2021-05-17T11:56:55-05:00 2020-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARDSUITE 1400 ARLINGTON VA 22209 990 2019-07-01 510224470 MID-SUSSEX MEDICAL CENTER INC MID- 3026296611 801 MIDDLEFORD ROAD SEAFORD DE 19973 DR KARIN DIBARI PRESIDENT 3026296611 2021-05-17 1 MARY TORRETTA P00847851 7038477500 2019 2022-09-23 18:48:47Z NANTICOKE PHYSICIAN NETWORK DR KARIN DIBARI 801 MIDDLEFORD ROAD SEAFORD DE 19973 29529937 0 X WWW.TIDALHEALTH.ORG X 1978 DE MID-SUSSEX MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY MEDICAL CARE. 5 4 330 20 0 0 7630000 9618531 18677327 18666000 0 0 1074512 1245406 27381839 29529937 0 0 0 0 21756426 24384974 0 0 0 6348277 5899201 28104703 30284175 -722864 -754238 1840129 4342062 1452446 4356335 387683 -14273 X MID-SUSSEX MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY MEDICAL CARE. 0 0 26347231 19820603 SEE SCHEDULE O 26347231 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 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 0 0 1 0 0 0 1 16 0 1 330 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 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 3026296611 801 MIDDLEFORD ROAD SEAFORD DE 19973 TAREK WAKED PHYSICIAN 40.00 0.00 X 1348633 0 7721 STEVEN LEONARD DIRECTOR 1.00 41.00 X 0 844182 97168 WILLIAM DORAN PHYSICIAN 40.00 0.00 X 713712 0 9271 ZIYAD WADI PHYSICIAN 40.00 0.00 X 713937 0 6621 STEVEN ROSE CEO TO 01/20/2020 7.00 32.00 X X 0 564494 41195 ISMET LUKLOIC PHYSICIAN 40.00 0.00 X 599537 0 1511 MUHAMMAD SIDDIQUE PHYSICIAN 40.00 0.00 X 575471 0 6621 DR KARIN DIBARI PRESIDENT 1.00 0.00 X X 0 474530 28614 PENNY SHORT COO/CNO 1.00 38.00 X 0 309610 11506 THOMAS BROWN SENIOR VP TO 06/11/2020 19.00 20.00 X X 0 272579 9572 HARRY ANTHONY MD CHIEF MEDICAL OFFICER 1.00 16.00 X 0 272785 3362 DENISE JESTER CFO 9.00 30.00 X 0 262296 13288 TRACI ALLEY CHIEF HR OFFICER TO 02/01/2020 8.00 30.00 X 0 205564 6938 LILIA KULMACZEWSKI CHIEF COMPLIANCE OFFICER 4.00 35.00 X 0 159957 5575 SONJA BIDDLE BOARD CHAIR TO 12/31/2019 1.00 1.00 X X 0 0 0 MARIA LEHMAN DIRECTOR TO 12/31/2019 1.00 1.00 X 0 0 0 DOUG POTVIN DIRECTOR TO 12/31/2019 1.00 1.00 X 0 0 0 ROB RIDER DIRECTOR TO 12/31/2019 1.00 1.00 X 0 0 0 TRACY TULL NEILSON DIRECTOR TO 12/31/2019 1.00 1.00 X 0 0 0 RYAN MCLAUGHLIN BOARD CHAIR 1.00 2.00 X X 0 0 0 DR TOM RICCIO SECRETARY 1.00 2.00 X X 0 0 0 KAREN POISKER DIRECTOR 1.00 0.00 X 0 0 0 3951290 3365997 248963 54 1 1 0 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 PHYSICIAN SERVICES 376804 ARLENE COLEMAN 1177 VICTORY CHAPEL RD DOVER DE 19904 ULTRASOUND 111960 DOVER BEHAVIORAL HEALTH 725 HORSEPOND ROAD DOVER DE 19901 BEHAVIORAL HEALTH 106312 3 9245000 373531 9618531 MEDICAL SERVICES 621400 18666000 18666000 18666000 MEDICAL AND OTHER REIM 621400 1154603 1154603 AFFILIATION GAIN 900099 92708 92708 PENSION ADJUSTMENT 900099 -1905 -1905 1245406 29529937 19820603 0 90803 21253112 18490207 2762905 502274 436978 65296 1481920 1289270 192650 1147668 998471 149197 594998 517648 77350 1678 1460 218 69252 60249 9003 1183619 1029749 153870 101926 88676 13250 92452 80433 12019 616997 536787 80210 BAD DEBT EXPENSE 1613962 1404147 209815 0 DRUGS 982431 854715 127716 0 MEDICAL SUPPLIES 364447 317069 47378 0 MISCELLANEOUS 172867 150394 22473 0 104572 90978 13594 30284175 26347231 3936944 0 91558 211003 0 0 1447583 1509919 10163 14227 411000 42328 264425 368672 0 0 0 0 0 0 26400 2238241 1840129 4342062 1447369 2277520 0 0 5077 2078815 1452446 4356335 X 387683 -14273 387683 -14273 1840129 4342062 X -754238 352282 X 0 1 X 1 0 X 5391933 6286243 7850000 7630000 9618531 36776707 15027699 18014184 17993109 18677327 18666000 88378319 20419632 24300427 25843109 26307327 28284531 125155026 0 0 0 125155026 1071305 1173702 1364499 1074512 1245406 5929424 21490937 25474129 27207608 27381839 29529937 131084450 0.95480 0.95420 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUES - 2015 AMOUNT: $ 1,071,305. 2016 AMOUNT: $ 1,173,702. 2017 AMOUNT: $ 1,364,499. 2018 AMOUNT: $ 1,074,512. 2019 AMOUNT: $ 1,245,406. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 122500 6806 115694 288500 35522 252978 0 368672 RIGHT OF USE - LEASES 2050166 INTERCOMPANY RECEIVABLE 161675 OTHER ASSETS 26400 2238241 OTHER LIABILITIES 2078815 2078815 X PART X, LINE 2: LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) THE TAX YEARS ENDING JUNE 30, 2020, 2019 AND 2018 ARE STILL OPEN TO AUDIT FOR BOTH FEDERAL AND STATE PURPOSES. THE ORGANIZATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURES IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2020 AND 2019. X X X X X 0 1 0 0 0 0 0 0 0 TAREK WAKED PHYSICIAN 646778 0 701855 0 0 0 0 0 7721 0 1356354 0 0 0 STEVEN LEONARD DIRECTOR 0 650174 0 178672 0 15336 0 76054 0 21114 0 941350 0 0 WILLIAM DORAN PHYSICIAN 563232 0 150480 0 0 0 0 0 9271 0 722983 0 0 0 ZIYAD WADI PHYSICIAN 494380 0 219557 0 0 0 0 0 6621 0 720558 0 0 0 STEVEN ROSE CEO TO 01/20/2020 0 465535 0 50000 0 48959 0 36545 0 4650 0 605689 0 0 ISMET LUKLOIC PHYSICIAN 474488 0 125049 0 0 0 0 0 1511 0 601048 0 0 0 MUHAMMAD SIDDIQUE PHYSICIAN 523019 0 52452 0 0 0 0 0 6621 0 582092 0 0 0 DR KARIN DIBARI PRESIDENT 0 415130 0 58650 0 750 0 10732 0 17882 0 503144 0 0 PENNY SHORT COO/CNO 0 289836 0 0 0 19774 0 9090 0 2416 0 321116 0 0 THOMAS BROWN SENIOR VP TO 06/11/2020 0 252561 0 0 0 20018 0 8227 0 1345 0 282151 0 0 HARRY ANTHONY MD CHIEF MEDICAL OFFICER 0 249138 0 5733 0 17914 0 1923 0 1439 0 276147 0 0 DENISE JESTER CFO 0 243723 0 0 0 18573 0 8086 0 5202 0 275584 0 0 TRACI ALLEY CHIEF HR OFFICER TO 02/01/2020 0 191830 0 0 0 13734 0 4181 0 2757 0 212502 0 0 LILIA KULMACZEWSKI CHIEF COMPLIANCE OFFICER 0 148010 0 0 0 11947 0 4230 0 1345 0 165532 0 0 PART I, LINE 1B 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 REFLECT ATTAINMENT OF CERTAIN GOALS. PART I, LINE 3 PROCESS TO ESTABLISH THE PRESIDENT'S COMPENSATION COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS DETERMINED BY THE PRESIDENT OF PENINSULA REGIONAL MEDICAL CENTER (PRMC), A RELATED TAX EXEMPT ORGANIZATION IDENTIFIED IN FORM 990, SCHEDULE R. THE ORGANIZATION'S PRESIDENT IS AN EMPLOYEE OF THE MEDICAL CENTER AND RECEIVES ALL COMPENSATION FROM THIS RELATED ORGANIZATION. PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PRMC HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457 (F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE PRMC 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 INDIVIDUAL PARTICIPATED IN THIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: STEVEN LEONARD PRMC PROVIDED THE FOLLOWING FUNDING AMOUNT DURING 2019: STEVEN LEONARD $25,525 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 A DESIGNATED AS A PRIMARY CARE SHORTAGE AREA. PENINSULA REGIONAL HEALTH SYSTEM, THE PARENT COMPANY OF MID-SUSSEX MEDICAL CENTER, 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. MID-SUSSEX MEDICAL CENTER PRIMARY CARE PRACTICES RECEIVED AND MAINTAIN 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. MID-SUSSEX MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE REGARDLESS OF THE 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 MID-SUSSEX MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THE MEDICAL CENTER'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. DURING THE FISCAL YEAR ENDED JUNE 30, 2020, MID-SUSSEX MEDICAL CENTER HAD THE FOLLOWING: TOTAL VISITS 155,354 FORM 990, PART VI, SECTION A, LINE 4 CHANGES TO ORGANIZATIONAL DOCUMENTS ON JANUARY 1, 2020, (THE NANTICOKE ACQUISITION DATE), PENINSULA REGIONAL HEALTH SYSTEM ACQUIRED AND BECAME THE SOLE CORPORATE MEMBER OF MID-SUSSEX MEDICAL CENTER, INC. AND NANTICOKE MEMORIAL HOSPITAL. ON MARCH 1, 2020, (THE MCCREADY ACQUISITION DATE), PENINSULA REGIONAL HEALTH SYSTEM ACQUIRED AND BECAME THE SOLE CORPORATE MEMBER OF MCCREADY FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS/STOCKHOLDERS PENINSULA REGIONAL HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS OF GOVERNING BODY IN ITS CAPACITY AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, PENINSULA REGIONAL HEALTH SYSTEM HAS THE ABILITY TO ELECT MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF GOVERNING BODY DECISIONS AS THE SOLE CORPORATE MEMBER, PENINSULA REGIONAL HEALTH SYSTEM ALSO HAS THE ABILITY TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS OF THE ORGANIZATION. 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 PENINSULA REGIONAL HEALTH SYSTEM, THE PARENT CORPORATION OF BOTH PENINSULA REGIONAL MEDICAL CENTER AND THE ORGANIZATION. THE AGENT OF THE ORGANIZATION IS ALSO THE CHIEF FINANCIAL OFFICER OF THE MEDICAL CENTER. THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE PRESIDENT OF THE HEALTH SYSTEM. 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 FOUNDATION'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 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 PRESIDENT'S COMPENSATION ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS' CHAIRMAN AND CHAIRMAN-ELECT REVIEW THE EXECUTIVE COMPENSATION OF THE CEO, SENIOR VP'S AND VP'S. AS PART OF THAT PROCESS, THE FACILITY'S OPERATIONS AND PERFORMANCE ARE TAKEN INTO CONSIDERATION, WHICH INCLUDE REVIEW OF HOSPITAL QUALITY INDICATORS, FINANCIAL PERFORMANCE, EMPLOYEE SATISFACTION SCORES AND PHYSICIAN SATISFACTION SCORES. THE PROCESS INCLUDES A REVIEW OF ACCOMPLISHMENTS OF EACH OF THE EXECUTIVES AND THEIR IMPORTANCE TO THE OVERALL ORGANIZATION. IN DETERMINING THE REASONABLENESS OF COMPENSATION, OTHER AREA HOSPITAL FORM 990'S ARE REVIEWED FOR THEIR EXECUTIVE COMPENSATION, AS WELL AS PUBLISHED NATIONAL SALARY SURVEY DATA. AFTER THE REVIEW AND RECOMMENDATION OF THE CHAIRMAN AND VICE CHAIRMAN, IT IS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS, WHO REVIEW THE ANNUAL COMPENSATION REQUESTS AND EITHER APPROVE OR RECOMMEND APPROPRIATE CHANGES FOR IMPLEMENTATION. THE SAME PROCESS GOES FOR OTHER KEY EMPLOYEES AND OFFICERS. THIS IS COMPLETED ANNUALLY. COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS DETERMINED BY THE PRESIDENT OF PENINSULA REGIONAL MEDICAL CENTER, A RELATED TAX-EXEMPT ORGANIZATION IDENTIFIED IN FORM 990, SCHEDULE R. THE ORGANIZATION'S PRESIDENT IS AN EMPLOYEE OF THE MEDICAL CENTER 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 PENINSULA REGIONAL MEDICAL CENTER AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT 352,282. NANTICOKE HEALTH SERVICES INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510293888 HEALTH SERVICES DE 501(C)(3) LINE 12B, II N/A 0 NANTICOKE MEMORIAL HOSPITAL INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510069243 HOSPITAL DE 501(C)(3) LINE 3 PRHS 0 NANTICOKE INSURANCE COMPANY LTD PO BOX 10233 3RD FLR WILLOW HOUSE CJ 980446259 INSURANCE CJ 501(C)(3) NHS 0 NANTICOKE HEALTH FOUNDATION 801 MIDDLEFORD ROAD SEAFORD DE 19973 812731803 FUNDRAISING DE 501(C)(3) LINE 7 NHS 0 PENINSULA REGIONAL MEDICAL CENTER 100 EAST CARROLL STREET SALISBURY MD 21801 520591628 HOSPITAL MD 501(C)(3) LINE 3 PRHS 0 PENINSULA REGIONAL HEALTH SYSTEM (PRHS) 100 EAST CARROLL STREET SALISBURY MD 21801 522132761 PARENT MD 501(C)(3) LINE 12B, II 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 PRHS 0 DELMARVA PENINSULA INSURANCE COMPANY PO BOX 1159 KY GRAND CAYMAN CJ 981110617 INSURANCE CJ 501(C)(3) PRHS 0 PENINSULA REGIONAL MEDICAL CENTER FOUNDATION 100 EAST CARROLL STREET SALISBURY MD 21801 521851935 FUNDRAISING MD 501(C)(3) LINE 7 PRHS 0 MCCREADY FOUNDATION INC 201 HALL HIGHWAY CRISFIELD MD 21817 520607921 FUNDRAISING MD 501(C)(3) LINE 3 PRHS 0 DELMARVA SURG CTR 641 S SALISBURY BLVD SALISBURY MD 21801 522251436 HEALTHCARE MD N/A N/A 0 0 DELMARVA ENDOSC CTR 11103 CATHAGE ROAD BERLIN MD 21811 831509115 HEALTHCARE MD N/A N/A 0 0 PROPRIETARY ENTERPRISES INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510293887 INACTIVE DE N/A C 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 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 C K L M N O P Q