4A (Expenses $ 30319041 including grants of $ 0) (Revenue $ 43913704)
SEE SCHEDULE O

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN THE CHNA ARE PRESENTED AS A PRIORITIZED DESCRIPTION.

Schedule H, Part V, Section B, Line 5 Facility , 1
"Facility , 1 - NORTH TEXAS MEDICAL CENTER. NORTH TEXAS MEDICAL CENTER, (NTMC), IS AN ACUTE CARE HOSPITAL LOCATED IN GAINESVILLE, TEXAS AND SERVES THE RESIDENTS OF COOKE, EASTERN MONTAGUE, WESTERN GRAYSON AND NORTHERN DENTON COUNTIES IN TEXAS AND SOUTHERN LOVE COUNTY, OKLAHOMA. COOKE COUNTY COMPRISES 81.1% OF FY 2019 INPATIENT DISCHARGES. THE 125,000-SQUARE-FOOT MEDICAL CENTER HOUSES 42 MEDICAL/SURGICAL BEDS, A 6-BED INTENSIVE CARE UNIT, AND A 12-BED WOMEN'S CENTER. ALSO INCLUDED IN THE MEDICAL FACILITY ARE A 15-BED OUTPATIENT SURGERY CENTER, AN EXPANDED SURGICAL DEPARTMENT, A VASCULAR LAB AND A GREATLY EXPANDED EMERGENCY DEPARTMENT (FIVE FASTTRACK, THREE TRAUMA AND THREE SPECIALTY ROOMS). THE MISSION OF NORTH TEXAS MEDICAL CENTER IS TO PROVIDE EXCEPTIONAL, PATIENT CENTERED CARE. NTMC IS OPERATED BY COMMUNITY HOSPITAL CORPORATION AND OWNED BY GAINESVILLE HOSPITAL DISTRICT. THE DEFINED SERVICE AREA OF NTMC IS COOKE COUNTY. THE POPULATION OF COOKE COUNTY IS EXPECTED TO INCREASE BY 3.0% FROM 2019 (41,283) TO 2024 (42,517), WHICH IS BELOW THE 8.2% EXPECTED GROWTH FOR THE STATE OF TEXAS FROM 2019 (29,443,411) TO 2024 (31,853,753). IN 2019, THE RACIAL/ETHNIC BREAKOUT OF COOKE COUNTY WAS 82.7% WHITE NON HISPANIC, 3.3% BLACK, 1.1% ASIAN, 1.1% AMERICAN INDIAN AND 11.8% ALL OTHERS. BY 2024, THE WHITE POPULATION IN COOKE COUNTY IS EXPECTED TO INCREASE BY 0.7%. BY 2024, THE BLACK POPULATION AND THE ASIAN POPULATION IN COOKE COUNTY IS EXPECTED TO INCREASE BY 9.5% AND 27.9%, RESPECTIVELY. ADDITIONALLY, BY 2024, THE HISPANIC POPULATION AND THE AMERICAN INDIAN POPULATION IN COOKE COUNTY IS EXPECTED TO INCREASE BY 15.7% AND 5.7%, RESPECTIVELY. ALL OTHER RACIAL/ETHNIC GROUPS ARE EXPECTED TO INCREASE BY 14.8% IN COOKE COUNTY BY 2024. AS OF 2019, COOKE COUNTY (40.3 YEARS) HAS AN OLDER MEDIAN AGE THAN THE STATE OF TEXAS (35.0 YEARS). THE MEDIAN AGE IN BOTH COOKE COUNTY AND THE STATE IS EXPECTED TO INCREASE OVER THE NEXT FIVE YEARS (2019-2024). COOKE COUNTY ($57,681) HAS A LOWER MEDIAN HOUSEHOLD INCOME THAN THE OF STATE TEXAS ($59,676) (2019). THE MEDIAN HOUSEHOLD INCOME IN BOTH COOKE COUNTY AND THE STATE IS PROJECTED TO INCREASE OVER THE NEXT FIVE YEARS (2019-2024). UNEMPLOYMENT RATES IN COOKE COUNTY AND THE STATE DECREASED BETWEEN 2016 AND 2018. IN 2018, COOKE COUNTY (3.1) HAD A LOWER UNEMPLOYMENT RATE THAN THE STATE OF TEXAS (3.9). COOKE COUNTY (16.2%) HAS A LOWER PERCENTAGE OF FAMILIES LIVING BELOW POVERTY AS COMPARED TO THE STATE (19.6%) (2019). IN 2017, COOKE COUNTY (20.6%) HAS A SLIGHTLY LOWER PERCENTAGE OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY THAN TEXAS (21.0%). BETWEEN 2015 AND 2017, THE PERCENT OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY IN COOKE COUNTY REMAINED RELATIVELY STEADY WHILE RATES IN THE STATE DECREASED. COOKE COUNTY (23.8%) HAS A LOWER PERCENTAGE OF RESIDENTS WITH A BACHELOR OR ADVANCED DEGREE THAN THE STATE (30.1%) (2019). COOKE COUNTY (94.1%) HAS A HIGHER HIGH SCHOOL GRADUATION RATE THAN THE STATE (91.0%) AND THE NATION (86.8%)(2016-2017). ACCORDING TO FEEDING AMERICA, AN ESTIMATED 15.6% OF COOKE COUNTY RESIDENTS ARE FOOD INSECURE AS COMPARED TO 14.9% IN TEXAS. ADDITIONALLY, 23.9% OF THE YOUTH POPULATION (UNDER 18 YEARS OF AGE) IN COOKE COUNTY ARE FOOD INSECURE, AS COMPARED TO 22.5% IN TEXAS (2017). IN 2016-2017, COOKE COUNTY (56.8%) HAS A SLIGHTLY LOWER PERCENTAGE OF PUBLIC-SCHOOL STUDENTS ELIGIBLE FOR FREE OR REDUCED-PRICE LUNCH THAN THE STATE (58.9%), BUT A HIGHER RATE THAN THE NATION (49.2%). COOKE COUNTY (94.1%) HAS A HIGHER HIGH SCHOOL GRADUATION RATE THAN THE STATE (91.0%) AND THE NATION (86.8%)(2016-2017). HEART DISEASE IS THE LEADING CAUSE OF DEATH IN COOKE COUNTY AND THE STATE OF TEXAS (2014-2018). BETWEEN 2014 AND 2018, HEART DISEASE MORTALITY RATES IN COOKE COUNTY AND THE STATE DECREASED. CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE COOKE COUNTY AND THE STATE (2014-2018). BETWEEN 2014 AND 2018, CANCER MORTALITY RATES INCREASED IN COOKE COUNTY AND DECREASED IN THE STATE. FATAL ACCIDENTS ARE THE THIRD LEADING CAUSE OF DEATH IN COOKE COUNTY AND THE FIFTH LEADING CAUSE OF DEATH IN THE STATE OF TEXAS (2014-2018). BETWEEN 2014 AND 2018, ACCIDENT MORTALITY RATES DECREASED IN COOKE COUNTY AND INCREASED IN THE STATE. THE LEADING CAUSE OF FATAL ACCIDENTS IN COOKE COUNTY IS DUE TO MOTOR VEHICLE ACCIDENTS (2016-2018). CEREBROVASCULAR DISEASES ARE THE FOURTH LEADING CAUSE OF DEATH IN COOKE COUNTY AND THE THIRD LEADING CAUSE OF DEATH IN THE STATE (2014-2018). BETWEEN 2014 AND 2018, CEREBROVASCULAR DISEASE MORTALITY RATES IN COOKE COUNTY AND THE STATE DECREASED. CHRONIC LOWER RESPIRATORY DISEASES (CLRD) ARE THE FIFTH LEADING CAUSE OF DEATH IN COOKE COUNTY AND THE FOURTH LEADING CAUSE OF DEATH IN THE STATE (2014-2018). BETWEEN 2016 AND 2018, CLRD MORTALITY RATES INCREASED IN COOKE COUNTY AND SLIGHTLY DECREASED IN THE STATE. ALZHEIMER'S DISEASE, NEPHRITIS, NEPHROTIC SYNDROME AND NEPHROSIS, INTENTIONAL SELF-HARM (SUICIDE), DIABETES MELLITUS AND INFLUENZA AND PNEUMONIA ARE ALSO LEADING CAUSES OF DEATH IN COOKE COUNTY. ARTHRITIS IS A PREVALENT CHRONIC CONDITION IN NTMC 4-COUNTY AREA, WHICH INCLUDES COOKE, MONTAGUE, GRAYSON AND WISE COUNTIES. BETWEEN 2014 AND 2018, ARTHRITIS PREVALENCE RATES IN ADULTS (AGE 18+) IN THE NTMC 4-COUNTY AREA AND THE STATE INCREASED IN 2016-2018, THE NTMC 4-COUNTY AREA THE NTMC 4-COUNTY AREA (59.9%) HAD A HIGHER PERCENTAGE OF ADULTS (AGE 18+) EVER DIAGNOSED WITH ARTHRITIS THAN THE STATE (21.5%). PHYSICAL INACTIVITY, OBESITY, DIABETES, SMOKING AND TOBACCO USE ARE HIGHLY PREVALENT HEALTH ISSUES IN THE AREA AS WELL. AS OF 2017, COOKE COUNTY (20.7%) HAS A SLIGHTLY HIGHER RATE OF UNINSURED ADULTS (AGE 18-64) AS COMPARED TO THE STATE (19.4%). COOKE COUNTY AND THE STATE DID NOT EXPERIENCE SIMILAR DECLINES IN THE PERCENTAGE OF UNINSURED ADULTS (AGE 18-64) BETWEEN 2015 AND 2017 (4.8% AND 5.4%, RESPECTIVELY). A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") WAS CONDUCTED FOR NTMC BY COMMUNITY HOSPITAL CORPORATION (CHC). THIS CHNA UTILIZES RELEVANT HEALTH DATA AND STAKEHOLDER INPUT TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS IN COOKE COUNTY, TEXAS, AND IS THE FIRST CHNA CONDUCTED FOR NTMC DUE TO ITS TRANSITION TO TAX EXEMPT STATUS ON DECEMBER 1, 2018. COMMUNITY INPUT WAS RECEIVED DURING INTERVIEWS CONDUCTED FROM FEBRUARY 6, 2020 - MARCH 4, 2020. THE CHNA IS DESIGNED IN ACCORDANCE WITH CHNA REQUIREMENTS IDENTIFIED IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND FURTHER ADDRESSED IN THE INTERNAL REVENUE SERVICE FINAL REGULATIONS RELEASED ON DECEMBER 29, 2014. THE NTMC BOARD REVIEWED AND ADOPTED THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ON MAY 19, 2020. INTERVIEW METHODOLOGY: NTMC WORKED WITH COMMUNITY HOSPITAL CORPORATION, (CHC), IN THE DEVELOPMENT OF ITS CHNA. NTMC PROVIDED ESSENTIAL DATA AND RESOURCES NECESSARY TO INITIATE AND COMPLETE THE PROCESS, INCLUDING THE DEFINITION OF THE HOSPITAL'S STUDY AREA AND THE IDENTIFICATION OF KEY COMMUNITY STAKEHOLDERS TO BE INTERVIEWED. THE STUDY AREA FOR NTMC IS BASED ON HOSPITAL INPATIENT DISCHARGE DATA FROM JULY 1, 2018 - JUNE 30, 2019 AND DISCUSSIONS WITH HOSPITAL STAFF. HEALTH DATA WAS ALSO COLLECTED FROM A VARIETY OF SOURCES, INCLUDING BUT NOT LIMITED TO, THE ROBERT WOOD JOHNSON FOUNDATION, TEXAS STATE DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE CARES ENGAGEMENT NETWORK, THE UNITED STATES CENSUS BUREAU, AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). BACKGROUND INFORMATION ABOUT NTMC INCLUDING THE MISSION, VISION, VALUES, AND HOSPITAL SERVICES WERE PROVIDED BY THE HOSPITAL OR TAKEN FROM ITS WEBSITE. POPULATION DEMOGRAPHICS INCLUDE POPULATION CHANGE BY RACE, ETHNICITY, AGE, MEDIAN INCOME ANALYSIS, UNEMPLOYMENT AND ECONOMIC STATISTICS IN THE STUDY AREA. DEMOGRAPHIC DATA SOURCES INCLUDE, BUT ARE NOT LIMITED TO, STRATASAN, THE U.S. CENSUS BUREAU, THE UNITED STATES BUREAU OF LABOR STATISTICS. NTMC PROVIDED CHC WITH A LIST OF PERSONS WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH IN THE COOKE COUNTY AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS. FROM THAT LIST, EIGHTEEN IN DEPTH INTERVIEWS WERE CONDUCTED, USING A STRUCTURED INTERVIEW GUIDE, WITH THE TWO GROUPS OUTLINED IN INTERNAL REVENUE SERVICE FINAL REGULATIONS ISSUED DECEMBER 29, 2014. DISCUSSED WERE THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. BACKGROUND INFORMATION WAS GATHERED ON EACH INTERVIEWEE."

Schedule H, Part V, Section B, Line 5 Facility , 2
Facility , 2 - NORTH TEXAS MEDICAL CENTER (CONTINUED). WITH RESPECT TO INDIVIDUALS PROVIDING INPUT, IT WAS NOTED IN THE CHNA THAT 94.4% OF THOSE PROVIDING INPUT ARE MEMBERS OF A MEDICALLY UNDERSERVED, LOW INCOME OR MINORITY POPULATION IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS. 5.6% OF THOSE PROVIDING INPUT WORK FOR A STATE, LOCAL, TRIBAL OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT WITH KNOWLEDGE, INFORMATION OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY. INTERVIEWEES INCLUDED: -MEGAN ANDERLE: MARKETING DIRECTOR, RENAISSANCE CENTER OF GAINESVILLE -JASON BRINKLEY: COUNTY JUDGE, COOKE COUNTY -JIM GOLDSWORTHY: MAYOR, CITY OF GAINESVILLE -CHERYL GOMEZ: DIRECTOR, WORKFORCE SOLUTIONS -MELANIE HESSE: EXECUTIVE DIRECTOR, ABBA WOMEN'S CENTER -GINGER JOHNSON: INTERIM DIRECTOR, ABIGAIL'S ARMS COOKE COUNTY FAMILY CRISIS CENTER -BEKKI JONES: EXECUTIVE DIRECTOR, VISTO OF GAINESVILLE -EMILY LEWIS, RN: BOARD MEMBER, NORTH TEXAS MEDICAL CENTER; INSTRUCTOR OF NURSING DEPARTMENT, NORTH CENTRAL TEXAS COLLEGE -ARLEENE LLOYD: EXECUTIVE DIRECTOR, GAINESVILLE ECONOMIC DEVELOPMENT CORPORATION -NICKI PICKETT: PASTOR, REAL LIFE CHURCH -VICKI ROBERTSON: EXECUTIVE DIRECTOR, COURT APPOINTED SPECIAL ADVOCATES (CASA) FOR KIDS OF NORTH TEXAS -DOREEN RUE: CHIEF EXECUTIVE OFFICER, HEALTH SERVICES OF NORTH TEXAS -MARIA SMITH: HEALTH SERVICES COORDINATOR, TEXAS DEPARTMENT OF STATE HEALTH SERVICES - GAINESVILLE OFFICE -DES STEWART: SUPERINTENDENT, GAINESVILLE INDEPENDENT SCHOOL DISTRICT -JEREMY THOMPSON: SUPERINTENDENT, ERA INDEPENDENT SCHOOL DISTRICT -MORGAN TOBIAS: EXECUTIVE DIRECTOR, GAINESVILLE AREA CHAMBER OF COMMERCE -SHAWN WHITE, MD: PHYSICIAN, GAINESVILLE CLINIC -NIKI WILLIS: PROGRAM DIRECTOR, COURT APPOINTED SPECIAL ADVOCATES (CASA) FOR KIDS OF NORTH TEXAS EXTENSIVE NOTES WERE TAKEN DURING EACH INTERVIEW AND THEN QUANTIFIED BASED ON RESPONSES, COMMUNITIES AND POPULATIONS (MINORITY, ELDERLY, UN/UNDERINSURED, ETC.) SERVED, AND PRIORITIES IDENTIFIED BY RESPONDENTS. QUALITATIVE DATA FROM THE INTERVIEWS WAS ALSO ANALYZED AND REPORTED. POPULATIONS THAT WERE IDENTIFIED AS THE MOST AT RISK FOR INADEQUATE CARE IN THE COMMUNITY BY INTERVIEWEES WERE: YOUTH, ELDERLY, HOMELESS, LOW INCOME/WORKING POOR AND RACIAL/ETHNIC GROUPS. THESE UNDERSERVED GROUPS WERE IDENTIFIED AS MOST AT RISK FOR INADEQUATE CARE DUE TO THE FOLLOWING: YOUTH -POVERTY -TEEN PREGNANCY -LACK OF EXTRACURRICULAR ACTIVITIES -TRANSPORTATION BARRIERS -MENTAL HEALTH CONCERNS (BULLYING, SUICIDE) -DRUG USE, VAPING -ACCESS TO PRIMARY CARE -INCREASING HOMELESS RATE -HEALTH CARE INDEPENDENCE ELDERLY -LIMITED HOME HEALTH OPTIONS -TRANSPORTATION BARRIERS -ISOLATION -LACK OF AFFORDABLE MEDICATIONS -LACK OF ACCESS TO LOCAL SPECIALTY CARE HOMELESS -GROWING POPULATION -LACK OF SHELTERS IN COMMUNITY LOW INCOME/WORKING POOR -LACK OF AWARENESS/EDUCATION REGARDING HEALTH CARE SETTINGS -LIMITED COMPUTER SKILLS -LOW PRIORITIZATION OF HEALTH CARE NEEDS -LACK OF ACCESS TO HEALTHY FOOD -MISUSE OF THE EMERGENCY ROOM RACIAL/ETHNIC GROUPS -LANGUAGE BARRIERS (HISPANIC) -LIMITED NUMBER OF BILINGUAL PROVIDERS -FEAR OF HEALTH CARE SYSTEM (UNDOCUMENTED)

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - NORTH TEXAS MEDICAL CENTER, (NTMC). THE CHNA IDENTIFIED FOUR SIGNIFICANT NEEDS IN THE COMMUNITY SERVED BY NORTH TEXAS MEDICAL CENTER (NTMC), WHICH WERE DETERMINED BY ASSESSING THE PREVALENCE OF THE ISSUES IDENTIFIED FROM THE HEALTH DATA FINDINGS, COMBINED WITH THE FREQUENCY AND SEVERITY OF MENTIONS IN COMMUNITY INPUT. NTMC LEADERSHIP PRIORITIZED THOSE NEEDS USING A STRUCTURED MATRIX TO RANK THE COMMUNITY HEALTH NEEDS BASED ON THREE CHARACTERISTICS: SIZE AND PREVALENCE OF THE ISSUE, EFFECTIVENESS OF INTERVENTIONS AND THE HOSPITAL'S CAPACITY TO ADDRESS THE NEED. THE LIST OF PRIORITIZED NEEDS, IN ORDER OF IMPORTANCE, IS AS FOLLOWS: 1. CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION 2. ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE PROVIDERS AND SERVICES 3. ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS 4. PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES ONCE THIS PRIORITIZATION PROCESS WAS COMPLETE, HOSPITAL LEADERSHIP DISCUSSED THE RESULTS AND DECIDED TO ADDRESS ALL OF THE RANKED HEALTH NEEDS IN VARIOUS CAPACITIES THROUGH A HOSPITAL SPECIFIC IMPLEMENTATION PLAN. PRIORITY #1: CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION OBJECTIVE: PROVIDE AND PROMOTE ACCESS TO PRIMARY HEALTH CARE SERVICES IN THE COMMUNITY 1.A. NTMC WILL CONTINUE TO CONSULT ITS MEDICAL STAFF DEVELOPMENT PLAN REPORT TO DETERMINE THE PHYSICIAN NEEDS OF THE COUNTY AND CONSIDER THE RECRUITMENT OF PROVIDERS ACCORDINGLY. 1.B. NTMC WILL CONTINUE TO STRENGTHEN THE CONTINUUM OF CARE BY INCREASING HEALTH INFORMATION EXCHANGE OPPORTUNITIES, SUCH AS ELECTRONICALLY EXCHANGING PATIENT SUMMARIES OF CARE WITH OTHER PHYSICIANS TO RECONCILE ANY MEDICATION CONCERNS AND CONDUCTING ROUTINE FOLLOW-UP PHONE CALLS WITH DISCHARGED PATIENTS. 1.C. NTMC WILL CONTINUE TO SERVE AS A CLINICAL SITE FOR HEALTH CARE STUDENTS FROM SEVERAL LOCAL ACADEMIC INSTITUTIONS TO ROTATE THROUGH THE FACILITY. 1.D. NTMC WILL CONTINUE TO HOST AREA HIGH SCHOOL STUDENTS DURING THE SUMMERTIME SO THAT THEY MAY OBSERVE DIFFERENT AREAS OF THE HOSPITAL. 1.E. NTMC WILL CONTINUE TO PROVIDE SPECIALTY SERVICES SUCH AS GENERAL SURGERY, BARIATRIC SURGERY, CARDIOLOGY, ORTHOPEDIC SURGERY, OB/GYN, OPHTHALMOLOGY, PAIN MANAGEMENT, PODIATRY AND PULMONOLOGY IN ORDER TO INCREASE ACCESS TO SPECIALTY CARE PROVIDERS AND SERVICES IN THE COMMUNITY. 1.F. NTMC WILL CONTINUE TO PROVIDE TELEHEALTH SERVICES, AND WILL EXPLORE EXPANDING TELEMEDICINE SERVICES AS OPPORTUNITIES ARISE. PRIORITY #2: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE PROVIDERS AND SERVICES OBJECTIVE: PROVIDE AND PROMOTE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES IN THE COMMUNITY 2.A. NTMC WILL CONTINUE TO STAFF A LICENSED SOCIAL WORKER WHO COUNSELS PATIENTS ON VARYING ISSUES AS APPROPRIATE. 2.B. NTMC WILL CONTINUE TO EVALUATE AND TRANSFER ANY PATIENTS THAT PRESENT TO THE EMERGENCY ROOM WITH A MENTAL OR BEHAVIORAL HEALTH ISSUE TO APPLICABLE FACILITIES AS APPROPRIATE. ADDITIONALLY, NTMC SOCIAL WORKERS WILL CONTINUE TO PROVIDE A BROCHURE OF COMMUNITY RESOURCES TO APPLICABLE PATIENTS AND WILL WORK TO UPDATE THE INFORMATION BASED ON NEW AGENCIES IN THE AREA. 2.C. NTMC WILL CONTINUE TO PROVIDE SEXUAL ASSAULT NURSE EXAMINER (SANE) SERVICES IN THE HOSPITAL FOR APPROPRIATE PATIENTS. 2.D. NTMC WILL CONTINUE TO EDUCATE LOCAL HIGH SCHOOL STUDENTS ON MENTAL AND BEHAVIORAL HEALTH TOPICS. PRIORITY #3: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS OBJECTIVE: IMPLEMENT AND OFFER PROGRAMS THAT AIM TO REDUCE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS 3.A. NTMC WILL CONTINUE TO HOST AND/OR PARTICIPATE IN FUNDRAISING EVENTS AND DONATION DRIVES TO BENEFIT UNDERSERVED ORGANIZATIONS IN THE COMMUNITY, AS WELL AS EDUCATIONAL EVENTS. 3.B. NTMC WILL CONTINUE STRENGTHENING ITS PARTNERSHIPS WITH LOCAL NURSING HOMES TO PROVIDE LAB AND IMAGING SERVICES. 3.C. NTMC WILL CONTINUE TO WORK WITH SELF PAY PATIENTS ON PAYMENT PLANS AND/OR INSURANCE COVERAGE THROUGH FINANCIAL COUNSELING. 3.D. NTMC WILL CONTINUE TO PROVIDE TRANSLATION SERVICES AND RESOURCES IN MULTIPLE LANGUAGES, INCLUDING SERVICES FOR THOSE WHO MAY BE VISION AND/OR HEARING IMPAIRED. 3.E. NTMC WILL CONTINUE TO CONNECT PATIENTS TO AFFORDABLE RESOURCES, SUCH AS DISCOUNT PHARMACY SERVICES WHEN AVAILABLE. PRIORITY #4: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES OBJECTIVE: IMPLEMENT PROGRAMS AND PROVIDE EDUCATIONAL OPPORTUNITIES THAT SEEK TO ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS IN THE COMMUNITY. 4.A. NTMC WILL CONTINUE TO HOST AND/OR PARTICIPATE IN LOCALHEALTH-RELATED EVENTS TO PROMOTE HOSPITAL SERVICES, OFFER A VARIETY OF HEALTH SCREENINGS TO THE COMMUNITY, AND/OR SUPPORT OR PARTNER WITH LOCAL ORGANIZATIONS THAT PROVIDE SERVICES TO VULNERABLE POPULATIONS. 4.B. NTMC WILL CONTINUE TO INCREASE EDUCATIONAL OPPORTUNITIES FOR THE PUBLIC CONCERNING WELLNESS TOPICS AND HEALTH RISK CONCERNS. 4.C. NTMC PERSONNEL WILL CONTINUE TO SERVE IN LEADERSHIP ROLES AND AS VOLUNTEERS WITH MANY AGENCIES AND COMMITTEES IN THE COMMUNITY. ADDITIONALLY, NTMC WILL CONTINUE TO PROVIDE STAFF REPRESENTATION AT VARIOUS CONFERENCES AND IN LOCAL CONSORTIUMS FOCUSED AROUND ITS PATIENT POPULATION'S NEEDS. 4.D. NTMC WILL CONTINUE TO INCREASE AWARENESS OF ITS SERVICE OFFERINGS IN THE COMMUNITY THROUGH LOCAL MEDIA OUTLETS, SUCH AS THE RADIO, BILLBOARDS, DIRECT MAIL ADVERTISEMENTS, FACEBOOK AND UPDATING THE HOSPITAL'S WEBSITE. 4.E. NTMC WILL CONTINUE TO PROVIDE MEDICATION MANAGEMENT RESOURCES TO PATIENTS UPON DISCHARGE AS NEEDED.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - NORTH TEXAS MEDICAL CENTER. GAINESVILLE COMMUNITY HOSPITAL, INC. (NORTH TEXAS MEDICAL CENTER) DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTION ON ANY OUTSTANDING PATIENT ACCOUNTS.

Schedule H, Part I, Line 6a SCHEDULE H, PART I, LINE 6A
THE COMMUNITY BENEFIT REPORT FOR FISCAL YEAR ENDING JUNE 30, 2022 WAS PREPARED BY OUR CORPORATE OFFICE, COMMUNITY HOSPITAL CORPORATION.

Schedule H, Part V, Section B, Line 22 SCHEDULE H, PART V, SECTION B, LINE 22
DURING THE FISCAL YEAR ENDED JUNE 30, 2022 NTMC USED A COMBINATION OF THE LOOKBACK METHOD AND THE PRESUMPTIVE MEDICARE AND MEDICAID METHOD IN DETERMINING THE MAXIMUM AMOUNTS TO BE CHARGED TO FAPS ELIGIBLE INDIVIDUALS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. LOOKING BACK AT WHAT MEDICARE AND MEDICAID REIMBURSEMENT / CONTRACTUALS WERE BEING CALCULATED AT OVER THE PRIOR 12 MONTH PERIOD, A WEIGHTED AVERAGE WAS THEN TAKEN. THIS RESULT LED TO THE APPLICATION OF A 75% DISCOUNT FOR ALL SELF-PAY PATIENTS.

Schedule H, Part III, Line 4 BAD DEBT EXPENSE FOOTNOTE
PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE NET REALIZABLE VALUE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGES, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL CLAIMS PAID DATA BY PAYOR. 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 NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE.

Schedule H, Part VI, Line 6 AFFILIATED HEALTH CARE SYSTEM
GAINESVILLE COMMUNITY HOSPITAL (D/B/A NORTH TEXAS MEDICAL CENTER) IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COSTING METHODOLOGY USED ON LINE 6 COMES FROM THE COST REPORT (INPATIENT PPS COST-TO-CHARGE COMPUTATION). ANY SHORTFALL IS A COMMUNITY BENEFIT AS IT IS THE COST OF PROVIDING CARE TO THE COMMUNITY THAT IS NOT REIMBURSED BY THE MEDICARE PROGRAM. BY PROVIDING CARE TO THESE INDIVIDUALS, THE HOSPITAL IS IMPROVING THE HEALTH OF THE COMMUNITY.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
ALL PATIENTS WITHOUT INSURANCE, AND OR AFTER INSURANCE IS BILLED AND COLLECTED, ARE SENT A LETTER FROM OUR EARLY OUT VENDOR FOR THEIR PATIENT BALANCE. ALL STATEMENTS SENT INDICATE NTMC HAS A FINANCIAL ASSISTANCE POLICY AND THAT PATIENTS THINK IT APPLIES TO THEM TO CALL THE NUMBER INDICATED. ALL EMERGENT SERVICES ARE PROVIDED WITHOUT ASKING FOR MONEY AND PATIENT IS BILLED AFTER THE SERVICES ARE PROVIDED. THE ONLY DIFFERENCE ON PATIENTS WITH FINANCIAL ASSISTANCE IS RELATED TO ELECTIVE (NON-EMERGENT) SERVICES. THOSE HAVE TO BE APPROVED PRIOR TO PROVIDING / SCHEDULING THE SERVICE. IF PATIENTS HAVE ALREADY QUALIFIED FOR FINANCIAL ASSISTANCE, THE SELF-PAY PERCENT (IS APPLIED FIRST IF TRUE SELF PAY) THEN IF THEY QUALIFY FOR FINANCIAL ASSISTANCE THE APPLICABLE PERCENT IS APPLIED AND ANY REMAINING BALANCE (IF LESS THAN 100% FA) IS THEN BILLED TO THE PATIENT. ONLY THE PART THEY ARE RESPONSIBLE FOR IS BILLED TO THEM.

Schedule H, Part V, Section B, Line 16a FAP website
- NORTH TEXAS MEDICAL CENTER: Line 16a URL: https://ntmconline.net/YOUR-HOSPITAL/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16b FAP Application website
- NORTH TEXAS MEDICAL CENTER: Line 16b URL: https://ntmconline.net/YOUR-HOSPITAL/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- NORTH TEXAS MEDICAL CENTER: Line 16c URL: https://ntmconline.net/YOUR-HOSPITAL/FINANCIAL-ASSISTANCE/;

Schedule H, Part VI, Line 2 Needs assessment
"GCH WAS FORMED ON AUGUST 10, 2018 AS AN ACUTE CARE HOSPITAL LOCATED IN GAINESVILLE, TX AND SERVING THE RESIDENTS OF COOKE COUNTY, TEXAS. AS REPORTED IN SCHEDULE H, PART V, SECTION C, THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THE FISCAL YEAR ENDING JUNE 30, 2020. THE CHNA WAS ADOPTED BY ITS GOVERNING BOARD ON MAY 19, 2020. THE HOSPITAL'S CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN THE FINAL REGULATIONS RELEASED DECEMBER 29, 2014. IN ADDITION TO THE CHNA DISCUSSED ABOVE IN SCHEDULE H, PART V, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. THE ORGANIZATION SPEAKS WITH MEMBERS OF THE COMMUNITY AND LOCAL LEADERS TO SEE WHAT THEY FEEL ARE MAJOR NEEDS OF THE COMMUNITY. THE MISSION OF THE NTMC FAMILY IS TO PROVIDE EXCEPTIONAL, PATIENT CENTERED CARE. THE NTMC VISION IS TO EXPAND HEALTHCARE SERVICES TO THE COMMUNITY WE SERVE. NTMC OPERATES UNDER THE VALUES OF ""HEART"" HONESTY, EXCELLENCE, ACCOUNTABILITY, RESPECT AND TEAMWORK. BASED ON THE FINDINGS FROM THE NTMC 2020 CHNA THAT WAS RECENTLY COMPLETED, NTMC WILL FOCUS ON THE IDENTIFIED ISSUES AND ADDRESS THOSE IDENTIFIED NEEDS THROUGH ITS IMPLEMENTATION PLAN. A FEW EXAMPLES OF ACTIONS BEING TAKEN BY THE HOSPITAL TO PROMOTE THE HEALTH OF THE COMMUNITY INCLUDE, BUT ARE NOT LIMITED TO: WEIGHT LOSS SURGERY SEMINARS, MONTHLY EDUCATION SESSIONS AT THE STANFORD HOUSE, THE ANNUAL HALLOWEEN HUSTLE, THE HEART HUSTLE, BACK TO SCHOOL WELLNESS EVENTS, BLOOD DRIVES AND LOCAL MEDIAL OUTLET EDUCATIONAL SEGMENTS."

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES ARE INFORMED UPON ADMISSION TO THE HOSPITAL BY A FACE TO FACE VISIT WITH THE HOSPITAL/ADMISSIONS STAFF. THE PATIENT FINANCIAL OBLIGATION IS DISCUSSED WITH THE RESPONSIBLE PARTY. THE HOSPITAL CHARITY CARE POLICY IS DISCUSSED WITH EACH RESPONSIBLE PARTY AND IF IT IS FELT THAT THE PATIENT WOULD QUALIFY FOR THE CHARITY PROGRAM THEN THE NECESSARY DOCUMENTS WOULD BE PRESENTED BY THE RESPONSIBLE PARTY TO THE BUSINESS OFFICE ASSOCIATE FOR REVIEW. THE CHARITY CARE POLICY IS ALSO POSTED IN THE ADMISSIONS OFFICE AND ON ITS WEBSITE.

Schedule H, Part VI, Line 7 State filing of community benefit report
TX

Schedule H, Part VI, Line 4 Community information
NORTH TEXAS MEDICAL CENTER (NTMC) IS AN ACUTE CARE HOSPITAL LOCATED IN GAINESVILLE, TEXAS WHICH IS IN COOKE COUNTY TEXAS. THE 125,000-SQUARE-FOOT MEDICAL CENTER HOUSES 42 MEDICAL/SURGICAL BEDS, A 6-BED INTENSIVE CARE UNIT, AND A 12-BED WOMEN'S CENTER. ALSO INCLUDED IN THE MEDICAL FACILITY ARE A 15-BED OUTPATIENT SURGERY CENTER, AN EXPANDED SURGICAL DEPARTMENT, A VASCULAR LAB AND A GREATLY EXPANDED EMERGENCY DEPARTMENT (FIVE FAST-TRACK, THREE TRAUMA AND THREE SPECIALTY ROOMS). NTMC SERVES THE RESIDENTS OF COOKE, EASTERN MONTAGUE, WESTERN GRAYSON AND NORTHERN DENTON COUNTIES IN TEXAS AND SOUTHERN LOVE COUNTY, OKLAHOMA. NTMC IS OPERATED BY COMMUNITY HOSPITAL CORPORATION AND OWNED BY GAINESVILLE HOSPITAL DISTRICT. GAINESVILLE, TEXAS IS PART OF THE TEXOMA REGION. LAKE TEXOMA IS SITUATED ON THE BORDER BETWEEN OKLAHOMA AND TEXAS AND INCLUDES GRAYSON AND COOKE COUNTIES ON THE TEXAS SIDE. THE LAKE IS ONE OF THE LARGEST RESERVOIRS IN THE COUNTRY AND DRAWS MILLIONS OF VISITORS EACH YEAR DUE TO THE DIVERSE RECREATIONAL ACTIVITIES INCLUDING FISHING, BOATING, SAILING, STATE PARKS AND MUSEUMS. THE CITY OF GAINESVILLE HAS NUMEROUS CITY PARKS AND AN INTEGRATED SOCCER COMPLEX WHICH HOSTS YEAR ROUND SOFTBALL. THE CITY ALSO HAS A POPULAR ZOO, MUSEUMS, DINING AND SHOPPING. THE CITY OF GAINESVILLE ALSO HAS A HISTORIC TRAIN DEPOT WHICH OPERATES DAILY BETWEEN OKLAHOMA CITY AND FORT WORTH AND A MUNICIPAL AIRPORT. GAINESVILLE HAS AN EXCELLENT ECONOMY AND A NUMBER OF LARGE MANUFACTURING COMPANIES HEADQUARTERED IN THE CITY. THE CITY OFFERS RESIDENTS A QUIET SUBURBAN LIVING WITH A LOW COST OF LIVING, LOW UNEMPLOYMENT, A GOOD PUBLIC SCHOOL SYSTEM AND A PUBLIC COLLEGE WHICH SERVES ALL OF COOKE COUNTY. THE DEFINED SERVICE AREA OF NTMC FOR PURPOSES OF THEIR CHNA IS COOKE COUNTY, TEXAS. DURING FISCAL YEAR ENDED JUNE 30, 2019, COOKE COUNTY COMPRISED 81.1% OF ALL INPATIENT DISCHARGES FROM NTMC. THE POPULATION OF COOKE COUNTY IS EXPECTED TO GROW BY 3.0% FROM 2019 (41,283) TO 2024 (42,517), WHICH IS BELOW THE 8.2% EXPECTED GROWTH FOR THE STATE OF TEXAS FROM 2019 (29,443,411) TO 2024 (31,853,753). AS OF 2019, THE RACIAL/ETHNIC BREAKOUT OF COOKE COUNTY WAS 82.7% WHITE, 3.3% BLACK, 1.1% ASIAN, 1.1% AMERICAN INDIAN, 11.8% ALL OTHERS AND 18.9% HISPANIC. THE AVERAGE MEDIAN HOUSEHOLD INCOME IN COOKE COUNTY, AS OF 2019, WAS APPROXIMATELY $57,681 WHICH WAS SLIGHTLY LOWER THAN THE STATE OF TEXAS AT $59,676. THE UNEMPLOYMENT RATE FOR COOKE COUNTY IN 2018 WAS 3.1%. AS OF 2019, APPROXIMATELY 16.2% OF FAMILIES IN COOKE COUNTY LIVED BELOW THE POVERTY LEVEL COMPARED TO THE STATE AT 19.6%. IN 2017, 20.6% OF THE CHILDREN, (<18 YEARS OLD), IN COOKE COUNTY LIVED BELOW THE POVERTY LEVEL, WHICH WAS SLIGHTLY LOWER THAN THE STATE OF TEXAS AT 20.6%. IN 2019, APPROXIMATELY 23.8% OF THE RESIDENTS OF COOKE COUNTY HAD A BACHELORS OR ADVANCED DEGREE COMPARED TO THE STATE OF TEXAS, WHICH HAD A HIGHER PERCENTAGE, AT 30.1%. AS OF 2016-2017, COOKE COUNTY (94.1%) HAS A HIGHER HIGH SCHOOL GRADUATION RATE THAN THE STATE (91.0%) AND THE NATION (86.8%). COOKE COUNTY (40.3 YEARS) HAS AN OLDER MEDIAN AGE THAN TEXAS (35.0 YEARS) (2019). THE MEDIAN AGE IN COOKE COUNTY AND THE STATE IS EXPECTED TO INCREASE OVER THE NEXT FIVE YEARS (2019-2024).

Schedule H, Part VI, Line 5 Promotion of community health
North Texas Medical Center (NTMC) participates in a number of activities in order to promote and improve the health and wellness of our community. Below are some of those activities NTMC participated in during 2020 and/or 2021. NTMC will continue to consult its Medical Staff Development Plan report to determine the physician needs of the county and consider the recruitment of providers accordingly. NTMC will continue to strengthen the continuum of care by increasing health information exchange opportunities, such as electronically exchanging patient summaries of care with other physicians to reconcile any medication concerns and conducting routine follow-up phone calls with discharged patients. NTMC will continue to serve as a clinical site for health care students from several local academic institutions to rotate through the facility. Current Examples include: North Central Texas College nursing students NTMC will continue to host area high school students during the summer time so that they may observe different areas of the hospital. Current Examples include: Lindsay ISD, Callisburg ISD, Muenster ISD NTMC will continue to provide specialty services such as general surgery, bariatric surgery, cardiology, orthopedic surgery, OB/GYN, ophthalmology, pain management, and wound care in order to increase access to specialty care providers and services in the community. NTMC will continue to staff a licensed social worker who counsels patients on varying issues as appropriate. NTMC will continue to evaluate and transfer any patients that present to the Emergency Room with a mental or behavioral health issue to applicable facilities as appropriate. Additionally, NTMC social workers will continue to provide a brochure of community resources to applicable patients, and will work to update the information based on new agencies in the area. NTMC will continue to provide Sexual Assault Nurse Examiner (SANE) services in the hospital for appropriate patients. NTMC will continue to educate local high school students on mental and behavioral health topics. Current Examples include: risky lifestyle behaviors (alcohol use) NTMC will continue to host and/or participate in fundraising events and donation drives to benefit underserved organizations in the community, as well as educational events. Current examples include: blood drives, Taste of NTMC, Great Basket Raffle, Great Day for United Way, Red River Steakoff, NTMC Scrub Fair, Zoo La La Fashion Show, Gainesville Area Chamber of Commerce Golf Tournament, VISTO fundraising events NTMC will continue strengthening its partnerships with local nursing homes to provide lab and imaging services. NTMC will continue to work with uninsured patients on payment plans and/or insurance coverage through financial counseling NTMC will continue to provide translation services and resources in multiple languages, including services for those who may be vision and/or hearing impaired. NTMC will continue to connect patients to affordable resources, such as discount pharmacy services when available. NTMC will continue to host and/or participate in local health-related events to promote hospital services, offer a variety of health screenings to the community, and/or support or partner with local organizations that provide services to vulnerable populations. Current examples include: NTMC Auxiliary Thanksgiving Bake Sale, Annual Halloween Hustle, Back to School Wellness Event, Heart Hustle NTMC will continue to increase educational opportunities for the public concerning wellness topics and health risk concerns. Current examples include: Facebook education (lymphedema, sleep awareness, brain injury awareness, national heart month, cardiac rehabilitation week), stroke education, health and safety (COVID-19 prevention), Joint Camp, Childbirth Class, Weight Loss Surgery seminars, snake bite education, health information and education contributions to the Gainesville Register journal, monthly education at the Stanford House NTMC personnel will continue to serve in leadership roles and as volunteers with many agencies and committees in the community. Additionally, NTMC will continue to provide staff representation at various conferences and in local consortiums focused around its patient population's needs. Current examples include: Gainesville Area Chamber of Commerce, Gainesville Economic Development Corporation, Leadership Gainesville, NTMC Foundation, Kiwanis Group, United Way of Cooke County, Rotary Club NTMC will continue to increase awareness of its service offerings in the community through local media outlets, such as the radio, billboards, direct mail advertisements, Facebook and updating the hospital's website. Current examples include: KGAF educational segments, Facebook, hospital website NTMC will continue to provide medication management resources to patients upon discharge as needed