2022-05-16T13:12:21-05:00 2021-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARDSUITE 1400 ARLINGTON VA 22209 990 2020-07-01 510224470 TIDALHEALTH PHYSICIAN NETWORK INC TIDA 3026296611 801 MIDDLEFORD ROAD SEAFORD DE 19973 BRUCE I RITCHIE CFO 3026296611 2022-05-16 1 BRUCE RITCHIE 999009999 MARY TORRETTA P00847851 7038477500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X DR KARIN DIBARI 801 MIDDLEFORD ROAD SEAFORD DE 19973 3596862 0 X WWW.TIDALHEALTH.ORG X 1978 DE TIDALHEALTH PHYSICIAN NETWORK'S MISSION IS TO PROVIDE QUALITY MEDICAL CARE. X 5 3 330 20 0 0 9618531 0 18666000 3244746 0 0 1245406 352116 29529937 3596862 0 0 0 0 24384974 4362367 0 0 0 5899201 926406 30284175 5288773 -754238 -1691911 4342062 0 4356335 0 -14273 0 X 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. 0 0 4601233 3596862 SEE SCHEDULE O 4601233 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 14 0 1 330 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 DE X DEAN A SWINGLE DIRECTOR OF FINANCE 3025365203 100 EAST CARROLL ST SALISBURY MD 21801 STEVEN LEONARD BOARD MEMBER 1.00 42.00 X 0 1037091 166821 DR KARIN DIBARI PRESIDENT 1.00 40.00 X X 0 542576 82295 RYAN MCLAUGHLIN CHAIRPERSON 1.00 2.00 X X 0 0 0 DR TOM RICCIO SECRETARY 1.00 1.00 X X 0 0 0 KAREN POISKER BOARD MEMBER 1.00 1.00 X 0 0 0 BRUCE RITCHIE CFO 1.00 41.00 X 0 730288 158256 JANET PEDRO MD PHYSICIAN 40.00 1.00 X 461770 0 28542 DENISE JESTER SENIOR DIRECTOR 1.00 40.00 X 0 312008 65368 JOSEPH KIM MD PHYSICIAN 40.00 1.00 X 313464 0 45015 HARRY ANTHONY MD CHIEF MEDICAL OFFICER 1.00 40.00 X 0 238455 35403 TAREK WAKED PHYSICIAN 40.00 0.00 X 1278113 0 39771 WILLIAM DORAN PHYSICIAN 40.00 0.00 X 766908 0 37610 STEPHEN CAREY PHYSICIAN 40.00 0.00 X 536541 0 33650 DAVID COHEN PHYSICIAN 40.00 0.00 X 473334 0 35811 ZIYAD WADI PHYSICIAN 40.00 0.00 X 445270 0 15661 STEVEN ROSE FORMER CEO TO 01/31/20 0.00 0.00 X 0 1021122 2307 TRACI ALLEY FORMER CHIEF HR OFFICER TO 02/02/20 0.00 0.00 X 0 250306 0 THOMAS BROWN FORMER SENIOR VP TO 06/11/20 0.00 0.00 X 0 320344 23667 LILIA KULMACZEWSKI FORMER CHIEF COMPLIANCE OFFICER 1.00 40.00 X 0 208235 27852 4275400 4660425 798029 61 1 1 0 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 PHYSICIAN SRVICES 163468 1 MEDICAL SERVICES 621400 3244746 3244746 3244746 MEDICAL & OTHER REIMB 621400 352116 352116 352116 3596862 3596862 0 0 3756568 3268214 488354 146667 127600 19067 279285 242978 36307 179847 156467 23380 289726 252062 37664 171 149 22 32258 28064 4194 205062 178404 26658 26646 23182 3464 14140 12302 1838 154530 134441 20089 BAD DEBT EXPENSE 203873 177370 26503 0 5288773 4601233 687540 0 211003 0 0 1509919 0 14227 0 0 0 368672 0 2238241 0 4342062 0 2277520 0 0 0 0 0 2078815 0 4356335 0 X -14273 0 -14273 0 4342062 0 X -1691911 1706184 X 0 1 X 1 0 X 6286243 7850000 7630000 9618531 0 31384774 18014184 17993109 18677327 18666000 3244746 76595366 24300427 25843109 26307327 28284531 3244746 107980140 0 0 0 107980140 1173702 1364499 1074512 1245406 352116 5210235 25474129 27207608 27381839 29529937 3596862 113190375 0.95400 0.95480 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 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. 0 0 0 0 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, 2021 AND 2020. 1 1 0 0 0 0 0 1 0 TAREK WAKED PHYSICIAN 467544 0 626569 0 184000 0 15819 0 23952 0 1317884 0 0 0 STEVEN LEONARD BOARD MEMBER 0 737498 0 228713 0 70880 0 145657 0 21164 0 1203912 0 0 STEVEN ROSE FORMER CEO TO 01/31/20 0 22106 0 2707 0 996309 0 0 0 2307 0 1023429 0 490945 BRUCE RITCHIE CFO 0 540191 0 147591 0 42506 0 142856 0 15400 0 888544 0 0 WILLIAM DORAN PHYSICIAN 525265 0 131912 0 109731 0 13658 0 23952 0 804518 0 0 0 DR KARIN DIBARI PRESIDENT 0 451777 0 82394 0 8405 0 64037 0 18258 0 624871 0 0 STEPHEN CAREY PHYSICIAN 426111 0 70190 0 40240 0 13658 0 19992 0 570191 0 0 0 DAVID COHEN PHYSICIAN 472584 0 750 0 0 0 15819 0 19992 0 509145 0 0 0 JANET PEDRO MD PHYSICIAN 324940 0 106830 0 30000 0 20142 0 8400 0 490312 0 0 0 ZIYAD WADI PHYSICIAN 312826 0 127444 0 5000 0 0 0 15661 0 460931 0 0 0 DENISE JESTER SENIOR DIRECTOR 0 244776 0 67232 0 0 0 44607 0 20761 0 377376 0 0 JOSEPH KIM MD PHYSICIAN 290145 0 8319 0 15000 0 20142 0 24873 0 358479 0 0 0 THOMAS BROWN FORMER SENIOR VP TO 06/11/20 0 100737 0 50000 0 169607 0 19500 0 4167 0 344011 0 0 HARRY ANTHONY MD CHIEF MEDICAL OFFICER 0 212825 0 25630 0 0 0 31638 0 3765 0 273858 0 0 TRACI ALLEY FORMER CHIEF HR OFFICER TO 02/02/20 0 19966 0 50000 0 180340 0 0 0 0 0 250306 0 0 LILIA KULMACZEWSKI FORMER CHIEF COMPLIANCE OFFICER 0 150712 0 57523 0 0 0 19466 0 8386 0 236087 0 0 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. TRANSFER OF ASSETS TO TIDALHEALTH MEDICAL PARTNERS, LLC 2020-08-31 306184 FMV 510224470 TIDALHEALTH PHYSICIAN NETWORK INC 100 E CARROLL ST SALISBURY MD 21801 501(C)(3) 0 1 0 0 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. 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 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 KY GRAND CAYMAN CJ 981110617 INSURANCE CJ 501(C)(3) TIDALHEALTH INC 0 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 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 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 1 1 1 1 1 1 1 0 0 C K L M N O P Q