Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
TIDALHEALTH PENINSULA REGIONAL |
520591628 | 3 | Yes | 0 | 0 | |
| (B)
TIDALHEALTH NANTICOKE |
510069243 | 3 | Yes | 0 | 0 | |
| (C)
TIDALHEALTH PHYSICIAN NETWORK |
510224470 | 10 | Yes | 0 | 0 | |
|
Total 3
|
0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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.).. | ||||||
| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 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 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART IV, SECTION D, LINE 3: | ORGANIZATION'S ROLE IN SUPPORTED ORGANIZATIONS TIDALHEALTH, INC. IS THE SOLE MEMBER OF EACH OF THE SUPPORTED ORGANIZATIONS. FURTHER, THERE IS SIGNIFICANT OVERLAP BETWEEN THE BOARDS OF DIRECTORS AND OFFICERS OF THE SUPPORTING AND SUPPORTED ORGANIZATIONS. THESE MEMBERS HAVE A SIGNIFICANT VOICE IN DETERMINING THE INVESTMENT POLICIES OF TIDALHEALTH, INC. AND THE USE OF THE INCOME AND ASSETS THROUGH THEIR DUAL POSITIONS ON THE BOARDS. THE SHARING OF SUCH INDIVIDUALS ALLOWS TIDALHEALTH, INC. TO MAINTAIN A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH ITS SUPPORTED ORGANIZATION. |
| SCHEDULE A, PART IV, SECTION E, LINE 3A: | PARENT TO SUPPORTED ORGANIZATIONS TIDALHEALTH, INC. IS THE PARENT AND SOLE MEMBER OF THE SUPPORT ORGANIZATIONS. TIDALHEALTH, INC. HAS THE POWER TO APPOINT THE FULL BOARD OF THE SUPPORTED ORGANIZATIONS (TIDALHEALTH PENINSULA REGIONAL, TIDALHEALTH NANTICOKE, AND TIDALHEALTH PHYSICIAN NETWORK, INC.). IN ADDITION, THE BYLAWS OF THE SUPPORTED ORGANIZATIONS GIVE THE SOLE MEMBER THE POWER TO PLAN, DIRECT AND ESTABLISH POLICY RELATED TO THE DEVELOPMENT AND ULTIMATE DELIVERY OF HEALTH CARE AND OTHER COMMUNITY SERVICES ON AN INTEGRATED AND COST-EFFECTIVE BASIS. FURTHER, TIDALHEALTH, INC. IS TASKED WITH THE OVERALL PLANNING AND COORDINATION OF THE DELIVERY OF HEALTH CARE AND OTHER COMMUNITY SERVICES, FACILITIES AND PROGRAMS, PATIENT CARE, THE DEVELOPMENT AND IMPLEMENTATION OF MANAGED CARE STRATEGIES, AND THE SECURING AND ARRANGING OF CAPITAL FOR ITS SUPPORTED ORGANIZATIONS. |
| SCHEDULE A, PART IV, SECTION E, LINE 3B: | PARENT TO SUPPORTED ORGANIZATIONS SEE NARRATIVE TO LINE 3A. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIPS STEVEN LEONARD, DAVID ROMMEL, MEMO DIRIKER, RYAN MCLAUGHLIN, MONTGOMERY SAYLER, THOMAS COATES AND THOMAS RICCIO, M.D. ARE MEMBERS OF THE BOARD OF DIRECTORS OF PENINSULA HEALTH VENTURES, A WHOLLY-OWNED TAXABLE SUBSIDIARY OF TIDALHEALTH, INC. BRUCE I. RITCHIE, TPR'S CFO, ALSO SERVES AS SECRETARY/TREASURER OF PENINSULA HEALTH VENTURES. |
| FORM 990, PART VI, SECTION A, LINE 4 | CHANGES TO GOVERNING DOCUMENTS AS OF JULY 29, 2020, PENINSULA REGIONAL HEALTH SYSTEM, INC. WAS RENAMED TO TIDALHEALTH, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS/STOCKHOLDERS TIDALHEALTH, INC. IS ORGANIZED AS A NON-STOCK, NOT-FOR-PROFIT CORPORATION WITH MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS OF GOVERNING BODY THE NOMINATING COMMITTEE OF THE BOARD MAKES RECOMMENDATIONS FOR NEW MEMBERSHIP. THE BOARD OF TRUSTEES GIVES FINAL APPROVAL. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL OF GOVERNING BODY DECISIONS NEW RESOLUTIONS ARE ADOPTED BY THE BOARD'S COMMITTEE CHAIRPERSONS OR MEMBERS OF THE BOARD AND PRESENTED TO THE BOARD FOR APPROVAL. |
| FORM 990, PART VI, SECTION A, LINE 8B | CONTEMPORANEOUS DOCUMENTATION OF MEETINGS HELD/WRITTEN ACTIONS UNDERTAKEN THE GOVERNING BODY OF TIDALHEALTH, INC. DOCUMENTS ALL MEETINGS HELD. COMMITTEES OF THE HEALTH SYSTEM ALSO DOCUMENT ALL MEETINGS HELD, BUT DO NOT HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. COMMITTEE CHAIRS PRESENT RESOLUTIONS TO THE GOVERNING BODY FOR APPROVAL. |
| 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 CFO OF TIDALHEALTH PENINSULA REGIONAL (TPR) BY THE PRESIDENT OF TIDALHEALTH INC., THE PARENT CORPORATION OF TPR. THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE PRESIDENT OF THE HEALTH SYSTEM PRIOR TO FILING. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO THE FILING WITH IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST POLICY THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY AND ALL INTERESTS WHICH THEY OR ANY MEMBER OF THEIR IMMEDIATE FAMILY, MAY HAVE IN ANY BUSINESS ENTITY WHICH HAS OR SEEKS A CONTRACTUAL OR COMPETITIVE RELATIONSHIP WITH THE CORPORATION OR ANY OF ITS AFFILIATES. THE BOARD HAS 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. ALL DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER. ANY CONFLICTS ARE PRESENTED TO THE BOARD. IF A PERSON IS CONFLICTED, THEY WILL RECUSE THEMSELVES FROM ALL DISCUSSIONS AND DELIBERATIONS TO WHICH THEY WOULD APPEAR TO BE CONFLICTED. FORM 990, PART VI, SECTION B, LINES 13 AND 14 WRITTEN WHISTLEBLOWER/DOCUMENT RETENTION AND DESTRUCTION POLICIES TIDALHEALTH INC. HAS NO EMPLOYEES AS THE PARENT CORPORATION TO TIDALHEALTH PENINSULA REGIONAL (TPR). TPR HAS A WRITTEN WHISTLEBLOWER POLICY AND A DOCUMENT RETENTION AND DESTRUCTION POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION USES A COMPENSATION COMMITTEE OF TIDALHEALTH PENINSULA REGIONAL (TPR), A RELATED TAX EXEMPT ORGANIZATION IDENTIFIED IN FORM 990, SCHEDULE R, TO DETERMINE THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THE CEO OF THE ORGANIZATION HAS A WRITTEN EMPLOYMENT CONTRACT. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS. |
| 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 PUBLIC INFORMATION OFFICE OF TIDALHEALTH PENINSULA REGIONAL AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. |
| FORM 990, PART XI, LINE 9: | INCREASE IN EQUITY IN INVESTMENT IN SUBSIDIARIES 181,869,552. TIDALHEALTH PHYSICIAN NETWORK ACTIVITY THROUGH AUGUST 31, 2020 1,691,870. RECLASS BAD DEBT TO EXPENSE 2,722,131. |
| Software ID: | |
| Software Version: |