TIDALHEALTH PHYSICIAN NETWORK INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- TIDALHEALTH PHYSICIAN NETWORK INC (EIN 51-0224470)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202221369349306892
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T13:12:21-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 366055558 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRANT THORNTON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 WILSON BOULEVARDSUITE 1400 | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22209 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 510224470 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIDALHEALTH PHYSICIAN NETWORK INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TIDA | BusinessNameControlTxt |
| Phone | 3026296611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 MIDDLEFORD ROAD | AddressLine1Txt |
| City | SEAFORD | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 19973 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRUCE I RITCHIE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3026296611 | PhoneNum |
| Signature | 2022-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | BRUCE | PersonFirstNm |
| Person Last | RITCHIE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARY TORRETTA | PreparerPersonNm |
| PTIN | P00847851 | PTIN |
| Phone | 7038477500 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Change | Yes (X) | NameChangeInd |
| Principal Officer | DR KARIN DIBARI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 MIDDLEFORD ROAD | AddressLine1Txt |
| City | SEAFORD | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 19973 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,596,862 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TIDALHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Activity Or Mission | TIDALHEALTH PHYSICIAN NETWORK'S MISSION IS TO PROVIDE QUALITY MEDICAL CARE. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 330 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,618,531 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,666,000 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,244,746 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,245,406 | PYOtherRevenueAmt |
| CY Other Revenue | $352,116 | CYOtherRevenueAmt |
| PY Total Revenue | $29,529,937 | PYTotalRevenueAmt |
| CY Total Revenue | $3,596,862 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,384,974 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,362,367 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,899,201 | PYOtherExpensesAmt |
| CY Other Expenses | $926,406 | CYOtherExpensesAmt |
| PY Total Expenses | $30,284,175 | PYTotalExpensesAmt |
| CY Total Expenses | $5,288,773 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$754,238 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,691,911 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,342,062 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,356,335 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$14,273 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TIDALHEALTH PHYSICIAN NETWORK'S MISSION IS TO PROVIDE QUALITY MEDICAL CARE.EFFECTIVE 9/1/20, TIDALHEALTH PHYSICIAN NETWORK, INC. IS A SUBSIDIARY OF TIDALHEALTH MEDICAL PARTNERS, INC. (THMP). THMP'S REVENUE AND EXPENSES ARE REPORTED ON ITS PARENT CORPORATION - TIDALHEALTH, INC. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,601,233 | ExpenseAmt |
| Revenue | $3,596,862 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $4,601,233 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 14 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 330 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | DE | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEAN A SWINGLE DIRECTOR OF FINANCE | PersonNm |
| Phone | 3025365203 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 EAST CARROLL ST | AddressLine1Txt |
| City | SALISBURY | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN LEONARD | ||||||||||
| BOARD MEMBER | 1.00 | 42.00 | Yes (X) | $0 | $1,037,091 | $166,821 | ||||
| DR KARIN DIBARI | ||||||||||
| PRESIDENT | 1.00 | 40.00 | Yes (X) | $0 | $542,576 | $82,295 | Yes (X) | |||
| RYAN MCLAUGHLIN | ||||||||||
| CHAIRPERSON | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| DR TOM RICCIO | ||||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| KAREN POISKER | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| BRUCE RITCHIE | ||||||||||
| CFO | 1.00 | 41.00 | $0 | $730,288 | $158,256 | Yes (X) | ||||
| JANET PEDRO MD | ||||||||||
| PHYSICIAN | 40.00 | 1.00 | $461,770 | $0 | $28,542 | Yes (X) | ||||
| DENISE JESTER | ||||||||||
| SENIOR DIRECTOR | 1.00 | 40.00 | $0 | $312,008 | $65,368 | Yes (X) | ||||
| JOSEPH KIM MD | ||||||||||
| PHYSICIAN | 40.00 | 1.00 | $313,464 | $0 | $45,015 | Yes (X) | ||||
| HARRY ANTHONY MD | ||||||||||
| CHIEF MEDICAL OFFICER | 1.00 | 40.00 | $0 | $238,455 | $35,403 | Yes (X) | ||||
| TAREK WAKED | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,278,113 | $0 | $39,771 | Yes (X) | ||||
| WILLIAM DORAN | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $766,908 | $0 | $37,610 | Yes (X) | ||||
| STEPHEN CAREY | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $536,541 | $0 | $33,650 | Yes (X) | ||||
| DAVID COHEN | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $473,334 | $0 | $35,811 | Yes (X) | ||||
| ZIYAD WADI | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $445,270 | $0 | $15,661 | Yes (X) | ||||
| STEVEN ROSE | ||||||||||
| FORMER CEO TO 01/31/20 | 0.00 | 0.00 | $0 | $1,021,122 | $2,307 | Yes (X) | ||||
| TRACI ALLEY | ||||||||||
| FORMER CHIEF HR OFFICER TO 02/02/20 | 0.00 | 0.00 | $0 | $250,306 | $0 | Yes (X) | ||||
| THOMAS BROWN | ||||||||||
| FORMER SENIOR VP TO 06/11/20 | 0.00 | 0.00 | $0 | $320,344 | $23,667 | Yes (X) | ||||
| LILIA KULMACZEWSKI | ||||||||||
| FORMER CHIEF COMPLIANCE OFFICER | 1.00 | 40.00 | $0 | $208,235 | $27,852 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,275,400 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,660,425 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $798,029 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 61 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEATHERBY LOCUMS | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 972633 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75397 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PHYSICIAN SRVICES | ServicesDesc |
| Compensation | $163,468 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $3,244,746 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,244,746 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,244,746 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL & OTHER REIMB | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $352,116 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $352,116 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $352,116 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,596,862 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,596,862 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,756,568 | TotalAmt |
| Program Services | $3,268,214 | ProgramServicesAmt |
| Management And General | $488,354 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,667 | TotalAmt |
| Program Services | $127,600 | ProgramServicesAmt |
| Management And General | $19,067 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,285 | TotalAmt |
| Program Services | $242,978 | ProgramServicesAmt |
| Management And General | $36,307 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,847 | TotalAmt |
| Program Services | $156,467 | ProgramServicesAmt |
| Management And General | $23,380 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,726 | TotalAmt |
| Program Services | $252,062 | ProgramServicesAmt |
| Management And General | $37,664 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171 | TotalAmt |
| Program Services | $149 | ProgramServicesAmt |
| Management And General | $22 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,258 | TotalAmt |
| Program Services | $28,064 | ProgramServicesAmt |
| Management And General | $4,194 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,062 | TotalAmt |
| Program Services | $178,404 | ProgramServicesAmt |
| Management And General | $26,658 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,646 | TotalAmt |
| Program Services | $23,182 | ProgramServicesAmt |
| Management And General | $3,464 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,140 | TotalAmt |
| Program Services | $12,302 | ProgramServicesAmt |
| Management And General | $1,838 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,530 | TotalAmt |
| Program Services | $134,441 | ProgramServicesAmt |
| Management And General | $20,089 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BAD DEBT EXPENSE | Desc |
| Total | $203,873 | TotalAmt |
| Program Services | $177,370 | ProgramServicesAmt |
| Management And General | $26,503 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,288,773 | TotalAmt |
| Program Services | $4,601,233 | ProgramServicesAmt |
| Management And General | $687,540 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,003 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,509,919 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,227 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $368,672 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,238,241 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,342,062 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,277,520 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,078,815 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,356,335 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,273 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,273 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,342,062 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,691,911 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,706,184 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,286,243 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,850,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,630,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,618,531 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $31,384,774 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,014,184 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,993,109 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,677,327 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,666,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,244,746 | CurrentTaxYearAmt |
| Total | $76,595,366 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,300,427 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,843,109 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,307,327 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $28,284,531 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,244,746 | CurrentTaxYearAmt |
| Total | $107,980,140 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $107,980,140 | PublicSupportTotal509Amt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,173,702 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,364,499 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,074,512 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,245,406 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $352,116 | CurrentTaxYearAmt |
| Total | $5,210,235 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $25,474,129 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,207,608 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,381,839 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,529,937 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,596,862 | CurrentTaxYearAmt |
| Total | $113,190,375 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.95400 | PublicSupportCY509Pct |
| Public Support PY509 | 0.95480 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER REVENUES - 2016 AMOUNT: $ 1,173,702. 2017 AMOUNT: $ 1,364,499. 2018 AMOUNT: $ 1,074,512. 2019 AMOUNT: $ 1,245,406. 2020 AMOUNT: $ 352,116. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $0 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $0 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2021 AND 2020. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAREK WAKED | ||||||||||||||
| PHYSICIAN | $467,544 | $0 | $626,569 | $0 | $184,000 | $0 | $15,819 | $0 | $23,952 | $0 | $1,317,884 | $0 | $0 | $0 |
| STEVEN LEONARD | ||||||||||||||
| BOARD MEMBER | $0 | $737,498 | $0 | $228,713 | $0 | $70,880 | $0 | $145,657 | $0 | $21,164 | $0 | $1,203,912 | $0 | $0 |
| STEVEN ROSE | ||||||||||||||
| FORMER CEO TO 01/31/20 | $0 | $22,106 | $0 | $2,707 | $0 | $996,309 | $0 | $0 | $0 | $2,307 | $0 | $1,023,429 | $0 | $490,945 |
| BRUCE RITCHIE | ||||||||||||||
| CFO | $0 | $540,191 | $0 | $147,591 | $0 | $42,506 | $0 | $142,856 | $0 | $15,400 | $0 | $888,544 | $0 | $0 |
| WILLIAM DORAN | ||||||||||||||
| PHYSICIAN | $525,265 | $0 | $131,912 | $0 | $109,731 | $0 | $13,658 | $0 | $23,952 | $0 | $804,518 | $0 | $0 | $0 |
| DR KARIN DIBARI | ||||||||||||||
| PRESIDENT | $0 | $451,777 | $0 | $82,394 | $0 | $8,405 | $0 | $64,037 | $0 | $18,258 | $0 | $624,871 | $0 | $0 |
| STEPHEN CAREY | ||||||||||||||
| PHYSICIAN | $426,111 | $0 | $70,190 | $0 | $40,240 | $0 | $13,658 | $0 | $19,992 | $0 | $570,191 | $0 | $0 | $0 |
| DAVID COHEN | ||||||||||||||
| PHYSICIAN | $472,584 | $0 | $750 | $0 | $0 | $0 | $15,819 | $0 | $19,992 | $0 | $509,145 | $0 | $0 | $0 |
| JANET PEDRO MD | ||||||||||||||
| PHYSICIAN | $324,940 | $0 | $106,830 | $0 | $30,000 | $0 | $20,142 | $0 | $8,400 | $0 | $490,312 | $0 | $0 | $0 |
| ZIYAD WADI | ||||||||||||||
| PHYSICIAN | $312,826 | $0 | $127,444 | $0 | $5,000 | $0 | $0 | $0 | $15,661 | $0 | $460,931 | $0 | $0 | $0 |
| DENISE JESTER | ||||||||||||||
| SENIOR DIRECTOR | $0 | $244,776 | $0 | $67,232 | $0 | $0 | $0 | $44,607 | $0 | $20,761 | $0 | $377,376 | $0 | $0 |
| JOSEPH KIM MD | ||||||||||||||
| PHYSICIAN | $290,145 | $0 | $8,319 | $0 | $15,000 | $0 | $20,142 | $0 | $24,873 | $0 | $358,479 | $0 | $0 | $0 |
| THOMAS BROWN | ||||||||||||||
| FORMER SENIOR VP TO 06/11/20 | $0 | $100,737 | $0 | $50,000 | $0 | $169,607 | $0 | $19,500 | $0 | $4,167 | $0 | $344,011 | $0 | $0 |
| HARRY ANTHONY MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $212,825 | $0 | $25,630 | $0 | $0 | $0 | $31,638 | $0 | $3,765 | $0 | $273,858 | $0 | $0 |
| TRACI ALLEY | ||||||||||||||
| FORMER CHIEF HR OFFICER TO 02/02/20 | $0 | $19,966 | $0 | $50,000 | $0 | $180,340 | $0 | $0 | $0 | $0 | $0 | $250,306 | $0 | $0 |
| LILIA KULMACZEWSKI | ||||||||||||||
| FORMER CHIEF COMPLIANCE OFFICER | $0 | $150,712 | $0 | $57,523 | $0 | $0 | $0 | $19,466 | $0 | $8,386 | $0 | $236,087 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | PROCESS FOR DETERMINING COMPENSATION COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS DETERMINED BY THE PRESIDENT OF TIDALHEALTH PENINSULA REGIONAL (TPR), A RELATED TAX EXEMPT ORGANIZATION IDENTIFIED IN FORM 990, SCHEDULE R. THE ORGANIZATION'S PRESIDENT IS AN EMPLOYEE OF TPR AND RECEIVES ALL COMPENSATION FROM THIS RELATED ORGANIZATION. |
| PART I, LINES 4A-B | SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: TPR HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457 (F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE TPR BOARD OF DIRECTORS TO SUPPLEMENT THE EXECUTIVE'S RETIREMENT INCOME. THE CONSULTANT REPORT ON MARKET-BASED PRACTICES FOR SUPPLEMENTAL RETIREMENT PARTICIPANTS, AND PAY-OUT PROVISIONS WERE ESTABLISHED, REVIEWED, AND SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART SUPPLEMENTAL RETIREMENT PLAN WAS DEVELOPED BASED ON AN INDEPENDENT PLANS. THE PERCENTAGE OF FINAL AVERAGE PAY, THE REQUIREMENTS FOR VESTING, 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: STEVEN LEONARD BRUCE RITCHIE KARIN DIBARI TPR PROVIDED THE FOLLOWING FUNDING AMOUNTS DURING 2020: STEVEN LEONARD $90,625 BRUCE RITCHIE $200,000 KARIN DIBARI $250,000 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2020. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B) (III): STEVEN ROSE $419,125 THOMAS BROWN $118,087 TRACI ALLEY $173,010 |
| PART I, LINE 7: | NON-FIXED PAYMENTS HIGHEST COMPENSATED EMPLOYEES OF THE ORGANIZATION ARE PAID COMPENSATION 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. VARIABLE COMPENSATION PAYMENTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN B(II) AND REFELCT ATTAINMENT OF CERTAIN GOALS. |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | TRANSFER OF ASSETS TO TIDALHEALTH MEDICAL PARTNERS, LLC | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2020-08-31 | DistributionDt |
| Fair Market Value Of Asset | $306,184 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | FMV | MethodOfFMVDeterminationTxt |
| EIN | 510224470 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIDALHEALTH PHYSICIAN NETWORK INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E CARROLL ST | AddressLine1Txt |
| City | SALISBURY | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | Yes (1) | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | ACCESS TO HEALTH CARE IN MOST OF RURAL AMERICA CONTINUES TO BE CHALLENGING WHEN IT COMES TO RECRUITING PRIMARY CARE PROVIDERS. SUSSEX COUNTY DELAWARE IS DESIGNATED AS A PRIMARY CARE SHORTAGE AREA. TIDALHEALTH, INC, THE PARENT COMPANY OF TIDALHEALTH PHYSICIAN NETWORK, HAS FOCUSED ON THIS PROBLEM FOR SEVERAL YEARS AND HAS BEEN ABLE TO OPEN MEDICAL CENTERS IN THE SMALL COMMUNITIES SURROUNDING SEAFORD. FAMILY PRACTITIONERS HAVE BEEN PLACED IN NANTICOKE'S GEORGETOWN, BRIDGEVILLE, LAUREL, DELMAR AND SEAFORD COMMUNITIES IN DELAWARE AND THE FEDERALSBURG COMMUNITY IN MARYLAND. TIDALHEALTH PHYSICIAN NETWORK PRIMARY CARE PRACTICES RECEIVED AND MAINTAINS A LEVEL 3 RECOGNITION AS A PATIENT-CENTERED MEDICAL HOME BY THE NATIONAL COUNCIL ON QUALITY ASSURANCE. THIS IS THE HIGHEST RECOGNITION RECEIVED IN THE STATE OF DELAWARE. TIDALHEALTH PHYSICIAN NETWORK PROVIDES QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, HANDICAP, AGE, RELIGION, DISABILITY, GENETICS OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF TIDALHEALTH PHYSICIAN NETWORK , IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THE PHYSICIAN NETWORK'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, HEALTH ACTIVITIES AND PROGRAMS NEEDED TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR THE INDIVIDUAL'S INABILITY TO PAY CO-EXIST. |
| FORM 990, PART VI, SECTION A, LINE 4 | CHANGES TO GOVERNING DOCUMENTS AS OF JULY 29, 2020, MID-SUSSEX MEDICAL CENTER, INC. WAS RENAMED TO TIDALHEALTH PHYSICIAN NETWORK, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OR STOCKHOLDERS TIDALHEALTH, INC. IS THE SOLE SHAREHOLDER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS OF GOVERNING BODY TIDALHEALTH, INC., THE SOLE SHAREHOLDER OF TIDALHEALTH PHYSICIAN NETWORK, INC, HAS THE POWER TO APPOINT ALL BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL OF GOVERNING BODY DECISIONS THE FOLLOWING POWERS ARE RESERVED FOR TIDALHEALTH, THE SOLE MEMBER: A) THE POWER TO APPROVE AMENDMENTS TO THE CERTIFICATE OF INCORPORATION AND THE BYLAWS OF THE CORPORATION, B) THE POWER TO APPROVE THE ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND TO APPROVE SUBSTANTIAL UNBUDGETED EXPENSES, C) THE POWER TO APPROVE THE SELECTION OF INDEPENDENT AUDITORS AND ACCOUNTANTS FOR THE CORPORATION, D) THE POWER TO REVIEW AND APPROVE THE BUSINESS AND STRATEGIC PLANS OF THE CORPORATION, E) THE POWER TO APPROVE THE INSURANCE OF ANY INDEBTEDNESS BY THE CORPORATION ABOVE THE AMOUNT THAT SHALL BE SPECIFIED BY THE SOLE MEMBER, F) THE POWER TO APPROVE THE ACQUISITION OF, OR MERGER WITH, ANOTHER ENTITY, OR THE FORMATION OF ANY PARTNERSHIP, JOINT VENTURE OR OTHER LEGAL RELATIONSHIP IN WHICH THE CORPORATION SHALL HAVE ANY INTEREST, FINANCIAL OR OTHERWISE OR SHALL HAVE ANY VOTING RIGHTS, G) THE POWER TO APPROVE THE SELECTION OF THE PRESIDENT OF THE CORPORATION, H) THE POWER TO REVIEW AND APPROVE THE POLICIES OF THE CORPORATION IN CONNECTION WITH COMMUNITY HEALTH NEEDS, AND I) THE POWER TO APPROVE THE DIRECTORS, OFFICERS AND AGENTS OF THE CORPORATION. |
| 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 THE ORGANIZATION BY THE PRESIDENT OF TIDALHEALTH, INC., THE PARENT CORPORATION OF BOTH TIDALHEALTH PENINSULA REGIONAL, INC. (TPR) AND THE ORGANIZATION. THE AGENT OF THE ORGANIZATION IS ALSO THE CHIEF FINANCIAL OFFICER OF TPR. THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE PRESIDENT OF TPR. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO THE FILING WITH THE 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 ORGANIZATION'S BOARD OF DIRECTORS/EXECUTIVE COMMITTEE. THE BOARD OF TRUSTEES 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 ORGANIZATION. 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 COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS DETERMINED BY THE PRESIDENT OF TIDALHEALTH PENINSULA REGIONAL (TPR), A RELATED TAX EXEMPT ORGANIZATION IDENTIFIED IN FORM 990, SCHEDULE R. THE ORGANIZATION'S PRESIDENT IS AN EMPLOYEE OF TPR AND RECEIVES ALL COMPENSATION FROM THIS RELATED ORGANIZATION. |
| 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 THE ORGANIZATION'S OR THE PUBLIC INFORMATION OFFICE OF TIDALHEALTH PENINSULA REGIONAL, INC. AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF ASSETS TO TIDALHEALTH MEDICAL PARTNERS 306,184. TRANSFER OF CAPITAL FROM TIDALHEALTH NANTICOKE 1,400,000. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIDALHEALTH NANTICOKE INC | ||||||||||||||||
| 801 MIDDLEFORD ROAD | SEAFORD | DE | 19973 | 510069243 | HOSPITAL | DE | 501(C)(3) | LINE 3 | TIDALHEALTH INC | 0 | ||||||
| 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 | 0 | N/A | ||||||
| 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 | ||||||||||||||||
| 981110617 | INSURANCE | 501(C)(3) | TIDALHEALTH INC | 0 | PO BOX 1159 | KY | GRAND CAYMAN | CJ | CJ | |||||||
| TIDALHEALTH FOUNDATION INC | ||||||||||||||||
| 100 EAST CARROLL STREET | SALISBURY | MD | 21801 | 521851935 | FUNDRAISING | MD | 501(C)(3) | LINE 7 | TIDALHEALTH INC | 0 | ||||||
| MCCREADY FOUNDATION INC | ||||||||||||||||
| 201 HALL HIGHWAY | CRISFIELD | MD | 21817 | 520607921 | FUNDRAISING | MD | 501(C)(3) | LINE 10 | TIDALHEALTH INC | 0 | ||||||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| DELMARVA SURG CTR | |||||||||
| 641 S SALISBURY BLVD | SALISBURY | MD | 21801 | 522251436 | HEALTHCARE | MD | N/A | 0 | 0 |
| DELMARVA ENDOSC CTR | |||||||||
| 11103 CATHAGE ROAD | BERLIN | MD | 21811 | 831509115 | HEALTHCARE | MD | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (8 entries)
| Transaction TypeTransactionTypeTxt |
|---|
| C |
| K |
| L |
| M |
| N |
| O |
| P |
| Q |
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