2024-05-14T17:15:48-05:00 2023-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARD SUITE 1500 ARLINGTON VA 22209 990 2022-07-01 521851935 TIDALHEALTH FOUNDATION INC TIDA 4105466400 100 EAST CARROLL STREET SALISBURY MD 218015493 STEPHANIE GARY CFO 4105466400 2024-05-14 1 STEPHANIE GARY XXX-XX-XXXX 1 MARY TORRETTA P00847851 7038477500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JESSICA HALES 100 EAST CARROLL STREET SALISBURY MD 218015493 2185432 0 X WWW.TIDALHEALTH.ORG X 1993 MD SEE SCHEDULE O 28 22 0 44 0 0 2050094 2062970 0 0 -14801 46916 0 25969 2035293 2135855 411611 4650011 0 0 0 0 0 0 0 4068 9147 415679 4659158 1619614 -2523303 13228318 10586776 380626 262387 12847692 10324389 X SEE SCHEDULE O 0 0 4650011 4650011 RAISE FUNDS FOR PROGRAM EXPANSION, CAPITAL PROJECTS AND TO SUPPORT EDUCATIONAL PROGRAMS AND COMMUNITY, HEALTH AND WELLNESS INITIATIVES AT TIDALHEALTH PENINSULA REGIONAL AND TIDALHEALTH NANTICOKE. 4650011 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 28 22 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MD X DEAN A SWINGLE DIRECTOR OF FINANC 3025365203 100 EAST CARROLL STREET SALISBURY MD 218015493 RYAN MCLAUGHLIN BOARD MEMBER 1.00 3.00 X 0 30000 0 JAMES HARTSTEIN CHAIRPERSON 3.00 1.00 X X 0 0 0 JOHN MANSUETI MD BOARD MEMBER 1.00 40.00 X 0 473803 22851 KURT WEHBERG MD BOARD MEMBER 1.00 40.00 X 0 919071 81455 SCOTT PHILLIPS BOARD MEMBER 1.00 40.00 X 0 257210 37078 BETH BARNES BOARD MEMBER 1.00 40.00 X 0 181743 37462 PATTI SERKES BOARD MEMBER 1.00 40.00 X 0 169745 52163 COLE TAUSTIN VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 PALMER GILLIS SECRETARY 1.00 0.00 X X 0 0 0 AUDREY HARKINS TREASURER 1.00 0.00 X X 0 0 0 MICHAEL GUERRIERI ASSISTANT TREASURER 1.00 0.00 X X 0 0 0 LEIGHTON MOORE BOARD MEMBER 1.00 0.00 X 0 0 0 KARI BERGER BOARD MEMBER THRU 12/22 1.00 0.00 X 0 0 0 FRANK HANNA JR BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID KERRIGAN MD BOARD MEMBER THRU 06/23 1.00 0.00 X 0 0 0 VIRGINIA MALONE BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID OREM BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN STERN JR BOARD MEMBER 1.00 0.00 X 0 0 0 GREGORY TAWES BOARD MEMBER 1.00 0.00 X 0 0 0 NEVINS TODD JR MD BOARD MEMBER 1.00 0.00 X 0 0 0 WILLIAM TODD MD BOARD MEMBER 1.00 0.00 X 0 0 0 PHYLLIS VINYARD BOARD MEMBER 1.00 0.00 X 0 0 0 JOSEPH ZIMMER III BOARD MEMBER 1.00 0.00 X 0 0 0 KATHRYN DANKO BOARD MEMBER THRU 09/22 1.00 0.00 X 0 0 0 BRYAN LECOMPTE BOARD MEMBER 1.00 0.00 X 0 0 0 SUSAN WILGUS-MURPHY BOARD MEMBER 1.00 1.00 X 0 0 0 MONTGOMERY SAYLER BOARD MEMBER 1.00 1.00 X 0 0 0 KEVIN MYERS BOARD MEMBER 1.00 0.00 X 0 0 0 LYNN CATHCART BOARD MEMBER 1.00 0.00 X 0 0 0 AULIE PERRY BOARD MEMBER BEG 12/22 1.00 0.00 X 0 0 0 MATTHEW PARKER BOARD MEMBER BEG 12/22 1.00 0.00 X 0 0 0 DENISE BILLING IMMEDIATE PAST PRESIDENT THRU 10/22 50.00 0.00 X 0 268605 56858 JESSICA HALES PRESIDENT BEG 07/22 50.00 0.00 X 0 93387 11497 STEPHANIE GARY CFO BEG 01/23 1.00 53.00 X 0 475048 43804 0 2868612 343168 0 0 1 0 0 321154 1741816 2062970 46916 46916 75546 321154 49577 25969 25969 2135855 0 0 72885 4650011 4650011 9147 9147 4659158 4650011 9147 0 1917909 1841339 9305016 7325236 2005393 1420201 13228318 10586776 380626 262387 380626 262387 X 1537283 1578952 11310409 8745437 12847692 10324389 13228318 10586776 -2523303 0 X 0 1 X 1 0 X 1779415 2215723 2421761 2050094 2062970 10529963 1779415 2215723 2421761 2050094 2062970 10529963 2536782 7993181 29358 16637 14867 0 46916 107778 35213 8898 21788 35770 75546 177215 10814956 0.73910 0.77290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING EVENTS - 2018 AMOUNT: $ 35,213. 2019 AMOUNT: $ 8,898. 2020 AMOUNT: $ 21,788. 2021 AMOUNT: $ 35,770. 2022 AMOUNT: $ 75,546. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INTERCOMPANY PAYABLES 230590 BNY CRAT ANNUITY 31797 262387 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, 2023 AND 2022. GOLF TOURNAMENT PENINSULA 164450 143547 20903 6550 SUMMER EVENT 104000 76682 27318 27317 2 128250 100925 27325 15710 396700 321154 75546 49577 49577 25969 1 TIDALHEALTH PENINSULA REGIONAL INC 100 EAST CARROLL STREET SALISBURY MD 21801 520591628 501(C)(3) 4605840 0 HEALTHCARE SERVICES TIDALHEALTH NANTICOKE INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510069243 501(C)(3) 44171 0 HEALTHCARE SERVICES 2 0 PART I, LINE 2: DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS REQUESTS FOR THE USE OF GRANT FUNDS ARE SUBMITTED TO THE FILING ORGANIZATION BY DEPARTMENT DIRECTORS OF TIDALHEALTH PENINSULA REGIONAL (TPR) AND TIDALHEALTH NANTICOKE (THN), AFTER RECEIVING THE NECESSARY INTERNAL APPROVAL. THE REQUEST CONTAINS VENDOR INFORMATION AND THE EXPLANATION OF THE PROGRAM OF BENEFIT FOR WHICH THE FUNDS ARE REQUESTED. THE ORGANIZATION APPROVES THE USE OF FUNDS BASED ON THE DESIGNATED PERMITTED USE OF THE ORIGINAL CONTRIBUTION. 0 1 0 0 0 0 0 0 0 KURT WEHBERG MD BOARD MEMBER 0 842853 0 75000 0 1218 0 62096 0 19359 0 1000526 0 0 STEPHANIE GARY CFO BEG 01/23 0 413584 0 56372 0 5092 0 32654 0 11150 0 518852 0 0 JOHN MANSUETI MD BOARD MEMBER 0 384703 0 87882 0 1218 0 15785 0 7066 0 496654 0 0 DENISE BILLING IMMEDIATE PAST PRESIDENT THRU 10/22 0 199599 0 23385 0 45621 0 44630 0 12228 0 325463 0 0 SCOTT PHILLIPS BOARD MEMBER 0 227123 0 30087 0 0 0 21832 0 15246 0 294288 0 0 PATTI SERKES BOARD MEMBER 0 146959 0 11597 0 11189 0 38035 0 14128 0 221908 0 0 BETH BARNES BOARD MEMBER 0 160674 0 12713 0 8356 0 19483 0 17979 0 219205 0 0 PART I, LINE 3 PROCESS FOR DETERMINING COMPENSATION A COMPENSATION COMMITTEE OF TIDALHEALTH INC. (THI), THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, DETERMINES THE COMPENSATION OF THE PRESIDENT OF THE ORGANIZATION. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS, AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS AND KEEPS CONTEMPORANEOUS RECORDS OF DECISIONS MADE. PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN THI HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457(F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE THI BOARD OF DIRECTORS TO SUPPLEMENT THE EXECUTIVE'S RETIREMENT INCOME. THE SUPPLEMENTAL RETIREMENT PLAN WAS DEVELOPED BASED ON AN INDEPENDENT CONSULTANT REPORT ON MARKET-BASED PRACTICES FOR SUPPLEMENTAL RETIREMENT PLANS. THE PERCENTAGE OF FINAL AVERAGE PAY, THE REQUIREMENTS FOR VESTING, PARTICIPANTS, AND PAY-OUT PROVISIONS WERE ESTABLISHED, REVIEWED, AND APPROVED BY THE COMPENSATION COMMITTEE. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN C OR IN SCHEDULE J, PART II, COLUMN B(III) AS PART OF DEFERRED COMPENSATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: JOHN MANSUETI, M.D. KURT WEHBURG, M.D. TIDALHEALTH PROVIDED THE FOLLOWING FUNDING AMOUNT DURING 2022: KURT WEHBURG, M.D. - $50,000 PART I, LINE 6A, 6B AND 7: CONTINGENT COMPENSATION AND NON-FIXED PAYMENTS OFFICERS OF THE FILING ORGANIZATION ARE PAID BY THI. THE COMPENSATION IS DETERMINED BY A NUMBER OF VARIABLES INCLUDING BUT NOT LIMITED TO INDIVIDUAL GOALS AS WELL AS ORGANIZATION OPERATIONAL ACHIEVEMENTS IN SERVICE, QUALITY, SAFETY, EMPLOYEE SATISFACTION, AND COST. THE FINAL DETERMINATION OF THE CONTINGENT COMPENSATION AMOUNT IS DETERMINED AND APPROVED BY THE BOARD AS PART OF THE OVERALL COMPENSATION REVIEW OF OFFICERS. FORM 990, PART I, LINES 1 AND 3 DESCRIPTION OF ORGANIZATION MISSION: ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, MEDICAL AND SCIENTIFIC PURPOSES, INCLUDING, FOR SUCH PURPOSES THE MAKING OF DISTRIBUTIONS TO TIDALHEALTH PENINSULA REGIONAL AND TIDALHEALTH NANTICOKE, NOT-FOR-PROFIT, NON-STOCK ORGANIZATIONS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MORE SPECIFICALLY, BUT NOT EXCLUSIVELY, ITS PURPOSE SHALL INCLUDE: THE RAISING OF CONTRIBUTIONS, GIFTS, BEQUESTS AND OTHER DISTRIBUTIONS FOR THE BENEFIT OF TIDALHEALTH PENINSULA REGIONAL AND TIDALHEALTH NANTICOKE. FORM 990, PART V, LINES 1A & 2A: THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A AND LINE 2A BECAUSE THE ORGANIZATION'S 1099 AND W-2 RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF TIDALHEALTH, INC., A RELATED ENTITY, UNDER A SHARED SERVICES AGREEMENT. ACCORDINGLY, THE REQUIRED DISCLOSURES RELATED TO EMPLOYEES AND INDEPENDENT CONTRACTORS ARE INCLUDED ON THE FORM 990 OF TIDALHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIPS NEVINS W. TODD, JR, M.D. AND WILLIAM C. TODD, M.D. ARE FAMILY MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS/STOCKHOLDERS TIDALHEALTH, INC. IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS OF GOVERNING BODY IN ITS CAPACITY AS THE SOLE CORPORATE MEMBER OF THE FOUNDATION, TIDALHEALTH, INC. HAS THE ABILITY TO ELECT MEMBERS OF THE FOUNDATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF GOVERNING BODY DECISIONS AS THE SOLE CORPORATE MEMBER, TIDALHEALTH, INC. ALSO HAS THE ABILITY TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 8B CONTEMPORANEOUS DOCUMENTATION OF MEETINGS HELD/WRITTEN ACTIONS UNDERTAKEN THE GOVERNING BODY OF THE TIDALHEALTH FOUNDATION DOCUMENTS ALL MEETINGS HELD. COMMITTEES OF THE FOUNDATION ALSO DOCUMENT ALL MEETINGS HELD, BUT DO NOT HAVE AUTHORITY TO ACT ON BEHALF OF THE BOARD. COMMITTEE CHAIRPERSONS PRESENT RESOLUTIONS TO THE GOVERNING BODY FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS OF FORM 990 THE COMPLETION OF THE ORGANIZATION'S FORM 990 HAS BEEN DELEGATED TO THE AGENT OF TIDALHEALTH FOUNDATION BY THE PRESIDENT OF TIDALHEALTH, INC., THE PARENT CORPORATION. THE AGENT OF THE FOUNDATION IS ALSO THE CHIEF FINANCIAL OFFICER OF THI. THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE PRESIDENT OF THI. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO THE FILING WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST POLICY A CONFLICT OF INTEREST POLICY HAS BEEN ADOPTED BY THE FOUNDATION'S BOARD OF DIRECTORS/EXECUTIVE COMMITTEE. THE BOARD OF DIRECTORS IS REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY AND ALL INTERESTS WHICH THEY OR ANY IMMEDIATE FAMILY MEMBER MAY HAVE IN ANY BUSINESS ENTITY WHICH HAS OR SEEKS A CONTRACTUAL OR COMPETITIVE RELATIONSHIP WITH THE FOUNDATION. THE BOARD WILL HAVE THE AUTHORITY TO DETERMINE IF A VIOLATION HAS OCCURRED AND WHETHER ANY INTEREST WHICH SHOULD BE DISCLOSED SHOULD DISQUALIFY A DIRECTOR FROM PARTICIPATING IN ANY SPECIFIC BOARD DISCUSSION OR BOARD MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION A COMPENSATION COMMITTEE OF TIDALHEALTH INC., THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, DETERMINES THE COMPENSATION OF THE PRESIDENT OF THE ORGANIZATION. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS, AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS AND KEEPS CONTEMPORANEOUS RECORDS OF DECISIONS MADE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS TO PUBLIC THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO TIDALHEALTH FOUNDATION OR THE PUBLIC INFORMATION OFFICE OF TIDALHEALTH PENINSULA REGIONAL, INC. AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. 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 10 N/A 0 PENINSULA GENERAL HOSPITAL INS TRUST 100 EAST CARROLL STREET SALISBURY MD 21801 526321234 INSURANCE MD 501(C)(3) LINE 12C, III-FI TIDALHEALTH INC 0 DELMARVA PENINSULA INSURANCE COMPANY PO BOX 1159 KY1-1102 GRAND CAYMAN CJ 981110617 INSURANCE CJ 501(C)(3) TIDALHEALTH INC 0 TIDALHEALTH PHYSICIANS 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 MCCREADY FOUNDATION INC 201 HALL HIGHWAY CRISFIELD MD 21817 520607921 HEALTH SERVICES MD 501(C)(3) LINE 10 TIDALHEALTH INC 0 DELMARVA ENDOSC CTR 11103 CATHAGE ROAD BERLIN MD 21801 831509115 HEALTHCARE 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 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0