TY 2023 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) SHEILAH GRAY...................................................................... TRUSTEE/CHAIR	2.00 ................. 0.00	X	X		0	0
(2) JOSEPH WATSON...................................................................... TRUSTEE/CHAIR	2.00 ................. 0.00	X	X		0	0
(3) ROBERT FRENCH...................................................................... TRUSTEE/VICE CHAIR	2.00 ................. 0.00	X	X		0	0
(4) JENNIFER MCKELL...................................................................... TRUSTEE/VICE CHAIR	2.00 ................. 0.00	X	X		0	0
(5) STEVE HIRSCH...................................................................... TRUSTEE/TREASURER	2.00 ................. 0.00	X	X		0	0
(6) BARTON HENSHAW...................................................................... TRUSTEE/SECRETARY	2.00 ................. 0.00	X	X		0	0
(7) CARVEL SIMMONS...................................................................... TRUSTEE/SECRETARY	2.00 ................. 0.00	X	X		0	0
(8) RONALD COFFEY...................................................................... TRUSTEE	2.00 ................. 0.00	X			0	0
(9) ANTHONY FISH...................................................................... TRUSTEE	2.00 ................. 2.00	X			0	0
(10) JERRY PHILLIPS...................................................................... TRUSTEE	2.00 ................. 0.00	X			0	0
(11) BRIAN REAM...................................................................... TRUSTEE	2.00 ................. 2.00	X			0	0
(12) KEVIN SHOEMAKER...................................................................... TRUSTEE	2.00 ................. 2.00	X			0	0
(13) BETH WORKMAN...................................................................... TRUSTEE	2.00 ................. 0.00	X			0	0
(14) JEFF GRAHAM...................................................................... CEO	50.00 ................. 4.00		X		1,010,366	58,200
(15) JAMES MCMANUS...................................................................... AHS CHIEF FINANCIAL OFFICER	53.00 ................. 1.00		X		621,511	125,944
(16) KATHERINE EDRINGTON...................................................................... COO	50.00 ................. 4.00		X		621,194	32,774
(17) CRAIG BABBITT...................................................................... CHIEF LEGAL OFFICER	50.00 ................. 0.00			X	494,821	102,319

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) RICHARD D MIZER........................................................................ PRESIDENT OF AMG	50.00 .......................0.00	X			440,203	0	81,316
(19) KRISTIN BOGGS........................................................................ CHIEF COMPLIANCE OFFICER	50.00 .......................0.00	X			421,210	0	61,246
(20) HEATHER SPRAGUE........................................................................ CHIEF HUMAN RESOURCE OFFICER	50.00 .......................0.00	X			436,802	0	76,934
(21) JAMIE SMITH........................................................................ CHIEF INFORMATION OFFICER	50.00 .......................1.00	X			344,991	0	83,652
(22) MOLLY M GROOMS........................................................................ CHIEF NURSING OFFICER	50.00 .......................0.00	X			346,276	0	51,775
(23) JOHN GABIS........................................................................ PRESIDENT OF AMG	50.00 .......................0.00	X			373,748	0	39,646
(24) DONALD DIENER........................................................................ PRESIDENT OF ARMC	50.00 .......................0.00	X			290,422	0	99,189
(25) TY MCBEE........................................................................ VP OF STRATEGIC OPERATIONS	50.00 .......................0.00	X			228,972	0	24,784
(26) DR SHAHEED KOURY........................................................................ CHIEF CLINICAL OFFICER	50.00 .......................0.00	X			625,200	0	126,912
(27) ATIQ REHMAN........................................................................ PHYSICIAN	50.00 .......................0.00		X		1,571,885	1,644,119	72,234
(28) ROGER WILTFONG........................................................................ PHYSICIAN	50.00 .......................0.00		X		1,399,401	1,462,744	63,343
(29) JAMES FLEMING........................................................................ PHYSICIAN	50.00 .......................0.00		X		1,120,385	1,190,583	70,198
(30) WAHEED GUL........................................................................ PHYSICIAN	50.00 .......................0.00		X		967,011	1,051,988	84,977
(31) KELLY GALLINA........................................................................ PHYSICIAN	50.00 .......................0.00		X		934,413	1,011,737	77,324
(32) REGGINA YANDILA........................................................................ FORMER TRUSTEE/PHYSICIAN	50.00 .......................0.00			X	334,797	380,470	45,673
(33) LISA CARLSON........................................................................ FORMER CFO	50.00 .......................4.00			X	270,056	0	1,020
(34) ANTHONY FREEMAN........................................................................ FORMER CHIEF MEDICAL OFFICER	0.00 .......................0.00			X	614,096	0	78,079

(A) Name and business address	(B) Description of services	(C) Compensation
ENSEMBLE RCM LLC 4605 DUKE DRIVE SUITE 600 MASON,OH45040	REVENUE CYCLE MANAGEMENT	31,207,482
APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD 600 SCOTTSDALE,AZ85254	PHYSICIAN SERVICES	8,839,094
CAPTIVE RADIOLOGY 6273 FRANK AVE NW NORTH CANTON,OH44720	RADIOLOGY SERVICES	2,637,440
SJN DATA CENTER LLC 4620 WESLEY AVE CINCINATTI,OH45212	DATA SERVICES	2,070,592
KEGLER BROWN HILL & RITTER CO LLC 65 E STATE ST 1800 COLUMBUS,OH43215	CONSTRUCTION SERVICES	1,983,891
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 68

- 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

2023

Open to Public
Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

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) 2023

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) 2023

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) 2023

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 2023 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-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

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

2023

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization ADENA HEALTH SYSTEM

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) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization ADENA HEALTH SYSTEM		Employer identification number 31-4379443

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) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization ADENA HEALTH SYSTEM			Employer identification number 31-4379443
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) (2023)

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

right arrow

Complete if the organization is described below. 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

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

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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) 2022

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 right arrow

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 right arrow

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) 2019	(b) 2020	(c) 2021	(d) 2022	(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) 2022

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? ...........................................................................................................

Yes

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

5,469

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

5,469

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:	THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION.

Schedule C (Form 990) 2022

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.
right arrow

Attach to Form 990.
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

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 ....	1,240,821	1,693,379	1,691,757	1,663,413	1,428,564
b	Contributions ...			1,622	38,177	24,401
c	Net investment earnings, gains, and losses	163,199	-452,558		-9,710	229,105
d	Grants or scholarships ...					-18,657
e	Other expenditures for facilities and programs ...				123
f	Administrative expenses ....
g	End of year balance ......	1,404,020	1,240,821	1,693,379	1,691,757	1,663,413

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

Board designated or quasi-endowment right arrow

100.000 %

Permanent endowment right arrow

0 %

Term endowment right arrow

0 %

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 .....	8,576,779		8,576,779
b	Buildings ....	340,954,791	144,712,530	196,242,261
c	Leasehold improvements	3,840,073	86,396	3,753,677
d	Equipment ....	206,201,511	153,364,342	52,837,169
e	Other .....	16,419,528	7,485,160	8,934,368
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				270,344,254

Schedule D (Form 990) 2022

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)RIGHT-OF-USE OPERATING LEASE ASSETS				5,780,550
(2)SOFTWARE IMPLEMENTATION ASSET				18,139,537
(3)SPLIT VALUE RETIREMENT				3,096,504
(4)MALPRACTICE INSURANCE RECOVERY LT				3,919,847
(5)457B STATE RETIREMENT INVESTMENT				16,233,604
(6)BOND ISSUE COSTS				1,625,445
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				48,795,487

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
ACCRUED MALPRACTICE INSURANCE - LT	13,901,150
DEFERRED COMPENSATION LIABILITY	16,131,828
INTERCOMPANY PAYABLE	3,034,903
CAPITAL LEASE OBLIGATION	5,252,304
RIGHT-OF-USE OPERATING LEASE OBLIGATION	5,780,550
COST REPORT PAYABLE	2,184,255



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	46,284,990
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) 2022

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 V, LINE 4:	ADENA HEALTH FOUNDATION ENDOWMENT FUNDS ARE USED TO PROVIDE SCHOLARSHIPS AND PURCHASE CAPITAL FOR ADENA HEALTH SYSTEM. THESE FUNDS ARE HELD BY ADENA HEALTH SYSTEM AND ARE ADMINISTERED BY ADENA HEALTH FOUNDATION.

Schedule D (Form 990) 2022

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.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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? . . . . . .

Yes

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? . . . . . . . . .

Yes

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

Yes

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) . . .	7,920,278	13,929,013	0	0 %
b	Medicaid (from Worksheet 3, column a) . . . . .	150,992,276	90,384,850	60,607,426	9.150 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	158,912,554	104,313,863	60,607,426	9.150 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	671,840		671,840	0.100 %
f	Health professions education (from Worksheet 5) . . .	8,569,577	2,249,142	6,320,435	0.950 %
g	Subsidized health services (from Worksheet 6) . . . .	22,385,810	11,353,071	11,032,739	1.670 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	31,627,227	13,602,213	18,025,014	2.720 %
k	Total. Add lines 7d and 7j .	190,539,781	117,916,076	78,632,440	11.870 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support			131,016		131,016	0.020 %
4	Environmental improvements			16,181		16,181	0 %
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development			36,000		36,000	0.010 %
9	Other
10	Total			183,197		183,197	0.030 %

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? ..........................

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

22,113,589

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. ......

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).....

176,913,953

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

242,545,963

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

-65,632,010

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) 2023

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	ADENA REGIONAL MEDICAL CENTER 272 HOSPITAL RD CHILLICOTHE,OH45601 WWW.ADENA.ORG ST. REG. NUM. 1029	X	X	X

Schedule H (Form 990) 2023

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)

	ADENA REGIONAL MEDICAL CENTER
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. ............................

Yes

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): SEE PART V, PAGE 8

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 22

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) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ADENA REGIONAL MEDICAL CENTER
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) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

	ADENA REGIONAL MEDICAL CENTER
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) 2023

Page 7

Part VFacility Information (continued)

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

	ADENA REGIONAL MEDICAL CENTER
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) 2023

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
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 5: THE ADENA REGIONAL MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO PRIMARY METHODS: PUBLIC SURVEYS AND KEY STAKEHOLDER INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED IN BOTH ELECTRONIC AND PAPER FORM ACROSS THE ROSS COUNTY COMMUNITY AND RECEIVED APPROXIMATELY 1,100 RESPONSES. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS.
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 6A: THE CHNA FOR ADENA REGIONAL MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING HOSPITALS: VETERANS ADMINISTRATION HOSPITAL, CHILLICOTHE
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 6B: THE CHNA FOR ADENA REGIONAL MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING ORGANIZATIONS WHO PARTICIPATE AS THE PARTNERS FOR A HEALTHIER ROSS COUNTY: ADENA HEALTH, CHILLICOTHE ROSS LIBRARIES, HOPE CLINIC OF ROSS COUNTY, HOPEWELL HEALTH CENTER, CITY OF CHILLICOTHE, ROSS COUNTY PARKS, OHIO HEALTH, OHIO STATE UNIVERSITY EXTENSION, OHIO UNIVERSITY-CHILLICOTHE, PAINT VALLEY ADAMH BOARD, ROSS COUNTY COMMUNITY ACTION, ROSS COUNTY HEALTH DISTRICT, ROSS COUNTY YMCA, UNITED WAY OF ROSS COUNTY, ROSS COUNTY BOARD OF DEVELOPMENTAL DISABILITIES/PIONEER CENTER, VETERANS ADMINISTRATION HOSPITAL.
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 7D: THE CHNA WAS MADE AVAILABLE IN ELECTRONIC FORM THROUGH SOCIAL MEDIA, NEWSPAPER, AND PARTICIPATING AGENCY WEBSITES. PRESENTATIONS OF ITS CONTENT WERE MADE TO GOVERNMENT, COMMUNITY AND CIVIC ORGANIZATIONS. HARD COPIES OF THE CHNA REPORT WERE ALSO PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES.
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 11: THE FOLLOWING DETAILS THE SPECIFIC IMPLEMENTATION STRATEGIES USED FOR HEALTH PRIORITIES IDENTIFIED FOR THE ADENA REGIONAL MEDICAL CENTER IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT WAS UTILIZED TO DEVELOP THE AREAS OF FOCUS FOR ADENA IN 2023.SUBSTANCE USE DISORDER COMMUNITY DEVELOPMENTADENA, AS PART OF ITS COORDINATION EFFORTS FOR PARTNERS FOR A HEALTHIER ROSS COUNTY (PHRC), BEGAN DATA SHARING IN JANUARY OF 2017 WITH THE HOPE PARTNERSHIP PROJECT (HPP). ADENA HEALTH ASSISTED IN THE DEVELOPMENT OF A HRSA RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) IMPLEMENTATION GRANT IN 2019. IN 2022, ADENA HEALTH AWARDED $1.6 MILLION OVER THREE YEARS. ADENA HEALTH IS THE FISCAL AGENT FOR THE GRANT, OVERSEES ALL OF THE GRANTS MANAGEMENT AND PROVIDES 1FTE PROJECT COORDINATOR TO OVERSEE THE PROJECT.ADENA WORKS WITH BRIGHT VIEW TREATMENT TO PROVIDE PRIORITY APPOINTMENTS TO PATIENTS IDENTIFIED WITH SUBSTANCE USE DISORDER TO FACILITATE MORE IMMEDIATE ACCESS TO TREATMENT.ADVOCACY ADENA HEALTH CONTRIBUTED .30 FTE COMMUNITY HEALTH DIRECTOR TO CO-CHAIR THE PARTNERS FOR A HEALTHIER ROSS COUNTY IN 2023. ARMC HAS A TOTAL OF FOUR EMPLOYEES WHO DEDICATED A MINIMUM TOTAL OF THREE TO SIX HOURS A MONTH TO PARTICIPATING IN COMMITTEE AND SUBCOMMITTEE MEETINGS, IN ADDITION TO COORDINATING PROJECTS FOR THE PARTNERS FOR A HEALTHIER ROSS COUNTY IN 2023. PROGRAMS AND INITIATIVESIN 2023, ADENA HEALTH PARTICIPATED IN THE OPTIMIZING IN OHIO HEALING COMMUNITIES STUDY. THE HEALING COMMUNITIES STUDY (HCS) WAS A NATIONAL INSTITUTES OF HEALTH RESEARCH STUDY IN FOUR STATES (OHIO, KENTUCKY, NEW YORK, AND MASSACHUSETTS) WITH THE GOAL OF REDUCING OPIOID OVERDOSE DEATHS. ADDITIONAL STUDY GOALS INCLUDED INCREASING OVERDOSE EDUCATION AND NALOXONE DISTRIBUTION, INCREASING ACCESS TO MEDICATIONS FOR OPIOID USE DISORDER, AND INCREASING SAFER OPIOID PRESCRIBING AND DISPENSING PRACTICES. ADENA HEALTH WAS ONE OF THE SUBGRANTEES/FISCAL AGENT OF THE GRANT. THE WORK INCLUDED PARTICIPATING IN EDUCATION CAMPAIGNS IN THE COMMUNITY RELATED TO SUBSTANCE USE, WORKING WITH HOPE PARTNERSHIP PROJECT TO ESTABLISH HARM REDUCTION VENDING MACHINES IN THE AREA AND PROVIDING SUPPORT FOR PROVIDER EDUCATION ABOUT SUBSTANCE USE. ADENA PROVIDED 3 EMPLOYEES WORKING AN AVERAGE OF 10 HOURS EACH FOR SIX MONTHS ON THIS INITIATIVE.THE BABY CENTERED RECOVERY PROGRAM PROVIDED A TOTAL OF 5 WOMEN (FROM MULTIPLE COUNTIES INCLUDING ROSS) WITH PREGNANCY EDUCATION AND ADDICTION COUNSELING IN 2023. IN ADDITION, PARTICIPANTS WERE PROVIDED RESOURCE REFERRALS, AS WELL AS FOOD AND BABY SUPPLIES AT NO CHARGE TO PARTICIPANTS. A TOTAL OF 5 COMPLETED THE PROGRAM. A TOTAL OF 289 MOTHERS HAVE BEEN SUPPORTED BY THE PROGRAM SINCE 2014. THE PROGRAM HAS BEEN RECOGNIZED WITH MULTIPLE AWARDS, INCLUDING:NATIONAL AWARDS "PROGRAM OF PROMISE" BY NATIONAL HOSPITAL CHARITABLE SERVICES "A BEST PRACTICE SITE" BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' CENTERS FOR MEDICARE AND MEDICAID SERVICE (CMS) MEDICATION MANAGEMENT AND OPIOID SUPPORT TEAM (1 OF ONLY 3 IN OHIO) FEATURED IN THE EMMY NOMINATED DOCUMENTARY SHORT BY "FAULT LINES": HEROIN'S CHILDREN: INSIDE THE US OPIOID CRISIS. STATE AWARDS THE OHIO SENATE HAS RECOGNIZED THE PROGRAM TWICE FOR THE CREATION OF THE ADENA BABY-CENTERED CLOSET. THE OHIO STATE SENATE ALSO RECOGNIZED THE PROGRAM FOR ITS WORK WITH MEDICAID PATIENTS. THE OHIO LACTATION ASSOCIATION RECOGNIZED ONE OF THE PROGRAM'S FACILITATORS "AS MOST BREASTFEEDING SUPPORTIVE HEALTH PROFESSIONAL IN OHIO".COMMUNITY AWARDS THE PROGRAM RECEIVED A COMMUNITY AWARD FROM OHIO CAN-ROSS COUNTY-2019 STEPS OF CHANGE FOR THE IMPACT THE PROGRAM MADE IN A YOUNG WOMAN'S LIFE. PAINT VALLEY ADAMH BOARD NAMED ONE OF THE PROGRAM'S FACILITATOR A ROSS COUNTY RECOVERY CHAMPIONTHE HOPE PARTNERSHIP PROJECT NAMED OF THE PROGRAM'S FACILITATORS "PROVIDER OF THE YEAR" IN 2021.FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH WORKS TO ALIGN ITS SERVICE LINES AND CLINICS WITH COMMUNITY RESOURCES THAT WILL ADDRESS THE SOCIAL FACTORS AND BARRIERS FACED BY MANY OF ITS RURAL PATIENTS. THIS OFTEN INVOLVES COMMUNITY PARTNERING AND MONETARY SUPPORT FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT. THESE TWO STRATEGIES ARE CONNECTED AND REPORTED TOGETHER. ADENA HEALTH PROVIDED $35,000 IN SUPPORT DURING 2023 FOR THE BUCK FIFTY WHICH COORDINATES THE DRUG FREE CLUBS OF AMERICA/MADE PROGRAM DEPLOYED IN SIX ROSS COUNTY SCHOOL DISTRICTS WHICH INCENTIVIZES STUDENT PARTICIPATION IN DRUG TESTING. ADENA COMMUNITY HEALTH AND DEVELOPMENT ALSO PROVIDED AN ADDITIONAL $7,500 IN SUPPORT FOR HARM REDUCTION KITS DEPLOYED IN THE ARMC, AFMC, APMC AND AGMC EMERGENCY DEPARTMENTS. ADENA HEALTH PROVIDE $1,000 IN SUPPORT THE ADAMH ANNUAL RECOVERY CELEBRATION DINNER, HONORING THOSE WHO WORK TO PREVENT, TREAT AND SUPPORT RECOVERY FOR THOSE IN ROSS, HIGHLAND, FAYETTE, PIKE AND PICKAWAY COUNTIES. PROVIDED $4,000 IN SUPPORT TO CHILLICOTHE CITY SCHOOLS KEYS TO SUCCESS PROGRAM, A DRUG AND ALCOHOL PREVENTION AND EDUCATION INITIATIVE.OBESITY AND DIABETESCOMMUNITY DEVELOPMENTA REPRESENTATIVE FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT SERVES ON THE LIVE WELL ROSS/CREATING HEALTHY COMMUNITIES STEERING TEAM. THIS GROUP PLANS AND IMPLEMENTS; ACTIVE TRANSPORTATION INITIATIVES FRESH FOOD ACCESS POINTS ACROSS, AND SOCIAL DETERMINATES OF HEALTH INITIATIVES IN ROSS COUNTY. ADENA HEALTH HAS A REPRESENTATIVE WHO OVERSEES THESE ACTIVITIES, INCLUDING COMMUNITY GARDENS AND ASSESSMENTS. A REPRESENTATIVE OF ADENA'S STRATEGIC BUSINESS DEVELOPMENT TEAM SERVED AS A BOARD MEMBER OF THE ROSS COUNTY PARKS DISTRICT IN 2023, PROVIDING 68 HOURS OF PLANNING AND OVERSIGHT SERVICE. A REPRESENTATIVE OF ADENA'S STRATEGIC BUSINESS DEVELOPMENT TEAM SERVED AS A BOARD MEMBER OF ROSS COUNTY TRAILS IN 2023, PROVIDING 112 HOURS OF PLANNING AND DEVELOPMENT SERVICE. ADVOCACYARMC CONTRIBUTED THE TIME OF TWO EMPLOYEES WHO DEDICATED A MINIMUM TOTAL OF 4 HOURS PER MONTH TO PARTICIPATING IN COMMITTEE MEETINGS FOR LIVEWELL ROSS.ARMC DEPLOYED PUBLIC SERVICE ANNOUNCEMENTS VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON NUTRITION, FITNESS EDUCATION AND AWARENESS.PROGRAMS AND INITIATIVES ARMC PARTNERED WITH THE OHIO STATE UNIVERSITY EXTENSION ROSS COUNTY OFFICE TO DELIVER COOKING CLASSES TO ADENA PATIENTS WITH OBESITY AND DIABETES. THESE CLASSES WENT VIRTUAL IN 2020 DUE TO THE COVID 19 PANDEMIC. A VIRTUAL OPTION WAS CONTINUED IN 2023, AS WELL AS IN-PERSON CLASSES. A TOTAL OF 79 INDIVIDUALS WERE SERVED IN ROSS COUNTY WITH NUTRITION EDUCATION, FOOD PREPARATION AND EDUCATION ON SHOPPING HEALTHY ON A BUDGET AND LABEL READING. ADENA HEALTH SUPPORTS THE INCENTIVES GIVEN TO PARTICIPANTS. ADENA HEALTH PARTNERS WITH THE ROSS COUNTY YMCA TO COORDINATE SEVERAL PROGRAMS TO IMPROVE HEALTH OUTCOMES OF PATIENTS. THESE PROGRAMS ARE LED BY CERTIFIED YMCA TRAINERS AND ARE EVIDENCED-BASED. ONE PROGRAM IS THE AMERICAN DIABETES ASSOCIATION APPROVED DIABETES PREVENTION PROGRAM WELLNESS CLASSES. THE CLASSES ARE FREE FOR PARTICIPANTS. IN 2023, 18 PATIENTS WERE SERVED IN THIS PROGRAM. THE BLOOD PRESSURE SELF-MONITORING PROGRAM (5 PARTICIPANTS), LIVESTRONG (22 PARTICIPANTS) AND FIRST STEP (23 PARTICIPANTS) PROGRAMS ARE ALSO SUPPORTED AT THE YMCA BY ADENA HEALTH. IN 2023, ADENA PAID $32,805 TO SUPPORT PATIENTS ON THEIR WELLNESS JOURNEY AT THE YMCA.FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH WORKS TO ALIGN ITS SERVICE LINES AND CLINICS WITH COMMUNITY RESOURCES TO ADDRESS THE SOCIAL FACTORS AND BARRIERS FACED BY MANY OF ITS RURAL PATIENTS. THIS OFTEN INVOLVES COMMUNITY PARTNERING AND MONETARY SUPPORT FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT. THESE TWO STRATEGIES ARE CONNECTED AND REPORTED TOGETHER. ADENA HEALTH PARTNERED AGAIN IN 2023 WITH THE CHILLICOTHE FARMER'S MARKET TO FUND THE "FOOD RX AND FRUIT & VEGGIE PERKS PROGRAMING. THIS PROGRAM PROVIDES ADENA PATIENTS REFERRED BY THEIR PROVIDER FOR A TOTAL OF $10,090 IN FRESH FRUITS AND VEGETABLES. IN 2023, ADENA HEALTH CONTINUED ITS PARTNERSHIP WITH THE YMCA OF ROSS COUNTY TO COORDINATE THE "FIRST STEP" PROGRAM. THIS PROGRAM UTILIZES A YMCA TRAINER TO OPTIMIZE (REDUCE BMI) ADENA BONE & JOINT PATIENTS PRIOR TO SURGERY TO IMPROVE SURGICAL OUTCOMES OF JOINT REPLACEMENT. A TOTAL OF 23 PATIENTS WERE SERVED IN 2023. CARE OF ALL ADENA PATIENTS IN PARTNERED PROGRAMMING WITH THE ROSS COUNTY YMCA TOTALED $32,805. RESPIRATORY ISSUESCOMMUNITY DEVELOPMENT ADENA PROVIDES A COMMUNITY HEALTH AND DEVELOPMENT REPRESENTATIVE TO PARTICIPATE IN THE BREATHEWELL ROSS COMMITTEE. THE GROUP ADDRESSES COMMUNITY INITIATIVES THAT CAN IMPROVE THE LUNG AND RESPIRATORY HEALTH OF THE COMMUNITY SUCH AS SMOKING AND VAPING CESSATION, LUNG CANCER SCREENINGS, AIR MONITORING, AND MORE. ONE ADENA EMPLOYEE SPENDS 2 HOURS/MONTH ON MEETING OBLIGATIONS. OTHER ADENA CAREGIVERS ARE INVOLVED IN PROJECTS AND PROGRAMMING AS NEEDED AS A RESULT OF THIS COMMITTEE.
ADENA REGIONAL MEDICAL CENTER	PART V, SECTION B, LINE 20E: PATIENTS HAVE 120 DAYS FROM THE TIME THEIR ACCOUNT GOES TO "SELF-PAY" TO PAY IN FULL OR MAKE PAYMENT ARRANGEMENTS. ON THE 121ST DAY, THEY ARE SENT TO A COLLECTION AGENCY. COLLECTION AGENCIES REQUIRE ADENA MANAGEMENT APPROVAL TO PURSUE LEGAL ACTION. IF AVAILABLE, SELFPAY PATIENTS ARE SCREENED FOR GOVERNMENT ASSISTANCE PROGRAMS AND FINANCIAL ASSISTANCE DURING THE INPATIENT STAY. FAP APPLICATIONS ARE PROVIDED TO THE PATIENT AS PART OF THE SCREENING. FINANCIAL ASSISTANCE APPLICATIONS ARE ALSO AVAILABLE ONLINE AND THROUGHOUT THE HOSPITALS AND CLINICS. THIS IS ALSO AVAILABLE AT THE HOPE CLINIC.
PART V, SECTION B, LINE 11 CONTINUED	ADVOCACYADENA HEALTH CONTRIBUTED THE TIME OF ONE EMPLOYEE WHO DEDICATED A MINIMUM TOTAL OF 2 HOURS PER MONTH IN 2023 TO PARTICIPATING IN COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR BREATHEWELL ROSS.PROGRAMMING & INITIATIVESADENA HEALTH CONTINUED ITS COORDINATION OF THE ADENA QUIT CLINIC IN 2023. THE CLINIC PROVIDED A TOTAL OF 19 PATIENTS SERVED IN 5 LOCATIONS: CHILLICOTHE (ROSS COUNTY); WAVERLY (PIKE COUNTY); WASHINGTON COURT HOUSE (FAYETTE COUNTY); GREENFIELD (HIGHLAND COUNTY) AND JACKSON (JACKSON COUNTY). ADENA PHARMACISTS COMPLETED 35 VISITS WITH PATIENT WITH TOBACCO CESSATION COUNSELING SERVICES INCLUDING CESSATION PLANNING, SUPPORT AND NICOTINE REPLACEMENT EDUCATION IS PROVIDED BY ADENA PHARMACISTS. ADENA PROVIDED A TOTAL OF 1,726 PATIENTS FROM THE REGION INCLUDING PIKE, FAYETTE, HIGHLAND AND ROSS COUNTIES WITH FREE LUNG CANCER SCREENINGS IN 2023 WHICH RESULTED IN 32 POSITIVE CANCER FINDINGS. BY PROVIDING CANCER SCREENINGS ADENA HEALTH IS HELPING TO DECREASE RATES OF DEATH DECLINING DUE TO EARLY INTERVENTION AND TREATMENT. THE ADENA HEALTH PARTNERS WITH THE ROSS COUNTY YMCA TO COORDINATE LIVESTRONG WELLNESS CLASSES FOR PATIENTS RECEIVING TREATMENT AT THE ADENA CANCER CENTER. IN 2023, 22 PATIENTS WERE SERVED BY THE PROGRAM. ADENA SPENT $11,550 TO SUPPORT THE PROGRAM. MENTAL HEALTHCOMMUNITY DEVELOPMENT AN ADENA REPRESENTATIVE FROM THE COMMUNITY HEALTH AND DEVELOPMENT TEAM LEAD THE ROSS COUNTY MENTAL HEALTH FORUM. THE ROSS COUNTY MENTAL HEALTH FORUM ADDRESSES TOPICS SUCH AS MENTAL HEALTH ACCESS, STIGMA REDUCTION AND OTHER MENTAL HEALTH RELATED ISSUES IN ROSS COUNTY. ADVOCACYADENA CONTRIBUTED THE TIME OF THREE EMPLOYEES (COMMUNITY HEALTH, SOCIAL WORK AND MENTAL HEALTH) IN 2023 WHO PARTICIPATED IN VIRTUAL COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR THE ROSS COUNTY MENTAL HEALTH FORUM.PROGRAMMING & INITIATIVESTHE ADENA HEALTH HOUSES A VICTIM'S ADVOCATE TEAM IN THE ARMC EMERGENCY DEPARTMENT WHICH PROVIDED A TOTAL OF 477 VICTIMS OF SEXUAL ASSAULT (ADULT AND PEDIATRIC), DOMESTIC VIOLENCE, CHILD ABUSE, ELDER ABUSE, HUMAN TRAFFICKING AND HATE CRIMES WITH MENTAL HEALTH REFERRAL, SAFETY AND SUPPORT SERVICES FREE OF CHARGE, VALUED AT $250,000 IN 2023. PATIENTS ARE SERVED 24 HOURS A DAY, SEVEN DAYS PER WEEK IN ROSS, PIKE, AND HIGHLAND AND FAYETTE COUNTIES. IN ADDITION TO THIS SUPPORT, THE ADVOCACY TEAM ALSO RESPONDED TO CASES ACROSS THE HEALTH SYSTEM TO PROVIDE SUPPORT AND RESOURCES FOR INDIVIDUALS EXPERIENCING HOMELESSNESS AND OTHER SOCIAL NEEDS. FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH SUPPORTED THE TRISTAN MILLER FOUNDATION WITH A $1,000 CONTRIBUTION FOR THE TRISTAN MILLER MUSIC FEST HELD ANNUALLY TO RAISE AWARENESS TO MENTAL HEALTH AND SUICIDE PREVENTION. CHILD SAFETY AND WELLNESSADVOCACYADENA CONTRIBUTED THE TIME OF ONE EMPLOYEE WHO DEDICATES A MINIMUM TOTAL OF 2 HOURS PER QUARTER TO PARTICIPATING IN MEETINGS AND COORDINATING PROJECTS FOR THE FAMILY AND CHILDREN FIRST COUNCIL.PROGRAMMING & INITIATIVESADENA HEALTH PROVIDED ATHLETIC TRAINER SERVICES TO 12 LOCAL PUBLIC HIGH SCHOOLS WITHIN A SIX COUNTY (ROSS, PIKE, FAYETTE, HIGHLAND, JACKSON, PICKAWAY) SERVICE REGION IN 2023. A TOTAL OF 13 ATHLETIC TRAINERS WORKED WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUSED ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE VALUE OF THIS COMMUNITY SUPPORT WAS $660,340. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN HIGHLAND, FAYETTE, AND JACKSON, PICKAWAY, PIKE, AND ROSS COUNTIES. ADENA HEALTH PARTNERED WITH THE ROSS COUNTY PUBLIC LIBRARIES TO COORDINATE THE HEALTHY KIDS SUMMER FUN CHALLENGE, ALL MADE OF GOO, AND COORDINATED WITH THE BOOKWORM SUMMER READING PROGRAM. APPROXIMATELY 1,400 ROSS COUNTY RESIDENTS - CHILDREN, TEENS, AND ADULTS- WERE ENGAGED IN THE PROGRAM THAT REWARDED THEM FOR COMPLETING HEALTH CHALLENGES. PARTICIPANTS ARE OFFERED THE OPPORTUNITY TO EARN PRIZES AS THEY COMPLETE CHALLENGES AND THOSE WHO COMPLETE ALL CHALLENGES ARE ENTERED INTO A DRAWING FOR A NEW BICYCLE AND ADULTS GOT THE OPPORTUNITY FOR A FITBIT. A TOTAL OF $2,500 WAS SPENT ON REWARD PRIZES FOR PARTICIPANTS IN ROSS, FAYETTE, HIGHLAND AND PIKE COUNTIES. ADENA HEALTH CONTINUED ITS PARTNERSHIP WITH CHILLICOTHE CITY SCHOOLS TO COORDINATE THE AIM PROGRAM, WHICH OFFERS SIX STUDENTS A FELLOWSHIP OPPORTUNITY DURING THEIR SENIOR YEAR OF HIGH SCHOOL TO EXPLORE THE CAREER OF MEDICINE. STUDENTS ARE OFFERED THE OPPORTUNITY TO SHADOW PHYSICIANS ACROSS VARIOUS SPECIALTIES AND COMPLETE A COMMUNITY HEALTH PROJECT. APPROXIMATELY $2,150 WAS SPENT ON THE PROGRAM IN 2023. IN 2021, ADENA HEALTH PARTNERED WITH NATIONWIDE CHILDREN'S HOSPITAL TO DEVELOP THE APPALACHIAN WHOLE CHILD INITIATIVE. IN 2023, ADENA HEALTH EXPANDED THE PROGRAM AND PROVIDED A 1.0 FTE VALUED AT $101,608 TO WORK WITH PARTNERED SCHOOL DISTRICT TO COMPLETE SCHOOL NEEDS ASSESSMENTS, DEVELOP SCHOOL WELLNESS PLANS, AND IMPROVE HEALTHCARE ACCESS TO STUDENTS AND STAFF. ALSO IN SEPTEMBER 2023, ADENA LAUNCHED A MOBILE HEALTH CLINIC TO PROVIDE MEDICAL CARE TO 373 STUDENTS AND STAFF. IN ADDITION, THE COORDINATOR IS ASSISTING THE DISTRICTS IN DEVELOPING PRIMARY CARE AND TELEHEALTH RESOURCES FOR THE DISTRICT, AS WELL AS BRING IN ADDITIONAL COMMUNITY PARTNERS TO ADDRESS MENTAL HEALTH AND SOCIAL NEEDS OF STUDENTS. FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH WORKS TO ALIGN ITS SERVICE LINES AND CLINICS WITH COMMUNITY RESOURCES THAT WILL ADDRESS THE SOCIAL FACTORS AND BARRIERS FACED BY MANY OF ITS RURAL PATIENTS. THIS OFTEN INVOLVES COMMUNITY PARTNERING AND MONETARY SUPPORT FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT. THESE TWO STRATEGIES ARE CONNECTED AND REPORTED TOGETHER. ROSS COUNTY JUNIOR ACHIEVEMENT: ADENA HEALTH PROVIDES ANNUAL SUPPORT IN THE AMOUNT OF $3,125 EACH YEAR TO THE ROSS COUNTY JUNIOR ACHIEVEMENT, WHICH WORKS WITH YOUTH IN ALL SCHOOL DISTRICTS, GRADES 5-12, TO EDUCATE ON FINANCIAL LITERACY, CAREER DEVELOPMENT AND ENTREPRENEURSHIP. SUPPORT IS UTILIZED TO PURCHASE LEARNING MATERIALS, AND ADENA COMMUNITY HEALTH AND DEVELOPMENT STAFF TO TEACH THE PREPARED CURRICULUM IN ROSS COUNTY SCHOOL DISTRICTS. ADENA WOMEN'S & CHILDREN'S CENTER: ADENA HEALTH PROVIDED SLEEP SACKS FOR THE 1,200 BABIES BORN AT THE ADENA WOMEN'S AND CHILDREN'S CENTER IN 2023, VALUED AT $12,777. PATIENTS COME FROM A NUMBER OF COUNTIES INCLUDING FAYETTE, ROSS, PIKE AND HIGHLAND. SCHOOL DISTRICTS: A TOTAL OF 6 ROSS COUNTY SCHOOL DISTRICTS CHILLICOTHE CITY SCHOOLS, UNION-SCIOTO LOCAL SCHOOLS, SOUTHEASTERN LOCAL SCHOOLS, ADENA LOCAL SCHOOLS, ZANE TRACE LOCAL SCHOOLS AND HUNTINGTON SCHOOL DISTRICT - EACH RECEIVED $25,000 OR A TOTAL OF $150,000 TO SUPPORT THE HEALTH AND WELLNESS OF THEIR DISTRICT'S ATHLETES, ALIGNED WITH THE SUPPORT OF ATHLETIC TRAINERS PROVIDED BY ADENA HEALTH. UNITED WAY: ARMC PROVIDED $1,390 IN SUPPORT TO UNITED WAY'S SUCCESS BY SIX PROGRAM. THE PROGRAM PROVIDED OVER 100 PRESCHOOLERS A SIX-WEEK "BOOT CAMP" TO PREPARE FOR KINDERGARTEN AHEAD OF THE UPCOMING SCHOOL YEAR. CHILLICOTHE CIVIC THEATER: ADENA PROVIDED $10,000 IN SUPPORT FOR THE CIVIC THEATER, WHICH COORDINATES THEATER PRODUCTIONS FOR ROSS COUNTY. THE CHILLICOTHE CIVIC THEATER ALSO COORDINATES A YOUTH THEATER PROGRAM WHERE CHILDREN ARE PROVIDED THE OPPORTUNITY TO PERFORM AND COORDINATE PRODUCTIONS AS PART OF THEIR EXPERIENCE.
PART V, SECTION B, LINE 11 CONTINUED	COMMUNITY HEALTH OUTCOMES AND HEALTH FACTORS SUMMARY ROSS COUNTY HEALTH OUTCOMES STAYED AT 77 IN 2022 (COUNTY HEALTH RANKINGS). ROSS COUNTY HEALTH FACTORS MOVED FROM 49 TO 56 IN 2022 (COUNTY HEALTH RANKINGS).ADDITIONAL INITIATIVES AND RESOURCESTHE ADENA FAMILY MEDICINE - RESIDENCY CLINIC AND THE ADENA RESIDENCY CLINIC INTERNAL MEDICINE CONTINUED OPERATIONS OF ITS CLINIC IN 2023 PROVIDING AFFORDABLE, QUALITY HEALTH CARE. THE CLINICS PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS PROVIDING SERVICES TO PATIENTS IN THE CLINIC. COMBINED THE CLINICS HAD 10,084 VISITS FROM PATIENTS MOSTLY FROM SEVEN COUNTIES (ROSS, PICKAWAY, PIKE, JACKSON, HIGHLAND, FAYETTE, VINTON). APPROXIMATELY 5% OF PATIENTS SERVED BY THE CLINICS ARE UNINSURED. COMMUNITY SERVICE: ADENA ALSO PROVIDES SUPPORT TO THE ROSS COUNTY COMMUNITY THROUGH A VARIETY OF ENGAGEMENT ACTIVITIES, INCLUDING FINANCIAL SUPPORT AND PARTICIPATION IN LOCAL COMMUNITY EVENTS AND INITIATIVES. MORE THAN 150 CAREGIVERS FROM ACROSS THE SYSTEM PROVIDED A 500+ OF HOURS OF COMMUNITY SERVICE AND VOLUNTEER TIME PARTICIPATING IN COMMUNITY OUTREACH EVENTS, PACKING WEEKEND FOOD BAGS FOR FOOD INSECURE CHILDREN, NON-PROFIT BOARD PARTICIPATION AND LEADERSHIP, COMMUNITY EVENTS AND OTHER INITIATIVES. COMMUNITY SPONSORSHIPS: ADENA SUPPORT A NUMBER OF INITIATIVES IN THE COMMUNITY AND REGION TO BENEFIT THE WELLBEING OF THOSE IN THE COMMUNITY.IN ADDITION TO ITEMS LISTED PREVIOUSLY IN THIS REPORT, OTHER SPONSORSHIPS INCLUDE: $15,000 IN SUPPORT FOR THE 2-1-1 INFORMATION AND REFERRAL LINE OPERATED BY THE ROSS COUNTY UNITED WAY. THE LINE IS A 24/7 RESOURCE AND CONNECTION TO FOOD, EDUCATION, TRANSPORTATION, FINANCIAL ASSISTANCE AND HEALTHCARE RESOURCES. $20,000 IN SUPPORT OF THE ROSS COUNTY UNITED WAY'S ANNUAL CAMPAIGN. UNITED WAY UTILIZES FUNDS RAISED TO OFFER GRANTS FOR EDUCATION, HEALTH AND FINANCIAL MOBILITY PROGRAMMING. $15,000 SPONSORSHIP TO THE ROSS COUNTY YMCA. OVER $2,956 IN COORDINATED TRANSPORTATION SERVICES FOR PATIENTS IN FAYETTE, ROSS, HIGHLAND AND PIKE COUNTIES WITHOUT TRANSPORT TO MEDICAL APPOINTS AND NO INSURANCE COVERAGE. ADENA PROVIDED $1,000 IN FINANCIAL SUPPORT TO BIG BROTHER BIG SISTERS OF SOUTH CENTRAL OHIO FOR ANNUAL BOWL FOR KIDS' SAKE. ALSO PROVIDED AN ADDITIONAL $2,800 FOR THE DANCE FOR KIDS' SAKE EVENT. SUPPORTED THE CHILLICOTHE ROSS CHAMBER OF COMMERCE WITH A $1,000 CONTRIBUTION FOR THE EPIC PROGRAM TO MENTOR YOUNG ADULTS IN BUSINESS. PROVIDED $750 TO HOPE CLINIC TO SUPPORT ANNUAL 5K. $5,000 SPONSORSHIP OF THE CHILLICOTHE HALF MARATHON. ADENA HEALTH PROVIDED $10,000 IN SUPPORT TO ASSIST THE CHILLICOTHE ROTARY IN COORDINATING THE CHILLICOTHE 4TH OF JULY FIREWORKS CELEBRATION IN THE DOWNTOWN AREA. $2,000 SPONSORSHIP OF THE DR. ATER MEMORIAL GOLF OUTING BENEFITING THE CHILD PROTECTION CENTER OF ROSS COUNTY. ADENA HEALTH PROVIDED $7,000 IN SUPPORT TO ASSIST THE DOWNTOWN CHILLICOTHE DEVELOPMENT ASSOCIATES IN COORDINATING THE SAND IN THE STREETS VOLLEYBALL TOURNAMENT. CAREGIVERS FROM ADENA BONE & JOINT ALSO VOLUNTEERED TIME TO PROVIDE FIRST AID SERVICES FOR THE EVENT. ADENA HEALTH PROVIDED $10,000 IN SUPPORT TO ASSIST THE DOWNTOWN DEVELOPMENT ASSOCIATES IN COORDINATING THE 2023 HOLIDAY LIGHTING OF YOCTANGEE PARK IN DOWNTOWN CHILLICOTHE. ADENA PROVIDED $1,000 IN SUPPORT TO THE FALL FESTIVAL OF LEAVES. ADENA PROVIDED THE ROSS COUNTY AGRICULTURAL SOCIETY $6,150 TO SUPPORT THE FAIR MARKET SALES, $9,500 IN SUPPORT TO PROVIDE A FREE RIDE DAY FOR THE CHILDREN ATTENDING THE FAIR, AND AN ADDITIONAL $2,000 IN SUPPORT. $1,500 FOR FEAST OF THE FLOWERING MOON SPONSORSHIP. ADENA CONTRIBUTED $2,000 TO THE JUNIOR CIVIC LEAGUE'S HOLIDAY GALA EVENT. A $10,607 INVESTMENT FOR SCOREBOARDS FOR THE SCIOTO VALLEY YOUTH LEAGUE SOFTBALL. $360 DONATION TO THE ROSS COUNTY CHAPTER OF THE NAACP. PROVIDED $3,240 IN SUPPORT TO ROSS COUNTY PARTNER SCHOOLS FOR BANNERS. $10,000 SPONSOARSHIP FOR THE CHILLICOTHE CIVIC THEATRE. ADDITIONAL COMMUNITY COLLABORATIONSROSS COUNTY CHILD PROTECTION CENTER: ADENA HEALTH CONTINUED IT'S MORE THAN 25 YEAR RELATIONSHIP WITH AND SUPPORT OF THE ROSS COUNTY CHILD PROTECTION CENTER IN 2023 WHICH PROVIDES RESOURCES AND COUNSELING TO YOUNG VICTIMS OF INTERPERSONAL VIOLENCE AND SEXUAL ASSAULT IN A NINE COUNTY SERVICE REGION THAT INCLUDES FAYETTE, ROSS, PIKE AND HIGHLAND COUNTIES. ADENA PROVIDED A TOTAL OF $61,374 IN FINANCIAL SUPPORT FOR THE CPC'S FACILITY COSTS AND INFORMATION TECHNOLOGY NEEDS. MEDICAL AND NURSING STAFF ALSO PROVIDE SUPPORT TO THE CENTER. AN ADDITIONAL $2,000 IN SUPPORT WAS PROVIDED TO SUPPORT THE FUNDRAISING EFFORTS OF THE ORGANIZATION. HOPE CLINIC: ADENA PROVIDER, JAMI EASTERDAY, CNP, CONTINUED VOLUNTEER EFFORTS AS THE DIRECTOR OF THE HOPE CLINIC OF ROSS COUNTY IN 2023. THIS CLINIC PROVIDES FREE MEDICAL CARE TO THOSE WITHOUT HEALTH INSURANCE COVERAGE, INCLUDING MEDICAL, DENTAL AND VISION CARE. LOCATED IN CHILLICOTHE, OHIO, THE CLINIC SERVES PATIENTS FROM AROUND THE REGION INCLUDING ROSS, PIKE FAYETTE, AND HIGHLAND COUNTIES. IT IS OPEN ONE DAY PER WEEK. THE CLINIC SAW MORE THAN 1500 PATIENTS FOR MEDICAL, DENTAL AND PHARMACY SERVICES AND DISPENSED MORE THAN 4000 PRESCRIPTIONS THROUGH THE CHARITABLE PHARMACY. TEN PROVIDERS FROM ADENA HEALTH VOLUNTEERED 68 HOURS OF CARE AT HOPE CLINIC IN 2023. ADENA CAREGIVERS ALSO VOLUNTEER AS STAFF IN THE CLINIC AND/OR AT THE MOBILE FOOD CLINIC TO ASSIST THOSE WHO ARE FOOD INSECURE (MORE THAN 7900 RESIDENTS IN 2023). ADENA HEALTH PROVIDES ADDITIONAL MONETARY SUPPORT FROM ITS COMMUNITY HEALTH BUDGET TO THE HOPE CLINIC FOR THE CLINIC'S COMMUNITY CHARITABLE PHARMACY AND MEDICAL RESOURCE SYSTEM ELSEVIER. AN ADDITIONAL $1500 WAS ALSO PROVIDED TO SUPPORT GENERAL FUNDRAISING CAMPAIGN FOR SERVICES. FOR MORE INFORMATION, GO TO HTTP://WWW.HOPECLINICFREE.ORG/. PARTNERS FOR A HEALTHIER ROSS COUNTY HEALTH COALITION: IN 2015, ADENA HEALTH COLLABORATED WITH THE ROSS COUNTY HEALTH DISTRICT TO COORDINATE AND CONVENE A COMMUNITY HEALTH COALITION FOCUSED ON COMPLETING REGULAR COMMUNITY HEALTH ASSESSMENTS (CHA) AND A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR ROSS COUNTY. A TOTAL OF 19 LOCAL GOVERNMENT, CIVIC AND BUSINESS LEADERS PARTICIPATE TO IDENTIFY STRATEGIC HEALTH PRIORITIES FOR THE COMMUNITY AND ASSIST IN ALLOCATING RESOURCES TO SUPPORT INITIATIVES BUILT AROUND THESE STRATEGIC PRIORITIES. ADENA HEALTH HAD A TOTAL OF FIVE ADENA EMPLOYEES THAT VOLUNTEERED OVER 40 HOURS IN 2023 TO CONTRIBUTING TO THE PARTNERS FOR A HEALTHIER ROSS COUNTY STEERING COMMITTEE IN ADDITION TO OTHER SUB-COMMITTEES MENTIONED THROUGHOUT THIS REPORT.
PART V, LINE 7A	HTTPS://WWW.ADENA.ORG/COMMUNITY-HEALTH/OVERVIEW
PART V, LINE 10A	HTTPS://WWW.ADENA.ORG/COMMUNITY-HEALTH/OVERVIEW
PARY V, LINE 16A, FAP	HTTPS://WWW.ADENA.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE
PART V, LINE 16B, FAP APPLICATION	HTTPS://WWW.ADENA.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY	HTTPS://WWW.ADENA.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE

Schedule H (Form 990) 2023

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?24
Name and address		Type of Facility (describe)
1	1 - ADENA HEALTH PAVILION 4437 STATE ROUTE 159 CHILLICOTHE,OH45601	PHYSICIAN OFFICES, OUTPATIENT SURGERY CENTER
2	2 - ADENA MEDICAL OFFICE BUILDING 4439 STATE ROUTE 159 CHILLICOTHE,OH45601	PHYSICIAN OFFICES
3	3 - ADENA HEALTH CENTER - WAVERLY 12340 STATE ROUTE 104 WAVERLY,OH45690	AMBULATORY CARE CENTER
4	4 - ADENA URGENT CARE 55 CENTENNIAL BLVD CHILLICOTHE,OH45601	AMBULATORY CARE CENTER
5	5 - ADENA HOME CARE SERVICES 111 W WATER STREET CHILLICOTHE,OH45601	HOME HEALTH CARE AND HOSPICE
6	6 - ADENA HEALTH CENTER - JACKSON 1000 VETERANS DRIVE JACKSON,OH45640	AMBULATORY CARE CENTER
7	7 - ADENA REHABILITATION AND WELLNESS CENTER 445 SHAWNEE LANE CHILLICOTHE,OH45601	OUTPATIENT REHABILITATION CENTER
8	8 - ADENA FAMILY MEDICINE - OAK HILL 315 WASHINGTON STREET OAK HILL,OH45656	PHYSICIAN OFFICES
9	9 - ADENA PICKAWAY-ROSS FAMILY PHYSICIANS 100 N WALNUT STREET CHILLICOTHE,OH45601	PHYSICIAN OFFICES
10	10 - ADENA FAMILY MEDICINE - CIRCLEVILLE 798 N COURT STREET CIRCLEVILLE,OH43113	PHYSICIAN OFFICES
11	11 - ADENA COUNSELING CENTER 445 SHAWNEE LANE CHILLICOTHE,OH45601	MENTAL HEALTH COUNSELING
12	12 - ADENA FAMILY MEDICINE OF CHILLICOTHE 626 CENTRAL CENTER CHILLICOTHE,OH45601	PHYSICIAN OFFICES
13	13 - ADENA ROSS UROLOGY 8 MEDICAL DRIVE CHILLICOTHE,OH45601	PHYSICIAN OFFICES
14	14 - ADENA FAMILY MEDICINE - GREENFIELD 536 MIRABEAU STREET GREENFIELD,OH45123	PHYSICIAN OFFICES
15	15 - ADENA FAMILY MEDICINE - WASHINGTON CH 308 HIGHLAND AVENUE SUITE C WASHINGTON COURT HOU,OH43160	PHYSICIAN OFFICES
16	16 - ADENA FAMILY MEDICINE - WELLSTON 118 SOUTH NEW YORK AVE SUITE A WELLSTON,OH45692	NURSE PRACTITIONER CLINIC
17	17 - ADENA FAMILY MEDICINE - HILLSBORO 160 ROBERTS LANE HILLSBORO,OH45133	URGENT CARE AND FAMILY PRACTICE
18	18 - ADENA HEALTH & WELLNESS CNTR-MAIN CAMPUS 4457 ST RT 159 CHILLICOTHE,OH45601	PHYSICIAN OFFICE, CARDIAC REHAB, OCCUPATIONAL MEDICINE
19	19 - ADENA CANCER CENTER 4435 ST RT 159 CHILLICOTHE,OH45601	OUTPATIENT CHEMOTHERAPY AND RADIATION
20	20 - ADENA WELLNESS CENTER WEST 2077 WESTERN AVENUE CHILLICOTHE,OH45601	HOME HEALTH AND REHABILITATION
21	21 - ADENA HEALTH CENTER CIRCLEVILLE 140 MORRIS ROAD CIRCLEVILLE,OH43113	AMBULATORY CARE CENTER
22	22 - AOSI CIRCLEVILLE 160 SUMMIT AVE CIRCLEVILLE,OH43113	PHYSICIAN OFFICE
23	23 - ADENA HEALTH URGENT CARE CIRCLEVILLE 166 SUMMIT AVE CIRCLEVILLE,OH43113	URGENT CARE
24	24 - ADENA URGENT CARE BRIDGE STREET 1450 N BRIDGE STREET CHILLICOTHE,OH45601	URGENT CARE

Schedule H (Form 990) 2023

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 7:	THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B.
PART I, LN 7 COL(F):	BAD DEBT EXPENSE OF $22,113,589 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN.
PART II, COMMUNITY BUILDING ACTIVITIES:	ADENA HEALTH SYSTEM SUPPORTS COMMUNITY BUILDING ACTIVITIES BY PROVIDING GRANTS TO THE FOLLOWING ORGANIZATIONS:CHILLICOTHE CAVALIER CLUB- GRANT PROVIDED TO INSTALL A SCOREBOARDUNITED WAY OF ROSS COUNTY- GRANT PROVIDED TO SUPPORT RELAY FOR LIFEMIGHTY CHILDREN'S MUSEUM- GRANT PROVIDED TO BUILD A CHILDREN'S MUSEUM TO ENCOURAGE LEARNING AND CREATIVITYROSS COUNTY AGRICULTURAL SOCIETY- GRANT PROVIDED TO SUPPORT FREE RIDE DAY AT THE ROSS COUNTY FAIR AND TO PROVIDE A STAGE FOR THE HEALTHY KIDS EVENTROSS COUNTY CHILD PROTECTION CENTER- GRANT PROVIDED TO SUPPORT ADVOCATES FOR CHILDREN OF ABUSE AND NEGLECT
PART III, LINE 2:	THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS.
PART III, LINE 3:	ENSEMBLE PERFORMS ALL MEDICAID AND FINANCIAL ASSISTANCE ELIGIBILITY PER POLICY.
PART III, LINE 4:	WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA REGIONAL MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF THE SYSTEM'S FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE, ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE."
PART III, LINE 8:	MEDICARE SHORTFALL, WHICH IS THE EXCESS OF COSTS TO TREAT MEDICARE PATIENTS OVER THE REIMBURSEMENT RECEIVED FROM THE FEDERAL GOVERNMENT, SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - THE MEDICARE SHORTFALL REPRESENTS THE RELIEF OF A FINANCIAL BURDEN THAT WOULD OTHERWISE BE BORNE BY A GOVERNMENT PROGRAM.- THE MEDICARE SHORTFALL REPRESENTS A SOCIETAL BENEFIT INSOFAR AS MANY OF THE PROGRAMS AND SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY, IF THE DECISION TO PROVIDE SUCH SERVICES WAS MADE ON A FINANCIAL BASIS.- MEDICARE IS A SOCIETAL BENEFIT, PROVIDED BY THE FEDERAL GOVERNMENT, FOR THOSE WHO WOULD OTHERWISE BE UNINSURED AFTER AGING OUT OF TRADITIONAL MEANS OF HEALTH INSURANCE, SUCH AS INSURANCE PROVIDED BY AN EMPLOYER.- MEDICARE IS NOT A TRUE MARKET PAYER, AS COMPARED TO COMMERCIAL PAYERS, WHEREBY REIMBURSEMENT RATES CAN BE NEGOTIATED AND ADJUSTED IN ORDER TO REDUCE INCURRED LOSSES.ADENA HEALTH SYSTEM USED THE MEDICARE ALLOWABLE COSTS PER ITS 2023 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF APPLICABLE. ALLOWABLE COSTS ARE CALCULATED BY ALLOCATING TOTAL FACILITY COSTS TO REVENUE GENERATING UNITS WITHIN THE HOSPITAL. THE MEDICARE COST REPORT DOES NOT REFLECT ALL OF THE COSTS ASSOCIATED WITH MEDICARE PROGRAMS.PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES THAT WERE BOOKED IN THE CURRENT TAX YEAR ARE ALSO INCLUDED IN THE CURRENT TAX YEAR CALCULATION.
PART III, LINE 9B:	IF THE RESPONSIBLE INDIVIDUAL HAS NOT SUBMITTED A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE OR HAS NOT PAID-IN-FULL, FOUR SEPARATE STATEMENTS ARE SENT OUT FOR THE COLLECTION OF SELF-PAY ACCOUNTS. THE FINAL STATEMENT SENT WILL INFORM THE INDIVIDUAL OF POSSIBLE EXTRAORDINARY COLLECTION ACTIONS (ECA) TO BE TAKEN IF FINANCIAL ASSISTANCE IS NOT APPLIED FOR OR THE ACCOUNT IS NOT PAID IN FULL. AFTER THE FINAL STATEMENT AND BEFORE ECAS ARE TAKEN, REASONABLE EFFORTS ARE MADE TO ORALLY CONTACT THE INDIVIDUAL AS A FINAL NOTICE. PATIENTS WHO CANNOT PAY CHARGES IN FULL MAY ALSO BE OFFERED A PAYMENT PLAN THAT IS CONSISTENT WITH ADENA'S CUSTOMER SERVICE PROCEDURES.
PART VI, LINE 3:	THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. STAFF AT THE CASHIER AREA EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE.
PART VI, LINE 4:	ROSS COUNTY, HOME TO ADENA REGIONAL MEDICAL CENTER, IS LOCATED IN SOUTH CENTRAL OHIO. IT IS PART OF 2 CONGRESSIONAL DISTRICTS (2ND AND THE 15TH) AND ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES TO IMPROVE THE LIVES OF ITS 77,000 RESIDENTS. THESE INCLUDE LOW EDUCATIONAL ATTAINMENT PERCENTAGES AND HIGH RATES OF UNEMPLOYMENT AND POVERTY. THE TOTAL POPULATION OF ROSS COUNTY REPRESENTS 15% OF THE TOTAL ADENA HEALTH SYSTEM SERVICE REGION AND IS THE PRIMARY PLACE OF RESIDENCE FOR 80% OF THE PATIENTS IT SERVES. THE COUNTY, AS WELL AS THE REMAINDER OF THE 12 COUNTY SERVICE REGION, HAS SIMILAR DEMOGRAPHICS AS THE STATE OF OHIO AND U.S. OVER 64% OF THE POPULATION IS BETWEEN THE AGES OF 19 AND 64 AND 13% OF THE POPULATION IS OVER THE AGE OF 65. THE MAJORITY OF THE POPULATION IS WHITE WITH AFRICAN AMERICANS MAKING UP THE MAJORITY OF THE REGION'S MINORITY POPULATION.THE 28,269 HOUSEHOLDS IN ROSS COUNTY REPRESENT 14.7% OF THE HOUSEHOLDS IN ADENA HEALTH SYSTEM'S 12-COUNTY SERVICE REGION. THE AVERAGE HOUSEHOLD SIZE IS 2.54 PEOPLE, COMPARABLE WITH THE REST OF OHIO AND THE U.S. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.05 PEOPLE. A LITTLE MORE THAN 50% OF THE POPULATION IS NOW MARRIED WHICH IS COMPARABLE WITH OHIO AND NATIONAL AVERAGES. MORE THAN 14% ARE DIVORCED WHICH IS NOTICEABLY HIGHER THAN BOTH THE STATE AND NATIONAL AVERAGES. MORE THAN 15% OF THE ADULTS IN ROSS COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN BOTH THE OHIO (12.2%) AND NATIONAL (14.6%) AVERAGES, BUT IS LOWER THAN THE AVERAGE FOR THE 12-COUNTY SERVICE REGION (18.9%). MORE THAN 10% OF THE POPULATION OF ROSS COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS.THE UNEMPLOYMENT RATE IN ROSS COUNTY (4.8%) IS COMPARABLE TO THE U.S. AVERAGE. IN ADDITION, MORE THAN 45% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE AND NATIONAL AVERAGES. THE TOP FIVE EMPLOYMENT INDUSTRIES IN ROSS COUNTY ARE MANAGEMENT/PROFESSIONAL OCCUPATIONS, EDUCATION/HEALTHCARE SERVICES, SALES, PRODUCTION/TRANSPORTATION SERVICES, AND SERVICE OCCUPATIONS. ROSS COUNTY HAS MORE PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE COUNTY HAS ABOUT HALF AS MANY PROFESSIONAL, SCIENTIFIC AND MANAGEMENT SERVICES PROFESSIONALS AS OHIO AND THE U.S.THE PER CAPITA, MEDIAN AND MEAN HOUSEHOLD INCOMES IN ROSS COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES, BUT HIGHER THAN REGIONAL AVERAGE. POVERTY RATES ARE ALSO HIGHER THAN STATE AND NATIONAL AVERAGES BUT LOWER THAN THE REST OF THE REGION. ACCESS TO EMPLOYMENT IN ROSS COUNTY IS HIGHER THAN OTHER COUNTIES IN THE REGION.THERE ARE 6,348 CIVILIAN VETERANS LIVING IN ROSS COUNTY, ACCOUNTING FOR ALMOST 8% OF THE REGION'S POPULATION. THE TOTAL CIVILIAN VETERANS WITHIN THE ADENA HEALTH SYSTEM 12-COUNTY SERVICE REGION REPRESENT 5% OF OHIO'S TOTAL CIVILIAN VETERAN POPULATION. ROSS COUNTY ALSO HAS A VETERAN'S ADMINISTRATION HOSPITAL LOCATED 4.5 MILES FROM ADENA REGIONAL MEDICAL CENTER.ROSS COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. ROSS COUNTY'S PREVALENCE RATE IS 13.5%.
PART VI, LINE 5:	ADENA REGIONAL MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES, AND VOLUNTEERS. THE 2022 BOARD OF TRUSTEES OF ADENA HEALTH SYSTEM WAS COMPRISED OF 14 MEMBERS WHO ALL RESIDE IN THE HOSPITAL SERVICE AREA. TWO OF THE BOARD MEMBERS WERE AN EMPLOYEE OF ADENA HEALTH SYSTEM AT THE END OF THE YEAR.
PART VI, LINE 6:	FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. IN 2018 THE SYSTEM COMPLETED THE FIRST OF 3 PHASES OF A $40M RENOVATION/EXPANSION OF ITS EMERGENCY CENTER. THIS WAS IN DIRECT RESPONSE TO PUBLIC COMMENTS ABOUT THE CONGESTION OF SPACE. IT HAS ALLOWED FOR ENHANCED CARE AND IMPROVED COORDINATION OF CARE WITH THE EMERGENCY RESPONSE SERVICES IN THE SERVICE AREA. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WASHINGTON COURT HOUSE, WAVERLY, HILLSBORO, AND WELLSTON, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE, WAVERLY, AND HILLSBORO. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN). THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS.

Schedule H (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
ADENA HEALTH SYSTEM

Employer identification number
31-4379443

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE,OH45601	75-3008742	501 C (3)	768,570	COMMUNITY IMPROVEMENT INITIATIVE
(2) ADENA LOCAL SCHOOL DISTRICT 3367 COUNTY ROAD 550 FRANKFORT,OH45628	31-0709140	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE
(3) CHILD PROTECTION CENTER OF ROSS CO 138 MARIETTA RD STE E CHILLICOTHE,OH45601	31-1579825	501 C (3)	63,747	COMMUNITY IMPROVEMENT INITIATIVE
(4) CHILLICOTHE CITY SCHOOLS 425 TOCTANGEE PARKWAY CHILLICOTHE,OH45601	31-6400384	115	29,000	COMMUNITY IMPROVEMENT INITIATIVE
(5) CHILLICOTHE FARMERS MARKET ASSOCIATION 300 CHILLICOTHE AVE HILLSBORO,OH45133	26-2216517	501 C (4)	16,181	COMMUNITY IMPROVEMENT INITIATIVE
(6) CHILLICOTHE ROSS CHAMBER OF COMMERCE 41 E MAIN ST CHILLICOTHE,OH45601	31-4147100	501 C (3)	5,500	COMMUNITY IMPROVEMENT INITIATIVE
(7) CHILLICOTHE ROTARY FOUNDATION PO BOX 6357 CHILLICOTHE,OH45601	31-6059785	115	10,000	COMMUNITY IMPROVEMENT INITIATIVE
(8) DOWNTOWN CHILLICOTHE 45 E MAIN ST CHILLICOTHE,OH45601	36-4901133	115	7,000	COMMUNITY IMPROVEMENT INITIATIVE
(9) FAYETTE COUNTY AGRICULTURAL SOCIETY PO BOX 1017 WASHINGTON,OH43160	31-0606010	115	11,300	COMMUNITY IMPROVEMENT INITIATIVE
(10) FAYETTE COUNTY YMCA 100 CIVIC DRIVE WASHINGTON COURT HOUSE,OH43160	61-1416843	115	32,033	COMMUNITY IMPROVEMENT INITIATIVE
(11) GREENFIELD EXEMPTED VILLAGE SCHOOL 200 NORTH FIFTH ST GREENFIELD,OH45123	31-6000808	115	50,000	COMMUNITY IMPROVEMENT INITIATIVE
(12) HOPE CLINIC OF ROSS COUNTY INC 7479 COUNTY RD 550 FANKFORT,OH45628	45-2390821	501 C (3)	20,000	COMMUNITY IMPROVEMENT INITIATIVE
(13) HOPE PARTNERSHIP PROJECTS 22 YAPLES ORCHARD DR CHILLICOTHE,OH45601	86-2294038	501 C (3)	31,573	COMMUNITY IMPROVEMENT INITIATIVE
(14) HUNTINGTON LOCAL BOARD OF EDUCATION 188 HUNTSMAN ROAD CHILLICOTHE,OH45601	31-6400570	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE
(15) JACKSON AREA FESTIVALS & EVENTS PO BOX 488 JACKSON,OH45640	46-1960880	115	12,000	COMMUNITY IMPROVEMENT INITIATIVE
(16) OHIO STATE UNIVERSITY 901 WOODY HAYES DR 2020 BLANKENSHIP HALL COLUMBUS,OH43210	31-6025986	115	32,324	COMMUNITY IMPROVEMENT INITIATIVE
(17) PICKAWAY ADDICTION ACTION COALITION 770 NORTH COURT STREET CIRCLEVILLE,OH43113	82-4089691	501 C (3)	15,000	COMMUNITY IMPROVEMENT INITIATIVE
(18) PIKE COUNTY AGRICULTURAL SOCIETY 311 MILL ST PIKETON,OH45661	31-6106189	501 C (3)	15,000	COMMUNITY IMPROVEMENT INITIATIVE
(19) ROSS COUNTY AGRICULUTURAL SOCIETY PO BOX 614 CHILLICOTHE,OH45601	31-6050864	501 C (3)	11,985	COMMUNITY IMPROVEMENT INITIATIVE
(20) ROSS COUNTY COMMUNITY ACTION 250 N WOODRIDGE AVE CHILLICOTHE,OH45601	31-6059908	501 C (3)	160,203	COMMUNITY IMPROVEMENT INITIATIVE
(21) ROSS COUNTY HEALTH DEPARTMENT 150 E SECOND STREET CHILLICOTHE,OH45601	31-6400085	115	8,646	COMMUNITY IMPROVEMENT INITIATIVE
(22) ROSS COUNTY YMCA 100 MILL STREET CHILLICOTHE,OH45601	31-4379806	501 C (3)	51,263	COMMUNITY IMPROVEMENT INITIATIVE
(23) SCIOTO VALLEY LOCAL SCHOOL DISTRICT 1414 PIKETON RD PIKETON,OH45661	31-6402789	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE
(24) SCIOTO VALLEY YOUTH LEAGUE PO BOX 169 CHILLICOTHE,OH45601	31-0803685	115	10,607	COMMUNITY IMPROVEMENT INITIATIVE
(25) SHINE ON CHILLICOTHE 562 BELLEVIEW AVE CHILLICOTHE,OH45601	88-1367174	115	10,000	COMMUNITY IMPROVEMENT INITIATIVE
(26) SOUTHEASTERN LOCAL SCHOOL DTISRICT 2003 LANCASTER ROAD CHILLICOTHE,OH45601	31-6400983	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE
(27) THE BUCK FIFTY INC 113 GORDON DRIVE CHILLICOTHE,OH45601	81-1817174	501 C (3)	35,000	COMMUNITY IMPROVEMENT INITIATIVE
(28) UNITED WAY ROSS CO 69 EAST WATER STREET CHILLICOTHE,OH45601	31-4389671	501 C (3)	36,000	JOB DEVELOPMENT INITIATIVE
(29) WASHINGTON COURT HOUSE CITY SCHOOLS 306 HIGHLAND AVENUE WASHINGTON COURT HOUSE,OH43160	31-6001001	115	25,300	COMMUNITY IMPROVEMENT INITIATIVE
(30) WAVERLY CITY BOARD OF EDUCATION 1 TIGER DRIVE WAVERLY,OH45690	31-6401098	115	25,500	COMMUNITY IMPROVEMENT INITIATIVE
(31) WELLSTON CITY SCHOOLS 1 E BROADWAY ST WELLSTON,OH45692	31-6401103	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE
(32) ZANE TRACE LOCAL SCHOOL DISTRICT 946 STATE ROUTE 180 CHILLICOTHE,OH45601	37-0711566	115	25,000	COMMUNITY IMPROVEMENT INITIATIVE

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2023

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	DECISIONS TO DONATE TO COMMUNITY PROJECTS ARE BROUGHT TO CEO FOR APPROVAL FROM MEMBERS OF SENIOR LEADERSHIP AND/OR THE STRATEGY DEPARTMENT. FOR EACH GRANT THERE IS AN AGREEMENT SIGNED BY ADENA AND THE ORGANIZATION RECEIVING THE DONATION THAT CONFIRMS FUNDS ARE BEING USED FOR THE INTENDED PURPOSE. A BLANKET AMOUNT IS BUDGETED FOR THE FISCAL YEAR AND CONSIDERED AS EACH REQUEST IS MADE.

Schedule I (Form 990) 2023

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
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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 ............

Yes

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) 2023

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)
1ATIQ REHMAN PHYSICIAN	(i) (ii)	993,491 ------------- 1,644,119	554,523 ------------- 0	23,871 ------------- 0	19,939 ------------- 0	52,295 ------------- 0	1,644,119 ------------- 1,644,119	0 ------------- 0
2ROGER WILTFONG PHYSICIAN	(i) (ii)	383,685 ------------- 1,462,744	998,341 ------------- 0	17,375 ------------- 0	16,500 ------------- 0	46,843 ------------- 0	1,462,744 ------------- 1,462,744	0 ------------- 0
3JAMES FLEMING PHYSICIAN	(i) (ii)	487,079 ------------- 1,190,583	532,901 ------------- 0	100,405 ------------- 0	20,160 ------------- 0	50,038 ------------- 0	1,190,583 ------------- 1,190,583	0 ------------- 0
4WAHEED GUL PHYSICIAN	(i) (ii)	637,987 ------------- 1,051,988	275,273 ------------- 0	53,751 ------------- 0	23,000 ------------- 0	61,977 ------------- 0	1,051,988 ------------- 1,051,988	0 ------------- 0
5KELLY GALLINA PHYSICIAN	(i) (ii)	308,615 ------------- 1,011,737	603,156 ------------- 0	22,642 ------------- 0	16,500 ------------- 0	60,824 ------------- 0	1,011,737 ------------- 1,011,737	0 ------------- 0
6JEFF GRAHAM CEO	(i) (ii)	956,818 ------------- 0	39,688 ------------- 0	13,860 ------------- 0	23,080 ------------- 0	35,120 ------------- 0	1,068,566 ------------- 0	0 ------------- 0
7REGGINA YANDILA FORMER TRUSTEE/PHYSICIAN	(i) (ii)	154,372 ------------- 380,470	132,880 ------------- 0	47,545 ------------- 0	10,605 ------------- 0	35,068 ------------- 0	380,470 ------------- 380,470	0 ------------- 0
8DR SHAHEED KOURY CHIEF CLINICAL OFFICER	(i) (ii)	547,451 ------------- 0	52,677 ------------- 0	25,072 ------------- 0	76,153 ------------- 0	50,759 ------------- 0	752,112 ------------- 0	0 ------------- 0
9JAMES MCMANUS AHS CHIEF FINANCIAL OFFICER	(i) (ii)	547,954 ------------- 0	35,472 ------------- 0	38,085 ------------- 0	74,012 ------------- 0	51,932 ------------- 0	747,455 ------------- 0	29,615 ------------- 0
10ANTHONY FREEMAN FORMER CHIEF MEDICAL OFFICER	(i) (ii)	469,949 ------------- 0	0 ------------- 0	144,147 ------------- 0	21,276 ------------- 0	56,803 ------------- 0	692,175 ------------- 0	0 ------------- 0
11KATHERINE EDRINGTON COO	(i) (ii)	605,161 ------------- 0	13,933 ------------- 0	2,100 ------------- 0	17,691 ------------- 0	15,083 ------------- 0	653,968 ------------- 0	0 ------------- 0
12CRAIG BABBITT CHIEF LEGAL OFFICER	(i) (ii)	441,135 ------------- 0	7,813 ------------- 0	45,873 ------------- 0	65,500 ------------- 0	36,819 ------------- 0	597,140 ------------- 0	43,544 ------------- 0
13RICHARD D MIZER PRESIDENT OF AMG	(i) (ii)	388,472 ------------- 0	3,629 ------------- 0	48,102 ------------- 0	58,868 ------------- 0	22,448 ------------- 0	521,519 ------------- 0	38,895 ------------- 0
14HEATHER SPRAGUE CHIEF HUMAN RESOURCE OFFICER	(i) (ii)	387,878 ------------- 0	8,314 ------------- 0	40,610 ------------- 0	17,244 ------------- 0	59,690 ------------- 0	513,736 ------------- 0	0 ------------- 0
15KRISTIN BOGGS CHIEF COMPLIANCE OFFICER	(i) (ii)	340,102 ------------- 0	6,991 ------------- 0	74,117 ------------- 0	56,792 ------------- 0	4,454 ------------- 0	482,456 ------------- 0	38,875 ------------- 0
16JAMIE SMITH CHIEF INFORMATION OFFICER	(i) (ii)	305,428 ------------- 0	4,328 ------------- 0	35,235 ------------- 0	48,138 ------------- 0	35,514 ------------- 0	428,643 ------------- 0	34,610 ------------- 0
17JOHN GABIS PRESIDENT OF AMG	(i) (ii)	365,780 ------------- 0	2,677 ------------- 0	5,291 ------------- 0	14,646 ------------- 0	25,000 ------------- 0	413,394 ------------- 0	0 ------------- 0
18MOLLY M GROOMS CHIEF NURSING OFFICER	(i) (ii)	308,991 ------------- 0	2,747 ------------- 0	34,538 ------------- 0	48,879 ------------- 0	2,896 ------------- 0	398,051 ------------- 0	33,855 ------------- 0
19DONALD DIENER PRESIDENT OF ARMC	(i) (ii)	286,217 ------------- 0	0 ------------- 0	4,205 ------------- 0	67,727 ------------- 0	31,462 ------------- 0	389,611 ------------- 0	0 ------------- 0
20LISA CARLSON FORMER CFO	(i) (ii)	28,082 ------------- 0	291 ------------- 0	241,683 ------------- 0	931 ------------- 0	89 ------------- 0	271,076 ------------- 0	241,505 ------------- 0
21TY MCBEE VP OF STRATEGIC OPERATIONS	(i) (ii)	223,347 ------------- 0	4,514 ------------- 0	1,111 ------------- 0	11,580 ------------- 0	13,204 ------------- 0	253,756 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

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	ADENA HEALTH SYSTEM PROVIDES FOR A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR ALL OFFICERS AND KEY EMPLOYEES. THIS BENEFIT IS GROSSED UP AND TAXED AND RECEIVED BY SEVEN OF THE OFFICERS AND KEY EMPLOYEES.
PART I, LINE 4B	THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM THE SERP IN 2023: LISA CARLSON $241,505 SERP EARNINGS JAMES MCMANUS $29,615 SERP EARNINGS CRAIG BABBITT $43,544 SERP EARNINGS RICHARD MIZER $38,895 SERP EARNINGS KRISTIN BOGGS $38,875 SERP EARNINGS JAMIE SMITH $34,610 SERP EARNINGS MOLLY GROOMS $33,855 SERP EARNINGS THE SERP ACCRUALS, INCLUDED IN PART II, COLUMN (C), ARE AMOUNTS CREDITED TO THE EXECUTIVE UNDER THE SECTION 457(F) DEFERRED COMPENSATION PLAN. JAMES MCMANUS $60,232 SERP ACCURAL DR. SHAHEED KOURY $59,652 SERP ACCRUAL CRAIG BABBITT $48,080 SERP ACCRUAL RICHARD MIZER $42,368 SERP ACCRUAL KRISTIN BOGGS $40,292 SERP ACCRUAL JAMIE SMITH $33,790 SERP ACCRUAL MOLLY GROOMS $33,263 SERP ACCRUAL
PART I, LINE 7	MANAGEMENT OF ADENA HEALTH SYSTEM HAVE A PORTION OF THEIR ANNUAL SALARY AT RISK UNDER AN INDUSTRY STANDARD VARIABLE COMPENSATION PLAN. IF THE OPERATING RESULTS OF AHS MEET A MARGIN TARGET IN ANY FISCAL YEAR, ADDITIONAL COMPENSATION IS PAID THAT IS CALCULATED USING THE OPERATING MARGIN ALONG WITH RESULTS IN EMPLOYEE ENGAGEMENT, PATIENT QUALITY, AND SATISFACTION USING A BALANCED SCORECARD FORMULA.

Schedule J (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
ADENA HEALTH SYSTEM

Employer identification number
31-4379443

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CITY OF CHILLICOTHE OHIO	31-6400221	169203AK2	06-22-2017	161,095,326	ADVANCE REFUNDING OF 2008 ISSUE AND EMERGENCY ROOM		X		X		X
B	COUNTY OF ROSS OHIO	31-6400085	778260FN4	06-19-2019	83,270,000	ORTHO ROBOTIC CENTER		X		X		X
C	COUNTY OF ROSS OHIO	31-6400085		05-13-2021	30,000,000	HOSPITAL FACILITIES		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	6,010,000		7,375,000		2,755,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	164,402,962		99,845,477		30,060,426
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,777,526		964,347		117,290
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	40,648,173		75,362,052		29,937,239
11 Other spent proceeds .............	121,977,262		23,486,711
12 Other unspent proceeds .............			32,367		5,898
13 Year of substantial completion .............	2020		2022
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........		X	X			X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X			X		X
16 Has the final allocation of proceeds been made? ..........	X			X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2023

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X			X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X			X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	X			X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X	X

Schedule K (Form 990) 2023

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
PART II, LINE 3, COLUMN A	TOTAL PROCEEDS OF ISSUE ARE SALE PROCEEDS PLUS AGGREGATE INVESTMENT PROCEEDS.
PART II, LINE 10, COLUMN A	INCLUDES $546,277 OF TRANSFERRED PROCEEDS FROM SERIES 2008 BONDS.
PART II, LINE 3, COLUMN B	TOTAL PROCEEDS OF ISSUE ARE SALE PROCEEDS PLUS AGGREGATE INVESTMENT PROCEEDS.
PART II, LINE 3, COLUMN C	TOTAL PROCEEDS OF ISSUE ARE SALE PROCEEDS PLUS AGGREGATE INVESTMENT PROCEEDS.
PART III, LINE 6, COLUMN A	ONE RESEARCH AGREEMENT FOR CLINICAL TRIALS COMMENCED AUGUST 2022 WILL RESULT IN DE MINIMIS PRIVATE USE.
SCHEDULE K, PART IV, LINE 2C	REBATE COMPUTATION PERFORMED ON JUNE 22, 2022.

Schedule K (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No




Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990) 2023

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) DOUGLAS FRENCH	SON OF TRUSTEE ROBERT FRENCH	37,220	EMPLOYEE COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2023

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	KATHERINE EDRINGTON CHIEF OPERATING OFFICER AND KRISTIN BOGGS, CHIEF INTEGRITY & COMPLIANCE OFFICER ARE SIBLINGS. ADENA HAS IMPLEMENTED A MECHANISM FOR TRIAGING ANY UNDERLYING CONCERNS INVOLVING EITHER PARTY DIRECTLY TO THE CHRO AS WELL AS BOTH PARTIES SHALL RECUSE THEMSELVES FROM ANY DECISIONS INVOLVING THE OTHER PARTY.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION IS COMPOSED OF 9 MEMBER CHURCHES. ALL OF THE CHURCHES ARE IN THE CHILLICOTHE, OHIO AREA. 1. FIRST PRESBYTERIAN CHURCH 2. ORCHARD HILL UNITED CHURCH OF CHRIST 3. TABERNACLE BAPTIST CHURCH 4. ST. MARY'S CATHOLIC CHURCH 5. TRINITY UNITED METHODIST CHURCH 6. ST. PAUL'S EPISCOPAL CHURCH 7. WALNUT STREET UNITED METHODIST CHURCH 8. ST. PETER'S CATHOLIC CHURCH
FORM 990, PART VI, SECTION A, LINE 7A	THE CORPORATE MEMBER CHURCHES MAY NOMINATE A BOARD MEMBER, BUT THE BOARD OF DIRECTORS OF AHS RESERVES THE FINAL APPROVAL. THE CORPORATE MEMBER CHURCHES MAY ONLY ELECT ONE PERSON PER CHURCH TO ACT AS THEIR TRUSTEE. THE TRUSTEES AT LARGE GET APPOINTED AS FOLLOWS. SECTION 3.03 OF THE CODE OF REGULATIONS OF AHS - "THE BOARD SHALL ELECT SIX (6) AT-LARGE TRUSTEE POSITIONS. TWO OF THESE POSITIONS SHALL BE FILLED WITH PHYSICIANS WHO ARE MEMBERS OF THE ACTIVE MEDICAL STAFF RECOMMENDED BY THE MEDICAL STAFF IN ACCORDANCE WITH THE MEDICAL STAFF BYLAWS. WHEN A VACANCY OCCURS AMONG THE FOUR (4) AT LARGE TRUSTEES, WITH THE EXCEPTION OF MEMBERS ELIGIBLE FOR REAPPOINTMENT, THE TRUSTEE COMMITTEE SHALL NOMINATE TO THE BOARD A CANDIDATE FOR THE VACANT POSITION."
FORM 990, PART VI, SECTION A, LINE 7B	SECTION 2.04 RIGHTS OF THE CORPORATE MEMBERS: (A) THE RIGHT TO ELECT NINE TRUSTEES OF THE CORPORATION AS SPECIFIED IN THESE BYLAWS. (B) THE RIGHT TO APPROVE ANY LEASE, SALE EXCHANGE, TRANSFER, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION. (C) THE RIGHT TO APPROVE ANY PROPOSED MERGER OR CONSOLIDATION OF THE CORPORATION. (D) THE RIGHT TO APPROVE ANY PROPOSED DISSOLUTION OF THE CORPORATION. (E) THE RIGHT TO APPROVE ANY PROPOSED CHANGE TO THE FUNDAMENTAL PURPOSE OF THE CORPORATION AS STATED IN SECTION 1.01. (F) THE RIGHT TO APPROVE ANY PROPOSED AMENDMENTS TO THE CODE OF REGULATIONS.
FORM 990, PART VI, SECTION B, LINE 11B	COPIES OF THE 990 ARE SENT TO BOARD MEMBERS VIA THE SERCURE INFORMATION PORTAL PROVIDED BY ADENA HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 12C	THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. ADVANCED PRACTICE CLINICIANS, FRONT LINE SUPERVISORS UP THROUGH THE CEO, AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS RETAINS AN INDEPENDENT COMPENSATION CONSULTANT, TO EVALUATE THE TOTAL COMPENSATION FOR EXECUTIVE LEADERSHIP. THE INDEPENDENT COMPENSATION CONSULTANT UTILIZES THE COMPENSATION PHILOSOPHY TO CONDUCT THE EVALUATION. EACH POSITION IS COMPARED TO PEER DATA OF ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY. THE DATA ANALYSIS COVERS CASH COMPENSATION (BASE SALARY), TOTAL CASH COMPENSATION (BASE SALARY AND INCENTIVES, BOTH PAID AND OPPORTUNITY), AND TOTAL COMPENSATION (BASE SALARY, INCENTIVES AND ALL BENEFITS). THE EXECUTIVE COMPENSATION COMMITTEE MEETS WITH THE INDEPENDENT COMPENSATION CONSULTANT REGULARLY TO REVIEW AND MONITOR ALL TOTAL COMPENSATION FOR THE EXECUTIVE LEADERSHIP. OTHER MANAGEMENT WAGES ARE REVIEWED INTERNALLY USING MARKET DATA. COMPENSATION WAS LAST REVIEWED IN 2023.
FORM 990, PART VI, SECTION C, LINE 19	THE ARTICLES OF INCORPORATION ARE AVAILABLE THRU OHIO SECRETARY OF STATE WEBSITE. AS A RESULT OF HAVING ISSUED PUBLIC DEBT, THE AUDITED FINANCIALS FOR ADENA HEALTH SYSTEM ARE AVAILABLE FOR VIEWING AT EMMR.MSRB.ORG. COPIES OF MOST RECENT 990 IS AVAILABLE UPON REQUEST BY CONTACTING ADMINISTRATION AT ADENA HEALTH SYSTEM; PRIOR 990S ARE AVAILABLE FOR VIEWING AT GUIDESTAR.COM.
FORM 990, PART IX, LINE 11G	MEDICAL CONSULTING FEES: PROGRAM SERVICE EXPENSES 726,648. MANAGEMENT AND GENERAL EXPENSES 9,543. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 736,191. NON-PHYSICIAN HEALTHCARE SERVICES: PROGRAM SERVICE EXPENSES 24,335,167. MANAGEMENT AND GENERAL EXPENSES 35,225,895. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,561,062. CONTRACTED PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 26,049,911. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,049,911.
FORM 990, PART XI, LINE 9:	TRANSFERS (TO) FROM AFFILIATED ORGANIZATION 15,378,696. INTERCOMPANY RECEIPTS ELIMINATED IN CONSOLIDATION -3,001. PRIOR PERIOD ADJUSTMENT -1,643.
FORM 990: PART XII, LINE 2C	THE AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. ADENA HEALTH FOUNDATION IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

ADENA HEALTH SYSTEM

Employer identification number

31-4379443

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
(1) ADENA MEDICAL GROUP LLC 272 HOSPITAL ROAD CHILLICOTHE,OH45601 27-1370967	HEALTHCARE PROVIDERS	OH	104,857,226	4,547,005	ADENA HEALTH SYSTEM
(2) ADENA HOSPICE LLC 272 HOSPITAL ROAD CHILLICOTHE,OH45601 27-5340755	HEALTHCARE PROVIDERS	OH	6,496,427	814,805	ADENA HEALTH SYSTEM
(3) ADENA HOME HEALTH 272 HOSPITAL ROAD CHILLICOTHE,OH45601 27-3752730	HEALTHCARE PROVIDERS	OH	5,981,612	859,549	ADENA HEALTH SYSTEM
(4) ADENA HOME INFUSIONHOME RESPIRATORY 272 HOSPITAL ROAD CHILLICOTHE,OH45601 27-3752854	HEALTHCARE PROVIDERS	OH	2,656,432	2,113,628	ADENA HEALTH SYSTEM
(5) ADENA PHARMACY 272 HOSPITAL ROAD CHILLICOTHE,OH45601 45-1138187	HEALTHCARE PROVIDERS	OH	15,549,109	3,549,888	ADENA HEALTH SYSTEM
(6) ADENA HEALTHCARE COLLABORATIVE 272 HOSPITAL ROAD CHILLICOTHE,OH45601 46-5731515	HEALTHCARE PROVIDERS	OH	0	0	ADENA HEALTH SYSTEM
(7) MAXIMUM PROPERTIES LLC 272 HOSPITAL ROAD CHILLICOTHE,OH45601 31-4379443	PROPERTY HOLDING	OH	0	5,927,804	ADENA HEALTH SYSTEM

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)GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD,OH45123 31-0993422	HOSPITAL	OH	501(C)(3)	3	ADENA HEALTH SYSTEM	Yes
(2)ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE,OH45601 75-3008742	FUNDRAISING	OH	501(C)(3)	12A	ADENA HEALTH SYSTEM	Yes
(3)SOUTHERN OHIO HEALTHCARE NETWORK 272 HOSPITAL ROAD CHILLICOTHE,OH45601 26-1566590	FIBEROPTIC NETWORK GRANTS	OH	501(C)(3)	12A	ADENA HEALTH SYSTEM	Yes
(4)PIKE HEALTH SERVICES INC 100 DAWN LANE WAVERLY,OH45690 31-1072406	HOSPITAL	OH	501(C)(3)	3	ADENA HEALTH SYSTEM	Yes
(5)ADENA FAYETTE MEDICAL CENTER 272 HOSPITAL ROAD CHILLICOTHE,OH45601 85-2985806	HOSPITAL	OH	501(C)(3)	3	ADENA HEALTH SYSTEM	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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

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) ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE,OH45601 45-3980850	SEE SCHEDULE R, PART VII	OH	ADENA HEALTH SYSTEM	C	-77,338		100.000 %	Yes

Schedule R (Form 990) 2023

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) ............................

Yes

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) .................

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

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

Yes

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) ............................

Yes

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

Yes

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) GREENFIELD AREA MEDICAL CENTER	S	796,574	BOOK VALUE
(2) PIKE HEALTH SERVICES	S	1,618,764	BOOK VALUE
(3) ADENA HEALTH FOUNDATION	B	768,570	BOOK VALUE
(4) ADENA HEALTH FOUNDATION	C	539,316	BOOK VALUE
(5) ADENA FAYETTE MEDICAL CENTER	S	4,369,783	BOOK VALUE

Schedule R (Form 990) 2023

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) 2023

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation
SCHEDULE R, PART IV, COLUMN (B)	THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES.

Schedule R (Form 990) 2023

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE REPORTING ORGANIZATION IS A REGIONAL HEALTHCARE SYSTEM WITH ONE HOSPITAL AND SEVERAL AMBULATORY CENTERS, IN ADDITION TO MULTIPLE PHYSICIAN PRACTICES. AHS OFFERS A WIDE SCOPE OF DIAGNOSTIC AND REHABILITATIVE SERVICES BOTH FOR INPATIENTS AND OUTPATIENTS, INCLUDING COMPREHENSIVE CARDIOLOGY AND CANCER CARE. FURTHERMORE, AHS IS THE SOLE MEMBER OF THREE CRITICAL ACCESS HOSPITALS, ADENA PIKE MEDICAL CENTER, ADENA GREENFIELD MEDICAL CENTER, AND ADENA FAYETTE MEDCIAL CENTER, THAT FILE SEPARATELY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	3,987
6	Total number of volunteers (estimate if necessary) .............	6	87
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	68,065
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	8,464

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,207,395	3,465,419
9	Program service revenue (Part VIII, line 2g) .........	607,647,900	623,884,851
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	36,931,546	16,094,218
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	26,769,378	26,591,977
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	678,556,219	670,036,465
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,101,195	1,643,732
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)	353,023,485	357,304,948
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)....	316,297,497	325,505,620
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	670,422,177	684,454,300
19	Revenue less expenses. Subtract line 18 from line 12.......	8,134,042	-14,417,835
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	777,131,298	806,490,536
21	Total liabilities (Part X, line 26).............	411,646,764	415,441,458
22	Net assets or fund balances. Subtract line 21 from line 20.....	365,484,534	391,049,078

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 564,596,097 including grants of $ 1,643,732 ) (Revenue $ 646,432,496 )
	HEALTH CARE PROGRAMS, GENERAL/OTHER: ROUTINE HOSPITAL SERVICES. ADENA REGIONAL MEDICAL CENTER PROVIDED CARE FOR 11,225 INPATIENTS.EMERGENCY SERVICES - TREATMENT OF EMERGENCY ACCIDENT AND ILLNESS AS WELL AS LESS URGENT CONDITIONS IN THE ABSENCE OF A FAMILY PHYSICIAN. THERE WERE 40,323 EMERGENT VISITS IN 2023.

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 expenses564,596,097

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	13,467,760	6,741,641	1,457,539

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	539,316
e	Government grants (contributions)		1e	1,153,103

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,773,000

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

h Total. Add lines 1a-1f.......		3,465,419

		Business Code
2a	NET PATIENT SVC REV	621110	623,884,851	623,884,851
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		623,884,851

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-161,424			-161,424
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	157,790
b	Less: rental expenses	6b	30,870
c	Rental income or (loss)	6c	126,920
d	Net rental income or (loss).......			126,920			126,920
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	61,483,710	35,628
b	Less: cost or other basis and sales expenses	7b	45,263,696	0
c	Gain or (loss)	7c	16,220,014	35,628
d	Net gain or (loss).........			16,255,642			16,255,642
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
11a	OUTPATIENT PHARMACY SALES		456110	22,615,710	22,547,645	68,065
b	CAFETERIA REVENUE		722514	2,527,093			2,527,093
c	DAVITA DIALYSIS		621400	737,522			737,522
d	All other revenue ....			584,732			584,732
e	Total. Add lines 11a–11d ......			26,465,057
12	Total revenue. See instructions.....			670,036,465	646,432,496	68,065	20,070,485

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,643,732	1,643,732
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 ...........	7,439,801	6,198,595	1,241,206
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........	278,121,971	231,721,986	46,399,985
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	12,448,698	10,650,242	1,798,456
9	Other employee benefits .......	4,582,750	3,920,683	662,067
10	Payroll taxes ...........	54,711,728	44,242,777	10,468,951
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	2,736,156		2,736,156
c	Accounting ...........	334,606		334,606
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	86,347,164	51,111,726	35,235,438
12	Advertising and promotion ....	1,127,717	460,757	666,960
13	Office expenses .......	6,288,191	5,379,740	908,451
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	37,680,075	29,819,524	7,860,551
17	Travel ............	652,843	367,645	285,198
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,267,015	713,513	553,502
20	Interest ...........	12,156,536	9,896,243	2,260,293
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	26,351,098	19,344,029	7,007,069
23	Insurance ...	4,478,490	3,387,956	1,090,534
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 EQUIPMENT & SUP	105,338,014	105,338,014
b	BAD DEBT EXPENSE	22,113,589	22,113,589
c	HCAP ASSESSMENT	13,817,944	13,817,944
d	CAFETERIA/CATERING	3,554,104	3,346,813	207,291
e	All other expenses	1,262,078	1,120,589	141,489
25	Total functional expenses. Add lines 1 through 24e	684,454,300	564,596,097	119,858,203	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 ........			14,824	1	15,300
2	Savings and temporary cash investments .........			4,288,560	2	4,100,406
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			111,146,126	4	100,949,597
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 ............			14,015,914	8	14,404,163
9	Prepaid expenses and deferred charges ......			6,583,860	9	8,046,860
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	575,992,682
b	Less: accumulated depreciation	10b	305,648,428	272,249,679	10c	270,344,254
11	Investments—publicly traded securities .			318,325,126	11	359,318,889
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			572,359	13	515,580
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			49,934,850	15	48,795,487
16	Total assets. Add lines 1 through 15 (must equal line 33)...			777,131,298	16	806,490,536

17	Accounts payable and accrued expenses .....	65,531,350	17	70,077,880
18	Grants payable ...		18
19	Deferred revenue .........	2,964,494	19	3,214,874
20	Tax-exempt bond liabilities .........	283,223,781	20	276,163,714
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 ..	15,000,000	23	19,700,000
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	44,927,139	25	46,284,990
26	Total liabilities. Add lines 17 through 25..	411,646,764	26	415,441,458

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	361,285,245	27	386,794,840
28	Net assets with donor restrictions ...........	4,199,289	28	4,254,238
	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 ...........	365,484,534	32	391,049,078
33	Total liabilities and net assets/fund balances ........	777,131,298	33	806,490,536