2025-06-27T12:30:08-05:00 2025-02-20 991856619 GRANT THORNTON ADVISORS LLC 1000 WILSON BOULEVARD SUITE 1500 ARLINGTON VA 22209 990 2024-02-29 526321234 PENINSULA GENERAL HOSPITAL INSURANCE TRUST PENI 4105466400 100 EAST CARROLL STREET SALISBURY MD 218015493 STEPHANIE GARY CFO 4105466400 2025-06-27 1 0 MARY TORRETTA P00847851 7038477500 2024 2025-03-06 01:10:19Z X TRUSTEE 100 EAST CARROLL STREET SALISBURY MD 218015493 11956973 0 X N/A X 1986 MD SUPPORT TIDALHEALTH, INC. BY PROVIDING A SEGREGATED FUND FROM WHICH COVERED CLAIMS NOT OTHERWISE COVERED BY OTHER WORKERS COMPENSATION INSURANCE MAY BE PAID. X 0 0 0 0 0 0 0 0 0 0 608225 2856935 0 0 608225 2856935 0 0 0 0 2221 2965 0 0 0 33504 38528 35725 41493 572500 2815442 8192202 0 0 0 8192202 0 TO SUPPORT TIDALHEALTH, INC. (EIN 52-2132761) 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 41493 TIDALHEALTH, INC. (EIN 52-2132761), THE PARENT ORGANIZATION OF A COMMUNITY HEALTH SYSTEM, MAINTAINS A SEGREGATED FUND FROM WHICH WORKERS COMPENSATION CLAIMS AND ASSOCIATED ADMINISTRATIVE COSTS NOT OTHERWISE COVERED BY OTHER WORKERS COMPENSATION INSURANCE MAY BE PAID, AND, 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 CLAIMS. ACCOUNTING ACTIVITIES OF THIS TRUST ARE ALSO INCLUDED IN THE ANNUAL FORM 990 FILING BY TIDALHEALTH, INC. THIS TRUST DOES NOT HAVE ANY EMPLOYEES. 41493 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 1 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 2965 0 0 2965 0 0 0 0 0 0 0 219583 219583 11737390 9100038 2637352 2637352 2637352 2856935 0 0 2856935 2965 2965 38528 38528 41493 41493 0 0 0 0 0 41643 0 0 0 0 0 0 0 8150559 0 0 0 0 0 8192202 0 0 0 X 8192202 0 8192202 0 8192202 0 X 2815442 -1984924 -9022720 X 0 1 X 1 0 X X 1 TIDALHEALTH INC 522132761 10 0 0 41493 1 0 41493 0 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 2/28/2025. SCHEDULE A, PART IV, SECTION A, LINE 1: THE ORGANIZATION'S TRUST AGREEMENT PROVIDES THAT THE PURPOSE OF THE TRUST IS TO MAINTAIN A SEGREGATED FUND FROM WHICH CLAIMS FOR MEDICAL AND PROFESSIONAL LIABILITY AND RELATED COSTS COULD BE PAID ON BEHALF OF TIDALHEALTH PENINSULA REGIONAL, INC. EFFECTIVE JANUARY 1, 2021, THE EMPLOYEES AND CORRESPONDING INSURANCE POLICIES OF TIDALHEALTH PENINSULA REGIONAL TRANSFERRED TO ITS PARENT ORGANIZATION, TIDALHEALTH, INC (THI). ALTHOUGH TIDALHEALTH, INC. IS NOT NAMED IN THE TRUST'S ORGANIZING DOCUMENTS, TIDALHEALTH, INC. IS FULFILLING THE PURPOSE ORIGINALLY INTENDED BY THE TRUST AGREEMENT. SCHEDULE A, PART IV, SECTION D, LINE 3: ROLE OF SUPPORTED ORGANIZATION THE SUPPORTED ORGANIZATION, TIDALHEALTH, INC., APPOINTS THE SOLE INSTITUTIONAL TRUSTEE AND HAS FINAL AUTHORITY OVER ALL ACTIONS OF THE TRUST. TIDALHEALTH, 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, 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, INC. (A TAX-EXEMPT ENTITY). THE ASSETS HELD IN THE TRUST DIRECTLY FURTHER THE CHARITABLE PURPOSES OF THE EXEMPT ORGANIZATION IN FULFILLING THE ORGANIZATION'S TAX-EXEMPT MISSION. THE FILING ORGANIZATION EXISTS AS A MATTER OF LAW TO FULFILL POTENTIAL WORKER'S COMPENSATION CLAIMS FOR THE EMPLOYEES OF THE SUPPORTED ORGANIZATION, TIDALHEALTH, INC. 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 ORGANIZATION, 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, 2024 AND 2023. CASH 2025-02-20 219 BOOK VALUE 522132761 TIDALHEALTH INC 100 EAST CARROLL STREET SALISBURY MD 21801 501(C)(3) ACCRUED INTEREST 2025-02-20 4962 BOOK VALUE 522132761 TIDALHEALTH INC 100 EAST CARROLL STREET SALISBURY MD 21801 501(C)(3) INVESTMENTS 2025-02-20 9017539 BOOK VALUE 522132761 TIDALHEALTH INC 100 EAST CARROLL STREET SALISBURY MD 21801 501(C)(3) 0 0 0 0 1 0 0 1 0 SCHEDULE N, PART I DUE TO THE FACT THAT THE GRANTOR IS NO LONGER REQUIRED TO MAINTAIN THE TRUST UNDER THE LAWS AND REGULATIONS OF THE STATE OF MARYLAND, PENINSULA GENERAL HOSPITAL INSURANCE TRUST WAS LEGALLY TERMINATED EFFECTIVE 2/20/2025 AND ALL ITS ASSETS WERE TRANSFERRED TO TIDALHEALTH, INC., A MARYLAND NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OR APPOINTMENT TIDALHEALTH, INC. IS THE GRANTOR OF THE PENINSULA GENERAL HEALTH INSURANCE TRUST. IN ITS CAPACITY AS GRANTOR OF THE ORGANIZATION, TIDALHEALTH, INC. HAS THE ABILITY TO APPOINT THE TRUSTEE. 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, INC., THE SUPPORTED ORGANIZATION. 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, 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 FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO AFFILIATE UPON LIQUIDATION OF TRUST -9,022,720. 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 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 HEALTH SERVICES 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 1 0