDES ADVENTHEALTH ALTAMONTE, ADVENTHEALTH APOPKA, ADVENTHEALTH CELEBRATION, ADVENTHEALTH EAST ORLANDO, ADVENTHEALTH HEART OF FLORIDA, ADVENTHEALTH KISSIMMEE, ADVENTHEALTH LAKE WALES, ADVENTHEALTH ORLANDO AND ADVENTHEALTH WINTER PARK TO UNIFY AS ONE UNDER THE CENTRAL FLORIDA DIVISION. THE COMBINATION INCLUDED SIX HOSPITALS FROM CFD-N AND NINE HOSPITALS FROM CFD-S. THE COMMUNITY HEALTH PLANS/IMPLEMENTATION STRATEGIES FOR BOTH REGIONS WERE FINALIZED BEFORE THE COMBINATION. THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH NOW INCLUDES 15 HOSPITALS.THIS IS THE SECOND-YEAR UPDATE FOR ADVENTHEALTH PALM COAST'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 PALM COAST 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 PALM COAST CHOSE FIVE PRIORITIES FOR ITS 2020-2022 COMMUNITY HEALTH PLAN: 1. ADULT BEHAVIORAL HEALTH 2. YOUTH BEHAVIORAL HEALTH 3. CARDIOVASCULAR DISEASES & DIABETES 4. MOTHERS AND CHILDREN UNDER AGE 5 5. FAMILY VIOLENCE PRIORITY 1: ADULT BEHAVIORAL HEALTH 2019 DESCRIPTION OF THE ISSUE:ALCOHOL USE - BINGE DRINKING AMONG FLAGLER COUNTY ADULTS IS LOWER THAN IN 2013 AND LOWER THAN FLORIDA'S PERCENT. - ALCOHOL-SUSPECTED MOTOR VEHICLE CRASH DEATHS HAVE INCREASED IN FLAGLER COUNTY AND ARE HIGHER THAN THE FLORIDA RATE. - FLAGLER COUNTY'S DEATH RATE IS HIGHER THAN FLORIDA AND THE RATE OF DEATH FOR HISPANICS HAS INCREASED. SMOKING AND SUBSTANCE MISUSE - FLAGLER'S DEATHS FROM OPIOID OVERDOSES HAVE INCREASED AS HAS ITS USE AMONG INDIVIDUALS SEEKING TREATMENT FOR ADDICTION. - THE PERCENT OF FLAGLER WOMEN AND BLACK INDIVIDUALS USING TOBACCO EXCEEDS THE FLORIDA PERCENT. MENTAL HEALTH - 9.3% OF FLAGLER COUNTY ADULTS HAD 14 OR MORE POOR MENTAL HEALTH DAYS IN THE LAST MONTH AND 12.6% HAVE A DEPRESSIVE DISORDER (BOTH FIGURES ARE LOWER THAN FLORIDA). - FLAGLER COUNTY HAS THE HIGHEST SUICIDE RATE IN FLORIDA AND THE RATE IS INCREASING. 2021 UPDATE: THE ADVENTHEALTH PALM COAST COMMUNITY HEALTH PLAN HAS THREE DESIRED GOAL STATEMENTS UNDER THE ADULT BEHAVIORAL HEALTH PRIORITY. 1. ESTABLISH A NEW EMERGENCY DEPARTMENT (ED) INTERVENTION PROJECT BY PLACING A PEER SPECIALIST IN THE ED OF ADVENTHEALTH PALM COAST TO ENGAGE INDIVIDUALS IN AN OPIOID CRISIS AND CONNECT THEM WITH TREATMENT.2. ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.3. INCREASE THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO TOBACCO CESSATION SUPPORT.GOAL 1: ESTABLISH A NEW EMERGENCY DEPARTMENT (ED) INTERVENTION PROJECT BY PLACING A PEER SPECIALIST IN THE ED OF ADVENTHEALTH PALM COAST TO ENGAGE INDIVIDUALS IN AN OPIOID CRISIS AND CONNECT THEM WITH TREATMENT.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO ESTABLISH A PARTNERSHIP WITH SMA HEALTHCARE TO CREATE A NEW PEER SPECIALIST POSITION WORKING IN THE EMERGENCY DEPARTMENT TO ENGAGE AT LEAST 50 PATIENTS IN SUBSTANCE USE DISORDER TREATMENT. SMA HEALTHCARE IS A PROVIDER OF BEHAVIORAL HEALTHCARE SERVICES AND PROVIDES COMPREHENSIVE SERVICES FOR INDIVIDUALS SUFFERING FROM MENTAL ILLNESS AND/OR ADDICTION IN FLAGLER, VOLUSIA, ST. JOHNS, AND PUTNAM COUNTIES. THE SMA PEER INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SMA PEER INITIATIVE PROVIDES TIMELY ACCESS TO A PEER SUPPORT SPECIALIST WHO WILL OUTREACH TO INDIVIDUALS WITH SUBSTANCE USE DISORDERS OR AN INDIVIDUAL AFTER AN OVERDOSE TO ENGAGE THEM IN SUBSTANCE USE DISORDER TREATMENT. THE HOSPITAL PROGRESSED ON ITS SET METRIC OF CREATING A NEW PEER SPECIALIST POSITION IN 2020, BY FINALIZING THE POSITION AND BEGINNING RECRUITMENT EFFORTS FOR A 2021 PLACEMENT. ALTHOUGH THE POSITION WAS CREATED AND FUNDED, SMA HEALTHCARE WAS NOT ABLE TO FILL THE OPEN POSITION IN 2021. TO SUPPORT INDIVIDUALS AT RISK OF OVERDOSE, ADVENTHEALTH PALM COAST DISTRIBUTED 14 NARCAN KITS TO PATIENTS. AS AN EXPANSION OF THEIR COMMITMENT TO ADULT BEHAVIORAL HEALTH, ADVENTHEALTH PALM COAST PROVIDED FLAGLER CARES $25,000 IN FINANCIAL SUPPORT FOR A NEW ONE-STOP SERVICE LOCATION CALLED THE FLAGLER COUNTY VILLAGE. THE NEW ACCESS POINT OPENED IN NOVEMBER 2021 AND HOUSES STAFF FROM 4 ORGANIZATIONS PROVIDING SOCIAL, HEALTH, EDUCATIONAL, FINANCIAL, AND BEHAVIORAL HEALTH SERVICES. GOAL 2: ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.OBJECTIVE 1: THE FIRST OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THE OBJECTIVE IS TO SUPPORT THE DEVELOPMENT OF A PILOT PROJECT TO CONNECT HEALTH AND BEHAVIORAL HEALTH SYSTEMS THROUGH THE UTILIZATION OF A REFERRAL AND COMMUNICATION MANAGEMENT TECHNOLOGY SYSTEM TO BE LAUNCHED BY THE END OF YEAR TWO. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND OUTCOMES ARE REPORTED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING IS SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S SUPPORT PROVIDES FUNDING TO FLAGLER CARES, A LOCAL NOT-FOR-PROFIT, WHICH FOCUSES ON INCREASING CAPACITY AND COORDINATION FOR HEALTH AND HUMAN SERVICES PROGRAMS, FOR THE PLANNING AND IMPLEMENTATION OF A DIGITAL SOLUTION TO FACILITATE REFERRALS TO BEHAVIORAL HEALTH SERVICES, AND TO INCREASE ACCESS TO CARE AND IMPROVE HEALTH. THE DIVISION PROGRESSED ON ITS SET METRIC THROUGH THE LAUNCH OF A PLAN TO SUPPORT THE LARGER OBJECTIVE. FLAGLER CARES LAUNCHED THE LINC FLAGLER VOLUSIA REFERRAL MANAGEMENT SYSTEM IN AUGUST 2021 WITH AN INITIAL FOCUS ON BEHAVIORAL HEALTH SERVICES. BY THE END OF 2021, FOURTEEN ORGANIZATIONS WERE PARTICIPATING IN THE NETWORK AND 889 REFERRALS WERE SENT THROUGH THE SYSTEM. SEE CONTINUATION 2"

MEMORIAL HOSPITAL FLAGLER, INC.
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 2
GOAL 3: INCREASE THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO TOBACCO CESSATION SUPPORT.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN FREE TOOLS TO QUIT TOBACCO CESSATION PROGRAMS BY AT LEAST 10% OVER THE NUMBER OF PARTICIPANTS IN 2019 (82). THE OBJECTIVE IS MANAGED BY THE DIVISION; HOWEVER, THE HOSPITAL PROVIDES IN-KIND RESOURCES AND ALL OUTCOMES REPORTED ARE SPECIFIC TO THE REPORTING HOSPITAL. THE NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER (NEFAHEC) TOBACCO CESSATION PROGRAMS PROVIDE FREE INTERVENTION THERAPIES TO QUIT SMOKING TOBACCO. THROUGH A PARTNERSHIP WITH NEFAHEC, A LOCAL CHAPTER OF THE NATIONAL AREA HEALTH EDUCATION CENTER (AHEC) ORGANIZATION, WE WILL INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN THE CLASSES BY PROVIDING CONNECTION POINTS TO NEFAHEC'S CLASSES THROUGH SOCIAL MEDIA POSTS AND INTERNAL RESOURCES. NEFAHEC IS A COMMUNITY FOCUSED ORGANIZATION THAT DEVELOPS AND IMPLEMENTS COMMUNITY-BASED HEALTH PROMOTION ACTIVITIES AND EDUCATION PROGRAMS, WHICH TARGET THE UNDERSERVED. AS IT RELATES TO OUR RELATIONSHIP WITH NEFAHEC, WE ARE PARTNERING WITH NEFAHEC TO PROVIDE COMMUNITY MEMBERS THE TOOLS AND RESOURCES TO ASSIST WITH TOBACCO CESSATION. THE HOSPITAL PROGRESSED ON ITS SET METRIC. ADVENTHEALTH PALM COAST REFERRED 696 INDIVIDUALS FOR SMOKING CESSATION SERVICES PROVIDED BY AHEC IN 2021. THERE WERE 86 INDIVIDUALS WHO ACCEPTED SERVICES AND/OR ENROLLED IN A CESSATION CLASS. PRIORITY 2: YOUTH BEHAVIORAL HEALTH 2019 DESCRIPTION OF THE ISSUE:ALCOHOL USE - FLAGLER MIDDLE AND HIGH SCHOOL STUDENTS USE ALCOHOL AT A SLIGHTLY HIGHER RATE THAN FLORIDA, BUT THE RATE HAS BEEN DECREASING SINCE 2008 (SAME FOR BINGE DRINKING). SMOKING AND SUBSTANCE MISUSE - FLAGLER MIDDLE SCHOOL STUDENTS REPORTED A HIGHER RATE OF MARIJUANA USE THAN FLORIDA AND THE TREND INCREASED BETWEEN 2016 AND 2018. FLAGLER HIGH SCHOOL STUDENTS REPORTED MARIJUANA USE INCREASED FROM 2014-2018. - REPORTED CIGARETTE USE AMONG FLAGLER MIDDLE AND HIGH SCHOOL STUDENTS HAS DECLINED, BUT THE HIGH SCHOOL RATE IS HIGHER THAN FLORIDA. - THE MIDDLE AND HIGH SCHOOL USE OF VAPORIZERS/E-CIGARETTES HAS INCREASED SINCE 2016 AND FAR EXCEEDS CIGARETTE USE AMONG MIDDLE AND HIGH SCHOOLERS (DATA ONLY COLLECTED SINCE 2016). MENTAL HEALTH - FLAGLER COUNTY'S SUICIDE RATE AMONG YOUTH AGE 12-18 IS HIGHER THAN FLORIDA, PEAKING IN 2013-15 (ALTHOUGH A RELATIVELY SMALL NUMBER/COUNT). - FLAGLER'S K-12 OUT OF SCHOOL SUSPENSION RATE IS HIGHER THAN FLORIDA AND HAS BEEN INCREASING SINCE 2014. 2021 UPDATE: THE ADVENTHEALTH PALM COAST COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE YOUTH BEHAVIORAL HEALTH PRIORITY. 1. INCREASE YOUTH ACCESS TO PSYCHIATRIC SERVICES IN FLAGLER COUNTY THROUGH THE ESTABLISHMENT OF A NEW PROGRAM IN SCHOOL AND IN THE COMMUNITY.2. ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.GOAL 1: INCREASE YOUTH ACCESS TO PSYCHIATRIC SERVICES IN FLAGLER COUNTY THROUGH THE ESTABLISHMENT OF A NEW PROGRAM IN SCHOOL AND IN THE COMMUNITY. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO WORK WITH FLAGLER SCHOOLS AND COMMUNITY STAKEHOLDERS TO IDENTIFY WHICH PSYCHIATRIC GAP WILL BE THE PRIORITY TO ADDRESS BY THE END OF YEAR ONE. THE EFFORT TO IDENTIFY PRIORITIES IS CONDUCTED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE EFFORT TO IDENTIFY A SPECIFIC YOUTH MENTAL HEALTH PRIORITY IN PARTNERSHIP WITH COMMUNITY STAKEHOLDERS, INCLUDING FLAGLER SCHOOLS, WAS THE IDENTIFIED ACTIVITY FOR 2020 IMPLEMENTATION. THE HOSPITAL MET ITS SET METRIC WITH ONE PRIORITY IDENTIFIED. IN 2020, ADVENTHEALTH PALM COAST BEGAN DISCUSSIONS WITH IMPOWER TO HELP ADDRESS YOUTH BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY. IMPOWER IS A LEADING NON-PROFIT MENTAL HEALTH, SUBSTANCE MISUSE AND CHILD WELL-BEING ORGANIZATION FOUNDED IN 1994, WHICH OFFERS TELEHEALTH SERVICES FOR MENTAL HEALTH NEEDS. IN 2021, ADVENTHEALTH PALM COAST EXPANDED THEIR COMMITMENT TO SUPPORT MENTAL HEALTH CAPACITY BY ESTABLISHING A FIVE-YEAR PARTNERSHIP WITH FLAGLER SCHOOLS AND BY MAKING A FINANCIAL INVESTMENT OF $750,000 THAT INCLUDED $10,000 PER YEAR FOR A MENTAL HEALTH FUND WITH IMPOWER FOR STUDENTS WHO COULD NOT AFFORD THE COST OF CARE. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO PROVIDE NEW SCHOOL-BASED PSYCHIATRIC OUTPATIENT SERVICES TO AT LEAST 50 STUDENTS PER YEAR BY YEAR TWO TO ADDRESS THE NEED IDENTIFIED IN OBJECTIVE ONE. THE PROGRAM, WHICH WILL PROVIDE INCREASED PSYCHIATRIC SERVICES, IS DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL PROGRESSED ON ITS SET METRIC OF 50 YOUTH REFERRED BY THE IDENTIFICATION OF A SPECIFIC CAPACITY GAP IN FLAGLER COUNTY. DURING THE 2021-22 SCHOOL YEAR, 12 REFERRALS WERE MADE BY FLAGLER SCHOOLS TO ACCESS THE IMPOWER SERVICES FUNDED BY ADVENTHEALTH PALM COAST. GOAL 2: ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.OBJECTIVE 1: THE FIRST OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THE OBJECTIVE IS TO SUPPORT THE DEVELOPMENT OF A PILOT PROJECT TO CONNECT FLAGLER SCHOOLS, HEALTH, AND BEHAVIORAL HEALTH SYSTEMS THROUGH THE UTILIZATION OF A REFERRAL AND COMMUNICATION MANAGEMENT TECHNOLOGY SYSTEM TO BE LAUNCHED BY THE END OF YEAR TWO. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND OUTCOMES ARE REPORTED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING IS SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S SUPPORT PROVIDES FUNDING TO FLAGLER CARES, A LOCAL NOT-FOR-PROFIT, WHICH FOCUSES ON INCREASING CAPACITY AND COORDINATION FOR HEALTH AND HUMAN SERVICES PROGRAMS, FOR THE PLANNING AND IMPLEMENTATION OF A DIGITAL SOLUTION TO FACILITATE REFERRALS TO BEHAVIORAL HEALTH SERVICES, AND TO INCREASE ACCESS TO CARE AND IMPROVE HEALTH. THE DIVISION PROGRESSED ON ITS SET METRIC THROUGH THE LAUNCH OF A PLAN TO SUPPORT THE LARGER OBJECTIVE. FLAGLER CARES LAUNCHED THE LINC FLAGLER VOLUSIA REFERRAL MANAGEMENT SYSTEM IN AUGUST 2021 WITH AN INITIAL FOCUS ON BEHAVIORAL HEALTH SERVICES. BY THE END OF 2021, FOURTEEN ORGANIZATIONS WERE PARTICIPATING IN THE NETWORK AND 889 REFERRALS WERE SENT THROUGH THE SYSTEM.SEE CONTINUATION 3

PART V, SECTION B, LINE 11: CONTINUATION 3
PRIORITY 3: CARDIOVASCULAR DISEASES & DIABETES 2019 DESCRIPTION OF THE ISSUE: - THE FLAGLER COUNTY DEATH RATE FOR HEART FAILURE IS HIGHER THAN FLORIDA AND HIGHEST FOR WHITE INDIVIDUALS. FLAGLER HOSPITALIZATION RATES FOR CONGESTIVE HEART FAILURE ARE LOWER THAN FLORIDA EXCEPT AMONG BLACK INDIVIDUALS THAT RATE IS HIGHER. THE CORONARY HEART DISEASE DEATH RATE IS HIGHER FOR MEN THAN WOMEN. - THE FLAGLER COUNTY HOSPITALIZATION RATE FOR STROKE IS HIGHER FOR BLACK INDIVIDUALS THAN OTHER GROUPS. THE FLAGLER COUNTY DEATH RATE FOR STROKE IS INCREASING FOR FLAGLER COUNTY AND IS INCREASING SIGNIFICANTLY FOR HISPANIC INDIVIDUALS. THE FLAGLER COUNTY STROKE DEATH RATE HAS BEEN HIGHER THAN FLORIDA FOR THE PAST THREE YEARS. - THE PERCENT OF ADULTS WITH DIABETES IN 2016 IS HIGHER IN FLAGLER COUNTY THAN FLORIDA. - OVER 70% OF FLAGLER COUNTY MIDDLE AND HIGH SCHOOL STUDENTS LACK VIGOROUS PHYSICAL ACTIVITY. THE FLAGLER COUNTY PERCENT IS BETTER THAN FLORIDA. ALSO, 47% OF FLAGLER COUNTY ADULTS ARE INACTIVE OR INSUFFICIENTLY ACTIVE (FLORIDA'S PERCENT IS WORSE). - THE PERCENT OF ADULTS WHO ARE OBESE INCREASED IN FLAGLER COUNTY BETWEEN 2013 AND 2016. - THE YEARS OF POTENTIAL LIFE LOST (YPLL) RATE FOR FLAGLER COUNTY WAS HIGHER THAN FLORIDA FOR FOUR OF THE FIVE PAST YEARS AND INCREASED FROM 2016 TO 2017.2021 UPDATE: THE ADVENTHEALTH PALM COAST COMMUNITY HEALTH PLAN HAS FOUR DESIRED GOAL STATEMENTS UNDER THE CARDIOVASCULAR DISEASES & DIABETES PRIORITY. 1. PROVIDE FINANCIAL SUPPORT TO THE FLAGLER COUNTY FREE CLINIC TO SUPPORT ACCESS TO CARE FOR THE UNINSURED. 2. INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE YOUTH.3. PROVIDE DIABETES EDUCATION IN PARTNERSHIP WITH ADVENTHEALTH PALM COAST FOUNDATION AND DIABEATES ALLIANCE TO RAISE AWARENESS TO PREVENT AND MANAGE TYPE 1 AND TYPE 2 DIABETES IN PALM COAST COMMUNITY.4. PROVIDE CREATION LIFE EDUCATIONAL SESSIONS FOR AREA RESIDENTS.GOAL 1: PROVIDE FINANCIAL SUPPORT TO THE FLAGLER COUNTY FREE CLINIC TO SUPPORT ACCESS TO CARE FOR THE UNINSURED. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE 250 VOUCHERS FOR NO COST LABS AND DIAGNOSTICS, TO BE REDEEMED ANNUALLY BY PATIENTS REFERRED THROUGH THE FLAGLER COUNTY FREE CLINIC TO INCREASE ACCESS TO PRIMARY CARE FOR UNINSURED AT-RISK INDIVIDUALS. THE FLAGLER COUNTY FREE CLINIC IS A LOCAL NONPROFIT, WHICH PROVIDES CARE TO UNINSURED AND UNDERINSURED FLAGLER COUNTY RESIDENTS. THE OBJECTIVE IS FUNDED SOLELY THROUGH THE REPORTING HOSPITAL AND DOES NOT APPEAR ON OTHER COMMUNITY HEALTH PLANS WITHIN THE CENTRAL FLORIDA DIVISION. THIS SUPPORT PROVIDES FLAGLER COUNTY FREE CLINIC PATIENTS, WHO ARE UNINSURED, ACCESS TO NECESSARY LABS AND OTHER DIAGNOSTIC PROCEDURES. THE HOSPITAL EXCEEDED ITS METRIC OF 250 VOUCHERS WITH 429 VOUCHERS PROVIDED. ADVENTHEALTH PALM COAST PROVIDED FLAGLER COUNTY FREE CLINIC PATIENTS WITH 429 VOUCHERS FOR CARE VALUED AT $745,035. GOAL 2: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE YOUTH.OBJECTIVE 1: THE FIRST OBJECTIVE, A DIVISIONAL INITIATIVE WHICH APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, IS TO PROVIDE EDUCATION ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY TO 75% OF BOYS & GIRLS CLUBS MEMBERS FOUR TIMES ANNUALLY. THE BOYS & GIRLS CLUBS EDUCATION INITIATIVE IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE BOYS & GIRLS CLUBS EDUCATION INITIATIVE IS FOCUSED ON PROVIDING AT LEAST FOUR EDUCATION SESSIONS A YEAR TO CLUB PARTICIPANTS TO INCREASE THEIR UNDERSTANDING OF HEALTHY EATING AND PHYSICAL ACTIVITY. THE HOSPITAL EXCEEDED ITS SET METRIC AND PROVIDED EIGHT HEALTHY LIFESTYLE VIDEOS AND ACTIVITIES TO PUT WHAT THE YOUTH LEARNED INTO ACTION. 75% OF THE 70 CLUB MEMBERS PARTICIPATED AT RYMFIRE ELEMENTARY BOYS & GIRLS CLUB IN PALM COAST.OBJECTIVE 2: THE SECOND OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE DIVISION CHOSE THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE, TO PROVIDE $4,000 IN FINANCIAL SUPPORT ANNUALLY TO THE BOYS & GIRLS CLUBS AS PART OF A STRATEGIC PARTNERSHIP, IS TO PROVIDE DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS TO CLUB MEMBERS. THE OBJECTIVE IS FUNDED THROUGH THE HOSPITAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL, HOWEVER THE INITIATIVE IS MANAGED BY THE DIVISION. THIS INITIATIVE PROVIDES FINANCIAL SUPPORT SO THAT YOUTH PARTICIPATING IN LOCAL BOYS & GIRLS CLUBS CAN HAVE ACCESS TO DAILY HEALTHY SNACKS. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FUNDING SUPPORT WITH $4,000 DOLLARS PROVIDED. THE PROVIDED FUNDING WAS ABLE TO MAKE UP FOR A SHORTFALL IN THE USDA GRANT THAT THE BOYS & GIRLS CLUBS OF VOLUSIA/FLAGLER PREVIOUSLY USED TO PROVIDE RYMFIRE BOYS & GIRLS CLUB MEMBERS WITH DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS. THE WEEK OF CARING 2021 ADVENTHEALTH TEAM MEMBERS MADE A TOTAL OF 480 TRAIL MIX BAGS FOR THE BOYS & GIRLS CLUBS OF VOLUSIA AND FLAGLER COUNTIES FOR DISTRIBUTION TO EACH OF THE EIGHT CLUBS THROUGHOUT VOLUSIA AND FLAGLER.GOAL 3: PROVIDE DIABETES EDUCATION IN PARTNERSHIP WITH ADVENTHEALTH PALM COAST FOUNDATION AND DIABEATES ALLIANCE TO RAISE AWARENESS TO PREVENT AND MANAGE TYPE 1 AND TYPE 2 DIABETES IN PALM COAST COMMUNITY.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE DIABETES EDUCATION TO INCREASE AWARENESS TO PREVENT AND MANAGE TYPE 1 AND TYPE 2 DIABETES TOUCHING 1,000 PALM COAST RESIDENTS DURING YEAR ONE AND WITH A FOCUS ON DIABETES AWARENESS MONTH NOVEMBER 2020. THE EDUCATION INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE DIABETES ALLIANCE, AN INITIATIVE OF THE ADVENTHEALTH PALM COAST FOUNDATION, LEADS THIS EDUCATIONAL CAMPAIGN IN PARTNERSHIP WITH THE FLAGLER COUNTY HEALTH DEPARTMENT AND MANY OTHER COMMUNITY ORGANIZATIONS. THE HOSPITAL FELL SHORT OF ITS SET METRIC OF REACHING 1,000 RESIDENTS WITH 110 RESIDENTS REACHED. DUE TO COVID-19, THE METRIC WAS NOT REACHED DUE TO THE LACK OF EVENTS AND NECESSARY PUBLIC HEALTH MEASURES. THE DIVISION PARTNERED WITH MISSION FIT; A NATIONAL INITIATIVE PROVIDED BY ADVENTHEALTH FOR CHILDREN. IT IS A COMPREHENSIVE WELLNESS PROGRAM THAT INCLUDES 4 COMPONENTS: HEALTHY EATING, EMOTIONAL WELLBEING, PHYSICAL ACTIVITY, AND REST. THE MISSION FIT PROGRAM WAS PROVIDED TO 169 STUDENTS AT RYMFIRE ELEMENTARY SCHOOL.OBJECTIVE 2: THE SECOND OBJECTIVE IS TO ENGAGE 100 AT RISK RESIDENTS IN DIABETES BLOOD SUGAR AND RETINOPATHY SCREENINGS IN PARTNERSHIP WITH THE FLAGLER COUNTY HEALTH DEPARTMENT AND ADVENTHEALTH PALM COAST FOUNDATION BY END OF YEAR ONE. THE SCREENING INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SCREENING INITIATIVE IS IMPLEMENTED IN PARTNERSHIP WITH THE FLAGLER COUNTY HEALTH DEPARTMENT AND FOCUSED ON PROVIDING IMPORTANT SCREENINGS TO VULNERABLE POPULATIONS. THE HOSPITAL FELL SHORT OF ITS SET METRIC OF 100 INDIVIDUALS SCREENED WITH 40 INDIVIDUALS SCREENED. AWARENESS EVENTS WERE HELD IN NOVEMBER 2021 IN OBSERVANCE OF DIABETES AWARENESS MONTH, REACHING 80 INDIVIDUALS WITH 50 INDIVIDUALS PARTICIPATING IN BLOOD SUGAR AND RETINOPATHY SCREENINGS. GOAL 4: PROVIDE CREATION LIFE EDUCATIONAL SESSIONS FOR AREA RESIDENTS.OBJECTIVE 1: THE FIRST OBJECTIVE IS THAT 75% OF CREATION LIFE SESSION ATTENDEES WHO COMPLETE THE PROGRAM WILL DEMONSTRATE AN IMPROVEMENT IN KNOWLEDGE AND/OR ATTITUDE AFTER COMPLETING A SESSION (TWO SESSIONS WITH 50 PARTICIPANTS IN EACH SESSION). THE CREATION LIFE PROGRAM IS A DIVISIONAL PROGRAM; HOWEVER, IT IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE CREATION LIFE PROGRAM IS A SERIES OF EDUCATIONAL AND WELLNESS SESSIONS FOCUSED ON EIGHT HEALTH PRINCIPLES: CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST, INTERPERSONAL RELATIONSHIPS, OUTLOOK, AND NUTRITION. THE HOSPITAL FELL SHORT OF ITS SET METRIC OF 50 PARTICIPANTS IN TWO SESSIONS, HAVING ONLY BEEN ABLE TO PROVIDE TWO SESSIONS WITH 44 PEOPLE EDUCATED. SEE CONTINUATION 4

PART V, SECTION B, LINE 11: CONTINUATION 4
"PRIORITY 4: MOTHERS AND CHILDREN UNDER AGE 5 2019 DESCRIPTION OF THE ISSUE: - BIRTHS TO FLAGLER COUNTY MOTHERS AGE 15-19 INCREASED FROM 2015 TO 2017 AND THE LATEST RATE IS HIGHER THAN FLORIDA. - THE FLAGLER COUNTY RATE OF BACTERIAL STDS AMONG WOMEN 15-34 HAS STEADILY INCREASED SINCE 2013. - THE RATE OF VERY LOW BIRTH WEIGHT BABIES BORN TO BLACK FLAGLER WOMEN HAS INCREASED SINCE 2012 AND EXCEEDS THE FLORIDA RATE. THE RATE OF LOW-BIRTH-WEIGHT BABIES BORN TO BLACK FLAGLER COUNTY MOTHERS IS ALSO HIGHER THAN THE FLORIDA RATE. - BIRTHS TO FLAGLER COUNTY WOMEN WITH NO PRENATAL CARE HAS STEADILY INCREASED FOR BLACK WOMEN SINCE 2011 AND INCREASED IN THE LAST 3 YEARS FOR WHITE WOMEN AND ALL WOMEN IN FLAGLER COUNTY. - THE PERCENT OF FLAGLER COUNTY MOMS WHO INITIATED BREASTFEEDING HAS BEEN LOWER THAN FLORIDA FOR THE LAST 5 YEARS. THE PERCENT OF BLACK MOMS WHO INITIATIVE BREASTFEEDING IS LOWER THAN ALL OTHER GROUPS. CHILDREN UNDER 5 - THE PERCENT OF FLAGLER COUNTY CHILDREN ""READY FOR KINDERGARTEN"" IS LOWER THAN FLORIDA. - THE PERCENT OF FLAGLER COUNTY CHILDREN FULLY IMMUNIZED HAS DECREASED FROM 2016 TO 2018 AND THE FLAGLER COUNTY PERCENT WAS LOWER THAN FLORIDA IN 2017 AND 2018. - THE FLAGLER COUNTY RATE OF INFANT MORTALITY FOR HISPANIC BABIES HAS INCREASED SINCE 2011 AND IS HIGHER THAN ALL OTHER GROUPS. 2021 UPDATE: THE ADVENTHEALTH PALM COAST COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE MOTHERS AND CHILDREN UNDER AGE 5 PRIORITY. 1. PROVIDE FREE PRENATAL AND OB EDUCATION TO LOW INCOME WOMEN. GOAL 1: PROVIDE FREE PRENATAL AND OB EDUCATION TO LOW INCOME WOMEN. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE FREE PRENATAL AND OBSTETRICS (OB) EDUCATION CLASSES TO 25% OF LOW-INCOME WOMEN ANNUALLY. THE EDUCATION PROGRAM IS DRIVEN BY THE DIVISION; HOWEVER, IT IS DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE EDUCATION PROGRAM WAS ESTABLISHED TO PROVIDE EDUCATION TO LOW-INCOME WOMEN IN CONVENIENT LOCATIONS IN FLAGLER COUNTY TO CREATE ACCESS FOR WOMEN WHO MUST DELIVER THEIR BABIES IN ANOTHER COUNTY. THE HOSPITAL DID NOT MEET ITS SET METRIC WITH ZERO PEOPLE EDUCATED. DUE TO COVID-19, THE PROGRAM WAS DELAYED. AS A RESULT OF THE PANDEMIC, THE NEEDS AND RESOURCES IN OUR COMMUNITY HAVE CHANGED AND ADVENTHEALTH IS ATTENTIVE TO THAT. DURING THE PAST YEAR, WE HAVE PIVOTED WHERE NECESSARY TO ADDRESS THE IMMEDIATE NEEDS OF OUR COMMUNITY DURING THE PANDEMIC AND WILL CONTINUE TO DO SO. WE WILL WORK TO IDENTIFY WAYS TO SUPPORT OUR COMMUNITY AND THE COMMUNITY-BASED ORGANIZATIONS THAT AID IT, WHILE FINDING NEW WAYS TO MEET THE NEW AND EXISTING NEEDS IN IT. IN 2021 PRENATAL AND OB EDUCATION CLASSES WERE PROVIDED IN VIRTUAL FORMAT. ALTHOUGH NOT ATTRIBUTABLE TO JUST ADVENTHEALTH PALM COAST, 508 INDIVIDUALS FROM VOLUSIA AND FLAGLER COUNTIES PARTICIPATED IN VIRTUAL EDUCATION SESSIONS. PRIORITY 5: FAMILY VIOLENCE 2019 DESCRIPTION OF THE ISSUE: - FLAGLER COUNTY'S DOMESTIC VIOLENCE OFFENSE RATE IS HIGHER THAN FLORIDA. - FLAGLER COUNTY'S CHILD ABUSE RATES FOR CHILDREN AGE 5-11 EXCEEDED FLORIDA IN 2014 TO 2017 AND THE RATE OF CHILDREN THE SAME AGE EXPERIENCING SEXUAL VIOLENCE IS HIGHER THAN FLORIDA AND INCREASING. THE NUMBER OF FLAGLER COUNTY INFANTS, CHILDREN AGE 1-5 AND CHILDREN AGE 12-17 IN FOSTER CARE HAS BEEN INCREASING SINCE 2012. THE NUMBER OF INFANTS IN FOSTER CARE IS HIGHER THAN FLORIDA SINCE 2014. 2021 UPDATE: THE ADVENTHEALTH PALM COAST COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE FAMILY VIOLENCE PRIORITY. 1. PARTNER WITH THE FAMILY LIFE CENTER TO PROVIDE DOMESTIC VIOLENCE AND SEXUAL ASSAULT AWARENESS TRAINING TO ADVENTHEALTH STAFF.GOAL 1: PARTNER WITH THE FAMILY LIFE CENTER TO PROVIDE DOMESTIC VIOLENCE AND SEXUAL ASSAULT AWARENESS TRAINING TO ADVENTHEALTH STAFF.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE QUARTERLY ONE-HOUR TRAINING SESSIONS TO AT LEAST 50 STAFF MEMBERS ANNUALLY THROUGH PROGRAMMING VALUED AT $3,000 FROM THE FAMILY LIFE CENTER. THE TRAINING PROGRAM IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH PALM COAST AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE TRAINING PROGRAM WAS DESIGNED TO INCREASE THE UNDERSTANDING AND ABILITY OF ADVENTHEALTH PALM COAST STAFF TO IDENTIFY THE SIGNS OF DOMESTIC VIOLENCE AND SEXUAL ASSAULT AND TO PROVIDE THEM WITH INFORMATION ABOUT LOCAL RESOURCES AVAILABLE. THE HOSPITAL DID NOT MEET ITS SET METRIC OF 50 STAFF TRAINED WITH NO PEOPLE EDUCATED. DUE TO COVID-19, THE PROGRAM WAS DELAYED. AS A RESULT OF THE PANDEMIC, THE NEEDS AND RESOURCES IN OUR COMMUNITY HAVE CHANGED AND ADVENTHEALTH IS ATTENTIVE TO THAT. DURING THE PAST YEAR, WE HAVE PIVOTED WHERE NECESSARY TO ADDRESS THE IMMEDIATE NEEDS OF OUR COMMUNITY DURING THE PANDEMIC AND WILL CONTINUE TO DO SO. FAMILY LIFE CENTER IS SCHEDULED TO OFFER THE PROGRAM IN MAY 2022 TO ADVENTHEALTH PALM COAST TEAM MEMBERS.COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH PALM COAST: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. AVAILABILITY OF HEALTH RESOURCES THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. MANY ACCESS ISSUES WILL BE ADDRESSED AS A COMPONENT OF OTHER HEALTH PRIORITIES. 2. SOCIAL AND ECONOMIC ISSUES SOCIAL AND ECONOMIC ISSUES WILL BE CONSIDERED AS A COMPONENT OF ALL PRIORITY INDICATORS."

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: 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-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE 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 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.

PART VI, LINE 7:
THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES.

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
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: $ 3,787,489- DIFFERENCE IN COSTING METHODOLOGY: (3,559,094)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,914,820) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (2,686,425)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 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.

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MEMORIAL HOSPITAL FLAGLER (THE HOSPITAL) IS A 99-BED ACUTE CARE FACILITY THAT PROVIDES QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF PALM COAST AND SURROUNDING FLAGLER COUNTY IN THE STATE OF FLORIDA. THE HOSPITAL IS THE SOLE PROVIDER OF EMERGENCY HOSPITAL SERVICES IN FLAGLER COUNTY. THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY LOCATED BETWEEN TWO LARGER CITIES. 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 93.9% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 62% - MEDICAID PATIENTS 8.3% - SELF-PAY PATIENTS 3.6% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 97,207 - POPULATION OVER 65 29.5% - POVERTY (BELOW 100% FPL) 13.8% - UNEMPLOYMENT RATE 7.7% - VIOLENT CRIME RATE (PER 100,000 POP.) 265 - POP. AGE 25+ WITH NO HIGH SCHOOL DIPLOMA 8.2% - UNINSURED ADULTS 17.82% - UNINSURED CHILDREN 8.02% - FOOD INSECURITY RATE 17.2% - POP. WITH LOW FOOD ACCESS 54.13%

PART VI, LINE 5:
"THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZAN'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 $418,111 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 $24,684,408 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 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.