2018 PRELIMINARY OHIO HCAP ASSESSMENT AND DISTRIBUTION MODEL - UPDATED June 5, 2018 NOTE: DRAFT MODEL/ALL NUMBERS SUBJECT TO CHANGE

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1 Jefferson Acuity Specialty Hospital - Ohio Valley $0 $229,860 $0 $0 $0 $0 $0 $0 $0 $0 ($229,860) Stark Acute Care Specialty Altman $0 $50,686 $0 $0 $0 $0 $0 $0 $0 $0 ($50,686) Adams Adams County Hospital $1,235,462 $159,949 $0 $447,549 $415,041 $0 $0 $0 $303 $862,893 $702,944 Ross Adena Regional Medical Center $13,095,364 $1,991,321 $0 $4,743,822 $0 $2,382,608 $0 $0 $4,857 $7,131,288 $5,139,967 Lucas Advanced Specialty Hospital of Toledo $0 $97,268 $0 $0 $0 $0 $0 $0 $0 $0 ($97,268) Stark Affinity Medical Center $1,410,896 $255,805 $0 $511,100 $0 $0 $0 $0 $732 $511,832 $256,027 Stark Affinity Medical Center - Ghost $2,432,217 $0 $0 $881,076 $0 $0 $0 $0 $0 $0 $0 Summit Akron General Medical Center $11,034,888 $3,236,134 $0 $3,997,411 $0 $0 $0 $0 $5,727 $4,003,137 $767,003 Lorain Allen Medical Center $2,048,367 $169,229 $0 $742,025 $688,128 $0 $0 $0 $503 $1,430,656 $1,261,427 Stark Alliance Community Hospital $2,655,160 $532,872 $0 $961,837 $0 $0 $69,983 $0 $1,321 $1,033,141 $500,269 Franklin Arthur G. James Cancer Hospital $0 $6,022,460 $0 $0 $0 $0 $0 $0 $0 $0 ($6,022,460) Ashtabula Ashtabula County Medical Center $4,663,414 $764,224 $0 $1,689,331 $0 $848,475 $0 $0 $1,730 $2,539,536 $1,775,312 Butler Atrium Medical Center $15,537,171 $1,647,261 $0 $5,628,372 $0 $0 $0 $0 $8,063 $5,636,435 $3,989,174 Wayne Aultman Hosp Orville $1,926,350 $161,680 $0 $697,824 $647,137 $0 $0 $0 $473 $1,345,434 $1,183,754 Stark Aultman Hospital $15,763,932 $2,540,610 $0 $5,710,516 $0 $0 $238,035 $0 $7,987 $5,956,539 $3,415,929 Richland Avita Ontario Hospital $323,913 $136,341 $0 $117,338 $0 $0 $0 $0 $168 $117,506 ($18,835) Belmont Barnesville Hospital Association $1,311,370 $128,232 $0 $475,046 $440,541 $0 $0 $0 $322 $915,909 $787,677 Lucas Bay Park Community Hospital $3,883,006 $510,277 $0 $1,406,627 $0 $0 $0 $0 $2,015 $1,408,642 $898,365 Sandusky Bellevue Hospital $3,330,574 $319,110 $0 $1,206,507 $0 $605,974 $0 $0 $1,235 $1,813,717 $1,494,607 Belmont Belmont Community Hospital $1,145,713 $133,900 $0 $415,037 $0 $0 $0 $0 $595 $415,631 $281,731 Pickaway Berger Hospital $4,438,684 $459,140 $0 $1,607,922 $0 $0 $0 $0 $2,304 $1,610,226 $1,151,086 Hamilton Bethesda Hospital $17,580,385 $3,398,125 $0 $6,368,530 $0 $0 $0 $0 $9,124 $6,377,654 $2,979,529 Allen Blanchard Valley Reg. Hlth - Bluffton $1,876,431 $135,769 $0 $679,741 $630,367 $0 $0 $0 $461 $1,310,569 $1,174,800 Hancock Blanchard Valley Regional Hlth Ctr $8,682,717 $1,319,759 $0 $3,145,332 $0 $1,579,759 $0 $0 $3,221 $4,728,311 $3,408,552 Crawford Bucyrus Community Hospital $2,537,027 $319,724 $0 $919,043 $852,288 $0 $0 $0 $623 $1,771,954 $1,452,230 Summit Children's Hospital Med Ctr Akron $38,209,522 $3,892,552 $8,370,109 $10,809,388 $0 $0 $0 $1,561,923 $14,215 $20,755,635 $16,863,083 Hamilton Children's Hospital Med Ctr Cinnci $74,379,057 $7,542,294 $9,492,722 $23,505,206 $0 $0 $0 $3,396,430 $30,911 $36,425,269 $28,882,975 Montgomery Children's Medical Center - Dayton $51,828,999 $1,835,231 $4,168,450 $17,265,130 $0 $0 $0 $2,494,758 $22,705 $23,951,043 $22,115,812 Hamilton Christ Hospital $18,865,232 $4,380,464 $0 $6,833,968 $0 $0 $0 $0 $9,791 $6,843,759 $2,463,295 Williams CHWC Montpelier Hospital $757,844 $97,676 $0 $274,530 $254,590 $0 $0 $0 $186 $529,306 $431,630 Clermont Clermont Mercy Hospital $4,786,941 $776,587 $0 $1,734,079 $0 $0 $0 $0 $2,484 $1,736,563 $959,976 Cuyahoga Cleveland Clinic Children's Hosp. $1,852,850 $242,883 $330,883 $551,336 $0 $0 $0 $79,666 $725 $962,610 $719,727 Cuyahoga Cleveland Clinic Hospital $5,489,475 $17,198,811 $0 $1,988,573 $0 $0 $0 $0 $2,849 $1,991,422 ($15,207,389) Lorain Cleveland Clinic Rehabiliation Hospital $0 $92,273 $0 $0 $0 $0 $0 $0 $0 $0 ($92,273) Clinton Clinton Memoral Hospital $3,472,204 $572,317 $0 $1,257,813 $0 $631,743 $0 $0 $1,288 $1,890,843 $1,318,526 Williams Community Hospital of Wms County $3,436,726 $441,947 $0 $1,244,961 $0 $625,288 $0 $0 $1,275 $1,871,523 $1,429,576 Defiance Community Memorial Hospital $3,176,343 $149,811 $0 $1,150,637 $1,067,059 $0 $0 $0 $780 $2,218,476 $2,068,665 Coshocton Coshocton Regional Medical Center $4,621,483 $345,330 $0 $1,674,141 $0 $840,846 $0 $0 $1,714 $2,516,702 $2,171,372 Summit Cyrstal Clinic Orthopaedic Center LLC $0 $888,667 $0 $0 $0 $0 $0 $0 $0 $0 ($888,667) Defiance Defiance Hospital $3,043,517 $360,520 $306,919 $991,338 $919,331 $0 $0 $0 $672 $2,218,261 $1,857,741 Fairfield Diley Ridge Medical Center $0 $91,380 $0 $0 $0 $0 $0 $0 $0 $0 ($91,380) Franklin Doctor's Hospital - Columbus $23,557,187 $1,492,253 $0 $8,533,639 $0 $0 $0 $0 $12,226 $8,545,864 $7,053,611 Hamilton Drake Center, Inc. $0 $387,767 $0 $0 $0 $0 $0 $0 $0 $0 ($387,767) Franklin Dublin Methodist Hospital $3,261,689 $1,105,033 $0 $1,181,553 $0 $0 $0 $0 $1,693 $1,183,246 $78,213 Columbiana East Liverpool City Hospital $4,229,859 $405,754 $0 $1,532,275 $0 $769,593 $0 $0 $1,569 $2,303,437 $1,897,683 Belmont East Ohio Regional Hospital $2,972,069 $403,535 $0 $1,076,638 $0 $0 $0 $0 $1,542 $1,078,180 $674,645 Seneca Eden Springs Healthcare Center $0 $69,793 $0 $0 $0 $0 $0 $0 $0 $0 ($69,793)

2 Summit Edwin Shaw Rehab Hospital $0 $12,940 $0 $0 $0 $0 $0 $0 $0 $0 ($12,940) Lorain EMH Regional Medical Center $12,482,818 $1,546,622 $0 $4,521,926 $0 $0 $0 $0 $6,478 $4,528,404 $2,981,782 Cuyahoga Euclid Hospital $3,213,587 $750,552 $0 $1,164,128 $0 $0 $0 $0 $1,668 $1,165,796 $415,244 Fairfield Fairfield Medical Center $13,099,389 $1,775,074 $0 $4,745,280 $0 $0 $0 $0 $6,798 $4,752,078 $2,977,004 Cuyahoga Fairview Hospital $11,568,380 $2,615,060 $0 $4,190,669 $0 $0 $0 $0 $6,004 $4,196,673 $1,581,613 Fayette Fayette County Memorial Hospital $1,956,142 $292,382 $0 $708,616 $657,145 $0 $0 $0 $480 $1,366,242 $1,073,860 Erie Firelands Regional Medical Center $3,290,913 $1,450,876 $0 $1,192,140 $0 $598,758 $0 $0 $1,221 $1,792,119 $341,243 Huron Fisher-Titus Medical Center $1,898,508 $711,508 $0 $687,738 $0 $345,420 $0 $0 $704 $1,033,863 $322,355 Lucas Flower Hospital $5,746,337 $1,533,169 $0 $2,081,622 $0 $0 $0 $0 $2,982 $2,084,604 $551,435 Butler Fort Hamilton Hospital $9,567,364 $884,853 $0 $3,465,797 $0 $0 $0 $0 $4,965 $3,470,762 $2,585,909 Hancock Fostoria Community Hospital $2,557,856 $235,687 $0 $926,588 $859,285 $0 $0 $0 $628 $1,786,501 $1,550,814 Fulton Fulton County Health Center $3,436,732 $448,926 $0 $1,244,963 $1,154,534 $0 $0 $0 $844 $2,400,341 $1,951,415 Crawford Galion Community Hospital $4,188,770 $635,013 $0 $1,517,391 $1,407,174 $0 $0 $0 $1,029 $2,925,593 $2,290,580 Muskingum Genesis Healthcare System $21,081,645 $2,274,382 $0 $7,636,868 $0 $3,835,655 $0 $0 $7,820 $11,480,343 $9,205,961 Hamilton Good Samaritan Hospital $19,527,401 $3,433,786 $0 $7,073,840 $0 $0 $0 $0 $10,134 $7,083,975 $3,650,189 Montgomery Good Samaritan Hospital - Dayton $15,931,693 $2,196,003 $0 $5,771,288 $0 $0 $0 $0 $8,268 $5,779,556 $3,583,553 Montgomery Good Samaritan Hospital - Dayton - Ghost $1,578,816 $0 $0 $571,929 $0 $0 $0 $0 $0 $0 $0 Cuyahoga Grace Hospital $0 $89,643 $0 $0 $0 $0 $0 $0 $0 $0 ($89,643) Delaware Grady Memorial Hospital $8,351,033 $641,408 $0 $3,025,179 $0 $0 $0 $0 $4,334 $3,029,513 $2,388,105 Montgomery Grandview Hospital $11,483,970 $2,230,959 $0 $4,160,091 $0 $0 $110,057 $0 $5,870 $4,276,019 $2,045,060 Franklin Grant Medical Center $38,804,480 $3,732,312 $4,629,436 $12,379,979 $0 $0 $0 $0 $17,736 $17,027,151 $13,294,839 Greene Greene Memorial Hospital, Inc. $2,684,075 $346,862 $0 $972,312 $0 $0 $0 $0 $1,393 $973,705 $626,843 Highland Greenfield Area Medical Center $925,691 $96,356 $0 $335,333 $310,976 $0 $0 $0 $227 $646,537 $550,181 Ottawa H B Magruder Memorial Hospital $2,961,210 $298,758 $0 $1,072,704 $994,787 $0 $0 $0 $727 $2,068,219 $1,769,461 Hardin Hardin Memorial Hospital $3,099,844 $186,562 $0 $1,122,925 $1,041,360 $0 $0 $0 $761 $2,165,046 $1,978,484 Harrison Harrison Community Hospital $967,591 $86,653 $0 $350,512 $325,052 $0 $0 $0 $238 $675,801 $589,148 Hamilton HealthSouth Rehab Hospital At Drake $0 $190,957 $0 $0 $0 $0 $0 $0 $0 $0 ($190,957) Geauga Heather Hill Care Communities $152,848 $62,203 $0 $55,369 $0 $0 $0 $0 $79 $55,449 ($6,754) Henry Henry County Hospital $1,823,163 $186,693 $0 $660,444 $612,472 $0 $0 $0 $448 $1,273,364 $1,086,671 Highland Highland District Hospital $405,929 $251,633 $0 $147,049 $136,368 $0 $0 $0 $100 $283,516 $31,883 Cuyahoga Hillcrest Hospital $6,686,613 $2,471,985 $0 $2,422,239 $0 $0 $0 $0 $3,470 $2,425,709 ($46,276) Trumbull Hillside Rehabilitation Hospital $0 $141,863 $0 $0 $0 $0 $0 $0 $0 $0 ($141,863) Hocking Hocking Valley Community Hospital $1,699,535 $233,469 $0 $615,660 $570,941 $0 $0 $0 $417 $1,187,018 $953,549 Gallia Holzer Medical Center $15,860,953 $1,246,971 $0 $5,745,662 $0 $2,885,788 $0 $0 $5,883 $8,637,333 $7,390,362 Jackson Holzer Medical Center - Jackson $2,117,536 $201,128 $0 $767,082 $711,364 $0 $0 $0 $520 $1,478,966 $1,277,838 Allen Institute for Orthopedic Surgery $0 $167,402 $0 $0 $0 $0 $0 $0 $0 $0 ($167,402) Hamilton Jewish Hospital LLC $8,474,634 $1,664,203 $0 $3,069,953 $0 $0 $0 $0 $4,398 $3,074,352 $1,410,149 Auglaize Joint Township District Memorial Ho $3,166,515 $368,684 $0 $1,147,076 $0 $576,125 $0 $0 $1,175 $1,724,376 $1,355,692 Montgomery Kettering Memorial Hospital $9,366,207 $3,023,592 $0 $3,392,927 $0 $0 $69,566 $0 $4,804 $3,467,298 $443,706 Montgomery Kindred Hospital - Dayton $0 $201,654 $0 $0 $0 $0 $0 $0 $0 $0 ($201,654) Allen Kindred Hospital - Lima $0 $99,435 $0 $0 $0 $0 $0 $0 $0 $0 ($99,435) Scioto Kings Daughers Medical Center - Ohio $770,163 $149,902 $0 $278,993 $0 $140,126 $0 $0 $286 $419,404 $269,502 Knox Knox Community Hospital $5,533,464 $822,369 $0 $2,004,509 $0 $1,006,774 $0 $0 $2,052 $3,013,336 $2,190,967 Lake Lake Hospital System, Inc. $14,195,616 $2,224,234 $0 $5,142,391 $0 $0 $0 $0 $7,367 $5,149,758 $2,925,524 Licking Licking Memorial Hospital $14,441,966 $1,238,071 $0 $5,231,631 $0 $0 $0 $0 $7,495 $5,239,126 $4,001,055 Montgomery Life Care Hospitals of Dayton $0 $149,492 $0 $0 $0 $0 $0 $0 $0 $0 ($149,492) Jefferson Life Line Hospital $0 $110,241 $0 $0 $0 $0 $0 $0 $0 $0 ($110,241) Allen Lima Memorial Hospital $7,012,542 $1,177,690 $0 $2,540,307 $0 $0 $0 $0 $3,639 $2,543,947 $1,366,257 Medina Lodi Community Hospital $945,365 $96,783 $0 $342,460 $317,586 $0 $0 $0 $232 $660,278 $563,495 Cuyahoga Lutheran Hospital $5,330,011 $747,642 $815,982 $1,635,216 $0 $0 $0 $0 $2,343 $2,453,541 $1,705,899 Madison Madison County Hospital $4,744,146 $284,597 $0 $1,718,576 $0 $0 $0 $0 $2,462 $1,721,039 $1,436,442

3 Washington Marietta Memorial Hospital $10,020,543 $2,175,856 $0 $3,629,962 $0 $1,823,167 $0 $0 $3,717 $5,456,845 $3,280,989 Marion Marion General Hospital $13,846,712 $1,303,693 $0 $5,015,999 $0 $2,519,311 $0 $0 $5,136 $7,540,446 $6,236,753 Logan Mary Rutan Hospital $6,538,484 $593,133 $0 $2,368,579 $0 $1,189,631 $0 $0 $2,425 $3,560,635 $2,967,502 Cuyahoga Marymount Hospital $7,437,144 $1,149,393 $0 $2,694,120 $0 $0 $0 $0 $3,860 $2,697,980 $1,548,587 Butler McCullough-Hyde Memorial Hospital $3,066,308 $338,711 $0 $1,110,776 $0 $0 $0 $0 $1,591 $1,112,367 $773,656 Richland MedCentral Health System $15,418,117 $1,804,856 $0 $5,585,244 $0 $0 $0 $0 $8,002 $5,593,246 $3,788,390 Montgomery Medical Center at Elizabeth Place $181,151 $102,415 $0 $65,622 $0 $0 $0 $0 $94 $65,716 ($36,699) Medina Medina General Hospital $2,297,554 $740,914 $0 $832,294 $0 $0 $0 $0 $1,192 $833,486 $92,572 Sandusky Memorial Hospital $4,454,935 $427,076 $0 $1,613,809 $0 $810,544 $0 $0 $1,652 $2,426,005 $1,998,929 Union Memorial Hospital of Union County $3,494,734 $566,265 $0 $1,265,974 $0 $0 $0 $0 $1,814 $1,267,788 $701,523 Mercer Mercer County Community Hospital $786,498 $313,253 $0 $284,911 $0 $143,098 $0 $0 $292 $428,300 $115,047 Hamilton Mercy Health - West Hospital $17,225,533 $1,596,394 $0 $6,239,984 $0 $0 $0 $0 $8,940 $6,248,924 $4,652,530 Huron Mercy Hospital - Willard $2,182,605 $177,275 $0 $790,653 $733,223 $0 $0 $0 $536 $1,524,413 $1,347,138 Hamilton Mercy Hospital Anderson $11,904,790 $1,447,345 $0 $4,312,534 $0 $0 $0 $0 $6,178 $4,318,712 $2,871,367 Butler Mercy Hospital Hamilton/Farifield $10,654,967 $1,625,177 $0 $3,859,783 $0 $0 $0 $0 $5,530 $3,865,313 $2,240,136 Defiance Mercy Hospital of Defiance $902,262 $147,376 $0 $326,846 $0 $164,160 $0 $0 $335 $491,341 $343,965 Seneca Mercy Hospital of Tiffin $3,085,996 $387,980 $0 $1,117,908 $0 $561,475 $0 $0 $1,145 $1,680,528 $1,292,548 Stark Mercy Medical Center $7,691,610 $1,862,046 $0 $2,786,301 $0 $0 $133,975 $0 $3,883 $2,924,159 $1,062,113 Champaign Mercy Memorial Hospital $1,468,474 $148,470 $0 $531,958 $493,318 $0 $0 $0 $361 $1,025,637 $877,167 Lorain Mercy Regional Medical Center $12,775,483 $1,340,304 $0 $4,627,945 $0 $0 $0 $0 $6,630 $4,634,575 $3,294,271 Cuyahoga MetroHealth Medical Center $17,046,949 $4,598,686 $7,286,077 $3,535,895 $0 $0 $0 $0 $5,066 $10,827,038 $6,228,352 Montgomery Miami Valley Hospital $29,079,646 $4,958,635 $0 $10,534,160 $0 $0 $116,073 $0 $14,997 $10,665,230 $5,706,595 Morrow Morrow County Hospital $1,993,567 $198,798 $0 $722,174 $669,718 $0 $0 $0 $490 $1,392,381 $1,193,583 Franklin Mount Carmel Hospital $26,599,846 $4,388,413 $0 $9,635,848 $0 $0 $0 $0 $13,805 $9,649,653 $5,261,240 Franklin Mount Carmel New Albany Surgical Hosp $0 $622,844 $0 $0 $0 $0 $0 $0 $0 $0 ($622,844) Franklin Nationwide Children's Hospital $108,744,539 $6,813,300 $15,010,745 $33,955,256 $0 $0 $0 $4,906,430 $44,653 $53,917,084 $47,103,784 Mahoning Northside Medical Center $6,724,061 $686,973 $0 $2,435,805 $0 $0 $0 $0 $3,490 $2,439,294 $1,752,321 Athens O'Bleness Memorial Hospital $9,995,504 $659,644 $749,604 $3,349,346 $0 $1,682,226 $0 $0 $3,429 $5,784,605 $5,124,961 Franklin Ohio State University Hospital $34,140,856 $8,147,878 $8,702,001 $9,215,276 $0 $0 $0 $0 $13,202 $17,930,480 $9,782,602 Montgomery Ohio Valley Medical Center $0 $267,226 $0 $0 $0 $0 $0 $0 $0 $0 ($267,226) Franklin OhioHealth Rehabilitation Hospital $0 $171,673 $0 $0 $0 $0 $0 $0 $0 $0 ($171,673) Cuyahoga Parma Community General Hospital $5,207,169 $1,373,696 $0 $1,886,308 $0 $0 $0 $0 $2,702 $1,889,010 $515,314 Paulding Paulding County Hospital $1,118,941 $113,973 $0 $405,339 $375,897 $0 $0 $0 $275 $781,510 $667,537 Pike Pike Community Hospital $1,960,543 $114,669 $0 $710,211 $658,624 $0 $0 $0 $482 $1,369,316 $1,254,647 Holmes Pomerene Hospital $1,256,455 $181,609 $0 $455,153 $0 $228,603 $0 $0 $466 $684,222 $502,613 Hamilton Regency Hospital of Columbus $0 $194,121 $0 $0 $0 $0 $0 $0 $0 $0 ($194,121) Franklin Regency Hospital of North Central Ohio $0 $260,847 $0 $0 $0 $0 $0 $0 $0 $0 ($260,847) Lucas Regency Hospital of Toledo $0 $129,369 $0 $0 $0 $0 $0 $0 $0 $0 ($129,369) Lucas Rehabilitation Hospital of Northwest Ohio $0 $99,465 $0 $0 $0 $0 $0 $0 $0 $0 ($99,465) Montgomery Reliant Rehabilitation Hospital $0 $73,529 $0 $0 $0 $0 $0 $0 $0 $0 ($73,529) Franklin Riverside Methodist Hospital $42,718,649 $7,028,217 $0 $15,474,917 $0 $0 $0 $0 $22,170 $15,497,087 $8,468,870 Portage Robinson Memorial $2,812,904 $837,027 $0 $1,018,980 $0 $0 $0 $0 $1,460 $1,020,440 $183,413 Columbiana Salem Community Hospital $4,956,444 $736,787 $0 $1,795,482 $0 $901,790 $0 $0 $1,838 $2,699,110 $1,962,323 Ashland Samaritan Regional Health System $4,698,707 $483,474 $0 $1,702,116 $0 $854,896 $0 $0 $1,743 $2,558,755 $2,075,281 Washington Selby General Hospital $2,924,750 $322,693 $0 $1,059,497 $982,539 $0 $0 $0 $718 $2,042,754 $1,720,061 Summit Select Specialty Hospital - Akron $0 $86,540 $0 $0 $0 $0 $0 $0 $0 $0 ($86,540) Summit Select Specialty Hospital - Akron LLC $0 $183,605 $0 $0 $0 $0 $0 $0 $0 $0 ($183,605) Hamilton Select Specialty Hospital - Cincinnati $0 $204,101 $0 $0 $0 $0 $0 $0 $0 $0 ($204,101) Cuyahoga Select Specialty Hospital - Cleveland $0 $222,449 $0 $0 $0 $0 $0 $0 $0 $0 ($222,449) Franklin Select Specialty Hospital - W Cols $0 $407,234 $0 $0 $0 $0 $0 $0 $0 $0 ($407,234) Mahoning Select Specialty Hospital - Youngstown $0 $108,116 $0 $0 $0 $0 $0 $0 $0 $0 ($108,116)

4 Muskingum Select Specialty Hospital - Zanesville $0 $97,923 $0 $0 $0 $0 $0 $0 $0 $0 ($97,923) Richland Shelby Hospital - MedCentral $2,727,739 $230,065 $0 $988,129 $916,355 $0 $0 $0 $670 $1,905,154 $1,675,089 Hamilton Shriner's Hospital for Children - Cincin $9,899,789 $166,241 $0 $3,586,219 $0 $0 $0 $518,198 $4,716 $4,109,132 $3,942,891 Greene Soin Medical Center $9,214,878 $917,721 $0 $3,338,108 $0 $0 $0 $0 $4,782 $3,342,891 $2,425,170 Cuyahoga South Pointe Hospital $2,102,119 $819,023 $0 $761,497 $0 $0 $0 $0 $1,091 $762,588 ($56,435) Guernsey Southeastern Ohio Regional MC $4,193,544 $630,930 $0 $1,519,120 $0 $762,986 $0 $0 $1,555 $2,283,661 $1,652,731 Scioto Southern Ohio Medical Center $15,276,309 $1,900,032 $0 $5,533,874 $0 $2,779,416 $0 $0 $5,666 $8,318,956 $6,418,924 Cuyahoga Southwest General Health Center $7,008,970 $2,010,624 $0 $2,539,014 $0 $0 $0 $0 $3,637 $2,542,651 $532,027 Lorain Specialty Hospital of Lorain $0 $67,674 $0 $0 $0 $0 $0 $0 $0 $0 ($67,674) Clark Springfield Regional Medical Center $13,388,063 $1,624,205 $0 $4,849,853 $0 $0 $0 $0 $6,948 $4,856,801 $3,232,596 Lucas St. Anne Mercy Hospital $7,170,673 $903,781 $0 $2,597,591 $0 $0 $0 $0 $3,721 $2,601,312 $1,697,531 Franklin St. Ann's Hospital $13,596,427 $1,917,992 $0 $4,925,333 $0 $0 $0 $0 $7,056 $4,932,389 $3,014,397 Lucas St. Charles Mercy Hospital $7,030,961 $1,023,596 $1,077,819 $2,156,538 $0 $0 $0 $0 $3,090 $3,237,447 $2,213,851 Mahoning St. Elizabeth - Boardman $6,275,258 $1,237,841 $0 $2,273,225 $0 $0 $0 $0 $3,257 $2,276,482 $1,038,641 Mahoning St. Elizabeth Health Center $14,407,960 $2,340,332 $0 $5,219,313 $0 $0 $0 $0 $7,477 $5,226,790 $2,886,458 Cuyahoga St. John Medical Center $4,475,761 $1,120,090 $0 $1,621,353 $0 $0 $0 $0 $2,323 $1,623,676 $503,586 Trumbull St. Joseph Health Center $5,671,690 $1,136,065 $0 $2,054,581 $0 $0 $0 $0 $2,943 $2,057,525 $921,460 Lucas St. Luke's Hospital $4,491,455 $1,357,923 $0 $1,627,039 $0 $0 $0 $0 $2,331 $1,629,370 $271,447 Allen St. Rita's Medical Center $17,937,750 $2,188,969 $0 $6,497,986 $0 $0 $0 $0 $9,309 $6,507,295 $4,318,326 Cuyahoga St. Vincent Charity Medical Center $13,238,330 $1,101,822 $1,243,626 $4,345,106 $0 $0 $0 $0 $6,225 $5,594,957 $4,493,135 Lucas St. Vincent Mercy Medical Center $34,624,276 $3,003,523 $3,625,671 $11,229,307 $0 $0 $0 $0 $16,088 $14,871,065 $11,867,542 Summit Summa Health System Hospitals $0 $4,695,903 $0 $0 $0 $0 $0 $0 $0 $0 ($4,695,903) Summit Summa Rehab Hospital LLC $0 $165,317 $0 $0 $0 $0 $0 $0 $0 $0 ($165,317) Summit Summa Western Reserve Hospital $607,857 $799,876 $0 $220,197 $0 $0 $0 $0 $315 $220,513 ($579,363) Montgomery Sycamore Hospital $7,099,395 $936,033 $0 $2,571,770 $0 $0 $50,891 $0 $3,643 $2,626,304 $1,690,271 Mahoning The Surgical Hospital at Southwoods $0 $370,151 $0 $0 $0 $0 $0 $0 $0 $0 ($370,151) Lawrence Three Gables Surgical Center $0 $92,320 $0 $0 $0 $0 $0 $0 $0 $0 ($92,320) Lucas Toledo Children's Hospital $0 $433,339 $0 $0 $0 $0 $0 $0 $0 $0 ($433,339) Lucas Toledo Hospital $7,673,517 $4,116,744 $0 $2,779,747 $0 $0 $0 $0 $3,982 $2,783,729 ($1,333,015) Hamilton Tri-Health Evendale Hospital $0 $370,553 $0 $0 $0 $0 $0 $0 $0 $0 ($370,553) Hamilton Trihealth Rehabiliation Hospital $0 $115,055 $0 $0 $0 $0 $0 $0 $0 $0 ($115,055) Jefferson Trinity Hospital Holding Company $7,356,463 $1,289,732 $0 $2,664,894 $0 $0 $0 $0 $3,818 $2,668,711 $1,378,979 Tuscarawas Trinity Hosptial Twin City $1,734,629 $144,881 $0 $628,373 $582,730 $0 $0 $0 $426 $1,211,529 $1,066,648 Trumbull Trumbull Memorial Hospital $4,107,774 $895,964 $0 $1,488,049 $0 $0 $0 $0 $2,132 $1,490,181 $594,217 Cuyahoga UHHS/Ahuja Medical Center $6,077,441 $1,341,195 $0 $2,201,565 $0 $0 $0 $0 $3,154 $2,204,719 $863,524 Ashtabula UHHS/Brown Memorial Hospital $2,963,763 $208,174 $0 $1,073,629 $995,645 $0 $0 $0 $728 $2,070,002 $1,861,828 Geauga UHHS/Geauga Regional Hospital $3,556,505 $1,033,670 $0 $1,288,351 $0 $0 $0 $0 $1,846 $1,290,197 $256,527 Ashtabula UHHS/Memorial Hospital of Geneva $2,303,977 $269,067 $0 $834,620 $773,997 $0 $0 $0 $566 $1,609,183 $1,340,116 Cuyahoga UHHS/Rainbow Babies & Children's Ho $0 $2,032,907 $0 $0 $0 $0 $0 $0 $0 $0 ($2,032,907) Cuyahoga UHHS/Richmond Heights Gen Hosp. $9,293,246 $832,521 $0 $3,366,497 $0 $0 $0 $0 $4,823 $3,371,320 $2,538,799 Cuyahoga UHHS/University Hosp. of Cleveland $31,613,091 $7,330,145 $6,303,351 $9,168,504 $0 $0 $0 $0 $13,135 $15,484,991 $8,154,846 Tuscarawas Union Hospital $4,716,172 $726,785 $0 $1,708,443 $0 $858,074 $0 $0 $1,749 $2,568,266 $1,841,481 Hamilton University Hospital $39,802,692 $5,325,446 $6,416,336 $12,094,275 $0 $0 $0 $0 $17,327 $18,527,938 $13,202,492 Cuyahoga University Hospitals Avon Rehabilitation Hospital $0 $66,755 $0 $0 $0 $0 $0 $0 $0 $0 ($66,755) Cuyahoga University Hospitals Rehab Hospital $0 $121,683 $0 $0 $0 $0 $0 $0 $0 $0 ($121,683) Lucas University of Toledo Medical Center $11,222,489 $2,369,738 $0 $4,065,369 $0 $0 $0 $0 $5,824 $4,071,193 $1,701,455 Miami Upper Valley Medical Center $6,842,181 $927,820 $0 $2,478,594 $0 $0 $0 $0 $3,551 $2,482,145 $1,554,325 Van Wert Van Wert County Hospital $2,168,837 $262,192 $0 $785,666 $0 $394,604 $0 $0 $804 $1,181,074 $918,882 Mahoning Vibra Hospital of Mahoning Valley $0 $125,083 $0 $0 $0 $0 $0 $0 $0 $0 ($125,083) Darke Wayne Hospital Company $4,101,318 $391,362 $0 $1,485,711 $0 $746,206 $0 $0 $1,521 $2,233,438 $1,842,076 Butler West Chester Medical Center $12,777,827 $1,789,275 $0 $4,628,794 $0 $0 $0 $0 $6,631 $4,635,425 $2,846,150

5 Shelby Wilson Memorial Hospital $1,638,033 $490,665 $0 $593,381 $0 $298,029 $0 $0 $608 $892,017 $401,352 Wood Wood County Hospital $4,522,907 $603,497 $0 $1,638,432 $0 $0 $0 $0 $2,347 $1,640,779 $1,037,282 Wayne Wooster Community Hospital $3,776,263 $784,363 $0 $1,367,959 $0 $687,064 $0 $0 $1,401 $2,056,424 $1,272,061 Wyandot Wyandot Memorial Hospital $157,532 $233,094 $0 $57,066 $52,921 $0 $0 $0 $39 $110,026 ($123,068) LOWER RATE: % CLOSED Net Gain Total UC UPPER RATE: % HOSPITAL to Distribute in County THRESHOLD: $216,372,500 Affinity Medical Center $441,994 $1,823,622 EFFECTIVE RATE: % Good Samaritan - Dayton $346,586 $3,526,973 ASSESSMENT NEEDED: $243,923,053 STATE SHARE: $243,573,053 STATEWIDE MISERY INDEX: 3.13% ODM: $350,000