TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) STEVEN ROSE...................................................................... CEO TO 01/20/2020	32.00 ................. 7.00	X	X			564,494	41,195
(2) JANET PEDRO MD...................................................................... DIRECTOR	1.00 ................. 0.00	X				427,875	3,419
(3) PENNY SHORT...................................................................... PRESIDENT	38.00 ................. 1.00		X			309,610	11,506
(4) THOMAS BROWN...................................................................... SENIOR VP TO 06/11/2020	20.00 ................. 19.00	X	X			272,579	9,572
(5) HARRY ANTHONY MD...................................................................... CHIEF MEDICAL OFFICER	16.00 ................. 1.00			X		272,785	3,362
(6) DENISE JESTER...................................................................... CFO	30.00 ................. 9.00		X			262,296	13,288
(7) TRACI ALLEY...................................................................... CHIEF HR OFFICER TO 02/01/2020	30.00 ................. 8.00			X		205,564	6,938
(8) GEORGE SCHWOBEL...................................................................... DIRECTOR OF PHARMACY	40.00 ................. 0.00				X	167,362	5,770
(9) LILIA KULMACZEWSKI...................................................................... CHIEF COMPLIANCE OFFICER	35.00 ................. 4.00			X		159,957	5,575
(10) KIMBERLY BOYKIN COUCH...................................................................... PHARMACIST	40.00 ................. 0.00				X	165,432	0
(11) RAY FULKROD...................................................................... CNO	40.00 ................. 0.00		X			161,044	4,274
(12) LUCY SCHWOBEL...................................................................... PHARMACIST	40.00 ................. 0.00				X	149,809	5,292
(13) MARY BETH D'AMICO...................................................................... APRN	40.00 ................. 0.00				X	152,897	1,628
(14) PAMELA PIQUETTE...................................................................... PHARMACIST	40.00 ................. 0.00				X	150,642	2,134
(15) JOHN ALLEN...................................................................... DIRECTOR - THRU 12/31/2019	5.00 ................. 0.00	X				0	0
(16) SONJA BIDDLE OD...................................................................... DIRECTOR	1.00 ................. 1.00	X				0	0
(17) DAVID CROUSE...................................................................... BOARD CHAIR	1.00 ................. 0.00	X	X			0	0

(A) Name and business address	(B) Description of services	(C) Compensation
CERNER CORPORATION 2800 ROCKCREEK PKWY KANSAS CITY,MO64141	TECHNOLOGY	9,909,592
APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD SCOTTSDALE,AZ85254	HOSPITALISTS	2,626,238
ANESTHESIA SERVICES PA 2 READS WAY NEW CASTLE,DE19720	ANESTHESIA	2,236,194
QUEST DIAGNOSTICS PO BOX 828669 PHILADELPHIA,PA19182	LAB SERVICES	1,218,895
CURA HOSPITALITY PO BOX 743676 ATLANTA,GA30374	FOOD SERVICES	1,205,738
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 40

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization NANTICOKE MEMORIAL HOSPITAL INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization NANTICOKE MEMORIAL HOSPITAL INC		Employer identification number 51-0069243

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization NANTICOKE MEMORIAL HOSPITAL INC			Employer identification number 51-0069243
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................	0
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................	0
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................	0
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

23,737

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

23,737

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1I	NANTICOKE MEMORIAL HOSPITAL PAYS DUES TO AHA AND DEHA: THE AMERICAN HOSPITAL ASSOCIATION AND THE DELAWARE HEALTHCARE ASSOCIATION. NANTICOKE MEMORIAL HOSPITAL'S MANAGEMENT ALSO CORRESPONDS WITH OUR STATE AND FEDERAL LEGISLATORS REGARDING CURRENT LEGISLATION AND REGULATIONS THAT MAY AFFECT THE FINANCIAL VIABILITY OF THE HOSPITAL AND ITS ABILITY TO CONTINUE TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY. ALSO, WINNING STRATEGIES WASHINGTON, LLC PROVIDES LOBBYING SERVICES TO NANTICOKE TO ASSIST THE HOSPITAL IN MAINTAINING ITS MEDICARE DEPENDENT HOSPITAL (MDH) STATUS.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1I

NANTICOKE MEMORIAL HOSPITAL PAYS DUES TO AHA AND DEHA: THE AMERICAN HOSPITAL ASSOCIATION AND THE DELAWARE HEALTHCARE ASSOCIATION. NANTICOKE MEMORIAL HOSPITAL'S MANAGEMENT ALSO CORRESPONDS WITH OUR STATE AND FEDERAL LEGISLATORS REGARDING CURRENT LEGISLATION AND REGULATIONS THAT MAY AFFECT THE FINANCIAL VIABILITY OF THE HOSPITAL AND ITS ABILITY TO CONTINUE TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY. ALSO, WINNING STRATEGIES WASHINGTON, LLC PROVIDES LOBBYING SERVICES TO NANTICOKE TO ASSIST THE HOSPITAL IN MAINTAINING ITS MEDICARE DEPENDENT HOSPITAL (MDH) STATUS.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	5,490,200		5,413,893
b	Buildings ....	66,921,647	1,639,594	65,358,360
c	Leasehold improvements	1,311,465	20,960	1,290,505
d	Equipment ....	19,248,033	2,603,012	16,645,021
e	Other .....	641,698		641,698
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				89,349,477

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	65,008,690
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART X, LINE 2:

LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) THE ORGANIZATION IS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS FOR PENINSULA REGIONAL HEALTH SYSTEM AND ITS FOOTNOTE STATES: THE TAX YEARS ENDING JUNE 30, 2020, 2019 AND 2018 ARE STILL OPEN TO AUDIT FOR BOTH FEDERAL AND STATE PURPOSES. THE HEALTH SYSTEM HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2020 AND 2019.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 25000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		3,296	4,173,117		4,173,117	2.720 %
b	Medicaid (from Worksheet 3, column a) . . . . .		36,831	29,620,765	12,933,369	16,687,396	10.860 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		40,127	33,793,882	12,933,369	20,860,513	13.580 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	312	5,934	789,912		789,912	0.510 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	143	3,679	54,640		54,640	0.040 %
j	Total. Other Benefits . .	455	9,613	844,552		844,552	0.550 %
k	Total. Add lines 7d and 7j .	455	49,740	34,638,434	12,933,369	21,705,065	14.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	37	37	186,201	186,201	0.110 %
9	Other
10	Total	37	37	186,201	186,201	0.110 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

9,599,508

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

44,643,073

Enter Medicare allowable costs of care relating to payments on line 5.....

53,310,549

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-8,667,476

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 NANTICOKE SURGICAL CENTER LLC	SURGERY CENTER	51.000 %	49.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	NANTICOKE MEMORIAL HOSPITAL 801 MIDDLEFORD ROAD SEAFORD,DE19973 HSPTL-008	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	NANTICOKE MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

Yes

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SUPPLEMENTAL INFORMATION

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SUPPLEMENTAL INFORMATION

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	NANTICOKE MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 250.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SUPPLEMENTAL INFORMATION

The FAP application form was widely available on a website (list url):

SEE SUPPLEMENTAL INFORMATION

A plain language summary of the FAP was widely available on a website (list url):
SEE SUPPLEMENTAL INFO

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	NANTICOKE MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	NANTICOKE MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
NANTICOKE MEMORIAL HOSPITAL, INC	PART V, SECTION B, LINE 2: THE ORGANIZATION WAS ACQUIRED BY THE PENINSULA REGIONAL HEALTH SYSTEM ON JANUARY 1, 2020.
NANTICOKE MEMORIAL HOSPITAL, INC	PART V, SECTION B, LINE 5: ASSIGNED STAFF MEMBERS WORKING IN CONJUNCTION WITH MEMBERS OF THE HEALTHIER SUSSEX COUNTY TASK FORCE AND THE SUSSEX COUNTY HEALTH COALITION WORKED TOGETHER TO CONDUCT THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN 2021, NANTICOKE, NOW A PART OF THE PENINSULA REGIONAL HEALTH SYSTEM/TIDALHEALTH, IS PREPARING TO CONDUCT A NEW COMMUNITY HEALTH NEEDS AS A HEALTH SYSTEM. ASSESSMENT THAT WILL COVER THE MD CBSA OF SOMERSET, WICOMICO AND WORCESTER COUNTIES AND A NEW AREA OF SUSSEX COUNTY, DELAWARE. EFFECTIVE JANUARY 1, 2020, NANTICOKE MEMORIAL HOSPITAL (NMH) AND MID-SUSSEX MEDICAL CENTER, DBA NANTICOKE PHYSICIAN NETWORK, (NPN), LOCATED IN SEAFORD, DELAWARE, JOINED PENINSULA REGIONAL HEALTH SYSTEM. NANTICOKE HAS 139 LICENSED ACUTE CARE BEDS (99 CURRENTLY OPERATED ) AND PRIMARILY SERVES THE WESTERN SUSSEX COUNTY, DELAWARE PORTION OF THE HEALTH SYSTEM'S PRIMARY SERVICE AREA. NANTICOKE PHYSICIAN NETWORK PROVIDES OUTPATIENT MEDICAL SERVICES IN WESTERN SUSSEX COUNTY AND FEDERALSBURG, MD. EFFECTIVE MARCH 1, 2020, MCCREADY FOUNDATION, WHICH CONSISTED OF A THREE BED HOSPITAL, ALICE BYRD TAWES NURSING HOME, A 76-LICENSED BED SKLLED NURSING HOME AND CHESAPEAKE COVE ASSISSTED LIVING CENTER IN CRISFIELD, MD, BECAME PART OF PENINSULA REGIONAL HEALTH SYSTEM. THE MCCREADY HOSPITAL DIVISION WAS MERGED IN PENINSULA REGIONAL MEDICAL CENTER AND LIMITED ITS FUNCTIONS TO THOSE CONSISTANT WITH STATUS AS A FREE-STANDING MEDICAL CENTER. HCI AND PRHS HAVE COLLABORATED SINCE 2012 TO DEVELOP THE PRHS CREATING HEALTHY COMMUNITIES PLATFORM. ASSIGNED STAFF ALONG WITH COMMUNITY PARTNERS CONDUCTED KEY INFORMANT INTERVIEWS IN ORDER TO COLLECT COMMUNITY INPUT. KEY INFORMANT INTERVIEWS WERE CONDUCTED BETWEEN 011/4/20198 AND 08/30/2018. INTERVIEWEES WHO WERE ASKED TO PARTICIPATE WERE RECOGNIZED AS HAVING EXPERTISE IN PUBLIC HEALTH, SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND/OR REPRESENTED THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HEALTH SYSTEM, AND/OR COULD SPEAK TO THE NEEDS OF THE MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS. THE FOLLOWING ORGANIZATIONS ARE REPRESENTATIVE OF THE INDIVIDUALS WHO PARTICIPATED IN THE INTERVIEWS:DELAWARE PUBLIC HEALTH INCLUDING REPRESENTATIVES FROM AREA SERVICES RANGING FROM CHILD TO SENIOR SERVICES, MEMBERS OF THE SUSSEX COUNTY HEALTH COALITION INCLUDING A WIDE RANGE OF REPRESENTATIVES PROVIDING HEALTH AND SOCIAL SERVICE SUPPORT TO VULNERABLE POPULATIONS (FOR A FULL LIST REFER TO NANTICOKE'S CHNA 2019, FIRST RESPONDERS, SKILLED NURSING REPRESENTATIVES, SENIOR SERVICE AGENCIES, SCHOOLS AND EDUCATORS AND LOCAL PHYSICIANS AND INDEPENDENT HEALTHCARE PROVIDERS. THREE FOCUS GROUPS WERE FACILITATED BY THE TEAM IN SUSSEX COUNTY. THESE INCLUDED FOCUS GROUPS HELD AT THE SUSSEX COUNTY HEALTH COALITION WELLNESS COMMITTEE, BEHAVIORAL HEALTH COMMITTEE AND ECONOMIC SUCCESS COMMITTEE. THESE FOCUS GROUPS WERE HELD JANUARY TO MARCH 2019. A COMMUNITY SURVEY WAS AVAILABLE USING SURVEY MONKEY, AN ONLINE SURVEY TOOL, AND A PAPER VERSION OF THE SURVEY. SURVEYS WERE CONDUCTED IN ENGLISH AND SPANISH, THOUGH MINIMAL LATINX PARTICIPATION WAS ACHIEVED. SURVEYING OF THE LATINX COMMUNITY WAS ATTEMPTED THROUGH COMMUNITY PARTNERS INCLUDING LA ESPERANZA. THE SURVEY WAS DISTRIBUTED ACROSS NANTICOKE'S SERVICE AREA FROM JULY 2018 UNTIL FEBRUARY 2019.
NANTICOKE MEMORIAL HOSPITAL, INC	PART V, SECTION B, LINE 6A: THE HOSPITAL FISCAL YEAR 2020 (ENDING 6/30/2020) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS COMPLETED JUNE 2019 FOLLOWED BY ITS ACCOMPANYING IMPLEMENTATION PLAN. THROUGH DECEMBER 2020, THEN NANTICOKE HEALTH SERVICES CONTINUED WORK WITH TWO OTHER COUNTY HOSPITALS (BAYHEALTH MILFORD AND BEEBE HEALTHCARE) THROUGH THE HEALTHIER SUSSEX COUNTY TASK FORCE ON IDENTIFIED COMMUNITY HEALTH PROJECTS. HOWEVER, AS COVID ARRIVED IN THE AREA, MOST COMMUNITY CLINICS AND IN-PERSON COMMUNITY OUTREACH WERE DISCONTINUED. AS AN INDIVIDUAL HOSPITAL IN 2020, FOCUS AREAS INCLUDED BEHAVIORAL HEALTH PROJECTS SPECIFICALLY FOCUSED ON OPIOID AND SUBSTANCE ABUSE IN OUR COMMUNITY; CHRONIC DISEASE MANAGEMENT FOR DIABETES; CERVICAL CANCER, AND FOOD INSECURITY PROGRAMS FOR PATIENTS OF OUR HOSPITAL AND EMPLOYED PROVIDER NETWORK. AT PRESENT, WORK FROM THIS IMPLEMENTATION PLAN IS APPROXIMATELY 50 PERCENT COMPLETE INCLUDING A PATIENT FOOD PANTRY FOR OUR INPATIENT, OUTPATIENT, ED AND WALK IN CARE PATIENTS. NANTICOKE IS ALSO PARTICIPATING IN STATE WORK FOR SUBSTANCE ABUSE AS WELL AS WITH THE SUSSEX COUNTY HEALTH COALITION IN SUPPORT OF SEAFORD'S DRUG FREE COMMUNITIES TASK FORCE. ADDITIONAL COMMUNITY HEALTH SUPPORT DUE WITH THE ARRIVAL OF COVID IN THE COMMUNITY INCLUDED SUPPORT OF STATE PUBLIC HEALTH COVID SCREENING CLINICS IN 2020. ON JANUARY 1, 2020, NANTICOKE HEALTH SERVICES AFFILIATED WITH PENINSULA REGIONAL HEALTH SYSTEM (NOW TIDALHEALTH), AND REBRANDED TO NANTICOKE MEMORIAL HOSPITAL. NOW PART OF A LARGER SYSTEM, NANTICOKE MEMORIAL HOSPITAL ANTICIPATES ADDITIONAL RESOURCES AROUND POPULATION AND COMMUNITY HEALTH PROJECTS INCLUDING THE EXPECTED ADDITION OF A MOBILE VAN TO PROVIDE SERVICES TO VULNERABLE POPULATIONS. AS OUR COMMUNITY BECOMES VACCINATED AND RETURNS TO MORE NORMAL OPERATIONS, WE ANTICIPATE RESUMING OUR WORK IN DIABETES MANAGEMENT AND CERVICAL CANCER AWARENESS AND SCREENING COMPLIANCE.
NANTICOKE MEMORIAL HOSPITAL, INC	PART V, SECTION B, LINE 6B: IN DEVELOPING ITS CHNA, NMH WORKED WITH SUSSEX COUNTY HEALTH COALITION, THE HEALTHIER SUSSEX COUNTY TASK FORCE, DRUG FREE COMMUNITIES, PUBLIC HEALTH, AND MANY OTHER SOCIAL SERVICE GROUPS AND HEALTHCARE ORGANIZATIONS.FORM 990, SCHEDULE H, PART V, LINE 7ACHNA ON HOSPITAL FACILITY'S WEBSITEHTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/NANTICOKE-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2019
NANTICOKE MEMORIAL HOSPITAL, INC	PART V, SECTION B, LINE 11: NANTICOKE MEMORIAL HOSPITAL WORKS WITH SEVERAL COMMUNITY PARTNERS AND AGENCIES TO ADDRESS HEALTH NEEDS IN THE COMMUNITY. FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, NANTICOKE IDENTIFIED FOUR AREAS OF GREATEST NEED WITHIN OUR COMMUNITY. THEY ARE MENTAL HEALTH & SUBSTANCE ABUSE, CERVICAL CANCER PREVENTION, CHRONIC DISEASE MANAGEMENT MORE SPECIFICALLY DIABETES MANAGEMENT, AND FOOD INSECURITY. NANTICOKE WORKED WITH THE SUSSEX COUNTY HEALTH COALITION, THE DRUG FREE COMMUNITIES TASK FORCE AND SEVERAL SERVICE AGENCIES AND DEPARTMENTS FROM DELAWARE PUBLIC HEALTH ON INITIATIVES AROUND BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. PROJECTS RANGED FROM SAFE PRESCRIBING TO CARE COORDINATION WITHIN THE MEDICAL PRACTICES TO AWARENESS AND PREVENTION. NANTICOKE ALSO PARTICIPATED IN SUPPORTING THE EXPANSION OF NARCAN TRAINING WITHIN THE COMMUNITY AS WELL AS YOUTH PREVENTION ACTIVITIES. FOR BOTH CERVICAL CANCER SCREENING AND DIABETES MANAGEMENT, EFFORTS WERE TAKEN IN PARTNERSHIP WITH THE EBRIGHT ACO AND THE HEALTHIER SUSSEX COUNTY TO DEVELOP SPECIFIC PROGRAMS OR INITIATIVES WITHIN PRIMARY CARE PROVIDER PRACTICES TO INCREASE COMPLIANCE. ADDITIONALLY, INITIATIVES WERE EXPANDED TO INCLUDE CARE MANAGEMENT FOR COMPLIANCE WITHIN EMPLOYEE POPULATIONS. WITH THE ONSET OF COVID 19, GENERAL COMMUNITY OUTREACH PROGRAMS SLOWED. HOWEVER, WITH THE INTEGRATION OF NANTICOKE MEMORIAL HOSPITAL INTO WHAT IS NOW KNOWN AS TIDALHEALTH, INITIATIVES FOR OUTREACH IN THESE AND OTHER COMMUNITY HEALTH AREAS FOR SUSSEX COUNTY ARE CURRENTLY BEING DEVELOPED THROUGH ITS POPULATION HEALTH DEPARTMENT. FOR FOOD INSECURITY, THE IDENTIFIED GAP WAS WITH PATIENTS OF NANTICOKE MEMORIAL HOSPITAL LEAVING THE HOSPITAL WITHOUT FOOD. UNDERSTANDING THE GAP WAS IN PROVIDING TIME TO HEAL TO GIVE TIME FOR PATIENTS TO CONNECT WITH OTHER AREA FOOD SERVICES, NANTICOKE OPENED A DEDICATED PATIENT FOOD PANTRY, PROVIDING FOOD TO PATIENTS FOR TWO TO FOUR WEEKS TO ALLOW PATIENTS TIME TO HEAL. NANTICOKE ALSO EXPANDED THE PROGRAM TO INCLUDE TRAVEL FOOD BAGS FOR HOMELESS PATIENTS COMING TO THE E.D. AS WELL AS WITHIN SPECIFIC PATIENT POPULATIONS INCLUDING CANCER PATIENTS AND MEDICAL PRACTICE PATIENTS. THIS PROGRAM IS DONE IN PARTNERSHIP WITH LOCAL BUSINESSES, THE DELAWARE FOOD BANK AND PROJECT SEARCH (STUDENT INTERNSHIP PROGRAM).
FORM 990, SCHEDULE H, PART V, LINE 10A	CHNA ON HOSPITAL FACILITY'S WEBSITEHTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/NANTICOKE-COMMUNITY-HEALTH-NEEDS-IMPLEMENTATION-PLAN-2019-2021
FORM 990, SCHEDULE H, PART V, LINES 16A-C	THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP WAS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://WWW.TIDALHEALTH.ORG/MEDICAL-CARE/FINANCIAL-ADMIN-SERVICES/BILLING/TIDALHEALTH-NANTICOKE-FINANCIAL-ASSISTANCE

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address		Type of Facility (describe)
1	1 - MEARS HEALTH CAMPUS 100 RAWLINS DRIVE SEAFORD,DE19973	MEDICAL FACILITY
2	2 - EZ LAB 9111 ANTIQUE ALLEY BRIDGEVILLE,DE19933	LAB DRAWING STATION
3	3 - EZ LAB 30549 SUSSEX HWY LAUREL,DE19956	LAB DRAWING STATION
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7:	THE COSTING METHOD USED TO CALCULATE THE AMOUNTS REPORTED WAS THE MEDICARE OPERATING COST-TO-CHARGE RATIO FOR BOTH OUTPATIENT AND INPATIENT SERVICES.
PART I, LINE 7G:	THE HOSPITAL DID NOT INCLUDE SUBSIDIZED HEALTH SERVICE ATTRIBUTABLE TO PHYSICIAN CLINICS.
PART I, LINE 7 COL(F):	THE AMOUNT OF BAD DEBT EXPENSE EXCLUDED FROM THE DENOMINATOR IN THE COLUMN (F) PERCENTAGES IS $9,559,508.
PART II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY OUTEACH:NANTICOKE MEMORIAL HOSPITAL HAS TRAINED STAFF THAT GOES INTO THE COMMUNITY TO PRESENT HEALTH EDUCATION SEMINARS, SUPPORT GROUPS AND HEALTH SCREENINGS. WE WORK WITH AREA SCHOOLS AND COMMUNITY HEALTH AND SOCIAL SERVICE ORGANIZATIONS TO EDUCATE OUT COMMUNITY ON DISEASE MANAGEMENT, CARE COORDINATION, DISEASE PREVENTION AND GENERAL WELLNESS. ADDITIONALLY, THERE ARE A NUMBER OF SUPPORT GROUPS AND EDUCATIONAL OPPORTUNITIES HELD ON CAMPUS. WITH THE ARRIVAL OF COVID TO OUR AREA, THESE ACTIVITIES BECAME LIMITED. WHERE POSSIBLE, VIRTUAL EDUCATION AND SUPPORT GROUPS WERE HELD. LIVING IN A RURAL AREA, INTERNET AND/OR HIGH-SPEED INTERNET IS NOT AVAILABLE IN ALL AREAS OF COMMUNITY. THE IMPLEMENTATION PLAN DEVELOPED FROM THE HOSPITALS 2019 CHNA IDENTIFIED AREAS OF NEED INCLUDING SUBSTANCE ABUSE, CERVICAL CANCER SCREENING COMPLIANCE, CHRONIC DISEASE MANAGEMENT WITH A FOCUS ON DIABETES, AND FOOD INSECURITY. NANTICOKE MEMORIAL HOSPITAL CONTINUES TO WORK WITH STATE AND LOCAL PROGRAMS ON SUBSTANCE ABUSE STRATEGIES RANGING FROM AWARENESS AND PREVENTION TO ADDICTIONS RECOVERY AND LIFESAVING RESOURCES. THROUGH THE ACO, NANTICOKE MEMORIAL HOSPITAL WORKS ON STRATEGIES FOR INCREASING PATIENT COMPLIANCE WITH CERVICAL SCREENING FOR PATIENTS ALONGSIDE COMMUNITY AWARENESS ACTIVITIES. NANTICOKE MEMORIAL HOSPITAL ALSO HAS DEVELOPED A FOOD PANTRY FOR PATIENTS BEING DISCHARGED FROM THE HOSPITAL WITH AN IDENTIFIED FOOD NEED. RESOURCES ARE ALSO PROVIDED TO HELP REFER THESE PEOPLE TO LONG TERM FOOD SOLUTIONS. THE HOSPITAL CONTINUES TO WORK WITH DELAWARE PUBLIC HEALTH, DELAWARE HEALTH INNOVATION CENTER, DELAWARE STATE HEALTH IMPROVEMENT PROGRAM, AND OTHER STATE AGENCIES WORKING ON COMMUNITY HEALTH ISSUES. THE HOSPITAL ALSO CONTINUES TO WORK WITH MANY LOCAL HEALTH AND SOCIAL SERVICES GROUPS INCLUDING THE SUSSEX COUNTY HEALTH COALITION. WITH THE NEW AFFILIATION, NANTICOKE MEMORIAL HOSPITAL NOW HAS ACCESS TO A DEDICATED POPULATION HEALTH TEAM. WORK HAS BEGUN ON GRANT APPLICATIONS FOR EXPANDING A PROVEN MOBILE HEALTH SERVICES PROGRAM INTO SUSSEX COUNTY. WITH THE ARRIVAL OF COVID, OUTREACH BECAME REFOCUSED ON SUPPORTING STATE AND PATIENT COVID 19 TESTING PROGRAMS AND NOW VACCINATION CLINICS. AS WE MOVE FORWARD, NANTICOKE MEMORIAL HOSPITAL ANTICIPATES A RETURN TO PREVIOUS COMMUNITY OUTREACH PROGRAMS BY THE FALL OF 2021 INCLUDING EXPANDED POPULATION HEALTH PROGRAMS FOR THE COMMUNITIES WE SERVE.
PART III, LINE 2 & LINE 3:	METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSESEE RESPONSE BELOW TO LINE 4 REGARDING THE METHODOLOGY USED BY THE ORGANIZATION REGARDING BAD DEBT.PART III, LINE 4:BAD DEBT FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTSUNDER THE PROVISIONS OF ASU 2014-09, WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS, WHICH HAVE THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECORDED AS RECEIVABLES SINCE THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE RECORDED AS A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN AN ALLOWANCE FOR DOUBTFUL ACCOUNTS.DISCOUNTS RANGING FROM 2% TO 6% OF CHARGES ARE GIVEN TO MEDICARE, MEDICAID, AND CERTAIN APPROVED COMMERCIAL HEALTH INSURANCE AND HEALTH MAINTENANCE ORGANIZATION PROGRAMS FOR REGULATED SERVICES. DISCOUNTS IN VARYING PERCENTAGES ARE GIVEN FOR CERTAIN UNREGULATED SERVICES.
PART III, LINE 8:	THE COSTING METHOD USED TO DETERMINE ALLOWABLE COSTS ARE THE COSTS IN ACCORDANCE WITH MEDICARE REQUIREMENTS AND REGULATIONS. ONLY COSTS THAT ARE CONSISTENT WITH EFFICIENT, COST-EFFECTIVE MANAGEMENT AND OPERATIONS ARE ALLOWED. ONLY OPERATING COSTS THAT ARE DIRECTLY RELATED TO THE DELIVERY OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID PATIENTS WERE ALLOWED.
PART III, LINE 9B:	THE COLLECTION POLICY PERTAINS TO ALL PATIENTS WITH A SELF PAY BALANCE. IF A PATIENT APPLIES FOR EITHER CHARITY CARE OR ANY OTHER ASSISTANCE PROGRAM SUCH AS MEDICARE AND MEDICAID, ALL COLLECTION ACTIVITY IS PUT ON HOLD UNTIL A DETERMINATION OF ELIGIBILITY IS MADE.
PART VI, LINE 2:	NANTICOKE MEMORIAL HOSPITAL CURRENTLY USES SECONDARY DATA FROM FEDERAL, STATE AND COUNTY RESOURCES. THESE RESOURCES ARE WIDELY USED BY LOCAL AND NATIONAL HEALTH ORGANIZATIONS IN PREPARING A CHNA. RESOURCES RANGE FROM DELAWARE PUBLIC HEALTH DATA TO DATA FROM SOURCES SUCH AS THE CDC, RESEARCH AND GRANT AGENCIES SUCH AS THE LONGWOOD FOUNDATION, NATIONAL DISEASE FOCUSED AGENCIES SUCH AS THE AMERICAN CANCER SOCIETY AND THE AMERICAN HEART ASSOCIATION. STATE PUBLIC HEALTH DATA INCLUDES DATA COLLECTED BY TASK FORCES WORKING ON TOPICS RANGING FROM CANCER TO SUBSTANCE ABUSE. ADDITIONALLY, LOCAL DEMOGRAPHIC AND ECONOMIC DATA IS USED AS WELL AS INFORMATION FROM THE U.S. CENSUS. NANTICOKE MEMORIAL HOSPITAL ALSO RELIES ON DATA PROVIDED FROM THE UNIVERSITY OF DELAWARE WHICH WORKS WITH THE STATE TO RESEARCH AND MONITOR HEALTH NEEDS THROUGHOUT THE STATE. NANTICOKE CONTINUES TO WORK WITH OTHER HOSPITALS, LOCAL PUBLIC HEALTH AND LOCAL SOCIAL SERVICE AGENCIES TO COLLECT DATA AND WORK ON IDENTIFIED NEEDS. ADDITIONALLY, NANTICOKE MEMORIAL HOSPITAL CONDUCTED PRIMARY RESEARCH THROUGH MANY COMMUNITY SURVEYS AND STAKEHOLDER SURVEYS, INTERVIEWS AND FOCUS GROUPS TO HELP COMPLETE RESEARCH FOR THE 2019 CHNA. IN JANUARY 2020, THE HOSPITAL BECAME AN AFFILIATE OF PENINSULA REGIONAL HEALTH SERVICES (A.K.A. TIDALHEALTH BEGINNING 9/1/2020) AND WORK BEGAN TO ANALYZE RESOURCES FOR FUTURE WORK TOWARD EXPANDED COMMUNITY OUTREACH, POST COVID, THROUGH TIDALHEALTH'S POPULATION HEALTH AND COMMUNITY OUTREACH TEAMS.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCENANTICOKE MEMORIAL HOSPITAL PROVIDES INFORMATION IN THEIR PATIENT INFORMATION AND VISITORS GUIDE UNDER THE "FINANCIAL ARRANGEMENT/INSURANCE" SECTION CONCERNING THE AVAILABILITY OF FINANCIAL COUNSELORS TO DISCUSS PAYMENT ARRANGEMENTS. AT THIS TIME, PATIENTS ARE INFORMED ABOUT ALL THE PROGRAMS AVAILABLE TO THEM, BOTH VERBALLY AND IN WRITTEN FORMAT OF POSSIBLE ELIGIBILITY FOR DELAWARE MEDICAID ASSISTANCE. THE FOLLOWING DEPARTMENTS OFFER THIS TYPE OF ASSISTANCE TO OUR PATIENTS: BUSINESS OFFICE, REGISTRATION, CASE MANAGEMENT, CHAPS COORDINATOR, CANCER CARE COORDINATOR, CANCER NURSE NAVIGATOR (SCREENING APPROACH), AND PRESCRIPTION ASSISTANCE PROGRAM. IN ADDITION, VARIOUS ORGANIZATIONS WERE INTERVIEWED FOR INPUT, INCLUDING: ALZHEIMER'S ASSOCIATION, AMERICAN CANCER SOCIETY, AMERICAN DIABETES ASSOCIATION, BAYHEALTH, BEEBE AND NANTICOKE SOCIAL WORKERS, DELAWARE ASSOCIATION OF HISPANIC NURSES, DELAWARE BREAST CANCER COALITION, DELAWARE HEALTHCARE ASSOCIATION, DELAWARE HOSPICE, DIVISION OF PUBLIC HEALTH -GEORGETOWN, EASTER SEALS, ELLENDALE RECOVERY CENTER, LA ESPERANZA, LA RED FEDERAL QUALIFIED HEALTH CENTERS, LAW ENFORCEMENT AGENCIES, MID-ATLANTIC AIDS TRAINING CENTER, MOUNTAIRE & PERDUE CHICKEN PLANTS, NANTICOKE INDIAN CENTER, PENINSULA HOME CARE, PEOPLE'S PLACE, PUBLIC HEALTH NURSES -GEORGETOWN, SOUTHERN DELAWARE TOURISM, STRONG COMMUNITIES, SUSSEX COUNTY ASSOCIATION OF TOWNS, SUSSEX CHILD HEALTH, SUSSEX COUNTY CHURCHES, SUSSEX COUNTY CHAMBER OF COMMERCE, SUSSEX COUNTY EMS, SUSSEX COUNTY LIBRARIES, SUSSEX COUNTY FIRE STATIONS, SUSSEX COUNTY SENIOR CENTERS, SUSSEX COUNTY VETERANS GROUP, VFW/AMERICAN LEGION.
PART VI, LINE 4:	NANTICOKE MEMORIAL HOSPITAL PRIMARILY SERVES WESTERN SUSSEX COUNTY, DELAWARE AND PORTIONS OF MARYLAND INCLUDING DORCHESTER COUNTY. THE PRIMARY SERVICE AREA IS DELMAR, BRIDGEVILLE, GREENWOOD AND GEORGETOWN, DELAWARE. SERVICE AREA IS EXPANDING WITH THE AFFILIATION. RESIDENTS OF WESTERN SUSSEX COUNTY GENERALLY HAVE A LOWER MEDIA INCOME, LOWER LEVEL OF POST HIGH SCHOOL EDUCATION AND EXPERIENCE A HIGHER UNEMPLOYMENT RATE THAT OTHER PARTS OF THE COUNTY. THE HOSPITAL SERVES A SIGNIFICANT NUMBER OF MEDICAID PATIENTS AND A HIGH NUMBER OF MEDICARE PATIENTS. MUCH OF THE WORKFORCE IS EMPLOYED IN HEALTHCARE, RETAIL OR AGRICULTURAL BUSINESSES. THE AREA CONTINUES TO EXPERIENCE RAPIDLY GROWING LATINX AND HAITIAN CREOLE POPULATIONS. WHILE THERE HAS BEEN A SMALL IMPROVEMENT, DISPARITIES REMAIN IN HEALTH EDUCATION AND EARLY DETECTION FOR THE BLACK AND HISPANIC COMMUNITIES.
PART VI, LINE 5:	PROMOTION OF COMMUNITY HEALTHA MAJORITY OF NANTICOKE MEMORIAL HOSPITAL'S (NMH) BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS, MOST LIVING AND/OR WORKING IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE VERY INVOLVED IN BETTERING THE HEALTH OF ITS COMMUNITY. BOARD MEMBERS PARTICIPATE IN THE OVERSIGHT OF COMMUNITY HEALTH PROGRAMS AND OFTEN GO INTO THE COMMUNITY ALONGSIDE STAFF MEMBERS TO HELP PROVIDE CONNECTION OF THE BOARD WITH COMMUNITY NEEDS. NMH IS COMMITTED TO THE EDUCATION OF THE COMMUNITY RANGING FROM GENERAL AWARENESS TO PATIENT OR CONDITION SPECIFIC INFORMATION TO CLINICAL SCHOLARSHIPS FOR LOCAL HIGH SCHOOL STUDENTS AND FOR STAFF WANTING TO EXPAND SKILLS AND EXPERTISE. NMH INVESTS IN MEDICAL EQUIPMENT AND TRAINING TO ENSURE THE BEST POSSIBLE CARE FOR ITS PATIENTS. IT USES PLANNED FUNDS, CONTINGENCY OR EXTRA FUNDS AND GRANT FUNDING TO AID IN ONGOING INVESTMENTS. PRIOR TO COMING ON STAFF TO CARE FOR PATIENTS, EACH PROVIDER PREPARES AN APPLICATION FOR MEMBERSHIP AND PRIVILEGES WHICH IS VERIFIED AND PRIMARY SOURCED, REVIEWED BY THE CREDENTIALS AND MEDICAL EXECUTIVE COMMITTEE BEFORE BEING RECOMMENDED TO THE BOARD OF DIRECTORS FOR THEIR APPROVAL. IN ADDITION, EVERY TWO YEARS, PROVIDER PERFORMANCE IS REVIEWED AND EVALUATED.
PART VI, LINE 6:	NANTICOKE MEMORIAL HOSPITAL IS PART OF THE PENINSULA REGIONAL HEALTH SYSTEM. THE SYSTEM INCLUDES TWO FOUNDATIONS, A MEDICAL CENTER, AND FOR-PROFIT ENTITIES WITH INTERESTS IN VARIOUS HEALTH CARE JOINT VENTURES. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE RELATED MEDICAL CENTER, THE HEALTH SYSTEM EVALUATES THE NEEDS OF THE COMMUNITY AND WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS AS NEEDED.
PART VI, LINE 7:	COMMUNITY BENEFIT REPORT STATE FILINGSSTATE(S) WITH WHICH THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: DELAWARE

Schedule H (Form 990) 2019

Additional Data

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- TIN:

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number
51-0069243

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) MID-SUSSEX MEDICAL CENTER INC 801 MIDDLEFORD ROAD SEAFORD,DE19973	51-0224470	501(C)(3)	9,245,000				TO PROVIDE FUNDS FOR MID-SUSSEX MEDICAL CENTER, INC.
(2) SUSSEX COUNTY HEALTH COALITION 21133 STERLING AVE GEORGETOWN,DE19947	22-2804785	501(C)(3)	10,000				COMMUNITY HEALTH

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) FINANCIAL ASSISTANCE	8	247,957	FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY UNDER THE FAP.
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

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 ORGANIZATION BY DEPARTMENT DIRECTORS OF PENINSULA REGIONAL MEDICAL CENTER, AFTER RECEIVING MEDICAL CENTER VICE PRESIDENT APPROVAL. THE REQUEST CONTAINS VENDOR INFORMATION AND THE EXPLANATION OF THE PROGRAM OF BENEFIT FOR WHICH THE FUNDS ARE REQUESTED. THE FOUNDATION APPROVES THE USE OF FUNDS BASED ON THE DESIGNATED PERMITTED USE OF THE ORIGINAL CONTRIBUTION.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1STEVEN ROSE CEO TO 01/20/2020	(i) (ii)	465,535 ------------- 0	50,000 ------------- 0	48,959 ------------- 0	36,545 ------------- 0	4,650 ------------- 0	605,689 ------------- 0	0 ------------- 0
2JANET PEDRO MD DIRECTOR	(i) (ii)	355,579 ------------- 0	72,296 ------------- 0	0 ------------- 0	0 ------------- 0	3,419 ------------- 0	431,294 ------------- 0	0 ------------- 0
3PENNY SHORT PRESIDENT	(i) (ii)	289,836 ------------- 0	0 ------------- 0	19,774 ------------- 0	9,090 ------------- 0	2,416 ------------- 0	321,116 ------------- 0	0 ------------- 0
4THOMAS BROWN SENIOR VP TO 06/11/2020	(i) (ii)	252,561 ------------- 0	0 ------------- 0	20,018 ------------- 0	8,227 ------------- 0	1,345 ------------- 0	282,151 ------------- 0	0 ------------- 0
5HARRY ANTHONY MD CHIEF MEDICAL OFFICER	(i) (ii)	249,138 ------------- 0	5,733 ------------- 0	17,914 ------------- 0	1,923 ------------- 0	1,439 ------------- 0	276,147 ------------- 0	0 ------------- 0
6DENISE JESTER CFO	(i) (ii)	243,723 ------------- 0	0 ------------- 0	18,573 ------------- 0	8,086 ------------- 0	5,202 ------------- 0	275,584 ------------- 0	0 ------------- 0
7TRACI ALLEY CHIEF HR OFFICER TO 02/01/2020	(i) (ii)	191,830 ------------- 0	0 ------------- 0	13,734 ------------- 0	4,181 ------------- 0	2,757 ------------- 0	212,502 ------------- 0	0 ------------- 0
8GEORGE SCHWOBEL DIRECTOR OF PHARMACY	(i) (ii)	167,254 ------------- 0	108 ------------- 0	0 ------------- 0	4,782 ------------- 0	988 ------------- 0	173,132 ------------- 0	0 ------------- 0
9LILIA KULMACZEWSKI CHIEF COMPLIANCE OFFICER	(i) (ii)	148,010 ------------- 0	0 ------------- 0	11,947 ------------- 0	4,230 ------------- 0	1,345 ------------- 0	165,532 ------------- 0	0 ------------- 0
10KIMBERLY BOYKIN COUCH PHARMACIST	(i) (ii)	165,324 ------------- 0	108 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	165,432 ------------- 0	0 ------------- 0
11RAY FULKROD CNO	(i) (ii)	154,194 ------------- 0	0 ------------- 0	6,850 ------------- 0	2,929 ------------- 0	1,345 ------------- 0	165,318 ------------- 0	0 ------------- 0
12LUCY SCHWOBEL PHARMACIST	(i) (ii)	149,701 ------------- 0	108 ------------- 0	0 ------------- 0	4,304 ------------- 0	988 ------------- 0	155,101 ------------- 0	0 ------------- 0
13MARY BETH D'AMICO APRN	(i) (ii)	152,789 ------------- 0	108 ------------- 0	0 ------------- 0	1,628 ------------- 0	0 ------------- 0	154,525 ------------- 0	0 ------------- 0
14PAMELA PIQUETTE PHARMACIST	(i) (ii)	150,534 ------------- 0	108 ------------- 0	0 ------------- 0	0 ------------- 0	2,134 ------------- 0	152,776 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 3

PROCESS TO ESTABLISH THE 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.

PART I, LINE 7

NON-FIXED PAYMENTS OFFICERS AND KEY 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.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ASHLEY PARKER	FAMILY MBR OF DIR	35,237	COMP		No
(2) KRISTINA WARD	FAMILY MBR OF DIR	86,566	COMP		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Return Reference	Explanation
FORM 990, PART III, LINE 4A	FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: NANTICOKE MEMORIAL HOSPITAL 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 OPERATION AND STABILITY OF NANTICOKE MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH NANTICOKE MEMORIAL HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, HEALTH ACTIVITIES AND PROGRAMS NEEDED TO SUPPORT THE INABILITY TO PAY CO-EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE UNDER SERVED, SCREENINGS ASSISTANCE AND A WIDE VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. NANTICOKE ALSO WORKS WITH CHOOSE DELAWARE, THE STATE HEALTH INSURANCE EXCHANGE PROGRAM, AND PARTICIPATES WITH COMMONWELL FOR PATIENT EMR PORTABILITY. NANTICOKE IS A PARTNER IN THE HEALTHIER SUSSEX COUNTY TASK FORCE AND THE SUSSEX COUNTY HEALTH COALITION WORKING WITH OTHER HOSPITALS AND COMMUNITY SUPPORT SERVICE ORGANIZATIONS IN THE COUNTY TO IMPROVE OVERALL COMMUNITY HEALTH. NANTICOKE LEARDERSHIP IS VERY ACTIVE WITH THE STATE OF DELAWARE HEALTH INNOVATIONS PLAN WORKING TO IMPROVE THE HEALTH OF ALL DELAWAREANS. PATIENTS SEEN: INPATIENTS 4,798; BIRTHS 934; ER VISITS 30,617; OP VISITS 103,082 DAYS OF INPATIENT CARE: ADULTS & PEDIATRICS 19,274; NEWBORN 1,987 OTHER FACTS: AVERAGE PATIENT STAY 4.02; OPERATIONS 3,047 NANTICOKE MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. SERVICES PROVIDED TO THOSE UNABLE TO PAY $19,040,949 DISCOUNTS TO MEDICARE, MEDICAID & OTHERS $184,576,009
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 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 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 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:	AFFILIATION GAIN 22,053,439. LOSS ON EXTINGUISHMENT OF DEBT -4,141,847. PENSION ADJUSTMENT -2,453,360. LOSS ON MINORITY INTEREST -1,181,285.
ABOUT NANTICOKE	NANTICOKE MEMORIAL HOSPITAL IS ORGANIZED UNDER THE CORPORATE TITLE OF NANTICOKE HEALTH SERVICES. WHAT BEGAN AS A 32-BED HOSPITAL IN 1952 HAS GROWN TO INCLUDE INPATIENT SERVICES, OUTPATIENT SERVICES, URGENT CARE AND PROVIDER PRACTICES ACROSS SUSSEX COUNTY DELAWARE; BUSINESS SERVICES; AND A HOST OF PREVENTATIVE MEDICINE AND HEALTH EDUCATION PROGRAMS. EACH PART OF NANTICOKE HEALTH SERVICES WORKS TOGETHER TO FOCUS ON FULFILLING OUR MISSION: "WE EXIST TO POSITIVELY IMPACT OUR COMMUNITIES QUALITY OF LIFE THROUGH SUPERIOR HEALTH SERVICES." TODAY, PATIENTS AND BUSINESSES ARE CONTINUALLY SEEKING SUPERIOR HEALTH CARE AT AN AFFORDABLE PRICE. NANTICOKE STANDS COMMITTED TO PROVIDING THAT CARE. AS A PARTICIPANT IN THE CMS AND JOINT COMMISSION CORE MEASURE PROJECTS, NANTICOKE MEMORIAL HOSPITAL IS AMONG ONLY 2% OF HOSPITALS NATIONALLY TO BE RECOGNIZED BY HEALTH GRADES (2017 AND 2018) FOR BOTH PATIENT SAFETY AND PATIENT EXPERIENCE. NANTICOKE HAS ALSO BEEN RECOGNIZED BY THE AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES PROGRAM FOR BOTH STROKE (GOLD PLUS ACHIEVEMENT AWARD) AND INTERVENTIONAL CARDIOLOGY (GOLD PLUS ACHIEVEMENT AWARD). NANTICOKE IS RATED AS A 4-STAR HOSPITAL FOR PATIENT EXPERIENCE BY CMS. NANTICOKE MEMORIAL IN CONJUNCTION WITH SUSSEX COUNTY EMS RECEIVED THE AHA MISSION LIFELINE AWARD IN 2017 FOR ITS EFFORTS TO FURTHER DECREASE TREATMENT TIMES FOR THOSE SUFFERING FROM STEMIS. FEEDBACK FROM OUR PATIENTS OVERWHELMINGLY COMPLIMENTS US ON THE CARE AND FRIENDLINESS OF OUR STAFF IN ALL OF OUR ENTITIES. OUR DEDICATION TO SERVING OUR PATIENTS IS EVIDENCED THROUGH A COORDINATED SYSTEM OF CARE. NANTICOKE PARTICIPATES IN A PROACTIVE ACCOUNTABLE CARE ORGANIZATION AND CONTINUES TO BE RECOGNIZED BY THE NATIONAL COUNCIL FOR QUALITY ASSURANCE AS A PATIENT-CENTERED MEDICAL HOME. NANTICOKE ALSO INCLUDES A CANCER CENTER THAT IS ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER. OUR GROWTH IS EVIDENCED NOT ONLY THROUGH THE CONTINUED ADDITION TO MEDICAL PROGRAMS, BUT ALSO THROUGH SUCCESSFUL PHYSICIAN RECRUITMENT AND EXPANSION OF OUR MEDICAL STAFF TO OVER 160 HEALTH CARE PROVIDERS PRACTICING IN 40 DIFFERENT SPECIALIES. AS OUR COMMUNITIES' HEALTHCARE NEEDS CHANGE, NANTICOKE HEALTH SERVICES CONTINUES TO CHANGE AND EXPAND SERVICES TO MEET THOSE NEEDS. COMMUNITY OUTREACH NANTICOKE MEMORIAL HOSPITAL'S TRAINED STAFF GOES INTO THE COMMUNITY TO PRESENT HEALTH EDUCATION SEMINARS AND PROVIDE HEALTH SCREENINGS. WE WORK WITH AREA SCHOOLS, AND COMMUNITY ORGANIZATIONS TO EDUCATE OUR COMMUNITY ON DISEASE MANAGEMENT, CARE COORDINATION, DISEASE PREVENTION AND GENERAL WELLNESS. THERE ARE MANY SUPPORT GROUPS AND EDUCATIONAL MEETINGS HOSTED BY NANTICOKE. NANTICOKE HOSTS SEVERAL MATERNITY CLASSES, DIABETES EDUCATION CLASSES CERTIFIED THROUGH THE AMERICAN DIABETES ASSOCIATION, AND HOST SUPPORT GROUPS INCLUDING STROKE, CHF, CANCER, AND MANY OTHERS. WE CONDUCT REGULAR CHOLESTEROL, DIABETES, AND BLOOD PRESSURE SCREENINGS AND ADULT AND INFANT / CHILD CPR INSTRUCTION IS OFFERED ON A REGULAR BASIS. IN 2016 NANTICOKE COMPLETED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). AN ANNUAL IMPLEMENTATION PLAN ASSOCIATED WITH THIS CHNA WAS DEVELOPED AND ADOPTED JANUARY 2017. NEEDS IDENTIFIED INCLUDED A CONTINUING NEED FOR PROGRAMMING AROUND HEALTH AND OBESITY, MENTAL HEALTH & SUBSTANCE ABUSE, AND CERVICAL CANCER AS A PART OF ITS IMPLEMENTATION FOR OBESITY AND MENTAL HEALTH NEEDS, NANTICOKE IS ACTIVELY WORKING WITH THE HEALTHIER SUSSEX COUNTY TASK FORCE, THE STATE OF DELAWARE HEALTH INNOVATION CENTER'S HEALTHY NEIGHBORHOODS PROGRAM, AND THE SUSSEX COUNTY HEALTH COALITION ON COUNTY WIDE INITIATIVES AROUND THESE NEEDS. NANTICOKE HAS AN ACTIVE EMPLOYEE WELLNESS PROGRAM ADDRESSING HEALTH AND WELLNESS ISSUES AMONG ITS EMPLOYED POPULATION. IT PARTICIPATES AS A LEAD ORGANIZATION IN HEALTHIER SUSSEX COUNTY, A PARTNERSHIP OF VARIOUS HEALTH CARE PROVIDERS IN THE AREA TO COMMONLY ADDRESS COUNTY HEALTH CARE NEEDS. HEALTHIER SUSSEX COUNTY SHARED FINDINGS FROM EACH OF THE COUNTY'S HOSPITAL'S HEALTH NEEDS ASSESSMENT AND DEVELOPED CORE STRATEGIES FOR THE TASK FORCE WHICH INCLUDED PHYSICAL ACTIVITY AND PHYSICIAN EDUCATION ON CANCER SCREENINGS. HEALTHIER SUSSEX COUNTY IS CURRENTLY ENGAGED IN DATA COLLECTION FOR ITS 2019 HEALTH NEEDS ASSESSMENT (PUBLISHED JUNE 2019). NANTICOKE IS A LEAD ORGANIZATION WITH THE SUSSEX COUNTY HEALTH COALITION, WORKING WITH COMMUNITY PARTNERS ON PROJECTS FROM SUBSTANCE ABUSE AWARENESS AND PREVENTION TO CONNECTING WITH COMMUNITY SUPPORT SERVICES TO REDUCE GAPS IN AND BARRIERS TO CARE. NANTICOKE WORKS WITH STATE PROJECTS SUCH AS BUT NOT LIMITED TOUPSTREAM TO HELP REDUCE UNPLANNED, UNWANTED PREGNANCIES AMONG OUR YOUNG WOMEN. NANTIOKE ALSO PARTICIPATES IN STATE DRIVEN INITIATIVES SUCH AS THE DEVELOPMENT OF A MH/SUBST. ABUSE SYSTEM OF CARE. PATIENT EDUCATION PATIENT AND FAMILY EDUCATION HAS BECOME AN INTEGRAL PART OF THE CLINICAL PATHWAY PROCESS UTILIZED THROUGHOUT NANTICOKE HEALTH SERVICES. THROUGH THE PATIENT EDUCATION CENTER AND LEVERAGING OUR EMR PROGRAM, OUR PATIENT CARE AND EDUCATION STAFF HAVE BEEN TRAINED TO TEACH OUR PATIENTS AND THEIR FAMILIES ABOUT THEIR ILLNESSES AND TREATMENTS. USING AN ASSORTMENT OF PRINTED MATERIALS AND CLOSED CIRCUIT TELEVISION, WE ARE ABLE TO EFFECTIVELY TRANSFER CRITICAL INFORMATION DURING ALL PHASES OF CARE. NANTICOKE CONTINUES TO EXPLORE WAYS TO PROVIDE PATIENT EDUCATION THAT IS EASIER TO ACCESS THROUGH TODAY'S TECHNOLOGIES.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NANTICOKE MEMORIAL HOSPITAL INC

Employer identification number

51-0069243

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)NANTICOKE HEALTH SERVICES INC 801 MIDDLEFORD ROAD SEAFORD,DE19973 51-0293888	HEALTH SERVICES	DE	501(C)(3)	LINE 12B, II	N/A		No
(2)MID-SUSSEX MEDICAL CENTER INC 801 MIDDLEFORD ROAD SEAFORD,DE19973 51-0224470	HEALTH SERVICES	DE	501(C)(3)	LINE 10	PRHS		No
(3)NANTICOKE INSURANCE COMPANYLTD PO BOX 10233 3RD FLR WILLOW HOUSE ELGIN AVE,GEORGETOWN CJ 98-0446259	INSURANCE	CJ	501(C)(3)		NHS		No
(4)NANTICOKE HEALTH FOUNDATION 801 MIDDLEFORD ROAD SEAFORD,DE19973 81-2731803	FUNDRAISING	DE	501(C)(3)	LINE 7	NHS		No
(5)PENINSULA REGIONAL HEALTH SYSTEM 100 EAST CARROLL STREET SALISBURY,MD21801 52-2132761	PARENT	MD	501(C)(3)	LINE 12B, II	N/A		No
(6)PENINSULA REGIONAL MEDICAL CENTER FOUNDATION 100 EAST CARROLL STREET SALISBURY,MD21801 52-1851935	FUNDRAISING	MD	501(C)(3)	LINE 7	PRHS		No
(7)DELMARVA PENINSULA INSURANCE COMPANY PO BOX 1159 KY,GRAND CAYMAN CJ 98-1110617	INSURANCE	CJ	501(C)(3)		PRHS		No
(8)PENINSULA GENERAL HOSPITAL INS TRUST 100 EAST CARROLL STREET SALISBURY,MD21801 52-6321234	INSURANCE	MD	501(C)(3)	LINE 12C, III-FI	PRHS		No
(9)MCCREADY FOUNDATION INC 201 HALL HIGHWAY CRISFIELD,MD21817 52-0607921	FUNDRAISING	MD	501(C)(3)	LINE 3	PRHS		No
(10)PENINSULA REGIONAL MEDICAL CENTER 100 EAST CARROLL STREET SALISBURY,MD21801 52-0591628	HOSPITAL	MD	501(C)(3)	LINE 3	PRHS		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) DELMARVA SURG CTR 641 S SALISBURY BLVD SALISBURY,MD21801 52-2251436	HEALTHCARE	MD	N/A	N/A				No			No
(2) DELMARVA ENDOSC CTR 11103 CATHAGE ROAD BERLIN,MD21811 83-1509115	HEALTHCARE	MD	N/A	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) PROPRIETARY ENTERPRISES INC 801 MIDDLEFORD ROAD SEAFORD,DE19973 51-0293887	INACTIVE	DE	N/A	C				No
(2) PENINSULA HEALTH VENTURES (PHV) 100 EAST CARROLL STREET SALISBURY,MD21801 52-2250012	P'SHIP INVESTMENT	MD	N/A	C				No
(3) PRLTC INC 100 EAST CARROLL STREET SALISBURY,MD21801 52-2190588	LONG TERM CARE	MD	N/A	C				No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1)	B
(2)	J
(3)	K
(4)	L
(5)	M
(6)	N
(7)	O
(8)	P
(9)	Q

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF THE ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,254
6	Total number of volunteers (estimate if necessary) .............	6	150
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,331,579	14,736,332
9	Program service revenue (Part VIII, line 2g) .........	155,643,704	133,937,883
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,297,705	2,196,354
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,947,450	2,232,724
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	164,220,438	153,103,293
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	11,349,373	9,502,957
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	69,207,914	63,999,771
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	87,508,106	89,764,480
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	168,065,393	163,267,208
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,844,955	-10,163,915
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	152,991,466	179,471,750
21	Total liabilities (Part X, line 26).............	63,493,386	86,306,050
22	Net assets or fund balances. Subtract line 21 from line 20.....	89,498,080	93,165,700

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 149,428,425 including grants of $ 9,502,957 ) (Revenue $ 133,937,883 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses149,428,425

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) ANDREW HARSTEIN........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(19) TRINA JOYNER........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(20) MARIA LEHMAN........................................................................ DIRECTOR	1.00 .......................1.00	X	0	0	0
(21) FREDERICK MAST........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(22) SEAN STEWARD........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(23) TAMMY PAXTON........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(24) KENT PETERSON........................................................................ DIRECTOR - THRU 12/31/2019	1.00 .......................0.00	X	0	0	0
(25) MICHELE PROCINO-WELLS........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(26) RICHARD SIMONS DO........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0
(27) TRACY TULL NEILSON........................................................................ DIRECTOR	1.00 .......................1.00	X	0	0	0
(28) SARAH RUFFCORN........................................................................ DIRECTOR	1.00 .......................0.00	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,422,346	0	113,953

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	4,803,049
e	Government grants (contributions)		1e	9,933,283

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		14,736,332

		Business Code
2a	PATIENT REVENUE	623000	133,937,883	133,937,883
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		133,937,883

3 Investment income (including dividends, interest, and othersimilar amounts) ......			372,924			372,924
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		635,983	6a
b	Less: rental expenses		413,389	6b
c	Rental income or (loss)		222,594	6c
d	Net rental income or (loss).......			222,594			222,594
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	42,000	15,322,339	7a
b	Less: cost or other basis and sales expenses	20,742	13,520,167	7b
c	Gain or (loss)	21,258	1,802,172	7c
d	Net gain or (loss).........			1,823,430			1,823,430
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS		623000	1,166,035			1,166,035
b	CAFETERIA		623000	844,095			844,095
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,010,130
12	Total revenue. See instructions.....			153,103,293	133,937,883	0	4,429,078

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	9,255,000	9,255,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	247,957	247,957
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,019,080	2,747,363	271,717
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	46,512,725	42,326,580	4,186,145
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,886,464	1,716,682	169,782
9	Other employee benefits .......	9,121,416	8,300,489	820,927
10	Payroll taxes ...........	3,460,086	3,148,678	311,408
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	495,233	450,662	44,571
c	Accounting ...........	177,130	161,188	15,942
d	Lobbying ...........	23,737		23,737
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	14,186,792	12,909,981	1,276,811
12	Advertising and promotion ....	702,472	639,250	63,222
13	Office expenses .......	104,099	94,730	9,369
14	Information technology ......	8,172,619	7,437,083	735,536
15	Royalties ..
16	Occupancy ...........	2,295,957	2,089,321	206,636
17	Travel ............	70,920	64,537	6,383
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	1,989,741	1,810,664	179,077
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	8,860,143	8,062,730	797,413
23	Insurance ...	1,027,981	935,463	92,518
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	17,378,371	15,814,318	1,564,053	0
b	DRUGS	12,438,202	11,318,764	1,119,438	0
c	BAD DEBT EXPENSE	9,599,508	8,735,552	863,956	0
d	PHYSICIAN FEES	6,865,111	6,247,251	617,860	0
e	All other expenses	5,376,464	4,914,182	462,282
25	Total functional expenses. Add lines 1 through 24e	163,267,208	149,428,425	13,838,783	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			3,312,980	1	8,228,921
2	Savings and temporary cash investments .........			0	2	22,731,016
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			15,850,335	4	12,003,679
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			4,069,113	8	4,584,412
9	Prepaid expenses and deferred charges ......			1,873,758	9	2,050,070
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	93,613,043
b	Less: accumulated depreciation	10b	4,263,566	70,583,119	10c	89,349,477
11	Investments—publicly traded securities .			51,755,971	11	37,783,297
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			470,234	13	0
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			5,075,956	15	2,740,878
16	Total assets. Add lines 1 through 15 (must equal line 33)...			152,991,466	16	179,471,750

17	Accounts payable and accrued expenses .....	13,105,297	17	14,704,587
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	37,948,293	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	11,587,731	23	6,592,773
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	852,065	25	65,008,690
26	Total liabilities. Add lines 17 through 25..	63,493,386	26	86,306,050

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	89,498,080	27	93,165,700
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	89,498,080	32	93,165,700
33	Total liabilities and net assets/fund balances ........	152,991,466	33	179,471,750