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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
2022
Open to Public
Inspection
Name of the organization
ADENA HEALTH SYSTEM
 
Employer identification number
31-4379443
Part I
General Information on Grants and Assistance
1
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? ........................
2
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 (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) CHILLICOTHE FARMERS MARKET ASSOCIATION
300 CHILLICOTHE AVE
HILLSBORO,OH45133
26-2216517 501 C (4) 9,886 0     COMMUNITY IMPROVEMENT INITIATIVE
(2) UNITED WAY ROSS CO
69 EAST WATER STREET
CHILLICOTHE,OH45601
31-4389671 501 C (3) 39,008 0     JOB DEVELOPMENT INITIATIVE
(3) CHILD PROTECTION CENTER OF ROSS CO
138 MARIETTA RD STE E
CHILLICOTHE,OH45601
31-1579825 501 C (3) 65,375 0     COMMUNITY IMPROVEMENT INITIATIVE
(4) ROSS COUNTY YMCA
100 MILL STREET
CHILLICOTHE,OH45601
31-4379806 501 C (3) 58,139 0     COMMUNITY IMPROVEMENT INITIATIVE
(5) CHILLICOTHE ROSS CHAMBER OF COMMERCE
41 E MAIN ST
CHILLICOTHE,OH45601
31-4147100 501 C (3) 10,269 0     COMMUNITY IMPROVEMENT INITIATIVE
(6) ROSS COUNTY COMMUNITY ACTION
250 N WOODRIDGE AVE
CHILLICOTHE,OH45601
31-6059908 501 C (3) 126,183 0     COMMUNITY IMPROVEMENT INITIATIVE
(7) PIKE COUNTY AGRICULTURAL SOCIETY
311 MILL ST
PIKETON,OH45661
31-6106189 501 C (3) 15,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(8) JACKSON AREA FESTIVALS & EVENTS
PO BOX 488
JACKSON,OH45640
46-1960880 115 9,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(9) WELLSTON CITY SCHOOLS
1 E BROADWAY ST
WELLSTON,OH45692
31-6401103 115 33,800 0     COMMUNITY IMPROVEMENT INITIATIVE
(10) TEAYS VALLEY BOARD OF EDUCATION
385 VIKING WAY
ASHVILLE,OH43103
31-6402688 115 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(11) MIAMI TRACE LOCAL SCHOOL DISTRICT
3818 STATE ROUTE 41 NW
WASHINGTON COURT HOUSE,OH43160
31-6006819 115 25,500 0     COMMUNITY IMPROVEMENT INITIATIVE
(12) GREENFIELD EXEMPTED VILLAGE SCHOOL
200 NORTH FIFTH ST
GREENFIELD,OH45123
31-6000808 115 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(13) ROSS COUNTY JUNIOR FAIR SALE COMMITTEE
475 WESTERN AVE SUITE F
CHILLICOTHE,OH45601
20-5233558 115 6,200 0     COMMUNITY IMPROVEMENT INITIATIVE
(14) SOUTHEASTERN LOCAL SCHOOL DTISRICT
2003 LANCASTER ROAD
CHILLICOTHE,OH45601
31-6400983 115 35,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(15) ZANE TRACE LOCAL SCHOOL DISTRICT
946 STATE ROUTE 180
CHILLICOTHE,OH45601
37-0711566 115 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(16) UNION-SCIOTO LOCAL SCHOOL DISTRICT
1565 EGYPT PIKE
CHILLICOTHE,OH45601
31-6401035 115 47,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(17) CHILLICOTHE CITY SCHOOLS
425 TOCTANGEE PARKWAY
CHILLICOTHE,OH45601
31-6400384 115 32,211 0     COMMUNITY IMPROVEMENT INITIATIVE
(18) HOPE CLINIC OF ROSS COUNTY INC
7479 COUNTY RD 550
FANKFORT,OH45628
45-2390821 501 C (3) 34,250 0     COMMUNITY IMPROVEMENT INITIATIVE
(19) SCIOTO VALLEY LOCAL SCHOOL DISTRICT
1414 PIKETON RD
PIKETON,OH45661
31-6402789 115 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(20) THE BUCK FIFTY INC
113 GORDON DRIVE
CHILLICOTHE,OH45601
81-1817174 501 C (3) 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(21) WASHINGTON COURT HOUSE CITY SCHOOLS
306 HIGHLAND AVENUE
WASHINGTON COURT HOUSE,OH43160
31-6001001 115 25,300 0     COMMUNITY IMPROVEMENT INITIATIVE
(22) HUNTINGTON LOCAL BOARD OF EDUCATION
188 HUNTSMAN ROAD
CHILLICOTHE,OH45601
31-6400570 115 45,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(23) ADENA LOCAL SCHOOL DISTRICT
3367 COUNTY ROAD 550
FRANKFORT,OH45628
31-0709140 115 37,830 0     COMMUNITY IMPROVEMENT INITIATIVE
(24) PAINT VALLEY ADAMH BOARD
394 CHESTNUT ST
CHILLICOTHE,OH45601
31-6400085 115 5,500 0     COMMUNITY IMPROVEMENT INITIATIVE
(25) PICKAWAY ADDICTION ACTION COALITION
770 NORTH COURT STREET
CIRCLEVILLE,OH43113
82-4089691 501 C (3) 15,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(26) ROSS COUNTY AGRICULUTURAL SOCIETY
PO BOX 614
CHILLICOTHE,OH45601
31-6050864 501 C (3) 30,110 0     COMMUNITY IMPROVEMENT INITIATIVE
(27) ROSS COUNTY HEALTH DEPARTMENT
150 E SECOND STREET
CHILLICOTHE,OH45601
31-6400085 115 14,333 0     JOB DEVELOPMENT INITIATIVE
(28) WAVERLY CITY BOARD OF EDUCATION
1 TIGER DRIVE
WAVERLY,OH45690
31-6401098 115 25,000 0     COMMUNITY IMPROVEMENT INITIATIVE
(29) HOPE PARTNERSHIP PROJECTS
22 YAPLES ORCHARD DR
CHILLICOTHE,OH45601
86-2294038 501 C (3) 14,619 0     COMMUNITY IMPROVEMENT INITIATIVE
(30) ADENA HEALTH FOUNDATION
272 HOSPITAL ROAD
CHILLICOTHE,OH45601
75-3008742 501 C (3) 211,682 0     RELATED ORGANIZATION SUPPORT.
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
28
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2022
Page 2

Schedule I (Form 990) 2022
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) 2022



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