2026-01-26T10:34:50-06:00 2023-12-31 874030146 LEE & TITSWORTH LLC 231 TIMBER RIDGE RD PROSPER TX 75078 990 2023-01-01 260328929 GPCH GPCH 8064675700 100 MEDICAL DRIVE BORGER TX 79007 AUDREY BULLOCK CFO 8064675700 2026-01-26 1 1 CHRISTOPHER TITSWORTH P01262502 2147990028 2026-01-26 2023 2025-03-06 01:10:19Z X GOLDEN PLAINS COMMUNITY HOSPITAL MELODY HENDERSON PHD 100 MEDICAL DRIVE BORGER TX 79007 32397934 0 X HTTPS://GOLDENPLAINS.ORG/ X 2023 TX TO PROVIDE QUALITY COMPASSIONATE CARE TO PROMOTE THE PHYSICAL AND EMOTIONAL WELL-BEING OF ALL CITIZENS OF HUTCHISON AND SURROUNDING COUNTIES. 9 7 244 5 0 0 1524424 30475887 42340 355283 32397934 0 0 14591347 0 0 21828118 36419465 -4021531 30555838 34577369 -4021531 GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL MISSION IS TO PROVIDE QUALITY COMPASSIONATE CARE TO PROMOTE THE PHYSICAL AND EMOTIONAL WELL-BEING OF ALL CITIZENS OF HUTCHISON AND SURROUNDING COUNTIES. 0 0 25633911 30794170 PROVIDE QUALITY COMPASSIONATE CARE TO PROMOTE THE PHYSICAL AND EMOTIONAL WELL-BEING OF THOSE WE SERVE IN OUR COMMUNITY. 25633911 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 86 0 1 244 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X THE ORGANIZATION 8064675700 100 MEDICAL DRIVE BORGER TX 79007 JIM CORBITT BOARD CHAIR 1.00 1.00 X 0 0 0 WALTER GADBERRY MD BOARD VICE CHAIR 1.00 1.00 X 0 0 0 JESSE SHUFFIELD BOARD SECRETARY 1.00 1.00 X 0 0 0 HANK LANDERS PHD BOARD MEMBER 1.00 1.00 X 0 0 0 CAROLYN BROWN BOARD MEMBER 1.00 1.00 X 0 0 0 DWIGHT KIRKSEY BOARD MEMBER 1.00 1.00 X 0 0 0 LESHA KREIG BOARD MEMBER 1.00 1.00 X 0 0 0 MELODY HENDERSON PHD BOARD MEMBER, CNO/COO 40.00 1.00 X X 145487 0 29728 AUDREY BULLOCK BOARD MEMBER, ACFO 40.00 1.00 X X 118589 0 16383 JAMES FESSER ACNO 40.00 1.00 X 120045 0 26237 DON BATES EDD CEO 40.00 1.00 X 0 0 0 DINA HERMES CFO 40.00 1.00 X 0 0 0 384121 0 72348 3 0 1 0 AMEDISTAFFTRS PO BOX 595 TONTITOWN AR 72770 CLINICAL STAFFING 1091371 CRITICAL ACCESS BILLING SERVICES 1800 TEAGUE DR SUITE 110 SHERMAN TX 75090 PATIENT FIN. SVCS. 918956 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON RD SUITE 1400 DALLAS TX 75252 ER PHYS. COVERAGE 848720 ORTHO-CLINICAL 9975 SUMMERS RIDGE RD SAN DIEGO CA 92121 LABORATORY 645600 FOREFRONT HEALTHCARE 12467 MERIT DR DALLAS TX 75251 FOOD SERVICES 625542 5 1401428 122996 1524424 NET PATIENT SERVICE REVENUE 622110 23685959 23685959 OTHER HOSPITAL SUPPORT 622110 6789928 6789928 30475887 42340 42340 37000 0 37000 37000 37000 OTHER OPERATING REVENUE 621990 154371 154371 DIETARY 621990 103895 103895 REBATES AND REFUNDS 621990 60017 60017 318283 32397934 30794170 0 79340 X 385577 265532 120045 9759303 6629593 3129710 131977 89700 42277 3574553 2429500 1145053 739937 502910 237027 505757 343746 162011 10082777 6852915 3229862 6282655 4866163 1416492 47602 34838 12764 32918 24091 8827 55300 42832 12468 556552 431071 125481 434054 317663 116391 MED./SURG. SUPPLIES 3059139 2238834 820305 OTHER OPERATING EXPENSE 771364 564523 206841 36419465 25633911 10785554 0 4410 3866736 873212 110857 5395847 4112103 0 1283744 0 24416879 0 30555838 8086496 0 26490873 0 34577369 X -4021531 0 -4021531 0 30555838 -4021531 0 X 0 1 X 1 0 X 8233 8233 1252260 733304 518956 4109718 3378799 730919 25636 25636 1283744 STOP LOSS RECEIVABLE 547902 OTHER CURRENT ASSETS 43264 GOODWILL 654557 RIGHT-OF-USE FINANCE LEASES 844221 RIGHT-OF-USE OPERATING LEASE 22326935 24416879 CURRENT PORTION OF LONG-TERM DEBT 3847252 SELF-FUNDED HEALTH INSURANCE 748402 LONG-TERM DEBT, NET OF CURRENT PORTION 19233331 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 314965 TX MEDICAID 1115 RECOUPMENTS LIAB. 1196745 PATIENT ACCOUNTS RELATED LIABILITIES 1150178 26490873 X 32397934 0 32397934 0 32397934 36419465 0 36419465 0 36419465 PART X, LINE 2: THE FINANCIAL STATEMENTS OF GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL ARE AUDITED BY AN INDEPENDENT CPA FIRM. MANAGEMENT REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2023. THE FIN 48 (ASC 740) FOOTNOTE INCLUDED IN THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2023, READS AS FOLLOWS: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND ARE QUALIFIED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW; THEREFORE, NO EXPENSE HAS BEEN PROVIDED FOR INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. 1 1 1 X 350.000000000000 1 X 100.000000000000 1 1 1 0 0 4120660 4120660 0.11310 7580603 7076653 503950 0.01380 11701263 7076653 4624610 0.12690 80054 80054 0.00220 80054 80054 0.00220 11781317 7076653 4704664 0.12910 1 937811 384579 8532216 11514347 -2982131 X 1 1 1 CRITICAL ACCESS HEALTHCARE LLC MANAGEMENT SERVICES 0.00000 0.00000 0.00000 1 1 GOLDEN PLAINS COMMUNITY HOSPITAL 100 MEDICAL DRIVE BORGER TX 79007 GOLDENPLAINS.ORG 100111 X X GOLDEN PLAINS COMMUNITY HOSPITAL 1 0 1 1 X X X X X X X X 23 1 0 0 1 X GOLDENPLAINS.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 0 0 1 X 100.000000000000 350.000000000000 X X X 1 1 X X X 1 X X X X X X 1 X 0 X X X X 1 X 0 0 GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 2: THE PREDECESSOR FOR-PROFIT ENTITY CEASED OPERATIONS, AND THE CORPORATE MEMBER DONATED THE ASSETS TO THE LOCAL PUBLIC HOSPITAL DISTRICT. THE MEMBERSHIP INTEREST WAS DONATED AS A GIFT WITH NO RESTRICTIONS. AT THAT TIME IT WAS THE PREDECESSOR ENTITY WAS CONVERTED TO A NONPROFIT CORPORATION, WHICH IMMEDIATELY TOOK OVER HOSPITAL OPERATIONS ON BEHALF OF THE LOCAL HOSPITAL DISTRICT. GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: BEGINNING WITHIN AND FOR THE 2023 TAX YEAR, GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL ("GPCH") IS AN ORGANIZATION THAT IS NEWLY SUBJECT TO THE REQUIREMENTS OF INTERNAL REVENUE CODE ("IRC") SECTION 501(R) BECAUSE IT IS NEWLY RECOGNIZED AS DESCRIBED IN IRC SECTION 501(C)(3) AND IS OPERATING A HOSPITAL FACILITY. ACCORDINGLY, GPCH MUST MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO ANY HOSPITAL FACILITY BY THE LAST DAY OF THE SECOND TAXABLE YEAR BEGINNING AFTER THE EFFECTIVE DATE OF THE DETERMINATION LETTER OR RULING RECOGNIZING THE ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3). AS OF THE END OF THE 2023 TAX YEAR, GPCH QUALIFIES FOR THE EXCEPTION UNDER IRS REGULATIONS SECTION 1.501(R)-3(D).ALTHOUGH NOT REQUIRED BASED ON THE EXCEPTION UNDER IRS REGULATIONS SECTION 1.501(R)-3(D), GPCH DID CONDUCT A CHNA WHICH TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL. TO GAIN PERSPECTIVE FROM COMMUNITY MEMBERS AND LOCAL ORGANIZATIONS, FORMAL FOCUS GROUPS AND INDIVIDUAL INTERVIEWS WERE CONDUCTED WHICH INCLUDED COMMUNITY HEALTH PROFESSIONALS, COUNTY/CITY GOVERNMENTAL OFFICIALS, EDUCATORS, BUSINESS LEADERS, PUBLIC CITIZENS, AND COMMUNITY NON-PROFITS. THE FOCUS GROUPS WERE WELL ATTENDED, ENTHUSIASTIC, WELL-INFORMED ABOUT COMMUNITY PROGRAMS, AND INTERESTED IN THE WELL- BEING OF THE COMMUNITY. ALL PARTICIPANTS WERE VERY IMPRESSIVE AND ENGAGED IN THE PROCESS. GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: BEGINNING WITHIN AND FOR THE 2023 TAX YEAR, GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL ("GPCH") IS AN ORGANIZATION THAT IS NEWLY SUBJECT TO THE REQUIREMENTS OF INTERNAL REVENUE CODE ("IRC") SECTION 501(R) BECAUSE IT IS NEWLY RECOGNIZED AS DESCRIBED IN IRC SECTION 501(C)(3) AND IS OPERATING A HOSPITAL FACILITY. ACCORDINGLY, GPCH MUST MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO ANY HOSPITAL FACILITY BY THE LAST DAY OF THE SECOND TAXABLE YEAR BEGINNING AFTER THE EFFECTIVE DATE OF THE DETERMINATION LETTER OR RULING RECOGNIZING THE ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3). AS OF THE END OF THE 2023 TAX YEAR, GPCH QUALIFIES FOR THE EXCEPTION UNDER IRS REGULATIONS SECTION 1.501(R)-3(D). GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: FAMILY INCOME IS DETERMINED USING THE CENSUS BUREAU DEFINITION, WHICH USES THE FOLLOWING INCOME WHEN COMPUTING FEDERAL POVERTY GUIDELINES: 1. INCLUDED EARNINGS, SELF-EMPLOYMENT INCOME, UNEMPLOYMENT COMPENSATION, WORKERS' COMPENSATION, SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLIC ASSISTANCE, VETERANS' PAYMENTS, SURVIVOR BENEFITS, PENSION OR RETIREMENT INCOME, INTEREST, DIVIDENDS, RENTS, ROYALTIES, INCOME FROM ESTATES, TRUSTS, EDUCATIONAL ASSISTANCE, ALIMONY, CHILD SUPPORT, ASSISTANCE FROM OUTSIDE THE HOUSEHOLD, AND OTHER MISCELLANEOUS SOURCES, 2. NONCASH BENEFITS (FOOD STAMPS AND HOUSING SUBSIDIES) DO NOT COUNT, 3. DETERMINED ON BEFORE-TAX BASIS, 4. IF A PERSON LIVES WITH A FAMILY, INCLUDES THE INCOME OF ALL FAMILY MEMBERS (NON-RELATIVES, SUCH AS HOUSEMATES, DO NOT COUNT). GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE THROUGH REVIEW AND ANALYSIS OF FINANCIAL AND HISTORIC DATA, AND OTHER INFORMATION PROVIDED BY THE PATIENT AND/OR AN INDEPENDENT THIRD-PARTY VENDOR, THERE IS ADEQUATE INFORMATION WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH CHARITY CARE ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, GPCH MAY USE OUTSIDE AGENCIES IN DETERMINING ESTIMATE INCOME AMOUNTS FOR THE BASIS OF DETERMINING CHARITY CARE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE ONLY DISCOUNT THAT CAN BE GRANTED IS A 100% WRITE OFF OF THE ACCOUNT BALANCE. GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 18E: ALL REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY UNDER GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE MADE BEFORE ANY COLLECTIONS ACTIONS MAY BE TAKEN BY THE HOSPITAL FACILITY OR ANY OTHER AUTHORIZED PARTY. GOLDEN PLAINS COMMUNITY HOSPITAL PART V, SECTION B, LINE 19E: ALL REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY UNDER GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE MADE BEFORE ANY COLLECTIONS ACTIONS MAY BE TAKEN BY THE HOSPITAL FACILITY OR ANY OTHER AUTHORIZED PARTY. 4 1 - FRITCH MEDICAL CLINIC 700 W BROADWAY FRITCH TX 79036 RURAL HEALTH CLINIC 2 - GOLDEN PLAINS RURAL HEALTH CLINIC 100 S MCGEE BORGER TX 79007 RURAL HEALTH CLINIC 3 - GOLDEN PLAINS WALK-IN CLINIC 202 S MCGEE SUITE B BORGER TX 79007 RURAL HEALTH CLINIC 4 - GOLDEN PLAINS SPECIALTY CLINIC 50 MEDICAL DRIVE BORGER TX 79007 RURAL HEALTH CLINIC PART I, LINE 3C: THE FOLLOWING CRITERIA IS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: INSURED STATUS, UNDERINSURED STATUS, INCOME LEVEL, AND FAMILY SIZE. PART I, LINE 7: THE IRS INSTRUCTIONS FOR SCHEDULE H (FORM 990), SPECIFICALLY WORKSHEETS 1 AND 2, ARE USED TO DETERMINE ALLOWABLE COSTS. PART III, LINE 2: THE AMOUNT OF THE ALLOWANCE IS BASED ON MANAGEMENT'S EVALUATION OF THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, INCLUDING THE NATURE OF THE ACCOUNTS, CREDIT CONCENTRATIONS, TRENDS IN HISTORICAL WRITE-OFF EXPERIENCE, SPECIFIC IMPAIRED ACCOUNTS, AND ECONOMIC CONDITIONS. ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS IS GENERALLY DETERMINED BY APPLYING HISTORICAL PERCENTAGES TO FINANCIAL CLASSES WITHIN ACCOUNTS RECEIVABLE. THE ALLOWANCE IS INCREASED BY A PROVISION FOR BAD DEBT EXPENSES AND REDUCED BY WRITE-OFFS, NET OF RECOVERIES. PART III, LINE 3: THE RATIO OF PATIENT CARE COST TO CHARGES AS DETERMINED BY USING THE IRS INSTRUCTIONS FOR SCHEDULE H (FORM 990), SPECIFICALLY 2, IS USED TO ESTIMATE THE COMMUNITY BENEFIT PORTION OF BAD DEBT COSTS. PART III, LINE 4: GPCH D.B.A GOLDEN PLAINS COMMUNITY HOSPITAL AUDITED FINANCIAL STATEMENTS AS OF THE YEAR ENDED DECEMBER 31, 2023, DO NOT CONTAIN A BAD DEBT FOOTNOTE. THE ACCOUNTING STANDARDS UPDATE ("ASU") 2014-09 HAS BEEN ADOPTED, WHICH TREATS THE PROVISION FOR DOUBTFUL ACCOUNTS AS AN IMPLICIT PRICE CONCESSION WITHIN NET PATIENT SERVICE REVENUE. THE PROVISION FOR DOUBTFUL ACCOUNTS IS NO LONGER SEPARATELY STATED AS A REDUCTION TO NET PATIENT SERVICE REVENUE. PART III, LINE 8: THE IRS INSTRUCTIONS FOR SCHEDULE H (FORM 990), SPECIFICALLY WORKSHEETS 1 AND 2, ARE USED TO DETERMINE ALLOWABLE COSTS. THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. PART III, LINE 9B: PATIENT ACCOUNTS WHICH ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE EXCLUDED FROM DEBT COLLECTIONS. ALL REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY UNDER GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE MADE BEFORE ANY COLLECTIONS ACTIONS MAY BE TAKEN BY THE HOSPITAL FACILITY OR ANY OTHER AUTHORIZED PARTY. PART VI, LINE 2: THE 2023 COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL (THE "HOSPITAL") ASSESSES THE NEEDS OF THE COMMUNITY BY LISTENING TO MEMBERS OF THE COMMUNITY AND REVIEWING DEMOGRAPHIC DATA, THE HOSPITAL AND COMMUNITY GAIN INFORMATION ON HEALTH STATUS AND WHERE GAPS IN HEALTHCARE DELIVERY CURRENTLY EXIST. FURTHERMORE, IT SOLIDIFIES THE HOSPITAL'S ROLE IN THE COMMUNITY AS A PARTNER IN IMPROVING OVERALL HEALTH STATUS, AS WELL AS IN AREAS BEYOND HEALTH, SUCH AS EDUCATION AND ECONOMIC DEVELOPMENT PART VI, LINE 3: INFORMATION REGARDING PATIENT ELIGIBILITY FOR FINANCIAL ASSISTANCE IS COMMUNICATED IN PERSON AT THE FACILITY, PRINTED MATERIALS AND APPLICATIONS, AND ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL (THE "HOSPITAL") DEFINES ITS COMMUNITY BASED ON ITS SERVICE OR MARKET AREAS. THE HOSPITAL IDENTIFIES ITS' PRIMARY MARKET AREA AS HUTCHINSON COUNTY. THE SECONDARY MARKET EXTENDS TO ALL SURROUNDING COUNTIES, WITH A RADIUS OF APPROXIMATELY 50 MILES FROM BORGER. PART VI, LINE 5: THE STAFF AT GPCH D.B.A. GOLDEN PLAINS COMMUNITY HOSPITAL (THE "HOSPITAL") IS A DRIVEN AND DEDICATED TEAM WITH A SET OF GOALS THAT WE STRIVE TO ACCOMPLISH EACH DAY, WHICH INCLUDE: IMPROVING THE QUALITY OF CARE, INCREASING CUSTOMER/PATIENT SATISFACTION, MINIMIZING COST, MINIMIZING TIME INVOLVED IN DELIVERING SERVICE, DECREASING STAFF FRUSTRATION, AND HAVING STAFF EMPOWERED TO BE MORE EFFECTIVE.WE ARE USING THE TAGLINE "QUALITY CARE-WHERE YOU LIVE" TO EMPHASIZE OUR DESIRE TO CONTINUE BUILDING A PARTNERSHIP WITH THE COMMUNITY AS WE ALL SEEK TO FIND OPPORTUNITIES TO SUPPORT WELLNESS, AND WHEN NEEDED, PROVIDE HIGH QUALITY HEALTH CARE, STATE-OF-THE-ART TECHNOLOGIES, AND DIAGNOSTIC IMPROVEMENTS IN A COMFORTABLE, HEALING ENVIRONMENT. I'M VERY PROUD TO BE ASSOCIATED WITH THE DEDICATED STAFF OF PROFESSIONALS THAT WORK AT THE HOSPITAL MANY OF WHOM HAVE DEDICATED THEIR ENTIRE CAREERS TO MEETING THE HEALTH CARE NEEDS OF OUR COMMUNITY. LIKEWISE, IT IS A PRIVILEGE TO PARTNER WITH OUTSTANDING PROVIDERS IN OUR COMMUNITY TO BRING YOU A LEVEL OF CARE ENVIED BY MANY COMMUNITIES. PART VI, LINE 7, REPORTS FILED WITH STATES TX 0 0 0 0 0 0 0 0 0 MELODY HENDERSON PHD BOARD MEMBER, CNO/COO 145487 0 0 0 0 0 19723 0 10005 0 175215 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DURING 2023, GPCH HAS A MANAGEMENT CONTRACT WITH CRITICAL ACCESS HEALTHCARE, LLC (CAH) TO PROVIDE EXECUTIVE LEVEL MANAGEMENT TALENT. PRESENTLY CAH PROVIDES CEO AND CFO STAFFING TO HOSPITAL UNDER THE MANAGEMENT CONTRACT. THERE ARE NO BUSINESS OR FAMILY RELATIONSHIPS BETWEEN THE MANAGER (CAH) OR THE GPCH'S OFFICERS AND DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 HUTCHINSON COUNTY EMS, INC. (A TEXAS NON-PROFIT CORPORATION AND AN IRC 501 (C)(3) TAX EXEMPT ORGANIZATION) IS THE SOLE CORPORATE MEMBER OF GPCH. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT, THIRD-PARTY CPA FIRM. THE ORGANIZATION'S MANAGEMENT REVIEWS THE RETURN FOR ACCURACY AND COMPLETENESS AND AUTHORIZES ITS FILING. A COPY OF FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO OR AT THE EARLIEST BOARD MEETING FOLLOWING THE COMPLETION OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C AS PROVIDED WITHIN GPCH'S CONFLICT OF INTEREST POLICY, ANY DIRECTOR OR OFFICER, HAVING AN EXISTING OR POTENTIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY SUCH PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN ANOTHER SUCH PERSON, SHALL MAKE A PROMPT M FULL AND FRANK DISCLOSURE OF THE INTEREST TO THE BOARD OR COMMITTEE AT THE EARLLEST POSSIBLE MEETING OF SUCH BOARD OR COMMITTEE AFTER THE INTEREST BECOMES KNOW. THE INTERESTED PARTY IS REQUIRED TO DISCLOSE THE NATURE AND EXTENT OF HIS/HER INTEREST AND ANY RELEVANT AND MATERIAL FACTS, KNOW TO HIM/HER, ABOUT THE CONTRACT OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE THE CORPORATION'S INTEREST AND TO ANSWER PERTINENT QUESTIONS PRESENTED TO HIM/HER. THE BODY TO WHICH DISCLOSURE IS MADE SHALL DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE REQUIRES THAT THE NON-VOTING AND NONPARTICIPATION PROVISIONS BELOW MUST BE OBSERVED, IF SO, SUCH PERSON SHALL NOT VOTE ON, NOR USE HIS PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION OR TO RESPOND TO QUESTIONS) IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION WHICH LS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE THEREON AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE APPOINTMENT OF GPCH'S CHIEF EXECUTIVE OFFICER (CEO) AND OTHER MANAGEMENT. IF APPOINTED UNDER CONTRACT, THE CONTRACT SHALL STATE THE TERM OF THE APPOINTMENT, SALARY, FUTURE BENEFITS, EXPENSE ALLOWANCE, DUTIES, RESPONSIBILITIES, AND AUTHORITIES AND PROCEDURE FOR TERMINATION. FORM 990, PART VI, SECTION C, LINE 18 COPIES OF FORM 1023, 990, AND 990-T ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, FORM 990 AND 990-T ARE PUBLICALLY AVAILABLE ONLINE THROUGH THE IRS WEBSITE'S TAX EXEMPT ORGANIZATION SERARCH (WEB-LINK: HTTPS://WWW.IRS.GOV/CHARITIES-NON-PROFITS/SEARCH-FOR-TAX-EXEMPT-ORGANIZATION S). FORM 990, PART VI, SECTION C, LINE 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,550,652. MANAGEMENT AND GENERAL EXPENSES 2,144,777. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,695,429. PHYSICIAN COVERAGE SERVICES: PROGRAM SERVICE EXPENSES 2,302,263. MANAGEMENT AND GENERAL EXPENSES 1,085,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,387,348. HUTCHINSON COUNTY EMS INC 2801 VIA FORTUNA STE 500 AUSTIN TX 78746 474966348 PUBLIC CHARITY TX 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 HUTCHINSON COUNTY EMS INC D 701715 COST