TY 2022 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Huenergardt Sam...................................................................... Director/Chairperson	3.00 ................. 47.00	X	X			0	1,080,966	193,052
(2) Heinrich William...................................................................... Dir/Treasurer	3.00 ................. 47.00	X				0	597,083	106,155
(3) Purkeypile Dallas...................................................................... CEO	50.00 ................. 0.00	X	X			0	325,081	96,517
(4) Carlson Ronald...................................................................... Director	1.00 ................. 2.00	X				495	5,212	0
(5) McCalla MD Rodney...................................................................... Director	1.00 ................. 0.00	X				525	0	0
(6) Coen John...................................................................... Director	1.00 ................. 0.00	X				525	0	0
(7) Frank MD Kenneth...................................................................... Director	1.00 ................. 0.00	X				525	0	0
(8) Wolzen Stuart...................................................................... Director	1.00 ................. 0.00	X				525	0	0
(9) Peters Janet...................................................................... Dir/Vice Chairperson	1.00 ................. 0.00	X				525	0	0
(10) Beebe Harmat...................................................................... CFO	45.00 ................. 5.00		X			0	228,333	49,196
(11) Steiner Stacy...................................................................... CNO	50.00 ................. 0.00			X		0	211,121	49,884
(12) Rich Doug...................................................................... COO	50.00 ................. 0.00			X		0	203,881	49,475
(13) Sheikh MD Farhan...................................................................... Physician	40.00 ................. 0.00				X	795,484	0	12,526
(14) Dalenberg MD Dale...................................................................... Physician	40.00 ................. 0.00				X	429,311	0	27,634
(15) Koster MD Christopher...................................................................... Physician	40.00 ................. 0.00				X	277,261	0	14,986
(16) Seto MD Takeshi...................................................................... Physician	40.00 ................. 0.00				X	237,362	0	33,803
(17) Swanson MD Evan...................................................................... Physician	40.00 ................. 0.00				X	192,848	0	27,860

(A) Name and business address	(B) Description of services	(C) Compensation
ER Physicians South PA PO Box 4385 Shawnee Mission,KS66204	Emergency Services	1,242,116
Ottawa Family Physicians 1418 S Main St 5 Ottawa,KS66067	Hospitalist Services	1,038,144
Loyd Builders Inc 2126 S Elm Ottawa,KS66067	Construction Services	876,299
Shawnee Mission Medical Center Inc 9100 W 74th St Shawnee Mission,KS66204	Cardiology and Oncology Services	726,585
Ascentist Physicians Group LLC 4860 College Blvd 201 Overland Park,KS66211	Surgery Services	493,050
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 24

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2022

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2021. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2022

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2021. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2022

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2022

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2022

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization AdventHealth Ransom Memorial Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization AdventHealth Ransom Memorial Inc		Employer identification number 83-0976641

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization AdventHealth Ransom Memorial Inc			Employer identification number 83-0976641
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

3,820

Total. Add lines 1c through 1i ....................................................................................................

3,820

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	American Hospital Association and Kansas Hospital Association Dues.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	45,121		45,121
b	Buildings ....	10,464,729	1,541,989	8,922,740
c	Leasehold improvements
d	Equipment ....	8,972,182	4,898,012	4,074,170
e	Other .....	3,653,000		3,653,000
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				16,695,031

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	11,310,952
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part X, Line 2:

The filing organization is a subsidiary organization within AdventHealth. The consolidated financial statements of AdventHealth contain the following FIN 48 (ASC 740) footnote: Please note that dollar amounts are in thousands. Healthcare Corporation and its affiliated organizations, other than North American Health Services, Inc. and its subsidiary (NAHS), are exempt from state and federal income taxes. Accordingly, Healthcare Corporation and its tax-exempt affiliates are not subject to federal, state or local income taxes except for any net unrelated business taxable income. NAHS is a wholly owned, for-profit subsidiary of Healthcare Corporation. NAHS and its subsidiary are subject to federal and state income taxes. NAHS files a consolidated federal income tax return and, where appropriate, consolidated state income tax returns. All taxable income was fully offset by net operating loss carryforwards for federal income tax purposes; as such, there is no provision for current federal or state income tax for the years ended December 31, 2022 and 2021. NAHS also has temporary deductible differences of approximately $18,200 and $33,000 at December 31, 2022 and 2021, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2022, NAHS had net operating loss carryforwards of approximately $10,000, expiring in 2023 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $4,500 and $8,100 at December 31, 2022 and 2021, respectively. NAHS remeasured its deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future, which is generally 21%. A full valuation allowance has been provided at December 31, 2022 and 2021 to offset the deferred tax asset since Healthcare Corporation has determined that it is more likely than not that the benefit of the net operating loss carryforwards will not be realized in future years. The Income Taxes Topic of the Accounting Standards Codification (ASC) (ASC 740) prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. There were no material uncertain tax positions as of December 31, 2022 and 2021.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,403,196		1,403,196	2.520 %
b	Medicaid (from Worksheet 3, column a) . . . . .	6,108,256	7,569,991	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	7,511,452	7,569,991	1,403,196	2.520 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	19,338		19,338	0.030 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	19,338		19,338	0.030 %
k	Total. Add lines 7d and 7j .	7,530,790	7,569,991	1,422,534	2.550 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	486	486	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	1,573	1,573	0 %
8	Workforce development	109	109	0 %
9	Other	11,222	11,222	0.020 %
10	Total	13,390	13,390	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,723,766

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

407,108

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

15,584,729

Enter Medicare allowable costs of care relating to payments on line 5.....

15,928,590

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-343,861

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	AdventHealth Ottawa 1301 South Main Street Ottawa,KS66067 adventhealth.com/hospital/adventhealth H030001-2	X	X	X

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AdventHealth Ottawa
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 22

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Page 8

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Page 8

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	AdventHealth Ottawa
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Page 8

The FAP application form was widely available on a website (list url):

See Part V, Page 8

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Page 8

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	AdventHealth Ottawa
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	AdventHealth Ottawa
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
AdventHealth Ottawa	Part V, Section B, Line 5: AdventHealth Ransom Memorial, Inc., d/b/a AdventHealth Ottawa (AHO or the Hospital), defines its community as 12 zip codes encompassing parts of six counties: Franklin, Miami, Anderson, Douglas, Osage and Linn. The Hospital's community does include the entirety of Franklin County. In conducting its 2022 Community Health Needs Assessment (CHNA), AHO collected input from organizations and individuals that represented the broad interests of the community, with specific representation from those organizations that represent the interests of the medically underserved and low-income populations in the Hospital's community. In order to ensure broad community input, AdventHealth Ottawa partnered with the Live Healthy Franklin County Coalition to form "the Collaborative", to help guide the Hospital through the assessment process. The Collaborative included representation from the Hospital, public health experts and the broad community with intentional representation from low-income, minority and other underserved populations. The Collaborative collected input directly from the community and community stakeholders, including individuals working in organizations that address the needs and interests of the community. Primary data was collected through a community survey, stakeholder interviews, and focus groups. A total of 26 stakeholders participated in the Collaborative and included the following organizations which specifically address the needs of the medically underserved, low-income and minority members of the Hospital's community.ECKAN, ECKAN Head Start, Franklin Count Health Department, Hope House, Blessing Box Foundation, Hope Anthem Church, Unified School District 290, Elizabeth Layton Center, Inc.
AdventHealth Ottawa	Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the Hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the Hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
AdventHealth Ottawa	Part V, Section B, Line 11: AdventHealth Ransom Memorial, Inc. d/b/a AdventHealth Ottawa will be referred to in this document as AdventHealth Ottawa or "the Hospital". The Hospital is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a hospital and healthcare system known as AdventHealth. In January 2019, every wholly-owned entity of AHSSHC adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Any references to our prior Community Health Needs Assessments (CHNAs) or prior Community Health Plans (CHPs) will utilize our new name for consistency. AdventHealth Ottawa is part of the Multi-State Division of AdventHealth. The division includes 22 hospital facilities. This is the second-year update for AdventHealth Ottawa's 2021-2022 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2021 as part of its 2020 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Ottawa worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2020 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the community health needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2021-2022 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the prioritized issues identified in 2020 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital did not address. AdventHealth Ottawa chose two priorities for its 2021-2022 Community Health Plan: 1. Chronic Disease Prevention and Management2. Mental HealthPriority 1: Chronic Disease Prevention and Management 2020 Description of the Issue:Heart disease is the leading cause of death in the Hospital's service area. When adjusted for age, 182 per 100,000 deaths are due to heart disease compared to the state rate at 158 per 100,000 deaths. Nearly 32% of adults have high blood pressure and 42% in the Hospital's primary service area have high cholesterol, both are risk factors for heart disease, which can be improved considerably with proper nutrition. More than 60% of individuals in the service area are overweight and/or obese and the age adjusted rate of diabetes in the population over the age of 18 is 8.4%.2022 Update: The AdventHealth Ottawa Community Health Plan has two desired goal statements under the Chronic Disease Prevention and Management priority. 1. Increase access to healthy food for low-income residents in low-food access areas in Franklin County 2. Increase knowledge, improve lifestyle behaviors and provide support to prevent and manage chronic disease in the Hospital's community Goal 1: Increase access to healthy food for low-income residents in low-food access areas in Franklin County Objective 1: The Hospital will support the Franklin County Food Policy Council's goals and objectives by providing professional expertise and actively participating in 10 meetings per year. The Franklin County Food Policy Council (FPC) is funded and deployed through the Franklin County Health Department. FPC is a broad representation of individuals and organizations throughout the county that support the provision of nutritious foods to all county residents. The Hospital met its set metric of attending 10 FPC meetings per year. FPC initiatives in 2022 included continued coordination and support for a mobile food pantry and launching a new pilot program that brought affordable produce bundles to towns lacking grocery stores, in addition to ongoing promotion of farmers markets and other methods for increasing access to healthy food. Hospital participation included monthly FPC meetings as well as work group meetings on the produce bundles program (called Harvest to Home). Objective 2: The Hospital will conduct four food collection drives and provide 20 volunteer hours for the Food Policy Council's identified food access initiatives. The Franklin County Food Policy Council (FPC) is funded and deployed through the Franklin County Health Department. FPC is a broad representation of individuals and organizations throughout the county that support the provision of nutritious foods to all county residents.The Hospital met its set metric of conducting four food collection drives and providing 20 volunteer hours for FPC initiatives. In the summer of 2022, Nursing Leadership held a Blessing Box collection/delivery for food items (and feminine products). In October 2022, a food drive was held to supply the Sharing Shelves at local school pantries. The additional two food collection drives were held in 2021, along with 20+ volunteer hours provided for FPC initiatives.See continuation
AdventHealth Ottawa	Part V, Section B, Line 13h: Effective March 1, 2020, the filing organization's hospital facility (or facilities) augmented their Financial Assistance Policy with a COVID-19 Financial Grace Addendum. Pursuant to the COVID-19 Financial Grace Addendum, uninsured patients treated for COVID-19 related evaluations are to receive free or discounted care depending on the patient's cooperation in submitting necessary financial assistance information. Insured patients tested for COVID-19 are not expected to have out-of-pocket expenses based on insurance community response to waive patient financial responsibility. If a payer unexpectedly fails to waive patient responsibility for COVID-19 related testing, the filing organization will not balance bill patients for any out-of-pocket expenses related to COVID-19. In addition, patients with existing payment plans are provided opportunities for reducing their monthly payments.
Part V, Section B, Line 11 - continuation	Goal 2: Increase knowledge, improve lifestyle behaviors and provide support to prevent and manage chronic disease in the Hospital's community Objective 1: The Hospital, in partnership with the Franklin County Health Department, will increase knowledge or improve health behaviors for 50 individuals participating in the Chronic Disease Self-Management Program. Participants will demonstrate increased knowledge from the pre-test to the post-test. The Chronic Disease Self-Management Program is funded and deployed through the Franklin County Health Department and K-State Research and Extension. The program increases access to and education about diabetes and self-care information, meal planning and healthy snack ideas, information for reading food labels, and ideas for low-impact physical activity.The Hospital did not meet the objective because the ongoing pandemic dictated online-only classes which garnered lower participation than planned. In partnership with K-State Research and Extension, the Hospital improved knowledge or behavior for ten community members participating in 2022 and eight in 2021. The Hospital helped advertise this on Facebook and word of mouth during patient visits with the Dietician. Participants in 2022 indicated that as a result of the class, they were cooking more at home, eating smaller portions, using the provided recipes, fitting exercise into their daily routine, and felt confident they could keep their diabetes under control or help the person they care for keep their diabetes under control. They were more aware of hidden sodium and sugar in foods and had a better understanding of ways to control blood glucose levels by portion control, regular exercise, using the plate method for meal planning, and better monitoring of risk factors. Objective 2: The Hospital will implement a Whole-Person health promotion and disease prevention campaign to 12,500 community members in the primary service area through the distribution of the MyHealth magazine and social media. One percent (125 community members) will demonstrate engagement by sharing on social media, requesting additional information, or signing up for an education program. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The campaign provides Whole-Person health promotion and disease prevention education, including lifestyle behaviors and tips to help prevent and manage chronic disease. The Hospital met the objective. Community member engagement in the community education and awareness campaign was 188 in 2021 and 19 in 2022. In 2021, the Hospital met its set metric by including relevant content in the Spring 2021 MyHealth magazine and over 13,000 houses reached. Priority 2: Mental Health 2020 Description of the Issue:Eleven percent of the Hospital's community survey respondents were unable to receive mental health or substance abuse treatment. Key stakeholder surveys indicated a very high importance and low satisfaction with current state on the issue of prescription drug addiction. Prescription related drug overdose deaths in Kansas dramatically increased from 1999 to 2018. Kansas psychostimulant overdose death rates almost doubled from 2018 to 2019 and accounted for 39% of all fatal overdoses statewide.Suicide and mental health issues were in the top four issues identified by the Community Health Needs Assessment Committee. Thirteen percent of respondents in the Hospital's community health survey reported a lack of emotional support. In the survey, 13.7% reported that their mental health was not good in the past month, and the Hospital admission rate for mental health needs in Franklin County was 73.8 per 10,000.2022 Update: The AdventHealth Ottawa Community Health Plan has two desired goal statements under the Mental Health priority. 1. Reduce prescription overdoses and deaths 2. Reduce suicide attempts and deaths in Franklin County Goal 1: Reduce prescription overdoses and deathsObjective 1: The Hospital will provide professional expertise to support the vision and strategic plan of the Franklin County Substance Use Prevention Coalition by actively participating in eight meetings per year. The Franklin County Substance Use Prevention (FCSUP) Coalition is funded and deployed through the Franklin County Health Department. The coalition works to make substance use reduction a priority in Franklin County through prevention, collaboration, and pursuing resources. The Hospital met its set metric of attending eight Franklin County Substance Use Prevention Coalition meetings per year. The Hospital contributed 24 volunteer hours in 2022, including one of its leadership staff serving as the FCSUP Coalition Chair. The Hospital also contributed food, feminine products, hats, and a donation to this effort in 2022.Objective 2: The Hospital will increase the knowledge of health professionals on best practices for prevention of opioid misuse and provide resources for patients with opioid dependency. Fifty health professionals will participate in education and 75% will indicate increased knowledge through post survey. The professional education is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The Hospital met its set metric with 72 health professionals participating in education in 2022 with 93% of participants indicating increased knowledge through post survey. Objective 3:The Hospital will implement a community education and awareness campaign on the proper handling of unused prescriptions reaching 12,500 community members in the Hospital's primary service area through the distribution of the MyHealth magazine and social media. One percent (125 community members) will demonstrate engagement by sharing on social media, requesting additional information, or signing up for an education program. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital.The Hospital did not meet the overall objective. In 2021, the Hospital met the first metric by including relevant content in the Fall 2021 MyHealth magazine and over 13,000 houses reached. This included content on how to properly dispose of unused medications. Three community members requested take-back kits. The second metric, engagement in the community education and awareness campaign, was not met. The social team did not have the bandwidth to track this metric.Goal 2: Reduce suicide attempts and deaths in Franklin CountyObjective 1: The Hospital will provide professional expertise and support for the development and implementation of the Healthy Minds Franklin County Committee's goals by actively participating in 15 meetings in two years. The Healthy Minds Franklin County Committee is funded and deployed through the Franklin County Health Department. The Healthy Minds Franklin County Committee is made up of a collaborative of organizations that meet regularly to discuss improving mental well-being of residents of Franklin County, KS and strive to implement strategies throughout the county that impact overall well-being. The Hospital did not meet the objective as written because the Committee disbanded in 2021 due to limited staff capacity at the local Health Department. Since that time, the Hospital urged discussions on alternate ways to ensure organizations are still collaborating on citizens' mental well-being. It was decided to include these discussions in the Franklin County Substance Use Prevention Coalition and/or the Community Health Improvement Plan committee meetings for the time being, since many of the same organizations are represented in those, including the Hospital. Additionally, the Hospital provided $2,000 in financial support to Hope HouseFranklin County Christian Caring Center, to support mental health specifically by helping to house the homeless during periods of extreme cold or heat. See continuation
Part V, Section B, Line 11 - continuation	Objective 2: The Hospital will increase the knowledge and skills of 50 community members to effectively respond to those who may be contemplating suicide with the evidence-based program QPR (Question-Persuade-Refer) through financial support, marketing and promotion of the program to the community. This support increases access to education classes that improve knowledge and skills to effectively respond to those who may be contemplating suicide. The Hospital did not meet the participation objective because fewer individuals attended the trainings than anticipated, despite the Hospital providing financial, marketing and promotional support. Three QPR sessions occurred in June and October 2022, with a total of 29 participants. The Hospital provided $2,000 in financial support and conference room space for these trainings in 2022. Pre/post surveys showed an improvement in knowledge, and 100% of participants indicated they would recommend the training to others.Objective 3: The Hospital will implement a messaging campaign on suicide prevention to 12,500 community members through the MyHealth magazine and social media. One percent (125 community members will demonstrate engagement by either sharing on social media, requesting additional information, registering for an educational program, or downloading resources. This community education and awareness campaign is funded and deployed through AdventHealth Ottawa and all outcomes are specific to the reporting Hospital. The Hospital did not meet its set metric. The messaging campaign on suicide prevention and mental health occurred through social media only and reached 8,830 people. Thirty-five community members demonstrated engagement.Community Needs Not Chosen by AdventHealth Ottawa:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. The Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. RISING HEALTH CARE COSTS AND LACK OF HEALTH INSURANCE One third of the AdventHealth Ottawa Community Survey responses indicated cost as a barrier to health care and 9.41% did not have health insurance. AdventHealth will continue to advocate for the expansion of Medicaid in Kansas. The Hospital currently provides financial assistance for those without health insurance and struggling to pay their medical bills. The Hospital will assist in connecting patients and the community to resources for accessing health coverage. 2. ISSUE 2: DENTAL CARE FOR ADULTS The 2017 Franklin County Health Department Quality of Life Survey conducted by Community Health Assessment team, survey indicated 38% of adults had not seen a dentist in the last 12 months and 18% of adults have poor dental health. While poor dental health leads to other health issues, it is not feasible for the Hospital to provide dental services. Health Partnership Clinic (Federally Qualified Health Center) currently offers dental services, but on a limited basis. 3. ISSUE 3: ACCESS TO HEALTH SPECIALISTS Through the prioritization process, the CHNAC identified the lack of access to specialty services as the third priority the Hospital should consider. Key Stakeholder surveys also highlighted this need through their comments. Types of specialists mentioned included mental and dental health providers. Patients needing to see health specialists not available in their community need to travel to southern Johnson County or Kansas City for services. More analysis and information are needed. It is not feasible for the Hospital to address this issue in a 2-year plan.
Schedule H, Part V, Line 16a, 16b, and 16c	Line 16AThe Financial Assistance Policy can be found at the following website: https://www.adventhealth.com/legal/financial-assistanceLine 16BThe Financial Assistance Policy Application can be found at the following website: https://www.adventhealth.com/legal/financial-assistanceLine 16CThe Plain Language Summary can be found at the following website: https://www.adventhealth.com/legal/financial-assistance
Schedule H, Part V, Section B, Line 7a and 10a:	Line 7a: The CHNA report can be found at URL:https://www.adventhealth.com/community-health-needs-assessmentsLine 10a: The Hospital's most recently adopted implementation strategy can be found at URL:https://www.adventhealth.com/community-health-needs-assessments
Part V, Section B, Line 8 - 10a -- CHNA Implementation Strategy Narrative:	The filing organization adopted a Community Health Needs Assessment Report by 12/31/2022 and was in the process of developing its Community Health Needs Implementation Strategy at that time. The filing organization's 2023-2025 Community Health Needs Implementation Strategy is documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) describes how the filing organization plans to meet its identified prioritized health needs or identifies the health need as one the filing organization does not intend to specifically address and provides an explanation as to why the filing organization does not intend to address that health need. The filing organization's 2023-2025 CHP was adopted by May 15, 2023 and is posted on the hospital facility's website.

Schedule H (Form 990) 2022

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2022

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	Under the Hospital facility's Financial Assistance Policy, an individual is eligible for a 100% reduction from applicable charges if the individual's household income is at or below 200% of the current Federal Poverty Guidelines. Alternatively, a patient may also qualify for a 100% reduction from charges when the unpaid portion of a patient's bill exceeds 25% of the individual's annual household income and where the total annual household income is less than 500% of the Federal Poverty Guidelines. Medicare recipients may also be eligible for financial assistance under the Hospital's Financial Assistance Policy depending upon the individual's income and resources. Resources are generally defined as assets such as money in checking or savings accounts, stocks, and bonds.
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 and 9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands.
Part III, Line 8:	Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Schedule H, Part III, Section B Medicare Narratives Rationale for Including Medicare Shortfall: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:	Collection Policies:The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made.
Supplemental Schedule to Schedule H, Part III, Section B, line 8:	Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by AdventHealth. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (343,861)- Difference in costing methodology: (1,519,121)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (1,566,673) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (3,429,655) 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 2022 CHNA was adopted by its governing board by December 31, 2022, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2022 CHNA complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of its community.Such practices and processes involve the following:1.A hospital operating/community board composed of individuals broadly representative of the community, community leaders, and those with specialized medical training and expertise;2.Post-discharge patient follow-up related to the on-going care and treatment of patients who suffer from chronic diseases; 3.Sponsorship and participation in community health and wellness activities that reach a broad spectrum of the filing organization's community; and 4.Collaboration with other local community groups to address the health care needs of the filing organization's community.
Part VI, Line 3:	The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facility are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on the filing organization's hospital facility's website. The website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains the hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of the hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facility's financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facility who are classified as self-pay during the course of their hospital stay or at time of discharge to explain the FAP and FAA Form and to provide information concerning other sources of assistance that may be available, such as Medicaid. A paper copy of the hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of the community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance.
Part VI, Line 4:	The filing organization (the hospital) is located in Ottawa, Kansas, and is licensed for 44 acute care beds. In May 2019 Ransom Memorial Hospital became AdventHealth Ottawa, joining AdventHealth's connected system of care comprised of nearly 50 hospital campses and hundreds of care sites in diverse markets throughout almost a dozen states. AdventHealth Ottawa delivers a wide range of inpatient, outpatient and surgical health care services across Franklin County and its surrounding areas. In addition to operating a hospital, the filing organization also runs two off-site locations which include rehabilitation and specialty services. The filing organization employs more than 400 local residents. AdventHealth Ottawa is a crucial community asset and strives to have a positive impact on the lives of patients, their families, and their healthcare partners no matter what their needs may be. Key servicecs include cardiology, obstetrics, emergency medicine, gynecology, sleep medicine, urology, pediatrics, pulmonology, oncology, neurology, occupational medicine, wound care, orthropedics, diagnostic imaging with digital mammography, general surgery, physical, occupational, speech therapy, family/internal medicine and much more. The closest competing hospital is located approximately 30 mintues away. During 2022, 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 2022, about 84.2% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 51.2% - Medicaid Patients 11.6% - Self-Pay Patients 4.1% The demographic makeup of the county that the Hospital serves is as follows: - Population 40,041 - Population Over 65 16.2% - Poverty (Below 100% FPL) 10.1% - High School Graduation Rage 93.8% - Uninsured Adults 6.9% - Food Insecurity Rate 13.5% - Pop. with Low Food Access 59.2%
Part VI, Line 5:	The provision of community benefit is central to AdventHealth Ransom Memorial's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the Hospital is a function of "extending the healing ministry of Christ and embodies the Hospital's commitment to its values and principles. The Hospital commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $1,863,040 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community.
Part VI, Line 6:	AdventHealth Ransom Memorial is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 49 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.
Schedule H, Part VI, Line 7:	The filing organization does not file an annual community benefit report with any state agencies.

Schedule H (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2022

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Huenergardt Sam Director/Chairperson	(i) (ii)	0 ------------- 751,872	0 ------------- 196,309	0 ------------- 132,785	0 ------------- 144,531	0 ------------- 48,521	0 ------------- 1,274,018	0 ------------- 85,211
2Trimble Tamara Former Officer	(i) (ii)	0 ------------- 634,011	0 ------------- 169,365	0 ------------- 191,687	0 ------------- 16,400	0 ------------- 13,154	0 ------------- 1,024,617	0 ------------- 0
3Sheikh MD Farhan Physician	(i) (ii)	317,769 ------------- 0	476,980 ------------- 0	735 ------------- 0	6,100 ------------- 0	6,426 ------------- 0	808,010 ------------- 0	0 ------------- 0
4Heinrich William Dir/Treasurer	(i) (ii)	0 ------------- 417,452	0 ------------- 65,158	0 ------------- 114,473	0 ------------- 59,232	0 ------------- 46,923	0 ------------- 703,238	0 ------------- 0
5Dalenberg MD Dale Physician	(i) (ii)	419,829 ------------- 0	0 ------------- 0	9,482 ------------- 0	16,400 ------------- 0	11,234 ------------- 0	456,945 ------------- 0	0 ------------- 0
6Purkeypile Dallas CEO	(i) (ii)	0 ------------- 253,278	0 ------------- 57,872	0 ------------- 13,931	0 ------------- 54,462	0 ------------- 42,055	0 ------------- 421,598	0 ------------- 0
7Koster MD Christopher Physician	(i) (ii)	276,670 ------------- 0	0 ------------- 0	591 ------------- 0	13,363 ------------- 0	1,623 ------------- 0	292,247 ------------- 0	0 ------------- 0
8Beebe Harmat CFO	(i) (ii)	0 ------------- 180,882	0 ------------- 36,149	0 ------------- 11,302	0 ------------- 10,862	0 ------------- 38,334	0 ------------- 277,529	0 ------------- 0
9Seto MD Takeshi Physician	(i) (ii)	228,845 ------------- 0	0 ------------- 0	8,517 ------------- 0	12,436 ------------- 0	21,367 ------------- 0	271,165 ------------- 0	0 ------------- 0
10Steiner Stacy CNO	(i) (ii)	0 ------------- 167,139	0 ------------- 33,072	0 ------------- 10,910	0 ------------- 10,574	0 ------------- 39,310	0 ------------- 261,005	0 ------------- 0
11Rich Doug COO	(i) (ii)	0 ------------- 161,188	0 ------------- 31,808	0 ------------- 10,885	0 ------------- 10,170	0 ------------- 39,305	0 ------------- 253,356	0 ------------- 0
12Swanson MD Evan Physician	(i) (ii)	191,757 ------------- 0	0 ------------- 0	1,091 ------------- 0	9,752 ------------- 0	18,108 ------------- 0	220,708 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 1a	The filing organization is a part of the system of healthcare organizations known as AdventHealth. Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives listed in Part VII that are on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 49 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (13 AdventHealth Cabinet members and the AdventHealth Multi-State CFO) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's, and Division Chief Officers (generally 50 - 55 individual executives). A Regional CEO for AdventHealth is a member of the Board of Directors of the filing organization. The Regional CEO is considered a common law employee of and is on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and either wholly or partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has wholly or partially paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AdventHealth has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval by the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, to encourage executives to establish and cultivate strong working relationships with the medical community and other leaders in the community and industry, certain AdventHealth executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be approved by the AdventHealth President/CEO initially as well as on an annual basis. Each AdventHealth executive who is approved for a club membership must submit an annual report describing how they used the membership to benefit their organization during the preceding year so that the AdventHealth President/CEO can determine if continuance of the club membership furthers the business interests of AdventHealth. In the current year, for this filing organization, three executives listed in Part VII received reimbursement for club fees. While the club dues membership is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed in whole or in part by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for health or social club dues since it has wholly or partially paid for the cost of providing this benefit.
Part I, Line 3	The individual who serves as the CEO of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation Section 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present, other than the Chief People Officer, who remains at the request of the Chairman/committee to provide assistance/information as needed. The Committee is advised by an independent third-party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership.
Part I, Line 4b	As discussed in Line 1a above, executives on the filing organization's management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2022. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. SERP III Plan: The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $305,000 in 2022 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. SERP II Plan: The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AdventHealth active employment inclusive of income from all other Seventh-day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. FLEX Plan: The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. Huenergardt, Samuel $ 128,131 $ 115,142 $ 0 $ 0 Trimble, Tamara $ 122,953 $ 102,453 $ 0 $ 0 Heinrich, William $ 49,430 $ 0 $ 0 $ 13,901 Purkeypile, Dallas $ 0 $ 0 $ 0 $ 38,062 * Including Investment Earnings

Schedule J (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Return Reference	Explanation
Form 990, Part V, Line 1a	The parent corporation and sole top-tier member of AdventHealth Ransom Memorial, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041.
Form 990, Part VI, Section A, line 2	Janet Peters and John Coen - Business Relationship
Form 990, Part VI, Section A, line 6	AdventHealth Ransom Memorial, Inc. has one member. The sole member of AdventHealth Ransom Memorial, Inc. is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in AdventHealth Ransom Memorial, Inc.
Form 990, Part VI, Section A, line 7a	The sole member of AdventHealth Ransom Memorial, Inc. is AHSSHC. The Board of Directors of AdventHealth Ransom Memorial, Inc. are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of AdventHealth Ransom Memorial, Inc.
Form 990, Part VI, Section A, line 7b	AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve or disapprove the executive and/or administrative leadership of the Hospital and their salaries; b) to adopt, amend, restate, and repeal the Articles of Incorporation or Bylaws of the filing organization and the medical staff Bylaws; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove the annual operating and capital budgets of the filing organization; e) to direct the placement of funds and capital of the filing organization; f) to approve or disapprove certain purchases or sales of personal property or real property equal to or in excess of established dollar thresholds; g) to establish general guiding policies, to implement quality assessment, improvement and utilization review programs; h) to approve the appointment of an auditing firm and election of the fiscal year for the filing organization; and i) to approve or disapprove the implementation of non-traditional, non-health care related activities.
Form 990, Part VI, Section B, line 11b	The filing organization's current year Form 990 was reviewed by the Board Chairman, Board Finance Committee Chair, CEO and by the CFO prior to its filing with the IRS. The review conducted by the Board Chairman, Board Finance Committee Chair, CEO and the CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990 but did include a review of the entire Form 990 and all supporting schedules.
Form 990, Part VI, Section B, line 12c	The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes.
Form 990, Part VI, Section B, line 15	The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3.
Form 990, Part VI, Section C, line 19	The filing organization is a part of the system of healthcare organizations known as AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AdventHealth on a consolidated basis and for the grouping of AdventHealth subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public.
Part VII, Section A, Columns (E) & (F)	For those Board of Director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities.
Part VIII, Lines 7a, b and c:	The amounts shown in Part VIII, Lines 7a(i), 7b(i) and 7c(i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program.
Form 990, Part IX, line 11g	Payments to Healthcare Professionals: Program service expenses 8,157,830. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,157,830. Professional Fees: Program service expenses 44,750. Management and general expenses 0. Fundraising expenses 0. Total expenses 44,750. Outside Lab Services: Program service expenses 323,755. Management and general expenses 0. Fundraising expenses 0. Total expenses 323,755. Laundry Services: Program service expenses 15,699. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,699. Transcription: Program service expenses 356. Management and general expenses 0. Fundraising expenses 0. Total expenses 356. Recruiting: Program service expenses 1,968. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,968. Miscellaneous Purchased Services: Program service expenses 1,501,656. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,501,656. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 582,833. Fundraising expenses 0. Total expenses 582,833. Billing & Collection Services: Program service expenses 0. Management and general expenses 160,969. Fundraising expenses 0. Total expenses 160,969. Management Fees JOA: Program service expenses 0. Management and general expenses 18. Fundraising expenses 0. Total expenses 18. AdventHealth Shared Service Fee: Program service expenses 0. Management and general expenses 505,158. Fundraising expenses 0. Total expenses 505,158.
Form 990, Part X, Line 2	The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value.
Form 990, Part XI, line 9:	Transfer to Tax-Exempt Top-Tier Parent -291,437. Gifts from Foundation 400,000. Donated Property 105,121. Prior Period Adjustment 33,792. Rounding 1.
Form 990, Part XII, Line 3b	Although the taxpayer is not required to undergo an audit as set forth in the Single Audit Act and OMB Circular A-133, the taxpayer is part of a controlled group of organizations that comprise a consolidated financial statement audit. The controlled group's parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), a 501(c)(3) organization. The system of healthcare entities owned and controlled by AHSSHC is known as AdventHealth. For the year ended December 31, 2022, AdventHealth will file a consolidated Single Audit which will include all entities that are part of the controlled group. Accordingly, the taxpayer has checked yes to the questions on Part XII, line 3a and 3b.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

AdventHealth Ransom Memorial Inc

Employer identification number

83-0976641

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)AdventHealth Ashville Inc (5922 - 123122) 900 Hope Way Altamonte Springs,FL32714 92-1144574	Future Operation of Hospital & Related Services	NC	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(2)AdventHealth Family Medicine Rural Health Clinics Inc 187 PR 4060 Lampasas,TX76550 27-1858033	Operation of Rural Health Clinics & Medical Services	FL	501(c)(3)	Line 3	Metroplex Adventist Hospital Inc	Yes
(3)AdventHealth Foundation fka SunSystem Development Corp 900 Hope Way Altamonte Springs,FL32714 59-2219301	Fund-Raising for Affiliated Tax-Exempt Hospitals	FL	501(c)(3)	Line 7	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(4)AdventHealth Home Care East Florida LLC 770 West Granada Blvd 319 Ormond Beach,FL32174 83-3768458	Inactive	FL	501(c)(3)	Line 10	Memorial Hlth Systems Inc	Yes
(5)AdventHealth Hospice Care East Florida Inc 770 West Granada Blvd 304 Ormond Beach,FL32174 83-3748461	Inactive	FL	501(c)(3)	Line 10	Memorial Hlth Systems Inc	Yes
(6)AdventHealth Kansas City Foundation 7315 E Frontage Road Merriam,KS66204 48-0868859	Fund-raising for Tax-exempt hospitals	KS	501(c)(3)	Line 7	Shawnee Mission Medical Center Inc	Yes
(7)AdventHealth North Polk Inc 3100 E Fletcher Ave Tampa,FL33613 59-3231322	Inactive	FL	501(c)(3)	Line 12a, I	University Community Hospital Inc	Yes
(8)AdventHealth Palm Coast Parkway Inc fka AH East Florida Inc 900 Hope Way Altamonte Springs,FL32714 88-2288563	Future Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(9)AdventHealth Polk North Inc 40100 US Highway 27 N Davenport,FL33837 84-1793121	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(10)AdventHealth Polk South Inc 410 South 11th Street Lake Wales,FL33853 83-4672945	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(11)AdventHealth Ransom Memorial Inc 1301 S Main Street Ottawa,KS66067 83-0976641	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(12)AdventHealth Riverview Inc 14055 Riveredge Drive Ste 150 Tampa,FL33637 87-0901094	Future Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(13)AdventHealth Senior Care Inc 900 Hope Way Altamonte Springs,FL32714 84-1817046	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(14)AdventHealth South Overland Park Inc 7820 W 165th Street Overland Park,KS66223 36-4595806	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(15)AdventHealth University Inc 671 Winyah Drive Orlando,FL32803 59-3069793	Education/Operation of School	FL	501(c)(3)	Line 2	Adventist Hlth SystemSunbelt Inc	Yes
(16)AdventHealth West Florida Ambulatory Services Inc 14055 Riveredge Drive Ste 250 Tampa,FL33637 47-1881744	Support of Imaging Center & Home Health Subsidiaries	FL	501(c)(3)	Line 12b, II	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(17)AdventHealth West Florida Imaging Inc 14055 Riveredge Drive Ste 250 Tampa,FL33637 84-3225135	Imaging & Testing	FL	501(c)(3)	Line 3	AdventHealth West Florida Ambulatory Services Inc	Yes
(18)Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook,IL60440 65-1219504	Operation of Hospital & Related Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(19)Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando,FL32804 20-5774723	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(20)Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights,IL60139 36-3208390	Operation of Hospital & Related Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(21)Adventist Health Mid-America Inc 9100 W 74th Street Shawnee Mission,KS66204 52-1347407	Support of Affiliated Hospital	KS	501(c)(3)	Line 12c, III-FI	Adventist Hlth SystemSunbelt Inc	Yes
(22)Adventist Health Partners Inc 5101 S Willow Springs Rd Suite B101 La Grange,IL60525 36-4138353	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(23)Adventist Health System Georgia Inc 1035 Red Bud Road NE Calhoun,GA30701 58-1425000	Operation of Hospital & Related Services	GA	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(24)Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs,FL32714 59-2170012	Management Services	FL	501(c)(3)	Line 12a, I	N/A		No
(25)Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs,FL32714 59-1479658	Operation of Hospitals & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(26)Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson,TX76028 74-2578952	Leasing Personnel to Affiliated Hospital	TX	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(27)Adventist Midwest Health 120 North Oak Street Hinsdale,IL60521 36-2276984	Operation of Hospitals & Related Services	IL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(28)AHP Specialty Care NFP 5101 S Willow Springs Rd Suite B101 La Grange,IL60525 81-1105774	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(29)AHS Midwest Management Inc 500 Remington Blvd Bolingbrook,IL60440 36-3354567	Operation of Physician Practice Management	IL	501(c)(3)	Line 12a, I	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(30)Apopka Health Care Properties Inc 305 E Oak Street Apopka,FL32703 51-0605694	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(31)Bert Fish Medical Center Auxiliary Inc 401 Palmetto Street New Smyrna Beach,FL32168 59-1054892	Volunteer support services	FL	501(c)(3)	Line 10	Southeast Volusia Healthcare Corp		No
(32)Bradford Heights Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland,FL32751 20-5782342	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(33)Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson,TX76028 20-5782243	Operation of Home for the Aged/Hlthcare Delivery	TX	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(34)Chickasaw Health Care Properties Inc 250 S Chickasaw Trail Orlando,FL32825 51-0605681	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(35)Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand,WI54736 39-1365168	Operation of Hospital & Related Services	WI	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(36)Coalition For Physician Well-Being Inc 900 Hope Way Altamonte Springs,FL32714 46-3477012	Provide support for Physician well-being	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(37)Courtland Health Care Properties Inc 730 Courtland Street Orlando,FL32804 51-0605682	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(38)Creekwood Place Nursing & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782260	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(39)Dairy Road Health Care Properties Inc 7350 Dairy Road Zephyrhills,FL33540 51-0605684	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(40)East Orlando Health & Rehab Center Inc 250 S Chickasaw Trail Orlando,FL32825 20-5774748	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(41)Fletcher Hospital Inc 100 Hospital Drive Hendersonville,NC28792 56-0543246	Operation of Hospital & Related Services	NC	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(42)FLNC Inc 3355 E Semoran Blvd Apopka,FL32703 20-5774761	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(43)Florida Hospital Dade City Inc 13100 Fort King Road Dade City,FL33525 82-2567308	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(44)Florida Hospital Healthcare Partners Inc 770 West Granada Blvd 101 Ormond Beach,FL32174 46-2354804	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(45)Florida Hospital Medical Group Inc 2600 Westhall Lane 4th Floor Maitland,FL32751 59-3214635	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(46)Florida Hospital Ocala Inc 1500 SW 1st Avenue Ocala,FL34471 82-4372339	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(47)Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa,FL33637 46-2021581	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(48)Florida Hospital Waterman Inc 1000 Waterman Way Tavares,FL32778 59-3140669	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(49)Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills,FL33541 59-2108057	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(50)Florida Radiology Imaging at Lake Mary LLC 2600 Westhall Lane 4th Floor Maitland,FL32751 55-0789387	Imaging & Testing	FL	501(c)(3)	Line 3	Florida Hospital Medical Group Inc	Yes
(51)Fountain Inn Nursing & Rehab Center Inc 4501 Waterman Way Tavares,FL32778 47-2180518	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(52)Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-2106043	Fund-raising for Tax-exempt hospital/foundation	FL	501(c)(3)	Line 12c, III-FI	N/A		No
(53)Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-3690149	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(54)Hinsdale Hospital Foundation 120 North Oak Street Hinsdale,IL60521 52-1466387	Fund-raising for Tax-exempt hospital	IL	501(c)(3)	Line 7	Midwest Hlth Foundation		No
(55)Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs,FL32714 59-2935928	Operation of Hospice	FL	501(c)(3)	Line 10	The Comforter Health Care Group Inc	Yes
(56)In-Motion Rehab Inc (11-122722) 485 North Keller Road 250 Maitland,FL32751 20-8023411	Inactive	KS	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(57)Lake County Health Care Properties Inc (11-122822) 485 North Keller Road 250 Maitland,FL32751 81-3923985	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(58)Memorial Health Systems Foundation Inc 305 Memorial Medical Pkwy 212 Daytona Beach,FL32117 31-1771522	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(59)Memorial Health Systems Inc 301 Memorial Medical Parkway Daytona Beach,FL32117 59-0973502	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(60)Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland,FL32720 59-3256803	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Memorial Hlth Systems Inc	Yes
(61)Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast,FL32164 59-2951990	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Memorial Hlth Systems Inc	Yes
(62)Memorial Hospital Inc 210 Marie Langdon Drive Manchester,KY40962 61-0594620	Operation of Hospital & Related Services	KY	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(63)Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen,TX76549 74-2225672	Operation of Hospital & Related Services	TX	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(64)Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen,TX76549 11-3762050	Physician Healthcare services to the community	TX	501(c)(3)	Line 3	Metroplex Adventist Hospital Inc	Yes
(65)Midwest Health Foundation 120 North Oak Street Hinsdale,IL60521 35-2230515	Fund-Raising for Supported Exempt Hospitals	IL	501(c)(3)	Line 7	N/A		No
(66)Mills Health & Rehab Center Inc(11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782320	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(67)Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland,FL32751 90-0866024	Provision of support to the nursing home division	GA	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(68)Missouri Adventist Health Inc 9100 W 74th Street Shawnee Mission,KS66204 43-1224729	Support Health Care Services	MO	501(c)(3)	Line 12d, III-O	Adventist Hlth Mid-America Inc	Yes
(69)Osceola Health Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3165729	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(70)Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park,KS66204 20-5774821	Operation of Home for the Aged/Hlthcare Delivery	KS	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(71)Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel,FL33544 20-8488713	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(72)Portercare Adventist Health System (630 YE) 9100 E Mineral Circle Centennial,CO80112 84-0438224	Operation of Hospitals & Related Services	CO	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(73)Princeton Health & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782272	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(74)Princeton Homecare Services LLC (81 - 123122) 602 Courtland Street 310 Orlando,FL32804 81-4196648	Home Health Care Servcies	FL	501(c)(3)	Line 10	Princeton Prof Services Inc	Yes
(75)Princeton Professional Services Inc 601 E Rollins Street Orlando,FL32803 59-1191045	Provision of Healthcare Services	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(76)Quality Circle for Healthcare Inc 900 Hope Way Altamonte Springs,FL32714 26-3789368	Healthcare Quality Services	FL	501(c)(3)	Line 12a, I	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(77)Redmond Park Hospital LLC 501 Redmond Road NW Rome,GA30165 58-1123037	Operation of Hospital & Related Services	GA	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(78)Resource Personnel Inc 485 North Keller Road 250 Maitland,FL32751 20-8040875	Provide administrative support to tax exempt nursing homes	FL	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(79)Rocky Mountain Adventist Hlthcare Foundation (630 YE) 960 E Harvard Avenue Ste 230 Denver,CO80210 84-0745018	Fund-raising for Tax-exempt hospital	CO	501(c)(3)	Line 7	N/A		No
(80)Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen,TX76549 46-1656773	Support Operation of Hospital	TX	501(c)(3)	Line 12a, I	Adventist Hlth SystemSunbelt Inc	Yes
(81)San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos,TX78666 20-5782224	Operation of Home for the Aged/Hlthcare Delivery	TX	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(82)Shawnee Mission Hlth Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3914908	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(83)Shawnee Mission Health Care Inc 6501 West 75th Street Overland Park,KS66204 48-0952508	Lease to Related Organization	KS	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(84)Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission,KS66204 48-0637331	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(85)South Pasco Health Care Properties Inc 38250 A Avenue Zephyrhills,FL33542 51-0605679	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(86)Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach,FL32168 47-3793197	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(87)Southwest Volusia Health Services Inc 1055 Saxon Blvd Orange City,FL32763 59-3281591	Medical Office Building for Hospital	FL	501(c)(3)	Line 12a, I	Southwest Volusia Hlthcare Corp	Yes
(88)Southwest Volusia Healthcare Corp 1055 Saxon Blvd Orange City,FL32763 59-3149293	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(89)Spring View Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland,FL32751 20-5782288	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(90)Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka,FL32703 20-5774856	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(91)Sunbelt Health Care Centers Inc 485 North Keller Road 250 Maitland,FL32751 58-1473135	Management Services	TN	501(c)(3)	Line 12b, II	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(92)Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-0898901	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	University Community Hospital Inc	Yes
(93)Tarrant County Health Care Properties Inc 301 Huguley Blvd Burleson,TX76028 51-0605677	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(94)The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs,FL32714 27-1857940	Support Services to Related Hospice	FL	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(95)Tri-County Nursing and Rehab Center Inc 1290 Celebration Blvd Kissimmee,FL34747 47-2219363	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(96)University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa,FL33613 59-2554889	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(97)University Community Hospital Inc 3100 E Fletcher Ave Tampa,FL33613 59-1113901	Operation of Hospitals & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(98)West Florida Health Home Care Inc 13601 Bruce B Downs Blvd Ste 110 Tampa,FL33613 59-3686109	Home Health Services	GA	501(c)(3)	Line 10	AdventHealth West Florida Ambulatory Svcs Inc	Yes
(99)Zephyr Haven Health & Rehab Center Inc 38250 A Avenue Zephyrhills,FL33542 20-5774930	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(100)Zephyrhills Health & Rehab Center Inc 7350 Dairy Road Zephyrhills,FL33540 20-5774967	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) Fletcher Hospital Surgical Ventures LLC 9131 Anson Way Ste 304 Raleigh,NC27615 86-1482646	Indirect Interest in Surgery Center	NC	N/A				No			No
(2) Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland,FL32751 20-2392253	Medical Equipment	FL	N/A				No		Yes
(3) Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland,FL32751 59-3142824	Home Infusion Services	FL	N/A				No		Yes
(4) Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton,CO80120 46-4426708	Surgery Center	CO	N/A				No			No
(5) M&O Orlando MOB I LLC 1919 N Orange Ave Ste E Orlando,FL32804 84-4259138	Operation of Medical Office Building	DE	N/A				No			No
(6) OnPoint OBGYN LLC (21-123122) 7780 S Broadway 280 Littleton,CO80122 87-3522453	Healthcare Services	CO	N/A				No			No
(7) PAHS OnPoint Imaging LLC 9205 S Broadway Highlands Ranch,CO80129 83-3275105	Imaging Center	CO	N/A				No			No
(8) PAHS OnPoint Urgent Care LLC 9100 E Mineral Circle Centennial,CO80112 83-2465331	Urgent Care Center	CO	N/A				No			No
(9) Princeton Homecare Services LLC (11-8122) 602 Courtland Street 310 Orlando,FL32804 81-4196648	Operation of Home Health Agency	FL	N/A				No			No
(10) Surgery Center of Rome LP 501 Redmond Road NW Rome,GA30165 20-0390305	Surgery Center	GA	N/A				No			No
(11) The Bariatric Center of Kansas City LLC 9100 W 74th Street Merriam,KS66204 82-3025378	Surgery Center	KS	N/A				No			No
(12) Urgent Care Centers of Brevard County LLC 2600 Westhall Lane Maitland,FL32751 84-4261523	Urgent Care Centers	FL	N/A				No		Yes

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) AdventHealth Orlando Network Inc (11 - 41922) 900 Hope Way Altamonte Springs,FL32714 86-2639185	Inactive	FL	N/A	C				Yes
(2) AdventHealth Professional Staffing Inc (11 - 12822) 900 Hope Way Altamonte Springs,FL32714 88-0742779	INACTIVE	FL	N/A	C				Yes
(3) AdventHealth Tampa Network Inc (11 - 41922) 900 Hope Way Altamonte Springs,FL32714 86-2666178	Inactive	FL	N/A	C				Yes
(4) AdventHealth Team Members Inc (11 - 12822) 900 Hope Way Altamonte Springs,FL32714 88-0763664	INACTIVE	FL	N/A	C				Yes
(5) AdventHealth Value Based Bundle Management LLC (61-123122) 101 Southhall Lane Ste 150 Maitland,FL32751 87-3487910	Medical Contracting and Billing	FL	N/A	C				Yes
(6) Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-2855792	Condo Association	FL	N/A	C				Yes
(7) Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-3000857	Condo Association	FL	N/A	C				Yes
(8) Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs,FL32714 38-1359189	Inactive	MI	N/A	C				Yes
(9) Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast,FL32164 26-2158309	Condo Association	FL	N/A	C				Yes
(10) Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando,FL32803 82-1748255	Condo Association	FL	N/A	C				Yes
(11) Florida Hospital Healthcare System Inc 2600 Lucien Way Maitland,FL32751 59-3215680	PHSO / CIN	FL	N/A	C				Yes
(12) Florida Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-2855791	Condo Association	FL	N/A	C				Yes
(13) Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee,FL34741 59-3539564	Condo Association	FL	N/A	C				Yes
(14) Midwest Management Services Inc 9100 West 74th Street Shawnee Mission,KS66204 48-0901551	Inactive	KS	N/A	C				Yes
(15) North American Health Services Inc & Sub 900 Hope Way Altamonte Springs,FL32714 62-1041820	Holding Co.	TN	N/A	C				Yes
(16) Ormond Prof Associates Condo Assoc Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach,FL32174 59-2694434	Condo Association	FL	N/A	C				Yes
(17) Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher,NC28732 03-0380531	Condo Association	NC	N/A	C				Yes
(18) Park Ridge Condominium #1 Unit Owners Association Inc 1 Park Place Naples Road Fletcher,NC28732 01-0584623	Condo Association	NC	N/A	C				Yes
(19) Surgicare of Rome Inc 501 Redmond Rd Rome,GA30165 20-0376307	Holding Company	GA	N/A	C				Yes
(20) Redmond Park Health Services Inc 501 Redmond Rd Rome,GA30165 62-1330078	Holding Company	GA	N/A	C				Yes
(21) The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland,FL32751 59-3414055	Real Estate Rental	FL	N/A	C				Yes
(22) Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando,FL32803 45-2228478	Condo Association	FL	N/A	C				Yes

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Shawnee Mission Medical Center Inc	P	2,768,927	Cost
(2) Adventist Health System Sunbelt Healthcare Corporation	M	471,603	% of Facility's Operating Expense
(3) Adventist Health System Sunbelt Healthcare Corporation-Shared Services	M	505,158	% of Facility's Operating Expense
(4) Adventist Health System Sunbelt Healthcare Corporation dba AdventHealth AIT	M	1,855,433	% of Facility's Operating Expense
(5) Adventist Health System Sunbelt Healthcare Corporation	P	2,631,510	Cost
(6) Adventist Health System Sunbelt Healthcare Corporation dba AdventHealth AIT	P	54,037	Cost
(7) Adventist Health System Sunbelt Healthcare Corporation	B	291,437	Actual Amount Given

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: The provision of medical care to the community through the operation of a 44 bed hospital.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	428
6	Total number of volunteers (estimate if necessary) .............	6	53
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	6,000
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	684,088	657,985
9	Program service revenue (Part VIII, line 2g) .........	53,231,207	59,028,176
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	254,107	93,124
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	54,169,402	59,779,285
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	5,100	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	26,794,715	25,803,643
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	25,574,181	29,839,001
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	52,373,996	55,642,644
19	Revenue less expenses. Subtract line 18 from line 12.......	1,795,406	4,136,641
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	32,868,922	30,920,476
21	Total liabilities (Part X, line 26).............	22,784,598	17,462,738
22	Net assets or fund balances. Subtract line 21 from line 20.....	10,084,324	13,457,738

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 51,030,471 including grants of $ ) (Revenue $ 59,022,176 )
	Provision of medical care to both inpatients and outpatients. During the current year, the hospital had 1,148 patient admissions which resulted in 3,684 patient days, 37,347 outpatient visits, and 50,406 physician practice patient visits. The hospital is a 44-bed acute care hospital located in Franklin County, Kansas.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses51,030,471

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,935,386	3,646,740	690,642

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Trimble Tamara........................................................................ Former Officer	0.00 .......................50.00	X	0	995,063	29,554

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	657,985

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		657,985

		Business Code
2a	Net Patient Revenue	622110	55,948,376	55,948,376
b	County Sales Tax Revenue	622110	2,637,827	2,637,827
c	Cafeteria Revenue	622110	102,727	102,727
d	Medical Office Building	622110	79,125	79,125
e	Gift Shop & Auxiliary Activities	622110	40,132	40,132
f	All other program service revenue.		219,989	213,989	6,000
g	Total. Add lines 2a–2f .....		59,028,176

3 Investment income (including dividends, interest, and othersimilar amounts) ......			194,664			194,664
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	7,900		7a
b	Less: cost or other basis and sales expenses	0	109,440	7b
c	Gain or (loss)	7,900	-109,440	7c
d	Net gain or (loss).........			-101,540			-101,540
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			59,779,285	59,022,176	6,000	93,124

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,304,370		1,304,370
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	17,854,130	17,854,130
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	616,876	585,268	31,608
9	Other employee benefits .......	4,664,447	4,385,904	278,543
10	Payroll taxes ...........	1,363,820	1,293,939	69,881
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	24,728		24,728
c	Accounting ...........	21,835		21,835
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	18,734		18,734
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,294,992	10,046,014	1,248,978
12	Advertising and promotion ....	454,536		454,536
13	Office expenses .......	825,675	496,808	328,867
14	Information technology ......	3,420,360	3,262,104	158,256
15	Royalties ..
16	Occupancy ...........	1,214,419	1,214,419
17	Travel ............	41,990	-10,886	52,876
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	26,800		26,800
20	Interest ...........	11,964	11,964
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,664,306	1,664,306
23	Insurance ...	201,559		201,559
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	9,091,839	9,091,839
b	Repairs & Maintenance	1,029,470	1,029,470
c
d
e	All other expenses	495,794	105,192	390,602
25	Total functional expenses. Add lines 1 through 24e	55,642,644	51,030,471	4,612,173	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,741	1	1,739
2	Savings and temporary cash investments .........			9,599,072	2	3,806,848
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			6,864,160	4	7,535,018
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			911,831	8	917,751
9	Prepaid expenses and deferred charges ......			1,211,122	9	1,338,825
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	23,135,032
b	Less: accumulated depreciation	10b	6,440,001	13,536,820	10c	16,695,031
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			744,176	15	625,264
16	Total assets. Add lines 1 through 15 (must equal line 33)...			32,868,922	16	30,920,476

17	Accounts payable and accrued expenses .....	5,778,810	17	6,151,786
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	17,005,788	25	11,310,952
26	Total liabilities. Add lines 17 through 25..	22,784,598	26	17,462,738

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	10,084,324	27	13,457,738
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	10,084,324	32	13,457,738
33	Total liabilities and net assets/fund balances ........	32,868,922	33	30,920,476