2023-07-07T12:32:51-05:00 2023-02-28 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARD SUITE 1500 ARLINGTON VA 22209 990 2022-03-01 526321234 PENINSULA GENERAL HOSPITAL INSURANCE TRUST PENI 4105466400 100 EAST CARROLL STREET SALISBURY MD 218015493 STEPHANIE GARY CFO 4105466400 2023-07-07 1 STEPHANIE GARY 999009999 1 MARY TORRETTA P00847851 7038477500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TRUSTEE 100 EAST CARROLL STREET SALISBURY MD 218015493 2360917 0 X N/A X 1986 MD SUPPORT TIDALHEALTH PENINSULA REGIONAL, INC. BY PROVIDING A SEGREGATED FUND FROM WHICH COVERED CLAIMS NOT OTHERWISE COVERED BY OTHER WORKERS COMPENSATION INSURANCE MAY BE PAID. 0 0 0 0 0 0 0 0 0 0 345054 225623 0 0 345054 225623 0 0 0 0 1637 2600 0 0 0 33828 31616 35465 34216 309589 191407 7219786 6911346 0 0 7219786 6911346 TO SUPPORT TIDALHEALTH PENINSULA REGIONAL, INC. (EIN 52-0591628) BY PROVIDING A SEGREGATED FUND FROM WHICH WORKERS COMPENSATION CLAIMS AND ASSOCIATED ADMINISTRATIVE COSTS NOT OTHERWISE COVERED BY OTHER WORKERS COMPENSATION INSURANCE MAY BE PAID. 0 0 34216 TIDALHEALTH PENINSULA REGIONAL, INC. (EIN 52-0591628), A COMMUNITY HOSPITAL, ESTABLISHED A TRUST ON 3/1/1986 FOR THE PURPOSE OF CREATING AND MAINTAINING A SEGREGATED FUND FROM WHICH WORKERS COMPENSATION CLAIMS AND ASSOCIATED ADMINISTRATIVE COSTS NOT OTHERWISE COVERED BY OTHER WORKERS COMPENSATION INSURANCE MAY BE PAID. TO THE EXTENT THAT SUCH COSTS ARE INCLUDED IN THE REQUIRED FUNDING AMOUNT, FOR THE PAYMENT OF REASONABLE COSTS OF INVESTIGATION, ADJUSTMENT, AND DEFENSE OF SUCH ACCOUNTING ACTIVITIES OF THIS TRUST ARE ALSO INCLUDED IN THE ANNUAL FORM 990 FILING BY TIDALHEALTH PENINSULA REGIONAL, INC. THIS TRUST DOES NOT HAVE ANY EMPLOYEES. 34216 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 X DEAN A SWINGLE - DIRECTOR OF FINANC 3025365203 100 EAST CARROLL ST SALISBURY MD 21801 X PNC INSTITUTIONAL INVESTMENTS TRUSTEE 1.00 0.00 X 2600 0 0 2600 0 0 0 0 0 0 0 127620 127620 2233297 2135294 98003 98003 98003 225623 0 0 225623 2600 2600 31616 31616 34216 34216 0 0 26590 32126 7193196 6879220 7219786 6911346 0 0 X 7219786 6911346 7219786 6911346 7219786 6911346 191407 -499847 0 X 0 1 X 0 0 X X 1 TIDALHEALTH PENINSULA REGIONAL INC 520591628 3 1 0 34216 1 0 34216 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART I: EXPLANATION OF BENEFITS PROVIDED ON BEHALF OF SUPPORTED ORGANIZATION THIS INSURANCE TRUST PROVIDES A SEGREGATED FUND FROM WHICH COVERED CLAIMS NOT OTHERWISE COVERED BY MEDICAL AND PROFESSIONAL LIABILITY INSURANCE MAY BE PAID. NO CLAIMS WERE PAID DURING FYE 2/28/2023. SCHEDULE A, PART IV, SECTION D, LINE 3: ROLE OF SUPPORTED ORGANIZATION THE SUPPORTED ORGANIZATION, TIDALHEALTH PENINSULA REGIONAL, INC., APPOINTS THE SOLE INSTITUTIONAL TRUSTEE AND HAS FINAL AUTHORITY OVER ALL ACTIONS OF THE TRUST. TIDALHEALTH PENINSULA REGIONAL, INC. HAS A SIGNIFICANT VOICE IN PENINSULA GENERAL HOSPITAL INSURANCE TRUST'S INVESTMENT POLICIES. THE SOLE USE OF INCOME AND ASSETS OF PENINSULA GENERAL HOSPITAL INSURANCE TRUST IS TO SUPPORT TIDALHEALTH PENINSULA REGIONAL, INC. BY PROVIDING A SEGREGATED FUND FROM WHICH WORKERS COMPENSATION CLAIMS AND ASSOCIATED ADMINISTRATIVE COSTS NOT OTHERWISE COVERED BY MEDICAL AND PROFESSIONAL LIABILITY INSURANCE MAY BE PAID. SCHEDULE A, PART IV, SECTION E, LINE 2A: EXEMPT PURPOSE ACTIVITIES THE ORGANIZATION WAS FORMED AS A TRUST TO FUND THE SELF-INSURANCE NEEDS OF THE SUPPORTED ORGANIZATION, TIDALHEALTH PENINSULA REGIONAL, INC. (A TAX-EXEMPT HOSPITAL). THE ASSETS HELD IN THE TRUST DIRECTLY FURTHER THE CHARITABLE PURPOSES OF THE EXEMPT ORGANIZATION IN FULFILLING THE HOSPITAL'S TAX-EXEMPT MISSION. SCHEDULE A, PART IV, SECTION E, LINE 2B: ORGANIZATION'S INVOLVEMENT THE TRUST EXISTS TO FULFILL A FUNCTION WHICH COULD BE PERFORMED DIRECTLY BY THE SUPPORTED ORGANIZATION, BUT TO AFFORD STATE LEGAL PROTECTIONS TO THE SUPPORTED HOSPITAL, IS SAFEST HELD IN THIS TRUST FORM. 0 X PART X, LINE 2: LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TIDALHEALTH, INC. THE RELEVANT TEXT OF THE INCOME TAX FOOTNOTE FROM THOSE FINANCIALS IS: THE HEALTH SYSTEM HAS DETERMINED THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2022 AND 2021. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS TIDALHEALTH PENINSULA REGIONAL, INC. IS THE GRANTOR OF THE PENINSULA GENERAL HEALTH INSURANCE TRUST. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL THE GRANTOR OF THE TRUST APPOINTS THE TRUSTEE AND HAS A FINAL AUTHORITY OVER ALL ACTIONS OF THE TRUST. FORM 990, PART VI, SECTION A, LINE 8A DOCUMENTATION OF MEETINGS OF THE GOVERNING BODY THE ORGANIZATION IS A SELF-INSURANCE TRUST AND, ACCORDINGLY, HAS NO PERIODIC MEETINGS OF THE GOVERNING BODY OR WRITTEN ACTIONS. FORM 990, PART VI, SECTION A, LINE 8B DOCUMENTATION OF MEETINGS OF THE COMMITTEE THE ORGANIZATION HAS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS OVERSIGHT OF THE COMPLETION OF THE ORGANIZATION'S FORM 990 HAS BEEN DELEGATED TO THE CHIEF FINANCIAL OFFICER OF TIDALHEALTH PENINSULA REGIONAL, INC. BY ITS SUPPORTED ORGANIZATION, TIDALHEALTH, INC. ONCE THE FORM 990 AND ALL SCHEDULES HAVE BEEN PREPARED BY THE ORGANIZATION'S INDEPENDENT TAX SERVICES PROVIDER, THEY ARE REVIEWED BY THE PRESIDENT OF TIDALHEALTH PENINSULA REGIONAL, INC. PRIOR TO FILING. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS THE TRUST AGREEMENT AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. OTHER DOCUMENTS ARE MADE PUBLICLY AVAILABLE TO THE EXTENT REQUIRED BY LAW. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC: PNC INSTITUTIONAL INVESTMENTS - 116 ALLEGHENY CENTER MALL PITTSBURGH, PA 15212 TIDALHEALTH PENINSULA REGIONAL INC 100 EAST CARROLL STREET SALISBURY MD 21801 520591628 HOSPITAL MD 501(C)(3) LINE 3 TIDALHEALTH INC 0 TIDALHEALTH INC 100 EAST CARROLL STREET SALISBURY MD 21801 522132761 PARENT MD 501(C)(3) LINE 12C, III-FI N/A 0 TIDALHEALTH FOUNDATION INC 100 EAST CARROLL STREET SALISBURY MD 21801 521851935 FUNDRAISING MD 501(C)(3) LINE 7 TIDALHEALTH INC 0 TIDALHEALTH PHYSICIAN NETWORK 801 MIDDLEFORD ROAD SEAFORD DE 19973 510224470 HEALTH SERVICES DE 501(C)(3) LINE 10 TIDALHEALTH INC 0 TIDALHEALTH NANTICOKE INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510069243 HOSPITAL DE 501(C)(3) LINE 3 TIDALHEALTH INC 0 DELMARVA PENINSULA INSURANCE COMPANY PO BOX 1159 KY1-1102 CJ 981110617 INSURANCE CJ 501(C)(3) TIDALHEALTH INC 0 MCCREADY FOUNDATION INC 201 HALL HIGHWAY CRISFIELD MD 21817 520607921 FUNDRAISING MD 501(C)(3) LINE 10 TIDALHEALTH INC 0 DELMARVA ENDOSC CTR 11103 CATHAGE RD BERLIN MD 21801 831509115 HEALTH CARE MD N/A 0 0 PENINSULA HEALTH VENTURES (PHV) 100 EAST CARROLL STREET SALISBURY MD 21801 522250012 P'SHIP INVESTMENT MD N/A C 0 PRLTC INC 100 EAST CARROLL STREET SALISBURY MD 21801 522190588 LONG TERM CARE MD N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0