TY 2017 Form 990

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

GEISINGER INSURANCE CORPORATION
RISK RETENTION GROUP

Employer identification number

14-1909894

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 ...............................13

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

(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)
(i) Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) GEISINGER MEDICAL CENTER	240795959	3	Yes		3,022,845	0
(B) GEISINGER WYOMING VALLEY MEDICAL CENTER	231996150	3	Yes		3,895,500	0
(C) COMMUNITY MEDICAL CENTER	240862246	3	Yes		2,750,000	0
(D) GEISINGER-BLOOMSBURG HOSPITAL	232193572	3	Yes		375,000	0
(E) GEISINGER-LEWISTOWN HOSPITAL	231352187	3	Yes		787,500	0
(F) HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARI	231512747	3	Yes		725,000	0
(G) GEISINGER COMMUNITY HEALTH SERVICES	232967235	10	Yes		0	0
(H) GEISINGER-BLOOMSBURG HEALTH CARE CENTER	232242854	10	Yes		90,000	0
(I) MOUNTAIN VIEW NURSING HOME INC	232568288	10	Yes		400,000	0
(J) SPIRIT PHYSICIAN SERVICES INC	251766971	10	Yes		0	0
(K) GEISINGER CLINIC	236291113	10	Yes		1,825,000	0
(L) FAMILY HEALTH ASSOCIATES OF GEISINGER LEWISTOWN HOSP	251651582	10	Yes		0	0
(M) GEISINGER JERSEY SHORE HOSPITAL	240792115	3	Yes		0	0
Total 13					13,870,845	0

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).

Yes

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).

Yes

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?

Yes

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.

Yes

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
PART I, LINE 11H	HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARI 23-1512747 3 X 725,000 0 GEISINGER COMMUNITY HEALTH SERVICES 23-2967235 10 X 0 0 GEISINGER-BLOOMSBURG HEALTH CARE CENTER 23-2242854 10 X 90,000 0 MOUNTAIN VIEW NURSING HOME, INC 23-2568288 10 X 400,000 0 SPIRIT PHYSICIAN SERVICES INC. 25-1766971 10 X 0 0 GEISINGER CLINIC 23-6291113 10 X 1,825,000 0 FAMILY HEALTH ASSOCIATES OF GEISINGER LEWISTOWN HOSP. 25-1651582 10 X 0 0 GEISINGER JERSEY SHORE HOSPITAL 24-0792115 3 X 0 0
PART IV, SECTION A, LINE 1	GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP'S (RRG) SUPPORTED ORGANIZATIONS ARE DESIGNATED BY CLASS AND PURPOSE. PER ARTICLE IV OF THE RRG ARTICLES OF INCORPORATION, THE PURPOSES OF THE CORPORATION ARE TO ENGAGE IN THE BUSINESS OF INSURING AND REINSURING VARIOUS TYPES OF RISKS AS A CAPTIVE INSURANCE COMPANY PURSUANT TO CHAPTER I 41 OF TITLE 8 OF THE VERMONT STATUTES ANNOTATED AND AS A RISK RETENTION GROUP PURSUANT TO THE FEDERAL LIABILITY RISK RETENTION ACT, 15 U.S.C. 3901 ET SEQ., CONDUCTING ALL ACTIVITIES NECESSARY OR INCIDENTAL TO THE FOREGOING, AND ENGAGING IN ANY OTHER LAWFUL BUSINESS OR ACTIVITY. NOTWITHSTANDING ANY OTHER PROVISION OF THESE ARTICLES OF INCORPORATION, THE CORPORATION IS ORGANIZED AND SHALL AT ALL TIMES BE OPERATED EXCLUSIVELY FOR CHARITABLE, RELIGIOUS, LITERARY, SCIENTIFIC OR EDUCATIONAL PURPOSES AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986 (OR THE CORRESPONDING PROVISIONS OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW) (THE "CODE"), FOR THE BENEFIT OF THE ORGANIZATIONS COMPRISING GEISINGER, WHICH ARE CHARITABLE ORGANIZATIONS DESCRIBED IN SECTION 501(C) (3) OF THE CODE.
PART IV, SECTION A, LINE 2	GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP PERIODICALLY CALCULATES THE 509(A)(1) AND/OR 509(A)(2) PUBLIC SUPPORT TEST TO ENSURE THAT THEY ARE SATISFIED BY ITS AFFILAITED 501(C)(3), 509(A)(3) ORGANIZATIONS. THE GEISINGER AFFILIATED 501(C)(3), 509(A)(3) SUPPORTING ORGANIZATIONS WHOSE PURPOSES INCLUDE SUPPORTING OTHER MEMBERS WITHIN GEISINGER AS DESCRIBED IN THEIR RESPECTIVE ARTICLES OF INCORPORATION, INCLUDE: NAME OF SUPPORTING ORGANIZATION EIN GEISINGER CLINIC 23-6291113 FAMILY HEALTH ASSOCIATES OF GEISINGER-LEWISTOWN HOSPITAL 25-1651582 THESE ORGANIZATIONS ARE LISTED IN FORM 990, SCHEDULE A, PART 1, LINE 11. THE TYPE OF ORGANIZATION REPORTED IN COLUMN (III) IDENTIFIES THE PUBLIC SUPPORT TEST SATISIFIED BY EACH ORGANIZATION. BY SUPPORTING THESE ORGANIZATION, GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP IS FULFILLING ITS MISSION TO SUPPORT GEISINGER HEALTH IN ITS CHARITABLE MISSION OF DIRECTLY OR INDIRECTLY SUPPORTING THE PURPOSES OF GEISINGER MEDICAL CENTER OR ANY OTHER ORGANIZATION AFFILIATED WITH GEISINGER HEALTH WHICH QUALIFIES AS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER- AND "SYSTEM" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH (GH) AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.
PART IV, SECTION A, LINE 5A	ORGANIZATIONS REMOVED: (I) MOUNTAIN VIEW NURSING HOME, INC., EIN: 23-2568288 GEISINGER BLOOMSBURG HEALTH CARE CENTER, EIN: 23-2242854 (II) THE ORGANIZATIONS WERE REMOVED AS SUPPORTED ORGANIZATIONS BECASUE, PURSUANT TO GEISINGER HEALTH BOARD APPROVAL, THE OPERATIONS OF MOUNTAIN VIEW NURSING HOME, INC. AND GEISINGER GEISINGER-BLOOMSBURG HEALTH CARE CENTER WERE SOLD TO AN UNRELATED ORGANIZATION DURING THE FISCAL YEAR. (III)GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP (RRG) IS A TYPE I SUPPORTING ORGANIZATION. PER THE RRG'S BYLAWS AND ARTICLES OF INCORPORATON, THE RRG SHALL AT ALL TIMES BE OPERATED EXCLUSIVELY FOR CHARITABLE, RELIGIOUS, LITERARY, SCIENTIFIC OR EDUCATIONAL PURPOSES AS AN ORGANIZATION DESCRIBED IN IRC SECTION 501(C)(3)FOR THE BENEFIT OF THE ORGANIZATIONS COMPRISING THE GEISINGER HEALTH SYSTEM (NOW "GEISINGER"), WHICH ARE CHARITABLE ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE (IV) THE REMOVAL OF THE ORGANIZATIONS WAS ACCOMPLISHED THROUGH THE CANCELLING AND REDISTRIBUTION OF THEIR MEMBERSHIP CERTIFICATES.
SUPPLEMENTAL INFORMATION	IN ADDITION TO THE ABOVE ORGANIZATIONS, GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP (RRG) ALSO SUPPORTS FAMILY HEALTH ASSOCIATES OF GEISINGER-LEWISTOWN HOSPITAL (FHA), A 501(C)(3), 509(A)(3) TYPE I, AFFILIATE OF GEISIGNER. FHA AND RRG BOTH SUPPORT GEISINGER- LEWISTOWN HOSPITAL (GLH) AND MAY SUPPORT OTHER AFFILIATED GEISINGER ORGANIZATIONS AS DESCRIBED IN THEIR RESPECTIVE ARTICLES OF INCORPORATION. BY PROVIDING SELF-INSURANCE COVERAGE TO FHA, THE RRG IS SUPPORTING GLH AND IS FULFILLING ITS MISSION TO SUPPORT THE GEISINGER HEALTH IN ITS CHARITABLE MISSION OF DIRECTLY OR INDIRECTLY SUPPORTING THE PURPOSES OF GEISINGER MEDICAL CENTER OR ANY OTHER ORGANIZATION AFFILIATED WITH GEISINGER HEALTH WHICH QUALIFIES AS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP SUPPORTS ITS SUPPORTED ORGANIZATION THROUGH THE MANAGEMENT OF THEIR MEDICAL PROFESSIONAL LIABILITY RISK EXPOSURES. THE COMPANY IS A SELF-INSURANCE FUNDING VEHICLE FOR THESE PARTICIPATING NON-PROFIT AFFILIATED ORGANIZATIONS, AND AS SUCH AN INTEGRAL PART OF EACH OF THEIR NONPROFIT, CHARITABLE HEALTHCARE OPERATIONS. THE COMPANY WAS FORMED PRIMARILY TO ADDRESS THE LACK OF MEDICAL PROFESSIONAL LIABILITY COVERAGE IN THE COMMONWEALTH OF PENNSYLVANIA, AND TO ENABLE GEISINGER TO COMPLY WITH THE PENNSYLVANIA MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR ACT (MCARE)(1), WHICH REQUIRES PENNSYLVANIA PHYSICIANS AND HEALTHCARE INSTITUTIONS TO OBTAIN PRIMARY PROFESSIONAL LIABILITY COVERAGE FROM A QUALIFIED SELF-INSURANCE TRUST OR AN INSURER LICENSED TO PROVIDE SUCH LIABILITY COVERAGE IN PENNSYLVANIA. (1) THE COMMONWEALTH OF PENNSYLVANIA CREATED THE BUREAU OF MEDICAL CARE AVAILABILITY AND REDUCTION ERROR FUND (MCARE) TO PROVIDE PROFESSIONAL LIABILITY INSURANCE COVERAGE FOR HEALTHCARE PROVIDERS FOR CLAIMS IN EXCESS OF SPECIFIED PER-CLAIM AND AGGREGATE INSURANCE LIMITS. PROVIDERS MUST HAVE THE MANDATORY PRIMARY-LAYER PROFESSIONAL LIABILITY COVERAGE TO BE ELIGIBLE FOR COVERAGE FROM THE MCARE FUND.

Schedule A (Form 990 or 990-EZ) 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

GEISINGER INSURANCE CORPORATION
RISK RETENTION GROUP

Employer identification number

14-1909894

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 .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..

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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	250,003
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
SCHEDULE D, PAGE 4, PART XIII	EFFECTIVE JULY 1, 2007, GEISINGER(1) ADOPTED ACCOUNTING STANDARDS CODIFICATION 740 (FIN 48), (FORMERLY KNOWN AS "STATEMENT 109: ACCOUNTING FOR INCOME TAXES- OR "FAS 109"). FIN 48 CLARIFIES THE ACCOUNTING AND REPORTING FOR INCOME TAXES WHERE INTERPRETATION OF THE TAX LAW MAY BE UNCERTAIN. FIN 48 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, PRESENTATION AND DISCLOSURE OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON UNRESTRICTED NET ASSETS AS OF THE END OF THE FISCAL YEAR OR ANY PREVIOUS YEARS SINCE ADOPTION. ACCORDINGLY, NO FIN 48 FOOTNOTE DISCLOSURE WAS MADE IN THE GEISINGER CONSOLIDATED FINANCIAL STATEMENTS. (1) THROUGHOUT THIS DOCUMENT, THE TERMS "SYSTEM- OR "GEISINGER", SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH "GH" AS PARENT AND ALL SUBSIDIARY ENTITIES COMPRISING THE SYSTEM.

Return Reference

Explanation

SCHEDULE D, PAGE 4, PART XIII

EFFECTIVE JULY 1, 2007, GEISINGER(1) ADOPTED ACCOUNTING STANDARDS CODIFICATION 740 (FIN 48), (FORMERLY KNOWN AS "STATEMENT 109: ACCOUNTING FOR INCOME TAXES- OR "FAS 109"). FIN 48 CLARIFIES THE ACCOUNTING AND REPORTING FOR INCOME TAXES WHERE INTERPRETATION OF THE TAX LAW MAY BE UNCERTAIN. FIN 48 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, PRESENTATION AND DISCLOSURE OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON UNRESTRICTED NET ASSETS AS OF THE END OF THE FISCAL YEAR OR ANY PREVIOUS YEARS SINCE ADOPTION. ACCORDINGLY, NO FIN 48 FOOTNOTE DISCLOSURE WAS MADE IN THE GEISINGER CONSOLIDATED FINANCIAL STATEMENTS. (1) THROUGHOUT THIS DOCUMENT, THE TERMS "SYSTEM- OR "GEISINGER", SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH "GH" AS PARENT AND ALL SUBSIDIARY ENTITIES COMPRISING THE SYSTEM.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

GEISINGER INSURANCE CORPORATION
RISK RETENTION GROUP

Employer identification number

14-1909894

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? .........

Yes

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 ............

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)
1EDELYN L MILLER VICE PRESIDENT, DIR	(i) (ii)	------------- 885,853	------------- 358,117	------------- 321,689	------------- 234,397	------------- 22,002	------------- 1,822,058	------------- 181,433
2JAEWON RYU MD JD DIRECTOR	(i) (ii)	------------- 961,804	------------- 471,004	------------- 163,802	------------- 179,214	------------- 39,001	------------- 1,814,825	-------------
3KEVIN F BRENNAN CPA FHFMA TREASURER, DIRECTOR	(i) (ii)	------------- 941,959	------------- 427,380	------------- 764,093	------------- 19,212	------------- 17,636	------------- 2,170,280	-------------
4DAVID T FEINBERG MD MBA PRESIDENT, DIRECTOR	(i) (ii)	------------- 2,399,174	------------- 1,339,735	------------- 204,244	------------- 996,710	------------- 28,638	------------- 4,968,501	-------------
5DAVID J FELICIO ESQUIRE SECRETARY	(i) (ii)	------------- 668,203	------------- 273,175	------------- 201,562	------------- 234,351	------------- 24,405	------------- 1,401,696	------------- 70,559

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
SCHEDULE J, PAGE 1, PART I, LINE 4	EDELYN L. MILLER 0 181,433 0 KEVIN F. BRENNAN, CPA, FHFMA 0 589,978 0 DAVID J. FELICIO, ESQUIRE 0 70,559 0
SCHEDULE J, PART III	PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMPENSATION FOR ELIGIBLE EMPLOYEES MAY BE DEFERRED TO A 457(F) NONQUALIFIED PLAN THAT VESTS WITH COMPLETION OF SERVICE, DEATH AND/OR PERMANENT DISABILITY. FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER- AND "SYSTEM" REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH "GH" AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.

Return Reference

Explanation

SCHEDULE J, PAGE 1, PART I, LINE 4

EDELYN L. MILLER 0 181,433 0 KEVIN F. BRENNAN, CPA, FHFMA 0 589,978 0 DAVID J. FELICIO, ESQUIRE 0 70,559 0

SCHEDULE J, PART III

PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMPENSATION FOR ELIGIBLE EMPLOYEES MAY BE DEFERRED TO A 457(F) NONQUALIFIED PLAN THAT VESTS WITH COMPLETION OF SERVICE, DEATH AND/OR PERMANENT DISABILITY. FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER- AND "SYSTEM" REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH "GH" AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.

Schedule J (Form 990) 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

GEISINGER INSURANCE CORPORATION
RISK RETENTION GROUP

Employer identification number

14-1909894

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4A	GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP (THE COMPANY) IS A SELF-INSURANCE FUNDING VEHICLE FOR THESE AFFILIATED ENTITIES, AND AS SUCH AN INTEGRAL PART OF EACH OF THEIR NONPROFIT, CHARITABLE HEALTHCARE OPERATIONS. THE COMPANY WAS FORMED PRIMARILY TO ADDRESS THE LACK OF MEDICAL PROFESSIONAL LIABILITY COVERAGE IN THE COMMONWEALTH OF PENNSYLVANIA, AND TO ENABLE GEISINGER TO COMPLY WITH THE PENNSYLVANIA MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR ACT (MCARE) (1), WHICH REQUIRES PENNSYLVANIA PHYSICIANS AND HEALTHCARE INSTITUTIONS TO OBTAIN PRIMARY PROFESSIONAL LIABILITY COVERAGE FROM A QUALIFIED SELF-INSURANCE TRUST OR AN INSURER LICENSED TO PROVIDE SUCH LIABILITY COVERAGE IN PENNSLYVANIA. THE COMPANY IS ORGANIZED AND OPERATED AS A NONPROFIT MEMBERSHIP CORPORATION UNDER THE VERMONT NONPROFIT CORPORATION ACT, TITLE 11B OF THE VERMONT STATUES ANNOTATED. THE COMPANY'S MEMBERSHIP IS LIMITED TO THE FOLLOWING MEMBER ORGANIZATIONS OF GEISINGER, EACH OF WHICH IS INSURED BY THE COMPANY: GEISINGER MEDICAL CENTER GEISINGER COMMUNITY HEALTH SERVICES GEISINGER WYOMING VALLEY MEDICAL CENTER GEISINGER CLINIC COMMUNITY MEDICAL CENTER DBA: GEISINGER COMMUNITY MEDICAL CENTER MOUNTAIN VIEW NURSING HOME, INC. GEISINGER-BLOOMSBURG HOSPITAL GEISINGER-BLOOMSBURG HEALTH CARE CENTER GEISINGER-LEWISTOWN HOSPITAL FAMILY HEALTH ASSOCIATION OF GEISINGER-LEWISTOWN HOSPITAL HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY SPIRIT PHYSICIAN SERVICES, INC. GEISINGER JERSEY SHORE HOSPITAL THE COMPANY PROVIDES MEDICAL PROFESSIONAL LIABILITY COVERAGE EXCLUSIVELY TO THE GEISINGER 501(C)(3) MEMBER AFFILIATES.
FORM 990, PART VI	FORM 990, PART I, SECTION A, LINE 4: FORM 990, PART VI, SECTION A, LINE 1B: ENTER THE NUMBER OF VOTING MEMBERS THAT ARE INDEPENDENT. BASED ON THE FORM 990 DEFINITION OF "INDEPENDENCE" AS IT RELATES TO VOTING MEMBERS OF THE GOVERNING BODY, FOUR OF THE FIVE VOTING MEMBERS OF THE GOVERNING BODY ARE NOT INDEPENDENT BECAUSE THEY ARE COMPENSATED AS EMPLOYEES OF RELATED TAX-EXEMPT ORGANIZATIONS. THE FIFTH VOTING MEMBER IS NOT INDEPENDENT BECAUSE SHE IS EMPLOYED BY AN INDEPENDENT CONTRACTOR THAT PROVIDES SIGNIFICANT SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2: DID ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE HAVE A FAMILY RELATION- SHIP OR BUSINESS RELATIONSHIP WITH ANY OTHER OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE? DAVID J. FELICIO, ESQUIRE, DAVID T. FEINBERG, MD, MBA, EDELYN L. MILLER, JAEWON RYU, MD, JD, AND KEVIN F. BRENNAN, CPA, FHFMA ALL HAVE A BUSINESS RELATIONSHIP WITH ONE ANOTHER BECAUSE THEY SERVE AS OFFICERS AND/OR DIRECTORS ON ONE OR MORE FOR-PROFIT AFFILIATE OF THE ENTITY. ALL OF THE AFFILIATES ARE PART OF GEISINGER.
FORM 990, PAGE 6, PART VI, LINE 6	THE COMPANY IS ORGANIZED AS A NON-PROFIT CORPORATION WITH MEMBERS. THE COMPANY HAS ONE CLASS OF MEMBERSHIP INTEREST DENOMINATED "COMMON MEMBERSHIP". THE ONLY MEMBER ORGANIZATIONS PERMITTED ARE 501(C)(3) ORGANIZATIONS THAT ARE INSURED BY THE COMPANY. THE MEMBERSHIP ORGANIZATIONS HAVE THE RIGHT TO ELECT THE BOARD OF DIRECTORS AND RETAIN THE RIGHT TO RECEIVE ASSETS OF THE CORPORATION UPON DISSOLUTION.
FORM 990, PAGE 6, PART VI, LINE 7A	SEE SCHEDULE O RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6.
FORM 990, PAGE 6, PART VI, LINE 11B	ALL OFFICERS AND DIRECTORS WERE ELECTRONICALLY PROVIDED A FINAL COPY OF THE FORM 990 PRIOR TO FILING THE RETURN WITH THE IRS. AN EXECUTIVE SUMMARY OF THE INFORMATION REPORTED ON THE RETURN IS PROVIDED TO ASSIST IN THE REVIEW. IN ACCORDANCE WITH THE GEISINGER HEALTH BOARD OF DIRECTOR'S FINANCE COMMITTEE CHARTER, GEISINGER ORGANIZATIONS' FORM 990 FILINGS ARE REVIEWED ANNUALLY. THE FORM 990 IS PREPARED BY GEISINGER TAX AND FINANCIAL REPORTING DEPARTMENTS WITH INFORMATION PROVIDED FROM FINANCE, TAX, HUMAN RESOURCES, LEGAL SERVICES AND OTHER RELEVANT DEPARTMENTS WITHIN GEISINGER. THE CHIEF FINANCIAL OFFICER (CFO) OF GEISINGER AND THE INDIVIDUAL ORGANIZATIONS SENIOR FINANCIAL MANAGERS REVIEW THEIR RESPECTIVE FORM 990 PRIOR TO MAKING THE FINAL RETURN AVAILABLE TO THE BOARD. IN ADDITION, THE CHIEF LEGAL OFFICER AND CHIEF HUMAN RESOURCE OFFICER OF GEISINGER REVIEW THE INFORMATION DISCLOSED ON THE FORM 990 RELEVANT TO THEIR RESPECTIVE AREAS OF RESPONSIBILITY. FOR PURPOSES OF THEIR ANNUAL AUDIT OF GEISINGER CONSOLIDATED FINANCIAL STATEMENTS, INDEPENDENT AUDITORS REVIEW ALL FEDERAL TAX RETURNS FILED BY GEISINGER ORGANIZATIONS TO IDENTIFY MATERIAL ITEMS, INCLUDING IF THERE ARE ANY UNCERTAIN TAX POSITIONS THAT MAY BE REQUIRED TO BE RECOGNIZED. THE COMPANY HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED FOR REPORTING PERIOD.
FORM 990, PAGE 6, PART VI, LINE 12C	THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE GEISINGER CONFLICT OF INTEREST POLICY FOR DIRECTORS, OFFICERS AND SENIOR LEADERS. AT LEAST ONCE EACH YEAR DIRECTORS, OFFICERS, KEY EMPLOYEES, SENIOR LEADERS AND OTHERS DESIGNATED BY THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE IN WRITING THE EXISTENCE OF ANY POTENTIAL FINANCIAL INTERESTS THAT MAY GIVE RISE TO A CONFLICT OF INTEREST WITH ANY AFFILIATE WITHIN GEISINGER. THE DISCLOSURES ARE REVIEWED BY THE OFFICE OF THE CHIEF LEGAL OFFICER AND REPORTED TO THE AUDIT AND COMPLIANCE COMMITTEES AND BOARD OF DIRECTORS. AFTER REVIEW OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, INPUT FROM DEPARTMENT OF LEGAL SERVICES AND ANY DISCUSSION WITH THE PERSON DESIRED BY THE BOARD OR COMMITTEE, THE BOARD DECIDES IF A CONFLICT EXISTS AND TAKES APPROPRIATE ACTION. THE INDIVIDUAL DISCLOSING THE FINANCIAL INTEREST IS ABSENT DURING THE BOARD DELIBERATIONS AND DECISIONS ON THE MATTER.
FORM 990, PAGE 6, PART VI, LINE 15A	THE PROCESS TO REVIEW AND APPROVE THE COMPENSATION OF GEISINGER EMPLOYED BOARD DIRECTORS, OFFICERS, AND EXECUTIVE MANAGEMENT IS DESIGNED TO SATISFY THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR INTERMEDIATE SANCTION PURPOSES. THE PROCESS REQUIRES A REVIEW OF COMPENSATION DETERMINATIONS BY DISINTERESTED PARTIES, USE OF APPROPRIATE COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS. ON AN ANNUAL BASIS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT COMPLETES A COMPARATIVE ASSESSMENT OF COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT WITHIN GEISINGER. THE CONSULTANT'S REPORT IS PRESENTED TO THE GEISINGER FAMILY COMMITTEE PRIOR TO ANY COMPENSATION ADJUSTMENT. THE REPORT SUPPORTS THE RIGOROUS REVIEW COMPLETED BY THE GEISINGER FAMILY COMMITTEE TO ENSURE THAT THE PROGRAM IS RESPONSIBLE TO THE GEISINGER CHARITABLE MISSION, REFLECTS REASONABLE COMPENSATION WITHIN THE NONPROFIT MARKET AND IS COMPLIANT WITH THE IRS'S INTERMEDIATE SANCTION REQUIREMENTS. THE SURVEY DATA IN THE COMPARATIVE ANALYSIS IS CAPTURED FOR FUNCTIONALLY COMPARABLE POSITIONS IN MULTIPLE SIMILAR NONPROFIT ORGANIZATIONS AND REFLECTS TOTAL REMUNERATION PROVIDED IN THE MARKET. ALL SURVEYS ARE CONDUCTED BY THIRD PARTY ORGANIZATIONS AND NOT CONDUCTED AT THE SPECIFIC DIRECTION OF GEISINGER. ANY COMPENSATION ADJUSTMENTS ARE APPROVED BY THE GEISINGER FAMILY COMMITTEE PRIOR TO THE EFFECTIVE DATE OF THE PAYMENT. THE GEISINGER FAMILY COMMITTEE AT ITS SOLE DISCRETION MAY POSITIVELY OR NEGATIVELY ADJUST ANY RECOMMENDED COMPENSATION.
FORM 990, PAGE 6, PART VI, LINE 15B	SEE SCHEDULE O RESPONSE TO FORM 990, PART VI, SECTION B, QUESTION 15A.
FORM 990, PAGE 6, PART VI, LINE 19	THE ANNUAL REPORT FOR GEISINGER, CONTAINING COMMUNITY BENEFIT INFORMATION, CONSOLIDATED FINANCIAL INFORMATION AND OTHER INFORMATION, IS AVAILABLE ON THE GEISINGER WEBSITE. GO TO: HTTPS://WWW.GEISINGER.ORG/ABOUT- GEISINGER/NEWS-AND-MEDIA/FOR-MEDIA/ANNUAL-REPORTS. FINANCIAL STATEMENTS, FORM 990, FORM 990-T, THE CONFLICTS OF INTEREST POLICY, AND OTHER GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9	CAPTIAL CONTRIBUTION 1,000 CONTRIBUTION OF CAPITAL FROM ADDITIONAL MEMBER, GEISINGER JERSEY SHORE HOSPITAL.
FORM 990, PART XII	FORM 990, PART XII, LINE 3A: AS A RESULT OF A FEDERAL AWARD, WAS THE ORGANIZATION REQUIRED TO UNDERGO AN AUDIT OR AUDITS AS SET FORTH IN THE AUDIT ACT OR OMB CIRCULAR A-133? FEDERAL AWARDS ARE AUDITED AS A PART OF THE GEISINGER'S CONSOLIDATED REPORT ON FEDERAL AWARDS IN ACCORDANCE WITH OMB CIRCULAR A-133. FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER- AND "SYSTEM" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.

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

GEISINGER INSURANCE CORPORATION
RISK RETENTION GROUP

Employer identification number

14-1909894

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)GEISINGER HEALTH 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1995911	PHILANTHRO	PA	501C3	7	N/A	Yes
(2)GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 24-0795959	HOSPITAL	PA	501C3	3	GH	Yes
(3)GEISINGER CLINIC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-6291113	PHYSICIAN	PA	501C3	12A	GH	Yes
(4)GEISINGER WYOMING VALLEY MED CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1996150	HOSPITAL	PA	501C3	3	GH	Yes
(5)MARWORTH 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2171417	D&A REHAB	PA	501C3	3	GH	Yes
(6)GEISINGER HEALTH PLAN 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2311553	HEALTH INS	PA	501C4		GH	Yes
(7)GEISINGER SYSTEM SERVICES 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2164794	SUPPORT SV	PA	501C3	12A	GH	Yes
(8)GEISINGER COMMUNITY HEALTH SERVICES 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2967235	HEALTHCARE	PA	501C3	10	GSS	Yes
(9)COMMUNITY MEDICAL CENTER 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 24-0862246	HOSPITAL	PA	501C3	3	GH	Yes
(10)MOUNTAIN VIEW NURSING HOME INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2568288	LONG TERM	PA	501C3	10	GH	Yes
(11)GEISINGER-BLOOMSBURG HOSPITAL 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2193572	HOSPITAL	PA	501C3	3	GH	Yes
(12)GEISINGER-BLOOMSBURG HEALTHCARE CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2242854	SKILLED NU	PA	501C3	10	GH	Yes
(13)GEISINGER-LEWISTOWN HOSPITAL 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1352187	HOSPITAL	PA	501C3	3	GH	Yes
(14)LEWISTOWN AMBULATORY CARE CORP 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2344362	HOLDING CO	PA	501C3	12A	GH	Yes
(15)FAMILY HEALTH ASSOCIATES OF GLH 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 25-1651582	PHYSICIAN	PA	501C3	12A	GH	Yes
(16)KEYSTONE HEALTH INFORMATION EXCH 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-4359893	RHIO	PA	501C3	12A	GH	Yes
(17)HEALTH CARE CORP OF NORTHEAST PA 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2337286	SUPPORT SV	PA	501C3	12A	CMC	Yes
(18)HOLY SPIRIT HEALTH SYSTEM 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 25-1865142	PHILANTHRO	PA	501C3	12A	GH	Yes
(19)HOLY SPIRIT HOSPITAL 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1512747	HOSPITAL	PA	501C3	3	HSHS	Yes
(20)HOLY SPIRIT CORPORATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2214540	HOLDING CO	PA	501C2		HSHS	Yes
(21)SPIRIT PHYSICIAN SERVICES INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 25-1766971	PHYSICIAN	PA	501C3	10	HSHS	Yes
(22)WEST SHORE ADVANCED LIFE SUPP SVCS 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2463002	HEALTHCARE	PA	501C3	7	HSHS	Yes
(23)GEISINGER COMMONWEALTH SCH OF MED 525 PINE STREET SCRANTON,PA18509 26-0812968	EDUCATION	PA	501C3	2	GH	Yes
(24)GEISINGER JERSEY SHORE HOSPITAL 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 24-0792115	HOSPITAL	PA	501C3	3	GH	Yes
(25)GEISINGER JERSEY SHORE HOSPITAL FND 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2480603	HEALTHCARE	PA	501C3	3	GH	Yes
(26)ATLANTICARE BEHAVORIAL HEALTH INC 2511 FIRE ROAD EGG HARBOR TOWNSHIP,NJ08234 21-0721208	HEALTHCARE	NJ	501C3	7	ARHS	Yes
(27)ATLANTICARE FOUNDATION 6725 DELILAH ROAD EGG HARBOR TOWNSHIP,NJ08234 22-2148992	SUPPORT AR	NJ	501C3	7	AH SYSTEM	Yes
(28)ATLANTICARE HEALTH ENGAGEMENT INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 61-1608389	HEALTHCARE	NJ	501C3	12A	AH SYSTEM	Yes
(29)ATLANTICARE HEALTH SERVICES INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3265214	HEALTHCARE	NJ	501C3	10	ARHS	Yes
(30)ATLANTICARE HEALTH SYSTEM INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3265213	SUPPORT AR	NJ	501C3	12A	GH	Yes
(31)ATLANTICARE REGIONAL MEDICAL CENTER 1925 PACIFIC AVENUE ATLANTIC CITY,NJ08401 21-0634549	HOSPITAL	NJ	501C3	3	ARHS	Yes
(32)ATLANTICARE PHYSICIAN GROUP PA 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 02-0701782	HEALTHCARE	NJ	501C3	10	AH SYSTEM	Yes
(33)ATLANTICARE REGIONAL HEALTH SERVICE 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 80-0834222	HOLDING CO	NJ	501C3	12A	AH SYSTEM	Yes
(34)GNJ PHYSICIANS GROUP PC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 82-0681884	HEALTHCARE	NJ	501C3	10	GH	Yes

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	(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) KEYSTONE ACCOUNTABLE CARE ORG LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-4475297	ACO	PA	N/A				No			No
(2) LIFESOURCE GEISINGER BLOOD CTR LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 36-4718005	BLOOD COLL	PA	N/A				No			No
(3) MERIDIAN GEISINGER HLTH NETWORKLLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-5484165	ORG DEL SY	NJ	N/A				No			No
(4) HEALTHSOUTH GHS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 72-1398803	PHY THERAP	PA	N/A				No			No
(5) EVANGELICAL-GEISINGER HEALTH LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-0567687	HEALTHCARE	PA	N/A				No			No
(6) LEMED II 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2391766	RENTAL	PA	N/A				No			No
(7) GEISINGER-SCA HOLDINGS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1615328	HEALTHCARE	DE	N/A				No			No
(8) CAMP HILL AMBULATORY SURG CTR LLC 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 52-1597478	HEALTHCARE	PA	N/A				No			No
(9) GRANDVIEW SURGERY CENTER LTD 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 52-1597483	HEALTHCARE	PA	N/A				No			No
(10) LACKAWANNA PHYS AMB SURG CTRLLC 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 23-3024998	HEALTHCARE	PA	N/A				No			No
(11) SOUTHERN JERSEY ONCOLOGY PROPERTIES 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 94-3463625	HEALTHCARE	NJ	N/A				No			No
(12) ATLANTICARE SURGERY CENTER LLC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3491867	HEALTHCARE	NJ	N/A				No			No
(13) COOPERATIVE HEALTH SRVS OF S JERSEY 1301 ATLANTIC AVENUE ATLANTIC CITY,NJ08401 22-3619231	PURCHASING	NJ	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) ISS SOLUTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2077663	HOTEL/REST	PA	N/A				Yes
(2) GEISINGER INDEMNITY INSURANCE CO 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2815174	HLTH INSUR	PA	N/A				Yes
(3) GEISINGER QUALITY OPTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 20-4275139	HLTH INSUR	PA	N/A				Yes
(4) XG HEALTH SOLUTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1657345	CONSULTING	DE	N/A				Yes
(5) GEISINGER ASSURANCE COMPANY LTD 878 WEST BAY ROAD PO BOX 1159 GRAND CAYMAN,GRAND CAYMANKY1-1102 CJ 98-1016737	INSURANCE	CJ	N/A				Yes
(6) HOLY SPIRIT VENTURES INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2407709	MED. SERV.	PA	N/A				Yes
(7) ENGLISH CREEK ASSURANCE LTD 44 CHURCH STREET HM12 HAMILTON BERMUDA,BERMUDA BD 98-0656394	FINANCIAL	BD	N/A				Yes
(8) ATLANTICARE HEALTH SOLUTIONS INC 2500 ENGLISH CREEK AVENUE BLDG 500 EGG HARBOR TOWNSHIP,NJ08234 38-3856295	ACO/HEALTH	NJ	N/A				Yes
(9) ATLANTICARE ASSURANCE ALLIANCE INC 2500 ENGLISH CREEK AVENUE BLDG 500 EGG HARBOR TOWNSHIP,NJ08234 46-3730123	HEALTHCARE	NJ	N/A				Yes

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) ............................

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

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) .......................

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) .....................

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

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

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

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) ............................

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

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) COMMUNITY MEDICAL CENTER	Q	831,564	GAAP
(2) GEISINGER ASSURANCE COMPANY LTD	P	20,338,107	GAAP
(3) GEISINGER ASSURANCE COMPANY LTD	Q	25,249,801	GAAP
(4) GEISINGER CLINIC	Q	8,619,917	GAAP
(5) GEISINGER CLINIC	Q	561,476	GAAP
(6) GEISINGER COMMUNITY HEALTH SERVICES	Q	56,740	GAAP
(7) GEISINGER MEDICAL CENTER	Q	6,532,259	GAAP
(8) GEISINGER WYOMING VALLEY MEDICAL CT	Q	1,934,943	GAAP
(9) GEISINGER-BLOOMSBURG HLTH CARE CTR	Q	64,961	GAAP
(10) GEISINGER-BLOOMSBURG HOSPITAL	Q	412,539	GAAP
(11) GEISINGER-LEWISTOWN HOSPITAL	Q	148,897	GAAP
(12) MOUNTAIN VIEW NURSING HOME INC	Q	98,320	GAAP
(13) HOLY SPIRIT HOSPITAL	Q	1,121,892	GAAP
(14) SPIRIT PHYSICIANS SERVICES INC	Q	1,056,476	GAAP
(15) GEISINGER JERSEY SHORE HOSPITAL	Q	163,100	GAAP

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, SCHEDULE R, PART V - TRANSACTIONS WITH RELATED ORGANIZATIONS: AS SHOWN IN FORM 990, SCHEDULE R, GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS. IN THE NORMAL COURSE OF THE OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMEROUS INTER ORGANIZATIONAL TRANSACTIONS, WHICH MAY INCLUDE SALES, EXCHANGES AND LEASES OF PROPERTY, EXTENSIONS OF CREDIT, FURNISHING OF GOODS, SERVICES AND FACILITIES, AND TRANSFERS OF ASSETS. THESE INTER ORGANIZATION TRANSACTIONS PROMOTE THE EFFICIENT OPERATION OF THE VARIOUS ORGANIZATIONS AND THE ATTAINMENT OF THEIR TAX EXEMPT PURPOSES. THESE TYPES OF INTER ORGANIZATION TRANSACTIONS WERE DESCRIBED TO THE INTERNAL REVENUE SERVICE IN A RULING APPLICATION AND WERE RECOGNIZED BY THE NATIONAL OFFICE OF THE IRS IN A SERIES OF GEISINGER PRIVATE RULINGS AS BEING ENTIRELY CONSISTENT WITH THE ORGANIZATIONS' TAX EXEMPT STATUS. ___________________________________________________________________________

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP PROVIDES COST EFFECTIVE LIABILITY INSURANCE OPTIONS TO ITS NONPROFIT MEMBERS IN ORDER TO FACILITATE THE ACHIEVEMENT OF THEIR MISSION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	5
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........	1,229,797	1,265,058
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,413	12,329
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,235,210	1,277,387
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,091,013	1,205,526
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,091,013	1,205,526
19	Revenue less expenses. Subtract line 18 from line 12.......	144,197	71,861
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	2,353,793	2,084,426
21	Total liabilities (Part X, line 26).............	615,826	273,598
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,737,967	1,810,828

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,084,363 including grants of $ ) (Revenue $ 1,265,067 )
	SELF INSURANCE FUNDING - SEE SCHEDULE O GEISINGER INSURANCE CORPORATION, RISK RETENTION GROUP (THE COMPANY) IS A SELF-INSURANCE FUNDING VEHICLE FOR THESE AFFILIATED ENTITIES, AND AS SUCH AN INTEGRAL PART OF EACH OF THEIR NONPROFIT, CHARITABLE HEALTHCARE OPERATIONS. THE COMPANY WAS FORMED PRIMARILY TO ADDRESS THE LACK OF MEDICAL PROFESSIONAL LIABILITY COVERAGE IN THE COMMONWEALTH OF PENNSYLVANIA, AND TO ENABLE GEISINGER TO COMPLY WITH THE PENNSYLVANIA MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR ACT (MCARE) (1), WHICH REQUIRES PENNSYLVANIA PHYSICIANS AND HEALTHCARE INSTITUTIONS TO OBTAIN PRIMARY PROFESSIONAL LIABILITY COVERAGE FROM A QUALIFIED SELF-INSURANCE TRUST OR AN INSURER LICENSED TO PROVIDE SUCH LIABILITY COVERAGE IN PENNSLYVANIA. THE COMPANY IS ORGANIZED AND OPERATED AS A NONPROFIT MEMBERSHIP CORPORATION UNDER THE VERMONT NONPROFIT CORPORATION ACT, TITLE 11B OF THE VERMONT STATUES ANNOTATED. THE COMPANY'S MEMBERSHIP IS LIMITED TO THE FOLLOWING MEMBER ORGANIZATIONS OF GEISINGER, EACH OF WHICH IS INSURED BY THE COMPANY: GEISINGER MEDICAL CENTER GEISINGER COMMUNITY HEALTH SERVICES GEISINGER WYOMING VALLEY MEDICAL CENTER GEISINGER CLINIC COMMUNITY MEDICAL CENTER DBA: GEISINGER COMMUNITY MEDICAL CENTER MOUNTAIN VIEW NURSING HOME, INC. GEISINGER-BLOOMSBURG HOSPITAL GEISINGER-BLOOMSBURG HEALTH CARE CENTER GEISINGER-LEWISTOWN HOSPITAL FAMILY HEALTH ASSOCIATION OF GEISINGER-LEWISTOWN HOSPITAL HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY SPIRIT PHYSICIAN SERVICES, INC. GEISINGER JERSEY SHORE HOSPITAL THE COMPANY PROVIDES MEDICAL PROFESSIONAL LIABILITY COVERAGE EXCLUSIVELY TO THE GEISINGER 501(C)(3) MEMBER AFFILIATES.

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 expenses1,084,363

(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
(1) EDELYN L MILLER...................................................................... VICE PRESIDE	................. 40.00	X	X	0	1,565,659	256,399
(2) JAEWON RYU MD JD...................................................................... DIRECTOR	................. 40.00	X		0	1,596,610	218,215
(3) KEVIN F BRENNAN CPA FHFMA...................................................................... TREASURER, D	................. 40.00	X	X	0	2,133,432	36,848
(4) PATTI PALLITO...................................................................... ASST. SECRET	0.25 .................	X	X	0	0	0
(5) DAVID T FEINBERG MD MBA...................................................................... PRESIDENT, D	................. 40.00	X	X	0	3,943,153	1,025,348
(6) DAVID J FELICIO ESQUIRE...................................................................... SECRETARY	................. 40.00		X	0	1,142,940	258,756

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	10,381,794	1,795,566

(A) Name and business address	(B) Description of services	(C) Compensation





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

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

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.......

		Business Code
2a	PREMIUMS EARNED	524298	1,265,058	1,265,058
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		1,265,058

3 Investment income (including dividends, interest, and othersimilar amounts) ......			12,329			12,329
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
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
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			1,277,387	1,265,058		12,329

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
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 ...........
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........
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	12,224	12,224
c	Accounting ...........	118,127	37,158	80,969
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	34,382	34,382
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	51,173	10,979	40,194
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........
17	Travel ............	3,164	3,164
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..
23	Insurance ...
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	RRG RISK PORTION	500,000	500,000
b	PREMIUM TAXES	483,727	483,727
c	LICENSES, FEES, AND DUES	2,729	2,729
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	1,205,526	1,084,363	121,163	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 ........			1
2	Savings and temporary cash investments .........		2,022,515	2	1,714,974
3	Pledges and grants receivable, net ......			3
4	Accounts receivable, net .............			4
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 ............			8
9	Prepaid expenses and deferred charges ......		328,776	9	366,086
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .			11
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........		2,502	15	3,366
16	Total assets. Add lines 1 through 15 (must equal line 33)...		2,353,793	16	2,084,426

17	Accounts payable and accrued expenses .....	30,826	17	23,595
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
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 ..		23
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	585,000	25	250,003
26	Total liabilities. Add lines 17 through 25..	615,826	26	273,598

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
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 ...	1,259,000	30	1,260,000
31	Retained earnings, endowment, accumulated income, or other funds	478,967	31	550,828
32	Total net assets or fund balances ...........	1,737,967	32	1,810,828
33	Total liabilities and net assets/fund balances ........	2,353,793	33	2,084,426